Chrubasik Sigrun, Droste Conrad, Glimm Ekkehard, Black Andrew
Institute of Forensic Medicine, University of Freiburg, Abertstr. 9, 79104 Freiburg, Germany. sigrun.chrubasik.uniklinik-freiburg.de
Blood Press Monit. 2007 Jun;12(3):157-66. doi: 10.1097/MBP.0b013e3280ad4073.
To compare different methods of measuring and averaging blood pressure readings, and see how they affect classification of patients as normotensive or hypertensive.
The comparisons were made in up to 145 suitable patients in the first and last week of a 6-week surveillance. Ambulatory blood pressure measurements were taken from the nondominant arm, as the average of up to 78 measurements over 24 h (24-h ambulatory blood pressure measurements), or 60 from 0700 h to 2200 h (daytime ambulatory blood pressure measurements), or 18 from 2200 h to 0700 h (night-time ambulatory blood pressure measurements). Office blood pressure measurements were taken by the outpatient department nurse in triplicate from both arms, and the averages were taken of the second and third of each triplicate. Home blood pressure measurements were taken in duplicate each morning and evening, entered by patients into diaries, and the available readings of up to four values per day were averaged for the first and sixth week. The classifications of normotensive versus hypertensive produced by criterion values of 24-h ambulatory blood pressure measurements of 125/80 and 130/80 mmHg were compared with the classifications produced by the other measurements with a range of criterion values.
The home blood pressure measurements and office blood pressure measurements of systolic values underestimated the corresponding 24-h ambulatory blood pressure measurements values by 3-9 average (SD 9-18) mmHg, and the diastolic values overestimated them by averages of 3-6 (SD 6-13) mmHg. Daytime ambulatory blood pressure measurement systolic and diastolic values overestimated them by 2-4 (SD 2-4) mmHg and night-time ambulatory blood pressure measurement values underestimated them by 7-12 (SD 5-9) mmHg. In comparing the 24-h ambulatory blood pressure measurement classifications of hypertensives versus normotensives with those produced from the other types of measurements, it was easiest to detect criterion values for daytime ambulatory blood pressure measurement that gave the best agreement and they appeared different for the different criterion values of 24-h ambulatory blood pressure measurement. For the other types of measurement, the agreement was generally worse and it was harder to detect a best criterion value for agreement with either of the 24-h ambulatory blood pressure measurement classifications. A subsample of 63 patients identified as needing institution, maintenance or modification of antihypertensive treatment excluded about half of the patients classified as hypertensive by either 24-h ambulatory blood pressure measurement criterion.
Limited agreement existed between different ways of classifying patients. The utility of the classifications depends on the purpose to which they are put.
比较测量和平均血压读数的不同方法，并观察它们如何影响将患者分类为血压正常或高血压。
在为期6周的监测的第一周和最后一周，对多达145名合适的患者进行了比较。动态血压测量取自非优势手臂，作为24小时内多达78次测量的平均值（24小时动态血压测量），或07:00至22:00期间60次测量的平均值（日间动态血压测量），或22:00至07:00期间18次测量的平均值（夜间动态血压测量）。门诊护士从双臂测量三次诊室血压，并取每次三次测量中第二次和第三次测量的平均值。家庭血压测量在每天早晚各进行两次，由患者记录在日记中，并对第一周和第六周每天最多四个值的可用读数进行平均。将24小时动态血压测量标准值125/80和130/80 mmHg产生的血压正常与高血压分类与其他测量在一系列标准值下产生的分类进行比较。
家庭血压测量和诊室血压测量的收缩压值分别比相应的24小时动态血压测量值平均低估3 - 9（标准差9 - 18）mmHg，舒张压值分别比其平均高估3 - 6（标准差6 - 13）mmHg。日间动态血压测量的收缩压和舒张压值分别比其高估2 - 4（标准差2 - 4）mmHg，夜间动态血压测量值比其低估7 - 12（标准差5 - 9）mmHg。在比较24小时动态血压测量对高血压与血压正常患者的分类与其他类型测量产生的分类时，最容易检测到与24小时动态血压测量不同标准值给出最佳一致性的日间动态血压测量标准值。对于其他类型的测量，一致性通常较差，并且更难检测到与24小时动态血压测量分类之一达成最佳一致性的标准值。一个由63名被确定需要调整、维持或更改抗高血压治疗的患者组成的子样本排除了约一半根据24小时动态血压测量标准分类为高血压的患者。
不同的患者分类方法之间存在有限的一致性。分类的效用取决于其使用目的。
