Wizner Barbara, Dechering Dirk G, Thijs Lutgarde, Atkins Neil, Fagard Robert, O'Brien Eoin, de Leeuw Peter W, Parati Gianfranco, Palatini Paolo, Clement Denis, Grodzicki Tomasz, Kario Kazuomi, Staessen Jan A
Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
J Hypertens. 2008 Jul;26(7):1328-35. doi: 10.1097/HJH.0b013e3283013b59.
Using 24-h ambulatory blood pressure monitoring, we studied the repeatability of the morning blood pressure in older (> or =60 years) patients with isolated systolic hypertension.
The sleep-through morning surge was the morning blood pressure minus the lowest nighttime blood pressure. The preawake morning surge was the morning blood pressure minus the preawake blood pressure. In addition, we determined the cusum plot height of blood pressure from 04:00 to 10:00 h from a plot of cumulative sums.
In 173 patients with repeat recordings within 33 days (median), the short-term repeatability coefficients, expressed as percentages of maximal variation, ranged from 35 to 41% for the daytime and nighttime blood pressures and from 50 to 56% for the night-to-day blood pressure ratios. Short-term repeatability ranged from 52 to 75% for the sleep-through and the preawake morning surge, and from 51 to 62% for the cusum plot height. In 219 patients with repeat recordings within 10 months (median), the corresponding long-term estimates ranged from 45 to 64%, from 69 to 71%, from 76 to 83%, and from 50 to 78%, respectively. In categorical analyses of the short-term repeatability of the sleep-through morning surge and the preawake morning surge, using the 75th percentile as arbitrary cut-off, surging status changed in 28.0 and 26.8% of patients (kappa-statistic < or =0.33). In the long-term interval, these proportions were 32.0 and 32.0%, respectively (kappa-statistic < or =0.20). The kappa-statistic threshold for moderate reproducibility is 0.4.
The morning surge of blood pressure is poorly reproducible, irrespective of whether it is analysed as continuous or categorical variable.
通过24小时动态血压监测，我们研究了老年（≥60岁）单纯收缩期高血压患者晨峰血压的重复性。
持续睡眠晨峰为晨峰血压减去夜间最低血压。觉醒前晨峰为晨峰血压减去觉醒前血压。此外，我们从累积和图中确定了04:00至10:00时血压的累积和曲线高度。
在173例于33天内（中位数）进行重复记录的患者中，以最大变异百分比表示的短期重复性系数，日间和夜间血压为35%至41%，夜间与日间血压比值为50%至56%。持续睡眠和觉醒前晨峰的短期重复性为52%至75%，累积和曲线高度为51%至62%。在219例于10个月内（中位数）进行重复记录的患者中，相应的长期估计值分别为45%至64%、69%至71%及76%至83%和50%至78%。在对持续睡眠晨峰和觉醒前晨峰短期重复性的分类分析中，以第75百分位数作为任意截断值，28.0%和26.8%的患者的晨峰状态发生改变（kappa统计量≤0.33）。在长期随访中，这些比例分别为32.0%和32.0%（kappa统计量≤0.20）。中等再现性的kappa统计量阈值为0.4。
无论将晨峰血压作为连续变量还是分类变量进行分析，其重复性均较差。
