School of Medicine, University of Florence, Florence, Italy.
J Hypertens. 2010 May;28(5):910-7. doi: 10.1097/HJH.0b013e32833778cc.
Guidelines recommend that blood pressure (BP) should be lowered in hypertensive patients to prevent cardiovascular accidents. Management of antihypertensive treatment by general practitioners is usually based on office measurements, which may not allow an assessment of BP control over 24 h, which requires ambulatory BP monitoring (ABPM) to be implemented. This is rarely done in general practice, and limited information is available on the consistency between the evaluations of the response to treatment provided by office measurement and by ABPM in this setting.
To assess concordance between office BP measurements and ABPM-based estimates of hypertension control in a general practice setting.
Prospective, comparative between techniques.
General practice.
Seventy-eight general practices, representative of all Italian regions, participated in this study by recruiting sequential hypertensive adults on stabilized treatment, who were subdivided into even groups with office BP, respectively, controlled or noncontrolled by treatment. In each individual, ABPM was applied by the general practitioner after appropriate training, and 24-h ABP values were defined as controlled or not according to current guidelines. Concordance between office and ABPM evaluation of BP control was assessed with kappa statistics. Positive and negative predictive values of office measurement versus ABPM were estimated.
Between July 2005 and November 2006, 190 general practitioners recruited 2059 hypertensive patients based on office BP measurements; in 1728 patients, a 24-h ABPM was performed, yielding 1524 recordings considered as valid for further analysis. The agreement between the assessment of BP control by office measurement and by ABPM was poor (kappa = 0.120), with office measurements showing a satisfactory positive predictive value (0.842) and a poor negative predictive value (0.278); the situation was worse in patients with three or more among the following features: male sex, age of at least 65 years, alcohol consumption, diabetes, and obesity (negative predictive value = 0.149).
In general practice, the agreement between assessment of BP control by treatment provided by office and ambulatory BP measurements is better in patients of 'uncontrolled' office BP than in 'controlled' office BP patients. This emphasizes the need for the larger use of out-of-office BP monitoring in a general practice setting, in particular, in patients considered as 'controlled' during consultation.
指南建议高血压患者降低血压以预防心血管意外。基层医生通常根据诊室测量来管理降压治疗，这可能无法评估 24 小时内的血压控制情况，需要进行动态血压监测（ABPM）。但这在基层医疗中很少进行，且有关在此环境下，诊室测量和 ABPM 评估治疗反应的一致性的信息有限。
评估在基层医疗环境中，诊室血压测量与基于 ABPM 的高血压控制评估之间的一致性。
前瞻性、技术间比较。
基层医疗。
78 家具有代表性的意大利各地基层医疗参与了这项研究，通过招募接受稳定治疗的连续高血压成年患者来进行。将患者按诊室血压分别为治疗控制或未控制分为偶数组。在每位患者中，由基层医生进行适当培训后应用 ABPM，根据现行指南将 24 小时 ABP 值定义为控制或未控制。使用 Kappa 统计评估诊室和 ABPM 评估血压控制的一致性。估计诊室测量与 ABPM 的阳性和阴性预测值。
2005 年 7 月至 2006 年 11 月期间，190 名基层医生根据诊室血压测量值招募了 2059 名高血压患者；在 1728 名患者中进行了 24 小时 ABPM，其中 1524 个记录被认为有效进行进一步分析。通过诊室测量和 ABPM 评估血压控制的一致性较差（kappa = 0.120），诊室测量具有较好的阳性预测值（0.842）和较差的阴性预测值（0.278）；在具有以下特征的患者中，这种情况更差：男性、年龄至少 65 岁、饮酒、糖尿病和肥胖（阴性预测值=0.149）。
在基层医疗中，与治疗提供的诊室血压测量相比，ABPM 测量评估血压控制的一致性在诊室血压“未控制”的患者中优于“控制”的患者。这强调了在基层医疗中更广泛使用诊室外血压监测的必要性，特别是在被认为在就诊时“控制”的患者中。
