Espinosa Regina, Spruill Tanya M, Zawadzki Matthew J, Vandekar Lillie, Garcia-Vera Maria Paz, Sanz Jesus, Pickering Thomas G, Linden Wolfgang L, Gerin William
School of Psychology, Complutense University of Madrid, Madrid, Spain.
Blood Press Monit. 2011 Oct;16(5):231-7. doi: 10.1097/MBP.0b013e32834b45d2.
Obtaining an accurate blood pressure (BP) reading is vital for diagnosing hypertension. However, BP measures taken in the physician's clinic (CBP) are subject to the 'white coat' bias. Measurements taken outside the office using ambulatory (ABP) and home (HBP) monitoring are superior predictors of cardiovascular diseases compared with CBP, but ABP remains underutilized because of the effort and expense involved. Unfortunately, HBP has limitations, including questionable device validity and patient compliance. Thus, it is important to identify feasible alternative techniques to measure BP in the office that will increase the accuracy of the diagnosis.
Auscultatory BP was measured in 249 patients in a nonclinical setting by trained technicians (NCBP); on the following day, patients were taken to their physician (CBP). They were also given an HBP monitor, and a 36 h ABP monitoring. Because ABP is considered the gold standard for prediction of cardiovascular disease, these readings were used as the criterion in a statistical model in which CBP, HBP, and NCBP were entered as predictors. The level of agreement between measurements was estimated.
Multiple regression analysis showed that HBP and NCBP (P < 0.001) explained 94 and 87% of the variance in systolic and diastolic ABP, respectively. The agreement between NCBP and ABP was greater than that between CBP and ABP or between HBP.
When ABP monitoring and HBP monitoring are not options, the NCBP at the clinic can avoid the white coat bias and therefore improve diagnosis.
获取准确的血压读数对于诊断高血压至关重要。然而，在医生诊所测量的血压（诊所血压，CBP）存在“白大褂”偏倚。与诊所血压相比，使用动态血压监测（ABP）和家庭血压监测（HBP）在诊所以外测量的血压是心血管疾病更好的预测指标，但由于所需的精力和费用，ABP的使用仍然不足。不幸的是，HBP存在局限性，包括设备有效性存疑和患者依从性问题。因此，确定在诊所测量血压的可行替代技术以提高诊断准确性非常重要。
由经过培训的技术人员在非临床环境中对249名患者进行听诊血压测量（非诊所血压，NCBP）；次日，患者前往看医生（测量CBP）。他们还被给予了一个HBP监测仪，并进行了36小时的ABP监测。由于ABP被认为是预测心血管疾病的金标准，这些读数被用作统计模型的标准，其中CBP、HBP和NCBP作为预测指标输入。估计了测量值之间的一致性水平。
多元回归分析表明，HBP和NCBP（P < 0.001）分别解释了收缩压和舒张压ABP方差的94%和87%。NCBP与ABP之间的一致性大于CBP与ABP之间或HBP之间的一致性。
当无法选择ABP监测和HBP监测时，诊所的NCBP可以避免白大褂偏倚，从而改善诊断。
