Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
J Hum Hypertens. 2012 Dec;26(12):696-700. doi: 10.1038/jhh.2011.98. Epub 2011 Nov 10.
Ambulatory blood pressure (ABP) monitoring is recommended as a standard method for the evaluation of resistant hypertension (RH). This study assessed the diagnostic value of home blood pressure (HBP) monitoring in RH. Subjects on stable treatment with ≥3 antihypertensive drugs were included. Clinic RH (CRH) was defined as elevated clinic blood pressure and true RH (TRH) as elevated ABP. The diagnosis of CRH was verified by ABP and HBP monitoring. The diagnostic value of HBP was assessed by taking ABP as reference method. Threshold for hypertension diagnosis was ≥135/85 mm Hg (systolic and/or diastolic) for HBP and awake ABP and ≥140/90 mm Hg for clinic blood pressure. Among 73 subjects on ≥3 antihypertensive drugs, 44 (60%) had CRH and 40 (55%) TRH. There was agreement between ABP and HBP in diagnosing CRH in 82% of the cases (26 subjects (59%) with CRH and 10 (23%) without CRH; kappa 0.59). Regarding the diagnosis of TRH, there was agreement between ABP and HBP in 74% of the cases (36 subjects (49%) with TRH and 18 (25%) without TRH; kappa 0.46). The sensitivity, specificity, and positive and negative predictive values of HBP in detecting CRH were 93%, 63%, and 81% and 83%, respectively, and TRH were 90%, 55%, and 71%, and 82%, respectively (ABP taken as reference method). These data suggest that HBP is a reliable alternative to ABP in the evaluation of RH. These methods are necessary in both uncontrolled and controlled subjects on triple therapy to detect the white coat phenomenon and also masked RH.
动态血压监测被推荐为评估难治性高血压（RH）的标准方法。本研究评估了家庭血压（HBP）监测在 RH 中的诊断价值。纳入了接受≥3 种降压药物稳定治疗的受试者。诊室 RH（CRH）定义为诊室血压升高，真正 RH（TRH）定义为动态血压升高。通过 ABP 和 HBP 监测来验证 CRH 的诊断。通过以 ABP 为参考方法来评估 HBP 的诊断价值。HBP 诊断高血压的阈值为≥135/85mmHg（收缩压和/或舒张压）和觉醒时 ABP，诊室血压的阈值为≥140/90mmHg。在 73 名接受≥3 种降压药物的受试者中，44 名（60%）患有 CRH，40 名（55%）患有 TRH。在诊断 CRH 时，ABP 和 HBP 的诊断结果在 82%的病例中一致（26 例（59%）CRH 和 10 例（23%）无 CRH；kappa 值为 0.59）。在诊断 TRH 时，ABP 和 HBP 的诊断结果在 74%的病例中一致（36 例（49%）TRH 和 18 例（25%）无 TRH；kappa 值为 0.46）。HBP 检测 CRH 的敏感性、特异性、阳性预测值和阴性预测值分别为 93%、63%、81%和 83%，TRH 的分别为 90%、55%、71%和 82%（以 ABP 为参考方法）。这些数据表明，HBP 是评估 RH 的可靠替代 ABP 的方法。这些方法在接受三联治疗的未控制和控制的受试者中都是必要的，以检测白大衣现象和隐匿性 RH。
