Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
Hypertens Res. 2012 Jul;35(7):750-5. doi: 10.1038/hr.2012.19. Epub 2012 Feb 23.
Several studies with relatively small size and different design and end points have investigated the diagnostic ability of home blood pressure (HBP). This study investigated the usefulness of HBP compared with ambulatory monitoring (ABP) in diagnosing sustained hypertension, white coat phenomenon (WCP) and masked hypertension (MH) in a large sample of untreated and treated subjects using a blood pressure (BP) measurement protocol according to the current guidelines. A total of 613 subjects attending a hypertension clinic (mean age 53±12.4 (s.d.) years, men 57%, untreated 59%) had measurements of clinic BP (three visits, triplicate measurements per visit), HBP (6 days, duplicate morning and evening measurements) and awake ABP (20-min intervals) within 6 weeks. Sustained hypertension was diagnosed in 50% of the participants by ABP and HBP (agreement 89%, κ=0.79), WCP in 14 and 15%, respectively (agreement 89%, κ=0.56) and MH in 16% and 15% (agreement 88%, κ=0.52). Only 4% of the subjects (27/613) showed clinically significant diagnostic disagreement with BP deviation >5 mm Hg above the diagnostic threshold (for HBP or ABP). By taking ABP as reference, the sensitivity, specificity, positive and negative predictive value of HBP in detecting sustained hypertension were 90, 89, 89 and 90%, respectively, WCP 61, 94, 64 and 94% and MH 60, 93, 60 and 93%. Similar diagnostic agreement was found in untreated and treated subjects. HBP appears to be a reliable alternative to ABP in the diagnosis of hypertension and the detection of WCP and MH in both untreated and treated subjects.
几项规模较小、设计和终点不同的研究已经探讨了家庭血压（HBp）的诊断能力。本研究使用根据当前指南制定的血压（BP）测量方案，在未经治疗和治疗的大量受试者中，比较 HBp 与动态血压监测（ABp）在诊断持续性高血压、白大衣现象（WCP）和隐蔽性高血压（MH）方面的有用性。共有 613 名参加高血压诊所的患者（平均年龄 53±12.4（标准差）岁，男性 57%，未经治疗者 59%）在 6 周内进行了诊所 BP（三次就诊，每次就诊重复测量三次）、HBp（6 天，早晚各测量两次）和清醒 ABp（20 分钟间隔）测量。ABp 和 HBp 诊断持续性高血压的比例分别为 50%（一致性 89%，κ=0.79）、WCP 分别为 14%和 15%（一致性 89%，κ=0.56）、MH 分别为 16%和 15%（一致性 88%，κ=0.52）。只有 4%的受试者（27/613）在 BP 偏差超过诊断阈值（HBp 或 ABp）5mmHg 以上时出现明显的临床诊断不一致。以 ABp 为参考，HBp 诊断持续性高血压的敏感度、特异度、阳性预测值和阴性预测值分别为 90%、89%、89%和 90%，WCP 分别为 61%、94%、64%和 94%，MH 分别为 60%、93%、60%和 93%。在未经治疗和治疗的患者中均发现了相似的诊断一致性。HBp 似乎是 ABp 诊断高血压和检测未经治疗和治疗患者的 WCP 和 MH 的可靠替代方法。
