Appel L J, Whelton P K, Seidler A J, Patel A R, Klag M J
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins U. School of Medicine, Baltimore, MD 21205.
Am J Epidemiol. 1990 Aug;132(2):343-54. doi: 10.1093/oxfordjournals.aje.a115664.
Prerequisite to the use of ambulatory blood pressure monitors in epidemiologic research is demonstration of a satisfactory level of accuracy and precision. Previous evaluations of these devices raise a number of methodological concerns which complicate interpretation of their findings. Also, important issues regarding the precision of blood pressure measurements and the identification of factors associated with measurement inaccuracies remain unaddressed. To assess the accuracy and precision of the Accutracker ambulatory blood pressure monitor, we obtained five serial estimates of resting blood pressure on 120 ambulatory subjects in The Johns Hopkins Medical Institutions in 1987. Two Accutrackers and two manual observers independently recorded blood pressure with the order determined at random. The fourth observer in each sequence obtained a replicate measurement. For both systolic and diastolic blood pressures, the mean difference between Accutracker and manual measurements was less than 3 mmHg for each pairwise comparison. Scatter plots and regression analyses demonstrated that both Accutrackers tended to underestimate high systolic and diastolic blood pressures. In bivariate and multivariate analyses, increased age was significantly associated with underestimation of systolic blood pressures by both Accutrackers. With respect to the precision of blood pressure measurement, no significant differences were present among the four observers. In summary, our data suggest that the Accutracker has satisfactory accuracy and precision, but that accuracy is not uniform across patient subgroups.
在流行病学研究中使用动态血压监测仪的前提是要证明其具有令人满意的准确度和精密度。以往对这些设备的评估引发了一些方法学上的问题，这使得对其研究结果的解读变得复杂。此外，关于血压测量精密度以及与测量不准确相关因素识别的重要问题仍未得到解决。为了评估Accutracker动态血压监测仪的准确度和精密度，我们于1987年在约翰霍普金斯医疗机构对120名动态监测对象进行了五次静息血压的连续测量。两台Accutracker和两名人工观察者独立记录血压，记录顺序随机确定。每个测量序列中的第四名观察者进行重复测量。对于收缩压和舒张压，在每次两两比较中，Accutracker与人工测量之间的平均差值均小于3 mmHg。散点图和回归分析表明，两台Accutracker都倾向于低估高收缩压和舒张压。在双变量和多变量分析中，年龄增加与两台Accutracker低估收缩压显著相关。关于血压测量的精密度，四名观察者之间没有显著差异。总之，我们的数据表明Accutracker具有令人满意的准确度和精密度，但准确度在不同患者亚组中并不一致。
