Edwards Cedric, Hiremath Swapnil, Gupta Ankur, McCormick Brendan B, Ruzicka Marcel
Renal Hypertension Unit, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Renal Hypertension Unit, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
J Am Soc Hypertens. 2013 Nov-Dec;7(6):448-53. doi: 10.1016/j.jash.2013.07.002. Epub 2013 Aug 19.
Manual measurement of blood pressure (BP) in the office (MOBP) is inferior in accuracy when compared with ambulatory BP measurements (ABPM) since it misses white coat and masked effects on BP. BpTRU, an automated office BP device (AOBP), has been reported to reduce white coat effect. We performed a retrospective review of the diagnostic accuracy of MOBP (taken by a trained nurse in clinical hypertension) and AOBP using the Bland-Altman method in hypertensive patients referred to a Renal Hypertension Clinic. In 329 hypertensive patients, the 95% limits of agreement between systolic AOBP and ABPM were -31 mm Hg to 33 mm Hg and for MOBP and ABPM were -27.8 mm Hg to 37.4 mm Hg. The bias between systolic MOBP and systolic ABPM was 4.9 mm Hg (95% confidence interval, 3.0-6.6 mm Hg) whereas the bias between the systolic AOBP and the systolic ABPM was -3.2 (95% confidence interval, -1.3 to -5.0). AOBP did not improve treatment relevant classification errors compared with MOBP (28% vs. 23%; P = .052). Our data support findings by others showing that AOBP improves, but does not eliminate, white coat effect. The increased detection of white coat effect appears related to systematic downward bias by BpTRU. As a result, detection of masked effect is undermined by BpTRU.
与动态血压测量（ABPM）相比，诊室手动测量血压（MOBP）的准确性较差，因为它无法捕捉到白大衣效应和隐匿性血压波动对血压的影响。据报道，自动化诊室血压设备（AOBP）BpTRU可减少白大衣效应。我们使用Bland-Altman方法对转诊至肾性高血压门诊的高血压患者进行了回顾性研究，比较MOBP（由临床高血压方面训练有素的护士测量）和AOBP的诊断准确性。在329例高血压患者中，收缩压AOBP与ABPM之间的95%一致性界限为-31 mmHg至33 mmHg，MOBP与ABPM之间的95%一致性界限为-27.8 mmHg至37.4 mmHg。收缩压MOBP与收缩压ABPM之间的偏差为4.9 mmHg（95%置信区间，3.0 - 6.6 mmHg），而收缩压AOBP与收缩压ABPM之间的偏差为-3.2（95%置信区间，-1.3至-5.0）。与MOBP相比，AOBP并没有改善与治疗相关的分类错误（28%对23%；P = 0.052）。我们的数据支持了其他人的研究结果，即AOBP可改善但不能消除白大衣效应。白大衣效应检测的增加似乎与BpTRU系统性的向下偏差有关。因此，BpTRU削弱了隐匿性效应的检测。
