Guzet Feza, Bitigen Atilla, Karabay Can Yücel, Cimen Arif Oguzhan, Teyfik Nihal
aDepartment of Cardiology, Istanbul Surp Pırgic Armenian Foundation Hospital bDepartment of Cardiology, Medikalpark Fatih Hospital Affiliation of İstanbul Kemerburgaz University cDepartment Cardiology, Süreyyapaşa Chest and Chest Surgery Center, Istanbul, Turkey.
Blood Press Monit. 2015 Feb;20(1):20-6. doi: 10.1097/MBP.0000000000000084.
To compare the methods of office blood pressure (BP) measurement and ambulatory blood pressure monitoring (ABPM) to ensure optimal BP control in hypertensive anticoagulated patients.
Seventy-eight patients who were receiving antihypertensive drugs and warfarin in a dose-adjusted approach to achieve therapeutic international normalized ratio because of the association of atrial fibrillation were enrolled in the study. Twenty-four hour ABPM was applied to all patients. For the assessment of optimal BP control, office BP measurements were compared with ABPM recordings. All patients were divided into 'good control' and 'poor control' groups with a cut-off level of 140 mmHg systolic blood pressure (SBP). The groups of patients with 'good control' and 'poor control' were further subdivided into four groups according to the cardiovascular outcome on the basis of ABPM reference threshold levels: 'true good control' or 'seemingly good control' and 'true poor control' or 'seemingly poor control' (white coat effect). Positive and negative predictive values of the office BP measurement method versus ABPM were estimated.
According to office measurements, 56.9% of all cases were in the 'good control' group and 43.1% were in the 'poor control' group. When we reclassified patients according to daytime and night-time mean SBP, we realized that they were in 'true good control', 'seemingly good control', 'true poor control', and 'seemingly poor control' groups with ratios of 25.5, 31.4, 21.6, and 21.6% on the basis of daytime systolic mean values and 19.6, 37.3, 35.3, and 7.8% on the basis of night-time systolic mean values, respectively. When we considered ABPM as a reference method, sensitivity, specificity, and positive and negative predictive values of office SBP measurements were 40.74, 54.17, 50.00, and 44.83% for daytime SBP mean values and 48.65, 71.43, 81.82, and 34.48% for night-time SBP mean values, respectively.
Poor control of SBP in patients with anticoagulant therapy may result in fatal events such as intracranial bleeding; thus, they are still under significant risk, although they are considered to have controlled BP with office measurements. ABPM is an essential method for accurate BP control in contrast to office BP measurement in anticoagulated patients.
比较诊室血压测量方法与动态血压监测（ABPM），以确保高血压抗凝患者的血压得到最佳控制。
本研究纳入了78例因房颤接受降压药物和剂量调整的华法林治疗以达到治疗性国际标准化比值的患者。所有患者均进行24小时ABPM。为评估血压的最佳控制情况，将诊室血压测量结果与ABPM记录进行比较。所有患者根据收缩压140 mmHg的临界值分为“控制良好”和“控制不佳”两组。根据ABPM参考阈值水平，将“控制良好”和“控制不佳”的患者组进一步细分为四组：“真正控制良好”或“看似控制良好”以及“真正控制不佳”或“看似控制不佳”（白大衣效应）。评估诊室血压测量方法相对于ABPM的阳性和阴性预测值。
根据诊室测量结果，所有病例中56.9%属于“控制良好”组，43.1%属于“控制不佳”组。当根据日间和夜间平均收缩压对患者重新分类时，我们发现根据日间收缩压平均值，他们分别处于“真正控制良好”、“看似控制良好”、“真正控制不佳”和“看似控制不佳”组，比例分别为25.5%、31.4%、21.6%和21.6%；根据夜间收缩压平均值，比例分别为19.6%、37.3%、35.3%和7.8%。当将ABPM作为参考方法时，诊室收缩压测量的敏感性、特异性以及阳性和阴性预测值，对于日间收缩压平均值分别为40.74%、54.17%、50.00%和44.83%，对于夜间收缩压平均值分别为48.65%、71.43%、81.82%和34.48%。
抗凝治疗患者收缩压控制不佳可能导致颅内出血等致命事件；因此，尽管通过诊室测量认为他们的血压得到了控制，但他们仍处于显著风险中。与抗凝患者的诊室血压测量相比，ABPM是准确控制血压的重要方法。
