Nunan David, Thompson Matthew, Heneghan Carl J, Perera Rafael, McManus Richard J, Ward Alison
aNuffield Department of Primary Care Health Sciences, University of Oxford bNational Institute for Health Research School for Primary Care Research, Oxford, UK cDepartment of Family Medicine, University of Washington, Seattle, Washington, USA.
J Hypertens. 2015 Apr;33(4):755-62; discussion 762. doi: 10.1097/HJH.0000000000000489.
To assess the diagnostic accuracy of recommendations for self-monitoring blood pressure (BP) for diagnosing hypertension in primary care.
Two hundred and forty-seven consecutive participants with raised (≥130 mmHg systolic) BP measured by their general practitioner from four primary care practices in the United Kingdom underwent 28 days of self-monitoring followed by 24-h ambulatory BP monitoring (ABPM). Diagnostic accuracy of the first 7 days of self-monitored BP (minimum 4 days, discarding readings on day 1) in detecting hypertension with ambulatory blood pressure was taken as reference.
Two hundred and three participants were included, 109 (53.7%) of whom were diagnosed with hypertension using daytime ambulatory BP. The average of days 2-7 self-monitored BP correctly classified 150 of 203 participants [sensitivity 93.6%, 95% confidence interval (CI) 87.2-97.4%; specificity 51.1%, 95% CI 40.5-61.5%). However, the average of days 2-5 self-monitoring correctly classified 152 of 203 participants due to better specificity (53.2%, 95% CI 42.6-63.6%). In sensitivity analysis, diagnostic accuracy was not improved by inclusion of readings beyond day 5, and inclusion of readings taken on day 1 had no impact on diagnostic accuracy. Self-monitoring in the clinic was more accurate than readings taken by the general practitioner, but not self-monitoring outside of the clinic.
Hypertension can be ruled out in the majority of patients with elevated clinic BP using the average of the first 5 consecutive days of self-monitored BP, supporting lower limits for self-monitoring readings in current guidelines. Performing readings beyond day 5 and including readings taken on the first day had no clinical impact on diagnostic accuracy.
评估基层医疗中自我监测血压（BP）用于诊断高血压的推荐方法的诊断准确性。
来自英国四个基层医疗机构的247名连续参与者，其经全科医生测量收缩压≥130 mmHg，进行了28天的自我血压监测，随后进行24小时动态血压监测（ABPM）。以动态血压监测诊断高血压时，自我监测血压的前7天（最少4天，舍弃第1天的读数）的诊断准确性作为参考。
纳入203名参与者，其中109名（53.7%）经日间动态血压监测诊断为高血压。第2 - 7天自我监测血压的平均值正确分类了203名参与者中的150名[敏感性93.6%，95%置信区间（CI）87.2 - 97.4%；特异性51.1%，95% CI 40.5 - 61.5%]。然而，由于特异性更高（53.2%，95% CI 42.6 - 63.6%），第2 - 5天自我监测的平均值正确分类了203名参与者中的152名。在敏感性分析中，纳入第5天之后的读数并未提高诊断准确性，且纳入第1天的读数对诊断准确性没有影响。诊所内的自我监测比全科医生测量更准确，但诊所外的自我监测则不然。
使用连续5天自我监测血压的平均值，可排除大多数诊所血压升高的患者患有高血压，这支持了当前指南中自我监测读数的下限。第5天之后进行读数以及纳入第1天的读数对诊断准确性没有临床影响。
