Okada Tomonari, Wada Toshikazu, Nagaoka Yume, Kanno Yoshihiko
Department of Nephrology, Tokyo Medical University, Tokyo, Japan.
Cardiorenal Med. 2015 Dec;6(1):8-15. doi: 10.1159/000438464. Epub 2015 Sep 15.
BACKGROUND/AIMS: Although several guidelines propose two or three measurements of home blood pressure (HBP) on each occasion, the actual status of multiple measurements is not clear in the practical management of hypertension. We surveyed the details regarding two measurements of HBP in patients with chronic kidney disease (CKD).
HBP was measured twice every morning and evening over 7 consecutive days in 175 CKD patients. The distribution of the differences between two BP values (2nd - 1st BP) and their association with BP parameters were evaluated.
The 2nd - 1st morning systolic BP (SBP) and diastolic BP (DBP) differences were -2.3 ± 4.1 and -0.4 ± 2.6 mm Hg, respectively. The proportion of 2nd - 1st morning SBP differences >0 mm Hg was 31.7% in a total of 1,195 measurements. Eighty patients (45.7%) had days with a difference ≤-5 mm Hg and days with a difference ≥5 mm Hg in morning SBP during 7 days. The multivariate regression analysis of the SD values of 2nd - 1st morning SBP as a dependent variable showed that the SD value of the 1st morning SBP (β = 0.65, p < 0.001) was a significant determinant.
Although the 2nd SBP was 2-3 mm Hg lower than the 1st SBP in the population as a whole, various differences were found for each subject during 7 days. 2nd - 1st BP variability might be associated with day-by-day 1st BP variability.
背景/目的：尽管多项指南建议每次测量家庭血压（HBP）两到三次，但在高血压的实际管理中，多次测量的实际情况尚不清楚。我们调查了慢性肾脏病（CKD）患者两次测量HBP的详细情况。
对175例CKD患者连续7天每天早晚各测量两次HBP。评估两次血压值（第二次血压 - 第一次血压）之间差异的分布及其与血压参数的关联。
第二次 - 第一次早晨收缩压（SBP）和舒张压（DBP）的差异分别为 -2.3±4.1和 -0.4±2.6毫米汞柱。在总共1195次测量中，第二次 - 第一次早晨SBP差异>0毫米汞柱的比例为31.7%。80例患者（45.7%）在7天内早晨SBP出现差异≤ -5毫米汞柱的天数和差异≥5毫米汞柱的天数。以第二次 - 第一次早晨SBP差值的标准差（SD）值为因变量的多因素回归分析显示，第一次早晨SBP的SD值（β = 0.65，p < 0.001）是一个显著的决定因素。
虽然总体人群中第二次SBP比第一次SBP低2 - 3毫米汞柱，但在7天内每个受试者都发现了各种差异。第二次 - 第一次血压变异性可能与每日第一次血压变异性有关。
