Grezzana Guilherme B, Stein Airton T, Pellanda Lucia C
aGraduate Department, Institute of Cardiology - University Foundation of Cardiology (IC/FUC) bPublic Health Department, Federal University of Health Sciences of Porto Alegre (UFCSPA) cPublic Health Department, Lutheran University of Brazil (ULBRA) dHealth Technology Assessment Department, Conceição Hospital, Porto Alegre, Brazil.
Blood Press Monit. 2017 Apr;22(2):72-78. doi: 10.1097/MBP.0000000000000238.
Arterial hypertension is an important risk factor for cardiovascular outcomes. Blood pressure (BP) control levels remain largely out of target among primary healthcare (PHC) patients. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) may contribute toward the identification of cardiovascular risk groups.
To assess concordance between conventional office BP measurements and 24-h ABPM of hypertension control in cardiovascular risk groups of PHC hypertensive patients.
A cross-sectional study with 569 hypertensive patients was carried out. The evaluation of BP was performed by a PHC doctor, and the 24-h ABPM was performed by a different and blinded provider. The therapeutic targets for BP followed the guidance of The Eighth Joint National Committee, the Brazilian guideline, and the 2013 European Society of Hypertension. Considering the hypertension control therapeutic targets, the guidelines were not similar and were used to evaluate differences in BP value concordances compared with BP standard measurements.
After a multivariate logistic regression analysis, a conventional BP was used in comparison with ABPM in different cardiovascular risk groups of hypertensive patients. According to the ABPM by European Society of Hypertension guideline, the subgroup of inactive patients (P=0.006), with altered glycemia (P=0.015) and over 30 mg/dl albuminuria (P=0.001), presented discordance among methods. When a conventional BP measurement in comparison with the ABPM results according to the Brazilian ABPM guideline was used, the discordance occurred significantly in inactive (P=0.001) and microalbuminuria more than 30 mg/dl (P=0.022) subgroups. However, in this comparison, a concordance between high-density lipoprotein more than 60 mg/dl (P=0.015) and obesity (P=0.035) subgroups occurred.
Uncontrolled glucose levels, a sedentary lifestyle, and the presence of microalbuminuria correspond to some cardiovascular risk groups that would particularly benefit from 24-h ABPM as a tool for the control of BP with the PHC hypertensive patients of this study.
动脉高血压是心血管疾病预后的重要危险因素。在初级医疗保健（PHC）患者中，血压（BP）控制水平大多未达目标。24小时动态血压监测（ABPM）可能有助于识别心血管风险群体。
评估PHC高血压患者心血管风险群体中传统诊室血压测量与24小时ABPM在高血压控制方面的一致性。
对569例高血压患者进行了一项横断面研究。由PHC医生进行血压评估，24小时ABPM由另一位不知情的提供者进行。血压治疗目标遵循美国国家联合委员会第八次报告、巴西指南以及2013年欧洲高血压学会的指导。考虑到高血压控制治疗目标，这些指南并不相同，用于评估与血压标准测量相比血压值一致性的差异。
经过多因素逻辑回归分析，在高血压患者的不同心血管风险群体中，将传统血压与ABPM进行比较。根据欧洲高血压学会指南的ABPM，不活动患者亚组（P = 0.006）、血糖异常患者亚组（P = 0.015）和蛋白尿超过30mg/dl的患者亚组（P = 0.001），两种测量方法存在不一致性。当根据巴西ABPM指南将传统血压测量结果与ABPM结果进行比较时，不活动患者亚组（P = 0.001）和微量蛋白尿超过30mg/dl的患者亚组（P = 0.022）出现了显著的不一致性。然而，在这种比较中，高密度脂蛋白超过60mg/dl的患者亚组（P = 0.015）和肥胖患者亚组（P = 0.035）出现了一致性。
血糖水平未得到控制、久坐不动的生活方式以及微量蛋白尿的存在，在某些心血管风险群体中较为常见，对于本研究中的PHC高血压患者而言，24小时ABPM作为一种控制手段可能会使这些群体特别受益。
