Département des sciences biomédicales, Université de Montréal, Montréal, Québec, Canada; Institut de recherches cliniques de Montréal (IRCM), Montréal, Québec, Canada.
Département des sciences infirmières, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada.
Can J Cardiol. 2017 May;33(5):653-657. doi: 10.1016/j.cjca.2017.01.021. Epub 2017 Feb 2.
Blood pressure (BP) readings taken in clinics are often higher than BP readings taken in a research setting. Recent guidelines and clinical trials have highlighted the necessity of using automated office blood pressure (AOBP) devices and standardizing measurement procedures. The goal of the present study was to compare AOBP vs manual BP measurement in both research and clinical environments in which operators and devices were the same and measurement procedures were standardized and optimal.
Clinical manual BP and AOBP measurement estimates were gathered from a retrospective cohort of patients followed in a hypertension clinic. Research AOBP and manual BP measurement data were obtained from past research studies. Descriptive statistics and agreement analyses with Cohen kappa coefficients were developed. The AOBP/manual BP measurement gap between clinical and research follow-up was compared using an unpaired t test.
Two hundred eighty-eight patients were included in the clinical cohort, and 195 patients contributed to research-grade BP data. All patients had hypertension. AOBP averages were lower than manual measurement averages in both clinical (-3.6 ± 14.9 mm Hg / -3.0 ± 8.8 mm Hg) and research (-2.7 ± 10.0 / -2.4 ± 6.3 mm Hg) environments. The gap between measurement methods did not differ between research and clinical data. Cohen kappa coefficient was lower in the clinical context because of greater variability and more time between BP measurements (5.5 ± 2.9 months).
Manual BP readings were slightly higher than AOBP estimates. The difference was not influenced by the real-world context of clinical practice. Office nonautomated BP measurements may still be valuable if measurement procedures are well standardized and performed by trained nurses.
在诊所测量的血压（BP）读数通常高于研究环境中的 BP 读数。最近的指南和临床试验强调了使用自动化诊室血压（AOBP）设备和标准化测量程序的必要性。本研究的目的是比较相同操作人员和设备以及标准化和最佳测量程序的研究和临床环境中 AOBP 与手动 BP 测量。
从高血压诊所随访的回顾性队列中收集临床手动 BP 和 AOBP 测量估计值。从过去的研究研究中获得研究级 AOBP 和手动 BP 测量数据。制定了描述性统计和一致性分析，包括 Cohen kappa 系数。使用未配对 t 检验比较临床和研究随访之间的 AOBP/手动 BP 测量差距。
临床队列包括 288 名患者，195 名患者提供了研究级 BP 数据。所有患者均患有高血压。在临床（-3.6 ± 14.9 毫米汞柱/-3.0 ± 8.8 毫米汞柱）和研究（-2.7 ± 10.0 /-2.4 ± 6.3 毫米汞柱）环境中，AOBP 平均值均低于手动测量平均值。测量方法之间的差距在研究和临床数据之间没有差异。由于 BP 测量之间的变异性更大且时间间隔更长（5.5 ± 2.9 个月），临床环境中的 Cohen kappa 系数较低。
手动 BP 读数略高于 AOBP 估计值。差异不受临床实践实际情况的影响。如果测量程序得到很好的标准化并由经过培训的护士进行，则办公室非自动化 BP 测量仍可能具有价值。
