Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Heart Institute, Edmonton, Alberta, Canada.
Can J Cardiol. 2018 Jan;34(1):61-65. doi: 10.1016/j.cjca.2017.09.022. Epub 2017 Oct 5.
Clinical practice guidelines endorse automated office blood pressure (AOBP) measurement as the preferred in-office measurement modality. However, recent data indicate that this method may underestimate daytime ambulatory BP. The objective of this study was to further assess the comparability of mean AOBP and daytime ambulatory BP in clinical practice.
A retrospective cross-sectional chart review was conducted of 96 consecutive patients referred from primary or specialty care practices to a tertiary care ambulatory BP monitoring service. Six AOBP readings were taken using an appropriately cuffed BpTRU (BpTRU Medical Devices, Coquitlam, Canada) device on the nondominant arm and no rest period (first reading discarded). Twenty-four-hour ambulatory BP monitoring was then performed. Between-group means were compared with paired t tests. The proportion of patients with differences of ≥ 5, 10, and 15 mm Hg was tabulated.
Mean age was 52.6 ± 16.7 years, 60% were women, and 79% had previously diagnosed hypertension. Mean AOBPs were 130.8 ± 15.5/82.3 ± 10.7 mm Hg, and mean daytime ambulatory BPs were 142.8 ± 14.9/83.9 ± 11.2 mm Hg (difference of -11.9 ± 13.5/-1.6 ± 7.6; P < 0.001 for systolic BP and P < 0.04 for diastolic BP). Between-group differences were greater in patients with previous hypertension and in those with daytime ambulatory BP levels ≥ 135 mm Hg. The proportions of patients with systolic or diastolic BP differences of ≥ 5, 10 and 15 mm Hg were 89%, 52%, and 33%, respectively.
Mean AOBP underestimates daytime ambulatory BP. Variability between the 2 methods is high. These findings do not support the premise that AOBP closely approximates daytime ambulatory BP.
临床实践指南支持自动化诊室血压（AOBP）测量作为诊室测量的首选方法。然而，最近的数据表明，这种方法可能会低估日间动态血压。本研究的目的是进一步评估在临床实践中平均 AOBP 和日间动态血压的可比性。
对 96 例连续患者进行回顾性横断面图表审查，这些患者来自初级或专科保健诊所，转诊至三级保健动态血压监测服务。使用适当袖口的 BpTRU（BpTRU Medical Devices，Coquitlam，加拿大）设备在非优势臂上进行 6 次 AOBP 读数，无休息期（丢弃第一个读数）。然后进行 24 小时动态血压监测。使用配对 t 检验比较组间均值。列出差异≥5、10 和 15mmHg 的患者比例。
平均年龄为 52.6±16.7 岁，60%为女性，79%患有先前诊断的高血压。平均 AOBP 为 130.8±15.5/82.3±10.7mmHg，平均日间动态血压为 142.8±14.9/83.9±11.2mmHg（差异-11.9±13.5/-1.6±7.6；收缩压 P<0.001，舒张压 P<0.04）。在有先前高血压和日间动态血压水平≥135mmHg 的患者中，组间差异更大。收缩压或舒张压差异≥5、10 和 15mmHg 的患者比例分别为 89%、52%和 33%。
平均 AOBP 低估了日间动态血压。两种方法之间的变异性很大。这些发现不支持 AOBP 密切接近日间动态血压的前提。
