Stevens Sarah L, McManus Richard J, Stevens Richard John
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BMJ Open. 2018 Apr 12;8(4):e020589. doi: 10.1136/bmjopen-2017-020589.
Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments.
(1) An online cross-sectional survey and (2) a prospective 'mystery shopper' study where patients agreed to report how BP was measured during their next appointment.
Primary care.
Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes.
Proportion of patients having BP measured according to guidelines.
217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively).
Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance.
高血压试验和流行病学研究在每次就诊时都采用多次诊室血压测量。国际指南也建议进行重复测量；然而，对于血压的常规测量方式却知之甚少。这对于个体患者管理很重要，因为常规记录的读数构成了研究数据库的一部分。我们旨在确定在常规全科诊疗预约期间血压测量的当前做法。
（1）一项在线横断面调查和（2）一项前瞻性“神秘顾客”研究，即患者同意报告下次预约时血压是如何测量的。
初级医疗保健。
2015年7月至2016年1月期间完成在线调查的患者慈善组织/患者参与小组成员。334名参与者完成了前瞻性研究（男性占51.5%，平均年龄 = 59.3岁），其中279名（83.5%）患有糖尿病。
按照指南测量血压的患者比例。
217名参与者（其中183名患有糖尿病，34名未患糖尿病）在最后一次预约时测量了血压。分别有63.7%患有糖尿病和60.0%未患糖尿病的参与者按照英国指南测量了血压。与仅测量一次的参与者相比，测量多次的参与者的初始血压明显更高（患有糖尿病的患者收缩压分别为p = 0.016/0.089，舒张压分别为p<0.001/p = 0.022；未患糖尿病的患者收缩压分别为p = 0.016/0.089，舒张压分别为p<0.001/p = 0.022）。
英国初级医疗保健中常规血压测量的当前做法通常符合重复测量的指南。需要进一步研究以在更广泛人群中证实研究结果，确定何时常规获取第三次重复读数，并评估对血压测量指南其他方面的依从性。
