Michaud André, Lamarre-Cliche Maxime, Cloutier Lyne
Department of Nusing, Université du Québec à Trois-Rivières, Trois-Rivières.
Institut De Recherches Cliniques De Montréal, Montreal, Quebec, Canada.
Blood Press Monit. 2019 Jun;24(3):123-129. doi: 10.1097/MBP.0000000000000382.
Previous studies have examined the relevance of hypertension (HTN) screening in walk-in clinics. So far, no valid algorithm has been proposed on how to integrate HTN screening in this context. The aim of our study was to assess, in a walk-in clinic setting, the HTN screening strategy for performing an automated office blood pressure (AOBP) measurement following an initially high office blood pressure (OBP) measurement.
Included participants were adults with nonemergent medical conditions and an initial walk-in clinic OBP between systolic 140 and/or diastolic 90 mmHg and systolic 180 and/or diastolic 110 mmHg. AOBP was performed with patients unattended. The 24-h ambulatory blood pressure measurement (ABPM) was used as the diagnostic threshold.
Fifty participants were included in the study. The overall HTN prevalence as confirmed by the 24-h ABPM was 46% [95% confidence interval (CI): 32.19-59.81]. After an elevated OBP, AOBP over diagnostic thresholds occurred in 32 patients and were confirmed by ABPM in 20 participants, leading to a 62.5% positive predictive value (95% CI: 51.5-72.3%). Measurements under the AOBP diagnostic threshold occurred in 18 patients and were confirmed by ABPM in 15 participants, leading to a negative predictive value of 83.3% (95% CI: 62.3-93.8%).
In a walk-in clinic, an elevated OBP is a useful screening tool due its ability to recognize nearly one in two patients as actually hypertensive. Adding an AOBP makes it possible to specify what course of action to take. This ultimately results in better targeting of patients for an ABPM referral.
以往的研究探讨了在即时诊疗诊所进行高血压（HTN）筛查的相关性。到目前为止，尚未提出关于如何在这种情况下整合HTN筛查的有效算法。我们研究的目的是在即时诊疗诊所环境中评估一种HTN筛查策略，即在首次诊室血压（OBP）测量值较高后进行自动诊室血压（AOBP）测量。
纳入的参与者为患有非紧急医疗状况且首次即时诊疗诊所OBP收缩压在140和/或舒张压在90mmHg至收缩压180和/或舒张压110mmHg之间的成年人。AOBP在患者无人陪伴的情况下进行。24小时动态血压测量（ABPM）用作诊断阈值。
50名参与者纳入研究。经24小时ABPM确认的总体HTN患病率为46%[95%置信区间（CI）：32.19 - 59.81]。OBP升高后，32例患者AOBP超过诊断阈值，其中20例经ABPM确认，阳性预测值为62.5%（95%CI：51.5 - 72.3%）。18例患者AOBP测量值低于诊断阈值，其中15例经ABPM确认，阴性预测值为83.3%（95%CI：62.3 - 93.8%）。
在即时诊疗诊所，升高的OBP是一种有用的筛查工具，因为它能够识别近二分之一实际患有高血压的患者。增加AOBP测量可以明确采取何种行动方案。这最终能更精准地将患者转诊进行ABPM检查。
