Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, New York, USA.
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Am Coll Cardiol. 2020 Dec 22;76(25):2911-2922. doi: 10.1016/j.jacc.2020.10.039.
Determining the reliability and predictive validity of office blood pressure (OBP), ambulatory BP (ABP), and home BP (HBP) can inform which is best for diagnosing hypertension and estimating risk of cardiovascular disease.
This study aimed to assess the reliability of OBP, HBP, and ABP and evaluate their associations with left ventricular mass index (LVMI) in untreated persons.
The Improving the Detection of Hypertension (IDH) study, a community-based observational study, enrolled 408 participants who had OBP assessed at 3 visits, and completed 3 weeks of HBP, 2 24-h ABP recordings, and a 2-dimensional echocardiogram. Mean age was 41.2 ± 13.1 years, 59.5% were women, 25.5% African American, and 64.0% Hispanic.
The reliability of 1 week of HBP, 3 office visits with mercury sphygmomanometry, and 24-h ABP were 0.938, 0.894, and 0.846 for systolic and 0.918, 0.847, and 0.843 for diastolic BP, respectively. The correlations among OBP, HBP, and ABP, corrected for regression dilution bias, were 0.74 to 0.89. After multivariable adjustment including OBP and 24-h ABP, 10 mm Hg higher systolic and diastolic HBP were associated with 5.07 (standard error [SE]: 1.48) and 3.92 (SE: 2.14) g/m higher LVMI, respectively. After adjustment for HBP, neither systolic or diastolic OBP nor ABP was associated with LVMI.
OBP, HBP, and ABP assess somewhat distinct parameters. Compared with OBP (3 visits) or 24-h ABP, systolic and diastolic HBP (1 week) were more reliable and more strongly associated with LVMI. These data suggest that 1 week of HBP monitoring may be the best approach for diagnosing hypertension.
确定诊室血压（OBP）、动态血压（ABP）和家庭血压（HBP）的可靠性和预测效度，可以帮助确定哪种方法最适合诊断高血压和估计心血管疾病风险。
本研究旨在评估 OBP、HBP 和 ABP 的可靠性，并评估它们与未经治疗人群左心室质量指数（LVMI）的关系。
改善高血压检测（IDH）研究是一项基于社区的观察性研究，共纳入 408 名参与者，他们在 3 次就诊时接受了 OBP 评估，并完成了 3 周的 HBP、2 次 24 小时 ABP 记录和 2 维超声心动图检查。平均年龄为 41.2±13.1 岁，59.5%为女性，25.5%为非裔美国人，64.0%为西班牙裔。
1 周 HBP、3 次水银柱血压计诊室就诊和 24 小时 ABP 的可靠性分别为收缩压 0.938、0.894 和 0.846，舒张压为 0.918、0.847 和 0.843。OBP、HBP 和 ABP 之间的相关性，经回归稀释偏差校正后，分别为 0.74 至 0.89。在包括 OBP 和 24 小时 ABP 的多变量调整后，HBP 收缩压和舒张压每升高 10mmHg，LVMI 分别升高 5.07（标准误 [SE]：1.48）和 3.92（SE：2.14）g/m。调整 HBP 后，收缩压或舒张压 OBP 或 ABP 与 LVMI 均无相关性。
OBP、HBP 和 ABP 评估的是略有不同的参数。与 OBP（3 次就诊）或 24 小时 ABP 相比，收缩压和舒张压 HBP（1 周）更可靠，与 LVMI 的相关性更强。这些数据表明，1 周的 HBP 监测可能是诊断高血压的最佳方法。
