Kinsara Abdulhalim J, Abuosa Ahmed, Meer Alaa, Elsheikh Aymen H, Abrar Mohammed, Vriz Olga
Cardiology, Ministry of National Guard - Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, College of Medicine, Western Region (COM-WR) - King Abdullah International Medical Research Center, Jeddah, SAU.
Cardiology, National Training Institute, Cairo, EGY.
Cureus. 2020 Nov 30;12(11):e11784. doi: 10.7759/cureus.11784.
Background The primary aim of this study was to evaluate the level of diagnostic overlap between daytime ambulatory blood pressure (BP) monitoring (DT-ABPM) and 24-hour ambulatory BP monitoring (24-h ABPM) in detecting masked hypertension (MH). Methods This is a prospective study that was performed in a sample of 196 soldiers aged between 21 and 50 years (without a history of hypertension) undergoing ABPM testing. The diagnosis of MH based on DT-ABPM defined as (office blood pressure (OBP) <140/90 and DT-ABPM ≥135/85) was compared with the 24-h ABPM defined as (OBP <140/90 mm Hg and 24-h ABPM ≥130/80 mm Hg). We critically analyzed the results to see the agreement between the two methods. Results The number of subjects classified as having MH based on both DT-ABPM and 24-h ABPM, only on 24-h ABPM, and only on DT-ABPM were 11 (5.6%), 29 (14.8%), and 18 (9.2%), respectively. The sensitivity, specificity, and positive and negative predictive values for DT-ABPM in detecting MH were: sensitivity = 100% (95% CI: 97.82% - 100%), specificity = 62.07% (95% CI: 42.26% - 79.31%), PPV = 93.82% (95% CI: 90.50% - 96.03%), and NPV = 100%, respectively. The level of agreement between DT-ABPM and 24-h ABPM in diagnosing MH was 94.4% and discordance in 5.6% (11/196); (kappa=0.736, p < 0.001). Conclusion The sensitivity, specificity, positive and negative predictive values all showed agreement between the two BP methods to confirm the diagnoses of MH. DT-ABPM can be used as an alternative to the 24-h ABPM. DT-ABPM eliminates sleep disturbance attributable to ABPM and maximizes patient compliance with the ABPM test. A further larger trial is needed for more confirmation and to affect the guidelines for using daytime ABPM.
本研究的主要目的是评估日间动态血压监测（DT-ABPM）和24小时动态血压监测（24-h ABPM）在检测隐匿性高血压（MH）时的诊断重叠程度。
这是一项前瞻性研究，对196名年龄在21至50岁之间（无高血压病史）接受ABPM检测的士兵样本进行了研究。将基于DT-ABPM定义为（诊室血压（OBP）<140/90且DT-ABPM≥135/85）的MH诊断与基于24-h ABPM定义为（OBP<140/90 mmHg且24-h ABPM≥130/80 mmHg）的诊断进行比较。我们对结果进行了严格分析，以观察两种方法之间的一致性。
根据DT-ABPM和24-h ABPM均被分类为患有MH的受试者数量、仅根据24-h ABPM被分类为患有MH的受试者数量以及仅根据DT-ABPM被分类为患有MH的受试者数量分别为11名（5.6%）、29名（14.8%）和18名（9.2%）。DT-ABPM检测MH的敏感性、特异性、阳性预测值和阴性预测值分别为：敏感性 = 100%（95% CI：97.82% - 100%），特异性 = 62.07%（95% CI：42.26% - 79.31%），PPV = 93.82%（95% CI：90.50% - 96.03%），NPV = 100%。DT-ABPM和24-h ABPM在诊断MH方面的一致性水平为94.4%，不一致性为5.6%（11/196）；（kappa = 0.736，p < 0.001）。
敏感性、特异性、阳性预测值和阴性预测值均表明两种血压测量方法在确诊MH方面具有一致性。DT-ABPM可作为24-h ABPM的替代方法。DT-ABPM消除了ABPM引起的睡眠干扰，并使患者对ABPM检测的依从性最大化。需要进一步开展更大规模的试验以进行更多验证，并影响日间ABPM的使用指南。
