在智利的基层医疗环境中，观察自动化办公室血压测量与动态血压监测的效果。

Attended Automated Office Blood Pressure Measurement Versus Ambulatory Blood Pressure Monitoring in a Primary Healthcare Setting in Chile.

机构信息

From the Sección de Nefrología, Departamento de Medicina, Hospital Clínico Universidad de Chile, the Instituto Milenio de Inmunología e Inmunoterapia, ICBM, Facultad de Medicina, Universidad de Chile, the Centro de Investigación Clínica Avanzada, Hospital Clínico Universidad de Chile, the Servicio de Salud Metropolitano Sur-Oriente, the Sociedad Chilena de Hipertensión, the Departamento Enfermedades no Transmisibles, División de Prevención y Control de Enfermedades, Ministerio de Salud, the Organización Panamericana de la Salud, the Unidad de Hipertensión, Servicio de Nefrología, Hospital del Salvador, Santiago, Chile.

出版信息

South Med J. 2021 Feb;114(2):63-69. doi: 10.14423/SMJ.0000000000001206.

DOI:10.14423/SMJ.0000000000001206

PMID:33537784

Abstract

OBJECTIVES

As part of the HEARTS in the Americas initiative, Chilean primary healthcare centers have implemented novel hypertension management strategies, including new diagnostic approaches. This study evaluated the concordance between attended automated office blood pressure (AOBP) measurements with an oscillometric device and ambulatory blood pressure monitoring (ABPM).

METHODS

This was an observational cohort study to evaluate and compare attended AOBP and ABPM for the diagnosis of hypertension in adults in a primary healthcare setting.

RESULTS

The study evaluated 309 participants (54.2 ± 15.7 years; 50.5% male) from four primary healthcare centers in Santiago, Chile. Attended AOBP measurements were obtained at the clinic on two separate days, followed by ABPM. AOBP values indicated that 69.6% of patients had a systolic blood pressure (SBP) of ≥140 mm Hg and 34.6% had a diastolic blood pressure (DBP) of ≥90 mm Hg. A total of 83.5% had hypertension, 45.3% had high SBP, and 56.0% had high DBP. ABPM values indicated that 65.0% of patients had hypertension. The combined AOBP and ABPM analysis showed that 57.0% of patients had sustained hypertension, 26.5% had white coat hypertension, 8.1% had masked hypertension, and 8.4% were normotensive. The concordance between AOBP and ABPM (κ coefficient) was low (κ = 0.133; 95% confidence interval 0.028-0.237). The comparison of AOBP and ABPM measurements (Bland-Altman plots and bias calculations) showed an important bias in BP as measured using the AOBP method, especially for SBP (13.7 ± 11.6, 95% confidence interval -9.1 to 36.5).

CONCLUSIONS

Attended AOBP alone may not be sufficient for adequate classification, diagnosis, and management of hypertension in Chile or other countries with similar demographics.

摘要

目的

作为“美洲心脏倡议”的一部分，智利基层医疗中心实施了新型高血压管理策略，包括新的诊断方法。本研究评估了新型血压管理策略中使用的 attended automated office blood pressure（AOBP）测量与 ambulatory blood pressure monitoring（ABPM）之间的一致性。

方法

这是一项观察性队列研究，旨在评估和比较 attended AOBP 和 ABPM 在成人初级保健环境中高血压诊断中的作用。

结果

本研究纳入了来自智利圣地亚哥的四家基层医疗中心的 309 名参与者（54.2±15.7 岁；50.5%为男性）。在两个不同的日子里，在诊所进行 attended AOBP 测量，随后进行 ABPM。AOBP 值表明，69.6%的患者收缩压（SBP）≥140mmHg，34.6%的患者舒张压（DBP）≥90mmHg。共有 83.5%的患者患有高血压，45.3%的患者 SBP 升高，56.0%的患者 DBP 升高。ABPM 值表明，65.0%的患者患有高血压。AOBP 和 ABPM 联合分析显示，57.0%的患者持续性高血压，26.5%的患者为白大衣高血压，8.1%的患者为隐匿性高血压，8.4%的患者为血压正常。AOBP 和 ABPM 之间的一致性（κ系数）较低（κ=0.133；95%置信区间 0.028-0.237）。AOBP 和 ABPM 测量值之间的比较（Bland-Altman 图和偏差计算）显示，AOBP 方法测量的 BP 存在显著偏差，尤其是 SBP（13.7±11.6，95%置信区间-9.1 至 36.5）。