Shahab Hunaina, Khan Hamza S, Tufail Mayera, Artani Azmina, Almas Aysha, Shah Hamad A, Khan Aamir H
Department of Medicine, Aga Khan University Hospital, Karachi, PAK.
Department of Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK.
Cureus. 2021 Aug 25;13(8):e17433. doi: 10.7759/cureus.17433. eCollection 2021 Aug.
Background Office blood pressure (BP) measurement is affected by the white-coat phenomenon and shows a weaker correlation with the gold standard ambulatory blood pressure monitoring (ABPM). To overcome this limitation, 24-hour ABPM is recommended by the guidelines for the diagnosis of hypertension. However, 24-hour ABPM is expensive and cumbersome, which limits its use in low to middle-income countries like Pakistan. We aimed to assess if an abbreviated ABPM interval can be utilized to diagnose hypertension effectively in our population. Methods A cross-sectional study, involving 150 participants as part of the Post Clinic Ambulatory Blood Pressure (PC-ABP) study, was conducted in the cardiology clinics. Participants ≥18 years of age, who were either hypertensive or referred for assessment of hypertension, were included. Blood pressure (BP) readings were taken with an ambulatory BP monitor over a 24-hour period. After excluding the first hour called the 'white-coat window,' the mean of the first six systolic readings taken every half hour during the daytime was calculated and was called systolic three-hour ABPM. Pearson correlation coefficients were calculated and Bland-Altman plots were constructed to determine the correlation and limits of agreement between mean systolic three-hour ABPM and daytime-ABPM. Receiver operating characteristic (ROC) curve for systolic and diastolic three-hour daytime ABPM and area under the curve (AUC) were analyzed for the level of accuracy in predicting hypertension. Results Of the 150 participants, 49% were male, and 76% of all were hypertensive. The mean age of participants was 60.3 ± 11.9 years. The mean systolic three-hour ABPM was 135.0 ± 16 mmHg. The mean systolic daytime ABPM was 134.7 ± 15 mmHg. Pearson correlation coefficient between mean systolic three-hour ABPM and mean systolic daytime ABPM was 0.85 (p-value <0.001). The limits of agreement were 18 mmHg to -17 mmHg between the two readings on Bland-Altman plots and the area under the curve of the receiver operating characteristic (ROC) was 0.96, suggesting that three-hour systolic ABPM is a good predictor of hypertension. Conclusion Three-hour ABPM correlates well with 24-hour ABPM in the Pakistani population. We recommend considering the use of this abbreviated ABPM to screen hypertension where a full-length ABPM cannot be used. Further studies can be conducted on a larger sample size to determine the prognostic implications of this shortened ABPM.
背景 诊室血压测量受白大衣现象影响，与金标准动态血压监测（ABPM）的相关性较弱。为克服这一局限性，高血压诊断指南推荐采用24小时ABPM。然而，24小时ABPM费用高昂且操作繁琐，限制了其在巴基斯坦等低收入和中等收入国家的应用。我们旨在评估缩短的ABPM间隔时间能否有效用于诊断我国人群的高血压。方法 作为门诊动态血压（PC-ABP）研究的一部分，在心脏病诊所进行了一项横断面研究，纳入150名参与者。纳入年龄≥18岁、患有高血压或被转诊进行高血压评估的参与者。使用动态血压监测仪在24小时内测量血压读数。在排除称为“白大衣窗口”的第一个小时后，计算白天每半小时测量的前六个收缩压读数的平均值，称为收缩压三小时ABPM。计算Pearson相关系数并绘制Bland-Altman图，以确定收缩压三小时ABPM与白天ABPM之间的相关性和一致性界限。分析收缩压和舒张压三小时白天ABPM的受试者工作特征（ROC）曲线及曲线下面积（AUC），以评估预测高血压的准确性。结果 150名参与者中，49%为男性，76%患有高血压。参与者的平均年龄为60.3±11.9岁。收缩压三小时ABPM的平均值为135.0±16 mmHg。收缩压白天ABPM的平均值为134.7±15 mmHg。收缩压三小时ABPM平均值与收缩压白天ABPM平均值之间的Pearson相关系数为0.85（p值<0.001）。Bland-Altman图上两次读数之间的一致性界限为18 mmHg至-17 mmHg，受试者工作特征（ROC）曲线下面积为0.96，表明收缩压三小时ABPM是高血压的良好预测指标。结论 在巴基斯坦人群中，三小时ABPM与24小时ABPM具有良好的相关性。我们建议在无法使用完整时长ABPM的情况下，考虑使用这种缩短的ABPM来筛查高血压。可对更大样本量进行进一步研究，以确定这种缩短的ABPM的预后意义。
