Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, South Korea.
Division of Hematology and Medical Oncology, Dongguk University Ilsan Hospital, Goyang, South Korea.
J Clin Hypertens (Greenwich). 2021 Nov;23(11):1965-1974. doi: 10.1111/jch.14382. Epub 2021 Oct 26.
The authors developed and validated a diagnostic algorithm using the optimal upper and lower cut-off values of office and home BP at which ambulatory BP measurements need to be applied. Patients presenting with high BP (≥140/90 mm Hg) at the outpatient clinic were referred to measure office, home, and ambulatory BP. Office and home BP were divided into hypertension, intermediate (requiring diagnosis using ambulatory BP), and normotension zones. The upper and lower BP cut-off levels of intermediate zone were determined corresponding to a level of 95% specificity and 95% sensitivity for detecting daytime ambulatory hypertension by using the receiver operator characteristic curve. A diagnostic algorithm using three methods, OBP-ABP: office BP measurement and subsequent ambulatory BP measurements if office BP is intermediate zone; OBP-HBP-ABP: office BP, subsequent home BP measurement if office BP is within intermediate zone and subsequent ambulatory BP measurement if home BP is within intermediate zone; and HBP-ABP: home BP measurement and subsequent ambulatory BP measurements if home BP is within intermediate zone, were developed and validated. In the development population (n = 256), the developed algorithm yielded better diagnostic accuracies than 75.8% (95%CI 70.1-80.9) for office BP alone and 76.2% (95%CI 70.5-81.3) for home BP alone as follows: 96.5% (95%CI: 93.4-98.4) for OBP-ABP, 93.4% (95%CI: 89.6-96.1) for OBP-HBP-ABP, and 94.9% (95%CI: 91.5-97.3%) for HBP-ABP. In the validation population (n = 399), the developed algorithm showed similarly improved diagnostic accuracy. The developed algorithm applying ambulatory BP measurement to the intermediate zone of office and home BP improves the diagnostic accuracy for hypertension.
作者开发并验证了一种诊断算法，该算法使用诊室和家庭血压的最佳上下截断值，当需要进行动态血压测量时，即应用这些截断值。在门诊就诊时出现高血压（≥140/90mmHg）的患者被转诊进行诊室、家庭和动态血压测量。诊室和家庭血压分为高血压、中间（需要通过动态血压诊断）和正常血压区。通过使用接收者操作特性曲线，确定中间区的上下血压截断水平，以达到 95%特异性和 95%敏感性检测日间动态高血压的水平。开发并验证了一种使用三种方法的诊断算法，即 OBP-ABP：诊室血压测量，如果诊室血压处于中间区，则进行后续的动态血压测量；OBP-HBP-ABP：诊室血压，如果诊室血压处于中间区，则进行后续的家庭血压测量，如果家庭血压处于中间区，则进行后续的动态血压测量；HBP-ABP：家庭血压测量，如果家庭血压处于中间区，则进行后续的动态血压测量。在开发人群（n=256）中，与单独使用诊室血压（75.8%[95%CI 70.1-80.9]）和单独使用家庭血压（76.2%[95%CI 70.5-81.3]）相比，该开发算法具有更好的诊断准确性：OBP-ABP 为 96.5%（95%CI：93.4-98.4），OBP-HBP-ABP 为 93.4%（95%CI：89.6-96.1），HBP-ABP 为 94.9%（95%CI：91.5-97.3%）。在验证人群（n=399）中，该开发算法显示出类似的诊断准确性提高。该算法将动态血压测量应用于诊室和家庭血压的中间区，提高了高血压的诊断准确性。
