诊室、家庭和自助血压测量在高血压诊断中的应用：一项随机诊断研究。
Clinic, Home, and Kiosk Blood Pressure Measurements for Diagnosing Hypertension: a Randomized Diagnostic Study.
机构信息
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Washington Permanente Medical Group, Seattle, WA, USA.
出版信息
J Gen Intern Med. 2022 Sep;37(12):2948-2956. doi: 10.1007/s11606-022-07400-z. Epub 2022 Mar 3.
BACKGROUND
The US Preventive Services Task Force recommends blood pressure (BP) measurements using 24-h ambulatory monitoring (ABPM) or home BP monitoring before making a new hypertension diagnosis.
OBJECTIVE
Compare clinic-, home-, and kiosk-based BP measurement to ABPM for diagnosing hypertension.
DESIGN, SETTING, AND PARTICIPANTS: Diagnostic study in 12 Washington State primary care centers, with participants aged 18-85 years without diagnosed hypertension or prescribed antihypertensive medications, with elevated BP in clinic.
INTERVENTIONS
Randomization into one of three diagnostic regimens: (1) clinic (usual care follow-up BPs); (2) home (duplicate BPs twice daily for 5 days); or (3) kiosk (triplicate BPs on 3 days). All participants completed ABPM at 3 weeks.
MAIN MEASURES
Primary outcome was difference between ABPM daytime and clinic, home, and kiosk mean systolic BP. Differences in diastolic BP, sensitivity, and specificity were secondary outcomes.
KEY RESULTS
Five hundred ten participants (mean age 58.7 years, 80.2% white) with 434 (85.1%) included in primary analyses. Compared to daytime ABPM, adjusted mean differences in systolic BP were clinic (-4.7mmHg [95% confidence interval -7.3, -2.2]; P<.001); home (-0.1mmHg [-1.6, 1.5];P=.92); and kiosk (9.5mmHg [7.5, 11.6];P<.001). Differences for diastolic BP were clinic (-7.2mmHg [-8.8, -5.5]; P<.001); home (-0.4mmHg [-1.4, 0.7];P=.52); and kiosk (5.0mmHg [3.8, 6.2]; P<.001). Sensitivities for clinic, home, and kiosk compared to ABPM were 31.1% (95% confidence interval, 22.9, 40.6), 82.2% (73.8, 88.4), and 96.0% (90.0, 98.5), and specificities 79.5% (64.0, 89.4), 53.3% (38.9, 67.2), and 28.2% (16.4, 44.1), respectively.
LIMITATIONS
Single health care organization and limited race/ethnicity representation.
CONCLUSIONS
Compared to ABPM, mean BP was significantly lower for clinic, significantly higher for kiosk, and without significant differences for home. Clinic BP measurements had low sensitivity for detecting hypertension. Findings support utility of home BP monitoring for making a new diagnosis of hypertension.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03130257 https://clinicaltrials.gov/ct2/show/NCT03130257.
背景
美国预防服务工作组建议在做出新的高血压诊断之前，使用 24 小时动态血压监测（ABPM）或家庭血压监测进行血压（BP）测量。
目的
比较诊所、家庭和亭基血压测量与 ABPM 对高血压的诊断价值。
设计、地点和参与者：在华盛顿州的 12 个初级保健中心进行的诊断性研究，参与者年龄在 18-85 岁之间，没有诊断出高血压或服用降压药物，且诊所血压升高。
干预措施
随机分为三种诊断方案之一：（1）诊所（常规护理随访血压）；（2）家庭（每日两次重复测量血压 5 天）；或（3）亭基（3 天内重复测量血压 3 次）。所有参与者在 3 周时完成 ABPM。
主要观察指标
主要结局是 ABPM 白天与诊所、家庭和亭基平均收缩压之间的差异。次要结局为舒张压差异、敏感性和特异性。
结果
510 名参与者（平均年龄 58.7 岁，80.2%为白人）中有 434 名（85.1%）纳入主要分析。与日间 ABPM 相比，收缩压的调整平均差异为：诊所（-4.7mmHg[95%置信区间-7.3，-2.2]；P<.001）；家庭（-0.1mmHg[-1.6，1.5]；P=.92）；和亭基（9.5mmHg[7.5，11.6]；P<.001）。舒张压差异为：诊所（-7.2mmHg[-8.8，-5.5]；P<.001）；家庭（-0.4mmHg[-1.4，0.7]；P=.52）；和亭基（5.0mmHg[3.8，6.2]；P<.001）。与 ABPM 相比，诊所、家庭和亭基的敏感性分别为 31.1%（95%置信区间，22.9，40.6）、82.2%（73.8，88.4）和 96.0%（90.0，98.5），特异性分别为 79.5%（64.0，89.4）、53.3%（38.9，67.2）和 28.2%（16.4，44.1）。
局限性
单一医疗保健机构和有限的种族/民族代表性。
结论
与 ABPM 相比，诊所的平均血压明显较低，亭基的血压明显较高，而家庭的血压无显著差异。诊所血压测量对高血压的检出敏感性较低。研究结果支持家庭血压监测在诊断高血压方面的应用价值。
试验注册
ClinicalTrials.gov NCT03130257 https://clinicaltrials.gov/ct2/show/NCT03130257.
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