Carrillo-Larco Rodrigo M, Guzman-Vilca Wilmer Cristobal, Neupane Dinesh
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
PLoS Med. 2022 Apr 1;19(4):e1003975. doi: 10.1371/journal.pmed.1003975. eCollection 2022 Apr.
Simplified blood pressure (BP) screening approaches have been proposed. However, evidence is limited to a few countries and has not documented the cardiovascular risk amongst missed hypertension cases, limiting the uptake of these simplified approaches. We quantified the proportion of missed, over-diagnosed, and consistently identified hypertension cases and the 10-year cardiovascular risk in these groups.
We used 60 WHO STEPS surveys (cross-sectional and nationally representative; n = 145,174) conducted in 60 countries in 6 world regions between 2004 and 2019. Nine simplified approaches were compared against the standard (average of the last 2 of 3 BP measurements). The 10-year cardiovascular risk was computed with the 2019 World Health Organization Cardiovascular Risk Charts. We used t tests to compare the cardiovascular risk between the missed and over-diagnosed cases and the consistent hypertension cases. We used Poisson multilevel regressions to identify risk factors for missed cases (adjusted for age, sex, body mass index, and 10-year cardiovascular risk). Across all countries, compared to the standard approach, the simplified approach that missed the fewest cases was using the second BP reading if the first BP reading was 130-145/80-95 mm Hg (5.62%); using only the second BP reading missed 5.82%. The simplified approach with the smallest over-diagnosis proportion was using the second BP reading if the first BP measurement was ≥140/90 mm Hg (3.03%). In many countries, cardiovascular risk was not significantly different between the missed and consistent hypertension groups, yet the mean was slightly lower amongst missed cases. Cardiovascular risk was positively associated with missed hypertension depending on the simplified approach. The main limitation of the work is the cross-sectional design.
Simplified BP screening approaches seem to have low misdiagnosis rates, and cardiovascular risk could be lower amongst missed cases than amongst consistent hypertension cases. Simplified BP screening approaches could be included in large screening programmes and busy clinics.
已有人提出简化血压（BP）筛查方法。然而，相关证据仅限于少数国家，且未记录漏诊高血压病例中的心血管风险，这限制了这些简化方法的采用。我们对漏诊、过度诊断和持续确诊的高血压病例比例以及这些组中的10年心血管风险进行了量化。
我们使用了2004年至2019年期间在世界6个区域的60个国家进行的60项世界卫生组织（WHO）逐步调查（横断面调查且具有全国代表性；n = 145,174）。将9种简化方法与标准方法（3次血压测量中最后2次的平均值）进行比较。使用2019年世界卫生组织心血管风险图表计算10年心血管风险。我们使用t检验比较漏诊和过度诊断病例与持续高血压病例之间的心血管风险。我们使用泊松多水平回归来确定漏诊病例的风险因素（根据年龄、性别、体重指数和10年心血管风险进行调整）。在所有国家中，与标准方法相比，漏诊病例最少的简化方法是：如果第一次血压读数为130 - 145/80 - 95 mmHg，则使用第二次血压读数（5.62%）；仅使用第二次血压读数漏诊率为5.82%。过度诊断比例最小的简化方法是：如果第一次血压测量≥140/90 mmHg，则使用第二次血压读数（3.03%）。在许多国家，漏诊和持续高血压组之间的心血管风险无显著差异，但漏诊病例的平均值略低。根据简化方法的不同，心血管风险与漏诊高血压呈正相关。这项工作的主要局限性在于横断面设计。
简化血压筛查方法似乎误诊率较低，且漏诊病例中的心血管风险可能低于持续高血压病例。简化血压筛查方法可纳入大型筛查项目和繁忙的诊所。
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