Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Blood Press. 2022 Dec;31(1):100-108. doi: 10.1080/08037051.2022.2071674.
Out-of-office blood pressure (BP) measurements are essential for the diagnosis and monitoring of hypertension. Current guidelines vary in their recommendations on the protocol for home blood pressure monitoring (HBPM). We aimed to assess the number of blood pressure (BP) measurement days needed for a reliable estimation of true home BP (the expected BP level over time) and hypertension status, using the European guideline-based 7-day HBPM protocol as a reference.
Data from 567 adults who performed a 7-day HBPM were analysed. Blood pressure was measured twice daily (morning and evening readings) using the Microlife Average Mode (MAM), which takes a weighted average of 3 consecutive BP readings. The variability of average BP for an increasing number of measurements was assessed using a linear mixed model including a random intercept per individual and correlated residuals. The reliability of home hypertension status was assessed by the κ statistic.
Mean home BP of the population was 143 ± 16/84 ± 10 mm Hg. On average, the first BP measurements gave the highest values which then decreased over time. Systolic BP in the morning was systematically lower than systolic BP in the evening (142 ± 17mm Hg versus 144 ± 17 mm Hg, <0.05). The average of 7 twice-daily MAM BP measurements was at most 5.2/3.3 mm Hg higher and 9.5/4.8 mm Hg lower than the true home BP for 95% of the individuals. Reducing this protocol to 3 days increased this variability by 1.5/1.0 mm Hg and 4.8/2.3 mm Hg, respectively. For diagnosing home hypertension, there was good agreement with a minimum of 4.5 days of HBPM (ĸ-statistic 0.88; 95% Confidence Interval: 0.82-0.94).
Twice-daily MAM BP measurements for 3 consecutive days provide a reliable estimate of home BP. At least 4.5 consecutive days of HBPM are required for a reliable diagnosis of home hypertension.
外出时血压（BP）测量对于高血压的诊断和监测至关重要。目前的指南在家庭血压监测（HBPM）方案的建议上存在差异。我们旨在评估使用基于欧洲指南的 7 天 HBPM 方案作为参考，进行可靠的真实家庭血压（随时间推移的预期血压水平）和高血压状态估计所需的血压测量天数。
分析了 567 名进行 7 天 HBPM 的成年人的数据。使用 Microlife Average Mode（MAM）每天测量两次血压（早晚读数），该模式对 3 次连续血压读数进行加权平均。使用线性混合模型评估随着测量次数的增加，平均血压的变异性，该模型包括每个个体的随机截距和相关残差。通过κ统计评估家庭高血压状态的可靠性。
人群的平均家庭血压为 143±16/84±10mmHg。平均而言，第一次血压测量值最高，然后随时间逐渐降低。早晨的收缩压系统地低于晚上的收缩压（142±17mmHg 与 144±17mmHg，<0.05）。7 次 MAM 血压测量的平均值最多比真实家庭血压高 5.2/3.3mmHg，低 9.5/4.8mmHg，对于 95%的个体。将该方案缩短至 3 天会分别增加 1.5/1.0mmHg 和 4.8/2.3mmHg 的变异性。对于诊断家庭高血压，使用最少 4.5 天的 HBPM 具有很好的一致性（κ统计量为 0.88；95%置信区间：0.82-0.94）。
连续 3 天进行 MAM 血压测量，可提供可靠的家庭血压估计值。对于家庭高血压的可靠诊断，需要至少连续 4.5 天进行 HBPM。
