Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
Eur J Prev Cardiol. 2022 Nov 15;29(16):2090-2098. doi: 10.1093/eurjpc/zwac108.
Most international guidelines recommend that repeat blood pressure (BP) readings are required for BP classification. Two international guidelines diverge from this by recommending that no further BP measurements are required if the first clinic BP is below a hypertension threshold. The extent to which within-visit BP variability patterns change over time, and whether this could impact BP classification is unknown. We sought to examine this.
Data were from the Cardiovascular Risk in Young Finns Study, a prospective cohort study. Up to 2799 participants were followed from childhood (9-15 years) to adulthood (18-49 years) over up to six visits. Patterns of within-visit systolic BP (SBP) variability were defined as no-change, decrease, increase between consecutive readings (with 5 mmHg change thresholds). Classification of SBP (normal, high-normal, hypertension) using the first reading was compared with repeat readings. On average, SBP decreased with subsequent measures, but with major individual variability (no-change: 56.9-62.7%; decrease: 24.1-31.6%; increase: 11.5-16.8%). Patterns of SBP variability were broadly similar from childhood to adulthood, with the highest prevalence of an increase among participants categorized with normal SBP (12.6-20.3%). The highest prevalence of SBP reclassification occurred among participants with hypertension (28.9-45.3% reclassified as normal or high-normal). The prevalence of reclassification increased with the magnitude of change between readings.
There is a major individual variation of within-visit SBP change in childhood and adulthood and can influence BP classification. This highlights the importance of consistency among guidelines recommending that repeat BP measurements are needed for BP classification.
大多数国际指南建议对血压（BP）读数进行重复测量，以进行 BP 分类。有两项国际指南与此不同，它们建议如果首次诊所 BP 低于高血压阈值，则无需进一步进行 BP 测量。目前尚不清楚在就诊期间 BP 变异性模式随时间的变化程度，以及这是否会影响 BP 分类。我们旨在对此进行研究。
数据来自年轻芬兰人心血管风险研究，这是一项前瞻性队列研究。多达 2799 名参与者从儿童期（9-15 岁）到成年期（18-49 岁）接受了最多六次随访。将就诊期间收缩压（SBP）变异性模式定义为无变化、减少、连续读数之间增加（变化阈值为 5mmHg）。使用首次读数对 SBP（正常、高正常、高血压）进行分类，并与重复读数进行比较。平均而言，SBP 随后续测量而降低，但个体差异较大（无变化：56.9-62.7%；减少：24.1-31.6%；增加：11.5-16.8%）。SBP 变异性模式从儿童期到成年期大致相似，其中正常 SBP 分类的参与者中增加的比例最高（12.6-20.3%）。SBP 再分类率最高的是高血压患者（28.9-45.3%重新归类为正常或高正常）。再分类的发生率随读数之间变化的幅度增加而增加。
在儿童期和成年期，就诊期间 SBP 变化存在较大的个体差异，这可能会影响 BP 分类。这突出了指南建议对 BP 分类需要进行重复 BP 测量的一致性的重要性。
