Rosner B, Polk B F
Am J Epidemiol. 1983 Apr;117(4):429-42. doi: 10.1093/oxfordjournals.aje.a113561.
There presently is no consensus regarding criteria for hypertension screening or case finding. Blood pressure variability results in differential ascertainment, depending upon the number of screening visits, the number of measurements per visit, and the method used in reducing the data obtained to an underlying measure of blood pressure status. To develop screening rules, the authors have computed the predictive values of blood pressure measurements for particular age-, race-, and sex-specific groups. Predictive value computations require estimates of between- and within-visit variability and of prevalence. Estimates of variability were calculated from data obtained at a worksite or a community blood pressure program from 991 persons, aged 30-69 years and not currently on antihypertensive medications, who were screened over two to five visits, one week apart. Estimates of prevalence were obtained from the screening of 158,955 adults by the Hypertension Detection and Follow-Up Program. Predictive values are presented for particular age-, race-, and sex-specific groups over a wide range of diastolic blood pressures, and are used to identify appropriate screening rules that minimize misclassification with the fewest possible blood pressure measurements. The results of a questionnaire sent to 30 hypertension experts indicated that the median acceptable predictive values for making screening decisions were 80% for predictive value positive and 77.5% for predictive value negative. When these criteria were adopted, 81%, 90%, and 93% of the subgroup of 901 persons with at least three visits from the above screened population were identified as having or not having true diastolic blood pressure greater than or equal to 90 mmHg after one, two, and three visits, respectively. The status of the remaining 7% remained uncertain after three visits.
目前，关于高血压筛查或病例发现的标准尚无共识。血压变异性会导致不同的诊断结果，这取决于筛查就诊次数、每次就诊的测量次数以及将所获数据归纳为血压状况基本测量值所采用的方法。为制定筛查规则，作者计算了特定年龄、种族和性别组血压测量的预测值。预测值计算需要对就诊间和就诊内变异性以及患病率进行估计。变异性估计值是根据在一个工作场所或社区血压项目中从991名年龄在30至69岁且目前未服用抗高血压药物的人那里获得的数据计算得出的，这些人在相隔一周的两到五次就诊中接受了筛查。患病率估计值来自高血压检测与随访项目对158,955名成年人的筛查结果。给出了特定年龄、种族和性别组在广泛舒张压范围内的预测值，并用于确定适当的筛查规则，以在尽可能少的血压测量次数下将错误分类降至最低。向30位高血压专家发送的一份调查问卷结果表明，做出筛查决策时可接受的预测值中位数为：阳性预测值80%，阴性预测值77.5%。采用这些标准后，在上述筛查人群中至少就诊三次的901人亚组中，分别在一次、两次和三次就诊后，有81%、90%和93%被确定为患有或未患有真正的舒张压大于或等于90 mmHg。三次就诊后，其余7%的情况仍不确定。
