Thijs L, Staessen J, O'Brien E, Amery A, Atkins N, Baumgart P, De Cort P, Degaute J P, Dolenc P, De Gaudemaris R
Departement Moleculair en Cardiovasulair Onderzoek, Katholieke Universiteit Leuven, Belgium.
Neth J Med. 1995 Feb;46(2):106-14. doi: 10.1016/0300-2977(94)00057-g.
To delineate more precisely an operational threshold for making clinical decisions based on ambulatory blood pressure (ABP) measurement by studying the ABP in subjects who were diagnosed as either normotensive or hypertensive by conventional blood pressure (CBP) measurement.
Twenty-four research groups recruited 7069 subjects. Of these, 4577 were normotensive (systolic CBP < or = 140 mmHg and diastolic CBP < or = 90 mmHg) and 1773 were hypertensive (systolic CBP > or = 160 mmHg and/or diastolic CBP > or = 90 mmHg). Of the latter, 1324 had systolic and 1310 had diastolic hypertension.
Ninety-five percent of the normotensive subjects had a 24-h ABP below (systolic and diastolic, respectively) 133 and 82 mmHg. Of the patients with systolic hypertension, 24% had a 24-h systolic ABP of < 133 mmHg. Similarly, 30% of those with diastolic hypertension had a 24-h diastolic ABP of < 82 mmHg. The probability that hypertensive patients had a 24-h ABP below these thresholds was higher in women than in men, increased with age and was 2- to 4-fold greater if the CBP of the patient had been measured at only one visit and if fewer than 3 CBP measurements had been averaged to establish the diagnosis of hypertension. By contrast, for each 10-mmHg increment in systolic CBP, this probability decreased by 54% for the 24-h systolic ABP and by 25% for the 24-h diastolic ABP, and for each 5 mmHg increment in diastolic CBP it increased by 6 and 9%, respectively.
The ABP distributions of the normotensive subjects included in the present international database were not materially different from those in previous reports in the literature. One-fifth to more than one-third of the hypertensive patients had an ABP which was below the 95th centile of the ABP in normotensive subjects, but this proportion decreased if the hypertensive patients had shown a higher CBP upon repeated measurement. The prognostic implications of elevated CBP in the presence of normal ABP remain to be determined.
通过研究经传统血压（CBP）测量诊断为血压正常或高血压的受试者的动态血压（ABP），更精确地确定基于ABP测量做出临床决策的操作阈值。
24个研究小组招募了7069名受试者。其中，4577名血压正常（收缩压CBP≤140 mmHg且舒张压CBP≤90 mmHg），1773名高血压患者（收缩压CBP≥160 mmHg和/或舒张压CBP≥90 mmHg）。后者中，1324名患有收缩期高血压，1310名患有舒张期高血压。
95%的血压正常受试者24小时ABP低于（收缩压和舒张压分别为）133 mmHg和82 mmHg。收缩期高血压患者中，24%的患者24小时收缩压ABP<133 mmHg。同样，30%的舒张期高血压患者24小时舒张压ABP<82 mmHg。高血压患者24小时ABP低于这些阈值的概率在女性中高于男性，随年龄增加而增加，如果患者的CBP仅在一次就诊时测量且用于确定高血压诊断的CBP测量平均值少于3次，则该概率会高出2至4倍。相比之下，收缩压CBP每增加10 mmHg，24小时收缩压ABP低于阈值的概率降低54%，24小时舒张压ABP低于阈值的概率降低25%，舒张压CBP每增加5 mmHg，该概率分别增加6%和9%。
纳入本国际数据库的血压正常受试者的ABP分布与文献中先前报告的分布没有实质性差异。五分之一至三分之一以上的高血压患者的ABP低于血压正常受试者ABP的第95百分位数，但如果高血压患者在重复测量时显示出更高的CBP，则该比例会降低。ABP正常但CBP升高的预后意义仍有待确定。
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