Markovic N, Olomu I N, Bunker C H, Huston S L, Ukoli F A, Kuller L H
Graduate School of Public Health, University of Pittsburgh, PA 15261.
Int J Epidemiol. 1994 Aug;23(4):723-9. doi: 10.1093/ije/23.4.723.
Concern has been expressed regarding the adequacy of classifying individuals as hypertensive based upon a single blood pressure determination and/or the average of readings taken at a single visit and the appropriateness of these determinations in cross-cultural comparisons of rates of hypertension.
This analysis investigated the potential classification variability by comparing hypertensive status determined by 1) a single reading, 2) an average of the second and third determination at the first visit, and 3) an average of the second and third determinations obtained at each of three visits according to a standardized protocol. Kappa statistic, sensitivity and specificity were calculated to assess the agreement of hypertension classification for 804 subjects in the Health Survey in Nigerian Civil Servants, Benin City, 1992. Data were also compared to other published studies for variability in hypertension classification with repeated blood pressure determinations.
Good to excellent agreement was observed for the entire population between the single blood pressure determination, the average of the first visit, and the average of three visits. Sensitivity and specificity measures were also acceptable for the entire population. Further analysis by sex and staff status (a measure of socioeconomic status) found no apparent distinctions between the groups.
Contrasting the data with other published studies, conducted in both developed and developing countries, we note no greater variability in repeated blood pressure measurements, and conclude that the average of blood pressure determinations at a single visit in this working urban population is adequate for determining hypertensive status for comparisons with hypertension rates in Westernized populations.
对于仅基于单次血压测量和/或单次就诊时所测读数的平均值来将个体分类为高血压患者的充分性，以及这些测量值在高血压患病率的跨文化比较中的适用性，人们已表示担忧。
本分析通过比较以下三种方式确定的高血压状态来研究潜在的分类变异性：1）单次读数；2）首次就诊时第二次和第三次测量值的平均值；3）根据标准化方案在三次就诊中的每次就诊时所获得的第二次和第三次测量值的平均值。计算卡帕统计量、敏感性和特异性，以评估1992年在贝宁城尼日利亚公务员健康调查中804名受试者的高血压分类一致性。还将数据与其他已发表研究中重复测量血压时高血压分类的变异性进行了比较。
在整个人口中，单次血压测量、首次就诊的平均值和三次就诊的平均值之间观察到良好至极好的一致性。整个人口的敏感性和特异性测量结果也可接受。按性别和工作人员状态（社会经济地位的一种衡量指标）进行的进一步分析发现，各群体之间没有明显差异。
将这些数据与在发达国家和发展中国家开展的其他已发表研究进行对比后，我们注意到重复血压测量中没有更大的变异性，并得出结论，在这个城市工作人群中，单次就诊时血压测量值的平均值足以确定高血压状态，以便与西方化人群的高血压患病率进行比较。
