简短报告：血压正常者与高血压患者的动态血压。特设工作组。

Short report: ambulatory blood pressure in normotensive compared with hypertensive subjects. The Ad-Hoc Working Group.

作者信息

Staessen J A, O'Brien E T, Atkins N, Amery A K

机构信息

Hypertensie en Cardiovasculaire Revalidatie Eenheid, Departement Pathofysiologie, Katholieke Universiteit Leuven, Belgium.

出版信息

J Hypertens. 1993 Nov;11(11):1289-97.

PMID:8301112

Abstract

OBJECTIVE

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.

SUBJECTS

Twenty-four research groups recruited 7069 subjects. Of these, 4577 were normotensive (CBP < or = 140/90 mmHg), 719 were borderline hypertensive (systolic CBP 141-159 mmHg or diastolic CBP 91-94 mmHg) and 1773 were definitely hypertensive. Of the subjects in the last of these categories, 1324 had systolic hypertension (systolic CBP > or = 160 mmHg) and 1310 had diastolic hypertension (diastolic CBP > or = 95 mmHg). Hypertension had been diagnosed from the mean of two to nine (median two) CBP measurements obtained at one to three (median two) visits.

RESULTS

The 95th centiles of the 24-h ABP distributions in the normotensive subjects were (systolic and diastolic, respectively) 133 and 82 mmHg. Of the subjects with systolic hypertension, 24% had 24-h systolic ABP < 133 mmHg. Similarly, 30% of those with diastolic hypertension had 24-h diastolic ABP < 82 mmHg. The probability that hypertensive subjects had 24-h ABP below these thresholds tended to increase with age and was two- to fourfold greater if the CBP of the subject had been measured at only one visit and if fewer than three CBP measurements had been averaged for establishing the diagnosis of hypertension. By contrast, for each 10-mmHg increment in systolic CBP, this probability decreased by 54% for 24-h systolic ABP and by 26% for 24-h diastolic ABP, and for each 5-mmHg increment in diastolic CBP it decreased by 6 and 9%, respectively.

CONCLUSIONS

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 hypertensive subjects had an ABP which was below the 95th centile of the ABP of normotensive subjects, but this proportion decreased if the hypertensive subjects had shown a higher CBP upon repeated measurement. The prognostic implications of elevated CBP in the presence of normal ABP remain to be determined.

摘要

目的

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。

受试者

24个研究小组招募了7069名受试者。其中，4577名血压正常（CBP≤140/90 mmHg），719名临界高血压（收缩压CBP 141 - 159 mmHg或舒张压CBP 91 - 94 mmHg），1773名确诊为高血压。在最后一类受试者中，1324名患有收缩期高血压（收缩压CBP≥160 mmHg），1310名患有舒张期高血压（舒张压CBP≥95 mmHg）。高血压是根据在1至3次（中位数为2次）就诊时获得的2至9次（中位数为2次）CBP测量值的平均值诊断的。

结果

血压正常受试者24小时ABP分布的第95百分位数分别为（收缩压和舒张压）133 mmHg和82 mmHg。在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倾向于随年龄增加，并且如果受试者的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，则该概率会增加2至4倍。相比之下，收缩压CBP每增加10 mmHg，24小时收缩压ABP的该概率降低54%，24小时舒张压ABP的该概率降低26%；舒张压CBP每增加5 mmHg，该概率分别降低6%和9%。