Veerman D P, van Montfrans G A
Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
J Hypertens. 1993 Mar;11(3):287-92. doi: 10.1097/00004872-199303000-00009.
Nurses are considered to evoke less white-coat hypertension, and might therefore be able to estimate average blood pressure as well as and more conveniently than ambulatory monitoring. The objective of the present study was to determine the correspondence between blood pressure measured by a doctor or a nurse and ambulatory blood pressure.
Hypertensive patients seen in an academic outpatients clinic were selected consecutively. Blood pressure measurements taken under different situations and by different persons were subjected to cross-sectional comparison.
Average daytime ambulatory blood pressure was compared to blood pressure measured in triplicate by a nurse and by a physician in 110 patients. The value of nurse-measured diastolic blood pressure as a diagnostic test for the detection of white-coat hypertension was compared with ambulatory monitoring as the standard.
Physician-measured diastolic pressure was 3 +/- 11 mmHg (P < 0.05) higher on average than ambulatory pressure, but the difference between nurse-measured and ambulatory diastolic pressure was 0 +/- 12 mmHg (not significant). Systolic pressure measured either by a physician or by a nurse overestimated daytime ambulatory blood pressure by the same amount. For the identification of white-coat hypertension, the sensitivity and specificity of nurse-measured blood pressure were 0.32 and 0.92, respectively, and the positive and negative predictive values were 0.53 and 0.82, respectively.
Nurse-measured blood pressure was not a very reliable indicator of white-coat hypertension, as a negative test was 18% in error. Thus, nurses rather than doctors should routinely measure blood pressure, but nurse-measured blood pressure is not an acceptable substitute for ambulatory monitoring.
护士被认为引起白大衣高血压的情况较少，因此可能能够像动态血压监测一样准确且更便捷地估计平均血压。本研究的目的是确定医生或护士测量的血压与动态血压之间的相关性。
连续选取在学术门诊就诊的高血压患者。对在不同情况下由不同人员测量的血压进行横断面比较。
比较了110例患者的日间动态平均血压与护士和医生分别测量三次的血压。将护士测量的舒张压作为检测白大衣高血压的诊断测试的值与作为标准的动态血压监测进行比较。
医生测量的舒张压平均比动态血压高3±11 mmHg（P<0.05），但护士测量的舒张压与动态舒张压之间的差异为0±12 mmHg（无显著性）。医生或护士测量的收缩压高估日间动态血压的幅度相同。对于白大衣高血压的识别，护士测量血压的敏感性和特异性分别为0.32和0.92，阳性和阴性预测值分别为0.53和0.82。
护士测量的血压不是白大衣高血压的非常可靠的指标，因为阴性测试有18%的误差。因此，护士而非医生应常规测量血压，但护士测量的血压不能替代动态血压监测。
