Mancia G, Sega R, Bravi C, De Vito G, Valagussa F, Cesana G, Zanchetti A
Cattedra di Medicina Interna, Istituto di Clinica Medica, Milan, Italy.
J Hypertens. 1995 Dec;13(12 Pt 1):1377-90.
To determine ambulatory and home blood pressure means and distributions in relation to clinic blood pressure in a general population.
We obtained a random sample of 2400 subjects stratified by sex and 10 year age groups to be representative of residents aged 25-64 years of the city of Monza. Participation rate was 69% (1651 subjects). Blood pressure measurements consisted of clinic blood pressure (average of three measurements, sphygmomanometry), home blood pressure (average of morning and evening measurements, semiautomatic device) and ambulatory blood pressure (automatic readings at 20 min intervals, Spacelabs 90207). Clinic blood pressure was obtained both before and after home and ambulatory blood pressures. Data analysis did not include 213 subjects receiving antihypertensive drug treatment and was therefore limited to 1438 participants.
In the 1438 subjects, clinic, home and ambulatory blood pressure showed a normal-like distribution, with a taller peak and a narrower base for ambulatory than for home and clinic values. Clinic, home and ambulatory blood pressures were significantly related to each other (P always < 0.001). The means of the two clinic blood pressures obtained on consecutive days were superimposable (127.4 +/- 17.0/82.3 +/- 9.8 and 128.2 +/- 16.5/81.9 +/- 9.9 mmHg) and both were markedly higher than home and 24 h average blood pressures (8.2 mmHg), which were similar to one another. The differences between clinic and home or 24 h average blood pressure were similar in both sexes but increased with increasing age and clinic blood pressure values. The influence of clinic blood pressure values on the clinic-ambulatory or clinic-home blood pressure differences was more important than age. Although higher than the 24 h average value, daytime average blood pressure was also lower than clinic blood pressure. Night-time blood pressure was markedly lower than the daytime value in both sexes and at all ages.
Data from a large and unbiased sample of a general population show that home and 24 h or daytime average blood pressures are much lower than clinic blood pressure. The relatively close correlation between blood pressure values measured with the different methods used has allowed calculation of home and ambulatory blood pressure values corresponding to the accepted upper limit of normality of clinic blood pressure (140/90 mmHg). The upper limit of normality for the population was for both home and ambulatory blood pressures in the range 120-130 and 75-81 mmHg for systolic and diastolic values, respectively, with slight differences depending on sex and age. Taking 140/90 mmHg as the upper normal limit of the population is therefore an error that leads to individuals whose home or ambulatory blood pressures are high being considered as normotensive.
确定普通人群中动态血压和家庭血压的均值及分布，并与诊室血压进行比较。
我们从蒙扎市25 - 64岁居民中随机抽取了2400名受试者，按性别和10岁年龄组进行分层，以使其具有代表性。参与率为69%（1651名受试者）。血压测量包括诊室血压（三次测量的平均值，使用血压计）、家庭血压（早晨和晚上测量的平均值，半自动设备）和动态血压（每隔20分钟自动读数，Spacelabs 90207）。在测量家庭血压和动态血压之前及之后均测量诊室血压。数据分析未纳入213名接受降压药物治疗的受试者，因此仅限于1438名参与者。
在1438名受试者中，诊室血压、家庭血压和动态血压呈近似正态分布，动态血压的峰值更高且分布范围比家庭血压和诊室血压更窄。诊室血压与家庭血压和动态血压均显著相关（P值均<0.001）。连续两天测量的诊室血压均值可叠加（分别为127.4±17.0/82.3±9.8 mmHg和128.2±16.5/81.9±9.9 mmHg），且均显著高于家庭血压和24小时平均血压（相差8.2 mmHg），而家庭血压和24小时平均血压彼此相似。诊室血压与家庭血压或24小时平均血压的差值在两性中相似，但随年龄和诊室血压值的增加而增大。诊室血压值对诊室血压与动态血压或诊室血压与家庭血压差值的影响比年龄更重要。白天平均血压虽高于24小时平均值，但仍低于诊室血压。夜间血压在所有年龄和两性中均显著低于白天血压。
来自普通人群的一个大样本且无偏倚的数据表明，家庭血压和24小时或白天平均血压远低于诊室血压。使用不同方法测量的血压值之间具有相对紧密的相关性，这使得能够计算出与公认的诊室血压正常上限（140/90 mmHg）相对应的家庭血压和动态血压值。该人群家庭血压和动态血压的正常上限分别为收缩压120 - 130 mmHg和舒张压75 - 81 mmHg，因性别和年龄略有差异。因此，将140/90 mmHg作为该人群的正常上限是错误的，这会导致家庭血压或动态血压较高的个体被视为血压正常。
