Imai Y, Tsuji I, Nagai K, Sakuma M, Ohkubo T, Watanabe N, Ito O, Satoh H, Hisamichi S, Abe K
Department of Medicine, Tohoku University School of Medicine, Sendai, Japan.
Hypertens Res. 1996 Sep;19(3):207-12. doi: 10.1291/hypres.19.207.
We estimated the prevalence of hypertension and evaluated the degree of blood pressure control on the basis of ambulatory blood pressure monitoring in patients receiving antihypertensive medication. A total of 969 adults (mean age +/- SD, 59.3 +/- 12.1 years old range: 20-79 yr) among 1,575 eligible persons (65.1%) recruited from a total adult population of 2,789 people living in a rural region of northern Japan underwent measurement of initial screening blood pressure; ambulatory blood pressure was measured subsequently. A total of 285 subjects (66.5 +/- 9.2 years old) were taking antihypertensive medication (treated group), while 684 (56.3 +/- 12.0 years old) were not (untreated group). The WHO criteria were used to categorize screening blood pressure. Ambulatory blood pressure levels were classified as follows: hypertension, systolic blood pressure > or = 144 mmHg and/or diastolic blood pressure > or = 85 mmHg; and normotension, systolic blood pressure < or = 133 and diastolic blood pressure < or = 78 mmHg. Of the 285 treated subjects, 49 (17.2%) were classified as hypertensive by screening measurements, while 36 (12.6%) were classified as such by ambulatory blood pressure monitoring. Only 12 (24.5%) of the former 49 subjects were also classified as hypertensive, while 20 (40.8%) were classified as normotensive by ambulatory blood pressure monitoring. Of the 684 untreated subjects, 34 (5.0%) were hypertensive by screening measurements and 43 (6.3%) were hypertensive by ambulatory blood pressure monitoring. Only 14 (41.2%) of the former 34 subjects were classified as hypertensive by ambulatory blood pressure monitoring. Of the 34 untreated subjects classified as hypertensive by screening measurements, ambulatory blood pressure monitoring showed 12 (35.3%) to be normotensive, suggesting that they were cases of "white coat" hypertension. The study first confirmed, based on community-derived data, that there are large discrepancies between screening (casual) blood pressure measurements and ambulatory blood pressure monitoring with respect to the recognition of hypertension and normotension. The determination of blood pressure levels by ambulatory blood pressure monitoring may result in a different prognosis of hypertension from that made on the basis of screening blood pressure measurements. The prognostic value of ambulatory blood pressure has to be further investigated.
我们根据接受抗高血压药物治疗患者的动态血压监测结果，估算了高血压患病率并评估了血压控制程度。从日本北部农村地区的2789名成年总人口中招募了1575名符合条件的人员（占65.1%），其中969名成年人（平均年龄±标准差，59.3±12.1岁；年龄范围：20 - 79岁）进行了初始筛查血压测量，随后测量了动态血压。共有285名受试者（66.5±9.2岁）正在服用抗高血压药物（治疗组），而684名（56.3±12.0岁）未服用（未治疗组）。采用世界卫生组织标准对筛查血压进行分类。动态血压水平分类如下：高血压，收缩压≥144 mmHg和/或舒张压≥85 mmHg；血压正常，收缩压≤133 mmHg且舒张压≤78 mmHg。在285名接受治疗的受试者中，49名（17.2%）经筛查测量被分类为高血压，而36名（12.6%）经动态血压监测被分类为高血压。前49名受试者中只有12名（24.5%）也被动态血压监测分类为高血压，而20名（40.8%）被分类为血压正常。在684名未治疗的受试者中，34名（5.0%）经筛查测量为高血压，43名（6.3%）经动态血压监测为高血压。前34名受试者中只有14名（41.2%）经动态血压监测被分类为高血压。在34名经筛查测量被分类为高血压的未治疗受试者中，动态血压监测显示12名（35.3%）为血压正常，表明他们是“白大衣”高血压病例。该研究首先基于社区数据证实，在高血压和血压正常的识别方面，筛查（偶测）血压测量与动态血压监测之间存在很大差异。通过动态血压监测确定血压水平可能导致与基于筛查血压测量得出的高血压预后不同。动态血压的预后价值有待进一步研究。
