Nesbitt S D, Amerena J V, Grant E, Jamerson K A, Lu H, Weder A, Julius S
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor 48109-0356, USA.
Am J Hypertens. 1997 Nov;10(11):1270-80. doi: 10.1016/s0895-7061(97)00267-7.
We evaluated time-related blood pressure trends in the Tecumseh study participants, none of whom received antihypertensive treatment. At baseline the blood pressures were measured in the field clinic and by self measurement at home (twice daily for 7 days). After a mean of 3.2 +/- 0.42 years, the clinic and home pressure readings were repeated. Nine hundred forty-six subjects had clinic and home blood pressure readings at baseline. Of these 735 (380 men, 355 women; average age, 32 years) also completed the second examination. Blood pressure, morphometric data, and biochemical measures at the first examination were used as predictors of future clinic blood pressures. Five hundred ninety-six subjects were normotensive on both examinations (81%). Of 79 subjects (10.7%) with clinic hypertension (> 140 mg Hg systolic or 90 mm Hg diastolic) at baseline, 38 remained hypertensive ("sustained hypertension") and 41 became normotensive ("transient hypertension") after 3 years. Another 60 normotensives at baseline (10.4%) became hypertensive on second examination ("de novo hypertensives"; incidence; 8.1%). The home blood pressure readings on both examinations were reproducible. The three hypertensive groups had elevated home blood pressure, were overweight, had dyslipidemia, and higher insulin values. Only the home blood pressure proved predictive of subsequent blood pressure trends. A home blood pressure of 128 and 83 mm Hg or higher detected "sustained" hypertension with a 48% sensitivity and 93% specificity. Readings of 120 and 80 mm Hg or lower predicted future normotension with a 45% sensitivity and a 91% specificity. We conclude that self determination of the blood pressure at home is useful in the management of borderline hypertension. An algorithm for the management of these patients is proposed.
我们在蒂卡姆西研究参与者中评估了与时间相关的血压趋势，这些参与者均未接受过降压治疗。在基线时，在现场诊所测量血压，并在家中自行测量（连续7天，每天两次）。平均3.2±0.42年后，再次进行诊所和家庭血压测量。946名受试者在基线时有诊所和家庭血压读数。其中735人（380名男性，355名女性；平均年龄32岁）也完成了第二次检查。第一次检查时的血压、形态学数据和生化指标被用作未来诊所血压的预测指标。596名受试者两次检查时血压均正常（81%）。基线时79名（10.7%）诊所高血压患者（收缩压>140mmHg或舒张压>90mmHg）中，3年后38人仍为高血压（“持续性高血压”），41人血压恢复正常（“短暂性高血压”）。另外60名基线时血压正常的受试者（10.4%）在第二次检查时血压升高（“新发高血压”；发病率8.1%）。两次检查时的家庭血压读数具有可重复性。三组高血压患者家庭血压升高、超重、血脂异常且胰岛素值较高。只有家庭血压能够预测随后的血压趋势。家庭血压为128/83mmHg或更高时，检测“持续性”高血压的敏感性为48%，特异性为93%。读数为120/80mmHg或更低时，预测未来血压正常的敏感性为45%，特异性为91%。我们得出结论，在家自行测定血压对临界高血压的管理有用。并提出了这些患者的管理算法。
