Mengden T, Schwartzkopff B, Strauer B E
Department of Medicine, Clinic B, University of Düsseldorf, Germany.
Am J Hypertens. 1998 Jul;11(7):813-9. doi: 10.1016/s0895-7061(98)00026-0.
The acceptable maximal blood pressure values for patients monitoring their own blood pressure at home have not yet been determined. Risk of cardiovascular disease may be increased at lower blood pressure limits than those suggested by the World Health Organization (WHO) for clinic readings. We have investigated 25 patients with proven hypertensive small-vessel disease and compared self-monitored, ambulatory 24-h (ABPM) and clinic blood pressure measurements. The diagnosis of hypertensive small-vessel disease was based on clinical evidence of myocardial ischemia, angiographic exclusion of coronary heart disease, and abnormal single-photon emission computed tomography (SPECT) thallium-201 myocardial scintigraphy. Mean self-monitored values were 143.4 +/- 13.6/84.0 +/- 9.4 mm Hg (95% confidence intervals 137.6-149.0 mm Hg for systolic and 80.1-87.9 mm Hg for diastolic blood pressure). Both home and ambulatory daytime readings (141.2 +/- 11.8/83.9 +/- 10.2 mm Hg) were significantly lower than the clinic readings by the physicians (clinic systolic, 169.2 +/- 16.5 mg; clinic diastolic, 95.0 +/- 11.6 mm Hg; P < .0001 v home and ambulatory readings). There was no significant difference between home and ambulatory readings. Agreement between home and ambulatory values was much closer than for clinic v ABPM readings. The respective correlation coefficients for systolic values were r = 0.702 (home v ABPM; P < .0001) and r = 0.32 (clinic v ABPM; NS). For diastolic values correlation coefficients were r = 0.674 (home v ABPM; P < .0002) and r = 0.574 (clinic v ABPM; P < .003) respectively. In conclusion, the reported results suggest that the WHO suggested definition of hypertension (> or = 140/90 mm Hg) may be set too high when blood pressures are measured by the patient at home. A cutoff value of < 135/85 mm Hg, as in ABPM, may be a more realistic upper limit for self-monitoring.
在家自行监测血压的患者可接受的最高血压值尚未确定。与世界卫生组织（WHO）建议的诊室测量血压下限相比，在更低的血压水平时心血管疾病风险可能会增加。我们对25例已证实患有高血压性小血管疾病的患者进行了研究，并比较了自我监测血压、动态24小时血压监测（ABPM）和诊室血压测量结果。高血压性小血管疾病的诊断基于心肌缺血的临床证据、冠状动脉造影排除冠心病以及异常的单光子发射计算机断层扫描（SPECT）铊-201心肌闪烁显像。自我监测的平均血压值为143.4±13.6/84.0±9.4毫米汞柱（收缩压95%置信区间为137.6 - 149.0毫米汞柱，舒张压为80.1 - 87.9毫米汞柱）。家庭自测和动态日间血压读数（141.2±11.8/83.9±10.2毫米汞柱）均显著低于医生测量的诊室血压读数（诊室收缩压为169.2±16.5毫克；诊室舒张压为95.0±11.6毫米汞柱；与家庭自测和动态血压读数相比，P <.0001）。家庭自测和动态血压读数之间无显著差异。家庭自测值与动态血压值之间的一致性比诊室血压值与ABPM读数之间的一致性更紧密。收缩压的各自相关系数分别为r = 0.702（家庭自测与ABPM；P <.0001）和r = 0.32（诊室血压与ABPM；无显著性差异）。舒张压的相关系数分别为r = 0.674（家庭自测与ABPM；P <.0002）和r = 0.574（诊室血压与ABPM；P <.003）。总之，报告结果表明，当患者在家测量血压时，WHO建议的高血压定义（≥140/90毫米汞柱）可能设定得过高。与ABPM一样，<135/85毫米汞柱的临界值可能是自我监测更现实的上限。
