Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study.
Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study.
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DOI：
10.1097/hjh.0000000000000319
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发表时间：
2014-11
影响因子：
4.9
通讯作者：
McManus RJ
中科院分区：
文献类型：
--
作者：
Sheppard JP;Holder R;Nichols L;Bray E;Hobbs FD;Mant J;Little P;Williams B;Greenfield S;McManus RJ
与诊所相比，在家中识别血压较低（白大褂效应）或较高（掩盖效应）的人通常需要门诊或家庭监测。本研究评估了在单个诊所重复测量收缩压的变化是否可以预测诊所和家庭测量之间的差异。本研究采用观察性队列设计，纳入了220名年龄在35-84岁之间接受高血压治疗但收缩压未得到控制的个体。采用多项式回归模型将6个临床读数的收缩压变化特征定义为收缩压下降、斜率和二次系数。这些特征对较低或较高的家庭收缩压读数的预测能力进行了逻辑回归和重复操作特征分析。单次临床收缩压下降预测白大褂效应的敏感性为90%，特异性为50%，阳性预测值为56%，阴性预测值为88%。掩盖效应的预测值和斜率、二次系数的预测值略低，但当斜率和二次变量联合使用时，掩盖效应的灵敏度、特异度、正预测值和负预测值分别提高到91%、48%、24%和97%。在一个诊所中，对接受治疗的高血压患者进行多次收缩压测量，可以合理地预测那些不太可能有大的白大褂效应或掩盖效应的患者，从而有可能在常规临床实践中更好地靶向室外监测。
Identification of people with lower (white-coat effect) or higher (masked effect) blood pressure at home compared to the clinic usually requires ambulatory or home monitoring. This study assessed whether changes in SBP with repeated measurement at a single clinic predict subsequent differences between clinic and home measurements. This study used an observational cohort design and included 220 individuals aged 35–84 years, receiving treatment for hypertension, but whose SBP was not controlled. The characteristics of change in SBP over six clinic readings were defined as the SBP drop, the slope and the quadratic coefficient using polynomial regression modelling. The predictive abilities of these characteristics for lower or higher home SBP readings were investigated with logistic regression and repeated operating characteristic analysis. The single clinic SBP drop was predictive of the white-coat effect with a sensitivity of 90%, specificity of 50%, positive predictive value of 56% and negative predictive value of 88%. Predictive values for the masked effect and those of the slope and quadratic coefficient were slightly lower, but when the slope and quadratic variables were combined, the sensitivity, specificity, positive and negative predictive values for the masked effect were improved to 91, 48, 24 and 97%, respectively. Characteristics obtainable from multiple SBP measurements in a single clinic in patients with treated hypertension appear to reasonably predict those unlikely to have a large white-coat or masked effect, potentially allowing better targeting of out-of-office monitoring in routine clinical practice.