Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review.
Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review.
复制标题
DOI：
10.1136/bmj.d3621
复制
发表时间：
2011-06-24
期刊：
影响因子：
--
通讯作者：
McManus RJ
中科院分区：
文献类型：
--
作者：
Hodgkinson J;Mant J;Martin U;Guo B;Hobbs FD;Deeks JJ;Heneghan C;Roberts N;McManus RJ
目的 确定临床测量和家庭血压监测与动态血压监测的相对准确性，作为高血压诊断的参考标准。设计系统审查与荟萃分析与分层总结接收者操作特征模型。评估了方法学质量，包括血压测量设备验证的证据。数据来源 Medline（自 1966 年起）、Embase（自 1980 年起）、Cochrane 系统评价数据库、DARE、Medion、ARIF 和 TRIP，截至 2010 年 5 月。 选择研究的资格标准 合格的研究使用家庭和/或诊所血压测量检查所有年龄段成人的高血压诊断，并与使用明确定义高血压诊断阈值的动态监测进行的诊断进行比较。结果 20 项符合条件的研究使用了不同的高血压诊断阈值，只有 7 项研究（临床）和 3 项研究（家庭）可以与动态监测直接进行比较。与 135/85 mm Hg 的动态监测阈值相比，超过 140/90 mm Hg 的临床测量的平均敏感性和特异性分别为 74.6%（95% 置信区间 60.7% 至 84.8%）和 74.6%（47.9% 至 90.4%），而超过 135/85 mm Hg 的家庭测量的平均敏感性和特异性为 85.7%（78.0%至91.0%）和62.4%（48.0%至75.0%）。结论 诊所和家庭测量都没有足够的敏感性或特异性来推荐作为单一诊断测试。如果将动态监测作为参考标准，那么仅根据诊所或家庭血压做出治疗决策可能会导致严重的过度诊断。在开始终身药物治疗之前进行动态监测可能会导致更合适的治疗目标，特别是在诊断阈值附近。
Objective To determine the relative accuracy of clinic measurements and home blood pressure monitoring compared with ambulatory blood pressure monitoring as a reference standard for the diagnosis of hypertension. Design Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Methodological quality was appraised, including evidence of validation of blood pressure measurement equipment. Data sources Medline (from 1966), Embase (from 1980), Cochrane Database of Systematic Reviews, DARE, Medion, ARIF, and TRIP up to May 2010. Eligibility criteria for selecting studies Eligible studies examined diagnosis of hypertension in adults of all ages using home and/or clinic blood pressure measurement compared with those made using ambulatory monitoring that clearly defined thresholds to diagnose hypertension. Results The 20 eligible studies used various thresholds for the diagnosis of hypertension, and only seven studies (clinic) and three studies (home) could be directly compared with ambulatory monitoring. Compared with ambulatory monitoring thresholds of 135/85 mm Hg, clinic measurements over 140/90 mm Hg had mean sensitivity and specificity of 74.6% (95% confidence interval 60.7% to 84.8%) and 74.6% (47.9% to 90.4%), respectively, whereas home measurements over 135/85 mm Hg had mean sensitivity and specificity of 85.7% (78.0% to 91.0%) and 62.4% (48.0% to 75.0%). Conclusions Neither clinic nor home measurement had sufficient sensitivity or specificity to be recommended as a single diagnostic test. If ambulatory monitoring is taken as the reference standard, then treatment decisions based on clinic or home blood pressure alone might result in substantial overdiagnosis. Ambulatory monitoring before the start of lifelong drug treatment might lead to more appropriate targeting of treatment, particularly around the diagnostic threshold.