Strategies for Classifying Patients Based on Office, Home, and Ambulatory Blood Pressure Measurement
Strategies for Classifying Patients Based on Office, Home, and Ambulatory Blood Pressure Measurement
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根据办公室、家庭和动态血压测量对患者进行分类的策略
DOI：
10.1161/hypertensionaha.114.05038
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发表时间：
2015-06-01
期刊：
影响因子：
8.3
通讯作者：
Staessen, Jan A.
中科院分区：
文献类型：
--
作者：
Zhang, Lu;Li, Yan;Staessen, Jan A.
高血压指南建议将家庭或动态血压监测作为办公室测量后必不可少的。然而，是否应该优先考虑家庭监测或动态监测仍未确定。在831名未接受治疗的门诊患者(平均年龄50.6岁，其中49.8%为女性)中，我们测量了办公室(3次就诊)、家庭(7天)和24小时动态血压。我们应用高血压指南将患者交叉分类为正常血压或白大衣、遮盖型或持续性高血压。根据办公室和家庭的血压，白大褂高血压、蒙面高血压和持续性高血压的患病率分别为61(10.3%)、166(20.0%)和162(19.5%)。以白天(上午8点至下午6点)代替家庭血压确认交叉分类575例(69.2%)，将风险从隐性高血压降至正常血压(n=24)或从持续高血压降至白大衣高血压(n=9)33例(4.0%)，但将风险从正常血压升至隐性高血压(n=179)或从白大衣降至持续高血压(n=44)223例(26.8%)。基于24小时动态血压的分析得到了证实。在校正后的分析中，在进入高危类别的患者中，尿白蛋白/肌酐比值(+20.6%；可信区间为4.4-39.3)和主动脉脉搏波速度(+0.30m/S；可信区间为0.09-0.51)均较高。靶器官损害指数和中枢增强指数均与重新分类的几率呈正相关(P≤0.048)。总之，为了可靠地诊断高血压和开始治疗，办公室测量之后应该进行动态血压监测。在超过25%的患者中，使用家庭监测而不是动态监测会漏掉掩蔽性或持续性高血压的高危诊断。
Hypertension guidelines propose home or ambulatory blood pressure monitoring as indispensable after office measurement. However, whether preference should be given to home or ambulatory monitoring remains undetermined. In 831 untreated outpatients (mean age, 50.6 years; 49.8% women), we measured office (3 visits), home (7 days), and 24-h ambulatory blood pressures. We applied hypertension guidelines for cross-classification of patients into normotension or white-coat, masked, or sustained hypertension. Based on office and home blood pressures, the prevalence of white-coat, masked, and sustained hypertension was 61 (10.3%), 166 (20.0%), and 162 (19.5%), respectively. Using daytime (from 8amto 6pm) instead of home blood pressure confirmed the cross-classification in 575 patients (69.2%), downgraded risk from masked hypertension to normotension (n=24) or from sustained to white-coat hypertension (n=9) in 33 (4.0%), but upgraded risk from normotension to masked hypertension (n=179) or from white-coat to sustained hypertension (n=44) in 223 (26.8%). Analyses based on 24-h ambulatory blood pressure were confirmatory. In adjusted analyses, both the urinary albumin-to-creatinine ratio (+20.6%; confidence interval, 4.4–39.3) and aortic pulse wave velocity (+0.30 m/s; confidence interval, 0.09–0.51) were higher in patients who moved up to a higher risk category. Both indexes of target organ damage and central augmentation index were positively associated (P≤0.048) with the odds of being reclassified. In conclusion, for reliably diagnosing hypertension and starting treatment, office measurement should be followed by ambulatory blood pressure monitoring. Using home instead of ambulatory monitoring misses the high-risk diagnoses of masked or sustained hypertension in over 25% of patients.