Reproducibility of visit-to-visit variability of blood pressure measured as part of routine clinical care.
Reproducibility of visit-to-visit variability of blood pressure measured as part of routine clinical care.
复制标题
作为常规临床护理的一部分，测量的每次就诊血压变异性的可重复性。
DOI：
10.1097/hjh.0b013e32834cf213
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发表时间：
2011-12
影响因子：
4.9
通讯作者：
Krousel-Wood M
中科院分区：
文献类型：
--
作者：
Muntner P;Joyce C;Levitan EB;Holt E;Shimbo D;Webber LS;Oparil S;Re R;Krousel-Wood M
临床试验数据的次要分析表明，血压的访视间变异性（VVV）与心血管疾病的发病率密切相关。在通常的实践环境中测量血压可能会出现很大的误差，这就对真实环境中的VVV值提出了质疑。我们分析了来自老年人药物依从性队列研究（n = 772，14次或以上血压测量）的≥ 65岁确诊高血压并正在服用降压药物的成人数据。所有的血压测量，作为常规门诊护理的一部分，中位数为2.8年，从患者的医疗图表中提取。使用每个参与者的前7个收缩压（SBP）测量值，平均个体内标准差为13.5 mmHg。基于前7次和后7次SBP测量值的标准差的类内相关系数为0.28（95% CI：0.20 - 0.34）。基于前7次测量，SBP标准差最高五分位数的个体更有可能在使用后7次测量时处于VVV最高五分位数（观察/预期比值= 1.71，95% CI：1.29 - 2.22）。其他VVV指标的结果相似。舒张压（DBP）的组内相关系数低于SBP。这些数据表明，在真实环境中测量的SBP的VVV不是随机的。未来的研究需要评估常规临床实践中评估的SBP的VVV的预后价值。
Secondary analysis of clinical trial data suggests visit-to-visit variability (VVV) of blood pressure is strongly associated with the incidence of cardiovascular disease. Measurement of blood pressure in usual practice settings may be subject to substantial error, calling into question the value of VVV in real-world settings. We analyzed data on adults ≥ 65 years of age with diagnosed hypertension who were taking antihypertensive medication from the Cohort Study of Medication Adherence among Older Adults (n=772 with 14 or more blood pressure measurements). All blood pressure measurements, taken as part of routine out-patient care over a median of 2.8 years, were abstracted from patients’ medical charts. Using each participant’s first 7 systolic blood pressure (SBP) measurements, the mean intra-individual standard deviation was 13.5 mmHg. The intra-class correlation coefficient for the standard deviation based on the first 7 and second 7 SBP measurements was 0.28 (95% CI: 0.20 – 0.34). Individuals in the highest quintile of standard deviation of SBP based on their first 7 measurements were more likely to be in the highest quintile of VVV using their second 7 measurements (observed/expected ratio = 1.71, 95% CI: 1.29 – 2.22). Results were similar for other metrics of VVV. The intra-class correlation coefficient was lower for diastolic blood pressure (DBP) than SBP. These data suggest VVV of SBP measured in a real-world setting is not random. Future studies are needed to assess the prognostic value of VVV of SBP assessed in routine clinical practice.