PREDICTIVE VALUES OF ROUTINE BLOOD-PRESSURE MEASUREMENTS IN SCREENING FOR HYPERTENSION
PREDICTIVE VALUES OF ROUTINE BLOOD-PRESSURE MEASUREMENTS IN SCREENING FOR HYPERTENSION
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DOI：
10.1093/oxfordjournals.aje.a113561
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发表时间：
1983-01-01
影响因子：
5
通讯作者：
POLK, BF
中科院分区：
文献类型：
--
作者：
ROSNER, B;POLK, BF
目前关于高血压筛查或病例发现的标准尚未达成共识。血压变异性会导致不同的确定，具体取决于筛查就诊次数、每次就诊的测量次数以及用于将获得的数据减少为血压状态的基本测量值的方法。为了制定筛查规则，作者计算了特定年龄、种族和性别群体的血压测量的预测值。预测值计算需要估计访问之间和访问内的变异性以及患病率。变异性的估计是根据在工作场所或社区血压项目中获得的数据计算的，该数据来自 991 名年龄在 30-69 岁且目前未服用抗高血压药物的人，这些人接受了 2 至 5 次随访（间隔 1 周）的筛查。患病率估计值是通过高血压检测和随访计划对 158,955 名成年人进行的筛查得出的。针对特定年龄、种族和性别特定群体在广泛的舒张压范围内提供预测值，并用于确定适当的筛查规则，以尽可能少的血压测量来最大程度地减少错误分类。向 30 名高血压专家发送的调查问卷结果表明，做出筛查决策的可接受预测值的中位数为预测值阳性的 80% 和预测值阴性的 77.5%。当采用这些标准时，来自上述筛选人群的至少 3 次就诊的 901 人亚组中，81%、90% 和 93% 被确定为具有或不具有真正的舒张压。分别在 1、2 和 3 次就诊后为 90 mm Hg。其余7%的人在3次就诊后状态仍不确定。
There presently is no consensus regarding criteria for hypertension screening or case finding. Blood pressure variability results in differential ascertainment, depending upon the number of screening visits, the number of measurements per visit, and the method used in reducing the data obtained to an underlying measure of blood pressure status. To develop screening rules, the authors have computed the predictive values of blood pressure measurements for particular age-, race- and sex-specific groups. Predictive value computations require estimates of between- and within-visit variability and of prevalence. Estimates of variability were calculated from data obtained at a worksite or a community blood pressure program from 991 persons, aged 30-69 yr and not currently on antihypertensive medications, who were screened over 2 to 5 visits, 1 wk apart. Estimates of prevalence were obtained from the screening of 158,955 adults by the Hypertension Detection and Follow-Up Program. Predictive values are presented for particular age-, race-, and sex-specific groups over a wide range of diastolic blood pressures, and are used to identify appropriate screening rules that minimize misclassification with the fewest possible blood pressure measurements. The results of a questionnaire sent to 30 hypertension experts indicated that the median acceptable predictive values for making screening decisions were 80% for predictive value positive and 77.5% for predictive value negative. When these criteria were adopted, 81, 90, and 93% of the subgroup of 901 persons with at least 3 visits from the above screened population were identified as having or not having true diastolic blood pressure .gtoreq. 90 mm Hg after 1, 2, and 3 visits, respectively. The status of the remaining 7% was uncertain after 3 visits.