白大衣性和隐蔽性高血压的诊断率:用一日或三日诊室血压诊断的差异  

White coat hypertension and masked hypertension:different diagnostic rate according to one-day or three-day office blood pressure

作　　者：丁芳[1] 俞蔚[1] 胡世云[1] 宣诚 俞柳燕 陈奇峰 范敏华 刘庆敏[6] 杨丽[1] 徐小玲[1] 严静[1] DING Fang;YU Wei;HU Shi-yun;XUAN Cheng;YU Liu-yan;CHEN Qi-feng;FAN Min-hua;LIU Qing-min;YANG Li;XU Xiao-lin;YAN Jing(*Center for Cardio-Cerebral-Vascular Disease Prevention and Treatment Research,Zhejiang Province,Zhejiang Hospital,Hangzhou Zhejiang 310013,China;不详)

机构地区：[1]浙江医院,浙江省心脑血管病防治研究中心,浙江杭州310013 [2]诸暨第二人民医院公共卫生科 [3]诸暨市疾病预防控制中心慢病科 [4]绍兴市疾控中心 [5]杭州市江干区闸弄口社区卫生服务中心 [6]杭州市疾病预防控制中心慢病科

出　　处：《中华高血压杂志》2020年第4期325-329,共5页Chinese Journal of Hypertension

基　　金：十二五国家科技支撑计划项目(2014BAI08B01);浙江省重大科技专项(2014C03045-1);浙江省医药卫生科技计划项目(2018ZH002)。

摘　　要：目的以家庭血压测量(HBPM)为基准,探讨一日诊室血压和非同日三次诊室血压对社区人群白大衣性高血压(WCH)和隐蔽性高血压(MH)诊断率的影响。方法于2015-2018年在浙江省4个社区纳入既往无高血压病史,首日诊室血压为正常高值或1级高血压水平的常住居民,于4周内完成2日诊室血压复查和连续7 dHBPM。诊室一日法的高血压诊断标准为首日诊室收缩压≥140和(或)舒张压≥90 mm Hg;诊室三日法的高血压诊断标准为3日诊室血压均达到收缩压≥140和(或)舒张压≥90 mm Hg。HBPM的高血压诊断标准为后6日平均血压值达到收缩压≥135和(或)舒张压≥85 mm Hg。诊室血压为高血压但HBPM诊断为非高血压者定义为WCH;诊室血压为非高血压但HBPM诊断为高血压者定义为MH。160例调查对象具有完整的血压监测数据。结果依据首日诊室血压、三日诊室血压、家庭血压分别诊断高血压75(46.9%)、23(14.4%)和78例(48.8%)。基于首日诊室血压和家庭血压检出WCH 39例(24.4%),MH 42例(26.3%);基于三日诊室血压和家庭血压检出WCH 11例(6.9%),MH 66例(41.3%),诊室一日法和三日法对于高血压、WCH、MH的诊断率差异有统计学意义(均P<0.05)。诊室血压存在日间差异,首日血压较高,而心率无日间差异。结论以连续7 d家庭血压为基准,在同一人群中,与诊室一日法相比,诊室三日法明显降低WCH的诊断率,而增加MH的诊断率。Objective To investigate the influence of office blood pressure(OBP)measured in 1 day or 3 days on the diagnosis rate of white coat hypertension(WCH)and masked hypertension(MH)in community population,based on home blood pressure measurement(HBPM).Methods Between 2015 and 2018,the residents who had high-normal blood pressure or grade 1 hypertension in the first day and had no history of hypertension were recruited from 4 community hospitals of Zhejiang province.They completed OBP measurements on other two days and 7-day continuous HBPM in 4 weeks.The diagnostic criteria for hypertension based on 1-day OBP was systolic blood pressure(SBP)≥140 mm Hg and/or diastolic blood pressure(DBP)≥90 mm Hg,the criteria based on the 3-day OBP was SBP and/or DBP obtained on all 3 days≥140/90 mm Hg.The criterion of diagnosing hypertension by HBPM was average SBP and/or DBP≥135/85 mm Hg in the followed 6 days.WCH was defined as blood pressure met the criteria of OBP but not HBPM.MH was determined as blood pressure met the criteria of HBPM but not for OBP.A total of 160 cases with qualified data of OBP and HBPM were included.Results The cases of hypertension according to the 1-day OBP,3-day OBP and 7-day continuous HBPM were 75(46.9%),23(14.4%)and 78(48.8%)respectively.Thirty-nine(24.4%)WCH and 42(26.3%)MH were detected based on 1-day OBP and HBPM.About 11(6.9%)WCH and 66(41.3%)MH subjects were found based on the 3-day OBP and HBPM.There were statistical difference between the 1-day OBP and 3-day OBP in diagnosis of hypertension,WCH and MH.OBP showed daytime difference,which was higher on the first day.But heart rate had no daytime difference.Conclusion According to HBPM of 7 continuous days,the 3-day OBP decreased WCH while increased MH diagnosis rate as compared with the 1-day OBP in the same population.

关 键 词：白大衣性高血压 隐蔽性高血压 家庭血压 一日诊室血压 三日诊室血压 诊断率 

分 类 号：R544.1[医药卫生—心血管疾病]