诊室血压波动的影响因素及不同测量方法对血压分级的影响  

Factors influencing office blood pressure fluctuation and the influence of different measurement methods on blood pressure grading

作　　者：张丽娟[1] 刘敏[1] 李志娟[2] 吕风华[3] 刘玉[2] 陈玉磊 田丹丹[1] 张晓营 陈洁[1] ZHANG Lijuan;LIU Min;LI Zhijuan;LYU Fenghua;LIU Yu;CHEN Yulei;TIAN Dandan;ZHANG Xiaoying;CHEN Jie(Department of Hypertension,Henan Provincial People′s Hospital,Henan University People′s Hospital,Zhengzhou 450003;Department of Cardiovascular Medicine,the First Affiliated Hospital,Henan University of Science and Technology,Luoyang,Henan 471003;Department of Cardiovascular Medicine,the First Affiliated Hospital,Xinxiang Medical University,Xinxiang,Henan 453100)

机构地区：[1]河南大学人民医院,河南省人民医院高血压科,郑州450003 [2]河南科技大学第一附属医院心血管内科,河南洛阳471003 [3]新乡医学院第一附属医院心血管内科,河南新乡453100

出　　处：《郑州大学学报（医学版）》2022年第3期400-405,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划省部共建项目(SBGJ2018070)。

摘　　要：目的:分析诊室血压波动的影响因素,不同诊室血压测量次数及取值方法对诊室血压分级准确性的影响。方法:收集2019年4月至2021年1月因高血压在河南省人民医院、新乡医学院第一附属医院及河南科技大学第一附属医院就诊的2 105例门诊患者。将所有患者按照前2次测量血压数值相差>5 mmHg分为诊室血压波动大组及非诊室血压波动大组,分析2组患者临床基线特点,应用单因素和Logistic回归分析得到诊室血压波动的影响因素。其中451例患者在诊室血压测量后被建议并成功完成24 h动态血压监测,比较不同诊室血压测量方法得到的诊室血压分级的准确率。结果:对2 105例患者进行Logistic回归分析,结果显示女性(OR=1.33;95%CI为1.11~1.59,P=0.002)、有高血压家族史(OR=1.24;95%CI为1.03~1.48,P=0.022)、首次测量血压分级高(Ⅰ级:OR=1.72,95%CI为1.38~2.13,P<0.001;Ⅱ级:OR=2.31,95%CI为1.81~2.95,P<0.001;Ⅲ级:OR=3.75,95%CI为2.72~5.17,P<0.001)是诊室血压波动大的危险因素。分析成功完成24 h动态血压监测的451例患者的动态血压白天均值分级及诊室血压分级结果,运用非参数检验发现第2、3次测量血压均值的分级准确率(53.4%)最高(P<0.001),《2020国际高血压学会全球高血压实践指南》建议的诊室血压水平分级的准确率高于《2018年中国高血压防治指南》(51.2%vs 45.9%,P=0.002)。结论:女性、有高血压家族史、首次测量血压分级高是诊室血压波动大的危险因素。第2、3次血压测量的均值在评估诊室血压水平分级上具有较高的准确性。建议在每次就诊时,所有患者均进行3次血压测量,取第2、3次测量血压均值作为诊室血压。Aim:To analyze the factors influencing the fluctuation of office blood pressure(OBP) and the influence of different blood pressure measurement times and value-taking methods on the accuracy of blood pressure grading.Methods:A total of 2 105 outpatient patients from Henan Provincial People′s Hospital,the First Affiliated Hospital of Xinxiang Medical University,and the First Affiliated Hospital of Henan University of Science and Technology,from April 2019 to January 2021,due to hypertension were included.All patients were divided into the large fluctuation group and the control group according to whether their OBP fluctuation was >5 mmHg or not.The clinical baseline characteristics of the two groups were analyzed,and the influencing factors of OBP fluctuation were obtained by univariate and Logistic regression analysis.Among them,451 patients underwent ambulatory blood pressure(ABP) measurement.By referring to ABP,the accuracy of OBP grading obtained by different measurement times and value-taking methods was compared.Results:Logistic regression analysis of 2 105 patients showed that being female(OR=1.33;95%CI was 1.11-1.59,P=0.002),having a family history of hypertension(OR=1.24;95%CI was 1.03-1.48,P=0.022),and having high blood pressure grade when first measured(Grade 1:OR=1.72,95%CI was 1.38-2.13,P<0.001;Grade 2:OR=2.31,95%CI was 1.81-2.95,P<0.001;Grade 3:OR=3.75,95%CI was 2.72-5.17,P<0.001)were risk factors for high OBP fluctuation.The mean values of ABP and OBP grading results of 451 patients were analyzed,nonparametric test showed that the second and third mean blood pressure measurements had the highest classification accuracy(53.4%)(P<0.001),and the accuracy of the 2020 ISH guidelines was higher than that of the 2018 Chinese guidelines(51.2% vs 45.9%,P=0.002).Conclusion:Female,a family history of hypertension and higher grade of the first measurement′s blood pressure are risk factors for high OBP fluctuations.The mean values of the second and third blood pressure measurements have high accuracy in evalu

关 键 词：高血压 血压测量 诊室血压波动 

分 类 号：R544[医药卫生—心血管疾病]