自动诊室血压测量与高血压诊断截点  

Measurement of automated office blood pressure and the cut-off point for hypertension diagnosis

作　　者：陈志华[1,2] 林丽[1,2] 何道奋 林从娟[1,2] 林志鸿[1,2] CHEN Zhihua;LIN Li;HE Daofen;LIN Congjuan;LIN Zhihong(Department of Emergency,the First Affiliated Hospital,Fujian Medical University,Fuzhou,Fujian 350004,China;Department of Emergency,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University)

机构地区：[1]福建医科大学附属第一医院急诊医学中心,福建福州350004 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心急诊医学中心

出　　处：《中华高血压杂志（中英文）》2024年第5期447-452,共6页Chinese Journal of Hypertension

摘　　要：目的比较高血压患者自动诊室血压(AOBP)与其他血压测量方式所测得的血压值差异,探索AOBP诊断高血压截断点。方法连续入选2017年9月至2020年1月在福建医科大学附属第一医院心血管内科门诊未治疗的原发性高血压患者206例,收集临床资料,检测生化指标;所有研究对象行诊室血压(OBP)、AOBP、家庭血压(HBP)及24 h动态血压(ABP)测量。根据2017年加拿大高血压教育计划,将高血压患者分为AOBP升高组(≥135/85 mmHg)和AOBP正常组(<135/85 mmHg)。应用重复测量方差分析及Pearson相关分析,比较不同血压测量方式测得的血压值差异及相关性;以ABP白天血压值(dABP)作为高血压诊断标准,受试者工作特征(ROC)曲线探讨AOBP诊断高血压的截断点。结果高血压患者血压测量值按从大到小排序为OBP>AOBP>dABP>HBP,当AOBP≥135/85 mmHg时,AOBP与OBP高度相关(r收缩压=0.768,r舒张压=0.705;均P<0.05),当AOBP<135/85 mmHg时,AOBP与dABP相关度最高(r收缩压=0.424、r舒张压=0.495;均P<0.01)。本研究AOBP诊断高血压最佳截断点为133.5/82.5 mmHg,灵敏度为88.1%,特异度为64.8%。结论未治疗的高血压患者血压测量值OBP>AOBP>dABP>HBP;AOBP诊断高血压截断点为133.5/82.5 mmHg。Objective To compare the differences of automated office blood pressure(AOBP)and blood pressure values measured by other methods,and to explore the cut-off point of AOBP for diagnosing hypertension.Methods From September 2017 to January 2020,206 patients with untreated essential hypertension in the outpatient department of cardiovascular of the First Affiliated Hospital of Fujian Medical University were enrolled.Clinical data were collected and biochemical indexes were detected.The office blood pressure(OBP),AOBP,home blood pressure(HBP)and 24-hour ambulatory blood pressure(ABP)were measured in all subjects.According to 2017 Canadian Hypertension Education Program(CHEP),patients with hypertension were divided into two groups:AOBP increased group(≥135/85 mmHg)and AOBP normal group(<135/85 mmHg).The difference of blood pressure values was compared by variance analysis of repeated measurement and the correlation was analysed by Pearson correlation analysis.The receiver operating characteristic(ROC)curve was used to identify the cut-off point of AOBP for diagnosing hypertension,using daytime ambulatory blood pressure(dABP)as the diagnostic standard.Results In patients with hypertension,the blood pressure values were ranked in descending order as follows:OBP>AOBP>dABP>HBP.AOBP was highly correlated with OBP when AOBP≥135/85 mmHg(r=0.768 for systolic blood pressure,r=0.705 for diastolic blood pressure,both P<0.05),and had the highest correlation with dABP(r=0.424 for systolic blood pressure,r=0.495 for diastolic blood pressure,both P<0.01)when AOBP<135/85 mmHg.The best cut-off point of AOBP in diagnosing hypertension was 133.5/82.5 mmHg,with a sensitivity of 88.1%,and a specificity of 64.8%.Conclusions Of untreated hypertension patients,OBP>AOBP>dABP>HBP.The cut-off point of AOBP for hypertension diagnosis is 133.5/82.5 mmHg.

关 键 词：自动诊室血压 高血压 动态血压 家庭血压 

分 类 号：R544.1[医药卫生—心血管疾病]