诊断学理论与实践 ›› 2020, Vol. 19 ›› Issue (05): 487-493.doi: 10.16150/j.1671-2870.2020.05.008
收稿日期:
2019-08-22
出版日期:
2020-10-25
发布日期:
2022-07-14
通讯作者:
王继光
E-mail:jiguangwang@aim.com
基金资助:
LI Zhoutong1,2, ZHANG Wei1, WANG Jiguang1()
Received:
2019-08-22
Online:
2020-10-25
Published:
2022-07-14
Contact:
WANG Jiguang
E-mail:jiguangwang@aim.com
摘要:
目的: 探究家庭血压测量和24 h动态血压(以下称动态血压)监测诊断白大衣高血压及隐匿性高血压的准确性。方法: 研究对象为全国多中心动态血压及家庭血压登记研究中上海地区的受试者,均接受动态血压监测,并进行了诊室血压测量和7 d家庭血压测量。本组总计纳入1 067例患者,平均年龄为57.5岁,男性占39.9%。依据相关高血压指南,白大衣高血压定义为诊室测平均收缩压≥140 mmHg和(或)平均收缩压≥90 mmHg,而动态血压监测正常(平均收缩压<130 mmHg且平均舒张压<80 mmHg)或家庭血压测量正常(平均收缩压<135 mmHg且平均舒张压<85 mmHg);隐匿性高血压为诊室测量血压正常而动态血压升高或家庭血压升高。结果: 在1 067例患者中,接受降压药物治疗的高血压患者为867例,未治疗患者200例。在未治疗患者中,动态血压监测和家庭血压测量诊断白大衣高血压的患病率分别为10.0%和17.0%(P=0.04),动态血压监测和家庭血压测量诊断隐匿性高血压的患病率分别为26.5%和14.5%(P=0.003)。以动态血压监测为标准,无论未治疗患者还是治疗患者,家庭血压测量诊断白大衣及隐匿性高血压的灵敏度都较低(43%~86%),特异度较高(91%~99%),阳性预测值较低(46%~91%),阴性预测值较高(84%~100%)。动态血压监测与家庭血压测量间的诊断一致性为81%~90%,Kappa值为0.43到0.78。结论: 家庭血压测量诊断白大衣及隐匿性高血压的灵敏度较低,但特异度较高。因此,尽管家庭血压测量不能替代动态血压监测,但可作为其有益的补充。
中图分类号:
李宙童, 张炜, 王继光. 家庭血压测量诊断白大衣高血压及隐匿性高血压的准确性研究[J]. 诊断学理论与实践, 2020, 19(05): 487-493.
LI Zhoutong, ZHANG Wei, WANG Jiguang. Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(05): 487-493.
表1
治疗组和未治疗组患者的临床基本特征
临床特征 | 治疗组 (n=867) | 未治疗组 (n=200) | P值 |
---|---|---|---|
男性[n (%)] | 335(38.6) | 94(47.0) | 0.030 0 |
年龄 (岁) | 59.0±10.2 | 50.8±13.4 | <0.000 1 |
体质量指数 (kg/m2) | 24.7±3.3 | 24.1±3.2 | 0.010 0 |
吸烟[n (%)] | 105(12.1) | 27(13.5) | 0.630 0 |
饮酒[n (%)] | 83(9.6) | 25(12.5) | 0.240 0 |
糖尿病[n (%)] | 107(12.3) | 8(4.0) | 0.000 3 |
高血压病程(年) | 11.3(0~62.6) | 3.3(0.02~50.5) | <0.000 1 |
服用降压药种类 | 2.1±1.1 | - | - |
心血管疾病史[n (%)] | 129(14.9) | 8(4.0) | <0.000 1 |
诊室血压 (mmHg) | |||
收缩压 | 136.7±16.7 | 136.8±14.3 | 0.970 0 |
舒张压 | 78.2±10.7 | 81.5±10.7 | <0.000 1 |
动态血压 (mmHg) | |||
读数 | 58.9±5.0 | 61.0±3.8 | <0.000 1 |
收缩压 (mmHg) | 127.0±14.2 | 128.3±10.4 | 0.130 0 |
舒张压 (mmHg) | 77.4±9.8 | 80.9±7.8 | <0.000 1 |
家庭血压 (mmHg) | |||
读数 | 67.9±5.5 | 66.4±8.6 | 0.020 0 |
收缩压 (mmHg) | 132.6±14.4 | 130.8±10.8 | 0.040 0 |
舒张压 (mmHg) | 77.8±9.5 | 80.6±8.6 | 0.020 0 |
表2
治疗组和未治疗组分别以动态血压监测和家庭血压测量诊断的白大衣高血压及隐匿性、持续性高血压的患病率[n(%)]
家庭血压测量诊断 | 动态血压监测诊断的各高血压亚型 | ||||||
---|---|---|---|---|---|---|---|
治疗组 (n=867) | 未治疗组 (n=200) | ||||||
是 | 否 | 总计 | 是 | 否 | 总计 | ||
白大衣高血压 | |||||||
是 | 57 (6.6%) | 46 (5.3%) | 103 (11.9%) | 17(8.5%) | 17(8.5%) | 34 (17.0%) | |
否 | 52 (6.0%) | 712 (82.1%) | 764 (88.1%) | 3 (1.5%) | 163 (81.5%) | 166 (83.0%) | |
总计 | 109 (12.6%) | 758 (87.4%) | 867 (100%) | 20 (10.0%) | 180 (90.0%) | 200 (100%) | |
隐匿性高血压 | |||||||
是 | 97 (11.2%) | 45 (5.2%) | 142 (16.4%) | 22 (11.0%) | 7 (3.5%) | 29 (14.5%) | |
否 | 95 (11.0%) | 630 (72.7%) | 725 (83.6%) | 31 (15.5%) | 140 (70.0%) | 171 (85.5%) | |
总计 | 192 (22.1%) | 675 (77.9%) | 867 (100%) | 53 (26.5%) | 147 (73.5%) | 200 (100%) | |
持续性高血压 | |||||||
是 | 205 (23.6%) | 52 (6.0%) | 257 (29.6%) | 58 (29.0%) | 3 (1.5%) | 61 (30.5%) | |
否 | 46 (5.3%) | 564 (65.1%) | 610 (70.4%) | 17 (8.5%) | 122 (61.0%) | 139 (69.5%) | |
总计 | 251 (29.0%) | 616 (71.0%) | 867 (100%) | 75 (37.5%) | 125 (62.5%) | 200 (100%) |
表3
治疗组和未治疗组中家庭血压测量诊断白大衣高血压及隐匿性高血压的效能[%(95%置信区间)]
分组及高血压亚型 | 灵敏度 (%) | 特异度 (%) | 阳性预测值 (%) | 阴性预测值 (%) | 一致性 (%) | Kappa值 |
---|---|---|---|---|---|---|
已治疗患者 | ||||||
白大衣高血压 | 52 (43~62) | 94 (92~96) | 55 (46~65) | 93 (91~95) | 89 | 0.47a) |
隐匿性高血压 | 51 (43~58) | 93 (91~95) | 68 (61~76) | 87 (84~89) | 84 | 0.48a) |
持续性高血压 | 82 (77~86) | 92 (90~94) | 80 (75~85) | 93 (91~95) | 89 | 0.73a) |
未治疗患者 | ||||||
白大衣高血压 | 85 (69~100) | 91 (86~95) | 50 (33~67) | 98 (96~100) | 90 | 0.58a) |
隐匿性高血压 | 42 (28~55) | 95 (92~99) | 76 (60~91) | 82 (76~88) | 81 | 0.43a) |
持续性高血压 | 77 (68~87) | 98 (95~100) | 95 (90~100) | 88 (82~93) | 90 | 0.78a) |
表4
治疗组和未治疗组动态血压监测和家庭血压测量分别诊断白大衣高血压及隐匿性高血压的影响因素
参数 | 动态血压 | 家庭血压 | |||
---|---|---|---|---|---|
OR值 (95%置信区间) | P值 | OR值 (95%置信区间) | P值 | ||
治疗组 | |||||
白大衣高血压 | |||||
高血压病程 | 0.98 (0.96~0.99) | 0.050 0 | 0.98 (0.96~1.00) | 0.070 0 | |
诊室收缩压 | 1.06 (1.05~1.08) | <0.000 1 | 1.05 (1.04~1.07) | <0.000 1 | |
诊室舒张压 | 0.97 (0.94~0.99) | 0.020 0 | - | - | |
吸烟 | - | - | 2.2 (0.92~5.28) | 0.080 0 | |
体质量指数 | - | - | 0.94 (0.88~1.01) | 0.080 0 | |
心血管疾病史 | - | - | 1.78 (1.01~3.13) | 0.050 0 | |
服用降压药数目 | - | - | 0.75 (0.59~0.95) | 0.020 0 | |
隐匿性高血压 | |||||
年龄 | 0.82 (0.66~1.01) | 0.070 0 | - | - | |
体质量指数 | 1.05 (0.99~1.11) | 0.080 0 | 1.09 (1.03~1.16) | 0.006 0 | |
糖尿病 | 1.78 (1.06~2.97) | 0.030 0 | - | - | |
诊室收缩压 | 0.93 (0.92~0.95) | <0.001 0 | 0.96 (0.94~0.97) | <0.000 1 | |
诊室舒张压 | 1.03 (1.00~1.06) | 0.030 0 | - | - | |
动态血压有效读数 | 1.04 (1.00~1.07) | 0.060 0 | - | - | |
高血压病程 | 1.01 (1.00~1.02) | 0.080 0 | - | - | |
吸烟 | - | - | 0.41 (0.23~0.75) | 0.004 0 | |
未治疗组 | |||||
白大衣高血压 | |||||
男性 | 0.26 (0.06~1.15) | 0.080 0 | 0.40 (0.14~1.13) | 0.090 0 | |
诊室收缩压 | 1.07 (1.02~1.12) | 0.005 0 | 1.06 (1.02~1.10) | 0.004 0 | |
隐匿性高血压 | |||||
男性 | 4.4 (1.70~11.61) | 0.002 0 | - | - | |
诊室收缩压 | 0.92 (0.88~0.96) | <0.000 1 | 0.95 (0.91~0.99) | 0.020 0 | |
心血管疾病史 | 4.68 (0.90~24.38) | 0.070 0 | - | - |
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