この 大人 の 患者 は 高血圧 を 患い て いる か : 合理的な臨床検査の体系的レビュー
Anthony J Viera1, Yuichiro Yano1,2, Feng-Chang Lin3
1Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina.
JAMA
|July 27, 2021
まとめ
事務所での血圧 (BP) の測定は高血圧の診断にはあまり正確ではありません. 家庭での血圧モニタリング (HBPM) は診療所での測定値よりも信頼性がありますが,24時間通院での血圧モニタリング (ABPM) は正確な高血圧診断の黄金基準です.
科学分野:
- 心血管医学
- 高血圧 診断
- 診断の精度に関する研究
背景:
- 事務所での血圧 (BP) 測定は,高血圧の診断のための従来の方法ですが,正確性は欠けている.
- 診療室外での血圧モニタリング (HBPM) や24時間出院中の血圧モニタリング (ABPM) などは代替手段です.
- ABPMはBP評価の基準として認識されています.
研究 の 目的:
- オシロメトリックオフィスと家庭のBP測定方法の精度を体系的にレビューする.
- 高血圧の成人を正しく分類する能力を評価する.
- 高血圧の分類は,24時間ABPMを基準として定義した.
主な方法:
- 多数のデータベース (PubMed,Cochrane Library,Embaseなど) で広範な文献検索が行われました. 2021年4月まで
- 2人の著者は独立してデータを抽象化し,研究の質を評価し,3人目の著者は不一致を解決した.
- ランダム効果モデルを使用して,BP測定方法の概要感度,特異性,および確率比 (LRs) を計算した.
主要な成果:
- 12つの研究 (n=6877) は診療室での血圧測定を評価し,6つの研究 (n=2049) は24時間の血圧測定と比較してHBPMを評価した.
- 従来のオフィスBP測定 (≥140/ 90mmHg) は51%の感度と88%の特異性を示した.
- 家庭用血圧測定 (HBPM) (≥135/85 mm Hg) は,オフィスでの測定と比較して,より高い感度 (75%) と特異性 (76%) を示した.
結論:
- 診察室での血圧測定は,高血圧を断定的に診断したり,排除したりするのに十分正確ではないかもしれません.
- 家庭での高血圧モニタリング (HBPM) は高血圧の診断を確かめるのに役立つツールです.
- 診察室と自宅の BP 値が不一致または不確実な場合は,決定的な診断のために 24 時間 ABPM が推奨されます.
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