这位成年患者有高血压吗? : 理性的临床检查系统审查
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
概括
办公室血压测量对诊断高血压的准确性较低. 家庭血压监测 (HBPM) 比办公室读数更可靠,但24小时门诊血压监测 (ABPM) 仍然是准确高血压诊断的黄金标准.
科学领域:
- 心血管医学
- 高血压的诊断
- 诊断准确性的研究
背景情况:
- 办公室血压测量是诊断高血压的常规方法,但缺乏准确性.
- 办公室外血压监测,包括家庭血压监测 (HBPM) 和24小时门诊血压监测 (ABPM),提供了替代方案.
- ABPM被认为是BP评估的参考标准.
研究的目的:
- 系统地审查振荡计办公室和家庭血压测量方法的准确性.
- 评估这些方法对高血压成年人进行正确分类的能力.
- 使用24小时ABPM作为参考标准来定义高血压分类.
主要方法:
- 在多个数据库 (PubMed,Cochrane Library,Embase等) 进行了全面的文献搜索. 直到2021年4月.
- 两位作者独立抽象数据并评估研究质量;第三位作者解决了差异.
- 随机效应模型用于计算BP测量方法的总结灵敏度,特异性和概率比率 (LR).
主要成果:
- 十二项研究 (n=6877) 评估了办公室血压测量,六项研究 (n=2049) 评估了HBPM与24小时ABPM.
- 传统的办公室血压测量 (≥140/ 90 mm Hg) 显示了51%的灵敏度和88%的特异性.
- 与办公室测量相比,家庭血压监测 (HBPM) (≥135/85 mm Hg) 的灵敏度 (75%) 和特异性 (76%) 较高.
结论:
- 办公室的血压测量可能不够准确,无法确诊或排除高血压.
- 家庭血压监测 (HBPM) 可以成为确认高血压诊断的重要工具.
- 当办公室和家庭的血压读数不一致或不确定时,建议使用24小时的ABPM进行确定的诊断.
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