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目的比较诊所手工测血压与动态自动测血压的质量和准确度。HT9.H〗设计多场所人群随机对照试验。场所加拿大东部5市初级保健诊所。HT9.H〗参试者67家社区诊所88名初级保健医生的555例收缩期高血压但无严重合并症病人。干预将参试诊所随机分入人工测血压组和使用BpTRU装置自动测血压组(干预组)。入选前,从病历中获得最近人工血压测量记录。干预组入选前、后血压读数进行比较;所有读数也与动态血压比较。主要结果测量清醒动态血压减去自动诊所血压与清醒动态血压减去人工诊所血压的收缩期血压的差异。结果将人群随机分入31家(252例病人)人工诊所血压测量组和36家(303例病人)自动诊所血压测量组。最近常规人工诊所血压[149.5(SD 10.8)/81.4(8.3)]高于自动诊所血压[135.6(17.3)/77.7(10.9),(P<0.001)]。对照组,入选前常规人工诊所血压149.9(10.7)/81.8(8.5)减少至入选后141.4(14.6)/80.2(9.5),(P<0.001/P=0.01),但从人工诊所改为自动诊所血压干预组明显减少(P<0.001/P=0.02)。入选后首次研究就诊,与对照组清醒动态血压和人工诊所血压的差异[-6.5(-4.3～-8.6)/-4.3(-2.9～-5.8)]相比,干预组清醒动态收缩/舒张期血压和自动诊所血压所评估的平均差[-2.3(95%CI:-0.31,-4.3)/-3.3(-2.7,-4.4)]要小。与入选前人工诊所血压对清醒动态血压相比(r=0.10/r=0.40),入选后收缩/舒张期自动诊所血压组内相关(r=0.34/r=0.56)要强(P<0.001);r检验平均差为0.24(0.12～0.36)/0.16(0.07～0.25)。与人工诊所血压对清醒动态血压组间相关性(r=0.30)相比,收缩期自动诊所血压与清醒动态血压组间相关性(r=0.56)要强(P<0.001);r检验平均差为0.26(0.09～0.41)。自动诊所血压的应用可有效地减少读数以0结尾的数字偏好。结论初级保健中其他方面健康收缩期高血压病人,与继续使用人工诊所血压测量相比,常规初级保健自动诊所血压的引入可使白大衣反应性明显减少。与人工诊所血压相比,清醒动态血压相关的自动诊所血压的质量及准确性明显要好。
Objective To compare the quality and accuracy of manual blood pressure measurement and dynamic automatic blood pressure measurement in clinics. HT9.H] design multi-site population randomized controlled trials. Place 5 primary health care clinics in eastern Canada. HT9.H] 555 systolic hypertension but no serious comorbidities among 88 primary care physicians in 67 community clinics. Interventions were randomly divided into artificial blood pressure test group and BpTRU device automatic blood pressure measurement group (intervention group). Prior to enrolling, records of recent artificial blood pressure measurements are obtained from the medical records. Interventions were compared before and after reading blood pressure readings; all readings were also compared with ambulatory blood pressure. The main results measure the difference between ambulatory ambulatory blood pressure minus ambulatory blood pressure and conscious ambulatory blood pressure minus systolic blood pressure at artificial ambulatory blood pressure. Results The population was randomized to a manual clinic blood pressure measurement group of 31 (252 patients) and 36 (303 patients) automated clinic blood pressure measurement groups. The blood pressure [149.5 (SD 10.8) /81.4 (8.3)] of the recent routine artificial clinic was higher than that of the automated clinic [135.6 (17.3) /77.7 (10.9), (P <0.001)]. In the control group, blood pressure was decreased from 149.9 (10.7) /81.8 (8.5) to 141.4 (14.6) /80.2 (9.5) at the routine artificial clinic before enrollment (P <0.001 / P = 0.01) Blood pressure intervention group was significantly reduced (P <0.001 / P = 0.02). Compared with the difference between conscious ambulatory blood pressure and artificial blood pressure in the control group [-6.5 (-4.3 ~ -8.6) / - 4.3 (-2.9 ~ -5.8)], the conscious dynamic contractile / diastolic phase Blood pressure and automated clinic blood pressure assessed mean differences [-2.3 (95% CI: -0.31, -4.3) / -3.3 (-2.7, -4.4)]. Compared with the ambulatory ambulatory blood pressure (r = 0.10 / r = 0.40), there was a significant correlation (r = 0.34 / r = 0.56) between the ambulatory voluntary diastolic blood pressure group and the prehypertensive artificial blood pressure group (P <0.001) The average difference of r test was 0.24 (0.12-0.36) /0.16 (0.07-0.25). The correlation between the systolic automatic clinic blood pressure and the conscious ambulatory blood pressure group (r = 0.56) was stronger than that of the artificial clinic blood pressure (r = 0.30) (P <0.001). The mean difference of r test was 0.26 (0.09 ~ 0.41). The use of automated clinic blood pressure can effectively reduce the numeric preference for readings ending in zero. CONCLUSIONS In other aspects of primary care, patients with systolic hypertension have significantly less white reactivity with the introduction of blood pressure at routine primary care automated clinics compared with continuous use of artificial clinic blood pressure measurements. Compared with the artificial clinic blood pressure, awake ambulatory blood pressure-related automatic clinic blood pressure quality and accuracy was significantly better.