Unattended versus two attended, ambulatory and central blood pressure measurements in hypertensive patients with and without diabetes

<b>Objective:</b> To compare unattended blood pressure (BP) with two attended BP, with 24-h ambulatory (ABPM) and central BP measurements in hypertensive patients with (DMs) and without diabetes (HTs). <b>Methods:</b> In the same hypertension clinic we evaluate 129 consecutive HTs (56% female, 59 + 16 yrs) and 91 DMs (62% female, 64 + 9 yrs) who were referred for 24-h ABPM. During 48 hours they underwent a first attended BP (5 minutes resting, 3 recordings 2 minutes apart), (AT1), an unattended BP (UnAT), 3 measurements 2 minutes apart with a pre-programmed oscillometric Omron M10- IT, a second attended BP (AT2) similar to AT1, a 24-h ABPM and an evaluation of central BP (C) from the aortic wave form (SpygmoCor). <b>Results:</b> BP (mm Hg) and differences (Δ) from UnAT = 135/82 ± 17/10 were 1AT = +13.8/3.9 ± 10.3/5.6, AT2 = +7.3/2.9 ± 7.4/4.9, 24-h = −1.3/−1.7 ± 7.5/7.5 and C = −2.4/1.2 ± 10.3/9.1, all <i>p</i> p <b>Conclusions:</b> In HTs with and without DM the unattended BP significantly underestimates attended BP being more close to ambulatory BP values. These differences should be taken into account since targets based on these BP measurements are not equivalent.

【研究目标】比较合并糖尿病的高血压患者（DMs）与无糖尿病的高血压患者（HTs）的无人值守血压（unattended BP）、两种值守式血压、24小时动态血压监测（24-h ambulatory blood pressure monitoring, ABPM）及中心血压测量结果的差异。
【研究方法】本研究于同一家高血压门诊开展，纳入129例连续性无糖尿病高血压患者（HTs，女性占56%，年龄59±16岁）及91例合并糖尿病的高血压患者（DMs，女性占62%，年龄64±9岁），所有受试者均为转诊至本门诊行24小时ABPM检查的患者。受试者在48小时内依次完成以下检查：首次值守式血压测量（AT1：静息5分钟后，每2分钟测量1次，共3次）、无人值守血压测量（UnAT：采用预设程序的示波法欧姆龙M10-IT（Omron M10-IT）血压计，每2分钟测量1次，共3次）、第二次值守式血压测量（AT2，操作流程与AT1一致）、24小时ABPM以及通过主动脉波形（SpygmoCor设备）评估中心血压（C）。
【研究结果】以无人值守血压（UnAT）的基线值135/82 ±17/10 mmHg为参照，各测量方式与UnAT的差值（Δ）分别为：AT1：+13.8/3.9 ±10.3/5.6；AT2：+7.3/2.9 ±7.4/4.9；24小时ABPM：-1.3/-1.7 ±7.5/7.5；中心血压（C）：-2.4/1.2 ±10.3/9.1，所有差异均具有统计学意义（p值均<）。
【研究结论】针对合并糖尿病与无糖尿病的高血压患者，无人值守血压会显著低估值守式血压测量结果，且其数值更贴近动态血压监测结果。鉴于基于不同血压测量方式的血压控制目标并不等同，临床实践中需充分考量上述测量差异。