| Objective:Hypertension is a recognized risk factor for target organ damage and cardiovascular and cerebrovascular events.The diagnosis,evaluation and epidemiological investigation of hypertension still use office blood pressure,and the measurement of blood pressure in the clinic is very critical for the management of hypertension.A large number of studies have shown that the fluctuation of blood pressure is closely related to cardiovascular and cerebrovascular events,so understanding the characteristics of blood pressure fluctuations is of great significance for the prevention and treatment of hypertension.A large number of studies have shown that the fluctuation of blood pressure is closely related to cardiovascular and cerebrovascular events,so understanding the characteristics of blood pressure fluctuations is of great significance for the prevention and treatment of hypertension.This study analyzed the relevant factors affecting the fluctuation of blood pressure in the clinic and the influence of different office blood pressure measurement methods on the accuracy of the blood pressure grading in the clinic.Methods:This study collected clinical data of 2105 outpatient patients who visited three tertiary hospitals in Henan Province due to hypertension from April 2019 to January 2021.2105 patients were divided into large fluctuation group and non-fluctuation group according to whether the difference of blood pressure values measured in the first two times was>5 mm Hg.The characteristics of blood pressure in the clinic were analyzed,and the differences of clinical data between the two groups were compared.Logistic multivariate regression analysis was used to obtain the influencing factors of blood pressure fluctuations in the clinic.The office blood pressure of 451 patients who completed 24h ambulatory blood pressure monitoring(ABPM)after the blood pressure measurement in the clinic was graded,and the accuracy of the office blood pressure classification of the number of blood pressure measurements in different clinics and the average of different blood pressure combinations was analyzed by non-parametric testing.In addition,the accuracy of blood pressure measurement in two hypertension guidelines was compared.Results:Logistic regression analysis of 2105 patients showed that being female(OR:1.33;95% CI:1.11-1.59,P=0.002),having a family history of hypertension(OR:1.24;95%CI:1.03-1.48,P=0.022),and having high blood pressure grade when first measured(Grade1:OR:1.72;95%CI:1.38-2.13;P<0.001;Grade 2:OR:2.31;95%CI:1.81-2.95;P<0.001;Grade 3:OR:3.75;95%CI:2.72-5.17;P<0.001)were risk factors for fluctuating blood pressure in the clinic.Based on the classification results of the daytime mean values of ABP as reference,the analysis of 451 patients with 24-hour APBM after blood pressure measurement in the clinic showed that the blood pressure values of the first,second and third blood pressure measurements and the mean values of the first and second blood pressure measurements,the mean values of the second and third blood pressure measurements,The accuracy of blood pressure classification was 43.0%47.2%46.3%and 45.7%53.4%46.6%,respectively.The results showed that the accuracy of the blood pressure classification of the mean 2nd and 3rd measurements(53.4%)was higher than that of other combined blood pressure classifications(P<0.001).The accuracy of the 2020ISH guidelines was higher than that of the 2018 Chinese guideline[51.2%(231/451)vs45.9%(207/451),χ2=258.062,P=0.002].According to the recommendations of the 2020ISH guidelines,59 outpatients(13.1%)only needed one blood pressure measurement(blood pressure<130/85 mm Hg at the first time),and the classification accuracy of the mean blood pressure measured at the second and third times was higher than that of the first time[45.8%(27/59)vs 28.8%(17/59),χ~2=30.519,P=0.013].Conclusion:Female,a family history of hypertension and higher classification of the first measurement’s blood pressure were risk factors for high OBP fluctuations.The mean values of the second and third blood pressure measurements have high accuracy in evaluating blood pressure levels.It is recommended to measure the BP in all patients three times at each visit and record the average of the last two BP measurements. |
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