中國人之白袍高血壓的研究(II)

The ability of blood pressure
parameters to predict hypertensive target
organ complications was evaluated on 290
consecutive patients with mild to moderate
essential hypertension.
Casual blood pressure (CBP)
measurements were obtained by standard
sphygmomanometric methods during the
day at an outpatient clinic. Twenty-four
hour ambulatory blood pressure (ABP)
recording with Del Mar Avionics, Model 1990
Pressurometer IV System was performed 1
to 3 days after CBP measurements were
taken. The blood pressure level for
hypertension was adopted from WHO
criteria. The target organ complications of
hypertension were assessed by ECG, chest
x-ray, urinalysis and eye-fundus
examinations.
The ABP parameters are shown to be
superior to CBP criteria for hypertension in
predicting hypertensive target organ
complications. Among the ABP
parameters, a comparison between CBP
and ABP levels, reversed circadian patterns
of BP and nocturnal non-reduction of BP are
found to be useful in predicting the target
organ complications. With regard to the predictive value for ECG evidence of left
ventricular hypertrophy (LVH), a SBP
average greater than casual SBP had a
sensitivity of 23.8%, specificity of 97.6%, a
positive predictive value of 79.2%, and a
negative predictive value of 77.1%. Their
counterparts in DBP gave the corresponding
values of 31.3%, 88.6%, 51.0% and 77.2%,
respectively. A reversed circadian pattern
of SBP achieved the corresponding values
of 31.3%, 88.6%, 51% and 77.2%,
respectively. Their counterparts of DBP
obtained the corresponding values of 32.5%,
87.1%, 49.1% and 77.2%, respectively.
The nocturnal non-reduction of SBP had the
corresponding values of 67.5%, 51.4%,
34.6% and 80.6%, respectively. Their
counterparts in DBP obtained the
corresponding values of 75%, 33.2%, 30%
and 77.8%, respectively. Similar results
were found in the predictive values of the
above-mentioned blood pressure
parameters for LVH on chest x-ray,
proteinuria and retinopathy.
The study has revealed the superiority
of ABP parameters to CBP values in
predicting the hypertensive target organ
complications. The distribution patterns of
BP have also been shown to have higher
predictive values for hypertensive target
organ complication than those of BP levels.