RT杂志文章A1 Viera, Anthony J. A1 Yano, Yuichiro A1 Lin, fengchang A1 Simel, David L. A1 Yun, Jonathan A1 Dave, Gaurav A1 Von Holle, Ann A1 Viera, Laura A. A1 Shimbo, Daichi A1 Hardy, Shakia T. A1 Donahue, Katrina E. A1 hinderl, Alan A1 Voisin, Christiane E. A1 Jonas, Daniel E. T1这个成年患者有高血压吗?[中文]:合理临床检查系统评价[f] JAMA [j] JAMA [j] YR [2021] DO 10.1001/ JAMA .2021.4533 VO 326 IS 4 SP 339 OP 347 SN 0098-7484 AB办公室血压(BP)测量不是诊断高血压最准确的方法。家庭血压监测(HBPM)和24小时动态血压监测(ABPM)是办公室外的替代方案，ABPM被认为是血压评估的参考标准。系统回顾办公室和家庭血压测量方法的准确性，以正确分类成人高血压，使用ABPM定义。检索PubMed、Cochrane Library、Embase、ClinicalTrials.gov、DARE数据库和美国心脏协会网站(从成立到2021年4月)，以及检索文章的参考文献列表。两位作者独立提取原始数据并评估方法学质量。第三位作者根据需要解决争议。计算血压测量方法诊断高血压的随机效应、敏感性、特异性和似然比(LRs)。ABPM(24小时平均血压≥130/80 mm Hg或清醒时平均血压≥135/85 mm Hg)作为参考标准。共有12项横断面研究(n = 6877)比较了常规办公室血压测量与24小时ABPM期间的平均血压，6项研究(n = 2049)比较了HBPM期间的平均血压与24小时ABPM期间的平均血压(范围，每个分析117-2209名参与者);其中2项研究(n = 3040)使用连续样本。在评估办公室测量的汇总研究中，24小时ABPM确定的高血压总体患病率为49% (95% CI, 39%-60%)，在评估HBPM的研究中为54% (95% CI, 39%-69%)。 All included studies assessed sensitivity and specificity at the office BP threshold of 140/90 mm Hg and the home BP threshold of 135/85 mm Hg. Conventional office oscillometric measurement (1-5 measurements in a single visit with BP ≥140/90 mm Hg) had a sensitivity of 51% (95% CI, 36%-67%), specificity of 88% (95% CI, 80%-96%), positive LR of 4.2 (95% CI, 2.5-6.0), and negative LR of 0.56 (95% CI, 0.42-0.69). Mean BP with HBPM (with BP ≥135/85 mm Hg) had a sensitivity of 75% (95% CI, 65%-86%), specificity of 76% (95% CI, 65%-86%), positive LR of 3.1 (95% CI, 2.2-4.0), and negative LR of 0.33 (95% CI, 0.20-0.47). Two studies (1 with a consecutive sample) that compared unattended automated mean office BP (with BP ≥135/85 mm Hg) with 24-hour ABPM had sensitivity ranging from 48% to 51% and specificity ranging from 80% to 91%. One study that compared attended automated mean office BP (with BP ≥140/90 mm Hg) with 24-hour ABPM had a sensitivity of 87.6% (95% CI, 83%-92%) and specificity of 24.1% (95% CI, 16%-32%).Office measurements of BP may not be accurate enough to rule in or rule out hypertension; HBPM may be helpful to confirm a diagnosis. When there is uncertainty around threshold values or when office and HBPM are not in agreement, 24-hour ABPM should be considered to establish the diagnosis. RD 4/5/2023 UL https://doi.org/10.1001/jama.2021.4533