Sensibilidade e especificidade no diagnóstico de hipertensão por diferentes métodos

Abstract

OBJECTIVE:To evaluate sensitivity and specifi city of different protocols for blood pressure measurement for the diagnosis of hypertension in adults. METHODS:Cross-sectional study conducted in a non-probabilistic sample of 250 public servants of both sexes aged 35 to 74 years in Vitória, southeastern Brazil, between 2008 and 2010. The participants had their blood pressure measured using three different methods: clinic measurement, self-measured and 24-hour ambulatory measurement. They were all interviewed to obtain sociodemographic information and had their anthropometric data (weight, height, waist circumference) collected. Clinic measurement and self-measured were analyzed against the gold standard ambulatory measurement. Measures of diagnostic performance (sensitivity, specifi city, accuracy and positive and negative predictive values) were calculated. The Bland & Altman method was used to evaluate agreement between ambulatory measurement (standard deviation for daytime measurements) and self-measured (standard deviation of four measurements). A 5% signifi cance level was used for all analyses. RESULTS: Self-measured blood pressure showed higher sensitivity (S=84%, 95%CI 75;93) and overall accuracy (0.817, p<0.001) in the diagnosis of hypertension than clinic measurement (S=79%, 95%CI 73;86, and overall accuracy=0.815, p<0.001). Despite the strong correlation with daytime ambulatory measurement values (r=0.843, p<0.001), self-measured values did not show good agreement with daytime systolic ambulatory values (bias=5.82, 95%CI 4.49;7.15). Seven (2.8%) cases of white coat hypertension, 26 (10.4%) of masked hypertension and 46 (18.4%) of white-coat effect were identifi ed. CONCLUSIONS:The study shows that self-measured blood pressure has higher sensitivity than clinic measurement to identify true hypertension. The negative predictive values found confi rm the superiority of self-measured when compared to clinic in identifying truly normotensive individuals. However, clinic measurement cannot be replaced with self-measured, as it is still the most reliable method for the diagnosis of hypertension.

Characterization of Oral Microbiota in Removable Dental Prosthesis Users: Influence of Arterial Hypertension

“…Most studies, differently, evidence that non-White individuals, mainly Afro-Americans, are at greater risk of developing arterial hypertension [25, 26]. Other authors found similar results, with a majority of White individuals in the hypertensive group, but argued that this fact can be rebuttable, as White individuals commonly have greater control over their health or clinical conditions [27].…”

Revisão Sistemática Sobre a Epidemiologia Das Doenças Cardiovasculares E Respiratórias E Suas Associações Com a Poluição Do Ar Em Vitória/Es

“…É possível afirmar, por meio dessa comparação, que a prevalência de hipertensão na cidade de Vitória não é diferente da estimativa para o resto do país. Além disso, os valores obtidos por Picon são compatíveis com os principais estudos conduzidos em Vitória, incluindo Mill et al 11 , que relataram prevalência de 38,2%, e Nascimento et al 19 , que encontraram prevalência de 30,8%. Portanto, os estudos mais relevantes acerca da prevalência da hipertensão em Vitória se apresentam em concordância com as principais estimativas nacionais.…”

Risco cardiovascular na hipertensão do avental branco: avaliação do Índice Tornozelo Braquial

“…De maneira divergente, a maioria dos estudos evidencia que indivíduos não brancos, principalmente negros, apresentam maior risco de desenvolver hipertensão arterial (LESSA et al, 2006;NASCIMENTO et al, 2011).…”