― 文献名 ―
Gregory M. Garrison, MD, MS, and Sara Oberbelman, MD. Screening for hypertension annually compared with current practice. Annals of Family Medicine. 2013 Mar-Apr; 11(2):116-121.
― この文献を選んだ背景 ―
In the clinics or hospitals where I have ever worked, every patient was routinely checked their blood pressure. Sometimes I found high blood pressure in these patients, but if they didn’t have any symptoms and usual blood pressures were within the normal range, I told them that it was just because of the length of waiting time… This time, I wonder if this routine blood pressure check is effective or not, then chose this article.
― 要約 ―
【Purpose】 Hypertension is the most common diagnosis in ambulatory care, yet little evidence exists regarding recommended screening intervals or the sensitivity and specificity of a routine office-based blood pressure measurement, the most common screening test. Screening for hypertension is usually performed by measuring blood pressure at every outpatient visit, which often results in transiently elevated findings among adults who do not have a diagnosis of hypertension. We hypothesize that a more limited annual screening strategy may increase specificity while maintaining sensitivity.
【Methods】 A retrospective case-control study of 372 adults without hypertension and 68 patients with newly diagnosed hypertension was conducted to compare the usual screening practice of checking blood pressure at every visit with a second strategy that considered only annual blood pressure measurements. ＊subjects: family medicine patients at Mayo Clinic Rochester ＊study period: 5 years →Figure 1, Figure 2
【Results】 Specificity improved from 70.4% (95% Cl, 65.5%-75.0%) for the usual practice to 82.0% (95% Cl, 77.7%-85.8%) for the annual screening strategy. No statistically significant difference in sensitivity existed between the 2 methods. →Table 2
【Conclusion】 A limited annual screening strategy for hypertension can improve specificity without sacrificing sensitivity when compared with routine screening at every visit in previously normotensive adults.
― 考察とディスカッション ―
Screening for hypertension is recommended to all adults. But if large numbers of disease-free individuals are screened repeatedly, then even highly specific tests can generate a number of false-positive results, for which patients must undergo further testing. In this article, to reduce the frequency of screening by 60.7%, they could achieve a significant decrease in the false-positive rate from 29.6% to 18.0%. Which strategy would you like to choose?