Junichi Ishigami, Hairong Liu, Di Zhao, Ahmed Sabit, Chathurangi H Pathiravasan, Jeanne Charleston, Edgar R Miller, Kunihiro Matsushita, Lawrence J Appel, Tammy M Brady
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引用次数: 0
Abstract
Background: Guidelines emphasize quiet settings for blood pressure (BP) measurement.
Objective: To determine the effect of noise and public environment on BP readings.
Design: Randomized crossover trial of adults in Baltimore, Maryland. (ClinicalTrials.gov: NCT05394376).
Setting: Study measures were obtained in a clinical research office and a public food market near Johns Hopkins University School of Medicine in Baltimore, Maryland.
Participants: 108 community-dwelling adults from the Baltimore, Maryland, area recruited through measurement-screening campaigns, mailings to previous study participants, and referrals from hypertension clinics.
Intervention: Participants were randomly assigned to the order in which they had triplicate BP measurements in each of 3 settings: 1) private quiet office (private quiet [reference]); 2) noisy public space (public loud); and 3) noisy public space plus earplugs (public quiet).
Measurements: Differences in mean BP readings obtained in public loud and public quiet versus private quiet, overall and stratified by baseline systolic BP (SBP), age, and recent health care utilization.
Results: Of the 108 randomly assigned participants, mean age was 56 years (SD, 17), 84% were self-reported Black, 41% were female, and 45% had an SBP of 130 mm Hg or more. The average noise level in public loud was 74 dB and in private quiet was 37 dB. Mean SBPs were: 128.9 mm Hg (SD, 22.3) in private quiet, 128.3 mm Hg (SD, 21.7) in public loud, and 129.0 mm Hg (SD, 22.2) in public quiet. Corresponding diastolic BPs (DBPs) were 74.2 mm Hg (SD, 11.4), 75.9 mm Hg (SD, 11.6), and 75.7 mm Hg (SD, 12.0), respectively. Public-loud and public-quiet BPs had minimal, non-clinically important differences from private quiet BPs: public loud: ΔSBP, -0.66 mm Hg (95% CI, -2.25 to 0.93 mm Hg) and ΔDBP, 1.65 mm Hg (CI, 0.77 to 2.54 mm Hg); public quiet: ΔSBP, 0.09 mm Hg (-1.53 to 1.72 mm Hg) and ΔDBP, 1.45 mm Hg (0.64 to 2.27 mm Hg). The patterns were generally consistent across subgroups.
Limitations: Single-center trial. Imbalance in the numbers and characteristics across the randomly assigned groups.
Conclusion: The BP readings obtained in public spaces were minimally different from BPs obtained in a private office, suggesting that public spaces are reasonable settings to screen for hypertension.
背景：指南强调血压（BP）测量的安静设置。目的：探讨噪声和公共环境对血压的影响。设计：在马里兰州巴尔的摩市进行的成人随机交叉试验。(ClinicalTrials.gov: NCT05394376)。环境：研究测量在马里兰州巴尔的摩市约翰霍普金斯大学医学院附近的临床研究办公室和公共食品市场获得。参与者：108名来自马里兰州巴尔的摩市的社区居住成年人，通过测量筛选活动、给以前的研究参与者的邮件和高血压诊所的转诊招募。干预：参与者被随机分配到他们在三种环境中的每一种环境中进行三次血压测量的顺序：1)私人安静办公室（私人安静[参考]）；2)嘈杂的公共空间（public loud）；3)嘈杂的公共空间加上耳塞（公共安静）。测量方法：在公共场所大声喧哗和公共场所安静与私人安静环境中获得的平均血压读数的差异，根据基线收缩压（SBP）、年龄和最近的医疗保健利用情况进行总体和分层。结果：在108名随机分配的参与者中，平均年龄为56岁（SD， 17岁），84%为黑人，41%为女性，45%的收缩压为130毫米汞柱或更高。公共场所的平均噪音水平为74分贝，私人场所的平均噪音水平为37分贝。安静环境下的平均血压为128.9 mm Hg (SD, 22.3)，公共环境下的平均血压为128.3 mm Hg (SD, 21.7)，安静环境下的平均血压为129.0 mm Hg （SD, 22.2）。相应的舒张压（DBPs）分别为74.2 mm Hg （SD, 11.4）、75.9 mm Hg （SD, 11.6）和75.7 mm Hg （SD, 12.0）。公共场所大声和公共场所安静的bp与私人安静的bp有最小的非临床重要差异：公共场所大声：ΔSBP， -0.66 mm Hg （95% CI, -2.25至0.93 mm Hg）和ΔDBP， 1.65 mm Hg (CI， 0.77至2.54 mm Hg)；公共安静：ΔSBP， 0.09毫米汞柱（-1.53至1.72毫米汞柱）和ΔDBP， 1.45毫米汞柱（0.64至2.27毫米汞柱）。这些模式在各个亚组之间基本一致。局限性：单中心试验。在随机分配的群体中，数量和特征不平衡。结论：在公共场所测得的血压与在私人办公室测得的血压相差极小，提示公共场所是筛查高血压的合理场所。主要资金来源：决心拯救生命。
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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