Background: In practice there is no definite clinical value of grading by casual blood pressure(CBP) and it is need to put forward new Suggestions.
Methods: According to the method of three grades by CBP, blood pressure of 270 hypertensives without treatment were graded by three patterns: 4 times of CBP per day(pattern A), 2 times of CBP that not on the same day(pattern B) and 4 times from randomized daily ambulatory blood pressure(pattern C), and then repeatability were compared.
Results: (1), In pattern A: BP gradings on the same level in total of 4 times of CBP were 18.50% (50/270 cases), BP gradings between two levels were 38.20% (103/270 cases), BP gradings between three levels were 43.30% (117/270 cases), total of BP gradings between two to three levels were 81.50% (220/270 cases); (2), In pattern B: BP gradings were respectively 25.19% (68/270 cases), 41.48% (112/270 cases), 33.33% (90/270 cases), 74.81% (202/270 cases); (3), In pattern C: BP gradings were respectively 23.70% (64/270 cases), 38.89% (105/270 cases), 37.41% (101/270 cases), 76.30% (206/270 cases).
Conclusion: The repeatability of blood pressure gradings judgment are very poor all of above three patterns, and were no clinical value. New recommendations are: (1) It is necessary to classified into stages by target organ damage in hypertensives without ABPM, and not necessary to do grading of CBP; The stages include the phase of pure high blood pressure, the phase of high blood pressure with compensatory target organ damage, the phase of high blood pressure with decompensated target-organ damage; (2) It is necessary not only to classified into stages by target organ damage in hypertensives with ABPM but also necessary to do grading by average ambulatory blood pressure in daytime and nighttime respectively.
Key words: hypertension; casual blood pressure; Ambulatory blood pressure; grading; Stage; proposals.