Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association
Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association
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DOI：
10.1161/cir.0000000000000803
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发表时间：
2020-07-28
期刊：
影响因子：
37.8
通讯作者：
Wozniak, Gregory
中科院分区：
文献类型：
--
作者：
Shimbo, Daichi;Artinian, Nancy T.;Wozniak, Gregory
高血压是普通人群中常见的心血管危险因素，其诊断和管理主要基于办公室血压（BP）的测量。在办公室内测量和在办公室外测量时，血压可能有很大差异，办公室外血压升高与心血管风险增加相关，与办公室血压无关。自我测量的BP监测，由个人在办公室外在家测量BP，是一种经过验证的办公室外BP测量方法。一些国家和国际高血压指南支持自我测量血压监测。适应症包括白大衣高血压和隐匿性高血压的诊断，以及白大衣效应和隐匿性未控制高血压的鉴别。其他适应症包括确认顽固性高血压的诊断和检测早晨高血压。首选使用经验证的自行测量的血压监测设备，并应遵循标准化的血压测量和监测方案。来自随机试验荟萃分析的证据表明，自测血压监测与血压降低和血压控制改善相关，当沿着联合干预时，自测血压监测的获益最大。在办公室血压监测中增加自测血压监测与单独的办公室血压监测或办公室高血压患者的常规护理相比具有成本效益。使用自我测量的BP监测通常由个人和供应商报告。因此，自我测量血压监测在改善美国高血压的诊断和管理方面具有很大的潜力。需要进行随机对照试验，检查自测血压监测对心血管结局的影响。为了充分解决实施自测血压监测的障碍，需要在以下领域进行财政投资：改善个人和提供者的教育和培训，建设卫生信息技术能力，将自测血压读数纳入临床性能指标，支持共同干预，并提高报销。
The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse self-measured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension. Validated self-measured BP monitoring devices that use the oscillometric method are preferred, and a standardized BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP. The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.