Effectiveness of blood pressure control outside the medical setting
Effectiveness of blood pressure control outside the medical setting
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DOI：
10.1161/01.hyp.0000250557.63490.55
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发表时间：
2007-01-01
期刊：
影响因子：
8.3
通讯作者：
Ruilope, Luis M.
中科院分区：
文献类型：
--
作者：
Banegas, Jose R.;Segura, Julian;Ruilope, Luis M.
我们研究了在西班牙的初级保健中心接受治疗的大量高血压受试者中，通过使用动态血压监测（ABPM）在诊所外控制血压（BP）的有效性。样本包括12897例接受ABPM治疗的高血压受试者。以2个读数的平均值计算基于动脉的BP。然后在标准化条件下使用SpaceLabs 90207监测仪进行24小时ABPM。共有3047例（23.6%）患者的诊室血压得到控制，6657例（51.6%）患者的日间ABPM得到控制。诊室医生对患者血压控制的抵抗或低估的比例（诊室血压>= 140/90 mm Hg，平均日间动态血压< 135/85 mm Hg）为33.4%，单独办公室控制或高估控制的比例（诊室血压< 140/90 mm Hg，日间平均动态血压< 135/ 85 mm Hg）为5.4%。年龄较大、女性、肥胖或早晨测定血压的患者的血压控制比其同行更常被低估。年轻、男性、非肥胖、吸烟者或夜间血压测定者的血压控制水平更常被高估。基于门诊的高血压控制远优于基于办公室的高血压控制。这向临床医生传达了一个令人鼓舞的信息，即他们实际上做得比基于办公室的数据所证明的更好。然而，办公室BP控制的低估和高估负担仍然显着。医生应该意识到，在一些高血压受试者中，错误估计血压控制的可能性更高。
We studied the effectiveness of blood pressure (BP) control outside the clinic by using ambulatory BP monitoring (ABPM) among a large number of hypertensive subjects treated in primary care centers across Spain. The sample consisted of 12 897 treated hypertensive subjects who had indications for ABPM. Office-based BP was calculated as the average of 2 readings. Twenty-four-hour ABPM was then performed using a SpaceLabs 90207 monitor under standardized conditions. A total of 3047 patients (23.6%) had their office BP controlled, and 6657 (51.6%) were controlled according to daytime ABPM. The proportion of office resistance or underestimation of patients' BP control by physicians in the office (office BP >= 140/90 mm Hg and average daytime ambulatory BP < 135/85 mm Hg) was 33.4%, and the proportion of isolated office control or overestimation of control (office BP < 140/90 mm Hg and average daytime ambulatory BP < 135/ 85 mm Hg) was 5.4%. BP control was more frequently underestimated in patients who were older, female, obese, or with morning BP determination than in their counterparts. BP control was more frequently overestimated in those who were younger, male, nonobese, smokers, or with evening BP determination. Ambulatory-based hypertension control was far better than office-based hypertension control. This conveys an encouraging message to clinicians, namely that they are actually doing better than is evidenced by office-based data. However, the burden of underestimation and overestimation of BP control at the office is still remarkable. Physicians should be aware that the likelihood of misestimating BP control is higher in some hypertensive subjects.