Prognostic value of ambulatory blood pressure - Current evidence and clinical implications
Prognostic value of ambulatory blood pressure - Current evidence and clinical implications
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DOI：
10.1161/01.hyp.35.3.844
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发表时间：
2000-03-01
期刊：
影响因子：
8.3
通讯作者：
Verdecchia, P
中科院分区：
文献类型：
--
作者：
Verdecchia, P
这篇文章是关于动态血压(ABP)预后价值的现有证据的重要综述。几项基于事件的队列研究表明，ABP改善了心血管风险分层，超过了包括办公室BP在内的传统风险因素。大多数这些研究是在执行ABP监测时未接受治疗的高血压患者中进行的；其他研究是在治疗控制不佳的受试者或普通人群中进行的。在这些研究中，ABP被视为一个连续变量或具有操作风险类别。心血管风险与观察到的动脉压(收缩压、舒张压和脉搏)直接和独立相关，与从白天到晚上的血压下降程度呈负相关。心血管风险也与ABP观察值和办公室BP预测值之间的差异直接相关。白大衣高血压与动态高血压和勺型高血压与非勺型高血压是基于任意操作风险类别的两种分类。无论24小时内ABP的平均值如何，从白天到晚上血压下降迟钝或缺失，将ABP定义为连续变量或操作阈值，也与更差的结果相关。总体而言，这些研究表明，在未经治疗的职业性高血压和顽固性高血压患者中，ABP监测对于完善心血管风险分层特别有价值。现在需要针对总部基地的干预研究。
This article is a critical review of the available evidence on the prognostic value of ambulatory blood pressure (ABP). Several event-based cohort studies have shown that ABP improves cardiovascular risk stratification over and beyond traditional risk factors, including office BP. Most of these studies have been conducted in subjects with essential hypertension who were untreated at the time of execution of ABP monitoring; other studies have been conducted in subjects who were poorly controlled with treatment or in the general population. In these studies, ABP was examined as a continuous variable or with operational risk categories. Cardiovascular risk showed a direct and independent association with the observed ABP (systolic, diastolic, and pulse) and an inverse association with the degree of BP reduction from day to night. Cardiovascular risk was also directly associated with the difference between the observed value of ABP and that predicted from the office BP. White-coat hypertension versus ambulatory hypertension and dippers versus nondippers are 2 classifications based on arbitrary operational risk categories. A blunted or absent BP reduction from day to night, defined with ABP as a continuous variable or with operational thresholds, was also associated with a worse outcome regardless of the average value of ABP during the 24 hours. Overall, these studies indicate that ABP monitoring is particularly valuable to refine cardiovascular risk stratification in untreated subjects with office hypertension and in those with resistant hypertension. Intervention studies targeted at ABP are now needed.