Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension.
Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension.
复制标题
动态血压监测可诊断和管理高血压。
DOI：
10.1161/hypertensionaha.120.14591
复制
发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Staessen JA
中科院分区：
文献类型：
--
作者：
Huang QF;Yang WY;Asayama K;Zhang ZY;Thijs L;Li Y;O'Brien E;Staessen JA
本文综述了如何建立动态血压（BP）监测，并推荐作为血压评估和合理使用降压药物的方法。为了建立急需的诊断性动态血压阈值，最初的统计方法演变为对患者和人群的纵向研究，这表明心血管并发症与24小时和夜间血压的关系比与办公室血压的关系更密切。根据动态和办公室血压阈值对个体进行交叉分类的研究确定了白大衣高血压，即在动态血压正常的情况下办公室血压升高为低风险状况，而其对应的隐性高血压的风险几乎与动态血压合并办公室高血压一样高。临床上最重要的是24小时和夜间血压的水平，而来自24小时动态血压记录的其他血压指数，在24小时和夜间血压水平之上，对风险分层或高血压管理几乎没有帮助。动态血压监测具有成本效益。门诊和家庭血压监测是免费的方法。它们的可扩展性为门诊BP测量的临床实施提供了很大的通用性。我们仍在等待来自随机临床试验的证据，以证明在调整抗高血压药物治疗和预防心血管并发症方面，门诊血压监测优于门诊血压监测上级。一个起始的研究线，可穿戴BP监测设备的标准化验证协议的开发，可能会促进动态BP监测的临床适用性。
This review portrays how ambulatory blood pressure (BP) monitoring was established and recommended as the method of choice for the assessment of BP and for the rational use of antihypertensive drugs. To establish much-needed diagnostic ambulatory BP thresholds, initial statistical approaches evolved into longitudinal studies of patients and populations, which demonstrated that cardiovascular complications are more closely associated with 24-hour and nighttime BP than with office BP. Studies cross-classifying individuals based on ambulatory and office BP thresholds identified white-coat hypertension, an elevated office BP in the presence of ambulatory normotension as a low-risk condition, whereas its counterpart, masked hypertension, carries a hazard almost as high as ambulatory combined with office hypertension. What clinically matters most is the level of the 24-hour and the nighttime BP, while other BP indexes derived from 24-hour ambulatory BP recordings, on top of the 24-hour and nighttime BP level, add little to risk stratification or hypertension management. Ambulatory BP monitoring is cost-effective. Ambulatory and home BP monitoring are complimentary approaches. Their interchangeability provides great versatility in the clinical implementation of out-of-office BP measurement. We are still waiting for evidence from randomized clinical trials to prove that out-of-office BP monitoring is superior to office BP in adjusting antihypertensive drug treatment and in the prevention of cardiovascular complications. A starting research line, the development of a standardized validation protocol for wearable BP monitoring devices, might facilitate the clinical applicability of ambulatory BP monitoring.