Improving the Detection of Hypertension and its Control

在办公室测量的血压（BP）用于诊断高血压并指导血压管理， 服用降压药的成年人。指南建议在办公室外测量BP， 动态血压监测（ABPM）或家庭血压监测（HBPM），以确认办公室血压，平均 多次拜访支持这一建议的证据是薄弱的，因为大多数先前的研究比较BP ABPM或HBPM与单次访视时测量的办公室血压。指南还建议ABPM应 在24小时内进行，HBPM基于早晨（AM）的2次测量和 在晚上（PM）测量7天。许多指南认可ABPM作为以下方面的参考标准： 门诊BP监测，但很少有数据比较ABPM和HBPM进行了7天。我们 最近完成了一项对400名成年人的研究，比较了3次办公室访视期间通过ABPM测量的血压， HBPM，每项都按照指南推荐的方法进行。研究发现：（1）HBPM上的BP 与左心室质量指数（LVMI）相关，LVMI是靶终末器官损伤的标志物，与办公室无关 （2）诊室血压和ABPM血压与LVMI无关， （3）HBPM比ABPM和诊室血压更可靠（即可重复性），（4）诊室血压更可靠（即可重复性）。 比ABPM更可靠。这些结果提示HBPM上级ABPM和Office的新范式 当同时进行诊室BP和HBPM时，不需要BP和ABPM。然而，没有人在这 一项服用抗高血压药物的研究，很少有老年人参加，少数人有高职位 BP.这些发现需要在更大规模的研究中进行测试，具有更广泛的普遍性。我们计划招收1696名学生 纽约、阿拉巴马州伯明翰和加利福尼亚州洛杉矶筛选收缩压/舒张压<160/100的成年人 mm Hg;其中50%将服用抗高血压药物。样本将根据年龄而多样化 (33各年龄组（18-39岁、40-59岁和≥60岁）、性别（50%女性）、人种/种族（≥25%非西班牙裔 白色、≥25%非西班牙裔黑人、≥25%西班牙裔和≥10%亚裔）和诊室血压水平（诊室血压50% ≥130/80 mm Hg）。将在3次访视时测量诊室血压。将在两个24小时内进行ABPM， HBPM将在两个7天的时间段内每天进行2 AM和2 PM测量。两个标记 将评估靶向终末器官损伤-超声心动图上的LVMI和白蛋白/肌酐比值。我们 将确定使用HBPM的BP是否比办公室BP与靶向终末器官损伤的相关性更强 并在ABPM上显示清醒BP（主要目标1）。我们将确定HBPM是否比办公室BP更可靠， ABPM上的清醒BP（主要目标2）。我们还将使用asleep来确定这些发现是否一致。 血压和24小时血压，而不是清醒血压，并调查年龄，性别， 人种/种族亚组（次要目的）。这项研究将确定测量血压的最佳方法， 诊断和管理高血压，这有可能改善数百万美国成年人的健康。

Blood pressure (BP) measured in the office is used to diagnose hypertension and guide BP management for adults taking antihypertensive medication. Guidelines recommend measuring BP outside of the office using ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM) to confirm office BP, averaged across multiple visits. The evidence supporting this recommendation is weak since most prior studies compared BP on ABPM or HBPM against office BP measured at a single visit. Guidelines also recommend that ABPM be performed over a 24-hour period and HBPM be based on 2 measurements in the morning (AM) and 2 measurements in the evening (PM) for 7 days. Many guidelines endorse ABPM as the reference standard for out-of-office BP monitoring, but there are few data comparing ABPM to HBPM conducted for 7 days. We recently completed a study of 400 adults that compared BP measured during 3 office visits, on ABPM, and HBPM, each conducted following guideline-recommended approaches. The study found (1) BP on HBPM was associated with left ventricular mass index (LVMI), a marker of target end-organ damage, independent of office BP and BP on ABPM, (2) office BP and BP on ABPM were not associated with LVMI, independent of BP on HBPM, (3) HBPM was more reliable (i.e. reproducible) than ABPM and office BP, and (4) office BP was more reliable than ABPM. These results suggest a new paradigm that HBPM is superior to ABPM and office BP, and ABPM is not needed when office BP and HBPM are both performed. However, no one in this study was taking antihypertensive medication, few older adults were enrolled, and a minority had high office BP. These findings need to be tested in a larger study with broader generalizability. We propose to enroll 1,696 adults in New York, NY, Birmingham, AL, and Los Angeles, CA with screening systolic/diastolic BP <160/100 mm Hg; 50% of whom will be taking antihypertensive medication. The sample will be diverse based on age (33% in each age group: 18-39, 40-59, and ≥60 years), sex (50% women), race/ethnicity (≥25% non-Hispanic white, ≥25% non-Hispanic Black, ≥25% Hispanic, and ≥10% Asian), and office BP level (50% with office BP ≥130/80 mm Hg). Office BP will be measured at 3 visits. ABPM will be performed over two 24-hour periods and HBPM will be performed with 2 AM and 2 PM measurements per day over two 7-day periods. Two markers of target end-organ damage – LVMI on echocardiogram and albumin-to-creatinine ratio – will be assessed. We will determine whether BP on HBPM is more strongly associated with target end-organ damage than office BP and awake BP on ABPM (Primary Aim 1). We will determine if HBPM is more reliable than office BP and awake BP on ABPM (Primary Aim 2). We will also determine whether the findings are consistent using asleep BP and 24-hour BP instead of awake BP, and investigate potential differences among age, sex, and race/ethnicity subgroups (Secondary Aims). The study will determine the best approach to measure BP for diagnosing and managing hypertension, which has the potential to improve the health of millions of US adults.