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 成人服用降压药。指南建议在办公室外使用 动态血压监测(ABPM)或家庭血压监测(HBPM)以确认办公室血压，平均为 多次访问。支持这一建议的证据很弱，因为之前的大多数研究都将英国石油公司 在ABPM或HBPM上相对于办公室BP在一次访问中测量。指导方针还建议将ABPM 在24小时内执行，HBPM基于上午(AM)和2点的两次测量 连续7天的夜间测量(PM)。许多指南认可ABPM作为以下方面的参考标准 不在办公室的血压监测，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次办公室访问期间在ABPM上测量的BP，以及 HBPM，每个都按照指南推荐的方法进行。研究发现(1)HBPM上的BP是 与左心室质量指数(LVMI)相关，LVMI是靶器官终末损害的标志，独立于办公室 ABPM上的BP和BP，(2)ABPM上的办公室BP和BP与LVMI无关，独立于 HBPM，(3)HBPM比ABPM和办公室BP更可靠(即可重复性)，以及(4)办公室BP更可靠 比ABPM更可靠。这些结果提出了一种新的范式，即HBPM优于ABPM和OFFICE 当同时执行办公室BP和HBPM时，不需要BP和ABPM。然而，在这件事上没有人 这项研究是在服用降压药的情况下进行的，很少有老年人参加，少数人拥有高级职位 BP。这些发现需要在具有更广泛普适性的更大规模的研究中进行测试。我们建议招收1,696人 纽约、纽约、伯明翰、亚利桑那州伯明翰和加利福尼亚州洛杉矶的成年人进行收缩压/舒张压筛查；160/100 其中50%的人将服用降压药。样本将根据年龄不同而不同 (33%在每个年龄段：18-39岁、40-59岁和≥60岁)，性别(50%女性)，种族/民族(≥25%非西班牙裔 白人，≥25%非西班牙裔黑人，≥25%西班牙裔，≥10%亚洲人)，以及办公室BP水平(50%与办公室BP ≥130/80毫米汞柱)。办公室BP将在3次访问中进行测量。ABPM将分两个24小时进行， HBPM将在两个7天的时间段内每天进行上午2点和下午2点的测量。两个标志物 将评估目标终末器官损害-超声心动图上的左心室重量指数和白蛋白/肌酐比率。我们 将确定HBPM上的BP是否比办公室BP与靶器官损害的相关性更强 和在ABPM上唤醒BP(主要目标1)。我们将确定HBPM是否比办公室BP更可靠 在ABPM上唤醒BP(主要目标2)。我们还将确定使用休眠的研究结果是否一致 血压和24小时血压，而不是清醒血压，并调查年龄、性别和 种族/民族分组(次级目标)。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.