偶测血压与动态血压监测结果分析

目的通过对偶测血压与动态血压监测的结果进行分析,探讨高血压可靠的监测方法。方法选择监测动态血压结果与平时偶测血压不同的18例患者资料进行对比分析。结果动态血压监测发现,白天血压正常而夜间高血压者4例;白大衣高血压5例;隐匿性高血压2例。偶测血压评价高血压疗效不准确者6例。结论单纯用偶测血压作为诊断高血压的标准或评价高血压的疗效存在一定的局限性。而动态血压与偶测血压相比,具有方便、变异性小、能监测24h血压等优点;但也有其局限性。     

高血压患者自我血压监测的应用

高血压诊断治疗传统上均根据医生办公室所测血压（ＯＢＰ）。但高血压患者２４小时血压常有较大变异；办公室偶测血压并不能够代表患者２４小时血压情况，而且有相当数量（２０％～３０％）的“白大衣高血压”。动态血压监测（ＡＢＰＭ）和家庭血压监测（ＨＢＰＭ）则弥补...     

动态血压监测老年高血压患者降压治疗效果

偶测血压 (即诊所血压 )是诊断高血压的依据 ,也是临床医生调整指导用药的重要指标 ,但高血压患者虽然经过积极的降压治疗 ,心血管病发生率仅下降 1 9% [1 ] ,有学者指出其可能原因之一是降压不足 ,偶测血压 (诊所血压 )并不能完全反映患者 2 4h的血压控制情况 ,应用 2 4h动态血压监测能更好地反映患者的血压控制情况[2 ] 。本文对 1 0 0例治疗后老年高血压患者进行动态血压检测 ,观察血压控制情况。1　资料和方法1 1　资料 :高血压组 :从 2 0 0 1 4～ 2 0 0 1 1 0来本院疗养的离休老干部中随机抽取 1 0 0例降压治疗中的高血压病患者 ,符…     

动态血压监测苯磺酸左旋氨氯地平治疗轻、中度高血压疗效观察

目的 应用动态血压监测评估苯磺酸左旋氨氯地平对轻、中度高血压降压效果.方法 选择42例轻、中度原发性高血压患者,观察苯磺酸左旋氨氯地平治疗前后的诊所偶测血压、动态血压、白昼和夜间的血压负荷及降压谷峰比率.结果 苯磺酸左旋氨氯地平治疗后偶测血压、动态血压均明显降低(P<0.05或P<0.01),降压疗效总有效率为90.5%.结论 对轻度高血压患者苯磺酸左旋氨氯地平能达到24 h全程平稳降血压,是符合时间诊疗学原理的理想降压药物.     

动态血压监测和高血压靶器官损害关系的研究进展

通过动态血压监测得到的血压昼夜节律、血压变异性、24h动态血压平均水平以及血压负荷都和高血压的靶器官损害有较好的相关性。动态血压监测比偶测血压能更好地预测高血压的心、脑、肾等病变。     

动态血压监测临床应用进展

目的对动态血压监测临床应用进展作一综述.方法查阅国内外文献.结果动态血压在研究白大衣高血压、运动血压及评价降压药物疗效、预测高血压靶器官损害方面优于偶测血压.结论动态血压亦有不足之处,提出了目前动态血压监测的临床应用指征.     

动态血压监测在高血压诊治中的价值

动态血压监测一日内可提供48～192个血压测值,可全面地反映不同环境条件下的血压变化,与常规的偶测血压相比,能更准确地确定高血压的诊断,预示靶器官受损,判断预后,并有助于鉴别原发性和继发性高血压,监测结果有助于决定治疗、选择用药、观察药物疗效与避免药物副作用。     

动态血压监测对于高血压诊治和预后判断的价值

血压易受许多内外因素(如体位、情绪、温度及体力活动等)的影响．24小时的血压波动性很大。临床医师在实践中早就发现诊室中偶测血压(casual blood pressure，CBP)不能完全代表患平时血压的真实情况，明显的存在如下缺陷：(1)测量技术可能不准确；(2)血压固有的变异性无法显出；(3)医师测压时，病人可能受警觉反应的影响导致所测血压常有增高倾向．即所谓“白大衣性高血压”或称为“孤立性诊所高血压”，而错误地将一部分血压正常诊断为高血压。     

动态血压监测的临床应用

全自动无创性动态血压监测仪在受试者完全自由活动情况下监测与记录 2 4 h内上百次的血压测量结果 ,不仅真实地反映了各时间点的血压状况 ,血压昼夜变化的规律 ,而且还可自动编辑提供平均血压、标准差、谷峰血压比和血压负荷等统计指标 ,较偶测血压有诸多优点 ,在临床应用中愈来愈受到关注。1　发现高血压患者　　由于血压有波动 ,偶测血压较易漏诊 ,而 2 4 h动态血压则更有助于及早发现高血压患者。2　明确高血压病的诊断　　动态血压在受检者 2 4 h日常生活环境中测得 ,比偶测值更接近真实 ,且信息量大 ,全面、重复性好和准确性高 ,并可消…     

原发性轻中度高血压与肾性高血压患者血压波动规律观察

无创性动态血压监测较偶测血压更能准确反应患者的24小时血压波动规律及范围,而不同病理条件下的动态血压(ABP)变化已受到许多学者观注。我们对58例原发性轻、中度高血压(原发性高血压)和肾性高血压患者的ABP资料进行分析,以探讨肾性高血压患者24小时血压节律变化,以及ABPM在肾性高血压诊断中的价值。     

Guidance on home blood pressure monitoring: A statement of the HOPE Asia Network

Hypertension is an important modifiable cardiovascular risk factor and a leading cause of death throughout Asia. Effective prevention and control of hypertension in the region remain a significant challenge despite the availability of several regional and international guidelines. Out‐of‐office measurement of blood pressure (BP), including home BP monitoring (HBPM), is an important hypertension management tool. Home BP is better than office BP for predicting cardiovascular risk and HBPM should be considered for all patients with office BP ≥ 130/85 mm Hg. It is important that HBPM is undertaken using a validated device and patients are educated about how to perform HBPM correctly. During antihypertensive therapy, monitoring of home BP control and variability is essential, especially in the morning. This is because HBPM can facilitate the choice of individualized optimal therapy. The evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for HBPM in Asia.     

Evaluation of a short home blood pressure measurement in an outpatient population of hypertensives

Current guidelines suggest the use of home blood pressure monitoring (HBPM) as a method complementary to ambulatory blood pressure monitoring (ABPM) for the identification of arterial hypertension. A cross-sectional study was conducted to evaluate the accuracy of a short HBPM schedule compared with ABPM, and to evaluate to what extent HBPM can replace ABPM. A total of 310 patients who performed ABPM in our hypertension clinic were enrolled between November 2011 and June 2015. They performed a 4-day HBPM schedule, with two readings in the morning and two readings at night. Results showed a moderate correlation between HBPM and ABPM (r = 0.59 for systolic blood pressure (SBP) and r = 0.72 for diastolic blood pressure (DBP)) and moderate diagnostic agreement (area under curve: 0.791 for SBP and 0.857 for DBP). No significant difference was found between first-day average and those of days 2–4. Diagnostic agreement between the two techniques was moderate, supporting the notion that HBPM cannot replace ABPM in the general population. However, we identified two HBPM thresholds, 123/75 and 144/87 mm Hg, through which subjects who may not require further ABPM can be identified.     

Insights on home blood pressure monitoring in Asia: Expert perspectives from 10 countries/regions

Hypertension is one of the most powerful modifiable risk factors for cardiovascular disease. It is usually asymptomatic and therefore essential to measure blood pressure regularly for the detection of hypertension. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to monitor blood pressure and facilitate effective diagnosis of hypertension. It is useful to identify the masked or white‐coat hypertension. There is also increasing evidence that supports the role of HBPM in guiding antihypertensive treatment, and improving treatment compliance and hypertension control. In addition, HBPM has also shown prognostic value in predicting cardiovascular events. Despite these benefits, the use of HBPM in many parts of Asia has been reported to be low. An expert panel comprising 12 leading experts from 10 Asian countries/regions convened to share their perspectives on the realities of HBPM. This article provides an expert summary of the current status of HBPM and the key factors hindering its use. It also describes HBPM‐related initiatives in the respective countries/regions and presents strategies that could be implemented to better support the use of HBPM in the management of hypertension.     

Asian management of hypertension: Current status,home blood pressure,and specific concerns in Taiwan

Approximately 25% of the population in Taiwan has hypertension, and the rate has increased over time. Although age‐standardized cardiovascular mortality has decreased over the last 25 years, the annual stroke incidence has increased, and national health insurance reimbursement for cardiovascular disease (CVD) has grown by 22% over the last 10 years. Automatic oscillometric sphygmomanometer devices are increasingly available and affordable in Taiwan, making this the main method of out‐of‐office blood pressure (BP) measurement. Furthermore, home blood pressure monitoring (HBPM), along with shared informed decision making, could be beneficial in driving changes in health behavior and hypertension management. The 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension recognize that home BP is a stronger predictor of CVD than office BP. Therefore, HBPM is recommended and implementation instructions provided. However, a home BP target that corresponds to the office BP used in the majority of clinical studies has yet to be clearly defined. Care for hypertension in Taiwan takes place more often in the hospital versus primary care setting. Combination therapy, often fixed drug combinations, is needed in 60% of patients to achieve BP control. Calcium channel blockers are the most commonly prescribed agents, followed by angiotensin receptor blockers. Overall, there is still substantial room for improvement in the awareness, treatment, and control rate of hypertension in Taiwan. HBPM has a central diagnostic and prognostic role in the management of hypertension.     

2020 Consensus summary on the management of hypertension in Asia from the HOPE Asia Network

Hypertension professionals from Asia have been meeting together for the last decade to discuss how to improve the management of hypertension. Based on these education and research activities, the Hypertension, brain, cardiovascular and renal Outcome Prevention and Evidence in Asia (HOPE Asia) Network was officially established in June 2018 and includes experts from 12 countries/regions across Asia. Among the numerous research and review papers published by members of the HOPE Asia Network since 2017, publications in three key areas provide important guidance on the management of hypertension in Asia. This article highlights key consensus documents, which relate to the Asian characteristics of hypertension, home blood pressure monitoring (HBPM), and ambulatory blood pressure monitoring (ABPM). Hypertension and hypertension‐related diseases are common in Asia, and their characteristics differ from those in other populations. It is essential that these are taken into consideration to provide the best opportunity for achieving “perfect 24‐hour blood pressure control”, guided by out‐of‐office (home and ambulatory) blood pressure monitoring. These region‐specific consensus documents should contribute to optimizing individual and population‐based hypertension management strategies in Asian country. In addition, the HOPE Asia Network model provides a good example of the local interpretation, modification, and dissemination of international best practice to benefit specific populations.     

Clinical significance of nocturnal home blood pressure monitoring and nocturnal hypertension in Asia

Nocturnal home blood pressure (BP) monitoring has been used in clinical practice for ~20 years. The authors recently showed that nocturnal systolic BP (SBP) measured by a home BP monitoring (HBPM) device in a Japanese general practice population was a significant predictor of incident cardiovascular disease (CVD) events, independent of office and morning home SBP levels, and that masked nocturnal hypertension obtained by HBPM (defined as nocturnal home BP ≥ 120/70 mmHg and average morning and evening BP < 135/85 mmHg) was associated with an increased risk of CVD events compared with controlled BP (nocturnal home BP < 120/70 mmHg and average morning and evening BP < 135/85 mmHg). This evidence revealed that (a) it is feasible to use a nocturnal HBPM device for monitoring nocturnal BP levels, and (b) such a device may offer an alternative to ambulatory BP monitoring, which has been the gold standard for the measurement of nocturnal BP. However, many unresolved clinical problems remain, such as the measurement schedule and conditions for the use of nocturnal HBPM. Further investigation of the measurement of nocturnal BP using an HBPM device and assessments of the prognostic value are thus warranted. Asians are at high risk of developing nocturnal hypertension due to high salt sensitivity and salt intake, and the precise management of their nocturnal BP levels is important. Information and communication technology‐based monitoring devices are expected to facilitate the management of nocturnal hypertension in Asian populations.     

Implementation of Home Blood Pressure Monitoring in Clinical Practice

To investigate the implementation of home blood pressure monitoring (HBPM) guidelines, a phone survey was performed in 366 primary care physicians (PCPs). Of the PCPs, 90% routinely used HBPM for white-coat hypertension, treatment titration, and diagnosis. Thirty percent trusted HBPM more than office measurements. Reported drawbacks were questionable reliability of patients’ reports and devices inaccuracy. Thirty-one percent advised patients on device selection, 38% were aware of validated devices, and 69% reviewed (not averaged) the readings. Seventy-nine percent used higher than recommended threshold for hypertension diagnosis. Although PCPs routinely use HBPM, there are important gaps in their knowledge and educational activities are required.     

Home blood pressure monitoring among Canadian adults with hypertension: Results from the 2009 Survey on Living with Chronic Diseases in Canada

BACKGROUND:

Canadians with hypertension are recommended to use home blood pressure monitoring (HBPM) on a regular basis.

OBJECTIVES:

To characterize the use of HBPM among Canadian adults with hypertension.

METHODS:

Respondents to the 2009 Survey on Living with Chronic Diseases in Canada who reported diagnosis of hypertension by a health professional (n=6142) were asked about blood pressure monitoring practices, sociodemographic characteristics, management of hypertension and blood pressure control.

RESULTS:

Among Canadian adults with hypertension, 45.9% (95% CI 43.5% to 48.3%) monitor their own blood pressure at home, 29.7% (95% CI 41.1% to 46.3%) receive health professional instruction and 35.9% (95% CI 33.5% to 38.4%) share the results with their health professional. However, fewer than one in six Canadian adults diagnosed with hypertension monitor their own blood pressure at home regularly, with health professional instruction, and communicate results to a health professional. Regular HBPM was more likely among older adults (45 years of age and older); individuals who believed they had a plan for how to control their blood pressure; and those who had been shown how to perform HBPM by a health professional – with the latter factor most strongly associated with regular HBPM (prevalence rate ratio 2.8; 95% CI 2.4 to 3.4).

CONCLUSIONS:

Although many Canadians with hypertension measure their blood pressure between health care professional visits, a minority do so according to current recommendations. More effective knowledge translation strategies are required to support self-management of hypertension through home measurement of blood pressure.     

Asian management of hypertension: Current status,home blood pressure,and specific concerns in China

Increasing life expectancy in the population means that the prevalence of hypertension in China will increase over the coming decades. Although awareness and control rates have improved, the absolute rates remain unacceptably low. Cardiovascular disease (CVD) is the biggest killer in China, and sharp increases in the prevalence of CVD risk factors associated with rapid lifestyle changes will contribute to ongoing morbidity and mortality. This highlights the importance of effectively diagnosing and managing hypertension, where home blood pressure monitoring (HBPM) has an important role. Use of HBPM in China is increasing, particularly now that Asia‐specific guidance is available, and this out‐of‐office BP monitoring tool will become increasingly important over time. To implement these recommendations and guidelines, a Web‐based and WeChat‐linked nationwide BP measurement system is being established in China. Local guidelines state that both HBPM and ambulatory blood pressure monitoring should be implemented where available. In China, hypertension is managed most often using calcium channel blockers, followed by angiotensin receptor blockers or angiotensin‐converting enzyme inhibitors. Key barriers to hypertension control in China are low awareness and control rates.     

The impact of changing home blood pressure monitoring cutoff from 135/85 to 130/80 mmHg on hypertension phenotypes

This study investigated the impact of changing abnormal home blood pressure monitoring (HBPM) cutoff from 135/85 to 130/80 mmHg on the prevalence of hypertension phenotypes, considering an abnormal office blood pressure cutoff of 140/90 mmHg. We evaluated 57 768 individuals (26 876 untreated and 30 892 treated with antihypertensive medications) from 719 Brazilian centers who performed HBPM. Changing the HBPM cutoff was associated with increases in masked (from 10% to 22%) and sustained (from 27% to 35%) hypertension, and decreases in white‐coat hypertension (from 16% to 7%) and normotension (from 47% to 36%) among untreated participants, and increases in masked (from 11% to 22%) and sustained (from 29% to 36%) uncontrolled hypertension, and decreases in white‐coat uncontrolled hypertension (from 15% to 8%) and controlled hypertension (from 45% to 34%) among treated participants. In conclusion, adoption of an abnormal HBPM cutoff of 130/80 mmHg markedly increased the prevalence of out‐of‐office hypertension and uncontrolled hypertension phenotypes.