动态血压监测与高血压预防及早期干预

目的随着动态血压测量方法的应用,使人们对血压的易变性、环境刺激对血压的影响、区别高危和低危患者以及降压治疗效果的观察方面有了许多新的认识,为此,作者分析了近几年动态血压监测与高血压的预防和早期干预相关研究内容.资料来源应用计算机检索Medline 1993-01/2002-01的相关文章,检索词"Ambulatory blood pressure monitoring,Hypertension,Life satisfaction,effect factors,blood pressure monitored",并限定语言种类为英文.资料选择对资料进行初审,选出包含研究目的的文献,纳入标准①已确诊的原发性高血压患者、继发性高血压患者和临界血压者的现况调查、随机对照临床试验和综述.②临床试验研究包含平行对照组;排除重复性实验.资料提炼共纳入20篇关于动态血压监测与高血压的预防和早期干预的文章,7个试验符合纳入标准,排除13篇试验中,有10篇与研究目的相关性不大,其余3篇是重复研究.资料综合动态血压监测评价降压药物治疗过程中休息、情绪变化及活动和睡眠等各种情况下,血压总体水平以及药物作用高峰与持续时间.根据服药后的峰效应(服一个剂量后舒张压或收缩压最大降低幅度)和谷效应(一个剂量结束时降低幅度)以及二者之间的关系,拟定药物的安全剂量及服药时间,要保持降压峰谷比值在60%以上,才能保证24 h之内平稳降压作用,有利于个体化治疗.结论动态血压监测可决定高血压患者是否需要接受早期干预,评价疔效,在预测高血压并发症的发生方面也是一个独立的重要因素.通过24 h动态血压监测,可以明确高血压的类型,而且让患者随时了解其血压波动的规律,避免夜间睡眠中血压过度的下降,更好地预防脑卒中等严重并发症的发生.另一方面动态血压监测还可判断高血压的严重程度,了解其血压变异性和昼夜节律,进行早期干预,指导其准确用药和规律生活.

Significance of ambulatory blood pressure monitoring in the prevention and early intervention of hypertension

OBJECTIVE: The application of ambulatory blood pressure monitoring (ABPM) has been a great impetus to clinical hypertension research in respect of the liability, differentiation between high-risk and low-risk patients and the therapeutic effect of antihypertensive drugs. Therefore, in this study we reviewed recent research on ABPM in the prevention and early intervention of hypertension.DATA SOURCF: Related articles were retrieved by computer in the Medline between January 1993 and January 2002, with the key words of 'ambulatory blood pressure monitoring', 'hypertension', 'life satisfaction', 'effect factors'and 'blood pressure monitoring' and the language confined to English.STUDY SELECTION: After the first trial, literature containing research randomized controlled clinical trial and review on the confirmed primary,allel control group. Repetitive studies were excluded.DATA EXTRACTION: We selected a total of 20 articles on the association of ABPM with the prevention and early intervention of hypertension, 7of which accorded with the inclusion criteria. The other 13 articles were excluded because 10 of them had little relevance to the objective of our study and 13 were repetitive studies.DATA SYNTHESIS: ABPM was used to assess general BP profile, the peak level of drug action and lasting time under various states, such as resting, instable emotion, as well as movement and sleep. Then the safe dosage and medication time were draw up according to the peak-effect (the maximum decrement of diastolic pressure and systolic pressure after a dosage administration) and the valley effect (the decreasing amplitude when completing a dosage medication), as well as the relationship between them, aiming to keep the antihypertensive peak-to-valley ratio above 60%,which guaranteed the stable antihypertensive effect within 24 hours and was beneficial to the individualized treatment.CONCLUSION: ABPM can decide whether patients with hypertension need earlier intervention, and has been used in the assessment of therapeutic effect. It is also considered as an important independent predictor for the occurrence of hypertension complications. Twenty-four hours ABPM can not only determine the type of hypertension, but also keep the patients informed of their BP fluctuation profile at any time in order to avoid hypotension when sleeping, thus helping prevent severe hypertension complications such as stroke. Furthermore, ABPM can predict the severity of hypertension, and BP variation and day-night fluctuation, which provides guidance for the early intervention, correct medication and regular life.