诊室血压、动态血压及家庭血压测量对于高血压患者诊断和管理的研究进展  

Home versus ambulatory versus office blood pressure monitoring in diagnosis and management of hypertension

作　　者：徐芳芳 刘迪雅 李瑶 张毅[2] XU Fangfang;LIU Diya;LI Yao;ZHANG Yi(Medical College of Tongji University,Shanghai,200092,P.R.China;Department of Cardiovascular,The 10th People's Hospital Affiliated to Tongji University,Shanghai 10th People's Hospital,Shanghai,200070,P.R.China)

机构地区：[1]同济大学医学院,上海200092 [2]同济大学附属第十人民医院/上海市第十人民医院心血管内科,上海200070

出　　处：《中国循证医学杂志》2020年第2期207-213,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的比较诊室血压测量(OBPM)、动态血压测量(ABPM)及家庭血压测量(HBPM)在高血压患者诊断和管理等方面的异同性,得出最优血压识别和管理模式。方法对OBPM、ABPM和HBPM在高血压患者诊断中的性价比、对靶器官损害的预测意义、预测慢性肾脏病(CKD)患者的不良结局和进展及血压变异性(BPV)等不同方面进行比较。结果与OBPM相比,ABPM在初步诊断高血压上性价比最高,HBPM在高血压患者的长期自我管理方面性价比最优。在高血压人群中,HBPM和ABPM在预测心血管事件、脑卒中、终末期肾脏病及全因死亡率等不良结局方面比OBPM有着更高的临床价值,且HBPM在临床实践中更有优势。对于肾功能不全的高血压患者,将ABPM和HBPM所得血压值控制在目标范围之内,有利于延缓患者肾功能不全的进展,降低其心血管事件的发生风险,并且减少患者长期透析治疗的需要,其中ABPM更胜一筹。OBPM、ABPM和HBPM得出的BPV都具有预测心血管事件的意义,然而HBPM表现更为突出。结论与OBPM相比,ABPM在初步诊断高血压及CKD患者的血压控制上最优;HBPM在预测靶器官损害、评估BPV及高血压的长期管理中临床实际运用价值最高。Objectives To compare home blood pressure monitoring(HBPM)versus ambulatory blood pressure monitoring(ABPM)versus office blood pressure monitoring(OBPM)in diagnosis and management of hypertension,so as to identify the optimal blood pressure measurement and management.Methods The following were compared among three BP monitoring,such as cost-effectiveness,prognostic value of target organ damage(TOD),predictive value of the progress in chronic kidney disease(CKD)and blood pressure variety(BPV).Results Compared to OBPM,ABPM was the most cost-effective method in the primary diagnosis of hypertension.However,HBPM was the optimal method in long-term and self-management in hypertension.In hypertensives,compared to OBPM,HBPM and ABPM,especially HBPM,had a stronger predictive value for cardiovascular events,stroke,end-stage renal dysfunction(ESRD)and all-cause mortality.In hypertensives with renal dysfunction,controlling HBPM and ABPM,especially controlling ABPM,was an effective way to delay the progress in renal dysfunction,decrease cardiovascular events,and requirements of dialysis.All BPV derived from OBPM,ABPM and HBPM had a predictive significance of cardiovascular events with HBPM BPV having optimal performance.Conclusions Compared to OBPM,ABPM is the optimal method in primary diagnosis of hypertension and BP control in CKD patients,while HBPM is the optimal method in predicting and evaluating BPV,as well as in long-term and self-management in hypertension.

关 键 词：诊室血压测量 家庭血压测量 动态血压测量 高血压 诊断 高血压靶器官损害 自我管理 

分 类 号：R544.1[医药卫生—心血管疾病]