Bailey B, Carney S L, Gillies A A, Smith A J
Faculty of Medicine & Health Sciences Department, Newcastle, NSW, Australia.
J Hum Hypertens. 1999 Feb;13(2):147-50. doi: 10.1038/sj.jhh.1000758.
Blood pressure self-measurement is increasing in most communities and yet its role in the management of hypertension is poorly understood. This study was devised to evaluate the behaviour of doctors in general practice when treating patients with poorly controlled essential hypertension who use self-measurement. Patients, most of whom were already taking antihypertensive medications were commenced on perindopril or indapamide at their doctor's discretion and were randomly allocated to self-measurement (SM) using an OMRON HEM706 oscillometric device or a continuation of their usual care (UC) over an 8-week period. This was an observational study without any specific or set treatment goals for the doctor to follow. Sixty of 62 subjects completed the study and the two groups were equally matched for age, body mass index, gender, and blood pressure (BP). While additional perindopril or indapamide produced a significant fall in BP in both groups over the study period, the systolic pressure remained significantly higher in the SM group (sitting 148 +/- 3 compared with 142 +/- 3; 145 +/- 3 compared with 138 +/- 3 mm Hg respectively; P < 0.05). Twenty-four hour and daytime ambulatory monitor systolic pressures were also significantly higher in the SM group. Differences in diastolic BP were not statistically significant. Furthermore, SM patients were less likely to have their medications increased and more likely to have them reduced or ceased. Doctors and patients found self-measurement convenient and useful. This study suggests that doctors prescribing decisions are influenced by evidence from self-measurement of BP with consequential increases in office BP related to reduced drug use. While self-BP measurement can offer reassurance about adequacy of control when away from a physicians office, our best evidence of understanding target blood pressures comes from large randomised studies using office blood pressures as an end-point. There is an urgent need for further study to provide arbitration between self-measurement and office blood pressures although each measurement must contribute to the management of hypertension.
在大多数社区，血压自我测量的情况日益普遍，但其在高血压管理中的作用却鲜为人知。本研究旨在评估全科医生在治疗使用自我测量法的原发性高血压控制不佳患者时的行为。患者大多已在服用抗高血压药物，由医生酌情决定开始使用培哚普利或吲达帕胺治疗，并随机分为两组，一组使用欧姆龙HEM706示波装置进行自我测量（SM），另一组在8周内继续常规护理（UC）。这是一项观察性研究，没有为医生设定任何具体的治疗目标。62名受试者中有60名完成了研究，两组在年龄、体重指数、性别和血压（BP）方面匹配良好。在研究期间，虽然额外使用培哚普利或吲达帕胺使两组的血压均显著下降，但SM组的收缩压仍显著较高（坐位时分别为148±3与142±3；145±3与138±3 mmHg；P<0.05）。SM组的24小时和日间动态监测收缩压也显著较高。舒张压的差异无统计学意义。此外，SM组患者增加药物剂量的可能性较小，而减少或停用药物的可能性较大。医生和患者都认为自我测量方便且有用。本研究表明，医生的处方决策受到血压自我测量证据的影响，导致与减少药物使用相关的诊室血压升高。虽然自我血压测量可以在离开医生办公室时为控制是否充分提供 reassurance，但我们对目标血压的最佳理解证据来自以诊室血压为终点的大型随机研究。迫切需要进一步研究以在自我测量和诊室血压之间进行仲裁，尽管每种测量都必须有助于高血压的管理。
