Myers M G, Haynes R B, Rabkin S W
Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
Am J Hypertens. 1999 Nov;12(11 Pt 1):1149-57. doi: 10.1016/s0895-7061(99)00199-5.
The Canadian Hypertension Society has developed guidelines for the use of ambulatory blood pressure (BP) monitoring in clinical practice. Published articles with the best available levels of evidence were used to support the following recommendations: Physicians should only use ambulatory BP monitoring devices that have been validated independently using established protocols. A decision to withhold drug therapy based upon the ambulatory BP should take into account normal values for 24-h and awake ambulatory BP. Based upon studies on prognosis and a clinical trial based upon BP control as an outcome, ambulatory BP monitoring should be considered for untreated patients whenever an office-induced increase in BP is suspected. Ambulatory BP monitoring should be considered for treated patients suspected of having an office-induced increase in BP, including individuals with apparent resistance to drug therapy, symptoms suggestive of hypotension, and fluctuating office BP readings. Based upon studies on prognosis, changes in nocturnal BP should be taken into account in any decision to withhold drug therapy based upon the ambulatory BP. Further studies are required to determine whether the clinical benefit of antihypertensive therapy is more closely related to ambulatory or office BP.
加拿大高血压协会制定了在临床实践中使用动态血压监测的指南。采用具有最佳现有证据水平的已发表文章来支持以下建议：医生应仅使用已根据既定方案独立验证的动态血压监测设备。基于动态血压而决定停用药物治疗时，应考虑24小时及清醒状态下动态血压的正常值。基于对预后的研究以及一项以血压控制为结果的临床试验，每当怀疑诊室血压升高时，对于未经治疗的患者应考虑进行动态血压监测。对于怀疑有诊室血压升高的接受治疗的患者，包括对药物治疗明显耐药、有低血压症状提示以及诊室血压读数波动的个体，应考虑进行动态血压监测。基于对预后的研究，在基于动态血压决定停用药物治疗的任何决策中，都应考虑夜间血压的变化。需要进一步研究以确定抗高血压治疗的临床益处与动态血压还是诊室血压的关系更为密切。
