Mengden T, Chamontin B, Phong Chau N, Luis Palma Gamiz J, Chanudet X
Medikalische Universitäts-Poliklinik, Bonn, Germany.
Blood Press Monit. 2000 Apr;5(2):111-29.
To review the medical literature regarding the methodology of self-measurement of blood pressure and to provide some practical recommendations regarding protocol and procedure for measurement, documentation and analysis of data, choice and provision of devices and education of patients and physicians.
Technical recommendations regarding measurement of blood pressure do not differ from usual guidelines. Frequency of measurement remains a matter of discussion. At the beginning of the self-measurements of blood pressure and during the titration phase, there should be a 7-day measurement period with two measurement of blood pressure each morning and two measurements in the evening at pre-stipulated times. For long-term observation, a minimum measurement period of 1 week per quarter is required. The minimum number of measurements performed during each period should be a total of 12 readings recorded within seven working days. Depending on individual needs (e.g. poor compliance) or for pharmacologic studies, a higher frequency of readings could be used.
Owing to the lack of reliability of patients' diaries, the use of printer-equipped or memory-equipped devices is advocated. All the recorded data, except those obtained on the first day, must be used for analysis.
Self-measurement of blood pressure should be performed with validated fully automated devices using a brachial cuff. The preference should be given to apparatus offering the possibility of storing and transmitting measurements. Wrist apparatus should be used with caution due to the risk of measurement errors if it is used inappropriately. A manual device should be considered for patients suffering from irregular cardiac rhythms and patients with large or small arm circumferences, since automated devices have not been validated for use in these situations. Reimbursement of hypertensive patients using validated devices should be considered, so long as they are adequately trained and supervised.
In a therapeutic perspective, self-measurement of blood pressure should be performed by trained patients under the supervision of their practitioner. Teaching must be performed by skilled staff in hypertension centers and ultimately in general practice. Self-measurement of blood pressure is to be recommended for any hypertensive patient who is sufficiently motivated to participate in the treatment of his own hypertension. Patients with physical problems or mental disabilities that make them unable to perform or to understand the measuring technique represent the limits of the method. Education of patients must encompass information about hypertension and cardiovascular risk, blood-pressure-measurement procedures, advice on items of equipment and their proper use, protocols, and interpretation of data. A patient's proficiency must be checked before he or she should be considered competent at performing the procedure. Annual reevaluation is required.
回顾关于血压自我测量方法的医学文献，并就测量、数据记录与分析的方案及程序、设备的选择与提供以及患者和医生教育等方面提供一些实用建议。
关于血压测量的技术建议与常规指南并无差异。测量频率仍是一个有待讨论的问题。在血压自我测量开始时以及滴定阶段，应有一个为期7天的测量期，每天早晨测量两次血压，晚上在预先规定的时间测量两次。对于长期观察，每季度至少需要1周的测量期。每个测量期内进行的测量次数最少应为在7个工作日内总共记录12次读数。根据个人需求（如依从性差）或用于药物研究，可以采用更高的读数频率。
由于患者日记的可靠性不足，提倡使用配备打印机或有存储功能的设备。除第一天获得的数据外，所有记录的数据都必须用于分析。
血压自我测量应使用经过验证的、配备臂式袖带的全自动设备进行。应优先选择能够存储和传输测量数据的仪器。如果使用不当，腕式仪器由于存在测量误差的风险，应谨慎使用。对于患有心律失常的患者以及臂围过大或过小的患者，应考虑使用手动设备，因为自动设备尚未在这些情况下得到验证。只要高血压患者经过充分培训和监督，使用经过验证的设备的费用应予以报销。
从治疗角度来看，血压自我测量应由经过培训的患者在其医生的监督下进行。教学必须由高血压中心的专业人员进行，并最终推广至普通医疗实践中。对于任何有足够积极性参与自身高血压治疗的高血压患者，都建议进行血压自我测量。身体有问题或有精神障碍而无法进行或理解测量技术的患者是该方法的局限性所在。对患者的教育必须包括有关高血压和心血管风险的信息、血压测量程序、关于设备及其正确使用的建议、方案以及数据解读。在患者被认为能够胜任该程序之前，必须检查其熟练程度。需要每年进行重新评估。
