Ishikawa Joji, Carroll Deirdre J, Kuruvilla Sujith, Schwartz Joseph E, Pickering Thomas G
Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York 10032, USA.
Hypertension. 2008 Nov;52(5):856-64. doi: 10.1161/HYPERTENSIONAHA.108.115600. Epub 2008 Sep 22.
Home blood pressure (HBP) monitoring is recommended for assessing the effects of antihypertensive treatment, but it is not clear how the treatment-induced changes in HBP compare with the changes in clinic blood pressure (CBP). We searched PubMed using the terms "home or self-measured blood pressure," and selected articles in which the changes in CBP and HBP (using the upper arm oscillometric method) induced by antihypertensive drugs were presented. We performed a systematic review of 30 articles published before March 2008 that included a total of 6794 subjects. As there was significant heterogeneity in most of the outcomes, a random effects model was used for the meta-analyses. The mean changes (+/-SE) in CBP and HBP (systolic/diastolic) were -15.2+/-0.03/-10.3+/-0.03 mm Hg and -12.2+/-0.04/-8.0+/-0.04 mm Hg respectively, although there were wide varieties of differences in the reduction between HBP and CBP. The reductions in CBP were correlated with those of HBP (systolic BP; r=0.66, B=0.48, diastolic BP; r=0.71, B=0.52, P<0.001). In 7 studies that also included 24-hour BP monitoring, the reduction of HBP was greater than that of 24-hour BP in systolic (HBP; -12.6+/-0.06 mm Hg, 24-hour BP; -11.9+/-0.04 mm Hg, P<0.001). In 5 studies that included daytime and nighttime systolic BP separately, HBP decreased 15% more than daytime ambulatory BP and 30% more than nighttime ambulatory BP. In conclusion, HBP falls approximately 20% less than CBP with antihypertensive treatments. Daytime systolic BP falls 15% less and nighttime systolic BP falls 30% less than home systolic BP.
家庭血压（HBP）监测对于评估降压治疗效果具有重要意义，但目前尚不清楚治疗引起的HBP变化与诊所血压（CBP）变化之间的对比情况。我们在PubMed数据库中使用“家庭或自测血压”等关键词进行检索，并挑选出呈现了降压药物引起的CBP和HBP（采用上臂示波法）变化的文章。我们对2008年3月之前发表的30篇文章进行了系统综述，这些文章共纳入6794名受试者。由于大多数结局存在显著异质性，因此采用随机效应模型进行荟萃分析。CBP和HBP（收缩压/舒张压）的平均变化（±标准误）分别为-15.2±0.03/-10.3±0.03 mmHg和-12.2±0.04/-8.0±0.04 mmHg，尽管HBP和CBP降低幅度存在广泛差异。CBP的降低与HBP的降低相关（收缩压；r = 0.66，B = 0.48，舒张压；r = 0.71，B = 0.52，P < 0.001）。在7项同时包含24小时血压监测的研究中，HBP在收缩压方面的降低幅度大于24小时血压（HBP；-12.6±0.06 mmHg，24小时血压；-11.9±0.04 mmHg，P < 0.001）。在5项分别包含日间和夜间收缩压的研究中，HBP下降幅度比日间动态血压多15%，比夜间动态血压多30%。总之，降压治疗后HBP下降幅度比CBP约少20%。日间收缩压比家庭收缩压少下降15%，夜间收缩压比家庭收缩压少下降30%。
