Parati Gianfranco, Omboni Stefano
Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy.
Blood Press Monit. 2010 Dec;15(6):285-95. doi: 10.1097/MBP.0b013e328340c5e4.
Despite the increasing use of home blood pressure monitoring (HBPM) in daily practice and the growing awareness in the scientific community about its positive impact on the diagnostic and therapeutic management of patients with high blood pressure (BP), the potential advantages offered by HBPM have not yet been fully exploited. Indeed, use of the information offered by HBPM is often incomplete and imprecise, with the BP values reported by patients in handwritten logbooks being frequently inaccurate, illegible to physicians, or unreliable. Although a practical solution for improvement may come from the use of devices equipped with a storage memory, a step forward in this regard has been taken more recently with the introduction and refinement of systems for the remote telemonitoring of BP values measured at home. However, although several studies have provided evidence on the clinical usefulness of HBPM, only limited data are available on the clinical impact of home blood pressure (HBP) telemonitoring, because of a number of reasons. First, most of the available studies are characterized by a small sample size, and in some cases, the patients were neither randomized nor even matched with a control group. Moreover, technological solutions used in the different studies carried out so far are often heterogeneous, some of them being particularly difficult to use for the patients, thus limiting the effectiveness of the results. BP monitoring programmes, number of BP readings and transmission schedules are often different among the various studies. In addition, patient selection criteria are different from study to study. Finally, different study objectives and important diversities in the types of centres involved (ranging from general practices, to specialists' offices, hospitals or university centres) may have also influenced the quality of results. Large-scale randomized controlled studies, based on easy-to-use technologies, are thus still needed to show the superiority and clinical usefulness of HBP telemonitoring as compared with conventional HBPM. This study summarizes the evidence available on the clinical usefulness and current limitations of this approach, highlighting the results of meta-analyses and randomized controlled trials on this issue. The role of HBP teletransmission in the context of integrated patients' management programmes is also addressed, with indications for further progress in this field.
尽管家庭血压监测（HBPM）在日常实践中的使用日益增加，且科学界对其对高血压（BP）患者诊断和治疗管理的积极影响的认识也在不断提高，但HBPM所提供的潜在优势尚未得到充分利用。事实上，对HBPM所提供信息的使用往往不完整且不准确，患者手写日志中记录的血压值常常不准确、医生难以辨认或不可靠。虽然配备存储记忆功能的设备可能是一种改进的实际解决方案，但最近在这方面向前迈进了一步，即引入并完善了用于远程遥测在家测量的血压值的系统。然而，尽管多项研究已提供证据证明HBPM的临床实用性，但由于多种原因，关于家庭血压（HBP）遥测的临床影响的数据仍然有限。首先，大多数现有研究的样本量较小，在某些情况下，患者既未随机分组，甚至也未与对照组匹配。此外，迄今为止进行的不同研究中所使用的技术解决方案往往各不相同，其中一些对患者来说特别难以使用，从而限制了结果的有效性。不同研究中的血压监测方案、血压读数数量和传输时间表往往不同。此外，患者选择标准因研究而异。最后，不同的研究目标以及所涉及中心类型的重大差异（从普通诊所到专科医生办公室、医院或大学中心）也可能影响了结果的质量。因此，仍需要基于易于使用的技术进行大规模随机对照研究，以证明与传统HBPM相比，HBP遥测的优越性和临床实用性。本研究总结了关于这种方法的临床实用性和当前局限性的现有证据，突出了关于此问题的荟萃分析和随机对照试验的结果。还讨论了HBP远程传输在综合患者管理计划中的作用，并指出了该领域进一步发展的方向。
