Hypertension Clinic, Department of Internal Medicine, Hospital Clinico, University of Valencia, Valencia, Spain.
Fam Pract. 2012 Aug;29(4):421-6. doi: 10.1093/fampra/cmr121. Epub 2011 Dec 26.
The morning blood pressure (BP) surge is associated with a peak increase in vascular events.
The aim of this observational study was to evaluate morning BP control in treated hypertensive patients using home BP (HBP) monitoring and to compare these findings with clinic BP control.
Clinic BP was measured twice during a 2-week period, prior to medication. Seated HBP was measured, using a BHS-validated device, three times per day over a 2-week period. Assessments included morning (06:00-11:59), lunch time (12:00-14:00) and evening (18:00-22:00) HBP control (all <135/85 mmHg) and clinic BP (<140/90 mmHg) control.
A total of 15618 patients were assessed. At baseline (Day 1 and Week 1), clinic BP control (<140/90 mmHg) and morning HBP control (<135/85 mmHg) were low: 23.6% and 21.9%, respectively. The percentage of patients with both clinic BP and morning HBP control was extremely low (8.5%). Similar values were obtained at lunch time (11.3%) and evening (9.9%). There was a slight improvement at the end of the second week, but values remained low. At final visit (Day 4 and Week 2), morning, lunch time and evening HBP control was observed in 31.8%, 42.2% and 36.4% of patients, respectively. Clinic BP control was observed in 41.7%.
Morning HBP control was low in this large hypertensive population. The improvement in BP control observed may be associated with inclusion in a study; this could indicate low medication compliance in general practices but may also be attributable to the use of agents that cannot sustain 24-hour BP control.
清晨血压（BP）飙升与血管事件高峰增加有关。
本观察性研究旨在使用家庭血压（HBP）监测评估治疗高血压患者的清晨 BP 控制情况，并将这些发现与诊所 BP 控制进行比较。
在服药前的两周内，两次测量诊所 BP。使用 BHS 验证的设备，在两周内每天测量三次 HBP。评估包括清晨（06:00-11:59）、午餐时间（12:00-14:00）和傍晚（18:00-22:00）HBP 控制（均<135/85mmHg）和诊所 BP（<140/90mmHg）控制。
共评估了 15618 名患者。在基线（第 1 天和第 1 周）时，诊所 BP 控制（<140/90mmHg）和清晨 HBP 控制（<135/85mmHg）均较低，分别为 23.6%和 21.9%。诊所 BP 和清晨 HBP 均得到控制的患者比例极低（8.5%）。午餐时间和傍晚时也获得了类似的数值（11.3%和 9.9%）。在第二周结束时，情况略有改善，但数值仍然较低。在最后一次就诊（第 4 天和第 2 周）时，分别有 31.8%、42.2%和 36.4%的患者观察到清晨、午餐时间和傍晚的 HBP 得到控制，分别有 41.7%的患者观察到诊所 BP 得到控制。
在这个大型高血压人群中，清晨 HBP 控制不佳。观察到的 BP 控制改善可能与纳入研究有关；这可能表明一般实践中药物依从性低，但也可能归因于使用不能维持 24 小时 BP 控制的药物。
