Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Monza, Milan, Italy.
EuroIntervention. 2013 May;9 Suppl R:R35-41. doi: 10.4244/EIJV9SRA7.
Since their introduction in the clinical setting home and ambulatory blood pressure measurements have gained growing popularity in the diagnosis and treatment of essential hypertension for a number of reasons. These reasons include: 1) the lack of the so-called "white-coat effect", 2) the ability of the two approaches to provide information on blood pressure phenomena of prognostic value, and 3) the close relationship of the derived values with the risk of developing fatal and non-fatal cardiovascular events. These features also apply to resistant hypertension, in which these approaches allow a precise definition of the diagnosis of this clinical condition, by excluding the presence of white-coat hypertension. Assessment of "out-of-office" blood pressure also allows us to define the patterns of blood pressure variability in this clinical condition as well as its relationships with target organ damage. Finally, home as well as ambulatory blood pressure measurements allow us to investigate the effects of therapeutic interventions, including those associated with the radiofrequency ablation of renal nerves. The present paper will provide a critical review of the main features of home and ambulatory blood pressure measurement in resistant hypertension, highlighting their main advantages as compared to office blood pressure. The prognostic significance, relationships with target organ damage and implications for treatment will also be discussed.
由于其在临床环境中的应用，家庭和动态血压测量在原发性高血压的诊断和治疗中越来越受欢迎，原因如下：1）缺乏所谓的“白大衣效应”；2）这两种方法提供与预后相关的血压现象信息的能力；3）衍生值与致命和非致命心血管事件风险的密切关系。这些特征也适用于耐药性高血压，这两种方法通过排除白大衣高血压的存在，允许对这种临床情况进行精确的诊断。评估“非诊室”血压也可以定义这种临床情况下血压变异性的模式及其与靶器官损伤的关系。最后，家庭和动态血压测量使我们能够研究治疗干预的效果，包括与肾神经射频消融相关的干预效果。本文将对耐药性高血压中家庭和动态血压测量的主要特征进行批判性回顾，突出其与诊室血压相比的主要优势。还将讨论其预后意义、与靶器官损伤的关系以及对治疗的影响。
