Cloutier Lyne, Daskalopoulou Stella S, Padwal Raj S, Lamarre-Cliche Maxime, Bolli Peter, McLean Donna, Milot Alain, Tobe Sheldon W, Tremblay Guy, McKay Donald W, Townsend Raymond, Campbell Norm, Gelfer Mark
Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
Divisions of General Internal Medicine and Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada.
Can J Cardiol. 2015 May;31(5):620-30. doi: 10.1016/j.cjca.2015.02.014. Epub 2015 Feb 19.
Accurate blood pressure measurement is critical to properly identify and treat individuals with hypertension. In 2005, the Canadian Hypertension Education Program produced a revised algorithm to be used for the diagnosis of hypertension. Subsequent annual reviews of the literature have identified 2 major deficiencies in the current diagnostic process. First, auscultatory measurements performed in routine clinical settings have serious accuracy limitations that have not been overcome despite great efforts to educate health care professionals over several years. Thus, alternatives to auscultatory measurements should be used. Second, recent data indicate that patients with white coat hypertension must be identified earlier in the process and in a systematic manner rather than on an ad hoc or voluntary basis so they are not unnecessarily treated with antihypertensive medications. The economic and health consequences of white coat hypertension are reviewed. In this article evidence for a revised algorithm to diagnose hypertension is presented. Protocols for home blood pressure measurement and ambulatory blood pressure monitoring are reviewed. The role of automated office blood pressure measurement is updated. The revised algorithm strongly encourages the use of validated electronic digital oscillometric devices and recommends that out-of-office blood pressure measurements, ambulatory blood pressure monitoring (preferred), or home blood pressure measurement, should be performed to confirm the diagnosis of hypertension.
准确测量血压对于正确识别和治疗高血压患者至关重要。2005年，加拿大高血压教育计划制定了一种修订算法，用于高血压的诊断。随后对文献的年度回顾发现了当前诊断过程中的两个主要缺陷。首先，在常规临床环境中进行的听诊测量存在严重的准确性限制，尽管多年来大力对医疗保健专业人员进行教育，但这些限制仍未克服。因此，应使用听诊测量的替代方法。其次，最近的数据表明，必须在诊断过程中更早且系统地识别白大衣高血压患者，而不是临时或自愿地识别，这样他们就不会不必要地接受抗高血压药物治疗。本文回顾了白大衣高血压的经济和健康后果。本文介绍了用于诊断高血压的修订算法的证据。回顾了家庭血压测量和动态血压监测的方案。更新了自动诊室血压测量的作用。修订后的算法强烈鼓励使用经过验证的电子数字示波装置，并建议进行诊室外血压测量、动态血压监测（首选）或家庭血压测量，以确认高血压的诊断。
