Mancia G, Casadel R, Mutti E, Trazzi S, Parati G
Cattedra di Semeiotica Medica, Università di Milano, Italy.
Am J Med. 1989 Dec 26;87(6B):64S-69S. doi: 10.1016/0002-9343(89)90096-x.
Cuff blood pressure measurements by doctors and self blood pressure measurements by patients reflect imprecisely 24-hour or daytime mean blood pressure values. This limits the physician's ability to diagnose the absence or presence of hypertension. It also limits his ability to evaluate the response to non-pharmacologic interventions or antihypertensive drugs. This is a major disadvantage because the prognosis of hypertensive persons depends to a large extent on the blood pressure attained during treatment. Ambulatory blood pressure monitoring is a valid method for assessing the effectiveness of antihypertensive treatment because it allows the physician: (1) to determine whether the initially elevated blood pressure is reduced under the various circumstances of the patient's lifetime; and (2) to exclude that this reduction is associated with hypotensive events that might interfere with organ nutrition and function during the day and night. However, this approach has a cost that makes its use impractical in clinical practice, except in cases in which there are reasons to suspect very low or excessively high blood pressures in conditions that are out of the reach of sphygmomanometry. Furthermore, the prognostic value of on-treatment ambulatory blood pressures is still unknown. On the other hand, studies on new antihypertensive agents derive great benefits from the use of ambulatory blood pressure monitoring. This is emphasized by the fact that the ambulatory blood pressure values are more reproducible than isolated cuff blood pressure values, allowing the number of patients necessary to establish an antihypertensive effect to be reduced. Furthermore, these values are little affected by placebo influences thus permitting simplification of the study design. Finally, sequential analysis of the data obtained provides accurate information on the duration of the antihypertensive effect, and thus on the optimal posology to be adopted. However, ambulatory blood pressure monitoring does have technical problems. In the case of non-invasive monitoring, the ability to measure blood pressure phasic events and variability is limited. Another problem, which is of greater importance, is that non-invasive blood pressure monitoring devices generate a number of artifactual and imprecise readings. These problems cannot be entirely eliminated by editing the blood pressure tracing.
医生测量的袖带血压和患者自测的血压并不能精确反映24小时或日间平均血压值。这限制了医生诊断高血压是否存在的能力。它还限制了医生评估非药物干预或抗高血压药物疗效的能力。这是一个主要缺点，因为高血压患者的预后在很大程度上取决于治疗期间达到的血压水平。动态血压监测是评估抗高血压治疗效果的有效方法，因为它能让医生：（1）确定初始升高的血压在患者日常生活的各种情况下是否降低；（2）排除这种降低与可能在白天和夜间干扰器官营养和功能的低血压事件有关。然而，这种方法成本较高，使得它在临床实践中不太实用，除非有理由怀疑在血压计无法测量的情况下血压极低或极高。此外，治疗期间动态血压的预后价值仍然未知。另一方面，对新型抗高血压药物的研究从动态血压监测的使用中受益匪浅。动态血压值比单次袖带血压值更具可重复性，这使得确定降压效果所需的患者数量得以减少，这一事实凸显了这一点。此外，这些值受安慰剂影响较小，因此可以简化研究设计。最后，对获得的数据进行序贯分析可提供关于降压效果持续时间的准确信息，从而提供关于应采用的最佳剂量的准确信息。然而，动态血压监测确实存在技术问题。在无创监测的情况下，测量血压相性事件和变异性的能力有限。另一个更重要的问题是，无创血压监测设备会产生一些人为的和不准确的读数。这些问题无法通过编辑血压描记图完全消除。
