Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Division of Cardiology, University of North Carolina at Chapel Hill, CB #7075, Burnett Womack Building, Chapel Hill, NC, 27599-7075, USA.
Curr Hypertens Rep. 2018 Feb 5;20(1):5. doi: 10.1007/s11906-018-0805-y.
To review the data supporting the use of ambulatory blood pressure monitoring (ABPM), and to provide practical guidance for practitioners who are establishing an ambulatory monitoring service.
ABPM results more accurately reflect the risk of cardiovascular events than do office measurements of blood pressure. Moreover, many patients with high blood pressure in the office have normal blood pressure on ABPM-a pattern known as white coat hypertension-and have a prognosis similar to individuals who are normotensive in both settings. For these reasons, ABPM is recommended by the US Preventive Services Task Force to confirm the diagnosis of hypertension in patients with high office blood pressure before medical therapy is initiated. Similarly, the 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline advocates the use of out-of-office blood pressure measurements to confirm hypertension and evaluate the efficacy of blood pressure-lowering medications. In addition to white coat hypertension, blood pressure phenotypes that are associated with increased cardiovascular risk and that can be recognized by ABPM include masked hypertension-characterized by normal office blood pressure but high values on ABPM-and high nocturnal blood pressure. In this review, best practices for starting a clinical ABPM service, performing an ABPM monitoring session, and interpreting and reporting ABPM data are described. ABPM is a valuable adjunct to careful office blood pressure measurement in diagnosing hypertension and in guiding antihypertensive therapy. Following recommended best practices can facilitate implementation of ABPM into clinical practice.
回顾支持使用动态血压监测（ABPM）的相关数据，并为正在建立动态监测服务的临床医生提供实用指南。
ABPM 结果比诊室血压测量更能准确反映心血管事件风险。此外，许多诊室血压升高的患者在 ABPM 中血压正常——这种模式被称为白大衣高血压，其预后与在两种情况下血压均正常的个体相似。基于这些原因，美国预防服务工作组建议在开始药物治疗之前，使用 ABPM 来确认诊室血压升高患者的高血压诊断。同样，2017 年 ACC/AHA 高血压临床实践指南提倡使用诊室外血压测量来确认高血压，并评估降压药物的疗效。除白大衣高血压外，ABPM 还可识别与心血管风险增加相关的血压表型，包括隐匿性高血压——其特征为诊室血压正常但 ABPM 值升高，以及夜间血压升高。在本次综述中，描述了启动临床 ABPM 服务、进行 ABPM 监测以及解释和报告 ABPM 数据的最佳实践。ABPM 是在诊断高血压和指导降压治疗方面，对仔细的诊室血压测量的有益补充。遵循推荐的最佳实践可以促进 ABPM 在临床实践中的应用。
