Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
Tohoku Institute for Management of Blood Pressure, Sendai, Japan.
Hypertens Res. 2018 Sep;41(9):669-678. doi: 10.1038/s41440-018-0054-0. Epub 2018 May 23.
The definition of diurnal blood pressure changes varies widely, which can be confusing. Short-term blood pressure variability during a 24-h period and the dipping status of diurnal blood pressure can be captured by ambulatory blood pressure monitoring, and these metrics are reported to have prognostic significance for cardiovascular complications. Morning blood pressure surge also indicates this risk, but its effect may be limited to populations with specific conditions. Meanwhile, the combined use of conventional office blood pressure and out-of-office blood pressure allows us to identify people with white-coat and masked hypertension. Current home devices can measure nocturnal blood pressure during sleep more conveniently than ambulatory monitoring; however, we should pay attention to blood pressure measurement conditions regardless of whether they are in a home, ambulatory, or office setting. The relatively poor reproducibility of diurnal blood pressure changes, including the nocturnal fall of blood pressure, is another underestimated issue to be addressed. Although information on diurnal blood pressure changes is expected to be used more effectively in the future, we should also keep in mind that blood pressure levels have remained central to the primary and secondary prevention of blood pressure-related cardiovascular diseases in clinical practice.
日间血压变化的定义差异很大，容易造成混淆。24 小时内的短期血压变异性和日间血压的下降状态可以通过动态血压监测来捕捉，这些指标被报道对心血管并发症具有预后意义。晨峰血压也表明存在这种风险，但它的作用可能仅限于具有特定条件的人群。同时，常规诊室血压和诊室外血压的联合使用可以帮助我们识别白大衣性高血压和隐匿性高血压患者。目前的家用设备可以更方便地测量睡眠期间的夜间血压；然而，无论在家庭、动态还是诊室环境中，我们都应该注意血压测量条件。日间血压变化的可重复性相对较差，包括夜间血压下降，这是另一个被低估的问题。虽然预计未来会更有效地利用日间血压变化的信息，但我们也应该记住，血压水平在临床实践中仍然是原发性和继发性预防与血压相关的心血管疾病的核心。
