Weber M A
Hypertension Center, Veterans Administration Medical Center, Long Beach, California 90822.
Am J Cardiol. 1988 Oct 5;62(11):97G-102G. doi: 10.1016/0002-9149(88)90040-9.
Whole-day automated monitoring with small portable devices allows the circadian pattern of blood pressure to be assessed conveniently in individual patients. Measurements provided by this technique appear to be more reproducible and physiologically relevant than conventional office readings. Ambulatory monitoring can enhance the evaluation of antihypertensive therapy, especially in clinical trials, in 3 ways. First, it can facilitate the diagnosis of hypertension and avoid potentially inappropriate treatment in patients whose hypertension is erroneously diagnosed by office measurements. Moreover, the monitoring technique appears to prevent placebo responses in therapeutic studies. Second, whole-day monitoring allows clear quantification of treatment effects. Because the standard deviations of treatment-induced blood pressure differences are lower with this method than with conventional readings, valid statistical evaluation of antihypertensive effects can be performed with far fewer patients. Finally, duration of action of drugs can be measured. By dividing the day into sequential periods (typically 12 two-hour periods), it is possible to determine statistical differences between baseline and treatment blood pressure values throughout the dosing intervals of the drugs being tested. This method may be more sensitive than the traditional "peak and trough" approach for assessing duration of action; it is not influenced by unsuspected discrepancies between the pharmacokinetic and pharmacodynamic properties of drugs, and can also provide information on nighttime effects. Thus, automated whole-day blood pressure monitoring appears to be a powerful tool for the evaluation of antihypertensive therapy.
使用小型便携式设备进行全天自动监测，能够方便地评估个体患者的血压昼夜模式。与传统诊室测量相比，该技术提供的测量结果似乎更具可重复性且与生理状况相关。动态血压监测可从三个方面加强对降压治疗的评估，尤其是在临床试验中。首先，它有助于高血压的诊断，避免对诊室测量误诊为高血压的患者进行潜在的不恰当治疗。此外，监测技术似乎能防止治疗研究中的安慰剂反应。其次，全天监测可明确量化治疗效果。由于这种方法导致的治疗引起的血压差异的标准差低于传统测量，因此使用少得多的患者数量就能对抗高血压效果进行有效的统计学评估。最后，可以测量药物的作用持续时间。通过将一天划分为连续的时间段（通常为12个两小时时间段），可以确定在受试药物的给药间隔期间基线血压值和治疗后血压值之间的统计学差异。这种方法在评估作用持续时间方面可能比传统的“峰谷”法更敏感；它不受药物药代动力学和药效学特性之间意外差异的影响，还能提供夜间效应的信息。因此，自动全天血压监测似乎是评估降压治疗的有力工具。
