Circulation. 2020 Jul 28;142(4):e42-e63. doi: 10.1161/CIR.0000000000000803. Epub 2020 Jun 22.
The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse self-measured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension. Validated self-measured BP monitoring devices that use the oscillometric method are preferred, and a standardized BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP. The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.
高血压的诊断和管理，作为普通人群中常见的心血管风险因素，主要基于在诊室测量血压（BP）。在诊室测量和在诊室外测量时，BP 可能有相当大的差异，而诊室外的 BP 升高与心血管风险增加独立于诊室 BP。自我测量血压监测，即个体在家庭环境中不在诊室测量血压，是一种经过验证的诊室外 BP 测量方法。几个国家和国际高血压指南都支持自我测量血压监测。其适应证包括白大衣高血压和隐匿性高血压的诊断，以及白大衣效应和隐匿性未控制高血压的识别。其他适应证包括确认难治性高血压的诊断和检测晨峰高血压。首选使用示波法的经过验证的自我测量血压监测设备，并且应该遵循标准化的 BP 测量和监测方案。随机试验荟萃分析的证据表明，自我测量血压监测与 BP 降低和 BP 控制改善相关，当与联合干预措施一起进行时，自我测量血压监测的益处最大。与仅进行诊室 BP 监测或高诊室 BP 个体的常规护理相比，将自我测量 BP 监测添加到诊室 BP 监测中具有成本效益。自我测量 BP 监测的使用在个体和提供者中都有广泛报告。因此，自我测量 BP 监测具有改善美国高血压诊断和管理的巨大潜力。需要进行随机对照试验来检查自我测量 BP 监测对心血管结局的影响。为了充分解决实施自我测量 BP 监测的障碍，需要在以下方面进行财务投资：改善个体和提供者的教育和培训，建立健康信息技术能力，将自我测量 BP 读数纳入临床绩效指标，支持联合干预措施，并增强报销。
