Bioengineering and Chronobiology Laboratory, Atlantic Research Center for Information and Communication Technologies (atlanTTic), University of Vigo, Vigo, Spain -
Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA -
Minerva Med. 2020 Dec;111(6):573-588. doi: 10.23736/S0026-4806.20.06834-2. Epub 2020 Jul 22.
Daytime office blood pressure measurements (OBPM), still recommended and utilized today for diagnosis and management of hypertension and categorization of cardiovascular disease (CVD) risk, fail to reveal clinically important features of the mostly predictable BP 24 h pattern and leads to a large proportion of individuals being misclassified. Most clinical guidelines now recommend ambulatory BP monitoring (ABPM) be applied to adult patients to confirm the OBPM-based diagnosis of hypertension, based on the high prevalence of masked hypertension and masked normotension plus demonstrated significantly better CVD prognostic value of around-the-clock ABPM than daytime OBPM. Nonetheless, there is yet no consensus of which parameter(s) and ABPM thresholds to utilize to diagnose hypertension. Findings of large prospective ABPM-based CVD outcome trials permit prospective evaluation of treatment and other induced changes in OBPM and ABPM during follow-up on CVD risk by incorporating multiple periodic (at least annual) patient ABPM assessments. They indicate: 1) asleep systolic BP (SBP) mean and sleep-time relative SBP decline (dipping) together are the most significant and only BP-derived prognostic markers of CVD risk; accordingly, around-the-clock ABPM should be the recommended method to diagnose true arterial hypertension and accurately assess CVD risk; and (2) treatment-induced lowering of the asleep SBP mean and rise of the sleep-time relative SBP decline towards the normal dipper BP pattern are both significantly protective against CVD events, thus constituting novel therapeutic targets to substantially better reduce CVD risk compared to the traditional approach that targets control of daytime OBPM or awake BP mean.
日间诊室血压测量（OBPM）目前仍被推荐用于高血压的诊断和管理，以及心血管疾病（CVD）风险的分类，但它无法揭示 24 小时血压模式中具有临床意义的特征，导致很大一部分人群被错误分类。大多数临床指南现在建议对成年患者进行动态血压监测（ABPM），以确认基于 OBPM 的高血压诊断，这是基于隐匿性高血压和隐匿性正常血压的高患病率，以及昼夜 ABPM 对心血管预后的显著改善。然而，目前仍未达成共识，即应该使用哪些参数和 ABPM 阈值来诊断高血压。基于前瞻性 ABPM 的 CVD 结局试验的结果允许通过在 CVD 风险的随访中对 OBPM 和 ABPM 进行前瞻性评估，以评估治疗和其他诱导性变化，方法是纳入多次定期（至少每年一次）患者 ABPM 评估。这些试验结果表明：1）睡眠时收缩压（SBP）均值和睡眠时间 SBP 下降（即杓型血压）是 CVD 风险最重要且唯一的血压预后标志物；因此，应推荐使用昼夜 ABPM 来诊断真正的动脉高血压，并准确评估 CVD 风险；2）治疗诱导的睡眠时 SBP 均值降低和睡眠时间相对 SBP 下降向正常杓型血压模式的上升，均显著有助于预防 CVD 事件，因此与传统的以控制日间 OBPM 或清醒时血压均值为目标的方法相比，构成了降低 CVD 风险的新治疗靶点。
