Excellence Center of the European Society of Hypertension, Kerckhoff-Klinik, Bad Nauheim,GermanyInstitute of Sports Science, Department of Sports Medicine, Kiel University, Kiel, Germany.
Dtsch Arztebl Int. 2021 Jul 12;118(27-28):473-478. doi: 10.3238/arztebl.m2021.0158.
The treatment of arterial hypertension can be monitored by office blood pressure (office BP), home blood pressure (home BP), or 24 hours ambulatory blood pressure (ABPM). In this review, we present current recommendations from Germany and from international guidelines as well as the findings of the main studies on the use of these methods to guide treatment.
This review is based on pertinent publications retrieved by a selective search in PubMed up to and including March 2020. Special attention was paid to guidelines and position papers.
The guidelines offer heterogeneous recommendations for treatment monitoring. Home BP is the most reproducible method, with test-retest correlation coefficients of 0.91/0.86 (systolic/diastolic), in comparison to office BP (0.77/0.76). Two meta-analyses revealed better blood pressure control with home measurement than with usual care (systolic, -3.2 to -8.9 mmHg). A meta-analysis of randomized controlled trials also suggests that home measurement promotes adherence. In the randomized and controlled TASMINH4 trial, the home BP group with telemetric surveillance achieved better blood pressure control than the group with treatment titration based on office BP (systolic -4.7 [CI: -7; -2.4] mmHg, diastolic -1.3 [-2.5; 0.02] mmHg). With ABPM, patients frequently reported moderate to severe discomfort, limiting its practical applicability.
Blood pressure measurement at home is recommended for treatment monitoring, using validated, automatic upper arm devices with data storage and trend analysis. Changes of treatment should be based on average values (28 home measurements) from seven days (two morning and two evening measurements per day). Office BP is mainly used for for screening purposes. There have not yet been any randomized trials comparing the three measuring methods in terms of hard cardiovascular endpoints.
动脉高血压的治疗可以通过诊室血压（office BP）、家庭血压（home BP）或 24 小时动态血压监测（ABPM）来监测。在本综述中，我们呈现了德国和国际指南的当前建议，以及这些方法在指导治疗中的主要研究结果。
本综述基于在 PubMed 中进行的选择性搜索检索到的相关出版物，截至 2020 年 3 月。特别关注指南和立场文件。
指南提供了治疗监测的异质建议。家庭血压是最可重复的方法，测试-再测试的相关系数为 0.91/0.86（收缩压/舒张压），而诊室血压为 0.77/0.76。两项荟萃分析显示，家庭测量比常规护理能更好地控制血压（收缩压，-3.2 至-8.9 mmHg）。一项随机对照试验的荟萃分析也表明，家庭测量可提高患者的治疗依从性。在随机对照的 TASMINH4 试验中，具有远程监测功能的家庭血压组比基于诊室血压进行治疗滴定的组血压控制更好（收缩压-4.7[CI：-7；-2.4]mmHg，舒张压-1.3[-2.5；0.02]mmHg）。ABPM 由于患者经常报告中度至重度不适，限制了其实用性。
建议使用经过验证的、具有数据存储和趋势分析功能的自动上臂设备进行家庭血压测量，以进行治疗监测。治疗的改变应基于七天（每天两次早上和两次晚上测量）的平均数值（28 次家庭测量）。诊室血压主要用于筛查目的。目前还没有任何随机试验比较这三种测量方法在硬心血管终点方面的差异。
