School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia.
Hypertension in Africa Research Team, MRC Unit for Hypertension and CVD, North-West University, Potchefstroom, South Africa.
Nat Rev Cardiol. 2022 Oct;19(10):643-654. doi: 10.1038/s41569-022-00690-0. Epub 2022 Apr 19.
Current hypertension guidelines recommend using the average values of several blood pressure (BP) readings obtained both in and out of the office for the diagnosis and management of hypertension. In-office BP measurement using an upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets. However, out-of-office BP evaluation using 24 h ambulatory or home BP monitoring is recommended by all major medical associations for obtaining further insights into the BP profile of an individual and how it relates to their daily activities. Importantly, the highly variable nature of office and out-of-office BP readings has been widely acknowledged, including the association of BP variability with cardiovascular outcomes. However, to date, the implications of BP variability on cardiovascular outcomes have largely been ignored, with limited application in clinical practice. Novel cuffless wearable technologies might provide a detailed assessment of the 24 h BP profile and behaviour over weeks or months. These devices offer many advantages for researchers and patients compared with traditional BP monitors, but their accuracy and utility remain uncertain. In this Review, we outline and compare conventional and novel methods and techniques for assessing average BP levels and BP variability, and reflect on the utility and potential of these methods for improving the treatment and management of patients with hypertension.
目前的高血压指南建议使用在诊所内外获得的几次血压（BP）读数的平均值来诊断和管理高血压。使用上臂袖带的诊室血压测量是目前 BP 分类和治疗目标的循证参考方法。然而，所有主要医学协会都推荐使用 24 小时动态或家庭 BP 监测进行诊室外 BP 评估，以进一步了解个体的 BP 谱及其与日常活动的关系。重要的是，人们广泛认识到诊室和诊室外 BP 读数的高度可变性，包括 BP 变异性与心血管结局的关系。然而，迄今为止，BP 变异性对心血管结局的影响在很大程度上被忽视，在临床实践中的应用有限。新型无袖带可穿戴技术可能提供对 24 小时 BP 谱和行为的详细评估，持续数周或数月。与传统 BP 监测器相比，这些设备为研究人员和患者提供了许多优势，但它们的准确性和实用性仍不确定。在这篇综述中，我们概述和比较了评估平均 BP 水平和 BP 变异性的传统和新型方法和技术，并思考了这些方法在改善高血压患者治疗和管理方面的实用性和潜力。
