Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of Paediatric Nephrology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
J Hum Hypertens. 2023 May;37(5):363-369. doi: 10.1038/s41371-022-00702-z. Epub 2022 May 5.
Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is widely accepted as a more accurate method for measurement of blood pressure (BP) compared to a single office-based measurement of BP. However, it is unclear how physicians interpret ABPM and make management decisions. This study's goal is to investigate variation in ABPM interpretation among paediatric nephrologists (Canada and UK) and paediatric cardiologists (Canada only) via an online survey. The survey content included baseline demographics, questions on the use and indications for ABPM, interpretation of results, and subsequent management decisions in various clinical scenarios. The survey was sent to 196 Canadian physicians, with 69 (35.2%) total responses. Thirty-five UK clinicians also completed the survey. Most respondents were >44 years old, were in practice for at least 11 years, and were university-based. There were substantial differences among clinicians in ABPM interpretation for isolated systolic, diastolic, and night-time hypertension. For example, only 53.1% of physicians would initiate or modify treatment in those with diastolic HTN in CKD. Further, even for the same abnormal ABPM parameter, the decision to start or alter treatment was influenced by the underlying medical condition. There is significant variation in clinical practice among physicians for interpretation and management of hypertension when using ABPM. Differences in guidelines among various jurisdictions, as well as knowledge gaps in the research on which guidelines are based, create ambiguity regarding ABPM interpretation and management decisions. A more protocolized approach and further insight into the reasoning behind the variation in physicians' interpretation may help to standardise practice.
24 小时动态血压监测（ABPM）被广泛认为是一种比单次诊室血压测量更准确的血压测量方法。然而，目前尚不清楚医生如何解读 ABPM 并做出管理决策。本研究旨在通过在线调查，调查加拿大和英国的儿科肾病学家（仅在加拿大）和儿科心脏病学家对 ABPM 解读的差异。调查内容包括基本人口统计学信息、ABPM 的使用和适应症问题、结果解读以及在各种临床情况下的后续管理决策。该调查共发送给 196 名加拿大医生，共收到 69 份（35.2%）总回复。35 名英国临床医生也完成了调查。大多数受访者年龄>44 岁，行医至少 11 年，且为大学附属医院医生。在孤立性收缩期、舒张期和夜间高血压的 ABPM 解读方面，临床医生之间存在很大差异。例如，只有 53.1%的医生会在 CKD 患者出现舒张期高血压时开始或改变治疗。此外，即使是相同的异常 ABPM 参数，开始或改变治疗的决定也受到潜在疾病状况的影响。当使用 ABPM 时，医生在高血压的解读和管理方面存在显著的临床实践差异。不同司法管辖区的指南差异，以及基于指南的研究中的知识差距，导致 ABPM 解读和管理决策存在不确定性。更规范化的方法以及深入了解医生解读差异背后的原因，可能有助于标准化实践。
