Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Hypertens Res. 2023 Mar;46(3):620-629. doi: 10.1038/s41440-022-01137-2. Epub 2023 Jan 5.
The diagnosis and management of hypertension has been based on the measurement of blood pressure (BP) in the office setting. However, data have demonstrated that BP may substantially differ when measured in the office than when measured outside the office setting. Higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) are validated approaches for out-of-office BP measurement. In the 2015 and 2021 United States Preventive Services Task Force (USPSTF) reports on screening for hypertension, ABPM was recommended as the reference standard for out-of-office BP monitoring and for confirming an initial diagnosis of hypertension. This recommendation was based on data from more published studies of ABPM vs. HBPM on the predictive value of out-of-office BP independent of office BP. Therefore, HBPM was recommended as an alternative approach when ABPM was not available or well tolerated. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline recommended ABPM as the preferred initial approach for detecting white-coat hypertension and masked hypertension among adults not taking antihypertensive medication. In contrast, HBPM was recommended as the preferred initial approach for detecting the white-coat effect and masked uncontrolled hypertension among adults taking antihypertensive medication. The current review provides an overview of ABPM and HBPM in the US, including best practices, BP thresholds that should be used for the diagnosis and treatment of hypertension, barriers to widespread use of such monitoring, US guideline recommendations for ABPM and HBPM, and data supporting HBPM over ABPM.
高血压的诊断和管理一直基于在诊室环境中测量血压（BP）。然而，数据表明，在诊室测量的血压与在诊室外测量的血压可能有很大差异。办公室外血压升高与心血管风险增加独立相关，而办公室血压升高。动态血压监测（ABPM）和家庭血压监测（HBPM）是测量办公室外血压的有效方法。在 2015 年和 2021 年美国预防服务工作组（USPSTF）关于高血压筛查的报告中，ABPM 被推荐作为办公室外 BP 监测的参考标准，并用于确认高血压的初始诊断。这一建议是基于 ABPM 与 HBPM 对独立于办公室血压的办公室外血压预测价值的更多已发表研究数据。因此，当 ABPM 不可用或不能耐受时，推荐 HBPM 作为替代方法。2017 年美国心脏病学会（ACC）/美国心脏协会（AHA）血压指南推荐 ABPM 作为检测未服用抗高血压药物的成年人白大衣高血压和隐匿性高血压的首选初始方法。相比之下，HBPM 被推荐作为检测正在服用抗高血压药物的成年人白大衣效应和隐匿性未控制高血压的首选初始方法。本综述提供了美国 ABPM 和 HBPM 的概述，包括最佳实践、用于诊断和治疗高血压的血压阈值、广泛使用此类监测的障碍、美国指南对 ABPM 和 HBPM 的建议以及支持 HBPM 优于 ABPM 的数据。
