Lee Eun Mi
Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, 15865, Republic of Korea.
Clin Hypertens. 2024 Apr 1;30(1):10. doi: 10.1186/s40885-024-00265-w.
Many individuals have different blood pressure (BP) values in the office setting compared to that outside the office setting. Therefore, confirming hypertension based on office BP (OBP) measurement alone can lead to misdiagnosis and mistreatment. The limitations of OBP measurement have led to the complementary use of out-of-office BP measurements, including 24-hour ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). This review aims to describe when and how ABPM or HBPM can be used to accurately diagnose and treat hypertension. Both methods should be performed using validated automated oscillometric devices. To minimize user errors, ABPM should be performed using standard techniques, whereas HBPM requires patient education regarding proper BP measurements. ABPM provides short-term comprehensive information on BP, including daytime, nighttime, morning, and 24-h BP. Therefore, ABPM is recommended for the initial diagnosis of hypertension, assessment of BP phenotypes and circadian patterns, and detection of nocturnal hypertension, Furthermore, ABPM plays a critical role in confirming true resistant hypertension thereby excluding pseudo-resistant hypertension. However, it is not suitable for long-term follow-up of patients with hypertension. In contrast, HBPM involves multiple BP readings taken at specific times during the day and evening over a long period. Therefore, HBPM is recommended for diagnosing hypertension and assessing BP phenotypes. However, this method has limitations in measuring nocturnal BP and circadian BP patterns. HBPM is preferred over ABPM for the long-term follow-up of patients with hypertension. This approach improves patient adherence to treatment and ultimately enhances the rate of control of hypertension. Additionally, both methods play an important role in diagnosing and treating white coat hypertension during pregnancy. Consequently, out-of-office BP measurement is essential to prevent the misdiagnosis and mistreatment of hypertension. However, these two methods offer different information regarding the BP status of an individual, and they indeed show discrepancies in the diagnosis of hypertensive phenotypes. Therefore, it is crucial to understand the advantages and limitations of both ABPM and HBPM to ensure their appropriate use in clinical practice.
与诊室环境外相比，许多人在诊室环境中的血压值有所不同。因此，仅基于诊室血压（OBP）测量来确诊高血压可能会导致误诊和误治。OBP测量的局限性促使人们补充使用诊室外血压测量方法，包括24小时动态血压监测（ABPM）和家庭血压监测（HBPM）。本综述旨在描述何时以及如何使用ABPM或HBPM来准确诊断和治疗高血压。两种方法均应使用经过验证的自动示波装置进行。为尽量减少用户误差，ABPM应采用标准技术进行，而HBPM则需要对患者进行正确血压测量的教育。ABPM提供有关血压的短期综合信息，包括日间、夜间、早晨和24小时血压。因此，ABPM推荐用于高血压的初始诊断、血压表型和昼夜节律模式的评估以及夜间高血压的检测。此外，ABPM在确诊真正的顽固性高血压从而排除假性顽固性高血压方面起着关键作用。然而，它不适用于高血压患者的长期随访。相比之下，HBPM涉及在一天中特定时间和晚上长时间进行多次血压读数。因此，HBPM推荐用于诊断高血压和评估血压表型。然而，这种方法在测量夜间血压和昼夜血压模式方面存在局限性。对于高血压患者的长期随访，HBPM优于ABPM。这种方法可提高患者的治疗依从性，并最终提高高血压的控制率。此外，两种方法在诊断和治疗妊娠期白大衣高血压方面均发挥着重要作用。因此，诊室外血压测量对于预防高血压的误诊和误治至关重要。然而，这两种方法提供的关于个体血压状况的信息不同，并且它们在高血压表型的诊断中确实存在差异。因此，了解ABPM和HBPM的优点和局限性对于确保它们在临床实践中的合理使用至关重要。
