Kario Kazuomi, Williams Bryan, Tomitani Naoko, McManus Richard J, Schutte Aletta E, Avolio Alberto, Shimbo Daichi, Wang Ji-Guang, Khan Nadia A, Picone Dean S, Tan Isabella, Charlton Peter H, Satoh Michihiro, Mmopi Keneilwe Nkgola, Lopez-Lopez Jose P, Bothe Tomas L, Bianchini Elisabetta, Bhandari Buna, Lopez-Rivera Jesús, Charchar Fadi J, Tomaszewski Maciej, Stergiou George
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
University College London (UCL) and National Insitute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom.
J Hypertens. 2024 Nov 1;42(11):1874-1888. doi: 10.1097/HJH.0000000000003827. Epub 2024 Sep 9.
Blood pressure (BP) is a key contributor to the lifetime risk of preclinical organ damage and cardiovascular disease. Traditional clinic-based BP readings are typically measured infrequently and under standardized/resting conditions and therefore do not capture BP values during normal everyday activity. Therefore, current hypertension guidelines emphasize the importance of incorporating out-of-office BP measurement into strategies for hypertension diagnosis and management. However, conventional home and ambulatory BP monitoring devices use the upper-arm cuff oscillometric method and only provide intermittent BP readings under static conditions or in a limited number of situations. New innovations include technologies for BP estimation based on processing of sensor signals supported by artificial intelligence tools, technologies for remote monitoring, reporting and storage of BP data, and technologies for BP data interpretation and patient interaction designed to improve hypertension management ("digital therapeutics"). The number and volume of data relating to new devices/technologies is increasing rapidly and will continue to grow. This International Society of Hypertension position paper describes the new devices/technologies, presents evidence relating to new BP measurement techniques and related indices, highlights standard for the validation of new devices/technologies, discusses the reliability and utility of novel BP monitoring devices, the association of these metrics with clinical outcomes, and the use of digital therapeutics. It also highlights the challenges and evidence gaps that need to be overcome before these new technologies can be considered as a user-friendly and accurate source of novel BP data to inform clinical hypertension management strategies.
血压(BP)是临床前器官损伤和心血管疾病终生风险的关键促成因素。传统的基于诊所的血压读数通常测量频率较低且在标准化/静息条件下进行,因此无法获取日常正常活动期间的血压值。因此,当前的高血压指南强调将诊室外血压测量纳入高血压诊断和管理策略的重要性。然而,传统的家庭和动态血压监测设备采用上臂袖带示波法,仅在静态条件下或有限的情况下提供间歇性血压读数。新的创新包括基于人工智能工具支持的传感器信号处理进行血压估计的技术、远程监测、报告和存储血压数据的技术,以及旨在改善高血压管理的血压数据解读和患者互动技术(“数字疗法”)。与新设备/技术相关的数据数量和体量正在迅速增加,并将持续增长。本国际高血压学会立场文件介绍了新设备/技术,展示了与新血压测量技术及相关指标有关的证据,强调了新设备/技术验证的标准,讨论了新型血压监测设备的可靠性和实用性、这些指标与临床结局的关联以及数字疗法的应用。它还强调了在这些新技术可被视为提供新型血压数据以指导临床高血压管理策略的用户友好且准确的来源之前需要克服的挑战和证据空白。