Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Blood Press. 2024 Dec;33(1):2402368. doi: 10.1080/08037051.2024.2402368. Epub 2024 Sep 18.
Accurate measurement of arterial blood pressure (BP) is crucial for the diagnosis, monitoring, and treatment of hypertension. This narrative review highlights the challenges associated with conventional (cuff-based) BP measurement and potential solutions. This work covers each method of cuff-based BP measurement, as well as cuffless alternatives, but is primarily focused on ambulatory BP monitoring.
Manual BP measurement requires stringent training and standardized protocols which are often difficult to ensure in stressful and time-restricted clinical office blood pressure monitoring (OBPM) scenarios. Home Blood pressure monitoring (HBPM) can identify white-coat and masked hypertension but strongly depends on patient adherence to measurement techniques and procedure. The widespread use of nonvalidated automated HBPM devices raises further concerns about measurement accuracy. Ambulatory blood pressure measurement (ABPM) may be used in addition to OBPM. It is recommended to diagnose white-coat and masked hypertension as well as nocturnal BP and dipping, which are the BP values most predictive for major adverse cardiac events. Nonetheless, ABPM is limited by its non-continuous nature and susceptibility to measurement artefacts. This leads to poor overall reproducibility of ABPM results, especially regarding clinical parameters such as BP variability or dipping patterns.
Cuff-based BP measurement, despite some limitations, is vital for cardiovascular health assessment in clinical practice. Given the wide range of methodological limitations, the paradigm's potential for improvement is not yet fully realized. There are impactful and easily incorporated opportunities for innovation regarding the enhancement of measurement accuracy and reliability as well as the clinical interpretation of the retrieved data. There is a clear need for continued research and technological advancement to improve BP measurement as the premier tool for cardiovascular disease detection and management.
准确测量动脉血压（BP）对于高血压的诊断、监测和治疗至关重要。本叙述性综述强调了与传统（袖带式）BP 测量相关的挑战和潜在解决方案。这项工作涵盖了袖带式 BP 测量的每种方法，以及无袖带替代方法，但主要集中在动态血压监测上。
手动 BP 测量需要严格的培训和标准化协议，而在紧张和时间受限的临床诊室血压监测（OBPM）情况下，往往难以确保这些协议的实施。家庭血压监测（HBPM）可以识别白大衣高血压和隐匿性高血压，但强烈依赖于患者对测量技术和程序的依从性。广泛使用未经验证的自动 HBPM 设备进一步引起了对测量准确性的担忧。动态血压监测（ABPM）可与 OBPM 联合使用。建议用于诊断白大衣高血压和隐匿性高血压以及夜间血压和降压，这些血压值对主要不良心脏事件的预测性最强。尽管如此，ABPM 受到其非连续性和易受测量干扰的限制。这导致 ABPM 结果的整体再现性较差，特别是在临床参数方面，如 BP 变异性或降压模式。
尽管存在一些局限性，但袖带式 BP 测量对于临床实践中的心血管健康评估至关重要。鉴于其广泛的方法学限制，该范式的改进潜力尚未得到充分实现。在提高测量准确性和可靠性以及对检索数据的临床解释方面，存在着有影响力且易于实施的创新机会。为了改善 BP 测量作为心血管疾病检测和管理的主要工具，需要持续进行研究和技术进步。
