Şirin Hülya, Arslan Ahmet, Güneş İbrahim Sefa, Öcal Arslan, Konyalıoğlu Fatma Sena, Ketrez Gamze, Şimşek Asiye Çiğdem, Yaşar Salim, Barçın Cem
Department of Public Health, University of Health Sciences, Gülhane School of Medicine, Ankara, Türkiye.
Department of Cardiology, University of Health Sciences, Gülhane School of Medicine, Ankara, Türkiye.
Anatol J Cardiol. 2024 Sep 20;28(10):499-506. doi: 10.14744/AnatolJCardiol.2024.4530.
Home blood pressure monitoring (HBPM) is commonly used to diagnose hypertension (HT), with a diagnostic threshold of ≥135/85 mm Hg, the same as daytime ambulatory BP monitoring (ABPM). This study hypothesizes that training and adherence to HBPM guidelines will yield more accurate BP readings compared to ABPM.
The study involved 129 patients with elevated office BP but no prior HT diagnosis. After a two-week observation period with lifestyle advice, HBPM was conducted over a week before and after structured measurement training, with ABPM performed in each period. Adherence to instructions post-training was also assessed.
Post-training, mean systolic and diastolic home BP values significantly decreased (from 128 ± 13.1/84.9 ± 8.2 to 122.6 ± 12.7/81.8 ± 7.8; P < 0.001 for both), while daytime ABPM values remained unchanged (131.7 ± 11.1/86.7 ± 9.3 before vs. 130.7 ± 11.7/85.9 ± 8.6 after; P = 0.185). Although HBPM values were consistently lower than ABPM values, the discrepancy grew post-training. The number of patients reaching the HT threshold via HBPM decreased significantly post-training [71 (55%) to 54 (41.9%); P = 0.006], whereas the number via daytime ABPM remained similar [82 (64.3%) vs. 84 (65.1%); P = 1.000].
Training and adherence to HBPM guidelines led to lower BP readings and fewer HT diagnoses. Contrary to the hypothesis, this method under "ideal conditions" underestimated HT prevalence when compared to daytime ABPM. Further studies with clinical endpoints are needed to refine HBPM methods and establish new BP thresholds for more accurate HT detection.
家庭血压监测（HBPM）常用于诊断高血压（HT），其诊断阈值为≥135/85 mmHg，与日间动态血压监测（ABPM）相同。本研究假设，与ABPM相比，遵循HBPM指南进行培训和监测将获得更准确的血压读数。
本研究纳入129例诊室血压升高但既往未诊断为HT的患者。在接受为期两周的生活方式建议观察期后，在结构化测量培训前后各进行一周的HBPM，并在每个阶段进行ABPM。同时评估培训后对指导的依从性。
培训后，家庭收缩压和舒张压的平均值显著降低（从128±13.1/84.9±8.2降至122.6±12.7/81.8±7.8；两者P均<0.001），而日间ABPM值保持不变（之前为131.7±11.1/86.7±9.3，之后为130.7±11.7/85.9±8.6；P = 0.185）。尽管HBPM值始终低于ABPM值，但培训后差异增大。通过HBPM达到HT阈值的患者数量在培训后显著减少[从71例（55%）降至54例（41.9%）；P = 0.006]，而通过日间ABPM达到阈值的患者数量保持相似[82例（64.3%）对84例（65.1%）；P = 1.000]。
遵循HBPM指南进行培训导致血压读数降低，HT诊断减少。与假设相反，在“理想条件”下，与日间ABPM相比，该方法低估了HT患病率。需要进一步开展具有临床终点的研究，以完善HBPM方法，并建立新的血压阈值，从而更准确地检测HT。
