Myers M G
Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ontario.
Can J Cardiol. 1996 Dec;12(12):1271-5.
Ambulatory blood pressure monitoring is rapidly becoming an integral part of the diagnosis and management of hypertensive patients, particularly in major urban Canadian centres. To date, there have been several attempts to define the indications for ambulatory blood pressure monitoring, the most recent coming from an ad hoc panel of the American Society of Hypertension. This panel developed an algorithm for diagnosing persistent hypertension using office, home and ambulatory blood pressure readings. A revised algorithm tailored to the Canadian health care setting is proposed for implementing ambulatory blood pressure monitoring in the diagnosis of hypertension. Concerns about the term 'white coat' hypertension are discussed and the concept of a white coat effect for both untreated and treated patients is presented. There is preliminary evidence that patients who have a white coat component to their office readings experience fewer cardiovascular outcomes than do those with more persistent ambulatory hypertension. Recommendations from the ad hoc committee of the American Society of Hypertension provide a practical basis for using ambulatory blood pressure monitoring in clinical practice in Canada.
动态血压监测正迅速成为高血压患者诊断和管理中不可或缺的一部分，尤其是在加拿大主要城市中心。迄今为止，已有多项尝试来界定动态血压监测的适应证，最近的一次尝试来自美国高血压学会的一个特别小组。该小组制定了一种利用诊室、家庭和动态血压读数诊断持续性高血压的算法。本文提出了一种针对加拿大医疗保健环境修订的算法，用于在高血压诊断中实施动态血压监测。文中讨论了对“白大衣”高血压这一术语的担忧，并介绍了未治疗和已治疗患者的白大衣效应概念。有初步证据表明，诊室读数存在白大衣成分的患者比持续性动态高血压患者经历的心血管事件更少。美国高血压学会特别委员会的建议为在加拿大临床实践中使用动态血压监测提供了实际依据。
