Staessen J A, Byttebier G, Buntinx F, Celis H, O'Brien E T, Fagard R
Hypertensie en Cardiovasculaire Revalidatie Eenheid, Departement voor Moleculair en Cardiovasculaire Onderzoek, Katholieke Universiteit Leuven, Belgium.
JAMA. 1997 Oct 1;278(13):1065-72.
Ambulatory blood pressure (ABP) monitoring is used increasingly in clinical practice, but how it affects treatment of blood pressure has not been determined.
To compare conventional blood pressure (CBP) measurement and ABP measurement in the management of hypertensive patients.
Multicenter, randomized, parallel-group trial.
Family practices and outpatient clinics at regional and university hospitals.
A total of 419 patients (> or =18 years), whose untreated diastolic blood pressure (DBP) on CBP measurement averaged 95 mm Hg or higher, randomized to CBP or ABP arms.
Antihypertensive drug treatment was adjusted in a stepwise fashion based on either the average daytime (from 10 AM to 8 PM) ambulatory DBP (n=213) or the average of 3 sitting DBP readings (n=206). If the DBP guiding treatment was above (>89 mm Hg), at (80-89 mm Hg), or below (<80 mm Hg) target, 1 physician blinded to the patients' randomization intensified antihypertensive treatment, left it unchanged, or reduced it, respectively.
The CBP and ABP levels, intensity of drug treatment, electrocardiographic and echocardiographic left ventricular mass, symptoms reported by questionnaire, and cost.
At the end of the study (median follow-up, 182 days; 5th to 95th percentile interval, 85-258 days), more ABP than CBP patients had stopped antihypertensive drug treatment (26.3% vs 7.3%; P<.001), and fewer ABP patients had progressed to sustained multiple-drug treatment (27.2% vs 42.7%; P<.001). The final CBP and 24-hour ABP averaged 144.1/89.9 mm Hg and 129.4/79.5 mm Hg in the ABP group and 140.3/89.6 mm Hg and 128.0/79.1 mm Hg in the CBP group. Left ventricular mass and reported symptoms were similar in the 2 groups. The potential savings in the ABP group in terms of less intensive drug treatment and fewer physician visits were offset by the costs of ABP monitoring.
Adjustment of antihypertensive treatment based on ABP monitoring instead of CBP measurement led to less intensive drug treatment with preservation of blood pressure control, general well-being, and inhibition of left ventricular enlargement but did not reduce the overall costs of antihypertensive treatment.
动态血压监测（ABP）在临床实践中的应用日益广泛，但它如何影响血压治疗尚未明确。
比较传统血压（CBP）测量与ABP测量在高血压患者管理中的效果。
多中心、随机、平行组试验。
地区和大学医院的家庭医疗诊所及门诊。
共419例患者（≥18岁），其未治疗时CBP测量的舒张压（DBP）平均为95mmHg或更高，随机分为CBP组或ABP组。
根据日间平均（上午10点至晚上8点）动态DBP（n = 213）或3次坐位DBP读数的平均值（n = 206），逐步调整降压药物治疗。如果指导治疗的DBP高于（>89mmHg）、处于（80 - 89mmHg）或低于（<80mmHg）目标值，1名对患者随机分组不知情的医生分别加强降压治疗、维持不变或减少治疗。
CBP和ABP水平、药物治疗强度、心电图和超声心动图测量的左心室质量、问卷报告的症状以及费用。
在研究结束时（中位随访时间182天；第5至95百分位数区间为85 - 258天），ABP组中停止降压药物治疗的患者比CBP组更多（26.3%对7.3%；P <.001），进展为持续联合药物治疗的ABP组患者更少（27.2%对42.7%；P <.001）。ABP组最终的CBP和24小时ABP平均分别为144.1/89.9mmHg和129.4/79.5mmHg，CBP组分别为140.3/89.6mmHg和128.0/79.1mmHg。两组的左心室质量和报告的症状相似。ABP组因药物治疗强度降低和医生就诊次数减少而可能节省的费用被ABP监测的成本抵消。
基于ABP监测而非CBP测量调整降压治疗可减少药物治疗强度，同时保持血压控制、总体健康状况并抑制左心室扩大，但并未降低降压治疗的总体成本。
