Vaisse B, Silhol F, Bouchlagem K, Maximovitch A, Poggi L
Service de médecine interne à orientation angéiologique, CHU Timone, Marseille.
Arch Mal Coeur Vaiss. 1998 Sep;91 Suppl:9-12.
Clinical measurement of the blood pressure associated with assessment of the other cardiovascular risk factors: cholesterol, smoking, age, sex, diabetes and cardiovascular heredity, allow appreciation of the cardiovascular risk of hypertensive patients after the results of the Framingham study. There is no consensus about the optimal clinical blood pressure with treatment and about the control of treated hypertensives which remains low in population studies (28% in France, 27% in the United States). New methods of blood pressure measurements such as ambulatory blood pressure monitoring and self-measurement of the blood pressure are better correlated to cardiovascular events and morbi-mortality than measurement of the blood pressure during consultation in hypertensive patients. Ambulatory blood pressure recording also seems to be more predictive of regression of left ventricular hypertrophy. Therefore, the latest recommendations, especially the American consensus, advise using these techniques when the physician is in doubt about the value of the clinical blood pressure measurement of hypertensive patients, especially in the case of apparent antihypertensive drug resistance. Finally, what does good blood pressure control imply in 1988: normal clinical blood pressure measurements compared with ambulatory blood pressure monitoring or self-measurement of the blood pressure? Does it mean control of the patient's absolute cardiovascular risk? The answers to these questions can only be obtained by future prospective studies.
与评估其他心血管危险因素（胆固醇、吸烟、年龄、性别、糖尿病和心血管遗传因素）相关的血压临床测量，结合弗雷明汉姆研究结果，有助于评估高血压患者的心血管风险。关于治疗时的最佳临床血压以及治疗的高血压患者的控制情况，目前尚无共识，在人群研究中治疗控制率仍然较低（法国为28%，美国为27%）。与高血压患者就诊时测量血压相比，动态血压监测和血压自我测量等新的血压测量方法与心血管事件及病残死亡率的相关性更好。动态血压记录似乎对左心室肥厚的消退也更具预测性。因此，最新的建议，尤其是美国的共识，建议当医生对高血压患者临床血压测量值存疑时，特别是在出现明显的抗高血压药物抵抗的情况下，使用这些技术。最后，在1988年，良好的血压控制意味着什么：与动态血压监测或血压自我测量相比，临床血压测量正常？这是否意味着控制患者的绝对心血管风险？这些问题的答案只能通过未来的前瞻性研究获得。
