动态血压监测对高血压诊断及降压治疗个体化的指导价值.pdf

《中国医学前沿杂志(电子版)》2012年第4卷第2期●专题笔谈● 3
动态血压监测
动态血压监测对高血压诊断及降压治疗个体化的指导价值················································徐新娟
动态血压技术检测血压变异性的方法与临床意义················································牟建军,刘治全
动态血压—血压水平与节律的统一体····················································································冯颖青
24小时动态血压监测与动脉硬化································································································杨萍
心血管病高危患者动态血压监测的重要性············································································戴秋艳
动态血压监测与心血管相关疾病································································································刘忠
动态血压监测对高血压诊断及降压治疗
个体化的指导价值
徐新娟(新疆医科大学第一附属医院心脏中心高血压科,乌鲁木齐 830054)
2011年英国高血压指南[1]中提出,若患者诊 1 实施24小时ABPM,提高诊断、评估高血压的水平
室血压≥140/90 mm Hg(1 mm Hg= kPa) 西班牙高血压协会在2004年的进行了一项大
应行动态血压监测(ambulatory blood pressure 型的“西班牙高血压学会动态血压登记研究”[3],
monitoring,ABPM)以进一步证实高血压的诊该研究共纳入了10万余例进行ABPM的患者,该研
断,除了诊室血压≥180/110 mm Hg的重度或3级究通过对比ABPM与诊室测量血压的结果发现,单
高血压患者,都应等待ABPM的结果才能启动降纯采用诊室血压管理高血压患者既可能低估血压
压药物治疗;另外,ABPM还可用于高血压的分控制情况,也可能高估了血压控制情况,不仅造
级,白天清醒状态的血压≥135/85 mm Hg,为1级高成大量医疗资源的浪费,也严重不利于患者的健
血压;≥150/95 mm Hg,为2级高血压。在最近进行康。如果仅根据诊室血压是否低于140/90 mm Hg
的欧洲高血压学会年会上,专门召开了“动态血判断血压达标情况,则高血压的控制率不到50%,
压监测指南研讨会”,共同讨论制定第一部“动但如果采用24小时平均动态血压小于130/80 mm Hg作
态血压监测指南”,拟在2012年发布。会议中认为判断达标的标准,高血压控制率上升至80%。
为:ABPM不仅可以通过增加血压测量次数特别是通过进行24小时ABPM,可以诊断出“白大
活动状态