ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A number of factors interact to promote the increased clinical use of both ambulatory blood pressure monitoring (ABPM) and self-blood pressure monitoring (SBPM). These include the phasing out of mercury, evidence of the unreliability of clinic measurements, technical advances in automated blood pressure measurement, increasing evidence that out-of-office measurements give the best risk assessment, and a gradual recognition by payers of the clinical utility of ABPM and SBPM. Both ABPM and SBPM have been endorsed by the two major guidelines for managing hypertensive patients (World Health Organization–International Society of Hypertension and Joint National Committee VI). The use of SBPM has grown enormously over the past few years, mostly because of direct sales to patients. Although SBPM may give a better estimate of the true blood pressure than clinic readings, there are concerns about the accuracy of the monitors in individual patients. The main clinical indication for ABPM is the diagnosis of white-coat hypertension. This requires the demonstration that the blood pressure is normal outside the clinic, which can be established using SBPM and confirmed by ABPM. Even though ABPM may save drug costs in patients with white-coat hypertension, its use may also lead to increased drug expenditure in others in whom it demonstrates suboptimal blood pressure control. SBPM has the potential to reduce the number of clinic visits and also to improve blood pressure control. The ultimate validation of both procedures will be whether they can prevent cardiovascular morbidity. There have been suggestions that a non-dipping pattern of nocturnal blood pressure may carry a bad prognosis, but this may apply only to certain disease end-points. The greater recognition of the relevance of dipping status should provide an additional stimulus to the growth of both procedures. It is anticipated that, in the future, hypertension will be managed by the ‘virtual hypertension clinic’, using ABPM for the initial diagnosis, and SBPM with electronic linkage between the patient and the health-care provider for maintenance and follow-up.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

During 2001, the Center for Medicare and Medicaid Services (CMS, formally known as HCFA) independently evaluated the US national insurance coverage policy for ambulatory blood pressure monitoring. Diagnostic uses evaluated included screening for white-coat hypertension, assessment for possible antihypertensive drug resistance, evaluation of hypotensive symptoms, episodic hypertension, and autonomic dysfunction. In their analysis, the committee presented and analyzed the relevant scientific and clinical literature on the use of ABPM in certain patient populations and delineated the reason for a limited national coverage decision for patients with suspected white-coat hypertension.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

BackgroundIt is commonly believed that the associations of left ventricular mass and cardiovascular morbidity/mortality with blood pressure are stronger for 24-h ambulatory pressure than for conventional clinic or casual pressure.MethodsThe investigation comprised a review of relevant studies, with particular emphasis on the characteristics of the conventional blood pressure measurement.ResultsA review of 21 studies on left ventricular mass, published between 1982 and 1993, showed that the relationship between mass and blood pressure was stronger for ambulatory blood pressure than for clinic blood pressure but that the methodology and conditions of the conventional blood pressure measurements were poorly described or standardized in several reports. Between 1983 and 2001, seven studies showed that ambulatory blood pressure was superior to conventional blood pressure with regard to the prediction of cardiovascular morbidity and/or mortality. From published data and requests for additional information, it appears that recommendations for the measurement of conventional blood pressure have been reasonably well observed, although the number of measurements has not always been adequate.ConclusionsWhereas the quality of the conventional blood pressure measurements left much to be desired in the studies on left ventricular mass, the quality appeared to be reasonably good in outcome studies, even though the published details were often incomplete.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The banning of mercury from clinical practice will lead to the inevitable demise of traditional clinical sphygmomanometry. There are differences in approach to this important issue between European countries on the one hand, which generally have accepted that the mercury sphygmomanometer must be replaced with alternative devices, and the U.S. on the other, where the view is that the mercury sphygmomanometer should remain as the mainstay of blood pressure measurement. The availability of alternative devices for the mercury sphygmomanometer is improving but the problem of independent validation is a serious issue, which is being addressed by the European Society of Hypertension Working Party on Blood Pressure Monitoring, which has drafted an International Protocol for validating blood pressure measuring devices. The removal of the mercury sphygmomanometer from clinical practice has other implications, which merit careful consideration; the advent of automated devices must lead inevitably to the disappearance of the traditional clinical auscultatory technique of blood pressure measurement, and with the disappearance of mercury it will be argued that theSystème International(SI) unit of measurement – the kilopascal – should replace the millimetre of mercury.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Electronic self-monitoring of blood pressure is increasing in popularity and most international guidelines on the management of hypertension approve cautious use of the technique in the assessment of potentially hypertensive individuals. A recent editorial in the Archives of Internal Medicine suggested that it was “appropriate to encourage the widespread use of self recorded BP as an important adjunct to the clinical care of the patient with hypertension”. Such a statement is based on increasing evidence that self-monitoring of blood pressure gives similar information to daytime ambulatory blood pressure – a now well-established technology in the management of hypertension. Suggested strategies for the use of self-monitoring of blood pressure include monitoring in individuals whose clinical risk status is low enough that they need not necessarily be given medical therapy simply on the basis of a clinic pressure (i.e. at a 10 year risk of cardiovascular disease below 20%). The threshold for defining ‘normotension/hypertension’ is now regarded as being broadly similar for ABPM and SBPM and is set at 135/85 mmHg. In a recent meta-analysis of all available studies the average difference between these techniques, using the same patients, is −1.7/1.2 mmHg. There is some evidence that careful use of self-monitoring may improve blood pressure control in patients who are otherwise resistant to care. Self-monitoring of blood pressure has now been shown in at least one major prospective study to predict outcome better than clinic pressures and in that setting it now has equivalence to the use of ABPM. There remain issues regarding the availability of validated devices, the quality of training of patients in their use and the possibility that inaccurate recording might occur, either deliberately or by accident. Self-monitoring of blood pressure may well not give the same readings as carefully measured blood pressure by research nurses but its use is clearly superior to routine clinical practice. The technique is ripe for widespread application.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ambulatory measurements are increasingly used to evaluate the effects of different aspects of lifestyle on blood pressure. Such measurements provide greater statistical power than casual measurements and are particularly useful for assessing diurnal variations, 24-hour load and variability, and both acute and sustained effects of common behaviours. Concomitant heart rate and biochemical and genetic measurements can provide clues as to the mechanisms underlying the effects of lifestyle on blood pressure in different target populations. The information obtained is proving helpful in evaluating actions and interactions of smoking, alcohol, physical activity, caffeine consumption, various types of psychological stress, obesity, and dietary habits.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Ambulatory blood pressure monitoring (ABPM) and home blood pressure (BP) measurement appear to be useful in the assessment of the effects of non-pharmacological treatment of hypertension because they can detect small changes in BP without observer bias. We studied the effects of various lifestyle modifications using ABPM and home BP measurement in Japanese patients with hypertension. Weight reduction by a hypocaloric diet (average 4 kg) was associated with decreases in 24-h BP (10/4 mmHg) as well as casual BP (9/6 mmHg). The reductions in daytime and night-time BPs were comparable. The effects of daily walking without weight loss on office, home, and 24-h BPs were 2–3/1–2 mmHg. The changes in home and 24-h BPs were more significant than those in office BP. A low-salt diet (25 mmol/dayversus250 mmol/day) decreased 24-h BP by 9/4 mmHg. This hypotensive effect was observed throughout the day. Potassium supplementation (64 mmol/day) decreased office, home and 24-h BPs by 3–4/1–2 mmHg. The changes in home and 24-h BPs were highly significant compared with office BP. Supplementation of magnesium (20 mmol/day) also reduced those BPs significantly. However, the effects of calcium supplementation (25 mmol/day) were small (1–2/1 mmHg) and were significant only for home BP. Alcohol restriction for 4 weeks decreased daytime BP by 3/2 mmHg but increased night-time BP by 4/2 mmHg. Average 24-h BP did not change. Smoking cessation lowered daytime BP without affecting night-time BP. Monitoring of 24-h BP and home BP can detect small changes in BP produced by lifestyle modifications. Ambulatory BP monitoring is particularly suitable in the assessment of changes in lifestyle affecting the circadian pattern of BP such as alcohol consumption and smoking.

ISSN:1359-5237    

出版商:OVID    

年代:2002

数据来源: OVID