24小时动态血压检测.pptVIP

24h Ambulatory Blood Pressure Measurement (ABPM) “From research to clinical practice” Professor BP McGrath Professor of Vascular Medicine Monash University, Melbourne ABPM: 24h BP profile 24h ABP monitoring 24h BP profile analysis Mean day, night, 24h ABPM Minnesota cosinor method (Halberg et al 1967) Fourier analysis (Chau et al. 1989) Square wave model (Idema et al. 1991) Double logistic analysis (Head et al. 2002) Recommended levels of normality for ABPM in adults (ESH guidelines 2005) Rate of morning rise in BP, HRHypertensive (n=51) vs Normotensive (n=63) Ambulatory blood pressure measurement (ABPM) Advantages Profile of BP away from medical environment Shows BP behaviour during usual daily activities A stronger predictor of cardiovascular morbidity and mortality than clinic BP Can identify patterns: ‘non-dippers’, isolated clinic hypertension, masked hypertension, enhanced BP variability, episodes of hypotension ‘White-coat’ hypertension(isolated clinic hypertension ) ‘ White-coat’ hypertension is a condition in which an individual is hypertensive during repeated clinic BP measurements, but outside the medical environment pressures measured by ABPM or self-BPM techniques are normal Isolated clinic hypertensionor hypertension in evolution? ‘White-coat’ effect in hypertensive patients Term used to describe phenomenon found in many hypertensive patients whereby clinic BP measurements are consistently greater than the BP values obtained by ABPM or self-BPM, the levels of which are nonetheless increased above normal Masked hypertension (isolated ambulatory hypertension) This phenomenon refers to patients in whom clinic BP is normal but blood pressure values by ABPM or self-BPM are increased Not uncommon: 29% Gourlay S et al. J Hum Hypertens 1993, 7:467-72 22% PAMELA study Circ 2001, 104:1385-92 Ambulatory blood pressure measurement (ABPM) Clinical Indications Suspected isolated clinic hypertension Suspected nocturnal hypertension Suspected ma