小时动态血压检测（ABPM）

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1、24hAmbulatoryBloodPressureMeasurement(ABPM)“Fromresearchtoclinicalpractice”ProfessorBPMcGrathProfessorofVascularMedicineMonashUniversity,MelbourneBMcG05ABPM:24hBPprofileSLEEPBMcG05Guilin2002BMcG0524hABPmonitoringHowshouldthecurvesbeanalysed?BMcG0524hBPprofileanalysisMeanday,night,24hA

2、BPMMinnesotacosinormethod(Halbergetal1967)Fourieranalysis(Chauetal.1989)Squarewavemodel(Idemaetal.1991)Doublelogisticanalysis(Headetal.2002)BMcG05RecommendedlevelsofnormalityforABPMinadults(ESHguidelines2005)Optimal*NormalAbnormalAwake<130/80<135/85>140/90Asleep<115/65<120/70>125/75*L

3、oweroptimalvaluesrecommendedindiabetesmellitusandhigh-riskpatientsBMcG05RateofmorningriseinBP,HRHypertensive(n=51)vsNormotensive(n=63)mmHgorbeats/minperh***HeadGetal.2003BMcG05Ambulatorybloodpressuremeasurement(ABPM)AdvantagesProfileofBPawayfrommedicalenvironmentShowsBPbehaviourdurin

4、gusualdailyactivitiesAstrongerpredictorofcardiovascularmorbidityandmortalitythanclinicBPCanidentifypatterns:‘non-dippers’,isolatedclinichypertension,maskedhypertension,enhancedBPvariability,episodesofhypotensionBMcG05‘White-coat’hypertension(isolatedclinichypertension)‘White-coat’hyp

5、ertensionisaconditioninwhichanindividualishypertensiveduringrepeatedclinicBPmeasurements,butoutsidethemedicalenvironmentpressuresmeasuredbyABPMorself-BPMtechniquesarenormalBMcG05Isolatedclinichypertensionorhypertensioninevolution?SLEEPBMcG05‘White-coat’effectinhypertensivepatientsTer

6、musedtodescribephenomenonfoundinmanyhypertensivepatientswherebyclinicBPmeasurementsareconsistentlygreaterthantheBPvaluesobtainedbyABPMorself-BPM,thelevelsofwhicharenonethelessincreasedabovenormalBMcG05Maskedhypertension(isolatedambulatoryhypertension)Thisphenomenonreferstopatientsinw

7、homclinicBPisnormalbutbloodpressurevaluesbyABPMorself-BPMareincreasedNotuncommon:29%GourlaySetal.JHumHypertens1993,7:467-7222%PAMELAstudyCirc2001,104:1385-92BMcG05Ambulatorybloodpressuremeasurement(ABPM)ClinicalIndicationsSuspectedisolatedclinichypertensionSuspectednocturnalhypertensi

8、onSus