142医学课件及论文

ISSN:1524-4563Copyright©2005AmericanHeartAssociation.Allrightsreserved.PrintISSN:0194-911X.Online72514HypertensionispublishedbytheAmericanHeartAssociation.7272GreenvilleAvenue,Dallas,TXDOI: 10.1161/01.HYP.0000150859.47929.8e2005;45;142-161;originallypublishedonlineDec20,2004;HypertensionEdwardJ.RoccellaGraves,MarthaN.Hill,DanielW.Jones,TheodoreKurtz,SheldonG.ShepsandThomasG.Pickering,JohnE.Hall,LawrenceJ.Appel,BonitaE.Falkner,JohnResearchEducationoftheAmericanHeartAssociationCouncilonHighBloodPressureStatementforProfessionalsFromtheSubcommitteeofProfessionalandPublicExperimentalAnimals:Part1:BloodPressureMeasurementinHumans:ARecommendationsforBloodPressureMeasurementinHumansand:Theonlineversionofthisarticle,alongwithupdatedinformationandservices,is:Informationaboutreprintscanbefoundonlineat [e-mail]410-528-8550.E-mail:Fax:KluwerHealth,351WestCamdenStreet,Baltimore,MD21202-2436.Phone:[phone].Permissions:Permissions&RightsDesk,LippincottWilliams&Wilkins,adivisionofWolters :InformationaboutsubscribingtoHypertensionisonlineatbyonJune26,2011hyper.ahajournals.orgDownloadedfromRecommendationsforBloodPressureMeasurementinHumansandExperimentalAnimalsPart1:BloodPressureMeasurementinHumansAStatementforProfessionalsFromtheSubcommitteeofProfessionalandPublicEducationoftheAmericanHeartAssociationCouncilonHighBloodPressureResearchThomasG.Pickering,MD,DPhil;JohnE.Hall,PhD;LawrenceJ.Appel,MD;BonitaE.Falkner,MD;JohnGraves,MD;MarthaN.Hill,RN,PhD;DanielW.Jones,MD;TheodoreKurtz,MD;SheldonG.Sheps,MD;EdwardJ.Roccella,PhD,MPHAbstract—Accuratemeasurementofbloodpressureisessentialtoclassifyindividuals,toascertainbloodpressure–relatedrisk,andtoguidemanagement.Theauscultatorytechniquewithatrainedobserverandmercurysphygmomanometercontinuestobethemethodofchoiceformeasurementintheoffice,usingthefirstandfifthphasesoftheKorotkoffsounds,includinginpregnantwomen.Theuseofmercuryisdeclining,andalternativesareneeded.Aneroiddevicesaresuitable,buttheyrequirefrequentcalibration.Hybriddevicesthatuseelectronictransducersinsteadofmercuryhavepromise.Theoscillometricmethodcanbeusedforofficemeasurement,butonlydevicesindependentlyvalidatedaccordingtostandardprotocolsshouldbeused,andindividualcalibrationisrecommended.Theyhavetheadvantageofbeingabletotakemultiplemeasurements.Propertrainingofobservers,positioningofthepatient,andselectionofcuffsizeareallessential.Itisincreasinglyrecognizedthatofficemeasurementscorrelatepoorlywithbloodpressuremeasuredinothersettings,andthattheycanbesupplementedbyself-measuredreadingstakenwithvalidateddevicesathome.Thereisincreasingevidencethathomereadingspredictcardiovasculareventsandareparticularlyusefulformonitoringtheeffectsoftreatment.Twenty-four-hourambulatorymonitoringgivesabetterpredictionofriskthanofficemeasurementsandisusefulfordiagnosingwhite-coathypertension.Thereisincreasingevidencethatafailureofbloodpressuretofallduringthenightmaybeassociatedwithincreasedrisk.Inobesepatientsandchildren,theuseofanappropriatecuffsizeisofparamountimportance.(Hypertension.2005;45:142-161.)KeyWords:hypertension
ambulatorymonitoring
self-measurementTableofContentsIntroduction.................................................................................................144EpidemiologyofHypertension..............................................................................144Overview.................................................................................................144Systolic,Diastolic,andPulsePressure....................................................................144ImportanceofBloodPressureVariability.................................................................145Classification/SubtypesofHypertension....................................................................145TheAmericanHeartAssociationmakeseveryefforttoavoidanyactualorpotentialconflictsofinterestthatmayariseasaresultofanoutsiderelationshiporapersonal,professional,orbusinessinterestofamemberofthewritingpanel.Specifically,allmembersofthewritinggrouparerequiredtocompleteandsubmitaDisclosureQuestionnaireshowingallsuchrelationshipsthatmightbeperceivedasrealorpotentialconflictsofinterest.ThisstatementwasapprovedbytheAmericanHeartAssociationScienceAdvisoryandCoordinatingCommitteeonOctober13,2004.Asinglereprintisavailablebycalling800-242-8721(USonly)orwritingtheAmericanHeartAssociation,PublicInformation,7272GreenvilleAve,Dallas,TX75231-4596.AskforreprintNo.71-0308.Topurchaseadditionalreprints:upto999copies,call800-611-6083(USonly)orfax413-665-2671;1000ormorecopies,call410-528-4121,fax[phone],[e-mail]onaloreducationaluse,calltheCopyrightClearanceCenter,978-750-8400.ExpertpeerreviewofAHAscientificstatementsisconductedattheAHANationalCenter.FormoreonAHAstatementandguidelinedevelopment,visit