<International Circulation>: How does the clinician then take the ambulatory blood pressure monitoring data and interpret that for the patient’s benefit?
　　Prof. White:  The ambulatory blood pressures data have been have been divided typically into three major components: the overall 24-hour average; the period when the patient is awake and physically active; and the sleeping or nocturnal blood pressure. There are published reference values for those three different kinds of measurements that are generally well accepted worldwide and are different from what are seen in the clinics. It helps to be knowledgeable about these values before making a decision about treatment. For example， a 24-hour blood pressure that is higher than 130/80mmHg would be considered abnormal. In contrast， a blood pressure of 130/80mmHg or higher in the doctor’s office would not be considered abnormal at all. It is a different perspective due to the effects of sleep.

　　《国际循环》：临床医生应该如何利用和解读动态血压监测的数据来判断患者的获益？
　　White教授：动态血压的数据主要可以被划分为三个部分：24小时的整体平均血压、患者清醒及体力活动期间的平均血压水平以及夜间平均血压。这三部分血压均有已经公布的且被全世界广泛接受的推荐参考值，其推荐值与诊室血压的推荐值是有所不同的。在制定治疗决策前了解这些数值是非常重要的。例如，24小时平均血压≥130/80 mm Hg将被视为异常。相反，诊室血压≥130/80 mm Hg则不能被认定为异常，两者是不同的，这可能是归因于睡眠的影响。

　　<International Circulation>: Does that then lead to the conclusion that more frequent measurements would lead to more accuracy?
　　Prof. White:  More frequent measurements do improve the precision of the test and actually make the test far more reproducible from day-to-day or week-to-week. For example， if a person has very little changes in their medication or diet or weight and they get a 24-hour ambulatory test in May of 2012 and they compare that to May of 2013， they are going to be extremely similar to each other. However， you could certainly not say that about a clinical measurement which measures just that one point in time and is far less reproducible.

　　《国际循环》：那这是否意味着检测频率越高精确性越高？
　　White教授：更频繁的检测能够提高精确度，并能使不同天之间、不同周之间的血压更具可重复性。例如，在患者的用药、饮食及体重较少改变时，2012年5月进行24小时动态监测的数值与2013年5月的监测值相比，两者将极度相近。而即刻血压的可重复性则更低。

　　<International Circulation>: What do you think should be the structure of the standard for interpreting that data?
　　Prof. White:  We have done our best to look at ambulatory blood pressure as it relates to the development of and prediction of cardiovascular disease particularly stroke， myocardial infarction， cardiovascular death and hospitalized heart failure. We can use those data to guide us as to where we might see some problems developing. There are now investigators in several places， including Japan， Belgium， the United States and Italy， who have long-term findings up to twenty years. It can be determined that， for example， the night time blood pressure which cannot be obtained by any other method， should probably be below 125/75mmHg. If it is not then you would interpret it as high and you may want to treat that. Similarly， we can look at the period of time between when somebody is just waking up and when deep asleep and if there is more than a 20-30mmHg increase， that morning surge may be interpreted as another risk factor and you may choose to treat it in a fashion which you would not otherwise have been able to do if you only had the clinical measurement.

　　《国际循环》：您认为应当如何解释动态血压监测数据？
　　White教授：我们做了大量的工作来研究动态血压对心血管疾病尤其是卒中、心肌梗死、心血管死亡、因心力衰竭住院的预测价值。我们可以利用这些数据来判断未来将发生什么。来自日本、比利时、美国及意大利等研究者进行了为期20年的研究。例如，其他方法所无法获得的夜间血压应低于125/75 mm Hg，否则的话我们会认为其属于高血压，并进行治疗。同样地，晨峰血压＞20～30 mm Hg则是心血管疾病的另一危险因素，应该进行治疗。而诊室血压测量则不易发现这一现象并对其进行治疗。
 

上一页  [1]  [2]