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国家心血管病中心陈伟伟:动态血压监测与高血压管理

2018-01-25 刘云丽 慢病管理网

高血压是一种最常见的慢性病,也是引发心脑血管疾病最重要的危险因素。据国家心血管病中心发布的《中国心血管病报告2017》显示:目前,中国成人高血压患病率高达25.2%,患者人数达2.7亿,每年与高血压有关的死亡人数达200万,约70%的脑卒中死亡和约50%心肌梗死死亡与高血压密切相关。据《中国居民营养与慢性病状况报告(2015年)》调查显示,我国高血压存在严重的“三低”现象,即“知晓率低、治疗率

高血压是一种最常见的慢性病,也是引发心脑血管疾病最重要的危险因素。据国家心血管病中心发布的《中国心血管病报告2017》显示:目前,中国成人高血压患病率高达25.2%,患者人数达2.7亿,每年与高血压有关的死亡人数达200万,约70%的脑卒中死亡和约50%心肌梗死死亡与高血压密切相关。据《中国居民营养与慢性病状况报告(2015年)》调查显示,我国高血压存在严重的“三低”现象,即“知晓率低、治疗率低、达标率低”,分别仅为46.5%、41.1%和13.8%。

想要及时发现高血压,控制好高血压,首先要知晓自己的血压状况,而测量血压是诊断高血压并进行有效管理的必需手段,因此十分重要。目前除了大家熟知的在医院由医生、护士进行的诊室血压测量,以及在家自测血压外,动态血压监测在高血压管理中发挥着不可替代的作用。

慢病界就“动态血压监测与高血压管理”这一话题,采访了陈伟伟教授。

受访专家:陈伟伟

现任国家心血管病中心防治资讯部主任,中国医学科学院阜外医院教授、主任医师。国家心血管病专家委员会委员兼副秘书长,国家卫计委基本公共卫生服务项目和慢性病防治专家,中国高血压联盟常务理事,北京高血压防治协会副会长,《中华高血压杂志》、《慢性病学杂志》、《心脑血管病防治》杂志编委。

从医三十多年来潜心医学临床及心血管病防治研究,在心脏电生理学和心血管病防治领域富有专长,先后在《Journal of Internal Medicine》《中华内科杂志》、《中华心血管病杂志》、《中华高血压杂志》、《中华健康管理学杂志》等医学刊物发表学术论文80余篇,合编着作30余部。

动态血压监测是血压测量的金标准

据陈伟伟教授介绍,动态血压监测实际上是一个老技术,国内运用稍微晚一些。动态血压监测是监测一个人在日常生活状态下一整天的血压水平和血压波动情况的方法,能非常精准地反映一个人的血压情况。目前,在国际上被看作是血压测量的金标准,甚至作为诊断高血压必须检查的项目。英国的高血压指南就明确提出,对于新发现的1级、2级高血压患者,要做动态血压监测,才能进一步诊断高血压以及启动高血压药物治疗。而对于3级高血压,由于其危险性高,故可以直接启用药物治疗。

动态血压监测的特点与意义

动态血压监测对于高血压的诊断、鉴别诊断以及治疗,均有指导意义。

能非常精准地评估夜间血压

陈教授说,常用测血压的方法有三种:诊室血压、家庭自测血压和动态血压监测,这都是非常好的血压测量技术,各有其特长和优点。相比前两种血压监测方式,动态血压监测最大的特点就是能评估一个人的血压波动状态,特别是在夜间睡着状态下的血压。夜间血压与靶器官损伤的关系密切,因此测量夜间血压特别重要。众所周知,人的血压24小时内存在波动,动态血压监测能在夜晚睡着之后测量血压,消除了周围因素在白天生活状态下对血压的影响,能非常精准地评估夜间高血压,而家庭自测血压和诊室血压都解决不了这个问题。

是排除白大衣高血压,检出隐匿性高血压

非常有效的工具

陈教授说,动态血压监测还是排除白大衣高血压,检出隐匿性高血压非常有效的工具。白大衣高血压是指有些患者在医生诊室测量血压时血压升高,但在家自测血压时血压正常。陈教授说,临床上白大衣高血压约有15%,白大衣效应在一般人群中约20%。白大衣高血压不是真正意义上的高血压,是不需要治疗的,通过做动态血压监测,可以明确诊断,消除患者心理负担,避免抗高血压药物的不合理应用。

隐匿性高血压最典型的表现有单纯夜间高血压、单纯清晨高血压。但是隐匿性高血压用诊室测量和家庭自测均不易发现,容易漏诊,而做动态血压监测就能发现这些隐匿性高血压。隐匿性高血压同样会导致血管和心脑脏器损伤,因此,通过动态血压监测把这些病人监测出来,采取适当的干预措施也是高血压防治的一个重要内容。

指导医生和患者用药

动态血压监测是对一个人血压状况的全面评估,包括血压的高低以及血压波动的时间、波动类型等,能够客观真实地“绘制”出人一天的血压波动“曲线”。合理的降压治疗在于选择合适的给药时间以及合适的药物,通过了解一个人血压的波动类型,可指导医生以及患者,应在血压高峰前用药,这样能够使更有效的血药浓度作用于血压高峰,让血压能得到更好的控制。陈教授一直倡导的高血压治疗原则之一是:基于动态血压测量的高血压个性化治疗,在一天血压的高峰期用药,全天24小时平稳控制血压。

我国动态血压监测尚未普及

陈教授介绍说,动态血压监测技术自上世纪八九十年代进入我国,大医院早就开展了,中小医院现在开展也逐渐普遍,甚至可以借助互联网技术在广大基层偏远的地区都能开展,是高血压管理的有效工具,也是血压测量非常好的一个办法。尤其是基于互联网+的远程动态血压测量,能够实现基层偏远地区动态血压测量与高等级医院动态血压测量的同质化,监测结果、质量都完全一样。

但是,有技术解决方案和技术的普及应用情况是两回事。动态血压监测的普及应用需要应用的医生要掌握监测技术,并且对动态血压监测报告有很好的解读,能充分认识动态血压监测的临床意义,对监测的主要适应证有很好的掌握。

目前,我国虽然有不少医院在用动态血压监测,但普及性还是不够。很多基层医疗单位还没有应用,很多医生都没有接触到,对于老百姓来讲,根本就不知道有动态血压监测这个工具。陈教授说,究其原因有以下两方面——

一方面是缺乏大众教育,老百姓对动态血压监测工具的认识不够,所以很少有人主动要求做动态血压监测;

另一方面也是医生的业务能力跟不上,这也是源头上的因素。很多基层的心血管医生、高血压医生都没有很好地掌握动态血压监测的技术,更何况其他非专业的医生了。这是一个短板,需要加强专业医生在这方面的业务能力。

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  7. [GetPortalCommentsPageByObjectIdResponse(id=1946141, encodeId=be011946141a8, content=<a href='/topic/show?id=f6fb102e02e4' target=_blank style='color:#2F92EE;'>#高血压管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102702, encryptionId=f6fb102e02e4, topicName=高血压管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Tue Feb 20 22:37:00 CST 2018, time=2018-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644636, encodeId=9389164463679, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Sat Dec 08 22:37:00 CST 2018, time=2018-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2022163, encodeId=250120221631c, content=<a href='/topic/show?id=348a3311836' target=_blank style='color:#2F92EE;'>#动态血压监#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33118, encryptionId=348a3311836, topicName=动态血压监)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85df2500173, createdName=654699882_84926986, createdTime=Thu Feb 22 16:37:00 CST 2018, time=2018-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344312, encodeId=babd1344312f6, content=<a href='/topic/show?id=683a88964b0' target=_blank style='color:#2F92EE;'>#血压管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88964, encryptionId=683a88964b0, topicName=血压管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=793a2500200, createdName=12498e5fm12(暂无昵称), createdTime=Sat Jan 27 11:37:00 CST 2018, time=2018-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1458364, encodeId=22db14583640d, content=<a href='/topic/show?id=e7543311913' target=_blank style='color:#2F92EE;'>#动态血压监测#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33119, encryptionId=e7543311913, topicName=动态血压监测)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d7096025384, createdName=lsndxfj, createdTime=Sat Jan 27 11:37:00 CST 2018, time=2018-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508998, encodeId=0c721508998ed, content=<a href='/topic/show?id=a7c83311e88' target=_blank style='color:#2F92EE;'>#动态血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33117, encryptionId=a7c83311e88, topicName=动态血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1e10025437, createdName=limedical1977, createdTime=Sat Jan 27 11:37:00 CST 2018, time=2018-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=282052, encodeId=2f3628205218, content=动态血压监测好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76d12257050, createdName=12177770m58暂无昵称, createdTime=Fri Jan 26 00:01:20 CST 2018, time=2018-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=281994, encodeId=81fe281994b1, content=很好的文章.谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jan 25 20:54:01 CST 2018, time=2018-01-25, status=1, ipAttribution=)]
    2018-01-26 12177770m58暂无昵称

    动态血压监测好!

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1946141, encodeId=be011946141a8, content=<a href='/topic/show?id=f6fb102e02e4' target=_blank style='color:#2F92EE;'>#高血压管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102702, encryptionId=f6fb102e02e4, topicName=高血压管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ac22500003, createdName=1249842em09(暂无昵称), createdTime=Tue Feb 20 22:37:00 CST 2018, time=2018-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1644636, encodeId=9389164463679, content=<a href='/topic/show?id=e3eb89e17fb' target=_blank style='color:#2F92EE;'>#血管病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89717, encryptionId=e3eb89e17fb, topicName=血管病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=64bb23195917, createdName=Luyuxie_17, createdTime=Sat Dec 08 22:37:00 CST 2018, time=2018-12-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2022163, encodeId=250120221631c, content=<a href='/topic/show?id=348a3311836' target=_blank style='color:#2F92EE;'>#动态血压监#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33118, encryptionId=348a3311836, topicName=动态血压监)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85df2500173, createdName=654699882_84926986, createdTime=Thu Feb 22 16:37:00 CST 2018, time=2018-02-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1344312, encodeId=babd1344312f6, content=<a href='/topic/show?id=683a88964b0' target=_blank style='color:#2F92EE;'>#血压管理#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88964, encryptionId=683a88964b0, topicName=血压管理)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=793a2500200, createdName=12498e5fm12(暂无昵称), createdTime=Sat Jan 27 11:37:00 CST 2018, time=2018-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1458364, encodeId=22db14583640d, content=<a href='/topic/show?id=e7543311913' target=_blank style='color:#2F92EE;'>#动态血压监测#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33119, encryptionId=e7543311913, topicName=动态血压监测)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d7096025384, createdName=lsndxfj, createdTime=Sat Jan 27 11:37:00 CST 2018, time=2018-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508998, encodeId=0c721508998ed, content=<a href='/topic/show?id=a7c83311e88' target=_blank style='color:#2F92EE;'>#动态血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33117, encryptionId=a7c83311e88, topicName=动态血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c1e10025437, createdName=limedical1977, createdTime=Sat Jan 27 11:37:00 CST 2018, time=2018-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=282052, encodeId=2f3628205218, content=动态血压监测好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=76d12257050, createdName=12177770m58暂无昵称, createdTime=Fri Jan 26 00:01:20 CST 2018, time=2018-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=281994, encodeId=81fe281994b1, content=很好的文章.谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Thu Jan 25 20:54:01 CST 2018, time=2018-01-25, status=1, ipAttribution=)]
    2018-01-25 清风拂面

    很好的文章.谢谢

    0

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