Статья
Суточное мониторирование артериального давления в клинической практике: не переоцениваем ли мы его значение?
Амбулаторное суточное мониторирование артериального давления (АД) - СМАД - по праву занимает место одного из крупнейших достижений в кардиологии. Воздавая заслуженную дань очевидным преимуществам этого метода, правомерен вопрос: всегда ли этот недешевый, трудоемкий, обременительный для пациента метод, дающий очень большой объем информации, используется в клинической практике оптимально и всегда ли мы критически относимся к полученным результатам? Многочисленные поперечные и продольные исследования продемонстрировали, что амбулаторное АД теснее, чем клиническое, коррелирует с поражением органов-мишеней и обладает большей прогностической силой для развития сердечно-сосудистых осложнений. Интерпретируя данные этих исследований, следует помнить, что, говоря о клиническом АД, в данном случае имеется в виду среднее значение менее 10 измерений в течение короткого периода времени, в то время как СМАД предоставляет информацию о нескольких десятках измерений АД. Имеются данные и о том, что только у больных с хорошей воспроизводимостью показателей СМАД обнаруживается более тесная по сравнению с клиническим АД корреляция с поражением органов-мишеней. Большинство пациентов с Al' могут наблюдаться с использованием повторных клинических измерений АД или самоконтроля АД. Ho СМАД является средством выбора при оценке пациентов с широкими колебаниями клинического и домашнего АД симптомами гипотонии, эпизодической гипертонией, необъяснимым поражением органов-мишеней. СМАД сохраняет свою ведущую роль для оценки антигипертензивной эффективности новых лекарственных средств в условиях клинических исследований.
1. Perlof fD, Sokolow М, Coman К. Tbe prognostic value of ambulatory blood pressure monitoring in treated hypertensive patients. J Hypertens 199I ; 9 (suppl. I): S33-S44.
2. Parati G, Pompidossi O, Albini E et al. Relationship of 24-hour blood pressure mean and variability and severity of target-organ damage in hypertension.J Hyperterts 1987; 5:93-8.
3. Prisant LM, Carrawith AA.Ambulatory blood pressure monitoring and echocar-diograßc ventricular wall thickness and mass. Amer J Hypertens 1990; 3:81 -9.
4. Sibm I, Schroeder P, Aelkjaer C et al. The relation between peripheral vascular structure, lefl ventricular hypertrophy, and ambulatory blood pressure in essential hypertension. Amer J Hypertens 1995; 8:987-96.
5. Staessen JA, Thijs L, Fagard R. et al. for the Systolic Hypertension in Europe Trial Investigators: Predict-ing cardiovascular risk using conventional and ambulatory blood pressure in older patients with systolic bypertension.JAMA 1999; 282: 539-46.
6. Verdecchia P. Prognostic value of ambulatory blood pressure. Currentevidence and clinical implications. Hypertension 2000; 35· 844-51
7. Verdeccbia P, Porcellati C, Schülaci G et al. Ambulatory blood pressure: an independent predictor of prognosis in essential hypertension. Hypertension 1994; 24: 793-801.
8. Schmieder RE, Veelken R, Gatzka ChD et al. Predictors for hypertensive nepbropatby: results of a 6-year follow-up study in essential bypertension.J Hypertens 1995; 13:357-65.
9. Khattar RS, Swales JD, Banfleld A et al. Predictionofeomnary and cerebrovascular morbidity and mortality by directeontinuous ambulatory blood pressure monitoring in essential hypertension Circulation 1999; 100:1071-1076.
10. Ohkubo T, Imai Y, Tsuji I et al. Prediction of mortality by ambulatory blood pressure monitoring versus screening blood pressure measurements: a pilot study in Obasama J Hypertens 1997; 15-357-64-
11. O'Brien E, Atkins N, Staessen J. State of the market. A review of ambulatory blood pressure monitoring devices. Hypertension 1995; 26:835-42.
12. Mancia G, Parati G. Ambulatory blood pressure monitoring and organdarnage. Hypertension 2000:36:894-900.
13. Sega R, Trocino G, LanzarottiA et alAlterations of cardiac structure in patients with isolated office, ambulatory.or home hypertension: data from the general population (PressioneArteriose Monitorate E Loro AssociazioniStudy). Circulation200l; 104:1385-92.
14. Fagard R, Staessen J, TbijsL Prediction of cardiac structure and function by repeated clinic and ambulatory blood pressure. Hypertension I997; 29- 22 -9-
15. Frigo G, Bertolo O, Roman E et al. Relationship of left ventricular mass urith clinic blood pressure measuredover a six-month period vs. ambulatory blood pressure.J Hypertens 2000; 18 (suppl. 2): S44-
16. Fagard R, Staessen J, Thijs L, AmeryA Multiple standardized clinic bloodpres-sures may predict left ventricular mass as well as ambulatory monitoring. Am J Hypertens 1995; 8:533-40.
17. Palatini P. Too much of a good thing? A critique of overemphasis on the use of ambulatory blood pressure monitoring in clinical practice. JHypertens 2002,-20:1917-23-
18. Joint National Committee on the detection, evaluation, and treatment o fhigh blood pressure. The sixth report of the Joint National Committee onthe detection, evaluation, and treatment of high blood pressure. Arch Intem Med 1997; 157: 2413-46.
19. Guidelines Subcommittee. 1999 World Health Organization -International Society of Hypertension Guidelines for the Management of Hypertension.J Hypertension 1999; 17:151-83-
20. Профилактика, диагностика лечение первичной артериальной гипертонии в Российской Федерации. Первый доклад экспертов научного общества по изучению артериальной гипертонии, Всероссийского научного общества кардиологов и Межведомственного совета по сердечно-сосудистым заболеваниям. Клин. фарм. и тер, 2000; 3:5-30.
21. Рекомендации по профилактике, диагностике иленению артериальной гипертензии. Артериальная гипертензия 2001; 7 (1) (приложение): 4-16.
22. Staessen J, Fagard R, Thijs L,Amery AA consensus view on the technique of ambulatory blood pressure monitoring. Hypertension 1995; 26:912-8.
23. Des Combes BJ, Porchet M, Waeber B,Brunner HR Ambulatory bloodpressure recordings. Reproducibility and unpredictability. Hypertensionl984; 6:110-4.
24. Palatini P, Mormino P, Canali C et al. Factors affecting ambulatory blood pressure reproducibility: results of the HARVEST trial. Hypertension 1994; 23:211-6.
25. Berardi L, Cbati NP, ChanudetX et al. Ambulatory bloodpressure monitoring: a critical review of the current methods to handleoutliers.J Hypertens 1992; 10: 1243-8.
26. Palatini P, Mortnino P, Santonastaso M et al. Ambulatorybloodpressure predicts end organ damage only in subjects withreproducible recordings. J Hypertens 1999; 17:465-73.
27. Mancia G. Ambidatory blood pressure monitoring: research and clinicalappli-cations. J Hypertens 1990; 8 (suppl- 7): SI-S13-
28. Lee DR, Farmer A)’ Swift CG. Jackson SHD. Investigation of ambulatoryblood pressure monitoring data editing criteria JHwn Hypertens 1995/9:195-8.
29. White WB, Lund-Johansen P, Omvik P. Assessment of four ambidatory monitors and measurements by clinicians versus intraarterial blood pressure at
30. Palatini P. Reliability of ambulatory blood pressure monitoring. Blood Press Monit2001; 6: 291-5.
31. National High Blood Pressure Education Coordinating Committee. National High Blood Pressure Education Program working group report on ambulatory blood pressure monitoring. Arch Intern Med 1990; 150:2270-80.
32. American College of Physicians. Automated ambidatory blood pressure and self-measured blood pressure monitoring devices: the role in the diagnosis and management of by pertesion. Ann Intern Med 1993; 118: 889-92.
33. National Institutes of Health. Fifth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure. National Institutes of Health; Bethesda1 MD, 1993.
34. Sheps SG, Clemen tDL, Pickering TG et al. FH. ACC position statement: ambulatory blood pressure monitoring. JAm Coll Cardiol 1994; 23: 1511
35. BloodPressure Measurement Section of the Deutsche Loga zur Bekämpfung des hohen Blutdruckes e. VJ Hum Hypertens 1995; 7: 777-9.
36. Parati G, Bosi S, Castellano M et al. Guidelinesdfor 24h noninvasive ambulatory blood pressure monitoring. Report of the Italian Society of Hypertension. High Blood Pressure 1995; 4:168-74.
37. Pickering TG, Kaplan NM, KrakoffLR et al. American Society of hypertension Expert Panel. Conclusions and recommendations on the clinical use of home (self) and ambulatory blood pressure monitoring. Am J Hypertens 1996; 9-1-11.
38. Wirmicki M, Canali C, Mormino P, Palatini P. Ambulatory bloodpressuremoni-toring editing criteria: Is a standardization needed?Am JHypertens1997; 10: 419-27
39. Verdecchia P,Palatini P, Schülaci G et al. Independent predictors of isotated clinic (white-coaV) bypertension.J Hypertens 2001; 19:1015-20.
40. Bidlingmeyer I, Bumier M, Bidlingmeyer M et al. Isolatedoffice hypertension: a prehypertensive state?J Hypertens 1996; 14:327-32.
41. Glen SK, Elliott HL, Curzio JL et al. White-coat hypertension asa саше of cardiovascular dysfunction.Lancet 1996; 348: 654-7.
42. Hoegholm A, Kristensen KS, Madsen NH, Svendsen TL. White coat hypertension diagnosedby 24-h ambulatory monitoring. Examination of 159 newly diagnosed hypertensive pattents Am J Hypertens 1992; 5·· 64-70.
43. Manda G, Zanchetti A White coat hypertension: misnomers, misconception-sand misunderstandings. What should we do next?J Hypertens 1996; 14: 1049-52.
44. Parati G, Ulian L, Santucciu C et al. Difference betweenelinic and daytime bloodpressure is not a measure of the white coat effect. Hypertension 1998■ 31: 1185-9.
45. Pickering TGJames GD, Boddie C et al. How common is while coat hypertension?JAMA 1988; 259:225-8.
46. Polonia JJ, Santos AR, Gama GM et al. Follow-up clinic and ambulatory blood pressure in untreated white-coat hypertensive patients (evaluation after 2-5 years). Blood Press Monit 1997; 2:289-95.
47. Saito I, Imai Y, Shimada K et al. on behalf of J-MUBA Study Group. Prevalence of and causativefactors in white coat hypertension: results of the Japanese Multi-cebter Study on Bamidipine with Ambulatory blood Pressure Monitoring. Blood PressMonit 200J; 6 (suppl. 2): SI 7-S23.
48. Wittenberg C, Zabłudowski JR, Rosenfeld JB. Overdiagnosis of hypertensionin the elderly.J Hum Hypertens 1992; 6:349-52.
49. Palatini P, Mormino P, Santonastaso M et al. Target organ damage in stage I hypertensive subjects with white coat and sustained hypertension: results from the Harvest study. Hypertension 1998; 31:5 7-63.
50. Palatini P, Dorigatti F, Roman E et al. White-coat hypertension: a selection bias? Harvest Study Investigators. Hypertension and Ambulatory Recording Venetia Study. J Hypertens 1998; 16:977-84-
51. O'Brien E, Coats A, Owens Petal. Useand interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society. BMJ 2000; 320:1128-34.
52. O'Brien E,Murhy J, Tynda UA et al. Tiventy-Jour-hour ambulatory blood pressure in men and women aged 17 to 80 years: The Allied hish Bank Study. J. Hypertens 1991; 9:355-60.
53. Staessen J, Fagard R, Lijnen P et al. Reference valuesfor ambulatory hlood pressure: a meta- analysis. J. Hyperiens 1990; 8 (suppl. 6.): S67-S69
54. Mancia G, Sega R, Bravi C et al. Ambulatory blood pressure normality: results of the PAMELA study.J Hyperiens 1995; 13:1377-90.
55. Thijs L, Staessen J, O'Brien E et aL The ambulatory blood pressure in nor-motensive and hypertensive subjects: results from an international database. Netherl J Med 1995; 46:106-14.
56. Weber M, Neutel J, Smith H, Graettinger F. Diagnosis of mild hypertension by ambulatory blood pressure monitoring. Circulation 1994; 90:2291
57. Ohkudo T, Imai Y, Tsuji I et al. Reference valuesfor 24 -hour ambulatory blood pressure monitoring based on a prognostic criterion: The Ohasama Study. / Hypertens 1998; 16 (suppl. 2): S260.
58. Imai Y, Ohkubo T, Tsuji I et al. Prognostic value of home and ambulatory blood pressure measurements in comparison to screening blood pressure measurements: a pilot study inOhasama. Blood Press Monit 1996; I (suppl. 2): S51-S58.
59. Mancia G, Parati G. The role of ambulatory blood pressure monitoring inelderly hypertensive patients. Blood Press Suppl 2000; 2:12-6.
60. Kario K, Pickering TG, Matsuo T et al. Stroke prognosis and abnormal nocturnal blood pressurefalls in olderhyperiensives. Hypertension 2001; 38:852-7.
61. Sander D, Kukla C, Klingelhofer J et al. Relationshipbetween circadian blood pressure patterns and progression of earlycarotid atherosclerosis. A 3 -year follow-up study. Circulation 2000; 102: 15З6-4І.
62. Nakano S, Fukuda Mv Hotta F et al. Reversed circadian blood pressure rlyytbm is associated with occurance of bothfatal and non-fatal vascular events in NlDDM subjects. Diabetes 1998; 47:1501-6.
63. Ohkubo T, Imai Y. Tsuji I et al. Relation between nocturnal decline in blood pressure and mortality. The Ohasarna study. Am,J Hypertem 1997; 10:1201-7.
64. Kikuya V, Hozawa A, Okubo T et al. Prognostic significance of blood pressure and heart rate variability: the Ohasama study. Hypertension 2000; 36:901 -6.
65. Mancia G. Parati G, HenningM et al. on behalf of ELSA investigators. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclewsis (ELSA)J Hypertens 2001; 19:1981-9-
66. Sleight P, Yusuf S, Ostergren J et al. Comparative effects oframipril on ambula-tory and office blood pressures: a HOPE Substudy. Hypertension 2001; 38: e28.
67. Zanchetti A, Bond M.G., Hennig M. et al. Calcium antagonist lacidipine slows down progression of asymptomatic carotid atherosclerosis: principal results of the European Lacidipine Study on Atherosclerosis (EISA), a randomized, doubleblind, long-term trial. Circulation 2002; 106:2422-7-
68. Luders S, Rothemeyer M, Zuehner C et al. Ambulatory blood pressure monitoring (ABPM) vs. Office blood pressure measurement(OM) - A prospective long-term study on the benefits during antilyypertensive treatment. J Hypertens 1998; 16 (suppl. 2): S215.
69. Кабалава Ж.Д., Котовская Ю.В. Мониторирование артериального давления; методические аспекты и клиническое значение. М., 1999; 234 с.