Abstract:
Recent evidence suggests that an exaggerated blood pressure (BP) response to standing (ERTS) is associated with an increased risk of adverse outcomes, both in young and old individuals. In addition, ERTS has been shown to be an independent predictor of masked hypertension. In the vast majority of studies reporting on the prognostic value of orthostatic hypertension (OHT), the definition was based only on systolic office BP measurements. This consensus statement provides recommendations on the assessment and management of individuals with ERTS and/or OHT. ERTS is defined as an orthostatic increase in SBP at least 20 mmHg and OHT as an ERTS with standing SBP at least 140 mmHg. This statement recommends a standardized methodology to assess ERTS, by considering body and arm position, and the number and timing of BP measurements. ERTS/OHT should be confirmed in a second visit, to account for its limited reproducibility. The second assessment should evaluate BP changes from the supine to the standing posture. Ambulatory BP monitoring is recommended in most individuals with ERTS/OHT, especially if they have high-normal seated office BP. Implementation of lifestyle changes and close follow-up are recommended in individuals with ERTS/OHT and normotensive seated office BP. Whether antihypertensive treatment should be administered in the latter is unknown. Hypertensive patients with ERTS/OHT should be managed as any other hypertensive patient. Standardized standing BP measurement should be implemented in future epidemiological and interventional studies.
摘要:
最近的证据表明,过度的血压(BP)对站立(ERTS)的反应与不良结局的风险增加有关。无论是年轻人还是老年人。此外,ERTS已被证明是隐性高血压的独立预测因子。在绝大多数报告直立性高血压(OHT)的预后价值的研究中,该定义仅基于收缩压办公室血压测量.该共识声明提供了有关ERTS和/或OHT个人评估和管理的建议。ERTS定义为SBP至少20mmHg的体位性增加,OHT定义为ERTS,SBP至少140mmHg。本声明建议采用标准化方法来评估ERTS,通过考虑身体和手臂的位置,以及BP测量的次数和时间。ERTS/OHT应在第二次访问中确认,考虑到其有限的可重复性。第二次评估应评估从仰卧到站立姿势的BP变化。建议大多数ERTS/OHT患者进行动态血压监测,特别是如果他们有正常的办公室血压。建议ERTS/OHT患者实施生活方式改变和密切随访。ERTS/OHT的高血压患者是否应进行特定的抗高血压治疗尚不清楚。因此,他们应该像任何其他高血压患者一样进行管理。在未来的流行病学和干预研究中,应实施标准化的站立BP测量。