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[ASH2012]动态血压监测的临床应用价值——ASH继任主席William B. White教授专访

作者:  W.B.White   日期:2012/5/29 11:02:37

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《国际循环》:您希望在您任职ASH主席期间能做出哪些成就?

  <International Circulation>: What is it you hope to accomplish in your tenure as the new ASH President?
  Prof. White:  It’s a pleasure to be able to speak to you here at the 27th Meeting of the American Society of Hypertension. Actually for the last two years, as President-elect of the Society and an Officer of the Board of Directors, I have already been involved with the development of our annual scientific meeting. I have been the Program Chair for both the 2011 and 2012 meetings. This of course is where we showcase a great deal of what is new and evolving in the world of hypertension and its complications and its comorbidities. We try very hard, and I will continue to do this as the President of the Society, to foster relationships with other medical societies including the National Lipid Association, the American Society of Nephrology, and the International Society for Hypertension and so forth. Many of these groups we are holding joint sessions with here. In addition, we have a number of educational initiatives that I would like to pursue and grow while I am President. These are things that can actually be done live with an audience, or could be done on a web-based style program in which clinicians could get continuing medical education credits for their review and work with our programs. Finally, a great thing that I am interested personally in doing for the Society is to grow our membership as it pertains to younger people. We do need to get Fellows and new faculty in hypertension and cardiovascular medicine centers to take part in what we do otherwise we will be just be a bunch of old guys. We really need to get new blood in here. That is something I am very interested in. We formed an American Society of Hypertension Research and Education Foundation to try and start raising funds to support clinical and research fellowships in the field of hypertension.

  《国际循环》:您希望在您任职ASH主席期间能做出哪些成就?
  White教授:很高兴能够在第27届美国高血压学会年会上接受这次采访。实际上,近两年来,作为候任主席,我担任了2011和2012年年会的组委会执行主席。在这两届年会上,我们展示了高血压及其并发症、合并症的新进展和新变化。我们做了大量的努力,我在自己任职主席期间会继续进行这项事业,并进一步加强与我国血脂协会、美国肾脏病学会、国际高血压学会等医学机构的合作。它们中有很多在这次会议期间与我们举行了联合会议。此外,我想开展一系列的教育措施,直接对观众进行现场直播或以网站形式来让临床医生得到继续医学教育认证。最后,我所感兴趣的、想为社会所做的另一件伟大的事情是壮大我们的会员,使更多的年轻人参与进来。我们需要高血压及心血管研究中心的同仁参与到我们所做的事情中来,我们需要更新我们的血液,这是我所感兴趣的一件事情。我们已经成立了美国高血压研究与教育基金会学会,旨在筹集资金为高血压领域提供临床及研究奖学金。

  <International Circulation>: Clinical blood pressure measurements can be affected by any number of things in the clinic but it is still used as a diagnostic criterion in clinical practice and guidelines. Do you think that ambulatory blood pressure monitoring will replace that in the future?
  Prof. White:  I don’t think it will replace it because it is a little bit too cumbersome and costly to replace clinical measurements. But that said, the clinical measurements that have been utilized in the clinical trials that determine how we decide what we are going to do or not in the management of hypertension, have a numbers of fallacies and faults. For example, a single measurement in time or even duplicate measurements in time in a clinical environment may or may not be representative of what is happening in the real life of that patient. Patients sometimes have a much lower blood pressure in the doctor’s office than when they are at work, or vice versa, they have a much higher blood pressure in the doctor’s office than when they are at home. It is a little difficult to guide therapy when you are only looking at that one point in time. I think the clinical blood pressure helps get us started with the diagnosis and the management of our patients but it shouldn’t be the end. We really need to have much more self-management with home blood pressure devices; that would be another great step. And when it gets to the point where we really feel uncomfortable with the diagnosis and the level, that is where ambulatory monitor will really help. The good news is that many consensus groups and organizations that make important recommendations for the management of cardiovascular disease have been very strong proponents for using ambulatory blood pressures more often.

  《国际循环》:血压测量受到多种因素的影响,但在临床实践或指南中血压仍被作为一种常用的诊断标准。那未来动态血压检测能够替代即刻血压?
  White教授:我认为,动态血压并不能取代传统袖带血压,这主要是因为其过于繁琐和昂贵。但我们目前临床试验中所应用的检测方法存在很多的错误。例如,临床上单次血压测量或多次血压测量可能无法代表患者的真实情况。有时患者的诊室血压低于平时工作时间的血压,而低于家庭自测血压。因此,单单根据某一个时间点的血压很难指导其治疗。我认为,临床血压有助于帮助我们对患者实施诊断和控制,但它不应该是终点。我们真正需要的是采用家庭血压仪实施更多的自我管理,这是更伟大的一步。当我们对针对及血压水平的检测感到不太适应的时候,动态监测将发挥其作用。有个好消息就是很多制定心血管疾病管理推荐的共识小组或组织强力支持更频繁地进行动态血压监测。

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动态血压监测ASH主席W. B.White

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