从监测到管理:数字健康技术在夜间高血压全周期管理中的应用与挑战

From monitoring to management: application and challenges of digital health technology in the whole-cycle management of nocturnal hypertension

  • 摘要: 夜间高血压是一种常见的血压表型,与心脑血管事件、靶器官损害风险相关,具有独立于诊室血压、日间血压的预后预测价值。大量研究表明,夜间血压水平及昼夜节律异常较日间血压更能反映个体的血流动力学状态和心血管风险。但是在临床实践中,夜间高血压的识别和管理主要依靠单次动态血压监测,受可及性、依从性、长期随访能力等因素的影响,不能满足持续风险评估和管理决策的需求。近些年来,夜间家庭血压监测、可穿戴设备和远程医疗平台等数字健康技术的发展,给夜间血压的多夜评估、动态随访以及管理干预带来新的可能。基于数字健康技术的夜间血压管理方式可以提高夜间高血压的检出率、风险分层精度,支持个体化治疗策略的实施,但是不同的技术在测量标准、数据准确性、循证基础等方面还存在差异。本文主要从夜间血压常用的评估方法入手,在数字健康技术支持下的夜间血压管理路径上进行系统综述,讨论目前现实应用中遇到的挑战。

     

    Abstract: Nocturnal hypertension is a common blood pressure phenotype associated with the risk of cardiovascular and cerebrovascular events as well as target organ damage. It holds prognostic predictive value independent of clinic and daytime blood pressure. Studies have demonstrated that nocturnal blood pressure levels and abnormal circadian rhythms reflect an individual’s hemodynamic status and cardiovascular risk more accurately than daytime blood pressure. However, in clinical practice, the identification and management of nocturnal hypertension predominantly rely on a single ambulatory blood pressure monitoring (ABPM) session. Limited by factors such as accessibility, patient compliance, and long-term follow-up capability, this approach cannot meet the requirements for continuous risk assessment and management decision-making. In recent years, the development of digital health technologies such as nocturnal home blood pressure monitoring, wearable devices, and telemedicine platforms has created new possibilities for multi-night assessment, dynamic follow-up, and management of nocturnal hypertension. Nighttime blood pressure management supported by digital health technologies can enhance the detection rate and improve the precision of risk stratification for nocturnal hypertension, while also facilitating the implementation of individualized treatment strategies. However, challenges remain across different technologies in terms of measurement standards, data accuracy, and evidence-based foundations. Starting with common methods for assessing nocturnal blood pressure, this article provides a systematic review of nocturnal blood pressure management pathways enabled by digital health technologies and discusses challenges encountered in real-world application.

     

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