JACC:袖带法量血压可能存在重大缺陷,或漏诊三分之二高血压前期或1级高血压

2017-07-28 文韬 中国循环杂志

近期,在美国心脏病学会杂志(JACC)发表的一项Meta分析中,研究者汇总了74项相关研究,对比了2500多人用袖带血压和直接用导管插入肱动脉或主动脉直接测得的血压。

近期,在美国心脏病学会杂志(JACC)发表的一项Meta分析中,研究者汇总了74项相关研究,对比了2500多人用袖带血压和直接用导管插入肱动脉或主动脉直接测得的血压。

结果发现,袖带测量的肱动脉收缩压被严重低估,与直接测量的肱动脉血压差值可达5.7 mmHg,但又明显高估了舒张压,比实际舒张压高了5.5 mmHg。

作者认为,目前普遍应用的用袖带量血压的方法存在重大缺陷。

对于直接测量的血压为120/80 mmHg或>160/100 mmHg的人,袖带血压准确率较高,可达80%。
但对于直接测量血压为120~159/80~99 mmHg的人,袖带法所测的血压准确率却降低至50%~57%。
作者认为,虽然袖带法测血压与实际血压有很强的相关性,但低估血压的程度可能在10 mmHg左右,预计袖带血压可能仅仅识别出了三分之一的高血压前期或1级高血压患者。

研究者强调,袖带法测血压仍是有用的,但如果能更准确地测量血压,就可以帮到更多的人。
但现在的问题是,“有些血压处于中间水平的人可能会被误诊。”

研究者认为,目前确定血压值的最好的方法是,在不同时间多次重复测量血压,然后取平均值。多次重复测血压既包括家庭自测血压、24 h动态血压和没有察觉到的血压。

研究还发现,直接测量的肱动脉收缩压比主动脉收缩压高8 mmHg,而舒张压低1 mmHg。
作者指出,上臂肱动脉和主动脉的血压数值可能有较大差值。主动脉压可能更能代表身体最重要器官如心脏和大脑所经受的血压压力,因此更有临床意义。

述评专家指出,该Meta分析存在局限性:首先,有创血压检测仅用于某些特定人群,因此不能公平地用于其他人群;其次,入选的研究中50%可能不应该纳入;另外,各研究中血压检测的方法可能不同,且有些研究样本量太小。

袖带法测血压始于1896年,已经被用了一个多世纪。述评专家表示,“非常惊讶的是,居然有这么长的时间没有人针对关键血压测量方法证据进行如此认真地分析。”

临床上采用更准确的肱动脉血压测量法或直接主动脉血压测量法是否能更有效地预防血管病,仍是具有挑战的研究话题。这也是科学界必须提上研究日程的话题。

原始出处:
1、Dean S. Picone, Martin G. Schultz,Petr Otahal, et al. Accuracy of Cuff-Measured Blood Pressure:Systematic Reviews and Meta-Analyses. J Am Coll Cardiol, 2017, 70:572-586.

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    2022-05-18 120d521dm50暂无昵称

    有意义的实验👍

    0

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    2017-12-09 hbwxf
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    2017-07-29 hhh678

    henhao

    0

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    2017-07-28 139****0239

    henhao

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1220633, encodeId=bce012206332b, content=有意义的实验👍, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3d3b2210771, createdName=120d521dm50暂无昵称, createdTime=Wed May 18 11:23:52 CST 2022, time=2022-05-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853708, encodeId=fb0f1853e08b6, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Sat Dec 09 19:22:00 CST 2017, time=2017-12-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1707953, encodeId=d63f1e0795329, content=<a href='/topic/show?id=b801961353c' target=_blank style='color:#2F92EE;'>#量血压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96135, encryptionId=b801961353c, topicName=量血压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e7a531519171, createdName=ms5768352621950538, createdTime=Tue Sep 26 09:22:00 CST 2017, time=2017-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1325454, encodeId=95071325454d4, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Sun Jul 30 03:22:00 CST 2017, time=2017-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1407339, encodeId=d040140e33981, content=<a href='/topic/show?id=144966640f8' target=_blank style='color:#2F92EE;'>#漏诊#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66640, encryptionId=144966640f8, topicName=漏诊)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2d362645427, createdName=makuansheng, createdTime=Sun Jul 30 03:22:00 CST 2017, time=2017-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1490846, encodeId=57b614908460f, content=<a href='/topic/show?id=ead91026621c' target=_blank style='color:#2F92EE;'>#高血压前期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102662, encryptionId=ead91026621c, topicName=高血压前期)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d1448837648, createdName=kord1985, createdTime=Sun Jul 30 03:22:00 CST 2017, time=2017-07-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227709, encodeId=e9ac22e70980, content=henhao, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=b0041939716, createdName=hhh678, createdTime=Sat Jul 29 15:36:35 CST 2017, time=2017-07-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227221, encodeId=cebd22e221ae, content=henhao, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NcXNhUvfhzd2VdicMnaLeK2Im5gKx4Ucxd8Bwu6S7RG0uILBFQx5HTW2bU4VricDYlQqN20ibASSMYAeGrZrrTpy2Q/0, createdBy=80d11516357, createdName=139****0239, createdTime=Fri Jul 28 13:56:21 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227210, encodeId=329a22e21094, content=不错的文章值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04f22055142, createdName=131****2916, createdTime=Fri Jul 28 13:04:49 CST 2017, time=2017-07-28, status=1, ipAttribution=)]
    2017-07-28 131****2916

    不错的文章值得学习

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