Cuff bladder width and blood pressure measurement in children and adolescents
Cuff bladder width and blood pressure measurement in children and adolescents
复制标题
儿童和青少年袖带膀胱宽度和血压测量
作者：
O. Gómez;R. Prineas;L. Råstam
目的：估计儿童和青少年血压袖带囊袋宽度：中上臂围（CW：AC）比值对收缩压（SBP）、舒张压4相（DBP 4）和舒张压5相（DBP 5）变异性的独立贡献，及其对筛选时得出的高血压患病率估计值的影响。设计：使用CW：AC比低于40%的袖带会导致高估真实血压水平。随着CW：AC比率的提高，该水平被低估了。对于成人的国家建议指出，CW：AC比率最佳为约40%，但对于儿童没有一致的建议。方法：我们测量了811名10 - 17岁男孩和771名10-17岁女孩（参与率为93%）的SBP和舒张压第4和第5阶段。在每例受试者中，使用符合40%规则的袖带（推荐袖带）测量血压，其中一个袖带较小（CW：AC比平均降低：7.4%），另一个袖带较大（CW：AC比平均增加：10.2%）。以随机顺序使用指套。结果：袖带越小，血压读数越高。袖带较大时，平均值显著降低。这些差异与使用推荐袖带获得的血压水平无关。对高血压患病率估计的影响是巨大的。结论：选择合适的袖带尺寸对儿童和青少年很重要，以避免过度诊断和诊断不足的高血压。
Objective: To estimate the independent contribution of the blood pressure cuff bladder width: mid-upper arm circumference (CW: AC) ratio to the variability in systolic blood pressure (SBP), diastolic blood pressure phase 4 (DBP4) and diastolic blood pressure phase 5 (DBP5) in children and adolescents, and its impact upon the estimate of prevalence of high blood pressure derived at screening. Design: Use of cuffs with a CW: AC ratio below 40% causes overestimation of the true blood pressure level. With higher CW: AC ratios the level is underestimated. National recommendations for adults state that the CW: AC ratio is optimal at approximately 40%, but no consistent recommendations exist for children. Methods: We measured SBP and diastolic blood pressure phases 4 and 5 in 811 boys and 771 girls aged 10—17 years (93% participation rate). In each subject the blood pressure was measured with a cuff conforming to the 40% rule (recommended cuff), with one smaller (mean decrease in the CW: AC ratio: 7.4%), and with one larger (mean increase in the CW: AC ratio: 10.2%). Cuffs were used in random order. Results: Smaller cuffs gave significantly higher blood pressure readings. With the larger cuff there were significant mean decreases. The differences were independent of the blood pressure level obtained with the recommended cuff. The impact upon the estimate of the prevalence of high blood pressure was substantial. Conclusions: Selection of the proper cuff size is important for children and adolescents, in order to avoid both over- and underdiagnosis of hypertension.