Blood Pressure Measurement Method and Inter-Arm Differences: A Meta-Analysis
Blood Pressure Measurement Method and Inter-Arm Differences: A Meta-Analysis
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DOI：
10.1038/ajh.2011.125
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发表时间：
2011-11-01
影响因子：
3.2
通讯作者：
Thien, Theo
中科院分区：
文献类型：
--
作者：
Verberk, Willem J.;Kessels, Alfons G. H.;Thien, Theo
许多指南建议筛查首次就诊时的血压臂间差(IAD)，但尚不清楚测量IAD的方法是否对IAD值有显著影响。方法系统地综述有关双臂测量以及IAD与操作特性(Medline/PubMed、Embase和Cochrane Library)的关系的研究报道。结果平均绝对IAD在收缩压和舒张压分别为5.4+/-1.7和3.6+/-1.2 mm Hg。在所有受试者中，14%的人收缩期IAD=10 mm Hg，4%的人收缩期Iad>；=20 mm Hg，7%的人舒张期Iad>；=10 mm Hg。当连续测量而不是同时测量时，获得收缩和舒张期IAD=10和20 mm Hg的相对风险(RR)更高(2.2(95%CI：1.4-3.6)，P<；0.01；4.8(95%CI：1.1-21.9)，P<；0.05和2.5(95%CI：1.0-6.3)P<；；当使用手动而不是自动设备时(2.1(95%CI：1.1-3.9)，P<；0.05；4.4(95%CI：1.8-10.8)，P<；0.01和3.7(95%CI：1.6-8.6)，P<；0.01)，以及当只进行一次BP测量而不是多次测量时(2.0(95%CI：1.1-3.8)，P<；0.05；4.3(95%CI：1.6~11.4)，P<；0.01和4.4(95%CI：1.7~11.4)，P<；0.01。结论BP的IAD筛查很重要，但测量方法对IAD结果有重要影响。为防止高估和观察者偏差，应在两个手臂同时评估IAD，并使用一个或两个自动装置和多个读数。
BackgroundScreening for inter-arm difference (IAD) of blood pressure (BP) at each first visit is recommended by numerous guidelines whereas it is unclear whether the method by which IAD is measured has significant influence on the IAD value.MethodsA systematic review is made of the studies reporting on double-arm measurements and the association of IAD with procedure characteristics (Medline/PubMed, Embase, and Cochrane Library).ResultsThe mean absolute IAD was 5.4 +/- 1.7 and 3.6 +/- 1.2 mm Hg for systolic and diastolic BP, respectively. Of all subjects 14% had a systolic IAD >= 10 mm Hg, 4% a systolic IAD >= 20 mm Hg, and 7% a diastolic IAD >= 10 mm Hg. The relative risk (RR) of obtaining a systolic IAD >= 10 and 20 mm Hg and a diastolic IAD >= 10 mm Hg is higher when measuring sequentially instead of simultaneously (2.2 (95% CI: 1.4-3.6), P < 0.01; 4.8 (95% CI: 1.1-21.9), P < 0.05 and 2.5 (95% CI: 1.0-6.3) P < 0.05, respectively), when using a manual instead of an automated device (2.1 (95% CI: 1.1-3.9), P < 0.05; 4.4 (95% CI: 1.8-10.8), P < 0.01 and 3.7 (95% CI: 1.6-8.6), P < 0.01, respectively) and when performing only one BP measurement instead of multiple (2.0 (95% CI: 1.1-3.8), P < 0.05; 4.3 (95% CI: 1.6-11.4), P < 0.01 and 4.4 (95% CI: 1.7-11.4), P < 0.01, respectively).ConclusionScreening for IAD of BP is important but the measurement methodology has a major influence on IAD results. To prevent overestimation and observer bias IAD should be assessed simultaneously at both arms, with one or two automatic devices and multiple readings should be taken.