老年原发性高血压患者水银柱血压计测定的舒张压取值点及其与电子血压计一致性研究
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摘要
目的研究水银柱血压计与电子血压计在老年原发性高血压(EH)患者舒张压取值点差异并分析两种血压计的一致性。方法选取2017年6月-2018年2月于昆明医科大学第二附属医院心血管内科三病区高血压门诊或住院部就诊的60～80岁EH患者143例,先后使用电子血压计及水银柱血压计对每位受试者双上臂重复连续测量血压5次,读取电子血压计测得收缩压、舒张压及水银柱血压计收缩压、柯氏音第Ⅴ时相(消失音)、第Ⅳ时相(变音)血压值,比较水银柱血压计柯氏音第Ⅳ时相与第Ⅴ时相对应血压值的差异及两种血压计测量值的一致性。结果水银柱血压计柯氏音第Ⅳ时相血压值变异系数[左/右臂(2.029±0.739)%/(2.413±1.313)%]低于第Ⅴ时相[左/右臂(2.539±1.017)%/(2.890±1.221)%]。电子血压计测得收缩压[左/右臂(130.1±16.0)/(129.0±16.2)mm Hg]与水银柱血压计测得收缩压[左/右臂(130.2±15.3)/(129.1±16.0)mm Hg]、电子血压计测得舒张压[左/右臂:(77.2±10.4)/(77.3±11.2)]与水银柱血压计测得柯氏音第Ⅳ时相舒张压值[左/右臂:(77.2±10.2)/(77.4±11.0)mm Hg]差异无统计学意义;组内相关系数均>0.80;Bland-Altman图中超过95%的散点分布在两血压计测得血压差值95%分布范围(即一致性界限,LoA)内。结论使用水银柱血压计测量老年EH患者血压时,舒张压取柯氏音第Ⅳ时相对应的血压值更准确,多次血压测量可提高血压数值的可靠性。电子血压计与水银柱血压计测得结果一致性较好,两种血压计可靠性一致。
Objective To study the difference of the value of diastolic blood pressure measured with mercury and electronic sphygmomanometer in elderly patients with essential hypertension(EH) and to analyze the consistency of the two sphygmomanometers. Methods A total of 143 patients(60 to 80 years old) with EH were selected from hypertention clinic and inpatient Department of Cardiology of the Second Affiliated Hospital of Kunming Medical University from June 2017 to February 2018. The blood pressure was successively measured five times consecutively with an electronic sphygmomanometer and a mercury sphygmomanometer for double upper arms of each subject. The systolic blood pressure, diastolic blood pressure measured by electronic sphygmomanometer and the systolic blood pressure, the diastolic blood pressure of the fourth Korotokoff sound(the sound changing), the fifth Korotokoff sound(the sound disappearing) were recorded. The differences between the blood pressure of the fourth and the fifth Korotokoff sound and the consistency between the two devices were compared. Results The coefficient of variation of the blood pressure of the fourth Korotkoff sound [left/right arm:(2.029±0.739)%/(2.413±1.313)%] was lower than the fifth Korotkoff sound [left/right arm:(2.539±1.017)%/(2.890±1.221)%]. The difference was not statistically significant between the systolic blood pressure measured by electronic sphygmomanometer [left/right arm:(130.1±16.0)/(129.0±16.2) mm Hg] and mercury sphygmomanometer [left/right arm:(130.2±15.3)/(129.1±16.0) mm Hg], the diastolic blood pressure [left/right arm:(77.2±10.4)/(77.3±11.2) mm Hg] measured by electronic sphygmomanometer and the blood pressure of the fourth Korotkoff sound [left/right arm:(77.2±10.2)/(77.4±11.0) mm Hg] measured by mercury sphygmomanometer. The intra-group correlation coefficient was greater than 0.80, and more than 95% scatters were within the 95% distribution range(Limits of Agreement, LoA) in every Bland-Altman plots. Conclusions The blood pressure of the fifth Korotkoff sound may be more accurate as the diastolic blood pressure when measured by mercury sphygmomanometer in elderly patients with EH,multiple blood pressure measurements can increase the reliability of blood pressure values. The measurement results of the mercury sphygmomanometer and electronic sphygmomanometer have a good consistency, and the reliability of both sphygmomanometers is consistent.
Objective To study the difference of the value of diastolic blood pressure measured with mercury and electronic sphygmomanometer in elderly patients with essential hypertension(EH) and to analyze the consistency of the two sphygmomanometers. Methods A total of 143 patients(60 to 80 years old) with EH were selected from hypertention clinic and inpatient Department of Cardiology of the Second Affiliated Hospital of Kunming Medical University from June 2017 to February 2018. The blood pressure was successively measured five times consecutively with an electronic sphygmomanometer and a mercury sphygmomanometer for double upper arms of each subject. The systolic blood pressure, diastolic blood pressure measured by electronic sphygmomanometer and the systolic blood pressure, the diastolic blood pressure of the fourth Korotokoff sound(the sound changing), the fifth Korotokoff sound(the sound disappearing) were recorded. The differences between the blood pressure of the fourth and the fifth Korotokoff sound and the consistency between the two devices were compared. Results The coefficient of variation of the blood pressure of the fourth Korotkoff sound [left/right arm:(2.029±0.739)%/(2.413±1.313)%] was lower than the fifth Korotkoff sound [left/right arm:(2.539±1.017)%/(2.890±1.221)%]. The difference was not statistically significant between the systolic blood pressure measured by electronic sphygmomanometer [left/right arm:(130.1±16.0)/(129.0±16.2) mm Hg] and mercury sphygmomanometer [left/right arm:(130.2±15.3)/(129.1±16.0) mm Hg], the diastolic blood pressure [left/right arm:(77.2±10.4)/(77.3±11.2) mm Hg] measured by electronic sphygmomanometer and the blood pressure of the fourth Korotkoff sound [left/right arm:(77.2±10.2)/(77.4±11.0) mm Hg] measured by mercury sphygmomanometer. The intra-group correlation coefficient was greater than 0.80, and more than 95% scatters were within the 95% distribution range(Limits of Agreement, LoA) in every Bland-Altman plots. Conclusions The blood pressure of the fifth Korotkoff sound may be more accurate as the diastolic blood pressure when measured by mercury sphygmomanometer in elderly patients with EH,multiple blood pressure measurements can increase the reliability of blood pressure values. The measurement results of the mercury sphygmomanometer and electronic sphygmomanometer have a good consistency, and the reliability of both sphygmomanometers is consistent.
引文
[1] 中国血压测量工作组. 中国血压测量指南[J].中华高血压杂志,2011,19(12):1101-1115.
[2] 岳月梅. 血压测量中以变音与消失音确定舒张压的实验研究[J].卫生职业教育,2004,22(12):119-120.
[3] Charles F. Babbs MP. The origin of Korotkoff sounds and the accuracy of auscultatory blood pressure measurements[J].J Am Soc Hypertens,2015,9(12):935-950.
[4] 尹仕红.动脉舒张压中变音现象的临床分析[J].临床医学工程,2013,20(1):83-84.
[5] Senthong V, Kukongviriyapan U, Settasatian N, et al. Low diastolic blood pressure is associated with a high atherosclerotic burden in patients with obstructive coronary artery disease[J].Cardiol J,2018,25(3):345-352.
[6] Peralta CA, Katz R, Newman AB, et al. Systolic and diastolic blood pressure, incident cardiovascular events, and death in elderly persons: the role of functional limitation in the cardiovascular health study[J].Hypertension,2014,64(3):472-480.
[7] Kai H, Kimura T, Fukuda K, et al. Impact of low diastolic blood pressure on risk of cardiovascular death in elderly patients with coronary artery disease after revascularization - the CREDO-Kyoto registry cohort-1[J].Circ J,2016,80(5):1232-1241.
[8] Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study[J].Lancet,2016,388(10056):2142-2152.
[9] Tziomalos K, Giampatzis V, Bouziana SD, et al. Elevated diastolic but not systolic blood pressure increases mortality risk in hypertensive but not normotensive patients with acute ischemic stroke[J]. Am J Hypertens,2015,28(6):765-771.
[10] Matsumoto S, Kishikawa M, Okuyama T, et al. Using diastolic blood pressure to diagnose acute stroke in isolated acute vestibular syndrome[J].J Gen Fam Med,2016,17(3):218-224.
[11] Park JH, Ovbiagele B. Post-stroke diastolic blood pressure and risk of recurrent vascular events[J].Eur J Neurol,2017,24(11):1416-1423.
[12] Micozkadioglu H. Higher diastolic blood pressure at admission and antiedema therapy is associated with acute kidney injury in acute ischemic stroke patients[J].Int J Nephrol Renovasc Dis,2014,7:101-105.
[13] 公绪合,丁彦春,张鹏强. 降压治疗中的J形曲线[J].中华高血压杂志,2011,19(8):744-749.
[14] Malyszko J, Muntner P, Rysz J, et al. Blood pressure levels and stroke: J-curve phenomenon?[J]. Curr Hypertens Rep,2013,15(6):575-581.
[15] 苏海,郭艺芳,林甲宜,等.电子血压计能否最终替代台式水银柱血压计?[J].中华高血压杂志,2013,21(7):610-613.
[16] SeongIl C, Yu-Mi K, Jinho S, et al.Comparison of the accuracy and errors of blood pressure measured by 2 types of non-mercury sphygmomanometers in an epidemiological survey[J].Medicine (Baltimore),2018,97(25): e10851.
[17] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[18] 陈伟伟,李小萌,陆迎,等.血压测量值即时波动研究——血压稳定值的取值建议[J].中华高血压杂志,2014,22(8):712-713.
[19] Rabkin SW, Yim J. A new approach to diastolic blood pressure targets in patients with hypertension and coronary artery disease[J].Eur Heart J,2017,38(1):758-759.
[20] Vishram JK, Borglykke A, Andreasen AH, et al. Impact of age on the importance of systolic and diastolic blood pressures for stroke risk:the MONICA, risk, genetics, archiving, and Monograph (MORGAM) project[J].Hypertension,2012,60(5):1117-1123.
[21] Tesauro M, Mauriello A, Rovella V, et al. Arterial ageing: from endothelial dysfunction to vascular calcification[J].J Intern Med,2017,281(5):471-482.
[22] Benmira A, Perez-Martin A, Schuster I, et al. From Korotkoff and Marey to automatic non-invasive oscillometric blood pressure measurement: does easiness come with reliability?[J].Expert Rev Med Devices,2016,13(2):179-189.
[23] 国家食品药品监督管理局.YY0670-2008.无创自动测量血压计[S].北京:中国标准出版社,2008.
[2] 岳月梅. 血压测量中以变音与消失音确定舒张压的实验研究[J].卫生职业教育,2004,22(12):119-120.
[3] Charles F. Babbs MP. The origin of Korotkoff sounds and the accuracy of auscultatory blood pressure measurements[J].J Am Soc Hypertens,2015,9(12):935-950.
[4] 尹仕红.动脉舒张压中变音现象的临床分析[J].临床医学工程,2013,20(1):83-84.
[5] Senthong V, Kukongviriyapan U, Settasatian N, et al. Low diastolic blood pressure is associated with a high atherosclerotic burden in patients with obstructive coronary artery disease[J].Cardiol J,2018,25(3):345-352.
[6] Peralta CA, Katz R, Newman AB, et al. Systolic and diastolic blood pressure, incident cardiovascular events, and death in elderly persons: the role of functional limitation in the cardiovascular health study[J].Hypertension,2014,64(3):472-480.
[7] Kai H, Kimura T, Fukuda K, et al. Impact of low diastolic blood pressure on risk of cardiovascular death in elderly patients with coronary artery disease after revascularization - the CREDO-Kyoto registry cohort-1[J].Circ J,2016,80(5):1232-1241.
[8] Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study[J].Lancet,2016,388(10056):2142-2152.
[9] Tziomalos K, Giampatzis V, Bouziana SD, et al. Elevated diastolic but not systolic blood pressure increases mortality risk in hypertensive but not normotensive patients with acute ischemic stroke[J]. Am J Hypertens,2015,28(6):765-771.
[10] Matsumoto S, Kishikawa M, Okuyama T, et al. Using diastolic blood pressure to diagnose acute stroke in isolated acute vestibular syndrome[J].J Gen Fam Med,2016,17(3):218-224.
[11] Park JH, Ovbiagele B. Post-stroke diastolic blood pressure and risk of recurrent vascular events[J].Eur J Neurol,2017,24(11):1416-1423.
[12] Micozkadioglu H. Higher diastolic blood pressure at admission and antiedema therapy is associated with acute kidney injury in acute ischemic stroke patients[J].Int J Nephrol Renovasc Dis,2014,7:101-105.
[13] 公绪合,丁彦春,张鹏强. 降压治疗中的J形曲线[J].中华高血压杂志,2011,19(8):744-749.
[14] Malyszko J, Muntner P, Rysz J, et al. Blood pressure levels and stroke: J-curve phenomenon?[J]. Curr Hypertens Rep,2013,15(6):575-581.
[15] 苏海,郭艺芳,林甲宜,等.电子血压计能否最终替代台式水银柱血压计?[J].中华高血压杂志,2013,21(7):610-613.
[16] SeongIl C, Yu-Mi K, Jinho S, et al.Comparison of the accuracy and errors of blood pressure measured by 2 types of non-mercury sphygmomanometers in an epidemiological survey[J].Medicine (Baltimore),2018,97(25): e10851.
[17] 中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[18] 陈伟伟,李小萌,陆迎,等.血压测量值即时波动研究——血压稳定值的取值建议[J].中华高血压杂志,2014,22(8):712-713.
[19] Rabkin SW, Yim J. A new approach to diastolic blood pressure targets in patients with hypertension and coronary artery disease[J].Eur Heart J,2017,38(1):758-759.
[20] Vishram JK, Borglykke A, Andreasen AH, et al. Impact of age on the importance of systolic and diastolic blood pressures for stroke risk:the MONICA, risk, genetics, archiving, and Monograph (MORGAM) project[J].Hypertension,2012,60(5):1117-1123.
[21] Tesauro M, Mauriello A, Rovella V, et al. Arterial ageing: from endothelial dysfunction to vascular calcification[J].J Intern Med,2017,281(5):471-482.
[22] Benmira A, Perez-Martin A, Schuster I, et al. From Korotkoff and Marey to automatic non-invasive oscillometric blood pressure measurement: does easiness come with reliability?[J].Expert Rev Med Devices,2016,13(2):179-189.
[23] 国家食品药品监督管理局.YY0670-2008.无创自动测量血压计[S].北京:中国标准出版社,2008.
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