Haluska B A, Jeffriess L, Fathi R B, Mottram P M, Carlier S G, Marwick T H
University Department of Medicine, Princes Alexandra Hospital, Brisbane, QLD, Australia.
Eur J Clin Invest. 2005 Jul;35(7):438-43. doi: 10.1111/j.1365-2362.2005.01513.x.
Brachial pulse pressure (BPP) is a predictor of outcome in epidemiologic studies, but brachial and aortic pulse pressure (AoPP) may not correspond and both are influenced by multiple parameters including arterial properties and cardiac output. We sought to what extent pulse pressure (PP) measurements reflected direct measurement of arterial properties, assessed as total arterial compliance (TAC).
We studied 123 patients (76 men; age 55 +/- 11); 31 normal controls, 46 patients with coronary artery disease and 46 patients with hypertension. PP was determined from brachial cuff pressure and TAC was measured by simultaneous radial applanation tonometry and pulsed wave Doppler of the LV outflow. AoPP was calculated using a transfer function from the radial waveform.
There was a significant difference between BPP and AoPP (57 +/- 16 vs. 45 +/- 14; P < 0.0001), although TAC correlated with BPP (r = -0.72; P = 0.01) and AoPP (r = -0.66; P = 0.01). In a multiple linear regression, the difference between BPP and AoPP was predicted by cardiac output (CO) (P = 0.002) and gender (P = 0.03). Bland-Altman analysis showed the best correspondence between BPP and AoPP in the middle tertile (CO 4.7 to 5.7 L min(-1)) with less correlation in the low and high tertiles. The same analysis by gender showed a higher difference in women than men (14 +/- 6 vs. 10 +/- 5; P < 0.0001). The difference between BPP and AoPP showed the best correlation in the control group and the worst in the hypertension group.
BPP correlates with TAC in men with normal cardiac function. However, in women, in patients at the low and high extremes of function, and in patients with preclinical and overt cardiovascular disease, there appears to be incremental value in measuring TAC.
在流行病学研究中，肱动脉脉压（BPP）是预后的一个预测指标，但肱动脉脉压和主动脉脉压（AoPP）可能并不一致，且二者均受包括动脉特性和心输出量在内的多个参数影响。我们试图探究脉压（PP）测量在多大程度上反映了对动脉特性的直接测量，动脉特性以总动脉顺应性（TAC）来评估。
我们研究了123例患者（76例男性；年龄55±11岁）；31例正常对照者、46例冠心病患者和46例高血压患者。通过肱动脉袖带压力测定PP，通过同时进行桡动脉压平式眼压测量和左室流出道脉冲波多普勒测量TAC。使用来自桡动脉波形的传递函数计算AoPP。
BPP与AoPP之间存在显著差异（57±16与45±14；P<0.0001），尽管TAC与BPP（r=-0.72；P=0.01）和AoPP（r=-0.66；P=0.01）相关。在多元线性回归中，BPP与AoPP之间的差异由心输出量（CO）（P=0.002）和性别（P=0.03）预测。Bland-Altman分析显示，在中间三分位数（CO 4.7至5.7 L min⁻¹）中BPP与AoPP之间的一致性最佳，在低三分位数和高三分位数中相关性较低。按性别进行的相同分析显示，女性的差异高于男性（14±6与10±5；P<0.0001）。BPP与AoPP之间的差异在对照组中相关性最佳，在高血压组中最差。
在心脏功能正常的男性中，BPP与TAC相关。然而，在女性、功能处于低极端和高极端的患者以及临床前期和明显心血管疾病患者中，测量TAC似乎具有额外价值。
