Braam Richard L, Thien Theo
Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Blood Press Monit. 2005 Oct;10(5):283-9. doi: 10.1097/01.mbp.0000180671.76279.c7.
In validation studies reporting on the accuracy of blood pressure measuring devices (ambulatory and non-ambulatory systems), it is frequently stated that the accuracy of blood pressure devices seems to decrease at increasing blood pressure levels. This has been shown for several ambulatory devices in the past. Whether more recently validated devices are less accurate at increasing blood pressure levels is unknown, however.
We therefore retrospectively searched the literature for studies performed between 1993 and 2003, reporting on the accuracy of blood pressure measuring devices over different blood pressure levels. When needed, additional information from the authors was requested.
In total, 30 studies were selected. Of these, the studies reporting on the accuracy of 14 different ambulatory and nine different non-ambulatory devices were useful. For both ambulatory and non-ambulatory devices, accuracy appeared to decrease at increasing blood pressure levels. This was particularly shown for systolic blood pressure.
We speculate whether this finding is due to the oscillometric method of blood pressure measurement. Another explanation may exist, however. Blood pressure variability increases with higher blood pressure. Further, the British Hypertension Society protocol 1993 uses sequential measurements. This may be the reason that, owing to the increased blood pressure variability, the accuracy of most devices tends to decrease at higher blood pressure levels. Consequently, the accuracy of blood pressure measuring devices may be underestimated at higher blood pressure levels.
Currently used automated blood pressure measurement devices seem to be less accurate at increasing blood pressure levels. It is important to be aware of this phenomenon when treating hypertensive patients. The reported decrease in accuracy, however, may well be explained by the increasing blood pressure variability at increasing blood pressure and the use of sequential measurements. If this is the case, then the accuracy of these devices is perhaps underestimated.
在关于血压测量设备（动态和非动态系统）准确性的验证研究中，经常提到血压设备的准确性似乎会随着血压水平的升高而降低。过去已有多项针对几种动态设备的研究表明了这一点。然而，对于最近经过验证的设备在血压水平升高时是否准确性较低尚不清楚。
因此，我们回顾性检索了1993年至2003年间进行的研究文献，这些研究报告了不同血压水平下血压测量设备的准确性。如有需要，还向作者索取了额外信息。
总共筛选出30项研究。其中，报告14种不同动态设备和9种不同非动态设备准确性的研究是有用的。对于动态和非动态设备，准确性似乎都随着血压水平的升高而降低。这在收缩压方面表现得尤为明显。
我们推测这一发现是否归因于示波法血压测量。然而，可能存在另一种解释。血压变异性会随着血压升高而增加。此外，1993年英国高血压学会的方案采用连续测量。这可能就是为什么由于血压变异性增加，大多数设备在较高血压水平时准确性往往会降低的原因。因此，在较高血压水平下，血压测量设备的准确性可能被低估。
目前使用的自动血压测量设备在血压水平升高时似乎准确性较低。在治疗高血压患者时，了解这一现象很重要。然而，报告的准确性下降很可能是由于血压升高时血压变异性增加以及采用连续测量所致。如果是这样，那么这些设备的准确性可能被低估了。
