Hickson Stacey S, Butlin Mark, Mir Fraz A, Graggaber Johann, Cheriyan Joseph, Khan Fakhar, Grace Andrew A, Cockcroft John R, Wilkinson Ian B, McEniery Carmel M
University of Cambridge, Addenbrooke's Hospital, UK.
J Hypertens. 2009 Sep;27(9):1784-8. doi: 10.1097/hjh.0b013e32832e0b58.
Recent evidence suggests that central aortic blood pressure may be a better predictor of cardiovascular risk than peripheral blood pressure. The central SBP (cSBP) can be estimated from the late systolic shoulder of the radial pulse waveform. We compared the second systolic peak of the radial waveform (pSBP(2)) with the central systolic pressure derived by a generalized transfer function in a large cohort, across a wide age range, of patients from the Anglo-Cardiff Collaborative Trial. We also compared pSBP(2) with the true cSBP measured by cardiac catheterization [invasively measured cSBP (cSBPi)].
Noninvasive measurements were made by applanation tonometry using the SphygmoCor device. The aortic pressure waveform was derived from the radial waveform using a validated transfer function. Invasive measures of cSBPi were carried out in a group of 38 patients undergoing diagnostic cardiac angiography, and radial artery pressure waveforms were simultaneously recorded using the SphygmoCor device.
Overall, there was a strong correlation (r = 0.99, P<0.001) and good agreement between pSBP(2) and the derived cSBP (mean difference +/- SD 1 +/- 4 mmHg). However, there was a systematic bias with a greater difference between these measures at lower average pressures. There was also a strong correlation and good agreement between the invasively measured cSBPi and pSBP(2) (r = 0.92, P<0.001, mean difference 2 +/- 6 mmHg).
The second systolic shoulder of the peripheral pressure waveform approximates the cSBP in a large cohort of patients across a wide age range, but this may be inaccurate at low SBP values.
近期证据表明，中心主动脉血压可能比外周血压更能准确预测心血管风险。中心收缩压（cSBP）可通过桡动脉脉搏波形的收缩晚期切迹进行估算。我们在来自英-加的夫协作试验的、年龄范围广泛的一大群患者中，比较了桡动脉波形的第二个收缩峰（pSBP(2)）与通过广义传递函数得出的中心收缩压。我们还将pSBP(2)与通过心导管插入术测量的真实cSBP[有创测量的cSBP（cSBPi）]进行了比较。
使用SphygmoCor设备通过压平式眼压计进行无创测量。利用经过验证的传递函数从桡动脉波形得出主动脉压力波形。对38例接受诊断性心脏血管造影的患者进行了cSBPi的有创测量，并同时使用SphygmoCor设备记录桡动脉压力波形。
总体而言，pSBP(2)与得出的cSBP之间存在强相关性（r = 0.99，P<0.001）且一致性良好（平均差值±标准差为1±4 mmHg）。然而，存在系统性偏差，在较低平均压力时这些测量值之间的差异更大。有创测量的cSBPi与pSBP(2)之间也存在强相关性且一致性良好（r = 0.92，P<0.001，平均差值为2±6 mmHg）。
在年龄范围广泛的一大群患者中，外周压力波形的第二个收缩切迹接近cSBP，但在低收缩压值时可能不准确。
