Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
J Hypertens. 2012 Nov;30(11):2074-82. doi: 10.1097/HJH.0b013e32835850d7.
The measurement of blood pressure in atrial fibrillation is considered as difficult and uncertain, and current guidelines recommend the use of the auscultatory method. The accuracy of automated blood pressure monitors in atrial fibrillation remains controversial.
A systematic review and meta-analysis was performed of studies comparing automated (oscillometric or automated Korotkov) versus manual auscultatory blood pressure measurements (mercury or aneroid sphygmomanometer) in patients with sustained atrial fibrillation.
Twelve validations were analyzed (566 patients; five home, three ambulatory and three office devices). Pooled correlation coefficients between automated and manual blood pressure measurements were stronger for SBP than DBP (r = 0.89 versus 0.76, P < 0.001). Automated measurements were higher than manual measurements [pooled average SBP difference 0.5 mmHg, 95% confidence interval (CI) -0.9, 1.9; DBP 2.5 mmHg, 95%CI -0.6, 5.7). The mean difference was within 5 mmHg in six and four (SBP and DBP, respectively) of six validations. The SD of mean difference was within 8 mmHg in two and three (SBP and DBP, respectively) of four validations. The proportion of absolute automated-manual differences within 5 mmHg was at least 65% in four and two (SBP and DBP, respectively) of eight validations. Three studies showed no impact of heart rate on the automated-manual blood pressure differences.
There is limited evidence and significant heterogeneity in the studies that validated automated blood pressure monitors in atrial fibrillation. These monitors appear to be accurate in measuring SBP but not DBP. Given that atrial fibrillation is common in the elderly, in whom systolic hypertension is more common and important than diastolic hypertension, automated monitors appear to be appropriate for self-home but not for office measurement.
心房颤动时的血压测量被认为较为困难且不确定，目前的指南建议使用听诊法。自动血压监测器在心房颤动中的准确性仍存在争议。
对比较自动（示波或自动柯氏音）与手动听诊血压测量（汞柱或无液血压计）在持续性心房颤动患者中的研究进行了系统回顾和荟萃分析。
分析了 12 项验证研究（566 例患者；5 项家庭、3 项动态和 3 项诊室设备）。自动血压测量与手动血压测量的相关性在收缩压方面强于舒张压（r = 0.89 对 0.76，P < 0.001）。自动测量值高于手动测量值[平均收缩压差值为 0.5 mmHg，95%置信区间（CI）-0.9，1.9；舒张压差值为 2.5 mmHg，95%CI-0.6，5.7]。在 6 项验证研究中的 6 项（收缩压和舒张压）和 4 项验证研究中的 4 项（收缩压和舒张压）中，平均差值在 5 mmHg 以内。在 4 项验证研究中的 2 项（收缩压和舒张压）和 4 项验证研究中的 3 项（收缩压和舒张压）中，平均差值的标准差在 8 mmHg 以内。在 8 项验证研究中的 4 项（收缩压和舒张压）和 2 项（收缩压和舒张压）中，自动-手动差值绝对值在 5 mmHg 以内的比例至少为 65%。有 3 项研究表明，心率对自动-手动血压差值无影响。
在验证自动血压监测器在心房颤动中准确性的研究中，证据有限且存在很大异质性。这些监测器似乎在测量收缩压方面准确，但在测量舒张压方面则不然。鉴于老年人中心房颤动更为常见，且收缩期高血压比舒张期高血压更为常见且重要，因此自动监测器似乎适合家庭自我测量，但不适合诊室测量。
