Narayan Om, Casan Joshua, Szarski Martin, Dart Anthony M, Meredith Ian T, Cameron James D
aMonash Cardiovascular Research Centre, MonashHeart and Department of Medicine (Southern Clinical School) Monash University bDepartment of Cardiology, Alfred Hospital cMonash Cardiovascular Research Centre, MonashHeart, Melbourne, Australia.
J Hypertens. 2014 Sep;32(9):1727-40. doi: 10.1097/HJH.0000000000000249.
Central aortic blood pressure (cBP) is often promoted to be a superior predictor of cardiovascular risk compared to brachial blood pressure, and brachial-central pulse pressure amplification is also suggested as prognostic. Several devices and techniques, each purporting to estimate cBP, have entered commercial use. The interchangeability of cBP measurements between devices and the influence of disease states on central to brachial pulse pressure amplification remain unclear. The useful measurement of cBP in clinical trials is dependent on clarification of these issues.
We performed a systematic meta-analysis of studies reporting cBP between 2000 and 2012. Studies were included if both central and brachial SBPs (cSBP and bSBP) were reported. Studies were categorized by technique and according to the prevalent disease state with the bSBP - cSBP difference calculated. Random-effects modeling (inverse variance weighted approach) was used to estimate the pooled mean difference associated with each technique.
Of the 164 eligible studies, the SphygmoCor device was most commonly reported (110 studies), with direct carotid applanation second-most utilized (31 studies). In 30 included invasive cohorts, the measured cSBP did not differ significantly from the oscillometric bSBP recorded [mean difference 4.19 mmHg, 95% confidence interval (CI) -4.13 to 12.51], whereas mean differences of 12.77 mmHg (95% CI 11.93, 13.60) and 8.83 mmHg (95% CI 7.86, 9.79) were obtained with the SphygmoCor and carotid applanation estimates of cSBP, respectively (both P < 0.05). Conversely, the reported mean cSBP-to-bSBP differences measured across various disease states with SphygmoCor did not differ significantly.
This meta-analysis suggests that noninvasive cBP estimation is device/technique-dependent. Consequently, caution is advisable in applying these devices and techniques across clinical studies.
与肱动脉血压相比，中心主动脉血压（cBP）常被认为是心血管风险的更好预测指标，并且肱动脉-中心脉压放大也被认为具有预后意义。几种声称可估算cBP的设备和技术已投入商业使用。设备之间cBP测量的互换性以及疾病状态对中心到肱动脉脉压放大的影响仍不明确。临床试验中cBP的有效测量取决于这些问题的澄清。
我们对2000年至2012年期间报告cBP的研究进行了系统的荟萃分析。如果同时报告了中心和肱动脉收缩压（cSBP和bSBP），则纳入研究。研究按技术分类，并根据普遍的疾病状态计算bSBP-cSBP差值。采用随机效应模型（逆方差加权法）来估计与每种技术相关的合并平均差值。
在164项符合条件的研究中，最常报告的是SphygmoCor设备（110项研究），其次是直接颈动脉压平法（31项研究）。在30个纳入的有创队列中，测量的cSBP与记录的示波法bSBP无显著差异[平均差值4.19 mmHg，95%置信区间（CI）-4.13至12.51]，而通过SphygmoCor和颈动脉压平法估算的cSBP的平均差值分别为12.77 mmHg（95%CI 11.93，13.60）和8.83 mmHg（95%CI 7.86，9.79）（均P<0.05）。相反，使用SphygmoCor在各种疾病状态下报告的平均cSBP与bSBP差值无显著差异。
这项荟萃分析表明，无创cBP估算是依赖于设备/技术的。因此，在临床研究中应用这些设备和技术时应谨慎。
