Pucci Giacomo, Battista Francesca, Anastasio Fabio, Sanesi Leandro, Gavish Benjamin, Butlin Mark, Avolio Alberto, Schillaci Giuseppe
aDipartimento di Medicina, Università degli Studi di Perugia, Perugia bUnità di Medicina Interna, Azienda Ospedaliero-Universitaria di Terni, Terni, Italy cYazmonit Ltd., Eshtaol, Israel dFaculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
J Hypertens. 2016 Jun;34(6):1091-8. doi: 10.1097/HJH.0000000000000931.
Local blood pressure (BP) changes induced by arm tilting may influence pressure wave transmission and reflection. We investigated the effects of upper-limb tilting on radial augmentation index (rAIx) and related central measures [aortic augmentation index (aAIx)].
In 45 volunteers (age 49 ± 19 years), supine brachial BP and radial artery waveforms were obtained by applanation tonometry with the dominant arm stretched and gently supported in three different positions: at the heart level, with the BP cuff 15 cm above heart level (approximately +30°), and 15 cm below heart level (-30°).
Brachial SBP/DBP was 120/68 ± 17/8 mmHg. Mean arterial pressure changed predictably with arm tilting (99 ± 12 mmHg at -30°, 88 ± 10 mmHg at 0°, 77 ± 11 mmHg at +30°, all P < 0.001). rAIx decreased at -30° (69 ± 22%), and increased at +30° (93 ± 20%) compared with 0° (82 ± 20%, all P less than 0.001). Changes in rAIx (value at +30° minus value at -30°) showed an inverse relationship with age (r = -0.32, P = 0.03). Heart rate, BP and rAIx did not change in the contralateral arm, which was held at the heart level during the examination. aAIx followed the same pattern as rAIx (123 ± 27% at -30°, 144 ± 33% at +30°, 136 ± 31% at 0°, all P less than 0.001); changes in rAIx and aAIx were strongly related each other (r = 0.82, P < 0.001).
Acute gravitational upper-limb BP changes generate opposite, profound changes in rAIx, and major artifactual changes in aAIx. These findings provide a rationale for recommending to keep the upper limb at the heart level during radial waveform assessment.
手臂倾斜引起的局部血压（BP）变化可能会影响压力波的传播和反射。我们研究了上肢倾斜对桡动脉增强指数（rAIx）及相关中心指标[主动脉增强指数（aAIx）]的影响。
在45名志愿者（年龄49±19岁）中，通过压平式眼压计获取仰卧位时优势臂伸展并在三个不同位置轻轻支撑时的肱动脉血压和桡动脉波形：心脏水平、血压袖带位于心脏水平上方15 cm（约+30°）以及心脏水平下方15 cm（-30°）。
肱动脉收缩压/舒张压为120/68±17/8 mmHg。平均动脉压随手臂倾斜而呈可预测的变化（-30°时为99±12 mmHg，0°时为88±10 mmHg，+30°时为77±11 mmHg，所有P<0.001）。与0°（82±20%）相比，rAIx在-30°时降低（69±22%），在+30°时升高（93±20%）（所有P<小于0.001）。rAIx的变化（+30°时的值减去-30°时的值）与年龄呈负相关（r=-0.32，P=0.03）。在检查期间，对侧手臂保持在心脏水平，其心率、血压和rAIx没有变化。aAIx与rAIx呈现相同模式（-30°时为123±27%，+30°时为144±33%，0°时为136±31%，所有P<小于0.001）；rAIx和aAIx的变化彼此密切相关（r=0.82，P<0.001）。
急性重力引起的上肢血压变化会使rAIx产生相反的显著变化，并使aAIx产生重大的人为变化。这些发现为在桡动脉波形评估期间建议将上肢保持在心脏水平提供了理论依据。
