Negishi Kazuaki, Yang Hong, Wang Ying, Nolan Mark T, Negishi Tomoko, Pathan Faraz, Marwick Thomas H, Sharman James E
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
Am J Hypertens. 2016 Sep;29(9):1070-6. doi: 10.1093/ajh/hpw039. Epub 2016 Apr 16.
Central blood pressure (CBP) independently predicts cardiovascular risk, but calibration methods may affect accuracy of central systolic blood pressure (CSBP). Standard central systolic blood pressure (Stan-CSBP) from peripheral waveforms is usually derived with calibration using brachial SBP and diastolic BP (DBP). However, calibration using oscillometric mean arterial pressure (MAP) and DBP (MAP-CSBP) is purported to provide more accurate representation of true invasive CSBP. This study sought to determine which derived CSBP could more accurately discriminate cardiac structural abnormalities.
A total of 349 community-based patients with risk factors (71±5years, 161 males) had CSBP measured by brachial oscillometry (Mobil-O-Graph, IEM GmbH, Stolberg, Germany) using 2 calibration methods: MAP-CSBP and Stan-CSBP. Left ventricular hypertrophy (LVH) and left atrial dilatation (LAD) were measured based on standard guidelines.
MAP-CSBP was higher than Stan-CSBP (149±20 vs. 128±15mm Hg, P < 0.0001). Although they were modestly correlated (rho = 0.74, P < 0.001), the Bland-Altman plot demonstrated a large bias (21mm Hg) and limits of agreement (24mm Hg). In receiver operating characteristic (ROC) curve analyses, MAP-CSBP significantly better discriminated LVH compared with Stan-CSBP (area under the curve (AUC) 0.66 vs. 0.59, P = 0.0063) and brachial SBP (0.62, P = 0.027). Continuous net reclassification improvement (NRI) (P < 0.001) and integrated discrimination improvement (IDI) (P < 0.001) corroborated superior discrimination of LVH by MAP-CSBP. Similarly, MAP-CSBP better distinguished LAD than Stan-CSBP (AUC 0.63 vs. 0.56, P = 0.005) and conventional brachial SBP (0.58, P = 0.006), whereas Stan-CSBP provided no better discrimination than conventional brachial BP (P = 0.09).
CSBP is calibration dependent and when oscillometric MAP and DBP are used, the derived CSBP is a better discriminator for cardiac structural abnormalities.
中心血压（CBP）可独立预测心血管风险，但校准方法可能会影响中心收缩压（CSBP）的准确性。外周波形的标准中心收缩压（Stan-CSBP）通常通过使用肱动脉收缩压和舒张压（DBP）进行校准得出。然而，使用示波平均动脉压（MAP）和DBP进行校准（MAP-CSBP）据称能更准确地反映真实的有创CSBP。本研究旨在确定哪种推导得出的CSBP能更准确地区分心脏结构异常。
共有349名有危险因素的社区患者（71±5岁，男性161名），通过肱动脉示波法（Mobil-O-Graph，IEM GmbH，德国斯托尔伯格）使用两种校准方法测量CSBP：MAP-CSBP和Stan-CSBP。根据标准指南测量左心室肥厚（LVH）和左心房扩大（LAD）。
MAP-CSBP高于Stan-CSBP（149±20 vs. 128±15mmHg，P < 0.0001）。虽然它们有适度的相关性（rho = 0.74，P < 0.001），但Bland-Altman图显示有较大偏差（21mmHg）和一致性界限（24mmHg）。在受试者工作特征（ROC）曲线分析中，与Stan-CSBP相比，MAP-CSBP能更显著地区分LVH（曲线下面积（AUC）0.66 vs. 0.59，P = 0.0063）和肱动脉收缩压（0.62，P = 0.027）。连续净重新分类改善（NRI）（P < 0.001）和综合判别改善（IDI）（P < 0.001）证实了MAP-CSBP对LVH有更好的判别能力。同样，与Stan-CSBP相比，MAP-CSBP能更好地区分LAD（AUC 0.63 vs. 0.56，P = 0.005）和传统肱动脉收缩压（0.58，P = 0.006），而Stan-CSBP的判别能力并不比传统肱动脉血压更好（P = 0.09）。
CSBP依赖于校准，当使用示波MAP和DBP时，推导得出的CSBP对心脏结构异常有更好的判别能力。
