Lacruz Maria Elena, Kluttig Alexander, Kuss Oliver, Tiller Daniel, Medenwald Daniel, Nuding Sebastian, Greiser Karin Halina, Frantz Stefan, Haerting Johannes
Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany.
Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
BMC Cardiovasc Disord. 2017 Jan 18;17(1):31. doi: 10.1186/s12872-017-0468-7.
Precise blood pressure (BP) measurements are central for the diagnosis of hypertension in clinical and epidemiological studies. The purpose of this study was to quantify the variability in BP associated with arm side, body position, and successive measurements in the setting of a population-based observational study. Additionally, we aimed to evaluate the influence of different measurement conditions on prevalence of hypertension.
The sample included 967 men and 812 women aged 45 to 83 years at baseline. BP was measured according to a standardized protocol with oscillometric devices including three sitting measurements at left arm, one simultaneous supine measurement at both arms, and four supine measurements at the arm with the higher BP. Hypertension was defined as systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg. Variability in SBP and DBP were analysed with sex-stratified linear covariance pattern models.
We found that overall, no mean BP differences were measured according to arm-side, but substantial higher DBP and for men also higher SBP was observed in sitting than in supine position and there was a clear BP decline by consecutive measurement. Accordingly, the prevalence of hypertension depends strongly on the number and scheme of BP measurements taken to calculate the index values.
Thus, BP measurements should only be compared between studies applying equal measurement conditions and index calculation. Moreover, the first BP measurement should not be used to define hypertension since it overestimates BP. The mean of second and third measurement offers the advantage of better reproducibility over single measurements.
在临床和流行病学研究中，精确测量血压对于高血压的诊断至关重要。本研究的目的是在一项基于人群的观察性研究中，量化与手臂侧别、身体姿势以及连续测量相关的血压变异性。此外，我们旨在评估不同测量条件对高血压患病率的影响。
样本包括基线时年龄在45至83岁的967名男性和812名女性。根据标准化方案，使用示波装置测量血压，包括左臂三次坐位测量、双臂同时进行一次仰卧位测量以及血压较高一侧手臂的四次仰卧位测量。高血压定义为收缩压（SBP）≥140 mmHg和/或舒张压（DBP）≥90 mmHg。采用性别分层的线性协方差模式模型分析SBP和DBP的变异性。
我们发现，总体而言，根据手臂侧别未测量到平均血压差异，但坐位时观察到DBP显著更高，男性的SBP也更高，并且连续测量时血压明显下降。因此，高血压的患病率在很大程度上取决于用于计算指标值的血压测量次数和方案。
因此，只有在采用相同测量条件和指标计算的研究之间才能比较血压测量结果。此外，首次血压测量不应被用于定义高血压，因为它会高估血压。第二次和第三次测量的平均值比单次测量具有更好的可重复性优势。
