Burns Matthew J, Seed Jeremy D, Incognito Anthony V, Doherty Connor J, Notay Karambir, Millar Philip J
Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada.
Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada; Toronto General Research Institute, Toronto General Hospital, Toronto, ON, Canada.
J Am Soc Hypertens. 2018 Apr;12(4):275-284. doi: 10.1016/j.jash.2018.01.014. Epub 2018 Feb 10.
Prior studies demonstrating clinical significance of noninvasive estimates of central blood pressure (BP) and pulse wave reflection have relied primarily on discrete resting measures. The aim of this study was to compare central BP and pulse wave reflection measures sampled during a single resting laboratory visit against those obtained under ambulatory conditions. The secondary aim was to investigate the reproducibility of ambulatory central BP and pulse wave reflection measurements. Forty healthy participants (21 males; 24 ± 3 years) completed three measurements of brachial artery pulse wave analysis (Oscar 2 with SphygmoCor Inside) in the laboratory followed by 24 hours of ambulatory monitoring. Seventeen participants repeated the 24-hour ambulatory monitoring visit after at least 1 week. Ambulatory measures were divided into daytime (9 AM-9 PM), nighttime (1 AM-6 AM), and 24-hour periods. Compared with laboratory measurements, central systolic BP, augmentation pressure, and augmentation index (with and without heart rate normalization) were higher (all P < .01) during daytime and 24-hour periods but lower during the nighttime period (all P < .001). The drop in nighttime brachial systolic BP was larger than central systolic pressure (Δ -20 ± 6 vs. -15 ± 6 mm Hg; P < .0001). Repeat ambulatory measurements of central BP and pulse wave reflection displayed good-to-excellent intraclass correlation coefficients (r = 0.58-0.86; all P < .01), although measures of pulse wave reflection had higher coefficients of variation (14%-41%). The results highlight absolute differences in central BP and pulse wave reflection between discrete laboratory and ambulatory conditions. The use of ambulatory measures of central BP and pulse wave reflection warrant further investigation for clinical prognostic value.
先前的研究表明，无创估计中心血压（BP）和脉搏波反射的临床意义主要依赖于离散的静息测量。本研究的目的是比较在单次静息实验室检查期间采集的中心血压和脉搏波反射测量值与动态条件下获得的测量值。次要目的是研究动态中心血压和脉搏波反射测量的可重复性。40名健康参与者（21名男性；24±3岁）在实验室完成了三次肱动脉脉搏波分析测量（使用带有SphygmoCor Inside的Oscar 2），随后进行了24小时动态监测。17名参与者在至少1周后重复了24小时动态监测检查。动态测量分为白天（上午9点至晚上9点）、夜间（凌晨1点至早上6点）和24小时时间段。与实验室测量相比，白天和24小时时间段的中心收缩压、增强压和增强指数（有或无心率标准化）较高（均P<.01），但夜间时间段较低（均P<.001）。夜间肱动脉收缩压的下降幅度大于中心收缩压（Δ -20±6 vs. -15±6 mmHg；P<.0001）。中心血压和脉搏波反射的重复动态测量显示出良好至优秀的组内相关系数（r = 0.58 - 0.86；均P<.01），尽管脉搏波反射测量的变异系数较高（14% - 41%）。结果突出了离散实验室条件和动态条件下中心血压和脉搏波反射的绝对差异。动态测量中心血压和脉搏波反射在临床预后价值方面值得进一步研究。
