Menzies Institute for Medical Research, University of Tasmania.
Royal Hobart Hospital, Hobart, Australia.
J Hypertens. 2019 Feb;37(2):307-315. doi: 10.1097/HJH.0000000000001902.
Estimation of aortic blood pressure (BP) requires peripheral BP waveform calibration. Mean arterial pressure (MAP)/DBP calibration is purported to estimate aortic BP more accurately than SBP/DBP calibration. However, this is based on inaccurate cuff calibration. Thus, direct comparisons of each calibration method using intra-arterial BP are required to confirm this, and was the aim of this study.
Ascending aortic, brachial and radial artery intra-arterial BPs were measured among 107 patients (61.9 ± 10.0 years, 70% men) undergoing coronary angiography. Radial waveforms were calibrated with brachial SBP/DBP and brachial MAP/DBP to directly test the accuracy of estimated aortic SBP (derived using a commercial device) from each calibration compared with intra-arterial aortic SBP. Estimated aortic BP accuracy from aortic MAP/DBP, brachial and radial SBP/DBP calibrations of peripheral waveforms was also tested (six calibration methods in total; all using intra-arterial BP).
Estimated aortic SBP from brachial MAP/DBP calibration of radial waveforms had a significantly smaller mean difference than from brachial SBP/DBP calibration (-0.7 ± 7.5 mmHg versus -6.9 ± 7.3 mmHg, P < 0.0001 for difference). Of the other calibration methods, estimated aortic SBP was most accurate from aortic MAP/DBP calibration of radial waveforms (-1.8 ± 5.0 mmHg, P = 0.00023). However, for all calibration methods, aortic-to-brachial artery and/or brachial-to-radial artery SBP amplification had a major influence on estimated aortic SBP.
Brachial and aortic MAP/DBP were confirmed as the best calibration methods to estimate aortic SBP, but irrespective of calibration method, accuracy was significantly influenced by the level of SBP amplification. Thus, improved accuracy of estimated aortic SBP should be possible by closer consideration of SBP amplification or individual waveform characteristics that differ according to the level of SBP amplification.
主动脉血压（BP）的估计需要外周 BP 波形校准。据称，平均动脉压（MAP）/舒张压（DBP）校准比收缩压（SBP）/舒张压（DBP）校准更能准确估计主动脉 BP。然而，这是基于不准确的袖带校准。因此，需要使用动脉内 BP 直接比较每种校准方法，以确认这一点，这也是本研究的目的。
在接受冠状动脉造影的 107 名患者（61.9±10.0 岁，70%为男性）中测量升主动脉、肱动脉和桡动脉的动脉内 BP。桡动脉波形使用肱动脉 SBP/DBP 和肱动脉 MAP/DBP 进行校准，以直接测试与动脉内主动脉 SBP 相比，从每种校准中得出的估计主动脉 SBP（使用商业设备）的准确性。还测试了外周波形的桡动脉 MAP/DBP、肱动脉和桡动脉 SBP/DBP 校准对估计主动脉 BP 的准确性（总共 6 种校准方法；均使用动脉内 BP）。
桡动脉 MAP/DBP 校准的桡动脉波形得出的估计主动脉 SBP 的平均差值明显小于肱动脉 SBP/DBP 校准（-0.7±7.5mmHg 与-6.9±7.3mmHg，差值 P<0.0001）。在其他校准方法中，桡动脉 MAP/DBP 校准的桡动脉波形得出的估计主动脉 SBP 最准确（-1.8±5.0mmHg，P=0.00023）。然而，对于所有校准方法，主动脉至肱动脉和/或肱动脉至桡动脉 SBP 放大对估计主动脉 SBP 有重大影响。
肱动脉和主动脉 MAP/DBP 被确认为估计主动脉 SBP 的最佳校准方法，但无论校准方法如何，准确性都受到 SBP 放大程度的显著影响。因此，通过更密切地考虑 SBP 放大或根据 SBP 放大程度而有所不同的个体波形特征，估计主动脉 SBP 的准确性应该可以提高。
