Fundora Michael P, Beshish Asaad G, Rao Nikita, Berry Christopher M, Figueroa Janet, McCracken Courtney, Maher Kevin O
Children's Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
School of Arts and Sciences, Auburn University, Auburn, Alabama, USA.
Am J Hypertens. 2021 Jun 22;34(6):619-625. doi: 10.1093/ajh/hpab049.
Obesity and hypertension are public health priorities, with obesity considered to be a potential cause of hypertension. Accurate blood pressure (BP) determination is required and often obtained by automated oscillometric cuff devices. We sought to determine the correlation of oscillometric measurement in children, and if obesity was associated with worse correlation between methods than nonobese children.
Retrospective matched case-controlled study of 100 obese (97-99th percentile) and 100 nonobese (25-70th percentile) children after cardiac surgery with simultaneous systolic, diastolic, and mean invasive and oscillometric measurements. Matching was 1:1 for age, sex, race, and Risk Adjustment for Congenital Heart Surgery-1 score. Intraclass correlation coefficients and Bland-Altman plots were used to determine agreement with 0.75 as threshold.
Median age was 13 years (10-15). Agreement was low for systolic (0.65 and 0.61), diastolic (0.68 and 0.61), and mean measurements (0.73 and 0.69) (obese/nonobese). Bland-Altman plots demonstrated oscillometric BP measurements underestimated systolic hypertension (oscillometric readings lower than intra-arterial). Oscillometric measurements underestimated hypotension (systolic oscillometric measurements were higher than intra-arterial). This occurred in obese and nonobese patients. Correlation of oscillometric measurements was similar for nonobese and obese patients.
In this first ever study of simultaneous BP measurement by oscillometric vs. intra-arterial in obese and nonobese children, correlation is below accepted norms. The correlation of oscillometric cuff measurements is not affected by habitus in children. There is less correlation between oscillometric measurements and intra-arterial measurements during hypertension or hypotension. Healthcare providers should be aware of the limitations of oscillometric measurements.
肥胖和高血压是公共卫生重点问题，肥胖被认为是高血压的一个潜在病因。需要准确测定血压（BP），且通常通过自动示波法袖带装置来获取。我们试图确定儿童示波法测量的相关性，以及肥胖儿童与非肥胖儿童相比，该方法之间的相关性是否更差。
对100名肥胖（第97 - 99百分位数）和100名非肥胖（第25 - 70百分位数）心脏手术后儿童进行回顾性配对病例对照研究，同时进行收缩压、舒张压及平均有创和示波法测量。按年龄、性别、种族和先天性心脏病手术风险调整-1评分进行1:1配对。使用组内相关系数和Bland-Altman图来确定一致性，阈值为0.75。
中位年龄为13岁（10 - 15岁）。收缩压（0.65和0.61）、舒张压（0.68和0.61）及平均测量值（0.73和0.69）（肥胖/非肥胖）的一致性较低。Bland-Altman图显示示波法血压测量低估了收缩期高血压（示波法读数低于动脉内测量值）。示波法测量低估了低血压（收缩期示波法测量值高于动脉内测量值）。肥胖和非肥胖患者均出现这种情况。非肥胖和肥胖患者示波法测量的相关性相似。
在这项首次针对肥胖和非肥胖儿童同时进行示波法与动脉内血压测量的研究中，相关性低于公认标准。儿童示波法袖带测量的相关性不受体型影响。高血压或低血压期间，示波法测量与动脉内测量之间的相关性较低。医疗服务提供者应意识到示波法测量的局限性。
