Bia Daniel, Zócalo Yanina, Sánchez Ramiro, Torrado Juan F, Lev Gustavo, Mendiz Oscar, Pessana Franco, Ramírez Agustín, Cabrera-Fischer Edmundo I
Departamento de Fisiología, Facultad de Medicina, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial (CUiiDARTE), Universidad de la República, Montevideo 11800, Uruguay.
Metabolic Unit and Hypertension Unit, University Hospital, Favaloro Foundation, Buenos Aires 1093, Argentina.
J Cardiovasc Dev Dis. 2023 Jan 26;10(2):45. doi: 10.3390/jcdd10020045.
The use of oscillometric methods to determine brachial blood pressure (bBP) can lead to a systematic underestimation of the invasively measured systolic (bSBP) and pulse (bPP) pressure levels, together with a significant overestimation of diastolic pressure (bDBP). Similarly, the agreement between brachial mean blood pressure (bMBP), invasively and non-invasively measured, can be affected by inaccurate estimations/assumptions. Despite several methodologies that can be applied to estimate bMBP non-invasively, there is no consensus on which approach leads to the most accurate estimation. Aims: to evaluate the association and agreement between: (1) non-invasive (oscillometry) and invasive bBP; (2) invasive bMBP, and bMBP (i) measured by oscillometry and (ii) calculated using six different equations; and (3) bSBP and bPP invasively and non-invasively obtained by applanation tonometry and employing different calibration methods. To this end, invasive aortic blood pressure and bBP (catheterization), and non-invasive bBP (oscillometry [Mobil-O-Graph] and brachial artery applanation tonometry [SphygmoCor]) were simultaneously obtained (34 subjects, 193 records). bMBP was calculated using different approaches. Results: (i) the agreement between invasive bBP and their respective non-invasive measurements (oscillometry) showed dependence on bBP levels (proportional error); (ii) among the different approaches used to obtain bMBP, the equation that includes a form factor equal to 33% (bMBP = bDBP + bPP/3) showed the best association with the invasive bMBP; (iii) the best approach to estimate invasive bSBP and bPP from tonometry recordings is based on the calibration scheme that employs oscillometric bMBP. On the contrary, the worst association between invasive and applanation tonometry-derived bBP levels was observed when the brachial pulse waveform was calibrated to bMBP quantified as bMBP = bDBP + bPP/3. Our study strongly emphasizes the need for methodological transparency and consensus for non-invasive bMBP assessment.
使用示波法测定肱动脉血压（bBP）可能会导致系统性低估有创测量的收缩压（bSBP）和脉压（bPP）水平，同时显著高估舒张压（bDBP）。同样，有创和无创测量的肱动脉平均血压（bMBP）之间的一致性可能会受到不准确估计/假设的影响。尽管有几种方法可用于无创估计bMBP，但对于哪种方法能得出最准确的估计尚无共识。目的：评估以下各项之间的关联和一致性：（1）无创（示波法）和有创bBP；（2）有创bMBP，以及通过示波法测量的bMBP（i）和使用六个不同方程计算得出的bMBP（ii）；（3）通过压平式眼压计并采用不同校准方法有创和无创获得的bSBP和bPP。为此，同时获取了有创主动脉血压和bBP（导管插入术）以及无创bBP（示波法[Mobil-O-Graph]和肱动脉压平式眼压计[SphygmoCor]）（34名受试者，193条记录）。使用不同方法计算bMBP。结果：（i）有创bBP与其各自的无创测量值（示波法）之间的一致性显示出对bBP水平的依赖性（比例误差）；（ii）在用于获得bMBP的不同方法中，包含等于33%的形状因子的方程（bMBP = bDBP + bPP/3）与有创bMBP显示出最佳关联；（iii）从眼压计记录估计有创bSBP和bPP的最佳方法基于采用示波法bMBP的校准方案。相反，当将肱动脉脉搏波形校准为量化为bMBP = bDBP + bPP/3的bMBP时，观察到有创和压平式眼压计得出的bBP水平之间的关联最差。我们的研究强烈强调了无创bMBP评估在方法透明度和共识方面的必要性。
