Alpert Bruce S, Schwartz Joseph E, Shapiro Mira, Wexler Randell K
Department of Pediatrics, University of Tennessee Health Science Center (retired), Memphis, TN, USA.
Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, USA.
EClinicalMedicine. 2023 Sep 14;64:102219. doi: 10.1016/j.eclinm.2023.102219. eCollection 2023 Oct.
Optimal clinical care, diagnosis and treatment requires accurate blood pressure (BP) values. The primary objective was to compare BP readings taken while adhering to American Heart Association (AHA) guidelines to those typical of routine clinical care. Specifically studied: the combined effect of feet flat on the floor, back supported, and arm supported with cuff at heart level, while adhering to other guideline recommendations.
In this prospective, randomised, three-group cohort study, a modified cross-over design was applied in a primary care outpatient office setting in Columbus (OH, USA). Eligible participants were adults (aged ≥18 years) with an arm circumference of ≥18 cm and ≤42 cm who did not have a renal dialysis shunt or a previous or current diagnosis of atrial fibrillation. 150 recruited volunteers meeting the inclusion criteria were randomly randomised into the three groups. Group methodologies were BP readings taken on a fixed-height exam table followed by readings taken in an exam chair with adjustable positioning options (Group A), readings taken in the reverse order, chair then table (Group B), and both sets of readings in the exam chair (Group C). A rest period occurred before each set of readings. Group C was included for the purpose of obtaining an independent estimate of the order effect. The order in which the two types of readings (table vs chair) were taken was randomised. The primary outcome was the difference between the mean of three BP readings taken on the table and the mean of three readings taken in the chair.
Between September and October, 2022, 150 participants were enrolled in the study; all 150 of whom completed testing: 48 in Group A, 49 in Group B, 53 in Group C. The mean systolic/diastolic BP (SBP/DBP) of readings taken on the table (Group A first readings, Group B second readings) were 7.0/4.5 mmHg higher than those taken in the chair (Group A second readings, Group B first readings); both statistically significant, p < 0.0001. These findings show that AHA-recommended positioning-feet flat on the floor, back supported, arm supported with the BP cuff at heart level-results in substantially lower BP values than improper positioning. The mean SBP/DBP of the first set of readings taken on the chair were 1.6/0.6 mmHg higher than for the second set of readings (Group C, included to estimate order effect).
The observed benefit of proper positioning is sufficient to change the BP classification of several million patients from having hypertension to not having hypertension and therefore avoiding medication and/or intense follow-up.
Midmark Corporation, Versailles, Ohio, USA.
最佳的临床护理、诊断和治疗需要准确的血压（BP）值。主要目标是将遵循美国心脏协会（AHA）指南时测得的血压读数与常规临床护理中的典型读数进行比较。具体研究内容为：双脚平放在地面、背部得到支撑且手臂在心脏水平位置佩戴袖带并遵循其他指南建议时的综合效果。
在这项前瞻性、随机、三组队列研究中，在美国俄亥俄州哥伦布市的一家初级保健门诊设置中采用了改良交叉设计。符合条件的参与者为成年人（年龄≥18岁），臂围≥18厘米且≤42厘米，没有肾透析分流器，也没有既往或当前心房颤动的诊断。150名符合纳入标准的招募志愿者被随机分为三组。分组方法为：在固定高度的检查台上测量血压读数，然后在具有可调节位置选项的检查椅上测量（A组）；按相反顺序测量，先在检查椅上后在检查台上（B组）；两组读数均在检查椅上测量（C组）。每组读数前都有一段休息时间。纳入C组是为了独立评估顺序效应。两种类型读数（检查台与检查椅）的测量顺序是随机的。主要结局是在检查台上测量的三次血压读数的平均值与在检查椅上测量的三次读数的平均值之间的差异。
2022年9月至10月期间，150名参与者纳入研究；所有150人均完成测试：A组48人，B组49人，C组53人。在检查台上测量的读数（A组首次读数，B组第二次读数）的平均收缩压/舒张压（SBP/DBP）比在检查椅上测量的读数（A组第二次读数，B组首次读数）高7.0/4.5毫米汞柱；两者均具有统计学意义，p<0.0001。这些结果表明，AHA推荐的姿势——双脚平放在地面、背部得到支撑、手臂在心脏水平位置佩戴血压袖带——导致的血压值明显低于姿势不当的情况。在检查椅上测量的第一组读数的平均SBP/DBP比第二组读数（纳入C组以评估顺序效应）高1.6/0.6毫米汞柱。
观察到的正确姿势的益处足以使数百万患者的血压分类从患有高血压变为没有高血压，从而避免用药和/或密切随访。
美国俄亥俄州凡尔赛市的Midmark公司。
