手臂位置与血压读数：双臂交叉随机临床试验
Arm Position and Blood Pressure Readings: The ARMS Crossover Randomized Clinical Trial.
作者信息
Liu Hairong, Zhao Di, Sabit Ahmed, Pathiravasan Chathurangi H, Ishigami Junichi, Charleston Jeanne, Miller Edgar R, Matsushita Kunihiro, Appel Lawrence J, Brady Tammy M
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
出版信息
JAMA Intern Med. 2024 Dec 1;184(12):1436-1442. doi: 10.1001/jamainternmed.2024.5213.
IMPORTANCE
Guidelines for blood pressure (BP) measurement recommend arm support on a desk with the midcuff positioned at heart level. Still, nonstandard positions are used in clinical practice (eg, with arm resting on the lap or unsupported on the side).
OBJECTIVE
To determine the effect of different arm positions on BP readings.
DESIGN, SETTING, AND PARTICIPANTS: This crossover randomized clinical trial recruited adults between the ages of 18 and 80 years in Baltimore, Maryland, from August 9, 2022, to June 1, 2023.
INTERVENTION
Participants were randomly assigned to sets of triplicate BP measurements with the arm positioned in 3 ways: (1) supported on a desk (desk 1; reference), (2) hand supported on lap (lap), and (3) arm unsupported at the side (side). To account for intrinsic BP variability, all participants underwent a fourth set of BP measurements with the arm supported on a desk (desk 2).
MAIN OUTCOMES AND MEASURES
The primary outcomes were the difference in differences in mean systolic BP (SBP) and diastolic BP (DBP) between the reference BP (desk 1) and the 2 arm support positions (lap and side): (lap or side - desk 1) - (desk 2 - desk 1). Results were also stratified by hypertensive status, age, obesity status, and access to health care within the past year.
RESULTS
The trial enrolled 133 participants (mean [SD] age, 57 [17] years; 70 [53%] female); 48 participants (36%) had SBP of 130 mm Hg or higher, and 55 participants (41%) had a body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher. Lap and side positions resulted in statistically significant higher BP readings than desk positions, with the difference in differences as follows: lap, SBP Δ 3.9 (95% CI, 2.5-5.2) mm Hg and DBP Δ 4.0 (95% CI, 3.1-5.0) mm Hg; and side, SBP Δ 6.5 (95% CI, 5.1-7.9) mm Hg and DBP Δ 4.4 (95% CI, 3.4-5.4) mm Hg. The patterns were generally consistent across subgroups.
CONCLUSION AND RELEVANCE
This crossover randomized clinical trial showed that commonly used arm positions (lap or side) resulted in substantial overestimation of BP readings and may lead to misdiagnosis and overestimation of hypertension.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT05372328.
重要性
血压测量指南建议将手臂支撑在桌子上，使袖带中部位于心脏水平。然而，在临床实践中仍会使用非标准姿势（例如，手臂放在腿上或无支撑地垂在身体一侧）。
目的
确定不同手臂姿势对血压读数的影响。
设计、地点和参与者：这项交叉随机临床试验于2022年8月9日至2023年6月1日在马里兰州巴尔的摩招募了18至80岁的成年人。
干预措施
参与者被随机分配以三种方式放置手臂进行三次重复血压测量：（1）支撑在桌子上（桌子1；参照组），（2）手支撑在腿上（腿上组），（3）手臂无支撑地垂在身体一侧（身体一侧组）。为了考虑血压的内在变异性，所有参与者都进行了第四次血压测量，手臂支撑在桌子上（桌子2）。
主要结局和测量指标
主要结局是参照血压（桌子1）与两种手臂支撑姿势（腿上组和身体一侧组）之间平均收缩压（SBP）和舒张压（DBP）差值的差异：（腿上组或身体一侧组 - 桌子1） - （桌子2 - 桌子1）。结果还按高血压状态、年龄、肥胖状态以及过去一年是否获得医疗保健进行了分层。
结果
该试验招募了133名参与者（平均[标准差]年龄为57[17]岁；70名[53%]为女性）；48名参与者（36%）收缩压为130 mmHg或更高，55名参与者（41%）体重指数（按千克体重除以米平方身高计算）为30或更高。腿上组和身体一侧组的血压读数在统计学上显著高于桌子组，差值差异如下：腿上组，收缩压差值为3.9（95%置信区间，2.5 - 5.2）mmHg，舒张压差值为4.0（95%置信区间，3.1 - 5.0）mmHg；身体一侧组，收缩压差值为6.5（95%置信区间，5.1 - 7.9）mmHg，舒张压差值为4.4（95%置信区间，3.4 - 5.4）mmHg。各亚组的模式总体一致。
结论及意义
这项交叉随机临床试验表明，常用的手臂姿势（腿上或身体一侧）会导致血压读数大幅高估，并可能导致高血压的误诊和高估。
试验注册
ClinicalTrials.gov标识符：NCT05372328。
Zotero 插件