严重慢性肾病患者收缩压的直接测定而非示波法估计,American Journal of Nephrology

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严重慢性肾病患者收缩压的直接测定而非示波法估计
American Journal of Nephrology ( IF 4.3 ) Pub Date : 2022-01-12 , DOI: 10.1159/000520996
Amir M Benmira _{1,

2} , Olivier Moranne _{3,

4} , Camelia Prelipcean ₅ , Emilie Pambrun ₅ , Michel Dauzat _{1,

6} , Christophe Demattei ₇ , Antonia Pérez-Martin _{1,

2}

Affiliation

简介：虽然动脉高血压是慢性肾脏病 (CKD) 患者的主要问题，但在自动示波设备可能会产生错误结果的人群中，获得准确的收缩压 (SBP) 测量是一项挑战。方法：这项横断面研究在 89 名 4、5 和 5D CKD 患者中进行，我们比较了通过最近描述的收缩期足尖时间间隔 (SFATI) 技术获得的 SBP 值，该技术提供直接 SBP 测定、标准技术（柯氏音）和示波法。我们调查了年龄、性别、糖尿病、CKD 分期和脉压的影响，以解释测量误差定义为相对于 110-130-mm Hg 的 SBP 阈值的偏差或错误分类。结果：所有 3 种技术均显示出令人满意的 SBP 测量重现性（CCC #x3e；0.84 和 #x3e；0.91，分别在透析和未透析患者中）。通过 Korotkoff 声音确定的 SBP 的平均值 ± SD 为 SFATI 的 1.7 ± 4.6 mm Hg (CCC = 0.98) 和示波法的 5.9 ± 9.3 mm Hg (CCC = 0.88)。参考 110-130-mm Hg SBP 范围，建议 CKD 患者在此范围之外进行治疗处方或调整，SFATI 低估了 3 名患者的 SBP，高估了 1 名患者的 SBP，而示波法低估了 12 名患者的 SBP，高估了 3 名患者的 SBP。压力是测量和分类错误的主要解释因素。讨论/结论：SFATI 为严重 CKD 患者提供准确的 SBP 测量，并为自动化无创血压测量设备的标准化铺平了道路。在开具或调整抗高血压治疗之前，医生应意识到使用示波法时可能出现错误分类的风险。
Am J 肾病

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Direct Determination rather than Oscillometric Estimation of Systolic Blood Pressure in Patients with Severe Chronic Kidney Disease

Introduction: Although arterial hypertension is a major concern in patients with chronic kidney disease (CKD), obtaining accurate systolic blood pressure (SBP) measurement is challenging in this population for whom automatic oscillometric devices may yield erroneous results. Methods: This cross-sectional study was conducted in 89 patients with stages 4, 5, and 5D CKD, for whom we compared SBP values obtained by the recently described systolic foot-to-apex time interval (SFATI) technique which provides direct SBP determination, the standard technique (Korotkoff sounds), and oscillometry. We investigated the effects of age, sex, diabetes, CKD stage, and pulse pressure to explain measurement errors defined as biases or misclassification relative to the SBP thresholds of 110–130-mm Hg. Results: All 3 techniques showed satisfactory reproducibility for SBP measurement (CCC #x3e; 0.84 and #x3e;0.91, respectively, in dialyzed and nondialyzed patients). The mean ± SD from SBP as determined via Korotkoff sounds was 1.7 ± 4.6 mm Hg for SFATI (CCC = 0.98) and 5.9 ± 9.3 mm Hg for oscillometry (CCC = 0.88). Referring to the 110–130-mm Hg SBP range outside which treatment prescription or adaptation is recommended for CKD patients, SFATI underestimated SBP in 3 patients and overestimated it in 1, whereas oscillometry underestimated SBP in 12 patients and overestimated it in 3. Higher pulse pressure was the main explanatory factor for measurement and classification errors. Discussion/Conclusion: SFATI provides accurate SBP measurements in patients with severe CKD and paves the way for the standardization of automated noninvasive blood pressure measurement devices. Before prescribing or adjusting antihypertensive therapy, physicians should be aware of the risk of misclassification when using oscillometry.
Am J Nephrol

更新日期：2022-01-12

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