Arm Position and Blood Pressure Readings: The ARMS Crossover Randomized Clinical Trial.

IF 22.5 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

JAMA Internal Medicine Pub Date : 2024-12-01 DOI:10.1001/jamainternmed.2024.5213

Hairong Liu, Di Zhao, Ahmed Sabit, Chathurangi H Pathiravasan, Junichi Ishigami, Jeanne Charleston, Edgar R Miller, Kunihiro Matsushita, Lawrence J Appel, Tammy M Brady

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引用次数: 0

Abstract

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.

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手臂位置与血压读数：ARMS 交叉随机临床试验。

重要性：血压（BP）测量指南建议将手臂支撑在桌子上，中袖置于心脏水平。但在临床实践中仍有使用非标准姿势的情况（如手臂放在膝盖上或无支撑侧卧）：目的：确定不同手臂位置对血压读数的影响：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市招募了 18 至 80 岁的成年人：参与者被随机分配到三组一式三份的血压测量中，手臂放置的方式有三种：（1）支撑在桌子上（桌子 1；参考）；（2）手支撑在膝盖上（膝盖）；（3）手臂不支撑在体侧（体侧）。为了考虑内在血压变化，所有参与者都在手臂支撑在桌子上（桌子 2）的情况下进行了第四组血压测量：主要结果和测量方法：主要结果是参考血压（桌面 1）和两种手臂支撑位置（膝上和侧面）之间平均收缩压（SBP）和舒张压（DBP）的差异：(膝位或侧位 - 桌面 1） - （桌面 2 - 桌面 1）。试验结果还根据高血压状况、年龄、肥胖状况和过去一年中的医疗保健情况进行了分层：试验共招募了 133 名参与者（平均 [SD] 年龄为 57 [17] 岁；70 [53%] 为女性）；48 名参与者（36%）的 SBP 达到或超过 130 毫米汞柱，55 名参与者（41%）的体重指数（以体重（公斤）除以身高（米）的平方计算）达到或超过 30。膝位和侧卧位的血压读数明显高于桌位，差异如下：膝位，SBP Δ 3.9 (95% CI, 2.5-5.2) mm Hg，DBP Δ 4.0 (95% CI, 3.1-5.0) mm Hg；侧卧位，SBP Δ 6.5 (95% CI, 5.1-7.9) mm Hg，DBP Δ 4.4 (95% CI, 3.4-5.4) mm Hg。各亚组的模式基本一致：这项交叉随机临床试验表明，常用的手臂体位（膝位或侧位）会导致血压读数严重高估，并可能导致高血压的误诊和高估：试验注册：ClinicalTrials.gov Identifier：试验注册：ClinicalTrials.gov Identifier：NCT05372328。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JAMA Internal Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

43.50

自引率

1.30%

发文量

371

期刊介绍： JAMA Internal Medicine is an international, peer-reviewed journal committed to advancing the field of internal medicine worldwide. With a focus on four core priorities—clinical relevance, clinical practice change, credibility, and effective communication—the journal aims to provide indispensable and trustworthy peer-reviewed evidence. Catering to academics, clinicians, educators, researchers, and trainees across the entire spectrum of internal medicine, including general internal medicine and subspecialties, JAMA Internal Medicine publishes innovative and clinically relevant research. The journal strives to deliver stimulating articles that educate and inform readers with the latest research findings, driving positive change in healthcare systems and patient care delivery. As a member of the JAMA Network, a consortium of peer-reviewed medical publications, JAMA Internal Medicine plays a pivotal role in shaping the discourse and advancing patient care in internal medicine.