Blood pressure measurement and nocturnal dipping patterns are heavily affected by body posture through changes in hydrostatic pressure between the arm and the heart.

IF 4.3 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Niklas Pilz, Krzysztof Narkiewicz, Jacek Wolf, Kazuomi Kario, Tinta Visser, Oliver S Opatz, Alma Reuter, Laura J Dippel, Leon Fesseler, Viktor Heinz, Andreas Patzak, Tomas L Bothe
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Abstract

Nocturnal blood pressure (BP) shows the highest predictive power for cardiovascular events. However, there is a poor reproducibility of personalized dipping patterns in single individuals. We hypothesize that changes in body position during sleep cause variations in hydrostatic pressure,leading to incorrect BP values and dipping classifications. 26 subjects aged 18-30 years, as well as 25 participants aged 50 years and older underwent ambulatory BP measurements on the left arm, as well as determination of the hydrostatic pressure difference between the cuff and heart level during BP measurement. We observed that the BP measurement cuff was above the heart level (negative hydrostatic pressure) mostly through the night. Laying on the right side revealed the largest hydrostatic pressure difference and maximum incorrect BP measurement, with a mean of -9.61 mmHg during sleep. Correcting for hydrostatic pressure led to reclassification of nocturnal hypertension in 14 subjects (27.5%). Dipping patterns changed in 19 participants (37.3%). In total, 25 subjects (49.0%) changed either their nocturnal hypertension and/or their dipping classification. Our findings underscore the importance of accounting for hydrostatic pressure in ambulatory BP monitoring. Changes in body posture during sleep provide a plausible reason for the variability seen in nocturnal dipping patterns. Further research should focus on incorporating hydrostatic pressure compensation mechanisms in 24-h BP measurement. Limiting the noticeable effect of hydrostatic pressure differences could greatly improve hypertension diagnosis, classification, and treatment monitoring.

通过手臂和心脏之间静水压力的变化,身体姿势严重影响血压测量和夜间下沉模式。
夜间血压(BP)对心血管事件的预测能力最强。然而,在单个个体中,个性化浸出模式的可重复性很差。我们假设睡眠时体位的变化会引起静水压力的变化,从而导致不正确的BP值和倾斜分类。26名年龄在18-30岁的受试者和25名年龄在50岁及以上的受试者在左臂进行了动态血压测量,并在测量血压时测定了袖带和心脏水平之间的静水压差。我们观察到血压测量袖带在夜间大部分时间高于心脏水平(负静水压力)。右侧卧位显示出最大的静水压力差和最大的不正确血压测量,在睡眠期间平均为-9.61 mmHg。纠正静水压力导致14例(27.5%)受试者夜间高血压重新分类。19名参与者(37.3%)的浸出模式发生了变化。总共有25名受试者(49.0%)改变了他们的夜间高血压和/或他们的下沉分类。我们的研究结果强调了在动态血压监测中考虑静水压力的重要性。睡眠时身体姿势的变化为夜间浸泡模式的可变性提供了一个合理的解释。进一步的研究应侧重于将静水压补偿机制纳入24小时血压测量。限制静水压力差的显著影响可以极大地改善高血压的诊断、分类和治疗监测。
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
Hypertension Research
Hypertension Research 医学-外周血管病
CiteScore
7.40
自引率
16.70%
发文量
249
审稿时长
3-8 weeks
期刊介绍: Hypertension Research is the official publication of the Japanese Society of Hypertension. The journal publishes papers reporting original clinical and experimental research that contribute to the advancement of knowledge in the field of hypertension and related cardiovascular diseases. The journal publishes Review Articles, Articles, Correspondence and Comments.
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