影响血压测量的相关因素探讨

目的探索影响血压测量的有关因素，为临床提供准确的科学依据。方法对血压测量部位、测量方式及受测者相关因素的调查分析，降低干预因素。结果间接血压测量的准确性受被测量者、测量者和仪器等多方面的影响。     

动态血压监测技术

动态血压测量装置有袖带式和指套式两种，目前国内临床上常用的是袖带武装置。动态血压监测技术对了解患者的血压的平均水平优于常规的测量方法，并且可对患者血压的变化进行动态观察。但由于袖带式测量装置存在重复性差的缺点，它的动态测量值还不能作为评价患者血压的昼夜变化的依据。本文以袖带式测量装置为例，分析了血压的测量原理及袖带的大小，患者的体位，测量的频率，患者的活动这些主要因素对测量结果的影响。     

裸臂与戴袖测量血压的比较分析

血压的测量是健康体检中很常见的检查内容之一，因此准确的测量血压是很重要的。目前的指南对于如何获得准确、可重复操作的血压做出了相应规定。这些标准包括血压袖带的尺寸、患者上臂的位置以及患者在测量血压前应该静坐5min等。另外，指南推荐血压测量应该在患者裸臂上进行测量。我们研究的目的是探讨戴袖及裸臂测量血压之间是否存在差异。     

北京市社区居民血压测量站项目评估

1998年，北京市在8个城区居民社区中设立了血压测量站，为评价该措施实施2个月的工作效果和了解影响血压测量的有关因素，本随机抽取9个社区中358人进行了问卷调查。结果表明，31．6％的居民在居委会血压测量站测量过血压，其中50岁以上占89％。但人群对高血压病知识的知晓率还偏低。居民中，1年内测量皿压率为78．6％。由于环境及周围人的影响去测量血压占57．4％，说明了腱康教育和具体环境等因素，对人群血压测量行为均有重要影响。     

北京16家医院血压测量椅试用情况评估

为配合北京市卫生局开展的医院35岁及以上首诊测量血压规定的实施，北京市卫Ⅷ项目办公室向北京天坛医院等16家医院，发放了由北京市心血管病防冶办公室设计并监制的血压自动测量椅，供各家医院摆放于门诊大厅，方便群众自行测量血压。同时要求各家医院对前来测量进行问卷调查，通过调查分析来评估血压自动测量椅的推广价值。本次活动，3日中测量血压总人数为4265人，其中男性1823人，女性2442人，平均年龄52．5岁，平均测量1421人，日。查出高血压(压缩压≥140和/或舒张压≥90mmHg）人数为1944人，占测量血压总人数的45．6％，其中男性935人，女性1009人。有99．3％的人认为医院安装这种血压测量椅很有必要：99．7％的人认为血压测量椅使用很方便；85．9％的人认为自己能够看懂血压计上的数字。自行测压人员中，有26．1％的人近一年中测量过血压，739％的人近一年中未测过血压。从调查结果可以看出，门诊大厅摆放血压测量椅具有必要性和方便性，是一项非常受欢迎的便利措施，它的设置较大方便了群众测量血压，对北京市卫生局开展医院适龄首诊均宜测血压的规定的贯彻落实，起到了积极的推动作用。     

设计门诊体检血压计的理论基础及总体结构

阐述了ＡＢＯＰ门诊体检血压计的设计思想和其基本构造及简单的测量过程。采用国际上先进的血压测试法———脉搏波法，在血压监护仪的基础上，加装一套固定测试者上臂的装置，编制了适于门诊体检血压测试仪的测试程序，测量结果送数码管显示，连同测量时间一并打印输出     

007在家中血压的自我监测[英]／StergiouG…／／BMJ

尽管在临床上，血压测定值一般被视作高血压诊断的基础，但由于血压的随机波动及白大衣效应，这些测量结果并不代表患者的真实血压。此外，医师也很少会按推荐的规范方法来测量血压。为改进高血压病的治疗，2003年美国高血压联合委员会建议在考虑花费较高但确诊性较好的动态血压监测以前，先采用血压的自我监测。     

基于振动法和柯氏音法的无创血压测量值差异性研究

对无创血压测量仪测量值误差异性展开分析。用与各种血压测量技术进行比较的方法，着重分析了振动法无创血压测量和柯氏音听诊法。使用振动法无创伤血压测量监护仪和柯氏音听诊法对样本人群进行了血压测量，分析所得数据，结果表明，基于振动法和柯氏音法无创血压测量仪测量值差异小，准确性也比较好。同时，也展望了无创血压装置未来的发展方向。     

杭州市居民高血压、高血脂认知情况调查

高血压、高血脂是最常见的慢性病，也是心脑血管疾病主要的危险因素，本文于2004年对杭州市居民测量血压、血脂的意识，血压、血脂测量情况及高血压、高血脂患者的血压、血脂控制相关情况等进行了分析。     

振动法无创血压测量

1血压测量方法简述血压是反映人体循环系统机能的重要生理参数。心脏的泵血功能、心率、周围血管的阻力、主动脉和大动脉的弹性、全身的血容量及血液的物理状态等因素都反映在血压的指标中，所以血压的监测在临床上具有十分重要的意义。血压测量方法很多，可分为直接法和间接法两种。直接法测量血压测量值准确，并能跟踪动脉血压的瞬时变化，但测量时必须经皮将导管放入血管内．是一种创伤性的方法，一般限于危重病人或开腔手术病人。间接法与直接法相比测量精度较低，但简便无创，是临床上普遍采用的血压测量方法。血压间接测量方法很多，…     

动脉顺应性及其影响因素

动脉顺应性又称动脉弹性，反映血管内皮功能。已成为预测心血管疾病的重要危险因素。无创测量动脉弹性的方法在临床上已有一定程度的应用。各种方法具有其各自适用范围及局限性。多种干预手段可以影响动脉弹性。合理测量及维持正常的动脉弹性可延缓多种心血管疾病的发生及发展。     

基于手机的血压无线监测系统研制及初步应用

研制一种新型的手机型血压无线监测系统．包括一个以硬件为主的血压测量信号采集端,以及可将血压测量振荡波法所需的两路信号以蓝牙方式发送至本系统的另一部分——手机软件接收端,实现血压和心率的计算以及所测波形的实时绘制、显示和存储等功能。通过与商用血压测量仪器的对比实验,验证了系统的可靠性与稳定性,并开展了一系列新颖的探究性实验,如不同时段人体血压的波动、身体姿态对血压测量值的影响以及运动改变血压的状况等。     

血压盐敏感性流行病学影响因素研究进展

个体血压对盐负荷表现出不同的反应称为盐敏感性。与血压盐抵抗者相比,血压盐敏感者更易出现靶器官损害和心血管病事件。早期识别血压盐敏感者,进行有针对性的限盐干预,有利于降低人群心血管病事件。本综述从流行病学角度,分析血压盐敏感性的可能影响因素,明确血压盐敏感性的高危人群,为预防心血管病事件提供参考依据。     

Who participates in cardiovascular disease risk factor screenings? Experience with a religious organization-based program.

Adult members who declined participation in cardiovascular disease risk factor screenings offered at religious organizations were randomly selected and asked to participate in screenings at their homes. Relationships between screening participation and sociodemographic, behavioral, and physiological measures were examined. Age, knowledge of cardiovascular disease risk factors, body mass index, current smoking status, previous report of elevated blood pressure, current diastolic blood pressure measurement, frequency of worship service attendance, and residential distance from the religious organization screening site were important predictors of screening response. Those with conspicuous risk factors appeared less likely to initially respond to religious organization site screening invitations.     

Evaluation of Patients with Hypertension

Hypertension has been defined as blood pressure levels of 140/90mm Hg or greater. This has been arbitrarily based on epidemiological evidence that demonstrates the risk associated with blood pressure levels and the benefits to be expected from therapy. Conventional blood pressure measurements with a sphygmomanometer are adequate in most patients for evaluation of arterial hypertension. Out-of-office self-measurements of blood pressure or 24-hour blood pressure recordings provide useful additional information and can help to exclude ‘white coat hypertension’ or office hypertension.The objective of screening patients with hypertension is to detect any treatable causes and to assess the cardiovascular risk by ascertaining the extent of target organ damage and other cardiovascular risk factors. Abasic screening programme is appropriate in the majority of older patients with hypertension to exclude treatable causes. Additional investigations are necessary in young patients and those with suspicion of an identifiable cause.Target organ damage and cardiovascular risk factors have to be evaluated in each patient with hypertension since the incidence of cardiovascular disease is related to the profile of these risk factors. Accordingly, the clinical management of patients with hypertension depends not on blood pressure levels alone but also on the burden of associated risk factors. The Sixth Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure has recently recommended a classification that stratifies patients with hypertension into risk groups for therapeutic decisions. It has to be pointed out that there is uncertainty about the prognostic relevance of risk stratification in patients over the age of 80 years.     

妊娠期高血压疾病动态血压监测的应用分析

目的:探讨妊娠期高血压疾病的动态血压监测变化。方法:选取山东省聊城市东昌府区妇幼保健院350例孕妇,进行24 h动态血压监测,跟踪观察其妊娠期血压变化。结果:69例为高血压疾病组A组,281例为对照B组,A组与B组比较,A组的24 h平均收缩压、夜间血压及血压昼夜节律异常率等指标明显高于B组,均有统计学意义(P<0.01)。A组心电图异常(室性早搏、房性早搏、窦性心动过速、ST-T改变)较B组突出,均有统计学意义(P<0.01)。结论:妊娠期,利用动态血压监测24 h平均舒张压和平均动脉压可很好地监测妊娠期高血压疾病。     

The "white coat effect" in hypertensive patients

The "white coat effect" has been investigated by non-invasive automatic blood pressure monitoring in patients with hypertension, defined by casual blood pressure readings. A significant "white coat effect" has been demonstrated in 30 (32%) of the 93 patients: the average values were 17/9 mmHg and 6 beat/min, the highest values were 37/29 mmHg and 13 beat/min. The examination has been repeated after 24 hours in 11 cases and the phenomenon was reproducible. The "white coat effect" did not disappear even when the changes were compared to the averages of three subsequent automatic blood pressure measurements. There were significantly more women, than men among the "white coat" positive patients. However, no difference was found in age, occupation and the known duration of hypertension. Neither was any correlation between the "white coat effect" and the blood pressure reaction to mental arithmetic test. It is emphasized that the casual readings can significantly overestimate the blood pressure. This finding must be considered especially in the diagnosis of borderline hypertension.     

Body mass index and cardiovascular mortality at different levels of blood pressure: a prospective study of Norwegian men and women.

STUDY OBJECTIVE--The study investigated the joint effect of body mass index and systolic blood pressure on cardiovascular and total mortality. DESIGN--This was a prospective cohort study. The main outcome measures were age adjusted mortality and relative risks estimated from survival models. SETTING--The population of the city of Bergen, Norway. PARTICIPANTS--Subjects were 21,145 men and 30,330 women aged 30-79 years at the time of examination in 1963. MAIN RESULTS--Both cause specific and all cause mortality increased with systolic blood pressure within each category of body mass index. Stroke mortality was not significantly associated with body mass index when adjusted for systolic blood pressure in either age group of men or women. Coronary heart disease mortality increased on average 30% per 5 kg/m2 increase in body mass index in men and women aged 30-59 years at baseline. Adjusted for systolic blood pressure, the relative risks were reduced to 1.20 (95% confidence interval (CI) 1.12, 1.29) in men and 1.10 (95% CI 1.03, 1.18) in women. They were similar at each level of systolic blood pressure. For coronary heart disease mortality in men and women aged 60-79 years at measurement a negative interaction between body mass index and systolic blood pressure was suggested in the first five years. Excluding the first five years, adjusted relative risks per 5 kg/m2, were 1.05 (95% CI 0.96, 1.15) in men and 1.11 (95% CI 1.04, 1.17) in women in the older age group. There was an upturn in cardiovascular mortality at low levels of body mass index in both age groups of women, but not in men. CONCLUSIONS--Hypertension is an important risk factor for cardiovascular and all cause mortality even in the obese. Body mass index is generally a weak predictor of cardiovascular mortality in this population. It is a stronger risk factor of coronary death in men when measured at a younger age. Thin people with hypertension are not at particularly high risk of death from coronary heart disease compared with their obese counterparts, except possibly in the first few years after measurement in the elderly. Being underweight is associated with increased risk of death from all cardiovascular causes in women, but not in men.     

Aetiology and Pathology of Beat Knee

The object of this study was to determine the mechanism of the production of beat knee and its relation to pathological findings. A clinical study was made among 598 coal-face workers at one large colliery: 579 were examined of whom 233 showed evidence of past or present beat knee. A considerable preponderance of non-inflammatory lesions, most commonly in the prepatellar bursa, was demonstrated. It was concluded that the single common factor in the causation of non-inflammatory or acute recurrent bursitis was the trauma of kneeling.

Experimental investigation of the pressures exerted showed great variations in the pressure on the knee as a whole and on different parts of its weight-bearing surfaces. The view that these localized and extreme variations in pressure may lead to rupture of a vessel found confirmation in the aspiration of blood from the bursae of 29 out of 30 patients. Histological sections from chronically enlarged bursae showed intense fibrosis in the wall of the bursa and sometimes deposition of haemosiderin.

In the management of a new case of acute simple bursitis immediate aspiration of the blood and the instillation of hyalase proved successful in all 12 cases. Aspiration was also successful in certain cases of acute recurrent simple bursitis. Surgical removal of chronically enlarged fibrotic bursae allowed eight out of 12 patients to return to the coal-face.

It is suggested that in order to reduce the incidence of beat knee the use of a knee pad that will not only protect the skin of the front of the knee from trauma by coal particles but will also cushion the knee from the effects of extreme variations in pressure may be desirable.

     

Longitudinal prediction of adult blood pressure from juvenile blood pressure levels.

The link between blood pressure measured at juvenile ages (3-18 years) and subsequent adult ages (30 and 50 years) was investigated in a community-based longitudinal study conducted in the San Francisco Bay Area from 1928 to the present. The original sample of 550 persons decreased 61 percent by age 50 years, leaving only 211 persons in the cohort. Blood pressure was measured annually up to age 18 years and each decade thereafter, providing a unique opportunity to link childhood and adult blood pressures over periods of up to 50 years. Juvenile blood pressure measured from age 6 years onward was a positive predictor of blood pressure at age 30 years. Blood pressure measured at age 50 years was predicted best by juvenile pressures measured at early school age and early puberty. The juvenile-adult blood pressure association was partly explained by controlling for smoking and parental history of cardiovascular disease, but was not explained by controlling for juvenile height or body mass. It was stronger in children from blue collar families. The reported correlations probably represent an underestimation of the true strength of the association because of a greater loss to follow-up among subjects with higher blood pressure and the effects of antihypertensive medication in adulthood.