【Hacker News搬运】常用的手臂姿势可能会高估血压读数：研究

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Title: Commonly used arm positions can overestimate blood pressure readings: study

常用的手臂姿势可能会高估血压读数：研究

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Url: https://medicalxpress.com/news/2024-10-commonly-arm-positions-substantially-overestimate.html

标题：常见手臂姿势会导致血压读数显著偏高，研究发现

摘要：一项发表于10月7日《JAMA Internal Medicine》杂志的研究报告显示，研究人员调查了三种不同的手臂姿势：手臂放在桌子上、手臂放在腿上以及没有支撑的手臂悬挂在患者身边。研究发现，放在腿上的姿势会使收缩压（血压读数中的顶部数字）偏高近4毫米汞柱，而悬挂在侧边的没有支撑的手臂会使收缩压偏高近7毫米汞柱。

约翰霍普金斯大学医学院儿科系临床研究副主席、儿童高血压计划医疗总监、Welch预防、流行病学和临床研究中心副主任及该研究的高级作者Tammy Brady博士表示，这些发现证实了手臂姿势在准确测量血压时起着“巨大的作用”。研究人员还强调，遵循临床指南，在测量血压时在桌子上或其他表面上给予牢固的支撑非常重要。

根据美国心脏协会的数据，近一半的美国成年人患有高血压，这是在血管中血液流动的力量高于通常认为的正常水平时做出的诊断，平均值为120/80。

未治疗的高血压会增加中风、心脏病发作和其他严重心血管疾病的风险。由于高血压可能引起最小或没有症状，因此在常规检查中进行早期和频繁的筛查被认为是高血压管理的基石。

在大多数情况下，生活方式的改变，如减肥、健康饮食和运动，以及使用任何一种药物的治疗，都可以将血压控制在正常范围内。

美国心脏协会的最新临床实践指南强调了几个关键步骤，以确保血压测量的准确性，包括适当的袖带尺寸、背部支撑、双脚平放在地板上，腿不交叉，以及适当的臂位，即在桌子或桌子上支撑的手臂上，血压袖带的中部位于心脏水平。

尽管有这些建议，研究人员表示，血压测量太经常在没有任何或不足够支撑的检查桌上进行。在某些情况下，临床医生会握住手臂，或者患者会用手臂夹在腿上。

在约翰霍普金斯大学的新研究中，研究人员在2022年8月9日至2023年6月1日期间招募了133名成年参与者（78%为黑人，52%为女性）。参与者年龄在18至80岁之间，随机分配到六个可能的组之一，这些组之间的差异在于三种坐姿手臂姿势的顺序。

测量在上午9点至下午6点之间的单个访问期间进行。在测量血压之前，所有参与者首先排空膀胱，然后步行两分钟，以模仿典型的临床场景，即人们在筛查之前进入诊所或办公室。然后，他们进行5分钟的静坐休息，背部和双脚都有支撑。

每个人佩戴的是根据他们的上臂尺寸选择和定制的上臂血压袖带，用数字血压计在30秒内进行三次重复测量。

每次完成三组测量后，袖带被取下，参与者步行两分钟，休息五分钟。在同一天，他们进行了第四组三重测量，手臂支撑在桌子上，用于考虑血压读数的已知变化。所有测量都是在安静和私密的空间内进行的，参与者被要求在筛查期间不要与研究人员交谈或使用手机。

研究人员发现，在临床实践中常用手臂姿势（手臂放在腿上或悬挂在侧面）获得的血压测量值明显高于手臂支撑在桌子上的标准、推荐的姿势获得的血压测量值。

将手臂放在腿上使收缩压偏高3.9毫米汞柱，使舒张压偏高4.0毫米汞柱，舒张压是血压读数中的底部数字，或心脏在心跳间休息时动脉的压力。悬挂在侧边的没有支撑的手臂使收缩压偏高6.5毫米汞柱，使舒张压偏高4.4毫米汞柱。

约翰霍普金斯大学公共卫生系流行病学系流行病学研究中心流行病学研究协调员、研究作者Sherry Liu表示：“如果你一直用没有支撑的手臂测量血压，并且血压读数偏高6.5毫米汞柱，那么这可能会导致收缩压在123和130之间，或者133和140之间的差异，这被认为是2级高血压。”

研究人员警告说，他们的研究结果可能仅适用于使用自动化血压计的筛查，可能不适用于其他血压计的读数。

然而，Brady说，这些发现表明，临床医生需要更加注意最佳实践指南，并且患者“必须在临床环境中为自己辩护，并在家中测量血压时为自己辩护”。

*当前的血压指南和变化

根据美国心脏协会2017年的指南，正常血压低于120/80毫米汞柱。血压读数在120-129/80毫米汞柱之间被归类为升高，高血压在130/80毫米汞柱或更高时被诊断。

需要注意的是，血压可能因压力、饮食、咖啡因摄入和吸烟等因素而变化。因此，为了获得准确的读数，在一致条件下按照临床指南进行血压测量至关重要。

Post by: wglb

Comments:

throwbmw: People shouldn't worry about accuracy too much. Everybody in healthcare knows about the problems in various measurement methods as well as individual responses to measurement anxiety and the physical and emotional state you are in that particular time. The only accurate measurements are direct measurements through an arterial catheter which is a very invasive procedure.
Routine clinic measurements are used only to have a general idea about trend and secondly to catch severely high BP which is usually due to a secondary disease.
Also, if BP is high above a certain limit it is significant regardless of if you took rest for 5 minutes and other precautions. Because if BP is high the normal BP regulating system should kick in and lower it regardless of the cause. With advancing age and hardened arteries this response becomes less optimal and you need the support of anti hypertensive medicines. You can see this in real time in patients under anesthesia. A young healthy patient would have an initial peak in response to pain or other surgical stimulus but they will be able to lower it either spontaneously or with minimal outside intervention. Whereas in older individuals much more effort is required to control and lower the BP.
The general trend has been to treat both hypertension and diabetes early because the microvascular complications start much earlier before they become apparent clinically.

throwbmw: 人们应该；不要太担心准确性。医疗保健领域的每个人都知道各种测量方法的问题，以及个人对测量焦虑的反应，以及你在特定时间的身体和情绪状态。唯一准确的测量方法是通过动脉导管直接测量，这是一种非常侵入性的手术。常规临床测量仅用于对趋势有一个大致的了解，其次用于捕捉通常由继发性疾病引起的严重高血压。此外，如果血压高于一定限度，无论你是否休息5分钟和采取其他预防措施，这都是非常重要的。因为如果血压很高，无论原因如何，正常的血压调节系统都应该启动并降低血压。随着年龄的增长和动脉硬化，这种反应变得不那么理想，你需要抗高血压药物的支持。你可以在麻醉下的患者身上实时看到这一点。年轻健康的患者对疼痛或其他手术刺激的反应会有一个初始峰值，但他们能够自发或在最小的外部干预下降低峰值。而对于老年人来说，需要付出更多的努力来控制和降低血压。总的趋势是尽早治疗高血压和糖尿病，因为微血管并发症在临床上变得明显之前就开始了。

crazygringo: There's definitely a huge variance in blood pressure readings depending on posture, relaxation, arm position, recent activity, etc. If you buy a blood pressure monitor, it's really interesting to see how "random" a single reading at the doctors' is, and how large your fluctuation throughout the day is.<p>That being said, it really makes me wonder about studies that correlate blood pressure with other things. Is the blood pressure really being measured "correctly" in all those studies? Or not?<p>In other words, if your "true correct" blood pressure is lower than what the doctor normally takes, but then a lot of the studies are based on real-life "incorrect" higher blood pressures, then don't you similarly want an "incorrect" higher reading for consistency? Or are the studies always really done with far more accurate blood pressure readings, where the patient sits still for 5 min beforehand, keeps their legs uncrossed, is totally free of stress and anxiety, didn't exercise beforehand, etc.?

crazygringo: 那里；根据姿势、放松程度、手臂位置、最近的活动等，血压读数肯定会有很大的差异。如果你买了血压监测仪，它；看看如何“；“随机”；在医生那里进行一次阅读；是的，以及你一天中的波动有多大。<p>话虽如此，这真的让我想知道血压与其他事物相关的研究。血压真的在测量吗&quot；正确&quot；在所有这些研究中？还是不<p> 换言之，如果你的&quot；真正正确&quot；血压低于医生通常的水平，但许多研究都是基于现实生活&quot；不正确&quot；血压升高，然后不要；你难道不同样想要一个“；不正确&quot；为了保持一致性而提高阅读量？或者，这些研究是否总是以更准确的血压读数进行的，患者在此之前静坐5分钟，双腿不交叉，完全没有压力和焦虑，没有；不能提前锻炼等。？

geye1234: Quite a few people here report getting anxious even when taking their BP themselves:<p><a href="https://www.innerhealthstudio.com/phobia-taking-blood-pressure.html?ezpage=1" rel="nofollow">https://www.innerhealthstudio.com/phobia-taking-blood-pressu...</a><p>I'm one of them. I bought a device with memory and covered the screen with a piece of card. Then I take BP for two weeks and ignore the first few days' readings. I seem to get used to it after a few days. This gets me readings that are very close to 120/80.<p>I've had anxiety about blood pressure ever since running for an appointment, while being on the first day of a new job when I was really amped up, and so (of course) had a dangerously high reading. I still remember the guy's eyes widening as he looked at the screen. Ever since then I've hated having BP taken and I can feel my BP and pulse increasing the moment I step into a doctor's office. Fortunately my doctor understands and doesn't try to push pills on me.<p>I wish there were some way of measuring BP without knowing it's being done. The act of measurement can greatly affect the result, which is counter-productive in several ways (not the least of which is un-needed anxiety).<p>York Cardiologist on Youtube is good on BP, and why apparently high BP should not automatically mean pills, although undoubtedly it <i>sometimes</i> should. (Usual disclaimer: this is not medical advice, ask your doctor about your specific situation.)

geye1234: 这里有很多人报告说，即使自己服用血压，他们也会感到焦虑：<p><a href=“https:#x2F；#x2F www.innerhealthstudio.com#x2F”血压恐惧症.html？ezpage=1“rel=”nofollow“>https:”&#x2F；www.innerhealthstudio.com；血压恐惧症</a> <p>我；我是其中之一。我买了一个有内存的设备，并用一张卡片盖住了屏幕。然后我服用BP两周，忽略前几天；阅读。几天后，我似乎已经习惯了。这使我的读数非常接近120°F；80.<p>我；自从参加约会以来，我一直对血压感到焦虑，而在新工作的第一天，我真的很紧张，所以（当然）血压读数很高。我仍然记得那个家伙；他看着屏幕，眼睛睁得大大的。从那时起，我；我讨厌做血压检查，当我走进医生的时候，我能感觉到我的血压和脉搏在增加；的办公室。幸运的是，我的医生理解，但并不理解；不要试图给我吃药。<p>我希望有某种方法可以在不知情的情况下测量血压；正在进行中。测量行为会极大地影响结果，这在几个方面会适得其反（其中最重要的是不必要的焦虑）<p> Youtube上的约克心脏病学家对血压很好，为什么显然高血压不应该自动意味着吃药，尽管毫无疑问，有时应该服用。（通常的免责声明：这不是医疗建议，请向您的医生询问您的具体情况。）

swores: I've never looked into research on this subject, but I always assumed this was already well established and known - and it was definitely somewhat already either known or at least believed to be the case:<p>- Every doctor in the UK I've ever seen do a BP test has made sure the patient's arm is in the right position, rested on a table/cushion if needed, in a way that matches the findings in this study (and while I've only needed my own BP tested once or twice, I've sat in on many, many doctors while they tested the BP of family members of mine).<p>- My home BP device is a Braun wrist cuff (and is at least a few years old), which has a built in feature that uses an accelerometer to guide you to raise your arm until it's at an angle which means your wrist is at the same level as your heart (this one: <a href="https://www.cora.health/guide/best-blood-pressure-monitor/#10braunicheck7" rel="nofollow">https://www.cora.health/guide/best-blood-pressure-monitor/#1...</a> )

swores: 我；我从未研究过这方面的研究，但我一直认为这已经得到了很好的证实和了解，而且肯定已经有所了解，或者至少被认为是这样：<p>-英国的每一位医生；我见过做BP测试以确保患者；s的手臂处于正确的位置，放在桌子上；如果需要，可以采取与本研究结果相匹配的方式进行缓冲（虽然我只需要对自己的血压进行一两次测试，但我在许多医生测试我家人的血压时，都坐在了他们的旁边）<p> -我家的BP设备是博朗腕带（至少有几年的历史），它有一个内置功能，使用加速计引导你抬起手臂，直到它；s处于一个角度，这意味着你的手腕与你的心脏处于同一水平面上（这个：<a href=“https:#x2F；www.cora.health；#x2F guide；#braunicheck7”rel=“nofollow”>https:#*2F；www.cora.health&#x2F guide&#x2G；best blood pressure monitor；#1.</a>）

eagerpace: I am not a doctor and this is not advice. This is a standard medical test I have completely given up on any doctor to perform accurately. I do it myself at home once or twice a month. I do it with the same device, in the same chair, at the same desk, the same time of day, after I’ve ate and drank the same thing. Yes, I still let everyone take it because it’s typically a precondition of receiving care but my readings at home are completely different and give me a more accurate data point that actually makes me feel good about the progress I’ve been making on my health.<p>I’m actively looking for more healthcare I can do this way. I trust my data and it all coming together on the safety of my personal device. We don’t need doctors with extremely limited datasets to do this and try to find obscure correlations for us.

eagerpace: 我不是医生，这不是建议。这是一个标准的医学测试，我完全放弃了任何医生来准确执行。我每月在家做一两次。我用同样的设备，在同样的椅子上，在同一张桌子上，在一天中的同一时间，在我吃过和喝过同样的东西之后。是的，我仍然让每个人都服用，因为这通常是接受护理的先决条件，但我在家里的读数完全不同，给了我一个更准确的数据点，这实际上让我对自己在健康方面取得的进步感到满意<p> 我正在积极寻找更多的医疗保健，我可以这样做。我相信我的数据，所有这些数据都会在我个人设备的安全性上汇集在一起。我们不需要数据集极其有限的医生来做这件事，并试图为我们找到模糊的相关性。