Izolovana dijastolna hipertenzija

8/9/2019 Izolovana dijastolna hipertenzija

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Articles

Isolated Elevation of Diastolic Blood Pressure

Real or Artifactual?

1. Seymour G. Blank,2. Samuel J. Mann,3. Gary D. James,4. James E. West,5. Thomas G. P!kern"

#Author Afliations

1. From the Cardiovascular Center, The New York Hospital$Cornell Universit

!edical Center, New York, NY "#.$.%., #.&.!., $.'.&., T.$.(.)* 'epartment o+

lectromechanical n-ineerin- Technolo-, New York Cit Technical

Colle-eCUNY, %rookln, NY "#.$.%.)* and Acoustic /esearch 'epartment, AT0T

%ell a2oratories, !urra Hill, N& "&..3.).

1. Correspondence to #emour $. %lank, (h', 'epartment o+ lectromechanical

n-ineerin- Technolo-, New York Cit Technical Colle-e, 145 &a #t, /oom 6577, %rookln, NY11891.

Ne:t #ection

Abstract

AbstractNot in+re;uentl, 2lood pressure measurement 2 the standard auscultatortechni;ue ields a normal sstolic pressure with an elevated diastolic pressure. The relativelnarrow pulse pressure o+ such a measurement raises concern a2out the accurac o+ the 2loodpressure measurement. The purpose o+ this stud was to assess the accurac o+ auscultator2lood pressure measurements in patients with an uncommonl narrow pulse pressure,particularl patients with an elevated diastolic 2ut normal sstolic pressure. Auscultator

2lood pressure measurements were compared with an o2?su2I? mm H-) 2ut were less than 7 mm H- "-reater) in the other three -roups " P.999B). Forsstolic pressure, diJerences were less than 7 mm H- in all +our clinical -roups. Auscultator=8 diJerences o+ diastolic pressure e:ceedin- ? mm H- "and 19 mm H-) were seen in >7.7K"and B9.9K) o+ isolated diastolic hpertensive su2


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pseudohpertension

2lood pressure determination

levated 2lood pressure "%() has 2een widel documented as an important risk +actor +orstroke and a maand patients with isolated sstolichpertension4have 2een shown to 2eneMt +rom dru- treatment. Thus, when #%( issi-niMcantl elevated, the ar-ument +or treatment can 2e made independent o+ a small de-reeo+ inaccurac or variation in '%(.Not in+re;uentl, patients present with elevation o+ '%( onl. This could 2e re-arded asisolated diastolic hpertension.O Gn the National Health :amination #urve "NH#) andNational Health and Nutrition :amination #urve "NHAN#) studies, 5K to K o+ su2


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2ut disappears when the cuJ pressure +alls 2elow the diastolic pressure. C$ indicateselectrocardio-ram. "These si-nals were recorded in the la2orator o+ 'r /o2ert &. Cod.)

The purpose o+ this stud was to compare %( measurement 2 auscultation with =8 analsis ina wide ran-e o+ su2and sensorampliMer sstem14have2een descri2ed./ecordin-s were o2tained in a ;uiet room, with the su2


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K2 BPGdentiMcation o+ #%( and '%( +rom the =8 analsis has 2een previousl descri2ed. 17%rieP,#%( was identiMed 2 the cuJ pressure at the cardiac ccle in which the =8 si-nal initiallappears and '%( 2 the cuJ pressure at the last cardiac ccle 2e+ore the =8 si-nal disappears.Statistical Analysis

Comparison by Clinical Subgroup

%ased on the auscultated %(, su2


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Ta)le 3.

Fre;uenc o+ AuscultatorL=8 %lood (ressure 'iJerences o+ ? and 19 mm H- Accordin- toClinical #u2-roups

For #%(, si-niMcant discrepancies were uncommon and did not diJer 2 clinical su2-roup. Theauscultated #%( was at least 19 mm H- lower than the =8 value in onl 8 o+ the 1>? su2 and 8 su2


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likelihood o+ a discrepanc "? mm H- or -reater) 2etween auscultated and =8 '%( was similar.Gnterestin-l, when one o2server +ound a narrow ratio and the other did not, the =8 value +or'%( consistentl coincided with the lower o+ the two auscultated measurements.

(revious #ectionNe:t #ection

Discussion

The ma


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occurrin- under the %( cuJ as sounds -enerated 2 the phsical events created 2 the initialopenin- o+ the compressed arter se-ment "ie, when the intraarterial pressure e:ceeds thecuJ pressure) modulated 2 the resultin- 2lood Pow "e-, 2lood tur2ulence). 7?3hen pulsatile2lood Pow is reduced, as in the state o+ peripheral vasoconstriction "e-, shock), sounddisappears prematurel, resultin- in overestimation o+ '%(.757> Gn contrast, in patients withaortic re-ur-itation,74which is associated with a wide pulse pressure and tur2ulent 2lood Pow,and in pre-nant women,7B9who have peripheral vasodilation, sound o+ten persists 2elow thetrue '%(. Thus, phsiolo-ical andor phsical mechanisms that modi+ peripheral 2lood Powma modi+ the accurac o+ the =orotkoJ sound techni;ue. Gn the present stud in su2

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