Correlation Between Anxiety State And Blood Pressure Reactivity Caused By Cuff Inflation

Objective:To investigate the effect of cuff inflation on the accuracy of blood pressure measurement and to evaluate the correlation between anxiety state and blood pressure reactivity caused by cuff inflation.Methods:A total of 234 patients(mean age 61.3±9.1 years old,including 124 males)who were admitted to the department of cardiovascular medicine or department of cardiac macrovascular surgery of the Second Affiliated Hospital of Nanchang University from September 2018 to June 2019 and required coronary angiography for suspected coronary heart disease were selected.First of all,a appropriate size of blood pressure monitor cuff was wrapped around the left upper arm for the cuff inflation test.Intraoperatively,the right radial artery was punctured,and a 6F angiography catheter(Medtronic or Cordis)was sent to the ascending aortic root to continuously record the intra-aortic blood pressure.After the intra-aortic blood pressure stabilized,the intra-aortic blood pressure under the number of 10 heart beats was recorded,and its mean value was taken as the baseline value of intra-aortic blood pressure(b-BP).Then inflate the cuff to 200mmHg by manual pressure at the rate of 20mmHg/s.During the period of cuff compression,the intra-aortic blood pressure under the same number of 10 heart beats was recorded,and the mean value was taken as the cuff inflation blood pressure(c-BP).At the end of the test,the cuff will deflate at the same rate to 0mmHg.Thirty seconds later,the intra-aortic BP was recorded for the 20 beats;the average of BP of the first 10 beats was used as the recovery BP1(r-BP~1)and that of the second 10 beats as recovery BP2(r-BP~2).The difference between b-BP and c-BP was calculated as cuff inflation induced BP elevation(CIBPE).And then the percentage increase of BP(PI-BP)was calculated with the formula:PI-BP=CIBPE/baseline BP×100%.On the second day after coronary arteriography,all subjects received the self-rating anxiety scale(SAS).The subjects were divided into three subgroups according to the anxiety score:the anxiety group(total anxiety score≥50),the sub-anxiety group(40-50),and the normal group(total anxiety score<40).The changes of CIBPE and PI-BP in each group were compared.P<0.05 was statistically significant.Results:1.When the cuff was inflated,the levels of c-SBP(134.9±22.4mmHg vs131.6±22.3mmHg),c-DBP(80.5±11.9mmHg vs 78.4±11.6mmHg)and c-MAP(96.1±13.2mmHg vs 98.7±13.3mmHg)were significantly higher than the baseline blood pressure(P<0.01),and their CIBPE were 3.3±4.7mmHg,2.1±4.9mmHg and2.6±3.8mmHg,respectively.2.Among the 234 included subjects,8.5%of subjects had systolic CIBPE≥10mmHg and 4.7%had diastolic CIBPE≥10mmHg.3.In the anxiety group,when the cuff was inflated,the intra-aortic blood pressure increased more significantly,and the systolic and diastolic CIBPE reached5.9±4.2mmHg and 4.2±4.6mmHg,respectively.Moreover,PI-SBP(4.5±3.1%and3.2±4.1%)in the anxiety group and the sub-anxiety group was significantly higher than that in the normal group(1.9±3.3%).PI-DBP in the anxiety group was also significantly higher than that in the normal group(5.6±6.3%vs 2.0±6.5%,P<0.05),but there was no statistically significant difference between the sub-anxiety group and the normal group(3.4±5.7%vs 2.0±6.5%).When the cuff was deflated,r-BP~1 and r-BP~2 at both systolic and diastolic blood pressures did not return to baseline blood pressure within 30 seconds in the anxiety group(P<0.05).4.Multivariate regression analysis showed that anxiety scale was positively correlated with CIBPE(systolic blood pressure OR value:3.44;95%CI:1.67--5.21;P<0.001)(diastolic blood pressure OR value:3.02;95%CI:1.17--4.86;P=0.001);Even in the sub-anxiety group,the increase of systolic blood pressure CIBPE was2.10 times that of the normal group(OR:2.10;95%CI:0.64 3.56;P=0.005).Conclusion:1.Cuff inflation can lead to increased systolic and diastolic blood pressure of the aorta;2.Anxiety state is an independent risk factor for the increase of CIBPE.