A comparison of blood pressure measurement over a sleeved arm versus a bare arm

Abstract

T he measurement of blood pressure is one of the most common examinations undertaken in family practice and has important health and management consequences for the patient. Accurate assessment of blood pressure, therefore, is very important. Current guidelines outline standards for obtaining accurate and reproducible blood pressure measurements.1 These standards include guidelines for the sizes of blood pressure cuffs and the position of the patient's arm, as well as a recommendation that the patient be seated for 5 minutes before his or her blood pressure is taken. In addition, it has been recommended that blood pressure be measured over the patient's bare arm.1 However, the current recommended method to determine blood pressure 2 has several limitations (e.g., high variability of blood pressure at different times of day or if measured only once, loss of proper technique post-training).Three previous studies have assessed whether blood pressure varies significantly when taken over a sleeved arm compared with a bare arm. Details of the literature review are described in Appendix 1, available online at www.cmaj .ca/cgi/content/full/178/5/585/DC2. In one study, involving 36 patients, Holleman et al 3 found no significant differences in systolic or diastolic blood pressure readings taken over the sleeved or bare arm of each patient. However, this study was limited because of its small sample and because blood pressure measurements were taken on both arms simultaneously. A study by Kahan et al, 4 involving 201 patients, compared blood pressure measurements taken over a sleeved arm, a bare arm and below a rolled-up sleeve. They found that the degree of clothing under the sphygmomanometer cuff did not have a clinically important effect on the reading. Although they found no significant difference in the effect of clothing on blood pressure readings, the study was limited by their design of measuring blood pressure below a rolled-up sleeve. The third study, conducted by Liebl et al, 5 was published while our study was in progress. Their study, which involved 201 patients, compared blood pressure measurements taken over a sleeved arm and a bare arm with both sphygmomanometric and oscillometric devices. They concluded no significant difference in readings between the sleeved and bare-arm groups. In contrast to previous studies, we sought to determine

Should blood pressure be measured with the cuff on a bare arm?

“…Our results are in line with data in six previous studies [1,[5][6][7][8][9] as shown in Table 4. As there were slight differences in the protocols used in these studies, we present the relevant differences for comparison in Table 4.…”

“…In clinical practice, these recommendations on removal of clothing are often not followed, and for practical or comfort reasons, clothing is left underneath the cuff. There are some studies that support this practice [1,[5][6][7][8][9], but these have some flaws. Previous studies had the limitations of very few BP readings, use of only one standard cuff bladder size, and absence of randomization.…”

Differences in Blood Pressure Measurements Obtained Using an Automatic Oscillometric Sphygmomanometer Depending on Clothes-Wearing Status

“…As a result, there were no significant differences between the two different settings. Ma et al14) reported that sleeve thickness had no correlation with the difference between bare- and sleeved-arm readings. In this study, we did not restrict the clothes the patients wore when visiting Gangneung Asan Hospital.…”

“…This is because we attempted to minimize measurement errors because we had to measure blood pressure a total of six times in each patient. Kahan et al12) and Ma et al14) measured blood pressure using a commercially automatic oscillometric device. There was also a report that oscillometric blood pressure measurements showed no difference from a classic mercury sphygmomanometer 13).…”

Looking Beyond Recurrence: Comorbidities in Cancer Survivors

“…Secondary hypertension may be caused by renal disease, oral contraceptives, chronic nonsteroidal anti-inflammatory drugs, antidepressants, pheochromocytoma, primary hyperaldosteronism, renovascular disease, Cushing syndrome, thyroid disease, or sleep apnea (Domino & Kaplan, 2009). Proper measurement is essential and no difference has been noted if a bare arm or sleeved arm is used (Ma, Sabin, & Dawes, 2008). History and physical, electrocardiogram, complete blood count, urinalysis, routine chemistries (glucose, creatinine, electrolytes), total LDL and HDL cholesterol, triglycerides, and estimation of glomerular filtration rate should be conducted (NHLBI, 2010b).…”