Blood Pressure

Singer, Adam J.

doi:10.1001/archinte.1996.00440160119014

Cited by 54 publications

(4 citation statements)

References 3 publications

(3 reference statements)

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“…This difference can be attributable to random variation but it also could indicate that those subjects suffered from a cardiac disease, e.g. coarcation of the aorta, upper extremity arterial obstruction, dissection or aneurysm of the thoracic aorta [10, 12, 19, 26], and thus the inter-arm difference could mask treatment effects. Unfortunately, this hypothesis cannot be tested, as this accurate diagnostic information is not available for the study population.…”

Section: Discussionmentioning

confidence: 99%

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Short-term blood pressure variability – variation between arm side, body position and successive measurements: a population-based cohort study

Lacruz

Kluttig

Kuß

et al. 2017

BMC Cardiovasc Disord

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BackgroundPrecise blood pressure (BP) measurements are central for the diagnosis of hypertension in clinical and epidemiological studies. The purpose of this study was to quantify the variability in BP associated with arm side, body position, and successive measurements in the setting of a population-based observational study. Additionally, we aimed to evaluate the influence of different measurement conditions on prevalence of hypertension.MethodsThe sample included 967 men and 812 women aged 45 to 83 years at baseline. BP was measured according to a standardized protocol with oscillometric devices including three sitting measurements at left arm, one simultaneous supine measurement at both arms, and four supine measurements at the arm with the higher BP. Hypertension was defined as systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg. Variability in SBP and DBP were analysed with sex-stratified linear covariance pattern models.ResultsWe found that overall, no mean BP differences were measured according to arm-side, but substantial higher DBP and for men also higher SBP was observed in sitting than in supine position and there was a clear BP decline by consecutive measurement. Accordingly, the prevalence of hypertension depends strongly on the number and scheme of BP measurements taken to calculate the index values.ConclusionsThus, BP measurements should only be compared between studies applying equal measurement conditions and index calculation. Moreover, the first BP measurement should not be used to define hypertension since it overestimates BP. The mean of second and third measurement offers the advantage of better reproducibility over single measurements.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0468-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…Some previous studies have suggested a bias towards higher readings from the right arm [9–11], whereas others have failed to show this [12–15]. Additionally, disagreement exists as to whether body position would make any difference in BP readings [6, 16–18].…”

Section: Introductionmentioning

confidence: 99%

Short-term blood pressure variability – variation between arm side, body position and successive measurements: a population-based cohort study

Lacruz

Kluttig

Kuß

et al. 2017

BMC Cardiovasc Disord

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“…Exclusion criteria included patients with a MAP difference of more than 20 mmHg between their upper arms as measured by automated oscillometric NIBP, a history of or concurrent known arterial vascular occlusive diseases such as thromboangiitis obliterans, Takayasu's disease, Raynaud's disease, lupus, scleroderma, rheumatoid arthritis, thoracic outlet syndrome, and a history of upper extremity embolisation. 20,21 Contraindications for intra-arterial catheterisation including a negative Allen test, a history of Raynaud's phenomenon or brachial artery injury, which were also not considered for enrolment. 21 Patients with contraindications to non-invasive blood pressure cuff placement such as the presence of an upper limb arteriovenous fistula for renal dialysis, previous lymph node removal and lymphoedema were also not considered for enrolment.…”

Section: Methodsmentioning

confidence: 99%

Blood pressure measurement in obese patients: non-invasive proximal forearm versus direct intra-arterial measurements

Verkhovsky

Smit

Levin

et al. 2018

Southern African Journal of Anaesthesia and Analgesia

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In obesity, accurate perioperative blood pressure measurement using upper arm, non-invasive blood pressure (NIBP) is technically challenging. Proximal forearm NIBP may be an acceptable substitute. Mean arterial blood pressures (MAP) estimated by proximal forearm NIBP were compared with direct intra-arterial measurements. It was hypothesised that the measurement techniques would be interchangeable if between-technique MAP differed ≤ 20% and MAP ratios were < 1.2 and > 0.8. Method: A total of 30 adults with body mass index ≥ 30 kg/m 2 in whom perioperative intra-arterial blood pressure measurement was considered mandatory were enrolled. MAP measurements using the two techniques were obtained at three random intervals in each patient. Bland-Altman analyses were employed. Results: Forearm mean NIBP MAP overestimated mean intra-arterial MAP by 2.2 (SD 8.1; range from 23.8 to -19.4 mmHg; p = 0.011, 95% CI 3.9 to 0.5). However, Bland-Altman analyses revealed a wide dispersion with several MAP differences and MAP ratios exceeding the pre-specified bounds for interchangeability. Conclusion: Forearm NIBP could not be considered interchangeable with direct intra-arterial MAP measurements in obese patients.

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“…Typical presentation for aortic dissection is the sudden onset of severe chest pain radiating to the back and frequently associated with sweating [Chen et al 1997;Klompas 2002;Januzzi et al 2004;Creager and Loscalzo 2015;AHA 2016]. Nonspecific signs during physical examination are differences among carotid, radial, and femoral pulses [Klompas 2002]; differences in blood pressure between the two arms [Singer and Hollander 1996;Von Kodolitsch et al 2000]; and a heart murmur heard through a…”

Section: Aortic Dissectionmentioning

confidence: 99%

Lieutenant suffers an acute aortic dissection after physical fitness training - North Carolina.

2016

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On August 17, 2015, a 40-year-old male career Lieutenant (LT) arrived for duty at his fire station at 0600 hours. He exercised by lifting weights in the fire station gym and running outside. A crewmember arriving at the station at 0735 hours for an emergency medical call found the LT sitting on the dayroom couch unresponsive. Despite cardiopulmonary resuscitation (CPR) and advanced life support, the LT was pronounced dead at the scene. The death certificate and the autopsy report were completed by the Associate Chief Medical Examiner. The cause of death was listed as "hemopericardium" due to "aortic dissection." It is unlikely the following recommendations could have prevented the LT's death. Nonetheless, the NIOSH investigators offer these recommendations to reduce the risk of on-the-job heart attacks and sudden cardiac arrest among fire fighters.

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Blood Pressure

Abstract: Bilateral upper-extremity blood pressure determinations, as measured by automated indirect measurement, have a wide degree of interarm variation.

Cited by 54 publications

References 3 publications

Short-term blood pressure variability – variation between arm side, body position and successive measurements: a population-based cohort study

Short-term blood pressure variability – variation between arm side, body position and successive measurements: a population-based cohort study

Blood pressure measurement in obese patients: non-invasive proximal forearm versus direct intra-arterial measurements

Lieutenant suffers an acute aortic dissection after physical fitness training - North Carolina.

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