Inaccuracy of brachial blood pressure and its potential impact on treatment and aortic blood pressure estimation

Kowalski, Cédric; Yang, Katie; Charron, Thierry; Doucet, Michel; Hatem, Raja; Kouz, Remi; Palisaitis, Donald; Schampaert, Erick; Terriault, Paul; Tessier, Pierre; Agharazii, Mohsen; Goupil, Rémi

doi:10.1097/hjh.0000000000002943

Cited by 12 publications

(27 citation statements)

References 41 publications

(63 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8 Inaccuracy can lead to misclassification of populations and, on an individual level, to undertreatment or overtreatment of patients and suboptimal drug therapy or adverse events. 5 , 9 , 10 …”

Section: Discussionmentioning

confidence: 99%

“…The invasive BP study cohort was composed of patients who had a clinical indication for coronary angiography at the Hôpital du Sacré-Coeur de Montréal in Quebec, Canada, from January 1 to December 31, 2019. 5 All included participants (n = 500) were without severe aortic stenosis or atrial fibrillation. Invasive aortic BP and cuff-based noninvasive brachial and central BP measurements were recorded simultaneously in all participants.…”

Section: Methodsmentioning

confidence: 99%

“…The percent mediation represents the proportion of the total effect attributable to each mediator. Because the degree of underestimation of the intra-arterial brachial SBP by the brachial cuff likely influences the association between sex and brachial cuff accuracy, 5 we repeated the mediation analysis but with the addition of the difference between brachial cuff and intra-arterial brachial SBP as a mediator in the subgroup of participants with available intra-arterial brachial BP. All mediation analyses were performed using the PROCESS Statistical Package for SPSS, release 3.5.3, with bootstrapping with 5000 resamples to calculate indirect effect and 95% CIs.…”

Section: Methodsmentioning

confidence: 99%

“…8 This misclassification can lead to suboptimal drug therapy caused by overtreatment and medication-related adverse effects or undertreatment and failure to adequately prevent cardiovascular complications. 5 , 9 , 10 This issue raises the importance of using accurate noninvasive BP to properly assess aortic BP. Noninvasive central BP devices have the potential to better estimate cardiovascular risk than brachial cuff BP because they aim to provide a more accurate measure of the invasive aortic BP and target organ perfusion.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Accuracy Difference of Noninvasive Blood Pressure Measurements by Sex and Height

et al. 2022

Self Cite

View full text Add to dashboard Cite

Key Points Question Do noninvasive brachial cuff blood pressure (BP) measurements accurately estimate the invasive aortic (or true) BP in men and women? Findings In this cross-sectional study of 500 patients undergoing cardiac catheterization at a tertiary care academic hospital, women had significantly higher invasively measured aortic systolic BP (SBP) compared with men with similar brachial cuff SBP. This disparity was mostly explained by a difference in height, with shorter height associated with greater underestimation of the invasive aortic SBP by the brachial cuff. Meaning These findings suggest that brachial cuff BP may significantly underestimate true aortic SBP in women, which may lead to unrecognized undertreatment of women compared with men and could partly explain why women are at higher risk of cardiovascular diseases for a given brachial cuff BP.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Accuracy Difference of Noninvasive Blood Pressure Measurements by Sex and Height

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…

owalski et al [1] should be congratulated for their study and its rigorous methodology. Their findings are clinically relevant with direct impact on cardiovascular risk management and accurate determination of brachial and aortic blood pressure.

…”

mentioning

confidence: 99%

Inaccuracy of blood pressure measurement: the mysterious role of arterial stiffness

Papaioannou

Vrachatis

Tsioufis

2022

Journal of Hypertension

View full text Add to dashboard Cite

owalski et al. [1] should be congratulated for their study and its rigorous methodology. Their findings are clinically relevant with direct impact on cardiovascular risk management and accurate determination of brachial and aortic blood pressure. Aiming to contribute to the understanding of the physical or technical factors related to blood pressure (BP) measurement errors, we would like to comment on the potential effect of arterial stiffness on the accuracy of BP measurement, which is, indeed, still unclear.Arterial stiffness has been found to be significantly correlated with the difference between cuff and intra-arterial measurements of both SBP and DBP [2]. Moreover, arterial stiffening has been supposed to represent the underlying mechanism of disagreement between oscillometry and sphygmomanometry regarding BP monitoring [3].Although pulse wave velocity (PWV) did not differ significantly among the three 'mismatch' subgroups in the study by Kowalski et al.[1], it would be of interest to further analyze any association of brachial SBP difference between invasive and noninvasive measurements with arterial stiffness. An additional sensitivity or comparative analysis for individuals with high vs. low arterial stiffness (i.e. PWV above or below 10 m/s) might shed light on a potential role of arterial compliance on measurement errors of brachial SBP. Furthermore, it would be very relevant to appreciate the respective mismatch -if anyof DBP between cuff and catheter measurements, which is expected to be more dependent on PWV than SBP [4].Last but not least, as the study cohort involved patients undergoing diagnostic catheterization, beyond coronary artery disease status (which was positive for more than half of the patients), it would also be important to take into account whether conduction of any interventional procedures (i.e. balloon angioplasty, stent implantation) might pose any impact in study findings. Additionally, it would be interesting to clarify whether any radial artery spasm prevention regimes were utilized (e.g. intra-arterial verapamil and/or nitroglycerin) as per routine or ad-hoc.Here, it should be underscored that different hemodynamic relationships (i.e. among BP, arterial stiffness, heart rate) may exist between individuals with different levels of arterial stiffness [5,6]. It is, hence, likely that sensors and algorithms used by oscillometric automated devices for the acquisition and analysis of arterial pulse waveforms may be susceptible to measurement errors according to vessel wall rigidity.Undoubtedly, several hemodynamic and vascular factors that might introduce errors in BP measurement in some individuals remain unclear and should be further investigated aiming to optimization of BP-related cardiovascular risk management and personalization of BP measurement techniques.

show abstract

Accuracy of cuff blood pressure and systolic blood pressure amplification

et al. 2023

View full text Add to dashboard Cite

Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Automated cuff BP and invasive brachial BP were recorded in 795 participants (74% male, aged 64 ± 11 years) receiving coronary angiography at five independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference –7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R2 = 19%). The accuracy of cuff SBP was greatest among participants with the lowest SBP amplification (ptrend < 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.

show abstract

Inaccuracy of brachial blood pressure and its potential impact on treatment and aortic blood pressure estimation

Cited by 12 publications

References 41 publications

Accuracy Difference of Noninvasive Blood Pressure Measurements by Sex and Height

Accuracy Difference of Noninvasive Blood Pressure Measurements by Sex and Height

Inaccuracy of blood pressure measurement: the mysterious role of arterial stiffness

Accuracy of cuff blood pressure and systolic blood pressure amplification

Contact Info

Product

Resources

About