The measurement of blood pressure: sitting or supine, once or twice?

Jamieson, M. J.; Webster, John; Philips, Santosh; Jeffers, T A; Scott, AK; Robb, O J; Lovell, H. G.; Petrie, J. C.

doi:10.1097/00004872-199007000-00006

Cited by 46 publications

(32 citation statements)

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“…For instance, it has been shown that body position slightly affects Effect of posture on stiffness measurements J Nürnberger et al peripheral diastolic blood pressure. Consistent with the reports in the literature, 11,12 in our study subjects mean diastolic blood pressure was 2-3 mm Hg lower than the corresponding sitting pressure. Hemodynamically, the increase in diastolic blood pressure may lead to an increase in PWV, which closely depends on diastolic blood pressure, particularly in young individuals.…”

Section: Discussionsupporting

confidence: 93%

Can arterial stiffness parameters be measured in the sitting position?

Nürnberger

Michalski²,

Türk³

et al. 2010

Hypertens Res

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Despite the introduction of arterial stiffness measurements in the European recommendation, pulse wave velocity (PWV) and augmentation index (AI) are still not used routinely in clinical practice. It would be of advantage if such measurements were done in the sitting position as is done for blood pressure. The aim of this study was to evaluate whether there is a difference in stiffness parameters in sitting vs. supine position. Arterial stiffness was measured in 24 healthy volunteers and 20 patients with cardiovascular disease using three different devices: SphygmoCor (Atcor Medical, Sydney, Australia), Arteriograph (TensioMed, Budapest, Hungary) and Vascular Explorer (Enverdis, Jena, Germany). Three measurements were performed in supine position followed by three measurements in sitting position. Methods were compared using correlation and Bland-Altman analysis. There was a significant correlation between PWV in supine and sitting position (Arteriograph: Po0.0001, r¼0.93; Vascular Explorer; Po0.0001, r¼0.87). There were significant correlations between AI sitting and AI supine using Arteriograph (Po0.0001, r¼0.97), Vascular Explorer (Po0.0001, r¼0.98) and SphygmoCor (Po0.0001, r¼0.96). When analyzed by Bland-Altman, PWV and AI measurements in supine vs. sitting showed good agreement. There was no significant difference in PWV obtained with the three different devices (Arteriograph 7.5 ± 1.6 m s À1 , Vascular Explorer 7.3 ± 0.9 m s À1 , SphygmoCor 7.0 ± 1.8 m s À1 ). AI was significantly higher using the Arteriograph (17.6±15.0%) than Vascular Explorer and SphygmoCor (10.2±15.1% and 10.3 ± 18.1%, respectively). The close agreement between sitting and supine measurements suggests that both PWV and AI can be reliably measured in the sitting position.

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Section: Discussionsupporting

confidence: 93%

Can arterial stiffness parameters be measured in the sitting position?

Nürnberger

Michalski²,

Türk³

et al. 2010

Hypertens Res

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“…[22] It is well established that if the BP is only measured in the supine position the systolic BP may increase by 3 mm Hg and the diastolic BP will be recorded lower by 3-5 mm Hg. [15,26] It would be worthwhile to record BP in both supine and sitting position if possible or at least the position in which the BP is recorded should be mentioned in the records. This would be helpful in follow-up visits by the patient.…”

Section: Discussionmentioning

confidence: 99%

“…In one study by Jamieson et al it was observed that the first systolic BP was on an average 3-4 mm Hg higher while the diastolic BP was not different when recorded twice. [26] Complete deflation of the cuff and allowing a few minutes rest between two consecutive measurements may circumvent this problem, however, this is not routinely done. The authors of this study have suggested an alternative, that taking two measurements and recording the average would help in reducing the errors, when the BP exceeds 155/90 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

“…The authors of this study have suggested an alternative, that taking two measurements and recording the average would help in reducing the errors, when the BP exceeds 155/90 mm Hg. [26] There is tendency by physicians to expect either a high or low BP. This results in rounding off the systolic and diastolic BP to the nearest 5-10 mm Hg, which may result in erroneous high or low BP recording.…”

Section: Discussionmentioning

confidence: 99%

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Accurate blood pressure recording: Is it difficult?

Bhalla¹,

Singh²,

D’cruz³

et al. 2005

Indian J Med Sci

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BACKGROUND: Blood pressure (BP) measurement is a routine procedure but errors are frequently committed during BP recording. AIMS AND SETTINGS: The aim of the study was to look at the prevalent practices in the institute regarding BP recording. The study was conducted in the Medicine Department at Government Medical College, Chandigarh, a teaching institute for MBBS students. METHODS: A prospective, observational study was performed amongst the 80 doctors in a tertiary care hospital. All of them were observed by a single observer during the act of BP recording. The observer was well versed with the guidelines issued by British Hypertension Society (BHS) and the deviations from the standard set of guidelines issued by BHS were noted. The errors were defined as deviations from these guidelines. STATISTICAL METHODS: The results were recorded as percentage of doctors committing these errors. RESULTS: In our study, 90% used mercury type sphygmomanometer. Zero error of the apparatus, hand dominance was not noted by any one. Every one used the standard BP cuff for recording BP. 70% of them did not let the patient rest before recording BP. 80% did not remove the clothing from the arm. None of them recorded BP in both arms. In out patient setting, 80% recorded blood pressure in sitting position and 14% in supine position. In all the patients where BP was recorded in sitting position BP apparatus was below the level of heart and 20% did not have their arm supported. 60% did not use palpatory method for noticing systolic BP and 70% did not raise pressure 30-40 mm Hg above the systolic level before checking the BP by auscultation. 80% lowered the BP at a rate of more than 2 mm/s and 60% rounded off the BP to nearest 5-10 mm Hg. 70% recorded BP only once and 90% of the rest re inflated the cuff without completely deflating and allowing rest before a second reading was obtained. CONCLUSION: The practice of recording BP in our hospital varies from the standard guidelines issued by the BHS.

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“…A series of studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] have shown that body posture affects bBP values. In most recommendations [31][32][33][34] as well as in most clinical trials and daily clinical practice, the sitting position for bBP measurement is most commonly applied.…”

Section: Introductionmentioning

confidence: 99%

Effect of supine versus sitting position on noninvasive assessment of aortic pressure waveform: a randomized cross-over study

et al. 2013

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Biomarkers derived noninvasively from the aortic blood pressure (BP) waveform provide information regarding cardiovascular (CV) risk independently of brachial BP (bBP). Although body position has significant impact on the assessment of bBP, its effect on aortic hemodynamics remains unknown. This study investigated the changes in both brachial and aortic hemodynamics, between the supine and sitting position. In this randomized cross-over study, the bBP and the aortic pressure waveform were assessed after a 5 min rest (sitting and supine in randomized order); aortic BP, pulse pressure (PP) amplification, augmentation index (AIx) and subendocardial viability index (SEVR) were assessed. Sixty-one subjects were examined (36 males, mean age 50±12 years). Mean BP did not differ between the sitting and supine position (110.8±13.7 vs 110.9±14.9, respectively, P=0.945). However, significant difference between the sitting and supine position in brachial PP (45.9±16.0 vs 52.6±15.6, respectively, P<0.001), aortic PP (36.7±15.2 vs 43.1±13.9, P<0.001), PP amplification (1.28±0.1 vs 1.23±0.1, P<0.001), AIx (26.9±11.9 vs 31.1±10.2, P<0.001) and SEVR (179.6±25.7 vs 161.2±25.8, P<0.001) were found. Review of the literature identified underestimation of the role of body position on aortic hemodynamics. In conclusion, increased PP in both the aorta and brachial artery were found in the supine compared to the sitting position. Reduced PP amplification and SEVR were further observed in the supine position, due to increased pressure wave reflections (AIx).

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The measurement of blood pressure: sitting or supine, once or twice?

Cited by 46 publications

References 0 publications

Can arterial stiffness parameters be measured in the sitting position?

Can arterial stiffness parameters be measured in the sitting position?

Accurate blood pressure recording: Is it difficult?

Effect of supine versus sitting position on noninvasive assessment of aortic pressure waveform: a randomized cross-over study

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