Dean S Picone1, Martin G Schultz1, Petr Otahal1, Svend Aakhus2, Ahmed M Al-Jumaily3, J Andrew Black4, Willem J Bos5, John B Chambers6, Chen-Huan Chen7, Hao-Min Cheng7, Antoine Cremer8, Justin E Davies9, Nathan Dwyer4, Brian A Gould10, Alun D Hughes11, Peter S Lacy12, Esben Laugesen13, Fuyou Liang14, Roman Melamed15, Sandy Muecke16, Nobuyuki Ohte17, Sho Okada18, Stefano Omboni19, Christian Ott20, Xiaoqing Peng1, Telmo Pereira21, Giacomo Pucci22, Ronak Rajani6, Philip Roberts-Thomson4, Niklas B Rossen13, Daisuke Sueta23, Manish D Sinha24, Roland E Schmieder20, Harold Smulyan25, Velandai K Srikanth26, Ralph Stewart27, George A Stouffer28, Kenji Takazawa29, Jiguang Wang30, Berend E Westerhof31, Franz Weber32, Thomas Weber33, Bryan Williams12, Hirotsugu Yamada34, Eiichiro Yamamoto23, James E Sharman35. 1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. 2. Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. 3. Institute of Biomedical Technologies, Auckland University of Technology, Auckland, New Zealand. 4. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Royal Hobart Hospital, Hobart, Tasmania, Australia. 5. Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands. 6. Cardiology Department, Guy's and St. Thomas' Hospitals, London, United Kingdom. 7. Department of Medicine, National Yang-Ming University, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan. 8. Department of Cardiology/Hypertension, University Hospital of Bordeaux, Bordeaux, France. 9. International Centre for Circulatory Health, Imperial College London, London, United Kingdom. 10. BMI Hospital Blackheath, London, United Kingdom. 11. Institute of Cardiovascular Sciences, University College London, London, United Kingdom. 12. Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, London, United Kingdom. 13. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. 14. School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China. 15. Abbott Northwestern Hospital, Allina Health, Minneapolis, Minnesota. 16. Department of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia. 17. Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 18. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 19. Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy. 20. Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. 21. Polytechnic Institute of Coimbra, Coimbra College of Health Technology, Department of Cardiopneumology, Lousã, Portugal. 22. Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Perugia, Italy. 23. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. 24. Department of Clinical Pharmacology and Department of Paediatric Nephrology, Kings College London, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. 25. Department of Medicine, State University of New York, Upstate Medical University, Cardiology Division, Syracuse, New York. 26. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medicine, Peninsula Health, Melbourne, Victoria, Australia. 27. Green Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Auckland, New Zealand. 28. Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 29. Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital, Tokyo, Japan. 30. Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 31. Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands. 32. Department of Nephrology, Center for Internal Medicine, University Clinic Essen, University Duisburg-Essen, Essen, Germany. 33. Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria. 34. Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan. 35. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. Electronic address: James.Sharman@utas.edu.au.
Abstract
BACKGROUND: Hypertension (HTN) is the single greatest cardiovascular risk factor worldwide. HTN management is usually guided by brachial cuff blood pressure (BP), but questions have been raised regarding accuracy. OBJECTIVES: This comprehensive analysis determined the accuracy of cuff BP and the consequent effect on BP classification compared with intra-arterial BP reference standards. METHODS: Three individual participant data meta-analyses were conducted among studies (from the 1950s to 2016) that measured intra-arterial aortic BP, intra-arterial brachial BP, and cuff BP. RESULTS: A total of 74 studies with 3,073 participants were included. Intra-arterial brachial systolic blood pressure (SBP) was higher than aortic values (8.0 mm Hg; 95% confidence interval [CI]: 5.9 to 10.1 mm Hg; p < 0.0001) and intra-arterial brachial diastolic BP was lower than aortic values (-1.0 mm Hg; 95% CI: -2.0 to -0.1 mm Hg; p = 0.038). Cuff BP underestimated intra-arterial brachial SBP (-5.7 mm Hg; 95% CI: -8.0 to -3.5 mm Hg; p < 0.0001) but overestimated intra-arterial diastolic BP (5.5 mm Hg; 95% CI: 3.5 to 7.5 mm Hg; p < 0.0001). Cuff and intra-arterial aortic SBP showed a small mean difference (0.3 mm Hg; 95% CI: -1.5 to 2.1 mm Hg; p = 0.77) but poor agreement (mean absolute difference 8.0 mm Hg; 95% CI: 7.1 to 8.9 mm Hg). Concordance between BP classification using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure cuff BP (normal, pre-HTN, and HTN stages 1 and 2) compared with intra-arterial brachial BP was 60%, 50%, 53%, and 80%, and using intra-arterial aortic BP was 79%, 57%, 52%, and 76%, respectively. Using revised intra-arterial thresholds based on cuff BP percentile rank, concordance between BP classification using cuff BP compared with intra-arterial brachial BP was 71%, 66%, 52%, and 76%, and using intra-arterial aortic BP was 74%, 61%, 56%, and 65%, respectively. CONCLUSIONS: Cuff BP has variable accuracy for measuring either brachial or aortic intra-arterial BP, and this adversely influences correct BP classification. These findings indicate that stronger accuracy standards for BP devices may improve cardiovascular risk management.
BACKGROUND:Hypertension (HTN) is the single greatest cardiovascular risk factor worldwide. HTN management is usually guided by brachial cuff blood pressure (BP), but questions have been raised regarding accuracy. OBJECTIVES: This comprehensive analysis determined the accuracy of cuff BP and the consequent effect on BP classification compared with intra-arterial BP reference standards. METHODS: Three individual participant data meta-analyses were conducted among studies (from the 1950s to 2016) that measured intra-arterial aortic BP, intra-arterial brachial BP, and cuff BP. RESULTS: A total of 74 studies with 3,073 participants were included. Intra-arterial brachial systolic blood pressure (SBP) was higher than aortic values (8.0 mm Hg; 95% confidence interval [CI]: 5.9 to 10.1 mm Hg; p < 0.0001) and intra-arterial brachial diastolic BP was lower than aortic values (-1.0 mm Hg; 95% CI: -2.0 to -0.1 mm Hg; p = 0.038). Cuff BP underestimated intra-arterial brachial SBP (-5.7 mm Hg; 95% CI: -8.0 to -3.5 mm Hg; p < 0.0001) but overestimated intra-arterial diastolic BP (5.5 mm Hg; 95% CI: 3.5 to 7.5 mm Hg; p < 0.0001). Cuff and intra-arterial aortic SBP showed a small mean difference (0.3 mm Hg; 95% CI: -1.5 to 2.1 mm Hg; p = 0.77) but poor agreement (mean absolute difference 8.0 mm Hg; 95% CI: 7.1 to 8.9 mm Hg). Concordance between BP classification using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure cuff BP (normal, pre-HTN, and HTN stages 1 and 2) compared with intra-arterial brachial BP was 60%, 50%, 53%, and 80%, and using intra-arterial aortic BP was 79%, 57%, 52%, and 76%, respectively. Using revised intra-arterial thresholds based on cuff BP percentile rank, concordance between BP classification using cuff BP compared with intra-arterial brachial BP was 71%, 66%, 52%, and 76%, and using intra-arterial aortic BP was 74%, 61%, 56%, and 65%, respectively. CONCLUSIONS: Cuff BP has variable accuracy for measuring either brachial or aortic intra-arterial BP, and this adversely influences correct BP classification. These findings indicate that stronger accuracy standards for BP devices may improve cardiovascular risk management.
Authors: Dean S Picone; Martin G Schultz; Petr Otahal; J Andrew Black; Willem J Bos; Chen-Huan Chen; Hao-Min Cheng; Antoine Cremer; Nathan Dwyer; Ricardo Fonseca; Alun D Hughes; Hack-Lyoung Kim; Peter S Lacy; Esben Laugesen; Nobuyuki Ohte; Stefano Omboni; Christian Ott; Telmo Pereira; Giacomo Pucci; Philip Roberts-Thomson; Niklas B Rossen; Roland E Schmieder; Daisuke Sueta; Kenji Takazawa; Jiguang Wang; Thomas Weber; Berend E Westerhof; Bryan Williams; Hirotsugu Yamada; Eiichiro Yamamoto; James E Sharman Journal: Hypertension Date: 2020-01-27 Impact factor: 10.190
Authors: Paul Muntner; Paula T Einhorn; William C Cushman; Paul K Whelton; Natalie A Bello; Paul E Drawz; Beverly B Green; Daniel W Jones; Stephen P Juraschek; Karen L Margolis; Edgar R Miller; Ann Marie Navar; Yechiam Ostchega; Michael K Rakotz; Bernard Rosner; Joseph E Schwartz; Daichi Shimbo; George S Stergiou; Raymond R Townsend; Jeff D Williamson; Jackson T Wright; Lawrence J Appel Journal: J Am Coll Cardiol Date: 2019-01-29 Impact factor: 24.094
Authors: Rachel E Climie; Martin G Schultz; James W Fell; Lorena Romero; Petr Otahal; James E Sharman Journal: J Hum Hypertens Date: 2018-11-13 Impact factor: 3.012
Authors: James E Sharman; Isabella Tan; George S Stergiou; Carolina Lombardi; Francesca Saladini; Mark Butlin; Raj Padwal; Kei Asayama; Alberto Avolio; Tammy M Brady; Alan Murray; Gianfranco Parati Journal: J Hum Hypertens Date: 2022-05-30 Impact factor: 3.012
Authors: Xiaoqing Peng; Martin G Schultz; Dean S Picone; Nathan Dwyer; J Andrew Black; Philip Roberts-Thomson; James E Sharman Journal: J Clin Hypertens (Greenwich) Date: 2018-11-19 Impact factor: 3.738
Authors: Angeliki Ntineri; Anastasios Kollias; Maria Elena Zeniodi; Andriani Vazeou; Alexandra Soldatou; George S Stergiou Journal: J Clin Hypertens (Greenwich) Date: 2020-08-19 Impact factor: 3.738