Dataset Information

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

ABSTRACT:

Background

The measurement of blood pressure is a common clinical exam with important health consequences. We sought to determine whether the measurement of blood pressure over a sleeved arm varies from that taken on a bare arm.

Methods

We recruited 376 patients between 18 and 85 years of age from a family medicine clinic between September 2004 and November 2006. They all had their blood pressure recorded using the same automatic oscillometric device, with the cuff placed over their bare arms for the first reading. Each patient was then randomly assigned to either the bare-arm group, for which the second blood pressure reading was also taken on a bare arm, or the sleeved-arm group, for which the second reading was taken with the cuff placed over the patient's sleeve.

Results

The mean age of the 376 participants was 61.6 years (standard deviation 15.0), 61% of the participants were male, 41% had hypertension and 11.7% had diabetes. We found no clinically important differences between the bare-arm group (n = 180) and the sleeved-arm group (n = 196) in age, sex or body mass index. The mean differences between the first and second readings for patients in the bare-arm group were 4.1 mm Hg (95% confidence interval [CI] 2.8 to 5.5) for systolic blood pressure and 0.1 mm Hg (95% CI -0.7 to 0.9) for diastolic blood pressure. The mean differences between the first and second readings for patients in the sleeved-arm group were 3.4 mm Hg (95% CI 2.1 to 4.7) for systolic blood pressure and 0.4 mm Hg (95% CI -0.4 to 1.3) for diastolic blood pressure. The between-group differences in these values was 0.76 mm Hg (95% CI -1.13 to 2.65) for systolic and -0.31 mm Hg (95% CI -1.48 to 0.86) for diastolic blood pressure; neither of these differences was clinically important or statistically significant.

Interpretation

We found that there was no significant difference in blood pressure recorded over a sleeve or on a bare arm. For practical purposes, the decision to measure blood pressure on a bare arm or over a sleeved arm should be left to the judgment of the health care professional taking the blood pressure.

SUBMITTER: Ma G

PROVIDER: S-EPMC2244664 | biostudies-literature | 2008 Feb

REPOSITORIES: biostudies-literature

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

Ma Grace G Sabin Norman N Dawes Martin M

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20080201 5

<h4>Background</h4>The measurement of blood pressure is a common clinical exam with important health consequences. We sought to determine whether the measurement of blood pressure over a sleeved arm varies from that taken on a bare arm.<h4>Methods</h4>We recruited 376 patients between 18 and 85 years of age from a family medicine clinic between September 2004 and November 2006. They all had their blood pressure recorded using the same automatic oscillometric device, with the cuff placed over the ...[more]

PMID: 18299548

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Project description:Arterial blood pressure (BP) can be measured directly using an invasive intra-arterial method. This method is considered a gold standard, however it is potentially hazardous and requires expensive equipment and professional skills. Therefore, two non-invasive methods-Doppler ultrasonic sphygmomanometry and oscillometry-have been introduced in veterinary medicine. Their accuracy has so far been reliably evaluated in various animal species, however only one study included a small group of goats. Therefore, we carried out a large-scale study which aimed to evaluate agreement between the two non-invasive methods and invasive intra-arterial BP measurement in anesthetized goats at various age. The study included 122 goats of two Polish local breeds (Polish White Improved and Polish Fawn Improved): 67 adult females, 35 adult males, and 20 two-month-old female kids. Goats were anesthetized with the intravenous mixture of xylazine and ketamine. BP was measured simultaneously with the three methods in each goat with 7 measurements on average taken. The study showed that according to the criteria of the American College of Veterinary Internal Medicine (ACVIM) oscillometric method yielded BP measurements sufficiently consistent with invasive intra-arterial method in anesthetized adult goats- 95% of oscillometric BP measurements were expected to differ from invasive BP measurements by at most ±20-25 mmHg. The agreement was worse in goat kids-oscillometry significantly overestimated invasive BP measurements, which resulted in highly asymmetrical 95% limits of agreement. Doppler systolic BP very poorly conformed to invasive systolic BP both in adult goats and in kids and all the ACVIM criteria were violated. Concluding, oscillometry, but not Doppler ultrasonic sphygmomanometry, may be regarded as an alternative to invasive BP measurement in large-scale scientific studies involving adult goats, however, individual oscillometric BP measurements should be treated with caution as estimated 95% limits of agreement were wide.

Project description:BackgroundOptimal clinical care, diagnosis and treatment requires accurate blood pressure (BP) values. The primary objective was to compare BP readings taken while adhering to American Heart Association (AHA) guidelines to those typical of routine clinical care. Specifically studied: the combined effect of feet flat on the floor, back supported, and arm supported with cuff at heart level, while adhering to other guideline recommendations.MethodsIn this prospective, randomised, three-group cohort study, a modified cross-over design was applied in a primary care outpatient office setting in Columbus (OH, USA). Eligible participants were adults (aged ≥18 years) with an arm circumference of ≥18 cm and ≤42 cm who did not have a renal dialysis shunt or a previous or current diagnosis of atrial fibrillation. 150 recruited volunteers meeting the inclusion criteria were randomly randomised into the three groups. Group methodologies were BP readings taken on a fixed-height exam table followed by readings taken in an exam chair with adjustable positioning options (Group A), readings taken in the reverse order, chair then table (Group B), and both sets of readings in the exam chair (Group C). A rest period occurred before each set of readings. Group C was included for the purpose of obtaining an independent estimate of the order effect. The order in which the two types of readings (table vs chair) were taken was randomised. The primary outcome was the difference between the mean of three BP readings taken on the table and the mean of three readings taken in the chair.FindingsBetween September and October, 2022, 150 participants were enrolled in the study; all 150 of whom completed testing: 48 in Group A, 49 in Group B, 53 in Group C. The mean systolic/diastolic BP (SBP/DBP) of readings taken on the table (Group A first readings, Group B second readings) were 7.0/4.5 mmHg higher than those taken in the chair (Group A second readings, Group B first readings); both statistically significant, p < 0.0001. These findings show that AHA-recommended positioning-feet flat on the floor, back supported, arm supported with the BP cuff at heart level-results in substantially lower BP values than improper positioning. The mean SBP/DBP of the first set of readings taken on the chair were 1.6/0.6 mmHg higher than for the second set of readings (Group C, included to estimate order effect).InterpretationThe observed benefit of proper positioning is sufficient to change the BP classification of several million patients from having hypertension to not having hypertension and therefore avoiding medication and/or intense follow-up.FundingMidmark Corporation, Versailles, Ohio, USA.

Dataset Information

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

Background

Methods

Results

Interpretation

Publications

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

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