Accuracy Difference of Noninvasive Blood Pressure Measurements by Sex and Height

Abbaoui, Yasmine; Fortier, Catherine; Desbiens, Louis‐Charles; Kowalski, Cédric; Lamarche, Florence; Nadeau‐Fredette, Annie‐Claire; Madore, François; Agharazii, Mohsen; Goupil, Rémi

doi:10.1001/jamanetworkopen.2022.15513

Cited by 12 publications

(11 citation statements)

References 45 publications

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“…Hypotheses such as smaller vessel caliber or more pronounced aging-related loss of compliance have been proposed to explain this association ( 33 , 34 ). As such, our team has recently shown that female sex is associated with a greater inaccuracy of brachial cuff, C1SBP for AoSBP while male sex is associated with greater inaccuracy of C2SBP for predicting AoSBP ( 20 , 21 ). As expected, we obtained similar findings in this study using the same cohort.…”

Section: Discussionmentioning

confidence: 95%

“…Although the inaccuracy between central BP and the true aortic SBP was traditionally attributed to errors in the measurement of brachial cuff BP, recent studies conducted by our group have shown that several clinical characteristics (notably female sex and height) influenced the accuracy between non-invasive and invasive brachial BP (20,21). Since central BP measurements are highly dependent on an accurate brachial cuff BP for calibration, we hypothesized that adjusting for such clinical parameters could enhance the performance of central BP devices.…”

Section: Introductionmentioning

confidence: 99%

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Enhancing central blood pressure accuracy through statistical modeling: A proof-of-concept study

Desbiens

Goulamhoussen

Fortier

et al. 2022

Front. Cardiovasc. Med.

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BackgroundNon-invasive estimation of central blood pressure (BP) may have better prognostic value than brachial BP. The accuracy of central BP is limited in certain populations, such as in females and the elderly. This study aims to examine whether statistical modeling of central BP for clinical and hemodynamic parameters results in enhanced accuracy.MethodsThis study is a cross-sectional analysis of 500 patients who underwent cardiac catheterization. Non-invasive brachial cuff and central BP were measured simultaneously to invasive aortic systolic BP (AoSBP). Central BP was calibrated for brachial systolic (SBP) and diastolic BP (Type I calibration; C1SBP) or brachial mean and diastolic BP (Type II calibration; C2SBP). Differences between central SBP and the corresponding AoSBP were assessed with linear regression models using clinical and hemodynamic parameters. These parameters were then added to C1SBP and C2SBP in adjusted models to predict AoSBP. Accuracy and precision were computed in the overall population and per age or sex strata.ResultsC1SBP underestimated AoSBP by 11.2 mmHg (±13.5) and C2SBP overestimated it by 6.2 mmHg (±14.8). Estimated SBP amplification and heart rate were the greatest predictors of C1- and C2-AoSBP accuracies, respectively. Statistical modeling improved both accuracy (0.0 mmHg) and precision (±11.4) but more importantly, eliminated the differences of accuracy seen in different sex and age groups.ConclusionStatistical modeling greatly enhances the accuracy of central BP measurements and abolishes sex- and age-based differences. Such factors could easily be implemented in central BP devices to improve their accuracy.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Enhancing central blood pressure accuracy through statistical modeling: A proof-of-concept study

Desbiens

Goulamhoussen

Fortier

et al. 2022

Front. Cardiovasc. Med.

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“…As previously mentioned, there are differences between women and men in standard upperarm cuff measured BP. However, there is emerging data that cuff BP measurements may be more inaccurate in women compared with men [78]. Two recent studies have found that for the same cuff systolic BP, invasive aortic systolic BP was significantly higher in women, but not men [78,79].…”

Section: Pressure and Flow Waveform Physiologymentioning

confidence: 99%

Sex differences in pressure and flow waveform physiology across the life course

Picone

Kodithuwakku

Mayer

et al. 2022

Journal of Hypertension

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Cardiovascular disease (CVD) has long been deemed a disease of old men. However, in 2019 CVD accounted for 35% of all deaths in women and, therefore, remains the leading cause of death in both men and women. There is increasing evidence to show that risk factors, pathophysiology and health outcomes related to CVD differ in women compared with men, yet CVD in women remains understudied, underdiagnosed and undertreated. Differences exist between the sexes in relation to the structure of the heart and vasculature, which translate into differences in blood pressure and flow waveform physiology. These physiological differences between women and men may represent an important explanatory factor contributing to the sex disparity in CVD presentation and outcomes but remain understudied. In this review we aim to describe sex differences in arterial pressure and flow waveform physiology and explore how they may contribute to differences in CVD in women compared to men. Given that unfavourable alterations in the cardiovascular structure and function can start as early as in utero, we report sex differences in waveform physiology across the entire life course.

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“…However, we are only in the beginning stages of understanding how physiologic measures, such as brachial BP, may also benefit from sex-specific considerations. In this study, Abbaoui et al press us to question even further the method of a physiologic measurement and its potentially limited generalizability across sexes. In effect, we are now challenged to ask whether we have been using the correct device, the correct device settings, or the correct units or reference ranges when performing a particular physiologic measure given what we know about fundamental sex differences in anatomy and the interdependence between anatomy and physiology.…”

mentioning

confidence: 97%

“…In JAMA Network Open, Abbaoui et al 3 have taken on the important task of clarifying how observed sex differences in peripherally measured systolic BP (SBP) and related outcomes may, in fact, be related to a discordance in how well the brachial cuff pressure reflects central BP. In a cohort of 500 patients with a mean (SD) age of 66 (10) years who were referred for coronary angiography, including 145 women (29%), postprocedural, catheter-based measurements of ascending aortic and intrabrachial pressures were recorded in sync with noninvasive central and brachial pressures assessed using an automatic BP monitor (Mobil-O-Graph; I.E.M.).…”

mentioning

confidence: 99%