Brachial and Radial Systolic Blood Pressure Are Not the Same

Armstrong, Matthew K.; Schultz, Martin; Picone, Dean; Black, J. Andrew; Dwyer, Nathan; Roberts‐Thomson, Philip; Sharman, James E.

doi:10.1161/hypertensionaha.119.12674

Cited by 57 publications

(35 citation statements)

References 34 publications

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“…Radial artery measurements would therefore not be suitable as a reference method. 28,30 Our results demonstrate that measurements done with the new cuff by noninvasive hydraulic coupling of the brachial artery pulsation were in close agreement with the femoral artery measurements. Arterial lines enable continuous blood pressure monitoring but are associated with complications such as vascular injuries, thromboembolism, pseudoaneurysm, hemorrhage, and infection.…”

Section: Discussionsupporting

confidence: 76%

Clinical Evaluation of a High-fidelity Upper Arm Cuff to Measure Arterial Blood Pressure during Noncardiac Surgery

et al. 2020

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Background In most patients having noncardiac surgery, blood pressure is measured with the oscillometric upper arm cuff method. Although the method is noninvasive and practical, it is known to overestimate intraarterial pressure in hypotension and to underestimate it in hypertension. A high-fidelity upper arm cuff incorporating a hydraulic sensor pad was recently developed. The aim of the present study was to investigate whether noninvasive blood pressure measurements with the new high-fidelity cuff correspond to invasive measurements with a femoral artery catheter, especially at low blood pressure. Methods Simultaneous measurements of blood pressure recorded from a femoral arterial catheter and from the high-fidelity upper arm cuff were compared in 110 patients having major abdominal surgery or neurosurgery. Results 550 pairs of blood pressure measurements (5 pairs per patient) were considered for analysis. For mean arterial pressure measurements, the average bias was 0 mmHg, and the precision was 3 mmHg. The Pearson correlation coefficient was 0.96 (P < 0.0001; 95% CI, 0.96 to 0.97), and the percentage error was 9%. Error grid analysis showed that the proportions of mean arterial pressure measurements done with the high-fidelity cuff method were 98.4% in zone A (no risk), 1.6% in zone B (low risk) and 0% in zones C, D, and E (moderate, significant, and dangerous risk, respectively). The high-fidelity cuff method detected mean arterial pressure values less than 65 mmHg with a sensitivity of 84% (95% CI, 74 to 92%) and a specificity of 97% (95% CI, 95% to 98%). To detect changes in mean arterial pressure of more than 5 mmHg, the concordance rate between the two methods was 99.7%. Comparable accuracy and precision were observed for systolic and diastolic blood pressure measurements. Conclusions The new high-fidelity upper arm cuff method met the current international standards in terms of accuracy and precision. It was also very accurate to track changes in blood pressure and reliably detect severe hypotension during noncardiac surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Discussionsupporting

confidence: 76%

Clinical Evaluation of a High-fidelity Upper Arm Cuff to Measure Arterial Blood Pressure during Noncardiac Surgery

et al. 2020

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“…One of the proposed mechanisms explaining the FA‐UA BP difference is the central‐to‐peripheral pulse pressure amplification, a phenomenon related to the superimposition between the forward and reflected components of pressure waveform 31 . In invasive studies, in which BP was measured with fluid‐filled catheters, the BP amplification along the brachio‐radial segment was about 4% 32 . Nevertheless, the phenomenon of BP amplification assumes mean and diastolic BP to be rather constant along the arterial tree.…”

Section: Discussionmentioning

confidence: 99%

Assessment of nocturnal hypertension by ambulatory blood pressure monitoring at the forearm in people with morbid obesity

Pucci

D’Abbondanza

Camilli

et al. 2020

J of Clinical Hypertension

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Blood pressure (BP) measurement at the forearm (FA) has been proposed as alternative site to upper arm (UA) in people with morbid obesity (MO). We compared nocturnal BP readings simultaneously taken at FA and UA by ambulatory blood pressure monitoring (ABPM). Fourteen individuals with MO and seven normal-weight controls underwent nocturnal ABPM with two devices placed at the UA and contralateral FA, respectively. Agreement between FA-UA BP, diagnosis of nocturnal hypertension, and potential determinants of BP differences were evaluated. BP at the FA was significantly higher than UA in both people with MO and controls. FA-UA differences in systolic and diastolic BP were similar in people with MO and controls. Nocturnal hypertension was diagnosed in 10 subjects (48%) according to UA BP and in 13 subjects (62%) according to FA BP (concordance 76%, moderate agreement). ΔFA-UA systolic BP was associated with ratio between FA/UA circumferences (R = 0.45, P < .05) and with cuff-UA slant angle difference (R = 0.44, P < .05). In conclusions, in people with MO, the agreement between FA and UA nighttime BP measured by ABPM is sub-optimal. Our results raise uncertainty in using ABPM at the FA as an alternative to UA placement in people with MO for the diagnosis of

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“…Radial artery pressure has been shown to be 5 to 15 mmHg 42 higher than the brachial artery, where blood pressure is often measured using the sphygmomanometer. An internal pressure of 130 mmHg 42 was imposed to the vessel representing the radial artery. The result of the FEM model at peak applied force is shown in Figure 3B.…”

Section: Vessel Geometrymentioning

confidence: 99%

Synthetic Photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to Body Mass Index (BMI)

Boonya-Ananta

Rodriguez

Ajmal

et al. 2020

Preprint

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Cardiovascular disease is one of the leading causes of death in the United States and obesity significantly increases the risk of cardiovascular disease. The measurement of blood pressure (BP) is critical in monitoring and managing cardiovascular disease hence new wearable devices are being developed to make the BP metric mode accessible to physicians and patients. Several wearables utilize photoplethysmography from the wrist vasculature to derive BP assessment although many of these devices are still at the experimental stage. With the ultimate goal of supporting instrument development, we have developed a model the photoplethysmographic waveform derived from the radial artery at the volar surface of the wrist. To do so we have utilized the relation between vessel biomechanics through Finite Element Method and Monte Carlo light transport model. The model shows similar features to that seen in PPG waveform captured using an off the shelf device. We observe the influence of body mass index (BMI) on the PPG signal. A degradation the PPG signal of up to 40% in AC to DC signal ratio was thus observed.

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Brachial and Radial Systolic Blood Pressure Are Not the Same

Cited by 57 publications

References 34 publications

Clinical Evaluation of a High-fidelity Upper Arm Cuff to Measure Arterial Blood Pressure during Noncardiac Surgery

Clinical Evaluation of a High-fidelity Upper Arm Cuff to Measure Arterial Blood Pressure during Noncardiac Surgery

Assessment of nocturnal hypertension by ambulatory blood pressure monitoring at the forearm in people with morbid obesity

Synthetic Photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to Body Mass Index (BMI)

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