Influence of the arm position on intra-arterial blood pressure measurement

Netea, Romana T.; Bijlstra, P.J.; Lenders, Jacques W.M.; Smits, Paul; Thien, Theo

doi:10.1038/sj.jhh.1000479

Cited by 33 publications

(31 citation statements)

References 13 publications

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“…Our findings are supported by our earlier results with respect to the influence of arm position on intra-arterial BP readings 20 and by the results obtained in a previous epidemiological study 11 in a large group of healthy volunteers. The hydrostatic factors were considered the most important for the differences observed between the BP readings at different arm levels.…”

Section: Discussionsupporting

confidence: 91%

Arm position is important for blood pressure measurement

et al. 1999

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Section: Discussionsupporting

confidence: 91%

Arm position is important for blood pressure measurement

et al. 1999

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“…It is believed that the difference in BP values produced by arm movement is largely accounted for by hydrostatic pressure 5 and this is supported by Netea et al, 11 although the differences demonstrated in regression analysis between SBP and DBP in our study cast doubt on such a simplistic view.…”

Section: Discussionsupporting

confidence: 69%

“…These important observations have been replicated using an oscillometric device 10 and confirmed by intraarterial BP measurements. 11 Despite studies confirming the importance of arm position on BP measurement, it is likely that arm position varies markedly in clinical practice and also in published studies. Resting an arm on a desk or arm of a chair as often recommended could vary the BP significantly, depending not just on the dimensions of the furniture but also on the height of the individual and also their posture.…”

Section: Introductionmentioning

confidence: 99%

Arm position and blood pressure: a risk factor for hypertension?

et al. 2003

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The objective of this study was to re-evaluate the effect of arm position on blood pressure (BP) measurement with auscultatory and oscillometric methods including ambulatory blood pressure monitoring (ABPM). The setting was the hospital outpatient department and the subjects chosen were normotensive and hypertensive. The effect of lowering the arm from heart level on indirect systolic BP (SBP) and diastolic BP (DBP) measurement as well as the importance of supporting the horizontal arm were measured. In the sitting position, lowering the supported horizontal arm to the dependent position increased BP measured by a mercury device from 103 7 10/60 7 7 to 111 7 14/ 67 7 10 mmHg in normotensive subjects, a mean increase of 8/7 mmHg (Po0.01). In hypertensive subjects, a similar manoeuvre increased BP from 143 7 21/78 7 17 to 166 7 29/88 7 20 mmHg, an increase of 23/10 mmHg (Po0.01). Combined results from normotensive and hypertensive subjects demonstrate a direct and proportional association between BP (SBP and DBP) and the increase produced by arm dependency. Similar changes and associations were noted with oscillometric devices in the clinic situation. However, supporting the horizontal arm did not alter BP. Of particular interest, analysis of 13 hypertensive subjects who underwent ABPM on two occasions, once with the arm in the 'usual' position and once with the arm held horizontally for BP measurement during waking hours, demonstrated changes comparable to the other devices. The mean 12-hour BP was 154 7 19/82 7 10 mmHg during the former period and significantly decreased to 141 7 18/74 7 9 mmHg during the latter period (Po0.01). Regression analysis of the change in SBP and DBP with arm position change again demonstrated a close correlation (r 2 ¼ 0.8113 and 0.7273; Po0.001) with the artefact being larger with higher systolic and diastolic pressures. In conclusion, arm movements lead to significant artefacts in BP measurement, which are greater, the higher the systolic or diastolic pressure. These systematic errors occur when using both auscultatory and oscillometric (clinic and ABPM) devices and might lead to an erroneous diagnosis of hypertension and unnecessary medication, particularly in individuals with high normal BP levels. Since clinical interpretations of heart level vary, the horizontal arm position should be the unambiguous standard for all sitting and standing BP auscultatory and oscillometric measurements.

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“…A possible explanation for the difference between these two studies could be the fact that oscillometric instruments were used in the present study, whereas standard mercury sphygmomanometers were used in the study of Ljungvall et al 4 However, the differences we obtained are closer to those theoretically expected, when one considers the effects of hydrostatic forces as a major determinant of the differences in BP between the two positions. 17 Differences of 3-4 mmHg may be small as absolute value, but are still important in epidemiological terms.…”

Section: Discussionmentioning

confidence: 99%

Both body and arm position significantly influence blood pressure measurement

et al. 2003

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The position of both the body and the arm during indirect blood pressure (BP) measurement is often neglected. The aim of the present study was to test the influence of the position of the patient on BP readings: (1) sitting with the arms supported precisely at the right atrium level and (2) supine: (a) with the arms precisely at the right atrium level and (b) with the arms on the examination bed. In a first group of 57 hypertensive patients, two sessions of BP and heart rate (HR) measurements were performed in two positions: sitting and supine with the arms supported precisely at right atrium level in both positions. BP was measured simultaneously at both arms, with a Hawksley Random Zero sphygmomanometer at the right arm, and with an automated oscillometric device (Bosomat) at the left arm. BP and HR readings obtained in the two positions were then compared. In a second group of 25 normoand hypertensive persons, two sessions of BP and HR readings were performed in supine with the arms in two different arm positions: (a) the arm placed precisely at right atrium level and (b) the other arm on the examination bed. The measurements were performed at both arms with two automated devices (Bosomat). The readings taken in the two positions were compared. Both systolic BP (SBP; by 9.5 7 9.0 (standard deviation, s.d.); right arm) and diastolic BP (DBP; by 4.8 7 6.0 mmHg; right arm) were significantly higher in the supine than in the sitting position. When the two different arm positions (body continously supine) were compared in the second part of the study, significantly higher SBP (by 4.6 7 6.1 mmHg) and DBP (by 3.9 7 2.8 mmHg) were obtained when the arm of the patient was placed on the bed (below the right atrium level), than when the arm was placed at the level of the right atrium. BP readings in sitting and supine positions are not the same. When according to guidelines the arm of the patient is meticulously placed at the right atrium level in both positions, the difference is even greater than when the arm rests on the desk or on the arm support of the chair. Moreover, in the supine position small but significant differences in BP are measured between arm on a 5 cm-high pillow and arm on the bed. In every study reporting BP values, the position of both the body and especially the arm should be precisely mentioned.

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Influence of the arm position on intra-arterial blood pressure measurement

Cited by 33 publications

References 13 publications

Arm position is important for blood pressure measurement

Arm position is important for blood pressure measurement

Arm position and blood pressure: a risk factor for hypertension?

Both body and arm position significantly influence blood pressure measurement

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