Wrist blood pressure overestimates blood pressure measured at the upper arm

Palatini, Paolo; Longo, Daniele; Toffanin, Gianluca; Bertolo, Olivo; Zaetta, Vania; Pessina, Achille C.

doi:10.1097/00126097-200404000-00004

Cited by 36 publications

(35 citation statements)

References 14 publications

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“…When BP was taken in the office, the values measured at the wrist were, as shown by others, [18][19][20][21][22][23][24][25] slightly lower than those measured at the upper-arm. In contrast, when BP was self-measured at home by the study participants, higher BP values were obtained at the wrist than at the arm.…”

Section: Discussionmentioning

confidence: 82%

“…17 However, in spite of technical improvement, their reliability in real-life conditions is not unanimously accepted. [18][19][20] Accuracy of BP measurement at wrist largely depends on the difference in height between the wrist and the heart because of the confounding effect of the hydrostatic pressure caused by the limb blood column. [21][22][23] Wrists kept at a higher level in comparison with the heart lead to a false lower, and wrists at a lower level lead to a false higher BP values.…”

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confidence: 99%

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Poor Reliability of Wrist Blood Pressure Self-Measurement at Home

et al. 2016

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Blood pressure (BP) independently predicts cardiovascular risk in affluent countries. [1][2][3][4][5] However, several studies have shown that awareness of hypertension and BP control is still suboptimal, 1 and thus effective strategies should be developed to improve BP control and adherence to therapy. One of the methods used to achieve these goals is represented by self-measurement of BP at home by automatic devices. Many studies have shown that BP self-measurement at home allows a better BP control in hypertension and has a greater prognostic value than office BP. 6,7 In addition, self BP measurement is more appealing to the patient than the customary procedure in the physician's surgery often causing long waits. Upper-arm automatic devices gave fresh impetus to home self-measurement because of their user friendliness, 8 the only conditions to be respected being adequate cuff dimensions and correct positioning of the cuff on the patient's arm. [9][10][11][12][13][14] For reasons of market penetration and following a general tendency to miniaturization, many wrist devices recently appeared on the market 15 having the advantage of being smaller and easier to fit than upper-arm monitors, 16 and today wrist devices are used by a large portion of people who measure their BP at home. 17 However, in spite of technical improvement, their reliability in real-life conditions is not unanimously accepted. [18][19][20] Accuracy of BP measurement at wrist largely depends on the difference in height between the wrist and the heart because of the confounding effect of the hydrostatic pressure caused by the limb blood column.21-23 Wrists kept at a higher level in comparison with the heart lead to a false lower, and wrists at a lower level lead to a false higher BP values. Very rarely do patients receive appropriate training from family doctors or other healthcare personnel. Instructions attached to commercial packages require a certain degree of personal discernment, i.e., a good cognitive pattern. Only a few models have a position sensor to verify that the wrist is placed properly at heart level, 24 but even for these devices, no study has evaluated their reliability in real-life conditions.The aim of the present study was to ascertain whether wrist home BP is performed reliably or an error is present in measurement, and to identify the determinants of this error if any.To verify the reliability of wrist BP self-measurement, we determined at a population level the upper-arm−wrist BP difference in the office under a doctor's supervision and then verified whether this difference was maintained during home self-measurement.Abstract-The reliability of blood pressure measurement with wrist devices, which has not previously been assessed under real-life circumstances in general population, is dependent on correct positioning of the wrist device at heart level. We determined whether an error was present when blood pressure was self-measured at the wrist in 721 unselected subjects from the general population. After training, blood p...

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Poor Reliability of Wrist Blood Pressure Self-Measurement at Home

et al. 2016

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“…[5][6][7]9 This led us to question whether a lower or upper forearm cuff location would lead to different results than we obtained in our 2011 study. The results of this study found all three BP Although a number of prior studies have compared BP measurements obtained in the forearm location to upper arm, 2-10 comparison of our findings to prior studies is difficult because most had one or more serious methodological problems (poorly described methods for BP measurement, including forearm cuff location and/or leveling to heart 2-4,6 ; forearm BP cuff not positioned at recommended level of heart 6,9 ; inappropriate analysis of study data [no bias/precision and/or Bland-Altman analysis] 2,4,8 ; used correlational statistics 2,4 ; lacking correction for potential inflation of the alpha level [3][4][5][6][7][8][9] ; using the average of two or three sequential BP [3][4][5][6][7][8][9] or used BP equipment which is no longer available for clinical use. [2][3][4]8 In studies describing the location of the forearm BP cuff, 5-10 several did not position the forearm as recommended during BP measurement at the level of the heart, 6,9 making comparison to those studies inappropriate.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10] However, most of these studies had serious methodological problems (ie, poorly described procedures for BP measurement [2][3][4]6 ; incorrect positioning of the BP cuff in relation to the heart 6,9 ; inappropriate statistical analysis 2,4-9 ), making generalization of their findings difficult. Additional studies are needed to determine if forearm BP can be used to replace upper arm BP.…”

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Level of Agreement Between Forearm and Upper Arm Blood Pressure Measurements in Patients With Large Arm Circumference

Watson¹,

Aguas²,

Colegrove³

et al. 2017

Journal of PeriAnesthesia Nursing

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“…Apparatene kan også vaere upålitelige ved måling på barn, gravide og eldre (13). Automatiske oscillometriske blodtrykksapparater som måler blodtrykket ved håndleddet anbefales ikke ved blodtrykksdiagnostikk og -behandling (14).…”

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