Accuracy of Cuff-Measured Blood Pressure: Systematic Reviews and Meta-Analyses

Picone DS, Schultz MG, Otahal P, Aakhus S, Al-Jumaily AM, Black JA, Bos WJ, Chambers JB, Chen CH, Cheng HM, Cremer A, Davies JE, Dwyer N, Gould BA, Hughes AD, Lacy PS, Laugesen E, Liang F, Melamed R, Muecke S, Ohte N, Okada S, Omboni S, Ott C, Peng X, Pereira T, Pucci G, Rajani R, Roberts-Thomson PA, Rossen NB, Sueta D, Sinha MD, Schmieder R, Smulyan H, Srikanth VK, Stewart R, Stouffer GA, Takazawa K, Wang J, Westerhof BE, Weber F, Weber T, Williams B, Yamada H, Yamamoto E, Sharman JE (2017)

Publication Type: Journal article

Publication year: 2017

Journal

Book Volume: 70

Pages Range: 572-586

Journal Issue: 5

DOI: 10.1016/j.jacc.2017.05.064

Abstract

Hypertension (HTN) is the single greatest cardiovascular risk factor worldwide. HTN management is usually guided by brachial cuff blood pressure (BP), but questions have been raised regarding accuracy.This comprehensive analysis determined the accuracy of cuff BP and the consequent effect on BP classification compared with intra-arterial BP reference standards.Three individual participant data meta-analyses were conducted among studies (from the 1950s to 2016) that measured intra-arterial aortic BP, intra-arterial brachial BP, and cuff BP.A total of 74 studies with 3,073 participants were included. Intra-arterial brachial systolic blood pressure (SBP) was higher than aortic values (8.0 mm Hg; 95% confidence interval [CI]: 5.9 to 10.1 mm Hg; p < 0.0001) and intra-arterial brachial diastolic BP was lower than aortic values (-1.0 mm Hg; 95% CI: -2.0 to -0.1 mm Hg; p = 0.038). Cuff BP underestimated intra-arterial brachial SBP (-5.7 mm Hg; 95% CI: -8.0 to -3.5 mm Hg; p < 0.0001) but overestimated intra-arterial diastolic BP (5.5 mm Hg; 95% CI: 3.5 to 7.5 mm Hg; p < 0.0001). Cuff and intra-arterial aortic SBP showed a small mean difference (0.3 mm Hg; 95% CI: -1.5 to 2.1 mm Hg; p = 0.77) but poor agreement (mean absolute difference 8.0 mm Hg; 95% CI: 7.1 to 8.9 mm Hg). Concordance between BP classification using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure cuff BP (normal, pre-HTN, and HTN stages 1 and 2) compared with intra-arterial brachial BP was 60%, 50%, 53%, and 80%, and using intra-arterial aortic BP was 79%, 57%, 52%, and 76%, respectively. Using revised intra-arterial thresholds based on cuff BP percentile rank, concordance between BP classification using cuff BP compared with intra-arterial brachial BP was 71%, 66%, 52%, and 76%, and using intra-arterial aortic BP was 74%, 61%, 56%, and 65%, respectively.Cuff BP has variable accuracy for measuring either brachial or aortic intra-arterial BP, and this adversely influences correct BP classification. These findings indicate that stronger accuracy standards for BP devices may improve cardiovascular risk management.

Authors with CRIS profile

Involved external institutions

University of Tasmania (UTAS) Australia (AU) Kumamoto University / 熊本大学 Japan (JP) Tokushima University Hospital Japan (JP) University College London (UCL) United Kingdom (GB) Klinikum Wels-Grieskirchen Austria (AT) Universität Duisburg-Essen (UDE) Germany (DE) Vrije Universiteit Amsterdam (VU) / University Amsterdam Netherlands (NL) Shanghai Jiao Tong University / 上海交通大学 China (CN) Tokyo Medical University Hospital Japan (JP) University of North Carolina at Chapel Hill United States (USA) (US) University of Auckland New Zealand (NZ) State University of New York at Albany (UNY Albany / UAlbany) United States (USA) (US) Guy's and St Thomas' (NHS Foundation Trust) United Kingdom (GB) Aarhus University Hospital / Aarhus Universitetshospital Denmark (DK) Università degli Studi di Perugia Italy (IT) Polytechnical Institute of Coimbra / Instituto Politécnico de Coimbra (IPC) Portugal (PT) Italian Institute of Telemedicine Italy (IT) Chiba University / 千葉大学 Japan (JP) Nagoya City University / 名古屋市立大学 Japan (JP) Flinders University Australia (AU) Abbott Northwestern Hospital United States (USA) (US) BMI The Blackheath Hospital United Kingdom (GB) Imperial College London / The Imperial College of Science, Technology and Medicine United Kingdom (GB) Centre Hospitalier Universitaire de Bordeaux / CHU Bordeaux France (FR) National Yang-Ming University / 國立陽明大學 Taiwan (TW) St. Antonius Ziekenhuis Netherlands (NL) Auckland University of Technology / Te Wānanga Aronui o Tāmaki Makau Rau New Zealand (NZ) NTNU Trondheim - Norwegian University of Science and Technology Norway (NO)

How to cite

APA:

Picone, D.S., Schultz, M.G., Otahal, P., Aakhus, S., Al-Jumaily, A.M., Black, J.A.,... Sharman, J.E. (2017). Accuracy of Cuff-Measured Blood Pressure: Systematic Reviews and Meta-Analyses. Journal of the American College of Cardiology, 70(5), 572-586. https://dx.doi.org/10.1016/j.jacc.2017.05.064

MLA:

Picone, Dean S., et al. "Accuracy of Cuff-Measured Blood Pressure: Systematic Reviews and Meta-Analyses." Journal of the American College of Cardiology 70.5 (2017): 572-586.

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