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

Journal article

Publication Details

Author(s): 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
Journal: Journal of the American College of Cardiology
Publication year: 2017
Volume: 70
Journal issue: 5
Pages range: 572-586
ISSN: 0735-1097


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.

FAU Authors / FAU Editors

Ott, Christian PD Dr.
Medizinische Fakultät
Schmieder, Roland Prof. Dr.
Professur für Innere Medizin (Nephrologie)

External institutions
Aarhus University Hospital / Aarhus Universitetshospital
Abbott Northwestern Hospital
Auckland University of Technology / Te Wānanga Aronui o Tāmaki Makau Rau
BMI The Blackheath Hospital
Centre Hospitalier Universitaire de Bordeaux / CHU Bordeaux
Chiba University / 千葉大学
Flinders University
Guy's and St Thomas'
Guy's and St Thomas' NHS Foundation Trust
Imperial College London / The Imperial College of Science, Technology and Medicine
Italian Institute of Telemedicine
Klinikum Wels-Grieskirchen
Kumamoto University / 熊本大学
Nagoya City University / 名古屋市立大学
National Yang-Ming University / 國立陽明大學
NTNU Trondheim - Norwegian University of Science and Technology
Polytechnical Institute of Coimbra / Instituto Politécnico de Coimbra (IPC)
Shanghai Jiao Tong University / 上海交通大学
St. Antonius Ziekenhuis
State University of New York (SUNY) Stony Brook
Tokushima University Hospital
Tokyo Medical University Hospital
Università degli Studi di Perugia
Universität Duisburg-Essen (UDE)
University College London (UCL) (University of London)
University of Auckland
University of North Carolina at Chapel Hill
University of Tasmania (UTAS)
Vrije Universiteit Amsterdam (VU) / University Amsterdam

How to cite

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.

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.


Last updated on 2018-07-10 at 03:08