Invasive Aortic, Brachial, and Cuff-based Blood Pressures: Their Impact on Hypertension Risk Assessment and Management

Hypertension, the most common modifiable risk factor for “cardiovascular disease” burden, with mortality risk doubling for each 20/10 mmHg blood pressure increase above 115/75 mmHg. While brachial cuff blood pressure is commonly used, it often fails to accurately reflect central aortic pressures, which have a direct impact on target organs. It also tends to underestimate systolic blood pressure and overestimate diastolic blood pressure. Therefore, accurate blood pressure measurement is crucial for diagnosis and risk assessment. Materials and Methods This cross-sectional observational study was performed at Kilpauk Medical College. Intra-arterial aortic, brachial, and noninvasive cuff brachial pressures were measured in 100 patients undergoing elective coronary angiography. Systolic blood pressure, diastolic blood pressure, and pulse pressure were assessed to determine the relationship between invasive and noninvasive measurements. Results Cuff systolic blood pressure (132 ± 16 mmHg) was significantly lower than invasive brachial systolic blood pressure (144 ± 14 mmHg; P < .001). Relative to invasive brachial measurements, cuff systolic blood pressure was 12 mmHg lower (95% confidence interval: –16.1 to –7.9; P < .001), diastolic blood pressure was 2 mmHg higher (95% confidence interval: –0.8 to 4.8; P = .04), and PP was 14 mmHg lower (95% confidence interval: –18.5 to –9.5; P < .001). Conclusion Significant discrepancies exist between invasive and cuff-based systolic blood pressure measurements. Cuff-based blood pressure consistently underestimates true systolic blood pressure and pulse pressure, which may lead to hypertension underdiagnosis, particularly in patients with increased arterial stiffness. Invasive blood pressure measurements are thus more appropriate for precise assessment in high-risk populations.