Key result
Forearm ABPM shows suboptimal ~76% diagnostic agreement with upper arm measurements in morbid obesity.
Why the study?
Forearm BP measurement has been proposed as an alternative site to the upper arm in individuals with morbid obesity, but nocturnal agreement remained unclear.
Does forearm ABPM provide accurate nocturnal blood pressure measurements compared to upper arm ABPM in people with morbid obesity?
Cross-Sectional (n=21)
Does forearm ABPM provide accurate nocturnal blood pressure measurements compared to upper arm ABPM in people with morbid obesity?
Effect estimate: concordance 76%
Absolute Event Rate: 62% vs 48%
Forearm ABPM yields significantly higher nocturnal blood pressure readings than upper arm ABPM in morbidly obese patients, raising uncertainty about its diagnostic reliability.
Forearm ABPM may overestimate nocturnal hypertension in morbid obesity; leaves open its diagnostic accuracy versus upper arm monitoring.
Blood pressure (BP) measurement at the forearm (FA) has been proposed as alternative site to upper arm (UA) in people with morbid obesity (MO). We compared nocturnal BP readings simultaneously taken at FA and UA by ambulatory blood pressure monitoring (ABPM). Fourteen individuals with MO and seven normal-weight controls underwent nocturnal ABPM with two devices placed at the UA and contralateral FA, respectively. Agreement between FA-UA BP, diagnosis of nocturnal hypertension, and potential determinants of BP differences were evaluated. BP at the FA was significantly higher than UA in both people with MO and controls. FA-UA differences in systolic and diastolic BP were similar in people with MO and controls. Nocturnal hypertension was diagnosed in 10 subjects (48%) according to UA BP and in 13 subjects (62%) according to FA BP (concordance 76%, moderate agreement). ΔFA-UA systolic BP was associated with ratio between FA/UA circumferences (R = 0.45, P < .05) and with cuff-UA slant angle difference (R = 0.44, P < .05). In conclusions, in people with MO, the agreement between FA and UA nighttime BP measured by ABPM is sub-optimal. Our results raise uncertainty in using ABPM at the FA as an alternative to UA placement in people with MO for the diagnosis of nocturnal hypertension.
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Pucci et al. (2020) conducted a cross-sectional in Morbid obesity and nocturnal hypertension (n=21). Ambulatory blood pressure monitoring at the forearm vs. Ambulatory blood pressure monitoring at the upper arm was evaluated on Diagnosis of nocturnal hypertension (concordance 76%). Ambulatory blood pressure monitoring at the forearm diagnosed nocturnal hypertension in 62% of subjects compared to 48% at the upper arm, demonstrating suboptimal agreement in morbid obesity.
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