What does this research mean for the field?

Upper arm non-invasive blood pressure measurements are the most accurate in obese patients, whereas alternative sites like the forearm and ankle demonstrate inconsistent reliability and significant deviation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to determine the most accurate site for non-invasive blood pressure monitoring in obese individuals and derive a correction formula.

June 24, 2026South African Medical JournalOpen Access

Agreement between various non-invasive blood pressure measurement sites in the obese population using the VitalStream system as control

Q: What are the key findings of this study?

Upper arm non-invasive blood pressure measurements were the most accurate in obese patients, whereas ankle systolic blood pressure showed significant deviation with a mean bias of +14.44 mmHg.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Obesity (n=50). Intervention: Non-invasive blood pressure measurement (upper arm, forearm, ankle) vs. VitalStream continuous blood pressure monitoring. Primary outcome: Agreement between ankle systolic blood pressure and VitalStream control (Mean bias +14.44 mmHg, 95% CI 8.26-20.62, p=<0.001).

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Key result

Upper arm BP is most accurate in obese patients, while ankle readings overestimate by ~14 mmHg.

Mean bias +14.44 mmHg
95% CI 8.26-20.62
P<0.001
n=50

Why the study?

Does non-invasive blood pressure measurement at the forearm or ankle agree with continuous control blood pressure in obese patients?

Key Points

This study aims to determine the most accurate site for non-invasive blood pressure monitoring in obese individuals and derive a correction formula.
Conducted at a provincial tertiary hospital in Gauteng, South Africa.
Fifty participants aged 20-60 years with BMI 35-40 kg/m2 were recruited.
Non-invasive blood pressure measurements were taken at upper arm, forearm, and ankle using appropriately sized cuffs.
Ankle systolic BP showed the greatest deviation with a mean bias of +14.44 mmHg (95% CI 8.26 - 20.62).
Upper arm NIBP measurements had significant agreements for mean arterial pressure, establishing a reliable correction formula (p<0.001).
Forearm and ankle measurements had wider limits of agreement, prone to overestimation, especially in systolic and diastolic pressures.

Study Design

Type

Cross-Sectional (n=50)

Multicenter

Structured PICO

Does non-invasive blood pressure measurement at the forearm or ankle agree with continuous control blood pressure in obese patients?

Population

50 adults aged 20 - 60 years, with BMI 35 - 40 kg/m2, recruited at a provincial tertiary hospital in Gauteng Province, South Africa.

Intervention

Non-invasive blood pressure (NIBP) measurements obtained from the left upper arm, forearm and ankle using appropriately sized cuffs.

Comparator

Simultaneous continuous blood pressure measurements recorded using the VitalStream device on the contralateral hand.

Outcome

Agreement between different NIBP sites (upper arm, forearm and ankle) and control blood pressure.surrogate

Main Result

Effect estimate: Mean bias +14.44 mmHg (95% CI 8.26-20.62)

p-value: p=<0.001

Upper arm non-invasive blood pressure remains the most accurate measurement site in obese patients, as forearm and ankle measurements demonstrate inconsistent reliability and tend to overestimate blood pressure.

Limitations

Limited sample size may not represent the full diversity of the obese population
Most participants were female, which may skew findings
Measurements were taken under controlled conditions (supine) after a fixed rest period, potentially minimising physiological variations
Single-centre study
Convenience sampling was employed
Standard rectangular cuffs were used, which may not accommodate conically shaped limbs in obese patients

Discussion

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Implication

Supports upper arm NIBP preference in obese patients; leaves open prospective validation against invasive standards.

Cite This Study

Dyk et al. (2026) conducted a cross-sectional in Obesity (n=50). Non-invasive blood pressure measurement (upper arm, forearm, ankle) vs. VitalStream continuous blood pressure monitoring was evaluated on Agreement between ankle systolic blood pressure and VitalStream control (Mean bias +14.44 mmHg, 95% CI 8.26-20.62, p=<0.001). Upper arm non-invasive blood pressure measurements were the most accurate in obese patients, whereas ankle systolic blood pressure showed significant deviation with a mean bias of +14.44 mmHg.

synapsesocial.com/papers/6a3c235fd15afadd906fa0b9 https://doi.org/10.7196/samj.2026.v116i5.3341

Topics

Cardiac Rehabilitation and Lifestyle Interventions Hypertension management

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Agreement between various non-invasive blood pressure measurement sites in the obese population using the VitalStream system as control

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Agreement between various non-invasive blood pressure measurement sites in the obese population using the VitalStream system as control

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

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Topics

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