Key result
Blood pressure measurement over a sleeve shows no average difference vs bare arm despite individual variation.
Why the study?
Accurate office blood pressure measurement is crucial for diagnosing and managing hypertension, but the effect of measuring over a sleeved versus bare arm remained to be evaluated while controlling for other variance.
Does measuring office blood pressure over a sleeved arm alter blood pressure readings compared to measuring over a bare arm in hypertensive patients?
Cross-Sectional (n=100)
No
Does measuring office blood pressure over a sleeved arm alter blood pressure readings compared to measuring over a bare arm in hypertensive patients?
Although average blood pressure differences between bare and sleeved arms appear minimal due to bidirectional variation, the large median absolute difference (7-8 mmHg systolic and 5.5 mmHg diastolic) confirms that blood pressure should always be measured on bare skin.
Answers are grounded in this paper and cite their sources.
Sleeved-arm BP shows clinically relevant individual variability; leaves open whether bare-skin standardization improves accuracy in practice or trials.
Accurate office blood pressure (BP) measurement remains crucial in diagnosing and managing hypertension. In this study, we aimed to compare BP measurements done over a bare arm versus a sleeved arm, while controlling all other possible sources of variance. We collected BP measurements of 100 hypertensive patients visiting a nephrology and hypertension clinic between January 2019 and December 2023. Measurements were taken by a single operator and according to the updated guidelines. BP measurements were performed first with one arm bare, and the other arm sleeved, with measurements taken simultaneously. Then, measurements were again taken simultaneously after exposing the arm which was first sleeved, and dressing the arm which was bare at first. A nonparametric Wilcoxon test was performed to compare each patient's measurements on each arm. No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of SBP measured on the left arm (slightly lower SBP on the bare arm). While looking at the absolute value of differences, the median difference was impressive with a 7-8 mmHg systolic difference and 5.5 mmHg diastolic difference. Our study revealed a robust and unpredicted effect of clothing on BP; in some patients, BP was increased while in others decreased. Therefore, we believe there is importance in measuring BP on bare skin, regardless of clothing or sleeve type.
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Ishay et al. (2023) conducted a cross-sectional in Hypertension (n=100). Blood pressure measurement over a sleeved arm vs. Simultaneous blood pressure measurement over a bare arm was evaluated on Average of both arms median systolic blood pressure (mmHg) (Median absolute difference 7-8 mmHg SBP and 5.5 mmHg DBP, p=0.125). Measuring blood pressure over a sleeved arm yielded no significant average difference vs bare skin, but produced a median absolute difference of 7-8 mmHg systolic and 5.5 mmHg diastolic.
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