Key result
Brachial cuff SBP measurement underestimated intraarterial SBP in 142 of 303 patients, leading to a 59% risk of undertreatment, and overestimated it in 25 patients, with a 50% risk of overtreatment.
Why the study?
Although brachial cuff SBP is universally used to guide hypertension management, it can differ significantly from intraarterial SBP, with unclear impacts on treatment and central SBP accuracy.
Does brachial cuff SBP accurately reflect intraarterial SBP and central SBP, and what is the impact of mismatch on hypertension treatment?
Cross-Sectional (n=303)
Does brachial cuff SBP accurately reflect intraarterial SBP and central SBP, and what is the impact of mismatch on hypertension treatment?
Brachial cuff blood pressure measurements frequently mismatch intraarterial pressures, potentially leading to significant risks of hypertension mismanagement.
OBJECTIVE: Although brachial cuff SBP is universally used to guide hypertension management, it can differ significantly from intraarterial SBP. We examine the potential impacts of cuff-to-intraarterial brachial SBP (bSBP) mismatch on hypertension treatment and accuracy towards central SBP. METHODS: In 303 individuals, cuff bSBP (CUFF-bSBP) and central SBP were measured using a Mobil-o-Graph simultaneously to intraarterial bSBP (IA-bSBP) and aortic SBP. According to the difference between CUFF-bSBP and IA-bSBP, we identified three phenotypes: Underestimation (CUFF-bSBP < IA-bSBP by >10 mmHg); No Mismatch (CUFF-bSBP within 10 mmHg of IA-bSBP); Overestimation (CUFF-bSBP > IA-bSBP by >10 mmHg) phenotypes. Risk of overtreatment and undertreatment, and accuracy (ARTERY society criteria: mean difference ≤5 ± 8 mmHg) were determined. A multiple linear regression model was used to assess variables associated with the bSBP difference. RESULTS: Underestimation (n = 142), No Mismatch (n = 136) and Overestimation (n = 25) phenotypes had relatively similar characteristics and CUFF-bSBP (124 ± 17, 122 ± 14, 127 ± 19 mmHg, P = 0.19) but different aortic SBP (133 ± 21, 120 ± 16, 112 ± 18 mmHg, P < 0.001). In the underestimation phenotype, 59% were at risk of undertreatment (14% in No Mismatch), whereas 50% in the Overestimation phenotype were at risk of overtreatment (17% in No Mismatch). CUFF-bSBP accurately estimated aortic SBP only in the No Mismatch Group (mean difference 1.6 ± 8.2 mmHg) whereas central BP never met the accuracy criteria. Male sex, higher height and active smoking were associated with lesser underestimation of bSBP difference. CONCLUSION: The brachial cuff lacks accuracy towards intraarterial BP in a significant proportion of patients, potentially leading to increased risks of BP mismanagement and inaccurate determination of central BP. This illustrates the need to improve the accuracy of cuff-based BP monitors.
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A 2021 study conducted a cross-sectional in Hypertension (n=303). Brachial cuff SBP measurement vs. Intraarterial brachial SBP measurement was evaluated on Mismatch between cuff and intraarterial brachial SBP and accuracy towards central SBP. Brachial cuff SBP measurement underestimated intraarterial SBP in 142 of 303 patients, leading to a 59% risk of undertreatment, and overestimated it in 25 patients, with a 50% risk of overtreatment.
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