Compared with invasive blood pressure measurement, a correctly fitting upper arm cuff had a sensitivity of 0.87 and a specificity of 0.85 for diagnosing hypertension in patients with obesity.
Meta-Analysis
Does non-invasive blood pressure measurement at different sites accurately diagnose hypertension compared to reference standards in patients with obesity with a large arm circumference?
In patients with obesity and a large arm circumference, if a correctly fitting upper arm cuff is unavailable, wrist blood pressure measurement is a more accurate alternative than using an incorrectly fitting standard cuff.
Effect estimate: Sensitivity 0.87 (95% CI 0.79-0.93)
OBJECTIVE: To determine the diagnostic accuracy of different methods of blood pressure (BP) measurement compared with reference standards for the diagnosis of hypertension in patients with obesity with a large arm circumference. DESIGN: Systematic review with meta-analysis with hierarchical summary receiver operating characteristic models. Bland-Altman analyses where individual patient data were available. Methodological quality appraised using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS2) criteria. DATA SOURCES: MEDLINE, EMBASE, Cochrane, DARE, Medion and Trip databases were searched. ELIGIBILITY CRITERIA: Cross-sectional, randomised and cohort studies of diagnostic test accuracy that compared any non-invasive BP tests (upper arm, forearm, wrist, finger) with an appropriate reference standard (invasive BP, correctly fitting upper arm cuff, ambulatory BP monitoring) in primary care were included. RESULTS: 4037 potentially relevant papers were identified. 20 studies involving 26 different comparisons met the inclusion criteria. Individual patient data were available from 4 studies. No studies satisfied all QUADAS2 criteria. Compared with the reference test of invasive BP, a correctly fitting upper arm BP cuff had a sensitivity of 0.87 (0.79 to 0.93) and a specificity of 0.85 (0.64 to 0.95); insufficient evidence was available for other comparisons to invasive BP. Compared with the reference test of a correctly fitting upper arm cuff, BP measurement at the wrist had a sensitivity of 0.92 (0.64 to 0.99) and a specificity of 0.92 (0.85 to 0.87). Measurement with an incorrectly fitting standard cuff had a sensitivity of 0.73 (0.67 to 0.78) and a specificity of 0.76 (0.69 to 0.82). Measurement at the forearm had a sensitivity of 0.84 (0.71 to 0.92) and a specificity 0.75 of (0.66 to 0.83). Bland-Altman analysis of individual patient data from 3 studies comparing wrist and upper arm BP showed a mean difference of 0.46 mm Hg for systolic BP measurement and 2.2 mm Hg for diastolic BP measurement. CONCLUSIONS: BP measurement with a correctly fitting upper arm cuff is sufficiently sensitive and specific to diagnose hypertension in patients with obesity with a large upper arm circumference. If a correctly fitting upper arm cuff cannot be applied, an incorrectly fitting standard size cuff should not be used and BP measurement at the wrist should be considered.
Irving et al. (Tue,) conducted a meta-analysis in Hypertension in patients with obesity. Correctly fitting upper arm blood pressure cuff vs. Invasive blood pressure measurement was evaluated on Sensitivity for diagnosis of hypertension (Sensitivity 0.87, 95% CI 0.79-0.93). Compared with invasive blood pressure measurement, a correctly fitting upper arm cuff had a sensitivity of 0.87 and a specificity of 0.85 for diagnosing hypertension in patients with obesity.