Author + information
- Received February 23, 2017
- Revision received May 26, 2017
- Accepted May 30, 2017
- Published online July 24, 2017.
- Dean S. Picone, BMedRes(Hons)a,
- Martin G. Schultz, PhDa,
- Petr Otahal, GDipScia,
- Svend Aakhus, MD, PhDb,
- Ahmed M. Al-Jumaily, PhDc,
- J. Andrew Black, MBBS(Hons)a,d,
- Willem J. Bos, MD, PhDe,
- John B. Chambers, MDf,
- Chen-Huan Chen, MDg,
- Hao-Min Cheng, MD, PhDg,
- Antoine Cremer, MDh,
- Justin E. Davies, PhDi,
- Nathan Dwyer, MBBS, PhDa,d,
- Brian A. Gould, MD, PhDj,
- Alun D. Hughes, MBBS, PhDk,
- Peter S. Lacy, PhDl,
- Esben Laugesen, MD, PhDm,
- Fuyou Liang, PhDn,
- Roman Melamed, MDo,
- Sandy Muecke, PhDp,
- Nobuyuki Ohte, MD, PhDq,
- Sho Okada, MD, PhDr,
- Stefano Omboni, MDs,
- Christian Ott, MDt,
- Xiaoqing Peng, MPharma,
- Telmo Pereira, PhDu,
- Giacomo Pucci, MDv,
- Ronak Rajani, MDf,
- Philip Roberts-Thomson, MBBSa,d,
- Niklas B. Rossen, MD, PhDm,
- Daisuke Sueta, MD, PhDw,
- Manish D. Sinha, PhDx,
- Roland E. Schmieder, MDt,
- Harold Smulyan, MDy,
- Velandai K. Srikanth, PhDa,z,aa,
- Ralph Stewart, MDbb,
- George A. Stouffer, MDcc,
- Kenji Takazawa, MD, PhDdd,
- Jiguang Wang, MD, PhDee,
- Berend E. Westerhof, PhDff,
- Franz Weber, MDgg,
- Thomas Weber, MDhh,
- Bryan Williams, MDl,
- Hirotsugu Yamada, MD, PhDii,
- Eiichiro Yamamoto, MD, PhDw and
- James E. Sharman, PhDa,∗ ()
- aMenzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- bDepartment of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- cInstitute of Biomedical Technologies, Auckland University of Technology, Auckland, New Zealand
- dRoyal Hobart Hospital, Hobart, Tasmania, Australia
- eDepartment of Internal Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands
- fCardiology Department, Guy’s and St. Thomas’ Hospitals, London, United Kingdom
- gDepartment of Medicine, National Yang-Ming University, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- hDepartment of Cardiology/Hypertension, University Hospital of Bordeaux, Bordeaux, France
- iInternational Centre for Circulatory Health, Imperial College London, London, United Kingdom
- jBMI Hospital Blackheath, London, United Kingdom
- kInstitute of Cardiovascular Sciences, University College London, London, United Kingdom
- lInstitute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, London, United Kingdom
- mDepartment of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- nSchool of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- oAbbott Northwestern Hospital, Allina Health, Minneapolis, Minnesota
- pDepartment of Critical Care Medicine, Flinders University, Adelaide, South Australia, Australia
- qDepartment of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- rDepartment of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
- sClinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- tDepartment of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- uPolytechnic Institute of Coimbra, Coimbra College of Health Technology, Department of Cardiopneumology, Lousã, Portugal
- vUnit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Perugia, Italy
- wDepartment of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- xDepartment of Clinical Pharmacology and Department of Paediatric Nephrology, Kings College London, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
- yDepartment of Medicine, State University of New York, Upstate Medical University, Cardiology Division, Syracuse, New York
- zCentral Clinical School, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
- aaDepartment of Medicine, Peninsula Health, Melbourne, Victoria, Australia
- bbGreen Lane Cardiovascular Service, Auckland City Hospital, University of Auckland, Auckland, New Zealand
- ccDivision of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- ddCenter for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital, Tokyo, Japan
- eeCentre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- ffDepartment of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
- ggDepartment of Nephrology, Center for Internal Medicine, University Clinic Essen, University Duisburg-Essen, Essen, Germany
- hhCardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
- iiDepartment of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
- ↵∗Address for correspondence:
Prof. James E. Sharman, Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
Background Hypertension (HTN) is the single greatest cardiovascular risk factor worldwide. HTN management is usually guided by brachial cuff blood pressure (BP), but questions have been raised regarding accuracy.
Objectives This comprehensive analysis determined the accuracy of cuff BP and the consequent effect on BP classification compared with intra-arterial BP reference standards.
Methods Three individual participant data meta-analyses were conducted among studies (from the 1950s to 2016) that measured intra-arterial aortic BP, intra-arterial brachial BP, and cuff BP.
Results A total of 74 studies with 3,073 participants were included. Intra-arterial brachial systolic blood pressure (SBP) was higher than aortic values (8.0 mm Hg; 95% confidence interval [CI]: 5.9 to 10.1 mm Hg; p < 0.0001) and intra-arterial brachial diastolic BP was lower than aortic values (−1.0 mm Hg; 95% CI: −2.0 to −0.1 mm Hg; p = 0.038). Cuff BP underestimated intra-arterial brachial SBP (−5.7 mm Hg; 95% CI: −8.0 to −3.5 mm Hg; p < 0.0001) but overestimated intra-arterial diastolic BP (5.5 mm Hg; 95% CI: 3.5 to 7.5 mm Hg; p < 0.0001). Cuff and intra-arterial aortic SBP showed a small mean difference (0.3 mm Hg; 95% CI: −1.5 to 2.1 mm Hg; p = 0.77) but poor agreement (mean absolute difference 8.0 mm Hg; 95% CI: 7.1 to 8.9 mm Hg). Concordance between BP classification using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure cuff BP (normal, pre-HTN, and HTN stages 1 and 2) compared with intra-arterial brachial BP was 60%, 50%, 53%, and 80%, and using intra-arterial aortic BP was 79%, 57%, 52%, and 76%, respectively. Using revised intra-arterial thresholds based on cuff BP percentile rank, concordance between BP classification using cuff BP compared with intra-arterial brachial BP was 71%, 66%, 52%, and 76%, and using intra-arterial aortic BP was 74%, 61%, 56%, and 65%, respectively.
Conclusions Cuff BP has variable accuracy for measuring either brachial or aortic intra-arterial BP, and this adversely influences correct BP classification. These findings indicate that stronger accuracy standards for BP devices may improve cardiovascular risk management.
Microlife Co., Ltd., and National Yang-Ming University have signed a contract for transfer of the noninvasive central blood pressure technique. The contract of technology transfer includes research funding for conducting the validation study. Dr. Chen has served as a speaker or a member of a speakers bureau for AstraZeneca, Pfizer, Bayer AG, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi-Sankyo, Novartis Pharmaceuticals, Servier, Merck & Co., Sanofi, and Takeda Pharmaceuticals International. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 23, 2017.
- Revision received May 26, 2017.
- Accepted May 30, 2017.
- 2017 American College of Cardiology Foundation
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