Cuff Under Pressure for Greater Accuracy
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BLOOD PRESSURE MONITORING AND MANAGEMENT (J COCKCROFT, SECTION EDITOR)
Cuff Under Pressure for Greater Accuracy Dean S. Picone 1 & Martin G. Schultz 1 & Alun D. Hughes 2 & James E. Sharman 1 Accepted: 4 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To present the evidence that describes what is being measured by upper-arm cuff blood pressure (BP) and the level of accuracy compared with invasive central aortic and brachial BP. Potential causes of inaccuracy and emerging methods are also discussed. Recent Findings On average cuff systolic BP systematically underestimates invasive brachial systolic BP, although in a given individual it may substantially under- or over-estimate central aortic systolic BP. Such errors may affect individual health management outcomes and distort population level data on hypertension prevalence and control. Oscillometric cuff BP is particularly susceptible to inaccuracy in people with high arterial stiffness and with pathophysiological BP waveform shapes. Emerging cuff-less BP methods will be susceptible to inaccuracy if oscillometric cuff BP is used for calibration. Summary The original purpose of cuff BP was to estimate central aortic BP. Recent evidence has shown substantial inaccuracy of oscillometric cuff BP exists for the measurement of invasive central aortic and brachial BP. Thus, development of more accurate BP methods, through better understanding of oscillometric and BP waveform morphology, is needed to improve health outcomes related to high BP. Keywords Hypertension . BP . Blood pressure cuff . Brachial blood pressure . Aortic blood pressure . BP management
Introduction Raised blood pressure (BP) is the leading cause of disability adjusted life years globally [1]. It is the number one risk factor for cardiovascular disease, which itself is responsible for one in three global deaths [2]. Lowering of BP through lifestyle changes (e.g., exercise and/or diet interventions) or antihypertensive treatment leads to lower risk of adverse events related to BP [3]. Management of BP in clinical practice is guided by measurements taken from upper-arm cuff oscillometric BP devices. However, there remain two major issues regarding the function of oscillometric BP devices: (1) confusion as to
This article is part of the Topical Collection on Blood Pressure Monitoring and Management * Dean S. Picone [email protected] 1
Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Private Bag 23, Hobart 7000, Australia
2
Institute of Cardiovascular Sciences, University College London, London, UK
what is being measured—do the devices seek to measure central (aortic) BP, that which vital organs are exposed to, or peripheral (brachial) BP, the site of the cuff placement, and (2) significant concerns regarding accuracy. These two highly inter-related issues are important and will be the focus of this review. Potential causes of cuff BP inaccuracy and emerging measurement methods will al
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