Picone, D; Schultz, M; Otahal, P; Black, JA; Dwyer, N; Hughes, A; Liang, F; ... Sharman, J; + view all Picone, D; Schultz, M; Otahal, P; Black, JA; Dwyer, N; Hughes, A; Liang, F; Rajani, R; Roberts-Thomson, P; Srikanth, V; Takazawa, K; Sharman, J; - view fewer (2016) Principal Findings of the Invasive Blood Pressure Meta-Analysis Consortium (Inspect) on the Accuracy of Brachial Cuff Blood Pressure Devices. Presented at: The 26th Scientific Meeting of the International Society of Hypertension 2016, Seoul, South Korea.

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Abstract

OBJECTIVE: Accurate measurement of blood pressure (BP) is crucial for hypertension management. Accuracy of brachial cuff (B_CUFF) devices to measure invasive (intra-arterial) BP at the brachial artery (B_INV) and aorta (A_INV) has never been systematically assessed. This study aimed to determine the: 1) relationship between B_INV and A_INV; 2) accuracy of B_CUFF devices to estimate invasive BP and; 3) accuracy of B_CUFF devices to classify BP thresholds. DESIGN AND METHOD: Three individual patient meta-analyses (by search of online databases and systematic review supplemented by measurements in a tertiary hospital cardiac catheterization laboratory) were performed to determine: 1) B_INV versus A_INV BP; 2) B_CUFF versus B_INV BP and A_INV BP and; 3) B_CUFF for BP classification versus invasive BP. RESULTS: Most subjects (90%) were patients undergoing cardiac catheterization (total N = 3004; mean age 58.7 years, 95%CI [54.0, 63.4], 68% male). As shown in the table: 1) B_INV systolic BP (SBP) was significantly higher than A_INV SBP whilst A_INV diastolic BP (DBP) was slightly higher than B_INV DBP. 2) B_CUFF underestimated B_INV SBP and overestimated B_INV DBP. The mean difference between B_CUFF SBP and A_INV SBP was small, whilst B_CUFF DBP overestimated A_INV DBP. However, according to mean absolute difference, B_CUFF and A_INV showed poor agreement. 3) B_CUFF correctly classified 31.1/28.4% of high-normal (SBP 130–139 mmHg), 54.2/52.6% of grade I (SBP 140–159 mmHg) and 45.2/50.3% of grade II (SBP 160–179 mmHg) hypertension cases, using B_INV/A_INV, respectively, as the reference. Correct classification was more frequent for SBP B_CUFF values < 120 mmHg or ≥180 mmHg (both > 75%). CONCLUSIONS: While recognising the clinical importance of B_CUFF devices, there is wide variability in device accuracy for measuring intra-arterial BP. Although B_CUFF devices are reasonable for correctly classifying BP at low and very high BP thresholds, more accurate B_CUFF devices in the high-normal BP to grade II hypertension range should improve hypertension management.

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