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Cited by 51Blood Pressure and Hypertension StudiesNon-Invasive Vital Sign MonitoringCardiovascular Health and Disease Prevention

Which cuff should I use? Indirect blood pressure measurement for the diagnosis of hypertension in patients with obesity: a diagnostic accuracy review

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Irving, Greg, Holden, John, Stevens, Richard, McManus, Richard J·2016·BMJ Open
DOI 10.1136/bmjopen-2016-012429PMC PMC5129068
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Abstract

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.

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Cited by

Sorted by citations

Authors
Irving, G., Holden, J., Stevens, R., & McManus, R. J.
Affiliations
  • University of Cambridge (GB)
  • Department of Garswood Surgery, Garswood, UK
  • University of Oxford (GB)
Corresponding author
Irving, Greg
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2016-11
Volume
6
Issue
11
Pages
e012429
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2016-012429
PMC
PMC5129068
OpenAlex
W2546973642
Cited by
51
References
2
Citations by year
2025: 3 · 2024: 9 · 2023: 3 · 2022: 6 · 2021: 5 · 2020: 8 · 2019: 5 · 2018: 6 · 2017: 5 · 2014: 1
FWCI
0.94
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Edge Hill University Research Information Repository (Edge Hill University) (submittedVersion, cc-by-nc)
  • HighWire Press Open Archive (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by-nc)
  • Apollo
Funders
  • National Institute for Health and Care Research (CDF/01/017, CL-2013-14-001, NIHR-RP-02-12-015, RP-PG-1209-10051)
  • European Society of Cardiology
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
hypertension diagnosis, obesity, blood pressure measurement, cuff size, upper arm cuff, finger blood pressure, diagnostic accuracy, ambulatory blood pressure monitoring, invasive blood pressure, sensitivity and specificity, measurement agreement, primary care, individual patient data, systolic and diastolic blood pressure, cardiovascular risk stratification
MeSH terms
Adult, Aged, Arm, Blood Pressure, Blood Pressure Determination, Humans, Hypertension, Middle Aged, Obesity, Sensitivity and Specificity, Wrist, Blood Pressure Monitoring, Ambulatory, Body Size

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