Brachial and Radial Systolic Blood Pressure Are Not the Same: Evidence to Support the Popeye Phenomenon
Abstract
Radial intra-arterial blood pressure (BP) is sometimes used as the reference standard for validation of brachial cuff BP devices. Moreover, there is an emerging wearables market seeking to measure BP at the wrist. However, radial systolic BP may differ when compared with brachial; yet some authors have labeled these differences as a fictional Popeye phenomenon. Indeed, differences between brachial and radial systolic BP have never been accurately quantified, and this was the aim of this study. Intra-arterial BP was measured consecutively at the brachial and radial artery in 180 participants undergoing coronary angiography (aged 61±10 years; 69% men). On average, radial systolic BP was 5.5 mm Hg higher than brachial systolic BP. Only 43% of participants had radial systolic BP within ±5 mm Hg of brachial. Additionally, 46%, 19%, and 13% of participants had radial systolic BP >5, between 5 and 10, and between 10 and 15 mm Hg higher than brachial respectively. A further 14% of participants had radial systolic BP >15 mm Hg higher than brachial, representing the so-called Popeye phenomenon. Finally, 11% of participants had radial systolic BP >5 mm Hg lower than brachial. In conclusion, radial systolic BP is not representative of brachial systolic BP, with most participants having a radial systolic BP >5 mm Hg higher than brachial and many with differences >15 mm Hg. Therefore, validation testing of BP devices utilizing intra-arterial BP as the reference standard should use intra-arterial BP measured at the same site as the brachial cuff or wearable device.
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Radial artery pressure is 5 to 15 mmHg higher than brachial artery pressure.
“Radial artery pressure has been shown to be 5 to 15 mmHg50 higher than the brachial artery, where blood pressure is often measured using the sphygmomanometer.”
From Synthetic photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to body mass index (BMI) (2021) · cites this paper as [50]
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- Authors
- Armstrong, M. K., Schultz, M. G., Picone, D. S., Black, J. A., Dwyer, N., Roberts-Thomson, P., & Sharman, J. E.
- Affiliations
- University of Tasmania (AU)
- Royal Hobart Hospital (AU)
- Department of Cardiology, Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D., P.R.-T.).
- Corresponding author
- Sharman, James E.
- ORCID
- Venue
- Hypertension
- Published
- 2019-05
- Volume
- 73
- Issue
- 5
- Pages
- 1036-1041
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2927070984
- Cited by
- 59
- References
- 34
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 8 · 2022: 11 · 2021: 12 · 2020: 12 · 2019: 6
- FWCI
- 7.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- UTAS Research Repository (submittedVersion)
- Figshare (submittedVersion)
- 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
- brachial blood pressure, systolic blood pressure, intra-arterial blood pressure
- MeSH terms
- Blood Pressure, Blood Pressure Determination, Brachial Artery, Female, Humans, Hypertension, Male, Middle Aged, Radial Artery
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