A17826 Cuff blood pressure is progressively more biased with increasing age

Abstract

Objectives: Accurate blood pressure (BP) measurement is critical for appropriate hypertension diagnosis and management. Aortic BP represents pressure loading on vital organs and this can be approximated using standard upper arm cuff BP. With advancing age, cuff systolic BP (SBP) increases and diastolic BP (DBP) decreases (widening pulse pressure [PP]), but the extent to which age may influence cuff BP compared with invasive BP is unknown and was the aim of this study. Methods: Cuff BP was measured simultaneously, or near-simultaneously, with invasive aortic BP during cardiac catheterization in 1478 individuals within the INSPECT consortium (an international collaboration comprising data from 30 studies and 18 different cuff BP devices [16 oscillometric, 2 mercury sphygmomanometry]). Differences in cuff and invasive BP were assessed using mixed models to account for within study clustering of patients. Results: Subjects were aged 63.2 ± 10.8 years and 31% female. Cuff SBP overestimated invasive aortic SBP in those aged 40–49 years, but with increasing age there was a progressive increase in the underestimation of aortic SBP (Table). Conversely, cuff DBP overestimated aortic DBP systematically and increasingly with age. Thus, there was a progressively higher error (underestimation) in cuff PP with older age. Adjusting models for sex and mean arterial pressure did not alter the findings, and no interactions between these parameters and age were found. Conclusion: Cuff BP becomes progressively more biased with increasing age, thus exposing older people to greater chance for misdiagnosis of risk related to BP. The findings highlight the need to improve cuff BP methods to ensure all people receive appropriate diagnosis and management of hypertension.