Assessment of body position to quantify its effect on nocturnal blood pressure under ambulatory conditions

Abstract

Nocturnal blood pressure readings may be influenced by body position because of variation in the vertical distance between heart and cuff level. To quantify the effect of body position on nocturnal blood pressure and to assess whether this effect influences the reproducibility of nocturnal blood pressure. In 16 individuals (three normotensive and 13 hypertensive) 24 h ambulatory measurement of blood pressure and body position was performed twice, separated by an interval of 2-6 weeks. Body position was measured with five acceleration sensors, which were mounted on the trunk and legs. During the first night, 43 +/- 31% of blood pressure values were measured while participants were in the supine position, 29 +/- 28% when they were lying on their side with the cuffed arm down and 28 +/- 29% when they were lying on their side with the cuffed arm up. During the second night these percentages were 40 +/- 29%, 32 +/- 29% and 28 +/- 25% respectively. Blood pressure readings obtained while individuals were lying with the cuffed arm up were about 10 mmHg lower than those obtained with the individual in either the supine position or lying with the cuffed arm down. After correction for the underestimation attributable to 'cuff-up' readings, nocturnal blood pressure increased by 3 mmHg and the number of non-dippers increased from two to four. Correction did not affect the reproducibility of nocturnal blood pressure measurements (standard deviation of the differences 8.3 mmHg for systolic and 6.0 mmHg for diastolic blood pressure after correction). Dipping status was reproduced in 88% of individuals before correction, and in 87% after correction. Under ambulatory conditions, a highly variable but sometimes substantial number of blood pressure readings are taken with the cuffed arm above heart level. These readings result in underestimation of nocturnal blood pressure and hence influence dipper-non-dipper classification. However, body position does not seem to have an important influence on the reproducibility of nocturnal blood pressure or dipping status.