Central-to-peripheral systolic blood pressure different phenotypes and relation to accuracy of daily used cuff devices

Abstract

Background. Cuff blood pressure (BP) measurement has been the standard method for taking BP in routine daily practice for more than a century. However, some concerns were raised about the accuracy of this method which could lead to misclassification of BP in many situations. We aimed primarily to confirm a recent major discovery that distinct BP phenotypes based on central-to-peripheral systolic blood pressure (SBP) amplification do exist, and whether application of a validated cuff BP method (e.g. oscillometric) could accurately discriminate these differences. Material and methods. Among 106 participants (mean age 62 ± 11; 58% males) undergoing coronary angiography, intra-arterial BP was measured at 3 points (ascending aorta, brachial and radial arteries). Central-to-peripheral SBP amplification (SBPamp) was defined as ≥ 5 mm Hg SBP increased from aorta-to-brachial and/or from brachial-to-radial arteries. A validated cuff BP device (oscillometric) was used to measure BP at 4 different time points. Results. Four different BP phenotypes were confirmed based on the magnitude of SBPamp; phenotype-I, both aortic-to brachial and brachial-to radial SBPamp; phenotype-II, only aortic-to-brachial SBPamp; phenotype-III, only brachial-to-radial SBPamp; and phenotype-IV, no SBPamp at all. Aortic SBP was significantly higher in phenotypes-III and IV compared to phenotypes-I and II (p = 0.001). This was not discriminated using a validated cuff BP device measurement (p = 0.996). Results for the pulse pressure (PP) followed the same pattern. Conclusion. Distinct BP phenotypes do exist based on SBPamp. A validated cuff BP method failed to discriminate this. Improving quality of BP measurements in daily practice is a priority.