CUFF-BASED AND INTRAARTERIAL BRACHIAL BLOOD PRESSURE MISMATCH AND ITS POTENTIAL IMPACT ON ANTIHYPERTENSIVE TREATMENT AND ESTIMATION OF AORTIC BLOOD PRESSURE

Abstract

Objective: Cuff-based brachial blood pressure (BP) is universally used as a guide to treat hypertension, although it can differ from the intraarterial BP. In this study, we examine the potential impact of cuff-to-intraarterial brachial systolic BP (bSBP) mismatch phenotypes on BP treatment and its impact on determination of central BP. Design and method: In 379 hypertensive subjects undergoing cardiac catheterization through the radial artery, non-invasive brachial cuff and central BPs were measured using the Mobil-o-Graph device simultaneously to intraarterial brachial and aortic BP. According to the difference between cuff-based bSBP (CUFF-bSBP) and intraarterial bSBP (IA-bSBP), we identified three phenotypes: Underestimation Mismatch group (CUFF-bSBP < IA-bSBP by more than 10 mmHg); No Mismatch group (CUFF-bSBP within 10 mmHg of IA-bSBP); Overestimation Mismatch group (CUFF-bSBP > IA-bSBP by more than 10 mmHg). Influence on ACC/AHA BP categories was evaluated and accuracy was determined following ARTERY society recommendations (mean difference <=5 ± 8 mmHg). Results: The Underestimation (n = 190), No Mismatch (n = 155) and Overestimation (n = 34) groups, despite overall similar clinical characteristics, showed only minor differences in CUFF-bSBP (127 ± 17, 123 ± 15, 126 ± 19 mmHg) despite highly different IA-bSBP (147 ± 18, 126 ± 16 vs 108 ± 18 mmHg, p < 0.001) and aortic SBP (136 ± 20, 122 ± 16, 109 ± 18 mmHg, p < 0.001). ACC/AHA BP categories were concordant in 33%, 68% and 44% of the Underestimation, No Mismatch and Overestimation groups. The Underestimation Mismatch group had 64% of individuals at risk of undertreatment compared to 16% in the No Mismatch Group, while in the Overestimation Mismatch Group 50% were at risk of overtreatment compared to 17% in the No Mismatch group. Cuff bSBP accurately estimated the aortic SBP only in the No Mismatch Group (mean difference 1.7 ± 8.2 mmHg) whereas central BP with the Mobil-o-Graph device did not reach the strict ARTERY criteria for accuracy in any groups. Conclusions: Our study shows that the brachial cuff underestimates and overestimates intraarterial brachial BP in a significant proportion of hypertensive subjects, potentially leading to an increased risk of BP mismanagement, and inaccurate non-invasive estimation of central BPs. This underlines the importance of improving the accuracy of cuff-based brachial and central BP monitors, ideally taking into consideration invasive BP phenotypes.