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Arm position and blood pressure: a risk factor for hypertension?

Journal of Human Hypertension volume 17, pages 389–395 (2003)Cite this article

Abstract

The objective of this study was to re-evaluate the effect of arm position on blood pressure (BP) measurement with auscultatory and oscillometric methods including ambulatory blood pressure monitoring (ABPM). The setting was the hospital outpatient department and the subjects chosen were normotensive and hypertensive. The effect of lowering the arm from heart level on indirect systolic BP (SBP) and diastolic BP (DBP) measurement as well as the importance of supporting the horizontal arm were measured. In the sitting position, lowering the supported horizontal arm to the dependent position increased BP measured by a mercury device from 103±10/60±7 to 111±14/67±10 mmHg in normotensive subjects, a mean increase of 8/7 mmHg (P<0.01). In hypertensive subjects, a similar manoeuvre increased BP from 143±21/78±17 to 166±29/88±20 mmHg, an increase of 23/10 mmHg (P<0.01). Combined results from normotensive and hypertensive subjects demonstrate a direct and proportional association between BP (SBP and DBP) and the increase produced by arm dependency. Similar changes and associations were noted with oscillometric devices in the clinic situation. However, supporting the horizontal arm did not alter BP. Of particular interest, analysis of 13 hypertensive subjects who underwent ABPM on two occasions, once with the arm in the ‘usual’ position and once with the arm held horizontally for BP measurement during waking hours, demonstrated changes comparable to the other devices. The mean 12-hour BP was 154±19/82±10 mmHg during the former period and significantly decreased to 141±18/74±9 mmHg during the latter period (P<0.01). Regression analysis of the change in SBP and DBP with arm position change again demonstrated a close correlation (r2=0.8113 and 0.7273; P<0.001) with the artefact being larger with higher systolic and diastolic pressures. In conclusion, arm movements lead to significant artefacts in BP measurement, which are greater, the higher the systolic or diastolic pressure. These systematic errors occur when using both auscultatory and oscillometric (clinic and ABPM) devices and might lead to an erroneous diagnosis of hypertension and unnecessary medication, particularly in individuals with high normal BP levels. Since clinical interpretations of heart level vary, the horizontal arm position should be the unambiguous standard for all sitting and standing BP auscultatory and oscillometric measurements.

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References

  1. Feher M, Harris-StJohn K, Lant A . Blood pressure measurement by junior doctors—a gap in medical education? Health Trends 1992; 24: 59–61.

    CAS  PubMed  Google Scholar 

  2. Carney S et al. Hospital blood pressure measurement: staff and device assessment. J Qual Clin Pract 1999; 19: 95–98.

    Article  CAS  Google Scholar 

  3. Moore KL . Clinically Oriented Anatomy, 3rd edn. Williams & Wilkins: Baltimore, MD, 1992.

    Google Scholar 

  4. WHO. Guidelines for the management of mild hypertension. Memorandum from a WHO/ISH meeting. Hypertension 1993; 22: 392–403.

    Article  Google Scholar 

  5. American Heart Association. Recommendations for human blood pressure determination by sphygmomanometers: report of a special taskforce appointed by the Steering committee. Hypertension 1988; 11: 210A–222A.

    Google Scholar 

  6. Petrie JC, O'Brien ET, Littler WA, de Swiet M . British Hypertension Society Recommendations on blood pressure measurement. BMJ 1986; 293: 611–615.

    Article  CAS  Google Scholar 

  7. Guyton A . Textbook of Medical Physiology. WB Saunders Company: Philadelphia; 1986, p 224.

    Google Scholar 

  8. Hill L . Measurement of systolic blood pressure in men. Heart 1909; 1: 73–82.

    Google Scholar 

  9. Webster J, Newnham D, Petrie JC, Lovell HG . Influence of arm position on measurement of blood pressure. BMJ 1984; 288: 1574–1575.

    Article  CAS  Google Scholar 

  10. Netea RT, Lenders JWM, Smits P, Thien T . Arm position is important for blood pressure measurements. J Hum Hypertens 1999; 13: 105–109.

    Article  CAS  Google Scholar 

  11. Netea RT et al. Influence of arm position on intra-arterial blood pressure measurement. J Hum Hypertens 1999; 13: 157–160.

    Article  Google Scholar 

  12. Parker D et al. A comparison of the random zero and standard mercury sphygmomanometer. Hypertension 1988; 11: 269–272.

    Article  CAS  Google Scholar 

  13. O'Brien E, Mee F, Atkins N, O'Mally K . Inaccuracy of the Hawksley random zero sphygmomanometer. Lancet 1990; 336: 1465–1468.

    Article  CAS  Google Scholar 

  14. Mann S . Inaccuracy of electronic sphygmomanometers. Clin Exp Pharmacol Physiol 1992; 19: 304–306.

    Article  CAS  Google Scholar 

  15. O'Brien E, Mee F, Atkins N, Thomas M . Evaluation of three devices for self-measurement of blood pressure according to the revised British Hypertension Society Protocol: the Omron HEM-705CP, Phillips HP5332, and Nissei DS-175. Blood Press Monitor 1996; 55–61.

  16. Fotherby MC, Potter JF . Reproducibility of ambulatory and clinic blood pressure measurements in elderly hypertensive subjects. J Hypertens 1993; 11: 573–579.

    Article  CAS  Google Scholar 

  17. Mansoor GA, McCabe EJ, White WB . Long-term reproducibility of ambulatory blood pressure. J Hypertens 1994; 12: 703–708.

    Article  CAS  Google Scholar 

  18. Palatini P, Mormino P, Caneli C . Factors affecting ambulatory blood pressure reproducibility Results of the HARVEST trial. Hypertension 1994; 23: 211–216.

    Article  CAS  Google Scholar 

  19. Engfeldt P et al. 24-Hour ambulatory blood pressure monitoring in elderly normotensive individuals and its reproducibility after one year. J Hum Hypertens 1994; 8: 545–550.

    CAS  PubMed  Google Scholar 

  20. Prisant LM et al. Repeatability of automated ambulatory blood pressure measurements. J Fam Pract 1992; 11: 177–183.

    Google Scholar 

  21. Peiper C, Warren K, Pickering TG . A comparison of ambulatory blood pressure and heart rate at home and work on work day and non-work days. J Hypertens 1993; 11: 177–183.

    Article  Google Scholar 

  22. Enstrom I, Pennert K . Does it matter whether ambulatory blood pressure is recorded duirng a work day or non-work day? J Hypertens 1996; 14: 565–569.

    Article  CAS  Google Scholar 

  23. Sega R et al. Seasonal variations in home and ambulatory blood pressure in the PAMELA population. J Hypertens 1998; 16: 1585–1592.

    Article  CAS  Google Scholar 

  24. Van der Steen MS, Pleijers AMLJ, Lenders JCUM, Thein T . Influence of different supine body positions on blood pressure: consequences for night blood pressure/dipper-status. J Hypertens 2000; 18: 1731–1736.

    Article  CAS  Google Scholar 

  25. Prasad N, Isles C . Ambulatory blood pressure monitoring: a guide for general practitioners. BMJ 1996; 313: 1535–1541.

    Article  CAS  Google Scholar 

  26. O'Brien E et al. The British Hypertension Society Protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems. J Hypertens 1990; 8: 607–619.

    Article  CAS  Google Scholar 

  27. Ludbrook J . Comparing methods of measurement. Clin Exp Pharmacol Physiol 1997; 24: 193–203.

    Article  CAS  Google Scholar 

  28. Cushman WC, Cooper KM, Horne RA, Meydrech EF . Effect of back support and stethoscope on seated blood pressure determinations. Am J Hypertens 1990; 3: 240–241.

    Article  CAS  Google Scholar 

  29. Van den Hoogen PCW et al. The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. N Engl J Med 2000; 342: 1–8.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology, John Hunter Hospital, Hunter Region Mail Centre, NSW, Australia

    A Mourad, S Carney, A Gillies, B Jones, R Nanra & P Trevillian

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  1. A Mourad
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Correspondence to S Carney.

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Mourad, A., Carney, S., Gillies, A. et al. Arm position and blood pressure: a risk factor for hypertension?. J Hum Hypertens 17, 389–395 (2003). https://doi.org/10.1038/sj.jhh.1001563

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