Comparison of the blood pressure measurement

INTRODUCTIONThe measurement of blood pressure is a common clinical exam with important health consequences. Here is the study for the measurement of blood pressure over a sleeved arm &bare arm.At over 400 consecutive participants were recruited for the study of comparison of methods of blood pressure measurement, taken by the Department of family medicine.The study period was from September 2004 – November 2006. The criterion for age was agesbetween 18-85 years. They excluded people unable to use their right hand due to any disabilityor disease.CRITICAL COMMENT ON METHODOLOGYThey all had their blood pressure recorded using the same automatic oscillometric device, with the cuff placed over their bare arms for the first reading.

Each patient was then randomly assigned to either the bare-arm group, for which the second blood pressure reading was also taken on a bare arm, or the sleeved-arm group, for which the second reading was taken with the cuff placed over the patient’s sleeve.Their prospective study was approved by the McGill University Health Centre Research EthicsBoard.During an interview with each participant, they recorded factors, such as age and sex, that might affect blood pressure. They measured each patient’s height and weight using the same scale. The patient’s sleeve was folded, and they  measured its thickness in millimeters using a HoltainSkinfold Caliper.Participants were randomly assigned to have either both blood pressure measurements taken over a bare arm (bare-arm group, n = 180) or the first measurement taken over a bare arm and the second over the sleeve (sleeved-arm group, n = 196). The patients were seated for 5 minutes, with feet flat on the ground and back supported, before a clinical examiner measured their blood pressure using a commercially available automated blood pressure machine (LifeSource BloodPressure Monitor Model UA-767CN, A;D Medical, San Jose).

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This device is approved by the Canadian Hypertension Society and validated according to the Association for Advancement of Medical Instrumentation protocol, and it has an accuracy of ± 3 mm Hg or 2%, whichever is greater. The same size of blood pressure cuff was used for each patient. One of 5 clinical examiners took 2 blood pressure measurements on the right arm of each patient.

The first measurement was on a bare arm for both the bare-arm and sleeved-arm groups. Examiners waited 3 minutes between the first and second measurements in both groups. All 5 examiners (1 medical doctor, 2 nurses and 2 medical students) were trained to use the blood pressure machine.They hypothesized that readings taken over sleeved arms would be higher than those taken over bare arms.

Thus, they expected the difference between the first and second readings to be lower for  patients in the sleeved-arm group than for patients in the bare-arm group.Normally, blood pressure drops between the first and second readings. Because of the nature of the study, blinding the participants, recruiter and examiners was not possible. The list of patients assigned to the bare-arm and sleeved-arm groups was kept on the nurses’ computer.

 Participants were randomly assigned to have either both blood pressure measurements taken over a bare arm (bare-arm group, n = 180) or the first measurement taken over a bare arm and the second over the sleeve (sleeved-arm group, n = 196).Examiners waited 3 minutes between the first and second measurements in both groups. All 5 examiners (1 medical doctor, 2 nurses and 2 medical students) were trained to use the blood pressure machine. Clinical examiner measured their blood pressure using a commercially available automated blood pressure machine (LifeSource Blood Pressure Monitor Model UA-767CN, A&D Medical, San Jose)The device was approved by the Canadian Hypertension Society and validated according to the Association for Advancement of Medical Instrumentation protocol  and it has an accuracy of ± 3 mm Hg or 2%, whichever is greater.RESULTSThe mean age of the 376 participants was 61.

6 years (standard deviation 15.0), 61% of the participants were male, 41% had hypertension and 11.7% had diabetes. We found no clinically important differences between the bare-arm group (n = 180) and the sleeved-arm group (n = 196) in age, sex or body mass index.The mean differences between first & second reading for :Systolic blood pressure: 4.1 mm Hg (95% confidence interval [CI] 2.

8 to 5.5)Diastolic blood pressure: 0.1 mm Hg (95% CI –0.7 to 0.9)neither of these differences was clinically important or statistically significant.CONCLUSIONIn the above study the research people found that there was no significant difference in blood pressure recorded over a sleeve or on a bare arm. For practical purposes, the decision to measure blood pressure on a bare arm or over a sleeved arm should be left to the judgment of the health  care professional taking the blood pressure.