Brief Report  |   June 2019
Relationship Between Elevated Automatic Blood Pressure Readings and Manual Blood Pressure Readings in Adult Patients With Normal and High Body Mass Index
Author Notes
  • From The Wright Center National Family Medicine Residency Program at New York University Langone-Brooklyn Campus (Drs Hussain, Solomon, Bandarpalle, and Shneyder); the Department of Research Support at A.T. Still University in Kirksville, Missouri (Ms Pazdernik); the Departments of Public Health and Graduate Medical Education at A.T. Still University School of Osteopathic Medicine in Arizona in Mesa (Dr Navarro); and the Department of Graduate Medical Education, School of Osteopathic Medicine in Arizona, at A.T. Still University, Mesa (Dr LeBeau). Drs Hussain, Solomon, and Bandarpalle conducted the research for this study while in their residencies at New York University Langone-Brooklyn Campus. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •   Address correspondence to Munif M. Hussain, MS, DO, The Wright Center for Graduate Medical Education, 162 Dahill Rd, Brooklyn, NY, 11218-2255. Email: munifhussain@gmail.com
     
Article Information
Cardiovascular Disorders / Endocrinology / Hypertension/Kidney Disease / Preventive Medicine / Professional Issues
Brief Report   |   June 2019
Relationship Between Elevated Automatic Blood Pressure Readings and Manual Blood Pressure Readings in Adult Patients With Normal and High Body Mass Index
The Journal of the American Osteopathic Association, June 2019, Vol. 119, 364-370. doi:https://doi.org/10.7556/jaoa.2019.065
The Journal of the American Osteopathic Association, June 2019, Vol. 119, 364-370. doi:https://doi.org/10.7556/jaoa.2019.065
Abstract

Context: Discrepancies in ambulatory blood mercury sphygmomanometers pressure readings exist between automated blood pressure machines and manual mercury sphygmomanometers. For patients with elevated blood pressure, consistent blood pressure readings between these methods are important across all body mass index (BMI) levels.

Objective: To determine the relationship between automated and manual blood pressure readings and the effect of BMI in patients with an elevated automated blood pressure reading.

Methods: Automated and manual blood pressure readings (using the same arm) were collected from July 2014 to December 2016 across community-oriented primary care clinics in New York City for a retrospective medical record review. Automated systolic blood pressure (SBP) readings greater than 140 mm Hg or diastolic blood pressure (DBP) readings greater than 90 mm Hg were qualifying criteria for a manual blood pressure assessment. The difference in automated blood pressure readings relative to a manual blood pressure reading was assessed overall and for any relationship with BMI using linear regression and analysis of variance.

Results: Data from 281 patients (166 [59%] women, 115 [41%] men; mean [SD] age of 57 [12.6] years) were assessed. For SBP, automated readings had an overall mean that was 8.0% greater than manual readings (P<.001). This relative difference decreased linearly by 2.7 points (95% CI, 1.0-4.4) for each 10-unit increase in BMI (P=.002). For DBP, automated readings had an overall mean that was 4.5% greater than manual readings (P<.001). This relative difference followed a quadratic relationship with BMI (P=.01), where the downward curve peaked at 6.6% (95% CI, 4.5-8.7) for a BMI of 35. When BMI was grouped into 4 categories, (normal weight, overweight, obese, and morbidly obese), morbidly obese patients had a smaller mean percentage SBP difference (4.3% [95% CI, 1.5-7.1]) compared with the other 3 categories (8.6% [95% CI, 7.2-9.9], P=.007). No relative differences between automated and manual methods for DBP were found among the BMI categories (P=.11).

Conclusions: The current study found significant differences between automated and manual blood pressure readings. The relationship of these differences with BMI was also statistically significant, but their clinical significance remains inconclusive. Because manual blood pressure readings may have clinical value when evaluating or treating a patient with elevated blood pressure, better adherence to proper technique may improve accuracy.

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