Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

The impact of pulse pressure on the accuracy of wrist blood pressure measurement

Abstract

There is an increasing number of wrist blood pressure measurement devices that successfully passed the validation procedures of the British Hypertension Society (BHS) and the European Society of Hypertension (ESH). It remains unknown, however, whether pulse pressure as a marker of arterial stiffness and vascular ageing affects the accuracy of these devices. An ESH protocol validated wrist device was compared with the upper arm mercury sphygmomanometry in a study population (33 patients, 99 measurements) including a relevant number of subjects with pulse pressure >50 mm Hg (84.8%) and isolated systolic hypertension (27.3%). Mean systolic bias was 10.2 mm Hg with 95% limits of agreement of −13.1 and 33.6 mm Hg, mean diastolic bias was 4.8 mm Hg with limits of agreement of −11.0 and 20.7 mm Hg. The impact of body mass index, age, systolic blood pressure and pulse pressure on the absolute value of blood pressure bias was tested by stepwise multiple regression analysis. The systolic bias significantly depended on pulse pressure, whereas there was no significant effect of the independent variables on the diastolic bias. Separate correlation analysis showed a significant correlation between pulse pressure and both absolute systolic bias (Pearson r=0.48, P<0.001) and relative systolic bias (systolic bias divided by systolic blood pressure, Pearson r=0.29, P=0.003). Even well-validated wrist blood pressure devices can show a clinically relevant bias in patients with elevated pulse pressure. Increased arterial stiffness may impair the accuracy of oscillometric blood pressure measurement at the wrist.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Ohkubo T, Imai Y, Tsuji I, Nagai K, Kato J, Kikuchi N et al. Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens 1998; 16: 971–975.

    Article  CAS  Google Scholar 

  2. O'Brien E, Petrie J, Littler W, de Swiet M, Padfield PL, O'Malley K 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 

  3. O'Brien E, Pickering T, Asmar R, Myers M, Parati G, Staessen J et al. Working Group on Blood Pressure Monitoring of the European Society of Hypertension International Protocol for validation of blood pressure measuring devices in adults. Blood Press Monit 2002; 7: 3–17.

    Article  Google Scholar 

  4. Association for the Advancement of Medical Instrumentation. American National Standard. Manual, electronic, or automated sphygmomanometers. In: ANSI/AAMI SP-10 (1992 and 2002) AAMI: Arlington, VA.

  5. Westhoff TH, Schmidt S, Zidek W, van der Giet M . Validation of the Stabil-O-Graph blood pressure self-measurement device. J Hum Hypertens 2008; 22: 233–235.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  7. O'Rourke MF, Nichols WW . Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension 2005; 45: 652–658.

    Article  CAS  Google Scholar 

  8. Franklin SS, Gustin WT, Wong ND, Larson MG, Weber MA, Kannel WB et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 1997; 96: 308–315.

    Article  CAS  Google Scholar 

  9. Wilking SV, Belanger A, Kannel WB, D'Agostino RB, Steel K . Determinants of isolated systolic hypertension. JAMA 1988; 260: 3451–3455.

    Article  CAS  Google Scholar 

  10. van Popele NM, Bos WJ, de Beer NA, van Der Kuip DA, Hofman A, Grobbee DE et al. Arterial stiffness as underlying mechanism of disagreement between an oscillometric blood pressure monitor and a sphygmomanometer. Hypertension 2000; 36: 484–488.

    Article  CAS  Google Scholar 

  11. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation 2005; 111: 697–716.

    Article  Google Scholar 

  12. O'Rourke MF . From theory into practice: arterial haemodynamics in clinical hypertension. J Hypertens 2002; 20: 1901–1915.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Mrs Christl Harsch for her organization of the measurements.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T H Westhoff.

Additional information

Sources of financial support

None.

Conflict of interest

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Westhoff, T., Schmidt, S., Meissner, R. et al. The impact of pulse pressure on the accuracy of wrist blood pressure measurement. J Hum Hypertens 23, 391–395 (2009). https://doi.org/10.1038/jhh.2008.150

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2008.150

Keywords

This article is cited by

Search

Quick links