Trends in Anesthesiology

A study led by Johns Hopkins Medicine researchers concludes that commonly used ways of positioning the patient’s arm during blood pressure (BP) screenings can substantially overestimate test results and may lead to a misdiagnosis of hypertension.

In a report on the study, published in JAMA Internal Medicine, investigators examined the effects of three different arm positions: an arm supported on a desk, arm supported on a lap, and an unsupported arm hanging at the patient’s side. Researchers found that lap support overestimated systolic pressure (the top number in a BP reading) by nearly 4 mmHg, and an unsupported arm hanging at the side overestimated systolic pressure by nearly 7 mmHg.

The latest clinical practice guidelines from the American Heart Association emphasize several key steps for an accurate measurement – including appropriate cuff size, back support, feet flat on the floor with legs uncrossed, and an appropriate arm position, in which the middle of an adjustable BP cuff is positioned at mid-heart level on an arm supported on a desk or table.

Despite these recommendations, the researchers say BP is too often measured with patients seated on an exam table without any, or inadequate, arm support. In some cases, a clinician holds the arm, or the patient holds an arm in their lap. Investigators caution that their study results may only apply during screenings with automated BP devices and may not apply to readings done with other BP devices.

Source: asamonitor.pub/3ZOmtFU