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Updated: Nov 14, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Comparison of Invasive and Oscillometric Blood Pressure Measurement in Obese and Nonobese Children
Michael P Fundora1, Asaad G Beshish1, Nikita Rao1
1Children's Healthcare of Atlanta, Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Automated blood pressure cuffs show poor accuracy in children, regardless of obesity. Healthcare providers should recognize these limitations for reliable patient monitoring.
Area of Science:
- Pediatric cardiology
- Biomedical engineering
- Public health
Background:
- Obesity and hypertension are significant public health concerns.
- Obesity is a potential contributing factor to hypertension.
- Accurate blood pressure (BP) measurement is crucial, often using automated oscillometric devices.
Purpose of the Study:
- To evaluate the correlation of oscillometric BP measurements with invasive measurements in children.
- To determine if obesity impacts the accuracy of oscillometric BP measurements compared to nonobese children.
Main Methods:
- A retrospective matched case-controlled study involving 100 obese and 100 nonobese children post-cardiac surgery.
- Simultaneous invasive and oscillometric BP measurements (systolic, diastolic, mean) were recorded.
- Intraclass correlation coefficients and Bland-Altman plots were used to assess agreement, with a threshold of 0.75.
Main Results:
- Low agreement was observed between oscillometric and invasive BP measurements for systolic (0.65/0.61), diastolic (0.68/0.61), and mean (0.73/0.69) values in obese and nonobese children, respectively.
- Bland-Altman plots indicated oscillometric underestimation of systolic hypertension and overestimation of hypotension.
- The correlation between oscillometric and invasive measurements was similar in both obese and nonobese children.
Conclusions:
- The correlation of oscillometric BP measurements in children is below accepted standards.
- Childhood obesity does not appear to affect the accuracy of oscillometric BP measurements.
- Reduced correlation is noted during hypertensive or hypotensive states, highlighting limitations of cuff-based devices.
Background:
Obesity and hypertension are public health priorities, with obesity considered to be a potential cause of hypertension. Accurate blood pressure (BP) determination is required and often obtained by automated oscillometric cuff devices. We sought to determine the correlation of oscillometric measurement in children, and if obesity was associated with worse correlation between methods than nonobese children.
Methods:
Retrospective matched case-controlled study of 100 obese (97-99th percentile) and 100 nonobese (25-70th percentile) children after cardiac surgery with simultaneous systolic, diastolic, and mean invasive and oscillometric measurements. Matching was 1:1 for age, sex, race, and Risk Adjustment for Congenital Heart Surgery-1 score. Intraclass correlation coefficients and Bland-Altman plots were used to determine agreement with 0.75 as threshold.
Results:
Median age was 13 years (10-15). Agreement was low for systolic (0.65 and 0.61), diastolic (0.68 and 0.61), and mean measurements (0.73 and 0.69) (obese/nonobese). Bland-Altman plots demonstrated oscillometric BP measurements underestimated systolic hypertension (oscillometric readings lower than intra-arterial). Oscillometric measurements underestimated hypotension (systolic oscillometric measurements were higher than intra-arterial). This occurred in obese and nonobese patients. Correlation of oscillometric measurements was similar for nonobese and obese patients.
Conclusions:
In this first ever study of simultaneous BP measurement by oscillometric vs. intra-arterial in obese and nonobese children, correlation is below accepted norms. The correlation of oscillometric cuff measurements is not affected by habitus in children. There is less correlation between oscillometric measurements and intra-arterial measurements during hypertension or hypotension. Healthcare providers should be aware of the limitations of oscillometric measurements.
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