Pseudohypertension: a diagnostic dilemma

Pseudohypertension is a condition in which the indirect measurement of intra-arterial pressure using a sphygmomanometer (cuff pressure) is artifactually high in comparison with directly measured intra-arterial pressure. If unrecognized, pseudohypertension may result in unwarranted and sometimes dangerous treatment. Pseudohypertension results from medial sclerosis and/or calcification of arteries, which markedly decrease their collapsibility. Both the systolic and diastolic pressures are affected. The literature concerning pseudohypertension is quite limited; indeed, the very frequency of the condition is unknown. Very high blood pressure in the absence of significant target organ impairment is an important clue to this subtype of hypertension and should lead to simple diagnostic techniques, such as Osler's maneuver (an attempt to palpate a pulseless radial artery) and radiographs of the soft tissues of the arms. The definitive diagnosis is made by comparing the intra-arterial pressure with the indirectly determined blood pressure.