Invasive observation of reactive systolic blood pressure responses to upper-arm cuff inflation

Non-invasive blood pressure (BP) measurement is performed by the inflation of an upper-arm cuff, which itself could induce a reactive BP response and potentially influence BP management. The aim of this study was to determine if cuff inflation was associated with reactive BP responses. Beat-to-beat invasive aortic BP was measured continuously before and during inflation of an automated upper-arm cuff in 234 participants (61 ± 10 years, 31% female) undergoing coronary angiography. Reactive responses were calculated as invasive aortic systolic BP immediately post cuff inflation minus baseline aortic systolic BP immediately pre-cuff inflation. Three groups were defined based on an increase (≥ 5 mmHg), decrease (≤ -5 mmHg) or no response (>-5-<5 mmHg) in aortic systolic BP. Cuff inflation was associated with an average increase in aortic systolic BP of 9.8 ± 5.1 mmHg in 28 (12%) participants, an average decrease of 9.2 ± 5.4 mmHg in 43 (18%) participants, and no response in 163 (70%) participants (-0.3 ± 2.4 mmHg). Cuff and baseline aortic systolic BP were higher in participants who exhibited a reactive response and BP variability was greater among the decrease group (ANOVA p < 0.05). No clinical characteristics were associated with reactive responses. Similar findings were observed for diastolic BP, mean arterial pressure and pulse pressure. Approximately one-third of participants exhibited a substantial reactive systolic BP response (increase or decrease) to upper-arm cuff inflation as determined from invasive BP measurements. Whether this could influence the accuracy of cuff BP measures, and consequent hypertension management, should be determined in future, prospectively designed studies.