Blood pressure measured at wrist may lead to incorrect diagnosis, finds study

Blood pressure measured at the wrist is higher than the upper arm and it does not meet clinical standards and may lead to incorrect diagnosis and suboptimal decisions.

There are many devices in the market that measures blood pressure from the wrist (radial artery) compared to standard BP measuring devices which measure BP at the upper arm (brachial artery). But which position gives the accurate result is a million dollar question.

Systolic Blood Pressure (BP) measured at the wrist is 5.5 mmHg higher than the blood pressure measured from the upper arm. Radial intra-arterial blood pressure (BP) is sometimes used as the reference standard for validation of brachial cuff BP devices. The study has appeared in the Journal Hypertension.

The brachial cuff is the most preferred location for blood pressure measurement and has been a golden standard over hundreds of years. In fact, the American heart association and the European society for hypertension also recommend this position for blood measure measurement.

Read also: American heart association updates scientific statement on blood pressure measurement

In this light, a new study has revealed that systolic blood pressure measured from the wrist is generally higher than pressure measured from the brachial cuff. The result of the study was published in the journal Hypertension

Sharman et al did a trial on 180 patient where they measured the intra-arterial blood pressure consecutively at the brachial and radial artery and compared the systolic BP.

They found that 43% of the patients had radial systolic BP in the range of 5 mmHg of the brachial systolic BP. 46% of the patients had radial BP >5 mmHg higher than the brachial BP including 19% with radial systolic BP between 5 and 10 mmHg higher, 13% with radial systolic BP between 10 and 15 mmHg higher, and 14% with radial systolic BP >15 mmHg higher than brachial systolic BP.

On average, radial systolic BP was 12.9 mmHg higher than aortic systolic BP. Differences in systolic BP from the aorta to the brachial artery accounted for 57% of this difference, and differences between the brachial artery and radial artery accounted for the remaining 43%.

The authors concluded that the systolic pressure at the radial artery was on average 5.5 mmHg higher than the blood pressure measured at the brachial artery.

The findings have further strengthened the evidence that blood pressure measurement device pay a crucial role. Blood pressure measured at the wrist does not meet clinical standards and may lead to incorrect diagnosis and suboptimal decision. Therefore validation testing of BP devices utilizing intra-arterial BP as the reference standard should use intra-arterial BP measured at the same site as the brachial cuff or wearable device.

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