Paper
Friday, 21 July 2006
This presentation is part of : Women's Cardiac and Mental Health Issues
Blood Pressure Measurement and Misdiagnosis of Hypertension in Women
Edna Apparecida Moura Arcuri, RN, PhD, Mestrado em Enfermagem, Universidade de Guarulhos, São Paulo, Brazil, Sonia M. J. V. Oliveira, RN, PhD, Departamento de Enfermagem Materno-Infantil, Escola de Enfermagem, Universidade de São Paulo, Sao Paulo, Brazil, Silvia M. Arcuri, MD, PhD, LIM 44 - Functional Neuroimaging Group, USP, Araraquara - SP, Brazil, Eugenia Velludo Veiga, RN, PhD, Departamento de Enfermagem Geral e Especializado, University of São Paulo at Ribeirão Preto, São Paulo, Brazil, and Jair L. F. Santos, MSc, PhD, Departamento de Medicina Social, Faculdade de Medicina da Universidade de São Paulo- Ribeirão Preto, Ribeirao Preto - SP, Brazil.
Learning Objective #1: Recognise that standard cuff width is not adequate to evaluate blood pressure for a great proportion of the population.
Learning Objective #2: Criticise the American Heart Association decisions upon cuff size to measure blood pressure.
Background: In 1983 we measured blood pressure (BP) in 450 women and 450 men, using correct cuff width (CCW, ratio arm circumference/cuff width of 0.40), as recommended by the American Heart Association (AHA). BP readings were compared to those recorded with the standard cuff width (SCC - 12 cm large). Employing cuffs varying from 8 - 14 cm we found lean females requiring CCW 8 to 10 cm large, presenting normal BP values with SCW, but hypertensive ones with CCW. Objective: To evaluate the development of hypertension and cardiovascular complications within the original sample in the past 21 years, looking at gender differences. Method: From 1983 to 2004 we followed 221 females and 219 males using cuffs 8 - 11 cm. Hypertension and cardiovascular complications were assessed in 2004, using standard cuff (12 cm). Results: We found an inverted proportion of hypertension between females and males, according to cuff 8, 9, 10 and 11, respectively: 0.39 vs. 0 (p = 0.004); 0.25 vs. 0.19 (p < 0.001); 0.25 vs. 0.21 (p = 0.095); 0.11 vs. 0.23 (p =0.024). Similarly, the proportion of cardiovascular complications between females and males were also inverted: 0.04 vs. 0. (p < 0.001); 0.07 vs. 0 (p = 0.003); 0.14 vs. 0.14 (p =0.011); 0 vs. 0.11 (p < 0.001). The differences found with cuff width 8 and 11 between males and females are striking. Eight cases of hypertension and two complications occurred during pregnancy. The leanest women died in 2005 from stroke. Discussion: Our findings confirm the SCW(12 cm) inadequacy to measure BP, in women, and also in men. We suggest that lean women suffer from complications due to misdiagnosis and mistreatment of hypertension. The 2005 AHA statement recommending cuffs 12 cm large to arm circumferences 22-26 cm is inadequate and should be reviewed.

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