Correlation of patient characteristics with arm and finger measurements in Asian parturients: a preliminary study

Ming Jian Lim, Chin Wen Tan, Hon Sen Tan, Rehena Sultana, Victoria Eley, Ban Leong Sng, Ming Jian Lim, Chin Wen Tan, Hon Sen Tan, Rehena Sultana, Victoria Eley, Ban Leong Sng

Abstract

Background: Accurate blood pressure (BP) measurement depends on appropriate cuff size and shape in relation to the arm. Arm dimensions outside the recommended range of cuff sizes or trunco-conical arms may result in inaccurate BP measurements. Measuring BP using finger cuffs is a potential solution. Arm cuff size is based on mid-arm circumference (MAC), and trunco-conicity is quantified by conicity index. We aimed to determine the correlation of MAC, body mass index (BMI), and weight with conicity index.

Methods: A prospective cohort study was conducted in the KK Women's and Children's Hospital where third trimester parturients scheduled for cesarean delivery were recruited after obtaining informed consent. Parturients were asked to rate their experience with time taken to obtain BP readings, cuff popping off during measurement, need to move the cuff from the upper arm to lower arm or leg, and need to change to a different cuff. Our primary outcome was the correlation between MAC and conicity index, calculated using Pearson's correlation. The correlation between BMI and weight with conicity index was also determined.

Results: We enrolled 300 parturients. Moderate correlation was found between left MAC and left conicity index (r = 0.41, 95% CI 0.32 to 0.51), and right MAC and right conicity index (r = 0.39, 95% CI 0.29 to 0.48). Weight (r = 0.35 to 0.39) and BMI (r = 0.41 to 0.43) correlated with conicity index in this study. MAC of 1 parturient fell outside the recommended range for arm cuffs, but all parturients fit into available finger cuffs. Obese parturients had increased problems with arm cuffs popping off and needing a change of cuff.

Conclusions: BMI better correlated with conicity index compared to MAC or weight. Standard finger cuffs were suitable for all parturients studied and may be a suitable alternative.

Trial registration: Clinicaltrials.gov NCT04012151 . Registered 9 Jul 2019.

Keywords: Blood pressure; Body weight; Obstetrics.

Conflict of interest statement

Ban Leong Sng is an associate editor of BMC Anesthesiology. All other authors report no conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Frequency distribution of left and right arm cuff sizes (n = 300). Data presented as % of study population
Fig. 2
Fig. 2
Frequency distribution of left and right finger cuff sizes for Nexfin™ or CNAP™ devices (n = 300). Data presented as % of study population

References

    1. Knight M., Clarke B., James R. et al. on behalf of MBRRACE-UK. Saving Lives, Improving Mothers' Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2015-17. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2019.
    1. Lowe SA, Bowyer L, Lust K, et al. The SOMANZ guidelines for the Management of Hypertensive Disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol. 2015;55:11–16. doi: 10.1111/ajo.12253.
    1. Eley VA, Roberts L, Rickards L, et al. Arm and finger measurements in the third trimester: implications for blood pressure measurement. Pregnancy Hypertension. 2018;14:105–109. doi: 10.1016/j.preghy.2018.09.002.
    1. Palatini P, Asmar R. Cuff challenges in blood pressure measurement. J Clin Hypertens (Greenwich) 2018;20:1100–1103. doi: 10.1111/jch.13301.
    1. O'Brien E, Asmar R, Beilin L, et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens. 2003;21:821–848. doi: 10.1097/00004872-200305000-00001.
    1. Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on high blood pressure research. Circulation. 2005;111:697–716. doi: 10.1161/01.CIR.0000154900.76284.F6.
    1. Perloff D, Grim C, Flack J, et al. Human blood pressure determination by sphygmomanometry. Circulation. 1993;88:2460–2470. doi: 10.1161/01.CIR.88.5.2460.
    1. Marks LA, Groch A. Optimizing cuff width for noninvasive measurement of blood pressure. Blood Press Monit. 2000;5:153–158. doi: 10.1097/00126097-200006000-00002.
    1. Palatini P, Parati G. Blood pressure measurement in very obese patients: a challenging problem. J Hypertens. 2011;29(3):425–9.
    1. Fonseca-Reyes S, de Alba-García JG, Parra-Carrillo JZ, Paczka-Zapata JA. Effect of standard cuff on blood pressure readings in patients with obese arms. How frequent are arms of a 'large circumference'? Blood Press Monit. 2003;8:101–106. doi: 10.1097/00126097-200306000-00002.
    1. Kho CL, Brown MA, Ong SL, Mangos GJ. Blood pressure measurement in pregnancy: the effect of arm circumference and sphygmomanometer cuff size. Obstet Med. 2009;2:116–120. doi: 10.1258/om.2009.090017.
    1. Bonso E, Saladini F, Zanier A, Benetti E, Dorigatti F, Palatini P. Accuracy of a single rigid conical cuff with standard-size bladder coupled to an automatic oscillometric device over a wide range of arm circumferences. Hypertens Res. 2010;33:1186–1191. doi: 10.1038/hr.2010.146.
    1. Palatini P, Benetti E, Fania C, Malipiero G, Saladini F. Rectangular cuffs may overestimate blood pressure in individuals with large conical arms. J Hypertens. 2012;30:530–536. doi: 10.1097/HJH.0b013e32834f98a0.
    1. Wang J, Thornton JC, Russell M, Burastero S, Heymsfield S, Pierson RN., Jr Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. Am J Clin Nutr. 1994;60:23–28. doi: 10.1093/ajcn/60.1.23.
    1. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573–577. doi: 10.7326/0003-4819-147-8-200710160-00010.
    1. National Health and Nutrition Examination Survey: Anthropometry Procedures Manual 2007-08. USA: Centers for Disease Control and Prevention. 2007.
    1. Hogan JL, Maguire P, Farah N, Kennelly MM, Stuart B, Turner MJ. Body mass index and blood pressure measurement during pregnancy. Hypertens Pregnancy. 2011;30:396–400. doi: 10.3109/10641955.2010.506233.
    1. Cooley SM, Donnelly JC, Walsh T, et al. The relationship between body mass index and mid-arm circumference in a pregnant population. J Obstet Gynaecol. 2011;31:594–596. doi: 10.3109/01443615.2011.597892.
    1. Wu LW, Lin YY, Kao TW, et al. Mid-arm circumference and all-cause, cardiovascular, and Cancer mortality among obese and non-obese US adults: the National Health and nutrition examination survey III. Sci Rep. 2017;7:2302. doi: 10.1038/s41598-017-02663-7.
    1. Forsberg SA, de Guzman M, Berlind S. Validity of blood pressure measurement with cuff in the arm and forearm. Acta Med Scand. 1970;188:389–396. doi: 10.1111/j.0954-6820.1970.tb08056.x.
    1. Pierin AM, Alavarce DC, Gusmão JL, Halpern A, Mion D., Jr Blood pressure measurement in obese patients: comparison between upper arm and forearm measurements. Blood Press Monit. 2004;9:101–105. doi: 10.1097/.
    1. Schell K, Bradley E, Bucher L, et al. Clinical comparison of automatic, noninvasive measurements of blood pressure in the forearm and upper arm. Am J Crit Care. 2005;14:232–241. doi: 10.4037/ajcc2005.14.3.232.
    1. Maxwell GF, Pruijt JF, Arntzenius AC. Comparison of the conical cuff and the standard rectangular cuffs. Int J Epidemiol. 1985;14:468–472. doi: 10.1093/ije/14.3.468.
    1. Executive Summary on National Population Health Survey 2016/17. Singapore: Ministry of Health Singapore and Health Promotion Board. 2017.
    1. Akkermans J, Diepeveen M, Ganzevoort W, van Montfrans GA, Westerhof BE, Wolf H. Continuous non-invasive blood pressure monitoring, a validation study of Nexfin in a pregnant population. Hypertens Pregnancy. 2009;28:230–242. doi: 10.1080/10641950802601260.
    1. Ilies C, Bauer M, Berg P, et al. Investigation of the agreement of a continuous non-invasive arterial pressure device in comparison with invasive radial artery measurement. Br J Anaesth. 2012;108:202–210. doi: 10.1093/bja/aer394.
    1. Hohn A, Defosse JM, Becker S, Steffen C, Wappler F, Sakka SG. Non-invasive continuous arterial pressure monitoring with Nexfin does not sufficiently replace invasive measurements in critically ill patients. Br J Anaesth. 2013;111:178–184. doi: 10.1093/bja/aet023.
    1. Heslehurst N, Simpson H, Ells LJ, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev. 2008;9:635–683. doi: 10.1111/j.1467-789X.2008.00511.x.

Source: PubMed

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