Sphygmomanometry induces different blood pressure changes in normotensive and untreated (borderline) hypertensive subjects

High versus low measurement frequency during 24-h ambulatory blood pressure monitoring - a randomized crossover study

Ambulatory blood pressure monitoring (ABPM) may be stressful and associated with discomfort, possibly influenced by the number of cuff inflations. We compared a low frequency (LF-ABPM) regimen with one cuff inflation per hour, with a high frequency (HF-ABPM) regimen performed according to current guidelines using three cuff-inflations per hour during daytime and two cuff-inflations during night time. In a crossover study, patients underwent ABPMs with both frequencies, in a randomized order, within an interval of a few days. Patients reported pain (visual analogue scale from 0 to 10) and sleep disturbances after each ABPM. The primary endpoint was the difference in mean 24 h systolic BP (SBP) between HF-ABPM and LF-ABPM. A total of 171 patients were randomized, and data from 131 (age 58 ± 14 years, 47% females, 24% normotensive, 53% mildly hypertensive, and 22% moderately-severely hypertensive) completing both ABPMs were included in the analysis. Mean SBP was 137.5 mmHg (95% CI, 134.8;140.2) for HF-ABPM and 138.2 mmHg (95%CI, 135.2;141.1) for LF-ABPM. The 95% limits of agreement were -15.3 mmHg and +14.0 mmHg. Mean 24 h SBP difference between HF-ABPM and LF-ABPM was -0.7 mmHg (95%CI, -2.0;0.6). Coefficients of variation were similar for LF-ABPM and HF-ABPM. Pain scores (median with interquartile range), for HF-ABPM and LF-ABPM were 1.5 (0.6;3.0) and 1.3 (0.6;2.9) during daytime, and 1.3 (0.4:3.4) and 0.9 (0.4;2.0) during nighttime (P < 0.05 for both differences). We conclude that LF-ABPM and HF-ABPM values are in good agreement without any clinically relevant differences in BP. Furthermore, LF-ABPM causes a relatively modest reduction in procedure-related pain.

Gender Differences in Cardiovascular Responses to Sphygmomanometric Measurements

Objective: To study gender differences of cardiovascular responses due to painful stimuli during sphygmomanometry. Methods: We studied 80 subjects (40 women, 40 men). Blood pressure (BP) was determined continuously and noninvasively using a Finapres device (Penaz technique). The painful stimulus was administered by inflating the arm cuff of a sphygmomanometric device to 300 mmHg maximum pressure. Results: During cuff inflation systolic blood pressure (SBP) increased in women (+3.7 mmHg, SD = 9.9), but was unchanged in men (repeated measures ANOVA, P < .05). Diastolic blood pressure (DBP) and heart rate did not show significant changes. Cycle and oral contraceptives did not influence cardiovascular reactivity in the female subpopulation. Women reported a different pain quality but not intensity. Conclusions: Women and men exhibit a slightly different vascular reactivity to painful stimuli. Since cycle and hormonal contraception did not influence reactivity, hormonal influences seem to play a minor role. However, different pain perception might account for gender differences in vascular reactivity.

Cardiovascular reactions induced by unpredictable, predictable, and controllable painful stimuli during sphygmomanometry

Sphygmomanometry is the most common technique of blood pressure (BP) determination. In order to study effects of predictability and controllability in sphygmomanometric BP measurements, 72 normotensive healthy subjects were examined. BP was determined continuously and non-invasively using a Finapres device (Penaz-technique) and by sphygmomanometry. Five sphygmomanometric measurements took place, during the fourth the arm cuff was inflated to 300 mmHg, the others were done with a pressure of 175 mmHg. Subjects were randomly assigned to one of three groups: In one group the recordings were unpredictable to the subject, in the second group measurements were announced 1 min before cuff inflation took place, and in the third group, subjects could decide when the sphygmomanometric recordings should occur. With unpredictable measurements systolic and diastolic BP decreased (approx. 5 mmHg). When sphygmomanometric recordings were controllable or predictable to the subject BP remained relatively stable. We would suggest that automatic BP devices (e.g. in ambulatory BP monitoring) should generally work with acoustic signals, making cuff inflation predictable for the subject.

Anxiety moderates cardiovascular responses to painful stimuli during sphygmomanometry

Sphygmomanometry is the most common technique of blood pressure (BP) determination. We were interested in the role of anxiety as a predictor of BP changes induced by painful stimuli during sphygmomanometry. We studied 141 normotensive healthy subjects who were asked to complete a State-Trait-Anxiety-Inventory (STAI) prior to the experiment. BP was determined continuously and non-invasively using a Finapres device (Penaz-technique) and by arm sphygmomanometry. Five sphygmomanometric measurements took place, during the fourth the arm cuff was inflated to 300 mmHg (unpredictable to the subject), the others were done with a pressure of 175 mmHg. State and trait anxiety (STAI X1 and X2) correlated positively with diastolic BP changes during inflation of the arm cuff (state anxiety: r = 0.26, P < 0.05; trait anxiety: r = 0.20, P < 0.05). Our results suggest that anxiety may have an impact on cardiovascular responses following painful stimuli.