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Benetti, Elisabetta (2017) Effect of the anthropometric characteristics of the arm on blood pressure measurement in the obese. [Ph.D. thesis]

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Abstract (english)

BACKGROUND
The type of cuff that should be used for blood pressure measurement in the obese is still the subject of debate. The problem is even more controversial in people with morbid obesity due to the pronounced tronco-conical shape of the upper arm.
OBJECTIVES
In this study we investigated the effect of the shape of the cuff on blood pressure measurement in obese subjects with arm circumference > 42 cm by comparing the blood pressure readings obtained with a cylindrical and a tronco-conical cuff with the same width.
MATERIAL AND METHODOS
We enrolled 33 obese subjects (mean BMI, 45 ± 5 kg/m2) with arm circumference between 42 and 50 cm (mean 44.8 ± 2.7 cm ). In each subject, body weight and height, upper arm length, proximal, medial and distal circumference, biceps and triceps skinfold, and blood pressure at enrolment were measured. From the proximal and distal arm circumference and the arm length the slant angle (in degrees) of the truncated cone was calculated. Two cuffs and bladders of different shape (cylindrical and conical) of proper fit were built following the recommendations of the American Heart Association. The tronco-conical cuff had a 85.5° slant angle (bladder had proximal and distal length, respectively, of 45 and 35 cm). Sequential same-arm measurements were performed in triplicate by two observers using the two cuffs in a random order. The obese subjects (group 2) were compared with a group of individuals with normal upper arm circumference (< 32 cm, group 1). In group 2, the pressure transmitted to the arm surface under the centre of the two cuffs was also measured using a paper thin sensor.
RESULTS
The blood pressure differences between the two cuffs were negligible in group 1. In contrast, in the obese subjects of Group 2 the systolic blood pressure (SBP) and diastolic blood pressure (DBP) differences were 4.8±4.0 and 3.0±4.3 mmHg, respectively, and were significantly greater than in the control group (SBP, p< 0.001 and DBP, p=0.01, after adjustment for age an sex). These differences remained significant also after adjustment for BP at enrolment (p< 0.001/0.01). Among the obese participants, in a multivariable linear regression that included sex, age, height, upper arm length and systolic blood pressure, upper arm slant angle was an independent predictor of the between-cuff SBP difference (p=0.003). A close correlation was found between SBP at enrolment and the measurement error with the cylindrical cuff (r=0.55, p<0.001). In the subjects of the top SBP quintile (SBP≥150 mmHg), the between-cuff SBP difference was particularly elevated, being 9.1±5.1 mmHg.
Measurement of BP under the cuffs with the pressure sensor revealed that there was a loss of pressure under the cylindrical cuff which was proportional to the BP applied, with a mean difference of -10.2 ± 5.2 mmHg.
CONCLUSIONS
In people with morbid obesity, the upper arm has a pronunced tronco-conical shape and cylindrical cuffs may overestimate the true pressure especially in people with high SBP. Tronco-conical cuffs should be used for blood pressure measurement in individuals with very large arms.

Abstract (italian)

Il tipo di bracciale che dovrebbe essere usato per la misurazione della pressione arteriosa (PA) negli obesi è ancora oggetto di dibattito. Il problema è ancora più controverso nelle persone con obesità grave ("morbid obesity") a causa della marcata forma tronco-conica del braccio.
OBIETTIVI
In questo studio abbiamo valutato l'effetto della forma del bracciale sulla misurazione della pressione arteriosa in soggetti obesi con circonferenza del braccio> 42 cm, confrontando le misurazioni della pressione arteriosa ottenute con un bracciale cilindrico e uno di forma tronco-conica aventi la stessa larghezza.
MATERIALI E METODI
Abbiamo arruolato 33 soggetti obesi (BMI medio, 45 ± 5 kg/m2) con circonferenza del braccio compresa tra 42 e 50 cm (media 44.8 ± 2.7 cm). In ciascun soggetto sono stati misurati peso corporeo e altezza, lunghezza, circonferenza prossimale, mediale e distale del braccio, plica bicipitale e tricipitale e la pressione arteriosa all'arruolamento. Utilizzando le circonferenze prossimale e distale del braccio e la lunghezza del braccio è stato calcolato l'angolo di conicità (in gradi) del tronco di cono. Due bracciali e due camere d'aria di diversa forma (cilindrica e conica) di misura adeguata sono stati costruiti seguendo le raccomandazioni della American Heart Association. Il bracciale tronco-conica aveva un angolo di inclinazione di 85,5 ° (camera d'aria con lunghezza prossimale e distale, rispettivamente, di 45 e 35 cm). Le misurazioni pressorie sequenziali sullo stesso braccio sono state eseguite in triplice copia da due osservatori utilizzando i due bracciali in ordine casuale. I soggetti obesi (gruppo 2) sono stati confrontati con un gruppo di individui con circonferenza normale del braccio (<32 cm, gruppo 1). Nel gruppo 2, è stata misurata anche la pressione trasmessa alla superficie del braccio al di sotto dei 2 bracciali, utilizzando un sensore sottile posto al centro di ciascun bracciale.
RISULTATI
Le differenze di pressione arteriosa tra i due bracciali erano trascurabili nel gruppo 1. Al contrario, nei soggetti obesi del gruppo 2 le differenze di pressione arteriosa sistolica (PAS) e diastolica (PAD) erano rispettivamente 4.8 ± 4.0 e 3.0 ± 4.3 mmHg ed erano significativamente maggiori rispetto al gruppo di controllo (PAS, p <0,001 e PAD, p = 0,01, dopo aggiustamento per età e sesso).Queste differenze sono rimaste significative anche dopo aggiustamento per la pressione arteriosa all'arruolamento (p <0,001 / 0,01). Nei soggetti obesi, in una regressione lineare multivariata che includeva sesso, età, altezza, lunghezza del braccio e pressione sistolica, l'angolo di conicità del braccio risultava un predittore indipendente della differenza di PAS tra i bracciali (p = 0,003).Una stretta correlazione è stata trovata tra la PAS all'arruolamento e l'errore di misurazione con il bracciale cilindrico (r = 0,55, p <0,001). Nei soggetti del quintile superiore di PAS (PAS≥150 mmHg), la differenza di PAS tra i bracciali era particolarmente elevata, essendo di 9,1 ± 5,1 mmHg.
La misurazione della PA al di sotto dei bracciali con l'utilizzo del sensore ha rivelato che c'era una perdita di pressione sotto il bracciale cilindrico proporzionale alla pressione arteriosa applicata, con una differenza media di -10,2 ± 5,2 mmHg.
CONCLUSIONI
Nelle persone con obesità grave, il braccio ha una forma tronco-conica pronunciata e i bracciali cilindrici possono sovrastimare la pressione arteriosa soprattutto nelle persone con PAS alta. I bracciali tronco-conici dovrebbero essere utilizzati per la misurazione della pressione arteriosa in individui con braccia molto grandi.

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EPrint type:Ph.D. thesis
Tutor:Vettor, Roberto
Ph.D. course:Ciclo 29 > Corsi 29 > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI
Data di deposito della tesi:30 January 2018
Anno di Pubblicazione:13 November 2017
Key Words:ipertensione arteriosa/ arterial hypertension bracciale/cuff obesità/obesity
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/09 Medicina interna
Struttura di riferimento:Dipartimenti > Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari
Codice ID:11094
Depositato il:09 Nov 2018 09:22
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