How to measure BP: on a bare arm, over a sleeve, or below a rolled-up sleeve?

Blood pressure (BP) measurement over a thin sleeve in the office appears to have no significant effect on recorded values, but BP measurement over a thick sleeve may result in a small overestimation, a study has found. Moreover, measuring BP over a thin sleeve must be preferred to rolling it up.

“Several guidelines call for BP measurement on a bare arm, which is not always easy,” the investigators said. “This systematic review aims to synthesize existing evidence concerning the effect of a sleeve on BP measurement.”

The databases of PubMed and Embase were searched for cross-sectional studies comparing BP values measured on a bare arm, over a sleeve, or below a rolled-up sleeve. Then, available data were used to carry out a meta-analysis.

Of the 13 studies selected from 720 references, 12 compared measurements on a bare arm and on a sleeve, four performed measurements below a rolled-up sleeve, with heterogeneous sleeve types and thicknesses. All studies reported BP values.

A high risk of bias was noted in most studies. Three studies had a small overestimation of BP measured over a sleeve, while the other 10 did not find statistically significant differences between measurements.

In meta-analysis, a nonsignificant 0.55-mm Hg (95 percent confidence interval [CI], –0.11 to 1.30; p=0.10) overestimation of systolic (S)BP was observed over a sleeve when the thinnest sleeve was considered for studies that investigated various thickness.

Additionally, there was a nonsignificant 1.10-mm Hg (95 percent CI, –0.21 to 2.40; p=0.10) overestimation of SBP when the thickest sleeve was considered and a nonsignificant 2.76-mm Hg (95 percent CI, –0.96 to 6.47; p=0.15) overestimation of SBP measured below a rolled-up sleeve.