Comparison of automated oscillometric versus auscultatory blood pressure measurement

Abstract

Most clinical offices rely on automated oscillometric devices to measure blood pressure (BP), but the accuracy of this technique versus auscultatory determination using a mercury manometer is controversial. To assess the accuracy of automated oscillometric readings, BP was measured from the same site and cuff, in 337 consecutive patients seen in a routine cardiology office, using a simultaneous connection to an automated oscillometric and a mercury manometer technique. The mean systolic BP (133 +/- 20 mm Hg) and diastolic BP (72 +/- 11 mm Hg) were significantly greater using the mercury manometer than the automated oscillometric technique (systolic 131 +/- 18 and diastolic 70 +/- 12 mm Hg, p <0.0001). Discrepancies (almost always lower oscillometric and greater mercury manometer) in systolic BP were seen in 22% of all patients. Discrepancies in diastolic BP were seen in 20% of all patients. The mean of the discrepancy between the 2 techniques was 1.95 +/- 5 mm Hg (range 1 to 26) for systolic BP and 1.3 +/- 4 mm Hg (range 1 to 25) for diastolic BP. The discrepancies were greater in patients >65 years. In conclusion, the mercury manometer technique resulted in consistently greater BP values than oscillometric devices. These findings have important clinical implications, including the concept that patients whose BP appears to be under control using the oscillometric technique might not be at their goal BP and might have been undertreated.