Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: Although we agree with Dr Jones
and colleagues1 about the importance of
accurate BP measurement, we would like to make a few comments about the accuracy
of BP measurement in elderly individuals.
We agree with Jones et al that oscillometric devices and auscultatory
methods using either mercury or well-calibrated aneroid manometers may not
yield the same results, particularly in elderly individuals with stiff arteries
due to atherosclerosis. This is because systolic and diastolic pressure measurements
by oscillometric devices are not directly related to a signal specific to
these pressures, but derived from the mean blood pressure determined by the
oscillation maximum. Because age-related arterial stiffening leads to an increase
in systolic BP and a decrease in diastolic BP for the same mean BP,2 it remains to be determined which algorithm is
more appropriate to reflect the systolic and diastolic BP for each decade
of age. Indeed, BP indices measured by auscultatory methods generally have
been used in cohort studies to establish the log-linear relation between the
cardiovascular risk difference with the blood pressure difference.3
Fournier A, Safar M. Accurate Measurement of Blood PressureAccurate Measurement of Blood Pressure. JAMA. 2003;289(21):2792–2794. doi:10.1001/jama.289.21.2792-a
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