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June 4, 2003

Accurate Measurement of Blood PressureAccurate Measurement of Blood Pressure

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(21):2792-2794. doi:10.1001/jama.289.21.2792-a

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