Pevalence of Pseudohypertension in a Contemporary Patient Cohort Undergoing Cardiac Catheterisation

Background: Pseudohypertension refers to the phenomenon of indirect sphymanonometry to overestimate systolic blood pressure when compared to invasive measurement. This frequently complicates assessment in the elderly due to arterial calcification, which results in an inability to compress the artery during cuff inflation and has important clinical implications. The prevalence and predictors of pseudohypertension are poorly defined. Aims: We sought to evaluate the prevalence of pseudohypertension in a contemporary cohort undergoing cardiac catheterisation to document relevant risk factors, predictive value of Olsers test (a clinical method of assessing for arterial calcification and vessel stiffness) and the relationship to aortic arch calcium as documented on chest X-ray. Results: One hundred and thirty-nine patients undergoing diagnostic cardiac catheterisation were included for assessment. All patients underwent baseline non-invasive blood pressure measurement before arterial access. After vascular sheath insertion, peripheral and central transduced blood pressures were recorded. All patients underwent Oslers test prior to the procedure. Systolic pseudohypertension was defined as invasive blood pressure >10 mmHg less blood cuff measurement. A total of 138 (65% male) patients with a mean age of 65.8 years underwent analysis (one patient excluded due to blood pressure instability during the study). Systolic psuedohypertension was detected in 10.8% of patients. Conclusions: Systolic pseudohypertension was noted in a significant proportion of patients undergoing cardiac catheterisation. In patients with hypertension by non-invasive assessment with (postural) symptoms of low blood pressure, this condition should be considered and appropriate adjustment of therapy should be instituted.