Blood Pressure Difference Between Cuff Inflation and Deflation by Auscultatory Method: Impact of Hypertension Grade

Background: The aim of this study was to evaluate blood pressure (BP) difference between cuff inflation and deflation and to investigate whether hypertension grade and patients' characteristics could be influential. Methods: We selected 328 asymptomatic patients, 219 with mild systolic/diastolic hypertension, 75 with moderate systolic/diastolic hypertension and 34 with severe systolic/diastolic hypertension. Results: Hypertension grade was a determinant of the difference between systolic/diastolic BP during cuff inflation and deflation; the difference was progressively and significantly higher from mild to moderate to severe hypertension (1.80 +/- 1.03/1.21 +/- 0.56 vs. 5.32 +/- 1.09/3.04 +/- 0.81 vs. 9.74 +/- 1.46/4.88 +/- 0.73 mmHg, respectively (all differences were significant). Age, gender, body mass index, smoking habits and laboratory parameters were not associated with BP differences. The observed differences led to a reclassification of 24% of patients with moderate and 32% of patients with severe hypertension to a lower grade, but all were classified as hypertensive patients during cuff inflation. Conclusions: Hypertension grade influences the difference in systolic/diastolic BP during cuff inflation and deflation. This difference leads to a reclassification of hypertension grade during cuff inflation within the hypertensive range but does not influence the definition of hypertensive status. Future studies are needed to confirm whether the differences in systolic/diastolic BP between cuff inflation and deflation are due to BP increases induced by sympathetic activation, as well as a potential different behavior of the brachial artery during closing or opening, or both.