Bui Tan V, Sharman James E, Chapman Niamh, Schultz Martin G, Ringrose Jennifer S, Gall Seana L, Bothe Tomas L, Brady Tammy M, Picone Dean S
Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (T.V.B., J.E.S., N.C., M.G.S., S.L.G., D.S.P.).
School of Health Sciences, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia (N.C., T.L.B., D.S.P.).
Hypertension. 2025 Sep;82(9):1449-1459. doi: 10.1161/HYPERTENSIONAHA.124.24640. Epub 2025 Jul 1.
Automated blood pressure (BP) devices may be less accurate in females than males, but this requires further investigation. This study aimed to determine sex differences in automated BP, measured with a single brand and model of device, compared with manual BP, with a focus on cuff sizes and associations with measures of adiposity.
Automated (Omron HEM-907XL) and manual BP were taken sequentially in a random order among a subsample of participants attending the US National Health and Nutrition Examination Survey, 2017 to 2018. Anthropometry and dual-energy x-ray absorptiometry were used to record body size and composition. Analyses, including multivariable regression to determine sex differences in BP, by cuff size, followed complex survey statistical principles.
A total of 3735 participants (49.0% female [95% CI, 46.4-51.6], 45 years [43-46]) were included. In females, automated systolic BP (SBP) incrementally underestimated manual SBP across larger cuffs up to extra-large (-6.4 mm Hg [-8.0 to -4.9]). In males, automated SBP underestimated manual SBP only with extra-large cuffs (-2.4 mm Hg [95% CI-3.9 to -0.9]). Underestimation by automated SBP with extra-large cuffs was independently associated with all measures of body size indicative of increased adiposity in both females and males. Hypertension classification from automated and manual SBP had moderate agreement for adult/large cuffs (weighted kappa range 0.66-0.79) but weak agreement for extra-large cuffs (0.55-0.58) for females and males.
The automated device used in this study underestimated manual SBP at larger cuff sizes, which was associated with indices of adiposity. Poorer accuracy of automated BP in larger cuff sizes could contribute to inequitable BP-related health care for females and males and requires further investigation.
自动血压测量设备在女性中的准确性可能低于男性，但这需要进一步研究。本研究旨在确定使用单一品牌和型号设备测量的自动血压与手动血压之间的性别差异，重点关注袖带尺寸以及与肥胖测量指标的关联。
在参加2017 - 2018年美国国家健康与营养检查调查的参与者子样本中，以随机顺序依次进行自动（欧姆龙HEM - 907XL）和手动血压测量。使用人体测量学和双能X线吸收法记录身体大小和成分。分析包括多变量回归，以按袖带尺寸确定血压的性别差异，遵循复杂的调查统计原则。
共纳入3735名参与者（49.0%为女性[95%CI，46.4 - 51.6]，年龄45岁[43 - 46]）。在女性中，随着袖带尺寸增大至特大号，自动收缩压（SBP）逐渐低估手动SBP（-6.4 mmHg[-8.0至-4.9]）。在男性中，仅在使用特大号袖带时自动SBP低估手动SBP（-2.4 mmHg[95%CI - 3.9至-0.9]）。特大号袖带自动SBP的低估与女性和男性中所有表明肥胖增加的身体大小测量指标独立相关。自动和手动SBP的高血压分类在成人/大号袖带时具有中度一致性（加权kappa范围0.66 - 0.79），但在女性和男性的特大号袖带时一致性较弱（0.55 - 0.58）。
本研究中使用的自动设备在较大袖带尺寸时低估了手动SBP，这与肥胖指标相关。较大袖带尺寸时自动血压的准确性较差可能导致男女在血压相关医疗保健方面的不平等，需要进一步研究。
