J. Belmin et al., OSLERS MANEUVER - ABSENCE OF USEFULNESS FOR THE DETECTION OF PSEUDOHYPERTENSION IN AN ELDERLY POPULATION, The American journal of medicine, 98(1), 1995, pp. 42-49
PURPOSE: TO investigate the prevalence and clinical relevance of Osler
's maneuver for detecting pseudohypertension in the elderly. PATIENTS
AND METHODS: Osler's maneuver was performed by one investigator in 205
consecutive inpatients of a French geriatric hospital (40 men and 165
women; mean age 84.2 +/- 6.2 years). In 12 Osler-positive and 12 Osle
r-negative patients matched for age, sex, and presence of hypertension
, the blood pressure values measured directly at the radial artery wer
e compared to those measured indirectly with a standard mercury sphygm
omanometer. Aortic and upper limb purse wave velocities (PWV) were als
o measured in these 24 patients. RESULTS: Twenty-three of 205 patients
(11%) were Osler-positive. Age, sex ratio, and prevalence of hyperten
sion or other cardiovascular diseases did not differ significantly in
Osler-positive and Osler-negative patients. Systolic blood pressure (S
BP), measured by standard mercury sphygmomanometer, was significantly
greater in Osler-positive than Osler-negative patients (157 +/- 37 ver
sus 132 +/- 28 mm Hg; P <0.01). Diastolic blood pressure (DBP) did not
differ significantly (78 +/- 18 versus 74 +/- 14 mm Hg). Interobserve
r agreement concerning Osler's sign, studied in 40 patients, was good
(kappa = 0.72). In 12 Osler-positive and 12 Osler-negative patients, t
he mean differences between SBP obtained by cuff-manual indirect brood
pressure and direct measurements were -3.71 +/- 22.85 mm Hg and -8.59
+/- 14.40 mm Hg (P = NS). For DBP, these differences were 18.40 +/- 1
5.72 and 12.01 +/- 5.80 mm Hg (P = NS). The differences between the in
direct and direct blood pressure measurements were significantly corre
lated to upper limb PWV, but not aortic PWV, for both SBP and DBP. Pse
udohypertension, defined as the indirect measurement overestimation of
SBP or DBP by 10 mm Hg or more, was found in 15 of the 24 patients (6
3%). In these patients, upper limb PWV was significantly greater than
in those with no pseudohypertension (7.0 +/- 2.2 versus 5.4 +/- 1.3 m/
s; P <0.05). CONCLUSIONS: The Osler-positive maneuver is frequently fo
und in elderly hospital inpatients, but its ability to detect pseudohy
pertension in clinical practice is poor. Measurement of upper limb PWV
might be a more appropriate way of screening for this condition.