Differences in blood pressure values by simultaneous auscultation of Korotkoff sounds inside the cuff and in the antecubital fossa

To elucidate whether auscultation of the Korotkoff sounds inside the cuff a nd in the antecubital fossa leads to different blood pressure (BP) values w e measured BP at both sites simultaneously with identical flat stethoscopes in a same-arm test design (part A) in 64 normotensive (N: 32 men, 32 women ; mean age: 38.7 +/- 15.1 years) and 67 hypertensive subjects (H: 36 men, 3 1 women; mean age: 44.6 +/- 12.9 years), and additionally in a same- and op posite-arm test design (part B) in 20 normotensive young women. While in pa rt A systolic BP measured inside the cuff was only slightly higher (N: +1.6 +/- 3.2 mm Hg; H: +1.0 +/- 1.4 mm Hg), diastolic BP was considerably lower (N: -10.6 +/- 5.6 mmHg; H: -8.4 +/- 4.9 mm Hg). This result was corroborat ed by part B with differences in systolic/diastolic BP of +0.8 +/- 1.0/-8.5 +/- 2.2 mm Hg in the same-arm test and +0.4 +/- 4.8/-10.6 +/- 5.2 mm Hg in the opposite-arm test. Subject's age was the main variable determining dif ferences in diastolic BP with significantly higher differences in younger t han in older subjects, indicating that the elastic properties of arteries m ay be responsible for these differences. Our results demonstrate that a mod ification in the auscultatory technique of BP measurement produces signific antly different diastolic BP values, the magnitude of which is important fo r our conceptions of threshold and target values in diagnosing and treating hypertension.