Influence of Biological Sex on Brachial Cuff Blood Pressure Accuracy
Bibliographic record
Abstract
Background: Females have higher risks of cardiovascular events compared to males with similar BP. Our objective was to assess if the accuracy of brachial cuff and central BP measurements towards intra-aortic BP is influenced by biological sex. Methods: We enrolled 500 patients undergoing coronary angiography for simultaneous measurements of invasive aortic BP with brachial cuff and central BP (Mobil-o-Graph device). Acceptable accuracy was defined as a mean difference between non-invasive and aortic BPs ≤5 ± ≤8 mmHg. Linear regression and mediation analyses were used to adjust for potential confounders in the relationship between biological sex and BP accuracy. Results: Of 500 participants, 145 were females. Several characteristics were different in males and females (Table). Brachial cuff systolic BP (SBP) was identical in both groups whereas aortic SBP was 6.2 mmHg higher in females (p<0.001). As such, the brachial cuff appreciably underestimated the aortic SBP in females but not in males. Type II central SBP was the most accurate BP in females, whereas it was brachial cuff SBP in males. In an adjusted linear regression model, only height and pulse pressure were independently associated with the accuracy of brachial cuff SBP. This effect of sex on accuracy was mostly mediated by height (3.5 mmHg; 95% CI 1.4 to 5.6; 57% mediation) to an extent that the direct effect of sex became non-significant (2.9 mmHg; 95% CI -0.3 to 6.2). Conclusions: Females have higher aortic SBPs than males with identical brachial cuff SBP, which is mostly mediated by a lower height. This could partly explain why females are at higher risk of cardiovascular diseases than males at similar brachial cuff SBP levels. - Clinical characteristics Female (n=145) Male (n=355) p-value Age 66 ± 11 66 ± 10 0.6 Height (cm) 159 ± 7 174 ± 7 <0.001 Weight (kg) 74 ± 18 86 ± 18 <0.001 BMI (kg/m2) 29 ± 6 28 ± 5 0.3 Active smoking 26% 24% 0.6 Diabetes 26% 29% 0.5 eGFR (mL/min/1.73m2) 79 ± 18 81 ± 17 0.5 Anti-hypertensive medication 76% 81% 0.2 Cuff Brachial SBP (mmHg) 125 ± 18 124 ± 16 1.0 Cuff brachial DBP (mmHg) 74 ± 11 78 ± 11 <0.001 Brachial cuff PP (mmHg) 51 ± 13 47 ± 11 <0.001 Heart rate (bpm) 71 ± 13 66 ± 11 <0.001 Aortic pulse wave velocity (m/s) 9.4 ± 2.1 9.4 ± 1.7 0.9 Augmentation index @ 75 bmp 26 ± 13 17 ± 13 <0.001 Accuracy Invasive Aortic SBP 131 ± 22 125 ± 20 <0.001 Difference with invasive Aortic SBP Cuff Brachial SBP -6.5 ± 12.1 -0.3 ± 11.7 <0.001 Cuff Type I central SBP -17.3 ± 13.1 -8.8 ± 13.1 <0.001 Cuff Type II central SBP 0.6 ± 15.3 8.3 ± 14.2 <0.001 Mean differences represent the difference between non-invasive BP and aortic BP and are expressed with ± SD. Type I central BP is obtained through calibration with brachial cuff SBP and DBP. Type II central BP is obtamed through calibration with brachial cuff mean BP and DBP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".