{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T11:13:36Z","timestamp":1767093216075,"version":"build-2065373602"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>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\u2019 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 \u00b1 1.03\/1.21 \u00b1 0.56 vs. 5.32 \u00b1 1.09\/3.04 \u00b1 0.81 vs. 9.74 \u00b1 1.46\/4.88 \u00b1 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.<\/jats:p>","DOI":"10.3390\/diagnostics15060687","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T08:59:52Z","timestamp":1741683592000},"page":"687","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Blood Pressure Difference Between Cuff Inflation and Deflation by Auscultatory Method: Impact of Hypertension Grade"],"prefix":"10.3390","volume":"15","author":[{"given":"Francesca","family":"Coccina","sequence":"first","affiliation":[{"name":"Department of Innovative Technologies in Medicine & Dentistry, University \u201cGabriele d\u2019Annunzio\u201d, Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacopo","family":"Pizzicannella","sequence":"additional","affiliation":[{"name":"Department of Engineering and Geology, University \u201cGabriele d\u2019Annunzio\u201d, Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7459-4898","authenticated-orcid":false,"given":"Oriana","family":"Trubiani","sequence":"additional","affiliation":[{"name":"Department of Innovative Technologies in Medicine & Dentistry, University \u201cGabriele d\u2019Annunzio\u201d, Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8038-9076","authenticated-orcid":false,"given":"Sante D.","family":"Pierdomenico","sequence":"additional","affiliation":[{"name":"Department of Innovative Technologies in Medicine & Dentistry, University \u201cGabriele d\u2019Annunzio\u201d, Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1161\/01.HYP.0000150859.47929.8e","article-title":"Recommendations for blood pressure measurement in humans and experimental animals: Part 1: Blood pressure measurement in humans: A statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research","volume":"45","author":"Pickering","year":"2005","journal-title":"Hypertension"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e35","DOI":"10.1161\/HYP.0000000000000087","article-title":"Measurement of Blood Pressure in Humans: A Scientific Statement from the American Heart Association","volume":"73","author":"Muntner","year":"2019","journal-title":"Hypertension"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1097\/HJH.0000000000003480","article-title":"2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)","volume":"41","author":"Mancia","year":"2023","journal-title":"J. Hypertens."},{"key":"ref_4","first-page":"729","article-title":"Blood pressure difference between the measurements taken during cuff inflation and deflation","volume":"39","author":"Zheng","year":"2012","journal-title":"Comput. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/MBP.0b013e3283651d55","article-title":"Effect of mechanical behaviour of the brachial artery on blood pressure measurement during both cuff inflation and cuff deflation","volume":"18","author":"Zheng","year":"2013","journal-title":"Blood Press. Monit."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1097\/01.hjh.0000938960.09338.01","article-title":"Can recording korotkoff sounds during brachial cuff inflation provide more accurate non-invasive estimates of intra-arterial blood pressure?","volume":"41","author":"Celler","year":"2023","journal-title":"J. Hypertens."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1097\/HJH.0000000000003659","article-title":"Comparison of cuff inflation and cuff deflation brachial sphygmomanometry with intra-arterial blood pressure as reference","volume":"42","author":"Celler","year":"2024","journal-title":"J. Hypertens."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"055027","DOI":"10.1088\/1361-6579\/ad39a2","article-title":"Measuring blood pressure from Korotkoff sounds as the brachial cuff inflates on average provides higher values than when the cuff deflates","volume":"45","author":"Celler","year":"2024","journal-title":"Physiol. Meas."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1161\/01.HYP.13.5.422","article-title":"Neurogenic pressor episodes fail to cause hypertension, but do induce cardiac hypertrophy","volume":"13","author":"Julius","year":"1989","journal-title":"Hypertension"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"270","DOI":"10.7326\/0003-4819-112-4-270","article-title":"Artefacts in measurement of blood pressure and lack of target organ involvement in the assessment of patients with treatment-resistant hypertension","volume":"112","author":"Mejia","year":"1990","journal-title":"Ann. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/j.1524-6175.2003.02830.x","article-title":"Effects of stress and behavioral interventions in hypertension. Pain and blood pressure","volume":"5","author":"Pickering","year":"2003","journal-title":"J. Clin. Hypertens."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/MBP.0b013e3282c9ac9a","article-title":"Reactive rise in blood pressure upon cuff inflation: Cuff inflation at the arm causes a greater rise in pressure than at the wrist in hypertensive patients","volume":"12","author":"Charmoy","year":"2007","journal-title":"Blood Press. Monit."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1097\/j.pain.0000000000000294","article-title":"Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry: A reliability study","volume":"156","author":"Vaegter","year":"2015","journal-title":"Pain"},{"key":"ref_14","first-page":"1573","article-title":"Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects","volume":"18","author":"Lemming","year":"2017","journal-title":"Pain Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1016\/j.pain.2011.11.025","article-title":"A systematic literature review of 10 years of research on sex\/gender and experimental pain perception-part 1: Are there really differences between women and men?","volume":"153","author":"Racine","year":"2012","journal-title":"Pain"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.neubiorev.2017.01.039","article-title":"Age changes in pain perception: A systematic-review and meta-analysis of age effects on pain and tolerance thresholds","volume":"75","author":"Lautenbacher","year":"2017","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"307","DOI":"10.7861\/clinmed.22.4.phys","article-title":"Physiological changes from ageing regarding pain perception and its impact on pain management for older adults","volume":"22","author":"Mullins","year":"2022","journal-title":"Clin. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1093\/ajh\/hpx104","article-title":"Prognosis of Masked and White Coat Uncontrolled Hypertension Detected by Ambulatory Blood Pressure Monitoring in Elderly Treated Hypertensive Patients","volume":"30","author":"Pierdomenico","year":"2017","journal-title":"Am. J. Hypertens."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"94","DOI":"10.7326\/0003-4819-80-1-94","article-title":"The auscultatory gap in sphygmomanometry","volume":"80","author":"Askey","year":"1974","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1161\/01.HYP.17.2.225","article-title":"Characterization of auscultatory gaps with wideband external pulse recording","volume":"17","author":"Blank","year":"1991","journal-title":"Hypertension"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Danish, M., Thakare, A.E., Salkar, P.S., and Wakode, S.L. (2020). Clinical Utility of Blood Pressure Measurement Using the Newer Palpatory Method for Both Systolic and Diastolic Blood Pressure. Adv. Biomed. Res., 9.","DOI":"10.4103\/abr.abr_254_19"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.jacc.2017.05.064","article-title":"Accuracy of Cuff-Measured Blood Pressure: Systematic Reviews and Meta-Analyses","volume":"70","author":"Picone","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1038\/s41371-022-00693-x","article-title":"Automated \u2018oscillometric\u2019 blood pressure measuring devices: How they work and what they measure","volume":"37","author":"Sharman","year":"2023","journal-title":"J. Hum. Hypertens."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1161\/HYPERTENSIONAHA.119.12674","article-title":"Brachial and Radial Systolic Blood Pressure Are Not the Same","volume":"73","author":"Armstrong","year":"2019","journal-title":"Hypertension"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1161\/01.HYP.13.6.647","article-title":"Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing","volume":"13","author":"Parati","year":"1989","journal-title":"Hypertension"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez, G., Howard, N., Abbott, D., Lim, K., Ward, R., and Elgendi, M. (2018). Can Photoplethysmography Replace Arterial Blood Pressure in the Assessment of Blood Pressure?. J. Clin. Med., 7.","DOI":"10.3390\/jcm7100316"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/6\/687\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:50:30Z","timestamp":1760028630000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/6\/687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,11]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["diagnostics15060687"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15060687","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,3,11]]}}}