A recent study has found that a wrong arm position during blood pressure (BP) checks may lead to misdiagnosis and overestimation of hypertension.

BP is the pressure of circulating blood against the walls of blood vessels. It is measured in units of millimeters of mercury (mmHg). The reading consists of two numbers — with the upper (systolic) value first, followed by the lower (diastolic) value. A person is considered hypertensive if they have consistent readings of 130/80 or higher.

The new study, published on Monday in Journal JAMA Internal Medicine, analysed the blood pressure readings of 133 adults from August 2022 to June 2023. The study volunteers’ ages ranged from 18 to 80.

The blood pressure readings were measured and compared while the people held their arms in three different ways — leaning on a surface, resting on the lap, or hanging by the side of the body.

The researchers from Johns Hopkins University discovered that when participants had their arms hanging by their sides during the reading, their systolic pressure was 6.5 points higher than when their arms were resting on a desk, while the diastolic blood pressure — the bottom number — was 4.4 points higher than in the supported condition.

The experts also found out that when their arms were on their laps, the systolic blood pressure was 3.9 points higher than when their arms were supported by a surface, while the diastolic pressure was 4 points higher than in the supported condition.

For example, if a person’s actual blood pressure is 134, and blood pressure is measured on a dangling arm, the reading could end up over 140, which is considered to be stage 2 hypertension.

Tammy Brady, the vice-chair for clinical research in the department of pediatrics at the Johns Hopkins University School of Medicine, said the two other positions were tested because it was realised that they are the most used positions during blood pressure readings.

“I did not expect there to be that much of a difference when the arms were placed in the two alternative positions,” he said.

“We tested those positions because those are the positions that most people have their blood pressure measured, according to data and personal observations.

“We thought there’d be a difference, but I was surprised by how much of a difference there was.”

According to the study, the wrong positioning of the arm during BP readings leads to overestimation due to several physiological reasons.

First, there can be muscle contraction when the arm is not supported which can lead to an increase in BP reading.

Also, a greater vertical distance between the heart and where the cuff is placed can increase hydrostatic pressure in the arteries, or the blood pressure against the wall due to gravity’s pull. This can lead to an overestimation of blood pressure.

Brandy said the study was conducted to educate people on the appropriate arm position for BP reading.

“I just hope that it raises awareness regarding how important things like arm position are to blood pressure measurement accuracy,” he added.

“I also hope this study educates patients, empowering them to advocate for proper measurement when they’re in a clinic setting.

“But also, because so many patients rely on home blood pressure measurements for hypertension diagnosis, evaluation, and treatment.

“I hope this educates them on how to properly position their arms because our findings absolutely extend to measurements in the home.”

The researchers also gave the following steps to achieve an accurate BP measurement.

The steps include:

• Wear the appropriate cuff size
• Have your back supported
• Keep feet flat on the floor with legs uncrossed
• Have the appropriate arm position – the cuff should be positioned at heart level with the arm supported on a desk or table

Wearing the appropriate cuff size was found to be the most important step.

Because an improperly sized blood pressure cuff can distort blood pressure readings taken by automated blood pressure devices.

Also speaking, Gail Adler, a cardiovascular endocrinologist in the Hypertension Clinic at Brigham and Women’s Hospital, disclosed some steps that should taken 30 minutes for BP measurement.

“Before you take your blood pressure, you want no smoking, exercise, caffeine, alcohol, major arguments. Don’t be psychologically stressed,” Adler said.

“Sit in the chair, get in the right position. And for five minutes, you relax, you don’t talk, make sure you don’t have to pee. If you have to pee or urinate, that’s going to raise your blood pressure.”

The National Agency for Food and Drug Administration and Control (NAFDAC) has warned Nigerians against sale and distribution of Foula Condoms.

In a statement on Wednesday, the agency said officials from the post-marketing surveillance (PMS) directorate discovered Foula condoms (packaged in threes) in Abakaliki, Ebonyi state, and Zango, Katsina state.

The agency said the condom is not registered by NAFDAC for use in Nigeria, and the labeling of the product is not in English Language.

“Condoms are a proven effective barrier method that can be used as a dual-purpose method for both prevention of unintended pregnancy and protection against HIV and other sexually transmitted infections (STIs),” the statement reads.

“To be most effective, any barrier method used for contraception or preventing infection must be used correctly.

“The illegal distribution or sale of unregistered condoms poses a risk as the safety, quality, and efficacy of the products are not guaranteed.

“The purchase and use of poor-quality condoms will adversely affect every aspect of condom promotion for the prevention of unintended pregnancy and protection against HIV and other Sexually Transmitted Infections.

“If condoms leak or break, they cannot offer adequate protection.

“All NAFDAC zonal directors and state coordinators have been directed to carry out surveillance and mop up the unregistered products within the zones and states.

“Importers, distributors, retailers, healthcare professionals, and consumers are hereby advised to exercise caution and vigilance within the supply chain to avoid the importation, distribution, sale, and use of illegally distributed products.

“All medical products/ medical devices must be obtained from authorized/licensed suppliers. The products’ authenticity and physical condition should be carefully checked.”

“Healthcare professionals and consumers are advised to report any suspicion of the sale of substandard and falsified medicines or medical devices to the nearest NAFDAC office, NAFDAC on 0800-162-3322 or via email: sf.alert@nafdac.gov.ng.”

The National Agency for Food and Drug Administration and Control (NAFDAC) has alerted Nigerians to the recall of Nivea BLACK&WHITE Invisible Roll-on deodorant 50ml by the European Union’s (EU) rapid alert system for dangerous non-food products (RAPEX) in Brussels.

In a notice on Thursday, NAFDAC said the recalled Nivea product contains 2-(4-tert-Butylbenzyl propionaldehyde) (BMHCA), a chemical prohibited in cosmetics products due to its ability to harm the reproductive system, impair the health of an unborn child, cause skin irritation, and cause burns to users.

The agency said the product, produced in Germany, is marked ‘48H protection in African climate’, with batch number: 93529610 and bar code number: 42299882.

“Importers, distributors, retailers, and consumers are advised to exercise caution and vigilance within the supply chain to avoid the importation, distribution, sale, and use of the above-mentioned Nivea Roll-on with the affected batch,” the alert reads.

“Members of the public in possession of the affected batch of product should discontinue the sale or use and submit stock to the nearest NAFDAC office.

“Healthcare professionals and consumers are encouraged to report adverse events experienced with the use of regulated products to the nearest NAFDAC office, via pharmacovigilance@nafdac.gov.ng, E-reporting platforms available at www.nafdac.gov.ng or via the Med-safety application for download on android and iOS stores.”