title: Variations of blood pressure in stroke unit patients may result from alternating body positions.
abstract: BACKGROUND
  Blood pressure (BP) is one of the major vital parameters monitored in the stroke unit. The accuracy of indirect BP measurement is strongly influenced by the position of both patient and arm during the measurement. Acute stroke patients are often nursed in lateral decubitus positions. The effect of these alternating body positions in relation to affected body side on the outcome and reliability of BP readings in acute stroke patients is unknown.
  
  
  METHODS
  An automatic oscillometric BP device was used. BP was measured in both arms in the (back) supine and both lateral decubitus positions.
  
  
  RESULTS
  In total, 54 consecutive acute stroke patients were included. Thirty-five patients had right-sided deficits and 19 patients had left-sided deficits. Supine BP readings were similar in the right and left arms regardless of side of deficit. Measurements of BP in the lateral decubitus positions resulted in significantly lower BP readings in the uppermost arm (around 12 mm Hg in both arms) and significantly higher readings in the right lowermost arm (around 6 mm Hg) compared to the supine position. This effect seemed less pronounced when the left lowermost arm was measured. There was no relation between change of BP readings in various lateral positions and side of stroke.
  
  
  CONCLUSIONS
  Alternating lateral decubitus positions according to nursing standards in acute stroke patients lead to a mean 18 mm Hg BP fluctuation. This may largely be explained by hydrostatic pressure effects, partly by anatomic factors in the left lowermost arm, but not by the side of stroke.
authors.affiliation: Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands. m.j.h.aries@neuro.umcg.nl
authors.forename: Marcel J H
authors.initials: MJ
authors.lastname: Aries
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Elting
authors.forename: Roy E
authors.initials: RE
authors.lastname: Stewart
authors.forename: Jacques
authors.initials: J
authors.lastname: de Keyser
authors.forename: Theo
authors.initials: T
authors.lastname: Thien
authors.forename: Berry P
authors.initials: BP
authors.lastname: Kremer
authors.forename: Patrick C A J
authors.initials: PC
authors.lastname: Vroomen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods; D005260:Female; D006757:Hospital Units; D006801:Humans; D006874:Hydrostatic Pressure; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D056888:Patient Positioning; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D016683:Supine Position; D013997:Time Factors; D034941:Upper Extremity / Q000098:blood supply*