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Effect of body position on blood pressure in dogs | VETgirl Veterinary CE Podcasts

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How do you measure blood pressure non-invasively in your patients? Do you use Doppler? Oscillometric? Do you perform the measurement with your patient sitting or standing? Do you always do it the same way? Have you ever given it much thought? Well, in today’s  VETgirl online veterinary CE podcast, we review the effect of body position on blood pressure measurement in dogs.

While specific guidelines exist for blood pressure monitoring and measurement in people, no such guidelines exist in veterinary patients. So Rondeau et al from University of Pennsylvania wanted to evaluate this in a study called “Effect of body position on indirect measurement of systolic arterial blood pressure in dogs.” The authors set out to investigate whether a difference exists in Doppler blood pressures obtained in sitting versus lateral recumbency, and whether the measurements were repeatable. In this study, 51 healthy or sick awake, unsedated adult dogs had their blood pressures measured 7 times in each position. Dogs included a variety of breeds with mean body weight of 20 ± 11.8 kg. 49% (25/21) of the dogs were healthy and the remaining  51% (n=26) were classified as unhealthy, with various diseases present.

So what did this study find? In awake dogs, Doppler blood pressure measurements are higher when sitting than in lateral recumbency, and measurements taken in lateral have less variability. The mean systolic arterial pressure in the sitting position (taken on a hind limb, 172.1±33.3 mmHg) was significantly higher than in the lateral position (147.0±24.6 mmHg). Also, the repeatability of the blood pressure measurements was significantly worse in the sitting position compared to the lateral position (p<0.001).

Blood pressure measurements in different positions were not significantly affected by any characteristics assessed, including severity of hypertension, first position of measurement, reproductive status, breed, frequency of hospital visits, body weight, body condition score, anxiety score, health status or medications. 55% (28/51) of the dogs had blood pressure measurements that were classified differently depending on body position, with most of them suggestive of moderate to severe hypertension in the sitting position.

So, what can we take away from VETgirl podcast?

86% of the dogs in this study had significantly higher Doppler systolic arterial pressure measurements in the sitting position compared to lateral, with an average difference of 25 mmHg between positions. A systolic arterial pressure difference of 25 mmHg has the potential to incorrectly classify patients as hypertensive (or massively hypotensive); thus, the authors stress that blood pressure measurements should be performed consistently in the same position with that information recorded in the medical record.

While this was a great, prospective study, one limitation is that direct blood pressure measurements (which are the most accurate way of assessing blood pressure) were not performed in this study, so the more accurate body position for blood pressure measurement is unknown.

So, this study reminds us about the value of consistency – it’s a good idea to record your patients’ blood pressures with the same techniques over time, and to include that information in the medical record. It can be helpful for monitoring trends and ensuring accurate comparison for your patients! When in doubt, make sure to take the blood pressure in lateral recumbency, which may be more accurate and offer less variability between measurements.

References:
Rondeau DA, Mackalonis ME, Hess RS. Effect of body position on indirect measurement of systolic arterial blood pressure in dogs. JAVMA 2013;242:1523-1527.

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