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Author's Reply: Issues regarding ambulatory blood pressure measurement in severely obese population: The guilty upper-arm' Item cover sheet has been updated accordingly

      Leblanc et al. are correct to note that using inappropriate cuff size and shape for blood pressure (BP) measurements, may lead to measurement error, especially in population of obese patients [
      • Leblanc M.È.
      • Piché M.E.
      • Poirier P.
      Issues regarding ambulatory blood pressure measurement in severely obese population: the guilty upper-arm.
      ]. In our study, we therefore made every effort to obtain accurate blood pressure measurements based on the current guidelines of the European Society of Hypertension [
      • Williams B.
      • Mancia G.
      • Spiering W.
      • et al.
      2018 ESC/ESH Guidelines for the management of arterial hypertension.
      ,
      • Parati G.
      • Stergiou G.
      • O'Brien E.
      • et al.
      European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.
      ]. To minimalize impact of arm size and shape in obese persons on BP values, we used cuffs with bladder size adapted to arm circumference and with tonco-conical shape. Our methodology meets all actual standards concerning BP measurements in obese patients. Using the same stringent methodology, we assessed the blood pressure at baseline, after ten-day and six-month follow-up, which indicated reduction of blood pressure values and variability after bariatric surgery in extremely obese patients already 10 days after procedure before weight loss occurred [
      • Głuszewska A.
      • Gryglewska B.
      • Gąsowski J.
      • et al.
      Reduction of 24-h blood pressure variability in extreme obese patients 10 days and 6 months after bariatric surgery depending on pre-existing hypertension.
      ].
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      References

        • Leblanc M.È.
        • Piché M.E.
        • Poirier P.
        Issues regarding ambulatory blood pressure measurement in severely obese population: the guilty upper-arm.
        Eur J Intern Med. 2019 Mar 25; ([pii: S0953-6205(19)30102-5. In press in EJIM])
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        • Mancia G.
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        • et al.
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        Eur Heart J. 2018; 39: 3021-3104
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        • Głuszewska A.
        • Gryglewska B.
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        • et al.
        Reduction of 24-h blood pressure variability in extreme obese patients 10 days and 6 months after bariatric surgery depending on pre-existing hypertension.
        Eur J Intern Med. 2019; 60: 39-45
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