Pseudohypertension

Pseudohypertension is a falsely elevated blood pressure reading obtained with a cuff and sphygmomanometer because calcified blood vessels cannot be compressed. It is also called pseudohypertension in the elderly, noncompressibility artery syndrome, and Osler sign of pseudohypertension, the sign being named for William Osler. Pressure measured from inside the artery is normal, yet the condition is associated with significant cardiovascular disease risk. It is seen often in the elderly whether or not they are hypertensive. In the Osler maneuver the cuff is inflated above the systolic pressure, and the maneuver is positive when the brachial or radial artery stays palpable although the pulse has vanished on auscultation. The sign is linked to Monckeberg sclerosis, calcification of the middle layer of small and medium arteries of the limbs, which shows a rail-tracking pattern on X-ray. It should be suspected when dizziness appears after antihypertensive drugs are started without any fall in measured pressure.