Observer variability of Osler's maneuver in detection of pseudohypertension.


Journal Article

Pseudohypertension in the elderly occurs when blood pressure is overestimated because of inelastic, sclerotic arteries. Osler's maneuver (OM), the palpability of a pulseless artery, is recommended as a non-invasive test to detect pseudohypertension, despite limited data concerning its reproducibility. We assessed the maximum achievable inter-and intra-observer agreement of OM among 6 examiners: cardiologists, geriatricians and general internists. Each examiner performed OM twice on 65 elderly hypertensive men attending the general medicine and geriatric clinics. The inter-observer agreement for brachial and radial examinations was 79 and 70%, while intra-observer agreement was 82 and 75%, respectively. After adjusting for chance agreement the kappa values for inter-observer agreement for brachial and radial arteries were 0.38 (95% confidence interval (CI): 0.21-0.55) and 0.37 (0.28-0.46), respectively. Similarly, the kappa values for intra-observer agreement were 0.45 (95% CI: 0.35-0.55) and 0.49 (0.39-0.59). Kappa values never exceeded 0.6 in any time period, suggesting no training effect. OM cannot be recommended as a screening test for pseudohypertension given this low inter- and intra-observer agreement.

Full Text

Duke Authors

Cited Authors

  • Hla, KM; Samsa, GP; Stoneking, HT; Feussner, JR

Published Date

  • 1991

Published In

Volume / Issue

  • 44 / 6

Start / End Page

  • 513 - 518

PubMed ID

  • 2037855

Pubmed Central ID

  • 2037855

International Standard Serial Number (ISSN)

  • 0895-4356

Digital Object Identifier (DOI)

  • 10.1016/0895-4356(91)90214-t


  • eng

Conference Location

  • United States