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To the Editor: Dr Chae and colleagues¹ evaluated increased pulse pressure as an independent risk of congestive heart failure in the elderly. However, the authors did not mention the use of the Osler maneuver to differentiate true hypertension from pseudohypertension. In pseudohypertension the cuff blood pressure is inappropriately higher than the true intra-arterial pressure because of excessive arteriosclerosis common in the elderly.^2-3

Although Osler⁴ described this phenomenon in 1892, it was Messerli et al² who in 1985 proposed the term "Osler's maneuver" for the clinical detection of pseudohypertension. The Osler maneuver is performed by palpating the pulseless radial or brachial artery distal to the point of occlusion of the artery by the sphygmomanometric cuff. When either of these arteries remains palpable (despite being pulseless), the patient is described as "Osler positive." In contrast, when either artery collapses and becomes impalpable, the patient is "Osler negative."

In the study reported by . . . [Full Text of this Article]