455023

2012
JFM141210.1177/1098612X12455023Cannon and BrettJournal of Feline Medicine and Surgery

Short Communication

Journal of Feline Medicine and Surgery

Comparison of how well conscious 14(12) 906­–909

© ISFM and AAFP 2012
Reprints and permission:
cats tolerate blood pressure sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/1098612X12455023

measurement from the radial and jfms.com

coccygeal arteries

Martha J Cannon and Jo Brett

Abstract
Hypertension is a common condition of older cats and acquiring clinically relevant and repeatable blood pressure
(BP) measurements in conscious cats is important in its diagnosis and management. The most common sites for
indirect BP measurement in the cat are the radial artery (RA) and the coccygeal artery (CA) but, to date, there are
no published data comparing how conscious cats tolerate BP measurements from these sites. A high-definition
oscillometric BP monitor was used to measure BP in 30 cats admitted to a cat-only veterinary clinic for reasons other
than hypertension. Systolic arterial pressure (SAP), mean arterial pressure (MAP) and diastolic arterial pressure
(DAP) were measured using the RA and CA, alternating which site was used first. The number of failed attempts
and total time to achieve six measurements was recorded. Measurement of BP using the CA was better tolerated
than the RA, resulting in fewer failures and shorter total time required. SAP measurements were slightly higher from
the CA compared with the RA, irrespective of which site was used first. There were no significant differences in MAP
and DAP. The coccygeal artery appears to be the more appropriate site to use when measuring BP in conscious
cats using this oscillometric machine. Further studies are required using alternative BP monitors, including Doppler
machines, to establish whether this is a consistent finding. When measuring BP in cats the site used should be
recorded and the same site used for all subsequent measurements from the same cat.

Accepted: 25 June 2012

Hypertension is a common problem in older cats, espe-
cially those with chronic renal failure1–4 or hyperthyroid-
ism.5,6 Routine monitoring of blood pressure (BP) is
recommended in all cats aged 11 years and older,7 all cats
with chronic renal failure and all cats that have recently
started treatment for hyperthyroidism.8 Acquiring clini-
cally-useful, repeatable BP measurements in a timely
way is an important requirement in clinical practice, but
can be challenging in conscious cats owing to the con-
founding effects of stress.9–11 Using an anatomic site that
is better tolerated may produce more reliable results and
may shorten the time required to achieve a result, encour-
aging increased utilisation of routine BP monitoring in
veterinary practice.
The recommended sites for indirect BP measurement
in the cat are the radial artery (RA) and coccygeal artery
(CA).8,12 To date, there are no published data comparing
how conscious cats tolerate BP measurements from
these sites.
A high definition oscillometric BP monitor (HDO
Memodiagnostic-15) was used to measure BP in 30
client-owned cats of different gender, breed and age
(range: 6 months to 18 years) that were admitted to a cat-
only veterinary clinic for reasons other than hyperten-
sion. All cats were allowed a minimum 5-min period of
acclimatisation before BP measurements were made, as
recommended in the 2007 American College of Veterinary
Internal Medicine (ACVIM) Guidelines on Systemic
Hypertension.12 Each cat was then allowed to settle in a
natural position or, if still unsettled, was gently restrained
while systolic arterial pressure (SAP), mean arterial pres-
sure (MAP) and diastolic arterial pressure (DAP) were
measured. Measurements were made using both the RA
and CA, alternating which site was used first. The same
investigator operated the HDO MD-15 machine in each
case, using a standard procedure recommended by the
Oxford Cat Clinic, Oxford, UK
Corresponding author:
Martha Cannon BA VetMB DSAM(Fel), Oxford Cat Clinic,
78A Westway, Oxford, OX2 9JU, UK
Email: enquiries@oxfordcatclinic.co.uk
Cannon and Brett 907
manufacturers. The cats were restrained gently by an
experienced veterinary nurse, but it was not possible to
use the same veterinary nurse for all cases. All measure-
ments were taken in the same consultation room to
reduce the number of external variables that may have
affected the results.
Six successful readings of SAP, MAP and DAP were
recorded from each site. In each case the first reading
was discarded and the average of the remaining five
readings was calculated in accordance with the recom-
mendations of the 2007 ACVIM Guidelines on Systemic
Hypertension.12 The number of failed attempts and total
time required to achieve six measurements was recorded.
The HDO MD-15 machine comes with a single, stand-
ard-sized cuff for use in cats which measures 4.3 cm
across; the same cuff was used in all cases. For RA meas-
urements the cuff was positioned on the forelimb distal
to the elbow with the inflation bladder over the palmar
mid-line. Either the right or left fore limb was used
according to how the cat settled on the examination
table. For the CA measurements the cuff was placed
around the tail base with the inflation bladder positioned
over the ventral mid-line. In both cuff locations the cat
was gently restrained or was allowed to rest naturally,
keeping the cuff within a 10 cm vertical height of the
heart. The order in which the two cuff locations were
used was alternated between each case.
It was not possible to measure the BP from the RA in
one cat — a small male Sphynx cat whose fore limb cir-
cumference was too small for the standard sized cuff
provided with the HDO MD-15 machine. This cat was
excluded from the study and results for the remaining
29 cats were included in the subsequent analysis. A
summary of all results is shown in Table 1.
Measuring BP using the CA was better tolerated than
using the RA, resulting in fewer failures (see Figure 1)
and shorter total time required (see Figure 2). When tak-
ing measurements from the CA 33 failed attempts
occurred while obtaining the 174 useable measurements
(15.9%) compared with 161 failed attempts (48.1%)
encountered while obtaining the required 174 measure-
ments from the RA. The significantly higher failure rate
encountered when using the RA contributed to the
increased time required to obtain a clinically-useful BP
reading from that site. Mean time required to obtain six
BP readings from the CA was 4.35 mins (SD 2.1, range
2–13 mins) compared with a mean time of 8.1 minutes
(SD 6.7, range 2–28 mins) for the RA.
SAP measurements were slightly higher from the CA
compared with the RA (mean 8.7%, P = 0.002), irrespec-
tive of which site was used first. There were no signifi-
cant differences in MAP and DAP.
This study did not attempt to assess the accuracy, or
otherwise, of the BP measurements that were obtained,
but rather attempted to assess the practical utility of the
RA versus the CA for indirect oscillometric BP measure-
ment in the conscious cat in day-to-day veterinary prac-
tice. We followed current ACVIM guidelines regarding
measurement of BP, but also tried to mimic the con-
straints that apply when measuring feline BP in general
practice. Under these conditions the CA was the pre-
ferred site for measurement for the majority of the cats in
the study. It is also interesting to note that in the six cats
for which there was no difference in time required, and
in the four cats for which RA measurements were
achieved more easily than CA measurements, the time
required for either set of measurements was only a maxi-
mum of 6 mins, suggesting that these cats were at the
more placid or relaxed end of the temperament range.
The increased number of failed readings encountered
when using the RA was largely due to movement arte-
fact in a weight-bearing limb and oscillometric BP moni-
tors are particularly susceptible to this problem. In a
previous study, Jepson et al measured BP in the fore limb
of conscious cats using a Doppler BP monitor and a
standard (not high definition) oscillometric machine.13
In this study operators using the Doppler machine were
successful in making five BP readings within 5 mins in
37.5% of cases, whereas with the oscillometric machine
this was achieved in only 5% of cases. In 55% of cases it
took longer than 10 mins to achieve five readings. In our
study using the HDO-MemoDiagnostic 15 on the RA
five readings were achieved in under 5 mins in 34.5% of
cases (10/29) and more than 10 mins was required in
24.1% of cases (7/29). In comparison, when using the
CA, five measurements could be made in under 5 mins
in 69% of cases (20/29) and more than 10 mins was
required in only 1/29 cats.
While weight-bearing artefacts could be reduced by
measuring the BP with the subject in lateral or sternal
recumbency this cannot be achieved in a majority of con-
scious feline patients so this is a limitation of the oscillo-
metric method. Further studies are required to identify
whether similar disparity between results would be found
using a Doppler BP machine on the CA and the RA.
The difference in SAP measured in the CA compared
to the RA is in line with findings in anaesthetised dogs14
but in this study may also be due, in part, to positioning.
Measured BP will be higher the greater the vertical dis-
tance of the cuff below the heart. In this study cats were
allowed to settle in a natural position whenever possible
to reduce stress to the cat. In many cases the cat settled
into sternal recumbency and the tailhead would have
been approximately level with the heart; however, the
position adopted by the cat was not recorded in this
study and cats that settled or were gently restrained in
an upright position would have had a relatively large
vertical distance from heart to tailhead, and likely a
larger distance than when their BP was measured via a
cuff on their antebrachium. In this study a second factor
908 Journal of Feline Medicine and Surgery 14(12)

Table 1  Summary of data

Case Cuff site Radial artery measurements Coccygeal artery measurements

number  used first
Timea Failuresb Av Av Av Timea Failuresb Av Av Av
SBPc MAPd DBPe SBPc MAPd DBPe

 1 Forelimb 10 0 142.8 109.6 91 6 0 138.6 100.4 79.2

 2 Tail 5 5 142 97.4 73 4 4 134 100 80.8
 3 Forelimb 3 0 169.4 115.4 86.2 4 0 161 120 97.4
 4 Tail 12 9 113.4 87 71.6 3 0 115 78.4 57.8
 5 Forelimb 3 1 145.4 107.6 86.6 2 0 186.8 122 87.6
 6 Tail 7 4 145.6 102.4 78.8 3 1 147.6 103 78.8
 7 Forelimb 23 18 147 104.8 81.6 5 2 153.8 108.2 83.8
 8 Tail 2 0 142 104.6 83.8 2 0 146.2 105.4 83
 9 Forelimb 3 2 152.4 115.4 94.8 3 1 171.8 109.2 76
10 Tail 16 19 115.4 82.8 64.8 5 2 163.8 117.8 92.8
11 Forelimb 14 6 134.4 93.4 70.8 5 1 114.2 80.6 61.8
12 Tail 20 9 110.2 81.8 65.6 13 5 170.2 119.6 92.2
13 Forelimb 5 2 111.4 81.6 64.6 4 1 126 88.6 68
14 Tail 5 1 160.4 119.6 97.4 3 0 181.4 129.6 101.6
15 Forelimb 8 7 126 94.8 77 7 4 120.2 78.8 56
16 Tail 4 5 127.2 89.6 68.8 3 1 127.2 93.6 75
17 Forelimb 14 15 131 90.4 68.2 4 2 152.4 103.8 77.4
18 Tail N/A 9 N/A N/A N/A N/R 1 119.2 86.8 68.8
19 Forelimb 5 4 110.6 84.6 69.6 3 1 104.6 74.6 58
20 Tail 3 2 158.2 116.2 93.4 3 0 164 119.6 95.4
21 Forelimb 3 1 129 95.8 77 3 0 141.4 103.8 83
22 Tail 3 0 129 97.2 79.4 4 0 139.2 89.8 62.8
23 Forelimb 8 4 142.6 107.6 88.2 3 0 144.6 100.4 76.2
24 Tail 6 3 118.8 92.2 76.8 4 0 127.2 90.6 70.6
25 Forelimb 28 29 119.2 87.6 66.6 6 1 125.2 89.6 69.6
26 Tail 5 5 127.4 96.4 78.2 6 4 134.2 98 77.8
27 Forelimb 5 2 129.2 96.4 78 5 2 156 114.2 91
28 Tail 8 7 107.8 73.4 54 4 1 129.2 92 71.4
29 Forelimb 4 0 109.2 84.4 69.8 4 0 135.2 93.6 70.8
30 Tail 3 1 123 93.4 76.8 4 0 135.2 90.8 66.4
Average 8.1 5.7 4.3 1.2  

aTime,number of minutes taken to get six blood pressure measurements

bFailure,
number of failed attempts while getting six reliable readings
cAv SBP, average of five reliable systolic blood pressure measurements in mmHg
dAv MAP, average mean arterial pressure in mmHg
eAv DBP, average of five reliable diastolic blood pressure measurements in mmHg

may also have been the requirement to use the single
cuff size supplied with the HDO-Memodiagnostic
machine to measure BP at both sites. Cuff size should be
approximately 40% of the circumference of the append-
age to which it is applied: if the proximal tail has a sig-
nificantly larger circumference than the distal fore limb
this would tend to produce a higher reading when using
the same sized cuff at each site.
Whatever the source of the difference in measured BP
between the CA and the RA it is interesting to note that
in this study seven cats had systolic BP (SBP) above 160
mmHg when it was measured in the CA (see Table 1,
cases 3, 5, 9, 10, 12, 14 and 20). These results were in a
range that would be considered to produce ‘moderate’
or, in two cases, ‘high’ risk of target organ damage.12
However, in five of these cats (cases 5, 9, 10, 12 and 20)
the SBP measured in the RA was below 160 mmHg such
that they would have been categorised as at ‘mild’ or
‘minimal’ risk of target organ damage. One cat (case 14)
was confirmed as hypertensive based on repeated BP
measurement using a Doppler BP monitor 1 month later
(SBP in the RA: 230 mmHg; SBP in the CA: 225 mmHg).
Long-term (range: 17–39 months) follow-up information
was available on five of the other six cats none of which
developed hypertensive end organ damage or chronic
renal failure during that period.
Cannon and Brett 909

7 12.0

6 10.0
Number of Failed Aempts

5
8.0

Time (Minutes)
4
6.0
3

2 4.0

1
2.0

0
0.0
Coccygeal Artery 1st Coccygeal Artery 2nd Radial Artery 1st Radial Artery 2nd
Coccygeal Artery 1st Coccygeal Artery 2nd Radial Artery 1st Radial Artery 2nd

Figure 1  Comparison of mean number of failed attempts to Figure 2  Comparison of mean time taken to obtain six
measure blood pressure from each site measurements from each site

The difference in BP measured in the CA compared 4 Jepsen RE. Feline systemic hypertension: classification
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highlights that it is essential to use clinical findings, 6 Morrow LD, Adams VJ, Elliott J and Syme HM. Hyperten-
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Further studies comparing BP measurements obtained 8 Stepien RL. Feline systemic hypertension: diagnosis and
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Funding  This research received no grant from any funding 10 Sparkes AH, Caney SMA, King MCA and Gruffydd-Jones
agency in the public, commercial or not-for-profit sectors for TJ. Inter- and intra-individual variation in Doppler ultra-
this short communication. sonic indirect blood pressure measurements in healthy
cats. J Vet Intern Med 1999; 13: 314–318.
Conflict of interest  The authors declare that there is no 11 Quimby JM, Smith ML and Lunn KF. Evaluation of the
conflict of interest. effects of hospital visit stress on physiologic parameters
in the cat. J Feline Med Surg 2011; 13: 733–737.
12 Brown S, Atkins C, Bagley R, et al. ACVIM Consensus
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