Pseudo hypertension: Clue from Osler sign

Dear Editor, Pseudo hypertension (HTN) is a condition in which indirect blood pressure (BP) measured by the cuff method overestimates the true intra‐arterial BP.[1] It should be suspected if a patient develops dizziness after the start of antihypertensive or following dose escalation. The direct measurement of intra‐arterial BP is the gold standard for its diagnosis. However, it is an invasive method and needs expertise. Eliciting Osler sign is noninvasive and easy to perform. A palpable although pulseless, radial artery while the BP cuff is inflated above systolic pressure, is a positive Osler sign. It can be used as a cost‐effective screening tool in resource‐limited settings, but it has low sensitivity and specificity.[1] However, it can obviate the need for invasive BP monitoring if used along with X‐rays of arteries of the upper limb.