Nonvalidated Home Blood Pressure Devices Dominate the Online Marketplace in Australia: Major Implications for Cardiovascular Risk Management.

Self-home blood pressure (BP) monitoring is recommended to guide clinical decisions on hypertension and is used worldwide for cardiovascular risk management. People usually make their own decisions when purchasing BP devices, which can be made online. If patients purchase nonvalidated devices (those not proven accurate according to internationally accepted standards), hypertension management may be based on inaccurate readings resulting in under- or over-diagnosis or treatment. This study aimed to evaluate the number, type, percentage validated, and cost of home BP devices available online. A search of online businesses selling devices for home BP monitoring was conducted. Multinational companies make worldwide deliveries, so searches were restricted to BP devices available for one nation (Australia) as an example of device availability through the global online marketplace. Validation status of BP devices was determined according to established protocols. Fifty nine online businesses, selling 972 unique BP devices were identified. These included 278 upper-arm cuff devices (18.3% validated), 162 wrist-cuff devices (8.0% validated), and 532 wrist-band wearables (0% validated). Most BP devices (92.4%) were stocked by international e-commerce businesses (eg, eBay, Amazon), but only 5.5% were validated. Validated cuff BP devices were more expensive than nonvalidated devices: median (interquartile range) of 101.1 (75.0-151.5) versus 67.4 (30.4-112.8) Australian Dollars. Nonvalidated BP devices dominate the online marketplace and are sold at lower cost than validated ones, which is a major barrier to accurate home BP monitoring and cardiovascular risk management. Before purchasing a BP device, people should check it has been validated at https://www.stridebp.org.

Unfounded concerns about the use of automated office blood pressure measurement in SPRINT.

SPRINT reported significantly fewer cardiovascular events when patients with a higher cardiovascular risk were treated to a target systolic blood pressure (BP) of <120 versus <140 mm Hg. In SPRINT, BP was recorded using the automated office BP (AOBP) method, with multiple readings being taken automatically with the patient resting alone. This technique for BP measurement eliminates the white-coat effect and gives lower BP readings than conventional manual office BP. Critics have questioned if the readings were actually taken with the subject alone and have expressed concerns about the time taken to obtain the readings and the cost of automated sphygmomanometers. Others have suggested that the findings in SPRINT can be applied to current clinical practice if a correction factor is used to convert conventional BP readings to AOBP. This article responds to these criticisms and explains why current methods for recording BP in clinical practice should be changed to AOBP, the technique for BP measurement used in SPRINT.

Field testing in Suriname of two blood pressure-measuring devices for low-resource and middle-resource countries, according to a WHO protocol.

INTRODUCTION: High blood pressure (BP) is known to be the greatest modifiable risk factor of cardiovascular diseases, of which 80% occur in low-resource and middle-resource settings. Yet, BP measurement in these countries remains extremely poor. In 2005, a WHO committee invited manufacturers to produce devices especially for use in low-resource settings. Our study assesses the accuracy, performance, and acceptability of two submitted oscillometric devices under field circumstances in Suriname (South America), namely, the Microlife BP 3AS1-2 and Omron HEM-SOLAR. METHODS: We compared BP measurements of test devices using a conventional Mercury sphygmomanometer, performed by local healthcare workers under field circumstances. Three hundred and forty-two individuals were included. Statistics included t-tests, analysis of variance, and Bland-Altman plots. RESULTS: The mean systolic/diastolic BP differences (SD) were -3.5 (8.0)/-7.0 (6.0) for Omron versus Mercury and -6.4 (7.8)/-6.5 (6.0) mmHg for Microlife versus Mercury. Microlife was more accepted by healthcare workers, and both devices performed adequately under field conditions. DISCUSSION AND CONCLUSION: The acceptability, durability, and performance of both test devices were adequate. However, Microlife BP 3AS1-2 underestimated systolic pressure almost twice as much compared with Omron HEM-SOLAR, with identical diastolic underestimations. Guaranteed global availability, users could make a choice between the Omron HEM-SOLAR being more accurate in BP measurement, and Microlife BP 3AS1-2 being more accepted by healthcare workers.

[Effect of the presence of a drug in the list of supplementary drug provision on compliance to its administration by outpatients with arterial hypertension].

Aim of the study was to investigate relationship between the presence of a drug in the list of supplementary drug provision (SDP) and compliance to its consumption by outpatients with arterial hypertension as well as determination of the place of SDP in a row of other factors affecting compliance to treatment. Methods. Patients (men and women) older than 18 years with initial level of office systolic arterial pressure (AP) 140-179 mm Hg and diastolic AP up to 100 mm Hg who visited regional internist. The study was conducted at the base of 82 Moscow polyclinics with participation of 185 physicians and 5474 patients. In all patients besides general clinical examination with office AP measurement calculation of body mass index and assessment of risk factors and concomitant therapy were carried out. All patients assessed themselves their self feeling with the use of visual-analog scale (VAS). Compliance of patients to antihypertensive therapy was evaluated with the help of the Moriski - Green test. Fact of continuous use of antihypertensive drugs received by patients within framework of the SDP system was necessarily obligatory. For final analysis 4816 ambulatory cards were selected. Results. Portion of patients with low compliance to therapy was greatly than that of patients with high compliance to therapy (61.1 vs. 38.9%, respectively, p=0.00001). Inclusion into analysis of additional factor (presence of CHD) reduced contribution of SDP to compliance to 25%, but it remained as before significant (p<0.0007). However addition to these factors of other parameters such as presence of diabetes mellitus or tonometer at home completely leveled effect of SDP on compliance to therapy (p<0.12). Conclusion. Presence of drugs in the SDP list significantly elevates compliance to therapy. However SDP does not appear the only independent predictor of high compliance. If SDP is considered together with other determining factors (presence of concomitant IHD and diabete, readiness to spend money for tonometer) its role as independent factor of high compliance is diminished and loses significance.

A survey of validated automated home blood pressure monitors available for the Internet shopper.

OBJECTIVE: Self-measurement of blood pressure using an automated home blood pressure monitoring (AHBPM) is increasingly used in hypertension management. Internet commerce increases dramatically each year. This study looked to identify the availability of validity of AHBPM and the correct cuff size to go with the AHBPM. METHODS AND RESULTS: Using the search engine 'Google.com', the author identified 124 consecutive unique sites offering at least one AHBPM. Validated AHBPM were those devices that had published studies showing that they had passed a recognized validation protocol. Each site was evaluated for all forms of sphygmomanometer, number of AHBPM, manual blood pressure devices, all cuff sizes available, additional cost of large adult cuff, number of validated AHBPM offered, and whether the site mentioned device validation. Of the 124 sites, 109 (81%) offered arm AHBPM and 66 (53%) offered one or more (range, 1-11) validated AHBPM. Only six of the 66 (9%) offering a validated AHBPM mentioned that fact; 58 of the 109 (53%) sites offering arm AHBPM offered more than one size of cuff; and 46 of the 58 (80%) charged extra for a large adult cuff (average US dollars 23.75, range, US dollars 4.80-98). CONCLUSIONS: Validated AHBPMs are readily available on the Internet. Currently, these sites do little to aid the consumer in purchasing a validated AHBPM. Large adult cuffs, commonly needed by hypertensive patients, are not always available for purchase. Charging extra for large adult cuffs is a potential hindrance to consumers purchasing the correct cuff size for accurate blood pressure measurement and should be eliminated.

Accuracy of aneroid sphygmomanometers in clinical usage: University of Michigan experience.

BACKGROUND: Aneroid manometers are frequently used to measure blood pressure. Aneroid manometers have moving parts that are subject to fatigue. The accuracy duration of the aneroid devices, like most digital devices, is unstudied. It has been accepted that if the aneroid device does not rest at '0' it is inaccurate, but how often is the device inaccurate when it does rest at '0'? METHODS: A Universal Biometer DPM-III measuring unit was used for all of the measurements at 10 University of Michigan Health System sites. A total of 136 aneroid manometers were tested. Two additional aneroid devices were not tested, as the needle did not start within '0'. Static pressure measurements were made at nine levels for all devices: 50, 80, 90, 100, 120, 150, 200 and 250mmHg. RESULTS: The average difference of the nine pressure settings of the whole group was 0.2+/-0.31 (95% confidence interval 0.1-0.2) mmHg. The largest number of devices that were not calibrated within +/-3mmHg was seen at the 150mmHg setting with six (4.4%) of the devices failing. If an accuracy standard of +/-2mmHg was used, the largest number of devices failed at 250mmHg (22 devices, 16.2%). The largest number of devices that were inaccurate was manufactured 6 years prior to testing and was from two sites. CONCLUSIONS: Aneroid devices were accurate. A yearly calibration programme should be performed and a +/-2mmHg standard should be used. Portable aneroid manometers may need to be more frequently calibrated due to the trauma associated with dropping.

Devices for blood pressure measurement.

Blood pressure may be recorded by manual or automatic methods. Manual techniques are susceptible to operator bias. Automatic devices are prone to unreliable readings in patients with certain conditions. Staff need training in the use of blood pressure monitoring devices.