Comparison of 3 Devices for 24-Hour Ambulatory Blood Pressure Monitoring in a Nonclinical Environment Through a Randomized Trial.

BACKGROUND: The U.S. Preventive Services Task Force recommends the use of 24-hour ambulatory blood pressure monitoring (ABPM) as part of screening and diagnosis of hypertension. The optimal ABPM device for population-based surveys is unknown. METHODS: We compared the proportion of valid blood pressure (BP) readings, mean awake and asleep BP readings, differences between awake ABPM readings and initial standardized BP readings, and sleep experience among three ABPM devices. We randomized a convenience sample of 365 adults to 1 of 3 ABPM devices: Welch Allyn Mobil-O-Graph (WA), Sun Tech Classic Oscar2 (STO) and Spacelabs 90227 (SL). Participants completed sleep quality questionnaires on the nights before and during ABPM testing. RESULTS: The proportions of valid BP readings were not different among the 3 devices (P > 0.45). Mean awake and asleep systolic BP were significantly higher for STO device (WA vs. STO vs. SL: 126.65, 138.09, 127.44 mm Hg; 114.34, 120.34, 113.13 mm Hg; P < 0.0001 for both). The difference between the initial average standardized mercury systolic BP readings and the ABPM mean awake systolic BP was larger for STO device (WA vs. STO. vs. SL: -5.26, -16.24, -5.36 mm Hg; P < 0.0001); diastolic BP mean differences were ~ -6 mm Hg for all 3 devices (P = 0.6). Approximately 55% of participants reported that the devices interfered with sleep; however, there were no sleep differences across the devices (P > 0.4 for all). CONCLUSION: Most of the participants met the threshold of 70% valid readings over 24 hours. Sleep disturbance was common but did not interfere with completion of measurement in most of the participants.

Preference of blood pressure measurement methods by primary care doctors in Hong Kong: a cross-sectional survey.

BACKGROUND: Hypertension is the most common chronic disease and is the leading cause of morbidity and mortality. Its screening, diagnosis, and management depend heavily on accurate blood pressure (BP) measurement. It is recommended that the diagnosis of hypertension should be confirmed or corroborated by out-of-office BP values, measured using ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). When office BP is used, automated office BP (AOBP) measurement method, which automatically provides an average of 3-5 BP readings, should be preferred. This study aimed to describe the BP measurement methods commonly used by doctors in primary care in Hong Kong, to screen, diagnose, and manage hypertensive patients. METHODS: In this cross-sectional survey, all doctors registered in the Hong Kong "Primary Care Directory" were mailed a questionnaire, asking their preferred BP-measuring methods to screen, diagnose, and manage hypertensive patients. Furthermore, we also elicited information on the usual number of office BP or HBPM readings obtained, to diagnose or manage hypertension. RESULTS: Of the 1738 doctors included from the directory, 445 responded. Manual measurement using a mercury or aneroid device was found to be the commonest method to screen (63.1%), diagnose (56.4%), and manage (72.4%) hypertension. There was a significant underutilisation of ABPM, with only 1.6% doctors using this method to diagnose hypertension. HBPM was used by 22.2% and 56.8% of the respondents to diagnose and manage hypertension, respectively. A quarter (26.7%) of the respondents reported using only one in-office BP reading, while around 40% participants reported using ≥12 HBPM readings. Doctors with specialist qualification in family medicine were more likely to use AOBP in clinics and to obtain the recommended number of office BP readings for diagnosis and management of hypertension. CONCLUSION: Primary Care doctors in Hong Kong prefer to use manual office BP values, measured using mercury or aneroid devices, to screen, diagnose, and manage hypertension, highlighting a marked underutilisation of AOBP and out-of-office BP measuring techniques, especially that of ABPM. Further studies are indicated to understand the underlying reasons and to minimise the gap between real-life clinical practice and those recommended, based on scientific advances. TRIAL REGISTRATION: Clinicaltrial.gov; ref. no.: NCT03926897.

Comparison of cuff-based and cuffless continuous blood pressure measurements in children and adolescents.

OBJECTIVE: In recent times, new methods of blood pressure measurements have been introduced, including cuffless blood pressure (BP) measurement device using pulse transit time (PTT) for calculation of BP values. However, it is still unknown how values obtained with a new cuffless device compare with standard ambulatory measurements in children. The main aim of the study was to investigate whether BP values measured by a cuffless PTT device are comparable with measurements by a standard upper arm cuff-based BP device. METHODS: Thirty children were prospectively included. Blood pressure measurements using the cuffless device (Somnotouch-NIBP) and cuff-based standard device (Omron 907) were performed simultaneously on the left and right arm. RESULTS: Mean systolic BP of the standard measurements was 123,47 ± 14,91 mmHg and 127,48 ± 15,98 mmHg (p < .001) measured by cuffless method. Mean diastolic BP of the standard ABPM measurements was 66,88 ± 11,86 mmHg and 68,52 ± 12,36 mmHg (p < .001). There were significant positive correlations between standard and cuffless measurements. CONCLUSION: The results show that the created PWV-BP function produces a significant correlation between BP derived from the PWV and the SBP measured by sphygmomanometry. When applying this device in clinical practice, one may keep in mind that the reported mean values over 24 hours, awake and asleep time are not directly interchangeable with cuff-based standard 24-hour BP values. The measured BP values were higher by the new technique. Although differences in SBP between both methods reached values up to 20 mmHg, we think that the development of a cuffless BP monitoring system will provide novel solutions in various medical situations.

Validation of the SunTech Medical Advantage Model 2 Series Automated Blood Pressure Module in Pregnancy.

OBJECTIVE: We sought to validate the SunTech Medical Advantage Model 2 Series with firmware LX 3.40.8 algorithm noninvasive blood pressure module in a pregnant population, including those with preeclampsia. STUDY DESIGN: Validation study of an oscillometric noninvasive blood pressure module using the ANSI/AAMI ISO 81060-2:2013 standard guidelines. Pregnant women were enrolled into three subgroups: normotensive, hypertensive without proteinuria, and preeclampsia (hypertensive with random protein-to-creatinine ratio ≥ 0.3 or a 24-hour urine protein > 300 mg). Two trained research nurses, blinded to each other's measurements, used a mercury sphygmomanometer to validate the module by following the protocol set forth in the ANSI/AAMI ISO 81060-2:2013 standard guidelines. RESULTS: A total of 45 patients, 15 in each subgroup, were included. The mean systolic and diastolic differences with standard deviations between the module and the mean observers' measurements for all participants were -2.3 ± 7.3 and 0.2 ± 6.5 mm Hg, respectively. The systolic and diastolic standard deviations of the mean of the individual patient's paired module and observers' measurements were 6.27 and 5.98 mm Hg, respectively. The test device, relative to a mercury sphygmomanometer, underestimated the systolic blood pressure in patients with preeclampsia by at least 10 mm Hg in 24% (11/45) of paired measurements. CONCLUSION: The SunTech Medical Advantage Model 2 Series with firmware LX 3.40.8 algorithm noninvasive blood pressure module is validated in pregnancy, including patients with preeclampsia; however, it may underestimate systolic blood pressure measurements in patients with preeclampsia.

The Gap Between Manual and Automated Office Blood Pressure Measurements Results at a Hypertension Clinic.

BACKGROUND: Blood pressure (BP) readings taken in clinics are often higher than BP readings taken in a research setting. Recent guidelines and clinical trials have highlighted the necessity of using automated office blood pressure (AOBP) devices and standardizing measurement procedures. The goal of the present study was to compare AOBP vs manual BP measurement in both research and clinical environments in which operators and devices were the same and measurement procedures were standardized and optimal. METHODS: Clinical manual BP and AOBP measurement estimates were gathered from a retrospective cohort of patients followed in a hypertension clinic. Research AOBP and manual BP measurement data were obtained from past research studies. Descriptive statistics and agreement analyses with Cohen kappa coefficients were developed. The AOBP/manual BP measurement gap between clinical and research follow-up was compared using an unpaired t test. RESULTS: Two hundred eighty-eight patients were included in the clinical cohort, and 195 patients contributed to research-grade BP data. All patients had hypertension. AOBP averages were lower than manual measurement averages in both clinical (-3.6 ± 14.9 mm Hg / -3.0 ± 8.8 mm Hg) and research (-2.7 ± 10.0 / -2.4 ± 6.3 mm Hg) environments. The gap between measurement methods did not differ between research and clinical data. Cohen kappa coefficient was lower in the clinical context because of greater variability and more time between BP measurements (5.5 ± 2.9 months). CONCLUSIONS: Manual BP readings were slightly higher than AOBP estimates. The difference was not influenced by the real-world context of clinical practice. Office nonautomated BP measurements may still be valuable if measurement procedures are well standardized and performed by trained nurses.

Avaliação da acurácia do rastreômetro: um novo equipamento para rastreamento de hipertensão arterial / Evaluation of accuracy of rastreometer: a new equipment for hypertension tracking

Fundamento: A hipertensão arterial sistêmica é um dos principais fatores de risco cardiovascular afetando mais de um bilhão de pessoas. A baixa taxa de conhecimento da doença constitui uma das maiores dificuldades relacionadas à hipertensão. O rastreamento populacional para hipertensão é amplamente reconhecido como estratégia efetiva na detecção de casos novos, porém, até o momento, não se dispõe de nenhum instrumento que torne viável o rastreamento em massa da população. Objetivo: Avaliar a acurácia e a reprodutibilidade do Rastreômetro, um novo instrumento para o rastreamento de hipertensão arterial para agentes comunitários de saúde. Métodos: Estudo transversal com amostra de 436 indivíduos atendidos pela Estratégia de Saúde da Família. A avaliação foi feita comparando-se os resultados de pressão arterial obtidos pelo método oscilométrico e a leitura do Rastreômetro realizada pelos agentes comunitários de saúde. Resultados: o Rastreômetro apresentou sensibilidade de 81,3 por cento e especificidade de 85,6 por cento quando avaliado em relação aos valores de pressão sistólica. O desempenho dos operadores influenciou os resultados do Rastreômetro de forma independente (p = 0,0001). O Rastreômetro apresentou reprodutibilidade substancial (Kendall’s W 0,71). Conclusão: O Rastreômetro, quando operado por agentes comunitários de saúde, apresentou boa sensibilidade, especificidade e reprodutibilidade, especialmente quando avaliados à luz dos valores de pressão sistólica, tendendo a confirmar esse novo instrumento como método de rastreamento para hipertensão arterial na atenção primária a saúde.

Background: Hypertension is one of the major cardiovascular risk factors affecting more than one billion people. The low awareness of the disease is one of the greatest difficulties related to hypertension. The population screening for hypertension is widely recognized as an effective strategy to detect new cases, but until now, there is no instrument that has become feasible for mass screening of the population. Objective: Evaluate the accuracy and reproducibility of the Rastreometer, a new instrument for the screening of hypertension for community health agents. Methods: Cross-sectional study with a sample of 436 individuals served by the Family Health Strategy. The evaluation was conducted comparing the results of blood pressure obtained by the oscillometric method and reading of the Rastreometer performed by community health agents. Results: The Rastreometer presented a sensitivity of 81.3 percent and a specificity of 85.6 percent when assessed in relation to the values of systolic pressure. The operators’ performance influenced the results of the Rastreometer independently (p = 0.0001). The Rastreometer showed substantial reproducibility (Kendall’s W 0.71). Conclusion: The Rastreometer, when operated by community health agents, showed good sensitivity, specificity and reproducibility, especially when evaluated with the values of systolic pressure, tending to confirm this new instrument as a method of screening for hypertension in primary health care.

Evaluation of accuracy of rastreometer: a new equipment for hypertension tracking.

BACKGROUND: Hypertension is one of the major cardiovascular risk factors affecting more than one billion people. The low awareness of the disease is one of the greatest difficulties related to hypertension. The population screening for hypertension is widely recognized as an effective strategy to detect new cases, but until now, there is no instrument that has become feasible for mass screening of the population. OBJECTIVE: Evaluate the accuracy and reproducibility of the Rastreometer, a new instrument for the screening of hypertension for community health agents. METHODS: Cross-sectional study with a sample of 436 individuals served by the Family Health Strategy. The evaluation was conducted comparing the results of blood pressure obtained by the oscillometric method and reading of the Rastreometer performed by community health agents. RESULTS: The Rastreometer presented a sensitivity of 81.3% and a specificity of 85.6% when assessed in relation to the values of systolic pressure. The operators' performance influenced the results of the Rastreometer independently (p = 0.0001). The Rastreometer showed substantial reproducibility (Kendall’s W 0.71). CONCLUSION: The Rastreometer, when operated by community health agents, showed good sensitivity, specificity and reproducibility, especially when evaluated with the values of systolic pressure, tending to confirm this new instrument as a method of screening for hypertension in primary health care.

Accuracy of automated blood pressure monitors.

PURPOSE: The purpose of this study is to determine if automated and aneroid manometers are as accurate a means of determining blood pressure as the mercury manometer. Obtaining vital signs for patients is considered standard of care, yet many dental offices do not routinely perform this health service because of technique inconsistencies and time constraints. The use of automatic blood pressure monitors addresses both concerns. The mercury column manometer, the control in this study, has long been considered the most accurate and preferred instrument for obtaining blood pressure measurements. METHODS: During this study, 94 participants (19 years of age and older) consented to having blood pressure taken by each of 4 different monitors. These included the mercury column manometer and stethoscope, the aneroid manometer and stethoscope, the automatic arm blood pressure monitor, and the automatic wrist blood pressure monitor. Each of 3 investigators was assigned to and calibrated for a specific monitoring device. All measurements were taken from the left arm with 5 minutes allowed between measurements. Identical stethoscopes were used with the manual monitors. Strict adherence to the manufacturers' directions and patient preparation was followed for all monitors. Investigators were not aware of readings obtained by other investigators during testing. Eighty-three subjects completed all tests. RESULTS: Review and analysis of data indicates little difference for pulse readings between the automated and digital methods. Systolic readings by automated wrist manometers were the most unreliable. Automated arm monitors tended to provide higher measures than the mercury standard on average, and demonstrated significantly different diastolic readings in one age group compared to the control. All monitors exhibited low reliability for participants over age 50 compared to the control. CONCLUSION: This study demonstrates there is inaccuracy in the use of automated blood pressure monitors and traditional aneroid manometers when compared to the gold standard mercury column manometer for subjects of all ages and blood pressure ranges.

Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk.

BACKGROUND: Current diagnostic thresholds for ambulatory blood pressure (ABP) mainly rely on statistical parameters derived from reference populations. We determined an outcome-driven reference frame for ABP measurement. METHODS AND RESULTS: We performed 24-hour ABP monitoring in 5682 participants (mean age 59.0 years; 43.3% women) enrolled in prospective population studies in Copenhagen, Denmark; Noorderkempen, Belgium; Ohasama, Japan; and Uppsala, Sweden. In multivariate analyses, we determined ABP thresholds, which yielded 10-year cardiovascular risks similar to those associated with optimal (120/80 mm Hg), normal (130/85 mm Hg), and high (140/90 mm Hg) blood pressure on office measurement. Over 9.7 years (median), 814 cardiovascular end points occurred, including 377 strokes and 435 cardiac events. Systolic/diastolic thresholds for optimal ABP were 116.8/74.2 mm Hg for 24 hours, 121.6/78.9 mm Hg for daytime, and 100.9/65.3 mm Hg for nighttime. Corresponding thresholds for normal ABP were 123.9/76.8, 129.9/82.6, and 110.2/68.1 mm Hg, respectively, and those for ambulatory hypertension were 131.0/79.4, 138.2/86.4, and 119.5/70.8 mm Hg. After rounding, approximate thresholds for optimal ABP amounted to 115/75 mm Hg for 24 hours, 120/80 mm Hg for daytime, and 100/65 mm Hg for nighttime. Rounded thresholds for normal ABP were 125/75, 130/85, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80, 140/85, and 120/70 mm Hg. CONCLUSIONS: Population-based outcome-driven thresholds for optimal and normal ABP are lower than those currently proposed by hypertension guidelines.

A verificação da calibração dos manômetros e condições dos esfigmomanômetros aneroídes: um programa de educação continuada para enfermeiros supervisores do Hospital de Base / Evaluation the manometers calibration accuracy and conditions of the aneroid sphygmomanometers: a continuing coordinators program nursing education at Hospital de Base

A pressão arterial é a pressão exercida pelo sangue sobre as paredes das artérias. Mesmo considerando o aparecimento de aparelhos de grande precisão, os manômetros de mercúrio continuam sendo considerados os mais fidedignos para verificação da pressão arterial. No entanto, os aparelhos aneróides menos precisos são mais utilizados. Por esse motivo, recomenda-se que devam ser testadas contra o manômetros de mercúrio. Um paciente erroneamente rotulado de hipertenso será induzido a seguir um tratamento desnecessário, enquanto pacientes hipertensos não diagnosticados podem estar sendo excluídos dos benefícios do tratamento. O objetivo deste estudo é verificar a calibragem do manômetro aneróide, verificar as condições dos esfigmomanômetros e elaborar e implantar um programa de educação continuada. Trata-se de um estudo descritivo, onde participaram todos os enfermeiros supervisores do Ambulatório e do Hospital de Base de São José do Rio Preto/SP. Em relação a calibragem dos manômetros verificou-se: 87,5 por cento encontraram-se descalibrados no Hospital de Base e 44 por cento no Ambulatório. Quanto as condições gerais dos esfigmomanômetros, 95 por cento dos aparelhos estavam em boas condições de uso no Hospital em estudo, enquanto que, apenas 14,4 por cento dos aparelhos no Ambulatório estão nestas condições