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A Comparison of the Diagnostic Accuracy of Common Office Blood Pressure Measurement Protocols.

ABSTRACT: BACKGROUND:The optimal approach to measuring office blood pressure (BP) is uncertain. We aimed to compare BP measurement protocols that differed based on numbers of readings within and between visits and by assessment method. METHODS:We enrolled a sample of 707 employees without known hypertension or cardiovascular disease, and obtained 6 standardized BP readings during each of 3 office visits at least 1 week apart, using mercury sphygmomanometer and BpTRU oscillometric devices (18 readings per participant) for a total of 12,645 readings. We used confirmatory factor analysis to develop a model estimating "true" office BP that could be used to compare the probability of correctly classifying participants' office BP status using differing numbers and types of office BP readings. RESULTS:Averaging 2 systolic BP readings across 2 visits correctly classified participants as having BP below or above the 140 mm Hg threshold at least 95% of the time if the averaged reading was <134 or >149 mm Hg, respectively. Our model demonstrated that more confidence was gained by increasing the number of visits with readings than by increasing the number of readings within a visit. No clinically significant confidence was gained by dropping the first reading vs. averaging all readings, nor by measuring with a manual mercury device vs. with an automated oscillometric device. CONCLUSIONS:Averaging 2 BP readings across 2 office visits appeared to best balance increased confidence in office BP status with efficiency of BP measurement, though the preferred measurement strategy may vary with the clinical context.

SUBMITTER: Kronish IM

PROVIDER: S-EPMC7190886 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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A Comparison of the Diagnostic Accuracy of Common Office Blood Pressure Measurement Protocols.

Kronish Ian M IM Edmondson Donald D Shimbo Daichi D Shaffer Jonathan A JA Krakoff Lawrence R LR Schwartz Joseph E JE

American journal of hypertension 20180601 7

<h4>Background</h4>The optimal approach to measuring office blood pressure (BP) is uncertain. We aimed to compare BP measurement protocols that differed based on numbers of readings within and between visits and by assessment method.<h4>Methods</h4>We enrolled a sample of 707 employees without known hypertension or cardiovascular disease, and obtained 6 standardized BP readings during each of 3 office visits at least 1 week apart, using mercury sphygmomanometer and BpTRU oscillometric devices (1 ...[more]

PMID: 29897394

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Project description:BackgroundHypertension and cognitive impairment often coexist in older people. Office blood pressure measurement is a poor indicator for diagnosing hypertension in the general population. However, its diagnostic accuracy has not been substantially studied in patients with cognitive impairment.AimThe aim of this study was to determine the proportion of misdiagnosis of hypertension in patients with mild cognitive impairment and dementia compared to no cognitive impairment, by comparing office blood pressure measurement with home blood pressure measurement.MethodsA cross-sectional study including consecutive patients visiting a memory clinic between 2014 and 2017. Home blood pressure was measured for one week according to the European guidelines. Office blood pressure was assessed during routine clinical practice. Using guideline definitions for normal blood pressure and hypertension, we investigated the proportion of disagreement between office blood pressure measurement and home blood pressure measurement. Univariable and multivariable logistic regression compared disagreement in diagnosis between patients with dementia, mild cognitive impairment and no cognitive impairment.ResultsOf 213 patients (aged 73.4±9.0 years, 42% women) 82 had dementia, 65 had mild cognitive impairment and 66 had no cognitive impairment. Mean office blood pressure was 156/84±23/11 mmHg and mean home blood pressure was 139/79±16/10 mmHg. In 31% of patients, there was disagreement in hypertension diagnosis. This proportion was higher for mild cognitive impairment (38.5%) and dementia (35.4%) compared to no cognitive impairment (18.2%), with adjusted odds ratios of 3.7 (95% confidence interval 1.5-9.0), P=0.005 for mild cognitive impairment and 3.4 (1.3-8.6), P=0.011 for dementia.ConclusionsIn memory clinic patients with dementia and mild cognitive impairment, the diagnostic accuracy of office blood pressure measurement is lower compared to patients without cognitive impairment. To avoid the risk of making improper treatment decisions in this vulnerable group, a diagnosis of hypertension should be based on home blood pressure measurement, not office blood pressure measurement.

Project description:BackgroundNovel smartwatch-based cuffless blood pressure (BP) measuring devices are coming to market and receive FDA and CE labels. These devices are often insufficiently validated for clinical use. This study aims to investigate a recently CE-cleared smartwatch using cuffless BP measurement in a population with normotensive and hypertensive individuals scheduled for 24-h BP measurement.MethodsPatients that were scheduled for 24-h ambulatory blood pressure monitoring (ABPM) were recruited and received an additional Samsung Galaxy Watch Active 2 smartwatch for simultaneous BP measurement on their opposite arm. After calibration, patients were asked to measure as much as possible in a 24-h period. Manual activation of the smartwatch is necessary to measure the BP. Accuracy was calculated using sensitivity, specificity, positive and negative predictive values and ROC curves. Bland-Altman method and Taffé methods were used for bias and precision assessment. BP variability was calculated using average real variability, standard deviation and coefficient of variation.ResultsForty patients were included. Bland-Altman and Taffé methods demonstrated a proportional bias, in which low systolic BPs are overestimated, and high BPs are underestimated. Diastolic BPs were all overestimated, with increasing bias toward lower BPs. Sensitivity and specificity for detecting systolic and/or diastolic hypertension were 83 and 41%, respectively. ROC curves demonstrate an area under the curve (AUC) of 0.78 for systolic hypertension and of 0.93 for diastolic hypertension. BP variability was systematically higher in the ABPM measurements compared to the smartwatch measurements.ConclusionThis study demonstrates that the BP measurements by the Samsung Galaxy Watch Active 2 show a systematic bias toward a calibration point, overestimating low BPs and underestimating high BPs, when investigated in both normotensive and hypertensive patients. Standards for traditional non-invasive sphygmomanometers are not met, but these standards are not fully applicable to cuffless devices, emphasizing the urgent need for new standards for cuffless devices. The smartwatch-based BP measurement is not yet ready for clinical usage. Future studies are needed to further validate wearable devices, and also to demonstrate new possibilities of non-invasive, high-frequency BP monitoring.

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A Comparison of the Diagnostic Accuracy of Common Office Blood Pressure Measurement Protocols.

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A Comparison of the Diagnostic Accuracy of Common Office Blood Pressure Measurement Protocols.

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