Dataset Information

Uneven Accuracy of Home Blood Pressure Measurement: A Multicentric Survey.

ABSTRACT: Home blood pressure monitoring (HBPM) is increasingly commonly performed, but the concordance between patient HBPM measurement technique and prevailing recommendations has not been well-assessed according to the literature. The authors performed a multicentric survey to evaluate the degree of patients' adherence to current recommendations on HBPM, and investigate potential predictors of a higher-quality self-measurement. A structured questionnaire was administered to 725 Italian outpatient hypertensive patients (mean age, 52.2±14.4 years). Overall, ≥10 recommended procedures were followed by 52.8% of the participants; only 1.0% followed all recommendations. A total of 49.7% of participants rested for ≥5 minutes before the measurement, 36.8% recorded BP more than once in each measurement session, and 34.3% used a chair or bed saddle to support their back. Less than 40% of the patients received some form of training by health professionals. After multivariate analysis, patients receiving/reading instructions showed higher-quality HBPM (P<.01). The accuracy of HBPM needs to be improved, and more efforts should be devoted to provide patient training on HBPM, especially on the less-frequently followed recommendations.

SUBMITTER: Flacco ME

PROVIDER: S-EPMC8032095 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Uneven Accuracy of Home Blood Pressure Measurement: A Multicentric Survey.

Flacco Maria Elena ME Manzoli Lamberto L Bucci Marco M Capasso Lorenzo L Comparcini Dania D Simonetti Valentina V Gualano Maria Rosaria MR Nocciolini Manuela M D'Amario Claudio C Cicolini Giancarlo G

Journal of clinical hypertension (Greenwich, Conn.) 20150416 8

Home blood pressure monitoring (HBPM) is increasingly commonly performed, but the concordance between patient HBPM measurement technique and prevailing recommendations has not been well-assessed according to the literature. The authors performed a multicentric survey to evaluate the degree of patients' adherence to current recommendations on HBPM, and investigate potential predictors of a higher-quality self-measurement. A structured questionnaire was administered to 725 Italian outpatient hyper ...[more]

PMID: 25880129

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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.

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.

Dataset Information

Uneven Accuracy of Home Blood Pressure Measurement: A Multicentric Survey.

Publications

Uneven Accuracy of Home Blood Pressure Measurement: A Multicentric Survey.

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