Abstract
BackgroundWrist blood pressure (BP) devices have physiological limits with regards to accuracy, therefore they were not preferred for home BP monitoring. However some wrist devices have been successfully validated using etablished validation protocols. Therefore this study assessed the reproducibility of wrist home BP measurement with position sensor and automatic data storage.MethodsTo compare the reproducibility of three different(BP) measurement methods: 1) office BP, 2) home BP (Omron wrist device HEM- 637 IT with position sensor), 3) 24-hour ambulatory BP(24-h ABPM) (ABPM-04, Meditech, Hun)conventional sphygmomanometric office BP was measured on study days 1 and 7, 24-h ABPM on study days 7 and 14 and home BP between study days 1 and 7 and between study days 8 and 14 in 69 hypertensive and 28 normotensive subjects. The correlation coeffcient of each BP measurement method with echocardiographic left ventricular mass index was analyzed. The schedule of home readings was performed according to recently published European Society of Hypertension (ESH)- guidelines.ResultsThe reproducibility of home BP measurement analyzed by the standard deviation as well as the squared differeces of mean individual differences between the respective BP measurements was significantly higher than the reproducibility of office BP (p < 0.001 for systolic and diastolic BP) and the reproducibility of 24-h ABPM (p < 0.001 systolic BP, p = 0.127 diastolic BP). The reproducibility of systolic and diastolic office versus 24-h ABPM was not significantly different (p = 0.80 systolic BP, p = 0.1 diastolic BP). The correlation coefficient of 24-h ABMP (r = 0.52) with left ventricular mass index was significantly higher than with office BP (r = 0.31). The difference between 24-h ABPM and home BP (r = 0.46) was not significant.ConclusionThe short-term reproducibility of home BP measurement with the Omron HEM-637 IT wrist device was superior to the reproducibility of office BP and 24- h ABPM measurement. Furthermore, home BP with the wrist device showed similar correlations to targed organ damage as recently reported for upper arm devices. Although wrist devices have to be used cautious and with defined limitations, the use of validated devices with position sensor according to recently recommended measurement schedules might have the potential to be used for therapy monitoring.
Highlights
Wrist blood pressure (BP) devices have physiological limits with regards to accuracy, they were not preferred for home BP monitoring
Office blood pressure measurement The blood pressure was measured in the doctor's office in accordance with the recommendations of the American Heart Association (AHA) and the European Society of Hypertension (ESH) after the participant had rested for five minutes in a sitting position [6,8]
It could be shown that home BP measurements at the wrist using a validated instrument with activated position sensor show very much better reproducibility compared to conventional office BP measurements, and compared to standardized 24h ABPM
Summary
Wrist blood pressure (BP) devices have physiological limits with regards to accuracy, they were not preferred for home BP monitoring. The reproducibility of office blood pressure (office BP) measurement in clinical studies as well as in doctor's offices is very limited for various reasons. These include for example observer bias, the white-coat and placebo effects [1]. The poor reproducibility of office BP means that a much larger number of patients must be included in clinical pharmacological studies owing to the high individual variability between two office BP measurements. This is a prerequisite for demonstrating for example the therapeutic effects of antihypertensive agents. On the other hand accuracy of wrist devices may be limited by several factors such as anatomy of the wrist and arteriosclerotic vascular changes as pointed out in a recent paper by Kikuya et al [7]
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