Within-subject variability of differences between conventional and automated blood pressure measurements in pregnancy

Abstract

Objective: To determine whether measured differences between standard mercury sphygmomanometry and the SpaceLabs 90207 ambulatory blood pressure monitor in pregnant women remain constant during 24 h measurements. Study design: Repeated comparisons between standard mercury sphygmomanometry and Spacelabs 90207 were performed at nine predetermined time points during 24 h ambulatory blood pressure measurements in a group of ten pregnant women with various pregnancy complications, including hypertension. Individual and group differences between standard mercury sphygmomanometry and SpaceLabs 90207 were calculated for each time point. Friedman's ANOVA was used to test stability of differences across time. Results: Mean group differences (standard deviation) between mercury sphygmomanometry and the SpaceLabs 90207 were −2 (6) mmHg and 3 (7) mmHg for systolic and diastolic pressure respectively. For systolic pressure the differences between time points were not statistically significant. Although a statistical significant trend was found for diastolic pressure differences ( P<0.05), none of the contrasts between any pair of time points reached statistical significance. For both systolic and diastolic pressure the minimal and maximal difference lay at least 10 mmHg apart in seven patients. Conclusions: Despite standardisation and training, a substantial within-subject variability of the pressure difference between observers and SpaceLabs was found in this heterogeneous group of women. However, a systematic time-related effect on this pressure difference could not be demonstrated. The pressure difference between both methods cannot be estimated with great precision. This is a serious impediment for the clinical interpretation of automated or ambulatory blood pressure data.