Auscultatory Methods Research Articles

Blood pressure measurement and blood pressure control in Veterans Affairs medical centers.

The Veterans Affairs (VA) medical centers provide care for millions of Veterans at high risk of cardiovascular disease and accurate BP measurement in this population is vital for optimal BP control. Few studies have examined terminal digit preference (TDP), a marker of BP measurement bias, clinician perceptions of BP measurement, and BP control in VA medical centers. This mixed methods study examined BP measurements from Veterans aged 18 to 85 years with hypertension and a primary care visit within 8 VA medical centers. TDP for all clinic BP measurements was examined using a goodness of fit test assuming 10% frequency for each digit. Interviews were also conducted with clinicians from 3 VA medical centers to assess perceptions of BP measurement. The mean age of the 98,433 Veterans (93% male) was 68.5 years (SD 12.7). BP was controlled(<140/90mmHg) in 76.5% and control rates ranged from 72.2% to 81.0% across the 8 VA medical centers. Frequency of terminal digits 0 through 9 differed significantly from 10% for both SBP and DBP within each center (P<.001) but level of TDP differed by center. The highest BP control rates were noted in centers with highest TDP for digits 0 and 8 for both SBP and DBP. Clinicians reported use of semi-automated oscillometric devices for clinic BP measurement, but elevated BP readings were often confirmed by auscultatory methods. Significant TDP exists for BP measurement in VA medical centers, which reflects continued use of auscultatory methods.

KOROTKOFF SOUNDS DO NOT PROVIDE AN ACCURATE ESTIMATE OF SYSTOLIC AND DIASTOLIC PRESSURE IN SPHYGMOMANOMETRY AND CANNOT BE USED AS A CALIBRATION STANDARD FOR NIBP DEVICES

Objective: Noninvasive blood pressure (NIBP) devices are calibrated against validated auscultation sphygmomanometers using Korotkoff sounds. This study aimed to investigate the timing of Korotkoff sounds in relation to pulse appearance in the brachial artery and values of intra-arterial blood pressure. Design and method: Experiments were carried out on 15 participants, (14 males, 64.3 ±10.4 years; one female, 86 yo), undergoing coronary angiography. A conventional (oscillometric) BP cuff, with a microphone for Korotkoff sounds, was placed on the upper arm. Intra-arterial brachial artery pressure (IABP) was measured below the cuff with a fluid-filled catheter inserted via the radial artery and an external transducer. Finger photoplethysmography was used to measure brachial pulse wave velocity (PWV). Korotkoff sounds were processed electronically and custom algorithms identified the cuff pressure (CP) at which the first and last Korotkoff sounds were heard. PWV and max slope of the IABP pressure pulse were recorded to estimate arterial stiffness. Results: The brachial artery closed at a CP of 132.0±17.1 mmHg. Systolic (SBP), and diastolic (DBP) pressure were 147.6±14.3 and 72.7±10.1mmHg; mean pressure (MP, 100.1±10.4 mmHg) was similar to MP derived from the peak of the oscillogram (98.5±13.6 mmHg). Difference between IABP and CP recorded at first and last occurrence of Korotkoff sounds were, SBP: 18.9±8.3 (range 2-29) mmHg, DBP: 4.0±4.3 (range -1.6 -12.4) mmHg. Multiple linear regression showed that differences increase with arterial stiffness and can be compensated for using a prediction equation for calculation of true SBP (tSBP) using heart rate (HR) and Korotkoff derived systolic (SBPk) and diastolic (DBPk), at least over the limited age range for this study cohort. Conclusions: SBP and DBP derived from the onset and termination of Korotkoff sounds can underestimate IABP by up to 29 mmHg. Since Korotkoff sounds are the recommended method mandated by the universal standard for the validation of blood pressure measuring devices, these errors are propagated through to all NIBP measurement devices irrespective of whether they use auscultatory or oscillometric methods thus explaining the well known differences recorded between NIBP measurements and intra-arterial BP measurements.

Agreement of Oscillometric and Auscultatory blood pressure measurement methods: An ambulance noise simulation study

ObjectiveAlthough noise is known to negatively affect blood pressure (BP) measurements, its impact on different BP measurement methods remains unclear. The aim of this study is to compare the agreement of oscillometric and auscultatory BP measurement methods under in-ambulance noise levels. MethodsThis method-comparison study was conducted on 50 healthy volunteers in a tertiary emergency department (ED). Participants were divided into two groups of 25, and BP was measured using auscultatory and oscillometric methods in noisy and ambient environments by 2 emergency medicine technicians (EMT). The primary object of the study was to compare the agreement of auscultatory mercury sphygmomanometers and automated auscillometric BP measurements in ambient and noisy environments. ResultsWe examined the agreement between auscultative and oscillometric measurements of BP conducted in an ambient environment (46.75 [IQR (41.2--55.18)] dB) and found that both systolic and diastolic BP were within the level of agreement (LoA) established before the study (systolic BP [−13.96 to 8.48 mmHG], diastolic BP [−7.44 to 8.08 mmHg]); whereas, in noisy environment (92.35 [IQR 88–96.55] dB) both systolic and diastolic BP were outside the range of LoA (systolic BP [−37.77 to 9.94 mmHg], diastolic BP [−21.73 to 16.37 mmHg]). Additionally, we found that in ambient environments, concordance correlation coefficients were higher than in noisy environments (0.943 [0.906–0.966], 0.957 [0.93–0.974]; 0.574 [0.419–0.697], 0.544 [0.326–0.707]; systolic and diastolic BP, respectively). ConclusionThe results of this study demonstrate that noise significantly affects the agreement between oscillometric and auscultatory blood pressure measurement methods.

Effect of modifiable and non-modifiable risk factors on hypertension among diabetics: An observational study

Background: This study was increased prevalence of hypertension among diabetics. Aim and Objectives: The aims of this study were to assess the influence of various modifiable and non-modifiable risk factors on hypertension among diabetics. Materials and Methods: Five hundred and one (n = 501) known diabetics in the age group of 40–70 of both the gender were included in the study. Various non-modifiable risk factors such as age, gender, and duration of diabetes mellitus were recorded in a standard pro forma. Various modifiable risk factors such as smoking and alcohol consumption were reordered in a standard pro forma. The glycosylated hemoglobin value and lipid profile were collected from the laboratory reports. The blood pressure value was recorded using mercury sphygmomanometer with both palpatory and auscultatory methods. All the values were statistically analyzed using t-test and Chi-square by SPSS 20 software. Results: Study shows that the prevalence of hypertension among diabetics was 53.89%. The study shows that among the non-modifiable risk factors duration of diabetes was higher among the diabetics with hypertension (P = 0.001**). The study shows that among the modifiable risk factors smoking and alcohol consumption were significantly associated with development of hypertension among diabetics (P = 0.00**). The study shows that high-density lipoprotein (P = 0.011*) value were significantly higher, whereas total cholesterol (P = 0.001*) values were significantly lower among diabetics with hypertension. Conclusion: Increase in duration of diabetes, smoking, and alcohol consumption influences the development of hypertension among diabetics.

PS-C09-5: AUSCULTATORY AND OSCILLOMETRIC AMBULATORY BLOOD PRESSURE MONITORING: METHODS COMPARISON IN ADULT PATIENTS

Background/Introduction: Ambulatory blood pressure monitoring (ABPM) is an out-of-office method of blood pressure (BP) detection in usual patients activities via oscillometric or auscultatory recording devices. Correct measurement is crucial as for diagnosis, as treatment purpose. There are different rules for each method exist, however, they are not respected much for ABPM. The aim of the study was to compare a combined (oscillometric and auscultatory) ABPM device in adult individuals. Methods: One-hundred twenty-two patients had 24-hour clock-based definitions (nighttime: 01:00 to 05:59) ABPM patterns (mean age, 62 [95% CI, 60–63] years, 44% men) performed with a combined (oscillometric and AUSCULTATORY) device. Analyzing reading numbers in awake and night periods (not-valid: &lt; 20 and &lt; 7 readings, respectively) the validity was verified. Arterial hypertension was evaluated according to diurnal ABPM. Results: Twenty-four-hour systolic and diastolic BP were equal using auscultatory and oscillometric monitoring (140.3 and 139.6 mmHg, 77.2 and 79.0, respectively, NS). In hypertensions, 9.5% systolic and 4.0% diastolic BP patterns were outside the limits of agreements according to Bland-Altman analysis. Meanwhile, in normotensive individuals, 6.4% both for systolic and diastolic (for the population, 7.4% systolic and 5.0% diastolic BP). Conclusion: Using the oscillometric and auscultatory methods for ABPM show the same level of diurnal systolic and diastolic BP, but with the hypertension misclassification along with systolic BP rises in adults.

A Comparative Study of Upper Limb and Lower Limb Blood Pressure Measured by Auscultatory and Oscillometric Method with Intra-arterial Blood Pressure in Hemodynamically Unstable Patients

Introduction: Blood pressure (BP) measurement frequently guides management in critical care. Direct readings from a major artery is considered the gold standard. However, intra-arterial cannulation is associated with many risks. Hence, alternative noninvasive BP (NIBP) measurements are used for prolonged monitoring of BP among critically ill patients. Discrepancies between intra-arterial BP (IABP) and NIBP measurement can adversely affect therapeutic decisions and may have a negative impact of outcomes. Objectives: To compare upper limb and lower limb BP measured by auscultatory and oscillometric methods with IABP (by arterial cannulation) in hemodynamically unstable patients. Materials and Methods: Patients in the medical intensive care unit of Pushpagiri Institute of Medical Science and Research Centre were included over 24 months (50 patients admitted) in the clinical cross-sectional study. All patients who had a systolic BP (SBP) below 100 mmHg with an intra-arterial line were included under the study after obtaining an informed consent from the patient/patient’s bystander. The study design was approved by the Ethics Committee at Pushpagiri Institute of Medical Science and Research Centre. Choice of cuff size was made based on the limb circumference (midarm and midcalf) and manufacturer guidelines. BP was measured in arm using a welch allyn aneroid manometer. Oscillometric NIBP was relied on an MP20 model (Philips Medical Systems) connected to the nondisposable, reusable cuff. The intra-arterial catheter was connected through a pressure transducer to the monitor (Philips). With the patient supine, the pressure transducer was zeroed at the level of the mid-axillary line and the correct shape of the arterial pressure waveform was ascertained. Measurements: BP was measured at 0 h, 3 h and once the patient becomes hemodynamically stable using auscultatory, oscillometric, and IABP at arm and calf, respectively. Quantitative variables were expressed as mean standard deviation, whereas categorical variables were expressed as frequency (%). Karl Pearson’s Correlation Coefficient was used to find our relationship of BP measured by two different methods with BP measured using arterial cannulation. P &lt; 0.05 was considered the threshold for statistical significance. Statistical analyses was performed using a Statistical Software Package SPSS version 20. Results: Out of 50 patients admitted in a hemodynamically unstable state, 68% were male and 32% were female. Male-to-female ratio was 2.125. The mean age of patients was 65.9 ± 12.2. Majority of the patients belonged to the age group 61–70 years (30%) and the least number of patients in age group &lt;50 years (8%). Arm SBP and diastolic BP (DBP) measured by auscultatory and oscillometric method at the arm showed a positive correlation to intra-arterial SBP (IASBP) and intra-arterial DBP (IADBP) at 0 h, 3 h and once stable, which were statistically significant. Similarly, Arm SBP and DBP measured by auscultatory and oscillometric method at calf showed positive correlation to IASBP and IADBP at 0 h, 3 h, and once stable, which were statistically significant. The method used for measuring BP was irrelevant at 0 h and once stable, but at 3 h, SBP was better measured by the oscillometric method than by the auscultatory method. Conclusion: Noninvasive methods (auscultatory and oscillometric) can be used reliably for measuring BP in hemodynamically unstable patients instead of intra-arterial methods. Correlation tends to improve as BP becomes more stable.

The effectiveness of auscultatory, colorimetric capnometry and pH measurement methods to confirm placement of nasogastric tubes: A methodological study.

To determine the effectiveness of auscultatory, colorimetric capnometry and pH measurement methods for confirmation of correct nasogastric tube placement in critically ill patients. Incorrect nasogastric tube placement causes serious complications. This was a methodological and comparative study. The study sample consisted of 88 new insertions of nasogastric feeding tubes between April 2018-2019. Results from the 'auscultatory', 'pH' and 'colorimetric capnometry' methods were compared with the location of the nasogastric tube as determined through radiography. Descriptive statistics, Eta analysis and the Cohen kappa compliance test as well as sensitivity and specificity were conducted. There was a weak agreement (26.3%) between the auscultation and radiological evaluation for confirming nasogastric tube placement. The pH measurement and colorimetric capnometry methods were not correlated with radiological evaluation. Stomach pH increased as patient age increased and use of the colorimetric capnometry method failed to confirm the oesophageal and duodenal location. The specificity of the auscultation was low, and both the specificity and sensitivity pH methods were low. It was determined that auscultation, measuring pH and colorimetric capnometry were unreliable methods for confirming placement of nasogastric tubes. It is recommended to confirm initial placement of the nasogastric tube with radiography and to develop effective and reliable non-radiological measurement methods that can be performed at the bedside.

Correlation study of socio-demographic factors like gender, age, body mass index and some cardiovascular parameters in hypertensive subjects of Yenagoa, Bayelsa state, Nigeria

Hypertension is defined as a sustained elevated arterial pressure to a level that places the patient at increased risk of organ damage. It is a non-communicable disease which constitutes a public health importance. Its risk factors include advancing age, high salt intake, excessive alcohol consumption and stress. This study was performed to determine the correlation between some socio-demographic factors like gender, age, body mass index (BMI) and some cardiovascular parameters in hypertensive patients of Yenagoa, Bayelsa State, Nigeria. The study was carried out with 400 hypertensive subjects, whose blood pressures were determined using palpatory and auscultatory methods. The gender, age and body mass index of the subjects were also determined. Statistical analysis was done using Z-statistics. We found a significant positive relationship between the age and cardiovascular parameters. Gender and BMI were found to have an insignificant positive correlation with the cardiovascular parameters. The study demonstrated that body mass index, age and gender are closely associated with cardiovascular parameters, though the degree of correlation differed. The risk of hypertension is therefore expected to be higher among the aged and populations who are overweight or obese.

Systematic Review: Blood Pressure Value Difference Between Measurement with Oscillometric and Auscultation of Patients in Health Services

Blood pressure is a vital sign that is very important and is a basic physiological parameter in conducting physical assessments of critical patients. Blood pressure can be measured using manual or automatic instruments. The gold standard measures blood pressure with a mercury sphygmomanometer, but its use has been withdrawn due to the risk of mercury contamination. In practice, different values ​​are often obtained between the oscillometric method and auscultation. The objective of this review is to evaluate the significant difference in blood pressure between using the oscillometric method and auscultation in patients in health care. Method A systematic review approach is carried out on research results published in 3 search engines, namely EBSCO, Proquest, and Science Direct. Articles found according to the inclusion criteria that have been set are then assessed using the level of evidence using the NICE approach. The appraisal study uses the Critical Appraisal Skills Program (CASP), and the synthesis method uses a modified PICO. The result indicates that a total of 3 (three) studies were obtained according to the inclusion criteria. The intervention carried out was measuring blood pressure using two methods, namely oscillometric and auscultation. To sum up, there was a statistically significant difference in systolic pressure between the oscillometric and auscultatory methods.

Pilot study of comparability of a smartphone blood pressure monitoring algorithm to conventional cuff-based blood pressure measurements

Abstract Background/Introduction There is a growing market for smartphone applications (apps), offering medical assessments such as blood pressure measurements (BPM). These apps have the potential to improve blood pressure (BP) control by making BPM broadly and easily accessible. Yet, to be suitable for clinical and diagnostic purposes, BPM measured with smartphone apps need to be comparable to conventional BPM. Purpose We sought to compare a novel photoplethysmographic BPM algorithm used in a smartphone app to conventional cuff-based BPM. Methods We included consecutive patients with an indication for ambulatory BPM. Office blood pressure measurements (OBPM) were taken with an oscillometric cuff-based device (Welch Allyn SureBP). The algorithm of the smartphone app detects the pulse wave in finger capillaries using the phone's camera and estimates BP based on the form of the pulse wave. Before estimating a BP value, the algorithm performs a quality assessment to automatically reject recordings with insufficient quality. On the first day (D1), we took 6 OBPM alternating with 5 smartphone BPM (TestBP). On the second day (D2), 4 OBPM alternating with 3 TestBP were measured. TestBP calibrated based on the first OBPM of D1. Each TestBP was then compared to its RefBP (defined as mean of the previous and following OBPM). Results 50 patients were included in the study, resulting in 50 TestBP values on D1 and 33 on D2. There was no difference at the 5% significance level between the TestBP and RefBP distributions on both days, and for both systolic and diastolic pressures. The mean ± standard deviation (SD) of the differences between TestBP and RefBP was 0.7±9.4 / 1.0±4.5 mmHg on D1 and 2.6±8.2 / 1.3±4.1 mmHg on D2 for systolic/diastolic values, respectively. The number of TestBP measurements within 5, 10 and 15 mmHg from RefBP are shown in Table 1. Bland-Altman plots depicting the agreement between TestBP and RefBP are shown in Figure 1. Conclusion This smartphone algorithm shows comparable values to oscillometric cuff-based especially diastolic values. Its differences between TestBP – RefBP have a good stability 1 day after calibration. Before clinical use, this algorithm needs to undergo formal validation against a reference BP method accepted by international standards (auscultatory or invasive methods). Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Centre Suisse d'Electronique et de Microtechnique Table 1Figure 1

Validation of blood pressure measurement by the complex for daily monitoring of ECG and blood pressure “Medicom-Combi" by oscillometric and auscultatory methods in pediatric population (according to the BHS-93 protocol)

Purpose. To assess the accuracy of blood pressure (BP) measurement by the complex for daily monitoring of ECG and blood pressure «MedicomCombi» in comparison with a mercury sphygmomanometer in pediatric patients.Materials and methods. The recruitment of study participants was carried out in accordance with the criteria outlined in the international protocol BHS-93 for the pediatric population. During the tests, repeated sequential measurements of blood pressure were carried out by experts (using mercury sphygmomanometers) and the tested complex (by oscillometric and auscultatory methods).Results. The mean SBP, determined by the oscillometric method, was 116.0 ± 13.6 mm Hg, DBP - 69.0 ± 11.8 mm Hg. The mean SBP according to the auscultatory method was 116.0 ± 14.6 mm Hg, DBP - 70.4 ± 11.9 mm Hg. In 66% of cases for SBP and in 62% of cases for DBP, the difference between expert and test measurements by the oscillometric method did not exceed 5 mm Hg. In 100% of cases for SBP and in 96% of cases for DBP, the differences were within 10 mm Hg. The average differences between the experts and the tested complex were - 0.2 ± 5.7 mm Hg for SBP and 1.6 ± 6.1 for DBP. In 68 % of cases for SBP and in 65 % of cases for DBP, the difference between expert and test measurements by the auscultatory method was no more than 5 mm Hg. In 100% of cases for SBP and in 95% of cases for DBP, the differences did not exceed 10 mm Hg. The average differences between the experts and the tested complex were - 0.3 ± 4.7 mm Hg for SBP and 0.1 ± 5.7 for DBP.Conclusion. The complex for daily monitoring of ECG and blood pressure «Medicom-Combi» has demonstrated compliance with the accuracy requirements specified in the BHS 1993 protocol (class «А/А»), and can be recommended for measuring blood pressure by oscillometric and auscultatory methods in pediatric practice.

Validation of the complex for daily monitoring of ECG and blood pressure "Medicom-Combi" for blood pressure measurement in medical institutions in the general population (according to the Universal standard AAMi / ESH / ISO UNIVERSAL)

Purpose. To assess the accuracy of blood pressure measurement by oscillometric and auscultatory methods using the complex for daily monitoring of ECG and blood pressure «Medicom-Combi» in accordance with the criteria outlined in the Universal Standard AAMI/SH/ISO (ISO 81060-2:2018) for children and adults.Materials and methods. The study involved 90 patients (average age -33.8 ± 26.7 years) of the cardiological profile of the City Clinical Hospital No. 13 DZM, Children’s City Clinical Hospital No. 9 named after G. N. Speransky, as well as medical personnel, of which 85 were included in the analysis. For each participant, 3 pairs of valid measurements were obtained (reference-test, 255 pairs of measurements in total). Reference measurements were carried out by two experts, independently of each other, using the auscultatory method. Test measurements were read from the complex by a third expert.Results. According to validation criterion 1, the mean ± standard deviation of differences between test and reference measurements was 0.1 ± 6.0/1.7 ± 5.8 mm Hg for SBP/DBP by the oscillometric method and 0.0 ± 6.5/1.3 ± 6.6 mm Hg for SBP/DBP by the auscultatory method. According to validation criterion 2, the standard deviation of the average difference between the BP values of the same patient according to the results of test and reference measurements did not exceed 6.95/6.73 for SBP/DBP by the oscillometric method and 6.95/6.82 mm Hg for SBP/DBP by the auscultatory method.Conclusion. The complex for daily monitoring of ECG and blood pressure «Medicom-Combi» meets the requirements of the Universal Standard AAMI/ESH/ISO in terms of measurement accuracy for devices intended for use among children and adults when assessing blood pressure by oscillometric and auscultatory methods.

Blood pressure measurements and hypertension in infants, children, and adolescents: from the postmercury to mobile devices.

A mercury sphygmomanometer (MS) has been the gold standard for pediatric blood pressure (BP) measurements, and diagnosing hypertension is critical. However, because of environmental issues, other alternatives are needed. Noninvasive BP measurement devices are largely divided into auscultatory and oscillometric types. The aneroid sphygmomanometer, the currently used auscultatory method, is inferior to MS in terms of limitations such as validation and regular calibration and difficult to apply to infants, in whom Korotkoff sounds are not audible. The oscillometric method uses an automatic device that eliminates errors caused by human observers and has the advantage of being easy to use; however, owing to its measurement accuracy issues, the development of an international validation protocol for children is important. The hybrid method, which combines the auscultatory and electronic methods, solves some of these problems by eliminating the observer bias of terminal digit preference while maintaining measurement accuracy; however, the auscultatory method remains limited. As the age-related characteristics of the pediatric group are heterogeneous, it is necessary to reconsider the appropriate BP measurement method suitable for this indication. In addition, the mobile application-based BP measurement market is growing rapidly with the development of smartphone applications. Although more research is still needed on their accuracy, many experts expect that mobile application-based BP measurement will effectively reduce medical costs due to increased ease of access and early BP management.

Accuracy of non-invasive blood pressure measurement in patients with atrial fibrillation.

Although the accuracy of oscillometric blood pressure (BP) measurement is not so satisfied, the BP reading is still associated with cardiovascular events and death in patients with atrial fibrillation (AF). Because the currently used auscultatory or oscillometric methods were developed on sinus rhythm (SR), these BP measurement methods were not reasonable for AF patients. It is suggested that the average of three BP readings in the AF patients is accepted in clinical, even so, high systolic BP (SBP) variability and inaccurate diastolic BP (DBP) value have been reported in AF patients. In sinus rhythm, oscillometric pressure pulses (OPPs) are spindle-like, regardless of the heart rate. However, the shape of OPP is obviously associated with frequency of ventricular rate (VR) in AF patients. When the VR is rapid, the OPP is far from a spindle-like shape. With intro-aortic BP as reference, a study demonstrated that the oscillometric SBP level significantly underestimated the intro-aortic SBP level in the AF patients with increasing VR. In clinical practice, the physician should use the average of three BP readings in the AF patients. When the mean pulse rates (PR) reported by the oscillometric BP devise is less than 90 bpm and the variation of three pulse rate <10 bpm, the oscillometric SBP readings may be clinically accepted in AF patients. It is necessary to develop a new BP measurement method for AF as the current methods in AF are not so accurate as in SR.

Comparing Intra-Arterial, Auscultatory, and Oscillometric Measurement Methods for Arterial Blood Pressure.

AIMThis study aimed to compare the measurement results of arterial blood pressure obtained through intra-arterial, auscultatory, and oscillometric methods.METHODThis prospective and descriptive study was conducted with 180 patients hospitalized in the intensive care units of cardiovascular surgery and anesthesia. Arterial blood pressures of the patients in the study were measured with 3 methods, and the mean arterial pressure values obtained by each method were analyzed to find out whether they were different or consistent.RESULTSThe average systolic blood pressure value using the intra-arterial method was found to be 125.47 ± 21.39 mm Hg, and the average of diastolic blood pressure measurement obtained using the oscillometric method was the highest (73.91 ± 10.62 mm Hg). The highest correlation was seen between the arterial BP measurements of the intra-arterial and auscultatory methods (systolic [0.96] and diastolic [0.90]). According to the British and Irish Hypertension Society protocol, a very good agreement between the diastolic blood pressure values and a good agreement between the systolic blood pressure values were obtained.CONCLUSIONThe measurement results obtained through the auscultatory method more consistent with the results obtained through the intra-arterial method compared with those obtained using the oscillometric method.

Brazilian health professionals' perceptions and knowledge about automated blood pressure monitors.

Obtaining accurate blood pressure readings is vital. However, students and health professionals do not always receive adequate training on blood pressure measurement, especially regarding new technologies, leading to insufficient knowledge. Therefore, the aim of this study is to analyze Brazilian health professionals' perceptions and knowledge about automated blood pressure monitors. This cross-sectional study involved 1734 Brazilian nurses, nursing technicians, and doctors who reported having some experience of using automated monitors. Perceptions about differences between readings obtained through the auscultatory and oscillometric methods, influence of small differences in clinical decision-making, confidence in automated monitors, and knowledge about contraindications for the use of these devices were assessed. Most medical and nursing professionals considered differences of up to 5 mmHg (40.94%) between auscultatory and oscillometric measurements acceptable. Of these, 69.02% reported that even small differences can influence clinical decisions. Confidence in readings obtained using automated blood pressure monitors was reported by 53.92%. Among the motivations for making these devices available in health services, the most frequent was the saving of time (48.85%) and the least frequent, the perception that the use of this technology requires less training (9.40%). Arrhythmia was the most recognized contraindication for the use of automated monitors (28.49%), followed by obesity (28.14%) and blood pressure readings above 160 × 100 mmHg. In conclusion, there is a lack of knowledge about the functionalities and indications of blood pressure monitors and a low tolerance for measurements different from those obtained through manual mercury sphygmomanometers or aneroids.

EFFECT OF UNDERCUFFING ON AUSCULTATORY AND OSCILLOMETRIC BLOOD PRESSURE MEASUREMENT

Abstract Objective: The objective of the present investigation was to identify the effect of using a blood pressure (BP) cuff size smaller than that appropriate for patient's arm circumference (undercuffing) on auscultatory and oscillometric measurements. Design and method: It was a single-centre equivalence trial that recruited 47 adult subjects with upper arm circumferences between 35 and 44 cm. After ten minutes rest, six sequential BP measurements were performed 30 and, at most, 60 seconds apart while seated. First, third and fifth measurements were performed using blinded, simultaneous, two-observer auscultation using a calibrated anaeroid sphygmomanometer and requiring a between-observer agreement equal to or less than 4 mmHg. Second, fourth and sixth were performed with the Omron HBP-1100 oscillometric monitor. The first two measurements (one auscultatory and one oscillometric) were performed using a large adult cuff (16 x 36 cm), which represented appropriate cuffing for the study subjects. Third, fourth, fifth and sixth measurements were performed with a standard adult cuff size (16 × 30 cm). BP differences were calculated using device – observer measurement. A paired t-test was used to identify statistically significant differences between BP readings in each method. Results: 282 complete measurements were available. Mean upper arm circumference size was 38.38 (±2.85) cm. Mean SBP and DBP when the appropriate cuff was used was 115.08 ± 18.32/70.25 ± 12.3 mmHg using the auscultatory method vs. 120.91 ± 17.15/72.57 ± 11.74 mmHg using the oscillometric method (p-value &lt; 0.005). When smaller cuff size was used, mean SBP and DBP was 119.97 ± 15.88/76.78 ± 12.03 mmHg in the auscultatory method vs. 126.95 ± 16.17/74.56 ± 10.97 mmHg in the oscillometric method (p-value &lt; 0.005). The mean device-observer disagreement for SBP (Fig 1) was 5.82 (±9.12) when appropriate cuff size was used and 6.98 (±8.06) with a smaller cuff size (p-value = 0.79). For DBP (Fig 2), the disagreement was 2.31 (±6.28) vs. -2.22 (±5.88) (p-value &lt; 0.005). Conclusions: Using a smaller cuff size overestimates SBP and DBP, in both auscultatory and oscillometric methods and also results in a greater systolic disagreement between these two measurement methods.

IMPACT OF USING INAPPROPRIATE CUFF SIZE IN BLOOD PRESSURE CLASSIFICATION: ANALYSIS FOR AUSCULTATORY AND OSCILLOMETRIC METHODS

Abstract Objective: This study aims to identify how using an inappropriate cuff size in auscultatory and oscillometric methods changes blood pressure (BP) classification according American hypertension guidelines. Design and method: In this diagnostic accuracy study, 60 adult subjects were recruited. After ten-minutes of rest, six sequential BP measurements were performed. First measurement was considered the reference measurement as it was performed using a calibrated aneroid sphygmomanomether and a cuff size appropriate to participant's arm circumference. Second measurement was also performed with an appropriate cuff size, but using a HBP-1100 atuomatic monitor. The next four measurement were test measurements so they were taken using a standard adult cuff size (16 × 30 cm). Participants with upper arm circumference between 27 and 34 cm were excluded as the standard adult cuff size was the appropriate size for them. Third and fifth measurements were auscultatory and fourth and sixth were oscillometric measurements. Hypertension was considered present when BP readings were classified as stage 1 or 2. Stata/SE 15.0 was used to calculated performance measurements of diagnostic tests. Results: 360 complete measurements were performed. Mean upper arm circumference was 30.01 (±6.74). According to ACC/AHA classification, the automatic monitor with an appropriate cuff size had a sensitivity of 0.9, a specificity of 0.82 and a diagnostic accuracy of 83%, compared to the aneroid with the same cuff size. When a smaller or larger cuff was used instead of an appropriate cuff, the automatic monitor had a sensitivity of 0.9, a specificity of 0.8 and a diagnostic accuracy of 81,66% and the aneroid had a sensitivity of 0.9, a specificity of 0.92 and a diagnostic accuracy of 91,66%. Conclusions: According to ACC/AHA hypertension guidelines, the automatic monitor was not as sensitive, specific and accurate as the aneroid to classify hypertension when BP is measured with an appropriate cuff size. In addition, when an inappropriate cuff size is used, the automatic monitor was also relatively less accurate than aneroid for classifying BP according to the ACC/AHA guidelines. Based on the findings, auscultatory measurements are most appropriate when only the standard adult cuff size is available.

Office blood pressure measurement: A comprehensive review.

The conventional auscultatory methods for measuring blood pressure have been used to screen, diagnose, and manage hypertension since long. However, these have been found to be prone to errors especially the white coat phenomena which cause falsely high blood pressure readings. The Mercury sphygmomanometer and the Aneroid variety are no longer recommended by WHO for varying reasons. The Oscillometric devices are now recommended with preference for the Automated Office Blood Pressure measurement device which was found to have readings nearest to the Awake Ambulatory Blood Pressure readings. The downside for this device is the cost barrier. The alternative is to use the simple oscillometric device, which is much cheaper, with the rest and isolation criteria of the SPRINT study. This too may be difficult due to space constraints and the post‐clinic blood measurement is a new concept worth further exploration.

Validation of blood pressure measurement with Medicom-Combi blood pressure monitor using oscillometric and auscultatory methods for use among adults (according to International Protocol of European Society of Hypertension for validation of blood pressure measuring devices in adults)

Purpose. To evaluate the accuracy of measuring blood pressure (BP) by the ECG and Medicom-Combi daily blood pressure monitoring system, designed to monitor blood pressure with oscillometric and auscultatory methods, among adults in accordance with the European Hypertension Society’s International Protocol for validation of adult blood pressure measuring instruments (ESH‑2001). Materials and methods. Patients were recruited based on criteria recommended by the ESH‑2001 protocol. A total of 99 pairs of test and control measurements of blood pressure were obtained (three pairs of measurements for each of 33 subjects). The measurements were carried out sequentially on the same arm. For the arm circumference of 24–32 cm and 32–42 cm, two cuffs of the test complex were used (adult small and adult large, respectively). Results. When testing the complex, 66, 93, and 99 measurements were obtained within 5, 10, and 15 mmHg for systolic blood pressure (SBP) and 66, 89 and 95 measurements for diastolic blood pressure (DBP), respectively, using the oscillometric method, as well as 71, 93 and 97 measurements for SBP and 71, 84 and 93 measurements for DBP, respectively, when using the auscultatory method. The mean ± SD of the differences between the test and control measurements were 1.8 ± 5.4 / 1.6 ± 6.9 mmHg for SBP / DBP using the oscillometric method and 0.8 ± 5.9 / –1.2 ± 7.9 mmHg for SBP / DBP using the auscultatory method. Conclusion. The complex of daily monitoring of ECG and blood pressure Medicom-Combi, designed for daily monitoring of blood pressure, meets the requirements stated in the international protocol ESH‑2001 (class ‘Passed’) for adults and is recommended for use in clinical practice.