Auscultatory Sphygmomanometry Research Articles

WATCH-BPM-Comparison of a WATCH-Type Blood Pressure Monitor with a Conventional Ambulatory Blood Pressure Monitor and Auscultatory Sphygmomanometry.

Smart devices that are able to measure blood pressure (BP) are valuable for hypertension or heart failure management using digital technology. Data regarding their diagnostic accuracy in comparison to standard noninvasive measurement in accordance to Riva-Rocci are sparse. This study compared a wearable watch-type oscillometric BP monitor (Omron HeartGuide), a wearable watch-type infrared BP monitor (Smart Wear), a conventional ambulatory BP monitor, and auscultatory sphygmomanometry. Therefore, 159 consecutive patients (84 male, 75 female, mean age 64.33 ± 16.14 years) performed observed single measurements with the smart device compared to auscultatory sphygmomanometry (n = 109) or multiple measurements during 24 h compared to a conventional ambulatory BP monitor on the upper arm (n = 50). The two BP monitoring devices were simultaneously worn on the same arm throughout the monitoring period. In a subgroup of 50 patients, single measurements were also performed with an additional infrared smart device. The intraclass correlation coefficient (ICC) between the difference and the mean of the oscillometric Omron HeartGuide and the conventional method for the single measurement was calculated for both systole (0.765) and diastole (0.732). This is exactly how the ICC was calculated for the individual mean values calculated over the 24 h long-term measurement of the individual patients for both systole (0.880) and diastole (0.829). The ICC between the infrared device and the conventional method was "bad" for SBP (0.329) and DBP (0.025). Therefore, no further long-term measurements were performed with the infrared device. The Omron HeartGuide device provided comparable BP values to the standard devices for single and long-term measurements. The infrared smart device failed to acquire valid measurement data.

Feasibility of Precision Medicine in Hypertension Management-Scope and Technological Aspects.

Personalized management of diseases by considering relevant patient features enables optimal treatment, instead of management according to an average patient. Precision management of hypertension is important, because both susceptibility to complications and response to treatment vary between individuals. While the use of genomic and proteomic personal features for widespread precision hypertension management is not practical, other features, such as age, ethnicity, and cardiovascular diseases, have been utilized in guidelines for hypertension management. In precision medicine, more blood-pressure-related clinical and physiological characteristics in the patient's profile can be utilized for the determination of the threshold of hypertension and optimal treatment. Several non-invasive and simple-to-use techniques for the measurement of hypertension-related physiological features are suggested for use in precision management of hypertension. In order to provide precise management of hypertension, accurate measurement of blood pressure is required, but the available non-invasive blood pressure measurement techniques, auscultatory sphygmomanometry and oscillometry, have inherent significant inaccuracy-either functional or technological-limiting the precision of personalized management of hypertension. A novel photoplethysmography-based technique for the measurement of systolic blood pressure that was recently found to be more accurate than the two available techniques can be utilized for more precise and personalized hypertension management.

Blood Pressure Characteristics and Responses During Resistance Exercise

ABSTRACT Blood pressure changes acutely during resistance exercise. Continuous, beat-by-beat assessment provides detailed temporal resolution of blood pressure profiles, through techniques including intra-arterial catheterization, photoplethysmography, or applanation tonometry. However, noncontinuous measurements may be conducted before and after resistance exercise through auscultatory sphygmomanometry or oscillometry. Blood pressures tend to increase across repetitions within sets, influenced by load magnitude, repetitions and sets performed, muscle mass recruited, and rest periods; the highest pressures result from multi-joint, large muscle group exercises. Evaluation of such factors may facilitate better understanding of blood pressure responses to acute resistance exercise and influence program design considerations relative to anticipated hemodynamic changes.

Validation of the iHealth Track and Omron HEM-9210T automated blood pressure devices for use in pregnancy.

Self monitoring of blood pressure in pregnancy is increasingly popular with both health care professionals and patients. We assessed the validity of the iHealth Track and Omron HEM-9210T automated blood pressure devices (with Bluetooth connectivity) for the use in telemonitoring of blood pressure in pregnancy. In this prospective observational study, the revised 2010 International Protocol of the European Hypertension Society (EHS) was used for the validation of the two devices against auscultatory sphygmomanometry by two independent observers who took 13 same arm measurements in 33 pregnant women, of which 10 were diagnosed with preeclampsia. The measurements were alternated between the test device and a calibrated aneroid sphygmomanometer following the protocol. Both automated devices were assessed sequentially in the same women. In the group of 33 women, the iHealth Track passed the EHS 2010 validation criteria with 86/98/99 of 99 device-observer systolic measurement comparisons and 88/96/98 of 99 device-observer diastolic measurement comparisons within the 5/10/15 mmHg boundaries respectively. The Omron HEM-9210T passed the same criteria with 85/94/99 of 99 device-observer systolic measurement comparisons and 82/95/99 of 99 device-observer diastolic measurement comparisons. The iHealth Track and Omron HEM-9210T automated blood pressure monitors are validated for use in pregnancy. These two devices can now be added to the short list of validated devices in pregnancy and can be used for self-measurement of blood pressure in a telemonitoring setting of pregnant patients with (a high risk of) hypertensive disease.

Validation of the G.LAB MD2680 digital automatic blood pressure monitor according to international protocols.

The aim of this study was to validate the G.LAB MD2680 digital automatic blood pressure (BP) monitor according to major international protocols. The device was evaluated against auscultatory sphygmomanometry according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010, the British Hypertension Society (BHS), and the International Organization for Standardization (ISO) 81060-2:2013 protocols. Bland-Altman plots were completed for systolic (SBP) and diastolic blood pressures (DBP), and the mean differences and SDs between the test device and the reference device were computed for all BP values. The G.LAB MD2680 passed the ESH-IP revision 2010 on 33 participants with a mean device-observer difference of 0.89±4.97 mmHg for SBP and 0.72±4.91 mmHg for DBP, respectively. The device achieved A/A grading for the BHS protocol among 85 participants with a device-observer difference of 0.70±6.35 mmHg for SBP and 0.62±6.41 mmHg for DBP, respectively. Furthermore, it also fulfilled the two criteria of the ISO 81060-2:2013 protocol. The G.LAB MD2680 digital automatic BP monitor fulfilled the accuracy requirements of the ESH-IP revision 2010 and the ISO 81060-2:2013 protocols, and achieved A/A grade of the BHS protocol, and it can be recommended for self-measurement in adults.

Validation of the Tel-O-GRAPH, a new oscillometric blood pressure-measuring device, according to the British Hypertension Society protocol.

Hypertension is a major cardiovascular risk factor. Therefore, the accuracy of blood pressure (BP) measurement with self-measuring devices is of fundamental importance. Consequently, emerging BP devices should be evaluated against the gold standard according to an established and proven protocol. Tel-O-GRAPH, a new oscillometric self-measuring device of brachial BP, was evaluated against auscultatory sphygmomanometry according to the BHS protocol. Bland-Altman plots were completed for systolic (SBP) and diastolic blood pressures (DBP), and the mean differences and SDs between the test device and the reference device were computed for all BP values. A total of 85 individuals (mean age 48.11±18.0 years; 61% men) were included after they provided informed consent. Overall, 510 measurements were performed. The mean device-observer difference was -0.2±6.6 for SBP and 0.2±6.6 for DBP. The device achieved grade A for SBP and DBP for both observers. Examination of the different BP ranges indicated grade B for SBP more than 160 mmHg and grade A for all BP ranges. Tel-O-GRAPH fulfilled the accuracy requirements of the BHS with the highest accuracy level (A) and can thus be used reliably in the oscillometric measurement of the brachial BP.

Impact of Atrial Fibrillation on the Accuracy of Oscillometric Blood Pressure Monitoring

The introduction of automated oscillometric blood pressure monitors was the basis for today's widespread use of blood pressure self-measurement. However, in atrial fibrillation, there is a controversial debate on the use of oscillometry because there is a high variability of heart rate and stroke volume. To date, the accuracy of oscillometric blood pressure monitoring in atrial fibrillation has only been investigated using auscultatory sphygmomanometry as reference method, which may be biased by arrhythmia as well. We performed a cross-sectional study in 102 patients (52 sinus rhythm, 50 atrial fibrillation) assessing the accuracy of an automated and validated oscillometric upper arm (M5 Professional, Omron) and wrist device (R5 Professional, Omron) to invasively assessed arterial pressure. Blood pressure values were calculated as the mean of 3 consecutive measurements. Systolic and diastolic blood pressure did not significantly differ in patients with sinus rhythm and atrial fibrillation, independent of the method of measurement (P>0.05 each). The within-subject variability of the oscillometric measurements was higher in patients with atrial fibrillation compared with sinus rhythm (P<0.01 each). The biases of systolic and diastolic blood pressure, however, did not significantly differ in presence or absence of atrial fibrillation in Bland-Altmann analysis (P>0.05 each). In conclusion, atrial fibrillation did not significantly affect the accuracy of oscillometric measurements, if 3 repeated measurements were performed.

Der Einfluss von Bekleidung auf die sphygmomanometrische und oszillometrische Blutdruckmessung bei Hypertonikern

The few studies published on this subject have shown that blood pressure measurements give similar results whether the patients' arm is covered by clothing or not. But it has not been clarified whether this is also true in the case of hypertensive persons, Yet, in practice the correct measurement is of critical importance in the diagnosis of hypertension. 203 hypertensive patients were examined with the auscultatory sphygmomanometry and the automatic oscillometry by measuring the pressure three times with each method. These tests were carried out in a randomized sequence on a covered arm (the patient's own clothing of maximally 2 mm thickness), the bare arm and the arm covered with a standardized cotton sleeve (2 mm). The auscultatory sphygmomanometry was done blinded (non-sleeved, sleeved, standardized). Calculation of confidence intervals for the mean differences of the three settings (bare, clothing and standard sleeve) and equivalence testing demonstrated that a garment or cloth on the arm under the manometer cuffs did not significantly effect the blood pressure within the predefined interval of equivalence of +/- 4 mm Hg. Thus, measuring blood pressure with the cuff over the person's sleeve does not significantly effect the result. This study shows that measuring blood pressure in hypertensive persons with or without a cloth sleeve (maximally 2 mm thick) does not result in any statistically significant difference. This simplifies the blood pressure measurement that have to be taken frequently on hypertensive persons.

Arterial stiffness and fetal growth in normotensive pregnancy

Normal pregnancy is characterized by a decrease in peripheral resistance and generalized vasodilation resulting in plasma volume expansion, which is associated with intrauterine growth. Stiffness of the arterial system may be a measure of the degree of plasma volume expansion. Pulse wave velocity (PWV), measured by applanation tonometry, is a validated approach to determine arterial stiffness. Pulse pressure (PP) is considered a surrogate measure for arterial stiffness. The aim of this study was to evaluate the association between arterial stiffness and fetal growth. In 50 normotensive pregnancies, carotid-femoral PWV was measured in the third trimester in 30 degrees lateral position. Blood pressure measurements were performed with conventional auscultatory sphygmomanometry. Birth weight centiles and weight centiles at the age of 6 months were recorded. Linear regression models were used for statistical analyses. There was a significant relationship in PWV with both birth weight centiles and catch-up growth after birth, independent of mean arterial pressure (MAP). An increase of 1 m/sec in PWV was associated with a decrease in birth weight centiles by 17.6% and a catch-up of 22.3% in weight centiles after birth. A stronger association was found for pulse pressure and birth weight centiles. An increase of 1 mm Hg was associated with a decrease in birth weight centiles by 1.8%. There was no association between MAP and birth weight centiles. In normotensive pregnancy arterial stiffness is associated with birth weight centile and catch-up growth after birth, independently from MAP. This suggests that arterial stiffness reflects maternal vascular adaptation to pregnancy better than blood pressure.

Automated blood pressure measurement at rest and during exercise: evaluation of the motion tolerant CardioDyne NBP 2000.

The purpose of this study was to validate the use of a motion tolerant blood pressure monitor (CardioDyne NBP 2000, Luxtec, Worcester, MA) ) against standard manual auscultation at rest and during exercise. Nineteen subjects (men, N = 9; women, N = 10) participated in the study (mean: age 21+/-1.2 yr; height 172.5+/-8 cm; mass 69.4+/-14.5 kg). Standard Bruce protocol treadmill exercise tests with 12-lead ECG and metabolic measures were administered to the subjects, with blood pressure measures taken at rest before, during, and after the exercise tests. Blood pressure by manual auscultatory sphygmomanometry and the CardioDyne NBP 2000 was recorded simultaneously in the same arm. Manual auscultatory blood pressure measures obtained by one experimenter were used as the criterion measure, and the data of two NBP 2000 audio reviewers were averaged for each data point recorded. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) via manual auscultation and the NBP 2000 "automatic" values were not significantly different and were highly correlated at rest and during exercise. Resting intraclass correlation SBP values were high (range 0.95 to 0.98), as were DBP intraclass correlation values (range 0.83 to 0.95). Exercise intraclass correlation SBP values ranged from 0.94 to 0.99, and DBP intraclass correlation values from 0.88 to 0.93. We conclude that the NBP 2000 is simple to use at rest and during exercise stress testing and provides accurate and verifiable information.

Elevated systolic blood pressure: Increased cardiovascular risk and rationale for treatment

S ince the invention of indirect auscultatory sphygmomanometry at the turn of the century, physicians have tended to focus more on treating elevations of diastolic blood pressure (DBP) than elevations of systolic blood pressure (SBP). The primary focus on DBP resulted from theoretical concerns that the level of DBP was more related to end organ damage.’ Also, the original Veterans Affairs Cooperative Study,2 the first to prove benefit in treating high blood pressure, focused on DBP. The fact that SBP rises on average throughout the life span in industrialized societies gave impetus to the notion that elevation of SBP was an aging-related phenomenon attributable to decreased compliance of the major arteries. For years a common clinical dictum was that a normal SBP for older persons was “100 plus the person’s age.” Therefore clinicians have been uncertain whether to treat isolated systolic hypertension (ISH; SBP 2 160 mm Hg, DBP 45 years of age, SBP is a greater risk factor for subsequent cardiovascular morbidity and mortality than are elevations of DBP.4 In fact, elevation of SBP is the only traditional reversible cardiovascular risk factor that does not have an attenuation of risk with advancing age. The recent publication of epidemiologic data from the Multiple Risk Factor Intervention Trial (MRFIT) screenees strongly reinforces the fact that elevations of SBP are a more potent risk factor than elevation of DBP, even in middle-aged males.5 It now appears that, for

The Relative Importance of Focusing on Elevations of Systolic vs Diastolic Blood Pressure

Since the invention of indirect auscultatory sphygmomanometry at the turn of the century, physicians have tended to focus more on treating elevations of diastolic blood pressure (DBP) than elevations of systolic blood pressure (SBP). As described by Rutan et al,¹the primary focus on DBP resulted from theoretical concerns that the level of DBP was more related to end organ damage. Also, as mentioned by Mann²in the review article in this edition, the original Veterans Affairs Cooperative Study, the first to prove benefit in treating high blood pressure, focused on DBP. The fact that SBP rises on average throughout the life span in industrialized societies gave impetus to the notion that elevation of SBP was an aging-related phenomenon attributable to decreased compliance of the major arteries. A common clinical dictum for years was that a normal SBP for older persons was "100 plus the person's age." Therefore,