Mercury Sphygmomanometry Research Articles

Maternal smoking in pregnancy and blood pressure during childhood and adolescence: a meta-analysis

Arterial hypertension during childhood or adolescence is rising, and smoking during pregnancy may constitute a modifiable risk factor. This study aims to evaluate the effect of maternal smoking during pregnancy on diastolic (DBP) and systolic blood pressure (SBP) in childhood and adolescence. A bibliographic search was conducted in PubMed, Embase, and CENTRAL databases in March 2022. Meta-analysis was performed with the difference in mean-adjusted SBP/DBP of children and adolescents aged 3–17 years, according to maternal smoking/non-smoking in pregnancy. A random effects model was applied; a leave-one-out analysis and meta-analysis by subgroups were performed. A modified Newcastle–Ottawa scale was used to assess the quality of the studies. Evidence levels were rated using the GRADE system. Fifteen studies were included in the meta-analysis; all of them evaluated the mean-adjusted SBP difference in children or adolescents (N = 73,448), and 6 also that of DBP (N = 31,459). Results showed that maternal smoking during pregnancy significantly increased SBP (β = 0.31 mmHg 95% CI 0.14–0.49). A greater increase in mean-adjusted SBP was observed in those studies that completed the recruitment before 1990, were conducted in non-European countries, used standard mercury or manual sphygmomanometry, adjusted for birth weight, and were in the lowest quality subgroup. No significant association was found for DBP. The GRADE level of evidence was low for SBP and very low for DBP.Conclusion: Smoking in pregnancy might increase SBP in childhood and adolescence. Due to the low level of evidence, solid inferences cannot be drawn about the clinical relevance of these findings. What is Known:• AHT is the leading cause of premature death among adults worldwide.• Deleterious effects derived from SHS exposure on children's health have been documented since early 1970. To date, there are contradictory results about the effects of prenatal SHS exposure on children’s BP.What is New:• Smoking in pregnancy may increase SBP during childhood and adolescence.• Maternal smoking during pregnancy could have greater influence on their offspring's SBP than on DBP.

Comparison of the BPLab® Sphygmomanometer for Ambulatory Blood Pressure Monitoring with Mercury Sphygmomanometry in Pregnant Women: Validation Study According to the British Hypertension Society Protocol [Retraction

[This retracts the article DOI: 10.2147/VHRM.S82381.].

Reliability of Office, Home, and Ambulatory Blood Pressure Measurements and Correlation With Left Ventricular Mass

BackgroundDetermining the reliability and predictive validity of office blood pressure (OBP), ambulatory BP (ABP), and home BP (HBP) can inform which is best for diagnosing hypertension and estimating risk of cardiovascular disease. ObjectivesThis study aimed to assess the reliability of OBP, HBP, and ABP and evaluate their associations with left ventricular mass index (LVMI) in untreated persons. MethodsThe Improving the Detection of Hypertension (IDH) study, a community-based observational study, enrolled 408 participants who had OBP assessed at 3 visits, and completed 3 weeks of HBP, 2 24-h ABP recordings, and a 2-dimensional echocardiogram. Mean age was 41.2 ± 13.1 years, 59.5% were women, 25.5% African American, and 64.0% Hispanic. ResultsThe reliability of 1 week of HBP, 3 office visits with mercury sphygmomanometry, and 24-h ABP were 0.938, 0.894, and 0.846 for systolic and 0.918, 0.847, and 0.843 for diastolic BP, respectively. The correlations among OBP, HBP, and ABP, corrected for regression dilution bias, were 0.74 to 0.89. After multivariable adjustment including OBP and 24-h ABP, 10 mm Hg higher systolic and diastolic HBP were associated with 5.07 (standard error [SE]: 1.48) and 3.92 (SE: 2.14) g/m2 higher LVMI, respectively. After adjustment for HBP, neither systolic or diastolic OBP nor ABP was associated with LVMI. ConclusionsOBP, HBP, and ABP assess somewhat distinct parameters. Compared with OBP (3 visits) or 24-h ABP, systolic and diastolic HBP (1 week) were more reliable and more strongly associated with LVMI. These data suggest that 1 week of HBP monitoring may be the best approach for diagnosing hypertension.

Influence of Age on Upper Arm Cuff Blood Pressure Measurement.

Blood pressure (BP) is a leading global risk factor. Increasing age is related to changes in cardiovascular physiology that could influence cuff BP measurement, but this has never been examined systematically and was the aim of this study. Cuff BP was compared with invasive aortic BP across decades of age (from 40 to 89 years) using individual-level data from 31 studies (1674 patients undergoing coronary angiography) and 22 different cuff BP devices (19 oscillometric, 1 automated auscultation, 2 mercury sphygmomanometry) from the Invasive Blood Pressure Consortium. Subjects were aged 64±11 years, and 32% female. Cuff systolic BP overestimated invasive aortic systolic BP in those aged 40 to 49 years, but with each older decade of age, there was a progressive shift toward increasing underestimation of aortic systolic BP (P<0.0001). Conversely, cuff diastolic BP overestimated invasive aortic diastolic BP, and this progressively increased with increasing age (P<0.0001). Thus, there was a progressive increase in cuff pulse pressure underestimation of invasive aortic PP with increasing decades of age (P<0.0001). These age-related trends were observed across all categories of BP control. We conclude that cuff BP as an estimate of aortic BP was substantially influenced by increasing age, thus potentially exposing older people to greater chance for misdiagnosis of the true risk related to BP.

Cuff blood pressure is progressively more biased with increasing age: individual participant level analysis from the inspect consortium

ObjectivesAccurate blood pressure (BP) measurement is critical for appropriate hypertension diagnosis and management. Aortic BP represents pressure loading on vital organs and this can be approximated using upper arm cuff BP. With advancing age, cuff systolic BP (SBP) increases and diastolic BP (DBP) decreases (widening pulse pressure [PP]), but whether age may influence cuff BP compared with invasive BP is unknown and was the aim of this study. Methods: Cuff BP was measured simultaneously, or near-simultaneously, with invasive aortic BP during catheterization in 1696 individuals within the INSPECT consortium (an international collaboration comprising data from 31 studies and 19 different cuff BP devices [17 oscillometric, 2 mercury sphygmomanometry]). Differences in cuff and invasive BP were assessed using mixed models.ResultsSubjects were aged 63.3 ± 10.6 years and 32% female. Cuff SBP overestimated invasive aortic SBP in those aged 40–49, but with increasing age there was a progressive increase in the underestimation of aortic SBP (Table). Conversely, cuff DBP systematically overestimated aortic DBP, increasingly with age. Thus, there was a progressively higher error (underestimation) in cuff PP with older age. Adjusting models for sex, mean arterial pressure, heart rate and catheter type did not alter the findings, and no interactions between these parameters and age were found.ConclusionCuff BP is progressively more biased with increasing age, exposing older people to greater chance for misdiagnosis of risk related to BP. The findings highlight the need to improve cuff BP methods to ensure all people receive appropriate diagnosis and management of hypertension.TableAge categorynCuff - invasive systolic BPCuff – invasive diastolic BPCuff – invasive pulse pressure40–49 years1703.5 [0.5 to 6.6]4.5 [2.5 to 6.5]−0.7 [−4.4 to 2.9]50–59 years4060.9 [−1.2 to 2.9]5.6 [3.7 to 7.4]−4.6 [−7.2 to −2.1]60–69 years558−0.6 [−3.4 to 2.2]6.0 [4.1 to 8.0]−6.7 [−9.6 to −3.9]70–79 years456−3.3 [−5.5 to −1.1]7.9 [5.6 to 10.2]−11.0 [−14.2 to −7.9]80–89 years106−4.5 [−8.8 to −0.3]9.6 [5.9 to 13.2]−13.8 [−19.2 10−8.5]Data are mean [95% confidence interval], BP, blood pressure.

A17826 Cuff blood pressure is progressively more biased with increasing age

Objectives: Accurate blood pressure (BP) measurement is critical for appropriate hypertension diagnosis and management. Aortic BP represents pressure loading on vital organs and this can be approximated using standard upper arm cuff BP. With advancing age, cuff systolic BP (SBP) increases and diastolic BP (DBP) decreases (widening pulse pressure [PP]), but the extent to which age may influence cuff BP compared with invasive BP is unknown and was the aim of this study. Methods: Cuff BP was measured simultaneously, or near-simultaneously, with invasive aortic BP during cardiac catheterization in 1478 individuals within the INSPECT consortium (an international collaboration comprising data from 30 studies and 18 different cuff BP devices [16 oscillometric, 2 mercury sphygmomanometry]). Differences in cuff and invasive BP were assessed using mixed models to account for within study clustering of patients. Results: Subjects were aged 63.2 ± 10.8 years and 31% female. Cuff SBP overestimated invasive aortic SBP in those aged 40–49 years, but with increasing age there was a progressive increase in the underestimation of aortic SBP (Table). Conversely, cuff DBP overestimated aortic DBP systematically and increasingly with age. Thus, there was a progressively higher error (underestimation) in cuff PP with older age. Adjusting models for sex and mean arterial pressure did not alter the findings, and no interactions between these parameters and age were found. Conclusion: Cuff BP becomes progressively more biased with increasing age, thus exposing older people to greater chance for misdiagnosis of risk related to BP. The findings highlight the need to improve cuff BP methods to ensure all people receive appropriate diagnosis and management of hypertension.

Abstract P206: Interarm Difference in Blood Pressure: Prevalence, Risk Factors, and Relevance for Diagnosis of Disease of the Aorta Among Patients Referred to Specialized Regional Hypertension Center

Background: Initial evaluation of hypertension (HTN) should include assessment of blood pressure (BP) in both arms. The prevalence of high interarm differ ranges from 3% in the general adult population to about 10% in the patients with HTN. However, we lack proper estimates of its prevalence, and existing practice of follow up for these patients in a referred population. Methods: We performed a retrospective chart review of all prevalent patients followed at the Hypertension Center at the Ottawa Hospital. BP data from the first visit were used for assessment for interarm BP difference. We considered interarm difference in either systolic or diastolic BP in excess of 10 mmHg for casual BP by mercury sphygmomanometry to be clinically significant. Results: 493 patients of 580 patients were included in this study based on available data. The prevalence of clinically significant interarm difference in systolic or diastolic BP was 16.2% and was similar among men and women. These patients were more likely to be smokers (current or previous; 53.5% vs 36.8%) with peripheral arterial disease (PAD, 15% vs 8%). None of these patients had undergone further investigations of ascending aorta/aortic arch. Conclusions: A significant proportion of referred patients have a high interarm difference in systolic or diastolic BP. No clinical investigations were ordered to evaluate for ascending aorta/aortic arch disease reflecting the physicians’ lack of understanding of its clinical relevance. The association with smoking and PAD suggests underlying aortic/large vessel disease as a potential mechanism in some patients.

The association between serum uric acid and blood pressure in different age groups in a healthy Chinese cohort.

High serum uric acid (sUA) has been reported to be a risk factor for hypertension however, whether this is the case for all age groups is not clear. We examined the association between sUA concentrations and systolic and diastolic blood pressure (SBP and DBP) in different age groups in a cohort of healthy Chinese participants.A total of 1082 healthy participants aged from 41 to 70 years were included. sUA concentration was measured by the uricase-peroxidase method. SBP and DBP were assessed using mercury sphygmomanometry. Hypertension was defined as SBP ≥140 mm Hg or DBP ≥90 mm Hg. Hyperuricemia (HUA) was defined as sUA concentration of >7 mg/dL in men and >6 mg/dL in women. The association between sUA concentration and SBP and DBP was examined using Pearson's correlation test, multivariate linear regression, and logistic regression analysis.The prevalence of hypertension and HUA increased with age (P < .001). Hypertension was more common in participants that had HUA than in those that did not (38.95% vs 30.16%, P = .02). Higher sUA was significantly associated with higher SBP and DBP in the 41- to 50-year-old participants (SBP, β = 0.35, P < .001; DBP, β = .29, P < .001; after adjustment for age, sex, total cholesterol, estimated glomerular filtration rate, and fasting plasma glucose). HUA was also a risk factor for hypertension in this age group (odds ratio 1.425, 95% confidence interval, 1.217–1.668, P < .001). There was no association between sUA concentration and SBP and DBP in the other age groups.In this population of healthy Chinese participants, sUA concentration was positively associated with hypertension only in the 41- to 50-year-old group. Lowering uric acid in this age group may help to reduce the incidence of hypertension.

Diagnostic Procedures for Cardiac Arrhythmias, MI or Hypertension

Background: The goal of this study was to highlight the diagnostic methods and approaches toward most devastating cardiac disorders which are cardiac arrhythmias, MI and hypertensive. Methods: We searched thorough electronic databases as, MEDLINE, EMBASE using the following terms individually and/or in combination: ‘Cardiac arrhythmias’, ‘myocardial infarction (MI)’, ‘hypertension’, ‘ventricular arrhythmias’ and ‘diagnosis’, to look for the most important and relevant articles concerning with the diagnostic approaches of hypertension, MI, and arrhythmias in general. Conclusion: Some ideal cardiac biochemical markers need to have not only high level of sensitivity but additionally high specificity to coronary infarction. The creatine kinase-MB, a reasonably certain cardiac marker, could be elevated in situations other than acute myocardial infarction. The ECG continues to be a cornerstone in the diagnosis of MI as well as need to be regularly duplicated, particularly if the first ECG is not analysis of MI. The diagnosing high blood pressure consist of 24-h ambulatory blood pressure monitoring (ABPM) as well as self-home) BP surveillance (SBPM) as optional methods for determining hypertensive patients. None of the current standards have actually yet consisted of ABPM or SBPM as essential devices for detecting hypertension, preferring instead to depend on standard workplace analyses tape-recorded by mercury sphygmomanometry.

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Objectives To assess the Microlife 3AS1-2, a semi-automated oscillometric BP device, compared to mercury sphygmomanometry for use in pregnancy and pre-eclampsia in a low resource setting, according to the requirements of the British Hypertension Society (BHS) Protocol and the International Organization of Standardization (ISO). Methods Prospective observational study, using validation methods recommended by the BHS. 45 pregnant women were recruited from Kimberley Hospital, South Africa, of which 15 were pre-eclamptic. 10 women were in their second trimester, 10 were in their third trimester and 10 had an arm circumference >35 cm. All participants provided written consent. Any subject with cardiac arrhythmia or unclear Korotkoff sounds was excluded. Results The Microlife 3AS1-2 device achieved an overall B/A grade in pregnancy (including pre-eclampsia) and passed all the BHS protocol requirements. The device achieved the ISO standard for mean difference and standard deviation (⩽5 ± 8 mmHg) in pregnancy (including pre-eclampsia). Conclusions The Microlife 3AS1-2 device can be recommended for use in pregnancy, including pre-eclampsia, according to BHS and ISO protocols. As well as demonstrating accuracy in a pregnant low-resource population, it also fulfils all of the requirements stipulated by the World Health Organization for an automated device suitable for use in a low-resource setting. This makes it the ideal device for use in antenatal clinics and primary health-care facilities in low- and middle-income countries. Table 1. Results according to the BHS protocol. Grade ⩽5 mmHg ⩽10 mmHg ⩽15 mmHg Mean difference ± SD (mmHg) Pregnancy (n = 30) Systolic BP A 63 86 96 −2.9 ± 7.4 Diastolic BP A 81 93 99 0.3 ± 5.0 Pregnancy (incl. pre-eclampsia (n = 45)) Systolic BP B 58 82 95 −3.8 ± 7.3 Diastolic BP A 70 90 97 −1.5 ± 6.2 Disclosures H.L. Nathan: None. A. de Greeff: None. N.L. Hezelgrave: None. K.E. Duhig: None. L.C. Chappell: None. A.H. Shennan: None.

PMM.51 An Accurate Semi-Automated Oscillometric Blood Pressure (BP) Device for Use in Pregnancy in a Low- and Middle-Income Country Population: the Microlife 3AS1–2

ObjectivesTo assess the Microlife 3AS1–2, a semi-automated oscillometric BP device, compared to mercury sphygmomanometry for use in pregnancy and pre-eclampsia in a low resource setting, according to the requirements of...

Comparison of indirect and direct blood pressure measurements in baboons during ketamine anaesthesia

The aim of this study was to assess agreement between different methods of blood pressure measurement in anaesthetised baboons. Systolic and diastolic blood pressure (SBP and DBP) were measured in anaesthetised baboons using intra-arterial radiotelemetry, automated oscillometry and mercury sphygmomanometry. Correlation between the different methods was assessed. The correlation between intra-arterial radiotelemetry and automated oscillometry was 0.9 (P<0.001) for SBP and 0.9 (P<0.001) for DBP. Between-method differences were -4.4±7.2mm Hg for SBP and -3.4±7.1mm Hg for DBP. For automated oscillometry vs. mercury sphygmomanometry, correlation was 0.4 for both SBP (P<0.001) and DBP (P<0.001). Between-method differences were 7.9±12.7mm Hg for SBP and 7.3±12.6mm Hg for DBP. Our study demonstrates that automated oscillometry may be an appropriate alternative to telemetry for measuring blood pressure in anaesthetised baboons.

Central vs. peripheral blood pressure components as determinants of retinal microvessel diameters

BackgroundWe assessed association of retinal arteriolar and venular diameters with central and peripheral blood pressure (BP). MethodsWe post-processed retinal photographs from 514 participants randomly recruited from a Flemish population (mean age, 50.6 years; 50.8% women), using IVAN software to generate retinal arteriolar (CRAE) and venular (CRVE) equivalents. We measured peripheral BP by mercury sphygmomanometry and central BP by tonometry at the carotid artery. We applied multivariable-adjusted regression analysis. ResultsFor peripheral vs. central BP (mmHg) average levels were 126.6 vs. 122.1 systolic and 79.4 vs. 79.6 diastolic, and 95.1 vs. 97.9 and 47.2 vs. 42.5 for mean and pulse pressure, respectively. CRAE and CRVE averaged 153 μm and 219 μm. Effect sizes (μm) for CRAE for 1 − SD increase in peripheral vs. central BP were −3.77 vs. −3.52 systolic, −3.16 vs. −3.13 diastolic, −3.84 vs. −3.64 for mean BP, and −2.07 vs. −1.83 for pulse pressure (p ≤ 0.006). Models that included two BP components demonstrated that CRAE decreased (p ≤ 0.035) with systolic (peripheral vs. central, −2.87 vs. −2.40) and diastolic (−1.58 vs. −1.80) BP. CRAE decreased with mean BP (−3.53 vs. −3.53; p < 0.0001), but not with pulse pressure (p ≥ 0.19). CRVE was not related to any peripheral or central BP component (p ≥ 0.062). All CRAE regression slopes on corresponding peripheral and central BP components were similar (p ≥ 0.28). ConclusionHigher systolic, diastolic and mean BPs were associated with smaller CRAE, regardless of whether BP was measured centrally or peripherally. Central BP does not refine the inverse association of CRAE and CRVE with peripheral BP.

Measuring blood pressure in pregnancy and postpartum: assessing the reliability of automated measuring devices

Objective: To determine the reliability of automated blood pressure (BP) measuring devices in hypertensive pregnancies. Methods: Three sequential measurements were taken using mercury sphygmomanometry and an automated device in pregnant hypertensive women (n = 89). Results: Systolic BP (SBP) was higher with the automated device (mean difference 2.5 mmHg, 95% CI: 1.9–3.2 mmHg), whereas diastolic BP (DBP) was higher with the mercury sphygmomanometer (mean difference 2.0 mmHg, 95% CI: 1.5–2.6 mmHg). Within-patient variability for the automated device was: SBP 4.8 mmHg (95% CI: 4.6–5.2 mmHg), DBP 3.4 mmHg (95% CI: 3.1–3.7 mmHg); and for mercury sphygmomanometry: SBP 3.7 mmHg (95% CI: 3.5–4.0 mmHg), DBP 3.0 mmHg (95% CI: 2.8–3.3 mmHg). Conclusion: Outpatient automated BP measurement agrees well with mercury sphygmomanometry in hypertensive pregnancies.

Clinical accuracy of inflationary oscillometry in pregnancy and pre-eclampsia: Omron-MIT Elite

ObjectiveTo evaluate the accuracy of the Omron MIT Elite in pregnancy and pre-eclampsia according to the British Hypertension Society protocol (BHS). DesignProspective observational study. SettingAntenatal clinics and wards at St. Thomas’ Hospital (London, UK). PopulationForty-five pregnant women including 15 with pre-eclampsia. MethodsNine sequential same arm blood pressure (BP) measurements were taken from each woman by trained observers, alternating between mercury sphygmomanometry and the test device. Main outcome measuresGrading criteria of the BHS protocol (A/B grade=pass; C/D=fail). ResultsThe Omron MIT Elite achieved a grade A/A in both pregnancy and pre-eclampsia. The mean difference (SD) between the mercury standard and the device in pregnancy was −1.1 (5.2)mmHg and 1.5 (4.8)mmHg for systolic and diastolic BP respectively compared to 0.2 (5.3)mmHg and 2.2 (5.5)mmHg in pre-eclampsia. ConclusionThe Omron MIT Elite can be recommended for use in pregnancy and pre-eclampsia according to the BHS protocol. To date, this is the most accurate automated BP device validated in pre-eclampsia.

Validation of a solar powered blood pressure device, suitable for use in low resource settings

Hypertensive diseases in pregnancy are a significant cause of morbidity and mortality, particularly in low resource settings (LRS). Pre-eclampsia and eclampsia alone claim up to 50 000 women's lives globally...

A Prospective Randomized Study of Automated versus Mercury Blood Pressure Recordings in Hypertensive Pregnancy (PRAM Study)

Background. Mercury sphygmomanometry is being replaced with automated blood pressure (BP) recording. We tested the potential impact of this change on the outcomes of pregnant women with hypertension. Methods. Following routine detection of hypertension by mercury sphygmomanometry, 220 pregnant women with hypertension were randomized to have all subsequent BPs recorded with either mercury sphygmomanometry or an automated BP device (Omron HEM-705CP) for the remainder of their pregnancy. We used a prospective randomized open study with blinded end points design. Main Outcome Measures. The primary maternal outcome measure was the number of women having any episode of severe hypertension (BP 170/110 mmHg). The primary fetal outcome measure was small for gestational age baby. Results. Both groups were similar in age, weight, parity, race, use of assisted reproductive technology before this pregnancy, diabetes prevalence, smoking, mercury BP in the first trimester, use of antihypertensives at the time of study entry, and type of hypertension (essential, gestational or preeclampsia) at study entry. Severe hypertension occurred in 39% of women using mercury sphygmomanometry and 44% using the automated device (p = 0.5). Small for gestational age rates were 12 and 17%, respectively (p = 0.3). About 47% of women had preeclampsia at delivery. Birth weight and perinatal mortality were similar between groups. Conclusions. Using this automated BP recording device in hypertensive pregnant women is associated with similar maternal and fetal outcomes as in women whose BP is measured by sphygmomanometry, despite intra-individual BP differences between the two methods of recording BP.

Can We Use the Omron T9P Automated Blood Pressure Monitor in Pregnancy?

Background. Recent events in our hospital, combined with international recommendations, catalyzed the need to move from mercury sphygmomanometry to automated blood pressure (BP) recording in pregnancy. Aim. To test the accuracy of the Omron T9P automated BP recorder in pregnant women, using mercury sphygmomanometry as the gold standard. Setting. Antenatal clinics and obstetric day assessment unit, St George Hospital, Sydney. Participants. Eighty-five pregnant women, 11% of whom were receiving antihypertensives. Methods. Differences in both systolic and diastolic BP between the T9P Omron device and mercury sphygmomanometer were obtained for each woman, using sequential automated and mercury BP recordings, as required by a modified British Hypertension Society (BHS) protocol. The accuracy of the device was graded according to the BHS and the Association for the Advancement of Medical Instrumentation (AAMI) standards. Results. The Omron T9P device received an A/A grade according to this modified BHS and AAMI testing process, though the range of the 255 differences was 1–13 for systolic BP and 1–10 for diastolic BP. Conclusions. The Omron T9P device is an accurate device for use predominantly in an outpatient antenatal clinical setting. Further studies are required solely within hypertensive pregnant women before its use can be recommended with certainty in this group.

Accuracy Assessment of the Dinamap ProCare 400 in Pregnancy and Preeclampsia

Objective. To assess the accuracy of the Dinamap ProCare 400 in pregnancy and preeclampsia, according to the British Hypertension Society protocol. Methods. Ethical approval was obtained. Forty-five women were recruited at two large teaching hospitals. Nine sequential same arm measurements were taken from each woman alternating between the Dinamap and mercury sphygmomanometry. Results. The device achieved an A/A grade (pregnancy) and an A/B grade (preeclampsia). Mean difference (SD) were 1.1(5.8)/0.1(5.7) mmHg (pregnancy) and –0.5(5.4)/0.9(9.5) mmHg (preeclampsia) for systolic/diastolic. Conclusion. The Dinamap ProCare 400 is recommended for use in pregnancy and has good accuracy in preeclampsia, although caution is still advised.

Validation of the Nissei DS-400 in a low-resource setting

Hypertension affects approximately one billion individuals worldwide. The effective management of hypertension requires accurate measurement and monitoring of blood pressure. We evaluated the accuracy of a low cost self-measurement oscillometric device, with features suitable for use in a low-resource setting, in an adult population in the developing world according to the International Protocol of the European Society of Hypertension. Trained observers using a double-headed stethoscope took nine sequential same arm measurements from 33 participants, alternating between mercury sphygmomanometry and the test device. Anyone with an arrhythmia or unclear Korotkoff sounds was excluded. Data were analyzed according to the protocol guidelines. The device passed all the criteria of the International Protocol with 78/95/99 and 80/95/99 of systolic and diastolic differences, respectively, within 5/10/15 mmHg of the mercury standard. It also achieved the Association for the Advancement of Medical Instrumentation criteria with a mean difference (standard deviation) of 0.8 (4.4) mmHg and -0.9 (4.5) mmHg for systolic blood pressure and diastolic blood pressure, respectively. The Nissei DS-400 can be recommended for use in the adult population, particularly in the developing world. Its impressive performance may be related to theoretical factors within the patient population and environment (e.g. temperature, humidity and altitude) that could influence the device's performance.