Blood Pressure Measurement Methods Research Articles

Highly sensitive resistance-type flexible pressure sensor for cuffless blood-pressure monitoring by using neural network techniques

Blood pressure is an important parameter of a heart-pumping function, vascular peripheral resistance, and blood volume in human body. The non-invasive blood pressure measurement method has attracted tremendous attention due to its advantages of simple operation and comfort. In this paper, graft-modified MWCNTs and water-based polyurethane are used as filler and matrix, which are combined with simple dipping process to produce a resistance-type flexible pressure sensor with crack structure. The sensor with crack structure exhibits a high gauge factor (∼1582.7), fast response time (∼58 ms) and good repeatability (>2000 cycles) under 0–5% strain. By attaching the sensor to the radial artery of human wrist, the pulse waveform is accurately captured. By adopting the time-domain analysis method, in addition to the fast Fourier transform and threshold method which is employed to position and extract the characteristic value of pulse signal, a three-layer back propagation neural network is constructed to regress blood pressure value. The correlation coefficients of systolic blood pressure, diastolic blood pressure and mean blood pressure were 0.950, 0.875 and 0.947, respectively, which could meet the A-level standards of British Hypertension Society and Association for the Advancement of Medical Instrumentation. This study provides a good real-time and portable technology for home blood pressure measurement.

Accuracy Analysis of Various Blood Pressure Measurement Methods by 119 Paramedics

Background/Objectives: This study is to confirm the accuracy of various blood pressure measurementmethods by 119 paramedics.Methods/Statistical analysis: This study evaluated the accuracy of blood pressure measurement andthe confidence of blood pressure measurement in stable, stable and noisy, driving, and driving noisesituations for 40 119 paramedics. The collected data were analysed with SPSS 22.0 using frequency,descriptive statistics, and paired t-test.Findings: The confidence of blood pressure measurement was significantly higher in four situationsafter education. In blood pressure measurement accuracy, there was the significant difference in thefollowing situations: Stable noisy and driving noisy in normal blood pressure(t=-2.823, p=.007).Stabledriving, stable noisy(t=-2.191, p=.034), and driving noisy(t=-2.421, p=.020)in hypertension. Stabledriving, stable noisy(t=-3.674, p=.001), and driving noisy(t=-2.095, p=.043) in hypotension. In theaccuracy of blood pressure measurement by palpation, there was the significant difference in stable anddriving situation under hypotension(t=-2.211, p=.033).Improvements/Applications: The education on blood pressure measurement in various environmentsis necessary to improve the measurement accuracy of 119 emergency personnel.

Piezoelectric Sensor for the Monitoring of Arterial Pulse Wave: Detection of Arrhythmia Occurring in PAC/PVC Patients.

Previous studies have found that the non-invasive blood pressure measurement method based on the oscillometric method is inaccurate when an arrhythmia occurs. Therefore, we propose a high-sensitivity pulse sensor that can measure the hemodynamic characteristics of the pulse wave and then estimate the blood pressure. When an arrhythmia occurs, the hemodynamics of the pulse wave are abnormal and change the morphology of the pulse wave. Our proposed sensor can measure the occurrence of ectopic beats from the radial artery, and the detection algorithm can reduce the error of blood pressure estimation caused by the distortion of ectopic beats that occurs when the pulse wave is measured. In this study, we tested patients with premature atrial contraction (PAC) or premature ventricular contraction (PVC) and analyzed the morphology of the pulse waves when the sensor detected the ectopic beats. We discuss the advantages of using the Moens–Korteweg equation to estimate the blood pressure of patients with arrhythmia, which is different from the oscillometric method. Our research provides a possible arrhythmia detection method for wearable devices and can accurately estimate blood pressure in a non-invasive way during an arrhythmia.

Comparison of a self-automated blood pressure measurement according to the American Heart Association recommendation versus a routine practice, a randomized-controlled trial

Abstract Background Home blood pressure monitoring is currently a gold standard for guiding an adjustment of antihypertensive medications. According to the American Heart Association (AHA), the self-automated blood pressure (BP) measurement may represent accurate home BP. However, there is a limited data in real-world practice Objective To explore the accuracy of a self-automated BP measurement in representing the actual home BP monitoring, in comparison with a single spot-arm automated BP measurement, which is routinely used in the clinical setting. Methods We conducted a single center, randomized cross-over trial. At the Cardiology clinic, hypertensive patients aged between 18 and 80 years, who were able to perform self-automated BP measurement, were included in the study. The patients were categorized into two groups using different BP measurement methods: a self-automated BP measurement according to the AHA Recommendation 2017 and a single spot-arm automated BP measurement, and then crossed over to alternative methods. All participants were instructed to rest at least 5 minutes prior to undergo BP measurement in both methods. The data of BP measurements were subsequently compared with the standard home BP monitoring. Results Overall, 190 patients underwent randomization. Mean differences of systolic blood pressure (SBP) in the self-automated AHA measurement and the single spot-arm measurement, compared with the standard home BP monitoring, were 3.57 mmHg (95% confidence interval (CI); 1.39 to 5.74 mmHg) and 9.44 mmHg (95% CI; 7.03 to11.86 mmHg), respectively (P<0.001) (table1). Mean differences of diastolic blood pressure (DBP) in the self-automated AHA and the single spot-arm measurements, compared with the standard home BP were −1.51 mmHg (95% CI; −2.76 to −0.25) and 2.69 mmHg (95% CI; 1.07–4.31), respectively (P<0.001) (table 1). White coat hypertension was detected in 7 (3.72%) of patients by AHA measurement and 17 (9.04%) by the single-spot arm measurement (P=0.008). Conclusion The self-automated BP measurement according to the AHA Recommendation 2017 was more accurate than the single spot-arm automated BP measurement in representing the actual home BP monitoring and reduced the possibility of the white coat effect. Funding Acknowledgement Type of funding sources: None. Table 1

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Accuracy of a cuffless blood pressure measurement with a single-channel electrocardiogram monitor with photoplethysmography

Abstract Introduction The accurate assessment of the blood pressure (BP) allows to diagnose of the cardiovascular diseases and correct their treatment timely. Cuff-less BP measurement can be more convenient to use and can also provide the blood pressure monitoring using with telemedicine. In this study, we evaluated the cuff-less BP measurement method based on photoplethysmography. Purpose To evaluate the accuracy of cuffless blood pressure measurement using with the single-channel electrocardiogram (ECG) monitor with photoplethysmography pulse wave registration. Methods The study included 500 patients aged from 32 to 88 years (mean 64±7,9 years) with arterial hypertension. We used the single-channel electrocardiogram monitor with photoplethysmography, this device looks like a phone case and records electrocardiogram (I standard lead) and photoplethysmogram (PPG) simultaneously. For each patient, blood pressure was measured using a sphygmomanometer with a cuff (3 times and the mean value was calculated). Then within 1 minute after blood pressure measurement, an electrocardiogram and photoplethysmogram were recorded for 3 minutes using the single-channel electrocardiogram monitor with photoplethysmography. ECG and PPG were recorded from the patient's fingers in a sitting position. According to the combination of the electrocardiogram signal and the photoplethysmogram signal, using a special algorithm based on machine learning, the levels of systolic and diastolic blood pressure were calculated. We compared measurement of blood pressure obtained using with the sphygmomanometer and the single-channel electrocardiogram monitor with photoplethysmography.We used the Bland-Altman method for statistical data analysis. Results In total of 1000 blood pressure measurements were obtained from 500 patients. According to the Bland-Altman analysis of systolic pressure the average discrepancy was 3,49 mmHg, the standard deviation was 4,21, the standard error of the average was 0,61. One-sampled 2-sided t-test was −0,477 (confidence interval −2.83; −4.33). The average discrepancy for diastolic blood pressure was 3,1 mm Hg, the standard deviation was 3,61 mm Hg, standard error of the average 0,52, One-sampled 2-sided t-test was −0,455 (95% confidence interval −2,64; −4,18). The correlation of the systolic and diastolic pressure using with two measurement methods was 0,89 (p=0,001) and 0.87 (p=0,002), respectively. Conclusion There is not significant difference between the results of cuffless measurement of the blood pressure by the single-channel electrocardiogram monitor with photoplethysmography and cuff-based sphygmomanometer measurement in patients with cardiovascular diseases. Funding Acknowledgement Type of funding sources: None.

Validation of the InBody BPBIO210 manual auscultatory hybrid device for professional office use in a general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard.

To evaluate the accuracy of the InBody BPBIO210 manual auscultatory mercury-free hybrid blood pressure (BP) measuring device for professional office use in a general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018). Subjects were recruited to fulfil the age, sex, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in a general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumference 22-32 (medium) and 32-42 cm (large). A total of 94 subjects were recruited and 86 were analysed (mean age 53.7 ± 18.4 [SD] years, 50 men, arm circumference 32.5 ± 4.8 cm, range 22-42 cm). For the validation Criterion 1, the mean ± SD of the differences between the test device and reference BP readings was -1.0 ± 4.1/-0.7 ± 2.5 mmHg (systolic/diastolic). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 2.65/1.59 mmHg (systolic/diastolic). The InBody BPBIO210 manual auscultatory hybrid device for professional office BP measurement fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in a general population and can be recommended for clinical use.

In vitro validation of a non-invasive continuous blood pressure measurement method for the perioperative application

Abstract Hypotensive periods during surgery lead to an increase in postoperative complications. To further avoid the adverse events associated with the invasive measurement of the blood pressure, a perioperative, continuous, non-invasive blood pressure measurement method was developed. The precision of the method was tested for different mean pressure values and different thicknesses of the tissue model using a specifically designed and validated simulator that has the characteristics of the lower arm. The mean pressure difference between the pressure determined by the proposed method and simulated blood pressure from the simulator was 3.93 mmHg (±4.75 mmHg) for the systole and 4.89 mmHg (±6.10 mmHg) for the diastole. The results showed that the method can be a promising alternative to invasive blood pressure measurement methods.

280 Arterial Line versus Noninvasive Blood Pressure Monitoring in Hypertensive Emergencies

Blood pressure (BP) monitoring is important for managing patients with hypertensive emergencies. Management of such conditions often involves relatively narrow and specific blood pressure windows. While invasive arterial blood pressure (IABP) monitoring is considered the gold standard method of BP measurement, its usefulness is unclear. Although previous studies demonstrated differences between IABP and NIBP values, few had assessed whether these differences would affect clinical management. Our study aimed to determine whether the difference between NIBP and IABP would change BP management in patients with hypertensive emergencies. This was a prospective observational study of adult patients with any hypertensive emergency admitted to the Critical Care Resuscitation Unit (CCRU) at a quaternary academic center from January 2019—April 2021. We included consecutive patients with diagnoses of ischemic stroke, acute aortic disease, spontaneous intracranial hemorrhage (sICH), etc, and who required arterial monitoring. We excluded patients who had hypertensive diagnoses but required vasopressors due to overtreatment of anti-hypertensive medications or those who had arterial catheters prior to arrival. All arterial catheters were inserted upon patients’ arrival per CCRU clinical policy. Patients who had IABP and NIBP in the same extremity and four consecutive measurements of each modality following arterial catheter placement were eligible. Before arterial catheter placement, we recorded in real time clinicians’ decisions to manage patients’ systolic BP (SBP) according to the NIBP values and current guidelines, for example maintaining SBP ≤160 mmHg for patients with sICH. After the arterial catheter was placed, we again recorded in real time clinicians’ management of patients’ arterial SBP. We defined change in clinical management as any difference in blood pressure management (eg, adding a new antihypertensive agent, increasing or decreasing dose). We used Classification and Regression Tree (CART) analysis to identify sensitive and specific clinical predictors of management differences. A total of 183 patients were identified and analyzed, 71 (39%) female. Mean age was 63 years (standard deviation [SD] 14), mean body mass index (BMI) was 29 (6). Mean difference between IABP and NIBP and was 11 mmHg (95% CI 5-17). One hundred and seventeen patients (64%) had difference >10 mmHg between the two modalities, while 70 (38%) had a difference >20 mmHg. Seventy-nine patients (43%) had a change in management after arterial catheters were inserted. The most important factors in predicting management change included mean SBP >148 mmHg. Subsequent important factors were BMI >21, difference in BP value [IABP – NIBP] >6 mmHg, and diagnoses of ruptured abdominal aortic aneurysm, ischemic stroke + alteplase, any aortic dissection. Arterial BP monitoring identified a change in clinical management in almost half of patients with hypertensive emergencies. Clinicians should consider using arterial BP monitoring more frequently in the management of hypertensive emergencies, especially when strict BP goals are warranted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

PTT-based Contact-less Blood Pressure Measurement using an RGB-Camera

Abstract Commonly used blood pressure measurement devices have noticeable limitations in accuracy, measuring time, comfort or safety. To overcome these limitations, we developed and tested a surrogate-based, non-invasive blood pressure measurement method using an RGB-camera. Our proposed method employs the relation between the pulse transit time (PTT) and blood pressure. Two remote photoplethysmography (rPPG) signals at different distances from the heart are extracted to calculate the temporal delay of the pulse wave. In order to establish the correlation between the PTT values and the blood pressure, a regression model is trained and evaluated. Tests were performed with five subjects, where each subject was recorded fifteen times for 30 seconds. Since the physiological parameters of the cardiac system are different for each person, an individual calibration is required to obtain the systolic and diastolic blood pressure from the PTT values. The calibration results are limited by the small number of samples and the accuracy of the reference system. However, our results show a strong correlation between the PTT values and the blood pressure and we obtained a mean error of 0.18 +/- 5.50 mmHg for the diastolic blood pressure and 0.01 +/- 7.71 mmHg for the systolic pressure, respectively.

Методи вимірювання артеріального тиску лікарями та пацієнтами

Артеріальний тиск (АТ), що вимірюється лікарем на прийомі в кабінеті, називається офісним АТ, в домашніх умовах — домашнім АТ. Коли пацієнт самостійно вимірює артеріальний тиск в домашніх умовах — самомоніторування АТ. Коли АТ вимірюється протягом доби за допомогою спеціального портативного приладу — амбулаторне або добове (24-годинне) моніторування АТ. Аускультативний метод на сьогодні є офіційним еталоном неінвазивного визначення АТ для діагностики артеріальної гіпертензії. Крім того, він використовується для неінвазивної верифікації автоматичних вимірювачів артеріального тиску. На даний момент осцилометричні прилади становлять більше 80 % усіх автоматичних і напівавтоматичних приладів для побутового вимірювання АТ. Серед сучасних професійних апаратів для амбулаторного вимірювання і моніторування АТ осцилометричні прилади становлять близько половини, до 25 % — аускультативні і 25 % — комбіновані прилади. Найбільш простим ручним приладом для вимірювання артеріального тиску залишається ртутний сфігмоманометр. Саме при використанні ртутних сфігмоманометрів була доведена точність самого методу неінвазивного вимірювання артеріального тиску за Ріва-Роччі і Коротковим. Заборона ртуті в багатьох країнах сприяла розвитку і поширенню напів- і повністю автоматичних приладів для вимірювання артеріального тиску методом осцилометрії. АТ вимірюється двічі, з інтервалом 2–3 хвилини, і фіксується середня цифра з двох вимірів. Якщо різниця між результатами становить більше 5 мм рт.ст., необхідно ще раз виміряти артеріальний тиск.

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.

Blood pressure visit-to-visit variability and outcomes in patients with heart failure with preserved ejection fraction.

AimsPrevious studies report that blood pressure (BP) variability is associated with increased risk of adverse outcomes in patients diagnosed with cardiovascular disease. However, studies have not fully explored this association in patients with heart failure with preserved ejection fraction (HFpEF). This study sought to explore the association between visit‐to‐visit variability (VVV) of BP and clinical outcomes in patients with HFpEF.Methods and resultsA total of 1988 patients (mean age of 67.73 ± 9.22, 51.7% female) from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial were included in this study. BP‐VVV was determined by standard deviation (SD) of mean systolic BP (SBP‐SD) from six measurements (baseline and months 1, 2, 4, 8, and 12) during the first 12 months after randomization. Mean on‐treatment SBP during the first 12 months was 127.77 ± 10.42 mmHg, and the median of SBP‐SD was 8.15 mmHg. A total of 192 (9.7%) patients met the primary outcome during the subsequent median follow‐up of 35.16 months, including a composite of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest. Multiple Cox regression analysis showed that SBP‐SD was independently associated with the increased risk of the primary outcome after adjusting for age, gender, method of BP measurement, treatment, renal function and common co‐morbidities, and the mean SBP during the first 12 months [hazard ratio (HR) for fourth vs. first quartile, 1.63; 95% confidence interval (CI), 1.07–2.49; P = 0.024]. Analysis showed that SBP‐SD as continuous variable was associated with a 23% increase in the risk of primary outcome (HR 1.23, 95% CI 1.06–1.43; P = 0.006).ConclusionsThe findings of the current study show that high SBP‐VVV in patients with HFpEF is associated with an increased risk of adverse outcomes independent of the mean on‐treatment SBP.

Knowledge, perception and practice of Québec nurses for ambulatory and clinic blood pressure measurement methods: are we there yet?

Guidelines regarding blood pressure measurement (BPM) methods, namely home (HBPM), ambulatory (ABPM), office (OBPM) and automated (AOBP) are published by Hypertension Canada and rely on accurate measurement technique. Nurses commonly perform BPM but their knowledge, perception and practice considering all methods is understudied. This study is the first to establish the picture of Québec nurses working in primary care settings concerning the four BPM methods. All nurses licensed to practice in primary care in Québec were targeted in our survey. Data were collected using a validated and pretested investigator-initiated questionnaire in English and French. A personalized e-mail invitation, and two reminders, including a link to a secured platform was sent in December 2019. A certificate of ethics was issued by UQTR. A total of 453 nurses participated in the study. Median age was 40 ± 11 years, and 92% were women. The overall score on BPM methods knowledge was slightly below 50% (46% ± 23). The perception was mostly positive, with an overall score above 50% (73% ± 8). In practice, HBPM was recommended by 47% of nurses, and ABPM by 18%. Although AOBP is the preferred method in Canada, only 25% of the nurses use it, including the 57% that use an oscillometric device and 11% that use manual auscultation. Nurses working in primary care play a central role in BPM. Our results highlight that overall knowledge and practice are suboptimal. Resources should, therefore, be allocated to ensure that initial training and continuing education are addressed.

Comparison of nurse attended and unattended automated office blood pressure with conventional measurement techniques in clinical practice.

Accuracy in blood pressure measurement is critical for proper hypertension diagnosis and treatment in clinical practice. Automated office blood pressure (AOBP) can simplify the measurement process, reducing human error and minimizing the white-coat effect in the unattended mode. The aim of this study was to compare AOBP, both unattended and nurse attended, with conventional office and out-of-office blood pressure measurement techniques. Four different methods of blood pressure measurement were performed in a cohort of hypertensive patients: conventional office blood pressure (OBP), unattended automated office blood pressure (uAOBP), nurse attended automated office blood pressure (nAOBP), and home blood pressure monitoring (HBPM). uAOBP and nAOBP were conducted with the same rigorous standardized procedure. We enrolled 118 consecutive patients. nAOBP values were slightly higher than uAOBP ones (respectively 132.8/73.3 ± 19.4/12.9 and 129.2/71.1 ± 19.0/12.3 mmHg), even if the difference was influenced by order of execution of AOBP measurement. nAOBP was significantly lower than HBPM and OBP (mean values 135.2/80.9 ± 16.6/8.1 and 140.9/84.6 ± 18.7/10.8 mmHg, respectively). AOBP, either attended or unattended, provides lower values than conventional OBP. uAOBP and nAOBP values showed small differences, even if they are not completely interchangeable. This evidence reflects a lower white-coat effect, even in nurse attended technique, but is also due to a lower measurement error through the application of a rigorous standardized protocol.

Blood pressure measurement in pediatric population: comparison between automated oscillometric devices and mercury sphygmomanometers-a systematic review and meta-analysis.

With the progressive elimination of mercury column devices for blood pressure (BP) measurement in children and adolescents, valid alternatives are needed. Oscillometric devices provide a replacement without mercury, are fully automated, and have excellent reliability among evaluators. Here, the goal was to test the accuracy of automatic blood pressure monitor devices compared to the mercury sphygmomanometer for BP measurement in children and adolescents. Electronic databases are EMBASE, MEDLINE (PubMed), SCOPUS, and Web of Science. We selected 8974 potentially eligible articles and two authors independently. We separately reviewed 370 full papers. Potentially eligible articles were selected according to the following criteria: (a) articles published in Portuguese, English, and Spanish; (b) screening of titles; (c) screening of abstracts; and (d) retrieval and screening of the full article to determine whether it met the inclusion criteria. We included 45 articles for analysis, 28 of which were selected for meta-analysis. The systolic BP measured by automatic blood pressure monitors presents 1.17mmHg on average (95% CI 0.85; 1.48); for diastolic BP, it produced -0.08mmHg (95% CI -0.69; 0.54) compared with a mercury sphygmomanometer. There is high heterogeneity between studies (> 90%) in the meta-analysis, partly explained by the device model, study environment, and observer training. Only articles that reported BP measurement by both methods were included.Conclusion:Automatic blood pressure monitors have strong measurement validity when compared with the mercury column. Thus, these can be safely used in blood pressure measurements of children and adolescents in clinical and epidemiological studies. What is Known: •The "gold standard" for indirect BP measurement is the mercury sphygmomanometer. •The accuracy of the automatic device is critical to any blood pressure measurement method. What is New: •Oscillometric or automatic devices can be a suitable alternative to auscultation for initial screening, consistent with current pediatric guidelines. •The automatic devices compared to the mercury column have a good validity of measurements, which can be used in blood pressure measurements of children and adolescents in clinical and epidemiological settings, provided that international protocols are followed.

Comparison of questionnaire responses regarding awareness of Japanese Society of Hypertension guidelines for the management of hypertension between 2014 and 2019 in primary care.

In 2019, the Japanese Society of Hypertension guidelines for the management of hypertension (JSH) were revised. We previously reported the awareness of JSH among general practitioners in 2014, and in the current study, the same questionnaire was administered to determine their awareness of JSH 2019, and their responses were compared. We also sought to identify effective strategies to raise awareness of hypertension. The questionnaires included the same 12 questions as in 2014 and were mailed to members of two professional organizations from October to November 2019. Responses from 256 general practitioners in 2019 and 209 in 2014 were compared using the propensity score matching method to align the responders’ backgrounds. Component analysis was performed to classify responders into appropriate clusters. The matched cohort of all 202 responders was analyzed. In both 2014 and 2019, >80% of responders instructed patients to perform home blood pressure monitoring (JSH 2014: 81.7% and JSH 2019: 84.6% in the matched cohort), and >70% instructed patients with hypertension to restrict their salt intake (JSH 2014: 79.7% and JSH 2019: 74.7% in the matched cohort). Regarding the clinical blood pressure measurement method, more responders answered “one time outside the consulting room” in the JSH 2019 group (p = 0.042). Fewer general practitioners responded that differential diagnosis for primary aldosteronism was performed in the JSH 2019 group (p = 0.032); however, the frequency of checking the aldosterone-renin ratio increased in the JSH 2019 group (p = 0.055). We confirmed the change in general practitioners’ awareness of hypertension management. The categorized clusters may be useful for the development of effective strategies for higher-quality hypertension management in clinical practice.

A new methodology of blood pressure measurement through the oscillometric method

Accurate measurement of blood pressure (BP) is of great importance in a medical diagnostic. It can be obtained by different methods. Nowadays, most BP devices use the oscillometric method which estimates systolic and diastolic BP through different algorithms. Unfortunately, the precision of these devices is always questioned and doctors prefer the use of traditional auscultatory-based methods. In this paper, a new oscillometric method for BP measurement is proposed. In fact, the proposed method is based on the design of a BP device which first detects and maintains the cuff pressure at the level of mean BP then the continuous determination of systolic and diastolic BP. device was assessed by measuring the systolic and diastolic BP on 20 healthy volunteers. The measured pressures were compared with those obtained by two commercially available BP devices. The results show a very high correlation coefficient (r = 0.97), an almost perfect agreement coefficient (kappa = 0.81), and a low mean absolute error (3.43 mmHg). The proposed methodology has a high probability to be complied with the Association for the Advancement of Medical Instrumentation and the British Hypertension Society (Grade A) standards, and can greatly improve the measurement of blood pressure using the oscillometric approach.

Personalized Blood Pressure Estimation Using Photoplethysmography: A Transfer Learning Approach.

In this paper, we present a personalized deep learning approach to estimate blood pressure (BP) using the photoplethysmogram (PPG) signal. We propose a hybrid neural network architecture consisting of convolutional, recurrent, and fully connected layers that operates directly on the raw PPG time series and provides BP estimation every 5 seconds. To address the problem of limited personal PPG and BP data for individuals, we propose a transfer learning technique that personalizes specific layers of a network pre-trained with abundant data from other patients. We use the MIMIC III database which contains PPG and continuous BP data measured invasively via an arterial catheter to develop and analyze our approach. Our transfer learning technique, namely BP-CRNN-Transfer, achieves a mean absolute error (MAE) of 3.52 and 2.20 mmHg for SBP and DBP estimation, respectively, outperforming existing methods. Our approach satisfies both the BHS and AAMI blood pressure measurement standards for SBP and DBP. Moreover, our results demonstrate that as little as 50 data samples per person are required to train accurate personalized models. We carry out Bland-Altman and correlation analysis to compare our method to the invasive arterial catheter, which is the gold-standard BP measurement method.