Wrist Blood Pressure Measurement Research Articles

Response to exercise-induced blood pressure elevation is blunted in wrist-cuff automated oscillometric measurement in healthy young college students.

BackgroundA wrist‐cuff automated oscillometric device is portable and useful for self‐monitoring of blood pressure (BP) at home and outdoors when an upper arm device is not available. Although the height of the forearm in wrist BP measurement is acknowledged to be the major cause of measurement error, it remains unclear whether exercise affects subsequent wrist BP measurement.Methods and ResultsNinety‐seven healthy college students (median age of 20 years with an age range of 19 to 36 years, 70.1% males) participated in this study. Care was taken to keep the position of the wrist at a level near the upper arm level in BP measurement. At rest, BP measured by a wrist‐cuff oscillometric device (Omron HEM‐6183) was generally acceptable when it was compared with BP measured by an upper arm oscillometric device (Omron HEM‐7130‐HP) and with BP measured by the auscultatory method using a mercury sphygmomanometer. However, the ratio of systolic BP measured by oscillometric devices just after a two‐step exercise test to that before exercise on the wrist (1.22 ± 0.14) was significantly lower than the ratio on the upper arm (1.27 ± 0.14), and the difference was significantly correlated with exercise‐induced increase in pulse rate (Spearman's ρ = 0.23), suggesting a possible role of autonomic nerve activity in the blunted response to exercise‐induced BP elevation in wrist BP measurement.ConclusionsThe results indicate that the blunted response to exercise‐induced BP elevation should be considered in wrist BP measurement when using a wrist‐cuff oscillometric device.

Accuracy and trending of non-invasive oscillometric blood pressure monitoring at the wrist in obese patients

BackgroundIn obese patients, non-invasive blood pressure monitoring in the arm is difficult due to the arm size and morphology. We compared the non-invasive oscillometric wrist blood pressure measurement with the arm and forearm in obese patients monitored with invasive radial blood pressure (reference standard). MethodsThis prospective observational study included adult obese patients scheduled for bariatric surgery. Non-invasive blood pressure was measured at the arm, upper forearm and wrist of one upper extremity, while invasive blood pressure was simultaneously measured through a radial arterial catheter in the contralateral upper extremity. The accuracy of non-invasive blood pressure reading at each site was evaluated for absolute and trending values using the Bland–Altman analysis and Spearman's correlation coefficient. ResultsIn 40 patients, 262, 259, and 263 pairs of non-invasive blood pressure readings were obtained from the arm, forearm, and wrist sites, respectively. As primary outcome, the correlation coefficient for systolic blood pressure was higher for the wrist (0.92, 95% confidence interval (CI) [0.9–0.94]) than for the arm (0.74, 95% CI [0.68–0.79]) and the forearm (0.71, 95% CI [0.64–0.76]) (P<0.05). The non-invasive systolic wrist blood pressure showed the least mean bias and the narrowest limits of agreement (−0.3±7.6mmHg) when compared with forearm (4.3±16) and arm measurements (14.2±13.6) (P<0.05). For trending values, the correlation coefficient was the highest at the wrist. ConclusionIn obese patients undergoing bariatric surgery, non-invasive blood pressure measured at the wrist showed the highest accuracy in comparison with the arm and forearm.

OP.6B.03] WRIST BLOOD PRESSURE SELF-MEASUREMENT AT HOME IS UNRELIABLE. RESULTS FROM THE POPULATION-BASED “GROWING OLD WITH LESS DISEASE ENHANCING NEUROFUNCTIONS” (GOLDEN) STUDY

Objective: To investigate the reliability of self-measured home blood pressure (BP) obtained with wrist devices. Design and method: Office and home upper-arm and wrist BP was obtained in 597 representative subjects from general population using two validated devices. Parti-cipants received an individual 20-min training in the office and were asked to repeat the upper-arm and wrist measurements at home for 7 consecutive days using the same procedures. In particular, they were recommended to keep the wrist at heart level during wrist BP measurement. The difference between upper-arm BP and wrist BP measured by the observer in the office was calculated for each individual and compared with the 7-day averaged self-measured upper-arm - wrist BP difference. Anthropometric measures and a complete cognitive assessment were also obtained. Results: In the office, under observer supervision, after adjustment for confounders, wrist BP was lower than upper-arm BP (systolic −2.4%, p < 0.0001; diastolic −0.6%, NS), while at home BP was higher at wrist than at upper-arm (systolic +5.9%, p < 0.0001; diastolic +5.6%, p < 0.0001). Both systolic and diastolic upper-arm - wrist BP differences obtained in office significantly differed from the upper-arm - wrist differences obtained by the participant at home (systolic 3.0 ± 13.7 vs. −6.7 ± 0.1 mmHg, p < 0.0001; diastolic 0.6 ± 9.4 vs. −4.0 ± 6.6 mmHg, p < 0.0001). Office (r = 0.37, p < 0.0001) but not home (r = −0.05, p = 0.9) wrist systolic BP correlated with office BP, the two regression coefficients differing significantly (p < 0.0001). Similar results were obtained for diastolic BP. In multivariable regression analyses, using the difference between the upper-arm - wrist BP discrepancies obtained in the office and at home as the dependent variable, forearm length (p < 0.06 for systolic, p < 0.04 for diastolic) and praxic abilities (p < 0.008, p < 0.0001, respectively) were independent determinants of the office-home difference. Conclusions: These data indicate that in spite of adequate training wrist BP measurement at home is unreliable. This is likely due to a cognitive (particularly praxic) deficit leading to incorrect forearm position, a problem that, for hydraulic reasons, is magnified in people with longer forearm. Wrist BP measurement should be discouraged chiefly in subjects presumed to have impaired cognitive function.

Continuous Wrist Blood Pressure Measurement with Ultrasound

Continuous Wrist Blood Pressure Measurement with Ultrasound

The impact of arm position and pulse pressure on the validation of a wrist-cuff blood pressure measurement device in a high risk population

Despite the increasing popularity of blood pressure (BP) wrist monitors for self-BP measurement at home, device validation and the effect of arm position remains an issue. This study focused on the validation of the Omron HEM-609 wrist BP device, including an evaluation of the impact of arm position and pulse pressure on BP measurement validation. Fifty patients at high risk for cardiovascular disease were selected (age 65 +/- 10 years). Each patient had two measurements with a mercury sphygmomanometer and three measurements with the wrist BP device (wrist at the heart level while the horizontal arm supported [HORIZONTAL], hand supported on the opposite shoulder [SHOULDER], and elbow placed on a desk [DESK]), in random order. The achieved systolic BP (SBP) and diastolic BP (DBP) wrist-cuff readings were compared to the mercury device and the frequencies of the readings within 5, 10, and 15 mmHg of the gold standard were computed and compared with the British Hypertension Society (BHS) and Association for the Advancement of Medical Instrumentation (AAMI) protocols. The results showed while SBP readings with HORIZONTAL and SHOULDER positions were significantly different from the mercury device (mean difference = 7.1 and 13.3 mmHg, respectively; P < 0.05), the DESK position created the closest reading to mercury (mean difference = 3.8, P > 0.1). Approximately 71% of SBP readings with the DESK position were within +/-10 mmHg, whereas it was 62.5% and 34% for HORIZONTAL and SHOULDER positions, respectively. Wrist DBP attained category D with BHS criteria with all three arm positions. Bland-Altman plots illustrated that the wrist monitor systematically underestimated SBP and DBP values. However a reading adjustment of 5 and 10 mmHg for SBP and DBP (DESK position) resulted in improvement with 75% and 77% of the readings being within 10 mmHg (grade B), respectively. AAMI criteria were not fulfilled due to heterogeneity. The findings also showed that the mismatch between the mercury and wrist-cuff systolic BP readings was directly associated with pulse pressure. In conclusion the DESK position produces the most accurate readings when compared to the mercury device. Although wrist BP measurement may underestimate BP measured compared to a mercury device, an adjustment by 5 and 10 mmHg for SBP and DBP, respectively, creates a valid result with the DESK position. Nevertheless, considering the observed variations and the possible impact of arterial stiffness, individual clinical validation is recommended.

Does "hidden undercuffing" occur among obese patients? Effect of arm sizes and other predictors of the difference between wrist and upper arm blood pressures.

Arm size can affect the accuracy of blood pressure (BP) measurement, and "undercuffing" of large upper arms is likely to be a growing problem. Therefore, the authors investigated the relationship between upper arm and wrist readings. Upper arm and wrist circumferences and BP were measured in 261 consecutive patients. Upper arm auscultation and wrist BP was measured in triplicate, rotating measurements every 30 seconds between sites. Upper arm BP was 131.9+/-20.6/71.6+/-12.6 mm Hg in an obese population (body mass index, 30.6+/-6.6 kg/m(2)) with mean upper arm size of 30.7+/-5.1 cm. Wrist BP was higher (2.6+/-9.2 mm Hg and 4.9+/-6.6 mm Hg, respectively, P<.001); however, there was moderate concordance for the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) strata (kappa value=0.27-0.71), and the difference was >or=5 mm Hg in 72% of the patients. The authors conclude that there was poor concordance between arm and wrist BP measurement and found no evidence that "hidden undercuffing" was associated with obesity; therefore, they do not support routine use of wrist BP measurements.

The impact of pulse pressure on the accuracy of wrist blood pressure measurement

There is an increasing number of wrist blood pressure measurement devices that successfully passed the validation procedures of the British Hypertension Society (BHS) and the European Society of Hypertension (ESH). It remains unknown, however, whether pulse pressure as a marker of arterial stiffness and vascular ageing affects the accuracy of these devices. An ESH protocol validated wrist device was compared with the upper arm mercury sphygmomanometry in a study population (33 patients, 99 measurements) including a relevant number of subjects with pulse pressure >50 mm Hg (84.8%) and isolated systolic hypertension (27.3%). Mean systolic bias was 10.2 mm Hg with 95% limits of agreement of -13.1 and 33.6 mm Hg, mean diastolic bias was 4.8 mm Hg with limits of agreement of -11.0 and 20.7 mm Hg. The impact of body mass index, age, systolic blood pressure and pulse pressure on the absolute value of blood pressure bias was tested by stepwise multiple regression analysis. The systolic bias significantly depended on pulse pressure, whereas there was no significant effect of the independent variables on the diastolic bias. Separate correlation analysis showed a significant correlation between pulse pressure and both absolute systolic bias (Pearson r=0.48, P<0.001) and relative systolic bias (systolic bias divided by systolic blood pressure, Pearson r=0.29, P=0.003). Even well-validated wrist blood pressure devices can show a clinically relevant bias in patients with elevated pulse pressure. Increased arterial stiffness may impair the accuracy of oscillometric blood pressure measurement at the wrist.

Clinical evaluation of the Braun BP 3000 Easy Click according to the ANSI/AAMI SP 10:2002

Home blood pressure monitoring has been increasingly encouraged as a supplement to measurements in the clinic in the 2003 European Society of Hypertension-European Society of Cardiology and in the Seventh Joint National Committee guidelines. Before marketing, however, blood pressure measuring devices for self-blood pressure monitoring should be independently validated. The main objective of the present study was to examine the clinical accuracy of the Braun BP 3000 (Braun GmbH, Kronberg, Germany) wrist blood pressure measurement device. Measurements of systolic and diastolic blood pressure in normotensive and hypertensive individuals were obtained using the mercury sphygmomanometer and the Braun BP 3000 equipment. Repeated sequential blood pressure single-arm measurements comparing the test device and the standard mercury sphygmomanometer were completed according to the American National Standard Institution (ANSI)/Association for the Advancement of Medical Instrumentation (AAMI) SP 10:2002 Protocol Guidelines on 90 study participants (270 measurements with each pressurometer). The equipment passed the test of systolic blood pressure measurements for method 1 (270 measurements treated separately) and method 2 (mean values of three observations on 90 patients). The mean+/-SD value was -2.01+/-5.61 (upper limit 5+/-8) and -2.01+/-4.41 (upper limit 2.01+/-6.65), respectively. The device also passed the diastolic blood pressure measurement requirements as the mean+/-SD value for method 1 was -0.97+/-5.52 (upper limit 5+/-8) and for method 2 was -0.97+/-4.87 (upper limit 0.97+/-6.87), respectively. The data from this study show that the Braun BP 3000 successfully passed the ANSI/AAMI SP 10:2002 requirements.

Can Wrist Blood Pressure Oscillometer Be Used for Triage in an Adult Emergency Department?

We compare the performance of a wrist blood pressure oscillometer with the mercury standard in the triage process of an emergency department (ED) and evaluate the impact of wrist blood pressure measurement on triage decision. Blood pressure was successively measured with the standard mercury sphygmomanometer and with the OMRON-RX-I wrist oscillometer in a convenience sample of 2,493 adult patients presenting to the ED with non-life-threatening emergencies. Wrist and mercury measures were compared using criteria of the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS). The impact on triage decisions was evaluated by estimating the rate of changes in triage decisions attributable to blood pressure results obtained with the wrist device. Wrist oscillometer failed to meet the minimal requirements for recommendation by underestimating diastolic and systolic blood pressure. Mean (+/-SD) differences between mercury and wrist devices were 8.0 mm Hg (+/-14.7) for systolic and 4.2 mm Hg (+/-12.0) for diastolic measures. The cumulative percentage of blood pressure readings within 5, 10, and 15 mm Hg of the mercury standard was 32%, 58%, and 72% for systolic, and 40%, 67%, and 83% for diastolic measures, respectively. Using the wrist device would have erroneously influenced the triage decision in 7.6% of the situations. The acuity level would have been overestimated in 2.2% and underestimated in 5.4% of the triage situations. The performance of the OMRON-RX-I wrist oscillometer does not fulfill the minimum criteria of AAMI and BHS compared with mercury standard in the ED triage setting.

Wrist blood pressure overestimates blood pressure measured at the upper arm

Whether blood pressure (BP) measured at the wrist differs from blood pressure measured at the arm is not well known. The aim of this study was to compare the BP readings obtained at the arm with those obtained at the forearm and to assess whether the wrist-arm discrepancies were related to subjects' clinical characteristics. We measured blood pressure at the forearm and at the upper arm in 85 subjects using conventional sphygmomanometry. Wrist-arm blood pressure discrepancies were assessed in relation to gender, age, body mass index, skin-fold thickness, arm size, blood pressure level, and arterial compliance measured with the HDI/Pulsewave CR-2000. Blood pressure measured at the wrist consistently overestimated blood pressure taken at the arm with a mean (+/-SD) discrepancy of 8.2 +/- 9.7/9.2 +/- 6.4 mmHg. The systolic blood pressure differences were greater in men than in women (p=0.006) and, among the men, varied according to arm adiposity (positive association, p=0.01). In men, diastolic blood pressure differences correlated with diastolic blood pressure level (negative association, p=0.01). Among the women, only age (p=0.04) was a significant positive independent predictor of the wrist-arm diastolic BP differences. These results indicate that forearm blood pressure measurement markedly overestimates upper arm blood pressure and that the between-site difference may vary from subject to subject. Wrist blood pressure measurement is not a valid alternative to traditional measurement at the arm and its use should be discouraged.