Are Automated Blood Pressure Monitors Accurate Enough to Calculate the Ankle Brachial Pressure Index?

Macdonald, E.; Froggatt, P.; Lawrence, Gwen; Blair, S. D.

doi:10.1007/s10877-008-9146-8

Cited by 19 publications

(17 citation statements)

References 17 publications

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“…156 In addition, most oscillometric blood pressure devices are unable to detect low pressures, eg, Ͻ50 mm Hg 148 or even 80 mm Hg, 178 and as a consequence, recording failures are frequent (from 11% 161 to 44% 178 ) in patients with advanced PAD. 153,158,160,161,178,179 The sensitivity (67%-97%) and specificity (62%-96%) of the ABI measured with oscillometry compared with the Doppler method have been reported in multiple studies (Table III in the online-only Data Supplement). 48,145, Bland-Altman plots were used in several studies to assess the agreement between the Doppler and oscillometric techniques.…”

Section: Methods Of Pressure Measurementmentioning

confidence: 99%

Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,369

827

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T he ankle-brachial index (ABI) is the ratio of the systolic blood pressure (SBP) measured at the ankle to that measured at the brachial artery. Originally described by Winsor 1 in 1950, this index was initially proposed for the noninvasive diagnosis of lower-extremity peripheral artery disease (PAD). 2,3 Later, it was shown that the ABI is an indicator of atherosclerosis at other vascular sites and can serve as a prognostic marker for cardiovascular events and functional impairment, even in the absence of symptoms of PAD. 4 -6 Rationale for Standardization of the ABIThe current lack of standards for measurement and calculation of the ABI leads to discrepant results with significant impact from clinical, public health, and economic standpoints. Indeed, the estimated prevalence of PAD may vary substantially according to the mode of ABI calculation. [7][8][9] In a review of 100 randomly selected reports using the ABI, multiple variations in technique were identified, including the position of the patient during measurement, the sizes of the arm and leg cuffs, the location of the cuff on the extremity, the method of pulse detection over the brachial artery and at the ankles, whether the arm and ankle pressures were measured bilaterally, which ankle pulses were used, and whether a single or replicate measures were obtained. 10 There is controversy about what ABI threshold should be used to diagnose PAD. The ABI threshold most commonly used is Յ0.90 based on studies reporting Ͼ90% sensitivity and specificity to detect PAD compared with angiography. 2,3 These studies were limited in that they included mostly older white men with PAD or who were at high risk for PAD and compared them with a younger healthy group. A recent metaanalysis of 8 studies of diverse populations, including diabetic patients, confirmed a high specificity but lower sensitivity (at best Ͻ80%) than that reported in earlier studies. 11 Similar to other vascular markers such as carotid intimamedia thickness 12 or coronary artery calcium score, 13 standardization of the techniques used to measure the ABI and the calculation and interpretation of its values is necessary. Aims and ScopeThe goals for this document are to provide a comprehensive review of the relevant literature on the measurement of the The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 10, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional repri...

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Section: Methods Of Pressure Measurementmentioning

confidence: 99%

Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,369

827

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“…Positive and negative study conclusion In 18 of the 25 studies reviewed in this paper (72%; n ¼ 3449), 7,14,[19][20][21][22][23][25][26][27][28]31,[34][35][36]38,40 the authors arrived at a conclusion in favor of oscillometric ABI measurement. Studies with Table 1a Studies that compared the oscillometric with Doppler method for ankle-brachial index measurement a positive conclusion compared with those with a negative one reported a lower but not significant average Doppler-oscillometric ABI difference (0.012±0.010 vs. 0.047±0.035 P ¼ 0.38) and absolute ABI difference (0.044 ± 0.011 vs. 0.060 ± 0.021; P ¼ 0.51), and a significantly higher sensitivity for PAD diagnosis (80 ± 3% vs. 51±5%; Po0.001).…”

Section: Methods and Device Type Analysesmentioning

confidence: 93%

“…Some studies reported that measurements could not be obtained when the ankle BP was o70 mmHg. 6,27,28,31,42 Another study reported that the oscillometric device failed to measure BP in three legs from three patients, all of whom had a Doppler ABI o0.90. 19 Some oscillometric devices have been suggested to potentially be unable to determine low BP values, such as o50 mmHg 36 or o30 mmHg.…”

Section: Automated Ankle-brachial Index Assessment Wj Verberk Et Almentioning

confidence: 99%

“…32 In other studies, the ankle measurements could not be obtained in patients with very low BP values. 6,27,28,31,42 Diehm et al 21 found that oscillometric ankle BP measurements yielded falsely low values in patients with a mean Doppler ABI value of 0.48 ± 0.12. Nukumizu et al 37 mentioned that there were significantly fewer patients with crural artery occlusion having similar oscillometric ABI values as Doppler than patients without major arterial lesions.…”

Section: Automated Ankle-brachial Index Assessment Wj Verberk Et Almentioning

confidence: 99%

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Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis

2012

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Measurement of the ankle-brachial index (ABI) using a Doppler device is widely used to identify subjects with peripheral artery disease (PAD), and those who are at high risk of cardiovascular disease. This paper presents a systematic review (Medline/ PubMed, Embase and Cochrane) and meta-analysis of studies assessing the usefulness of automated oscillometric devices for ABI estimation and PAD detection compared with the conventional Doppler method. A total of 25 studies including 4186 subjects were analyzed. A random-effects model analysis showed that the average oscillometric ABI was similar to the Doppler ABI (mean difference ± s.e. 0.020 ± 0.018, P ¼ 0.3) but that the absolute differences were significant (0.048 ± 0.009, Po0.01). The pooled correlation coefficient (r) between the oscillometric and Doppler ABI was 0.71 ± 0.05. Simultaneous arm-leg measurements resulted in a smaller difference between the average oscillometric ABI value and the average Doppler ABI value than did sequential measurements ( À0.012 ± 0.022 vs. 0.040 ± 0.026, respectively, Po0.01). The average sensitivity and specificity of the oscillometric ABI estimation in PAD diagnosis was 69 ± 6% and 96 ± 1%, respectively (with Doppler ABI taken as the reference). These data suggest that an automated ABI measurement obtained by oscillometric blood pressure monitors is a reliable and practical alternative to the conventional Doppler measurement for the detection of PAD.To increase the sensitivity of the PAD diagnosis based on an oscillometric ABI, a higher threshold of 1.0 might be preferable.

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“…However, blood pressure monitoring has been challenging, because aneroid and mercury manometers are expensive and require a trained health professional to use them 12 . As an alternative, digital devices have received growing attention, and well-known health associations are recommending their use [13][14][15] . Regardless of the recommendations, the validity of digital monitors needs to be confirmed prior to their widespread utilization.…”

Section: Discussionmentioning

confidence: 99%

Validade de um monitor digital de pulso para mensuração de pressão arterial em comparação com um esfigmomanômetro de mercúrio

Menezes

Dumith

Noal

et al. 2010

Arq. Bras. Cardiol.

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Background: Valid measurements of blood pressure, both at clinical and community settings, are essential for monitoring this variable at the population level.Objective: To evaluate the validity of a wrist digital monitor for measuring blood pressure among adolescents in comparison to a mercury sphygmomanometer.Methods: A validation study was carried out in the city of Pelotas, Southern Brazil. Blood pressure was measured twice using two different sphygmomanometers; an OMRON wrist digital and a desktop BD mercury one. Half of the sample was measured first with the digital manometer and subsequently with the mercury one, whereas the remaining half was evaluated in the opposite order. Agreement between both measures was evaluated using the Bland and Altman method.Results: 120 adolescents aged 14 to 15 years were included (50% of each sex). Mean systolic blood pressure among boys was 113.7 mmHg (SD 14.2) when using the mercury manometer and 115.5 mmHg (SD 15.2) when using the digital one. Equivalent values for diastolic blood pressure were 61.5 mmHg (SD 9.9) and 69.6 mmHg (10.2), respectively. Among girls, the mean systolic blood pressure was 104.7 mmHg (SD 10.1) when using the mercury manometer and 102.4 mmHg (SD 11.9) when using the digital device. Values for diastolic blood pressure were 60.0 mmHg (SD 10.4) and 65.7 mmHg (SD 7.7), respectively. Conclusions:The digital device showed a high level of agreement with the mercury manometer when measuring systolic blood pressure. The level of agreement was lower for diastolic blood pressure. The use of correction equations may be an alternative for studies using this wrist digital monitor in adolescent patients. ( 3,4 . It seems that this type of equipment can replace the others in some contexts, such as at home or in epidemiological studies within the community 5 . However, most studies so far included only adults, and therefore, the validity of these methods among adolescents in unclear.The aim of the present study was to test the validity of a wrist digital monitor against that of a mercury sphygmomanometer -the gold standard -in a convenience sample of adolescents living in Pelotas, southern Brazil. MethodsA sample of 120 adolescents aged 14 to 15 years from five public schools of the city had their blood pressure measured with two different sphygmomanometers -a desktop BD IntroductionAn accurate assessment of blood pressure is very important for the diagnosis and treatment of hypertension. The importance of attaining the diagnosis of high blood pressure and its continuous monitoring are well known. Therefore, several equipments have been available for the measurement of blood pressure, not only to be used by specialized individuals, but also by the population itself. In this sense, wrist digital monitors have been increasingly used, instead of mercury and aneroid devices, which require a trained professional to operate them 1,2 .Although digital monitors are much easier to use when compared to the mercury sphygmomanometers, it is 345Original Article mercur...

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Are Automated Blood Pressure Monitors Accurate Enough to Calculate the Ankle Brachial Pressure Index?

Cited by 19 publications

References 17 publications

Measurement and Interpretation of the Ankle-Brachial Index

Measurement and Interpretation of the Ankle-Brachial Index

Automated oscillometric determination of the ankle-brachial index: a systematic review and meta-analysis

Validade de um monitor digital de pulso para mensuração de pressão arterial em comparação com um esfigmomanômetro de mercúrio

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