Comparison of Oscillometric Blood Pressure Measurements at the Wrist With an Upper‐arm Auscultatory Mercury Sphygmomanometer

Abstract

1. Oscillometric devices for blood pressure (BP) measurement at the wrist are becoming more widely used in clinical practice. However, systematic comparisons with standard auscultatory BP measurement at the brachial artery are scarce. Therefore, we compared two such devices, the Boso-Mediwatch (Bosch & Sohn GmbH U. Co., Jungingen, Germany) and the Omron R3 (Omron Corp., Tokyo, Japan), with upper-arm auscultatory mercury sphygmomanometry. 2. In 20 normotensive subjects and 20 treated hypertensive subjects, the Boso-Mediwatch was applied to the left wrist by observer 1 and was compared with mercury sphygmomanometry of the right upper arm by observer 2. Each observer swapped sides and the procedure was repeated. The Boso-Mediwatch was then applied to the right wrist by observer 1 and was compared with mercury sphygmomanometry of the left upper arm by observer 2. Each observer once again swapped sides and the procedure was repeated. An identical protocol was followed for the Omron R3 in a further 20 treated hypertensive subjects and 20 normotensive subjects. 3. There were no significant differences between observers or left versus right arm for either oscillometric device or when measurements were performed by mercury sphygmomanometry. In normotensive subjects, the Boso-Mediwatch readings were higher than mercury sphygmomanometer readings, with mean differences (95% confidence intervals) of 3.9 (0.1, 7.6; P = 0.045) and 7.0 mmHg (4.7, 9.2; P < 0.001) for systolic and diastolic BP, respectively. In hypertensive subjects, the Boso-Mediwatch readings were lower for systolic BP (mean difference -6.0 mmHg (-11.6, -0.3; P = 0.04) but were higher for diastolic BP (mean difference 3.8 mmHg (1.4, 6.3; P < 0.01). 4. In normotensive subjects, the Omron R3 readings were higher, with mean differences of 3.2 (0.6, 5.8; P = 0.018) and 4.2 mmHg (1.6, 6.7; P = 0.003) for systolic and diastolic BP, respectively. In hypertensive subjects, the Omron R3 readings were lower for both systolic and diastolic BP (mean differences: -5.8 (-8.8, -2.8; P = 0.001) and -5.5 (-9.3, -1.6; P = 0.008), respectively). 5. For the Boso-Mediwatch, weighted least products analysis confirmed the presence of both fixed and proportional error for systolic BP but not for diastolic BP. For the Omron R3, fixed or proportional error was not detected for either systolic or diastolic BP. 6. These wrist oscillometric devices, although offering portability and convenience, give BP measurements that frequently differ substantially (by at least 5 mmHg) from readings simultaneously measured at the upper arm by a mercury sphygmomanometer. The magnitude and direction of differences detected are dependent on both the device used and the underlying level of BP.

Can Validated Wrist Devices With Position Sensors Replace Arm Devices for Self-Home Blood Pressure Monitoring? A Randomized Crossover Trial Using Ambulatory Monitoring as Reference

“…Some wrist devices have been shown to fulfill the validation requirements, 10-16 whereas others did not appear to be accurate. [26][27][28] These studies resulted in a change in the recommendation by the European Society of Hypertension and, in the 2007 Guidelines, it is mentioned that "few of the wrist devices have been successfully validated" and that they should be "carefully used at heart level. " 1 It is questionable, however, whether in the case of wrist monitors, formal validation studies performed in strictly controlled conditions of a research setting are adequate for the values to be accepted in clinical practice.…”

Does “Hidden Undercuffing” Occur Among Obese Patients? Effect of Arm Sizes and Other Predictors of the Difference Between Wrist and Upper Arm Blood Pressures

“…In the past few years, several wrist devices have been evaluated for validity and the accuracy of measurements 20–23 . Many of these studies have validated different wrist devices as being accurate for measuring BP in different populations according to the standards prescribed by the American Association for Medical Instrumentation 19 and the British Hypertension Society Working Party on Blood Pressure Measurement Standards 4 .…”

Diabetic Medicine diary Compiled by Johanna Tootell

“…An alternative or supplement to clinic BP is the use of a semiautomatic electronic device for self-monitored blood pressure (SMBP). Recent models have proved to be sufficiently reliable and accurate, leading many investigators to recommend SMBP [11][12][13][14][15][16]. We undertook a prospective study using a semiautomatic SMBP device with an onboard memory to: (i) determine the relationship between clinic BP and SMBP, and (ii) evaluate the accuracy of self-reported data.…”