Manual or Automated Sphygmomanometer? A Historical Cohort to Quantify Measurement Bias in Blood Pressure Recording

Nargesi, Arash Aghajani; Ghazizadeh, Zaniar; Larry, Mehrdad; Morteza, Afsaneh; Heidari, Firuzeh; Asgarani, Firouzeh; Esteghamati, Alireza; Mohammad, Kazem; Nakhjavani, Manouchehr

doi:10.1111/jch.12400

Cited by 8 publications

(6 citation statements)

References 19 publications

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“…No such bias was identified with any of the same 3 nurses using an automated device. This TDB was previously described in numerous other studies, 19,[21][22][23][24][25][26][27][28][29] most of which show that TDB is reduced but not completely eliminated by the introduction of automated devices in measuring BP. Myers and Campbell 11 found evidence of TDB of 14% of readings when using the BpTRU automated device, when the expected proportion of zero terminal digits is 10%.…”

Section: Discussionsupporting

confidence: 57%

Sources of Error in Office Blood Pressure Measurement

Morcos¹,

Carter

Castro

et al. 2019

J Am Board Fam Med

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Purposes: To evaluate 2 commonly overlooked sources of error in measuring blood pressure (BP) in the office, improper patient positioning and frequency of terminal digit bias (TDB) using manual and automated (BP) devices. Methods: BPs recorded by 3 nurses using manual and automated devices were analyzed for TDB. In the next part of the study, 294 patients were recruited and tested with each patient's BP measured twice in the table position and compared with BP measured in the chair position. To eliminate concern for position sequence, a randomized controlled trial was initially conducted. Results: Significant TDB for the digit zero was identified in BPs measured by all nurses using a manual device. No such bias was identified for any nurse when measuring BP with an automated device. For the positional study, the randomized controlled study showed no significant sequencing effect therefore the sequence of table then chair BP measurements was adopted. Significant BP lowering was observed in 128 patients (42.7%) in the chair compared with the table position. Misclassification of prehypertension and hypertension would have occurred in 15.3% and 16% of patients, respectively, when BP was recorded in the table instead of the chair position. Conclusions: Significant TDB was identified for all nurses when using a manual but not an automated device. Patient positioning on the examination table resulted in elevations of systolic and diastolic BPs.

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Section: Discussionsupporting

confidence: 57%

Sources of Error in Office Blood Pressure Measurement

Morcos¹,

Carter

Castro

et al. 2019

J Am Board Fam Med

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“…Similar results of higher home DBP were found in total subjects and in sub-groups <90mmHg with clinic measurement (p<0.05), but in the subjects with ≥90mmHg DBP had insignificant higher home DBP than clinic DBP. This study's finding had the opposite results from the previous studies showed that the mean SBP from clinic measurement was higher than the home measurement (Myers et al, 2008;Nargesi et al, 2014). Home (digital) sphygmomanometers often use oscillometry techniques, similar to auscultation used in clinical (mercury) sphygmomanometers.…”

Section: Subjects' Characteristicscontrasting

confidence: 74%

Comparison between clinic and home measurements of blood pressure, total cholesterol, blood sugar to identify 10-year atherosclerotic cardiovascular disease risk score

et al. 2021

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The clinical guideline recommends home monitoring for hypertension, diabetes, and hyperlipidemia maintenance therapy. The study aimed to compare the 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculated using systolic blood pressure, fasting totalcholesterol, and fasting blood sugar measured at the clinic and home. This analytical cross-sectional study was done in population from villages in Sleman District, Yogyakarta. The subjects were selected purposively with the criteria of 40-79 years old and signing the informed consent. The home-measured systolic blood pressure was monitored with a digital sphygmomanometer and peripheral finger-stick methods for cholesterol and blood sugar. On the same occasion, the clinic measurements were monitored with a mercury sphygmomanometer for systolic blood pressure, and with venous plasma analyzed in the laboratory for cholesterol and blood glucose. Measurements between methods were compared with paired T-tests. The subjects (n=171) had a mean age of 52.6 (8.1) years; 21.6% were male. The systolic blood pressure, total cholesterol, and blood glucose from clinic and home measurement were 130.0 (21.1) mmHg and 137.6 (22.4) mmHg (p<0.001); 202.8 (32.8) mg/dl and 205.2 (44.8) mg/dl (p= 0.44); and 98.5 (42.9) mg/dl and 91.9 (34.6) mg/dl (p<0.001) respectively. The average ASCVD risks of the clinic and home measurements were 6.4 (6.2)% and 7.1 (6.9)% (p<0.001); however, both methods had the same ASCVD risk category at borderline risk (5-<7.5%). Conclusion: The ASCVD risk scores calculated using clinic and home measurements were statistically different.

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“…Since hypertension is a chronic disease and BP is affected by various factors [ 8 ], accurate BP measurements are critical to its proper treatment. Virtually all digital BP monitors sold within the past decade use the oscillometric technique to measure BP.…”

Section: Discussionmentioning

confidence: 99%

Validation of Omron HBP-1300 professional blood pressure monitor based on auscultation in children and adults

Zhao

Pan

et al. 2016

BMC Cardiovasc Disord

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BackgroudTo determine whether the professional Omron HBP-1300 blood pressure (BP) monitor meets American Association for the Advancement of Medical Instrumentation (AAMI) accuracy standards in Chinese children and adults.MethodAccording to the AAMI protocol, simultaneous auscultatory measurements by two observers using a mercury manometer were obtained in participants using the Omron HBP-1300. Triple measurements were obtained after a minimum 5-min rest with a 1-min interval between adjacent measurements.ResultsA total of 85 participants submitted to 255 doctor-measured BP and 255 successful professional monitor readings. The initial auscultation systolic BP was <100 mmHg in 25 participants (29.4 %), 100–160 mmHg in 53 participants (62.4 %), and >160 mmHg in seven participants (8.2 %). All of the simultaneous measurements agreed to within ±10 mmHg, while 95 % agreed to within ±4 mmHg for both systolic and diastolic BP, and the consistency between two observers was satisfactory. The difference between the devices was -1.3 ± 3.6 mmHg for systolic BP and 0.7 ± 3.8 mmHg for diastolic BP and by AAMI method 1, which met this guideline. The average difference between two devices by AAMI method 2 was 1.4 ± 3.2 mmHg for systolic BP and 1.0 ± 3.9 mmHg for diastolic BP, which met this guideline.ConclusionThe professional BP monitor Omron HBP-1300 is desirable for measuring the BP for Chinese children and adults.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-015-0177-z) contains supplementary material, which is available to authorized users.

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Manual or Automated Sphygmomanometer? A Historical Cohort to Quantify Measurement Bias in Blood Pressure Recording

Cited by 8 publications

References 19 publications

Sources of Error in Office Blood Pressure Measurement

Sources of Error in Office Blood Pressure Measurement

Comparison between clinic and home measurements of blood pressure, total cholesterol, blood sugar to identify 10-year atherosclerotic cardiovascular disease risk score

Validation of Omron HBP-1300 professional blood pressure monitor based on auscultation in children and adults

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