Measurement reliability of automated oscillometric blood pressure monitor in the elderly with atrial fibrillation: a systematic review and meta-analysis

Abstract

Objectives This study aimed to identify whether automated oscillometric blood pressure monitor (AOBPM) is a reliable blood pressure (BP) measurement tool in geriatric patients with atrial fibrillation (AF) with high variability in BP and to evaluate whether it can be applied in practice. Methods Electronic searches were performed in databases including MEDLINE, EMBASE, the Cochrane Library, and CINAHL by using the following keywords: ‘atrial fibrillation,’ ‘atrial flutter, ‘blood pressure monitor’, ‘sphygmomanometer.’ The QUADAS-2 was applied to assess the internal validity of selected studies. Meta-analysis was performed using RevMan 5.3 program. Design: Systematic review. Results We identified 10 studies, including 938 geriatric patients with AF. We compared with the previously used BP measurement method (mainly office) and AOBPM, and the patients with AF were divided into the AF-AF (atrial fibrillation rhythm continued) and AF-SR groups (sinus rhythm recovered). The difference in the systolic BP was −3.0 mmHg [95% confidence interval (CI): −6.58 to 0.59] and −1.62 (95% CI: −6.08 to 2.84) mmHg in the AF-AF and AF-SR groups, respectively. The difference in the diastolic BP was 0.17 (95% CI: −2.90 to 3.25) mmHg and −0.23 (95% CI: −5.11 to 4.65) mmHg, respectively. Conclusion This review showed that the BP difference from AOBPM compared with the auscultatory BP method was less than 5 mmHg in the elderly with AF. This difference is acceptable in clinical practice. However, AOBPM compared with invasive arterial BP in the diastolic BP was a difference of 5 mmHg or more, and so its accuracy cannot be assured.

Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension

“…However, selfmeasurement using the auscultatory method at home is not feasible in the elderly hypertensive patients with atrial fibrillation. The current evidence from published validation studies of automated oscillometric BP monitors in atrial fibrillation is rather limited and methodologically heterogeneous [15,212,215]. However, it appears that there is reasonable accuracy of these devices in measuring SBP in the presence of atrial fibrillation but with a small yet consistent overestimation of DBP (pooled automated minus auscultatory SBP difference 1 mmHg, 95% CI -0.1 to 2.1, and DBP 2.1 mmHg, 95% CI 0.1-4.0) [212].…”

Intrasession Reliability Analysis for Oscillometric Blood Pressure Method Using a Digital Blood Pressure Monitor in Peruvian Population

“…Other studies have carried out comparisons between the auscultation method, the automatic device and the invasive method, the conclusion of which has shown that the difference between a measurement with a digital oscillometric device compared to auscultation was less than 5 mmHg in older people with atrial fibrillation, which is considered an acceptable margin in terms of reliability. However, compared with invasive methods, the difference was <5 mmHg, which would not be clinically acceptable [ 47 ].…”

“…In summary, reliability studies of digital oscillometry in both central [ 51 , 59 ] and peripheral [ 46 ] pressure measurements have been performed, comparing different protocols [ 52 ], in children [ 45 , 60 ], adults [ 61 ] and elderly people [ 49 ], in people with atrial fibrillation [ 46 , 47 , 53 ] and people undergoing endurance training [ 50 ] or with orthostatic conditions [ 48 ], all with different results (reliability between acceptable and excellent). However, high and excellent values of absolute and relative inter-session reliability of the oscillometric method using a digital BP monitor under a standardized protocol in a general population over 15 years of age will undoubtedly have a positive impact on the safety of brachial blood pressure monitoring in both hospital and home settings.…”

Diretrizes Brasileiras de Medidas da Pressão Arterial Dentro e Fora do Consultório – 2023

“… 173 Alguns aparelhos automáticos oscilométricos são equipados com algoritmo específico que podem sugerir a presença de fibrilação atrial, podendo auxiliar no diagnóstico dessas condições, principalmente na população idosa. 168 , 174 , 175 …”