Poor Reliability of Wrist Blood Pressure Self-Measurement at Home

Abstract

Blood pressure (BP) independently predicts cardiovascular risk in affluent countries. [1][2][3][4][5] However, several studies have shown that awareness of hypertension and BP control is still suboptimal, 1 and thus effective strategies should be developed to improve BP control and adherence to therapy. One of the methods used to achieve these goals is represented by self-measurement of BP at home by automatic devices. Many studies have shown that BP self-measurement at home allows a better BP control in hypertension and has a greater prognostic value than office BP. 6,7 In addition, self BP measurement is more appealing to the patient than the customary procedure in the physician's surgery often causing long waits. Upper-arm automatic devices gave fresh impetus to home self-measurement because of their user friendliness, 8 the only conditions to be respected being adequate cuff dimensions and correct positioning of the cuff on the patient's arm. [9][10][11][12][13][14] For reasons of market penetration and following a general tendency to miniaturization, many wrist devices recently appeared on the market 15 having the advantage of being smaller and easier to fit than upper-arm monitors, 16 and today wrist devices are used by a large portion of people who measure their BP at home. 17 However, in spite of technical improvement, their reliability in real-life conditions is not unanimously accepted. [18][19][20] Accuracy of BP measurement at wrist largely depends on the difference in height between the wrist and the heart because of the confounding effect of the hydrostatic pressure caused by the limb blood column.21-23 Wrists kept at a higher level in comparison with the heart lead to a false lower, and wrists at a lower level lead to a false higher BP values. Very rarely do patients receive appropriate training from family doctors or other healthcare personnel. Instructions attached to commercial packages require a certain degree of personal discernment, i.e., a good cognitive pattern. Only a few models have a position sensor to verify that the wrist is placed properly at heart level, 24 but even for these devices, no study has evaluated their reliability in real-life conditions.The aim of the present study was to ascertain whether wrist home BP is performed reliably or an error is present in measurement, and to identify the determinants of this error if any.To verify the reliability of wrist BP self-measurement, we determined at a population level the upper-arm−wrist BP difference in the office under a doctor's supervision and then verified whether this difference was maintained during home self-measurement.Abstract-The reliability of blood pressure measurement with wrist devices, which has not previously been assessed under real-life circumstances in general population, is dependent on correct positioning of the wrist device at heart level. We determined whether an error was present when blood pressure was self-measured at the wrist in 721 unselected subjects from the general population. After training, blood p...

An Evaluation of Biometric Monitoring Technologies for Vital Signs in the Era of COVID‐19

“…Despite the convenience and ease of use, the recommendation is to use wrist worn monitors only in cases when measurements in the upper arm are not feasible. 88 Other BioMeTs, like finger cuffs and smartphone-based BP measurements, also do not provide the same quality of measurements as conventional upper arm cuffs and/or lack validation studies. 75 They are not yet recommended for hypertension diagnosis and patient monitoring.…”

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

“…For BP measurements by the oscillometric method, the subjects were instructed how to place the cuff appropriately, and measurements were performed by the subjects pressing the start button according to the instruction manual. The position of the wrist was kept at a level near the upper arm level since it is recognized that the wrist position strongly affects the value of wrist BP measurement (Casiglia et al, 2016). The auscultatory method was performed by a single well-trained operator.…”

“…Thus, wrist BP measurement has some advantages, while it is not clear under what conditions wrist BP measurement is not suitable. The height of the forearm in wrist BP measurement is acknowledged to be one of the major causes of measurement error (Casiglia, Tikhonoff, Albertini, & Palatini, 2016); however, it remains unclear whether physical activity affects the accuracy of wrist BP measurement. Notably, it is important to clarify whether BP measurement on the wrist after exercise is as accurate as upper arm BP measurement since wrist-cuff devices are assumed to be used not only at home but also outdoors.…”

The Need for Accurate Data on Blood Pressure Measurement in the Dental Office

“…The latter is more susceptible to movement and the wrist arteries are narrower. 16 Typically, BP values obtained with the wrist cuff are higher. 17…”