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Advances in Experimental Medicine and... 2017Blood pressure measurement has a long history and a crucial role in clinical medicine. Manual measurement using a mercury sphygmomanometer and a stethoscope remains the... (Review)
Review
Blood pressure measurement has a long history and a crucial role in clinical medicine. Manual measurement using a mercury sphygmomanometer and a stethoscope remains the Gold Standard. However, this technique is technically demanding and commonly leads to faulty values. Automatic devices have helped to improve and simplify the technical aspects, but a standardised procedure of obtaining comparable measurements remains problematic and may therefore limit their validity in clinical practice. This underlines the importance of less error-prone measurement methods such as ambulatory or home blood pressure measurements and automated office blood pressure measurements. These techniques may help to uncover patients with otherwise unrecognised or overestimated arterial hypertension. Additionally these techniques may yield a better prognostic value.
Topics: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Humans; Hypertension; Observer Variation; Office Visits; Predictive Value of Tests; Reproducibility of Results; Sphygmomanometers; Stethoscopes
PubMed: 27417699
DOI: 10.1007/5584_2016_49 -
Lancet (London, England) Jun 2017
Topics: Antihypertensive Agents; Blood Circulation; Blood Pressure Determination; History, 17th Century; History, 18th Century; History, 20th Century; Humans; Hypertension; Sphygmomanometers
PubMed: 30199660
DOI: 10.1016/S0140-6736(17)31570-2 -
Journal of Hypertension Dec 2023There is intense effort to develop cuffless blood pressure (BP) measuring devices, and several are already on the market claiming that they provide accurate...
European Society of Hypertension recommendations for the validation of cuffless blood pressure measuring devices: European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability.
BACKGROUND
There is intense effort to develop cuffless blood pressure (BP) measuring devices, and several are already on the market claiming that they provide accurate measurements. These devices are heterogeneous in measurement principle, intended use, functions, and calibration, and have special accuracy issues requiring different validation than classic cuff BP monitors. To date, there are no generally accepted protocols for their validation to ensure adequate accuracy for clinical use.
OBJECTIVE
This statement by the European Society of Hypertension (ESH) Working Group on BP Monitoring and Cardiovascular Variability recommends procedures for validating intermittent cuffless BP devices (providing measurements every >30 sec and usually 30-60 min, or upon user initiation), which are most common.
VALIDATION PROCEDURES
Six validation tests are defined for evaluating different aspects of intermittent cuffless devices: static test (absolute BP accuracy); device position test (hydrostatic pressure effect robustness); treatment test (BP decrease accuracy); awake/asleep test (BP change accuracy); exercise test (BP increase accuracy); and recalibration test (cuff calibration stability over time). Not all these tests are required for a given device. The necessary tests depend on whether the device requires individual user calibration, measures automatically or manually, and takes measurements in more than one position.
CONCLUSION
The validation of cuffless BP devices is complex and needs to be tailored according to their functions and calibration. These ESH recommendations present specific, clinically meaningful, and pragmatic validation procedures for different types of intermittent cuffless devices to ensure that only accurate devices will be used in the evaluation and management of hypertension.
Topics: Humans; Blood Pressure; Blood Pressure Determination; Hypertension; Sphygmomanometers; Blood Pressure Monitors
PubMed: 37303198
DOI: 10.1097/HJH.0000000000003483 -
American Journal of Hypertension May 2022Hypertension is associated with more end-organ damage, cardiovascular events, and disability-adjusted life years lost in the United States compared with all other... (Review)
Review
Hypertension is associated with more end-organ damage, cardiovascular events, and disability-adjusted life years lost in the United States compared with all other modifiable risk factors. Several guidelines and scientific statements now endorse the use of out-of-office blood pressure (BP) monitoring with ambulatory BP monitoring or home BP monitoring to confirm or exclude hypertension status based on office BP measurement. Current ambulatory or home BP monitoring devices have been reliant on the placement of a BP cuff, typically on the upper arm, to measure BP. There are numerous limitations to this approach. Cuff-based BP may not be well-tolerated for repeated measurements as is utilized with ambulatory BP monitoring. Furthermore, improper technique, including incorrect cuff placement or use of the wrong cuff size, may lead to erroneous readings, affecting diagnosis and management of hypertension. Compared with devices that utilize a cuff, cuffless BP devices may overcome challenges related to technique, tolerability, and overall utility in the outpatient setting. However, cuffless devices have several potential limitations that limit its routine use for the diagnosis and management of hypertension. The review discusses the different approaches for determining BP using various cuffless devices including engineering aspects of cuffless device technologies, validation protocols to test accuracy of cuffless devices, potential barriers to widespread implementation, and future areas of research. This review is intended for the clinicians who utilize out-of-office BP monitoring for the diagnosis and management of hypertension.
Topics: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Humans; Hypertension; Reproducibility of Results; Sphygmomanometers
PubMed: 35136906
DOI: 10.1093/ajh/hpac017 -
Thrombosis Research Oct 2019Eponyms were established to serve the purpose of honoring individuals who have made important observations and discoveries. The use of eponyms remains controversial, and... (Review)
Review
Eponyms were established to serve the purpose of honoring individuals who have made important observations and discoveries. The use of eponyms remains controversial, and important questions have been raised regarding their appropriateness. Although there have been instances where eponyms were abandoned, the remainder are largely embedded within the established literature making their disappearance unlikely. Physicians used a variety of techniques to describe signs of medical eponyms as a method for diagnosing deep venous thrombosis (DVT), pulmonary embolism (PE) or venothromboembolism (VTE). These methods (observation, palpation, pressure, or maneuvers), were detected during the physical examination and using bedside sphygmomanometer or radiographic imaging. Reviewed are both common and less frequently encountered VTE eponyms identified during the physical examination and radiologic imaging. Most of these signs have not been further studied and, therefore, there is a lack of information regarding their accuracy and reliability in clinical practice.
Topics: Eponyms; History, 20th Century; History, 21st Century; Humans; Palpation; Percussion; Pulmonary Embolism; Radiography; Radiology; Sphygmomanometers; Venous Thromboembolism; Venous Thrombosis
PubMed: 31285052
DOI: 10.1016/j.thromres.2019.06.011 -
Current Cardiology Reports Oct 2023To discuss new and emerging technologies for blood pressure measurement and monitoring, including the limitations of current blood pressure measurement techniques, hopes... (Review)
Review
PURPOSE OF REVIEW
To discuss new and emerging technologies for blood pressure measurement and monitoring, including the limitations of current blood pressure measurement techniques, hopes for new device technologies, and the current barriers impeding change in this space.
RECENT FINDINGS
A number of new cuffless devices are being developed and poised to emerge on the marketplace in coming years. There are several different types of technologies and sensors currently under study. New guidelines for validation of cuffless blood pressure devices have recently been developed in anticipation of this change. The current standards for blood pressure device validation are specific to cuff-based technology and are insufficient for validating devices with cuffless-based technologies. In anticipation of a number of new cuffless technologies coming to market in the coming years, three sets of standards have been developed and published in recent years to address this gap.
Topics: Humans; Blood Pressure Determination; Sphygmomanometers; Monitoring, Physiologic; Blood Pressure
PubMed: 37698819
DOI: 10.1007/s11886-023-01956-w -
Current Cardiology Reports Oct 2023Blood pressure (BP) fluctuations outside of clinic are increasingly recognized for their role in the development of cardiovascular disease, syncope, and premature death... (Review)
Review
PURPOSE OF REVIEW
Blood pressure (BP) fluctuations outside of clinic are increasingly recognized for their role in the development of cardiovascular disease, syncope, and premature death and as a promising target for tailored hypertension treatment. However, current cuff-based BP devices, including home and ambulatory devices, are unable to capture the breadth of BP variability across human activities, experiences, and contexts.
RECENT FINDINGS
Cuffless, wearable BP devices offer the promise of beat-to-beat, continuous, noninvasive measurement of BP during both awake and sleep periods with minimal patient inconvenience. Importantly, cuffless BP devices can characterize BP variability, allowing for the identification of patient-specific triggers of BP surges in the home environment. Unfortunately, the pace of evidence, regulation, and validation testing has lagged behind the pace of innovation and direct consumer marketing. We provide an overview of the available technologies and devices for cuffless BP monitoring, considerations for the calibration and validation of these devices, and the promise and pitfalls of the cuffless BP paradigm.
Topics: Humans; Blood Pressure; Illusions; Blood Pressure Determination; Hypertension; Sphygmomanometers
PubMed: 37688763
DOI: 10.1007/s11886-023-01932-4 -
Hong Kong Medical Journal = Xianggang... Oct 2020
Topics: Blood Pressure Determination; History, 20th Century; Humans; Medical Illustration; Oscillometry; Sphygmomanometers
PubMed: 33089799
DOI: 10.12809/hkmj-hkmms202010 -
Annual International Conference of the... Jul 2018Convenient and painless blood pressure measurement can enable increased user adoption of regular monitoring and early intervention for hypertension, which is a...
Convenient and painless blood pressure measurement can enable increased user adoption of regular monitoring and early intervention for hypertension, which is a significant cause of mortality worldwide. This paper introduces a fingerwearable blood pressure measurement device to enable frequent daytime and nocturnal monitoring. The blood pressure measurement is achieved using a two-dimensional capacitive tactile sensor array that is located next to a digital artery. A pumpdriven pneumatic bladder presses the tactile array and the finger towards each other to obtain a pressure sweep versus time. The digital artery pressure waveform data collected during this sweep are used to estimate arterial blood pressure. A clinical study (N =97) was conducted to obtain training (N =49) and validation (N =19) data for blood pressure algorithm development and test (N =29) data to determine the estimation accuracy compared to brachial dual-observer auscultation. On the test set, the mean and standard deviation of the error in the systolic blood pressure estimate are 0.9 mmHg and 6.9 mmHg, respectively, while the corresponding quantities for diastolic blood pressure are -3.2 mmHg and 7.0 mmHg, respectively. These results compare favorably to blood pressure accuracy requirements specified by international standards.
Topics: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitors; Fingers; Humans; Sphygmomanometers; Wearable Electronic Devices
PubMed: 30441192
DOI: 10.1109/EMBC.2018.8513065 -
American Family Physician Sep 2021Home blood pressure monitoring provides important diagnostic information beyond in-office blood pressure readings and offers similar results to ambulatory blood pressure...
Home blood pressure monitoring provides important diagnostic information beyond in-office blood pressure readings and offers similar results to ambulatory blood pressure monitoring. Home blood pressure monitoring involves patients independently measuring their blood pressure with an electronic device, whereas ambulatory blood pressure monitoring involves patients wearing a portable monitor for 24 to 48 hours. Although ambulatory blood pressure monitoring is the diagnostic standard for measurement, home blood pressure monitoring is more practical and accessible to patients, and its use is recommended by the U.S. Preventive Services Task Force and the American College of Cardiology/American Heart Association. Home blood pressure monitoring generally results in lower blood pressure readings than in-office measurements, can confirm the diagnosis of hypertension after an elevated office blood pressure reading, and can identify patients with white coat hypertension or masked hypertension. Best practices for home blood pressure monitoring include using an appropriately fitting upper-arm cuff on a bare arm, emptying the bladder, avoiding caffeinated beverages for 30 minutes before taking the measurement, resting for five minutes before taking the measurement, keeping the feet on the floor uncrossed and the arm supported with the cuff at heart level, and not talking during the reading. An average of multiple readings, ideally two readings in the morning and again in the evening separated by at least one minute each, is recommended for one week. Home blood pressure readings can be used in hypertension quality measures.
Topics: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitors; Home Care Services; Humans; Hypertension; Reproducibility of Results
PubMed: 34523884
DOI: No ID Found