Can wrist blood pressure oscillometer be used for triage in an adult emergency department?

Blood pressure estimation and its recalibration assessment using wrist cuff blood pressure monitor

The rapid evolution of wearable technology in healthcare sectors has created the opportunity for people to measure their blood pressure (BP) using a smartwatch at any time during their daily activities. Several commercially-available wearable devices have recently been equipped with a BP monitoring feature. However, concerns about recalibration remain. Pulse transit time (PTT)-based estimation is required for initial calibration, followed by periodic recalibration. Recalibration using arm-cuff BP monitors is not practical during everyday activities. In this study, we investigated recalibration using PTT-based BP monitoring aided by a deep neural network (DNN) and validated the performance achieved with more practical wrist-cuff BP monitors. The PTT-based prediction produced a mean absolute error (MAE) of 4.746 ± 1.529 mmHg for systolic blood pressure (SBP) and 3.448 ± 0.608 mmHg for diastolic blood pressure (DBP) when tested with an arm-cuff monitor employing recalibration. Recalibration clearly improved the performance of both DNN and conventional linear regression approaches. We established that the periodic recalibration performed by a wrist-worn BP monitor could be as accurate as that obtained with an arm-worn monitor, confirming the suitability of wrist-worn devices for everyday use. This is the first study to establish the potential of wrist-cuff BP monitors as a means to calibrate BP monitoring devices that can reliably substitute for arm-cuff BP monitors. With the use of wrist-cuff BP monitoring devices, continuous BP estimation, as well as frequent calibrations to ensure accurate BP monitoring, are now feasible.

New Approaches to Evaluating and Monitoring Blood Pressure

Digital health innovations for hypertension include cuffless blood pressure sensors, wireless smartphone-enabled upper arm blood pressure monitors, mobile applications, and remote monitoring technologies. Wearable trackers have drawn interest from medical professionals and patients alike. They have the potential to improve hypertension control and medication adherence through easier logging of repeated blood pressure measurements, better connectivity with health-care providers, and medication reminder alerts. With increasing emphasis on home and ambulatory blood pressure monitoring to confirm hypertension prior to treatment, such devices also can help improve the diagnostic landscape. However, privacy, accuracy, and cost concerns have prevented widespread clinical uptake. To foster implementation, device designers and clinical researchers should collaborate on development of rigorous clinical trials that test cardiovascular outcomes associated with emerging technologies. We review the current literature on mobile health technologies and novel diagnostic and management protocols and make recommendations on how to incorporate these innovations into practice.

[High blood pressure in the emergency department: epidemiology and evaluation of a dedicated consultation]

OBJECTIVES

The Arterial High blood pressure represents a consultation on 5 in general medicine. The main objective of our study was to estimate patients' proportion appearing at emergency department (ED) with a high Blood pressure and to demonstrate that it is possible to detect the patients at risk of essential and secondary hypertension as well as their cardiovascular risk there.

METHODS

Non-interventional forward-looking Study led over 6 weeks. After measure of the vital parameters in the reception of ED, the patients were included if the Systolic Blood Pressure (SBP) was ≥ 140 mmHg and\or Diastolic Blood Pressure (DBP) ≥ 90 mmHg. A control of Blood Pressure (BP) was made at least 40 minutes after the inclusion. If the Arterial High blood pressure persisted (BP ≥ 140/90 mmHg and age < 30 years or BP ≥ 180/110 mmHg after 30 years), the patients had to see again a cardiologist of the hospital in 7 days because they were considered as at high cardiovascular risk.

RESULTS

A high initial BP was discovered to 582 (8,7 %) 6685 patients having consulted in ED during the period of the study. 64 % of them (n = 372) had a persistent Arterial High Blood pressure after 40 minutes. 27 patients, defined at high cardiovascular risk had a proposition of consultation of cardiology, appeared 11 to it. 4 secondary hypertension was discovered.

CONCLUSION

During the period of study, 582 patients presented a High BP. To 64 % of those who had a control of BP this imbalance was confirmed. The patients (n=27) presenting a high cardiovascular risk had a proposition of fast consultation. This one allowed discovering 4 secondary hypertension. There is thus a utility to estimate the BP in a systematic way at Emergency Department.