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Bui TV, Picone DS, Schultz MG, Peng X, Black JA, Dwyer N, Roberts-Thomson P, Adams H, Chen CH, Cheng HM, Pucci G, Wang J, Goupil R, Sharman JE. Accuracy of cuff blood pressure and systolic blood pressure amplification. Hypertens Res 2023; 46:1961-1969. [PMID: 37217732 PMCID: PMC10404511 DOI: 10.1038/s41440-023-01311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/23/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023]
Abstract
Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Automated cuff BP and invasive brachial BP were recorded in 795 participants (74% male, aged 64 ± 11 years) receiving coronary angiography at five independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference -7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R2 = 19%). The accuracy of cuff SBP was greatest among participants with the lowest SBP amplification (ptrend < 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.
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Affiliation(s)
- Tan V Bui
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Xiaoqing Peng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - J Andrew Black
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Royal Hobart Hospital, Hobart, TAS, Australia
| | - Nathan Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Royal Hobart Hospital, Hobart, TAS, Australia
| | - Philip Roberts-Thomson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Royal Hobart Hospital, Hobart, TAS, Australia
| | - Heath Adams
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Royal Hobart Hospital, Hobart, TAS, Australia
| | - Chen-Huan Chen
- Department of Medicine, National Yang Ming Chiao Tung University, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Perugia, Italy
| | - Jiguang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Remi Goupil
- Hopital du Sacre-Coeur de Montreal, Universite de Montreal, Montreal, Canada
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
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Feasibility of Precision Medicine in Hypertension Management-Scope and Technological Aspects. J Pers Med 2022; 12:jpm12111861. [PMID: 36573720 PMCID: PMC9698650 DOI: 10.3390/jpm12111861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Personalized management of diseases by considering relevant patient features enables optimal treatment, instead of management according to an average patient. Precision management of hypertension is important, because both susceptibility to complications and response to treatment vary between individuals. While the use of genomic and proteomic personal features for widespread precision hypertension management is not practical, other features, such as age, ethnicity, and cardiovascular diseases, have been utilized in guidelines for hypertension management. In precision medicine, more blood-pressure-related clinical and physiological characteristics in the patient's profile can be utilized for the determination of the threshold of hypertension and optimal treatment. Several non-invasive and simple-to-use techniques for the measurement of hypertension-related physiological features are suggested for use in precision management of hypertension. In order to provide precise management of hypertension, accurate measurement of blood pressure is required, but the available non-invasive blood pressure measurement techniques, auscultatory sphygmomanometry and oscillometry, have inherent significant inaccuracy-either functional or technological-limiting the precision of personalized management of hypertension. A novel photoplethysmography-based technique for the measurement of systolic blood pressure that was recently found to be more accurate than the two available techniques can be utilized for more precise and personalized hypertension management.
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Kumar R, Kumar M, Wander GS, Sahani AK. Concept, hardware development, and clinical trials of a Galinstan based Mercury free sphygmomanometer: Merkfree. Sci Rep 2022; 12:15813. [PMID: 36138083 PMCID: PMC9499926 DOI: 10.1038/s41598-022-19926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022] Open
Abstract
The aim of this work is to develop Merkfree-a mercury-free sphygmomanometer that looks, feels, and operates just like a traditional mercury sphygmomanometer (MS). For this we use Galinstan as a substitute for mercury, which is a non-toxic alloy of Gallium, Indium and Tin. Galinstan is nearly half as dense as mercury and sticks to class. To work with the lower density, we designed an enclosure and scale that is nearly double the length of MS. The issue of stickiness with glass was resolved by maintaining a small meniscus of a reducing agent in the measuring tube and tank of Merkfree. Clinical trials to validate the accuracy of Merkfree against MS and oscillometric sphygmomanometer (OS) were conducted over 252 patients. The results show a good correlation of the systolic and diastolic BP measurements from Merkfree with respect to MS and the OS. The mean absolute percentage error is less than 10% for both SBP and DBP. We also found that Merkfree has lower rounding-off errors compared to MS. Merkfree can be a viable alternative to mercury sphygmomanometer that can help achieve the goal of WHO in eliminating mercury from healthcare, while simultaneously making sure that gold standard technique of sphygmomanometry continues to be available to the clinicians.
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Affiliation(s)
- Ravinder Kumar
- Department of Biomedical Engineering, Indian Institute of Technology, Ropar, India.
| | - Mohit Kumar
- Department of Biomedical Engineering, Indian Institute of Technology, Ropar, India
| | | | - Ashish Kumar Sahani
- Department of Biomedical Engineering, Indian Institute of Technology, Ropar, India
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Frey L, Menon C, Elgendi M. Blood pressure measurement using only a smartphone. NPJ Digit Med 2022; 5:86. [PMID: 35794240 PMCID: PMC9259682 DOI: 10.1038/s41746-022-00629-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/10/2022] [Indexed: 11/30/2022] Open
Abstract
Hypertension is an immense challenge in public health. As one of the most prevalent medical conditions worldwide, it is a major cause of premature death. At present, the detection, diagnosis and monitoring of hypertension are subject to several limitations. In this review, we conducted a literature search on blood pressure measurement using only a smartphone, which has the potential to overcome current limitations and thus pave the way for long-term ambulatory blood pressure monitoring on a large scale. Among the 333 articles identified, we included 25 relevant articles over the past decade (November 2011–November 2021) and analyzed the described approaches to the types of underlying data recorded with smartphone sensors, the signal processing techniques applied to construct the desired signals, the features extracted from the constructed signals, and the algorithms used to estimate blood pressure. In addition, we analyzed the validation of the proposed methods against reference blood pressure measurements. We further examined and compared the effectiveness of the proposed approaches. Among the 25 articles, 23 propose an approach that requires direct contact between the sensor and the subject and two articles propose a contactless approach based on facial videos. The sample sizes in the identified articles range from three to 3000 subjects, where 8 articles used sample sizes of 85 or more subjects. Furthermore, 10 articles include hypertensive subjects in their participant pools. The methodologies applied for the evaluation of blood pressure measurement accuracy vary considerably among the analyzed articles. There is no consistency regarding the methods for blood pressure data collection and the reference blood pressure measurement and validation. Moreover, no established protocol is currently available for the validation of blood pressure measuring technologies using only a smartphone. We conclude the review with a discussion of the results and with recommendations for future research on the topic.
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Affiliation(s)
- Lorenz Frey
- Biomedical and Mobile Health Technology Lab, ETH Zurich, Zurich, 8008, Switzerland
| | - Carlo Menon
- Biomedical and Mobile Health Technology Lab, ETH Zurich, Zurich, 8008, Switzerland
| | - Mohamed Elgendi
- Biomedical and Mobile Health Technology Lab, ETH Zurich, Zurich, 8008, Switzerland.
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Huang B, Chen W, Lin CL, Juang CF, Wang J. MLP-BP: A novel framework for cuffless blood pressure measurement with PPG and ECG signals based on MLP-Mixer neural networks. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103404] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Brouwers S, Sudano I, Kokubo Y, Sulaica EM. Arterial hypertension. Lancet 2021; 398:249-261. [PMID: 34019821 DOI: 10.1016/s0140-6736(21)00221-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023]
Abstract
Arterial hypertension is the most important contributor to the global burden of disease; however, disease control remains poor. Although the diagnosis of hypertension is still based on office blood pressure, confirmation with out-of-office blood pressure measurements (ie, ambulatory or home monitoring) is strongly recommended. The definition of hypertension differs throughout various guidelines, but the indications for antihypertensive therapy are relatively similar. Lifestyle adaptation is absolutely key in non-pharmacological treatment. Pharmacologically, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, calcium channel blockers, and diuretics are the first-line agents, with advice for the use of single-pill combination therapy by most guidelines. As a fourth-line agent, spironolactone should be considered. The rapidly evolving field of device-based therapy, especially renal denervation, will further broaden therapeutic options. Despite being a largely controllable condition, the actual rates of awareness, treatment, and control of hypertension are disappointingly low. Further improvements throughout the process of patient screening, diagnosis, treatment, and follow-up need to be urgently addressed.
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Affiliation(s)
- Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Hospital Aalst, Aalst, Belgium; Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Isabella Sudano
- University Heart Center, Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Elisabeth M Sulaica
- Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
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Kumar V, Kumar R, Kumar M, Wander GS, Sahani A. Auscl-D: a mercury-free digital auscultatory sphygmomanometer. J Med Eng Technol 2021; 45:656-663. [PMID: 34254871 DOI: 10.1080/03091902.2021.1946182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
More than quarter of world's population is consumed by hypertension, leading to premature death of thousands of people per year across the globe. One of the major reasons behind hypertension misdiagnosis is inaccurate blood pressure (BP) measurements, which can be attributed to various human or instrumentation errors. Currently used BP measuring sphygmomanometers, suffers from poor reliability, performance deterioration over time or are unable to meet environmental protection protocols. In this article, we propose a low-cost, highly portable, light-weight, easily manufacturable, battery operated, mercury free, auscultation based digital sphygmomanometer - Auscl-D, for easy and accurate BP measurements. The proposed device can be made from easily available components with cheap manufacturing processes available throughout globe, even in remote areas. The device demonstrated to have accuracy comparable to mercury sphygmomanometer, which is the gold-standard for BP measurements. The preliminary clinical trials were conducted at Dayanand Medical College & Hospital (DMCH) (Ludhiana, India), to compare the performance of proposed device with commonly used aneroid sphygmomanometers employing the auscultatory method and validated oscillometric sphygmomanometers from MicroLife. The test results show good agreement for systolic and diastolic BP measurements taken using Auscl-D device compared to the aneroid and oscillometric types. This shows the potential of proposed design to serve as low-cost, highly portable replacement for conventionally used sphygmomanometers, without the toxicity and reliability issues.
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Affiliation(s)
- Vishal Kumar
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, India
| | - Ravinder Kumar
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, India
| | - Mohit Kumar
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, India
| | | | - Ashish Sahani
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, India
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Kumar R, Sahani AK, Wander GS. A survey to gauge confidence of Indian clinicians on three primary devices for blood pressure measurement. Blood Press Monit 2021; 26:196-199. [PMID: 33470647 DOI: 10.1097/mbp.0000000000000512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE As per its commitment at Minamata convention, and in line with other developed economies, the Indian government is set to ban the use of mercury sphygmomanometers by end of the year 2020. However, the Mercury sphygmomanometer is still widely used by clinicians in India. We conducted a survey to gauge the confidence of Indian clinicians on three primary devices of blood pressure (BP) measurement - mercury sphygmomanometer, aneroid sphygmomanometer and automatic digital BP monitor. MATERIALS AND METHODS We conducted an anonymous online survey through various clinician forums asking questions related to accuracy, reliability and expectations from BP monitors. RESULTS A total of 139 responses were received from clinicians across specialties. The results show that more than 80% of clinicians believe that mercury sphygmomanometers are the most accurate and nearly 50% find it most reliable. For most respondents, accuracy is the most important parameter and convenience of use and portability are secondary considerations. If a mercury-free sphygmomanometer is offered with the same accuracy and reliability, 88% of respondents said they are willing to buy it. CONCLUSIONS Mercury sphygmomanometer is still perceived favorably over other non-mercury alternatives by most Indian clinicians. Validated oscillometric devices should be promoted to bring about change in the perspectives of clinicians towards adopting non-mercury alternatives of BP measurement in India.
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Affiliation(s)
- Ravinder Kumar
- Center for Biomedical Engineering, Indian Institute Technology Ropar, Rupnagar
| | - Ashish Kumar Sahani
- Center for Biomedical Engineering, Indian Institute Technology Ropar, Rupnagar
| | - Gurpreet Singh Wander
- Hero DMC Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Oridupa OA, Oyagbemi AA, Adejumobi O, Falade FB, Obisesan AD, Abegunde BA, Ekwem PC, Adegboye VO, Omobowale TO. Compensatory depression of arterial pressure and reversal of ECG abnormalities by Annona muricata and Curcuma longa in hypertensive Wistar rats. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 19:375-382. [PMID: 34018384 DOI: 10.1515/jcim-2020-0280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/15/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Increasing hypertension incidence in Sub-Sahara Africa and the current cost of management of the metabolic disorder has necessitated research on medicinal plants employed in African Traditional Medicine for hypertension. Thus, this study evaluated antihypertensive effect of Annona muricata leaves or Curcuma longa rhizomes in experimentally-induced hypertensive male Wistar rats (n=70) which were unilaterally nephrectomized and daily loaded with 1% salt. Cardiovascular and haematological changes, as well as urinalysis were determined. METHODS Rats were uninephrectomized and NaCl (1%) included in drinking water for 42 days. Extract-treated hypertensive rats were compared to normotensive, untreated hypertensive and hypertensive rats treated with lisinopril (5 mg/70 kg) or hydrochlorothiazide (12.5 mg/70 kg). A. muricata extract or C. longa extract were administered at 100, 200 or 400 mg/kg. Blood pressure (systolic, diastolic and mean arterial) and electrocardiogram was measured on day 41. Twenty-four-hour urine samples were collected from day 42. Blood samples were collected on day 43 for haematology (PCV, red cell indices, WBC and its differentials, and platelets). RESULTS AND CONCULSIONS A. muricata or C. longa extracts caused a decline in elevated blood pressure of hypertensive rats. Heart rate and QT segment reduction coupled with prolonged QRS duration were reversed in extract-treated rats, with significant increases in hemogram parameters indicating increased blood viscosity. Also, leukocyturia, proteinuria and ketonuria with increased urine alkalinity, urobilinogen and specific gravity which are classical indicators of poor prognostic outcomes in hypertension were reversed in extract-treated rats. In conclusion, A. muricata and C. longa have cardioprotective effect with reversal of derangements in haemogram and urinalysis associated with hypertension.
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Affiliation(s)
| | | | | | | | | | | | - Precious Chima Ekwem
- Department of Veterinary Pharmacology and Toxicology, University of Ibadan, Ibadan, Nigeria
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Picone DS, Schultz MG, Hughes AD, Sharman JE. Cuff Under Pressure for Greater Accuracy. Curr Hypertens Rep 2020; 22:93. [PMID: 32959103 DOI: 10.1007/s11906-020-01103-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To present the evidence that describes what is being measured by upper-arm cuff blood pressure (BP) and the level of accuracy compared with invasive central aortic and brachial BP. Potential causes of inaccuracy and emerging methods are also discussed. RECENT FINDINGS On average cuff systolic BP systematically underestimates invasive brachial systolic BP, although in a given individual it may substantially under- or over-estimate central aortic systolic BP. Such errors may affect individual health management outcomes and distort population level data on hypertension prevalence and control. Oscillometric cuff BP is particularly susceptible to inaccuracy in people with high arterial stiffness and with pathophysiological BP waveform shapes. Emerging cuff-less BP methods will be susceptible to inaccuracy if oscillometric cuff BP is used for calibration. The original purpose of cuff BP was to estimate central aortic BP. Recent evidence has shown substantial inaccuracy of oscillometric cuff BP exists for the measurement of invasive central aortic and brachial BP. Thus, development of more accurate BP methods, through better understanding of oscillometric and BP waveform morphology, is needed to improve health outcomes related to high BP.
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Affiliation(s)
- Dean S Picone
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Private Bag 23, Hobart, 7000, Australia.
| | - Martin G Schultz
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Private Bag 23, Hobart, 7000, Australia
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - James E Sharman
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Private Bag 23, Hobart, 7000, Australia
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Agreement and Reliability of Clinician-in-Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services. Arch Rehabil Res Clin Transl 2020; 2:100066. [PMID: 33543092 PMCID: PMC7853394 DOI: 10.1016/j.arrct.2020.100066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To compare agreement and reliability between clinician-measured and patient self-measured clinical and functional assessments for use in remote monitoring, in a home-based setting, using telehealth. Design Reliability study: repeated-measure, within-subject design. Setting Trained clinicians measured standard clinical and functional parameters at a face-to-face clinic appointment. Participants were instructed on how to perform the measures at home and to repeat self-assessments within 1 week. Participants Liver transplant recipients (LTRs) (N=18) (52±14y, 56% men, 5.4±4.3y posttransplant] completed the home self-assessments. Interventions Not applicable. Main Outcome Measures The outcomes assessed were body weight, systolic and diastolic blood pressure (SBP and DBP), waist circumference, repeated chair sit-to-stand (STST), maximal push-ups, and the 6-minute walk test (6MWT). Intertester reliability and agreement between face-to-face clinician and self-reported home-based participant measures were determined by intraclass-correlation coefficients (ICCs) and Bland-Altman plots, which were compared with minimal clinically important differences (MCID) (determined a priori). Results The mean difference (95% confidence interval) and [limits of agreement] for measures (where positive values indicate lower participant value) were weight, 0.7 (0.01-1.4) kg [−2.2 to 3.6kg]; waist 0.4 (−1.2 to 2.0) cm [−5.9 to 6.8cm]; SBP 7.7 (0.6-14.7 ) mmHg [−19.4 to 34.9mmHg]; DBP 2.4 (−1.4 to 6.2 ) mmHg [−12.2 to 17.0mmHg]; 6MWT, 7.5 (−29.1 to 44.1) m [−127.3 to 142.4m]; STST 0.5 (−0.8 to 1.7) seconds [−4.3 to 5.3s]; maximal push-ups −2.2 (−4.4 to −0.1) [−10.5 to 6.0]. ICCs were all >0.75 except for STST (ICC=0.73). Mean differences indicated good agreement than MCIDs; however, wide limits of agreement indicated large individual variability in agreement. Conclusions Overall, LTRs can reliably self-assess clinical and functional measures at home. However, there was wide individual variability in accuracy and agreement, with no functional assessment being performed within acceptable limits relative to MCIDs >80% of the time.
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Heydari F, P. Ebrahim M, Redoute J, Joe K, Walker K, Avolio A, R. Yuce M. Clinical study of a chest‐based cuffless blood pressure monitoring system. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/mds3.10091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fatemeh Heydari
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
| | - Malikeh P. Ebrahim
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
| | - Jean‐Michel Redoute
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
| | - Keith Joe
- Emergency Department Cabrini Health Melbourne Vic. Australia
| | - Katie Walker
- Emergency Department Cabrini Health Melbourne Vic. Australia
- Department of Epidemiology and Preventive Medicine Monash University Melbourne Vic. Australia
| | - Alberto Avolio
- The Australian School of Advanced Medicine Macquarie University Sydney NSW Australia
| | - Mehmet R. Yuce
- Department of Electrical and Computer Systems Engineering Monash University Melbourne Vic. Australia
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Shalom E, Hirshtal E, Slotki I, Shavit L, Yitzhaky Y, Engelberg S, Nitzan M. Systolic blood pressure measurement by detecting the photoplethysmographic pulses and electronic Korotkoff-sounds during cuff deflation. Physiol Meas 2020; 41:034001. [DOI: 10.1088/1361-6579/ab7b41] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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14
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Sharman JE, O’Brien E, Alpert B, Schutte AE, Delles C, Olsen MH, Asmar R, Atkins N, Barbosa E, Calhoun D, Campbell NR, Chalmers J, Benjamin I, Jennings G, Laurent S, Boutouyrie P, Lopez-Jaramillo P, McManus RJ, Mihailidou AS, Ordunez P, Padwal R, Palatini P, Parati G, Poulter N, Rakotz MK, Rosendorff C, Saladini F, Scuteri A, Barroso WS, Cho MC, Sung KC, Townsend RR, Wang JG, Hansen TW, Wozniak G, Stergiou G. [Lancet Commission on Hypertension Group position statement on the global improvement of accuracy standards for devices that measure blood pressurePosicionamento do Grupo da Lancet Commission on Hypertension sobre a melhoria global dos padrões de acurácia para aparelhos que medem a pressão arterial]. Rev Panam Salud Publica 2020; 44:e21. [PMID: 32117468 PMCID: PMC7039279 DOI: 10.26633/rpsp.2020.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022] Open
Abstract
The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3 000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organization for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.
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Affiliation(s)
- James E. Sharman
- Menzies Institute for Medical ResearchUniversidad de TasmaniaHobartTasmaniaAustraliaMenzies Institute for Medical Research, Universidad de Tasmania, Hobart, Tasmania, Australia.
| | - Eoin O’Brien
- The Conway InstituteUniversity College DublinDublínIrlandaThe Conway Institute, University College Dublin, Dublín, Irlanda.
| | - Bruce Alpert
- Centro de Ciencias de la SaludUniversidad de TennesseeMemphisTennesseeEstados UnidosCentro de Ciencias de la Salud, Universidad de Tennessee, Memphis, Tennessee, Estados Unidos (retirado)
| | - Aletta E. Schutte
- Equipo de investigación en hipertensión en África, Medical Research Council Unit for Hypertension and Cardiovascular DiseaseUniversidad del NoroestePotchefstroomSudáfricaEquipo de investigación en hipertensión en África, Medical Research Council Unit for Hypertension and Cardiovascular Disease, Universidad del Noroeste, Potchefstroom, Sudáfrica.
| | - Christian Delles
- Institute of Cardiovascular and Medical SciencesUniversidad de GlasgowGlasgowReino UnidoInstitute of Cardiovascular and Medical Sciences, Universidad de Glasgow, Glasgow, Reino Unido.
| | - Michael Hecht Olsen
- Departamento de Medicina Interna, Hospital Holbaek, Holbaek, Dinamarca; y Centre for Individualized Medicine in Arterial Diseases (CIMA), Hospital de la Universidad de OdenseUniversidad de Dinamarca MeridionalOdenseDinamarcaDinamarcaDepartamento de Medicina Interna, Hospital Holbaek, Holbaek, Dinamarca; y Centre for Individualized Medicine in Arterial Diseases (CIMA), Hospital de la Universidad de Odense, Universidad de Dinamarca Meridional, Odense, Dinamarca.
| | - Roland Asmar
- Institutos de la Fundación para la Investigación MédicaInstitutos de la Fundación para la Investigación MédicaGinebraSuizaInstitutos de la Fundación para la Investigación Médica, Ginebra, Suiza.
| | - Neil Atkins
- Medaval LtdaMedaval LtdaDublínIrlandaMedaval Ltda., Dublín, Irlanda.
| | - Eduardo Barbosa
- Liga para la hipertensión de Porto AlegreLiga para la hipertensión de Porto AlegrePorto AlegreBrasilLiga para la hipertensión de Porto Alegre, Porto Alegre, Brasil.
| | - David Calhoun
- Grupo de biología vascular e hipertensiónUniversidad de Alabama en BirminghamBirminghamEstados UnidosGrupo de biología vascular e hipertensión, Universidad de Alabama en Birmingham, Birmingham, Estados Unidos.
| | - Norm R.C. Campbell
- Departamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud Comunitaria, O’Brien Institute for Public Health y Libin Cardiovascular Institute of AlbertaUniversidad de CalgaryCalgaryAlbertaCanadáDepartamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud Comunitaria, O’Brien Institute for Public Health y Libin Cardiovascular Institute of Alberta, Universidad de Calgary, Calgary, Alberta, Canadá.
| | - John Chalmers
- George Institute for Global HealthUniversidad de Nueva Gales del SurSídneyNueva Gales del SurAustraliaGeorge Institute for Global Health, Universidad de Nueva Gales del Sur, Sídney, Nueva Gales del Sur, Australia.
| | - Ivor Benjamin
- American Heart AssociationAmerican Heart AssociationDallasTexasEstados UnidosAmerican Heart Association, Dallas, Texas, Estados Unidos.
| | - Garry Jennings
- Facultad de Medicina de SídneyUniversidad de Sídney y Baker Heart & Diabetes InstituteMelbourneVictoriaAustraliaFacultad de Medicina de Sídney, Universidad de Sídney y Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia.
| | - Stéphane Laurent
- Departamentos de Farmacología, Hospital Europeo Georges Pompidou, Assistance Publique Hôpitaux de ParisInserm UMR 970 y Universidad Paris DescartesParísFranciaDepartamentos de Farmacología, Hospital Europeo Georges Pompidou, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 y Universidad Paris Descartes, París, Francia.
| | - Pierre Boutouyrie
- Departamentos de Farmacología, Hospital Europeo Georges Pompidou, Assistance Publique Hôpitaux de ParisInserm UMR 970 y Universidad Paris DescartesParísFranciaDepartamentos de Farmacología, Hospital Europeo Georges Pompidou, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 y Universidad Paris Descartes, París, Francia.
| | - Patricio Lopez-Jaramillo
- FOSCAL, Instituto Masira, Facultad de Ciencias de la SaludUDESBucaramangaColombiaFOSCAL, Instituto Masira, Facultad de Ciencias de la Salud, UDES, Bucaramanga, Colombia.
| | - Richard J. McManus
- Nuffield Department of Primary Care Health SciencesUniversidad de Oxford, Radcliffe Observatory QuarterOxfordReino UnidoNuffield Department of Primary Care Health Sciences, Universidad de Oxford, Radcliffe Observatory Quarter, Oxford, Reino Unido.
| | - Anastasia S. Mihailidou
- Laboratorio de Investigación Cardiovascular y HormonalDepartamento de Cardiología del Kolling Institute, Royal North Shore Hospital y Facultad de Medicina y Ciencias de la Salud, Universidad MacquarieSídneyNueva Gales del SurAustraliaLaboratorio de Investigación Cardiovascular y Hormonal, Departamento de Cardiología del Kolling Institute, Royal North Shore Hospital y Facultad de Medicina y Ciencias de la Salud, Universidad Macquarie, Sídney, Nueva Gales del Sur, Australia.
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.CEstados UnidosDepartamento de Enfermedades no Transmisibles y Salud Mental. Organización Panamericana de la Salud, Washington, D.C., Estados Unidos.
| | - Raj Padwal
- Departamento de Medicina, Universidad de AlbertaDepartamento de Medicina, Universidad de AlbertaEdmontonAlbertaCanadáDepartamento de Medicina, Universidad de Alberta, Edmonton, Alberta, Canadá.
| | - Paolo Palatini
- Studium Patavinum, Universidad de PaduaStudium Patavinum, Universidad de PaduaPaduaItaliaStudium Patavinum, Universidad de Padua, Padua, Italia.
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCSDepartamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Hospital San Luca, Milán, Italia; y Departamento de Medicina y Cirugía, Universidad de Milán-BicoccaMilánItaliaIstituto Auxologico Italiano, IRCCS, Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Hospital San Luca, Milán, Italia; y Departamento de Medicina y Cirugía, Universidad de Milán-Bicocca, Milán, Italia.
| | - Neil Poulter
- Imperial Clinical Trials UnitImperial College LondonLondresReino UnidoImperial Clinical Trials Unit, Imperial College London, Londres, Reino Unido.
| | - Michael K. Rakotz
- Asociación Médica EstadounidenseMejorar los Resultados en Materia de SaludChicagoIllinoisEstados UnidosAsociación Médica Estadounidense, Mejorar los Resultados en Materia de Salud, Chicago, Illinois, Estados Unidos.
| | - Clive Rosendorff
- Mount Sinai HeartDepartamento de Medicina (cardiología), Icahn School of Medicine en Mount Sinai, Nueva York, Estados Unidos, y The James J. Peters VA Medical CenterBronxNueva YorkEstados UnidosMount Sinai Heart, Departamento de Medicina (cardiología), Icahn School of Medicine en Mount Sinai, Nueva York, Estados Unidos, y The James J. Peters VA Medical Center, Bronx, Nueva York, Estados Unidos.
| | - Francesca Saladini
- Departamento de MedicinaUniversidad de Padua; Unidad de Cardiología, Hospital de CittadellaPaduaItaliaDepartamento de Medicina, Universidad de Padua; Unidad de Cardiología, Hospital de Cittadella, Padua, Italia.
| | - Angelo Scuteri
- Departamento de Ciencias Médicas, Quirúrgicas y ExperimentalesUniversidad de SácerSácerItaliaDepartamento de Ciencias Médicas, Quirúrgicas y Experimentales, Universidad de Sácer, Sácer, Italia.
| | - Weimar Sebba Barroso
- Liga para la hipertensiónDepartamento de Cardiología, Universidad Federal de GoiásGoiâniaBrasilLiga para la hipertensión. Departamento de Cardiología, Universidad Federal de Goiás, Goiânia, Brasil.
| | - Myeong-Chan Cho
- Departamento de Medicina Interna, Facultad de Medicina de la Universidad Nacional ChungbukDepartamento de Medicina Interna, Facultad de Medicina de la Universidad Nacional ChungbukCheongjuRepública de CoreaDepartamento de Medicina Interna, Facultad de Medicina de la Universidad Nacional Chungbuk, Cheongju, República de Corea.
| | - Ki-Chul Sung
- División de CardiologíaDepartamento de Medicina Interna, Hospital Kangbuk Samsung, Facultad de Medicina de la Universidad SungkyunkwanSeúlRepública de CoreaDivisión de Cardiología, Departamento de Medicina Interna, Hospital Kangbuk Samsung, Facultad de Medicina de la Universidad Sungkyunkwan, Seúl, República de Corea.
| | - Raymond R. Townsend
- Facultad de Medicina PerelmanUniversidad de PensilvaniaFiladelfiaEstados UnidosFacultad de Medicina Perelman, Universidad de Pensilvania, Filadelfia, Estados Unidos.
| | - Ji-Guang Wang
- Instituto de hipertensión de Shanghai, Hospital RuijinFacultad de Medicina de la Universidad Shanghai JiaotongShanghaiChinaInstituto de hipertensión de Shanghai, Hospital Ruijin, Facultad de Medicina de la Universidad Shanghai Jiaotong, Shanghai, China.
| | - Tine Willum Hansen
- Steno Diabetes Center CopenhagenSteno Diabetes Center CopenhagenGentofteDinamarcaSteno Diabetes Center Copenhagen, Gentofte, Dinamarca.
| | - Gregory Wozniak
- Asociación Médica EstadounidenseMejorar los Resultados en Materia de SaludChicagoIllinoisEstados UnidosAsociación Médica Estadounidense, Mejorar los Resultados en Materia de Salud, Chicago, Illinois, Estados Unidos.
| | - George Stergiou
- Hypertension Center STRIDE-7Universidad Nacional y Kapodistríaca de Atenas, Facultad de Medicina, Tercer Departamento de Medicina, Hospital SotiriaAtenasGreciaHypertension Center STRIDE-7, Universidad Nacional y Kapodistríaca de Atenas, Facultad de Medicina, Tercer Departamento de Medicina, Hospital Sotiria, Atenas, Grecia.
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15
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Picone DS, Schultz MG, Otahal P, Black JA, Bos WJ, Chen CH, Cheng HM, Cremer A, Dwyer N, Fonseca R, Hughes AD, Kim HL, Lacy PS, Laugesen E, Ohte N, Omboni S, Ott C, Pereira T, Pucci G, Roberts-Thomson P, Rossen NB, Schmieder RE, Sueta D, Takazawa K, Wang J, Weber T, Westerhof BE, Williams B, Yamada H, Yamamoto E, Sharman JE. Influence of Age on Upper Arm Cuff Blood Pressure Measurement. Hypertension 2020; 75:844-850. [PMID: 31983305 PMCID: PMC7035100 DOI: 10.1161/hypertensionaha.119.13973] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Blood pressure (BP) is a leading global risk factor. Increasing age is related to changes in cardiovascular physiology that could influence cuff BP measurement, but this has never been examined systematically and was the aim of this study. Cuff BP was compared with invasive aortic BP across decades of age (from 40 to 89 years) using individual-level data from 31 studies (1674 patients undergoing coronary angiography) and 22 different cuff BP devices (19 oscillometric, 1 automated auscultation, 2 mercury sphygmomanometry) from the Invasive Blood Pressure Consortium. Subjects were aged 64±11 years, and 32% female. Cuff systolic BP overestimated invasive aortic systolic BP in those aged 40 to 49 years, but with each older decade of age, there was a progressive shift toward increasing underestimation of aortic systolic BP (P<0.0001). Conversely, cuff diastolic BP overestimated invasive aortic diastolic BP, and this progressively increased with increasing age (P<0.0001). Thus, there was a progressive increase in cuff pulse pressure underestimation of invasive aortic PP with increasing decades of age (P<0.0001). These age-related trends were observed across all categories of BP control. We conclude that cuff BP as an estimate of aortic BP was substantially influenced by increasing age, thus potentially exposing older people to greater chance for misdiagnosis of the true risk related to BP.
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Affiliation(s)
- Dean S Picone
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., P.O., J.A.B., N.D., R.F., P.R.-T., J.E.S.)
| | - Martin G Schultz
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., P.O., J.A.B., N.D., R.F., P.R.-T., J.E.S.)
| | - Petr Otahal
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., P.O., J.A.B., N.D., R.F., P.R.-T., J.E.S.)
| | - J Andrew Black
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., P.O., J.A.B., N.D., R.F., P.R.-T., J.E.S.)
- Royal Hobart Hospital, Hobart, Tasmania (J.A.B., P.R-.T., N.D.)
| | - Willem J Bos
- St Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands (W.J.B.)
- Department of Internal Medicine, Leiden University Medical Center, the Netherlands (W.J.B.)
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (C.-H.C., H.-M.C.)
- Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., H.-M.C.)
| | - Hao-Min Cheng
- Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (C.-H.C., H.-M.C.)
- Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., H.-M.C.)
| | - Antoine Cremer
- Department of Cardiology/Hypertension, University Hospital of Bordeaux, France (A.C.)
| | - Nathan Dwyer
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., P.O., J.A.B., N.D., R.F., P.R.-T., J.E.S.)
- Royal Hobart Hospital, Hobart, Tasmania (J.A.B., P.R-.T., N.D.)
| | - Ricardo Fonseca
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., P.O., J.A.B., N.D., R.F., P.R.-T., J.E.S.)
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, United Kingdom (A.D.H.)
| | - Hack-Lyoung Kim
- Division of Cardiology, Seoul National University Boramae Hospital, South Korea (H.-L.K.)
| | - Peter S Lacy
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.S.L., B.W.)
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark (E.L.)
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan (N.O.)
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese (S.O.)
- Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Russian Federation (S.O.)
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.E.S.)
| | - Telmo Pereira
- Polytechnic Institute of Coimbra, ESTES, Department of Physiology, General Humberto Delgado Street 102, Lousã, Portugal (T.P.)
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Italy (G.P.)
| | - Philip Roberts-Thomson
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., P.O., J.A.B., N.D., R.F., P.R.-T., J.E.S.)
- Royal Hobart Hospital, Hobart, Tasmania (J.A.B., P.R-.T., N.D.)
| | | | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.E.S.)
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (D.S., E.Y.)
| | - Kenji Takazawa
- Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital, Japan (K.T.)
| | - Jiguang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (J.W.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria (T.W.)
| | - Berend E Westerhof
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands (B.E.W.)
| | - Bryan Williams
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.S.L., B.W.)
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima Graduate School of Biomedical Sciences, Japan (H.Y.)
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (D.S., E.Y.)
| | - James E Sharman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., P.O., J.A.B., N.D., R.F., P.R.-T., J.E.S.)
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16
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Joachim J, Coutrot M, Millasseau S, Matéo J, Mebazaa A, Gayat E, Vallée F. Real-time estimation of mean arterial blood pressure based on photoplethysmography dicrotic notch and perfusion index. A pilot study. J Clin Monit Comput 2020; 35:395-404. [PMID: 32078111 DOI: 10.1007/s10877-020-00486-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
Hypotension during general anesthesia is associated with poor outcome. Continuous monitoring of mean blood pressure (MAP) during anesthesia is useful and needs to be reliable and minimally invasive. Conventional cuff measurements can lead to delays due to its discontinuous nature. It has been shown that there is a relationship between MAP and photoplethysmography (PPG) parameters like the dicrotic notch and perfusion index (PI). The objective of the study was to continuously estimate MAP from PPG. Pulse wave analysis based on PPG was implemented using either notch relative amplitude (MAPNRA), notch absolute amplitude (MAPNAA) or PI (MAPPI) to estimate MAP from PPG waveform features during general anesthesia. Estimated MAP values were compared to brachial cuff MAP (MAPcuff) and to radial invasive MAP (MAPinv). Forty-six patients were analyzed for a total of 235 h. Compared to MAPcuff, mean bias and limits of agreement were 1 mmHg (- 26 to +29), - 1 mmHg (- 10 to +8) and - 3 mmHg (- 21 to +13) for MAPNRA, MAPNAA and MAPPI respectively. Compared to MAPinv, mean absolute error (MAE) was 20 mmHg [10 to 39], 11 mmHg [5 to 18] and 16 mmHg [9 to 24] for MAP derived from MAPNRA, MAPNAA and MAPPI respectively. When calibrated every 5 min, MAPNAA showed a MAE of 6 mmHg [5 to 9]. MAPNAA provides the best estimates with respect to brachial cuff MAP and invasive MAP. Regular calibration allows to reduce drift over time. Beat to beat estimation of MAP during general anesthesia from the PPG appears possible with an acceptable average error.
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Affiliation(s)
- Jona Joachim
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France. .,INSERM UMR-942, Paris, France. .,Université de Paris, Paris, France.
| | - Maxime Coutrot
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,INSERM UMR-942, Paris, France.,Université de Paris, Paris, France
| | | | - Joaquim Matéo
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,Université de Paris, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,INSERM UMR-942, Paris, France.,Université de Paris, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,INSERM UMR-942, Paris, France.,Université de Paris, Paris, France
| | - Fabrice Vallée
- Department of Anesthesiology, Burn and Critical Care, St-Louis-Lariboisière-Fernand Widal University Hospitals, Assistance Publique - Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,INSERM UMR-942, Paris, France.,Université de Paris, Paris, France
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17
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Sharman JE, O’Brien E, Alpert B, Schutte AE, Delles C, Hecht Olsen M, Asmar R, Atkins N, Barbosa E, Calhoun D, Campbell NR, Chalmers J, Benjamin I, Jennings G, Laurent S, Boutouyrie P, Lopez-Jaramillo P, McManus RJ, Mihailidou AS, Ordunez P, Padwal R, Palatini P, Parati G, Poulter N, Rakotz MK, Rosendorff C, Saladini F, Scuteri A, Sebba Barroso W, Cho MC, Sung KC, Townsend RR, Wang JG, Willum Hansen T, Wozniak G, Stergiou G. Lancet Commission on Hypertension group position statement on the global improvement of accuracy standards for devices that measure blood pressure. J Hypertens 2020; 38:21-29. [PMID: 31790375 PMCID: PMC6919228 DOI: 10.1097/hjh.0000000000002246] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/05/2019] [Accepted: 08/14/2019] [Indexed: 02/03/2023]
Abstract
: The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organisation for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.
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Affiliation(s)
- James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - Bruce Alpert
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Aletta E. Schutte
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbaek
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | | | - Eduardo Barbosa
- Hypertension League of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - David Calhoun
- Vascular Biology and Hypertension Group, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Norm R.C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O’Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Garry Jennings
- Sydney Medical School, University of Sydney and Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Stéphane Laurent
- Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 and University Paris Descartes, Paris, France
| | - Pierre Boutouyrie
- Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 and University Paris Descartes, Paris, France
| | | | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Anastasia S. Mihailidou
- Cardiovascular & Hormonal Research Laboratory, Department of Cardiology & Kolling Institute, Royal North Shore Hospital and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Pedro Ordunez
- Department of Non Communicable and Mental Health, Pan American Health Organization, Washington, District of Columbia
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Michael K. Rakotz
- American Medical Association, Improving Health Outcomes, Chicago, Illinois
| | - Clive Rosendorff
- Department of Medicine (Cardiology), Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York
- The James J. Peters VA Medical Center, Bronx, New York, USA
| | - Francesca Saladini
- Cardiology Unit, Department of Medicine, University of Padova, Town Hospital of Cittadella, Padova
| | - Angelo Scuteri
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Weimar Sebba Barroso
- Hypertension League, Department of Cardiology, Federal University of Goiás, Goiânia, Brazil
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Raymond R. Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ji-Guang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Gregory Wozniak
- American Medical Association, Improving Health Outcomes, Chicago, Illinois
| | - George Stergiou
- Third Department of Medicine, Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
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