Home Blood Pressure Monitoring.

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.

Brief online certification course for measuring blood pressure with an automated blood pressure device. A free new resource to support World Hypertension Day Oct 17, 2020.

Detection, diagnosis, and treatment of hypertension require accurate blood pressure assessment. However, in clinical practice, lack of training in or nonadherence to measurement recommendations, lack of patient preparation, unsuitable environments where blood pressure is measured, and inaccurate and inappropriate equipment are widespread and commonly lead to inaccurate blood pressure readings. This has led to calls to require regular training and certification for people assessing blood pressure. Hence, the Pan American Health Organization in collaboration with Resolve to Save Lives, the World Hypertension League, Lancet Commission on Hypertension Group, and Hypertension Canada has developed a free brief training and certification course in blood pressure measurement. The course is available at www. The release of the online certification course is timed to help support World Hypertension Day. This year World Hypertension Day has been delayed to October 17 due to the COVID-19 pandemic. For 2020, the World Hypertension League calls on all health care professionals, health care professional organizations, and indeed all of society, to assess the blood pressure of all adults, measure blood pressure accurately, and achieve blood pressure control in those with hypertension.

Management of Pre-eclampsia and Eclampsia: A Simulation.

Introduction: Pre-eclampsia is a hypertensive disorder in pregnancy. Maternal sequelae that may occur include impaired liver function, disseminated intravascular coagulation, seizures (eclampsia), stroke, and death. Thus, providers should know how to recognize (diagnose) and treat pre-eclampsia and eclampsia. Methods: A simulator with noninvasive blood pressure monitoring was used. Transducers for fetal heart rate and contraction monitoring were placed on the simulator, which represented the patient. After obtaining a history and performing a physical examination, resident physician (postgraduate years 1-4) and nurse learners had to diagnose pre-eclampsia and treat this condition. They also had to treat severe-range blood pressures and manage eclampsia. Learner performance was assessed with a checklist. Debriefing followed the simulation. Results: Thirty resident learners participated in the study. Nurses did not participate. All resident learners indicated familiarity with the diagnosis and management of pre-eclampsia and emergent hypertension and managed these conditions correctly. All resident learners reported not being confident in managing eclampsia. None of the learners were able to stop the eclamptic seizure. All resident learners were more confident in managing eclampsia after the scenario compared with before (mean confidence level 3.6 ± 0.5 vs. 1.1 ± 0.4, p < .001). Discussion: Resident learners were familiar with the management of pre-eclampsia and emergent hypertension but not with eclampsia. We recommend that eclampsia simulations occur in a laboratory and in situ on the labor and delivery floor with interprofessional team members including obstetricians, nurses, anesthesiologists, emergency and family medicine physicians, nurse practitioners, and physician assistants.

Diagnostic accuracy of a novel cuffless self-blood pressure monitor for atrial fibrillation screening in the elderly.

Blood pressure (BP) monitors equipped with atrial fibrillation (AF) detection algorithm are attractive screening tools for AF in elderly hypertensives. This study assessed the diagnostic accuracy of a novel cuffless pocket-size self-BP monitor (Freescan, Maisense) equipped with an AF detection algorithm, which displays results for the detection of "AF" or "Arrhythmia" during routine BP measurement. Subjects aged >65 years or 60-65 years with hypertension, diabetes, or cardiovascular disease were subjected to BP measurements using the Freescan device with simultaneous continuous Holter electrocardiography (ECG) monitoring. Readings with device notification "Instability" (29%) or "Error" (20%) were discarded. Data from 136 subjects with five valid Freescan BP measurements were analyzed (age 73.8 ± 7.1 years, males 63%, treated hypertensives 88%, AF in ECG 21%). Analysis of 680 Freescan readings vs ECG revealed specificity 99%, sensitivity 67%, and diagnostic accuracy 93% for AF diagnosis. When the "Arrhythmia" notification was considered as AF diagnosis, the sensitivity was improved (93%, 96%, and 93%, respectively). Analysis of AF diagnosis in subjects (diagnosis defined as at least three of five readings indicating "AF" or "Arrhythmia") revealed specificity, sensitivity, and diagnostic accuracy for AF detection at 94%, 100%, and 95%, respectively. These data suggest that the Freescan cuffless device could be used as a useful screening tool for AF detection during routine self-measurement of BP in the elderly.

Validation of two watch-type wearable blood pressure monitors according to the ANSI/AAMI/ISO81060-2:2013 guidelines: Omron HEM-6410T-ZM and HEM-6410T-ZL.

There is growing evidence of the clinical significance of daytime masked hypertension (MHT) and blood pressure (BP) variability (BPV). Recently, watch-type wearable devices for self-BP measurement have become available. Such devices might be promising tools to identify patients with daytime MHT or large BPV in their real-life conditions. The present study aimed to validate the accuracy of the Omron HEM-6410T-ZM and the Omron HEM-6410T-ZL, which are automatic watch-type wearable devices for self-BP measurement, according to the American National Standards Institute, Inc/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 guideline. Watches were held with the wrist at heart level. The mean differences between reference BPs and HEM-6410T-ZM readings were -0.9 ± 7.6/-1.1 ± 6.1 mm Hg for systolic BP (SBP)/diastolic BP (DBP) for criterion 1, and -0.9 ± 6.8/-1.1 ± 5.5 mm Hg for SBP/DBP for criterion 2. The mean differences between reference BPs and HEM-6410T-ZL readings were 2.4 ± 7.3/0.7 ± 7.0 mm Hg for SBP/DBP for criterion 1, and 2.4 ± 6.5/0.7 ± 6.5 mm Hg for SBP/DBP for criterion 2. The Omron HEM-6410T-ZM and the Omron HEM-6410T-ZL both fulfilled both validation criteria 1 and 2 of the ANSI/AAMI/ISO 81060-2:2013 guidelines.

Validation of a wrist-type home nocturnal blood pressure monitor in the sitting and supine position according to the ANSI/AAMI/ISO81060-2:2013 guidelines: Omron HEM-9600T.

The purpose of the present study was to evaluate the performance of the Omron HEM-9600T, an automatic wrist-type device for self BP measurement, in the sitting position with the wrist at heart level and supine position according to the ANSI/AAMI/ISO81060-2:2013 guidelines. In the supine position, we evaluated the device under 3 different conditions: using the supine with sideways palm position, the supine with upwards palm position, and the supine with downwards palm position. After 106 subjects were screened and 21 subjects were excluded, the same 85 subjects (38 men [44.7%] and 47 women [55.3%]) were included in the analyses for each position. The average age of the subjects was 54.5 ± 12.2 years (mean ± SD). The mean wrist circumference was 17.0 ± 2.4 cm. The wrist size distribution fulfilled the requirements of the guidelines. The mean differences between reference BPs and HEM-9600T readings were 1.0 ± 6.7/1.4 ± 5.7 mm Hg, 6.6 ± 7.2/5.5 ± 6.0 mm Hg, 4.8 ± 7.2/4.9 ± 5.8 mm Hg, and 2.1 ± 7.2/2.8 ± 6.8 mm Hg for SBP/DBP in the sitting position, supine with sideways palm position, supine with upwards palm position, and supine with downwards palm position, respectively. In conclusion, the Omron HEM-9600T in the sitting position fulfilled the validation criteria of the ANSI/AAMI/ISO81060-2:2013 guidelines. On the other hand, the accuracies of HEM-9600T in the supine position differed depending on the positioning of the palm, with only the downwards palm-position measurement fulfilling both validation criteria of the ANSI/AAMI/ISO81060-2:2013 guidelines.

For a More Reliable Measure of Wrist Blood Pressure Using Smartwatch.

Background: If blood pressure (BP) measurement is important to monitor blood hypertension and other cardiac diseases, and can be taken using a wrist device, learned societies recommend to take it in specific conditions. In a telemedicine context, patients are likely to perform it without any help from a medical practitioner. Therefore, the device must guide individuals using it. Materials and Methods: A smartwatch application integrating an Attitude and Heading Reference System algorithm was developed. It was combined with a wrist BP monitor to help users position the BP monitor properly. Results: The system was tested on 30 individuals and a survey conducted to evaluate its usability. The experiment showed that individuals needed to be guided to measure correctly their BP and our application helped them in positioning the wrist BP monitor in a user-friendly way. Conclusions: In a telemedicine context, it is possible to guide easily individuals to position correctly any commercialized wrist BP monitor using a smartwatch. Manufacturers could also integrate affordable sensors into their BP monitors to provide this assistance without the need of external devices.

Blood pressure measurement in special populations and circumstances.

According to the established validation protocols, a typical validation study of a blood pressure (BP) monitor includes general population adults with normal or elevated BP. It is recognized, however, that the automated (oscillometric) BP monitors may have different accuracy or uses in some special populations compared with adults in the general population. Thus, an automated BP monitor with proven accuracy in a general population of adults may not be accurate in a special population, and therefore separate validation is needed. Recognized special populations deserving separate validation are those for which there is theoretical, and also clinical evidence, that the accuracy of BP monitors in these groups differs from that in the general population. Young children, pregnant women (including those with preeclampsia), individuals with arm circumference >42 cm, and patients with atrial fibrillation are regarded as special populations. Adolescents, individuals older than 80 years, and patients with end-stage renal disease or diabetes mellitus have also been considered as possible special groups, but there is still inadequate evidence of altered accuracy of BP monitors in these subjects. Validation studies should be performed in special populations and evaluated separately after the BP-measuring device has successfully undergone a validation study in a general population (unless the test device is intended only for a special population). This article discusses issues relating to the measurement of BP and the diagnosis of hypertension in selected special populations, as well as in low-resource settings, where a simplified yet efficient evaluation strategy is necessary.

Sensing and Storing the Blood Pressure Measure by Patients through A Platform and Mobile Devices †.

In this article, we present a platform that allows for the integration of different applications for the follow-up of patients with chronic diseases. We developed two elements: a mobile and a web application. The mobile application allows the capture and processing of vital signs for patients with high blood pressure (hypertension). This application allows for the patient to store the data obtained, provides historical information and trends of the stored measures, and provides alerts and recommendations according to ranges of measures that were obtained. The web application allows the doctor and patients to obtain updated information of the disease behavior through the measures obtained. We used different biometric devices including an efimomanometer, glucometer, scale, and a thermometer with a wi-fi connection. Through this web application, we also generated information about average measures at a given time, by age, by region, and by a specific date. The developed system was evaluated in a medical center with different types of patients.

Overview of the 2011 Food and Drug Administration Circulatory System Devices Panel of the Medical Devices Advisory Committee Meeting on the CardioMEMS Champion Heart Failure Monitoring System.

The CardioMEMS Champion Heart Failure Monitoring System (CardioMEMS, Atlanta, Georgia) is a permanently implantable pressure measurement system designed to wirelessly measure and monitor pulmonary artery (PA) pressure and heart rate in heart failure (HF) patients to guide ambulatory HF management and to reduce HF hospital stays. On December 8, 2011, the Food and Drug Administration (FDA) Circulatory System Device Panel reviewed the CardioMEMS Champion HF Monitoring System premarket approval (PMA) application. The majority of Panel members agreed that that the discussed monitoring system is safe for use in the indicated patient population. However, new information reported by the FDA with regard to preferential support in management of patients in the treatment group raised concerns among the Panel members with regard to potential bias in analyzing the efficacy of the device itself. Additionally, Panel members raised concerns with regard to the efficacy of the device in certain patient subpopulations. Hence, most Panel members decided that there was not reasonable assurance that the discussed monitoring system is effective. This summary aims to describe the discussions and recommendations made during this meeting.

A perfect replacement for the mercury sphygmomanometer: the case of the hybrid blood pressure monitor.

This study validated a hybrid mercury-free device as a replacement of the mercury sphygmomanometer for professional use, and also as a standard for future validations. A validation study was performed according to the European Society of Hypertension International Protocol 2010 (ESH-IP) in 33 subjects using simultaneous blood pressure (BP) measurements. A total of six BP measurements were taken per participant simultaneously by a supervisor (S; hybrid auscultatory device Nissei DM3000) and two observers (A and B; mercury sphygmomanometers). ESH-IP analysis (99 BP readings): mean device-observer systolic/diastolic BP difference 0.2±2.0/0.1±2.0 mm Hg; systolic BP differences ≤5/10/15 mm Hg in 97/99/99 readings, respectively (diastolic 98/99/99). All 33 subjects had 2 of 3 BP differences ≤5 mm Hg and none without a difference ≤5 mm Hg. Further analysis (198 BP readings): mean differences S-A 0.1±2.4/0.2±2.4 mm Hg (systolic/diastolic), S-B 0.3±2.1/0.2±2.2, A-B 0.2±2.4/0.0±2.3; differences ≤2 mm Hg S-A in 88/84% (systolic/diastolic), S-B 87/85%, A-B 87/86% and ≤4 mm Hg S-A 95/96%, S-B 95/96%, A-B 95/98%. In conclusion, a hybrid mercury-free auscultatory BP monitor comfortably passed the ESH-IP 2010 requirements and has the same level of accuracy as the mercury sphygmomanometer. This device appears to be a reliable alternative to the mercury sphygmomanometer for professional use and also as a standard for future validations.

Self-monitoring of ambulatory blood pressure by the Microlife WatchBP O3--an application test.

Ambulatory blood pressure monitoring (ABPM) is not widely used in clinical practice, because the measuring procedure is complex and the devices are expensive and need to be fitted by skilled medical technologists. The Microlife WatchBP O3 (Microlife AG, Widnau, Switzerland), which was developed for self blood pressure monitoring at home and adapted for ABPM, is highly affordable for an ABPM device and easy to manipulate. We performed an application test of the WatchBP O3 to confirm reliability of the device. Thirty-seven volunteer participants (age 30.4 ± 13.5 y) underwent blood pressure (BP) measurements every 30 min for 24 h, and were asked to complete a questionnaire about the user-friendliness and acceptability of the device. The participants were asked to attach the device and to detach it the next morning by themselves. The quality of recordings was assessed in terms of percentage of valid readings. The mean number of 24-h BP readings per participant was 46.6 ± 5.3. The percentage of valid readings was 90%, which was similar to that reported for traditional ambulatory devices. Eighty-six percent of participants found it is "easy" or "very easy" to attach the device by themselves. The WatchBP O3, which is easy to manipulate, may be convenient and acceptable for users. The percentage of valid readings is similar to that reported previously. A new era of self-monitoring of ambulatory BP is anticipated in the near future.

Avaliação de um modelo de parâmetros distribuídos aplicado à estimação da geometria arterial na hipertensão / Evaluation of a distributed parameter model applied to arterial geometry estimation in hypertension

A hipertensão arterial provoca adaptações estruturais nas artérias, principalmente pelos processos de hipertrofia e remodelagem, as quais antecedem lesões de órgãos-alvo. A determinação de variáveis mecânicas e geométricas associadas ao sistema arterial possibilita ao clínico identificar precocemente as adaptações que decorrem da hipertensão arterial sistêmica no paciente, permitindo a intervenção terapêutica mais adequada. Este trabalho apresenta a avaliação de um modelo eletro-hidráulico e seu método associado para a determinaçãodos parâmetros geométricos do segmento arterial do antebraço. O método proposto requer somente a aquisição não-invasiva de ondas de pulso em dois sítios distintos. Séries de ondas de pulso da artéria radial foram simuladas a partir de ondas de pulso reais da artéria braquial, empregandoum modelo de parâmetros distribuídos simplificado das artérias do antebraço. O modelo é composto por três seções,representando os segmentos arteriais braquial, radial e a mão. As artérias braquial e radial foram representadas por componentes resistivos (atrito local), indutivos (massa do sangue) e capacitivos (complacência arterial), enquanto a mão foi representada por elementos resistivos (resistências de pequenos vasos da mão e periféricos) e capacitivos (complacência de pequenos vasos). Os resultados mostram um erro médio de estimação que pode ser considerado pequeno (3,7%) quando comparado aos valores de adaptação arterial in vivo (alterações de até 15%), indicando a utilização deste procedimento para estimar o processo de remodelagem das artérias de médio calibre observado na hipertensão arterial sistêmica.

Arterial hypertension leads to structural adaptation of arteries, mainly hypertrophy or remodeling, which precedes target-organ injuries. Determination of both mechanical and geometrical variables related to arterial system allows physicians to identify early arterial adaptation derived from systemic hypertension and to propose therapeutics. This work presents the evaluation of an electric-hydraulic model, and associated method, for determination of geometrical and mechanical parameters of forearm arteries. The proposed method requires only noninvasive acquisition of two pressure pulses at distinct sites. Series of pressure pulses from radial artery were simulated using acquired brachial artery pulses and a simplified distributed-model of the forearm arteries. The model presents three sections, representing brachial, radial, and hand vasculature. Brachial and radial arteries were represented with resistive (friction), inductive (blood mass), and capacitive (arterial compliance) elements. The hand was modeled with resistive (small vessels and capillaries) and capacitive elements (small vessels compliance). The results show that an average estimation error of 3.7% is small compared to “in vivo” findings (changes up to 15%), indicatingthat the procedure can be used to assess the remodeling of medium-sized arteries on primary systemic arterial hypertension.

Calculating arterial pressure-based cardiac output using a novel measurement and analysis method.

Work on applying physical and physiological principles for determining cardiac output by analysis of pressure measurements has been pursued for decades. Reference measurements for this kind of cardiac output analysis rely on the pulmonary artery catheter (PAC), considered the clinical gold standard for cardiac output monitoring. Recent advances in signal processing, as well as applied information on the relationships that enable arterial pulse pressure to be used to determine stroke volume, have led to the development of a novel system that can continuously measure cardiac output from an arterial pressure waveform that does not require an external calibration reference method. There are significant challenges in applying statistical- and signal-processing practices to the analysis of complex physiological waveforms. This paper reviews the historical basis for measuring flow from the analysis of pressure in a vessel, establishes the physiological and mathematical basis for this new system and describes its performance under various physiological conditions.

Blood pressure measurement in research and in clinical practice: recent evidence.

PURPOSE OF REVIEW: For over a century the technique of blood pressure measurement developed by Riva-Rocci and Korotkoff has provided most of the data on hypertension diagnosis and treatment. Its limitations, however, are becoming increasingly evident and therefore alternative solutions are under investigation. This paper is intended to provide an overview of important recent progress in this field, and to highlight future perspectives. RECENT FINDINGS: A major development in blood pressure measurement is the technical improvement of electronic manometers for use either in the clinic (with the auscultatory approach, as an alternative to use of mercury columns), or in automated oscillometric devices yielding blood pressure measurements devoid of observer-dependency, and allowing long-term blood pressure monitoring. In the latter case, blood pressure measurement is made possible in settings other than the physician's office, either through ambulatory blood pressure monitoring or through self blood pressure measurement at home. These methods are growing in clinical importance, but further studies are needed to define their indications more precisely in the clinical evaluation of hypertensive patients. Recently, important steps towards better standards of blood pressure measurement have been taken, as summarized in the guidelines jointly issued by the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC), in the 7th Joint National Committee Report and (in even more detail) in the Blood Pressure Measurement Guidelines published by the ESH Working Group on Blood Pressure Monitoring. SUMMARY: Blood pressure measurement is a rapidly developing field, the importance of which is increasingly acknowledged in the light of the growing awareness of the impact of hypertension on public health. Despite remarkable progress, many methodological issues still remain to be properly addressed.