The optimal use of automated office blood pressure measurement in clinical practice

This evidence‐based article endorses the use of automated office blood pressure (AOBP). AOBP is the most favorable office blood pressure (BP) measuring technique as it provides accurate readings with 3‐15 mm Hg lower values than the casual conventional office measurements with auscultatory or semi‐automated oscillometric devices and relates closely to awake ABP readings. The AOBP technique seems to be superior to conventional office BP in predicting hypertension‐mediated organ damage and appears to be equally reliable to awake ABP in the prediction of cardiovascular (CV) disease. AOBP readings should be obtained either unattended, with the patient alone in the examination room, or attended with the presence of personnel in the room but with no talking to the patient, although this recommendation is not frequently followed in routine clinical practice. To optimize office BP readings, the type of device, the rest period before AOBP measurements (preceding rest), and the time intervals between measurements were evaluated. As AOBP readings have the advantage of removing many confounding factors, the authors propose to perform measurements with a preceding rest in all patients at the initial visit; if AOBP readings remain <130 mm Hg in subsequent visits, measurements could be accepted, otherwise, if are higher, patients should be evaluated by out‐of‐office BP measurements.     

The first study comparing a wearable watch‐type blood pressure monitor with a conventional ambulatory blood pressure monitor on in‐office and out‐of‐office settings

Wearable blood pressure (BP) monitoring devices which measure BP levels accurately both in and out of the office are valuable for hypertension management using digital technology. The authors have conducted the first comparison study of BPs measured by a recently developed wrist‐worn watch‐type oscillometric BP monitoring (WBPM) device, the “HeartGuide,” versus BPs measured by an ambulatory BP monitoring (ABPM) device, A&D TM‐2441, in the office (total of 4 readings alternately measured in the sitting position) and outside the office (30‐minutes interval measurements during daytime) in 50 consecutive patients (mean age 66.1 ± 10.8 years). The 2 BP monitoring devices were simultaneously worn on the same non‐dominant arm throughout the monitoring period. The mean difference (±SD) in systolic BPs (average of 2 readings) between WBPM and ABPM was 0.8 ± 12.8 mm Hg (P = .564) in the office and 3.2 ± 17.0 mm Hg (P < .001) outside the office. The proportion of differences that were within ±10 mm Hg was 58.7% in the office and 47.2% outside the office. In a mixed‐effects model analysis, the temporal trend in the difference between the out‐of‐office BPs measured by the two devices was not statistically significant. In conclusion, the difference between the WBPM and ABPM device was acceptable both in and out of the office.     

Auscultatory and oscillometric methods of ambulatory blood pressure monitoring, advantages and limits: a technical point of view

Two methods of indirect blood pressure (BP) measurement are currently used for ambulatory blood pressure measurement (ABPM): the auscultatory and oscillometric methods. The auscultatory method is based on the detection of Korotkoff sounds issued from the acoustic transudcer signal. Its main advantages are (1) similarities with usual clinical measurement of BP; and (2) accurate detection of systolic and diastolic pressures on the appearance and disappearance of sounds. The main disadvantages of this method are (1) artefacts due to movements; and (2) difficulties in signal analysis due to physiological variations of the Korotkoff sound patterns or poor signals. Difficulties can be overcome by appropriate signal processing (K2 recognition), noise rejection and/or ECG gating. This may allow relatively accurate BP measurement during mild exercise. With the oscillometric method, air volume variations in the cuff are detected during deflation. The maximum oscillation is related to the mean arterial pressure. The systolic and diastolic BP are determined by an algorithmic interpretation of the shape of oscillometric amplitudes as well as the heart rate. The main advantages are (1) possibility of BP measurement when the Korotkoff signal is poor; (2) measurement of the mean arterial BP; and (3) no need of a microphonic sensor. The main disadvantages are (1) some oscillometric curves are difficult to read accurately; (2) oscillometry is very sensitive to movements due to the bandwidth of the signals, so the arm must be immobile; and (3) the accuracy of the systolic and diastolic BP depends on the algorithm used. These two methods are complementary and should ideally be associated in the same device.     

Regression to the mean in home blood pressure: Analyses of the BP GUIDE study

The aim of our study was to estimate the size of regression to the mean with home blood pressure (BP) monitoring and compare with that for office BP. Office and home BP measures were obtained from the BP GUIDE (value of central Blood Pressure for GUIDing managEment for hypertension) study, in which 286 patients had BP measured every 3 months for 12 months. Patients were categorized by 10 mm Hg strata of baseline BP, and regression to the mean measures was calculated for home and office BP. High baseline home BP readings tended to be lower on long‐term follow‐up, and low baseline readings tended to be higher. For example, patients in the group with mean baseline home systolic BP ≥ 150 mm Hg had a mean baseline systolic BP of 156 mm Hg, which fell to 143 mm Hg at 12 months; and patients in the group with mean baseline home systolic BP < 120 mm Hg had a mean baseline systolic BP of 113 mm Hg which rose to 120 mm Hg at 12 months. Similar patterns were seen in intervention and control groups, and for diastolic BP. The regression dilution ratio for home systolic BP and diastolic BP was 0.52 and 0.64, respectively, compared to 0.40 and 0.55 for office systolic BP and diastolic BP, respectively. Home BP is subject to regression to the mean to a similar degree as office BP. These findings have implications for the diagnosis and management of hypertension using home BP.     

Does the Position or Contact Pressure of the Stethoscope Make Any Difference to Clinical Blood Pressure Measurements: An Observational Study

This study aimed to investigate the effect of stethoscope position and contact pressure on auscultatory blood pressure (BP) measurement.Thirty healthy subjects were studied. Two identical stethoscopes (one under the cuff, the other outside the cuff) were used to simultaneously and digitally record 2 channels of Korotkoff sounds during linear cuff pressure deflation. For each subject, 3 measurements with different contact pressures (0, 50, and 100 mm Hg) on the stethoscope outside the cuff were each recorded at 3 repeat sessions. The Korotkoff sounds were replayed twice on separate days to each of 2 experienced listeners to determine systolic and diastolic BPs (SBP and DBP). Variance analysis was performed to study the measurement repeatability and the effect of stethoscope position and contact pressure on BPs.There was no significant BP difference between the 3 repeat sessions, between the 2 determinations from each listener, between the 2 listeners and between the 3 stethoscope contact pressures (all P > 0.06). There was no significant SBP difference between the 2 stethoscope positions at the 2 lower stethoscope pressures (P = 0.23 and 0.45), but there was a small (0.4 mm Hg, clinically unimportant) significant difference (P = 0.005) at the highest stethoscope pressure. The key result was that, DBP from the stethoscope under the cuff was significantly lower than that from outside the cuff by 2.8 mm Hg (P < 0.001, 95% confidence interval −3.5 to −2.1 mm Hg).Since it is known that the traditional Korotkoff sound method, with the stethoscope outside the cuff, tends to give a higher DBP than the true intra-arterial pressure, this study could suggest that the stethoscope position under the cuff, and closer to the arterial occlusion, might yield measurements closer to the actual invasive DBP.     

Accuracy of oscillometric blood pressure monitoring with concurrent auscultatory blood pressure in hemodialysis patients

BACKGROUND: Oscillometric devices are commonly used to measure blood pressure and their validation entails sequential measurements of auscultated and oscillometric blood pressures. It is unknown whether simultaneous measurement of auscultated blood pressure and concurrent digitization and recording of the sounds can improve assessment of such devices. The aim of this study was to develop a technique of simultaneous measurement of blood pressure using oscillometric and auscultated measurements in the same deflation. Using such a device, we validated the Omron HEM-907 blood pressure measuring device in hemodialysis patients. METHODS: Twenty non-hypertensive subjects and 20 hemodialysis patients were studied. Six blood pressure readings were obtained in each participant; three readings were obtained using the automatic, oscillometric mode of Omron HEM-907 and three readings were obtained using the manual mode of the Omron HEM-907. In each situation, simultaneous digitized Korotkoff sounds and manometric pressures were recorded. The grading scale indicated by the British Hypertension Society protocol was used to assess the device. RESULTS: Systolic blood pressure measured simultaneously by digitized sound and pressures agreed closely for systolic pressure (Grade A for both hemodialysis and normal controls) but not for diastolic pressure (Grade C for both hemodialysis and controls). Sequential comparison of oscillometric readings with auscultated systolic and diastolic pressure yielded a Grade B for both hemodialysis patients and controls. When concurrent digitized systolic readings were used, however, Grade A was achieved for both populations for systolic readings, but Grade C for diastolic readings. The mean differences (SD) between the oscillometric and auscultatory blood pressure reading in normal controls were 4.3 (8.9) and 0.6 (8.7) for systolic and diastolic blood pressures, respectively. In hemodialysis patients, the mean differences (SD) were 2.7 (9.3) and 0.4 (7.0) for systolic and diastolic blood pressures, respectively. CONCLUSION: Simultaneous measurement of digitized Korotkoff sounds and pressure can improve the assessment of devices for systolic but not diastolic blood pressure. The Omron HEM-907 device can be recommended for use in hemodialysis patients.     

Antecedent rest may not be necessary for automated office blood pressure at lower treatment targets

In SPRINT (Systolic Blood Pressure Intervention Trial), use of the Omron 907XL blood pressure (BP) monitor set at 5 minutes of antecedent rest to record BP produced an automated office BP value 7/6 mm Hg lower than awake ambulatory BP at 27 months. The authors studied the impact on automated office BP of setting the Omron 907XL to 0 minutes instead of 5 minutes of rest in patients with readings in the lower normal BP range, similar to on‐treatment BP in the SPRINT intensive therapy group. Patients (n = 100) in cardiac rehabilitation were randomized to three BP readings at 1‐minute intervals using an Omron 907XL BP device set for 5 or 0 minutes of antecedent rest. Mean (±standard deviation) automated office BP (mm Hg) after 5 minutes of rest (120.2 ± 14.6/66.9 ± 8.6 mm Hg) was lower (P < .001/P < .01) than without rest (124.2 ± 16.4/67.9 ± 9.1 mm Hg). When target BP is in the lower normal range, automated office BP recorded without antecedent rest using an Omron 907XL device should be higher and closer to the awake ambulatory BP, compared with readings taken after 5 minutes of rest.     

Automated office blood pressure measurements obtained with and without preceding rest are associated with awake ambulatory blood pressure

Automated office blood pressure (AOBP) measurement, attended or unattended, eliminates the white coat effect (WCE) showing a strong association with awake ambulatory blood pressure (ABP). This study examined the difference in AOBP readings, with and without 5 minutes of rest prior to three readings recorded at 1‐min intervals. Cross‐sectional data from 100 randomized selected hypertensives, 61 men and 39 women, with a mean age of 52.2 ± 10.8 years, 82% treated, were analyzed. The mean systolic AOBP values without preceding rest were 127.0 ± 18.2 mm Hg, and the mean systolic AOBP values with 5 minutes of preceding rest were 125.7 ± 17.9 mm Hg (P = .05). A significant order effect was observed for the mean systolic BP values when AOBP without 5 minutes of preceding rest was performed as the first measurement (130.0 ± 17.7 vs 126.5 ± 16.2, P = .008). When we used a target systolic AOBP ≥ 130 mm Hg, awake ABP yielded lower readings, while at a target systolic AOBP value of < 130 mm Hg higher awake ABP values were obtained. Our findings indicate that systolic AOBP can be initially checked without any preceding rest and if readings are normal can be accepted. Otherwise, when AOBP is ≥ 130 mm Hg, measurements should be rechecked with 5 minutes of rest.     

A comparison between the oscillometric and the auscultatory method for ambulatory 24 h blood pressure monitoring

OBJECTIVES: To investigate the compatibility between oscillometric and auscultatory methods, and to determine whether one is preferable over the other for ambulatory 24 h blood pressure monitoring. METHODS: For the blood pressure monitoring system we used an A&D TM 2421 device (Takeda), which enabled us to measure the blood pressure simultaneously with the two methods on the same arm. Our investigation included 281 patients (122 women and 159 men, aged 18-85 years) with suspected hypertension or undergoing treatment for hypertension. RESULTS: We obtained 23 531 measurements by the oscillometric method, which was 98% of the maximal possible number, and 81% of the maximal possible number were obtained by the auscultatory methjod. We were able to compare 98% of the paired measurements. The auscultatory method showed a uniform distribution of errors throughout the 24 h. Compared to the auscultatory method, the oscillometry method had fewer errors in the evenings, but more when the subjects were at work. There was a difference in paired single readings between the two methods amounting to 1.4+/-19 mmHg (mean+/-SD) for systolic and -2.4+/-18 mmHg for diastolic readings (auscultatory - oscillometric). The differences in mean values for the 281 cases of 24 h monitoring amounted to 0.7+/- 4 mmHg for systolic and -2.2+/-6 mmHg for diastolic measurements. For the mean systolic blood pressure, we found a difference of 0.3+/-4 mmHg in the daytime and 0.3+/-8 mmHg during the night. The mean diastolic pressures differed by -2.0+/-6 mmHg in the daytime and -1.6+/-8 mmHg during the night. We found only a weak correlation between the differences in the readings by the two methods and systolic blood pressure levels, age, pulse pressure and body mass index, and no correlations between these differences and the diastolic blood pressure levels. CONCLUSION: Although we found a considerable SD on single readings by the two methods, there was a good agreement between the mean values of the 24 h monitoring for the two methods. We obtained a significantly higher success rate by the oscillometric method. The findings suggest that, for this equipment, the oscillometric method is preferable for 24 h ambulatory blood pressure monitoring because it provides a much higher rate of successful readings.     

Comparison between oscillometric and intra-arterial blood pressure measurements in ill preterm and full-term neonates

Conflicting data exist regarding the accuracy of the oscillometric method of blood pressure (BP) measurement in neonates. There is limited data regarding intra-arterial BP trends in neonates. We aimed to determine the accuracy of oscillometric BP measurements and to evaluate the BP distributions in ill neonates. A total of 1492 simultaneously obtained oscillometric and intra-arterial (umbilical arterial [UAC] or radial arterial) BP measurements were used for comparisons and 125,580 intra-arterial BP readings were used to the evaluate BP distribution. There was a statistically significant difference (P < .0001) between the oscillometric and radial mean arterial BP (MAP) 4.8 ± 9.8 mm Hg, systolic BP 8.3 ± 11.6 mm Hg, diastolic BP 4.3 ± 9.3 mm Hg and between the oscillometric and UAC systolic BP 5.2 ± 11.9 mm Hg and diastolic BP −0.8 ± 10.4 mm Hg. The MAP increased with increases in weight (35.3 ± 4.92 mm Hg/kg), post-menstrual age (−0.29 ± 1.41 mm Hg/week) and advanced gestational age at birth (13.12 ± 0.90 mm Hg/week). Oscillometric BP measurements are not equivalent to the intra-arterial (UAC or radial arterial) BP in ill neonates. The BP increases with increase in weight, gestational age at birth, and post-menstrual age in ill neonates.     

Blood pressure control and cardiovascular risk profile in hypertensive patients under specialist care in Argentina: Results from the CHARTER study

Worldwide, hypertension control rate is far from ideal. Some studies suggest that patients treated by specialists have a greater chance to achieve control. The authors aimed to determine the BP control rate among treated hypertensive patients under specialist care in Argentina, to characterize patients regarding their cardiovascular risk profile and antihypertensive drug use, and to assess the variables independently associated with adequate BP control. The authors included adult hypertensive patients under stable treatment, managed in 10 specialist centers across Argentina. Office BP was measured thrice with a validated oscillometric device. Adequate BP control was defined as an average of the three readings <140/90 mm Hg (and <150/90 in patients older than 80 years). The authors estimated the proportion of adequate BP control and the variables independently associated with it through a multiple conditional logistic regression model. Among the 1146 included patients, 48.2% were men with a mean age of 63.5 (±13.1) years old. Mean office BP was 135.3 (±14.8)/80.8 (±10) mm Hg, with a 64.8% (95% CI: 62%‐67.6%) of adequate control. The mean number of antihypertensive drugs was 2.1 per participant, the commonest being angiotensin receptor blockers and calcium channel blockers. In multivariable analysis, only female sex was a predictor of adequate BP control (OR 1.33 [95% CI 1.02‐1.72], P = .04). In conclusion, almost 65% of hypertensive patients treated in specialist centers in Argentina have adequate BP control. The challenge for future research is to define strategies in order to translate this control rate to the primary care level, where most patients are managed.     

Overview of blood pressure measurement by Brazilian health professionals

Although automated monitors for blood pressure (BP) measurement are used increasingly worldwide, understanding of how such devices are used in Brazil is low. This study analyzed the status of BP measurement by Brazilian health professionals. A questionnaire regarding experience with BP measurement was sent electronically to Brazilian nurses, nursing assistants, and doctors. It had 2004 responses. Previous experience with use of automated monitors was most frequent in men (71.2%), nursing technicians (65.5%), specialists (61.1%), secondary care (71.9%), emergency care (70.6%), or the private sector (66.3%). The least complied aspects of the standardized measurement protocol were availability of various cuff sizes (53.9% and 72.9% for auscultatory and oscillometric methods, respectively) and proper calibration checks (21.5% and 46.8% for auscultatory and oscillometric methods, respectively). Brazilian health professionals report not adequately performing all the necessary aspects to measure BP in accordance with the standardized protocol in both methods, but mainly regarding the oscillometric.     

Single cuff comparison of two methods for indirect measurement of arterial blood pressure: standard auscultatory method versus automatic oscillometric method

Summary With the introduction of automatic oscillometric systems for indirect measurement of arterial blood pressure (e. g. DINAMAP), the problem of correspondence between that method and the standard auscultatory method arose. For an exact and valid comparison of two methods, for physiological and methodological reason, both measurements have to be performed simultaneously and using only one single cuff.Applying a methodological approach fulfilling these preconditions and offering in addition the advantage of a graphic documentation of the individual measurement cycles, we were able to investigate both methods in a sample of 216 comparative experiments.We found a mean difference (auscultatory method minus oscillometric method) between the methods (bias) of –0.82 mm Hg (–0.109 kPa) for systolic pressure, 1.25 mm Hg (0.166 kPa) for diastolic pressure and 1.00 mm Hg (0.133 kPa) for mean pressure. Except for systolic pressure, the differences were statistically significant (paired t-test and analysis of variance). We also obtained a significant negative correlation between the differences and the average of both pressure values (decreasing error with increasing pressure) and a significant negative correlation between differences and heart rate (decreasing differences with increasing heart rate).The conclusions drawn from the comparative study are that, although the oscillometric method exhibited a tendency to higher systolic and lower diastolic measurement values compared to the auscultatory method, both methods are well comparable and the differences are below the level of physiological and clinical significance.     

Can auscultatory blood pressure normative values be used for evaluation of oscillometric blood pressure in children?

The aim of the study was to analyze whether auscultatory normative values (Fourth Task Force [4TF]) can be applied to blood pressure (BP) obtained by oscillometric devices. The authors performed a retrospective analysis of oscillometric office BP and ambulatory BP monitoring in 229 children (116 boys), median age 15.31 years. Office systolic BP (SBP) and diastolic BP (DBP) values were converted into Z scores using 4TF and oscillometric (German Health Interview and Examination Survey for Children and Adolescent [KiGGS]) reference values. There was good correlation between the two normative methods (r=0.9773 for SBP, r=0.9627 for DBP). Results from Bland‐Altman test revealed only minimal differences in Z scores between 4TF and KiGGS for SBP, but a significant proportional error for DBP. 4TF and KiGGS Z scores were equally predictive of ambulatory hypertension. In conclusion, auscultatory and oscillometric normative data are interchangeable for SBP but not for DBP.     

Indirect blood pressure measurements: a matter of interpretation.

The indirect measurement of arterial blood pressure is discussed from the standpoint of the intravascular phenomena that occur under the cuff during the production of Korotkoff sounds. The influence of the physical and elastic properties of the vessel wall and blood flow parameters on indirect blood pressure measurement were investigated by using the results of model studies carried out in a properly scaled, simulated mechanical system under controlled conditions. The results of those studies indicate that auscultatory readings may be subject to large errors, depending on the thickness and stiffness of the artery wall. These results are shown to be consistent with comparisons of direct and indirect blood pressures in human subjects in that errors of the order of 30 to 50 mm Hg are not uncommon in the elderly or in patients with advanced arteriosclerosis. The errors discussed here are inherent to the auscultatory technique and are not related to instrument calibration, auditory acuity, or office technique.     

Blood pressure measurement and blood pressure control in Veterans Affairs medical centers

The Veterans Affairs (VA) medical centers provide care for millions of Veterans at high risk of cardiovascular disease and accurate BP measurement in this population is vital for optimal BP control. Few studies have examined terminal digit preference (TDP), a marker of BP measurement bias, clinician perceptions of BP measurement, and BP control in VA medical centers. This mixed methods study examined BP measurements from Veterans aged 18 to 85 years with hypertension and a primary care visit within 8 VA medical centers. TDP for all clinic BP measurements was examined using a goodness of fit test assuming 10% frequency for each digit. Interviews were also conducted with clinicians from 3 VA medical centers to assess perceptions of BP measurement. The mean age of the 98,433 Veterans (93% male) was 68.5 years (SD 12.7). BP was controlled (<140/90 mmHg) in 76.5% and control rates ranged from 72.2% to 81.0% across the 8 VA medical centers. Frequency of terminal digits 0 through 9 differed significantly from 10% for both SBP and DBP within each center (P < .001) but level of TDP differed by center. The highest BP control rates were noted in centers with highest TDP for digits 0 and 8 for both SBP and DBP. Clinicians reported use of semi-automated oscillometric devices for clinic BP measurement, but elevated BP readings were often confirmed by auscultatory methods. Significant TDP exists for BP measurement in VA medical centers, which reflects continued use of auscultatory methods.     

Effect of cuff positioning on the accuracy of blood pressure measurement with automated electronic blood pressure monitors

It is recommended that the cuff should be wrapped around the upper arm with the midline of the bladder placed over the brachial artery during blood pressure (BP) measurement. However, in practice, the cuff of sphygmomanometers is often incorrectly placed. The authors aimed to assess the effect on the accuracy of BP measurement as to the placement of the cuff bladder by using oscillometric devices. Participants aged 18 years or older were enrolled. The center of the cuff bladder was placed directly over the brachial artery as the standard position (correct position), which was rotated by 90°medially (medial position), 90°laterally (lateral position), and rotated by 180°(contralateral position), respectively. The main outcomes were non‐invasive brachial BP in the four cuff positions, brachial artery pulse wave velocity, ankle‐brachial index, and invasive radial BP. Of 799 participants, 56.4% were men (60.37 ± 12.73 years), and of the 104 intensive care unit participants, 60.57% were men (57.78 ± 15.89 years). There were no significant differences in non‐invasive brachial BP among the four cuff positions (P > .1), and the mean BP differences between incorrect and standard cuff positions were within 1.0 mm Hg. BP of the incorrect positions was positively correlated with standard position (P < .001, r > .88) and showed good consistency. There was no effect on the accuracy of BP measurement as to the location of the midline of the cuff bladder by using oscillometric devices with a conventional cuff.     

High prevalence of masked uncontrolled morning hypertension in elderly non‐valvular atrial fibrillation patients: Home blood pressure substudy of the ANAFIE Registry

In the ANAFIE Registry home blood pressure subcohort, we evaluated 5204 patients aged ≥75 years with non‐valvular atrial fibrillation (NVAF) to assess blood pressure (BP) control, prevalence of masked hypertension, and anticoagulant use. Mean clinic (C) and home (H) systolic/diastolic BP(SBP/DBP) was 128.5/71.3 and 127.7/72.6 mm Hg, respectively. Overall, 77.5% of patients had hypertension; of these, 27.7%, 13.4%, 23.4%, and 35.6% had well‐controlled, white coat, masked, and sustained hypertension, respectively. Masked hypertension prevalence increased with diabetes, decreased renal function, age ≥80 years, current smoker status, and chronic obstructive pulmonary disease. By morning/evening average, 59.0% of patients had mean H‐SBP ≥ 125 mm Hg; 48.9% had mean C‐SBP ≥ 130 mm Hg. Early morning hypertension (morning H‐SBP ≥ 125 mm Hg) was found in 65.9% of patients. Although 51.1% of patients had well‐controlled C‐SBP, 52.5% of these had uncontrolled morning H‐SBP. In elderly NVAF patients, morning H‐BP was poorly controlled, and masked uncontrolled morning hypertension remains significant.     

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.     

Home blood pressure control status in 2017‐2018 for hypertension specialist centers in Asia: Results of the Asia BP@Home study

A self‐measured home blood pressure (BP)‐guided strategy is an effective practical approach to hypertension management. The Asia BP@Home study is the first designed to investigate current home BP control status in different Asian countries/regions using standardized home BP measurements taken with the same validated home BP monitoring device with data memory. We enrolled 1443 medicated hypertensive patients from 15 Asian specialist centers in 11 countries/regions between April 2017 and March 2018. BP was relatively well controlled in 68.2% of patients using a morning home systolic BP (SBP) cutoff of <135 mm Hg, and in 55.1% of patients using a clinic SBP cutoff of <140 mm Hg. When cutoff values were changed to the 2017 AHA/ACC threshold (SBP <130 mm Hg), 53.6% of patients were well controlled for morning home SBP. Using clinic 140 mm Hg and morning home 135 mm Hg SBP thresholds, the proportion of patients with well‐controlled hypertension (46%) was higher than for uncontrolled sustained (22%), white‐coat (23%), and masked uncontrolled (9%) hypertension, with significant country/regional differences. Home BP variability in Asian countries was high, and varied by country/region. In conclusion, the Asia BP@Home study demonstrated that home BP is relatively well controlled at hypertension specialist centers in Asia. However, almost half of patients remain uncontrolled for morning BP according to new guidelines, with significant country/regional differences. Strict home BP control should be beneficial in Asian populations. The findings of this study are important to facilitate development of health policies focused on reducing cardiovascular complications in Asia.