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Clinical evaluation and user experience of the Cloud DX connected HealthKit Pulsewave wrist cuff blood pressure monitor (CDXP) for home blood pressure monitoring during pregnancy.In the first phase, an adjusted version of the European Society of Hypertension International Protocol Revision 2010 was used to compare the CDXP and Omron M6 Comfort to the gold standard, the aneroid manometer, In the second phase, we evaluated the performance of home blood pressure measurement (HMBPM) by the CDXP to standard hospital blood pressure measurement with the Welch Allyn 53000P. Additionally, patients filled out a questionnaire regarding user experience.In 34 pregnant patients the blood pressure measured by the CDXP did not differ from the aneroid manometer, while the Omron M6 Comfort measured the systolic blood pressure slightly higher (1.5 ± 5.8 mmHg (p = 0.04)) and diastolic blood pressure slightly lower (-2.8 ± 5.8 mmHg (p 0.01)) as compared to the aneroid manometer. In 32 patients the systolic blood pressure of home blood pressure measurement with the CDXP was significantly lower than the single standard hospital measurements. The mean system usability scaled score was high (85%). Of all patients, 97% reported they liked the idea of home monitoring and would like to use it in the future.The CDXP measured blood pressure correctly, even slightly better than the Omron M6 Comfort and gives a better representation of the blood pressure during the day at home than a single hospital measurement. Pregnant patients are positive about HMBPM and find the CDXP easy to use.

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 2 = 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 p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.

Automated 'oscillometric' blood pressure (BP) measuring devices (BPMDs) were developed in the 1970s to replace manual auscultatory BP measurement by mercury sphygmomanometer. Automated BPMDs that have passed accuracy testing versus a reference auscultatory sphygmomanometer using a scientifically accepted validation protocol are recommended for clinical use globally. Currently, there are many thousands of unique automated BPMDs manufactured by hundreds of companies, with each device using proprietary algorithms to estimate BP and using a method of operation that is largely unchanged since inception. Validated automated BPMDs provide similar BP values to those recorded using manual auscultation albeit with potential sources of error mostly associated with using empirical algorithms to derive BP from waveform pulsations. Much of the work to derive contemporary BP thresholds and treatment targets used to manage cardiovascular disease risk was obtained using automated BPMDs. While there is room for future refinement to improve accuracy for better individual risk stratification, validated BPMDs remain the recommended standard for office and out-of-office BP measurement to be used in hypertension diagnosis and management worldwide. ispartof: JOURNAL OF HUMAN HYPERTENSION vol:37 issue:2 ispartof: location:England status: published

Blood pressure monitoring (BPM) devices have to be validated according to strict international validation protocols. Each protocol requests a specific number of participants to be included. All protocols use vast amounts of resources, as three people have to be present for every measurement, making trials costly, especially when the manufacturer has no intention to execute a validation study, reflected in the low share of validated in the commercially available BPM devices. The aim of our study was to develop criteria, which could detect low accuracy devices that could not pass a validation protocol early in the course of the validation process. The 2010 European Society of Hypertension International Protocol (ESH-IP) and the Universal Standard for Validation of BPM devices (AAMI/ESH/ISO) were scrutinized for criteria which can be used for preclusion of passing. Based on this, we developed a fail model. We found that a BPM device cannot pass the ESH-IP protocol, if there are ≥27, 13, or 4 single measurements differing more than 5, 10, or 15 mmHg, respectively, from the reference. For the AAMI/ESH/ISO protocol, we developed a model, which calculates best-case standard deviations (SDs) to detect SDs which would prevent the passing of the protocol before its completion, making a stepwise validation process possible. In conclusion, we found that our model is able to predict failure of low-accuracy BPM devices early during a validation protocol if used in a stepwise-approach. This can be useful to keep costs of validation studies low and to enable investigator-initiated trials.

In 2020 the ANSI/AAMI/ISO published Amendment 1 to the 81060-2 Standard. The purpose was to try to address issues relating to the distribution of subjects with respect to limb size ranges. It also required a new plot showing the limb circumferences on the x-axis and the device minus reference errors on the y-axis (Alpert plot). The study reported here showed inadequacies of the Amendment if significantly overlapping cuffs were to be tested. The innovative approach led to the testing of 135 subjects. Requirements for blood pressure (BP), arm circumference, and gender were fulfilled. The standard same arm sequential protocol was used. Criterion 1 calculations gave a mean ± standard deviation (SD) device minus manual BP values of 0.22 ± 7.90 mmHg for systolic BP and -0.68 ± 7.36 mmHg for diastolic BP. The maximum allowed mean value for either measurement is 5.0 mmHg. The SD values for Criterion 2 were 6.03 mmHg for systolic BP (maximum allowed 6.95) and 6.47 mmHg for diastolic BP (maximum allowed 6.90). All results passed the Standard requirements. This study demonstrated inadequacies of Amendment 1 and led to the development of an Amendment 2, still in the process of finalization. The new Amendment corrects the issues with significantly overlapping cuffs and "wide-range" cuffs. The AD UA-651 Plus/UA-651SL Plus BP monitors and the five cuffs not only passed the requirements of 81060-2:2018 and Amendment 1 but also a revised and more rigorous protocol with more subjects involved. These devices and cuffs can be used with confidence.

The objective of this study is to determine the accuracy of the G.LAB MD41A0 upper-arm oscillometric blood pressure (BP) monitor for self/home BP measurement in patients with diabetes according to the Association for the Advancement of Medical Instrumentation /European Society of Hypertension /International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018).Patients with diabetes were recruited according to AAMI/ESH/ISO Universal Standard using the same arm sequential BP measurement method. The standard cuff of the test device was used for arm circumference 22-44 cm.A total of 92 patients with diabetes were recruited and 85 were analyzed with an average age of 55.1 ± 17.7 years, 48 men, and arm circumference of 32.0 ± 6.0 cm. For the validation Criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.89 ± 6.04/-0.84 ± 5.11 mmHg (systolic/diastolic). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 4.23/4.19 mmHg (systolic/diastolic).The G.LAB MD41A0 upper arm BP monitor fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in patients with diabetes and can be recommended for self/home use.

Jirar Topouchian,1 Parounak Zelveian,2 Zoya Hakobyan,2 Heghine Gharibyan,2 Roland Asmar3 1Diagnosis and Therapeutic Center, Hôtel Dieu Hospital, Paris, France; 2Preventive Cardiology Dept, Institute of Cardiology Named After Levon Hovhannisyan, Yerevan, Armenia; 3Foundation-Medical Research Institutes (F-MRI)®, Geneva, SwitzerlandCorrespondence: Roland Asmar, Foundation-Medical Research Institutes ®, Place St Gervais 1, Geneva, Switzerland, Tel +33640142239, Email ra@cmcv.orgBackground: As recommended by various authorities and scientific societies, electronic devices for blood pressure (BP) measurements must undergo independent clinical validations for accuracy assessment.Objective: To assess the accuracy of the Withings BPM Connect device in the general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization “AAMI/ESH/ISO Universal Standard (ISO 81060– 2:2018)”.Methods: The Withings BPM Connect device measures BP at the brachial level using the oscillometric method. According to this protocol using the same-arm sequential BP measurement method, subjects (n ≥ 85) fulfilling the age, gender, BP and cuff distribution criteria must be included. Two criteria are used for the analysis: Criterion 1: differences between observers’ mercury sphygmomanometer reference measurements and test device BP values (test versus reference) and their standard deviation (SD) must be ≤ 5 ± 8 mmHg for both systolic (SBP) and diastolic BP (DBP). Criterion 2: the SD of the mean BP differences between the test device and reference BP per subject must be ≤ 6.91/6.62 mmHg for SBP/DBP.Results: Ninety-two subjects were selected, 85 of whom were included. For validation criterion 1, the mean difference ± SD between the reference and device BP values was 0.6 ± 5.3 mmHg for SBP and 2.1 ± 4.3 mmHg for DBP. For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 4.2/3.6 mmHg (SBP/DBP). These results fulfilled the AAMI/ESH/ISO Universal Standard (ISO 81060– 2:2018) protocol requirements.Conclusion: The Withings BPM Connect oscillometric device for home BP measurement fulfilled all of the accuracy requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060– 2:2018) in general population and consequently can be recommended for home BP measurements.Keywords: blood pressure measurements, accuracy, validation, home blood pressure, oscillometric, Withings

BACKGROUND Measuring an accurate blood pressure (BP) in ambulatory patients is critical for therapeutic decisions. An accurate noninvasive device that measures BP continuously could provide a more comprehensive assessment of BP. The aim of this study was to determine whether the LiveOne device, a cuffless wristband that provides continuous BP measurements, is accurate in comparison to an invasive arterial line (A-line). METHODS We enrolled hospitalized patients and healthy volunteers in this multicenter study. All patients had an invasive A-line. Waveforms were simultaneously downloaded from the A-line and LiveOne device. The primary outcome was the correlation between the LiveOne device and the A-line for systolic BP (SBP) and diastolic BP (DBP). RESULTS Thirty-four patients with 233 measurement periods were included. Mean age was 60.7 ± 15.2 years, and 15 (44%) were female. The correlation for SBP was 0.91 and for DBP was 0.85. The mean band error was 0.0 ± 6.9 mm Hg for SBP and 1.2 ± 5.7 mm Hg for DBP. The mean absolute error was 8.2 ± 5.8 mm Hg for SBP and 6.4 ± 3.9 mm Hg for DBP. For SBP, 98% of LiveOne measurements were within 15 mm Hg and for DBP, 92% of LiveOne measurements were within 10 mm Hg. CONCLUSIONS The LiveOne device provides continuous, noninvasive BP measurements that are accurate in comparison to A-line measurements. The portability and unobtrusive nature of this device and the ability to provide continuous BP measurements may offer advantages over currently available BP monitors. CLINICAL TRIALS REGISTRATION Trial Number NCT03919136.

Hypertension is associated with more end-organ damage, cardiovascular events, and disability-adjusted life years lost in the United States compared with all other modifiable risk factors. Several guidelines and scientific statements now endorse the use of out-of-office blood pressure (BP) monitoring with ambulatory BP monitoring or home BP monitoring to confirm or exclude hypertension status based on office BP measurement. Current ambulatory or home BP monitoring devices have been reliant on the placement of a BP cuff, typically on the upper arm, to measure BP. There are numerous limitations to this approach. Cuff-based BP may not be well-tolerated for repeated measurements as is utilized with ambulatory BP monitoring. Furthermore, improper technique, including incorrect cuff placement or use of the wrong cuff size, may lead to erroneous readings, affecting diagnosis and management of hypertension. Compared with devices that utilize a cuff, cuffless BP devices may overcome challenges related to technique, tolerability, and overall utility in the outpatient setting. However, cuffless devices have several potential limitations that limit its routine use for the diagnosis and management of hypertension. The review discusses the different approaches for determining BP using various cuffless devices including engineering aspects of cuffless device technologies, validation protocols to test accuracy of cuffless devices, potential barriers to widespread implementation, and future areas of research. This review is intended for the clinicians who utilize out-of-office BP monitoring for the diagnosis and management of hypertension.

Guidelines differed on the required number of blood pressure (BP) readings for accurate BP assessment. We, therefore, compared the mean of the first two BP readings with the overall mean of three readings in the diagnosis of hypertension.BP was measured three times consecutively with a 1 min interval using a validated automated electronic BP monitor in volunteers aged at least 18 years. The mean of the first and second BP readings was compared with the mean of the three blood pressure readings for the diagnostic accuracy of hypertension.Of the 77 520 study participants, 65.2 and 25.2% had a SBP or DBP difference at least 5 mmHg and at least 10 mmHg between the first and second BP readings, respectively. Regardless whether the BP difference between the first two BP readings was at least 5 mmHg or at least 10 mmHg for systolic and diastolic alone or both, significant (P 0.0001) SBP/DBP differences between the mean of the first two BP readings and the overall mean of three readings were observed with an absolute value up to 1.28/1.11 mmHg. However, the mean of the first two BP readings exhibited good reliability and sufficient agreement in the diagnosis of hypertension with a kappa statistic at least 0.88, except that the difference between the first and second BP readings was at least 10 mmHg for both systolic and diastolic (κ=0.79). The diagnostic accuracy was similar across age quartile, sex, and BP category.Two BP readings may be sufficient, unless the BP difference between the two readings was at least 10 mmHg for both systolic and diastolic.

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.

Aims: In the general population, central arterial blood pressure has proved to be more closely related to left ventricular hypertrophy than brachial arterial blood pressure. We aimed to investigate whether this relationship was true in patients with chronic kidney disease. Methods: In this retrospective study, we reviewed the medical records of 289 adult patients with chronic kidney disease from the Zhejiang Provincial People’s Hospital in Zhejiang, China. Demographic, echocardiographic, and brachial and central blood pressure parameters were retrieved from medical records. Central blood pressure was measured using the SphygmoCor® CvMS (AtCor, Australia) device and its corresponding software. Multivariate logistic regression analyses were performed to identify independent predictors of left ventricular hypertrophy. Receiver operating characteristic curves were used to determine the ability of central and brachial blood pressure to predict left ventricular hypertrophy.Results: The left ventricular mass index was positively associated with both central and brachial blood pressures. However, multiple logistic regression analysis demonstrated that a central pulse pressure ≥ 58 mm Hg was an independent risk factor for left ventricular hypertrophy (OR=5.597, 95%CI 2.363-13.259, P Conclusions: Our results suggested that, similarly to the general population, central pulse pressure is a better parameter for predicting the occurrence of left ventricular hypertrophy in patients with chronic kidney disease.

The purpose of the Zero to Five study was to compare automated office blood pressure (AOBP) readings obtained after either 0 or 5 minutes of antecedent rest in relation to the awake ambulatory blood pressure. AOBP is recommended in different jurisdictions following either a 0- or 5-minute rest. This was a prospective, randomized, 2 arm, trial with blinded outcomes, recruiting adult patients referred for ambulatory blood pressure monitoring (ABPM). Participants had an AOBP measurement performed according to clinical practice guidelines with an OMRON HEM-907XL set to measure after 0 or 5 minutes of rest. The primary outcome was the difference between the mean AOBP and mean awake ABPM in the 0-minute wait group versus that in the 5-minute wait group. The study enrolled 618 participants, mean age 57.1 years, 52% women. For the 0-minute rest group, the mean AOBP was 141.2/83.1 (17.1/12.1 mm Hg) and the awake ABPM was 141.3/83.8 (16.1/10.2 mm Hg), with difference −0.02/0.52 (17.4/11.4 mm Hg). For the 5-minute rest group, the mean AOBP was 138.2/81.7 (16.9/12.4 mm Hg) and the awake ABPM was 143.4/83.6 (17.3/10.3 mm Hg), with difference −5.16/−0.8 (18.6/11.6 mm Hg). The difference of differences in systolic blood pressure (AOBP-awake ABPM) for the 0 versus the 5-minute wait group was 5.1 mm Hg (95% CI, 2.3–8.0, P =0.005) with the 0-minute AOBP measurement closest to the awake ABPM. The Zero to Five study demonstrated that a wait time of 0 minute before an AOBP measurement was closer to the daytime ABPM result than a 5-minute wait before the AOBP. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03732924.

Obtaining accurate blood pressure readings is vital. However, students and health professionals do not always receive adequate training on blood pressure measurement, especially regarding new technologies, leading to insufficient knowledge. Therefore, the aim of this study is to analyze Brazilian health professionals' perceptions and knowledge about automated blood pressure monitors. This cross-sectional study involved 1734 Brazilian nurses, nursing technicians, and doctors who reported having some experience of using automated monitors. Perceptions about differences between readings obtained through the auscultatory and oscillometric methods, influence of small differences in clinical decision-making, confidence in automated monitors, and knowledge about contraindications for the use of these devices were assessed. Most medical and nursing professionals considered differences of up to 5 mmHg (40.94%) between auscultatory and oscillometric measurements acceptable. Of these, 69.02% reported that even small differences can influence clinical decisions. Confidence in readings obtained using automated blood pressure monitors was reported by 53.92%. Among the motivations for making these devices available in health services, the most frequent was the saving of time (48.85%) and the least frequent, the perception that the use of this technology requires less training (9.40%). Arrhythmia was the most recognized contraindication for the use of automated monitors (28.49%), followed by obesity (28.14%) and blood pressure readings above 160 × 100 mmHg. In conclusion, there is a lack of knowledge about the functionalities and indications of blood pressure monitors and a low tolerance for measurements different from those obtained through manual mercury sphygmomanometers or aneroids.

Blood pressure (BP) monitoring can be performed either invasively via arterial catheterization or non-invasively through a cuff sphygmomanometer. However, for conscious individuals, traditional cuff-based BP monitoring devices are often uncomfortable, intermittent, and impractical for frequent measurements. Continuous and non-invasive BP (NIBP) monitoring is currently gaining attention in the human health monitoring area due to its promising potentials in assessing the health status of an individual, enabled by machine learning (ML), for various purposes such as early prediction of disease and intervention treatment. This review presents the development of a non-invasive BP measuring tool called sphygmomanometer in brief, summarizes state-of-the-art NIBP sensors, and identifies extended works on continuous NIBP monitoring using commercial devices. Moreover, the NIBP predictive techniques including pulse arrival time, pulse transit time, pulse wave velocity, and ML are elaborated on the basis of bio-signals acquisition from these sensors. Additionally, the different BP values (systolic BP, diastolic BP, mean arterial pressure) of the various ML models adopted in several reported studies are compared in terms of the international validation standards developed by the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS) for clinically-approved BP monitors. Finally, several challenges and possible solutions for the implementation and realization of continuous NIBP technology are addressed.

Mercury sphygmomanometer based on traditional auscultation method is widely used in primary medical institutions in China, but a large amount of blood pressure data can not be directly recorded and applied in scientific research analysis, meanwhile auscultation data is the clinical standard to verify the accuracy of non-invasive electronic sphygmomanometer. Focusing on this, we designed a miniature non-invasive blood pressure measurement and verification system, which can assist doctors to record blood pressure data automatically during the process of auscultation. Through the data playback function,the software of this system can evaluate and verify the blood pressure algorithm of oscillographic method, and then continuously modify the algorithm to improve the measurement accuracy. This study introduces the hardware selection and software design process in detail. The test results show that the system meets the requirements of relevant standards and has a good application prospect.

Various home blood pressure monitors (HBPMs) are available to the public for purchase but only some are validated against standardised protocols. This study aimed to assess whether HBPMs owned by participants taking part in a clinical trial were validated models. The TIME study is a decentralised randomised trial investigating the effect of antihypertensive medication dosing time on cardiovascular outcomes in adults with hypertension. No HBPMs were provided to participants in this trial but patients were asked to report if they already owned one. We identified the model of HBPM reported by participants, then cross-referenced this against lists of validated HBPMs produced by dabl Educational Trust and the British and Irish Hypertension Society (BIHS). Of 21,104 participants, 10,464 (49.6%) reported their model of HBPM. 7464 (71.3%) of these participants owned a monitor that could be identified from the participants’ entry. Of these, 6066 (81.3%) participants owned a monitor listed as validated by either dabl (n = 5903) or BIHS (n = 5491). Some were listed as validated by both. 1398 (18.7%) participants owned an identifiable HBPM that lacked clear evidence of validation. 6963 (93.3%) participants owned an upper arm HBPM and 501 (6.7%) owned a wrist HBPM. Validated HBPMs had a higher median online retail price of £45.00 compared to £20.00 for HBPMs lacking clear evidence of validation. A significant number of participants own HBPMs lacking evidence of validation.

Objectives There are limited non-invasive methods to assess lower extremity arterial injuries in the emergency department (ED) and pre-hospital setting. The ankle-brachial index (ABI) requires careful auscultation by Doppler, an approach made difficult in noisy environments. We sought to determine the agreement of the ABI measured using the pulse oximeter plethysmograph waveform (Pleth) with auscultation by Doppler in a controlled setting. A secondary outcome sought to examine the agreement of ABI by automated oscillometric sphygmomanometer (AOS) with Doppler. Methods We measured blood pressure in the right upper and lower extremities of healthy volunteers using: (1) Doppler and manual sphygmomanometer; (2) Pleth and manual sphygmomanometer; and (3) AOS. The Bland-Altman approach to assessing agreement between methods was used comparing mean differences between ABI pairs to their means for Doppler versus Pleth and Doppler versus AOS. The intraclass correlation coefficient (ICC) from mixed effects models examined intra- and inter-rater reliability. Results Among 100 participants with normal ABI the mean ABI (95%CI) were Doppler 1.11 (0.90–1.33), Pleth 1.10 (0.91–1.30), and AOS 1.10 (0.90–1.30). The ABI difference (95% CI for limits of agreement) were 0.01 (−0.20,0.18) for Doppler-Pleth and 0.02 (−0.26, 0.22) for Doppler-AOS. The ICC for the Doppler-Pleth comparison (ICC = 0.56, 95% CI 0.47–0.63) was greater than for the Doppler-AOS (ICC = 0.32, 95% CI 0.19–0.43). Conclusions The ABI measured using the Pleth has a high level of agreement with measurement by Doppler. The AOS and Doppler have good agreement with greater measurement variability. Pleth and AOS may be reasonable alternatives to Doppler for ABI.

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.

Objective We taught parents to use at home a hand-held Doppler device and aneroid sphygmomanometer for SBPmeasurement (HDBPM). Methods Retrospective study including all children referred to evaluate hypertension over a 6-year period. Each child underwent HDBPM measurements performed by parents while awake over 2 weeks with three measurements performed twice daily. Results Of n = 155 children, 145 (93.5%) were successful and aged median (interquartile range) 2.48 (1.01, 5.12) years, including 85 boys. Overall, there were 25, 19, 30 and 26% aged less than 1, 1 to less than 2, 2 to less than 5 and at least 5 years old, respectively. Seventy-eight (54%) had been referred for confirming diagnosis and 67 (46%) for ongoing monitoring of treated hypertension. Following HDBPM, 70 of 78 (90%) patients in the 'Diagnosis subgroup' were observed to have normal blood pressure (BP). In the monitoring subgroup, treated hypertension that required no medication changes was recorded in 35 of 67 (52%) and medication changed in 32 of 67 (48%), [increased, decreased or changed] in 22, 6 and 5%, respectively. In 10 of 67 (15%) medication was weaned and stopped completely following HDBPM. None of the children required admission to hospital to evaluate their BP level or manage hypertension. Conclusion Out-of-office BP monitoring using HDBPM is acceptable to children and families of young children when parents are taught to measure BP and supported by health professionals. We report evidence of the feasibility and clinical utility of HDBPM in a challenging population of children who are either too young or unable to tolerate 24-h ambulatory BP monitoring for both the diagnosis and ongoing management of clinically relevant hypertension.

This article presents the design of an unobtrusive and wireless-enabled blood pressure (BP) monitoring system that is suitable for ambulatory use. By adopting low-profile electromechanical actuators and a compact printed circuit board design, this lightweight device can be worn directly on the occlusive cuff, therefore eliminating the need of a long and obtrusive tubing interconnect between the device and the cuff, as seen in traditional ambulatory BP monitors (ABPM). Instead of executing the BP estimation algorithm directly on the device, the proposed design rather sends the raw oscillometric signal through a Bluetooth Low Energy link, thus granting any Bluetooth-enabled device to gather and process the signal using a dedicated application. This in turn allows to assess several BP estimation algorithms found in the literature without being limited by the device resources. Three of them were tested with the designed prototype and validated with a reference equipment on 11 subjects. Overall, two of the algorithms revealed a mean absolute difference with the reference equipment of less than 5 mmHg and almost zero bias along with a standard deviation of less than 6 mmHg. Reproducibility results shown a mean difference between successive measurements of less than 3.1 mmHg and a standard deviation of less than 2.4 mmHg. The assembled prototype dimensions are 63.8 × 134.8 × 24.8 mm and features an autonomy of 63.1 hours. Comparison with commercial ABPM devices shown that the proposed design is 18% to 33% smaller volume-wise, 5% to 27% weight-wise and height is reduced by 17% to 25%.

Hypertensive patients account for about 16% to 37% of the global population, and about 9.4 million people die each year from hypertension and its complications. Blood pressure is an important indicator for diagnosing hypertension. Currently, blood pressure measurement methods are mainly based on mercury sphygmomanometers in hospitals or electronic sphygmomanometers at home. However, people’s blood pressure changes with time, and using only the blood pressure value at the current moment to judge hypertension may cause misdiagnosis. Continuous blood pressure measurement can monitor sudden increases in blood pressure, and can also provide physicians with long-term continuous blood pressure changes as a diagnostic reference. In this article, we design an artificial intelligence-enhanced blood pressure monitoring wristband. The wristband’s sensors are based on piezoelectric nanogenerators, with a high signal-to-noise ratio of 29.7 dB. Through the transformer deep learning model, the wristband can predict blood pressure readings, and the loss value is lower than 4 mmHg. By wearing this blood pressure monitoring wristband, we realized three days of continuous blood pressure monitoring of the subjects. The blood pressure monitoring wristband is lightweight, has profound significance for the prevention and treatment of hypertension, and has wide application prospects in medical, military, aerospace and other fields.

The aim of this study was to assess the blood pressure (BP) measurement accuracy of the Kinetik Blood Pressure Monitor—Series 1 (BPM-1) for use in home or clinical settings according to the 2002 European Society of Hypertension International Protocol (ESH-IP). Forty-two participants were recruited to fulfil the required number of systolic and diastolic BP measurements according to the ESH-IP. Nine sequential same-arm BP readings were measured and analysed for each participant using the test device and observer mercury standard readings according to the 2002 ESH-IP. Forty one participants were used to obtain 33 sets of systolic and diastolic BP readings and were included in the analysis. Mean difference between the device measurements and the observer (mercury standard) measurements was 1.1 ± 7.2/1.1 ± 6.8 mmHg (mean ± standard deviation; systolic/diastolic). The number of systolic BP differences between the test and observer measurements that fell within 5, 10 and 15 mmHg was 65, 86 and 92. For diastolic readings, the number of test—observer measurement differences within 5, 10 and 15 mmHg was 77, 91 and 94. The number of participants with at least two out of three differences within 5 mmHg was 28 for systolic and 40 for diastolic BP readings. Three participants had no differences between the test and observer measurements within 5 mmHg in both the systolic and diastolic measurement categories. The Kinetik BPM-1 device fulfilled the requirements of the ESH-IP validation procedure and can be recommended for clinical use and self-measurement within the home.

Hypertension (HTN) is a common health problem and a major cardiovascular risk factor. Accurate measurement of blood pressure (BP) is mandatory for proper diagnosis and follow-up. The aim of this study was to evaluate the accuracy of mercury sphygmomanometer BP-measuring devices in public hospitals in Cairo, Egypt. Fifty public hospitals were included, and 10% of all mercury sphygmomanometer devices in each hospital were tested. Assessment included physical condition (e.g., mercury status, lid of the device, state of the rubber tubes), leakage rate, and calibration accuracy (as compared with a reference device). Devices were approved as accurate when they could successfully pass all three assessment tests. The total number of sphygmomanometer devices was 465. The overall pass rate was 1.3% (six devices). Twenty-five (5.2%) devices passed all of the physical tests, 50 (10.8%) passed the leakage test, and 50 (16.5%) passed the calibration accuracy test. There were 162 (34.8%) devices that showed a high leakage rate (>80 mmHg) and thus were not tested for calibration accuracy. In conclusion, most of the mercury sphygmomanometer devices in hospitals are neglected and not checked regularly for any errors. A plan should be made to gradually replace those failed devices with new, validated, and well-calibrated devices, preferably devices that do not contain mercury.

Numerous devices purport to measure central (aortic) blood pressure (BP) as distinct from conventional brachial BP. This validation study aimed to determine the accuracy of the Sphygmocor Xcel cuff device (AtCor Medical, CardieX, Sydney, Australia) for measuring central BP. 296 patients (mean age 61±12 years) undergoing coronary angiography had simultaneous measurement of invasive central BP and noninvasive cuff-derived central BP using the Xcel cuff device (total n=558 individual comparisons). A subsample (n=151) also had invasive brachial BP measured. Methods were undertaken according to the Artery Society recommendations, and several calibration techniques to derive central systolic BP (SBP) were examined. Minimum acceptable error was ≤5±≤8 mm Hg. Central SBP was significantly underestimated, and with wide variability, when using the default calibration of brachial-cuff SBP and diastolic BP (DBP; mean difference±SD, −7.7±11.0 mm Hg). Similar variability was observed using other calibration methods (cuff 33% form-factor mean arterial pressure and DBP, −4.4±11.5 mm Hg; cuff 40% form-factor mean arterial pressure and DBP, 4.7±11.9 mm Hg; cuff oscillometric mean arterial pressure and DBP, −18.2±12.1 mm Hg). Only calibration with invasive central integrated mean arterial pressure and DBP was within minimal acceptable error (3.3±7.5 mm Hg). The difference between brachial-cuff SBP and invasive central SBP was 3.3±10.7 mm Hg. A subsample analysis to determine the accuracy of central-to-brachial SBP amplification showed this to be overestimated by the Xcel cuff device (mean difference 4.3±9.1 mm Hg, P =0.02). Irrespective of cuff calibration technique, the Sphygmocor Xcel cuff device does not meet the Artery Society accuracy criteria for noninvasive measurement of central BP.

Objective Performance of the Omron HBP-1320, designed for professional use by adding several features to the home blood pressure (BP) measuring device, was validated using two different protocols, specifically the ANSI/AAMI/ISO 81060-2:2013 (ANSI/AAMI/ISO) and the European Society of Hypertension International Protocol, 2010 Revision (ESH IP2), as a separate study. Methods Three trained medical technologists validated the performance of this device by comparing data obtained from the device with those obtained using a standard mercury sphygmomanometer throughout the study. Results Mean differences in mercury readings for systolic BP (SBP) and diastolic BP (DBP) between the devices were 1.6 ± 5.8 and -0.4 ± 5.3 mmHg, respectively, according to the ANSI/AAMI/ISO protocol, and mean device-observer measurement differences were -0.4 ± 4.9 and -0.2 ± 4.2 mmHg, respectively, satisfying Part 1 of ESH IP2. Differences in SBP and DBP both satisfied Part 2 of ESH IP2. The number of absolute differences in the values obtained using the device and those obtained by the observers fulfilled the requirements of the ANSI/AAMI/ISO protocol and ESH IP2. Conclusion Omron HBP-1320 met all requirements of the ANSI/AAMI/ISO protocol and ESH IP2.

(a) to investigate the test-retest and inter-rater reliabilities and the criterion-related validity of the modified sphygmomanometer test (MST) for the assessment of muscle strength in community-dwelling older adults, (b) to calculate the standard error of measurement (SEM) and the smallest real difference (SRD); (c) to verify whether the number of trials affect the results.Bilateral strength of lower limbs (LL) and grip muscles were evaluated with the MST and with portable dynamometers in 50 older adults (69.92 ± 5.52 years). Intra-class Correlation Coefficients (ICC) was used to evaluate the inter-rater and test-retest reliabilities and Pearson Correlations was used to investigate the criterion-related validity of the MST. SEM and SRD were also calculated. Analysis of variance was used to investigate whether the number of trials affects the results.Significant correlations with high to very high magnitude were found for all muscle groups evaluated for test-retest and inter-rater reliabilities (0.80 ≤ ICC ≤ 0.99;The MST showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength of older adults.Implications for rehabilitationOlder adults often develop sarcopenia and dynapenia that are associated with an increased number of falls and fractures and loss of independence.Portable dynamometer is the standard instrument to evaluate isometric muscle strength, however this instrument is expensive and it is not readily available in the underdeveloped or in developed countries.The Modified Sphygmomanometer Test is an alternative method for the clinical measurement of muscle strength, is portable, has a low-cost and provides an objective measurement.In this study the Modified Sphygmomanometer Test showed adequate results for all the measurement properties evaluated for the assessment of the muscle strength in community-dwelling older adults and a single trial after test familiarization can be used to measure the muscle strength in this population.

Objective The aim of this study was to evaluate the accuracy of the automated oscillometric upper arm blood pressure monitor HL868ED for clinical use and self-measurement according to the International Protocol of the European Society of Hypertension revision 2010. Method Systolic and diastolic blood pressure were measured sequentially in 43 adult Chinese (21 women, mean age 51.7 years) using a mercury sphygmomanometer (two observers) and the HL868ED device (one supervisor). A total of 99 pairs of comparisons were obtained from 43 participants for judgements in two parts with three grading phases. Results The HL868ED device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10 and 15 mmHg was 68/99, 91/99 and 97/99, respectively, for systolic blood pressure and 85/99, 95/99 and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Twenty-four and 30 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥24). Three participants for systolic and one participant for diastolic blood pressure had all the three device-observer comparisons greater than 5 mmHg. Conclusion The Health & Life blood pressure monitor HL868ED has passed the requirements of the International Protocol revision 2010 and hence can be recommended for blood pressure measurements in adults.

Noninvasive blood-pressure measurement device and pulse oximeter are important for patient monitoring. When these are placed on the same side, cuff inflation sometimes causes measurement failure by pulse oximeter.The present study aimed to compare the pulse oximeter alarm frequency and pulse-wave disappearance duration between noninvasive blood-pressure measurement using the deflation method and that using the linear inflation method.The study included 10 healthy subjects. The cuff for automatic sphygmomanometer was wrapped on one side of the upper arm and for pulse oximeter was attached to the thumb of the same side of upper limbs.The alarm frequency was 0 and 26% using the linear inflation and the deflation methods, respectively. Additionally, the pulse-wave disappearance duration was significantly longer using the deflation method than that using the linear inflation method (10.0 ± 1.5 vs 1.7 ± 0.8 s). With the linear inflation method, this duration was or less 3 s. In the deflation method, an excess pressure of 40 mmHg was used, which caused the alarm to turn on. Additionally, the heart rate was found to influence the alarm occurrence during measurement using the deflation method.Heart rate may influence alarm occurrence during blood-pressure measurement using the step deflation method. Using the linear inflation method, the risks of alarm occurrence and measurement failure are low, even when the pulse oximeter and blood-pressure measurement cuffs are installed on the same side, suggesting that this method is suitable for clinical use.

In recent times, new methods of blood pressure measurements have been introduced, including cuffless blood pressure (BP) measurement device using pulse transit time (PTT) for calculation of BP values. However, it is still unknown how values obtained with a new cuffless device compare with standard ambulatory measurements in children. The main aim of the study was to investigate whether BP values measured by a cuffless PTT device are comparable with measurements by a standard upper arm cuff-based BP device.Thirty children were prospectively included. Blood pressure measurements using the cuffless device (Somnotouch-NIBP) and cuff-based standard device (Omron 907) were performed simultaneously on the left and right arm.Mean systolic BP of the standard measurements was 123,47 ± 14,91 mmHg and 127,48 ± 15,98 mmHg (The results show that the created PWV-BP function produces a significant correlation between BP derived from the PWV and the SBP measured by sphygmomanometry. When applying this device in clinical practice, one may keep in mind that the reported mean values over 24 hours, awake and asleep time are not directly interchangeable with cuff-based standard 24-hour BP values. The measured BP values were higher by the new technique. Although differences in SBP between both methods reached values up to 20 mmHg, we think that the development of a cuffless BP monitoring system will provide novel solutions in various medical situations.

Unlike other international guidelines but in accord with the earlier Japanese Society of Hypertension (JSH) guidelines, the 2019 JSH guidelines (“JSH 2019”) continue to emphasize the importance of out‐of‐office blood pressure (BP) measurements obtained with a home BP device. Another unique characteristic of JSH 2019 is that it sets clinical questions about the management of hypertension that are based on systematic reviews of updated evidence. JSH 2019 states that individuals with office BP

Using manometer sphygmomanometers as standard measurement tool, there are controversial data regarding accuracy and validity of digital manometers for measurement of systolic (SBP) and diastolic blood pressure (DBP). Thus, we aimed to compare the accuracy of readings of digital sphygmomanometer in reference to mercury sphygmomanometer in a large population of healthy adults.This cross-sectional study was performed on 1119 healthy adults. We measured participant's blood pressure once with mercury sphygmomanometer, as gold standard and again with digital mercury sphygmomanometer. Blood pressure was measured in sitting position after 5 min of rest and preferentially from right arm unless deformed.The mean ± standard deviation of age of participants was 37.25 ± 10.45 years. Majority of participants were male 588 (52.5%). The right/left SBP measured by digital sphygmomanometer were significantly higher compared with those measured by mercury sphygmomanometer: 115.37 ± 12.33 vs 110.95 ± 10.06/113.69 ± 11.77 vs 110.23 ± 10.34, respectively (According to the results of our data analysis, it was shown that the digital device measurements had significant incompatibility with the mercury sphygmomanometers and it seems that digital devices still cannot be used as the gold standard in blood pressure measurement.

Blood Pressure (BP) is one of the four primary vital signs indicating the status of the body's vital (life-sustaining) functions. BP is difficult to continuously monitor using a sphygmomanometer (i.e. a blood pressure cuff), especially in everyday-setting. However, other health signals which can be easily and continuously acquired, such as photoplethysmography (PPG), show some similarities with the Aortic Pressure waveform. Based on these similarities, in recent years several methods were proposed to predict BP from the PPG signal. Building on these results, we propose an advanced personalized data-driven approach that uses a three-layer deep neural network to estimate BP based on PPG signals. Different from previous work, the proposed model analyzes the PPG signal in time-domain and automatically extracts the most critical features for this specific application, then uses a variation of recurrent neural networks called Long-Short-Term-Memory (LSTM) to map the extracted features to the BP value associated with that time window. Experimental results on two separate standard hospital datasets, yielded absolute errors mean and absolute error standard deviation for systolic and diastolic BP values outperforming prior works., Comment: Accepted at EMBC'21

Objectives Iatrogenic guidewire perforation is a well-known complication of lower extremity angioplasty that is often benign or can be easily treated with endovascular techniques. However, perforations that occur in arterial side branches may be more challenging to manage. If bleeding persists, open surgery and fasciotomy may be required to evacuate the resulting hematoma and prevent compartment syndrome. These subsequent procedures increase morbidity and, if the angioplasty was performed in the outpatient setting, necessitate patient transfer to a hospital. To address these challenges, we describe a non-invasive hemostasis technique involving serial sphygmomanometer cuff inflations over the affected site in a series of five patients who experienced this complication at our office. Methods We retrospectively reviewed the medical records of consecutive patients undergoing lower extremity angioplasty that were found to have an arterial guidewire perforation on completion angiogram at our outpatient center between February 2012 and February 2017. Patients found to have iatrogenic guidewire perforations were administered intravenous protamine sulfate and were transferred to the surgical recovery room. Patients received ibuprofen or acetaminophen for pain management. A blood pressure cuff was placed around the site of perforation, and patients received serial cuff inflation cycles with repeated examinations of both limbs until patients reported cessation of pain and there were no signs of a developing hematoma. Patients were observed for two hours before they were discharged home. A follow-up duplex ultrasound examination was completed within one week of the intervention. Results Over the course of five years, 536 angioplasties were performed at our outpatient office. Five of these patients experienced iatrogenic guidewire perforation (0.93%). Perforations occurred in branches of the anterior or posterior tibial artery. All of these patients were successfully managed with the aforementioned hemostasis technique. None of these patients required transfer to a hospital for further management, and no complications were reported at follow-up. Conclusions Complications of iatrogenic guidewire perforations in lower extremity arterial side branches can be safely and effectively managed by applying external compression around the affected site with an automatic blood pressure cuff.

The use of wearable cuffless blood pressure (BP) devices is becoming commercially prevalent with little published validation information. Most devices rely, at least in part, on the relationship between pulse arrival time (PAT) and BP, a theoretical fundamental relationship that was first commercially exploited in 1993 with the release of the Casio BP-100 digital watch.This study explored the PAT method of BP estimation in a commercial device where it first began, the Casio BP-100 (Model No. 900) digital watch, which employs an individualized, two-point calibration method. Device accuracy was determined by comparison to a conventional cuff-based BP device measurements.Twenty participants (11 female, 9 male) had BP measured using both devices at rest, during a 5-minute isometric hand-grip exercise and at 1-minute post-exercise.Due to bidirectional scatter of BP estimation by the BP-100 device, there was no significant difference between the reference device and the BP-100. The devices showed poor correlation for both systolic BP (SBP) (R=0.36, p=0.13) and diastolic BP (DBP) (R=0.044, p=0.37). However, on average the watch was able to provide correct directional changes in SBP but not DBP with exercise.Despite being an industry first, the Casio BP-100 watch employed a method that gives a great chance of accuracy: a two point, individualized calibration method - more detailed than calibration methods in more modern devices. The watch, on average across a cohort, provided some information on BP directional change but was uncorrelated with cuff-based BP measurement. If the utility of beat-by-beat BP estimation is to be utilized, limitations of this method need to be addressed.

The present study aims to develop and validate a cuffless method for blood pressure continuous measurement through a wearable device. The goal is achieved according to the time-delay method, with the guiding principle of the time relation it takes for a blood volume to travel from the heart to a peripheral site. Inversely proportional to the blood pressure, this time relation is obtained as the time occurring between the R peak of the electrocardiographic signal and a marker point on the photoplethysmographic wave. Such physiological signals are recorded by using L.I.F.E. Italia’s wearable device, made of a sensorized shirt and wristband. A linear regression model is implemented to estimate the corresponding blood pressure variations from the obtained time-delay and other features of the photoplethysmographic wave. Then, according to the international standards, the model performance is assessed, comparing the estimates with the measurements provided by a certified digital sphygmomanometer. According to the standards, the results obtained during this study are notable, with 85% of the errors lower than 10 mmHg and a mean absolute error lower than 7 mmHg. In conclusion, this study suggests a time-delay method for continuous blood pressure estimates with good performance, compared with a reference device based on the oscillometric technique.

This study aims to systematically review the diagnostic accuracy of a digital blood pressure measurement device compared to the gold standard mercury sphygmomanometer in published studies. Searches were conducted in PubMed, Cochrane, EBSCO, EMBASE and Google Scholar host databases using the specific search strategy and filters from 1st January 2000 to 3rd April 2021. We included studies reporting data on the sensitivity or specificity of blood pressure measured by digital devices and mercury sphygmomanometer used as the reference standard. Studies conducted among children, special populations, and specific disease groups were excluded. We considered published manuscripts in the English language only. The risk of bias and applicability concerns were assessed based on the author’s judgment using the QUADAS2 manual measurement evaluation tool. Based on the screening, four studies were included in the final analysis. Sensitivity, specificity, diagnostic odds ratio (DOR), and 95% confidence interval were estimated. The digital blood pressure monitoring has a moderate level of accuracy and the device can correctly distinguish hypertension with a pooled estimate sensitivity of 65.7% and specificity of 95.9%. After removing one study, which had very low sensitivity and very high specificity, the pooled sensitivity estimate was 79%, and the specificity was 91%. The meta-analysis of DOR suggests that the digital blood pressure monitor had moderate accuracy with a mercury sphygmomanometer. This will provide the clinician and patients with accurate information on blood pressure with which diagnostic and treatment decisions could be made.

Objective To evaluate the accuracy of the YuWell YE900 oscillometric upper-arm professional office blood pressure monitor in adults and children according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018). Methods Subjects were recruited to fulfill the age, sex, blood pressure and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in adults and children (aged 3-12 years) using the same arm sequential blood pressure measurement method. Three cuffs of the test device were used for arm circumference 18-22 cm (small), 22-32 cm (medium) and 32-42 cm (large). Results Ninety-two subjects were recruited, and 85 (50 adults and 35 children) were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference blood pressure readings was 1.7 ± 6.62/3.1 ± 5.76 mmHg (systolic/diastolic). For validation criterion 2, the SD of the averaged blood pressure differences between the test device and reference blood pressure per subject was 5.25/5.13 mmHg (systolic/diastolic). Conclusion The YuWell YE900 professional electronic blood pressure monitor has passed the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in adults and children and can be recommended for clinical use.

Objective: Accurate and reliable blood pressure (BP) measurement is important for the prevention and treatment of hypertension. The oscillometric-based automatic office blood pressure measurement (AOBPM) is widely used in hospitals and clinics, but measurement errors are common in BP measurements. There is a lack of systematic review of the sources of measurement errors. Approach: A systematic review of all existing research on sources of AOBPM errors. A search strategy was designed in six online databases, and all the literature published before October 2021 was selected. Those studies that used the AOBPM device to measure BP from the upper arm of subjects were included. Main results: A total of 1365 studies were screened, and 224 studies were included in this final review. They investigated 22 common error sources with clinical AOBPM. Regarding the causes of BP errors, this review divided them into the following categories: the activities before measurement, patient’s factors, measurement environment, measurement procedure, and device settings. 13 sources caused increased systolic and diastolic BP (SBP and DBP), 2 sources caused the decrease in SBP and DBP, only 1 source had no significant effect on BPs, and the other errors had a non-uniform effect (either increase or decrease in BPs). The error ranges for SBP and DBP were −14 to 33 mmHg and −6 to 19 mmHg, respectively. Significance: The measurement accuracy of AOBPM is susceptible to the influence of measurement factors. Interpreting BP readings need to be treated with caution in clinical measurements. This review made comprehensive evidence for the need for standardized BP measurements and provided guidance for clinical practitioners when measuring BP with AOBPM devices.

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.

OBJECTIVE To validate the BPro blood pressure (BP) wrist device for use in pregnancy and preeclampsia according to the Universal Standard protocol. PARTICIPANTS AND METHODS BP was measured sequentially in 45 pregnant women (including 15 with preeclampsia, 15 with gestational hypertension and 15 who remained normotensive) alternating between a mercury sphygmomanometer and BPro device. RESULTS The BPro is accurate in pregnancy with a mean device-observer difference of -1.7 ± 6.1 and 0.1 ± 4.6 mmHg for SBP and DBP, respectively. In women with preeclampsia, BPro also met the validation criteria for the Universal Standard protocol with a mean device-observer difference of -2.7 ± 7.1 and 0.3 ± 4.7 mmHg for SBP and DBP, respectively. However, the number of absolute BP differences within 5 mmHg was considerably fewer in those with preeclampsia when compared to the other two subgroups. CONCLUSION The BPro device can be recommended for BP measurement in pregnancy but should be used with caution in those with confirmed preeclampsia.

Background: The purpose of this study was to develop a reproducible upper limb swelling model and quantify the efficacy of changing elevation posture in swelling reduction using this model. Methods: A manual sphygmomanometer was applied to healthy volunteers’ upper arms while in a dependent position for 25 minutes to create venous congestion and swelling. Seven different levels of pressure (250, 120, 100, 80, 50, 40 and 30 mmHg) were tested. Every 5 minutes, the level of swelling was measured using the volumetric method. Any complications were recorded. We then compared the swelling reduction potential among 3 limb postures (arm on head, elevation brace, and simple sling). The significance level was set at p < .05. Results: Thirty to forty milliliters of swelling was created for all pressure levels except the 250 and 30 mmHg. All complications including transient nerve palsy, pain and petechiae were severe at 250 and 120 mmHg, less severe at 100 mmHg, mild at 80 mmHg, and absent below 40 mmHg. Both the on head and elevated brace limb postures markedly and significantly decreased swelling greater than the simple sling posture. Conclusions: We found that 20 ml or greater swelling can be reliably created with a blood pressure cuff inflated to 40 mmHg on the upper limb. The on head and elevated brace postures demonstrated a greater degree of swelling reduction than the simple sling posture.

Tiernan, C, Lyons, M, Comyns, T, Nevill, AM, and Warrington, G. The relationship between adductor squeeze strength, subjective markers of recovery and training load in elite Rugby players. J Strength Cond Res 33(11): 2926-2931, 2019-The adductor squeeze strength test has become a popular training monitoring marker, particularly in team sports. The aim of this study was to investigate the relationship between adductor squeeze strength scores, subjective markers of recovery and training load in elite Rugby Union players, because of limited research in this area. Nineteen elite male Rugby Union players completed daily monitoring markers (adductor squeeze strength and 5 selected subjective markers of recovery), over a 10-week preseason training period. Rate of perceived exertion (RPE) was collected to determine training load (session RPE; RPE × session duration) and to calculate weekly training load. Spearman's correlation was used to analyze the relationship between adductor squeeze strength scores, subjective markers of recovery, and weekly training load. The results found that where adductor squeeze scores decreased, both perceived fatigue levels (r = -0.335; R = 11.2%; p < 0.001) and muscle soreness (r = -0.277; R = 7.7%; p < 0.001) increased. A weak correlation was found between Monday adductor squeeze strength scores and the previous week's training load (r = -0.235; R = 5.5%; p < 0.001) and Friday adductor squeeze strength scores and the same week's training load (r = -0.211; R = 4.5%; p < 0.05). These results show that adductor squeeze strength may provide coaches with a time-efficient, low-cost objective, player monitoring marker. Additionally, the combination of adductor strength squeeze, with subjective markers, perceived fatigue, and muscle soreness, and appropriately planned training load may help coaches to optimize training adaptations by determining a player's training status.

Objective To investigate the concurrent validity of the Modified Sphygmomanometer Test (MST) with fixed stabilization, compared to the portable dynamometer, and to verify its test-retest and inter-raterreliability. Methods Methodological study. The muscle strength of the following groups was measured: flexors and extensors of the wrist, of the hip, and of the knee and plantar flexors. The Tycos® aneroid sphygmomanometer and the Microfet 2® dynamometer were used. Stabilization was performed using the Mullingan® belt. Descriptive statistics were performed for characterization of the sample. To determine the validity of the MST with fixed stabilization, comparing it with the portable dynamometer, we investigated the correlation between the measurements obtained with the two instruments using the Pearson correlation coefficient. Intraclass Correlation Coefficient (ICC) was used to investigate inter-examiner and test-retest reliability (α = 0.05). Results 59 individuals were included (1176 evaluations). A statistically significant correlation of moderate to high magnitude (0.58 ≤ r ≤ 0.81) was observed for concurrent validity of the MST with fixed stabilization versus the portable dynamometer for all muscle groups. Regarding inter-rater reliability, it was observed statistically significant ICC considered excellent to good (0.72 ≤ r ≤ 0.94) for all muscle groups. Regarding test-retest reliability, first evaluator presented good to excellent ICC (0.64 ≤ r ≤ 0.94), while second evaluator presented good to excellent ICC (0.74 ≤ r ≤ 0.96) for all muscle groups. Conclusion The MST with fixed stabilization is valid and reliable for clinical measurement of muscle strength and can overcome previous limitations reported in the literature.