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Wednesday, 21 February 2018
ALERT: Oscillometric BPMs from the upperarm and from the wrist do NOT agree!

Oscillometric methods are well established for the noninvasive measurement of blood pressure (SBP/DBP) and pulse rate (PR). There is obvious interest in using more convenient measurements from the wrist (W) than conventional measurements with a cuff around thew upperarm. from the upperarm (A). If both methods would show sufficient agreement, W-measurements would be real asset also for ambulatory studies.

We tested this by analysing the extent of agreement (or lack thereof) between non-simultaneous paired SBP/DBP and PR measurements by means of well-established W- (OMRON RX-Genius) and A-devices (BOSO-medicus UNO) in 12 healthy young male and female subjects under conventional phase-I trial conditions when pre- and post-dose readings were compared.

The findings were discouraging: for the untransformed data (387 data pairs), there was obvious bias with W measuring lower SBP (A: 109.9 mmHg; bias W-A: -11.9 mmHg; CI: -13.0 to -10.9 mmHg; limits of agreement [LA]: -32.2 [CI: -34.0 to -30.4] to 8.3 mmHg [CI: 6.5 to 10.1]) and lower DBP (A: 68.3 mmHg; W-A: -13.3 mmHg; CI: -14.0 to -12.6 mmHg; LA: -27.0 [CI: -28.2 to -25.8] to 0.5 [CI: -0.7 to 1.7]), with less difference in PR (A: 62.2 bpm; bias W-A: 4 bpm; CI: 3.5 to 4.6; LA: -7.2 [CI: -8.2 to -6.2] to 15.2 [CI: 14.3 to 16.2]). The average difference ("bias") was far less when comparing post-dosing changes from baseline (346 data pairs) for SBP (A: 0.2 mmHg; W-A: -0.5 mmHg; LA: -26.3 to 25.2 mmHg), DBP (A: -0.8 mmHg; W-A: 0.5 mmHg; LA: -20.6 to 21.7 mmHg), and PR (A: 2.4 bpm; W-A: 1.2 bpm; LA: -14.9 to 17.3 bpm).

In conclusion: There is lack of average agreement between W- and A-measurements of blood pressure; the average bias is far less when considering post-dosing changes; however the within-subject spread of the data differences is too large to consider the methods interchangeable.

This also confirms our concern about the need to provide detailed method specifications when reporting BP-data (see de Mey C. Method specificity of the auscultatory estimates of the inodilatory reduction of diastolic blood pressure based on Korotkoff-IV and -V criteria. Br J Clin Pharmacol, 1995;39:485-490; de Mey C, Schroeter V, Butzer R, Roll S and Belz GG. Method specificity of non-invasive blood pressure measurement: oscillometry and finger pulse pressure vs. acoustic methods. Br J Clin Pharmacol,1995;40:291-297).

Last Updated (Wednesday, 9 November 2011)

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