Key result
Oscillometric blood pressure measurement yielded significantly higher systolic blood pressure values (average 6.1 mmHg higher) compared to the auscultatory method in patients with atrial fibrillation, with wide limits of agreement.
Why the study?
Does automated oscillometric blood pressure monitoring provide reliable measurements compared to auscultatory methods in hypertensive patients with atrial fibrillation?
Cross-Sectional (n=71)
No
Does automated oscillometric blood pressure monitoring provide reliable measurements compared to auscultatory methods in hypertensive patients with atrial fibrillation?
Mean Difference: 6.1 (95% CI -23.9–11.7)
Absolute Event Rate: 133.6% vs 127.5%
p-value: p=<0.001
Automated oscillometric blood pressure devices may yield wide random error rates compared to auscultation in patients with atrial fibrillation, potentially impacting clinical hypertension management.
Caution against relying on oscillometric BP in AF; leaves open whether auscultatory methods remain preferable pending validation studies.
BACKGROUND: The aim of our study was to investigate the reliability of automated oscillometric blood pressure (BP) monitoring in the presence and absence of atrial fibrillation (AF) in hypertensive patients. METHODS: BP was measured and compared in 71 randomly selected patients with AF and arterial hypertension diagnosis, 4 times each by auscultatory and oscillometric (Microlife BP A6 PC with AF detection system) methods. RESULTS: Study included 71 patients: 36 males (mean age 67.4 years) and 35 females (70.2 years). At the time of BP measuring procedure, 36 patients were in sinus rhythm (SR) and 35 in AF. In SR patients mean systolic blood pressure (SBP) was 132 ± 17.9 mmHg with auscultatory method (AM), 137.4 ± 19.4 mmHg with oscillometric method (OM); mean diastolic BP was 77.1 ± 10.9 mmHg (AM), 78.5 ± 12.2 mmHg (OM), in AF patients mean SBP was 127.5 ± 15.1 mmHg (AM), 133.6 ± 17.4 mmHg (OM); mean diastolic BP was 81.4 ± 9.9 mmHg (AM), 83.5 ± 11.8 mmHg (OM), p = 0.037. The averages of differences for SBP and DBP in sinus rhythm group were (-5.3 mmHg (95% limits of agreement -27.2 - 16.6)) and (-1.4 mmHg (95% limits of agreement -12.8 - 10.0)), respectively. In patients with AF the averages of differences for SBP and DBP were (-6.1 mmHg (95% limits of agreement -23.9 - 11.7)) and (-2.1 mmHg (95% limits of agreement -12.9 - 8.7)), respectively. CONCLUSIONS: The oscillometric device validated for patients with AF on average gives 5.3 mmHg higher systolic BP values for patients with SR and 6.3 mmHg higher BP values for patients with AF. However, the limits of agreement between two methods reveal wide range of random error rates which is a questionable topic in clinical practice, as it could possibly affect the treatment of arterial hypertension in patients with AF.
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Šelmytė–Besusparė et al. (2017) conducted a cross-sectional in Atrial fibrillation and arterial hypertension (n=71). Oscillometric blood pressure measurement vs. Auscultatory blood pressure measurement was evaluated on Systolic blood pressure in patients with atrial fibrillation (MD 6.1 mmHg, 95% CI -23.9 - 11.7, p=<0.001). Oscillometric blood pressure measurement yielded significantly higher systolic blood pressure values (average 6.1 mmHg higher) compared to the auscultatory method in patients with atrial fibrillation, with wide limits of agreement.