In patients with atrial fibrillation, non-invasive blood pressure assessment using an automated sphygmomanometer significantly underestimated systolic blood pressure compared to invasive arterial measurement (mean difference -5.29 mmHg).
Cross-Sectional (n=100)
Randomised sequence of device measurements
No
Do non-invasive blood pressure monitors accurately measure blood pressure compared to invasive assessment in patients with atrial fibrillation and sinus rhythm?
Effect estimate: Mean difference -5.29 mmHg (95% CI -7.08 to -3.50)
p-value: p=<0.0001
OBJECTIVE: To investigate the accuracy of three non-invasive blood pressure (BP) devices in atrial fibrillation (AF) compared with invasive arterial BP. METHODS: One hundred patients aged 45-90 years, 63% male (50 in AF and 50 age matched controls in sinus rhythm SR) were identified with arterial lines measuring beat-to-beat BP fluctuation. Non-invasive BP measurements utilising the manual sphygmomanometer (MS), PulseCor R6.5 (PC) and automated sphygmomanometer (AS) were taken simultaneously with invasive BP in a randomised sequence. This was repeated three times in each patient. RESULTS: In SR differences in systolic BP (SBP) for MS, AS and PC were -0.34 mm Hg (95% CI -2.31 to 1.63; P = .733), -3.80 mm Hg (95% CI -5.73 to -1.87; P = .0001) and -3.90 mm Hg (95% CI -5.90 to -1.90; P = .0001) and for diastolic BP (DBP) were 6.02 mm Hg (95% CI 4.39-7.64; P < .0001), 8.95 mm Hg (95% CI 7.36-10.55; P < .0001) and 7.54 mm Hg (95% CI 5.89-9.18; P < .0001), respectively. In AF mean differences in SBP for MS, AS and PC were -7.33 mm Hg (95% CI -9.11 to -5.55; P < .0001), -5.29 mm Hg (95% CI -7.08 to -3.50; P < .0001) and -5.75 mm Hg (95% CI -7.54 to -3.96; P < .0001) respectively and for DBP were 5.28 mm Hg (95% CI 4.03-6.54; P < .0001), 6.26 mm Hg (95% CI 5.00-7.52; P < .0001) and 6.89 mm Hg (95% CI 5.64-8.15; P < .0001) respectively. CONCLUSIONS: The MS is accurate in SR because of direct assessment of Korotkoff sounds. Non-invasive BP assessment in AF is significantly less accurate. These findings have important prognostic and therapeutic implications.
Eysenck et al. (Thu,) conducted a cross-sectional in Atrial fibrillation and sinus rhythm (n=100). Automated sphygmomanometer (AS) vs. Invasive arterial blood pressure was evaluated on Mean difference in systolic blood pressure (SBP) in atrial fibrillation for automated sphygmomanometer compared to invasive arterial pressure (Mean difference -5.29 mmHg, 95% CI -7.08 to -3.50, p=<0.0001). In patients with atrial fibrillation, non-invasive blood pressure assessment using an automated sphygmomanometer significantly underestimated systolic blood pressure compared to invasive arterial measurement (mean difference -5.29 mmHg).