Comparative Accuracy of Automated and Auscultatory Automated Blood Pressure Devices in Hypertensive Patients With Atrial Fibrillation

Objective: Accurate blood pressure (BP) measurement in atrial fibrillation (AF) is challenging because of marked beat-to-beat variability. Although guidelines recommend auscultatory methods and repeated triplicate measurements, performing multiple measurements is often impractical in routine clinical practice, leading to widespread use of automated BP monitors. This study evaluated BP accuracy and measurement repeatability between automated and auscultatory automated devices in AF.Design and method: A total of 109 hypertensive patients with AF underwent BP measurement using an automated device with an AF detection algorithm (Microlife WatchBP Office AFIB®, Microlife, n=53) or an auscultatory automated device displaying AF-related signals (KOROT P3 Accurate®, KOROT, n=56). BP was measured three times after 5 minutes of rest according to standardized protocols by a single trained nurse. Accuracy was indirectly compared with a reference device (Accoson Greenlight®) according to the 2018 Universal Standard (5 ± 8 mmHg), using the mean of three measurements. Results: Correlations between Greenlight and Microlife were strong (SBP r=0.97, DBP r=0.88), while correlations were slightly lower for KOROT (SBP r=0.87, DBP r=0.83). In patients aged 50–74 years, mean SBP differences were minimal (∼0.6 mmHg for both devices). For DBP, Microlife showed minimal differences (∼0.4 mmHg), whereas KOROT overestimated DBP by >5 mmHg. No significant differences were observed between the average of three measurements and the average of the second and third measurements. Conclusions: Both devices showed good agreement with the reference device for SBP, particularly Microlife. However, KOROT tended to overestimate DBP. When standard protocols were followed, averaging two measurements may be an acceptable alternative to three measurements across all three types of BP devices in patients with AF.