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This study attempted to investigate the behavior of 24‐hour central ambulatory blood pressure (ABP) in adolescents and young adults. Adolescents and young adults (age 10‐25 years) referred for elevated blood pressure (BP) and healthy volunteers had simultaneous 24‐hour peripheral (brachial) and central (aortic) ABP monitoring using the same automated upper‐arm cuff device (Mobil‐O‐Graph 24h PWA). Central BP was calculated by the device using two different calibration methods (C1SBP using peripheral systolic (pSBP)/diastolic BP and C2SBP using mean arterial/diastolic BP). A total of 136 participants (age 17.9 ± 4.7 years, 54% adolescents, 77% males, 25% volunteers, 34% with elevated peripheral ABP) were analyzed. Twenty‐four‐hour pSBP was higher than C1SBP, with this difference being more pronounced during daytime than nighttime (16.3 ± 4.5 and 10.5 ± 3.2 mm Hg, respectively, P <.001). Younger age, higher body height, and male gender were associated with greater systolic ABP amplification (pSBP‐C1SBP difference). C1SBP followed the variation pattern of pSBP, yet with smaller nighttime dip (8.4 ± 6.0% vs 11.9 ± 4.6%, P <.001), whereas C2SBP increased (2.4 ± 7.2%) during nighttime sleep (P <.001 for comparison with pSBP change). Older age remained independent determinant of larger nighttime BP fall for pSBP and C1SBP, whereas male gender predicted a larger nighttime C2SBP rise. These data suggest that the calibration method of the BP monitor considerably influences the diurnal variation in central BP, showing a lesser nocturnal dip than pSBP or even nocturnal BP rise, which are determined by the individual's age and gender. [ABSTRACT FROM AUTHOR]

Carotid‐femoral pulse wave velocity (cfPWV) is the gold standard method for assessing arterial stiffness. This study evaluated automated brachial‐ankle PWV (baPWV) taken by a professional oscillometric blood pressure monitor (Microlife WatchBP Office Vascular) versus reference cfPWV (Complior device). Subjects recruited from a hypertension outpatient clinic had duplicate baPWV and cfPWV measurements (randomized crossover design) and carotid ultrasonography. Of 102 subjects recruited, 101 had valid baPWV measurements. Four subjects were excluded and 97 were analyzed (age 58.3 ± 11.4 years, men 70%, hypertensives 76%, diabetics 17%, cardiovascular disease 10%, smokers 23%). The mean difference between baPWV (13.1 ± 1.8 m/s) and cfPWV (9.1 ± 1.8 m/s) was 4.0 ± 1.4 m/s (P <.01) with close association between them (r = 0.70, P <.01). baPWV and cfPWV were correlated with age (r 0.54/0.49 respectively), systolic blood pressure (0.45/0.50), carotid intima‐media thickness (0.31/0.44), and carotid distensibility coefficient (−0.47/−0.34) (all P <.05; no difference between the two methods, z test). There was reasonable agreement (77%) between the two methods in identifying subjects at the top quartile of their distributions (kappa 0.39, P <.01). The areas under the receiver operating characteristic curves for the identification of carotid plaques were comparable for cfPWV and baPWV (0.79 and 0.74 respectively, P = NS). Automated baPWV measurement by a professional oscillometric blood pressure monitor is feasible and observer‐independent. baPWV values differ from those by cfPWV, yet they are closely correlated, have reasonable agreement in detecting increased arterial stiffness and give similar associations with carotid stiffness and atherosclerosis. [ABSTRACT FROM AUTHOR]

There is disagreement between the American and the European guidelines for hypertension management in regard to the optimal blood pressure target in patients with chronic kidney disease (CKD). Randomized clinical trials and meta-analyses of individual patient data pooled from these trials do not clearly support an intensive blood pressure target for the entire population of CKD patients with hypertension. However, some evidence suggests that in CKD patients with proteinuria strict blood pressure control might confer benefit in terms of renal outcome. Tailored treatment strategy based on the individual's proteinuric profile and tolerability along with standardization of blood pressure measurement methodology including out-of-office evaluation are of paramount importance in patients with CKD. [ABSTRACT FROM AUTHOR]

Blood pressure (BP) monitors equipped with atrial fibrillation (AF) detection algorithm are attractive screening tools for AF in elderly hypertensives. This study assessed the diagnostic accuracy of a novel cuffless pocket-size self-BP monitor (Freescan, Maisense) equipped with an AF detection algorithm, which displays results for the detection of "AF" or "Arrhythmia" during routine BP measurement. Subjects aged >65 years or 60-65 years with hypertension, diabetes, or cardiovascular disease were subjected to BP measurements using the Freescan device with simultaneous continuous Holter electrocardiography (ECG) monitoring. Readings with device notification "Instability" (29%) or "Error" (20%) were discarded. Data from 136 subjects with five valid Freescan BP measurements were analyzed (age 73.8 ± 7.1 years, males 63%, treated hypertensives 88%, AF in ECG 21%). Analysis of 680 Freescan readings vs ECG revealed specificity 99%, sensitivity 67%, and diagnostic accuracy 93% for AF diagnosis. When the "Arrhythmia" notification was considered as AF diagnosis, the sensitivity was improved (93%, 96%, and 93%, respectively). Analysis of AF diagnosis in subjects (diagnosis defined as at least three of five readings indicating "AF" or "Arrhythmia") revealed specificity, sensitivity, and diagnostic accuracy for AF detection at 94%, 100%, and 95%, respectively. These data suggest that the Freescan cuffless device could be used as a useful screening tool for AF detection during routine self-measurement of BP in the elderly. [ABSTRACT FROM AUTHOR]

Blood pressure (BP) is a vital sign, and its measurement is essential for diagnosing and treating hypertension. The accuracy of BP monitors is therefore essential, but unfortunately very few devices available on the market have been validated using an established protocol. STRIDE BP (www.stridebp.org) is an international nonprofit organization with the mission to improve the accuracy of BP measurement and the diagnosis of hypertension. It has a prestigious Scientific Advisory Board and operates in affiliation with the European Society of Hypertension, the International Society of Hypertension, and the World Hypertension League. STRIDE BP provides lists of accurate office, ambulatory, and home BP monitors. STRIDE BP performed a systematic review of 419 published validations (270 articles and 260 devices). In these publications, 50 (12%) of the validations were rejected compared with 129 (31%) rejected by STRIDE BP (P < .001). Of 79 validations approved in publications but rejected by STRIDE BP, 7 (9%) were rejected due to device inaccuracy and 72 (91%) due to inadequate study quality (execution, analysis, and reporting). Errors in conducting and reporting published validations must be avoided. Peer review must ascertain that a comprehensive checklist of all aspects of a validation study have been adhered to. The implementation of a Universal Standard for device validation and the global dissemination of information on accurate devices by STRIDE BP are expected to improve the quality and accuracy of BP measurement, which should have a positive impact on the diagnosis and management of hypertension globally. [ABSTRACT FROM AUTHOR]

There is increasing interest in unattended automated office blood pressure (OBP) measurement, which gives lower blood pressure values than the conventional auscultatory OBP. Whether unattended automated OBP differs from standardized attended automated OBP performed using the same device and measurement protocol remains uncertain. A systematic review and meta-analysis of studies (aggregate data) comparing unattended vs attended automated OBP using the same device and measurement protocol (conditions, number of measurements, visits) was performed. Ten eligible studies (n = 1004, weighted age 60.8 ± 4.2 [SD] years, 55% males) were analyzed. Unattended OBP (pooled systolic/diastolic 133.9 [95% CI: 129.7, 138]/80.6 [95% CI: 77, 84.2] mm Hg) did not differ from attended OBP (135.3 [95% CI: 130.9, 139.6]/81 [95% CI: 77.6, 84.3] mm Hg); pooled systolic OBP difference -1.3, 95% CI: -4.3, 1.7 mm Hg and diastolic -0.4, 95% CI: -1.2, 0.3 mm Hg. Nine of ten studies achieved high quality score and no publication bias was identified. Meta-regression analysis did not reveal any effect of age, gender, or attended systolic OBP on the unattended-attended systolic OBP difference (P = NS for all). However, there was a trend toward higher attended than unattended OBP at higher OBP levels. These data suggest that, when the same device and measurement protocol are used, attended automated OBP provides similar blood pressure values as unattended automated OBP. Although unattended automated OBP is theoretically advantageous as it ensures that standardized conditions and measurement protocol are used, attended automated OBP, if carefully performed, appears to be a reasonable and practical alternative. [ABSTRACT FROM AUTHOR]

According to the established validation protocols, a typical validation study of a blood pressure (BP) monitor includes general population adults with normal or elevated BP. It is recognized, however, that the automated (oscillometric) BP monitors may have different accuracy or uses in some special populations compared with adults in the general population. Thus, an automated BP monitor with proven accuracy in a general population of adults may not be accurate in a special population, and therefore separate validation is needed. Recognized special populations deserving separate validation are those for which there is theoretical, and also clinical evidence, that the accuracy of BP monitors in these groups differs from that in the general population. Young children, pregnant women (including those with preeclampsia), individuals with arm circumference >42 cm, and patients with atrial fibrillation are regarded as special populations. Adolescents, individuals older than 80 years, and patients with end-stage renal disease or diabetes mellitus have also been considered as possible special groups, but there is still inadequate evidence of altered accuracy of BP monitors in these subjects. Validation studies should be performed in special populations and evaluated separately after the BP-measuring device has successfully undergone a validation study in a general population (unless the test device is intended only for a special population). This article discusses issues relating to the measurement of BP and the diagnosis of hypertension in selected special populations, as well as in low-resource settings, where a simplified yet efficient evaluation strategy is necessary. [ABSTRACT FROM AUTHOR]

Blood pressure variability is an entity that characterizes the continuous and dynamic fluctuations that occur in blood pressure levels throughout a lifetime. This phenomenon has a complex and yet not fully understood physiological background and can be evaluated over time spans ranging from seconds to years. The present paper provides a short overview of methodological aspects, clinical relevance, and potential therapeutic interventions related to the management of blood pressure variability. [ABSTRACT FROM AUTHOR]

Blood pressure (BP) is a vital sign and the essential measurement for the diagnosis of hypertension. Therefore, its accurate measurement is a key element for the evaluation of many medical conditions and for the reliable diagnosis and efficient treatment of hypertension. In the last 3 decades prestigious organizations, such as the US Association for the Advancement of Medical Instrumentation (AAMI), the British Hypertension Society, the European Society of Hypertension (ESH) Working Group on BP Monitoring, and the International Organization for Standardization (ISO), have developed protocols for clinical validation of BP measuring devices. All these initiatives aim to standardize validation procedures and establish minimum accuracy standards for BP monitors. Unfortunately, only a few of the BP measuring devices available on the market have been subjected to independent validation using one of these protocols. Recently, the AAMI, ESH, and ISO experts agreed to develop a single universally acceptable standard (AAMI/ESH/ISO), which will replace all previous protocols. This major international initiative has been undertaken to best serve the needs of patients with hypertension, a public interested in cardiovascular health, practicing physicians, scientific researchers, regulatory bodies, and manufacturers. There is an urgent need to influence regulatory authorities throughout the world to make it mandatory for all BP measuring devices to have undergone independent validation before approval for marketing. Efforts need to be intensified to improve the accuracy of BP measuring devices, further optimize the validation procedure, and ensure that objective and unbiased validation data become available. [ABSTRACT FROM AUTHOR]

Home blood pressure monitoring provides multiple measurements in the usual environment of each individual, allows the detection of intermediate hypertension phenotypes (white-coat and masked hypertension), and appears to have superior prognostic value compared to the conventional office blood pressure measurements. Accumulating evidence suggests that home blood pressure monitoring improves long-term hypertension control rates. Moreover, it is widely available, relatively inexpensive, and well accepted by patients. Thus, current guidelines recommend home blood pressure monitoring as an essential method for the evaluation of almost all untreated and treated patients with suspected or treated hypertension. Validated automated upper-arm cuff devices with automated storage and averaging of readings should be used. The home blood pressure monitoring schedule for 4 to 7 days with exclusion of the first day (12-24 readings) should be averaged to provide values for decision making. [ABSTRACT FROM AUTHOR]

The accuracy of blood pressure (BP) measuring devices is fundamental to good practice and scientific research. International guidelines on BP measurement are provided for clinicians who diagnose and treat patients with hypertension, clinical researchers who conduct trials on the efficacy of BP lowering drugs and interventional strategies, epidemiologists who conduct population surveys to determine the demographic consequences of hypertension on society, and researchers who perform meta-analyses on published research to further influence the practice of medicine and the provision of resources. Although the outcomes of the endeavors of all these groups are dependent on the accuracy of BP measurements, the equipment is often of doubtful accuracy and the methodology of measurement is often poorly described and frequently not standardized. Thus, the fundamental element of hypertension evaluation has been largely ignored by both clinical practitioners and scientific researchers. Here, the authors briefly review the development of efforts to improve and validate the accuracy of BP measuring devices and highlight the deficiencies that persist. We conclude that, to protect the public from the serious consequences of inaccurate BP measurements, the following steps are required: (1) regulatory requirement for mandatory independent validation of all BP measuring devices using a universal protocol; (2) accreditation of laboratories for the performance of BP device validations; (3) online evaluation of validation studies with detection of protocol violations prior to publication of results; and (4) establishment of an independent scientific forum for the listing of accurate BP measuring devices. [ABSTRACT FROM AUTHOR]

A summary of statements for blood pressure (BP) measurement in the evaluation of hypertension in the 21st century by 25 international experts is provided. The status of office, home and ambulatory BP measurement techniques are discussed. Office BP measurement, whether automated (preferred), or otherwise, should only be used as a screening measurement, and diagnostic decisions for the initiation and titration of drug treatment should be based on out-of-office measurements (ambulatory or home). The hardware and software requirements and the adaptations of BP measuring devices to record other cardiovascular functions, such as arrhythmias, and adaptations for smartphone use and for electronic transmission are discussed. Regulatory bodies are urged to make accuracy and performance assessment mandatory before marketing BP measuring devices. The legal implications of manufacturing inaccurate devices are noted. [ABSTRACT FROM AUTHOR]

Hypertension is now recognized as a major global cause of morbidity and death. All decisions relating to the epidemiology, diagnosis, and management of hypertension are dependent on being able to measure blood pressure accurately. Scientists have developed protocols to assess the accuracy of blood pressure-measuring devices, but little attention has been given to informing users which devices are accurate and inaccurate. This article identifies a recipient audience of researchers, clinicians, and scientists, the public, healthcare executives and administrators, and consumer and regulatory bodies, and discusses how best to communicate the results of device accuracy to these groups with the aim of improving the accurate measurement of blood pressure. [ABSTRACT FROM AUTHOR]

The measurement of blood pressure in the office (OBP) remains the basis for hypertension diagnosis and management for more than half a century. Despite the increasing use of out-of-office blood pressure measurement using home and less so ambulatory monitoring and their endorsement by hypertension societies, at present and for some time to come it is likely that in many people the diagnosis and management of hypertension will be based on OBP measurement alone. OBP measurement is a very variable method affected by multiple factors, which have major impact on the OBP level, reproducibility and prognostic ability. Thus, there are several types of OBP measurement, depending on the device type, conditions, observer's presence and the number of readings. The 4 main OBP types are: Type I: Auscultatory OBP in clinical practice; Type II: Automated attended OBP in clinical practice; Type III: Research setting OBP; Type IV: Unattended automated OBP. These OBP types have different standardization level, different reproducibility, different clinical relevance and different thresholds for hypertension diagnosis. Unless the methodological details of OBP measurement are reported, any conclusions based on such measurements in clinical research and in practice are questionable. [ABSTRACT FROM AUTHOR]

In the last 2 decades, several scientific societies have published specific guidelines for blood pressure (BP) measurement, providing detailed recommendations for office, home, and ambulatory BP monitoring. These documents typically provided strong support for using out-of-office BP monitoring (ambulatory and home). More recently, several organizations recommended out-of-office BP evaluation as a primary method for diagnosing hypertension and for treatment titration, with office BP regarded as a screening method. Efforts should now be directed towards making ambulatory and home BP monitoring readily available in primary care and ensuring that such measurements are obtained by following current guidelines. Moreover, it should be mandatory for all published clinical research papers on hypertension to provide details on the methodology of the BP measurement. [ABSTRACT FROM AUTHOR]

This study aims to test the hypothesis that in some hypertensive subjects the blood pressure (BP) response to angiotensin-converting enzyme inhibition differs from that to angiotensin receptor blockade (ARB); a responder to angiotensin-converting enzyme inhibition may not respond to ARB or the opposite. A randomized, open-label, crossover, comparative trial of lisinopril 20 mg compared with telmisartan 80 mg (5 weeks per treatment period) was conducted in 32 untreated hypertensives using 24-hour ambulatory BP monitoring. Subjects were classified as "responders" and "nonresponders" using an arbitrary threshold of ambulatory BP response (=10 mm Hg systolic or =5 diastolic) or the median response achieved by each drug. No difference was detected between the drugs in their effect on ambulatory BP (mean difference 1.2 ± 7.1/0.7 ± 5.1 mm Hg, systolic/diastolic). Significant correlations were found between the antihypertensive responses to the two drugs (r =0.77, p <0.001). Using the arbitrary response criterion,there was a difference between the drugs in the responses in 28%/13% of subjects (9/4 patients)for systolic/diastolic BP (19%/25% using the median response criterion). These data suggest that in some hypertensive patients the BP response to angiotensin-converting enzyme inhibition may fail to predict the response to ARB. It appears that there are differences in the antihypertensive action of angiotensin-converting enzyme inhibitors and ARBs that may be clinically important. [ABSTRACT FROM AUTHOR]