Wrist cuffs accuracy in measuring BP

  1. 0
    Where I currently work nurses are requesting to use wrist cuffs versus the standard forearm Blood Pressure cuffs. I don't trust them and have heard that they are very inaccurate. I searched the internet for an article to quote but was not successful. Has anyone seen a recent article comparing pressures taken with wrist cuffs versus the conventional method that I can quote? I would appreciate your help on this one. I think it is a liability issue that one could either miss a diagnosis of hypertension or misdiagnose someone with hypertension. I don't trust the wrist cuffs. What do you think of them, do you have any experience using them?

    MaryAnn
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  5. 0
    I will be interested to hear also. Most of the girls I work with use them also. I am still using my good old manual cuff.
  6. 0
    Quote from babynurselsa
    I will be interested to hear also. Most of the girls I work with use them also. I am still using my good old manual cuff.
    Okay, Lady storm and others

    I found an article on wrist cuffs for you:

    http://intapp.medscape.com/px/medlin...pressure+cuffs

    It is an abstract from medline.

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  7. 0
    Quote from button2cute
    Okay, Lady storm and others

    I found an article on wrist cuffs for you:

    http://intapp.medscape.com/px/medlin...pressure+cuffs

    It is an abstract from medline.

    Buttons
    I am not able to access this article, is there a way you can quote it and send it here. I registered but for some reason it did not take.
  8. 0
    Quote from LadyStorm
    I am not able to access this article, is there a way you can quote it and send it here. I registered but for some reason it did not take.
    Hello, Lady Storm

    Here is the abstract and if you wish to recieve the article medline charge a fee for it. I copied everything and you could find it at a local libary.

    Accuracy and reliability of wrist-cuff devices for self-measurement of blood pressure.
    J Hypertens 2002 Apr;20(4):629-38 (ISSN: 0263-6352)
    Kikuya M; Chonan K; Imai Y; Goto E; Ishii M
    Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Aobaku, Sendai, Japan; Collective Name: Research Group to Assess the Validity of Automated Blood Pressure Measurement Devices in Japan.
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    OBJECT: Self-measurement of blood pressure (BP) might offer some advantages in diagnosis and therapeutic evaluation and in patient management of hypertension. Recently, wrist-cuff devices for self-measurement of BP have gained more than one-third of the world market share. In the present study, we validated wrist-cuff devices and compared the results between wrist- and arm-cuff devices. The factors affecting the accuracy of wrist-cuff devices were also studied. METHOD: The research group to assess the validity of automated blood pressure measuring device consisted of 13 institutes in Japan, which validated two wrist-cuff devices (WC-1 and WC-2) and two arm-cuff devices (AC-1 and AC-2). They used a crossover method, where the comparison was done between auscultation, by two observers by means of a double stethoscope on one arm and the device on the opposite arm or wrist. RESULTS: There was good inter-observer agreement for the auscultation method in each institute (systolic blood pressure (SBP), -0.1 +/- 2.8 mmHg; diastolic blood pressure (DBP), -0.1 +/- 2.6 mmHg, n = 498). The mean difference between auscultation and the device was minimal both in arm-cuff devices (mean difference for AC-1, 2.2/1.9 mmHg, n = 97 and for AC-2, 5.1/2.9 mmHg, n = 136, SBP/DBP) and wrist-cuff devices (mean difference for WC-1, -2.1/1.2 mmHg, n = 173 mmHg and for WC-2, -2.3/-5.6 mmHg, n = 92). The standard deviation of the difference (SDD) in wrist-cuff devices, however (SDD for WC-1, 9.7/7.3 mmHg and for WC-2, 10.2/8.6 mmHg), was larger than that of the arm-cuff devices (SDD for AC-1, 5.6/6.6 mmHg and for AC-2, 6.3/5.1 mmHg). Grading of AC-1 and AC-2 based on criteria of British Hypertension Society was A/A and B/A, respectively, while that of WC-1 and WC-2 was C/B and D/B, respectively. Using the same validation protocol, the results of validation for one device were divergent in each institute. In wrist-cuff devices, the BP value obtained in palmar flexion was significantly higher and that obtained in palmar dorsiflexion was significantly lower than that in palmar extension. In some cases, finger plethysmogram did not disappear during maximum inflation of the wrist-cuff (congruent with 250 mmHg), even in palmar extension and especially in palmar flexion, suggesting incomplete obstruction of radial and/or ulnar arteries during inflation. CONCLUSION: The results suggest that wrist-cuff devices in the present form are inadequate for self-measurement of blood pressure and, thus, are inadequate for general use or clinical and practical use. However, there is much possibility in wrist-cuff device and the accuracy and reliability of wrist-cuff device are warranted by an improvement of technology.
    Comment In: Comment In: RefSource:J Hypertens. 2002 Apr; 20(4):573-8/PMID:11910283

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  9. 0
    Quote from button2cute
    Okay, Lady storm and others

    I found an article on wrist cuffs for you:

    http://intapp.medscape.com/px/medlin...pressure+cuffs

    It is an abstract from medline.

    Buttons
    Hello,

    Here is another abstract and medline charge a fee for the full article. Try a libary to get the article.

    Clinical evaluation of an automated oscillometric blood pressure wrist device.
    Blood Press Monit 2004 Feb;9(1):31-7 (ISSN: 1359-5237)
    Cuckson AC; Moran P; Seed P; Reinders A; Shennan AH
    Maternal and Foetal Research Unit, GKT School of Medicine, St Thomas' Hospital, London, UK.
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    OBJECTIVES: Up to one-third of all blood pressure devices sold are for measurement at the wrist. Wrist monitors are thought to be subject to errors associated with movement and incorrect posture. We used the British Hypertension Society protocol to determine the accuracy of the Omron Rx automated wrist blood pressure monitor in adults. We also investigated the errors associated with miscuffing and posture with measurements at the wrist compared to the upper arm. METHODS: The study was conducted at a large teaching hospital in the UK. Participants 18 years and over were eligible for inclusion. Exclusion criteria were cardiac arrhythmias and inaudible Korotkoff sounds. Eighty-five participants were selected for the main validation study. Thirty-four subjects took part in the study investigating miscuffing issues and 15 subjects were included in the study investigating postural errors. RESULTS: The Omron Rx achieved an overall grade B according to the British Hypertension Society Protocol. The mean differences (standard deviation) between the observers and the device were 0.3 (9.0) and 2.5 (8.8) mmHg for systolic and diastolic blood pressure respectively. In the medium and high-pressure ranges (> or =130/80 mmHg) the device achieved a grade C. When used at home the mean blood pressure reading over 60 measurements in 15 subjects was 123/75 mmHg when taken with the Omron Rx and 124/77 mmHg when taken with the automated upper arm device with no significant difference in the standard deviation of the readings. When compared with mercury sphygmomanometry using both a medium and large cuff, the wrist device readings were closest to the mercury measurements when the most appropriately sized cuff was used. CONCLUSIONS: The Omron Rx wrist monitor is accurate according to the British Hypertension Society protocol, but narrowly fails the Association of the Advancement of Medical Instrumentation criteria. Measurements at the wrist are not associated with miscuffing errors. Use of the wrist device by patients in the home setting gives comparable readings to a standard upper arm device.

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  10. 0
    Quote from LadyStorm
    I am not able to access this article, is there a way you can quote it and send it here. I registered but for some reason it did not take.
    Hello,

    Here is another abstract for you....Lady storm

    Inaccuracy of wrist-cuff oscillometric blood pressure devices: an arm position artefact? [In Process Citation]
    Blood Press Monit 2005 Apr;10(2):67-71 (ISSN: 1359-5237)
    Mourad A; Gillies A; Carney S
    aDepartment of Nephrology, John Hunter Hospital, NSW bFaculty of Health, The University of Newcastle, Australia.
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    BACKGROUND: Despite the increasing popularity of wrist-cuff blood pressure (BP) devices, their accuracy has not been established and international guidelines do not support their use. Because arm position influences BP measurement, it is possible that conflicting reports on wrist-cuff device accuracy reflects diverse arm positions. METHOD: This study compared BP measured by two oscillometric devices, the upper arm-cuff OMRON HEM 705 CP and the OMRON R6 oscillometric wrist-cuff device. In the former BP was measured with the arm in two supported positions, dependent on a table (manufacturer's instructions) and horizontal (mid sternum), while the latter followed the manufacturer's instructions. RESULTS: In contrast to the dependent arm where BP was significantly higher (P <0.05), the horizontal arm position with the arm-cuff produced a mean systolic and diastolic BP comparable to the wrist-cuff device where the wrist was at heart level being respectively, 137+/-29/80+/-16 and 134+/-27/77+/-16 mmHg. A close relationship over a wide BP range was also confirmed by least squares, least product linear regression and Bland-Altman analysis. CONCLUSION: This study supports the use of wrist-cuff monitors for self/home use and underlines the need for a more precise definition for arm position when using all BP devices - mercury and oscillometric.
    Language: English
    MEDLINE Indexing Date: 200504
    Publication Type: Owner: NLM
    Publication Type: Journal Article
    PreMedline Identifier: 0015812253
    Journal Code: IM

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  11. 0
    Quote from LadyStorm
    I am not able to access this article, is there a way you can quote it and send it here. I registered but for some reason it did not take.
    Hello,

    Here is one three years old.

    An evaluation of non-invasive blood pressure (NIBP) monitoring on the wrist: comparison with upper arm NIBP measurement.
    Anaesth Intensive Care 2002 Feb;30(1):43-7 (ISSN: 0310-057X)
    Emerick DR
    Division of Critical Care, Nambour General Hospital, Queensland.
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    The arm is the traditional site for application of an oscillometric non-invasive blood pressure (NIBP) cuff This study, which compares upper arm NIBP to wrist NIBP, involved 510 same arm sequential paired blood pressure (BP) measurements in 85 volunteers. Wrist NIBP consistently overestimated mean arterial, systolic and diastolic pressure by approximately 10 mmHg. Ninety per cent of the mean arterial pressure differences at the wrist were within a range of +/- 9 mmHg around a mean difference of 10.6 mmHg. The systolic pressure difference was 11.2 mmHg with 90% of differences between +/- 12 mmHg. The diastolic pressure difference was 10.2 mmHg with 90% of differences between +/- 9 mmHg. With the device used and within the normal blood pressure range, compensation can be performed by subtracting 10 mmHg from the measured values or simply by elevating the wrist about 15 cm and taking the BP at face value. Wrist NIBP may be a viable clinical alternative in situations where difficulty occurs with upper arm NIBP measurement.
    Major Subject Heading(s) Minor Subject Heading(s)
    Arm
    Blood Pressure Determination [methods]
    Blood Pressure
    Wrist
    Adult
    Evaluation Studies
    Humans
    Middle Aged
    Oscillometry
    Reproducibility of Results


    Indexing Check Tags: Comparative Study; Female; Male
    Language: English
    MEDLINE Indexing Date: 200209
    Publication Type: Owner: NLM
    Publication Type: Clinical Trial; Journal Article
    PreMedline Identifier: 0011939439
    Journal Code: IM; N

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  12. 0
    Quote from LadyStorm
    I am not able to access this article, is there a way you can quote it and send it here. I registered but for some reason it did not take.
    Hello, Again

    Here is another abstract for you;

    Wrist blood pressure-measuring devices: a comparative study of accuracy with a standard auscultatory method using a mercury manometer.
    Blood Press Monit 2002 Oct;7(5):281-4 (ISSN: 1359-5237)
    Altunkan S; Yildiz S; Azer S
    Division of Hypertension, Metropol Medical Center, Ankara, Turkey. saltunkan@veezy.com.
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    BACKGROUND: In this study, we compared two wrist blood pressure-measuring devices, the Omron RX and the Nissei WS-310, against a mercury manometer. METHOD: A total of 152 subjects attending an out-patient hypertensive clinic were recruited from a randomized blood pressure survey, 87 patients (mean 44.4 +/- 14.5 years of age) being selected according to the Association for the Advancement of Medical Instrumentation/British Hypertension Society standards. Device validation was assessed through the use of sequential same-arm readings compared with readings taken using a mercury sphygmomanometer by the two trained observers. RESULTS: There were no differences between the observers and the monitors for diastolic readings (2.8 +/- 4.8 mmHg for the Omron and 4.2 +/- 6.4 mmHg for the Nissei) according to the Association for the Advancement of Medical Instrumentation standards. The largest standard deviations -- 8.3 mmHg for the Omron and 8.8 mmHg for the Nissei, respectively -- were seen for systolic readings recorded by the observers and the monitors. According to the British Hypertension Society standards, the Omron achieved an A grade for diastolic readings and a B grade for systolic readings within 5 and 10 mmHg. The Nissei monitor achieved an A grade for diastolic readings and a B grade for systolic readings within 5 and 10 mmHg. CONCLUSION: Patients found the wrist oscillometric devices that we tested to be comfortable and easy to use. These devices are appropriate for measuring diastolic blood pressure according to the standards, but the reliability of both devices decreased when measuring systolic blood pressure.

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  13. 0
    Lady Storm,

    I hope you are able to find the atricles at a medical libary.

    I will search other places for you.

    Good luck. Oh you can perform your own studies at your facility and the reults will allow you to the performance of the standard and wrist cuffs.

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