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Blood pressure measurement in pediatric population: comparison between automated oscillometric devices and mercury sphygmomanometers—a systematic review and meta-analysis

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Abstract

With the progressive elimination of mercury column devices for blood pressure (BP) measurement in children and adolescents, valid alternatives are needed. Oscillometric devices provide a replacement without mercury, are fully automated, and have excellent reliability among evaluators. Here, the goal was to test the accuracy of automatic blood pressure monitor devices compared to the mercury sphygmomanometer for BP measurement in children and adolescents. Electronic databases are EMBASE, MEDLINE (PubMed), SCOPUS, and Web of Science. We selected 8974 potentially eligible articles and two authors independently. We separately reviewed 370 full papers. Potentially eligible articles were selected according to the following criteria: (a) articles published in Portuguese, English, and Spanish; (b) screening of titles; (c) screening of abstracts; and (d) retrieval and screening of the full article to determine whether it met the inclusion criteria. We included 45 articles for analysis, 28 of which were selected for meta-analysis. The systolic BP measured by automatic blood pressure monitors presents 1.17 mmHg on average (95% CI 0.85; 1.48); for diastolic BP, it produced −0.08 mmHg (95% CI −0.69; 0.54) compared with a mercury sphygmomanometer. There is high heterogeneity between studies (> 90%) in the meta-analysis, partly explained by the device model, study environment, and observer training. Only articles that reported BP measurement by both methods were included.

Conclusion: Automatic blood pressure monitors have strong measurement validity when compared with the mercury column. Thus, these can be safely used in blood pressure measurements of children and adolescents in clinical and epidemiological studies.

What is Known:

•The “gold standard” for indirect BP measurement is the mercury sphygmomanometer.

•The accuracy of the automatic device is critical to any blood pressure measurement method.

What is New:

•Oscillometric or automatic devices can be a suitable alternative to auscultation for initial screening, consistent with current pediatric guidelines.

•The automatic devices compared to the mercury column have a good validity of measurements, which can be used in blood pressure measurements of children and adolescents in clinical and epidemiological settings, provided that international protocols are followed.

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Availability of data and material

The data generated and analyzed during the current study were extracted from published paper and are available in several scientific journals. The dataset used in the meta-analysis is available from the corresponding author upon reasonable request.

Abbreviations

AHA:

American Heart Association

BP:

Blood pressure

DBP:

Diastolic blood pressure

EHS:

European Hypertension Society

HHS:

British Hypertension Society

PRISMA:

Preferred Reporting Items for Systematic Review and Meta-analysis

PROSPERO:

International Prospective Register of Systematic Reviews

SBP:

Systolic blood pressure

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Funding

Study researchers were supported for interpretation of data, and in writing the manuscript. Keisyanne Araujo‐Moura was given a PhD student scholarship from São Paulo Research Foundation—FAPESP (proc. 2019/24224‐1). Letícia Gabrielle Souza was given a scientific initiation scholarship on nutrition undergraduate student at School of Public Health, University of Sao Paulo, Sao Paulo, SP, Brazil. FAPESP (proc. 019/13527–3). Gabriele Luz Mello was given a scientific initiation scholarship on nutrition undergraduate student at School of Public Health, University of Sao Paulo, Sao Paulo, SP, Brazil FAPESP (proc. 2019/10852–0). Augusto César F. De Moraes was awarded by the Young Investigator grant from FAPESP (proc. 2017/20317–0 and 2019/02617–1).

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Authors and Affiliations

  1. Department of Epidemiology, Graduate Program in Public Health and Graduate Program in Epidemiology, School of Public Health, University of Sao Paulo, Sao Paulo, SP, 01246-904, Brazil

    Keisyanne Araujo-Moura, Letícia Gabrielle Souza, Gabriele Luz Mello & Augusto César Ferreira De Moraes

  2. Department of Epidemiology, School of Public Health, Human Genetics and Environmental Science, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center At Houston, Austin, Austin, TX, USA

    Augusto César Ferreira De Moraes

  3. YCARE (Youth/Child cARdiovascular Risk and Environmental) Research Group, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Keisyanne Araujo-Moura, Letícia Gabrielle Souza, Gabriele Luz Mello & Augusto César Ferreira De Moraes

Authors
  1. Keisyanne Araujo-Moura
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  2. Letícia Gabrielle Souza
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  3. Gabriele Luz Mello
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  4. Augusto César Ferreira De Moraes
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Contributions

MSc PhD Keisyanne de Araujo-Moura conceptualized and designed the initial study. In addition, she designed the data collection instruments, performed the initial analysis, wrote the initial manuscript, and revised the manuscript. Dr. Augusto César Ferreira de Moraes conceptualized and designed the initial study. He coordinated and supervised the data and critically reviewed the manuscript for content. Bs Letícia Gabrielle Souza and Bs Gabriele de Luz Mello searched the articles and extracted the data. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Keisyanne Araujo-Moura.

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This article is a systematic review and does not contain participating humans or animals evaluated by the authors, and because of this reason, our institution does not require that it be approved by the ethics committee. Meanwhile, the protocol was approved by the PROSPERO committee on the protocol (CRD42018110330).

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The authors declare no competing interests.

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Araujo-Moura, K., Souza, L.G., Mello, G.L. et al. Blood pressure measurement in pediatric population: comparison between automated oscillometric devices and mercury sphygmomanometers—a systematic review and meta-analysis. Eur J Pediatr 181, 9–22 (2022). https://doi.org/10.1007/s00431-021-04171-3

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