Abstract
Purpose
Blood pressure (BP) is one of the most important pieces of information to diagnose cardiovascular diseases but the measurement readings could be easily changed by various factors. If these readings are wrong, it may ultimately lead to a misdiagnosis. In addition, there is a problem when there are different devices used to read blood pressure because these devices may give different readings.
Methods
Four different BP measurement devices were used, including two mercury sphygmomanometers and two automatic digital devices. Thirty-eight healthy young people (mean age = 27.1±6.1 years) stayed one night at a clinical center and the BPs were measured from their right arms on the following day. Factors such as exercise, food, and smoking that may affect the BP were controlled and prohibited. All tests were repeated three times and all devices were calibrated before the test. Absolute BP value difference between a mercury sphygmomanometer and an automatic digital device was counted for the BP difference between devices ≥ 5 mmHg and ≥ 10 mmHg of each measurement.
Results
Significant inter-device BP differences were found between a mercury sphygmomanometer and two automatic devices (p<0.01) while no significant difference was found between mercury sphygmomanometers (p>0.5); all subjects showed BP difference less than 5 mmHg between two mercury sphygmomanometers while only 32% and 38% of subjects showed BP difference less than 5 mmHg for two out of three repeated tests between a mercury sphygmomanometer and an automatic device, and even 26% ~ 36% of subjects showed BP difference ≥ 10 mmHg.
Conclusions
This study result stresses that it is necessary to check the reliability of automatic blood pressure devices used in the hospitals. In addition, an easier and more convenient protocol should be developed for the routine calibration of automatic devices.
Similar content being viewed by others
References
Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell JL. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet. 2012; 379(9819):905–14.
Pater C. The Blood Pressure “Uncertainty Range” - a pragmatic approach to overcome current diagnostic uncertainties (II). Curr Contr Trial S C. 2005; 6(1):5.
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG, Roccella EJ. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005; 111(5):697–716.
Stergiou GS, Asayama K, Thijs L, Kollias A, Niiranen TJ, Hozawa A, Boggia J, Johansson JK, Ohkubo T, Tsuji I, Jula AM, Imai Y, Staessen JA. Prognosis of white-coat and masked hypertension: international database of home blood pressure in relation to cardiovascular outcome. Hypertension. 2014; 63(4):675–82.
Dolan E, James K. Current approach to masked hypertension: From diagnosis to clinical management. Clin Exp Pharmacol P. 2013; doi: 10.1111/1440-1681.12190.
Kobalava ZD, Kotovskaya YV, Babaeva LA, Moiseev VS. Validation of TM-2655 oscillometric device for blood pressure measurement. Blood Press Monit. 2006; 11(2):87–90.
O’Brien E, Atkins N, Stergiou G, Karpettas N, Parati G, Asmar R, Imai Y, Wang J, Mengden T, Shennan A. European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults. Blood Press Monit. 2010; 15(1):23–38.
O’Brien E, Petrie J, Littler W, de Swiet M, Padfield PL, Altman DG, Bland M, Coats A, Atkins N. An outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devices. J Hypertens. 1993; 11(6):677–9.
Manoharan G, Adgey AA. Current management of unstable angina: lessons from the TACTICS-TIMI 18 trial. Am J Cardiovasc Drug. 2002; 2(4):237–43.
Nieuwland W, Berkhuysen MA, Van Veldhuisen DJ, Rispens P. Individual assessment of intensity-level for exercise training in patients with coronary artery disease is necessary. Int J Cardiol. 2002; 84(1):15–20.
Lewis GN, Rice DA, Jourdain K, McNair PJ. Influence of stimulation location and posture on the reliability and comfort of the nociceptive flexion reflex. Pain Res Manag. 2012; 17(2):110–4.
Portney LG, Watkins MP. Foundations of Clinical Research. 2nd ed. Prentice Hall; 2000. pp. 96–101.
Chinn S. Repeatability and method comparison. Thorax. 1991; 46:454–6.
American National Standard. Non-invasive sphygmomanometers - Part 2:Clinical validation of automated measurement type. Arlington, Virginia: AAMI 2009.
Markandu ND, Whitcher F, Arnold A, Carney C. The mercury sphygmomanometer should be abandoned before it is proscribed. J Hum Hypertens. 2000; 14(1):31–6.
Bolger PM, Schwetz BA. Mercury and health. New Engl J Med. 2002; 347(22):1735–6.
Ali S, Rouse A. Practice audits: reliability of sphygmomanometers and blood pressure recording bias. J Hum Hypertens. 2002; 16(5):359–61.
Mion Júnior D, Pierin AM, Alavarce DC, Vasconcellos JH. The results of the campaign for evaluating sphygmomanometers accuracy and their physical conditions. Arq Bras Cardiol. 2000; 74(1):31–8.
Sigurdsson JA, Adalsteinsson B, Hardarson T, Kristinsson A. Blood pressure at the clinic, work and home. Are there white coats at work? Laeknabladid. 1996; 82(5):371–7.
Nelson D, Kennedy B, Regnerus C, Schweinle A. Accuracy of automated blood pressure monitors. J Dent Hyg. 2008; 82(4):35.
Wong WC, Shiu IK, Hwong TM, Dickinson JA. Reliability of automated blood pressure devices used by hypertensive patients. J Roy Soc Med. 2005; 98(3):111–3.
Skirton H, Chamberlain W, Lawson C, Ryan H, Young E. A systematic review of variability and reliability of manual and automated blood pressure readings. J Clin Nurs. 2011; 20(5):6–602.
Chio SS, Urbina EM, Lapointe J, Tsai J, Berenson GS. Korotkoff sound versus oscillometric cuff sphygmomanometers: comparison between auscultatory and DynaPulse blood pressure measurements. J Am Soc Hypertens. 2011; 5(1):12–20.
Amoore JN, Vacher E, Murray IC, Mieke S, King ST, Smith FE, Murray A. Effect of the shapes of the oscillometric pulse amplitude envelopes and their characteristic ratios on the differences between auscultatory and oscillometric blood pressure measurements. Blood Press Monit. 2007; 12(5):297–305.
Raamat R, Talts J, Jagomägi K, Kivastik J. Accuracy of some algorithms to determine the oscillometric mean arterial pressure: a theoretical study. Blood Press Monit. 2013; 18(1):50–6.
Baker PD, Westenskow DR, Kück K. Theoretical analysis of non-invasive oscillometric maximum amplitude algorithm for estimating mean blood pressure. Med Biol Eng Comput. 1997; 35(3):271–8.
de Greeff A, Lorde I, Wilton A, Seed P, Coleman AJ, Shennan AH. Calibration accuracy of hospital-based non-invasive blood pressure measuring devices. J Hum Hypertens. 2010; 24(1):58–63.
Grossardt BR, Graves JW, Gullerud RE, Bailey KR, Feldstein J. The occurrence of the alerting response is independent of the method of blood pressure measurement in hypertensive patients. Blood Press Monit. 2006; 11(6):321–7.
Ostchega Y, Zhang G, Sorlie P, Hughes JP, Reed-Gillette DS, Nwankwo T, Yoon S. Blood pressure randomized methodology study comparing automatic oscillometric and mercury sphygmomanometer devices: National Health and Nutrition Examination Survey, 2009-2010. Natl Health Stat Report. 2012; (59):1–15.
Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, Sever PS, McG Thom S. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens. 2004; 18(3):139–85.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lim, H.K., Doh, I. & Ahn, B. Blood pressure differences between a mercury sphygmomanometer and two automatic devices. Biomed. Eng. Lett. 5, 296–301 (2015). https://doi.org/10.1007/s13534-015-0207-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13534-015-0207-x