Blood Pressure Measurements: New Techniques in Automatic and 24-hour Indirect Monitoring

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The preferred blood pressure determination method would be one that reduces variability between measurements and that reflects the true blood pressure level.

Home Blood Pressure Monitoring

In this article, we present the variability of, and agreement between, the blood pressures collected by two indirect methods on the same patients during a hypertensive research project. Data obtained on patients in a typical clinical setting are also provided. Twenty-four-hour diastolic pressures obtained by the automated method demonstrated no regression to a lower mean, while blood pressures obtained casually in the office exhibited such regression.

The magnitudes of the differences in blood pressures obtained on separate occasions in the same subjects were significantly lower with automated vs casual blood pressure determination methods 7. Thus, the variability in mean hour automated blood pressures is less than that for casual office blood pressures. The clinician should understand that the variability of blood pressures measured on an individual may be much greater than that reported for populations of hypertensive patients, and must be considered when applying epidemiologic group data to a specific patient.

Moreover, any methodology of indirect blood pressure measurement that may reduce the variability and improve repeatability of casual office blood pressures deserves further consideration. Arch Intern Med. All Rights Reserved. Twitter Facebook Email. This Issue. Peter B. Bottini, PharmD ; Albert A.

Carr, MD ; Robert B. Rhoades, MD ; et al L. Michael Prisant, MD. Learn more. Save Preferences. Protocols for the validation of noninvasive BP monitors were initially established in the s to characterize the accuracy of new devices. Discrepancies between clinical measurements and oscillometric device measurements, including ABPM and HBPM, led to greater scrutiny and the standardization of the protocols in both Europe and the United States. A minority of BP monitor validation studies have correctly adhered to the relevant protocol, and many studies have biased or misrepresented results.

There are 4 main validation protocols for BP devices Table However, its advantage is that it is thorough and accounts for intradevice variability and consistency in performance after prolonged use. The ESH protocol is on the opposite extreme of complexity, having eliminated some prevalidation steps. It has the smallest sample size requirement and eliminates some of the redundancy seen in the British Hypertension Society protocol.

The validation protocol of the Association for the Advancement of Medical Instrumentation is less complex than the British Hypertension Society protocol but requires a similar sample size and participants with a wide range of BP and asks for specific assessment for special populations. Finally, the Quality Seal Protocol from Germany German Hypertension League requires the largest sample size and the most well-defined age groups. Modified from Beime et al with permission. Some recommend that the device be returned to the manufacturer for recalibration; however, there is often a nontrivial cost for this service.

In hospitals and some other settings, there is usually a biomedical engineering department that can evaluate whether each individual device is taking accurate readings. Because of their lower cost and because they are not used in the office setting, there are no standardized protocols for calibrating HBPM devices once they have left the manufacturer.

An HBPM device validated in a specific population may not always provide an accurate measure of BP for a specific individual. However, this approach may be appropriate for some individuals in whom it is suspected that home BP readings may be inaccurate despite the use of a validated device. Accurately measuring BP is essential for the proper diagnosis of hypertension and monitoring the effect of antihypertensive treatment. In addition, BP is a component of CVD risk prediction equations that, in turn, are used to guide the decision to initiate statins, pharmacological antihypertensive medication, and aspirin therapy.

A list of summary points from each section is provided in Table In the office setting, the use of oscillometric devices provides an approach to obtain a valid BP measurement that may reduce the human error associated with auscultatory measurements. The use of a validated AOBP device that can be programmed to take and average at least 3 BP readings should be considered the preferred approach for evaluating office BP.

Finally, we cannot overstate the importance of using only validated devices, routinely calibrating and maintaining BP measurement devices, and having BP measured by healthcare providers who have been properly trained and retrained. Figure 3. Detection of white-coat effect or masked uncontrolled hypertension in patients on drug therapy. Writing Group Disclosures.

This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. Reviewer Disclosures. This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit.

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

To purchase additional reprints, call or e-mail kelle. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. DOI: The expert peer review of AHA-commissioned documents eg, scientific statements, clinical practice guidelines, systematic reviews is conducted by the AHA Office of Science Operations. Home Hypertension Vol. View PDF. Tools Add to favorites Download citations Track citations Permissions. Jump to. Schwartz , PhD Raymond R. Daichi Shimbo Daichi Shimbo Search for more papers by this author.

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Ambulatory Blood Pressure Monitoring Techniques

William B. White William B. White Search for more papers by this author. Jackson T. Wright Jr Jackson T. Wright Jr Search for more papers by this author. Abstract The accurate measurement of blood pressure BP is essential for the diagnosis and management of hypertension. Hearing: The observer must be able to hear the Korotkoff sounds. Questionnaires or interviews can be used to assess knowledge of the BP measurement methodology.

Retraining of healthcare professionals every 6 mo to 1 y should be considered. Shirtsleeves should not be rolled up because this may create a tourniquet effect. Individual cuffs should be labeled with the ranges of arm circumferences; lines should be added that show whether the cuff size is appropriate when it is wrapped around the arm. Information on cuff selection for patients with morbid obesity is provided in the Obese Patients section.

When BP measurements are taken in the supine position, the cuffed arm should be supported with a pillow. In the seated position, the right atrium level is the midpoint of the sternum or the fourth intercostal space. The cuffed arm should be held up by the observer or resting on a table at heart level.

If the arm is held up by the patient, BP will be raised. Have the patient relax, sitting in a chair with feet flat on floor and back supported. The patient should be seated for 3—5 min without talking or moving around before recording the first BP reading. A shorter wait period is used for some AOBP devices.

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The patient should avoid caffeine, exercise, and smoking for at least 30 min before measurement. Neither the patient nor the observer should talk during the rest period or during the measurement. Remove clothing covering the location of cuff placement. Measurements made while the patient is sitting on an examining table do not fulfill these criteria.

Step 2: Use proper technique for BP measurements 1. Use an upper-arm cuff BP measurement device that has been validated, and ensure that the device is calibrated periodically. Use either the stethoscope diaphragm or bell for auscultatory readings. At the first visit, record BP in both arms. Separate repeated measurements by 1—2 min. For auscultatory determinations, use a palpated estimate of radial pulse obliteration pressure to estimate SBP. Step 4: Properly document accurate BP readings 1. If using the auscultatory technique, record SBP and DBP as the onset of the first of at least 2 consecutive beats and the last audible sound, respectively.

Note the time that the most recent BP medication was taken before measurements. Someone should help the patient interpret the results. For each period daytime, nighttime, and 24 h , the average of all readings should be calculated to determine mean daytime BP, mean nighttime BP, and mean h BP, respectively, and other BP measures eg, dipping. Download figure Download PowerPoint.

Some guidelines and scientific statements recommend excluding the first day of readings. If the first day of readings is excluded, the minimum and preferred periods of HBPM should be 4 and 8 d, respectively. Aneroid sphygmomanometers require frequent calibration every 2—4 wk for handheld devices and every 3—6 mo for wall-mounted devices.

How to: Measure Blood Pressure

Unattended AOBP has been associated with a lower prevalence of white-coat effect compared with office BP measured through auscultation and reduces the possibility of human error in BP measurement. The main indications for ABPM are to detect white-coat hypertension and masked hypertension. White-coat hypertension may not be associated with an increased risk for CVD. Masked hypertension is associated with a risk for CVD approaching that for individuals with sustained hypertension. Nocturnal hypertension is common among blacks.

ABPM is the preferred approach to assess for nocturnal hypertension. HBPM can be used to detect white-coat hypertension and masked hypertension. There is a tendency for the device not to maintain positioning over the radial artery. The wrist must be kept at heart level to obtain an accurate reading. A preliminary analysis of wireless BP monitors showed poor accuracy compared with auscultatory readings.

Kiosks that are commonly used to measure BP often do not have cuffs that fit large arms. Most normative data are based on auscultatory BP measurements. If elevated BP is present when measured with an oscillometric device, auscultation should be performed to define BP categories. BP should be taken in the right arm to align with normative data. A systematic review has reported devices that have been validated in pregnant women. If a thigh cuff does not fit, BP can be measured at the wrist. Standing BP should be obtained immediately after rising and 1 and 2 min later.

Orthostatic hypotension has been associated with risk for fractures, syncope, and mortality. ABPM may be useful in identifying white-coat hypertension, hypotension in the postprandial state, and after awakening in the morning. Visit-to-visit variability is associated with risk for CVD events. Calcium channel blockers and thiazide-type diuretics are associated with lower visit-to-visit variability of BP. These protocols vary in requirements eg, sample size, range of BP, success criteria. Many device validation studies do not adhere to these protocols.

Biomedical engineering departments can evaluate whether individual devices are taking accurate readings. Whelton Johns Hopkins School of Medicine None None None None None None None This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. References 1. Siu AL ; U. Preventive Services Task Force. Screening for high blood pressure in adults: U. Preventive Services Task Force recommendation statement. Ann Intern Med. Unmasking masked hypertension: prevalence, clinical implications, diagnosis, correlates and future directions.

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Pickering TG. What will replace the mercury sphygmomanometer? Using Hawksley random zero sphygmomanometer as a gold standard may result in misleading conclusions. Blood Press. Crossref Google Scholar Inaccuracy of the Hawksley random zero sphygmomanometer. Lawson M, Johnston A. The Hawksley random zero sphygmomanometer: should be abandoned. Properties of the random zero sphygmomanometer.

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European Society of Hypertension international protocol revision for the validation of blood pressure measuring devices in adults. Automated office blood pressure: being alone and not location is what matters most. Consistent relationship between automated office blood pressure recorded in different settings. Comparative assessment of four blood pressure measurement methods in hypertensives. Can J Cardiol. Comparison of two automated sphygmomanometers for use in the office setting.

Myers MG, Valdivieso M. Evaluation of an automated sphygmomanometer for use in the office setting. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. Use of automated office blood pressure measurement to reduce the white coat response. Beckett L, Godwin M. The BpTRU automatic blood pressure monitor compared to 24 hour ambulatory blood pressure monitoring in the assessment of blood pressure in patients with hypertension.

BMC Cardiovasc Disord. Optimum frequency of office blood pressure measurement using an automated sphygmomanometer. Myers MG. A proposed algorithm for diagnosing hypertension using automated office blood pressure measurement. Manual and automated office measurements in relation to awake ambulatory blood pressure monitoring. Fam Pract. Can sphygmomanometers designed for self-measurement of blood pressure in the home be used in office practice? Automated office blood pressure and h ambulatory measurements are equally associated with left ventricular mass index.

Am J Hypertens. Comparison of an in-pharmacy automated blood pressure kiosk to daytime ambulatory blood pressure in hypertensive subjects. Comparability of automated office blood pressure to daytime hour ambulatory blood pressure. Prevalence of white coat effect in treated hypertensive patients in the community. Automated oscillometric blood pressure versus auscultatory blood pressure as a predictor of carotid intima-medial thickness in male firefighters. Thresholds for diagnosing hypertension based on automated office blood pressure measurements and cardiovascular risk.

Cardiovascular risk in hypertension in relation to achieved blood pressure using automated office blood pressure measurement. How do family physicians measure blood pressure in routine clinical practice? National survey of Canadian family physicians. Can Fam Physician. Alerting reaction and rise in blood pressure during measurement by physician and nurse. Attended versus unattended blood pressure measurement in a real life setting.

Office blood pressure measurement: the weak cornerstone of hypertension diagnosis. J Clin Hypertens Greenwich. Measuring blood pressure for decision making and quality reporting: where and how many measures? Prevalence of systolic inter-arm differences in blood pressure for different primary care populations: systematic review and meta-analysis.

Br J Gen Pract. Consistency of blood pressure differences between the left and right arms. The systolic blood pressure difference between arms and cardiovascular disease in the Framingham Heart Study. Am J Med. Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk. Garrison GM, Oberhelman S.

Screening for hypertension annually compared with current practice. Ann Fam Med. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy. Sample size for short-term trials of antihypertensive drugs. Br J Clin Pharmacol. Reproducibility of home blood pressure measurements over a 1-year period.

Stergiou GS. How to cope with unreliable office blood pressure measurement? Blood pressure determination by traditionally trained personnel is less reliable and tends to underestimate the severity of moderate to severe hypertension. White WB, Barber V.

Ambulatory monitoring of blood pressure: an overview of devices, analyses, and clinical utility. White WB , ed. Cham, Switzerland : Springer International Publishing ; — The prognostic value of ambulatory blood pressures. The use of ambulatory blood pressure monitoring among Medicare beneficiaries in Franz Volhard Lecture: should doctors still monitor blood pressure?

The missing patients with masked hypertension. Validation and reliability testing of blood pressure monitors. Continuous vs intermittent blood pressure measurements in estimating hour average blood pressure. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.

European Society of Hypertension position paper on ambulatory blood pressure monitoring. Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients. National Institute for Health and Care Excellence. Accessed March 20, Relationship between clinic and ambulatory blood-pressure measurements and mortality.

Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Clinic and ambulatory blood pressure in a population-based sample of African Americans: the Jackson Heart Study. Is isolated nocturnal hypertension a novel clinical entity? Findings from a Chinese population study. The dilemma of nocturnal blood pressure.

Ambulatory blood pressure in the hypertensive population: patterns and prevalence of hypertensive subforms. Blood pressure during siesta: effect on h ambulatory blood pressure profiles analysis. Differences in night-time and daytime ambulatory blood pressure when diurnal periods are defined by self-report, fixed-times, and actigraphy: Improving the Detection of Hypertension study. How common is white coat hypertension? White-coat hypertension: new insights from recent studies.

Hypertension types defined by clinic and ambulatory blood pressure in 14 patients referred to hypertension clinics worldwide: data from the ARTEMIS study.

Blood pressure measurement - Wikipedia

Is resistant hypertension really resistant? Clinical features of patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Is white-coat hypertension associated with increased cardiovascular and mortality risk? Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population.

Prevalence and clinical characteristics of white-coat hypertension based on different definition criteria in untreated and treated patients. The cardiovascular risk of white-coat hypertension. J Am Coll Cardiol. Response to antihypertensive therapy in older patients with sustained and nonsustained systolic hypertension: Systolic Hypertension in Europe Syst-Eur Trial Investigators. Long-term risk of sustained hypertension in white-coat or masked hypertension.

When and how to use self home and ambulatory blood pressure monitoring. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U. Masked hypertension. Prevalence of masked hypertension among US adults with nonelevated clinic blood pressure. Am J Epidemiol. Masked hypertension and cardiovascular disease events in a prospective cohort of blacks: the Jackson Heart Study. Masked hypertension and prehypertension: diagnostic overlap and interrelationships with left ventricular mass: the Masked Hypertension Study.

Levels of office blood pressure and their operating characteristics for detecting masked hypertension based on ambulatory blood pressure monitoring. Clinic blood pressure underestimates ambulatory blood pressure in an untreated employer-based US population: results from the Masked Hypertension Study. Masked hypertension in diabetes mellitus: treatment implications for clinical practice. Differences between office and hour blood pressure control in hypertensive patients with CKD: a 5,patient cross-sectional analysis from Spain. Am J Kidney Dis. Masked hypertension in obstructive sleep apnea syndrome.

Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis.

Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. Masked hypertension and target organ damage in treated hypertensive patients. The reproducibility of racial differences in ambulatory blood pressure phenotypes and measurements.

Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin Outcome Study. Dippers and non-dippers. Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13, patients with hypertension.

Predictive role of the nighttime blood pressure. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in individuals from 10 populations. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int. A trial of 2 strategies to reduce nocturnal blood pressure in blacks with chronic kidney disease. Circadian rhythms and cardiovascular health.

Sleep Med Rev. The clinical significance of diurnal blood pressure variations. Dippers and nondippers. Night-day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes. Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high h blood pressure: the Ohasama study.

Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Fagard RH. Dipping pattern of nocturnal blood pressure in patients with hypertension. Expert Rev Cardiovasc Ther. Circadian variation in the frequency of onset of acute myocardial infarction. Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. Am J Cardiol.

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Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Kario K, White WB. Early morning hypertension: what does it contribute to overall cardiovascular risk assessment? Prognostic value of the morning blood pressure surge in subjects from 8 populations.

Kario K. Morning surge in blood pressure and cardiovascular risk: evidence and perspectives. Reproducibility of ambulatory blood pressure in treated and untreated hypertensive patients. Ambulatory blood pressure monitoring: how reproducible is it? Reproducibility of blood pressure dipping: relation to day-to-day variability in sleep quality.

Reproducibility of ambulatory blood pressure monitoring in daily practice. Is isolated nocturnal hypertension a reproducible phenotype? Reproducibility of masked hypertension among adults 30 years or older. Short-term and long-term reproducibility of hypertension phenotypes obtained by office and ambulatory blood pressure measurements. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension.

Management of hypertension: summary of NICE guidance. The Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Management of hypertension in adults in primary care: NICE guideline. Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice.

Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Home measurement of blood pressure and cardiovascular disease: systematic review and meta-analysis of prospective studies. Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan.

Home-measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn-Home study. Assessment of the diurnal blood pressure profile and detection of non-dippers based on home or ambulatory monitoring. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis.

A substudy evaluating treatment intensification on medication adherence among hypertensive patients receiving home blood pressure telemonitoring and pharmacist management. J Clin Pharm Ther. Crossref Medline Google Scholar a. Google Scholar b. Dabl Educational Trust. Measure and diagnose high BP. Accessed April 21, Self-monitoring of blood pressure at home: how many measurements are needed?

The optimal home blood pressure monitoring schedule based on the Didima outcome study. European Society of Hypertension practice guidelines for home blood pressure monitoring. Stergiou GS, Parati G. The optimal schedule for self-monitoring of blood pressure by patients at home. Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome.

Four-year test-retest reliability of self-measured blood pressure. Reliability and reproducibility of clinic and home blood pressure measurements in hypertensive women according to age and ethnicity. Kawabe H, Saito I. Reproducibility of masked hypertension determined from morning and evening home blood pressure measurements over a 6-month period. Hypertens Res. Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLoS Med. Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis.

A pharmacist-led, American Heart Association Heart Web-enabled home blood pressure monitoring program. Circ Cardiovasc Qual Outcomes. Adherence to blood pressure telemonitoring in a cluster-randomized clinical trial. Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control: a mediation analysis.

Appl Clin Inform. Home blood pressure management and improved blood pressure control: results from a randomized controlled trial. Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre randomised controlled trial. Ogedegbe G, Schoenthaler A. A systematic review of the effects of home blood pressure monitoring on medication adherence.

The Effect of Self-Monitoring of blood pressure on medication adherence and lifestyle factors: a systematic review and meta-analysis. Studies comparing ambulatory blood pressure and home blood pressure on cardiovascular disease and mortality outcomes: a systematic review. Barriers to conducting ambulatory and home blood pressure monitoring during hypertension screening in the United States. Rates, amounts, and determinants of ambulatory blood pressure monitoring claim reimbursements among Medicare beneficiaries. Tolerability of the Oscar 2 ambulatory blood pressure monitor among research participants: a cross-sectional repeated measures study.

Side effects of ambulatory blood pressure monitoring. Ambulatory blood pressure measurement: the case for implementation in primary care. Reliability of self-reported blood pressure measurements.

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  • Attitudes of primary care physicians and their patients about home blood pressure monitoring in Ontario. Primary care physician beliefs regarding usefulness of self-monitoring of blood pressure. Reference values for ambulatory blood pressure: a population study. J Hypertens Suppl. Ambulatory blood pressure in normotensive and hypertensive subjects: results from an international database. Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study.

    Diagnostic thresholds for ambulatory blood pressure monitoring based on year cardiovascular risk. Reference values for hour ambulatory blood pressure monitoring based on a prognostic criterion: the Ohasama Study. Staessen JA, Thijs L. Development of diagnostic thresholds for automated self-measurement of blood pressure in adults: First International Consensus Conference on Blood Pressure Self-Measurement.

    Outcome-driven thresholds for home blood pressure measurement: international database of home blood pressure in relation to cardiovascular outcome. Thirty years of research on diagnostic and therapeutic thresholds for the self-measured blood pressure at home. A new algorithm for the diagnosis of hypertension in Canada. Ambulatory blood pressure monitoring in Australia: consensus position statement. Invasive v. Br J Anaesth. Comparison of finger and intra-arterial blood pressure monitoring at rest and during laboratory testing.

    Validation of the Omron M6 HEME upper arm blood pressure measuring device according to the international protocol in elderly patients. Poor reliability of wrist blood pressure self-measurement at home: a population-based study. BioWatch: a noninvasive wrist-based blood pressure monitor that incorporates training techniques for posture and subject variability.

    Chapter 2. Measurement and clinical evaluation of blood pressure

    Comparison of the Omron RS6 wrist blood pressure monitor with the positioning sensor on or off with a standard mercury sphygmomanometer. Current utility of the ankle-brachial index ABI in general practice: implications for its use in cardiovascular disease screening. BMC Fam Pract. Comparison of non-invasive blood pressure monitoring using modified arterial applanation tonometry with intra-arterial measurement.