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Validation up-date.

Abstract

With the increasing marketing of automated and semi-automated devices for the measurement of blood pressure, there is a need for potential purchasers to be able to satisfy themselves that such devices have been evaluated according to agreed criteria. Since their introduction a large number of blood pressure measuring devices have been evaluated according to one or both protocols. However, experience has demonstrated that the conditions demanded by the protocols are extremely difficult to fulfil. The European Society of Hypertension (ESH) protocol, named the International Protocol, which will be published shortly, is based on the data from 19 validation studies performed according to the AAMI and BHS protocols. Critical assessment of this data base of evidence has permitted rationalisation and simplification of validation procedures without loosing the merits of the much more complicated earlier protocols. This has been achieved by elimination of pre-validation phases, improving observer recruitment and training, minimising observer error during validation, reducing the number of subjects recruited, relaxing the range of blood pressures required and eliminating 'hopeless' devices early in the validation procedure.

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BibTeXRIS

E O'Brien. 2001. Validation up-date.. https://doi.org/10.1097/00126097-200112000-00002

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[Accuracy of the automated oscillometric device Lohmeier B-606, for blood pressure measurement in hospitals].

BACKGROUND: The aim of the present study was to evaluate the accuracy of an automated oscillometric device, Lohmeier B-606, for clinical use in hospitals, according to there commendations of the European Society of Hypertension. METHODS: Thirty-three subjects were studied. We performed three pair of sequential comparisons of blood pressure in each patient, first with mercury sphygmomanometer, second with the oscillometric device, obtaining a whole number of 99 comparisons. RESULTS: From the total 99 comparisons, 55 for SBP and 66 for DBP showed differences 3/4 5 mmHg, 86 and 88 differences 3/4 10 mmHg and 99 for SBP and DBP differences 3/4 15 mmHg. Mean differences between procedures (mercury-automatic) were 0.08 (confidence interval [IC] 95%: 14.1, 14.3) for SBP and 0.99 (95% CI: 11.0, 13.0) for DBP. Intraclass correlation coefficients were 0.975 for SBP and 0.944 for DBP. CONCLUSIONS: The blood pressure measurement oscillometric device Lohmeier B-606 satisfies the European Society of Hypertension criteria for clinical use in hospitals.

Blood Pressure Determination↗

Comparison of agreement between different measures of blood pressure in primary care and daytime ambulatory blood pressure.

OBJECTIVE: To assess alternatives to measuring ambulatory pressure, which best predicts response to treatment and adverse outcome. SETTING: Three general practices in England. DESIGN: Validation study. PARTICIPANTS: Patients with newly diagnosed high or borderline high blood pressure; patients receiving treatment for hypertension but with poor control. MAIN OUTCOME MEASURES: Overall agreement with ambulatory pressure; prediction of high ambulatory pressure (>135/85 mm Hg) and treatment thresholds. RESULTS: Readings made by doctors were much higher than ambulatory systolic pressure (difference 18.9 mm Hg, 95% confidence interval 16.1 to 21.7), as were recent readings made in the clinic outside research settings (19.9 mm Hg,17.6 to 22.1). This applied equally to treated patients with poor control (doctor v ambulatory 21.4 mm Hg, 17.3 to 25.4). Doctors' and recent clinic readings ranked systolic pressure poorly compared with ambulatory pressure and other measurements (doctor r=0.46; clinic 0.47; repeated readings by nurse 0.60; repeated self measurement 0.73; home readings 0.75) and were not specific at predicting high blood pressure (doctor 26%; recent clinic 15%; nurse 72%; patient in surgery 81%; home 60%), with poor likelihood ratios for a positive test (doctor 1.2; clinic 1.1; nurse 2.1, patient in surgery 4.7; home 2.2). Nor were doctor or recent clinic measures specific in predicting treatment thresholds. CONCLUSION: The "white coat" effect is important in diagnosing and assessing control of hypertension in primary care and is not a research artefact. If ambulatory or home measurements are not available, repeated measurements by the nurse or patient should result in considerably less unnecessary monitoring, initiation, or changing of treatment. It is time to stop using high blood pressure readings documented by general practitioners to make treatment decisions.

Blood Pressure Determination↗