Earlier this month, on March 4, 2019, the American Heart Association published a new scientific statement on blood pressure measurement in humans. This publication gets into significant depth but not so deep that it’s unreadable by laypeople. This is the first such statement from the AHA since 2005, so it matters to anyone who measures blood pressure for others or for themselves.
In one sense the AHA statement is a meta study, because it pulls data and comments on methodology from 318 prior studies; nearly one third of the 32-pages are devoted to references. The paper does much more than aggregate and analyze others’ work and present the findings, however.
The statement is also a training reference for healthcare professionals and a consumer’s guide to understanding how blood pressure should be measured. It details common mistakes that can result in significant errors in pressure readings.
In addition, the document draws conclusions and makes recommendations on the uses of auscultatory and oscillometric blood pressure technologies. It also goes at some length to explain the differences between white coat hypertension and masked hypertension for hypertensive and non-hypertensive individuals. Nighttime hypertension and morning BP surges are two more interesting subtopics.
In sum, the statement takes a skeptical view of office visit single blood pressure readings as incomplete at the very best. In response, assuming the contents in the AHA statement are taken to heart (ahem) by the medical community, we can expect to hear quite a bit in the future about AOBP (ambulatory office blood pressure), ABPM (ambulatory blood pressure monitoring: anywhere but the doctor’s office or clinic), and HBPM (home blood pressure monitoring) using oscillometric bp wearables.
And that brings us to the second reason for the AHA statements significance to HTI readers. After pretty much blowing auscultatory blood pressure measurement out of the water in favor of oscillometric measurement, the AHA makes a good case for fully automated in-office (AOBP) and, better yet, anywhere-but-in-office blood pressure measurement and monitoring. Fully automated readers (ABPM) are expensive and often not covered by insurance, so for those reasons and more, the AHA suggests recommends the use of certified and periodically validated consumer oscillometric devices… but only those that use upper-arm cuffs “…because many non-validated devices do not provide accurate measurements of BP.”
The AHA statement refers to other BP measurement form factors including finger cuffs, wrist monitors, ultrasonography, and tonometry, but regards them as not ready or not suitable for patient home use. The statement suggests that smartphone technology, wearable sensors, and cuffless BP monitors have promise for future use after more work with calibration and sufficient validation studies.
