There is an urgent need for more automated BP devices to be validated in children as there is a severe shortage of validated automated BP device models for children.
Abstract
Background
Similar to adults, in children automated cuff devices are recommended for office, home, and ambulatory blood pressure (BP) measurement. However, a device validated in adults may not be accurate in children, and separate investigation is necessary. Moreover, current pediatric guidelines recommend hypertension detected by an automated device to be confirmed using auscultation. The evidence on validated automated BP devices for children (aged 3-12 years) is presented.
Methods
STRIDE BP (Science and Technology for Regional Innovation and Development in Europe-Blood Pressure; www.stridebp.org) performs periodic systematic PubMed searches for validation studies of automated BP devices. The data set of studies including children was analyzed.
Results
Fifty-one of 628 studies in the STRIDE BP database included children. Forty-one (80%) concluded that the test device passed the validation, yet due to protocol violations, STRIDE BP approved 22 of them (43%). These 22 studies validated 20 devices (14 on the market). Seven additional devices had measurement functions equivalent to STRIDE BP-approved devices (6 on the market). Meta-analysis of 20 successful studies including children and older individuals (N=1476) showed a pooled test-reference systolic BP difference of 0.6 mm Hg (95% CI, -0.2 to 1.4), and diastolic -0.3 (95% CI, -1.2 to 0.6). Meta-analysis of 7 studies including only children (N=410) showed a pooled difference of 1.0 (95% CI, -0.7 to 2.8)/-1.3 (95% CI, -2.9 to 0.4) mm Hg.
Conclusions
There is a severe shortage of validated automated BP device models for children, with published studies often having methodological issues. Some devices are validated in children and, as in adults, can replace auscultatory devices for office hypertension diagnosis. There is an urgent need for more automated BP devices to be validated in children.
OBJECTIVE
Hypertension impacts 26 900 pregnancies in Canada per year. Accurate blood pressure (BP) measurement is recognized as crucial to hypertension care outside pregnancy but has gained less attention in pregnancy. Canadian guidelines recommend measuring maternal BP with a manual auscultatory device, or an automated device validated in pregnancy. National adherence to this recommendation is unknown.
METHODS
We developed a 15-question survey to understand how health care professionals (HCPs) measure BP in pregnancy. We distributed it through Hypertension Canada's mailing list and the Snowball method.
RESULTS
86 HCPs from 7 provinces and various specialties (including 63% from internal medicine and 21% from obstetrics) responded. For clinic BP in pregnant people, respondents frequently use an appropriate cuff size (n = 82, 95%), take multiple readings (n = 77, 90%), and have patients sit with arm/back support (n = 72, 84%). HCPs often use automated clinic devices for pregnant people but are uncertain of their validation in pregnancy (n = 53, 62%). Respondents frequently recommended home BP measurement (n = 81, 94%) and asked patients to bring home devices in to compare against clinic devices (n = 61, 71%) but most did not recommend a specific home device nor specify one that is validated in pregnancy.
CONCLUSIONS
We identified four strengths of BP measurement in pregnancy: appropriate cuff size, taking multiple readings, recommending home measurement, and attempting calibration of home devices. The most concerning finding is failure to use (in clinic) and recommend (at home) devices validated for pregnant people, due at least in part, to the limited number of devices validated for this population.
L. Dubrofsky, Sachin V. Pasricha, J. Snelgrove et al.· Journal of Obstetrics and Gy...· 0 citations
Objectives
Accurate blood pressure (BP) measurement is essential for reliably estimating hypertension prevalence in population-based surveys. However, evidence supporting the use of oscillometric BP devices in pediatric populations remains limited. This study compared BP measurements obtained using an oscillometric device (OD) and an auscultatory device (AD) and evaluated inter-device agreement and the impact of device choice on hypertension prevalence estimates.
Methods
BP was measured sequentially with the AD and OD in 251 children and adolescents participating in the Korea National Health and Nutrition Examination Survey. Inter-device agreement was assessed using mean differences, limits of agreement, concordance correlation coefficients (CCCs), and regression analyses. Differences in prevalence estimates for elevated BP (EBP) and hypertension were also examined.
Results
Mean inter-device differences were minimal for systolic BP (SBP) (0.2 ± 5.9 mmHg) but negative for diastolic BP (DBP) (-1.5 ± 6.1 mmHg), with larger discrepancies in older girls. Agreement was moderate to good for SBP (CCC = 0.79) and weaker for DBP (CCC = 0.60). Nevertheless, more than 85% of paired measurements were within ±10 mmHg. Prevalence estimates for EBP (11.6% vs. 10.0%) and hypertension (4.8% vs. 4.4%) were comparable between devices, with relatively high negative agreement and overall agreement.
Conclusion
Despite modest underestimation of DBP in specific subgroups, oscillometric BP measurement showed acceptable agreement with the auscultatory method and yielded similar hypertension prevalence estimates. These findings suggest that oscillometric devices may be useful for pediatric BP measurement in public health surveillance systems.
Sung Hye Kim, Yu-Mi Kim, Hack-Lyoung Kim et al.· Epidemiology and Health· 0 citations
Wearable wristwatch-type cuff oscillometric blood pressure (BP) monitors represent a new category of BP devices and are the first wearable monitors to use established cuff-oscillometric BP measurement technology. This consensus statement by the European Society of Hypertension Working Group on BP Monitoring reviews the published evidence on their design, accuracy, validation, clinical application, and remaining research questions. Of 281 articles identified through a systematic PubMed search, 26 were relevant. Several devices are currently available; however, only two have published validation studies performed according to established standards (Omron HeartGuide and Huawei Watch D/D2). Static validation studies generally showed acceptable accuracy, whereas data on 24-h ambulatory use, in special populations, and clinical applications remain limited. Potential advantages include self-initiated measurement at home, at work, and in other settings and conditions; more convenient and repeatable 24-h ambulatory monitoring; more convenient and accurate assessment of asleep BP; capture of stress-related and other BP-related episodes. However, proper wrist position, user adherence, ambulatory performance, and clinical applications require further investigation. More research is needed to establish the accuracy and clinical utility of these novel devices and their role in improving the diagnosis and management of hypertension.
George S. Stergiou, A. Menti, Kei Asayama et al.· Journal of Hypertension· 0 citations
The 2015–2025 ecosystem shows rapid progress and a transition toward cuffless-specific validation, however, clinical utility depends on intended use, population, calibration/recalibration, and setting, and performance should not be extrapolated across technologies, populations, or contexts.
J. C. Bustamante-Rodríguez, Jhosmer Ballena-Caicedo, Julio César Bautista-Zuta et al.· Frontiers in Digital Health· 0 citations
This represents the first evaluation of a Device Type 3 cuffless blood pressure algorithm (automated, wearable, demographic-calibrated, not at heart level) meeting ESH awake/asleep test criteria, suggesting Alysis-001's potential as a clinically viable alternative for ambulatory blood pressure monitoring in hypertensive patients.
The Arm-Type Fully Automatic Blood Pressure Monitor (model: DBP-62F4B-P) meets the accuracy and consistency requirements of the AAMI/ESH/ISO standard for SBP and DBP measurement in adolescents and adults with arm circumference 22.0-42.0 cm and is suitable for home use based on its design features and validation performance.
