Use of oscillometric devices in atrial fibrillation: a comparison of three devices and invasive blood pressure measurement

Background: The use of automated (oscillometric) blood pressure (BP) devices is not validated in atrial fibrillation (AF) patients. Objectives: To assess the reliability of three oscillometric BP devices, and the agreement with invasive arterial blood pressure(IBP) in AF patients. Methods: 48 AF patients with randomized sequences of 10 consecutive BP measurements with two pairs of devices: (1) OmronR7™(wrist) and OmronHEM907™(arm); (2) OmronR7™ and Microlife WatchBPhome(arm). Reliability and agreement of each device were assessed by the intra-class correlation coefficient (ICC) for the continuous BP measurements and Bland & Altman methodology, respectively. In 10 additional AF patients, 10 consecutive measurements with IBP and OmronHEM907™, and IBP and Microlife WatchBPhome were performed. Results: The OmronR7™ was not able to obtain any BP Readings. Arm devices presented better ICC for systolicBP(SBP) than for diastolicBP(DBP) (Omron HEM907™:0.94 [0.90; 0.97] vs. 0.77 [0.67; 0.89]; Microlife WatchBPhome:0.92 [0.88; 0.96] vs.0.79 [0.69; 0.89]).The correlation coefficient between Microlife WatchBPhome and IBP computed using the average of repeated measurements from two to ten measurements improved up to the third and remained stable afterwards. The agreement between IBP and SBP, and IBP and DBP, was moderate as illustrated by a wide limit of agreement [−24; 26](SBP) and [−15;17](DBP) for Microlife WatchBPHome, respectively and [−30; 13](SBP) and [−7; 15](DBP) for OmronHEM907. Conclusions: BP measurement using the two arm oscillometric devices achieved a high reliability for SBP. The agreement between IBP and arm devices was low but using the average of three consecutive measurements improved the results substantially.

背景：目前针对心房颤动（Atrial Fibrillation, AF）患者使用自动化示波法血压（Blood Pressure, BP）测量设备的有效性验证仍存在空白。
目的：评估三款示波法血压测量设备的可靠性，并分析其与有创动脉血压（Invasive Arterial Blood Pressure, IBP）在心房颤动患者中的一致性。
方法：纳入48名心房颤动患者，针对两组配对设备分别开展10次连续血压测量，测量顺序采用随机化设计：（1）欧姆龙R7™（腕式）与欧姆龙HEM907™（臂式）；（2）欧姆龙R7™与迈克大夫WatchBP home（臂式）。分别采用组内相关系数（Intra-class Correlation Coefficient, ICC）分析连续血压测量数据的可靠性，采用Bland-Altman分析法评估设备间的测量一致性。此外，针对另外10名心房颤动患者，分别开展有创动脉血压与欧姆龙HEM907™、有创动脉血压与迈克大夫WatchBP home的10次连续配对测量。
结果：欧姆龙R7™未能获取任何有效血压读数。臂式设备的收缩压（Systolic Blood Pressure, SBP）组内相关系数优于舒张压（Diastolic Blood Pressure, DBP）：欧姆龙HEM907™的ICC分别为0.94[0.90, 0.97]（收缩压）与0.77[0.67, 0.89]（舒张压）；迈克大夫WatchBP home的ICC分别为0.92[0.88, 0.96]（收缩压）与0.79[0.69, 0.89]（舒张压）。以2至10次连续测量的平均值计算，迈克大夫WatchBP home与有创动脉血压的相关系数在取前3次测量平均值时达到最优，后续保持稳定。有创动脉血压与臂式设备的收缩压、舒张压一致性处于中等水平：迈克大夫WatchBP home的一致性界限分别为[-24, 26]（收缩压）与[-15, 17]（舒张压），欧姆龙HEM907™的一致性界限分别为[-30, 13]（收缩压）与[-7, 15]（舒张压）。
结论：两款臂式示波法血压测量设备的收缩压测量具有较高可靠性。有创动脉血压与臂式设备的一致性偏低，但采用连续3次测量的平均值可显著改善测量结果。