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Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis

Journal of Human Hypertension volume 33, pages 352–364 (2019)Cite this article

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Abstract

Atrial fibrillation (AF) affects ~3% of the general population and is twice as common with hypertension. Validation protocols for automated sphygmomanometers exclude people with AF, raising concerns over accuracy of hypertension diagnosis or management, using out-of-office blood pressure (BP) monitoring, in the presence of AF. Some devices include algorithms to detect AF; a feature open to misinterpretation as offering accurate BP measurement with AF. We undertook this review to explore accuracy of automated devices, with or without AF detection, for measuring BP. We searched Medline and Embase to October 2018 for studies comparing automated BP measurement devices to a standard mercury sphygmomanometer contemporaneously. Data were extracted by two reviewers. Mean BP differences between devices and mercury were calculated, where not reported and compared; meta-analyses were undertaken where possible. We included 13 studies reporting 14 devices. Mean systolic and diastolic BP differences from mercury ranged from −3.1 to + 6.1/−4.6 to +9.0 mmHg. Considerable heterogeneity existed between devices (I2: 80 to 90%). Devices with AF detection algorithms appeared no more accurate for BP measurement with AF than other devices. A previous review concluded that oscillometric devices are accurate for systolic but not diastolic BP measurement in AF. The present findings do not support that conclusion. Due to heterogeneity between devices, they should be evaluated on individual performance. We found no evidence that devices with AF detection measure BP more accurately in AF than other devices. More home or ambulatory automated BP monitors require validation in populations with AF.

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Funding

C.E.C. is supported by a NIHR Clinical Lectureship and R.Mc.M. by a NIHR Professorship. The views expressed are those of the authors and not necessarily those of the NIHR, the NHS or the Department of Health.

Author contributions

This study was conceived by C.E.C. and R.Mc.M. C.E.C. undertook the searches, selected studies, extracted and analysed the data. S.Mc.D. reviewed the search results, checked and agreed study selections and extracted data. C.E.C. drafted the manuscript which was revised by S.Mc.D. and R.Mc.M. All authors have read and reviewed the final manuscript.

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Authors and Affiliations

  1. Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, College of Medicine and Health, Smeall Building, St. Luke’s Campus, Magdalen Rd, EX1 2LU, Exeter, Devon, England

    Christopher E. Clark & Sinead T. J. McDonagh

  2. Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, OX2 6GG, Oxford, England

    Richard J. McManus

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  1. Christopher E. Clark
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Correspondence to Christopher E. Clark.

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Conflict of interest

C.E.C. sits on, and R.Mc.M. chairs the British and Irish Hypertension Society Blood Pressure Measurement Working Party. We both regularly review validation studies of blood pressure monitors against objective criteria set out in international protocols as part of our work with this registered charity. No manufacturer funding is received. C.E.C., has, in the past been loaned bilateral blood pressure monitors by Microlife and Jawon Medical for unrestricted evaluation. No company had any involvement in the design or conduct of this study.

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Clark, C.E., McDonagh, S.T. & McManus, R.J. Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis. J Hum Hypertens 33, 352–364 (2019). https://doi.org/10.1038/s41371-018-0153-z

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