How to evaluate BP measurements using the oscillometric method in atrial fibrillation: the value of pulse rate variation

Abstract

An oscillometric device is recommended for blood pressure (BP) measurement in atrial fibrillation (AF), but there is still controversy concerning its accuracy. Therefore, evaluation of BP values in AF patients remains a challenge. This study included 251 patients with AF and 154 participants with sinus rhythm (SR). Pulse rate (PR) and BP were measured using an oscillometric device three times. The differences between the highest and lowest PR and the systolic and diastolic BP (SBP and DBP) were calculated as ΔPR, ΔSBP and ΔDBP, respectively. AF patients were stratified with respect to ΔPR in 0–5, 6–10, 11–15 and >15 subgroups. The AF group had a greater ΔPR (12.1±8.6 vs. 4.10±3.21 b.p.m., P<0.001), ΔSBP and ΔDBP than the SR group at similar SBP and DBP. A positive correlation existed between ΔPR and ΔSBP (r=0.255, P<0.001) in AF patients, but no correlation was found in SR subjects. Meanwhile, the ΔSBP in the 0–5 and 6–10 subgroups (9.58±5.61 and 10.67±6.77 vs. 8.45±5.25 mm Hg, nonsignificant) was similar to the SR group, whereas ΔSBP in the 11–15 and >15 subgroups was significantly greater than the SR group. Regardless of ΔPR, the ΔDBP in the AF group was significantly greater than that of the SR group. The AF patients who exhibited greater variability in their PR also had a greater variability in their SBP readings. The SBP measurement for AF patients is accurate as the measurement for patients with SR if the ΔPR is of 0–10 b.p.m. in AF.

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References

  1. 1

    Badheka AO, Patel NJ, Grover PM, Shah N, Patel N, Singh V, Deshmukh AJ, Mehta K, Chothani A, Savani GT, Arora S, Rathod A, Marzouka GR, Lafferty J, Mehta JL, Mitrani RD . Optimal blood pressure in patients with atrial fibrillation (from the AFFIRM Trial). Am J Cardiol 2014; 114: 727–736.

    Article  Google Scholar 

  2. 2

    Carlsson AC, Wändell P, Sundquist K, Johansson SE, Sundquist J . Effects of prescribed antihypertensives and other cardiovascular drugs on mortality in patients with atrial fibrillation and hypertension: a cohort study from Sweden. Hypertens Res 2014; 37: 553–559.

    CAS  Article  Google Scholar 

  3. 3

    Jong GP, Chen HY, Li SY, Liou YS . Long-term effect of antihypertensive drugs on the risk of new-onset atrial fibrillation: a longitudinal cohort study. Hypertens Res 2014; 37: 950–953.

    CAS  Article  Google Scholar 

  4. 4

    Lip GY, Zarifis J, Beevers M, Beevers DG . Ambulatory blood pressure monitoring in atrial fibrillation. Am J Cardiol 1996; 78: 350–353.

    CAS  Article  Google Scholar 

  5. 5

    Jani B, Bulpitt CJ, Rajkumar C . Blood pressure measurement in patients with rate controlled atrial fibrillation using mercury sphygmomanometer and Omron HEM-750CP deice in the clinic setting. J Hum Hypertens 2006; 20: 543–545.

    CAS  Article  Google Scholar 

  6. 6

    Stergiou GS, Kollias A, Destounis A, Tzamouranis D . Automated blood pressure measurement in atrial fibrillation: a systematic review and meta-analysis. J Hypertens 2012; 30: 2074–2082.

    CAS  Article  Google Scholar 

  7. 7

    Pagonas N, Schmidt S, Eysel J, Compton F, Hoffmann C, Seibert F, Hipert J, Tschope C, Zidek W, Westhoff TH . Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring. Hypertension 2013; 62: 579–584.

    CAS  Article  Google Scholar 

  8. 8

    Kollias A, Stergiou GS . Automated measurement of office, home and ambulatory blood pressure in atrial fibrillation. Clin Exp Pharmacol Physiol 2014; 41: 9–15.

    CAS  Article  Google Scholar 

  9. 9

    Maselli M, Giantin V, Corrado D, Franchin A, Attanasio F, Pengo V, Tramontano A, De Toni P, Perissinotto E, Manzato E . Reliability of oscillometric blood pressure monitoring in atrial fibrillation patients admitted for electric cardioversion. J Clin Hypertens (Greenwich) 2015; 17: 558–564.

    Article  Google Scholar 

  10. 10

    Stergiou GS, Kollias A, Karpettas N . Does atrial fibrillation affect the automated oscillometric blood pressure measurement? Hypertension 2013; 62: e37.

    CAS  Article  Google Scholar 

  11. 11

    Myers MG, Stergiou GS . Should oscillometric blood pressure monitors be used in patients with atrial fibrillation? J Clin Hypertens (Greenwich) 2015; 17: 565–566.

    Article  Google Scholar 

  12. 12

    Alpert B, Quinn D, Gallick D . Oscillometric blood pressure: a review for clinicians. Jo Am Soc Hypertens 2014; 8: 930–938.

    Article  Google Scholar 

  13. 13

    Raamat R, Talts J, Jagomägi K, Kivastik J . Accuracy of some algorithms to determine the oscillometric mean arterial pressure: a theoretical study. Blood Press Monit 2013; 18: 50–56.

    Article  Google Scholar 

  14. 14

    Giantin V, Perissinotto E, Franchin A, Baccaglini K, Attanasio F, Maselli M, Grosso G, Luisa Corradin M, Tramontano A, Manzato E . Ambulatory blood pressure monitoring in elderly patients with chronic atrial fibrillation: is it absolutely contraindicated or a useful tool in clinical practice and research? Hypertens Res 2013; 36: 889–894.

    Article  Google Scholar 

  15. 15

    Pagonas N, Westhoff TH . Response to "Does atrial fibrillation affect the automated oscillometric blood pressure measurement"? Hypertension 2013; 62: e38.

    CAS  PubMed  Google Scholar 

  16. 16

    Stergiou GS, Kollias A, Destounis A, Tzamouranis D . Automated blood pressure measurement in atrial fibrillation: a systematic review and meta-analysis. J Hypertens 2013; 31: 215–216.

    CAS  Article  Google Scholar 

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (81530013). It was also supported by the National Science and Technology Infrastructure Program No. 2013BAI05B10 and the Ministry of Chinese Education Innovation Team Development Plan (IRT1141).

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Correspondence to Hai Su.

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Wang, X., Shuai, W., Hong, K. et al. How to evaluate BP measurements using the oscillometric method in atrial fibrillation: the value of pulse rate variation. Hypertens Res 39, 588–592 (2016). https://doi.org/10.1038/hr.2016.31

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Keywords

  • atrial fibrillation
  • blood pressure
  • pulse rate
  • sinus rhythm

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