Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Accuracy of non-invasive blood pressure measurement in patients with atrial fibrillation

Journal of Human Hypertension volume 36, pages 229–234 (2022)Cite this article

Subjects

Abstract

Although the accuracy of oscillometric blood pressure (BP) measurement is not so satisfied, the BP reading is still associated with cardiovascular events and death in patients with atrial fibrillation (AF). Because the currently used auscultatory or oscillometric methods were developed on sinus rhythm (SR), these BP measurement methods were not reasonable for AF patients. It is suggested that the average of three BP readings in the AF patients is accepted in clinical, even so, high systolic BP (SBP) variability and inaccurate diastolic BP (DBP) value have been reported in AF patients. In sinus rhythm, oscillometric pressure pulses (OPPs) are spindle-like, regardless of the heart rate. However, the shape of OPP is obviously associated with frequency of ventricular rate (VR) in AF patients. When the VR is rapid, the OPP is far from a spindle-like shape. With intro-aortic BP as reference, a study demonstrated that the oscillometric SBP level significantly underestimated the intro-aortic SBP level in the AF patients with increasing VR. In clinical practice, the physician should use the average of three BP readings in the AF patients. When the mean pulse rates (PR) reported by the oscillometric BP devise is less than 90 bpm and the variation of three pulse rate <10 bpm, the oscillometric SBP readings may be clinically accepted in AF patients. It is necessary to develop a new BP measurement method for AF as the current methods in AF are not so accurate as in SR.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: The intra-aortic BP curves from a patient with AF and one with SR.
Fig. 2
Fig. 3: The principle for oscillometric BP measurement in SR subject.
Fig. 4: The impact of VR on the shape of OPP in AF patients.

Similar content being viewed by others

References

  1. Rao MP, Halvorsen S, Wojdyla D, Thomas L, Alexander JH, Hylek EM. et al. Blood pressure control and risk of stroke or systemic embolism in patients with atrial fibrillation: results from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Trial. J Am Heart Assoc. 2015;4:pii: e002015. https://doi.org/10.1161/JAHA.115.002015.

    Article  Google Scholar 

  2. Grundvold I, Skretteberg PT, Liestøl K, Erikssen G, Kjeldsen SE, Arnesen H, et al. Upper normal blood pressures predict incident atrial fibrillation in healthy middle-aged men: a 35-year follow-up study. Hypertension. 2012;59:198–204.

    Article  CAS  Google Scholar 

  3. Lip GY, Frison L, Grind M, SPORTIF Investigators. Effect of hypertension on anticoagulated patients with atrial fibrillation. Eur Heart J. 2007;28:752–9.

  4. Badheka AO, Patel NJ, Grover PM, Shah N, Patel N, Singh V, et al. Optimal blood pressure in patients with atrial fibrillation (from the AFFIRM Trial). Am J Cardiol. 2014;114:727–36.

    Article  Google Scholar 

  5. Ochiai H, Mitake A, Miyata T, Ishigami T, Ashino K, Sumita S, et al. Assessment of auscultatory blood pressure measurements versus intro-arterial pressure in patients with atrial fibrillation. J Cardiol. 1997;29:331–6.

    CAS  PubMed  Google Scholar 

  6. Kyriakoulis KG, Kollias A, Stergiou GS. Blood pressure and outcome in patients with atrial fibrillation: floating in uncharted waters. J Hypertension. 2021;39:592–3.

    Article  CAS  Google Scholar 

  7. Posey JA, Geddes LA, Williams H, Moore AG. The meaning of the point of maximum oscillations in cuff pressure in the indirect measurement of blood pressure. 1. Cardiovasc Res Cent Bull. 1969;8:15–25.

    CAS  PubMed  Google Scholar 

  8. Geddes LA, Voelz M, Combs C, Reiner D, Babbs CF. Characterization of the oscillometric method for measuring indirect blood pressure. Ann Biomed Eng. 1982;10:271–80.

    Article  CAS  Google Scholar 

  9. Alpert BS, Quinn D, Gallick D. Oscillometric blood pressure: a review for clinicians. J Am Soc Hypertens. 2014;8:930–8.

    Article  Google Scholar 

  10. Stewart MJ, Gough K, Padfield PL. The accuracy of automated blood pressure measuring devices in patients with controlled atrial fibrillation. J Hypertens. 1995;13:297–300.

    Article  CAS  Google Scholar 

  11. Stergiou GS, Kollias A, Destounis A, Tzamouranis D. Automated blood pressure measurement in atrial fibrillation: a systematic review and meta-analysis. J Hypertens. 2012;30:2074–82.

    Article  CAS  Google Scholar 

  12. Stergiou GS, Kyriakoulis KG, Stambolliu E, Destounis A, Karpettas N, Kalogeropoulos P, et al. Blood pressure measurement in atrial fibrillation: review and meta-analysis of evidence on accuracy and clinical relevance. J Hypertens. 2019;37:2430–41.

    Article  CAS  Google Scholar 

  13. Clark CE, McDonagh STJ, McManus RJ. Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis. J Hum Hypertens. 2019;33:352–64.

    Article  Google Scholar 

  14. Park SH, Choi YK. Measurement reliability of automated oscillometric blood pressure monitor in the elderly with atrial fibrillation: a systematic review and meta-analysis. Blood Press Monit. 2020;25:2–12.

    Article  Google Scholar 

  15. Cheng HM, Tufanaru C, Pearson A, Chen CH. Automated blood pressure measurement in atrial fibrillation: a systematic review and meta-analysis. J Hypertension. 2013;31:214–5. (Opposite opinion).

    Article  CAS  Google Scholar 

  16. Stergiou GS, Kollias A, Destounis A, Tzamouranis D. Automated blood pressure measurement in atrial fibrillation: a systematic review and meta-analysis. J Hypertension. 2013;31:215–6.

    Article  CAS  Google Scholar 

  17. Šelmytė-Besusparė A, Barysienė J, Petrikonytė D, Aidietis A, Marinskis G, Laucevičius A. Auscultatory versus oscillometric blood pressure measurement in patients with atrial fibrillation and arterial hypertension. BMC Cardiovasc Disord. 2017;17:87. https://doi.org/10.1186/s12872-017-0521-6

    Article  PubMed  PubMed Central  Google Scholar 

  18. Maselli M, Giantin V, Corrado D, Franchin A, Attanasio F, Pengo V, et al. Reliability of oscillometric blood pressure monitoring in atrial fibrillation patients admitted for electric cardioversion. J Clin Hypertens (Greenwich). 2015;17:558–64.

    Article  Google Scholar 

  19. Vázquez-Rodríguez B, Pita-Fernández S, Regueiro-López M, García-Pedreira D, Carro-Rodriguez MJ, Pérez-Rivas G, et al. Concordance between automatic and manual recording of blood pressure depending on the absence or presence of atrial fibrillation. Am J Hypertens. 2010;23:1089–94.

    Article  Google Scholar 

  20. Caramella JP, Desmonts JM. Reliability of automatic oscillometric monitoring of arterial pressure. Effect of hypotension and arrhythmias. Arch Mal Coeur Vaiss. 1986;79:1794–9.

    CAS  PubMed  Google Scholar 

  21. Pagonas N, Schmidt S, Eysel J, Compton F, Hoffmann C, Seibert F, et al. Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring. Hypertension. 2013;62:579–84.

    Article  CAS  Google Scholar 

  22. Halfon M, Wuerzner G, Marques-Vidal P, Taffe P, Vaucher J, Waeber B, et al. Use of oscillometric devices in atrial fibrillation: a comparison of three devices and invasive blood pressure measurement. Blood Press. 2018;27:48–55.

    Article  Google Scholar 

  23. Pagonas N, Schmidt S, Eysel J. Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring. Hypertension. 2013;62:579–84.

    Article  CAS  Google Scholar 

  24. Giantin V, Perissinotto E, Franchin A, Baccaglini K, Attanasio F, Maselli M, et al. 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;36:889–94.

    Article  Google Scholar 

  25. Babbs CF. Oscillometric measurement of systolic and diastolic blood pressures validated in a physiologic mathematical model. Biomed Eng Online. 2012;22:56.

    Article  Google Scholar 

  26. Vos J, Vincent HH, Verhaar MC, Bos WJ. Inaccuracy in determining mean arterial pressure with oscillometric blood pressure techniques. Am J Hypertens. 2013;26:624–9.

    Article  CAS  Google Scholar 

  27. Xie F, Xu J, Xia LL, Luo X, Jiang Z, Wu Y, et al. The impact of atrial fibrillation on accuracy of oscillometric blood pressure measurement: effect of ventricular rate. Hypertens Res. 2020;43:518–24.

    Article  Google Scholar 

  28. Feenstra RK, Allaart CP, Berkelmans GFN, Westerhof BE, Smulders YM. Accuracy of oscillometric blood pressure measurement in atrial fibrillation. Blood Press Monit. 2018;23:59–63.

    Article  Google Scholar 

  29. Wang XX, Shuai W, Hong K, Xu J, Li JX, Li P, et al. How to evaluate BP measurements using the oscillometric method in atrial fibrillation: the value of pulse rate variation. Hypertens Res. 2016;39:588–92.

    Article  Google Scholar 

  30. Huppertz N, Lip GYH, Lane DA. Validation of the modified Microlife blood pressure monitor in patients with paroxysmal atrial fibrillation. Clin Res Cardiol. 2020;109:802–9.

    Article  Google Scholar 

  31. Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, et al. Measurement of blood pressure in humans: a scientific statement from the american heart association. Hypertension. 2019;73:e35–e66.

    CAS  PubMed  Google Scholar 

  32. Parati G, Omboni S, Palatini P, Rizzoni D, Bilo G, Valentini M, et al. Italian society of hypertension guidelines for conventional and automated blood pressure measurement in the office, at home and over 24h. High Blood Press Cardiovasc Prev. 2008;15:283–310.

    Article  Google Scholar 

  33. Tong HY, Fan WG, Su H. The usefulness of 24-hour blood pressure monitoring for the patients with atrial fibrillation: based on the variability of blood pressure parameters. Blood Press Monit. 2020;25:22–25.

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China

    Hai Su

  2. Department of Hypertension, Yunnan Fuwai Cardiovascular Hospital, Kunming, China

    Zihong Guo

Authors
  1. Hai Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zihong Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HS prepared the manuscript and ZG reviewed the paper.

Corresponding author

Correspondence to Hai Su.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Su, H., Guo, Z. Accuracy of non-invasive blood pressure measurement in patients with atrial fibrillation. J Hum Hypertens 36, 229–234 (2022). https://doi.org/10.1038/s41371-021-00596-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41371-021-00596-3

This article is cited by

Search

Advanced search

Quick links