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Validation of an ambulatory blood pressure monitoring device employing a novel method to detect atrial fibrillation

Hypertension Research volume 45, pages 1345–1352 (2022)Cite this article

Abstract

We evaluated the accuracy of a 24-hr ambulatory blood pressure monitoring (ABPM) device with a new irregular heartbeat (IHB) algorithm for detecting atrial fibrillation (AF) during each BP measurement. Ninety patients with a history of elevated BP and some type of arrhythmia (mean age 63.2 ± 10.3 years; 94% with hypertension; 81% with previously diagnosed AF) simultaneously underwent evaluation by 24-hr ABPM with the IHB algorithm and 24-hr Holter electrocardiography (ECG). Among the 3,347 valid readings, 843 readings were considered to indicate an IHB. Among these IHB readings, 195 readings were found to have an AF rhythm by 24-hr Holter ECG. The IHB algorithm showed 100% sensitivity and 79.4% specificity for accurately detecting AF rhythm. An IHB was detected in 12.1% of the measurements during normal rhythm, 48.8% of those during atrial premature complex, and 54.4% of those during ventricular premature complex. The percentage of IHBs detected during normal rhythm was higher in the daytime than at nighttime (16.3% vs. 4.5%, respectively), suggesting that daytime physical activity sometimes induces a false detection of IHBs. The optimal IHB parameters for suggesting potential AF were (1) an IHB burden defined as a percentage of IHB-positive readings in total valid BP measurements >22.5% (84.6% sensitivity, 85.1% specificity; AUC 0.906, p < 0.0001) and (2) 2.5 or more consecutive IHBs during 24-hr ABPM (84.6% sensitivity, 83.0% specificity; AUC 0.881, p < 0.0001). The novel 24-hr ABPM device with the IHB algorithm assessed herein could contribute to the future comprehensive management of hypertensive patients, with the main goal of preventing cerebrovascular events.

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Fig. 1: The cutoff value of the IHB burden and the maximum number of consecutive IHBs suggesting AF.

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Acknowledgements

We thank A&D Co. for the valuable advice about the ABPM device. A&D had no role in any of the study’s statistical analyses. NY is an employee of A&D Co.

Funding

This study was financially supported in part by a grant from the Japan Society for the Promotion of Science (JSPS) (KAKENHI, no. 20K08456) to T. Watanabe. The study was also funded in part by A&D Co. KK has received research funding from A&D Co.

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  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University, Tochigi, Japan

    Tomonori Watanabe, Naoko Tomitani & Kazuomi Kario

  2. A&D Co, Tokyo, Japan

    Nobuhiko Yasui

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  1. Tomonori Watanabe
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Correspondence to Kazuomi Kario.

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Watanabe, T., Tomitani, N., Yasui, N. et al. Validation of an ambulatory blood pressure monitoring device employing a novel method to detect atrial fibrillation. Hypertens Res 45, 1345–1352 (2022). https://doi.org/10.1038/s41440-022-00925-0

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