Blood pressure testing
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Advances in Blood Pressure Testing: Techniques and Innovations
Introduction to Blood Pressure Testing
Blood pressure (BP) testing is a critical component in diagnosing and managing hypertension, a major risk factor for cardiovascular diseases. Traditional methods, such as the use of a sphygmomanometer, have been the gold standard for BP measurement. However, recent advancements have introduced new techniques and devices aimed at improving accuracy, convenience, and continuous monitoring capabilities.
Traditional and Emerging Blood Pressure Measurement Techniques
Conventional Blood Pressure Measurement
The conventional method of BP measurement involves the use of a sphygmomanometer, which can be either mercury-based or aneroid. This method relies on occluding the artery with an inflatable cuff and detecting Korotkoff sounds or oscillometric signals 9. Despite its widespread use, this technique has limitations, including the potential for "white coat" hypertension, where BP readings are elevated in a clinical setting but not in everyday life 6.
Ambulatory and Home Blood Pressure Monitoring
Ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) are recommended for more accurate hypertension diagnosis. ABPM involves wearing a portable device that takes BP readings over 24 hours, providing a comprehensive profile of BP fluctuations throughout the day and night 2. HBPM allows patients to measure their BP at home, reducing the influence of clinical settings on BP readings and improving long-term BP management 5.
Kiosk-Based Blood Pressure Monitoring
Kiosk-based BP monitoring is another emerging method, where patients can measure their BP at public kiosks, such as those found in pharmacies. This method offers convenience and accessibility, although its accuracy and comparability to ABPM are still under investigation 2.
Innovative Blood Pressure Measurement Devices
Ring-Type Photoplethysmography Devices
A novel ring-type device, CART-I Plus, uses photoplethysmography (PPG) to measure BP continuously without a cuff. This device captures PPG signals from the finger and transmits data wirelessly to a smartphone. Studies have shown that this device has a good correlation with traditional auscultation methods, with minimal bias in systolic and diastolic BP measurements 1.
Smartphone-Based Transdermal Optical Imaging
Transdermal optical imaging technology uses a smartphone camera to capture facial blood flow changes and employs machine learning algorithms to estimate BP. This contactless method has shown promising results, with measurement biases within clinically acceptable ranges for normotensive adults 3. Future research aims to validate its accuracy across a broader range of BP levels.
Hybrid Optical Systems
Hybrid systems combining contact PPG and imaging PPG have been developed to estimate BP using pulse transit time (PTT). These systems can be integrated into wearable devices, offering an unobtrusive way to monitor BP continuously. Initial studies indicate that these systems can accurately estimate PTT and correlate well with BP variations 8.
Electrocardiogram-Assisted Blood Pressure Estimation
Integrating electrocardiogram (ECG) signals with oscillometric BP measurement enhances accuracy, especially in conditions like arrhythmias and obesity. This method uses ECG R-peaks to improve the reliability of BP readings and employs PTT analysis for additional accuracy. Preliminary studies have demonstrated that this approach achieves high accuracy compared to traditional oscillometric monitors 10.
Digital Interventions for Blood Pressure Management
Home and Online Management and Evaluation of Blood Pressure (HOME BP)
The HOME BP trial tested a digital intervention combining self-monitoring of BP with guided self-management. Participants used a digital platform to record BP readings and receive feedback, lifestyle advice, and motivational support. The intervention led to better control of systolic BP compared to usual care, demonstrating the potential of digital tools in hypertension management 4.
Conclusion
Advancements in BP measurement technologies and methods are transforming hypertension diagnosis and management. From innovative wearable devices to digital interventions, these new approaches offer improved accuracy, convenience, and continuous monitoring capabilities. As these technologies continue to evolve, they hold the promise of better cardiovascular health outcomes through more effective BP management.
Sources and full results
Most relevant research papers on this topic
First-in-human study for evaluating the accuracy of blood pressure measurement using the ring-type device with a photoplethysmography
The new ring-type blood pressure measuring device, CART-I Plus, accurately measures systolic and diastolic blood pressure with minimal bias compared to a cuff method, offering potential for continuous blood pressure monitoring.
Blood pressure checks and diagnosing hypertension (BP-CHECK): Design and methods of a randomized controlled diagnostic study comparing clinic, home, kiosk, and 24-hour ambulatory BP monitoring.
BP-CHECK aims to determine which hypertension diagnostic methods are most accurate, acceptable, and feasible for primary care implementation.
RCT
Large Human Trial
Rigorous JournalSmartphone-Based Blood Pressure Measurement Using Transdermal Optical Imaging Technology.
Smartphone-based transdermal optical imaging technology accurately measures blood pressure in normotensive adults within 5-8 mm Hg of reference measurements.
Highly CitedHome and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial
The HOME BP digital intervention led to better control of systolic blood pressure after one year than usual care, with low incremental costs.
RCTLarge Human TrialRigorous JournalHighly CitedPractice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement.
This paper updates the European Society of Hypertension's guidelines for clinic, ambulatory, and self blood pressure measurement, emphasizing the importance of accurate readings for diagnosis, management, treatment, epidemiology, and research.
Highly CitedBlood pressure measurement and monitoring.
Blood pressure monitoring devices can help detect silent complications and impending cardiovascular accidents, reducing the risk of cardiovascular accidents.
The blood pressure response to dynamic exercise testing: a systematic review.
The blood pressure response to exercise testing has potential diagnostic and prognostic applications, but its clinical significance remains unclear due to conflicting data and methodology.
Systematic ReviewHighly CitedHybrid Optical Unobtrusive Blood Pressure Measurements
The ICPPG system, combining contact and imaging PPG, can provide inconspicuous blood pressure measurements on wearable devices, potentially revolutionizing the field of cardiovascular disease diagnosis.
Blood pressure measurement
Blood pressure measurement accuracy is crucial, as it is influenced by factors such as respiration, emotion, exercise, meals, tobacco, alcohol, temperature, bladder distension, and pain, and is influenced by factors such as age, gender, and medications.
Highly CitedElectrocardiogram-Assisted Blood Pressure Estimation
Our prototype accurately estimates blood pressure using ECG-assisted oscillometric and pulse transit time analyses, achieving a mean absolute difference of less than 5 mmHg compared to a reference Omron monitor.
Highly Cited