[OP.6B.03] WRIST BLOOD PRESSURE SELF-MEASUREMENT AT HOME IS UNRELIABLE. RESULTS FROM THE POPULATION-BASED “GROWING OLD WITH LESS DISEASE ENHANCING NEUROFUNCTIONS” (GOLDEN) STUDY

    loading  Checking for direct PDF access through Ovid

Abstract

Objective:

To investigate the reliability of self-measured home blood pressure (BP) obtained with wrist devices.

Design and method:

Office and home upper-arm and wrist BP was obtained in 597 representative subjects from general population using two validated devices. Parti-cipants received an individual 20-min training in the office and were asked to repeat the upper-arm and wrist measurements at home for 7 consecutive days using the same procedures. In particular, they were recommended to keep the wrist at heart level during wrist BP measurement. The difference between upper-arm BP and wrist BP measured by the observer in the office was calculated for each individual and compared with the 7-day averaged self-measured upper-arm - wrist BP difference. Anthropometric measures and a complete cognitive assessment were also obtained.

Results:

In the office, under observer supervision, after adjustment for confounders, wrist BP was lower than upper-arm BP (systolic −2.4%, p < 0.0001; diastolic −0.6%, NS), while at home BP was higher at wrist than at upper-arm (systolic +5.9%, p < 0.0001; diastolic +5.6%, p < 0.0001). Both systolic and diastolic upper-arm - wrist BP differences obtained in office significantly differed from the upper-arm - wrist differences obtained by the participant at home (systolic 3.0 ± 13.7 vs. −6.7 ± 0.1 mmHg, p < 0.0001; diastolic 0.6 ± 9.4 vs. −4.0 ± 6.6 mmHg, p < 0.0001). Office (r = 0.37, p < 0.0001) but not home (r = −0.05, p = 0.9) wrist systolic BP correlated with office BP, the two regression coefficients differing significantly (p < 0.0001). Similar results were obtained for diastolic BP. In multivariable regression analyses, using the difference between the upper-arm - wrist BP discrepancies obtained in the office and at home as the dependent variable, forearm length (p < 0.06 for systolic, p < 0.04 for diastolic) and praxic abilities (p < 0.008, p < 0.0001, respectively) were independent determinants of the office-home difference.

Conclusions:

These data indicate that in spite of adequate training wrist BP measurement at home is unreliable. This is likely due to a cognitive (particularly praxic) deficit leading to incorrect forearm position, a problem that, for hydraulic reasons, is magnified in people with longer forearm. Wrist BP measurement should be discouraged chiefly in subjects presumed to have impaired cognitive function.

Related Topics

    loading  Loading Related Articles