Measure your blood pressure with approved devices!

When it comes to blood pressure, measurement is of fundamental importance, since the entire management process is based on these figures: defining what is considered normal, diagnosing whether blood pressure is too high, deciding whether to start treatment and assessing the results.
In addition to the various techniques for measuring blood pressure in a consultation, with a device that people use themselves (self-measurement) or with an automatic device that takes a series of measurements over 24 hours, a whole range of "connected" devices has recently appeared, which are becoming increasingly popular with both normal and hypertensive subjects, as well as athletes and other people concerned with monitoring their health. But what about the reliability of these new connected devices? The European Society of Hypertension (ESH) has just published its recommendations.

"Tensiometers without cuff :

All blood pressure measurement methods have limitations, mainly because they provide instantaneous blood pressure values under static conditions and ignore the dynamic nature of blood pressure, i.e. its variability in response to different challenges and daily activities. In addition, errors due to inadequate cuff size, shape and positioning are common, and compression of the limb during cuff inflation can cause discomfort, particularly at work and during sleep.

New cuffless blood pressure measurement devices, using sensors, signal processing, machine learning and other technologies embedded in wearables, smartphones, handhelds or other types of devices, are already available on the market and have considerable potential to improve awareness, diagnosis and treatment of high blood pressure (HBP). However, several issues need to be resolved before these devices can be recommended for clinical use. One major concern is that the universal standard (AAMI/ESH/ISO) protocols used to validate cuffed blood pressure devices are inadequate for uncuffed devices, meaning that their accuracy remains to be demonstrated. What's more, there is still no established performance standard for these new technologies. Finally, most cuffless blood pressure devices require periodic calibration using blood pressure values measured by a standard cuff device. Some also require user information such as age, gender and other characteristics. Fundamentally, these devices do not 'measure' blood pressure, but track changes in blood pressure relative to calibration blood pressure, or attempt to predict blood pressure using demographic data and machine learning technology.

For these reasons, at present, cuffless blood pressure devices should not be used for the diagnosis or management of hypertension in clinical practice."



Comment from our expert, Dr. Jean-François Renucci:

We're all in favor of the development of self-measurement of blood pressure whether for people in good health and a fortiori for people with hypertension. But reliable values are still needed. Classic" self-measurement with a humeral cuff is a fine tool which is fairly simple to use, and which is very useful for patients who have been taught how to use it. In this respect, we also know that devices measuring blood pressure at the wrist, which appear simpler to use than upper arm devices, are also less accurate, and even totally inaccurate, than those using a humeral cuff. All European and French scientific societies recommend the use of self-tensiometers with humeral cuffs, which are much more reliable, and the size of the cuff should be adapted to the circumference of the arm. Your pharmacist will be able to advise you on the purchase of this device.
Although these "e-health" techniques, soon to be coupled with artificial intelligence, are developing very rapidly and exist above all for commercial reasons, with attractive and aggressive marketing, we must be very cautious about their exclusive use, which would escape all medical control. Let's be wary of gadgets; it's better to have no figures than to reason on the basis of erroneous ones. The combined use of conventional arm self-measurement and connected devices for personalized monitoring, where results can be compared over three days, is a possibility that every individual can consider.

Reference:
2023 ESH Guidelines for the management of arterial hypertension Journal of Hypertension 2023, 41.

Links of interest:Dr Renucci has no conflicts of interest with conventional device manufacturers (provided they are on the list of validated devices) and even contacts with new manufacturers.