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. 2021 Aug 9;16(8):e0255871.
doi: 10.1371/journal.pone.0255871. eCollection 2021.

Patient preferences for ambulatory blood pressure monitoring devices: Wrist-type or arm-type?

Wei-Wei Zeng  1 , Sze Wa Chan  2 , Brian Tomlinson  3   4
Affiliations

Patient preferences for ambulatory blood pressure monitoring devices: Wrist-type or arm-type?

Wei-Wei Zeng et al. PLoS One. .

Abstract

Background: Ambulatory blood pressure monitoring (ABPM) is important in evaluating average 24-hour blood pressure (BP) levels, circadian rhythm, sleeping BP and BP variability but many patients are reluctant to use standard ABPM devices.

Methods: We compared two validated ABPM devices, the BPro tonometric wrist monitor and the A&D TM-2430 oscillometric upper arm monitor, for agreement of recordings and acceptability in 37 hypertensive patients (aged 55±9 years).

Results: Successful BP measurements were less frequent with the wrist-type than the arm-type device during the sleeping (66.3% vs. 92.9%, P <0.01) and awake periods (56.2% vs. 86.5%, P <0.01). Comparable paired readings showed no significant difference in systolic BP but diastolic BP (DBP) values were higher with the wrist compared to the arm monitor (24-hour 89±13 vs. 85±14 mmHg, P <0.01) with similar differences awake and sleeping. Bland-Altman analysis showed some large discrepancies between individual arm and wrist monitor measurements. More patients found the wrist monitor more comfortable to use than the arm monitor.

Conclusions: Despite the difference in individual BP measurements and the systematic overestimation of DBP values with the BPro device, wrist monitors with good patient acceptability may be useful to facilitate ABPM in some patients to provide additional information about cardiovascular risk and response to antihypertensive therapies.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
Bland–Altman plots presenting the mean and the difference in blood pressure measurements (mmHg) between the wrist and arm monitors over 24 hours for SBP (a) and DBP (b). The solid black horizontal line represents the mean difference and the dotted horizontal lines represent 2SD above and below the mean. There was a mean difference of +0.7 mmHg and a 2SD difference between the arm monitor and the wrist monitor of -37.7 to 39.1 mmHg for SBP and a mean difference of -3.9 mmHg and a 2SD difference of -30.9 to 23.1 mmHg for DBP. DBP = diastolic blood pressure, SBP = systolic blood pressure.
Fig 2
Fig 2
Bland–Altman plots presenting the mean and the difference in blood pressure measurements (mmHg) between the wrist and arm monitors for sleeping SBP (a) and sleeping DBP (b). The solid black horizontal line represents the mean difference and the dotted horizontal lines represent 2SD above and below the mean. There was a mean difference of -0.3 mmHg and a 2SD difference between the arm monitor and the wrist monitor of -39.1to 38.5 mmHg in SBP and a mean difference of -4.7 mmHg and a 2SD difference of -29.5 to 20.1 mmHg in DBP. DBP = diastolic blood pressure, SBP = systolic blood pressure.
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Grants and funding

The authors received no specific funding for this work.
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