To the Editor: Dr Jones and colleagues1 suggested several guidelines for maintaining the reliability of office blood pressure (BP) measurement. Even the most accurate office measurements, however, may not necessarily represent the patient's BP during daily life. Repeated readings taken in the patient's usual environment may be more useful than those taken in the physician's office for diagnosing hypertension and for adjusting therapy.2 - 3 We agree with Jones et al that the accuracy of such automated measurements must be ensured.
The most widely used protocols for validating automated monitors are those of the Association for the Advancement of Medical Administration (AAMI) and the British Hypertension Society (BHS). Under both protocols, validation of a brand of automated monitor involves assessment of only a single monitor unit in 85 individuals, each tested 3 times.4 To pass validation, the mean error across the resulting 255 readings must be no more than 5 mm Hg as tested against a mercury sphygmomanometer, and the SD of the errors no more than 8 mm Hg. However, the proportion of individuals who must receive accurate readings is not specified. The recently published validation protocol from the European Society of Hypertension5 modifies monitor assessment, but retains many of the same limitations.
We examined data from 3 published validation studies of automated monitors.4 Using monitors that passed the validation criteria, 20% to 38% of individuals had average measurements that were inaccurate by at least 5 mm Hg. In fact, when using a BP monitor that meets the AAMI and BHS validation criteria, more than 50% of persons may have average measurements that are in error by more than 5 mm Hg.
Automated devices have the potential to improve the management of hypertension, particularly when monitors are used to assess BP in the patient's home or work environment. However, current validation protocols fail to ensure the accuracy of these devices. In addition, our findings suggest the dangers of using unproven automated devices for defining the criterion standard of office blood pressure measurement.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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