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Evaluation of home blood pressure monitors in children and adolescents
T G Wells1, W A Neaville, J R Arnold
1Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock 72202, USA.
Insights
This study found that an aneroid manometer, when adapted and used by trained observers, is a reliable home blood pressure monitor for children aged 4-18. Semiautomated devices did not meet validation criteria.
Area of Science:
- Pediatric Cardiology
- Medical Device Validation
- Hypertension Management
Background:
- Accurate blood pressure monitoring in children is crucial for diagnosing and managing hypertension.
- Commercially available home blood pressure monitors often lack validation for pediatric use.
- Establishing reliable methods for home blood pressure monitoring in children is essential.
Purpose of the Study:
- To adapt and validate commercially available home blood pressure monitors for children aged 4 to 18 years.
- To compare the accuracy of adapted devices against a standard mercury sphygmomanometer.
- To determine the suitability of different monitor types for pediatric home use.
Main Methods:
- 106 children (ages 4-18) had sequential blood pressure measurements taken using a mercury-gravity manometer (reference) and three test devices (aneroid, two semiautomated oscillometric).
- Standardized procedures were followed, including appropriate cuff size selection based on mid-arm circumference.
- Device performance was evaluated against British Hypertension Society (BHS) and Association for the Advancement of Medical Instrumentation (AAMI) criteria.
Main Results:
- The aneroid manometer achieved a grade of 'A' by BHS criteria and passed AAMI criteria.
- Neither semiautomated oscillometric device met the validation standards for accuracy in children.
- The Labtron monitor showed slightly better performance than the Marshall 85 monitor among the semiautomated devices.
Conclusions:
- Home blood pressure monitors require rigorous validation for pediatric use before widespread adoption.
- An appropriately trained and verified observer using an adapted aneroid manometer is recommended for home blood pressure monitoring in children (ages 4-18).
- Further research into validating semiautomated devices for pediatric use is warranted.
Objective:
This study was designed to adapt commercially available home blood pressure monitors for use in children ages 4 to 18 years and to compare the recordings obtained from the adapted devices to those obtained using a standard mercury sphygmomanometer.
Methods:
Sequential same-arm blood pressures were measured by trained observers in 106 children, ages 4 to 18 years, using a calibrated mercury-gravity manometer (reference device) as the standard method, and 3 test devices (an aneroid manometer and two semiautomated oscillometric devices). For each patient, mid-arm circumference was measured and appropriate blood pressure cuff size was selected. Systolic and diastolic pressures were measured by trained observers using the reference device and the aneroid manometer in accordance with criteria established by the Second Task Force on Blood Pressure Control in Children. Other than variation in cuff size, all manufacturers' recommendations were followed for each test device.
Results:
Outcome was assessed using criteria established by the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI). The aneroid manometer consistently received a grade of A using BHS criteria and also passed using AAMI criteria. Neither of the two semiautomated monitors achieved a passing grade, although the Labtron monitor performed slightly better than the Marshall 85 monitor.
Conclusions:
Home blood pressure monitors must be validated for use in children prior to widespread use. Given appropriate training and verification of observer accuracy, the aneroid manometer can be recommended for home use in children ages 4 to 18 years.
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