How to use the wrist type electronic blood pressure monitor correctly

  With the development of science and technology and the improvement of our people’s living standards, a variety of electronic blood pressure monitors are gradually coming into people’s lives. Wrist type electronic blood pressure monitor with its small shape, easy to use and other characteristics by more and more users.  Electronic sphygmomanometer can make the patient at home many times self-measurement blood pressure, without the help of medical personnel and others, thus avoiding the “white coat effect”, it can make us more accurately understand the blood pressure changes in various states, grasp the antihypertensive efficacy of the drugs taken, in order to more accurately adjust the time of medication. At present, Europe has gradually used electronic blood pressure monitor instead of the traditional mercury column blood pressure monitor, and WHO (World Health Organization) also recognized the qualified electronic blood pressure monitor can be used as a tool for self-measurement of blood pressure at home. At present, there are a variety of models of upper-arm electronic blood pressure monitor in line with the BHS (British Hypertension Society) and AAMI (American Medical Device Development Committee) standards, recommended by international authorities for clinical applications, while the wrist electronic blood pressure monitor in line with the standard is relatively small. However, after a market survey, most patients think that wrist type electronic blood pressure monitor is convenient to carry, and it is more convenient to use without taking off the sleeves, so they prefer to use wrist type electronic blood pressure monitor. So is the wrist type electronic blood pressure monitor accurate? How to use the wrist type electronic blood pressure monitor correctly? This article will make a preliminary discussion on this issue.  In order to verify the accuracy of the wrist-type electronic blood pressure monitor, the current internationally recognized standards are BHS and AAMI, then the BHS and AAMI standards and how to specify?  The BHS standard was published in 1990 in a foreign professional journal, the Journal of Hypertension, and was subsequently revised in 1993. The main content is divided into two parts: the main validation procedure (general population) and the validation procedure for special populations and special conditions (e.g., pregnant women, the elderly, children, and during exercise or changes in body position). The first part is further divided into five steps: 1. pre-use accuracy testing; 2. evaluation during use; 3. post-use accuracy testing; 4. machine testing under static conditions; and 5. evaluation report. Only by passing the first part of the validation can we proceed to the second part of the validation. Here is a detailed description of the first part.  Pre-use accuracy testing must be done with three randomly selected machines of the same model. Each machine is tested by three testers (all highly trained), the first testers are responsible for manually inflating and deflating (2mmHg/s) and determining the timing of simultaneous measurements, the second testers are responsible for observing the measurement data of the tested machine, and the third testers are responsible for observing the measurement data of the mercury column sphygmomanometer. Five measurements were taken during each deflation, and each machine was inflated and deflated six times. The machine was considered qualified when 28 or more of the above 30 pairs of data were within 3 mmHg of each other, and at least two of the three machines were qualified before proceeding to the next step of the validation process.  Evaluation in use means that the machine that has passed the first step of the test continues to be used for more than 1 month, at least 400 times after filling and deflating and then re-verified by the method of the first step of the test, that is, to enter the third step of the post-use accuracy test, and if it passes again, it will enter the most critical fourth step of the static machine test.  At least 85 suitable subjects were included in the fourth step of the test, and seven consecutive blood pressure measurements were performed with the same arm, avoiding any external interference, in which the mercury column sphygmomanometer was used for the first, third, fifth, and seventh times, and the electronic sphygmomanometer was used for the second, fourth, and sixth times, and the absolute difference between all two adjacent blood pressure readings was evaluated according to the criteria in Table 1, and an evaluation report was written, with only the systolic and diastolic blood pressure Only those models of the tested machine that achieved both systolic and diastolic blood pressure of grade B or higher and met the AAMI criteria (mean and standard deviation of all differences not exceeding 5±8 mmHg) were considered to have passed the validation and could be recommended for clinical use.  Foreign literature reports that a new type of Omron HEM-637IT wrist-type electronic blood pressure monitor has been validated in the elderly, adult and obese adult populations. We have validated the Omron HEM-6001 wrist-type electronic blood pressure monitor with BHS and AAMI standards, and its diastolic blood pressure meets BHS standard B, systolic blood pressure meets BHS standard C, diastolic blood pressure meets AAMI standard, and systolic blood pressure, although not meeting AAMI standard, is very close to the standard, reaching 1±9 mmHg. Therefore, we recommend that the majority of hypertensive patients try to use We also recommend that patients with hypertension try to use a wrist-type electronic blood pressure monitor that has been authoritatively verified, and pay attention to the correct method of use. However, for patients with severe arrhythmias such as atrial fibrillation, electronic blood pressure monitors are not suitable.