81 - Comparison of Automated Wrist Blood Pressure with Manual Arm Blood Pressure Measurements in Children

Poster Number: 81
Publication Number: 81.324

Hannah Brummer, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States; Lawrence s. Milner, Tufts University School of Medicine, Boston, MA, United States; Julian P. Ponsetto, Tufts Childrens Hospital, Jamaica Plain, MA, United States; Linda M. Mazzola, Tufts Childrens Hospital, Naick, MA, United States; Juliann Reardon, Tufts Childrens Hospital, Boston, MA, United States

Background: Hypertension is increasingly common in children, with diagnosis and management largely necessitating clinic visits for obtaining accurate blood pressure (BP) measurements. While automated arm BP devices are commonly used for home BP monitoring, there are limited validation studies of automated wrist BP monitors in children.

Objective: The goal of this study was to compare manual arm with automated wrist BP measurements in pediatric patients, with a view to facilitate simple home BP monitoring using the wrist monitoring device.

Design/Methods: In a prospective study, manual arm systolic BP (SBP) and diastolic BP (DBP) readings were compared to automated Omron wrist SBP and DBP in 40 children. BPs were obtained in the right upper extremity in a seated position using appropriately sized cuffs. Three manual arm and three automated wrist BP measurements were obtained, with initial modality alternated in a randomized fashion. Descriptive and inferential statistics were performed with the IBM SPSS Statistics Version 28 to evaluate differences between the groups, and a Bland Altman plot was used to assess agreement between the two techniques. The results are expressed as the mean ± std dev.  A p value < 0.05 was considered to be significant.

Results: The mean age was 15 years (range 7-21 years), of whom 22 (55%) were males, 22 (55%) had a pre-existing diagnosis of hypertension, 18 (45%) were prescribed antihypertensives, and 8 (20%) had a diagnosis of CKD. The mean arm SBP was 108.3 (± 11.3) mmHg, and mean wrist SBP was 115.3 (± 13.2) mmHg (p < 0.001). The mean arm DBP was 69 (± 8) mmHg, and mean wrist DBP was 74.4 (± 12.5) mmHg, p < 0.01. The Bland Altman plot confirmed significant bias between manual arm and automated wrist measurements. In the 12 children less than 13 years of age, there was no significant SBP difference between manual arm (104 ± 9.7 mmHg), and automated wrist (104 ± 15.5 mmHg), p = 0.056. Additionally, there was no significant difference in DBP in children with CKD (71.6 ± 8.6 vs 74.9 ± 9.9 mmHg, p = 0.068). Manual arm and automated wrist SBP and DBP measurements were also significantly different regardless of presence of anti-hypertensive medications.Conclusion(s): Automated wrist BPs don’t appear to agree with manual arm BPs in children older than 13 years. However, SBP was not significantly different in children < 13 years, and DBP was not significantly different in those with CKD. Further studies are required to confirm these observations to validate automated wrist BPs in children < 13 years of age and in those with CKD.