Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

Abstract

Objective To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor.Design Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous electrocardiogram (ECG) recordings (1) in a controlled laboratory experiment and (2) during long-term recording in a true naturalistic setting.Participants Six normotensive subjects participated in the laboratory study. A total of 109 male white-collar workers underwent ambulatory monitoring, of which 30 were mildly hypertensive.Methods Four different laboratory conditions (postures: lying, sitting, standing, walking), repeated twice, were used to assess the short-term effects of cuff in¯ation on the HR. To test the actual ambulatory validity, participants simultaneously wore a continuous HR recorder and the ABP monitor from early morning to late evening on 2 workdays and one non-workday. Diary and vertical accelerometery information was used to obtain periods of ®xed posture and (physical) activity across which HR from both devices was compared.Results. Laboratory results showed that the ABP device reliably detected HR during blood pressure measurement, but that this HR was systematically lower than the HR directly before and after the blood pressure measurement. The ambulatory study con®rmed this systematic underestimation of the ongoing HR, but additionally showed that its amount increased when subjects went from sitting to standing to light physical activity (2.9; 4.3 and 9.1 bpm (beats/min), respectively). In spite of this activity-dependent underestimation of HR, the correlation of continuous ECG and intermittent ABP-derived HR was high (median r 0.81). Also, underestimation was not different for normotensives and mild hypertensives.Conclusions A direct effect of cuff in¯ation leads to the underestimation of ongoing HR during cuff-based ABP measurement. Additional underestimation of HR occurs during periods with physical activity, probably due to behavioural freezing during blood pressure measurements. HR underestimation was not affected by hypertensive state. When its limitations are taken into account, ABP-derived ambulatory HR can be considered a reliable and valid measure.

Comparison of heart rate variability between resting state and external-cuff-inflation-and-deflation state: a pilot study

“…The difference between this observation and ours, and Skov-Madsen et al's as well, may be mainly due to the absence of the white coat effect in ambulatory blood pressure meansurement. Here, in our study, the weak decreased sympathetic activity-related LFn and increased parasympathetic activity-related SDNN, RMSSD, HFn, and VLI for the ECID state might suggest an increased vascular resistance (Vrijkotte and de Geus 2001), introduced by the external cuff inflation. The increased vascular resistance leads to the elevation of blood pressure, and further induces the occurrence of depressor reflexes, and consequently, provokes the parasympathetic activity and restrains the sympathetic activity (Mark 1983).…”

“…However, ambulatory blood pressure monitoring in the studies was sometimes needed (Fagard et al 2001(Fagard et al , 2007. Cuff inflation-and-deflation is a common process for ambulatory blood pressure monitoring, which may bring about an increase in total peripheral resistance (Vrijkotte and de Geus 2001) and further induce the depressor reflexes, changing the balance of autonomic control (Mark 1983). It is unclear whether this process will affect the HRV indices.…”

The association between self-reported stress and cardiovascular measures in daily life: A systematic review

“…We also acknowledged that the validation of these used devices was not always well reported, and some devices have shown controversial results on its validity. For example, the most commonly used ABP monitor (Spacelabs model 90207) has raised concerns of its possible limitation as the readings were altered by venous blood redistribution [81], and a direct effect of cuff inflation lead to the underestimation of ongoing HR during a cuff-based ABP [82]. Besides these limitations, the model has been shown to be a valid monitoring tool to measure ABP [82,83].…”