Blood pressure measurements and hypertension in infants, children, and adolescents: from the postmercury to mobile devices

Abstract

A mercury sphygmomanometer (MS) has been the gold standard for pediatric blood pressure (BP) measurements, and diagnosing hypertension is critical. However, because of environmental issues, other alternatives are needed. Non-invasive BP measurement devices are largely divided into auscultatory and oscillometric types. The aneroid sphygmomanometer, the currently used auscultatory method, is inferior to mercury sphygmomanometers in terms of limitations such as validation and regular calibration and difficult to apply to infants, in whom Korotkoff sounds are not audible. The oscillometric method uses an automatic device that eliminates errors caused by human observers and has the advantage of being easy to use; however, owing to its measurement accuracy issues, the development of an international validation protocol for children is important.The hybrid method, which combines the auscultatory and electronic methods, solves some of these problems by eliminating the observer bias of terminal digit preference while maintaining measurement accuracy; however, the auscultatory method remains limited. As the age-related characteristics of the pediatric group are heterogeneous, it is necessary to reconsider the appropriate BP measurement method suitable for this indication. In addition, the mobile application-based BP measurement market is growing rapidly with the development of smartphone applications. Although more research is still needed on their accuracy, many experts expect that mobile application-based BP measurement will effectively reduce medical costs due to increased ease of access and early BP management.

The Oscillometric Pulse Wave Analysis Is Useful in Evaluating the Arterial Stiffness of Obese Children with Relevant Cardiometabolic Risks

“…The device has been validated in adults against the well-established SphygmoCor applanation tonometry device, combining the measurement of brachial BP, pulse wave analysis and central BP in one measurement [ 31 , 32 , 33 ]. Although the oscillometric noninvasive methods of acquiring this data are not completely validated in children, there are multiple studies that affirm that these devices’ accuracy is comparable to mercury sphygmomanometry [ 34 , 35 , 36 ]. The main issue seems to be the accuracy of the systolic peripheral BP and the central systolic BP, which, according to Mynard et al, could be overestimated [ 37 ].…”

Evaluating the Arterial Stiffness as a Useful Tool in the Management of Obese Children

“…The IEM Mobil-O-Graph device was chosen because, in addition to being a validated device [47], its use is facile, reproducible, and has very good acceptability in children. Multiple studies confirm that the oscillometric devices acquire accurate measurements even in children [47][48][49].…”

A Survey on Blood Pressure Measurement Technologies: Addressing Potential Sources of Bias

“…The precision of the aneroid sphygmomanometer depends on the operator’s proficiency in auscultation, use of a stethoscope, and visual acuity [ 42 ]. More recently, hybrid sphygmomanometers have been used to automate the detection of Korotkoff sounds and the display of the SBP, DSP, and pulse rate on digital monitors [ 44 ]. Notably, aneroid sphygmomanometers have varying accuracy across manufacturers.…”