The effect of heart rate on blood pressure measurement in patients with atrial fibrillation: a cross-sectional study

Zhao, Xiexiong; Li, Jingle; Huang, Miao; You, Nana; Li, Ruixuan; Chen, Shunsong; Liu, Tao; Zeng, Jianwei; Li, Yong; Jiang, Weihong

doi:10.1038/s41440-022-00897-1

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…Our data were obtained in an out-of-hospital setting where the observed maximum HR was 110 bpm, whereas Xie et al investigated a large part of the AF patients during tachycardia, with a maximum HR of 150 bpm [ 17 ]. Also Zhao et al [ 32 ] showed larger differences in BP with HR values beyond 120 bpm. This might explain the inconsistent findings.…”

Section: Discussionmentioning

confidence: 99%

“…Analyses were also performed to account for the potential impact of HR on BP. We found few previous studies [ 17 , 32 ], which evaluated the impact of HR on BP measurements in AF. Guided by these results and by the few cases in this study with a HR > 100 bpm (i.e., the prevailing clinical definition of tachycardia), the partition value for high HR was set to ≥90 bpm.…”

Section: Methodsmentioning

confidence: 99%

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Blood pressure in atrial fibrillation and in sinus rhythm during ambulatory blood pressure monitoring: data from the TEMPLAR project

Lundwall,

Kahan,

Omboni

2023

Hypertens Res

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The coexistence of hypertension and atrial fibrillation (AF) is common and accounts for a worse prognosis. Uncertainties exist regarding blood pressure (BP) measurements in AF patients by automated oscillometric devices. The Microlife WatchBP 03 AFIB ambulatory BP monitoring (ABPM) device including an AF algorithm with each measurement was used in 430 subjects aged >65 years referred for ABPM and with assumed paroxysmal AF to perform intra-individual comparisons of BP during both AF-indicated and sinus rhythm. Only subjects with >30% of measurements indicating AF and episodes >30 min for assumed AF and for sinus rhythm were included. Mean age was 78 ± 7 years, 43% were male, 77% hypertensive, and 72% were treated. Compared to sinus rhythm, 24-h mean arterial pressure was similar (87.2 ± 9.5 vs 87.5 ± 10.6 mm Hg, p = 0.47), whereas 24-h systolic BP tended to be lower (123.6 ± 13.9 vs 124.7 ± 16.1 mm Hg, p = 0.05) and night-time diastolic BP higher (64.6 ± 10.9 vs 63.3 ± 10.4 mm Hg, p = 0.01) in assumed AF. Diastolic (not systolic) BP variability was higher in AF (p < 0.001). Results were similar with heart rates <90 and ≥90 bpm. In conclusion, this is the first study to use intra-individual comparisons of averaged BP during an ABPM in assumed paroxysmal AF and sinus rhythm. Our results imply that ABPM is feasible and informative also in patients with AF. We also suggest that an AF detection algorithm offers a new approach to evaluate the reliability of averaged BP values in AF compared to SR during an ABPM.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Blood pressure in atrial fibrillation and in sinus rhythm during ambulatory blood pressure monitoring: data from the TEMPLAR project

Lundwall,

Kahan,

Omboni

2023

Hypertens Res

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“…A recent study in 2020 compared the arm oscillometric and intra-aortic BP biases in 138 atrial fibrillation and 112 sinus rhythm patients undergoing coronary angiography and revealed that systolic NIBP/IBP bias in atrial fibrillation patients was much higher than in sinus rhythm patients as ventricular rate increased [19]. Another study in 2022 repeatedly measured (10 consecutive measurements per patient) NIBP by a cuff oscillometric monitor and concurrent IBP by trans-radial arterial line in 383 AF and 200 sinus rhythm patients from ICU, and concluded that NIBP/IBP bias was significantly bigger in atrial fibrillation than in sinus rhythm patients, especially when the heart rate is low (<60 bpm) or high (≥100 bpm) [10]. However, the populations of the above studies were much smaller than ours, and did not adjust for potential confounders.…”

Section: Discussionmentioning

confidence: 99%

“…Many of them just showed BP bias of oscillometric devices and referenced BP values in atrial fibrillation and sinus rhythm patients, respectively, but did not compare the agreement between two situations [8,9]. A study in 2022 repeatedly measured noninvasive BP (NIBP) and concurrent IBP in 383 atrial fibrillation and 200 sinus rhythm patients from ICU and showed that NIBP/IBP bias was significantly bigger in atrial fibrillation than sinus rhythm patients, especially when the heart rate is low (<60 bpm) or high (!100 bpm) [10]. However, a few recent studies, including one on ICU patients [11], compared bias of oscillometric and IBP between atrial fibrillation and sinus rhythm patients and found no significant difference, but they were still based on small populations (1-200 patients) [11,12].…”

Section: Introductionmentioning

confidence: 99%

Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring in ICU patients from a large real-world database

Li¹,

Wang²,

Fan³

et al. 2023

Journal of Hypertension

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Objectives: Oscillometric blood pressure (BP) measurement in atrial fibrillation patients is controversial due to stroke volume variation. Here, we performed a cross-sectional study to investigate the impact of atrial fibrillation on the accuracy of oscillometric BP in the ICU setting.Methods: Adult patients with atrial fibrillation or sinus rhythm records were enrolled from Medical Information Mart for Intensive Care-III database. Concurrently recorded noninvasive oscillometric BPs (NIBPs) and intra-arterial BPs (IBPs) were classified as atrial fibrillation or sinus rhythm group according to heart rhythm. Bland-Altmann plots assessed bias and limits of agreement of NIBP to IBP. Pairwise comparison was performed on NIBP/IBP bias between atrial fibrillation and sinus rhythm. Linear mixedeffect model was used to assess the impact of heart rhythm on NIBP/IBP bias after adjusting confounders.Results: Two thousand, three hundred and thirty-five patients (71.95 AE 11.23 years old, 60.90% were men) were included. Systolic, diastolic, and mean NIBP/IBP biases were not clinically different between atrial fibrillation and sinus rhythm circumstances (SBP bias: 0.66 vs. 1.21 mmHg, P ¼ 0.002; DBP: À5.29 vs. À5.17, P ¼ 0.1; mean BP: À4.45 vs. À4.19, P ¼ 0.01). After adjusting for age, sex, heart rate, arterial BP, and vasopressor usage, the effect of heart rhythm on NIBP/IBP bias was within AE5 mmHg for SBP and DBP [effect on SBP bias: 3.32 mmHg (95% confidence interval (CI) 2.89-3.74), P < 0.001; DBP: À0.89 (À1.17 to À0.60), P < 0.001], while the effect on mean BP bias was not significant [0.18 mmHg (À0.10 to 0.46), P ¼ 0.2].Conclusion: Atrial fibrillation would not influence the agreement of oscillometric BP to IBP in ICU patients compared with sinus rhythm.

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A long unsolved major issue in blood pressure measurement: the accuracy in patients with arrythmia

Shirasaki

2022

Hypertens Res

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The effect of heart rate on blood pressure measurement in patients with atrial fibrillation: a cross-sectional study

Cited by 3 publications

References 25 publications

Blood pressure in atrial fibrillation and in sinus rhythm during ambulatory blood pressure monitoring: data from the TEMPLAR project

Blood pressure in atrial fibrillation and in sinus rhythm during ambulatory blood pressure monitoring: data from the TEMPLAR project

Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring in ICU patients from a large real-world database

A long unsolved major issue in blood pressure measurement: the accuracy in patients with arrythmia

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