Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): A cross-sectional, observational study in central England

James A. Hodgkinson; Mei Man Lee; Siobhan Milner; Peter Bradburn; Richard Stevens; F. D.Richard Hobbs; Constantinos Koshiaris; Sabrina Grant; Jonathan Mant; Richard J. McManus

doi:10.3399/bjgp20X710381

Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): A cross-sectional, observational study in central England

James A. Hodgkinson^*, Mei Man Lee, Siobhan Milner, Peter Bradburn, Richard Stevens, F. D.Richard Hobbs, Constantinos Koshiaris, Sabrina Grant, Jonathan Mant, Richard J. McManus

^*Corresponding author for this work

Applied Health Research

Research output: Contribution to journal › Article › peer-review

Abstract

Background Home blood-pressure (BP) monitoring is recommended in guidelines and is increasingly popular with patients and health professionals, but the accuracy of patients' own monitors in real-world use is not known. Aim To assess the accuracy of home BP monitors used by people with hypertension, and to investigate factors affecting accuracy. Design and setting Cross-sectional, observational study in urban and suburban settings in central England. Method Patients (n = 6891) on the hypertension register at seven practices in the West Midlands, England, were surveyed to ascertain whether they owned a BP monitor and wanted it tested. Monitor accuracy was compared with a calibrated reference device at 50 mmHg intervals between 0-280/300 mmHg (static pressure test); a difference from the reference monitor of +/-3 mmHg at any interval was considered a failure. Cuff performance was also assessed. Results were analysed by frequency of use, length of time in service, make and model, monitor validation status, purchase price, and any previous testing. Results In total, 251 (76%, 95% confidence interval [95% CI] = 71 to 80%) of 331 tested devices passed all tests (monitors and cuffs), and 86% (CI] = 82 to 90%) passed the static pressure test; deficiencies were, primarily, because of monitors overestimating BP. A total of 40% of testable monitors were not validated. The pass rate on the static pressure test was greater in validated monitors (96%, 95% CI = 94 to 98%) versus unvalidated monitors (64%, 95% CI = 58 to 69%), those retailing for >£10 (90%, 95% CI = 86 to 94%), those retailing for ≤£10 (66%, 95% CI = 51 to 80%), those in use for ≤4 years (95%, 95% CI = 91 to 98%), and those in use for >4 years (74%, 95% CI = 67 to 82%). All in all, 12% of cuffs failed. Conclusion Patients' own BP monitor failure rate was similar to that demonstrated in studies performed in professional settings, although cuff failure was more frequent. Clinicians can be confident of the accuracy of patients' own BP monitors if the devices are validated and ≤4 years old.

Original language	English
Pages (from-to)	E548-E554
Journal	British Journal of General Practice
Volume	70
Issue number	697
DOIs	https://doi.org/10.3399/bjgp20X710381
Publication status	Published - Aug 2020

Bibliographical note

Funding Information:
This work represents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-1209-10051). The views expressed in this study are those of the authors and not necessarily of the NHS, the NIHR, or the Department of Health. Richard J McManus was supported by an NIHR Research Professorship (NIHR-RP-02-12-015) and by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust, and is an NIHR Senior Investigator. FD Richard Hobbs is part-funded as director of the NIHR School for Primary Care Research, theme leader of the NIHR Oxford Biomedical Research Centre, and director of the NIHR CLAHRC Oxford. Jonathan Mant is an NIHR Senior Investigator. No funding for this study was received from any monitor manufacturer. Constantinos Koshiaris is funded by an SPCR and Wellcome Trust/Royal Society Sir Henry Dale fellowship.

Publisher Copyright:
© 2020 Royal College of General Practitioners. All rights reserved.

Keywords

Accuracy
Blood-pressure monitors
Calibration
Hypertension
Primary health care

ASJC Scopus subject areas

Family Practice

Access to Document

10.3399/bjgp20X710381

Cite this

Hodgkinson, J. A., Lee, M. M., Milner, S., Bradburn, P., Stevens, R., Hobbs, F. D. R., Koshiaris, C., Grant, S., Mant, J., & McManus, R. J. (2020). Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): A cross-sectional, observational study in central England. British Journal of General Practice, 70(697), E548-E554. https://doi.org/10.3399/bjgp20X710381

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title = "Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): A cross-sectional, observational study in central England",

abstract = "Background Home blood-pressure (BP) monitoring is recommended in guidelines and is increasingly popular with patients and health professionals, but the accuracy of patients' own monitors in real-world use is not known. Aim To assess the accuracy of home BP monitors used by people with hypertension, and to investigate factors affecting accuracy. Design and setting Cross-sectional, observational study in urban and suburban settings in central England. Method Patients (n = 6891) on the hypertension register at seven practices in the West Midlands, England, were surveyed to ascertain whether they owned a BP monitor and wanted it tested. Monitor accuracy was compared with a calibrated reference device at 50 mmHg intervals between 0-280/300 mmHg (static pressure test); a difference from the reference monitor of +/-3 mmHg at any interval was considered a failure. Cuff performance was also assessed. Results were analysed by frequency of use, length of time in service, make and model, monitor validation status, purchase price, and any previous testing. Results In total, 251 (76%, 95% confidence interval [95% CI] = 71 to 80%) of 331 tested devices passed all tests (monitors and cuffs), and 86% (CI] = 82 to 90%) passed the static pressure test; deficiencies were, primarily, because of monitors overestimating BP. A total of 40% of testable monitors were not validated. The pass rate on the static pressure test was greater in validated monitors (96%, 95% CI = 94 to 98%) versus unvalidated monitors (64%, 95% CI = 58 to 69%), those retailing for >£10 (90%, 95% CI = 86 to 94%), those retailing for ≤£10 (66%, 95% CI = 51 to 80%), those in use for ≤4 years (95%, 95% CI = 91 to 98%), and those in use for >4 years (74%, 95% CI = 67 to 82%). All in all, 12% of cuffs failed. Conclusion Patients' own BP monitor failure rate was similar to that demonstrated in studies performed in professional settings, although cuff failure was more frequent. Clinicians can be confident of the accuracy of patients' own BP monitors if the devices are validated and ≤4 years old.",

keywords = "Accuracy, Blood-pressure monitors, Calibration, Hypertension, Primary health care",

author = "Hodgkinson, {James A.} and Lee, {Mei Man} and Siobhan Milner and Peter Bradburn and Richard Stevens and Hobbs, {F. D.Richard} and Constantinos Koshiaris and Sabrina Grant and Jonathan Mant and McManus, {Richard J.}",

note = "Funding Information: This work represents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-1209-10051). The views expressed in this study are those of the authors and not necessarily of the NHS, the NIHR, or the Department of Health. Richard J McManus was supported by an NIHR Research Professorship (NIHR-RP-02-12-015) and by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust, and is an NIHR Senior Investigator. FD Richard Hobbs is part-funded as director of the NIHR School for Primary Care Research, theme leader of the NIHR Oxford Biomedical Research Centre, and director of the NIHR CLAHRC Oxford. Jonathan Mant is an NIHR Senior Investigator. No funding for this study was received from any monitor manufacturer. Constantinos Koshiaris is funded by an SPCR and Wellcome Trust/Royal Society Sir Henry Dale fellowship. Publisher Copyright: {\textcopyright} 2020 Royal College of General Practitioners. All rights reserved.",

year = "2020",

month = aug,

doi = "10.3399/bjgp20X710381",

language = "English",

volume = "70",

pages = "E548--E554",

journal = "British Journal of General Practice",

issn = "0960-1643",

publisher = "Royal College of General Practitioners",

number = "697",

}

Hodgkinson, JA, Lee, MM, Milner, S, Bradburn, P, Stevens, R, Hobbs, FDR, Koshiaris, C, Grant, S, Mant, J & McManus, RJ 2020, 'Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): A cross-sectional, observational study in central England', British Journal of General Practice, vol. 70, no. 697, pp. E548-E554. https://doi.org/10.3399/bjgp20X710381

TY - JOUR

T1 - Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study)

T2 - A cross-sectional, observational study in central England

AU - Hodgkinson, James A.

AU - Lee, Mei Man

AU - Milner, Siobhan

AU - Bradburn, Peter

AU - Stevens, Richard

AU - Hobbs, F. D.Richard

AU - Koshiaris, Constantinos

AU - Grant, Sabrina

AU - Mant, Jonathan

AU - McManus, Richard J.

N1 - Funding Information: This work represents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-1209-10051). The views expressed in this study are those of the authors and not necessarily of the NHS, the NIHR, or the Department of Health. Richard J McManus was supported by an NIHR Research Professorship (NIHR-RP-02-12-015) and by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust, and is an NIHR Senior Investigator. FD Richard Hobbs is part-funded as director of the NIHR School for Primary Care Research, theme leader of the NIHR Oxford Biomedical Research Centre, and director of the NIHR CLAHRC Oxford. Jonathan Mant is an NIHR Senior Investigator. No funding for this study was received from any monitor manufacturer. Constantinos Koshiaris is funded by an SPCR and Wellcome Trust/Royal Society Sir Henry Dale fellowship. Publisher Copyright: © 2020 Royal College of General Practitioners. All rights reserved.

PY - 2020/8

Y1 - 2020/8

N2 - Background Home blood-pressure (BP) monitoring is recommended in guidelines and is increasingly popular with patients and health professionals, but the accuracy of patients' own monitors in real-world use is not known. Aim To assess the accuracy of home BP monitors used by people with hypertension, and to investigate factors affecting accuracy. Design and setting Cross-sectional, observational study in urban and suburban settings in central England. Method Patients (n = 6891) on the hypertension register at seven practices in the West Midlands, England, were surveyed to ascertain whether they owned a BP monitor and wanted it tested. Monitor accuracy was compared with a calibrated reference device at 50 mmHg intervals between 0-280/300 mmHg (static pressure test); a difference from the reference monitor of +/-3 mmHg at any interval was considered a failure. Cuff performance was also assessed. Results were analysed by frequency of use, length of time in service, make and model, monitor validation status, purchase price, and any previous testing. Results In total, 251 (76%, 95% confidence interval [95% CI] = 71 to 80%) of 331 tested devices passed all tests (monitors and cuffs), and 86% (CI] = 82 to 90%) passed the static pressure test; deficiencies were, primarily, because of monitors overestimating BP. A total of 40% of testable monitors were not validated. The pass rate on the static pressure test was greater in validated monitors (96%, 95% CI = 94 to 98%) versus unvalidated monitors (64%, 95% CI = 58 to 69%), those retailing for >£10 (90%, 95% CI = 86 to 94%), those retailing for ≤£10 (66%, 95% CI = 51 to 80%), those in use for ≤4 years (95%, 95% CI = 91 to 98%), and those in use for >4 years (74%, 95% CI = 67 to 82%). All in all, 12% of cuffs failed. Conclusion Patients' own BP monitor failure rate was similar to that demonstrated in studies performed in professional settings, although cuff failure was more frequent. Clinicians can be confident of the accuracy of patients' own BP monitors if the devices are validated and ≤4 years old.

AB - Background Home blood-pressure (BP) monitoring is recommended in guidelines and is increasingly popular with patients and health professionals, but the accuracy of patients' own monitors in real-world use is not known. Aim To assess the accuracy of home BP monitors used by people with hypertension, and to investigate factors affecting accuracy. Design and setting Cross-sectional, observational study in urban and suburban settings in central England. Method Patients (n = 6891) on the hypertension register at seven practices in the West Midlands, England, were surveyed to ascertain whether they owned a BP monitor and wanted it tested. Monitor accuracy was compared with a calibrated reference device at 50 mmHg intervals between 0-280/300 mmHg (static pressure test); a difference from the reference monitor of +/-3 mmHg at any interval was considered a failure. Cuff performance was also assessed. Results were analysed by frequency of use, length of time in service, make and model, monitor validation status, purchase price, and any previous testing. Results In total, 251 (76%, 95% confidence interval [95% CI] = 71 to 80%) of 331 tested devices passed all tests (monitors and cuffs), and 86% (CI] = 82 to 90%) passed the static pressure test; deficiencies were, primarily, because of monitors overestimating BP. A total of 40% of testable monitors were not validated. The pass rate on the static pressure test was greater in validated monitors (96%, 95% CI = 94 to 98%) versus unvalidated monitors (64%, 95% CI = 58 to 69%), those retailing for >£10 (90%, 95% CI = 86 to 94%), those retailing for ≤£10 (66%, 95% CI = 51 to 80%), those in use for ≤4 years (95%, 95% CI = 91 to 98%), and those in use for >4 years (74%, 95% CI = 67 to 82%). All in all, 12% of cuffs failed. Conclusion Patients' own BP monitor failure rate was similar to that demonstrated in studies performed in professional settings, although cuff failure was more frequent. Clinicians can be confident of the accuracy of patients' own BP monitors if the devices are validated and ≤4 years old.

KW - Accuracy

KW - Blood-pressure monitors

KW - Calibration

KW - Hypertension

KW - Primary health care

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Accuracy of blood-pressure monitors owned by patients with hypertension (ACCU-RATE study): A cross-sectional, observational study in central England

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

Access to Document

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Cite this