Blood Pressure Cuff Innovations and the Role of Nurses

June 18, 2024|Keri Barron

Blood pressure readings aid in our understanding of patients’ cardiovascular health. Accurate measurements are crucial for diagnosing and managing health conditions that may hemodynamically impact our patients.1,2 Traditionally, the stethoscope and blood pressure cuff have been our trusted tools for external blood pressure assessment.2 However, recent innovations have ushered in cuffless alternatives, marking a significant stride in blood pressure monitoring technology. This article will cover blood pressure cuff innovations and the role of nurses in embracing and enhancing these technologies.

Cuff-Based Methods

Our conventional method of blood pressure measurement lies in cuff-based techniques, commonly known as the auscultation method. This approach involves selecting an appropriate cuff size based on the patient’s arm circumference, locating the brachial artery, inflating the cuff to occlude blood flow, following the gradual deflation of that cuff, and using a stethoscope to detect Korotkoff sounds while simultaneously observing the manometer for pressure readings.2

Another prevalent cuff-based method is the oscillometric method, where an automatic blood pressure cuff is employed to measure blood pressure without the need for Korotkoff sound identification. Despite their accuracy, cuff-based methods present challenges (described below) that can limit the reliability of readings obtained in this manner.

Challenges with Cuff-Based Methods

Some of the challenges identified with the utilization of cuff-based methods include lack of access to cuff-based blood pressure devices, such as in rural or low-income areas, and monitoring disruptions due to the cuff’s cumbersome nature.3

Lack of access to these devices

Individuals living with hypertension who reside in rural low-income areas may not have access to these devices, which impacts their ability to adequately monitor their blood pressure outside of the clinical setting.4 Social determinants of health, like health coverage, can hinder access to these devices, as insurance generally does not cover them. With blood pressure devices costing anywhere from $30 to $100, financial obstacles arise for certain individuals.5 In a previous study,6 concerns were raised about pregnant mothers’ access to blood pressure devices during the COVID-19 pandemic. Thirty-six percent of pregnant mothers purchased devices, while twenty percent received them at their 28-week visit. Nearly nine percent lacked a blood pressure device due to cost barriers. This raised concerns among mothers about potential delays in diagnosing complications.

Disruptions in hypertension monitoring

The standard measure for diagnosing a patient with hypertension is to frequently monitor their blood pressure.7,8 Some studies have reported this practice can be disruptive to the patient, especially at night, leading to inaccuracy or further delay in diagnosis.9 However, other studies report that patients are not significantly impacted during ambulatory blood pressure monitoring (such as at night).10–12

User error

User error poses a significant challenge with cuff-based methods, often resulting in inaccurate blood pressure measurements. Kallioinen et al.13 found that trained clinicians were identified as a source of blood pressure error in the clinical setting. Reported causes of these errors included time constraints, insufficient training, equipment shortages, unfavorable environments, and patient-specific factors like mobility constraints.14 Additionally, selecting the wrong cuff size can exacerbate incorrect readings or misdiagnoses.15

Cuffless Blood Pressure Monitoring Methods

Innovative cuffless blood pressure measurement methods are emerging as potential game changers, offering a more convenient approach to monitoring without a blood pressure cuff. These methods may rely on technology or sensors to measure pulse and blood pressure.3

Cuffless methods can be further differentiated into requiring or not requiring cuff calibration.16 Cuffless devices requiring calibration require an individual to take their initial blood pressure with a traditional device and input that data into the monitor. This form of calibration has to be done either every day, every few weeks, or monthly.16

Some current forms of cuffless blood pressure devices include smartwatches, wearable rings, and smartphone devices. Smartwatches use a technology known as photoplethysmography (PPG) to monitor blood pressure. This process involves the use of light sensors to detect variations in blood flow in the skin.17 Wearable rings use bioimpedance sensors to detect arterial blood flow and pressure in our digits.18

Currently, the FDA has not approved the use of smartphone devices for blood pressure monitoring as these devices primarily use phone applications, and there is concern regarding the accuracy of results.19,20 The current process for measuring blood pressure with a smartphone app includes taking a photo of the person’s artery to capture a 30-second report or using a self-portrait to analyze the arteries in a person’s face.20

Challenges with Cuffless Blood Pressure Monitoring Methods

Despite their potential, each cuffless blood pressure measurement method has its own limitations, particularly regarding accuracy and validation.19,21–23 Concerns persist regarding the reliability of data obtained from smartphone applications, with studies indicating discrepancies and false readings, especially in individuals with hypertension.24 Additionally, there is limited validation of cuffless devices, raising questions about their diagnostic agreement with conventional blood pressure monitoring methods such as ambulatory blood pressure monitoring.21,22,24

Implications for Cardiovascular Nurses

The advent of cuffless blood pressure measurement methods heralds a new era in cardiovascular health monitoring, offering benefits such as convenience, continuous monitoring, and integration of cutting-edge technology. These methods hold promise in alleviating patient discomfort associated with traditional cuffs and facilitating non-invasive, real-time blood pressure monitoring. However, further research is imperative to validate the accuracy and efficacy of cuffless devices, particularly in diverse patient populations.

Nurses, equipped with their profound understanding of blood pressure pathophysiology and clinical practice, are poised to play a pivotal role in advancing these technologies. Collaborative efforts between nurses, researchers, engineers, and technology experts can drive the development and validation of these innovative technologies, paving the way for a multidisciplinary approach to healthcare research and ultimately enhancing patient care and cardiovascular health outcomes.

Clinical Takeaways

  • The advancement of blood pressure monitoring technologies, particularly the emergence of cuffless methods, represents a significant stride towards more accessible and convenient cardiovascular health management.
  • However, challenges persist, including concerns about accuracy, validation, and equitable access, especially for vulnerable populations.
  • Despite these hurdles, nurses stand at the forefront of embracing and enhancing these technologies, leveraging their expertise to drive innovation and improve patient outcomes.
  • Through collaborative efforts and continued research, nurses can lead the way in realizing the full potential of cuffless blood pressure monitoring, ultimately advancing cardiovascular healthcare delivery.

References

  1. 1Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269-1324. doi:10.1161/HYP.0000000000000066
  2. Rehman S, Hashmi MF, Nelson VL. Blood pressure measurement. In: StatPearls. StatPearls Publishing; 2024. Accessed February 9, 2024.
  3. Mukkamala R, Stergiou GS, Avolio AP. Cuffless blood pressure measurement. Annu Rev Biomed Eng. 2022;24(1):203-230. doi:10.1146/annurev-bioeng-110220-014644
  4. Ranzani OT, Kalra A, Di Girolamo C, et al. Urban-rural differences in hypertension prevalence in low-income and middle-income countries, 1990-2020: A systematic review and meta-analysis. PLoS Med. 2022;19(8):e1004079. doi:10.1371/journal.pmed.1004079
  5. Litvin CB. The lagging adoption of home blood pressure monitoring: Has policy hindered quality? Health Aff Forefr. doi:10.1377/forefront.20220517.440131
  6. Peahl AF, Powell A, Berlin H, et al. Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic. Am J Obstet Gynecol. 2021;224(4):384.e1-384.e11. doi:10.1016/j.ajog.2020.10.008
  7. Armitage LC, Mahdi A, Lawson BK, et al. Screening for Hypertension in the INpatient Environment(SHINE): a protocol for a prospective study of diagnostic accuracy among adult hospital patients. BMJ Open. 2019;9(12):e033792. doi:10.1136/bmjopen-2019-033792
  8. US Preventive Services Task Force. Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2021;325(16):1650-1656. doi:10.1001/jama.2021.4987
  9. Tomitani N, Hoshide S, Kario K. Accurate nighttime blood pressure monitoring with less sleep disturbance. Hypertens Res. 2021;44(12):1671-1673. doi:10.1038/s41440-021-00745-8
  10. Geng X, Li F, Mao Z, Hu H, Cui W. Interrupted sleep by ambulatory blood pressure monitoring does not affect blood pressure. Blood Press Monit. 2022;27(3):180. doi:10.1097/MBP.0000000000000585
  11. Lehrer HM, Zhang G, Matthews KA, et al. Blood pressure cuff inflation briefly increases female adolescents’ restlessness during sleep on the first but not second night of ambulatory blood pressure monitoring. Psychosom Med. 2022;84(7):828. doi:10.1097/PSY.0000000000001098
  12. Sherwood A, Hill LK, Blumenthal JA, Hinderliter AL. The effects of ambulatory blood pressure monitoring on sleep quality in men and women with hypertension: Dipper vs. nondipper and race differences. Am J Hypertens. 2019;32(1):54-60. doi:10.1093/ajh/hpy138
  13. Kallioinen N, Hill A, Horswill MS, Ward HE, Watson MO. Sources of inaccuracy in the measurement of adult patients’ resting blood pressure in clinical settings: A systematic review. J Hypertens. 2017;35(3):421-441. doi:10.1097/HJH.0000000000001197
  14. Elias MF, Goodell AL. Human errors in automated office blood pressure measurement. Hypertension. 2021;77(1):6-15. doi:10.1161/HYPERTENSIONAHA.120.16164
  15. Ishigami J, Charleston J, Miller ER III, Matsushita K, Appel LJ, Brady TM. Effects of cuff size on the accuracy of blood pressure readings: The Cuff(SZ) Randomized Crossover Trial. JAMA Intern Med. 2023;183(10):1061-1068. doi:10.1001/jamainternmed.2023.3264
  16. Stergiou GS, Mukkamala R, Avolio A, et al. Cuffless blood pressure measuring devices: Review and statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens. 2022;40(8):1449. doi:10.1097/HJH.0000000000003224
  17. Gregory N. A guide to the best blood pressure monitor watches. Forbes Health. Published January 11, 2024. Accessed February 8, 2024.
  18. Sel K, Osman D, Huerta N, Edgar A, Pettigrew RI, Jafari R. Continuous cuffless blood pressure monitoring with a wearable ring bioimpedance device. Npj Digit Med. 2023;6(1):1-11. doi:10.1038/s41746-023-00796-w
  19. Frey L, Menon C, Elgendi M. Blood pressure measurement using only a smartphone. Npj Digit Med. 2022;5(1):1-14. doi:10.1038/s41746-022-00629-2
  20. Modaragamage, AJ. Can your smartphone take your blood pressure? HealthNews. Published January 30, 2023. Accessed February 8, 2024.
  21. Falter M, Scherrenberg M, Driesen K, et al. Smartwatch-based blood pressure measurement demonstrates insufficient accuracy. Front Cardiovasc Med. 2022;9. Accessed February 8, 2024.
  22. Groenland EH, Vendeville JPAC, Bemelmans RHH, et al. Smartphone application-assisted home blood pressure monitoring compared with office and ambulatory blood pressure monitoring in patients with hypertension: the AMUSE-BP Study. Hypertension. 2022;79(10):2373-2382.
  23. Jang Y, Seo JM, Ihm SH, Lee HY, on behalf of the Korean Society of Hypertension. Feasibility, credence, and usefulness of out-of-office cuffless blood pressure monitoring using smartwatch: A population survey. Clin Hypertens. 2023;29(1):15. doi:10.1186/s40885-023-00242-9
  24. Plante TB, Urrea B, MacFarlane ZT, et al. Validation of the instant blood pressure smartphone app. JAMA Intern Med. 2016;176(5):700-702. doi:10.1001/jamainternmed.2016.0157

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