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I don't think being able to monitor my blood pressure at any random time as useful. As my doctor explained to me, the studies that determine what is the normal

I don't think being able to monitor my blood pressure at any random time as useful. As my doctor explained to me, the studies that determine what is the normal BP range obtain the measurements after the patient has been sitting in a relaxed environment for around 15 minutes. This is something I need to schedule once or twice a week to check that my hypertension is under control. If I were to start taking measurements at random times, such as while walking or watching an action movie, the results would be misleading as they were not obtained under the same conditions as the gold standard measurements. I would also question how accurate these new devices are. I used to use a wrist cuff BP monitor but one day I took it into the doctor's office and did a side by side comparison with my doctor's BP monitor. My wrist cuff BP monitor was reading about 20mmHg too low. I thought I had my hypertension under control but it wasn't. I've since replaced it with an arm cuff BP monitor. If I have to go to the effort of sitting and relaxing for 15 minutes to obtain a measurement, attaching an arm cuff is not much of an inconvenience.

modeless 3y ago
I think exactly the opposite. It's because you should take a measurement after 15 minutes of relaxation that it's useful to have a wearable monitor. Those conditions may happen naturally throughout the day, and can be detected by your watch automatically (via continuous heart rate monitoring plus accelerometer readings), so blood pressure readings can be taken serendipitously, which is way more convenient. Also I think in theory true continuous blood pressure monitoring data ought to be a lot more informative than just resting blood pressure. We may not yet have the research to really draw conclusions yet, but it should become possible to do that research relatively quickly if a whole lot of continuous blood pressure data becomes available.
- kurthr 3y ago
  I agree that having a continuous measurement is more powerful, but one confounding factor is the location of the pressure measurement. If the measurement location goes up or down relative to your heart then that produces an error or offset in the measurement due to the weight of your blood. If you correct for this (and perhaps accelerations etc) with other measurements, then you can have a blood pressure measurement that is much less sensitive to physical motion. If you can estimate the pressures in the heart then you can make good estimates about many other nominal pressures elsewhere in the body.
  - matheusmoreira 3y ago
    Yes. Currently wrist blood pressure monitors must be level with the heart in order to be accurate. Can an unlevel measurement be corrected somehow? Would make the device much easier for patients to use. A lot of people don't know they need to hold it at the same level as the heart.
grogenaut 3y ago
never have I ever been in a relaxed environment sitting for 15 minutes when I've had my bp taken in a medical situation. oh hey sir follow me. go over here, sit down. cool you just stood in the waiting room for 30 minutes and walked 50 yards and took off your hoodie / long sleeve shirt. now lets immediately take your bp. it's fine if it reads high we'll just spend 30 minutes talking to you about it and ignoring that you stepped on a nail 40 minutes ago.
- deleted 3y ago
  [deleted]
makeitdouble 3y ago
Hypertension is not the only case blood pressure can be useful though. On accuracy on why take measurements continuously, I'm wondering how you see pulse measurint. Do you feel it should also be done at rest only, and constant numbers bring nothing to the table ?
matheusmoreira 3y ago
It would be extremely useful. 24 hour blood pressure monitoring is the gold standard. Samples blood pressure every 15 minutes regardless of what the patient is doing. Even during sleep. Wearing the equipment is pretty annoying so it's not done routinely. Better, more comfortable wearables with higher sampling rates would be great.
- Broken_Hippo 3y ago
  Both times I've had it done, it was every 15 minutes during the day and every 30 minutes at night. Approximately, anyway. I tend to go to bed later than the settings allowed, so the last couple hours I'm awake I get tested less. And yes, more comfortable wearables would be grand. Blood pressure cuffs hurt: Last time I had the 24 hour monitoring, I had bruising and blisters from the cuff.
- bubu-bln 3y ago
  I am using a Aktiia wristband which measures the blood pressure every so often per hour automatically and does so without me noticing it. My cardiologist recommended it to me. I was sceptic and first (and still am, to a certain degree), but it gives me bread useful insight on my blood pressure during day and Escoffier while sleeping. Aktiia's customer service is really terrible (only via email, two weeks response time, inflexible decisions), but the product is good and it's measurements hold up when compared to "usual" measurements.
- wl 3y ago
  The gold standard is an arterial line, which unlike a blood pressure cuff, measures blood pressure directly and continuously. You will usually only see them used in intensive care or during surgery.
  - matheusmoreira 3y ago
    Right. That's an invasive procedure though. I was thinking along the lines of "gold standard of ambulatory blood pressure monitoring".
quitit 3y ago
Your doctor is providing a correct explanation for the care you're receiving as this is likely a sufficiently good approach for you in your circumstances. However diagnosis, especially in early stages, is enhanced by more frequent testing: "To determine the most reliable way to measure blood pressure, researchers followed 11,135 people from Europe, East Asia, and Latin America for 14 years... The researchers found that the 24-hour and nighttime blood pressure measurements provided a more accurate estimate of one’s risk for heart and vascular disease compared to the in-office readings." (1) It is a fact that your blood pressure changes while you go about your day and while those values aren't useful for comparing a diagnosis against the standardised test, there is still value in understanding how your blood pressure changes, the duration and amount of that change and risk factors for bringing about those changes. Furthermore similar to measuring the beating of the heart, continuous blood pressure monitoring can be an useful as indicator of other kinds of medical conditions, this would go beyond what is pragmatically possible with a 24 hour testing cuff. If you're a person who needs to have their blood pressure checked - then you are a person who will benefit from continuous measurement. My only qualm to telegaph: continuous indirect BP measurement is hard, and past approaches have had a limited scope. This is one of those technologies where it is wise to have an amount of skepticism. (1) https://www.utrgv.edu/newsroom/2019/08/07-international-study-finds-blood-pressure-over-24-hours-is-best-predictor-of-heart-vascular-disease.htm https://www.utrgv.edu/newsroom/2019/08/07-international-stud...

modeless 3y ago

I think exactly the opposite. It's because you should take a measurement after 15 minutes of relaxation that it's useful to have a wearable monitor. Those conditions may happen naturally throughout the day, and can be detected by your watch automatically (via continuous heart rate monitoring plus accelerometer readings), so blood pressure readings can be taken serendipitously, which is way more convenient. Also I think in theory true continuous blood pressure monitoring data ought to be a lot more informative than just resting blood pressure. We may not yet have the research to really draw conclusions yet, but it should become possible to do that research relatively quickly if a whole lot of continuous blood pressure data becomes available.

kurthr 3y ago
I agree that having a continuous measurement is more powerful, but one confounding factor is the location of the pressure measurement. If the measurement location goes up or down relative to your heart then that produces an error or offset in the measurement due to the weight of your blood. If you correct for this (and perhaps accelerations etc) with other measurements, then you can have a blood pressure measurement that is much less sensitive to physical motion. If you can estimate the pressures in the heart then you can make good estimates about many other nominal pressures elsewhere in the body.
- matheusmoreira 3y ago
  Yes. Currently wrist blood pressure monitors must be level with the heart in order to be accurate. Can an unlevel measurement be corrected somehow? Would make the device much easier for patients to use. A lot of people don't know they need to hold it at the same level as the heart.

grogenaut 3y ago

never have I ever been in a relaxed environment sitting for 15 minutes when I've had my bp taken in a medical situation. oh hey sir follow me. go over here, sit down. cool you just stood in the waiting room for 30 minutes and walked 50 yards and took off your hoodie / long sleeve shirt. now lets immediately take your bp. it's fine if it reads high we'll just spend 30 minutes talking to you about it and ignoring that you stepped on a nail 40 minutes ago.

deleted 3y ago
[deleted]

makeitdouble 3y ago

Hypertension is not the only case blood pressure can be useful though. On accuracy on why take measurements continuously, I'm wondering how you see pulse measurint. Do you feel it should also be done at rest only, and constant numbers bring nothing to the table ?

matheusmoreira 3y ago

It would be extremely useful. 24 hour blood pressure monitoring is the gold standard. Samples blood pressure every 15 minutes regardless of what the patient is doing. Even during sleep. Wearing the equipment is pretty annoying so it's not done routinely. Better, more comfortable wearables with higher sampling rates would be great.

Broken_Hippo 3y ago
Both times I've had it done, it was every 15 minutes during the day and every 30 minutes at night. Approximately, anyway. I tend to go to bed later than the settings allowed, so the last couple hours I'm awake I get tested less. And yes, more comfortable wearables would be grand. Blood pressure cuffs hurt: Last time I had the 24 hour monitoring, I had bruising and blisters from the cuff.
bubu-bln 3y ago
I am using a Aktiia wristband which measures the blood pressure every so often per hour automatically and does so without me noticing it. My cardiologist recommended it to me. I was sceptic and first (and still am, to a certain degree), but it gives me bread useful insight on my blood pressure during day and Escoffier while sleeping. Aktiia's customer service is really terrible (only via email, two weeks response time, inflexible decisions), but the product is good and it's measurements hold up when compared to "usual" measurements.
wl 3y ago
The gold standard is an arterial line, which unlike a blood pressure cuff, measures blood pressure directly and continuously. You will usually only see them used in intensive care or during surgery.
- matheusmoreira 3y ago
  Right. That's an invasive procedure though. I was thinking along the lines of "gold standard of ambulatory blood pressure monitoring".

quitit 3y ago

Your doctor is providing a correct explanation for the care you're receiving as this is likely a sufficiently good approach for you in your circumstances. However diagnosis, especially in early stages, is enhanced by more frequent testing: "To determine the most reliable way to measure blood pressure, researchers followed 11,135 people from Europe, East Asia, and Latin America for 14 years... The researchers found that the 24-hour and nighttime blood pressure measurements provided a more accurate estimate of one’s risk for heart and vascular disease compared to the in-office readings." (1) It is a fact that your blood pressure changes while you go about your day and while those values aren't useful for comparing a diagnosis against the standardised test, there is still value in understanding how your blood pressure changes, the duration and amount of that change and risk factors for bringing about those changes. Furthermore similar to measuring the beating of the heart, continuous blood pressure monitoring can be an useful as indicator of other kinds of medical conditions, this would go beyond what is pragmatically possible with a 24 hour testing cuff. If you're a person who needs to have their blood pressure checked - then you are a person who will benefit from continuous measurement. My only qualm to telegaph: continuous indirect BP measurement is hard, and past approaches have had a limited scope. This is one of those technologies where it is wise to have an amount of skepticism. (1) https://www.utrgv.edu/newsroom/2019/08/07-international-study-finds-blood-pressure-over-24-hours-is-best-predictor-of-heart-vascular-disease.htm https://www.utrgv.edu/newsroom/2019/08/07-international-stud...