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Comparison of Dinamap- and mercury-measured blood pressure in MESA

Presenter’s Name: Colin O. Wu National Heart, Lung, and Blood Institute National Institutes of Health Department of Health and Human Services. Comparison of Dinamap- and mercury-measured blood pressure in MESA

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Comparison of Dinamap- and mercury-measured blood pressure in MESA

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  1. Presenter’s Name: Colin O. Wu National Heart, Lung, and Blood Institute National Institutes of Health Department of Health and Human Services Comparison of Dinamap- and mercury-measured blood pressure in MESA Hanyu Ni1, Colin O. Wu1, Ronald Prineas2, Steve Shea3, Kiang Liu4, Richard Kronmal5, Diane Bild1 1NHLBI, 2Wake Forest University, 3University of Columbia, 4Northwestern University, 5University of Washington

  2. Background Standard mercury device: • Long been gold standard for indirect BP measurement; • May have serious adverse health effects of mercury contamination; • Determines BP by detecting Korotkoff

  3. Dinamap Pro-100: • Automated oscillometric device • Requires less technician training, removes observer bias • Determines BP by detecting a sequence of oscillations in cuff pressure • Accuracy in question • Inconsistent results in the literature

  4. Objectives • To compare Dinamap- and mercury- measured blood pressures • To determine the acceptability of Dinamap Pro-100 using the BHS and AAMI criteria • To identify factors affecting the consistency between the two device measurements

  5. Study Design • Conducted at Exam 3 • 305 participants from 6 FCs • Randomly selected after stratified into two levels of Exam 2 pulse pressure (<60 mmHg and ≥60 mmHg) • BP measured 3 times by one device and repeated by the other after 5 minutes’ rest • Order of device at random

  6. Data Analysis Variables used • 3 readings of BP measurements • Cuff size, order of device, tech • Conditions: diabetes, BMI, CAC score, hypertension, pulse pressure • Demographics: age, sex, ethnicity, smoking

  7. Data Analysis –Cont. Statistical analysis • Average of 2nd and 3rd readings • Pair differences (Dinamap – Mercury) • Mean, SD, range • Pair t-test • Correlations analysis • Bland-Altman plot • Linear regression and smoothing curves • Multiple linear regression

  8. 4. Results

  9. Summary • AAMI criteria: For both systolic and diastolic pressures, the mean differences of the two device measurements were within AAMI criteria (<5 mmHg), but the SD for systolic pressure was slightly higher than the criteria. • BHS criteria: Grade B for diastolic blood pressure and borderline B grade for systolic blood pressure.

  10. Summary –cont. • Dinamap tended to underestimate diastolic pressure, but less pronounced in those aged 75+ yrs, with hypertension, and with PP 60+ mmHg. • Dinamap tended to underestimate systolic pressure in those aged 45-74 yrs, without hypertension, and with PP <60 mmHg, but overestimate systolic pressure in those 75+ yrs, with hypertension, and with PP 60+ mmHg.

  11. Conclusions • Dinamap Pro-100 is generally an acceptable alternative to conventional mercury sphygmomanometers in population-based epidemiologic research, although the actual number may not be interchangeable. • The discrepancy between Dinamap-measured and mercury-measured blood pressures may be partly attributed to factors related to the risk of arterial stiffness.

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