From the Guidelines
Automatic blood pressure machines can be used to measure blood pressure in patients with atrial fibrillation, and they provide a valid systolic blood pressure assessment, although they may be less accurate for estimating diastolic blood pressure. For patients with atrial fibrillation, manual blood pressure measurement using a sphygmomanometer is not necessarily preferred, as oscillometric devices can be used to measure blood pressure accurately in these patients 1. The idea that oscillometric devices do not measure blood pressure accurately among patients with atrial fibrillation is a misperception, and prior studies have shown that these devices provide a valid systolic blood pressure assessment in patients with atrial fibrillation.
Some key points to consider when using automatic blood pressure machines in patients with atrial fibrillation include:
- Oscillometric devices may be less accurate for estimating diastolic blood pressure than auscultatory techniques, but the emphasis in older adults, who are more likely to have atrial fibrillation, is on systolic blood pressure 1.
- Out-of-office blood pressure measurements with ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) can be used to complement standardized office blood pressure readings for the management of high blood pressure in patients with atrial fibrillation 1.
- The potential benefits of additional information obtained from out-of-office blood pressure measurements outweigh the additional costs and increased patient burden that these measurements impose 1.
It is essential to note that the evidence from older studies, such as the one published in 2005 1, suggested that automatic devices frequently are inaccurate for single observations in the presence of atrial fibrillation. However, more recent evidence, such as the study published in 2021 1, indicates that oscillometric devices can be used to measure blood pressure accurately in patients with atrial fibrillation. Another study published in 2015 1 also mentioned that noninvasive automatic oscillometric BP monitors are not recommended for use in patients with atrial fibrillation due to significant beat-to-beat variability, but this is not supported by the most recent evidence.
In real-life clinical practice, healthcare providers should be aware of the potential limitations of automatic blood pressure machines in patients with atrial fibrillation and use them in conjunction with other methods, such as manual blood pressure measurement, to ensure accurate blood pressure readings. However, based on the most recent and highest quality study 1, oscillometric devices can be used to measure blood pressure in patients with atrial fibrillation, and they provide a valid systolic blood pressure assessment.
From the Research
Accuracy of Automatic Blood Pressure Machines in Atrial Fibrillation
- The accuracy of automated blood pressure monitors in atrial fibrillation remains controversial, with some studies suggesting they are accurate for measuring systolic blood pressure (SBP) but not diastolic blood pressure (DBP) 2.
- A systematic review and meta-analysis found that pooled correlation coefficients between automated and manual blood pressure measurements were stronger for SBP than DBP, and automated measurements were higher than manual measurements 2.
- Another study found that ambulatory blood pressure monitoring devices can be used in clinical practice to assess blood pressure in stable outpatients with chronic atrial fibrillation 3.
Clinical Relevance of Blood Pressure Measurement in Atrial Fibrillation
- Blood pressure measurement in patients with atrial fibrillation is important, reliable, and clinically relevant, and should not be neglected in clinical research and practice 4.
- Both auscultatory and automated oscillometric blood pressure measurements appear to be clinically relevant in atrial fibrillation, providing similar associations with intra-arterial blood pressure measurements and with indices of preclinical cardiac damage as in patients without atrial fibrillation 4.
- Screening for atrial fibrillation in the elderly using an atrial fibrillation-specific algorithm during routine automated office, home, or ambulatory blood pressure measurement has high diagnostic accuracy 4.
Limitations and Heterogeneity of Studies
- There is limited evidence and significant heterogeneity in the studies that validated automated blood pressure monitors in atrial fibrillation 2, 5.
- Devices with atrial fibrillation detection algorithms appeared no more accurate for blood pressure measurement with atrial fibrillation than other devices 5.
- More home or ambulatory automated blood pressure monitors require validation in populations with atrial fibrillation 5.
Feasibility and Acceptability of Automated Blood Pressure Measurement
- The oscillometric method is feasible for static (office or home) and ambulatory use and appears to be more accurate for systolic than diastolic blood pressure measurement 6.
- Automated blood pressure measurement may be acceptable for self-home and ambulatory monitoring, but not for professional office or clinic measurement 6.