CoChat
Sign Up
Cited by 341Blood Pressure and Hypertension StudiesNon-Invasive Vital Sign MonitoringCardiovascular Health and Disease Prevention

Blood pressure and its variability: classic and novel measurement techniques

Open access
Schutte, Aletta E., Kollias, Anastasios, Stergiou, George S.·2022·Nature Reviews Cardiology
DOI 10.1038/s41569-022-00690-0PMC PMC9017082
Open this paper in CoChat — free accountOpen PDF

Abstract

Current hypertension guidelines recommend using the average values of several blood pressure (BP) readings obtained both in and out of the office for the diagnosis and management of hypertension. In-office BP measurement using an upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets. However, out-of-office BP evaluation using 24 h ambulatory or home BP monitoring is recommended by all major medical associations for obtaining further insights into the BP profile of an individual and how it relates to their daily activities. Importantly, the highly variable nature of office and out-of-office BP readings has been widely acknowledged, including the association of BP variability with cardiovascular outcomes. However, to date, the implications of BP variability on cardiovascular outcomes have largely been ignored, with limited application in clinical practice. Novel cuffless wearable technologies might provide a detailed assessment of the 24 h BP profile and behaviour over weeks or months. These devices offer many advantages for researchers and patients compared with traditional BP monitors, but their accuracy and utility remain uncertain. In this Review, we outline and compare conventional and novel methods and techniques for assessing average BP levels and BP variability, and reflect on the utility and potential of these methods for improving the treatment and management of patients with hypertension.

Integrity signals

Registry

Crossref · 10.1038/s41569-022-00690-0

Cites

102 of 102 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

51 of 152 cited sources checked · 27 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Major hypertension guidelines advise using the mean of multiple office and out-of-office BP readings when diagnosing and managing hypertension.

    “Current hypertension guidelines recommend using the average values of several blood pressure (BP) readings obtained both in and out of the office for the diagnosis and management of hypertension.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [5] Unger, T. et al. 2020 International Society of Hypertension Global Hypertension practice guidelines. Hypertension 75, 1334–1357 (2020). source
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
  • Premisecitation

    A 5 mmHg difference in systolic BP would misclassify hypertension status in 84 million people worldwide.

    “a 5 mmHg difference in systolic BP would correspond to an incorrect classification of hypertension status in 84 million individuals worldwide15.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Padwal, R. et al. Optimizing observer performance of clinic blood pressure measurement: a position statement from the Lancet Commission on Hypertension Group. J. Hypertens. 37, 1737–1745 (2019). source
  • Premisecitation

    Evidence is accumulating that BP variability has clinical relevance for cardiovascular and mortality outcomes beyond average BP levels.

    “Accumulating evidence has highlighted the clinical relevance of BPV, beyond the effect of average BP levels on cardiovascular and mortality outcomes8”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Stevens, S. L. et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ 354, i4098 (2016). source
      Experimental — accuracy not yet measured
  • Premisecitation

    BP variability is linked to cardiovascular outcomes.

    “including the association of BP variability with cardiovascular outcomes”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Stevens, S. L. et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ 354, i4098 (2016). source
  • Premisecitation

    Diagnosis and management of hypertension use an average of several office and out-of-office BP measurements.

    “An average of several office and out-of-office BP measurements is used to diagnose and manage hypertension.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [5] Unger, T. et al. 2020 International Society of Hypertension Global Hypertension practice guidelines. Hypertension 75, 1334–1357 (2020). source
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
  • May combine two claims. 44
  • Classified as probably not a substantial claim. 15

  • May combine two claims.

    Premisecitation

    The association between indices of different types of BP variability, and their agreement in detecting individuals with high BP variability, is moderate.

    “Of note, although all types of BPV have a certain degree of clinical relevance and prognostic value, the association between the indices of different types of BPV, as well as their agreement in detecting individuals with high BPV, is moderate87,88.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [87] Juhanoja, E. P., Niiranen, T. J., Johansson, J. K., Puukka, P. J. & Jula, A. M. Agreement between ambulatory, home, and office blood pressure variability. J. Hypertens. 34, 61–67 (2016). source
    • cites [88] Boubouchairopoulou, N., Ntineri, A., Kollias, A., Destounis, A. & Stergiou, G. S. Blood pressure variability assessed by office, home, and ambulatory measurements: comparison, agreement, and determinants. Hypertens. Res. 44, 1617–1624 (2021). source

      The Results report overall weak correlations between BPV indices measured by different methods and limited agreement (29–43%) in identifying people with high BPV. The Discussion likewise calls the correlations weak and the agreement limited, rather than moderate. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    All major medical associations recommend 24-hour ambulatory or home BP monitoring for out-of-office evaluation to reveal an individual's BP profile and its relation to daily activities.

    “out-of-office BP evaluation using 24 h ambulatory or home BP monitoring is recommended by all major medical associations for obtaining further insights into the BP profile of an individual and how it relates to their daily activities.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
    • cites [12] Williams, B. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 36, 1953–2041 (2018). source
    • cites [44] Parati, G. et al. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension. J. Hypertens. 39, 1742–1767 (2021). source

      The HOME vs. ABPM section (page unavailable) says current guidelines recommend home monitoring for evaluating suspected hypertension and describes ambulatory monitoring as capturing BP patterns across routine activities and sleep. It does not establish that all major medical associations make this recommendation, and its description of BP in relation to daily activities applies to ambulatory monitoring, not routine home monitoring. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many guidelines recommend a standardized office BP measurement procedure that systematically addresses factors causing BP fluctuations.

    “a standardized office BP measurement procedure is recommended by numerous guidelines5,6, which systematically addresses factors that contribute to BP fluctuations.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [5] Unger, T. et al. 2020 International Society of Hypertension Global Hypertension practice guidelines. Hypertension 75, 1334–1357 (2020). source
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Drug treatment of hypertension is arguably the most evidence-based and cost-effective medical intervention, with clear reductions in morbidity and mortality.

    “The pharmacological treatment of hypertension has been hailed as arguably the most evidence-based and cost-effective medical intervention, with clear benefits of reduced morbidity and mortality14.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Turnbull, F. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet 362, 1527–1535 (2003). source

      The Summary (p. 1) reports reduced major cardiovascular events, and the Total mortality section (p. 5) reports reduced deaths with ACE-inhibitor treatment versus placebo. The paper does not establish that hypertension treatment is the most evidence-based or cost-effective medical intervention; it also finds no clear mortality reduction for several other regimen comparisons. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Both office and out-of-office BP readings vary substantially.

    “the highly variable nature of office and out-of-office BP readings has been widely acknowledged”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [4] Kallioinen, N., Hill, A., Horswill, M. S., Ward, H. E. & Watson, M. O. Sources of inaccuracy in the measurement of adult patients’ resting blood pressure in clinical settings: a systematic review. J. Hypertens. 35, 421–441 (2017). source

      The Discussion (Conclusion and limitations) says clinical BP measurements can vary substantially and that a single reading may be substantially inaccurate. But the Methods explicitly limit the review to clinical settings and say it does not directly address home or 24-hour ambulatory monitoring. The claim is therefore supported for office readings, not specifically for out-of-office readings. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Upper-arm cuff measurement in the office is the evidence-based reference for classifying BP and setting treatment targets.

    “In-office BP measurement using an upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [5] Unger, T. et al. 2020 International Society of Hypertension Global Hypertension practice guidelines. Hypertension 75, 1334–1357 (2020). source
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
    • cites [11] Whelton, P. K. 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: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 71, e13–e115 (2018). source
    • cites [12] Williams, B. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 36, 1953–2041 (2018). source

  • May combine two claims.

    Premisecitation

    The Riva-Rocci-Korotkoff auscultatory method, now incorporated into automatic oscillometric brachial-cuff devices, remains the dominant BP assessment method and its data underpin WHO and guideline recommendations.

    “this technique (nowadays incorporated into automatic oscillometric devices with a brachial cuff) remains the dominant BP assessment method and its data form the basis of recommendations by the WHO10 and clinical hypertension guidelines5,6,11,12.”
    Quote in the paperNot a substantial claim1 of 5 sources checked
    • cites [10] World Health Organization. WHO technical specifications for automated non-invasive blood pressure measuring devices with cuff. https://apps.who.int/iris/handle/10665/331749 (Geneva, 2020).

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [5] Unger, T. et al. 2020 International Society of Hypertension Global Hypertension practice guidelines. Hypertension 75, 1334–1357 (2020). source

      In Hypertension Diagnosis – Office BP Measurement (pp. 4–5), the guideline says office BP measurement is the most common basis for diagnosis and follow-up and recommends an electronic oscillometric upper-arm cuff device. It lists a Korotkoff-sound auscultatory device as an alternative, not as a technique incorporated into oscillometric devices. The cited guideline therefore supports the role of brachial-cuff BP measurements in clinical recommendations, but not that methodological equivalence or the claim about WHO recommendations. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
    • cites [11] Whelton, P. K. 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: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 71, e13–e115 (2018). source
    • cites [12] Williams, B. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 36, 1953–2041 (2018). source

  • Classified as probably not a substantial claim.

    Premisecitation

    Home BP monitoring is recommended as the best method for long-term follow-up of patients treated for hypertension.

    “HBPM is currently recommended as the best method for long-term follow-up of patients who are being treated for hypertension6,12,44.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
    • cites [12] Williams, B. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 36, 1953–2041 (2018). source
    • cites [44] Parati, G. et al. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension. J. Hypertens. 39, 1742–1767 (2021). source

  • May combine two claims.

    Premisecitation

    A meta-analysis comparing intra-arterial and brachial cuff BP found that cuff measurement underestimated systolic BP and overestimated intra-arterial diastolic BP by 5-6 mmHg, causing considerable underestimation of pulse pressure.

    “A meta-analysis of studies that compared intra-arterial BP readings with brachial cuff BP readings showed that the latter underestimated systolic BP levels and overestimated intra-arterial diastolic BP levels (by 5–6 mmHg for each measurement), resulting in considerable underestimation of pulse pressure34.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [34] Picone, D. S. et al. Accuracy of cuff-measured blood pressure: systematic reviews and meta-analyses. J. Am. Coll. Cardiol. 70, 572–586 (2017). source

  • May combine two claims.

    Premisecitation

    No regulatory requirement exists for independent validation of every BP device marketed using the ISO standard, despite growing calls to mandate validation.

    “To date, no regulatory requirements exist for independent validation of all BP devices that are put on the market (using the universally accepted International Organization for Standardization (ISO) standard), despite increasing calls to mandate validation of these devices16.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [16] Sharman, J. E. et al. Lancet Commission on Hypertension Group position statement on the global improvement of accuracy standards for devices that measure blood pressure. J. Hypertens. 38, 21–29 (2020). source

  • May combine two claims.

    Premisecitation

    No standardized validation protocol exists for assessing the accuracy of central BP devices, so their accuracy and clinical usefulness remain questionable.

    “at present, a standardized validation protocol has not been established for assessing the accuracy of these devices, and thus their accuracy and clinical usefulness remain questionable37.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [37] Sharman, J. E. et al. Validation of non-invasive central blood pressure devices: ARTERY Society Task Force consensus statement on protocol standardization. Eur. Heart J. 38, 2805–2812 (2017). source

      The Introduction (page unavailable) says that, without standardized guidelines, central BP devices had not been accuracy-tested using uniform, comparable protocols. But the Conclusions and future directions (page unavailable) caution against dismissing their clinical use: some devices had already shown physiological or prognostic significance. The claim therefore overstates how questionable their clinical usefulness is. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The CARDIA study and ARIC cohort indicate that people with high cumulative systolic BP over many years have worse cardiac function and higher risk of incident heart failure later in life than those with lower cumulative systolic BP.

    “Mounting evidence, including data from the CARDIA study27 and the ARIC cohort28, indicates that individuals with high cumulative systolic BP levels over many years have worse cardiac function and increased risk of incident heart failure in later life compared with individuals with lower cumulative systolic BP levels.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [27] Kishi, S. et al. Cumulative blood pressure in early adulthood and cardiac dysfunction in middle age: the CARDIA study. J. Am. Coll. Cardiol. 65, 2679–2687 (2015). source
    • cites [28] Teramoto, K. et al. Mid- to late-life time-averaged cumulative blood pressure and late-life cardiac structure, function, and heart failure. Hypertension 76, 808–818 (2020). source

  • May combine two claims.

    Premisecitation

    Cuffless BP devices use various parameters and techniques and have different intended uses.

    “These devices use several different parameters and techniques to assess BP levels, including pulse transit time, pulse wave analysis, photoplethysmography and applanation tonometry, and have different intended uses (such as wearable devices for occasional use or for short-term continuous monitoring in an intensive care unit)55,56.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [55] Mukkamala, R. et al. Evaluation of the accuracy of cuffless blood pressure measurement devices: challenges and proposals. Hypertension 78, 1161–1167 (2021). source
    • cites [56] Mukkamala R., Stergiou G. S. & Avolio A. P. Cuffless blood pressure measurement. Annu. Rev. Biomed. Eng. 24, https://doi.org/10.1146/annurev-bioeng-110220-014644 (2022). source

  • May combine two claims.

    Premisecitation

    An evaluation of home BP monitors sold online in Australia found that only 18.3% of upper-arm-cuff devices had been validated for accuracy, and validated cuff devices cost more than non-validated ones.

    “A detailed evaluation of home BP monitoring (HBPM) devices available online in Australia reported that only 18.3% of upper-arm-cuff devices have been validated for accuracy, and that validated cuff BP devices are more expensive than non-validated devices17.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [17] Picone, D. S. et al. Nonvalidated home blood pressure devices dominate the online marketplace in Australia: major implications for cardiovascular risk management. Hypertension 75, 1593–1599 (2020). source

  • May combine two claims.

    Premisecitation

    A 2016 meta-analysis of prospective cohort studies and clinical trials found that increased long-term systolic BP variability was associated with higher risk of all-cause and cardiovascular death, cardiovascular events, coronary heart disease and stroke.

    “A 2016 meta-analysis of data from prospective cohort studies and clinical trials showed that increased long-term systolic BPV was associated with a higher risk of all-cause and cardiovascular death, cardiovascular events, coronary heart disease and stroke8.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Stevens, S. L. et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ 354, i4098 (2016). source

  • May combine two claims.

    Premisecitation

    Substantial heterogeneity exists in the BP variability indices used across studies, with standard deviation being the most common parameter.

    “Moreover, substantial heterogeneity was present in the BPV indices used across the studies included in the meta-analysis, with standard deviation being the most common parameter8.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Stevens, S. L. et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ 354, i4098 (2016). source

      The Methods (Data analysis and statistical methods; page unavailable) list several BP variability measures used by studies, supporting the point that indices differed. They place standard deviation first in a preference hierarchy for selecting results, but do not say it was the most common index. The Discussion’s finding of significant heterogeneity concerns study results, not the indices used. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Cuffless devices have accuracy problems not seen in automated cuff devices, including the need for individual calibration and questionable accuracy in tracking BP changes after calibration.

    “However, cuffless devices have specific accuracy issues that are not present in the automated cuff BP devices, such as the need for individual user calibration and their questionable accuracy in tracking BP changes after calibration55,56.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [55] Mukkamala, R. et al. Evaluation of the accuracy of cuffless blood pressure measurement devices: challenges and proposals. Hypertension 78, 1161–1167 (2021). source

      The Types of Cuffless BP Measurement Devices section says cuff-calibrated devices require calibration for an individual, but calibration-free devices do not. The Critical Review section says the accuracy of cuff-calibrated devices in tracking BP changes within an individual often remains unclear. Thus the tracking concern is supported, while the need for individual calibration does not apply to cuffless devices generally; page numbers were not provided. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [56] Mukkamala R., Stergiou G. S. & Avolio A. P. Cuffless blood pressure measurement. Annu. Rev. Biomed. Eng. 24, https://doi.org/10.1146/annurev-bioeng-110220-014644 (2022). source

  • May combine two claims.

    Premisecitation

    Most cuffless BP devices require initial calibration for each user and periodic recalibration over time.

    “Most of these devices require initial calibration in each user, which is usually performed by inputting a BP value measured using an upper-arm-cuff device or by inputting simple demographic data that are known to correlate with BP level (such as age and sex), with periodic recalibration required over time (every few hours, days or weeks).”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
    • cites [17] Picone, D. S. et al. Nonvalidated home blood pressure devices dominate the online marketplace in Australia: major implications for cardiovascular risk management. Hypertension 75, 1593–1599 (2020). source

      The Results (p. 7) and Discussion (p. 11) address the types and validation status of BP devices sold online, not how users calibrate them. Searches for cuffless-device calibration, demographic inputs, and periodic recalibration found no passage supporting the claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [55] Mukkamala, R. et al. Evaluation of the accuracy of cuffless blood pressure measurement devices: challenges and proposals. Hypertension 78, 1161–1167 (2021). source

      The “Types of Cuffless BP Measurement Devices” section says cuff-calibrated devices require periodic arm-cuff measurements, with intervals ranging from hours to weeks. It also identifies calibration-free devices that do not require calibration for each user, and does not establish that most devices require it. The “Simulation study” section treats demographic input as a feature of some calibration-free devices, not as periodic recalibration. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationreasoning

    Cuffless devices can provide detailed information about true BP profile and behaviour over time and about all types of BP variability.

    “Therefore, these devices can provide detailed information on true BP profile and behaviour over time, as well as all types of BPV (including short-term to long-term BPV6,55–57), and have great potential for use in screening, early diagnosis, close monitoring and optimal management of hypertension.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
    • cites [55] Mukkamala, R. et al. Evaluation of the accuracy of cuffless blood pressure measurement devices: challenges and proposals. Hypertension 78, 1161–1167 (2021). source

      The Potential of Cuffless Blood Pressure Measurement Devices section says these devices could provide a complete evaluation of BP level and behavior across daily circumstances and long periods. But the Critical Review of Data Presentation in Recent Studies cautions that their accuracy in tracking short- or long-term BP changes within an individual often remains unclear. The source therefore supports the potential for detailed monitoring, not the unqualified claim that cuffless devices can characterize all types of BP variability. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [56] Mukkamala R., Stergiou G. S. & Avolio A. P. Cuffless blood pressure measurement. Annu. Rev. Biomed. Eng. 24, https://doi.org/10.1146/annurev-bioeng-110220-014644 (2022). source

  • May combine two claims.

    Premisecitation

    In the ACCORD trial, visit-to-visit BP variability was associated with the primary cardiovascular outcome, but the relationship depended on baseline BP levels, with a stronger association in patients with low and high strata of baseline systolic and diastolic BP.

    “Furthermore, in the ACCORD trial76, visit-to-visit BPV was associated with the primary cardiovascular outcome, but this relationship was dependent on baseline BP levels; a stronger association was more evident in patients with low and high strata of baseline systolic and diastolic BP levels.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [76] Nuyujukian, D. S., Zhou, J. J., Koska, J. & Reaven, P. D. Refining determinants of associations of visit-to-visit blood pressure variability with cardiovascular risk: results from the Action to Control Cardiovascular Risk in Diabetes trial. J. Hypertens. 39, 2173–2182 (2021). source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Raised BP levels continue to be the leading cause of death globally.

    “Raised BP levels continue to be the leading cause of death globally9, highlighting the importance of accurate, broad and frequent assessment of BP levels in the general population.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] GBD. 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1223–1249 (2020). source

  • May combine two claims.

    Premisecitation

    Diastolic BP variability is strongly associated with coronary heart disease, especially in patients with a history of cardiovascular disease and low baseline BP levels, possibly through reduced coronary perfusion during diastole.

    “Interestingly, diastolic BPV was strongly associated with coronary heart disease, especially in patients with a history of cardiovascular disease and low baseline BP levels, which might indicate a pathophysiological mechanism of reduced coronary perfusion during diastole in patients with diastolic BPV76.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [76] Nuyujukian, D. S., Zhou, J. J., Koska, J. & Reaven, P. D. Refining determinants of associations of visit-to-visit blood pressure variability with cardiovascular risk: results from the Action to Control Cardiovascular Risk in Diabetes trial. J. Hypertens. 39, 2173–2182 (2021). source

  • May combine two claims.

    Premisecitation

    In the SPRINT trial, all-cause mortality was independently associated with visit-to-visit systolic BP variability quantified using variability independent of the mean or maximum minus minimum BP levels, but not with systolic BP variability quantified using the coefficient of variation.

    “In an analysis of the SPRINT trial77,78, which enrolled patients with hypertension and high cardiovascular risk, all-cause mortality was independently associated with visit-to-visit systolic BPV quantified using VIM or maximum minus minimum BP levels, but was not associated with systolic BPV quantified using the coefficient of variation.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [77] Chang, T. I. et al. Visit-to-visit office blood pressure variability and cardiovascular outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension 70, 751–758 (2017). source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [78] Cheng, Y. et al. Visit-to-visit office blood pressure variability combined with Framingham risk score to predict all-cause mortality: a post hoc analysis of the systolic blood pressure intervention trial. J. Clin. Hypertens. 23, 1516–1525 (2021). source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The accuracy and usefulness of cuffless wearable devices are still uncertain.

    “but their accuracy and utility remain uncertain”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The consequences of BP variability for cardiovascular outcomes have mostly been disregarded, and its use in clinical practice is limited.

    “the implications of BP variability on cardiovascular outcomes have largely been ignored, with limited application in clinical practice”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Cuffless wearable devices may allow detailed assessment of the 24-hour BP profile and behavior across weeks or months.

    “Novel cuffless wearable technologies might provide a detailed assessment of the 24 h BP profile and behaviour over weeks or months.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Cuffless wearable devices have advantages for researchers and patients over traditional BP monitors.

    “These devices offer many advantages for researchers and patients compared with traditional BP monitors”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    24-hour ambulatory BP monitoring is recommended as the best available method for diagnosing hypertension.

    “At present, 24 h ABPM is recommended as the best available method for diagnosing hypertension6,12.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
    • cites [12] Williams, B. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension. J. Hypertens. 36, 1953–2041 (2018). source

  • May combine two claims.

    Premisecitation

    Cumulative BP or BP load, the percentage of abnormally elevated BP readings over a period, shows that frequent BP elevations are linked with increased cardiovascular risk.

    “The concept of cumulative BP or BP load, defined as the percentage of abnormally elevated BP readings over a period of time, although not identical to BPV, also illustrates how frequent elevations in BP levels are linked with increased cardiovascular risk26.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Schutte, A. E. & Gnanenthiran, S. R. Toward a better understanding of why cumulative blood pressure is such a strong predictor of cardiovascular outcomes. Hypertension 78, 1267–1269 (2021). source

  • May combine two claims.

    Premisecitation

    Office BP assessment misses masked hypertension, which is present in 10-20% of people attending BP clinics.

    “Office BP assessment also misses masked hypertension (defined as normal BP levels in the office but elevated BP levels outside of the office), a condition present in 10–20% of individuals attending BP clinics20.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Stergiou, G. S. et al. Phenotypes of masked hypertension: isolated ambulatory, isolated home and dual masked hypertension. J. Hypertens. 38, 218–223 (2020). source

  • May combine two claims.

    Interpretationreasoning

    Despite its advantages, 24-hour ambulatory BP variability has inconsistent prognostic value, probably because of imperfect reproducibility of 24-hour monitoring and variable day-to-day activities.

    “Despite these advantages, 24 h ambulatory BPV has inconsistent prognostic value, probably owing to the imperfect reproducibility of 24 h ABPM and the variable day-to-day activities of individuals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Wearable watch-like BP devices with a thin wrist cuff have been developed and are undergoing validation for accuracy.

    “Aside from traditional ABPM and HBPM devices, wearable watch-like BP devices with a thin wrist-cuff have been developed, which can take BP measurements when prompted by the individual at any time of day, and are currently being validated for accuracy54.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Kuwabara, M., Harada, K., Hishiki, Y. & Kario, K. Validation of two watch-type wearable blood pressure monitors according to the ANSI/AAMI/ISO81060-2:2013 guidelines: Omron HEM-6410T-ZM and HEM-6410T-ZL. J. Clin. Hypertens. 21, 853–858 (2019). source

  • May combine two claims.

    Premisecitation

    The prognostic value of office BP variability depends on measurement methodology, such as number of visits or use of standardized protocols, and on drug treatment, including dosing time and compliance.

    “the prognostic value of office BPV is dependent on the measurement methodology (for example, the number of visits or the use of standardized protocols) and drug treatment (dosing time and compliance)43.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [43] Levitan, E. B., Kaciroti, N., Oparil, S., Julius, S. & Muntner, P. Blood pressure measurement device, number and timing of visits, and intra-individual visit-to-visit variability of blood pressure. J. Clin. Hypertens. 14, 744–750 (2012). source

  • May combine two claims.

    Premisecitation

    Two studies of 24-hour intra-arterial BP recordings in hospitalized patients with essential hypertension found that BP variability was related to the rate and severity of target-organ damage and predicted disease progression.

    “Two studies that assessed 24 h intra-arterial BP recordings in patients hospitalized with essential hypertension showed that BPV was related to the rate and severity of target-organ damage and, more importantly, was predictive of disease progression32,33.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [32] Parati, G., Pomidossi, G., Albini, F., Malaspina, D. & Mancia, G. Relationship of 24-h blood pressure mean and variability to severity of target-organ damage in hypertension. J. Hypertens. 5, 93–98 (1987). source
    • cites [33] Frattola, A., Parati, G., Cuspidi, C., Albini, F. & Mancia, G. Prognostic value of 24-h blood pressure variability. J. Hypertens. 11, 1133–1137 (1993). source

  • May combine two claims.

    Interpretationreasoning

    Home BP monitoring portrays BP variability more accurately than office BP measurement because it can provide many more readings over time.

    “HBPM provides a more accurate portrayal of BPV than in-office BP measurement, given that it can provide a much larger number of readings over time.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    BP levels and BP variability are linked to the arterial site where BP is recorded and the time of the reading.

    “Both BP levels and BPV are linked to the arterial site at which the BP is recorded and the time that the reading is taken31.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Stergiou, G. S., Kollias, A. & Protogerou, A. D. Evidence on blood pressure measurement methodology and clinical implementation: research agenda for the 21st century. J. Am. Coll. Cardiol. 70, 587–589 (2017). source

  • May combine two claims.

    Premisecitation

    ABPM and HBPM disagree in diagnosing white-coat or masked hypertension in roughly 15-20% of people, with only one method confirming the diagnosis.

    “However, these two methods have been shown to be inconsistent in the diagnosis of white-coat or masked hypertension in approximately 15–20% of individuals, in which a diagnosis of hypertension was confirmed by one method only6,11.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
    • cites [11] Whelton, P. K. 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: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 71, e13–e115 (2018). source

  • May combine two claims.

    Premisecitation

    Large meta-analyses show that central systolic BP is more closely associated with target-organ damage indices and has independent prognostic value for cardiovascular outcomes than brachial BP.

    “Large meta-analyses have shown that central systolic BP levels, compared with their brachial counterpart, are more closely associated with indices of target-organ damage and have independent prognostic value in terms of cardiovascular outcomes35,36.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [35] Kollias, A., Lagou, S., Zeniodi, M. E., Boubouchairopoulou, N. & Stergiou, G. S. Association of central versus brachial blood pressure with target-organ damage: systematic review and meta-analysis. Hypertension 67, 183–190 (2016). source
    • cites [36] Vlachopoulos, C. et al. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur. Heart J. 31, 1865–1871 (2010). source

  • May combine two claims.

    Premisenone given

    The invasive intra-arterial method directly assesses BP and is theoretically the gold standard for BP levels and short-term BP variability.

    “The invasive intra-arterial method provides direct assessment of BP levels and is theoretically the gold standard for measuring BP levels and short-term BPV.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Office BP assessment is crude and, when used alone, may often lead to an incorrect or missed diagnosis of hypertension.

    “Collectively, the challenge is that office BP assessment is a crude measurement and when used in isolation might often result in an incorrect or a missed diagnosis of hypertension.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    BP variability classifications reflect interactions between intrinsic regulatory mechanisms and extrinsic environmental and behavioural factors and are essential for maintaining BP homeostasis.

    “All these classifications of BPV represent complex, continuous and dynamic interactions between intrinsic (regulatory neurohormonal and cardiovascular) mechanisms and extrinsic (environmental and behavioural) factors and are essential for maintaining BP ‘homeostasis’ to ensure adequate vital organ perfusion under varying conditions41,42.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [41] Parati, G., Ochoa, J. E., Lombardi, C. & Bilo, G. Assessment and management of blood-pressure variability. Nat. Rev. Cardiol. 10, 143–155 (2013). source
    • cites [42] Parati, G., Torlasco, C., Pengo, M., Bilo, G. & Ochoa, J. E. Blood pressure variability: its relevance for cardiovascular homeostasis and cardiovascular diseases. Hypertens. Res. 43, 609–620 (2020). source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Both standard deviation and coefficient of variation are affected by diurnal BP variation and should be weighted for awake and asleep periods when assessing 24-hour BP variability.

    “Given that both the standard deviation and the coefficient of variation are affected by diurnal BP variation, these parameters should be weighted for the duration of the awake and asleep periods when assessing 24 h BPV61.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [61] Bilo, G. et al. A new method for assessing 24-h blood pressure variability after excluding the contribution of nocturnal blood pressure fall. J. Hypertens. 25, 2058–2066 (2007). source

  • May combine two claims.

    Premisecitation

    In the VALUE trial, higher visit-to-visit systolic BP variability was associated with increased risk of cardiovascular events in patients with hypertension, irrespective of baseline cardiovascular risk, and the association was stronger in younger patients and those with lower systolic BP levels.

    “In the VALUE trial75, a higher visit-to-visit systolic BPV was associated with increased risk of cardiovascular events in patients with hypertension, irrespective of baseline cardiovascular risk, and this association was stronger in younger patients and those with lower systolic BP levels.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Mehlum, M. H. et al. Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. Eur. Heart J. 39, 2243–2251 (2018). source

  • May combine two claims.

    Premisecitation

    BP readings from traditional methods show only moderate reproducibility, and out-of-office measurements are more reproducible than office measurements.

    “BP readings obtained using traditional methods show only moderate reproducibility, with out-of-office BP measurements being more reproducible than those taken in the office63.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [63] Stergiou, G. S. et al. Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy. Am. J. Hypertens. 15, 101–104 (2002). source

  • May combine two claims.

    Premisecitation

    Increased BP variability may reflect alterations in cardiovascular and renal regulatory mechanisms, subclinical or established cardiovascular damage, or pathological conditions linked to autonomic dysfunction and poor prognosis.

    “Conversely, increased BPV might also reflect alterations in functional and structural cardiovascular and renal regulatory mechanisms, subclinical or established cardiovascular damage, or underlying pathological conditions associated with autonomic dysfunction, which in turn are linked to poor prognosis41,42.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [41] Parati, G., Ochoa, J. E., Lombardi, C. & Bilo, G. Assessment and management of blood-pressure variability. Nat. Rev. Cardiol. 10, 143–155 (2013). source
    • cites [42] Parati, G., Torlasco, C., Pengo, M., Bilo, G. & Ochoa, J. E. Blood pressure variability: its relevance for cardiovascular homeostasis and cardiovascular diseases. Hypertens. Res. 43, 609–620 (2020). source

  • May combine two claims.

    Premisecitation

    All-cause and cardiovascular mortality was significantly increased only in the highest BP variability decile, suggesting that the association may not be linear.

    “However, all-cause and cardiovascular mortality was significantly increased only in the highest BPV decile, implying that the pattern of this association might not be linear.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [68] Juhanoja, E. P. et al. Outcome-driven thresholds for increased home blood pressure variability. Hypertension 69, 599–607 (2017). source

  • May combine two claims.

    Premisecitation

    White-coat and masked hypertension phenotypes have only moderate reproducibility, which is attributable to inherent BP variability.

    “These phenotypes also have only moderate reproducibility, which is attributable to inherent BPV6,20.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [6] Stergiou, G. S. et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurement. J. Hypertens. 39, 1293–1302 (2021). source
    • cites [20] Stergiou, G. S. et al. Phenotypes of masked hypertension: isolated ambulatory, isolated home and dual masked hypertension. J. Hypertens. 38, 218–223 (2020). source

  • May combine two claims.

    Premisecitation

    The coefficient of variation is independent of the average BP level and therefore allows comparison of data with different average values.

    “Furthermore, the coefficient of variation (the standard deviation divided by the corresponding mean) is another widely used parameter of BPV because it is independent of the association with the average BP levels and thus enables the comparison between data with different average values41,42.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [41] Parati, G., Ochoa, J. E., Lombardi, C. & Bilo, G. Assessment and management of blood-pressure variability. Nat. Rev. Cardiol. 10, 143–155 (2013). source
    • cites [42] Parati, G., Torlasco, C., Pengo, M., Bilo, G. & Ochoa, J. E. Blood pressure variability: its relevance for cardiovascular homeostasis and cardiovascular diseases. Hypertens. Res. 43, 609–620 (2020). source

  • May combine two claims.

    Premisecitation

    Different BP variability indices assess different aspects of BP variability and do not have uniform clinical or prognostic value.

    “All these indices assess different aspects of the complex BPV phenomenon and do not have uniform clinical and prognostic values.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [41] Parati, G., Ochoa, J. E., Lombardi, C. & Bilo, G. Assessment and management of blood-pressure variability. Nat. Rev. Cardiol. 10, 143–155 (2013). source
    • cites [42] Parati, G., Torlasco, C., Pengo, M., Bilo, G. & Ochoa, J. E. Blood pressure variability: its relevance for cardiovascular homeostasis and cardiovascular diseases. Hypertens. Res. 43, 609–620 (2020). source

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Home BP monitoring devices seem to be the most feasible and efficient method for long-term self-monitoring in patients with hypertension.

    “Home BP monitoring devices seem to be the most feasible and efficient method for long-term self-monitoring in patients with hypertension.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Cuffless wearable BP monitoring technologies have considerable potential for improving hypertension screening, diagnosis, control and long-term follow-up.

    “Cuffless wearable BP monitoring technologies have considerable potential for improving hypertension screening, diagnosis, control and long-term follow-up.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Office BP measurements will continue to have a major role in screening, diagnosis and management of hypertension.

    “Office blood pressure (BP) measurements will continue to have a major role in the screening, diagnosis and management of hypertension, and thus need further refinement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    BP is a continuous dynamic variable that is inadequately represented by snapshot measurements from all currently available clinical methods.

    “The key challenge is that BP is a continuous dynamic variable that is inadequately represented by the snapshot measurements provided by all the current clinically available methods.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: BP is a continuous dynamic variable.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    All measurement methods for assessing BP variability should be regarded as complementary rather than interchangeable or competitive.

    “Therefore, all the measurement methods for assessing BPV should be regarded as complementary rather than interchangeable or competitive.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The additive value of BP variability beyond average BP levels and its role in risk stratification remain unknown.

    “First, although the methods currently used to estimate BPV indicate that increased BPV confers an adverse prognosis, its additive value over and beyond that of average BP levels and its role in risk stratification remain unknown.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Different classes of antihypertensive drugs have similar effects on BP levels but differential effects on BP variability.

    “However, although numerous classes of antihypertensive drugs have similar effects on BP levels, they have differential effects on BPV.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [90] Rothwell, P. M. et al. Effects of beta blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. Lancet Neurol. 9, 469–480 (2010). source
56 of 56

  • The paper relies on this without support.

    BP is a continuous dynamic variable.

    “The key challenge is that BP is a continuous dynamic variable that is inadequately represented by the snapshot measurements provided by all the current clinically available methods.”

  • The paper relies on this without support.

    Snapshot office BP measurements have been extremely effective in predicting cardiovascular risk.

    “However, given that snapshot office BP measurements have been extremely effective in predicting cardiovascular risk, the goal of improving cardiovascular risk prediction with existing out-of-office BP monitoring methods or BPV measurement methods remains a challenge.”

  • The paper relies on this without support.

    BP measurement is the only method for diagnosing and managing hypertension.

    “Regardless of the advances in novel technologies in this field, BP measurement remains the only method for the diagnosis and management of hypertension.”
3 of 3

Cites

Flagged first, then by citations

7 of the 109 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Schutte, A. E., Kollias, A., & Stergiou, G. S.
Affiliations
  • North-West University (ZA)
  • National and Kapodistrian University of Athens (GR)
Corresponding author
Schutte, Aletta E.
ORCID
Venue
Nature Reviews Cardiology
Publisher
Springer Science and Business Media LLC
Published
2022-04-19
Volume
19
Issue
10
Pages
643-654
ISSN
  • 1759-5002 (ISSN-L)
  • 1759-5010
DOI
10.1038/s41569-022-00690-0
PMC
PMC9017082
OpenAlex
W4224274564
Cited by
335
References
109
Citations by year
2026: 77 · 2025: 101 · 2024: 79 · 2023: 70 · 2022: 8
FWCI
13.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Nature Reviews Cardiology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
blood pressure variability, hypertension, ambulatory blood pressure monitoring, home blood pressure monitoring, cardiovascular outcomes, blood pressure measurement methods, antihypertensive therapy
MeSH terms
Wearable Electronic Devices, Blood Pressure, Blood Pressure Determination, Humans, Hypertension, Blood Pressure Monitoring, Ambulatory

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review