Blood pressure and its variability: classic and novel measurement techniques

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• Disputed

  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.

  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). sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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
• Partly supported

  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)

  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). sourceExperimental — accuracy not yet measured

In the paper

“a standardized office BP measurement procedure is recommended by numerous guidelines5,6, which systematically addresses factors that contribute to BP fluctuations.”

What the sources say

• Supported

  The Office BP Measurement section (p. 4) recommends following Table 3. Table 3 (p. 5) specifies a standardized procedure addressing conditions that can affect readings, including room temperature, recent smoking or caffeine, posture, cuff size, and repeated measurements. This paper is one of the guidelines cited, not evidence by itself for the number of guidelines. (LLM, conf=0.92)

  cites [5] Unger, T. et al. 2020 International Society of Hypertension Global Hypertension practice guidelines. Hypertension 75, 1334–1357 (2020). source
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• Partly supported

  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)

  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). sourceExperimental — accuracy not yet measured

In the paper

“the highly variable nature of office and out-of-office BP readings has been widely acknowledged”

What the sources say

• Partly supported

  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)

  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). sourceExperimental — accuracy not yet measured

In the paper

“In-office BP measurement using an upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets.”

What the sources say

• Supported

  Section 2 (p. 4) bases BP classification on office measurements, and the guideline labels its treatment goals as office BP targets (p. 10). The office-measurement recommendations specify a validated upper-arm cuff (p. 5). Office BP is the usual basis, not the only measure: the guideline also recommends out-of-office confirmation when possible (p. 4). (LLM, conf=0.88)

  cites [5] Unger, T. et al. 2020 International Society of Hypertension Global Hypertension practice guidelines. Hypertension 75, 1334–1357 (2020). source
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be 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).
• Partly supported

  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)

  cites [5] Unger, T. et al. 2020 International Society of Hypertension Global Hypertension practice guidelines. Hypertension 75, 1334–1357 (2020). sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“HBPM is currently recommended as the best method for long-term follow-up of patients who are being treated for hypertension6,12,44.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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
• Supported

  The ‘HOME vs. ABPM’ section (page not available) recommends HBPM for long-term follow-up, while reserving ABPM for situations needing special evaluation. It also says current guidelines recommend HBPM particularly for monitoring long-term BP control in treated hypertensive patients. (LLM, conf=0.92)

  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

In the paper

“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.”

What the sources say

• Supported

  The Abstract reports that cuff BP underestimated intra-arterial brachial systolic BP by 5.7 mm Hg and overestimated intra-arterial diastolic BP by 5.5 mm Hg. The Cuff BP Validation Standards section reports significant underestimation of intra-arterial brachial pulse pressure. (LLM, conf=0.95)

  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

In the paper

“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.”

What the sources say

• Supported

  In ‘How a Blood Pressure Device Becomes Approved for Sale’ (page unavailable), the paper says conformity with published standards is not required by law. In ‘Recommendations and Actions to Address Identified Problems’ (page unavailable), it calls for legislation requiring independent validation under the ISO standard before sale, supporting the claim that such a requirement does not yet cover all marketed BP devices. (LLM, conf=0.90)

  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

In the paper

“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.”

What the sources say

• Partly supported

  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)

  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). sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• Supported

  The Results report that higher cumulative systolic BP over 25 years was associated with measures of worse left ventricular function in CARDIA participants at middle age. This citation identifies the CARDIA evidence; the citing sentence separately attaches the ARIC citation to the incident-heart-failure evidence. The CARDIA paper itself used a subclinical cardiac-function endpoint, not incident heart failure. (LLM, conf=0.90)

  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
• Supported

  The citation is attached to the ARIC cohort, not the CARDIA study. The Abstract reports that higher cumulative systolic BP over approximately 24 years was associated with worse late-life cardiac measures and greater risk of incident heart failure; the Conclusion states the same finding. Page numbers were not provided in our copy. (LLM, conf=0.94)

  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

In the paper

“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.”

What the sources say

• Supported

  The Types of Cuffless BP Measurement Devices section (page unavailable) distinguishes cuff-calibrated from calibration-free devices and describes wearable and anesthesia/surgery uses. The Proposals section (page unavailable) explicitly distinguishes intended uses such as screening, diagnosis, and therapy titration; the paper’s references also identify different measurement techniques. (LLM, conf=0.86)

  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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• Supported

  The Abstract (p. 4) reports that 18.3% of 278 upper-arm cuff devices available online in Australia were validated and that validated cuff devices cost more than non-validated ones. The Results (p. 8) also report a significant price difference for upper-arm and wrist cuff devices. (LLM, conf=0.93)

  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

In the paper

“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.”

What the sources say

• Supported

  The Abstract reports that the review included observational cohort studies and clinical trial cohorts. It states that increased long-term systolic blood-pressure variability was associated with higher risks of all-cause mortality, cardiovascular disease mortality and events, coronary heart disease, and stroke. (LLM, conf=0.95)

  cites [8] Stevens, S. L. et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ 354, i4098 (2016). source

In the paper

“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.”

What the sources say

• Partly supported

  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)

  cites [8] Stevens, S. L. et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ 354, i4098 (2016). sourceExperimental — accuracy not yet measured

In the paper

“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.”

What the sources say

• Partly supported

  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)

  cites [55] Mukkamala, R. et al. Evaluation of the accuracy of cuffless blood pressure measurement devices: challenges and proposals. Hypertension 78, 1161–1167 (2021). sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [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

In the paper

“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).”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Could not verify

  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)

  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). sourceExperimental — accuracy not yet measured
• Partly supported

  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)

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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• Partly supported

  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)

  cites [55] Mukkamala, R. et al. Evaluation of the accuracy of cuffless blood pressure measurement devices: challenges and proposals. Hypertension 78, 1161–1167 (2021). sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• Supported

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

  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

In the paper

“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.”

What the sources say

• Supported

  The Results section (Global attributable burden) identifies high systolic blood pressure as the leading global Level 2 risk factor for attributable deaths in 2019. That supports the cited claim about raised BP; the statement about the importance of frequent assessment is the citing authors’ own conclusion. (LLM, conf=0.94)

  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

In the paper

“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.”

What the sources say

• Supported

  The Results section reports a strong association between diastolic BP variability and major coronary heart disease in participants with prior cardiovascular disease, strongest among those with low baseline blood pressure. The Discussion presents reduced coronary perfusion during diastole as a possible mechanism, matching the citing sentence’s tentative wording. (LLM, conf=0.94)

  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

In the paper

“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.”

What the sources say

• Partly supported

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

  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). sourceExperimental — accuracy not yet measured
• Partly supported

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

  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). sourceExperimental — accuracy not yet measured

In the paper

“but their accuracy and utility remain uncertain”

In the paper

“the implications of BP variability on cardiovascular outcomes have largely been ignored, with limited application in clinical practice”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

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

In the paper

“These devices offer many advantages for researchers and patients compared with traditional BP monitors”

In the paper

“At present, 24 h ABPM is recommended as the best available method for diagnosing hypertension6,12.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [68] Juhanoja, E. P. et al. Outcome-driven thresholds for increased home blood pressure variability. Hypertension 69, 599–607 (2017). source

In the paper

“These phenotypes also have only moderate reproducibility, which is attributable to inherent BPV6,20.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“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.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

“All these indices assess different aspects of the complex BPV phenomenon and do not have uniform clinical and prognostic values.”

What the sources say

• ?Not checked — no full text of the sourcecites [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
• ?Not checked — no full text of the sourcecites [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

In the paper

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

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“Therefore, all the measurement methods for assessing BPV should be regarded as complementary rather than interchangeable or competitive.”

In the paper

“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.”

In the paper

“However, although numerous classes of antihypertensive drugs have similar effects on BP levels, they have differential effects on BPV.”

What the sources say

• ?Not checked — no full text of the sourcecites [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