NEW YORK (Reuters Health) – Only a third of blood pressure (BP) devices supposedly validated for use during pregnancy have in fact been properly validated, a new systematic review reports.
“Given the implications of inaccurate BP measurement in pregnant women, healthcare providers should be aware of and try to use the BP measurement devices which have been properly validated in this population,” the U.S.-based authors write.
Of 32 studies in which a device was validated using a standard or modified protocol, only 11 (34%) validated the device without a protocol violation.
In all, 28 devices were examined. Only 9 of them – 2 ambulatory (BP Lab; Welch Allyn QuietTrak), 2 home-based (Microlife WatchBP Home; Omron MIT), 4 clinic-based (A&D UM-101; Dinamap ProCare 400; Nissei DS-400; and Omron HEM907), and 1 home/clinic device (Omron MIT Elite) – passed a validation study in at least one population of pregnant women without any protocol violations.
“Our review demonstrated that there is a need for more studies to validate BP monitoring devices/methods during pregnancy,” coauthor Dr. Kirsten Cleary, of Columbia University Medical Center in New York, told Reuters Health by email.
“Rates of chronic high blood pressure as well as preeclampsia are increasing, and both of these are associated with significant risk for both mother and her baby,” she explained. “It is increasingly important that we are able to accurately track BP in our patients, given how much this measurement can impact on care.”
Hemodynamic changes during pregnancy can be substantial, including increased blood volume, stroke volume, heart rate, and consequently cardiac output, along with a decrease in peripheral vascular resistance. Guidelines therefore recommend that BP devices intended for use in pregnant women be validated in this population, according to the December 11 online report in Hypertension.
The researchers identified 41 articles that assessed the validity of an upper arm brachial BP measurement device, compared with a traditional mercury sphygmomanometer, in pregnant women. The studies, involving more than 2,000 women, encompassed various models of ambulatory, home, and clinic BP measurement devices.
“Data from systematic reviews of the validation of BP devices in pregnant women are sparse, and the results of our study address important knowledge gaps in this area,” the authors write.
“The most critical message of this study is to emphasize the importance of accurate BP readings,” Dr. Peter S. Bernstein, director of the Division of Maternal Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, told Reuters Health by email.
“Providers may feel that however a BP is obtained, they are getting a true measurement, but that may not be the case,” he cautioned. “There are issues related to proper positioning of the patient, using a suitable device, making sure that the patient has been sitting quietly, etc. More attention needs to focus on this.”
SOURCE: http://bit.ly/2pSUWUb
Hypertension 2017.
Tidak ada komentar:
Posting Komentar