title: New clinical validation method for automated sphygmomanometer: a proposal by Japan ISO-WG for sphygmomanometer standard.
abstract: BACKGROUND
  Owing to fast or stepwise cuff deflation, or measuring at places other than the upper arm, the clinical accuracy of most recent automated sphygmomanometers (auto-BPMs) cannot be validated by one-arm simultaneous comparison, which would be the only accurate validation method based on auscultation. Two main alternative methods are provided by current standards, that is, two-arm simultaneous comparison (method 1) and one-arm sequential comparison (method 2); however, the accuracy of these validation methods might not be sufficient to compensate for the suspicious accuracy in lateral blood pressure (BP) differences (LD) and/or BP variations (BPV) between the device and reference readings. Thus, the Japan ISO-WG for sphygmomanometer standards has been studying a new method that might improve validation accuracy (method 3). The purpose of this study is to determine the appropriateness of method 3 by comparing immunity to LD and BPV with those of the current validation methods (methods 1 and 2).
  
  
  METHODS
  The validation accuracy of the above three methods was assessed in human participants [N=120, 45+/-15.3 years (mean+/-SD)]. An oscillometric automated monitor, Omron HEM-762, was used as the tested device.
  
  
  RESULTS
  When compared with the others, methods 1 and 3 showed a smaller intra-individual standard deviation of device error (SD1), suggesting their higher reproducibility of validation. The SD1 by method 2 (P=0.004) significantly correlated with the participant's BP, supporting our hypothesis that the increased SD of device error by method 2 is at least partially caused by essential BPV. Method 3 showed a significantly (P=0.0044) smaller interparticipant SD of device error (SD2), suggesting its higher interparticipant consistency of validation.
  
  
  CONCLUSIONS
  Among the methods of validation of the clinical accuracy of auto-BPMs, method 3, which showed the highest reproducibility and highest interparticipant consistency, can be proposed as being the most appropriate.
authors.affiliation: Omron Healthcare Co. Ltd., Yamanouchi-yamanoshita-cho, Ukyo-ku, Kyoto, Japan. osamu_shirasaki@ohq.omron.co.jp
authors.forename: Osamu
authors.initials: O
authors.lastname: Shirasaki
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Asou
authors.forename: Yukio
authors.initials: Y
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D001795:Blood Pressure Determination / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D019722:Sphygmomanometers / Q000592:standards*