title: Assessing agreement of blood pressure-measuring devices in Tibetan areas of China: a systematic review.
abstract: BACKGROUND
  The validity of blood pressure (BP)-measuring tools at very high altitudes is uncertain. Therefore, the objective of this review was to examine the degree of agreement of BP-measuring devices in Tibet.
  
  
  METHODS
  We conducted electronic searches in Medline, Embase, Cinahl, Cochrane Library, Global Health Library and the ISI Web of Science. Randomised and observational studies were considered for inclusion. The methodological characteristics of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Our primary outcome was the difference in mean BP measurements between the new device and the gold standard.
  
  
  RESULTS
  We identified three eligible studies, out of which two with a total of 162 participants were included. The studies differed in their methodology. One study reported significantly higher systolic blood pressure (SBP) measurement with electronic sphygmomanometer (Omron) compared with mercury sphygmomanometer (mean difference 5.8±4.7 mm Hg; p<0.001), with no significant difference in diastolic blood pressure (DBP) measurement (0.4±3.9 mm Hg; p=0.23). The second study reported mean differences of 1.0±5.9 mm Hg and -3.1±4.6 mm Hg for SBP and DBP, respectively.
  
  
  CONCLUSIONS
  The limited evidence from published studies suggests that automated (Omron) BP monitors show a high degree of agreement for DBP when compared against mercury sphygmomanometer at high altitudes. However, the degree of such agreement for SBP is not consistent. Few studies assessing the validity of automated BP monitors at high altitudes have been conducted, and they differ in design and methodology. Further research assessing the suitability of BP-measuring instruments at high altitudes is therefore warranted.
authors.affiliation: Tibetan Medical College, Lhasa, Tibet; Austrian Academy of Science, Vienna, Austria.
authors.forename: Cuomu
authors.initials: C
authors.lastname: Mingji
authors.affiliation: Nuffield Department of Primary Care Health Sciences , Centre for Evidence-Based Medicine, University of Oxford , Oxford , UK.
authors.forename: Igho J
authors.initials: IJ
authors.lastname: Onakpoya
authors.affiliation: Nuffield Department of Primary Care Health Sciences , Centre for Evidence-Based Medicine, University of Oxford , Oxford , UK.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Heneghan
authors.affiliation: Nuffield Department of Primary Care Health Sciences , Centre for Evidence-Based Medicine, University of Oxford , Oxford , UK.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Ward
keywords: EBM; HYPERTENSION