Category Archives: Hypertension

Instant Blood Pressure Smartphone App Does Not Accurately Measure Blood Pressure

The skeptical cardiologist was shocked to hear that there was a smartphone app which he had heretofore been unaware of that claimed to measure blood pressure.

Made by Aura Life and named Instant Blood Pressure, the app was apparently selling like hotcakes on the Apple app store until it was abruptly removed in 2015.

Screen Shot 2016-03-09 at 4.51.12 PM

Users are instructed to put the top edge of the smartphone  on the left side of the chest while placing the right index finger over the smartphone’s camera

Since it was created by “a team of forward-thinking biomedical engineers and software developers” and is to be used to measure one’s blood pressure one might be fooled into thinking that it might accurately measure blood pressure. Don’t be silly!

The IBP web site clearly states:

“Instant Blood Pressure is intended for recreational use only. It is not a replacement or substitute for a cuff or other blood pressure monitor. Instant Blood Pressure’s performance and accuracy characteristics do not meet international standards for a blood pressure monitor intended for clinical use.”

How does one use a blood pressure device that is not really intended to measure blood pressure  for recreational use? Beats me.

A research letter in JAMA Internal Medicine reports that the app is really inaccurate: 77% of patients with hypertensive blood pressure levels were assured that their blood pressure was in the nonhypertensive range.

The authors note:

Between its release on June 5, 2014, and removal on July 30, 2015 (421 days), the IBP app spent 156 days as one of the top 50 best-selling iPhone apps; at least 950 copies of this $4.99 app were sold on each of those days.2Validation of this popular app or any of the similar iPhone apps still available (eg, Blood Pressure Pocket, Quick Blood Pressure Measure and Monitor), have not been performed.

Don’t rely on any smartphone app to accurately measure your blood pressure. None of them have been validated and they are being promoted by charlatans looking for a quick buck off naive consumers.

Excuse me while I check my BP with my Omron 10 real BP monitor. I think it might be really high now.

-ACP

 

The Perfect Christmas Gifts for the Palpitating or Hypertensive In Your Life

As December draws ever closer to the twenty-fifth you may find yourself  behind the wheel of a large automobile puzzling over the perfect gift for your loved ones.

Fear not, for the skeptical cardiologist has a few suggestions to help you.

The Omron 10 Blood Pressure Monitor

IMG_5618
EXTRA-LARGE digits with backlight!!

If your hypertensive friend or relative already has all the standard BP paraphernalia (pill splitter, basic BP cuff), owns a smart phone and has an engineer or scientist approach to data the Omron 10 (BP786, 59.99$ at Best buy.com) just might be the perfect gift.

The skeptical cardiologist recently purchased two (that’s right two) of these in anticipation of Christmas.

Christmas arrives with multiple stressors guaranteed to hike your blood pressure.

The Omron 10 offered three features not available on my basic Walgreen’s BP cuff that I felt were possibly useful:

  1. Averaging/automating three consecutive readings. After reading about the SPRINT BP trial which showed a benefit of aiming for SBP of 120 over 140,  I thought I should try to reproduce the method used in the trial. This involved measuring BP 3 times separated by 5 minutes and averaging the results. The Omron 10 can be set to make and average three BP readings separated by a variable time period.
  2. The ability to communicate with an iPhone or Android smartphone and record and display the data in an app.
  3. Works off both batteries and plug in electrical power.

I thought my dad (a retired chemist) would like the Omron 10’s features but, alas, he informed me that if he wanted to average three BP readings he could just write down the numbers and do the math.

IMG_5670If he had an iPhone he might really like the way the Omron sends its data to the free Omron app.

The app displays BP  and heart rate readings recorded for different time intervals.

You can take a screen shot like I did here or email it and share the data with your doctor through the doctor’s patient portal!

 

The AliveCor Mobile ECG

IMG_6936 copyI’ve mentioned this really cool device a few times (here and here).

It is now listed on Amazon.com for $57 (a significant drop from when I purchased it)  and can be attached to your smartphone case. It does a really good job of recording a single lead electrocardiogram (ECG) and diagnosing normality or atrial fibrillation.

If your friend or loved one  is experiencing periodic fluttering in their chest or a sensation of the heart skipping beats or racing (the general term for which is palpitations) then this could be the perfect gift.

A number of my patients have purchased these and have made ECG recordings which I can review online.

Primarily I have been recommending them to my patients who have atrial fibrillation periodically.

You may think this is too complicated a device to master but last week I saw in my office a 94 year old lady who had had an episode of atrial fibrillation earlier in the year.  Since her last visit she had purchased an AliveCor device and was able to show me the ECG recordings she had made on her iPhone.

May your holiday season be joyous, full of loved ones and free of stressors that raise your blood pressure and cause your heart to pound and race. But if it is not, consider purchasing one of these nifty devices.

Same as it ever was

-ACP

 

 

SPRINT Trial Data Suggest We Should Be Aiming For Lower Blood Pressure Goals

Would you rather have a systolic blood pressure (BP)  of 120 mm Hg or 140 mm Hg?

Prior to a week ago this sometimes skeptical cardiologist thought treating hypertensive patients to the lower BP didn’t necessarily help  avoid death from cardiovascular disease, heart attacks or strokes and that it resulted in more side effects.

Clinical trials have shown that treatment of hypertension reduces the risk of cardiovascular disease outcomes, including stroke (by 35 to 40%), heart attacks (by 15 to 25%), and heart failure (by up to 64%) but the target for systolic blood-pressure lowering has been uncertain.

I wrote in “Home Versus Office Blood Pressure and the “Landmark” NIH Blood Pressure Trial” about the somewhat premature announcement of the SPRINT NIH trial on blood pressure previously.

With the recent  publication of the SPRINT trial data (A Randomized Trial of Intensive versus Standard Blood-Pressure Control — NEJM.) there is now impressive evidence supporting the lower target BP and apparently with minimal side effects.

The SPRINT trial randomized almost ten thousand patients and compared the effects of antihypertensive treatment with a systolic blood pressure (SBP) target of <120 mm Hg (intensive treatment) versus <140 mm Hg (standard treatment).

They studied hypertensive adults ≥50 years of age who had an average SBP of 130–180 mm Hg (the acceptable upper limit decreasing as the number of pretrial antihypertensive medications increased) and were at additional risk for cardiovascular disease (CVD).SPRINT was designed to recruit study participants with an average CVD risk of ≈2% per year, equivalent to a Framingham 10-year CVD risk score of 20%.

To understand if these trial results apply to you it is important to know what patients were enrolled in the study (inclusion and exclusion criteria) and I’ve listed these at the end of this post.

The SPRINT trial found that cardiovascular events like stroke and heart attack and death from these cardiovascular causes was lower by 25% in those patients treated intensively.  Overall death was lower by 27%

Average systolic blood pressure was 121 mm HG in the intensive therapy group and 134 mm Hg in the standard therapy group.

Drugs used were: thiazide-type diuretics, calcium channels blockers, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Other agents, including spironolactone, amiloride, β-blockers, vasodilators, or α-receptor blockers, could be added if necessary. On average, 2.8 drugs were used in the lower BP group versus 1.8 in the higher BP group.

This more intensive BP treatment was surprisingly well tolerated. Very surprisingly, orthostatic hypotension, (drop in BP on standing I talked about in my post on burpees and dizziness) was significantly more common in the standard than in the intensive arm. I would have expected this opposite.

There were  significantly more kidney problems and electrolyte abnormalities in the intensive group compared to the standard therapy group.

This study provides a very powerful argument for shooting for a BP of 120 in many of my patients.

And the skeptical cardiologist (who splits BP pills )will be aiming for a lower BP in himself.

It’s important to replicate how BP was measured in the SPRINT trial if we are to apply the results. As the authors have written elsewhere:

“be mindful of the manner in which BP was measured in the trial: an average of 3 office BP readings taken with proper cuff size, participants seated with their back supported, 5 minutes of rest before measurement, and no conversation during the rest period or BP determinations. In SPRINT, this was achieved using an automated manometer (Omron Healthcare, Lake Forest, IL) that was preset to wait for 5 minutes before measurement, as well as to take and average the 3 readings. BP measurements taken without observing these conditions are likely to overestimate BP6 and result in over treatment, with the potential for higher rates of serious adverse effects and greater utilization of resources.”

Pressurelessly Yours

-ACP

And the entry criteria:

 Increased cardiovascular risk was defined by one or more of the following: clinical or subclinical cardiovascular disease other than stroke; chronic kidney disease, excluding polycystic kidney disease, with an estimated glomerular filtration rate (eGFR) of 20 to less than 60 ml per minute per 1.73 m2 of body-surface area, calculated with the use of the four-variable Modification of Diet in Renal Disease equation; a 10-year risk of cardiovascular disease of 15% or greater on the basis of the Framingham risk score; or an age of 75 years or older. Patients with diabetes mellitus or prior stroke were excluded