OPRHealth

 06  Can cuff-based instruments be used to profile blood pressure?

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There are severe drawbacks and limitations associated with legacy cuff-based instruments. The first drawback is built into the process of taking cuff-based measurements which requires that blood flow be interrupted by temporarily crushing the brachial artery in the upper arm. Performing this process a few times is usually not painful but repeating it ninety-six times over twenty-four hours (the ‘golden standard’ in legacy ambulatory blood pressure protocols) can cause severe discomfort and pain. Moreover, the sound generated by these systems can interfere with work and social activities, and are known to disrupt patients’ and their companions’ sleep patterns. These and other factors cause many patients to quit the monitoring process before completing it thereby negating the intended benefits. Even when patients endure the 24-hour process, pain, discomfort, frustrations, and sleep disruptions caused by the repeated inflation and sound of the pressure cuff are known to raise blood pressure. As a result, many of the intended benefits of blood pressure profiling are undermined by these century-old cuff-based methods.

 

The limitations of existing cuff-based instruments are reflected in the limited clinical information they measure and report, i.e., systolic and diastolic pressures and heart rate. These are the same clinically relevant information delivered by the first generations of instruments in the early 1900s – a century ago.  Missing are the underlying components of blood pressure including cardiac output, systemic vascular resistance, and stroke volume that help clinicians pinpoint their relative contributions to each patient’s hypertension. By contrast, the rich information and trends delivered by Biobeat’s ABPM help clinicians craft targeted treatment strategies and verify treatment efficacy. Taken together, the drawbacks and limitations of cuff-based systems limit their clinical value.  

 

 07  Why are vitals beyond blood pressure & heart rate important?

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These additional vitals are important because they reveal the underlying drivers of blood pressure. Specifically, blood pressure is defined as the product of cardiac output and systemic vascular resistance. Cardiac output is defined as the product of stroke volume (the amount of blood pumped every time the heart contracts) times heart rate (the number of times the heart beats each minute). These measurements help doctors better understand and diagnose each patient’s unique blood pressure profile and craft targeted treatment strategies.

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The same detailed information taken during and after the patient starts receiving treatment help doctors evaluate treatment efficacy.  This is important because patients frequently don’t respond to treatment as clinicians expect. Biobeat’s ABPM allows doctors to quickly evaluate and adjust treatment strategies based on individual patient responses. As a result, the times needed to quantify treatment efficacy and identify an effective treatment strategy are greatly reduced, often by a factor of ten, which helps promote patient engagement, compliance, and clinical outcomes.

 

 08  Do 24BP and ABPM require tech/IT upgrades?

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No. There are various deployment models that support different types of medical offices, clinics, and other providers. The majority do not require upgrades to infrastructure. Moreover, Biobeat devices can help providers expand telemedicine and care capacity by shifting long-term blood pressure monitoring and control to patients' homes.

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 10  Do patients require special equipment?

 

Patients need a smartphone running Apple’s IOS or Android OS with Bluetooth connectivity. The sensors connect to smartphones using Bluetooth and use their cellular service to upload measurements to the Biobeat cloud for processing and analysis. Patients need to keep their phones close to the sensor to upload measurements and receive operating instructions and support during the 24-hour profiling period. Patients report that they often forget that they are wearing a sensor, which is evidence that the profiling process is not artificially inflating their blood pressure as can be the case with legacy cuff-based profiling methods.

 

 11  References

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Mohamed Elgendi, Richard Fletcher, Yongbo Liang, Newton Howard, Nigel H. Lovell, Derek Abbott, Kenneth Lim & Rabab Ward, The use of photoplethysmography for assessing hypertension, June 26, 2019,  https://www.nature.com/articles/s41746-019-0136-7

 

Dean Nachman, Yftach Gepner, [...], and Arik Eisenkraft, Comparing blood pressure measurements between a photoplethysmography-based and a standard cuff-based manometry device, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527983/, accessed September 11, 2022

 

John Allen, Photoplethysmography and its application in clinical physiological measurement, National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/17322588/, accessed September 11, 2022

Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas. 2007 Mar;28(3):R1-39. doi: 10.1088/0967-3334/28/3/R01. Epub 2007 Feb 20. PMID: 17322588.

 

Cleveland Clinic, Brachial Artery, https://my.clevelandclinic.org/health/body/22193-brachial-artery, accessed September 11, 2022