Journal Article
Jake R Gibbon,
The Newcastle upon Tyne Hospitals NHS Foundation Trust
, Newcastle upon Tyne NE1 4LP,
UK
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Steve W Parry,The Newcastle upon Tyne Hospitals NHS Foundation Trust
, Newcastle upon Tyne NE1 4LP,
UK
Population Health Science Institute
, Newcastle University, Newcastle upon Tyne NE2 4AX,
UK
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Miles D Witham,The Newcastle upon Tyne Hospitals NHS Foundation Trust
, Newcastle upon Tyne NE1 4LP,
UK
AGE Research Group
, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle,
UK
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Alison Yarnall,The Newcastle upon Tyne Hospitals NHS Foundation Trust
, Newcastle upon Tyne NE1 4LP,
UK
Brain and Movement Research Group
, Translational and Clinical Research Institute, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne,
UK
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James FrithThe Newcastle upon Tyne Hospitals NHS Foundation Trust
, Newcastle upon Tyne NE1 4LP,
UK
Population Health Science Institute
, Newcastle University, Newcastle upon Tyne NE2 4AX,
UK
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Received:
12 January 2022
Revision requested:
11 May 2022
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Jake R Gibbon, Steve W Parry, Miles D Witham, Alison Yarnall, James Frith, Feasibility, reliability and safety of self-assessed orthostatic blood pressure at home, Age and Ageing, Volume 51, Issue 7, July 2022, afac153, //doi.org/10.1093/ageing/afac153
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Abstract
Background
A postural blood pressure assessment is required to diagnose Orthostatic Hypotension. With increasing remote consultations, alternative methods of performing postural blood pressure assessment are required.
Objective
Determine whether postural blood pressure measurement at home, without a clinician, is reliable, feasible and safe.
Design
Service improvement project within a falls and syncope service in Northeast England.
Subjects
Eligibility criteria: aged ≥60 years; postural blood pressure measurement is indicated and is physically and cognitively able to perform.
Exclusion criteria: nursing home residents, attending clinic in person.
Methods
Postural blood pressure measurements were performed in patients’ homes under clinical observation. Patient-led assessments were performed independent of the clinician, following written guidance. This was followed by a clinical-led assessment after 10-minute supine rest.
Outcomes
Agreement between patient and clinician derived postural blood pressure values and diagnosis of Orthostatic Hypotension; intervention safety, feasibility and acceptability.
Results
Twenty-eight patients were eligible and 25 participated (mean age 75, median Clinical Frailty Score five).
There was 95% agreement (Cohen’s kappa 0.90 (0.70, 1.00)) between patient and clinician derived readings to diagnose orthostatic hypotension.
Postural systolic blood pressure drop correlated strongly (r = 0.80), with patient derived readings overestimating by 1 (−6, 3) mmHg. Limits of agreement, determined via Bland Altman analysis, were +17 and −20 mmHg, greater than pre-determined maximum clinically important difference (±5 mmHg).
Twenty participants performed valid postural blood pressure assessments without clinical assistance.
Conclusions
Patient-led postural blood pressure assessment at home is a reliable, safe and acceptable method for diagnosing Orthostatic Hypotension.
© Crown copyright 2022.
This Open Access article contains public sector information licensed under the Open Government Licence v3.0 (//www.nationalarchives.gov.uk/doc/open-government-licence/version/3/).
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