STUDY OBJECTIVE--The aim was to compare the performance of the Dinamap 1846SX automated oscillometric blood pressure recorder with that of the Hawksley random zero sphygmomanometer during use under field study conditions. DESIGN--Two independent within subject measurement comparisons were made, one in adults and one in children, each conducted in three stages over several months while the Dinamap instruments were being used in epidemiological field surveys. SETTING--The studies were done in outpatients clinics (adults) and primary schools (children). PARTICIPANTS--141 adults (20-85 years) and 152 children (5-7 years) took part. MEASUREMENTS AND MAIN RESULTS--In adults a pair of measurements was made with each instrument, the order alternating for consecutive subjects. In children one measurements was made with each instrument, in random order. Measurements with the Dinamap 1846SX were higher than those with the random zero sphygmomanometer both in adults (mean difference 8.1 mm Hg; 95% CI 6.5 to 9.7 mm Hg) and in children (mean difference 8.3 mm Hg; 95% CI 6.9 to 9.7 mm Hg). Diastolic measurements were on average very similar both in adults and in children. The results were consistent at all three stages of both studies. The differences in systolic measurement were independent of blood pressure level. However, the extent of agreement in diastolic pressure depended on the diastolic blood pressure level; in both studies Dinamap diastolic measurements were higher at low diastolic pressures while random zero diastolic measurements were higher at high diastolic pressures. CONCLUSIONS--Systolic measurements made with the Dinamap 1846SX instrument are not directly comparable with those of the Hawksley random zero sphygmomanometer and are unlikely to be comparable with those of earlier Dinamap models. These differences have important implications for clinical practice and for comparisons of blood pressure measurement between epidemiological studies. However, the consistency of measurement by the Dinamap 1846SX over time suggests that the instrument may have a place in standardised blood pressure measurement in the research setting.
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