WatchBP Office, An ultimate OBP
WatchBP Office has developed several application configurations in response to primary care, and its extensive application at the primary care can be considered as the ultimate OBP.
As mentioned earlier, the WatchBP series is a range of professional blood pressure monitoring products developed for clinical and home use based on the ESH guidelines. The role of WatchBP Office primarily focuses on clinic-based blood pressure measurement.
Office Blood Pressure Measurement
Typical types of clinic office blood pressure measurement methods are as following.
As blood pressure is one of the fundamental vital signs, measuring blood pressure is essential in primary healthcare. The common method involves the patient sitting down, and the doctor or nurse immediately placing a cuff around the patient’s arm, manually applying pressure, and using a stethoscope to listen for Korotkoff sounds to determine the blood pressure value. Usually, only one measurement is taken.
However, in reality, this type of measurement cannot reflect the patient’s true blood pressure accurately due to the following reasons:
(1) White coat syndrome: Some patients become nervous when they see healthcare professionals, causing their blood pressure to be elevated in the clinic.
(2) Actions during measurement: If a patient comes for a consultation without resting adequately for 5 minutes and is in a rush, their blood pressure will typically be higher. Improper seating during blood pressure measurement, such as having the body partially compressed, can also lead to elevated readings. Therefore, guidelines recommend resting for 5 minutes and sitting upright without crossing legs to obtain a more accurate reflection of the patient’s blood pressure.
(3) Number of measurements: Taking only one measurement makes it challenging to determine its accuracy. It is recommended to take at least two measurements, and if the difference between them is within 5mmHg, the data can be considered reliable. However, guidelines suggest three measurements and averaging the results.
(4) Blood pressure preference in the higher arm: The blood pressure in a person’s two arms may differ. For the treatment of hypertension, guidelines recommend measuring both arms and using the arm with the higher blood pressure as the reference.
From this perspective, obtaining accurate blood pressure values requires following a series of standard operating procedures (SOP). These processes are often overlooked in general clinics, but if the existing equipment is used to perform this SOP, it can be very inconvenient for users. Therefore, Microlife has developed the WatchBP Office blood pressure monitor based on these guidelines, which assists healthcare professionals in correctly measuring blood pressure through an automated process.
The first generation of WatchBP Office
The first generation of the product can be found as below.
he prominent features of this product can be seen in the use of two sets of cuffs to simultaneously measure blood pressure in both arms. The sliding button in the middle allows for selection between three modes: Routine, Auscultation, and Screen.
Let’s first explain the Auscultation mode. In this mode, also known as the Auscultation mode, doctors can choose it if they are concerned about whether the oscillometric method used by automatic blood pressure monitors is suitable for a patient or if they prefer to use the traditional auscultation method to determine blood pressure.
The Screen mode is used during the patient’s initial examination when it is necessary to accurately determine which arm has higher blood pressure and the corresponding values. In this mode, the patient’s blood pressure in both arms is automatically measured three times, and the patient is informed which arm to use for future blood pressure measurements, helping to identify if the patient has hypertension.
During subsequent visits, the Routine mode is used to measure the patient’s reference arm blood pressure three times.
In summary, this provides healthcare professionals with a systematic way to obtain highly reliable blood pressure values.
Additionally, this product features a Bluetooth wireless remote control mode. It is primarily used to reduce the white coat effect (also known as white coat syndrome) in some patients who become nervous in the presence of healthcare professionals, leading to elevated blood pressure. By arranging for the patient to be alone in a small room while the blood pressure measurement is remotely controlled by healthcare professionals outside, the white coat effect can be minimized.
Lastly, due to the functionality of measuring blood pressure in both arms, this product can also assess the difference in blood pressure between the two arms. If the difference exceeds 10mmHg, it may indicate vascular obstruction.
In conclusion, this product provides a systematic and comprehensive approach to cardiovascular measurement.
Derivative, WatchBP Office AFIB
During this period, Microlife also acquired the license of the world’s first technology to detect atrial fibrillation (AFIB) using a blood pressure monitor to measure the pulse. Atrial fibrillation is one of the leading factors causing stroke, along with hypertension. Since this functionality is based on algorithms, it was added to the product without altering its external design.
The standardmethod for detecting atrial fibrillation (AFIB) typically involves using an electrocardiogram (ECG) machine as follows:
ECG operations are complex, and it can be challenging for general physicians to interpret ECG data. Although some machines offer automated interpretation, it is not a convenient approach for primary care clinics.
Traditionally, there is another method called pulse auscultation, which is a simple way of listening to the pulse. However, this method relies on intuitive medicine and lacks accuracy.
In such cases, Microlife’s AFIB detection method can complement the shortcomings of both approaches. Although it may not provide the same level of precision as an ECG, simultaneously detecting AFIB during blood pressure measurement is a practical solution for primary care clinics.
Derivative, WatchBP Office ABI
signed to simultaneously measure blood pressure in both hands and feet, calculating the Ankle-Brachial Index (ABI) for peripheral vascular disease screening. A conceptual device was sent to medical units in Europe for testing, and it was found to perform well. As a result, the development of a device capable of measuring ABI was initiated, and clinical validation was conducted.
The greatest value of this product lies in providing doctors with a convenient ABI measurement device.
ABI, also known as the Ankle-Brachial Index, is the ratio of blood pressure between the upper arm and ankle. By measuring the ratio of blood pressure between the ankle and upper arm, the degree of vascular blockage can be determined.
In healthy individuals, the blood pressure at the ankle is typically higher than that in the upper arm. If the blood flow in the foot arteries is compromised due to the accumulation of substances like fat, the blood pressure at the ankle will be lower than that in the upper arm, resulting in a lower ABI value. The normal range for ABI is 0.9 to 1.3. An ABI value greater than 1.3 may indicate severe vascular calcification and could underestimate the severity of vessel narrowing. An ABI value lower than 0.5 clinically indicates severe limb ischemia with a risk of amputation.
In traditional methods of ABI measurement, doctors not only use a blood pressure cuff but also require a Doppler ultrasound device to measure blood pressure, which is highly inconvenient and can be challenging for some doctors to handle. However, with the WatchBP Office ABI, ABI measurements can be easily obtained using the same procedure as a regular blood pressure measurement.
According to clinical research studies, using the WatchBP Office ABI, the average time required to complete ABI measurements is 5.8 minutes, while traditional Doppler methods take an average of 9.3 minutes. This makes it a very convenient product for primary healthcare professionals.
Derivative, WatchBP Office Central
This is a groundbreaking product from Microlife. Here, “Central” refers to Central BP, which stands for Central Arterial Blood Pressure.
Central BP
The difference between Central Arterial Blood Pressure (Central BP) and the blood pressure typically measured in the upper arm can be explained as follows:
In the item (3) of the above figure , the blood pressure measurement taken in the upper arm is commonly referred to as Peripheral Blood Pressure (PBP) or Brachial Blood Pressure. It represents the blood pressure in the peripheral arteries further away from the heart.
On the other hand, in the item (1), Central Arterial Blood Pressure (Central BP) is depicted. It represents the blood pressure directly outputted from the heart and is measured in the central arteries, such as the aorta.
The distinction between Peripheral BP and Central BP lies in the location of measurement and the proximity to the heart. Peripheral BP is typically measured using a standard blood pressure cuff on the upper arm, while Central BP requires more specialized techniques, such as invasive measurements or non-invasive methods that estimate central pressure based on peripheral measurements.
Central BP provides valuable insights into the hemodynamic characteristics of the cardiovascular system and its impact on vital organs. It is considered to be a more direct indicator of the pressure exerted on the heart, brain, and other vital organs. Monitoring both Peripheral BP and Central BP can provide a comprehensive assessment of an individual’s cardiovascular health.
However, traditional measurement of Central Arterial Blood Pressure (Central BP) involves an invasive procedure using a catheter inserted through the femoral artery in the groin region to reach the aorta for measurement. The equipment used for this invasive procedure is as follows
Obviously, the equipment shown is not suitable for general clinics. Therefore, the current technique utilizes non-invasive methods to estimate Central Arterial Blood Pressure (Central BP) using peripheral arterial blood pressure waveforms. Through waveform analysis techniques, the reflected waves are calibrated and removed to calculate the central arterial blood pressure.
Microlife is honored to have collaborated with Professor Chen Zhen-Huan (陳震寰教授) and Dr. Cheng Hao-Min (鄭浩民醫師)from Taipei Veterans General Hospital to develop a non-invasive technique for measuring central arterial blood pressure. The results obtained were compared with invasive catheter measurements and confirmed to meet the blood pressure standards (at that time, AAMI SP-10).
The author had the privilege of witnessing the first measurement outside the catheterization laboratory, with an accuracy within 1mmHg. The impact of that moment remains unchanged.
As this product focuses on cardiovascular diseases, its design originated from ABI and provides measurements of both central arterial blood pressure and peripheral vascular disease screening.
At this stage, the configuration of WatchBP Office covers almost all major cardiovascular disease screenings (except for one remaining feature). It offers a more convenient and cost-effective solution.
The 2nd Generation of WatchBP Office
The first generation of WatchBP Office was introduced in 2008. After receiving market feedback over the course of 10 years, the second generation product was launched, as shown below.
The representative product of the second generation is WatchBP Office Vascular. In addition to encompassing the previous functions, it now includes PWV (Pulse Wave Velocity), which measures the speed at which the pulse generated by the heart travels through the blood vessels to the hands and feet. The faster the pulse wave velocity, the stiffer the blood vessels. Therefore, PWV measurement provides information about the degree of arterial stiffness and vascular health [Reference 1].
With the introduction of WatchBP Office Vascular, the second generation product now covers all major cardiovascular diagnostic functions. Most importantly, it has made these capabilities accessible at a significantly lower cost, ranging from thousands of dollars instead of starting from tens of thousands of dollars. This affordability empowers primary healthcare providers with the necessary tools to care for patients with cardiovascular diseases.
The modular design of the device allows customers to select the specific functions they require, and they also have the option to upgrade and add additional functionalities in the future by making the necessary payments.
Notes
In conclusion, complicated specialist practice of examining cardiovascular diseases can be simplified to the process like generic blood pressure measurement as following concept.
Based on the characteristics of the product, the most suitable setting for this product would be in the healthcare industry, specifically in Integrated Service Providers (ISPs) or similar types of healthcare providers.
As discussed in Clayton Christensen’s book “The Innovator’s Prescription: A Disruptive Solution for Health Care,” healthcare delivery evolves from intuitive medicine to rule-based medicine. During this evolution, healthcare services and treatments are decentralized and delegated to lower levels of care. In the case of this product, it would involve shifting from specialized cardiology departments to primary care clinics. By strengthening the capabilities of primary care, specialized physicians can focus on managing complex cases. This type of design, which is evidence-based medicine, aims to improve the quality of healthcare and avoid unnecessary waste. It is a niche that aligns well with ISPs and similar healthcare providers.
Furthermore, stringent entities such as Contract Research Organizations (CROs) would also be potential customers for this type of product. Their focus on evidence-based medicine aligns with the design principles of the product, making it a valuable tool for their clinical research efforts.
