... this page: //medlineplus.gov/ency/article/007482.htm Blood pressure monitors for home To use the sharing features ... may ask you to keep track of your blood pressure at home. To do this, you will need ...
Steen, M.S. van der; Lenders, J.W.M.; Thien, Th.
OBJECTIVE: To study the experiences and complaints of patients who underwent 24 h blood pressure monitoring. METHODS: Two groups of hypertensive patients of a tertiary outpatient clinic were asked to fill in a nine-item questionnaire about the side effects of ambulatory blood pressure monitoring
Lopez, Guillaume; Shuzo, Masaki; Ushida, Hiroyuki; Hidaka, Keita; Yanagimoto, Shintaro; Imai, Yasushi; Kosaka, Akio; Delaunay, Jean-Jacques; Yamada, Ichiro
Continuous monitoring of blood pressure in daily life could improve early detection of cardiovascular disorders, as well as promoting healthcare. Conventional ambulatory blood pressure monitoring (ABPM) equipment can measure blood pressure at regular intervals for 24 hours, but is limited by long measuring time, low sampling rate, and constrained measuring posture. In this paper, we demonstrate a new method for continuous real-time measurement of blood pressure during daily activities. Our method is based on blood pressure estimation from pulse wave velocity (PWV) calculation, which formula we improved to take into account changes in the inner diameter of blood vessels. Blood pressure estimation results using our new method showed a greater precision of measured data during exercise, and a better accuracy than the conventional PWV method.
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels. Accuracy in blood pressure meters is of essence to health, especially in blood pressure monitoring and treatment. The aim of this research was to compare the readings and the sensitivities of some blood pressure monitors in use ...
Lee, Yong Jin
This device provides non-invasive beat-to-beat blood pressure measurements and can be worn over the upper arm for prolonged durations. Phase and waveform analyses are performed on filtered proximal and distal photoplethysmographic (PPG) waveforms obtained from the brachial artery. The phase analysis is used primarily for the computation of the mean arterial pressure, while the waveform analysis is used primarily to obtain the pulse pressure. Real-time compliance estimate is used to refine both the mean arterial and pulse pressures to provide the beat-to-beat blood pressure measurement. This wearable physiological monitor can be used to continuously observe the beat-to-beat blood pressure (B3P). It can be used to monitor the effect of prolonged exposures to reduced gravitational environments and the effectiveness of various countermeasures. A number of researchers have used pulse wave velocity (PWV) of blood in the arteries to infer the beat-to-beat blood pressure. There has been documentation of relative success, but a device that is able to provide the required accuracy and repeatability has not yet been developed. It has been demonstrated that an accurate and repeatable blood pressure measurement can be obtained by measuring the phase change (e.g., phase velocity), amplitude change, and distortion of the PPG waveforms along the brachial artery. The approach is based on comparing the full PPG waveform between two points along the artery rather than measuring the time-of-flight. Minimizing the measurement separation and confining the measurement area to a single, well-defined artery allows the waveform to retain the general shape between the two measurement points. This allows signal processing of waveforms to determine the phase and amplitude changes.
Get the most out of home blood pressure monitoring Checking your blood pressure at home is an important part of managing ... monitors might not give you an accurate reading. Most pharmacies, medical supply stores and some websites sell ...
ambulatory blood pressure recordings in private practice ... position according to established guidelines. ... white-coat effect was defined as a difference of at least 20 .... patients with hypertension: Importance of blood pressure response to ...
Formiga, Francesc; Ferrer, Assumpta; Sobrino, Javier; Coca, Antonio; Riera, Antoni; Pujol, Ramón
The objective of the study is to investigate ambulatory blood pressure monitoring (ABPM) in a sample of Spanish nonagenarians. We also analyzed the misdiagnosis of hypertension and investigated blood pressure (BP) control in treated hypertensive nonagenarians. Twenty-four-hour ABPM was undertaken in a group of 42 nonagenarians. The 24-h mean, daytime BP, nighttime BP and heart rate (HR) were extracted from the ABPM. Sociodemographic data, the ability to perform basic daily activities, measured by the Barthel index (BI) or instrumental activities revealed by the Lawton and Brody index (LI), cognition, and comorbidity were evaluated. Thirty-one subjects were receiving antihypertensive drug treatment. Twenty-four hour, daytime and sleeping pressures averaged 130/65, 131/68 and 128/63mmHg, respectively. Seventeen (40.5%) of the 42 patients had a daytime BP of 135/85 or higher. In terms of the BP pattern, 8 (19%) subjects were dippers, 19 (45%) non-dippers, and 15 (36%) were risers. Five (45.46%) out of 11 patients with no evidence of hypertension (normotensive patients) had a daytime BP of 135/85 or higher. The mean daytime BP was 135/85 or higher in 12 (38.7%) out of 31 nonagenarians who had previously received therapy for hypertension. In, conclusion a high prevalence of hypertension, misdiagnosis and inadequate BP control was found in nonagenarians treated for hypertension.
Gijón Conde, T; Banegas, J R
The early and accurate diagnosis of hypertension is essential given its importance in the development of cardiovascular disease. The boundaries between normal blood pressure (BP) and hypertension are arbitrary and based on the benefits of treating exceeding those of not treating. Conventional BP measurement at the clinic only offers information of a particular time and presents multiple biases dependent on inherent variability of BP and measurement technique itself. Multiple studies have demonstrated the prognosis superiority in the development of cardiovascular disease of ambulatory blood pressure monitoring (ABPM), allows detection of white coat hypertension, avoiding overdiagnosis and overtreatment, and the detection of patients with masked hypertension who are at risk of underdetection and undertreatment. ABPM also assess nightime BP and circadian variability, providing additional prognostic value. ABPM is recognized in the diagnosis of hypertension in 2011 British NICE Guidelines, very argued at the 2013 European Society of Hypertension guidelines, and recommended in the US Preventive Services Task Force in 2015, 2016 Canadian Guidelines and the 2016 Spanish Program of Preventive Activities and Health Promotion (PAPPS). Its generalization is likely to be only a matter of time. Copyright © 2017 Sociedad Española de Hipertension-Liga Española para la Lucha de la Hipertensión Arterial (SEH-LELHA). Publicado por Elsevier España, S.L.U. All rights reserved.
Viera, Anthony J.; Shimbo, Daichi
Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not on antihypertensive medication show elevated blood pressure in a clinical setting but show non-elevated blood pressure averages when assessed by ambulatory blood pressure monitoring. Additionally, readings can be segmented into time windows of particular interest, e.g., mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A non-dipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals dip ≥10% at night, while 30% have non-dipping patterns, when blood pressure remains similar to daytime average, or occasionally rises above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure since they increase accuracy for diagnosis and the prediction of cardiovascular risk. PMID:25107387
Zhang, Yang; Li, Yong; Gao, Shumei; Song, Yilin
A small experimental system is constructed with working principle of continuous blood pressure monitoring based on the volume compensation method. The preliminary experimental results show that the system can collect blood pressure signals at the radial artery effectively. The digital PID algorithm can track the variation of blood pressure. And the accuracy of continuous blood pressure detecting achieve the level of same kind of product.
Palade, D; Iliescu, D; Cotârleţ, Laura; Pandele, G I
Comparison of blood pressure values measured by two methods. 94 hypertensive patients (66 women and 28 men in relation to 2.36/1) were assessed classically and also by ABPM. For statistic evaluation we have used t - Student test, chi2 test, Pearson correlation coefficient and variation coefficient (cv%). It shows significant differences between mean values of systolic and diastolic blood pressure obtained by the 2 methods. ABPM measured values are more accurate compared to clinic, bringing also information on pattern hypertensive therapy.
Obesity in adults has been related to hypertension and abnormal nocturnal dipping of blood pressure, which are associated with poor cardiovascular and renal outcomes. Here, we aimed to resolve the relationship between the degree of obesity, the severity of hypertension and dipping status on ambulatory blood pressure in obese children. A total 72 patients with primary obesity aged 7 to 18 years (mean: 13.48 ± 3.25) were selected. Patients were divided into three groups based on body mass index (BMİ) Z-score. Diagnosis and staging of ambulatory hypertension based on 24-h blood pressure measurements, obtained from ambulatory blood pressure monitoring. Based on our ambulatory blood pressure data, 35 patients (48.6%) had hypertension, 7 (20%) had ambulatory prehypertension, 21 (60%) had hypertension, and 7 patients (20%) had severe ambulatory hypertension. There was a significant relationship between severity of hypertension and the degree of obesity (p lood pressure results and loads were similar between groups. Diastolic and mean arterial blood pressure levels during the night, diastolic blood pressure loads, and heart rate during the day were significantly higher in Group 3 (p lood pressure at night, mean arterial pressure at night, diastolic blood pressure loads and heart rate at day. Increase in BMI Z-score does not a significant impact on daytime blood pressure and nocturnal dipping status.
Concistrè, A; Grillo, A; La Torre, G; Carretta, R; Fabris, B; Petramala, L; Marinelli, C; Rebellato, A; Fallo, F; Letizia, C
Primary hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with primary hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. Twenty-five patients with primary hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h "weighted" Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-primary hyperparathyroidism patients, respectively. Normotensive-primary hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P blood pressure variability is increased in normotensive patients with primary hyperparathyroidism and is reduced by parathyroidectomy, and may potentially represent an additional cardiovascular risk factor in this disease.
Blood Pressure Home Monitoring in Hypertensive Patients Attending a Tertiary ... Sixty percent of the patients were aged 50 - 69 years. ... Patients with high BP readings reported that they exercise more and reduced their daily salt intake.
National Aeronautics and Space Administration — A key component of NASA's human exploration programs is a system that monitors the health of the crew during space missions. The wearable beat-to-beat blood pressure...
Stryker, Trina; Wilson, Merne; Wilson, Thomas W
To evaluate the accuracy of automated digital blood pressure monitoring devices and operators in the community. Also, we tested the effects of a simple education program, and looked for arm-arm differences. Subjects who had bought their own automated digital blood pressure monitor were recruited via an advertisement in the local newspaper. On arrival, they were asked to record their blood pressure exactly as they would at home. The investigator noted any technique deficiencies then corrected them. Blood pressures were then recorded by the investigator and the subject, on opposite arms, simultaneously, and repeated with the arms switched. Finally, subjects recorded their blood pressure again. The subjects' readings were compared to the average of monitor and mercury readings using Bland-Altman methods. A total of 80 subjects were tested. Before educating, subjects' systolic blood pressure (SBP) readings were +5.8+/-6.4 (standard deviation) mmHg greater than the mean of all readings, and diastolic blood pressure (DBP) were +1.3+/-4.0 mmHg; after educating they were +1.3+/-4.0 and -1.3+/-2.7 respectively. The monitors, as a group, were accurate, and met British Hypertension Society and AAMI highest standards. We found no differences among monitors that had been validated (n=26) and those that had not. There were differences between the arms: 5.3+/-5.2 mmHg for SBP and 3.4+/-3.3 mmHg for DBP. Most patients had never been informed by anyone of proper blood pressure measuring techniques. We conclude that home blood pressure measurement, as practiced in our community, is prone to error, mostly due to mistakes by the operator. These can easily be corrected, so that readings become more accurate. Attention should be paid to arm-arm differences.
Møller, Søren; Wiinberg, N; Henriksen, Jens Henrik
Cirrhotic patients have disturbed systemic hemodynamics with reduced arterial blood pressure, but this has not been investigated during daily activity and sleep. Systolic (SBP), diastolic (DBP), and mean arterial blood pressure (MAP), and heart rate (HR) were measured by an automatic ambulant...... device for monitoring blood pressure in 35 patients with cirrhosis and 35 healthy matched controls. During the daytime, SBP, DBP, and MAP were significantly lower in the patients than in the controls (median 118 vs. 127; 70 vs. 78; 86 vs. 94 mm Hg, P blood pressures...... were almost similar in the two groups (108 vs. 110; 65 vs. 67; 78 vs. 82 mm Hg, NS). Conversely, HR was significantly higher in the patients both in the daytime (86 vs. 72/min, P blood pressure and HR from daytime...
Padfield, Paul L
Electronic self-monitoring of blood pressure is increasing in popularity and most international guidelines on the management of hypertension approve cautious use of the technique in the assessment of potentially hypertensive individuals. A recent editorial in the Archives of Internal Medicine suggested that it was "appropriate to encourage the widespread use of self recorded BP as an important adjunct to the clinical care of the patient with hypertension". Such a statement is based on increasing evidence that self-monitoring of blood pressure gives similar information to daytime ambulatory blood pressure -- a now well-established technology in the management of hypertension. Suggested strategies for the use of self-monitoring of blood pressure include monitoring in individuals whose clinical risk status is low enough that they need not necessarily be given medical therapy simply on the basis of a clinic pressure (i.e. at a 10 year risk of cardiovascular disease below 20%). The threshold for defining 'normotension/hypertension' is now regarded as being broadly similar for ABPM and SBPM and is set at 135/85 mmHg. In a recent meta-analysis of all available studies the average difference between these techniques, using the same patients, is -1.7/1.2 mmHg. There is some evidence that careful use of self-monitoring may improve blood pressure control in patients who are otherwise resistant to care. Self-monitoring of blood pressure has now been shown in at least one major prospective study to predict outcome better than clinic pressures and in that setting it now has equivalence to the use of ABPM. There remain issues regarding the availability of validated devices, the quality of training of patients in their use and the possibility that inaccurate recording might occur, either deliberately or by accident. Self-monitoring of blood pressure may well not give the same readings as carefully measured blood pressure by research nurses but its use is clearly superior to
Full Text Available Mia Skov-Madsen, My Svensson, Jeppe Hagstrup ChristensenDepartment of Nephrology, Aarhus University Hospital, Aalborg, DenmarkIntroduction: Twenty four-hour ambulatory blood pressure monitoring is a clinically validated procedure in evaluation of blood pressure (BP. We hypothesised that the discomfort during cuff inflation would increase the heart rate (HR measured with 24-h ambulatory BP monitoring compared to a following HR measurement with a 24-h Holter monitor.Methods: The study population (n = 56 were recruited from the outpatient’s clinic at the Department of Nephrology, Aalborg Hospital, Aarhus University Hospital at Aalborg, Denmark. All the patients had chronic kidney disease (CKD. We compared HR measured with a 24-h Holter monitor with a following HR measured by a 24-h ambulatory BP monitoring.Results: We found a highly significant correlation between the HR measured with the Holter monitor and HR measured with 24-h ambulatory blood pressure monitoring (r = 0.77, p < 0.001. Using the Bland-Altman plot, the mean difference in HR was only 0.5 beat/min during 24 hours with acceptable limits of agreement for both high and low HR levels. Dividing the patients into groups according to betablocker treatment, body mass index, age, sex, angiotensin-converting enzyme inhibitor treatment, statins treatment, diuretic treatment, or calcium channel blocker treatment revealed similar results as described above.Conclusion: The results indicate that the discomfort induced by cuff inflation during 24-h ambulatory BP monitoring does not increase HR. Thus, 24-h ambulatory BP monitoring may be a reliable measurement of the BP among people with CKD.Keywords: ambulatory blood pressure monitoring, Holter monitoring, heart rate, chronic kidney disease, hypertension
A.H. van den Meiracker (Anton)
textabstractAmbulatory blood pressure monitoring (ABPM) is being used increasingly for the evaluation of antihypertensive agents in clinical trials. In this brief review several aspects of ABPM are discussed. In particular, attention is paid to the extent to which ABPM is subject to a placebo
Dec 1, 2012 ... an Alert System Using the Omron 790it Blood Pressure. Monitor ... detailed medical information on the vital signs of patients and will save many lives that may be lost. Keywords: Omron .... at rest, in beats per minute (BPM):.
Purpose: To explore the use of the blood pressure monitors by hypertensive patients in Jordanian homes and investigate their effect on emotional status and disease management, and the role of the pharmacist in this regard. Methods: This cross-sectional study was conducted over two months in 2012, in Amman, Jordan.
Burnier, Michel; Wuerzner, Gregoire
A small proportion of the treated hypertensive population consistently has a blood pressure greater than 140/90 mm Hg despite a triple therapy including a diuretic, a calcium channel blocker, and a blocker of the renin-angiotensin system. According to guidelines, these patients have so-called resistant hypertension. The prevalence of this clinical condition is higher in tertiary than primary care centers and often is associated with chronic kidney disease, diabetes, obesity, and sleep apnea syndrome. Exclusion of pseudoresistant hypertension using ambulatory or home blood pressure monitoring is a crucial step in the investigation of patients with resistant hypertension. Thus, among the multiple factors to consider when investigating patients with resistant hypertension, ambulatory blood pressure monitoring should be performed very early. Among other factors to consider, physicians should investigate patient adherence to therapy, assess the adequacy of treatment, exclude interfering factors, and, finally, look for secondary forms of hypertension. Poor adherence to therapy accounts for 30% to 50% of cases of resistance to therapy depending on the methodology used to diagnose adherence problems. This review discusses the clinical factors implicated in the pathogenesis of resistant hypertension with a particular emphasis on pseudoresistance, drug adherence, and the use of ambulatory blood pressure monitoring for the diagnosis and management of resistant hypertension.
... pressure monitors may have some limitations. Tracking your blood pressure readings It can be helpful in diagnosing or ... more Stage 2 high blood pressure (hypertension) Elevated blood pressure and stages 1 and 2 high blood pressure ( ...
Taylor, R S; Stockman, J; Kernick, D; Reinhold, D; Shore, A C; Tooke, J E
Ambulatory blood pressure monitoring (ABPM) is being increasingly used in general practice. There is at present little published evidence regarding the clinical utility of ABPM in the care of patients with established hypertension in this setting. We examined this issue by undertaking ABPM in a group of patients with established hypertension. 40 patients (aged 33-60 years) currently being treated for hypertension were randomly selected from a general practice list and underwent a single 24-ho...
Agnes S. Meidert
Full Text Available Since both, hypotension and hypertension, can potentially impair the function of vital organs such as heart, brain, or kidneys, monitoring of arterial blood pressure (BP is a mainstay of hemodynamic monitoring in acutely or critically ill patients. Arterial BP can either be obtained invasively via an arterial catheter or non-invasively. Non-invasive BP measurement provides either intermittent or continuous readings. Most commonly, an occluding upper arm cuff is used for intermittent non-invasive monitoring. BP values are then obtained either manually (by auscultation of Korotkoff sounds or palpation or automatically (e.g., by oscillometry. For continuous non-invasive BP monitoring, the volume clamp method or arterial applanation tonometry can be used. Both techniques enable the arterial waveform and BP values to be obtained continuously. This article describes the different techniques for non-invasive BP measurement, their advantages and limitations, and their clinical applicability.
Full Text Available The diagnosis and management of hypertension relies on accurate and precise blood pressure (BP measurements and monitoring techniques. Variability in traditional office based BP readings can contribute to misclassification and potential misdiagnosis of hypertension, leading to inappropriate treatment and possibly avoidable adverse drug events. Both home blood pressure monitoring (HBPM and 24-hour ambulatory blood pressure monitoring (ABPM can improve characterization of BP status over traditional office values and can predict cardiovascular morbidity and mortality risk; however, they are limited by availability and/or practical use in many situations. Available in-office blood pressure measuring methods include manual auscultation, automated oscillometric, and automated office blood pressure (AOBP devices. A strong correlation exists between AOBP and awake ABPM measurements and has been linked to better prediction of end-organ damage and white coat response compared to standard office BP methods. While AOBP does not provide nocturnal BP readings, it can be utilized in several outpatient settings, and has the capability to decrease utilization of ABPM, white coat effect, and improve optimization of cardiovascular assessment, evaluation, and therapeutic assessment in clinical practice. Hypertension affects over 80 million adults in the United States (US and is a major risk factor for cardiovascular morbidity and mortality . The condition’s ubiquitous nature and broad impact potentially makes understanding the diagnosis and treatment of hypertension key elements of managing cardiovascular risk. Though much attention is paid to the treatment of hypertension, from 2009 to 2012, 45.9% of US patients with hypertension were uncontrolled . Appreciating the aspects of proper assessment of blood pressure is crucial and creates the foundation for approaching hypertension management. Until recently, hypertension was defined as an appropriately
Normal blood pressure is important for proper blood flow to the body's organs and tissues. The force of the blood on the walls of the arteries is called blood pressure. Blood pressure is measured both as the heart ...
Klarskov, Pia; Bang, Lia E; Schultz-Larsen, Peter
To compare the effect of a conventional to an intensive blood pressure monitoring regimen on blood pressure in hypertensive patients in the general practice setting. Randomized controlled parallel group trial with 12-month follow-up. One hundred and ten general practices in all regions of Denmark....... One thousand forty-eight patients with essential hypertension. Conventional blood pressure monitoring ('usual group') continued usual ad hoc blood pressure monitoring by office blood pressure measurements, while intensive blood pressure monitoring ('intensive group') supplemented this with frequent...... a reduction of blood pressure. Clinical Trials NCT00244660....
Full Text Available Ambulatory blood pressure monitoring (ABPM became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.
measuring devices, patients' emotional response to their blood pressure readings and actions taken in response. ... pressure, their response regarding different readings, and the .... pivotal position for providing pharmaceutical care services ...
Perry, H; Sheehan, E; Thilaganathan, B; Khalil, A
The majority of patients with chronic or gestational hypertension do not develop pre-eclampsia. Home blood-pressure monitoring (HBPM) has the potential to offer a more accurate and acceptable means of monitoring hypertensive patients during pregnancy compared with traditional pathways of frequent outpatient monitoring. The aim of this study was to determine whether HBPM reduces visits to antenatal services and is safe in pregnancy. This was a case-control study of 166 hypertensive pregnant women, which took place at St George's Hospital, University of London. Inclusion criteria were: chronic hypertension, gestational hypertension or high risk of developing pre-eclampsia, no significant proteinuria (≤ 1+ proteinuria on dipstick testing) and normal biochemical and hematological markers. Exclusion criteria were maternal age 155 mmHg or diastolic blood pressure > 100 mmHg, significant proteinuria (≥ 2+ proteinuria on dipstick testing or protein/creatinine ratio > 30 mg/mmol), evidence of small-for-gestational age (estimated fetal weight < 10 th centile), signs of severe pre-eclampsia, significant mental health concerns or insufficient understanding of the English language. Pregnant women in the HBPM group were taught how to measure and record their blood pressure using a validated machine at home and attended every 1-2 weeks for assessment depending on clinical need. The control group was managed as per the local protocol prior to the implementation of HBPM. The two groups were compared with respect to number of visits to antenatal services and outcome. There were 108 women in the HBPM group and 58 in the control group. There was no difference in maternal age, parity, body mass index, ethnicity or smoking status between the groups, but there were more women with chronic hypertension in the HBPM group compared with the control group (49.1% vs 25.9%, P = 0.004). The HBPM group had significantly fewer outpatient attendances per patient (6
Supriyanti, Retno; Erfayanto, Uji; Ramadani, Yogi; Murdyantoro, Eko; Widodo, Haris B.
Currently, at least 18,000 women die every year in Indonesia due to pregnancy or childbirth. It means that every half hour a woman dies due to pregnancy or childbirth. As a result, every year 36,000 children became orphans. The high maternal mortality rate was put Indonesia on top in ASEAN. The main causes of maternal mortality are high-risk pregnancy. Mothers who have diseases like high blood pressure, pre-eclampsia, diabetes, hyperthyroidism, and already over 40 years old and infectious diseases such as rubella, hepatitis and HIV can be factors that lead to high-risk pregnancy. This paper will discuss the development of a blood pressure monitoring device that is suitable for pregnant women. It is based on convenience for pregnant women to get the equipment that is flexible with her presence. Results indicate that the equipment is in use daily support for pregnant women therefore, one of the causes of maternal mortality can be detected earlier.
Alpay, Harika; Ozdemir, Nihal; Wühl, Elke; Topuzoğlu, Ahmet
The aim of this study was to compare ambulatory blood pressure monitoring (ABPM) parameters in offspring with at least one hypertensive parent (HP) to offspring with normotensive parents (NP) and to determine whether gender of parent or child might influence the association between parental hypertension and blood pressure (BP). Eighty-nine healthy children (mean age 11.1 +/- 3.9 years) with HP and 90 controls (mean age 10.5 +/- 3.1 years) with NP were recruited. Age, gender, and height did not differ between the two groups, whereas children of HP had higher weight, body mass index (BMI), and waist circumference compared with healthy controls. No difference was found in casual BP between the two groups. In contrast, during ABPM daytime and nighttime mean systolic and diastolic BP and mean arterial pressure (MAP) standard deviation scores (SDS) were significantly elevated in children with HP. The mean percentage of nocturnal BP decline (dipping) was not significantly different between the two groups. Children with hypertensive mothers had higher daytime systolic and MAP SDS than controls; no such difference was detected for children with hypertensive fathers. Daytime systolic and MAP SDS were significantly elevated in boys with HP compared with boys with NP but failed to be significant in girls. Multiple linear regression analysis showed that parental history of hypertension (B = 0.29) and BMI (B = 0.03) were independently correlated with increase of daytime MAP SDS. Early changes in ambulatory BP parameters were present in healthy children of HP. BP in HP offspring was influenced by the gender of the affected parent and the offspring.
Ochoa, Adrian; Patarroyo-Aponte, Gabriel; Rahman, Mahboob
Central blood pressure is a novel predictor of cardiovascular risk that can be measured in the clinical setting using currently available technology. This paper will review current available methods of central blood pressure monitoring as well as its impact in cardiac and renal disease. Both aortic and carotid systolic blood pressure are independently associated with cardiovascular mortality and serious cardiac events. Furthermore, studies show that systolic aortic blood pressure has been shown to be superior predictor of cardiovascular as compared to brachial blood pressure. Inhibitors of the renin angiotensin axis may have a beneficial effect on central blood pressure; however, long term studies evaluating the impact of lowering central blood pressure on clinical outcomes are lacking. Central blood pressure is a good predictor of cardiovascular risk. As more studies emerge demonstrating the value of central blood pressure as a therapeutic target, it is possible that targeting central blood pressure may become an important part of the armamentarium to lower cardiovascular risk.
Full Text Available The increased secretion of thyroid gland hormones affects the cardiovascular system by increasing heart rate and often by increasing systolic and diastolic blood pressure. We examined the influence of elevated thyroid hormone on blood pressure. Blood pressure monitoring was performed prior to the introduction of therapy in people with increased FT4 and on therapy when FT4 was in the normal range. We analyzed 32 people, of which 26 women had normal blood pressure values measured by blood pressure monitoring. Average age 45 and body mass index 27 kg/m2. Blood pressure was measured by monitoring blood pressure for 24 hours. On average, before the introduction of the therapy, it was 133/83 mmHg P 96 / min. The blood pressure on average on therapy with tireosuppressive was 128/82 mmHg P 74 / min. The Wilcoxon-Mann-Whitney paired test shows a significant P <0.05 higher systolic blood pressure and pulse rate during the day and night before the treatment, when FT4 was higher, than the time when medication was taking, when the FT4 was in the normal range. No significant difference was found for diastolic blood pressure before the introduction of therapy and during therapy with tireosuppressives. When values of FT4 are increased, monitoring of blood pressure shows significantly higher values of systolic blood pressure and pulse during day and night compared to systolic blood pressure and pulse values when FT4 is in the normal range.
Full Text Available Abstract INTRODUCTION: The study was conducted to define the determinants of suboptimal blood pressure (BP control among hypertensive patients under treatment and explore a predictive model for detecting the patients at risk for increased BP. METHODS: We enrolled 97 patients (40 males, 57 females under treatment for hypertension between June 2006 and May 2007 in Shafa hospital, Kerman, Iran. BP was measured at clinic twice within 5-minute intervals. After setting up ambulatory blood pressure monitoring (ABPM, BP was measured at 30-minute intervals during the day and 60-minute intervals during the night. The frequency of increased BP (more than 140/90 mmHg was included in a regression model as dependent variable and all the others such as age, sex, body mass index (BMI, drugs and baseline clinical measurements as the predictors. RESULTS: Increased BP was detected in 44% (95% CI: 38.79%-49.65% of all measurements during 24-hour monitoring. The frequency of increased BP had a significant relationship with BMI (b=0.35, P=0.001. Clinic's pulse pressure was a significant predicting factor for BP increase (P=0.02. CONCLUSION: BMI and pulse pressure are the best predictors for being hypertensive during lifetime. Ineffective treatment of hypertension is frequent among the hypertensive patients. Keywords: Blood pressure control, Pulse pressure, Ambulatory blood pressure monitoring (ABPM, BMI.
Nobre, Fernando; Mion, Décio
Ambulatory blood pressure monitoring (ABPM) provides relevant data about blood pressure over a 24-h period. The analysis of parameters to determine the blood pressure profile from these data is of great importance. To calculate areas under systolic and diastolic blood pressure curves (SBP-AUC/DBP-AUC) and compare with systolic and diastolic blood pressure load (SBPL/DBPL) and 24-h systolic and diastolic blood pressure (24-h SBP/24-h DBP) in order to determine which provides the best correlation with left ventricular mass index (LVMI). ABPM measurements (1143 individuals) were analyzed to obtain 24-h SBP/24-h DBP, SBPL/DBPL, and SBP-AUC/ DBP-AUC, using Spacelabs (90207) and CardioSistemas devices. Left ventricular mass was determined using an echocardiograph HP Sonos 5500 and LVMI was calculated. The correlations between all possible pairs within the group 24-h SBP/SBPL/SBP-AUC and 24-h DBP/DBPL/DBP-AUC were high and statistically significant. The correlations between 24-h SBP/24-h DBP and SBP-AUC/DBP-AUC with SBPL/DBPL close to 100%, were lower than those mentioned above. The correlations of the parameters obtained by ABPM with LVMI were also high and statistically significant, except for blood pressure load between 90 and 100%, and for 24-h SBP of 135 mmHg or less and SBPL higher than 50%. SBPL/DBPL and SBP-AUC/DBP-AUC can be used for the evaluation of ABPM data owing to the strong correlation with 24-h SBP/24-h DBP and with LVMI, except when SBPL is close to 100% or 24-h SBP is below 135 mmHg but SBPL is above 50%. SBP-AUC/DBP-AUC, however, are a better alternative because they do not have the limitations of blood pressure load or even of 24-h blood pressure present.
Brguljan-Hitij, Jana; Thijs, Lutgarde; Li, Yan
BACKGROUND: Guidelines propose classification of conventional blood pressure (CBP) into normotension (<120/<80 mm Hg), prehypertension (120-139/80-89 mm Hg), and hypertension (≥140/≥90 mm Hg). METHODS: To assess the potential differential contribution of ambulatory blood pressure (ABP) in predict......BACKGROUND: Guidelines propose classification of conventional blood pressure (CBP) into normotension (ABP......%) and of cardiovascular (-34%), cardiac (-33%), or cerebrovascular (-47%) events. Multivariable-adjusted hazard ratios (HRs) for stroke associated with 24-hour and daytime diastolic ABP (+5 mm Hg) were higher (P ≤ 0.045) in normotension than in prehypertension and hypertension (1.98 vs.1.19 vs.1.28 and 1.73 vs.1.09 vs. 1.......24, respectively) with similar trends (0.03 ≤ P ≤ 0.11) for systolic ABP (+10 mm Hg). However, HRs for fatal endpoints and cardiac events associated with ABP did not differ significantly (P ≥ 0.13) across CBP categories. Of normotensive and prehypertensive participants, 7.5% and 29.3% had masked hypertension...
Kang, Yuan-Yuan; Chen, Qi; Li, Yan; Wang, Ji-Guang
This study aimed to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor SCIAN LD-735 for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were measured sequentially in 33 adult Chinese participants (10 women, mean age 44.8 years) using a mercury sphygmomanometer (two observers) and the SCIAN LD-735 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The SCIAN LD-735 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 86/99, 97/99, and 98/99, respectively, for systolic blood pressure and 85/99, 98/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. In total, 30 and 33 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥24). No participant had all of the three device-observer comparisons greater than 5 mmHg for systolic or diastolic blood pressure. The SCIAN wrist blood pressure monitor LD-735 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.
Kang, Yuan-Yuan; Chen, Qi; Liu, Chang-Yuan; Li, Yan; Wang, Ji-Guang
The aim of the present study was to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor AVITA BPM17 for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese (19 men, 45.7 years of mean age) using a mercury sphygmomanometer (two observers) and the AVITA BPM17 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The AVITA BPM17 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 94/99, 98/99, and 98/99, respectively, for systolic blood pressure and 92/99, 99/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Overall, 32 participants for both systolic and diastolic blood pressure, respectively, had at least two of the three device-observerss differences within 5 mmHg (required ≥24). None had all the three device-observers comparisons greater than 5 mmHg for systolic and diastolic blood pressure. The AVITA wrist blood pressure monitor BPM17 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.
Kang, Yuan-Yuan; Zeng, Wei-Fang; Zhang, Lu; Li, Yan; Wang, Ji-Guang
The present study aimed to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor AVITA BPM15S for home blood pressure monitoring according to the International Protocol revision 2010 of the European Society of Hypertension. Systolic and diastolic blood pressures were sequentially measured in 33 Chinese adults (15 women, mean age 51 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM15S device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The AVITA BPM15S device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and observers within 5, 10, and 15 mmHg were 85/99, 94/99, and 98/99, respectively, for systolic blood pressure, and 82/99, 96/99, and 98/99, respectively, for diastolic blood pressure. The device also achieved the criteria in part 2 of the validation study. Thirty-two and 28 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥ 24). No participant had all of the three device-observer comparisons greater than 5 mmHg for systolic or diastolic blood pressure. The AVITA wrist blood pressure monitor BPM15S fulfilled the requirements of the International Protocol revision 2010 and hence can be recommended for home use in an adult population.
Executive Summary Objective The objective of this health technology assessment was to determine the clinical effectiveness and cost-effectiveness of 24-hour ambulatory blood pressure monitoring (ABPM) for hypertension. Clinical Need: Condition and Target Population Hypertension occurs when either systolic blood pressure, the pressure in the artery when the heart contracts, or diastolic blood pressure, the pressure in the artery when the heart relaxes between beats, are consistently high. Blood pressure (BP) that is consistently more than 140/90 mmHg (systolic/diastolic) is considered high. A lower threshold, greater than 130/80 mmHg (systolic/diastolic), is set for individuals with diabetes or chronic kidney disease. In 2006 and 2007, the age-standardized incidence rate of diagnosed hypertension in Canada was 25.8 per 1,000 (450,000 individuals were newly diagnosed). During the same time period, 22.7% of adult Canadians were living with diagnosed hypertension. A smaller proportion of Canadians are unaware they have hypertension; therefore, the estimated number of Canadians affected by this disease may be higher. Diagnosis and management of hypertension are important, since elevated BP levels are related to the risk of cardiovascular disease, including stroke. In Canada in 2003, the costs to the health care system related to the diagnosis, treatment, and management of hypertension were over $2.3 billion (Cdn). Technology The 24-hour ABPM device consists of a standard inflatable cuff attached to a small computer weighing about 500 grams, which is worn over the shoulder or on a belt. The technology is noninvasive and fully automated. The device takes BP measurements every 15 to 30 minutes over a 24-to 28-hour time period, thus providing extended, continuous BP recordings even during a patient’s normal daily activities. Information on the multiple BP measurements can be downloaded to a computer. The main detection methods used by the device are auscultation and
Zhang, Lu; Kang, Yuan-Yuan; Zeng, Wei-Fang; Li, Yan; Wang, Ji-Guang
The present study aimed to evaluate the accuracy of the Rossmax CF175 upper-arm blood pressure monitor for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese (17 women, mean age 46 years) using a mercury sphygmomanometer (two observers) and the Rossmax CF175 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the blood pressure requirements were fulfilled. The Rossmax CF175 device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and observers within 5, 10, and 15 mmHg was 78/99, 94/99, and 98/99, respectively, for systolic blood pressure, and 81/99, 96/99, and 97/99, respectively, for diastolic blood pressure. The device also achieved the criteria in part 2 of the validation study. Twenty-nine participants, for both of systolic and diastolic blood pressure, had at least two of the three device-observers differences within 5 mmHg (required ≥24). Only one participant for diastolic blood pressure had all three device-observers comparisons greater than 5 mmHg. The Rossmax automated oscillometric upper-arm blood pressure monitor CF175 fulfilled the requirements of the International Protocol revision 2010, and hence can be recommended for blood pressure measurement in adults.
Kang, Yuan-Yuan; Zeng, Wei-Fang; Liu, Ming; Li, Yan; Wang, Ji-Guang
The present study aimed to evaluate the accuracy of the AVITA BPM63S upper arm blood pressure monitor for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese (14 women, mean age of 47 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM63S device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the blood pressure requirements were fulfilled. The AVITA BPM63S device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 68/99, 89/99, and 96/99, respectively, for systolic blood pressure, and 75/99, 95/99, and 97/99, respectively, for diastolic blood pressure. The device also achieved the criteria in part 2 of the validation study. Twenty-four and 25 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observers differences within 5 mmHg (required ≥24). One and two participants for systolic and diastolic blood pressure, respectively, had all three device-observers differences greater than 5 mmHg. The AVITA BPM63S automated oscillometric upper arm blood pressure monitor has passed the requirements of the International Protocol revision 2010, and hence can be recommended for blood pressure measurement at home in adults.
Zhang, Yi; Wang, Jie; Huang, Qi-Fang; Sheng, Chang-Sheng; Li, Yan; Wang, Ji-Guang
This study aimed to evaluate the accuracy of the automated oscillometric upper arm blood pressure monitor LD-578 (HONSUN Group, Shanghai, China) for home blood pressure monitoring according to the International Protocol. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese using a mercury sphygmomanometer (two observers) and the LD-578 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 15 participants in phase 1 and a further 18 participants in phase 2 of the validation study. Data analysis was performed using the ESHIP Analyzer. The LD-578 device successfully passed phase 1 of the validation study with a number of absolute differences between device and observers within 5, 10, and 15 mmHg for at least 32 of 45, 41 of 45, and 45 of 45 measurements (required 25, 35, and 40), respectively. The device also achieved the targets for phase 2.1, with 67 of 99, 90 of 99, and 98 of 99 differences within 5, 10, and 15 mmHg, respectively, for systolic blood pressure, and with 69 of 99, 95 of 99, and 98 of 99 within 5, 10, and 15 mmHg, respectively, for diastolic blood pressure. In phase 2.2, 24 participants had at least two of the three device-observers differences within 5 mmHg (required >or=22) for systolic and diastolic blood pressure. The HONSUN upper arm blood pressure monitor LD-578 can be recommended for home use in adults.
Vornovitsky, Michael; McClintic, Benjamin R; Beck, G Ronald; Bisognano, John D
The variability of blood pressure (BP) makes any single measurement a poor indicator of a patient's true BP. Multiple studies have confirmed the superiority of ambulatory BP measurements over clinic BP measurements in predicting cardiovascular risk; however, this method presents the problem of patient acceptance as it causes frequent arm discomfort and sleep disturbance. We hypothesized that 6 h of daytime BP measurements would result in slightly higher BP readings, yet reveal similar clinical decision making when compared to 24 h of BP measurements. The source for writing this article was a retrospective analysis of 30 patients who underwent ambulatory BP monitoring. Data obtained included: age, sex, ethnicity, baseline medical problems, medications, laboratory values, reason given for ordering 24-h ambulatory BP measurements, ambulatory BP measurements, and a subsequent decision to change medication. The average BP of the 24-h measurements was 127/75 mm Hg and the average BP of the 6-h daytime measurements was 131/79 mm Hg (SD 15, p = 0.009). Twenty-six out of 30 patients were at goal or pre-hypertensive. Two out of 30 patients had stage 1 hypertension and 2 out of 30 patients had stage 2 hypertension. Thirteen out of 30 patients had nocturnal dipping. Twelve out of 30 patients had a change in medication, but those changes were not associated with the presence or absence of nocturnal dipping (p = 0.5) or other factors beyond mean BP. Although there was a statistically significant, 4 mm Hg systolic difference between 24-h and 6-h average BP readings, there was no evidence that this difference led to changes in clinical management. The presence or absence of nocturnal dipping was not associated with a change in medication. We conclude that 6-h daytime ambulatory BP measurements provide sufficient information to guide clinical decision making without the problems of patient acceptance, arm discomfort, and sleep disturbance associated with 24-h BP measurements.
Wolak, Talya; Wilk, Lior; Paran, Esther; Wolak, Arik; Gutmacher, Bella; Shleyfer, Elena; Friger, Michael
The aim of this investigation was to find a time segment in which average blood pressure (BP) has the best correlation with 24-hour BP control. A total of 240 patients with full ambulatory BP monitoring (ABPM) were included; 120 had controlled BP (systolic BP [SBP] ≤135 mm Hg and diastolic BP [DBP] ≤85 mm Hg) and 120 had uncontrolled BP (SBP >135 mm Hg and/or DBP >85 mm Hg). Each ABPM was divided into 6- and 8-hour segments. Evaluation for correlation between mean BP for each time segment and 24-hour BP control was performed using receiver operating characteristic curve analysis and Youden's index for threshold with the best sensitivity and specificity. The mean BP in the following segments showed the highest area under the curve (AUC) compared with average controlled 24-hour BP: SBP 2 am to 8 am (AUC, 0.918; threshold value of 133.5 mm Hg, sensitivity-0.752 and specificity-0.904); SBP 2 pm to 10 pm (AUC, 0.911; threshold value of 138.5 mm Hg, sensitivity-0.803 and specificity-0.878); and SBP 6 am to 2 pm (AUC, 0.903; threshold value of 140.5 mm Hg, sensitivity-0.778 and specificity-0.888). The time segment 2 pm to 10 pm was shown to have good correlation with 24-hour BP control (AUC >0.9; sensitivity and specificity >80%). This time segment might replace full ABPM as a screening measure for BP control or as abbreviated ABPM for patients with difficulty in performing full ABPM. © 2013 Wiley Periodicals, Inc.
Stergiou, George S; Palatini, Paolo; Asmar, Roland; Bilo, Grzegorz; de la Sierra, Alejandro; Head, Geoff; Kario, Kazuomi; Mihailidou, Anastasia; Wang, Jiguang; Mancia, Giuseppe; O'Brien, Eoin; Parati, Gianfranco
The European Society of Hypertension (ESH) Working Group on Blood Pressure (BP) Monitoring and Cardiovascular Variability organized a Teaching Course on 'Blood Pressure Monitoring: Theory and Practice' during the 2017 ESH Meeting in Milan, Italy. This course performed by 11 international BP monitoring experts covered key topics of BP monitoring, including office BP measurement, ambulatory BP monitoring, home BP monitoring, ambulatory versus home BP, white-coat and masked hypertension, cuff use, and BP variability. This article presents a summary of the proceedings of the ESH BP Monitoring Teaching Course, including essential information, practical issues, and recommendations on the clinical application of BP monitoring methods, aiming to the optimal management of patients with suspected or diagnosed hypertension.
Halberg, Franz; Mult, Hc; Cornélissen, Germaine; Hillman, Dewayne; Beaty, Larry A; Hong, Shiyu; Schwartzkopff, Othild; Watanabe, Yoshihiko; Otsuka, Kuniaki; Siegelova, Jarmila
To detect vascular variability anomalies (VVAs), a blood pressure and heart rate profile around the clock for at least 7 days is a start. As a minimum, measurement every 60 or preferably 30 minutes for a week is needed, to be continued if abnormality is found, to assess the about 24-hour (circadian) variability that exists in all individuals. As a first dividend, one then also obtains a glimpse of 2 of the very many longer-than-circadian periodicities, the biological half-week and week. Certainly if we can have sensors and computer chips in our cars that continuously monitor the pressure over a tire's life, we should be able to do the same job for ourselves for diagnostic and therapeutic decisions. Healthcare today emphasizes wellness with recommendations for exercise and a proper diet, yet these evaluations may not be adequate. BP may be measured at a visit to the doctor or before an exercise session, along with measuring body weight and performing a physical exam. The seeds of disease are planted long before they are visible, and what appears to be normal from a conventional point of view may in fact actually be abnormal. Hidden alterations of physiological function, masked by the body's remarkable adaptive capabilities, may become visible through a new diagnostic and therapeutic realm-chronobiology-that reveals hitherto unseen abnormalities. The tools of chronobiology may yield additional dividends, such as the detection of physiological "loads" related to stress and stress relief and the undesirable effcts of space weather upon personal events such as sudden cardiac death, societal events like terrorism and war, and natural disasters. Chronobiologi cally interpreted automatic ambulatory BP and heart rate (HR) monitoring (C-ABPM) may detect the antecedents of these types of events. C-ABPM is of interest in preventive cardiology, since it reveals new diagnoses as vascular variability anomalies (VVAs) and renders previous conventional diagnoses more reliable, such
Manning, Gillian; Donnelly, Richard
Use of home blood-pressure monitoring is increasing but the technique and the equipment have limitations. We provide an overview of recent evidence in this rapidly evolving field. Home blood-pressure monitoring is an acceptable method for screening patients for hypertension. There is increasing evidence supporting the predictive power of home blood pressure for stroke risk even in the general population. The identification of white-coat and masked hypertension remains an important role for home blood-pressure monitoring. Unvalidated equipment and poor patient technique are major concerns. The purchase of devices needs to be linked to a simple patient-education programme, which is perhaps an opportunity for collaboration between healthcare providers and commercial companies. Devices that store the blood-pressure measurements in the memory are preferred to ensure accuracy of reporting. Data-transmission systems providing automatic storage, transmission and reporting of blood pressure, direct involvement of the patient and potentially a reduced number of hospital/general practitioner visits, offer significant advantages. To reduce patient anxiety, overuse of home blood-pressure monitoring should be avoided but there is the potential for self-modification of treatment, subject to certain safeguards. Self-monitoring of blood pressure is developing rapidly, linked to increasing awareness of the impact of reducing high blood pressure on public health and the marketing/advertising strategies used to sell automatic devices. Home blood-pressure monitoring has a role in the detection and management of blood pressure, but not at the expense of careful blood-pressure measurement in the office and adherence to national guidelines.
Huang, Jinhua; Li, Zhijie; Li, Guimei; Liu, Zhaoying
This study aimed to evaluate the accuracy of the Andon KD-5965 upper-arm blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adults, with 20 women using a mercury sphygmomanometer (two observers) and the Andon KD-5965 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The device achieved the targets in part 1 of the validation study. The number of absolute differences between the device and observers within 5, 10, and 15 mmHg was 70/99, 91/99, and 98/99, respectively, for systolic blood pressure and 81/99, 99/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Twenty-five and 29 participants, for systolic and diastolic blood pressure, respectively, had at least two of the three device-observers differences within 5 mmHg (required≥24). Two and one participants for systolic and diastolic blood pressure, respectively, had all three device-observers comparisons greater than 5 mmHg. According to the validation results, with better performance for diastolic blood pressure than that for systolic blood pressure, the Andon automated oscillometric upper-arm blood pressure monitor KD-5965 fulfilled the requirements of the European Society of Hypertension International Protocol revision 2010, and hence can be recommended for blood pressure measurement in adults.
Klarskov, Pia; Bang, Lia E; Schultz-Larsen, Peter; Gregers Petersen, Hans; Benee Olsen, David; Berg, Ronan M G; Abrahamsen, Henrik; Wiinberg, Niels
To compare the effect of a conventional to an intensive blood pressure monitoring regimen on blood pressure in hypertensive patients in the general practice setting. Randomized controlled parallel group trial with 12-month follow-up. One hundred and ten general practices in all regions of Denmark. One thousand forty-eight patients with essential hypertension. Conventional blood pressure monitoring ('usual group') continued usual ad hoc blood pressure monitoring by office blood pressure measurements, while intensive blood pressure monitoring ('intensive group') supplemented this with frequent home blood pressure monitoring and 24-hour ambulatory blood pressure monitoring. Mean day- and night-time systolic and diastolic 24-hour ambulatory blood pressure. Change in systolic and diastolic office blood pressure and change in cardiovascular risk profile. Of the patients, 515 (49%) were allocated to the usual group, and 533 (51%) to the intensive group. The reductions in day- and night-time 24-hour ambulatory blood pressure were similar (usual group: 4.6 ± 13.5/2.8 ± 82 mmHg; intensive group: 5.6 ± 13.0/3.5 ± 8.2 mmHg; P = 0.27/P = 0.20). Cardiovascular risk scores were reduced in both groups at follow-up, but more so in the intensive than in the usual group (P = 0.02). An intensive blood pressure monitoring strategy led to a similar blood pressure reduction to conventional monitoring. However, the intensive strategy appeared to improve patients' cardiovascular risk profile through other effects than a reduction of blood pressure. Clinical Trials NCT00244660. © The Author 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Wagner, Stefan Rahr; Toftegaard, Thomas Skjødeberg; Bertelsen, Olav Wedege
This paper proposes a novel technique to increase the validity of home blood pressure monitoring by using various sensor technologies as part of an intelligent environment platform in the home of the user. A range of recommendations exists on how to obtain a valid blood pressure but with the devi......This paper proposes a novel technique to increase the validity of home blood pressure monitoring by using various sensor technologies as part of an intelligent environment platform in the home of the user. A range of recommendations exists on how to obtain a valid blood pressure...
Full Text Available The aim of present work is to study the frequency of hypertension and the peculiarity of 24-hour blood pressure monitoring in patients with rheumatoid arthritis. We studied 584 patients with rheumatoid arthritis. Daily blood pressure monitoring was carried out in 46 patients with arthritis and 18 patients with essential hypertension. Frequency of hypertension was higher in patients with arthritis then in general population. Elevation of systolic blood pressure, heart rate and arterial blood pressure adequate decrease at night were developed to associate with advance of the disease.
Gorostidi, Manuel; Banegas, José R; de la Sierra, Alejandro; Vinyoles, Ernest; Segura, Julián; Ruilope, Luis M
Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, that is the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected one of three patients in each office status. On the other hand, rates of ambulatory blood pressure control (50%) doubled those of office blood pressure control (25%), still remaining half the patients uncontrolled. We think that a systematic use of ambulatory blood pressure monitoring, and strategies to improve blood pressure control constitute key priorities in hypertension management. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.
Wiesel, Joseph; Arbesfeld, Benjamin; Schechter, David
Screening for atrial fibrillation (AF) by assessing the pulse is recommended in high-risk patients. Some clinical trials demonstrated that the Microlife blood pressure monitor (BPM) with AF detection is more accurate than pulse palpation. This led to a change in practice guidelines in the United Kingdom where AF screening with the Microlife device is recommended instead of pulse palpation. Many BPMs have irregular heart beat detection, but they have not been shown to detect AF reliably. Recently, one study, in a highly select population, suggested that the Omron BPM with irregular heart beat detection has a higher sensitivity for AF than the Microlife BPM. We compared the Microlife and Omron BPMs to electrocardiographic readings for AF detection in general cardiology patients. Inclusion criteria were age≥50 years without a pacemaker or defibrillator. A total of 199 subjects were enrolled, 30 with AF. Each subject had a 12-lead electrocardiography, 1 Omron BPM reading, and 3 Microlife BPM readings as per device instructions. The Omron device had a sensitivity of 30% (95% confidence interval [CI] 15.4% to 49.1%) with the sensitivity for the first Microlife reading of 97% (95% CI 81.4% to 100%) and the Microlife readings using the majority rule (AF positive if at least 2 of 3 individual readings were positive for AF) of 100% (95% CI 85.9% to 100%). Specificity for the Omron device was 97% (95% CI 92.5% to 99.2%) and for the first Microlife reading of 90% (95% CI 83.8% to 94.2%) and for the majority rule Microlife device of 92% (95% CI 86.2% to 95.7%; p<0.0001). The specificity of both devices is acceptable, but only the Microlife BPM has a sensitivity value that is high enough to be used for AF screening in clinical practice. Copyright © 2014 Elsevier Inc. All rights reserved.
James, Kirstyn; Dolan, Eamon; O'Brien, Eoin
Ambulatory blood pressure measurement (ABPM), although recommended for the diagnosis and management of hypertension, has limited availability. The objective of this study was to show that if the characteristics of patients attending pharmacies for ABPM are similar to those attending primary care, the technique can be made more widely available to patients through pharmacies. A comparative study using a software program that allowed central collection, analysis and comparison of ABPM data from patients attending primary care and pharmacies for assessment of hypertension in Ireland. ABPM data from 46 978 patients attending primary care were compared with 1698 attending pharmacies between 2007 and 2013. The age, sex and blood pressure characteristics of patients attending primary care and pharmacies were similar. The mean pressures in all categories, except for systolic blood pressure recorded in primary care, were higher in men. The first ABPM measurements recorded in pharmacies were slightly higher than those in primary care (150.8 ± 19.5/88.7 ± 13.7 vs. 149.6 ± 20.7/88.0 ± 14.4 mmHg). More patients attending primary care were normotensive than those attending pharmacies (19.5 vs. 16.4%), whereas more patients attending pharmacies were hypertensive than those attending primary care (62.8 vs. 60.7%), particularly female patients (61.0 vs. 56.4%). White-coat hypertension was similar in patients attending primary care and pharmacies (19.8 vs. 20.8%), but it was more prevalent in men attending pharmacies (22.0 vs. 17.4%) and in women attending primary care (21.9 vs. 19.7%). There were more dippers in pharmacy then primary care ABPMs (84.7 vs. 79.4%). A preference for having ABPM on Fridays and Saturdays was evident in patients attending pharmacies (19.6 vs. 6.6%), whereas there was a preference for early morning recording in primary care (4.1 vs. 1.1%). This study, which is the first to report on ABPM data from the pharmacy setting, shows that the blood pressure
Zeng, Wei-Fang; Huang, Qi-Fang; Sheng, Chang-Sheng; Li, Yan; Wang, Ji-Guang
The present study aimed to evaluate the accuracy of the automated oscillometric wrist blood pressure monitor BP210 for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese participants (21 women, 51 years of mean age) using a mercury sphygmomanometer (two observers) and the BP210 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 15 participants in phase 1 and a further 18 participants in phase 2 of the validation study. Data analysis was conducted using the ESHIP analyzer. The BP210 device successfully passed phase 1 of the validation study with a number of absolute differences between device and observers within 5, 10, and 15 mmHg for at least 33/45, 44/45, and 44/45 measurements, respectively. The device also achieved the targets for phase 2.1, with 77/99, 95/99, and 97/99 differences within 5, 10, and 15 mmHg, respectively for systolic blood pressure, and with 78/99, 97/99, and 99/99 within 5, 10, and 15 mmHg, respectively for diastolic blood pressure. In phase 2.2, 29 and 25 participants had at least two of the three device-observers differences within 5 mmHg (required≥22) for systolic blood pressure and diastolic blood pressure, respectively. The Kingyield wrist blood pressure monitor BP210 has passed the International Protocol requirements, and hence can be recommended for home use in adults.
Shimbo, Daichi; Abdalla, Marwah; Falzon, Louise; Townsend, Raymond R.; Muntner, Paul
Hypertension, a common cardiovascular disease (CVD) risk factor, is usually diagnosed and treated based on blood pressure readings obtained in the clinic setting. Blood pressure may differ considerably when measured in the clinic versus outside of the clinic setting. Over the past several decades, evidence has accumulated on two approaches for measuring out-of-clinic blood pressure: ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). Blood pressure measures on ABPM and HBPM each have a stronger association with CVD outcomes than clinic blood pressure. Controversy exists whether ABPM or HBPM is superior for estimating CVD risk, and under what circumstances these methods should be used in clinical practice for assessing out-of-clinic blood pressure. This review describes ABPM and HBPM procedures, the blood pressure phenotypic measures that can be ascertained, and the evidence that supports the use of each approach to measure out-of-clinic blood pressure. This review also describes barriers to the successful implementation of ABPM and HBPM in clinical practice, proposes core competencies for the conduct of these procedures, and highlights important areas for future research. PMID:26457954
Lihme, Frederikke F; Madsen, Mette E; Lykke, Jacob A
arterial blood pressure (MAP) and were compared using the paired sample t-test. Mean values and differences of systolic and diastolic pressure were plotted in Bland-Altman plots to test the agreement of the measurements. Finally, a mean evaluation score was calculated. RESULTS: One hundred pregnant women...... and instructed each participant in correct measurement and then took three measurements on both arms. The participant then repeated the measurements and filled an evaluation questionnaire. We used a validated semiautomatic device for all measurements. Mean values were calculated for systolic, diastolic and mean...... were included in the study. Mean values of systolic, diastolic and MAP were 110.6, 69.7 and 83.3 mmHg, respectively, as assessed by the hospital staff. The corresponding self-measurements were 111.4, 70.2 and 83.9 mmHg, respectively. Mean differences between hospital and self-measurements were 0.79 mm...
Seidlerová, Jitka; Gelžinský, Julius; Mateřánková, Markéta; Ceral, Jiří; König, Petr; Filipovský, Jan
Several papers reported that unattended automated office blood pressure (uAutoOBP) is closely related to daytime ambulatory blood pressure monitoring (ABPM). In the present study, we aim to study uAutoOBP and its relation to 24-hour ABPM and ABPM variability. Stable treated hypertensive subjects were examined in two Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP three times with auscultatory method (AuscOBP) by the physician. ABPM was performed within one week from the clinical visit. Data on 98 subjects aged 67.7 ± 9.3 years with 24-hour ABPM 120.3 ± 10.6/72.7 ± 7.9 mm Hg are reported. uAutoOBP was lower than 24-hour (by -5.2 ± 11.3/-0.5 ± 6.9 mm Hg) and daytime (by -6.7 ± 12.82.4 ± 8.0 mm Hg) ABPM and the individual variability of the difference was very large (up to 30 mm Hg). The correlation coefficients between ABPM and uAutoOBP were similar compared to AuscOBP (p ≥ .17). Variability of uAutoOBP, but not AuscOBP, readings during one clinical visit was related to short-term blood pressure variability of ABPM. The difference between AuscOBP and uAutoOBP was larger in patients with white-coat effect compared to other blood pressure control groups (25.1 ± 7.0 vs. 2.2 ± 10.3 mm Hg; p = .0036). Our study shows that uAutoOBP is not good predictor of ambulatory blood pressure monitoring, not even of the daytime values. It might, however, indicate short-term blood pressure variability and, when compared with AuscOBP, also detect patients with white-coat effect.
Lei, Lei; Chen, Yi; Chen, Qi; Li, Yan; Wang, Ji-Guang
The present study aimed to evaluate the accuracy of the automated oscillometric upper-arm blood pressure monitor SEJOY BP-1307 (also called JOYTECH DBP-1307) for home blood pressure monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adult Chinese individuals (13 women, 45.1 years of mean age) using a mercury sphygmomanometer (two observers) and the SEJOY BP-1307 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The average±SD of the device-observer differences was 0.2±4.1 and -1.7±4.7 mmHg for systolic and diastolic blood pressure, respectively. The SEJOY BP-1307 device achieved the criteria in both part 1 and part 2 of the validation study. The SEJOY upper-arm blood pressure monitor BP-1307 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.
Cohen Cesar Nissan
Full Text Available OBJECTIVE: To assess the association between microalbuminuria with ambulatory blood pressure monitoring in normotensive individuals with insulin-dependent diabetes mellitus. METHODS: Thirty-seven patients underwent determination of the rate of urinary excretion of albumin through radioimmunoassay and ambulatory blood pressure monitoring. Their mean age was 26.5±6.7 years, and the mean duration of their disease was 8 (1-34 years. Microalbuminuria was defined as urinary excretion of albumin > or = 20 and 50% and diastolic pressure load > 30% during sleep was associated with microalbuminuria (p=0.008. The pressure drop during sleep did not differ between the groups. CONCLUSION: Microalbuminuric normotensive insulin-dependent diabetic patients show greater mean pressure value and pressure load during ambulatory blood pressure monitoring, and these variables correlate with urinary excretion of albumin.
Reynolds, Kristi; Bowling, C Barrett; Sim, John J; Sridharan, Lakshmi; Harrison, Teresa N; Shimbo, Daichi
The beneficial effect of antihypertensive medication on reducing the risk of cardiovascular disease (CVD) events is supported by data from randomized controlled trials of older adults with hypertension. However, in clinical practice, overtreatment of hypertension in older adults may lead to side effects and an increased risk of falls. The diagnosis and treatment of hypertension is primarily based on blood pressure measurements obtained in the clinic setting. Ambulatory blood pressure monitoring (ABPM) complements clinic blood pressure by measuring blood pressure in the out-of-clinic setting. ABPM can be used to identify white coat hypertension, defined as elevated clinic blood pressure and non-elevated ambulatory blood pressure. White coat hypertension is common in older adults but does not appear to be associated with an increased risk of CVD events among this population. Herein, we review the current literature on ABPM in the diagnoses of white coat hypertension in older adults, including its potential role in preventing overtreatment.
Reynolds, Kristi; Bowling, C. Barrett; Sim, John J.; Sridharan, Lakshmi; Harrison, Teresa N.; Shimbo, Daichi
The beneficial effect of antihypertensive medication on reducing the risk of cardiovascular disease (CVD) events is supported by data from randomized controlled trials of older adults with hypertension. However, in clinical practice, overtreatment of hypertension in older adults may lead to side effects and an increased risk of falls. The diagnosis and treatment of hypertension is primarily based on blood pressure measurements obtained in the clinic setting. Ambulatory blood pressure monitoring (ABPM) complements clinic blood pressure by measuring blood pressure in the out-of-clinic setting. ABPM can be used to identify white coat hypertension, defined as elevated clinic blood pressure and non-elevated ambulatory blood pressure. White coat hypertension is common in older adults but does not appear to be associated with an increased risk of CVD events among this population. Herein, we review the current literature on ABPM in the diagnoses of white coat hypertension in older adults, including its potential role in preventing overtreatment. PMID:26400076
Anthony, Chris A; Polgreen, Linnea A; Chounramany, James; Foster, Eric D; Goerdt, Christopher J; Miller, Michelle L; Suneja, Manish; Segre, Alberto M; Carter, Barry L; Polgreen, Philip M
To diagnose hypertension, multiple blood pressure (BP) measurements are recommended. We randomized patients into three groups: EMR-only (patients recorded BP measurements in an electronic medical record [EMR] web portal), EMR + reminders (patients were sent text message reminders to record their BP measurements in the EMR), and bi-directional text messaging (patients were sent a text message asking them to respond with their current BP). Subjects were asked to complete 14 measurements. Automated messages were sent to each patient in the bi-directional text messaging and EMR + reminder groups twice daily. Among 121 patients, those in the bi-directional text messaging group reported the full 14 measurements more often than both the EMR-only group (P text messaging is an effective way to gather patient BP data. Text-message-based reminders alone are an effective way to encourage patients to record BP measurements. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
Nelson, Joan M; Cook, Paul F; Ingram, Jennifer C
To evaluate constructs from the theory of planned behavior (TPB, Ajzen 2002) - attitudes, sense of control, subjective norms and intentions - as predictors of accuracy in blood pressure monitoring. Despite numerous initiatives aimed at teaching blood pressure measurement techniques, many healthcare providers measure blood pressures incorrectly. Descriptive, cohort design. Medical assistants and licensed practical nurses were asked to complete a questionnaire on TPB variables. These nursing staff's patients had their blood pressures measured and completed a survey about techniques used to measure their blood pressure. We correlated nursing staff's responses on the TBP questionnaire with their intention to measure an accurate blood pressure and with the difference between their actual blood pressure measurement and a second measurement taken by a researcher immediately after the clinic visit. Patients' perceptions of MAs' and LPNs' blood pressure measurement techniques were examined descriptively. Perceived control and social norm predicted intention to measure an accurate blood pressure, with a negative relationship between knowledge and intention. Consistent with the TPB, intention was the only significant predictor of blood pressure measurement accuracy. Theory of planned behavior constructs predicted the healthcare providers' intention to measure blood pressure accurately and intention predicted the actual accuracy of systolic blood pressure measurement. However, participants' knowledge about blood pressure measurement had an unexpected negative relationship with their intentions. These findings have important implications for nursing education departments and organisations which traditionally invest significant time and effort in annual competency training focused on knowledge enhancement by staff. This study suggests that a better strategy might involve efforts to enhance providers' intention to change, particularly by changing social norms or increasing
Asayama, Kei; Satoh, Michihiro; Kikuya, Masahiro
The definition of diurnal blood pressure changes varies widely, which can be confusing. Short-term blood pressure variability during a 24-h period and the dipping status of diurnal blood pressure can be captured by ambulatory blood pressure monitoring, and these metrics are reported to have prognostic significance for cardiovascular complications. Morning blood pressure surge also indicates this risk, but its effect may be limited to populations with specific conditions. Meanwhile, the combined use of conventional office blood pressure and out-of-office blood pressure allows us to identify people with white-coat and masked hypertension. Current home devices can measure nocturnal blood pressure during sleep more conveniently than ambulatory monitoring; however, we should pay attention to blood pressure measurement conditions regardless of whether they are in a home, ambulatory, or office setting. The relatively poor reproducibility of diurnal blood pressure changes, including the nocturnal fall of blood pressure, is another underestimated issue to be addressed. Although information on diurnal blood pressure changes is expected to be used more effectively in the future, we should also keep in mind that blood pressure levels have remained central to the primary and secondary prevention of blood pressure-related cardiovascular diseases in clinical practice.
Antonio Eduardo Monteiro de Almeida
Full Text Available Background: The importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM. Objective: To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM as gold-standard and measurements taken before morning micturition (BM and in the afternoon (AM, for the best diagnosis of systemic arterial hypertension (SAH, and their association with prognostic markers. Methods: After undergoing 24-hour wakefulness ABPM, 158 participants (84 women were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM; and with post-morning-micturition and evening measurements (PM+EM. All patients underwent echocardiography (for left ventricular hypertrophy - LVH and urinary albumin measurement (for microalbuminuria - MAU. Result: Kappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM and (PM+EM, and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM versus (PM+EM were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM and (PM+EM were 0.782 × 0.474 and 0.511 × 0.276, respectively. Conclusions: The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers.
Nobre, Fernando; Mion Junior, Décio
Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review. PMID:27168473
Koo, Sangjun; Kwon, Jongwon; Park, Yongman; Ayuzenara, Odgerel; Kim, Hiesik
A blood pressure sensor unit for ubiquitous healthcare monitoring was newly developed. The digital wrist band-type blood pressure devices for home are popular already in the market. It is useful for checking blood pressure level at home and control of hypertension. Especially, it is very essential home device to check the health condition of blood circulation disease. Nowadays many product types are available. But the measurement of blood pressure is not accurate enough compared with the mechanical type. It needs to be upgraded to assure the precise health data enough to use in the hospital. The structure, feature and output signal of capacitor type pressure sensors are analyzed. An improved design of capacitor sensor is suggested. It shows more precise health data after use on a wrist band type health unit. They can be applied for remote u-health medical service.
National Aeronautics and Space Administration — A key component of NASA's human exploration programs is a system that monitors the health of the crew during the space missions. The wearable physiological monitor...
Mendelson, Nitsan; Gontmacher, Bella; Vodonos, Allina; Novack, Victor; Abu-AjAj, Muhammad; Wolak, Arik; Shalev, Haddar; Wolak, Talya
The effect of chronic benzodiazepine use on blood pressure has not been documented. We aimed to evaluate whether regular benzodiazepine use can be associated to the results of ambulatory blood pressure monitoring (ABPM). A retrospective analysis of the ABPM database between 2009 and 2015 was performed. The study groups were divided according to benzodiazepine treatment at least 3 months before ABPM. Generalized estimating equation (GEE) model analysis was conducted to estimate the association between benzodiazepine treatment and ABPM test measurements. Multivariable COX regression survival analysis model for mortality and cardiovascular (CV) events was performed. A total of 4,938 ABPM studies were included in final analysis, 670 ABPMs of benzodiazepine-treated patients, and 4,268 of untreated patients. The benzodiazepine-treated group was significantly older, with a predominance of female patients, comprised more diabetic patients and consumed more antihypertensive medications. Adjustment for age, gender, diabetes mellitus, and number of antihypertensive medications, showed an association between benzodiazepine treatment and significantly lower ABPM measurements. When the analysis was split into those ≥60 years old and the other ABPM measurements only among ≥60 years old. Multivariable Cox regression survival analysis showed that regular benzodiazepine consumption was not associated with increased mortality or CV events (mean follow-up period of 42.4 ± 19.8 and 42.1 ± 20.0 months, respectively). Long-term use of benzodiazepines by ≥60 years old was independently associated with lower diastolic and systolic blood pressure in all parameters of ABPM, but not among younger patients.
Harianto, Harry; Valente, Michael; Hoetomo, Soenarno; Anpalahan, Mahesan
The current evidence suggests that ambulatory blood pressure monitoring (ABPM) should be an integral part of the diagnosis and management of hypertension. However, its uptake in routine clinical practice has been variable. This paper reviews the current evidence for the role of ABPM in clinical practice, including in hypotensive disorders and in specific comorbidities. It further discusses the clinical significance of abnormal ambulatory blood pressure patterns and hypertensive syndromes such as white coat, masked and resistant hypertension.
Usuda, Takashi; Kobayashi, Naoki; Takeda, Sunao; Kotake, Yoshifumi
We have developed the non-invasive blood pressure monitor which can measure the blood pressure quickly and robustly. This monitor combines two measurement mode: the linear inflation and the linear deflation. On the inflation mode, we realized a faster measurement with rapid inflation rate. On the deflation mode, we realized a robust noise reduction. When there is neither noise nor arrhythmia, the inflation mode incorporated on this monitor provides precise, quick and comfortable measurement. Once the inflation mode fails to calculate appropriate blood pressure due to body movement or arrhythmia, then the monitor switches automatically to the deflation mode and measure blood pressure by using digital signal processing as wavelet analysis, filter bank, filter combined with FFT and Inverse FFT. The inflation mode succeeded 2440 measurements out of 3099 measurements (79%) in an operating room and a rehabilitation room. The new designed blood pressure monitor provides the fastest measurement for patient with normal circulation and robust measurement for patients with body movement or severe arrhythmia. Also this fast measurement method provides comfortableness for patients.
Verdezoto, Nervo; Grönvall, Erik
for self-measuring, the importance of interpretation, understanding and health awareness, sharing self-monitoring information for prevention, various motivational factors, the role of the doctor in prevention, and the home as a distributed information space. An awareness of these aspects can help designers......, to understand existing challenges, and uncover opportunities for self-monitoring technologies to support preventive healthcare activities among older adults. From our study, several important aspects emerged to consider when designing preventive self-monitoring technology, such as the complexity of guidelines...... how these aspects can both inform people engaged in Quantified Self activities and designers alike, and the tools and approaches that have sprung from the so-called Quantified Self movement...
The connection between hypertension and diabetes emerges, in medical practice, from the current belief imposed by the European Society of Cardiology adding to the notion of total cardiovascular risk. An increse in the systolic blood pressure at night time is the first detectable manifestation of the regulation disorders of the blood pressure in type I diabetes. An early increase of the nocturnal blood pressure can play a key role in the detection of the evolution towards diabetic nephropathy. This modification can be a valuable potential marker for the diabetic nephropathy and could provide a reason for treating the high risk patients before the onset of microalbuminuria. The evaluation of the nefropathy risk in the early stages of type I diabetes using Ambulatory Blood Pressure Monitoring (ABPM) method offers the best premisses for preventing the progression of the disease towards microalbuminuria and hypertension.
Bellini, Luca; Veladiano, Irene A; Schrank, Magdalena; Candaten, Matteo; Mollo, Antonio
Rabbits are particularly sensitive to develop hypotension during sedation or anaesthesia. Values of systolic or mean non-invasive arterial blood pressure below 80 or 60 mmHg respectively are common under anaesthesia despite an ongoing surgery. A reliable method of monitoring arterial blood pressure is extremely important, although invasive technique is not always possible due to the anatomy and dimension of the artery. The aim of this study was to evaluate the agreement between a new oscillometric device for non-invasive arterial blood pressure measurement and the invasive method. Moreover the trending ability of the device, ability to identify changes in the same direction with the invasive methods, was evaluated as well as the sensibility of the device in identifying hypotension arbitrarily defined as invasive arterial blood pressure below 80 or 60 mmHg. Bland-Altman analysis for repeated measurements showed a poor agreement between the two methods; the oscillometric device overestimated the invasive arterial blood pressure, particularly at high arterial pressure values. The same analysis repeated considering oscillometric measurement that match invasive mean pressure lower or equal to 60 mmHg showed a decrease in biases and limits of agreement between methods. The trending ability of the device, evaluated with both the 4-quadrant plot and the polar plot was poor. Concordance rate of mean arterial blood pressure was higher than systolic and diastolic pressure although inferior to 90%. The sensibility of the device in detecting hypotension defined as systolic or mean invasive arterial blood pressure lower than 80 or 60 mmHg was superior for mean oscillometric pressure rather than systolic. A sensitivity of 92% was achieved with an oscillometric measurement for mean pressure below 65 mmHg instead of 60 mmHg. Non-invasive systolic blood pressure is less sensitive as indicator of hypotension regardless of the cutoff limit considered. Although mean invasive
Cleophas, A. F.; Zwinderman, A. H.; Cleophas, T. J.
Objective: Ambulatory blood pressure monitoring (ABPM) data using values of arbitrarily separated day- and nighttime hours are poorly reproducible, undermining the validity of this diagnostic tool. Previous studies from our group have demonstrated that polynomial curves can be produced of ABPM data
O'Brien, Eoin; Parati, Gianfranco; Stergiou, George; Asmar, Roland; Beilin, Laurie; Bilo, Grzegorz; Clement, Denis; de la Sierra, Alejandro; de Leeuw, Peter; Dolan, Eamon; Fagard, Robert; Graves, John; Head, Geoffrey A.; Imai, Yutaka; Kario, Kazuomi; Lurbe, Empar; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Ogedegbe, Gbenga; Ohkubo, Takayoshi; Omboni, Stefano; Palatini, Paolo; Redon, Josep; Ruilope, Luis M.; Shennan, Andrew; Staessen, Jan A.; vanMontfrans, Gert; Verdecchia, Paolo; Waeber, Bernard; Wang, Jiguang; Zanchetti, Alberto; Zhang, Yuqing
Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a
Lam, Jennifer Y.; Guirguis, Lisa M.
Hypertension is a modifiable risk factor for cardiovascular disease. Despite this, patients often cannot or inaccurately estimate their risk factors.Objectives: In order to improve pharmacist interventions, we sought to: 1) find out patients’ knowledge about blood pressure (BP) and their self- monitoring behaviors and 2) identify the relationships between these two elements. Specifically, if evaluation of BP control were related to knowledge of one’s BP level and self-monitoring habits, and i...
High 24-h ambulatory blood pressure (ABP) variability is associated with poor cardiovascular outcomes. We analysed a large ABP monitoring database containing data from hypertensive patients treated with telmisartan\\/amlodipine combination or various monotherapies with the aim of quantifying the 24-h distribution of blood pressure (BP) reduction by treatment through the smoothness index and of developing and testing a new treatment-on-variability index (TOVI) to quantify the effects of treatment on both mean BP and BP variability.
Grant, Sabrina; Greenfield, Sheila M; Nouwen, Arie; McManus, Richard J
Self-monitoring blood pressure (SMBP) is becoming an increasingly prevalent practice in UK primary care, yet there remains little conceptual understanding of why patients with hypertension engage in self-monitoring. To identify psychological factors or processes prompting the decision to self-monitor blood pressure. A qualitative study of patients previously participating in a survey study about SMBP from four general practices in the West Midlands. Taped and transcribed in-depth interviews with 16 patients (6 currently monitoring, 2 used to self-monitor, and 8 had never self-monitored). Thematic analysis was undertaken. Three main themes emerged: 'self' and 'living with hypertension' described the emotional element of living with an asymptomatic condition; 'self-monitoring behaviour and medication' described overall views about self-monitoring, current practice, reasons for monitoring, and the impact on medication adherence; and 'the GP-patient transaction' described the power relations affecting decisions to self-monitor. Self-monitoring was performed by some as a protective tool against the fears of a silent but serious condition, whereas others self-monitor simply out of curiosity. People who self-monitored tended not to discuss this with their nurse or GP, partly due to perceiving minimal or no interest from their clinician about home monitoring, and partly due to fear of being prescribed additional medication. The decision to self-monitor appeared often to be an individual choice with no schedule or systems to integrate it with other medical care. Better recognition by clinicians that patients are self-monitoring, perhaps utilising the results in shared decision-making, might help integrate it into daily practice. © British Journal of General Practice 2015.
Melville, Sarah; Teskey, Robert; Philip, Shona; Simpson, Jeremy A; Lutchmedial, Sohrab
Background Clinical guidelines recommend monitoring of blood pressure at home using an automatic blood pressure device for the management of hypertension. Devices are not often calibrated against direct blood pressure measures, leaving health care providers and patients with less reliable information than is possible with current technology. Rigorous assessments of medical devices are necessary for establishing clinical utility. Objective The purpose of our study was 2-fold: (1) to assess the validity and perform iterative calibration of indirect blood pressure measurements by a noninvasive wrist cuff blood pressure device in direct comparison with simultaneously recorded peripheral and central intra-arterial blood pressure measurements and (2) to assess the validity of the measurements thereafter of the noninvasive wrist cuff blood pressure device in comparison with measurements by a noninvasive upper arm blood pressure device to the Canadian hypertension guidelines. Methods The cloud-based blood pressure algorithms for an oscillometric wrist cuff device were iteratively calibrated to direct pressure measures in 20 consented patient participants. We then assessed measurement validity of the device, using Bland-Altman analysis during routine cardiovascular catheterization. Results The precalibrated absolute mean difference between direct intra-arterial to wrist cuff pressure measurements were 10.8 (SD 9.7) for systolic and 16.1 (SD 6.3) for diastolic. The postcalibrated absolute mean difference was 7.2 (SD 5.1) for systolic and 4.3 (SD 3.3) for diastolic pressures. This is an improvement in accuracy of 33% systolic and 73% diastolic with a 48% reduction in the variability for both measures. Furthermore, the wrist cuff device demonstrated similar sensitivity in measuring high blood pressure compared with the direct intra-arterial method. The device, when calibrated to direct aortic pressures, demonstrated the potential to reduce a treatment gap in high blood
Lam, Jennifer Y; Guirguis, Lisa M
Hypertension is a modifiable risk factor for cardiovascular disease. Despite this, patients often cannot or inaccurately estimate their risk factors. IN ORDER TO IMPROVE PHARMACIST INTERVENTIONS, WE SOUGHT TO: 1) find out patients' knowledge about blood pressure (BP) and their self-monitoring behaviors and 2) identify the relationships between these two elements. Specifically, if evaluation of BP control were related to knowledge of one's BP level and self-monitoring habits, and if knowledge of one's target and BP level varied with monitoring habits. Final year pharmacy students were trained and interviewed patients in community pharmacies as a required exercise in their pharmacy clerkship. Each student recruited a convenience sample of 5-10 patients who were on hypertension medication, and surveyed them regarding their BP targets, recent BP levels as well as monthly and home BP monitoring practices. One third of the 449 patients interviewed were able to report a blood pressure target with 26% reporting a JNC 7 recognized target. Three quarters of patients who reported a blood pressure target were able to report a blood pressure level, with 12% being at their self-reported target. Roughly two thirds of patients perceived their BP to be "about right", and slightly less than a third thought it to be "high". Sixty percent of patients monitor their BP monthly, but less than 50% of patients practice home BP monitoring. This study along with others before it point to the knowledge and self-management gaps in patients with chronic conditions. Furthermore, pharmacy students were able to use a brief intervention to screen patients during routine care. Pharmacists can help improve patient understanding and promote increased self-management through regular BP monitoring.
Full Text Available Hypertension is a modifiable risk factor for cardiovascular disease. Despite this, patients often cannot or inaccurately estimate their risk factors.Objectives: In order to improve pharmacist interventions, we sought to: 1 find out patients’ knowledge about blood pressure (BP and their self- monitoring behaviors and 2 identify the relationships between these two elements. Specifically, if evaluation of BP control were related to knowledge of one’s BP level and self-monitoring habits, and if knowledge of one’s target and BP level varied with monitoring habits. Methods: Final year pharmacy students were trained and interviewed patients in community pharmacies as a required exercise in their pharmacy clerkship. Each student recruited a convenience sample of 5-10 patients who were on hypertension medication, and surveyed them regarding their BP targets, recent BP levels as well as monthly and home BP monitoring practices. Results: One third of the 449 patients interviewed were able to report a blood pressure target with 26% reporting a JNC 7 recognized target. Three quarters of patients who reported a blood pressure target were able to report a blood pressure level, with 12% being at their self- reported target. Roughly two thirds of patients perceived their BP to be “about right”, and slightly less than a third thought it to be “high”. Sixty percent of patients monitor their BP monthly, but less than 50% of patients practice home BP monitoring. Conclusions: This study along with others before it point to the knowledge and self-management gaps in patients with chronic conditions. Furthermore, pharmacy students were able to use a brief intervention to screen patients during routine care. Pharmacists can help improve patient understanding and promote increased self-management through regular BP monitoring.
The guidelines for the use of ambulatory blood pressure monitoring published from Japanese Circulation Society in 2010 was briefly overviewed. The accuracy of devices now used in clinical practice in Japan is of sufficient grade. The thresholds for hypertension diagnosis based on ABPM have been determined with international concensus. The evaluation of ABPM data and the clinical indications for ABPM are suggested. Particularly, white-coat hypertension, masked hypertension, nocturnal hypertension, morning hypertension and diurnal blood pressure variation are conditions for which ABPM is very useful for the detection, treatment decision and follow-up. Hypertension treatment would be very much improved by the introduction of ABPM into clinical practice.
Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability.
Stergiou, George S; Parati, Gianfranco; Vlachopoulos, Charalambos; Achimastos, Apostolos; Andreadis, Emanouel; Asmar, Roland; Avolio, Alberto; Benetos, Athanase; Bilo, Grzegorz; Boubouchairopoulou, Nadia; Boutouyrie, Pierre; Castiglioni, Paolo; de la Sierra, Alejandro; Dolan, Eamon; Head, Geoffrey; Imai, Yutaka; Kario, Kazuomi; Kollias, Anastasios; Kotsis, Vasilis; Manios, Efstathios; McManus, Richard; Mengden, Thomas; Mihailidou, Anastasia; Myers, Martin; Niiranen, Teemu; Ochoa, Juan Eugenio; Ohkubo, Takayoshi; Omboni, Stefano; Padfield, Paul; Palatini, Paolo; Papaioannou, Theodore; Protogerou, Athanasios; Redon, Josep; Verdecchia, Paolo; Wang, Jiguang; Zanchetti, Alberto; Mancia, Giuseppe; O'Brien, Eoin
Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).
Naoki Watanabe, MD
Full Text Available Ordinary cuff-based blood pressure–monitoring devices remain a technical limitation that disturbs activities of daily life. Here we report a novel system for the cuff-less blood pressure estimation (CLB that requires only 1 sensor for photoplethysmography. The present study is the first report to validate and assess the clinical application of the CLB in accordance with the latest wearable device standard (issued by the Institute of Electrical and Electronics Engineers, standard 1708-2014. Our CLB is expected to offer a flexible and wearable device that permits blood pressure monitoring in more continuous and stress-free settings.
Altintas, Ersin; Takoh, Kimiyasu; Ohno, Yuji; Abe, Katsumi; Akagawa, Takeshi; Ariyama, Tetsuri; Kubo, Masahiro; Tsuda, Kenichiro; Tochikubo, Osamu
We propose a highly wearable, upper-arm type, oscillometric-based blood pressure monitoring technology with low-stress. The low-stress is realized by new developments in the hardware and software design. In the hardware design, conventional armband; cuff, is almost halved in volume thanks to a flexible plastic core and a liquid bag which enhances the fitness and pressure uniformity over the arm. Reduced air bag volume enables smaller motor pump size and battery leading to a thinner, more compact and more wearable unified device. In the software design, a new prediction algorithm enabled to apply less stress (and less pain) on arm of the patient. Proof-of-concept experiments on volunteers show a high accuracy on both technologies. This paper mainly introduces hardware developments. The system is promising for less-painful and less-stressful 24-hour blood pressure monitoring in hypertension managements and related healthcare solutions.
Groen, Maarten S.; Wu, Kai; Brookhuis, Robert A.; van Houwelingen, Marc J.; Brouwer, Dannis M.; Lötters, Joost C.; Wiegerink, Remco J.
We have designed and characterized a MEMS microvalve with built-in capacitive displacement sensing and fitted it with a miniature piezoelectric actuator to achieve active valve control. The integrated displacement sensor enables high bandwidth proportional control of the gas flow through the valve. This is an essential requirement for non-invasive blood pressure waveform monitoring based on following the arterial pressure with a counter pressure. Using the capacitive sensor, we demonstrate negligible hysteresis in the valve control characteristics. Fabrication of the valve requires only two mask steps for deep reactive ion etching (DRIE) and one release etch.
Groen, Maarten S; Wu, Kai; Brookhuis, Robert A; Lötters, Joost C; Wiegerink, Remco J; Van Houwelingen, Marc J; Brouwer, Dannis M
We have designed and characterized a MEMS microvalve with built-in capacitive displacement sensing and fitted it with a miniature piezoelectric actuator to achieve active valve control. The integrated displacement sensor enables high bandwidth proportional control of the gas flow through the valve. This is an essential requirement for non-invasive blood pressure waveform monitoring based on following the arterial pressure with a counter pressure. Using the capacitive sensor, we demonstrate negligible hysteresis in the valve control characteristics. Fabrication of the valve requires only two mask steps for deep reactive ion etching (DRIE) and one release etch. (paper)
Czaja-Mitura, Izabela; Bortkiewicz, Alicja
The application of long-term blood pressure monitoring (ABPM) in the occupational medicine practice, its advantages and disadvantages and the diagnostic and prognostic values of the parameters determined during the test were reviewed. The circumstances (e.g., social meeting, phone call) in which blood pressure value significantly differs from its resting value were identified. The methodology and reference values of systolic and diastolic blood pressure proposed by the European Society of Hypertension and the European Society of Cardiology were discussed as well as the recommended values of the blood pressure load. Ihe use of ABPM in the assessment of circadian blood pressure rhythm and the prognostic value of insufficient nocturnal drop (in non-dippers) or excessive nocturnal drop of ABP (in extreme dippers), and inverted circadian ABP variation (in reverse-dippers) was discussed. Attention was paid to the prognostic value of BP variability over short periods of time, which is specified in terms of standard deviation or coefficient of variance. This variability is considered as a factor capable of modifying the course, complications and prognosis of the hypertensive disease. The phenomena of "white coat hypertension" and masked hypertension were also described. It was demonstrated that the use of ABPM in occupational medicine is feasible, especially for preventive purposes, in workers exposed to different adverse work-related factors (noise, electromagnetic fields, shift work).
Full Text Available Background: A pressure ulcer is a complication related to the need for the care and treatment of primarily disabled and elderly people. With the decrease of the blood flow caused by the pressure loaded, ulcers are formed and the tissue will be wasted with the passage of time. Objective: The aim of this study was to construct blood flow monitoring system on the heel tissue which was under external pressure in order to evaluate the tissue treatment in the ulcer. Methods: To measure the blood flow changes, three infrared optical transmitters were used at the distances of 5, 10, and 15 mm to the receiver. Blood flow changes in heels were assessed in pressures 0, 30, and 60 mmHg. The time features were extracted for analysis from the recorded signal by MATLAB software. Changes of the time features under different pressures were evaluated at the three distances by ANOVA in SPSS software. The level of significance was considered at 0.05. Results: In this study, 15 subjects, including both male and female, with the mean age of 54±7 participated. The results showed that the signal amplitude, power and absolute signal decreased significantly when pressure on the tissue increased in different layers (p<0.05. Heart rate only decreased significantly in pressures more than 30 mmHg (p=0.02. In pressures more than 30 mmHg, in addition to a decrease in the time features, the pattern of blood flow signal changed and it wasn’t the same as noload signal. Conclusion: By detecting the time features, we can reach an early diagnosis to prognosticate the degeneration of the tissue under pressure and it can be recommended as a method to predict bedsores in the heel.
Rebellato, Andrea; Grillo, Andrea; Dassie, Francesca; Sonino, Nicoletta; Maffei, Pietro; Martini, Chiara; Paoletta, Agostino; Fabris, Bruno; Carretta, Renzo; Fallo, Francesco
Cushing's syndrome is associated with high cardiovascular morbility and mortality. Blood pressure (BP) variability within a 24-h period is increasingly recognized as an independent predictor of cardiovascular risk. The aim of our study was to investigate the short-term BP variability indices in Cushing's syndrome. Twenty-five patients with Cushing's syndrome (mean age 49 ± 13 years, 4 males; 21 Cushing's disease and 4 adrenal adenoma patients) underwent 24-h ambulatory BP monitoring (ABPM) and evaluation of cardiovascular risk factors. Cushing patients were divided into 8 normotensive (NOR-CUSH) and 17 hypertensive (HYP-CUSH) patients and were compared with 20 normotensive (NOR-CTR) and 20 hypertensive (HYP-CTR) age-, sex-, and BMI-matched control subjects. Short-term BP variability was derived from ABPM and calculated as the following: (1) standard deviation (SD) of 24-h, daytime, and nighttime BP; (2) 24-h weighted SD of BP; and (3) average real variability (ARV), i.e., the average of the absolute differences between consecutive BP measurements over 24 h. In comparison with controls, patients with Cushing's syndrome, either normotensive or hypertensive, had higher 24-h and daytime SD of BP, as well as higher 24-h weighted SD and ARV of BP (P = 0.03 to P CUSH or between HYP-CTR and HYP-CUSH subgroups. ABPM-derived short-term BP variability is increased in Cushing's syndrome, independent of BP elevation. It may represent an additional cardiovascular risk factor in this disease. The role of excess cortisol in BP variability has to be further clarified.
Zielinski, Todd M.; Hettrick, Doug; Cho, Yong
Non-invasive methods to monitor ambulatory blood pressure often have limitations that can affect measurement accuracy and patient adherence . Minimally invasive measurement of a relative blood pressure surrogate with an implantable device may provide a useful chronic diagnostic and monitoring tool. We assessed a technique that uses electrocardiogram and paravascular admittance waveform morphology analysis to one, measure a time duration (vascular tone index, VTI in milliseconds) change from the electrocardiogram R-wave to admittance waveform peak and two, measure the admittance waveform minimum, maximum and magnitude as indicators of change in arterial compliance/distensibility or pulse pressure secondary to change in afterload. Methods: Five anesthetized domestic pigs (32 ± 4.2 kg) were used to study the effects of phenylephrine (1-5 ug/kg/min) on femoral artery pressure and admittance waveform morphology measured with a quadrapolar electrode array catheter placed next to the femoral artery to assess the relative change in arterial compliance due to change in peripheral vascular tone. Results: Statistical difference was observed (p blood pressure may be suitable for implantable devices to detect progression of cardiovascular disease such as hypertension.
F?lez-Carrob?, Estel; Sagarra-Ti?, Maria; Romero, Araceli; Rubio, Montserrat; Planas, Lourdes; P?rez-Lucena, Mar?a Jos?; Baiget, Montserrat; Cabista?, Cristina; F?lez, Jordi
Background: Ambulatory blood pressure monitoring (ABPM) predicts cardiovascular risk and identifies white-coat and masked hypertension, efficacy of treatment and the circadian cycle of hypertensive patients. Objective: To analyze the effectiveness of ABPM implementation thoughtout a nurse-driven training program. Materials and Methodology: Twenty eight professionals were involved in the study carried out in the primary care center of the metropolitan area of Barcelona that serves 34,289 inhab...
Wen-Xuan Dai; Yuan-Ting Zhang; Jing Liu; Xiao-Rong Ding; Ni Zhao
Accurate and ambulatory measurement of blood pressure (BP) is essential for efficient diagnosis, management and prevention of cardiovascular diseases (CVDs). However, traditional cuff-based BP measurement methods provide only intermittent BP readings and can cause discomfort with the occlusive cuff. Although pulse transit time (PTT) method is promising for cuffless and continuous BP measurement, its pervasive use is restricted by its limited accuracy and requirement of placing sensors on multiple body sites. To tackle these issues, we propose a novel dual-modality arterial pulse monitoring system for continuous blood pressure measurement, which simultaneously records the pressure and photoplethysmography (PPG) signals of radial artery. The obtained signals can be used to generate a pressure-volume curve, from which the elasticity index (EI) and viscosity index (VI) can be extracted. Experiments were carried out among 7 healthy subjects with their PPG, ECG, arterial pressure wave and reference BP collected to examine the effectiveness of the proposed indexes. The results of this study demonstrate that a linear regression model combining EI and VI has significantly higher BP tracking correlation coefficient as compared to the PTT method. This suggests that the proposed system and method can potentially be used for convenient and continuous blood pressure estimation with higher accuracy.
Nesti, Nicola; Pieraccioli, Mariachiara; Mossello, Enrico; Sgrilli, Federica; Bulgaresi, Matteo; Crescioli, Elena; Biagini, Francesco; Caleri, Veronica; Tonon, Elisabetta; Cantini, Claudia; Biagini, Carlo A; Marchionni, Niccolò; Ungar, Andrea
Recent guidelines have widened clinical indications for out-of-office blood pressure measurement, including home blood pressure monitoring and ambulatory blood pressure monitoring (ABPM), suggesting the latter as recommended method in cognitively impaired patients. There is, however, a widespread belief that ABPM could be poorly tolerated in dementia, often leading to withdraw from its use in these patients. To assess the actual tolerability of ABPM in a group of cognitively impaired elderly, affected by dementia or mild cognitive impairment (MCI). We evaluated 176 patients aged 65 + years, recruited in two different memory clinics, with a Mini Mental State Examination (MMSE) between 10 and 27. Behavioral and psychological symptoms were assessed with Neuropsychiatric Inventory (NPI). A patient was considered tolerant if able to keep the device on continuously for 24 h. The minimum number of correct measurements required was 70% of the predicted total number. 16% of patients wore the device for less than 24 h. Dividing the study population in tertiles of MMSE performance, 29% failed to tolerate the device in the lowest, 12% in the middle and 7% in the highest tertile (p ABPM proved a generally well-tolerated technique even in cognitively impaired elderly. Only a minority of subjects with poorer cognitive performances and greater behavioral symptoms did not tolerate the monitoring. Among most patients who failed to achieve the minimum number of measurements needed, the number of valid measurements was very close to the minimum required.
Full Text Available Objectives: The relationship between obesity and essential hypertension is well known. In this study, we aimed to evaluate ambulatory arterial blood pressure monitoring of obese and non-obese children who had similar demographic characteristics.Materials and methods: Seventy one children and adolescents (n=39 obesity, n=32 controls were studied. Blood pressure of the children were measured by 24 hour ambulatory blood pressure monitoring device.Results: Obese children had significantly higher mean blood pressure values (systolic 121.9±11.7 mmHg, diastolic 70.2±5.3 mmHg than control subjects (systolic 109.3±6.7 mmHg, diastolic 65.1±4.6 mmHg, p0.05. Blood pressure load was found to be increased in obese children compared to the controls (%13.6±12.9 and %2.6±3.4, respectively; p<0.05. Serum total cholesterol and LDL-cholesterol levels of obese children (181.1±33.4 and 131.1±23.1mg/dl were significantly higher than those of the controls (134.3±11.1 and 103.3±14.2 mg/dl, p<0.05.Conclusions: Obesity in children and adolescents should not be regarded as variations of normality, but as abnormality with an extremely high risk for the development of hypertension and hyperlipidemia in adulthood.
Costa, Diogo; Peixoto Lima, Ricardo
The prevalence of hypertension in Portugal is between 29.1% and 42.2%. International studies show that 13% of individuals have masked hypertension and 13% of diagnoses based on office blood pressure measurements are in fact white coat hypertension. More sensitive and specific blood pressure measuring methods could avoid costs associated with misdiagnosis. The aim of this study was to review the cost-effectiveness of ambulatory blood pressure monitoring (ABPM) compared to other methods in the management of hypertension. We performed a literature search in CMA Infobase, Guidelines Finder, National Guideline Clearinghouse, Bandolier, BMJ Clinical Evidence, the Cochrane Library, DARE, Medline, the Trip Database, SUMSearch and Índex das Revistas Médicas Portuguesas. We researched articles published between January 2005 and August 2015 in Portuguese, English and Spanish, using the MeSH terms "Hypertension", "Blood Pressure Monitoring, Ambulatory" and "Cost-Benefit Analysis" and the Portuguese search terms "Hipertensão", "Monitorização Ambulatorial da Pressão Arterial" and "Análise Custo-Benefício". Levels of evidence and grades of recommendation were attributed according to the Oxford Centre for Evidence-Based Medicine scale. Five hundred and twenty-five articles were identified. We included five original studies and one clinical practice guideline. All of them state that ABPM is the most cost-effective method. Two report better blood pressure control, and a Portuguese study revealed a saving of 23%. The evidence shows that ABPM is cost-effective, avoiding iatrogenic effects and reducing expenditure on treatment (grade of recommendation B). The included studies provide a solid basis, but further evidence of reproducibility is needed in research that is not based mainly on analytical models. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.
... of the baby. Controlling your blood pressure during pregnancy and getting regular prenatal care are important for ... your baby. Treatments for high blood pressure in pregnancy may include close monitoring of the baby, lifestyle ...
Kang, Yuan-Yuan; Chen, Qi; Liu, Chang-Yuan; Li, Yan; Wang, Ji-Guang
The aim of this study was to evaluate the accuracy of the automated oscillometric upper arm blood pressure (BP) monitor AVITA BPM64 for home BP monitoring according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic BPs were measured sequentially in 33 adult Chinese (14 women, mean age 47.0 years) using a mercury sphygmomanometer (two observers) and the AVITA BPM64 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The AVITA BPM64 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 91/99, 98/99, and 98/99, respectively, for systolic BP and 92/99, 99/99, and 99/99, respectively, for diastolic BP. The device also fulfilled the criteria in part 2 of the validation study. Thirty-two participants for both systolic and diastolic BP had at least two of the three device-observer differences within 5 mmHg (required ≥24). Only one participant for systolic BP had all three device-observer comparisons greater than 5 mmHg. The AVITA upper arm BP monitor BPM64 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.
Chen, Qi; Kang, Yuan-Yuan; Li, Yan; Wang, Ji-Guang
The present study aimed to evaluate the accuracy of the automated oscillometric upper-arm blood pressure (BP) monitor BPUMP BF1112 for home BP monitoring according to the International Protocol of the European Society of Hypertension revision 2010 (ESH-IP2010). Systolic and diastolic BPs were sequentially measured in 33 adult Chinese (13 women, mean age 46.7 years) using a mercury sphygmomanometer (two observers) and the BF1112 device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. The BPUMP BF1112 device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 85/99, 96/99, and 97/99, respectively, for systolic BP, and 83/99, 97/99, and 99/99, respectively, for diastolic BP. The device also fulfilled the criteria in part 2 of the validation study. A total of 31 and 30 participants for systolic and diastolic BP, respectively, had at least two of the three device-observer differences within 5 mmHg (required≥24mmHg). No participant for systolic or diastolic BP had all the three device-observer comparisons greater than 5 mmHg. The BPUMP BP monitor BF1112 has passed the requirements of the ESH-IP2010, and hence can be recommended for home use in adults.
Bauk, L; Costa, H A; Caligiuri, S I
A low number of patients who are treated with antihypertensive drugs achieve therapeutic goals. Home blood pressure monitoring is an excellent tool for studying this population. To determine the prevalence of patients with controlled and uncontrolled hypertension, as well as white-coat-effect and masked hypertension, and to evaluate the relationship with target organ damage in different groups. Blood pressure readings were performed simultaneously in the clinic and in the home using the same validated oscillometric equipment on 83 hypertensive patients on treatment with 2 or more antihypertensive drugs. They were then classified into 4 groups according to the cut-off values of the clinic and home blood pressure measurements. Left ventricular mass index, carotid intima media thickness, and microalbuminuria as markers of target organ damage, were also evaluated. Controlled blood pressure was present in 32.5%, 30.2% had sustained hypertension. The white coat effect was seen in 26.5%, while 10.8% were masked uncontrolled hypertension. Left ventricular mass index was higher in patients with no ambulatory control compared to controlled patients, and carotid IMT was also higher too in uncontrolled and white coat effect groups than controlled patients. More than one third of our patients who were treated with 2 or more drugs were not properly controlled, and they had significantly greater target organ damage than controlled patients. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.
Full Text Available Sajita Setia,1 Kannan Subramaniam,2 Boon Wee Teo,3 Jam Chin Tay4 1Chief Medical Office, Medical Affairs, Pfizer Pte Ltd, Singapore; 2Global Medical Affairs, Asia Pacific Region, Pfizer Australia, West Ryde, New South Wales, Australia; 3Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 4Department of General Medicine, Tan Tock Seng Hospital, Singapore Purpose: Out-of-office blood pressure (BP measurements (home blood pressure monitoring [HBPM] and ambulatory blood pressure monitoring [ABPM] provide important additional information for effective hypertension detection and management decisions. Therefore, out-of-office BP measurement is now recommended by several international guidelines. This study evaluated the practice and uptake of HBPM and ABPM among physicians from Singapore. Materials and methods: A sample of physicians from Singapore was surveyed between 8 September and 5 October 2016. Those included were in public or private practice had been practicing for ≥3 years, directly cared for patients ≥70% of the time, and treated ≥30 patients for hypertension per month. The questionnaire covered six main categories: general BP management, BP variability (BPV awareness/diagnosis, HBPM, ABPM, BPV management, and associated training needs. Results: Sixty physicians (30 general practitioners, 20 cardiologists, and 10 nephrologists were included (77% male, 85% aged 31–60 years, and mean 22-year practice. Physicians recommended HBPM and ABPM to 81% and 27% of hypertensive patients, respectively. HBPM was most often used to monitor antihypertensive therapy (88% of physicians and 97% thought that ABPM was useful for providing information on BPV. HBPM instructions often differed from current guideline recommendations in terms of frequency, number of measurements, and timing. The proportion of consultation time devoted to discussing HBPM and BPV was one-quarter or less for 73% of physicians, and
... a problem. Sometimes blood pressure that is too low can also cause problems. Blood pressure is the ... reading is 90/60 or lower, you have low blood pressure. Some people have low blood pressure ...
... lowest at night and rises sharply on waking. Blood pressure: How low can you go? What's considered low ... low blood pressure. Medications that can cause low blood pressure Some medications can cause low blood pressure, including: ...
Zeng, Wei-Fang; Liu, Ming; Kang, Yuan-Yuan; Li, Yan; Wang, Ji-Guang
The present study aimed to evaluate the accuracy of the fully automated oscillometric upper-arm blood pressure monitor TM-2656 according to the British Hypertension Society (BHS) Protocol 1993. We recruited individuals until there were 85 eligible participants and their blood pressure could meet the blood pressure distribution requirements specified by the BHS Protocol. For each individual, we sequentially measured the systolic and diastolic blood pressures using a mercury sphygmomanometer (two observers) and the TM-2656 device (one supervisor). Data analysis was carried out according to the BHS Protocol. The device achieved grade A. The percentage of blood pressure differences within 5, 10, and 15 mmHg was 62, 85, and 96%, respectively, for systolic blood pressure, and 71, 93, and 99%, respectively, for diastolic blood pressure. The average (±SD) of the device-observer differences was -2.1±7.8 mmHg (P<0.0001) and -1.1±5.8 mmHg (P<0.0001) for systolic and diastolic blood pressures, respectively. The A&D upper-arm blood pressure monitor TM-2656 has passed the requirements of the BHS Protocol, and can thus be recommended for blood pressure measurement.
Parati, Gianfranco; Stergiou, George; O'Brien, Eoin; Asmar, Roland; Beilin, Lawrence; Bilo, Grzegorz; Clement, Denis; de la Sierra, Alejandro; de Leeuw, Peter; Dolan, Eamon; Fagard, Robert; Graves, John; Head, Geoffrey A; Imai, Yutaka; Kario, Kazuomi; Lurbe, Empar; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Ogedegbe, Gbenga; Ohkubo, Takayoshi; Omboni, Stefano; Palatini, Paolo; Redon, Josep; Ruilope, Luis M; Shennan, Andrew; Staessen, Jan A; vanMontfrans, Gert; Verdecchia, Paolo; Waeber, Bernard; Wang, Jiguang; Zanchetti, Alberto; Zhang, Yuqing
Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physicians. The present article details the requirements and the methodological issues to be addressed for using ABPM in clinical practice, The clinical indications for ABPM suggested by the available studies, among which white-coat phenomena, masked hypertension, and nocturnal hypertension, are outlined in detail, and the place of home measurement of blood pressure in relation to ABPM is discussed. The role of ABPM in pharmacological, epidemiological, and clinical research is also briefly mentioned. Finally, the implementation of ABPM in practice is considered in relation to the situation of different countries with regard to the reimbursement and the availability of ABPM in primary care practices, hospital clinics, and pharmacies.
Anderson-Jackson, LaTecia D.
Approximately one in every three adults age 20 older are diagnosed with high blood pressure or hypertension. It is estimated that hypertension affects 78 million people in the United States, is equally prevalent in both men and woman (Crabtree, Stuart-Shor, & McAllister, 2013). In the United States, around 78% of people suffering from hypertension are aware of their condition, with only 68% using hypertensive medications to control their blood pressure (Writing Group et al., 2010). Clinically, blood pressure measurements may lack accuracy, which can be attributed to various factors, including device limitations, cuff mis-sizing and misplacement, white-coat effect, masked hypertension, and lifestyle factors. The development of an arm phantom to simulate physiologic properties of a human arm and arterial BP waveforms may allow us to better assess the accuracy of non-invasive blood pressure (NIBP) monitors. The objective of this study are to: (1) Develop an arm phantom to replicate physiological properties of the human arm, and (2) Incorporate the arm phantom into a mock circulatory flow loop to simulate different physiological blood pressure readings on the bench. A tissue mimicking material, styrene-ethylene-butylene-styrene (SEBS), a co-block polymer was used to develop the arm phantom for in-vitro testing. To determine the optimal mechanical properties for the arm phantom, individual arm components were isolated and tested. A protocol was developed to evaluate various components for optimal arm phantom development. Mechanical testing was conducted on 10%, 15%, and 20% SEBS gel samples for modulus of elasticity measurements in order to simulate physiological properties of the human arm. As a result of the SEBS polymer being a new material for this application, this investigation will contribute to resolving the limitations that occurred during experimentation. In this study, we demonstrated that although SEBS polymer may be an ideal material to use for simulating
Setia, Sajita; Subramaniam, Kannan; Teo, Boon Wee; Tay, Jam Chin
Out-of-office blood pressure (BP) measurements (home blood pressure monitoring [HBPM] and ambulatory blood pressure monitoring [ABPM]) provide important additional information for effective hypertension detection and management decisions. Therefore, out-of-office BP measurement is now recommended by several international guidelines. This study evaluated the practice and uptake of HBPM and ABPM among physicians from Singapore. A sample of physicians from Singapore was surveyed between 8 September and 5 October 2016. Those included were in public or private practice had been practicing for ≥3 years, directly cared for patients ≥70% of the time, and treated ≥30 patients for hypertension per month. The questionnaire covered six main categories: general BP management, BP variability (BPV) awareness/diagnosis, HBPM, ABPM, BPV management, and associated training needs. Sixty physicians (30 general practitioners, 20 cardiologists, and 10 nephrologists) were included (77% male, 85% aged 31-60 years, and mean 22-year practice). Physicians recommended HBPM and ABPM to 81% and 27% of hypertensive patients, respectively. HBPM was most often used to monitor antihypertensive therapy (88% of physicians) and 97% thought that ABPM was useful for providing information on BPV. HBPM instructions often differed from current guideline recommendations in terms of frequency, number of measurements, and timing. The proportion of consultation time devoted to discussing HBPM and BPV was one-quarter or less for 73% of physicians, and only 55% said that they had the ability to provide education on HBPM and BPV. Patient inertia, poor patient compliance, lack of medical consultation time, and poor patient access to a BP machine were the most common challenges for implementing out-of-office BP monitoring. Although physicians from Singapore do recommend out-of-office BP measurement to patients with hypertension, this survey identified several important gaps in knowledge and clinical practice.
Kollias, Anastasios; Destounis, Antonios; Kalogeropoulos, Petros; Kyriakoulis, Konstantinos G; Ntineri, Angeliki; Stergiou, George S
This study assessed the diagnostic accuracy of a novel 24-hour ambulatory blood pressure (ABP) monitor (Microlife WatchBP O3 Afib) with implemented algorithm for automated atrial fibrillation (AF) detection during each ABP measurement. One hundred subjects (mean age 70.6±8.2 [SD] years; men 53%; hypertensives 85%; 17 with permanent AF; 4 paroxysmal AF; and 79 non-AF) had simultaneous 24-hour ABP monitoring and 24-hour Holter monitoring. Among a total of 6410 valid ABP readings, 1091 (17%) were taken in ECG AF rhythm. In reading-to-reading ABP analysis, the sensitivity, specificity, and accuracy of ABP monitoring in detecting AF were 93%, 87%, and 88%, respectively. In non-AF subjects, 12.8% of the 24-hour ABP readings indicated false-positive AF, of whom 27% were taken during supraventricular premature beats. There was a strong association between the proportion of false-positive AF readings and that of supraventricular premature beats ( r =0.67; P ABP monitoring had 100%/85% sensitivity/specificity (area under the curve 0.91; P ABP monitor with AF detector has high sensitivity and moderate specificity for AF screening during routine ABP monitoring. Thus, in elderly hypertensives, a 24-hour ABP recording with at least 26% of the readings suggesting AF indicates a high probability for AF diagnosis and should be regarded as an indication for performing 24-hour Holter monitoring. © 2018 American Heart Association, Inc.
Ralston, J D; Cook, A J; Anderson, M L; Catz, S L; Fishman, P A; Carlson, J; Johnson, R; Green, B B
We evaluated the role of home monitoring, communication with pharmacists, medication intensification, medication adherence and lifestyle factors in contributing to the effectiveness of an intervention to improve blood pressure control in patients with uncontrolled essential hypertension. We performed a mediation analysis of a published randomized trial based on the Chronic Care Model delivered over a secure patient website from June 2005 to December 2007. Study arms analyzed included usual care with a home blood pressure monitor and usual care with home blood pressure monitor and web-based pharmacist care. Mediator measures included secure messaging and telephone encounters; home blood pressure monitoring; medications intensification and adherence and lifestyle factors. Overall fidelity to the Chronic Care Model was assessed with the Patient Assessment of Chronic Care (PACIC) instrument. The primary outcome was percent of participants with blood pressure (BP) <140/90 mm Hg. At 12 months follow-up, patients in the web-based pharmacist care group were more likely to have BP <140/90 mm Hg (55%) compared to patients in the group with home blood pressure monitors only (37%) (p = 0.001). Home blood pressure monitoring accounted for 30.3% of the intervention effect, secure electronic messaging accounted for 96%, and medication intensification for 29.3%. Medication adherence and self-report of fruit and vegetable intake and weight change were not different between the two study groups. The PACIC score accounted for 22.0 % of the main intervention effect. The effect of web-based pharmacist care on improved blood pressure control was explained in part through a combination of home blood pressure monitoring, secure messaging, and antihypertensive medication intensification.
Gaurav, Aman; Maheedhar, Maram; Tiwari, Vijay N; Narayanan, Rangavittal
Cuff-less estimation of systolic (SBP) and diastolic (DBP) blood pressure is an efficient approach for non-invasive and continuous monitoring of an individual's vitals. Although pulse transit time (PTT) based approaches have been successful in estimating the systolic and diastolic blood pressures to a reasonable degree of accuracy, there is still scope for improvement in terms of accuracies. Moreover, PTT approach requires data from sensors placed at two different locations along with individual calibration of physiological parameters for deriving correct estimation of systolic and diastolic blood pressure (BP) and hence is not suitable for smartphone deployment. Heart Rate Variability is one of the extensively used non-invasive parameters to assess cardiovascular autonomic nervous system and is known to be associated with SBP and DBP indirectly. In this work, we propose a novel method to extract a comprehensive set of features by combining PPG signal based and Heart Rate Variability (HRV) related features using a single PPG sensor. Further, these features are fed into a DBP feedback based combinatorial neural network model to arrive at a common weighted average output of DBP and subsequently SBP. Our results show that using this current approach, an accuracy of ±6.8 mmHg for SBP and ±4.7 mmHg for DBP is achievable on 1,750,000 pulses extracted from a public database (comprising 3000 people). Since most of the smartphones are now equipped with PPG sensor, a mobile based cuff-less BP estimation will enable the user to monitor their BP as a vital parameter on demand. This will open new avenues towards development of pervasive and continuous BP monitoring systems leading to an early detection and prevention of cardiovascular diseases.
Liu, Wenjin; Ye, Hong; Tang, Bing; Sun, Zhiping; Wen, Ping; Wu, Wenhui; Bian, Xueqing; Shen, Xia; Yang, Junwei
The two most commonly used strategies to evaluate dialysis patients' blood pressure (BP) level are 44-hour and 24-hour ambulatory blood pressure monitoring (ABPM). The objective of this study was to find an appropriate 24-hour period that correlated well with the 44-hour BP level and determine the differences between these strategies. In a group of 51 dialysis patients, the authors performed 44-hour ABPM and extracted data for a fixed 24-hour ABPM. The fixed 24-hour ABPM started at 6 am on the nondialysis day. A strong correlation was found between all parameters of 44-hour and the fixed 24-hour ABPM, with paired sample t test showing only small magnitude changes in a few parameters. Both 24-hour ABPM and 44-hour ABPM were superior to clinic BP in predicting left ventricular mass index (LVMI) by multiple regression analysis. It was found that 44-hour ambulatory arterial stiffness index (AASI), but not 24-hour AASI, had a positive association with LVMI (r=0.328, P=.021). However, after adjustment for 44-hour systolic blood pressure, this association disappeared. Fixed 24-hour ABPM is a good surrogate of 44-hour ABPM to some extent, while 44-hour ABPM can provide more accurate and detailed information. ©2013 Wiley Periodicals, Inc.
de la Sierra, A
Clinical blood pressure measurement (BP) is an occasional and imperfect way of estimating this biological variable. Ambulatory blood pressure monitoring (ABPM) is by far the best clinical tool for measuring an individual's blood pressure. Mean values over 24h, through the daytime and at night all make it more possible to predict organic damage and the future development of the disorder. ABPM enables the detection of white-coat hypertension and masked hypertension in both the diagnosis and follow-up of treated patients. Although some of the advantages of ABPM can be reproduced by more automated measurement without the presence of an observer in the clinic or self-measurement at home, there are some other elements of great interest that are unique to ABPM, such as seeing what happens to a patient's BP at night, the night time dipping pattern and short-term variability, all of which relate equally to the patient's prognosis. There is no scientific or clinical justification for denying these advantages, and ABPM should form part of the evaluation and follow-up of practically all hypertensive patients. Rather than continuing unhelpful discussions as to its availability and acceptability, we should concentrate our efforts on ensuring its universal availability and clearly explaining its advantages to both doctors and patients. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.
Shimbo, Daichi; Kent, Shia T; Diaz, Keith M; Huang, Lei; Viera, Anthony J; Kilgore, Meredith; Oparil, Suzanne; Muntner, Paul
The US Centers for Medicaid and Medicare Services reimburses ambulatory blood pressure monitoring (ABPM) for suspected white coat hypertension. We estimated ABPM use between 2007 and 2010 among a 5% random sample of Medicare beneficiaries (≥ 65 years). In 2007, 2008, 2009 and 2010, the percentage of beneficiaries with ABPM claims was 0.10%, 0.11%, 0.10%, and 0.09% respectively. A prior diagnosis of hypertension was more common among those with versus without an ABPM claim (77.7% versus 47.0%)...
Afanas'eva, N L; Mordovin, V F; Semke, G V; Luk'ianenok, P I
To study relations between disturbances of cerebral venous circulation and parameters of 24-h blood pressure monitoring in hypertensive patients. A total of 72 patients aged 28 to 60 years with essential hypertension of stage II have undergone 24-h blood pressure monitoring and MR-venography of the brachiocephalic veins on a low-field MR-tomograph using 2D TOF angiography. Symptoms of disturbed cerebral venous circulation were found in 60% patients. Major venous collectors were asymmetric in 79.2% patients, 40.3% had marked asymmetry, 14% had severe asymmetry. Disturbances of venous outflow significantly more frequently occurred in non-dippers and night-peakers as well as in high variability of blood pressure. Patients with marked asymmetry of venous collectors had elevated nocturnal systolic and diastolic blood pressure, high load indices of nocturnal systolic and diastolic pressure, a low degree of nocturnal fall of blood pressure. Disturbance of venous cerebral outflow in hypertensive patients is closely related with alterations of a circadian profile of blood pressure: circadian index of blood pressure, variability of blood pressure.
Shin, Jae Hyuk; Lee, Kang Moo; Park, Kwang Suk
In this study, we developed a novel technique for estimating non-constrained and cuffless blood pressure (BP) that was based on electrocardiogram (ECG) and ballistocardiogram (BCG). The BCG was non-invasively measured using a common electronic weighing scale when a subject was standing on it. The ECG was measured using three different methods: on the chest using Ag/AgCl electrodes, on the hands using dry electrodes and on the feet also using dry electrodes. For a BP correlated parameter, a time interval parameter, which was defined as the time difference between the ECG R-peak and BCG J-peak, was employed for evaluating and estimating beat-to-beat BP. Under a BP varying experiment with a Valsalva manoeuvre, the R–J intervals were extracted at every beat cycle and a systolic blood pressure (SBP) estimation equation was established using linear regression analysis for each subject. In the case of feet delivered ECG (F-ECG), an ensemble average technique synchronized at the BCG J-peak point was applied to extract the ECG signal from the feet. The performance of the proposed method was evaluated using Finapres, a non-invasive blood pressure measurement system, as a reference BP signal, and a scatter plot was used to find the regression line between the reference values and estimated BPs. A moving-window averaging technique was applied to remove the high-frequency noise in the R–J intervals and was applied to enhance the accuracy of the SBP estimation. For all individuals, the estimated SBP was similar to the measured SBP with a reliable correlation, which makes the proposed method suitable for use in a home healthcare system to monitor blood pressure on a weighing scale at the same time as measuring weight
Sakai, Yoko; Yasuo M, Tsutsumi; Oyama, Takuro; Murakami, Chiaki; Kakuta, Nami; Tanaka, Katsuya
Robot-assisted laparoscopic radical prostatectomy (RALRP) is commonly performed in the surgical treatment of prostate cancer. However, the steep Trendelenburg position (25) and pneumoperitoneum required for this procedure can sometimes cause hemodynamic changes. Although blood pressure is traditionally monitored invasively during RALRP, the ClearSight system (BMEYE, Amsterdam, The Netherlands) enables a totally noninvasive and simple continuous blood pressure and cardiac output monitoring based on finger arterial pressure pulse contour analysis. We therefore investigated whether noninvasive continuous arterial blood pressure measurements using the ClearSight system were comparable to those obtained invasively in patients undergoing RALRP. Ten patients scheduled for RALRP with American Society of Anesthesiologists physical status I-II were included in this study. At each of the seven defined time points, noninvasive and invasive blood pressure measurements were documented and compared in each patient using Bland-Altman analysis. Although the blood pressure measured with the ClearSight system correlated with that measured invasively, a large difference between the values obtained by the two devices was noted. The ClearSight system was unable to detect blood pressure accurately during RALRP, suggesting that blood pressure monitoring using this device alone is not feasible in this small patient population. J. Med. Invest. 65:69-73, February, 2018.
Póvoa, Thaís Inacio Rolim; Jardim, Thiago Veiga; Carneiro, Carolina de Souza; Ferreira, Vanessa Roriz; Mendonça, Karla Lorena; de Morais, Polyana Resende Silva; Nascente, Flávia Miquetichuc Nogueira; de Souza, Weimar Kunz Sebba Barroso; Sousa, Ana Luiza Lima; Jardim, Paulo César Brandão Veiga
Background Regional differences of using home blood pressure monitoring (HBPM) as an alternative to ambulatory blood pressure monitoring (ABPM) in hypertensive adolescents are unknown. Objectives Define if HBPM is an option to confirm diagnoses of hypertension in adolescents from a Brazilian capital with elevated office blood pressure (BP). Methods Adolescents (12-18years) from public and private schools with BP > 90th percentile were studied to compare and evaluate the agreement among office BP measurements, HBPM and ambulatory BP monitoring. Office BP measurements, HBPM and ABPM were performed according to guidelines recommendations. Semi-automatic devices were used for BP measurements. Values of p ABPM values (120.3 ± 12.6 mmHg x 121.5 ± 9.8 mmHg - p = 0.111 and 69.4 ± 7.7 mmHg x 70.2 ± 6.6 mmHg - p = 0.139) and lower than the office measurement values (127.3 ± 13.8 mmHg over 74.4 ± 9.5 mmHg - p ABPM. Conclusions HBPM is an option to confirm diagnoses of hypertension in adolescents from a Brazilian state capital with elevated office BP and can be used as an alternative to ABPM. PMID:28793045
McCartney, David E; McManus, Richard J
This article reviews recent developments in self-monitoring and self-management of hypertension aimed at the improvement of blood pressure (BP) control. There is an increasing body of evidence examining the effects of self-monitoring on BP control. Several landmark studies in recent years have demonstrated clinically relevant benefit from self-monitoring based interventions. Self-management of BP with self-titration has shown particular promise, as has self-monitoring combined with intensive health-care led support. There is a lack of evidence on the benefits of self-monitoring for those with important comorbidity such as coronary heart disease, chronic kidney disease, diabetes and previous stroke, and future research should be directed towards this. There is a growing body of evidence supporting the use of self-monitoring along with additional intervention including telemonitoring and self-titration in improving BP control. Further research is needed to understand which patients are likely to benefit most and how this is best integrated with routine care.
Zeng, Wei-Fang; Kang, Yuan-Yuan; Liu, Ming; Li, Yan; Wang, Ji-Guang
The present study aimed to evaluate the accuracy of the automated oscillometric upper-arm blood pressure (BP) monitor A&D UA-1020 with two different-shaped cuffs for home BP monitoring according to the British Hypertension Society (BHS) Protocol. We recruited individuals for each of the two cuffs (D-ring and cylindrical) until there were 85 eligible participants (255 pairs of comparisons) and their BP could meet the BP distribution requirements specified by the BHS Protocol. For each participant, we sequentially measured the systolic and diastolic BP using a mercury sphygmomanometer (two observers) and the UA-1020 device (one supervisor). For the D-ring cuff, the device achieved grade A. The percentage of BP differences within 5, 10, and 15 mmHg was 67, 87, and 96%, respectively, for systolic BP, and 70, 90, and 99%, respectively, for diastolic BP. The average (±SD) of the device-observer differences was -0.2±7.3 mmHg (P=0.64) and 1.7±5.8 mmHg (P<0.0001) for systolic and diastolic BP, respectively. For the cylindrical cuff, the device also achieved grade A. The percentage of BP differences within 5, 10, and 15 mmHg was 67, 88, and 97%, respectively, for systolic BP and 64, 89, and 98%, respectively, for diastolic BP. The average of the device-observer differences was -0.1±7.0 mmHg (P=0.89) and 2.0±6.3 mmHg (P<0.0001) for systolic and diastolic BP, respectively. The UA-1020 device has passed the requirements of the BHS Protocol with both the D-ring and the cylindrical cuffs, and hence can be recommended for home use in adults.
Purdy, Phillip D; South, Charles; Klucznik, Richard P; Liu, Kenneth C; Novakovic, Robin L; Puri, Ajit S; Pride, G Lee; Aagaard-Kienitz, Beverly; Ray, Abishek; Elliott, Alan C
Monitoring of blood pressure (BP) during procedures is variable, depending on multiple factors. Common methods include sphygmomanometer (BP cuff), separate radial artery catheterization, and side port monitoring of an indwelling sheath. Each means of monitoring has disadvantages, including time consumption, added risk, and signal dampening due to multiple factors. We sought an alternative approach to monitoring during procedures in the catheterization laboratory. A new technology involving a 330 µm fiberoptic sensor embedded in the wall of a sheath structure was tested against both radial artery catheter and sphygmomanometer readings obtained simultaneous with readings recorded from the pressure sensing system (PSS). Correlations and Bland-Altman analysis were used to determine whether use of the PSS could substitute for these standard techniques. The results indicated highly significant correlations in systolic, diastolic, and mean arterial pressures (MAP) when compared against radial artery catheterization (p<0.0001), and MAP means differed by <4%. Bland-Altman analysis of the data suggested that the sheath measurements can replace a separate radial artery catheter. While less striking, significant correlations were seen when PSS readings were compared against BP cuff readings. The PSS has competitive functionality to that seen with a dedicated radial artery catheter for BP monitoring and is available immediately on sheath insertion without the added risk of radial catheterization. The sensor is structurally separated from the primary sheath lumen and readings are unaffected by device introduction through the primary lumen. Time delays and potential complications from radial artery catheterization are avoided. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Zwinderman, A. H.; Cleophas, T. A.; Cleophas, T. J.; van der Wall, E. E.
In normotensive subjects blood pressures follow a circadian rhythm. A circadian rhythm in hypertensive patients is less well established, and may be clinically important, particularly with rigorous treatments of daytime blood pressures. Polynomial analysis of ambulatory blood pressure monitoring
Tucker, Katherine L; Taylor, Kathryn S; Crawford, Carole; Hodgkinson, James A; Bankhead, Clare; Carver, Tricia; Ewers, Elizabeth; Glogowska, Margaret; Greenfield, Sheila M; Ingram, Lucy; Hinton, Lisa; Khan, Khalid S; Locock, Louise; Mackillop, Lucy; McCourt, Christine; Pirie, Alexander M; Stevens, Richard; McManus, Richard J
Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide, and a high proportion of affected women develop pre-eclampsia. This study aimed to evaluate the feasibility of self-monitoring of BP in pregnancy in women at higher risk of pre-eclampsia. This prospective cohort study of self-monitoring BP in pregnancy was carried out in two hospital trusts in Birmingham and Oxford and thirteen primary care practices in Oxfordshire. Eligible women were those defined by the UK National Institute for Health and Care Excellence (NICE) guidelines as at higher risk of pre-eclampsia. A total of 201 participants were recruited between 12 and 16 weeks of pregnancy and were asked to take two BP readings twice daily three times a week through their pregnancy. Primary outcomes were recruitment, retention and persistence of self-monitoring. Study recruitment and retention were analysed with descriptive statistics. Survival analysis was used to evaluate the persistence of self-monitoring and the performance of self-monitoring in the early detection of gestational hypertension, compared to clinic BP monitoring. Secondary outcomes were the mean clinic and self-monitored BP readings and the performance of self-monitoring in the detection of gestational hypertension and pre-eclampsia compared to clinic BP. Of 201 women recruited, 161 (80%) remained in the study at 36 weeks or to the end of their pregnancy, 162 (81%) provided any home readings suitable for analysis, 148 (74%) continued to self-monitor at 20 weeks and 107 (66%) at 36 weeks. Self-monitored readings were similar in value to contemporaneous matched clinic readings for both systolic and diastolic BP. Of the 23 who developed gestational hypertension or pre-eclampsia and self-monitored, 9 (39%) had a raised home BP prior to a raised clinic BP. Self-monitoring of BP in pregnancy is feasible and has potential to be useful in the early detection of gestational hypertensive disorders but maintaining self-monitoring
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Carrera, Pricivel M.; Lambooij, Mattijs S.
Abstract Out-of-office blood pressure monitoring is promoted by various clinical guidelines toward properly diagnosing and effectively managing hypertension and engaging the patient in their care process. In the Netherlands, however, the Dutch cardiovascular risk management (CVRM) guidelines do not explicitly prescribe 24-hour ambulatory blood pressure measurement (ABPM) and home BP measurement (HBPM). The aim of this descriptive study was to develop an understanding of patients’ and physicians’ acceptance and use of out-of-office BP monitoring in the Netherlands given the CVRM recommendations. Three small focus group discussions (FGDs) with patients and 1 FGD with physicians were conducted to explore the mechanisms behind the acceptance and use of out-of-office BP monitoring and reveal real-world challenges that limit the implementation of out-of-office BP monitoring methods. To facilitate the FGDs, an analytical framework based on the technology acceptance model (TAM), the theory of planned behavior and the model of personal computing utilization was developed to guide the FGDs and analysis of the transcriptions of each FGD. ABPM was the out-of-office BP monitoring method prescribed by physicians and used by patients. HBPM was not offered to patients even with patients’ feedback of poor tolerance of ABPM. Even as there was little awareness about HBPM among patients, there were a few patients who owned and used sphygmomanometers. Patients professed and seemed to exhibit self-efficacy, whereas physicians had reservations about (all of their) patients’ self-efficacy in properly using ABPM. Since negative experience with ABPM impacted patients’ acceptance of ABPM, the interaction of factors that determined acceptance and use was found to be dynamic among patients but not for physicians. In reference to the CVRM guidelines, physicians implemented out-of-office BP monitoring but showed a strong preference for ABPM even where there is poor tolerance of the
Xydopoulos, G; Perry, H; Sheehan, E; Thilaganathan, B; Fordham, R; Khalil, A
Traditional monitoring of blood pressure in hypertensive pregnant women requires frequent visits to the maternity outpatient services. Home blood-pressure monitoring (HBPM) could offer a cost-saving alternative that is acceptable to patients. The main objective of this study was to undertake a health economic analysis of HBPM compared with traditional monitoring in hypertensive pregnant women. This was a case-control study. Cases were pregnant women with hypertension who had HBPM with or without the adjunct of a smartphone app, via a specially designed pathway. The control group were managed as per existing hospital guidelines. Specific outcome measures were the number of outpatient visits, inpatient bed stays and investigations performed. Maternal, fetal and neonatal adverse outcomes were also recorded. Health economic analysis was performed using two methods: direct cost comparison of the study dataset and process scenario modelling. There were 108 women in the HBPM group, of whom 29 recorded their results on the smartphone app (App-HBPM) and 79 in their notes (Non-app HBPM). The control group comprised of 58 patients. There were significantly more women with chronic hypertension in the HBPM group (49.1% vs 25.9%, P = 0.004). The HBPM group had significantly longer duration of monitoring (9 weeks vs 5 weeks P = 0.004) and started monitoring from an earlier gestation (30 weeks vs 33.6 weeks, P = 0.001). Despite these differences, the mean saving per week for HBPM compared with the control group was £200.69. For the App-HBPM cohort, the saving per week compared with the control group was £286.53. The process modelling method predicted savings of between £98.32 and £245.80 per week using HBPM compared to the traditional monitoring. HBPM in hypertensive pregnancies appears to be cost-saving compared with traditional monitoring, without compromising maternal, fetal or neonatal safety. Larger studies are required to confirm these findings. This article is
Martin, Una; Holder, Roger; Hodgkinson, James; McManus, Richard
Background Inter-arm difference in blood pressure of >10 mmHg is associated with peripheral vascular disease, but it is unclear how much of the difference in sequential right and left arm blood pressure measurements might be due to a ‘white-coat’ effect. Aim To use ambulatory blood pressure monitoring (ABPM) to better understand the clinical significance of inter-arm differences in blood pressure. Design and setting Retrospective study in a teaching hospital in Birmingham. Method Anonymised clinical data collected from 784 patients attending a single hospital-based hypertension clinic were retrospectively analysed. Each participant had blood pressure measured sequentially in both arms, followed by ABPM over the subsequent 24 hours. Result Data were available for 710 (91%) patients, of whom 39.3% (279) had a blood pressure difference of 10 mmHg or more between each arm. Compared to daytime systolic ABPM, the difference was 25.1 mmHg using the arm with the highest reading, but only 15.5 mmHg if the lower reading was taken (mean difference 9.6 mmHg (95% confidence interval [CI] = 9.0 mmHg to 10.3 mmHg)). However, differences between mean right (20.7 mmHg) or left (19.9 mmHg) arm blood pressure and daytime systolic ABPM were very similar. Conclusion Compared with ABPM, use of the higher of the left and right arm readings measured sequentially appears to overestimate true mean blood pressure. As there is no significant difference in the extent of disparity with ABPM by left or right arm, this is unlikely to be due to arm dominance and may be due to the ‘white-coat’ effect reducing blood pressure on repeated measurement. Where a large inter-arm blood pressure difference is detected with sequential measurement, healthcare professionals should re-measure the blood pressure in the original arm. PMID:23561681
Martin, Una; Holder, Roger; Hodgkinson, James; McManus, Richard
Inter-arm difference in blood pressure of >10 mmHg is associated with peripheral vascular disease, but it is unclear how much of the difference in sequential right and left arm blood pressure measurements might be due to a 'white-coat' effect. To use ambulatory blood pressure monitoring (ABPM) to better understand the clinical significance of inter-arm differences in blood pressure. Retrospective study in a teaching hospital in Birmingham. Anonymised clinical data collected from 784 patients attending a single hospital-based hypertension clinic were retrospectively analysed. Each participant had blood pressure measured sequentially in both arms, followed by ABPM over the subsequent 24 hours. Data were available for 710 (91%) patients, of whom 39.3% (279) had a blood pressure difference of 10 mmHg or more between each arm. Compared to daytime systolic ABPM, the difference was 25.1 mmHg using the arm with the highest reading, but only 15.5 mmHg if the lower reading was taken (mean difference 9.6 mmHg (95% confidence interval [CI] = 9.0 mmHg to 10.3 mmHg)). However, differences between mean right (20.7 mmHg) or left (19.9 mmHg) arm blood pressure and daytime systolic ABPM were very similar. Compared with ABPM, use of the higher of the left and right arm readings measured sequentially appears to overestimate true mean blood pressure. As there is no significant difference in the extent of disparity with ABPM by left or right arm, this is unlikely to be due to arm dominance and may be due to the 'white-coat' effect reducing blood pressure on repeated measurement. Where a large inter-arm blood pressure difference is detected with sequential measurement, healthcare professionals should re-measure the blood pressure in the original arm.
Edwards, Lloyd J.; Simpson, Sean L.
The use of 24-hour ambulatory blood pressure monitoring (ABPM) in clinical practice and observational epidemiological studies has grown considerably in the past 25 years. ABPM is a very effective technique for assessing biological, environmental, and drug effects on blood pressure. In order to enhance the effectiveness of ABPM for clinical and observational research studies via analytical and graphical results, developing alternative data analysis approaches are important. The linear mixed mo...
Kent, Shia T.; Shimbo, Daichi; Huang, Lei; Diaz, Keith M.; Viera, Anthony J.; Kilgore, Meredith; Oparil, Suzanne; Muntner, Paul
Ambulatory blood pressure monitoring (ABPM) can be used to identify white coat hypertension and guide hypertensive treatment. We determined the percentage of ABPM claims submitted between 2007–2010 that were reimbursed. Among 1,970 Medicare beneficiaries with submitted claims, ABPM was reimbursed for 93.8% of claims that had an ICD-9 diagnosis code of 796.2 (“elevated blood pressure reading without diagnosis of hypertension”) versus 28.5% of claims without this code. Among claims without an ICD-9 diagnosis code of 796.2 listed, those for the component (e.g., recording, scanning analysis, physician review, reporting) versus full ABPM procedures and performed by institutional versus non-institutional providers were each more than two times as likely to be successfully reimbursed. Of the claims reimbursed, the median payment was $52.01 (25–75th percentiles: $32.95–$64.98). In conclusion, educating providers on the ABPM claims reimbursement process and evaluation of Medicare reimbursement may increase the appropriate use of ABPM and improve patient care. PMID:25492833
Peterson, Caitlin G.; Miyashita, Yosuke
Hypertension (HTN) is a significant global health problem, responsible for 7.5 million deaths each year worldwide. The prevalence of HTN is increasing in the pediatric population likely attributed to the increase in childhood obesity. Recent work has also shown that blood pressure (BP) tends to track from childhood to adulthood including BP-related target organ damage. In the last 25–30 years, pediatric use of ambulatory blood pressure monitoring (ABPM) has been expanding mainly in the setting of initial elevated BP measurement evaluation, HTN therapy efficacy follow-up, and renal disease. However, there are many clinical areas where ABPM could potentially be used but is currently underutilized. This review summarizes the current knowledge and the uses of pediatric ABPM and explores clinical areas where it can be very useful both to detect HTN and its longitudinal follow-up. And thus, ABPM could serve as a critical tool to potentially prevent early cardiovascular mortality and morbidity in wide variety of populations. With solid data to support ABPM’s superiority over clinic BP measurements and these clinical areas for its expansion, ABPM should now be part of standard of care in BP evaluation and management in pediatrics. PMID:28713799
This is a review of ambulatory blood pressure monitoring (ABPM) use in pediatrics, focusing on research published in the last 3 to 4 years. Recent data has shown that ABPM is more strongly associated with end-organ damage than casual BP, and that obesity and secondary causes of hypertension are strongly associated with nocturnal hypertension. There is evidence that ABPM is useful in management of a larger variety of diagnoses than previously thought. New guidelines from the American Academy of Pediatrics recognize the importance of ABPM in the management of pediatric hypertension. ABPM has an important and growing role in the diagnosis and management of hypertension in children and adolescents. Future efforts should include developing more generalizable normative data and investigating associations between pediatric ABPM results and adult outcomes.
Meng, Linghui; Zhao, Di; Pan, Yan; Ding, Wenqing; Wei, Qing; Li, Hua; Gao, Pingjin; Mi, Jie
BACKGROUnD: To determine whether the professional Omron HBP-1300 blood pressure (BP) monitor meets American Association for the Advancement of Medical Instrumentation (AAMI) accuracy standards in Chinese children and adults. According to the AAMI protocol, simultaneous auscultatory measurements by two observers using a mercury manometer were obtained in participants using the Omron HBP-1300. Triple measurements were obtained after a minimum 5-min rest with a 1-min interval between adjacent measurements. A total of 85 participants submitted to 255 doctor-measured BP and 255 successful professional monitor readings. The initial auscultation systolic BP was 160 mmHg in seven participants (8.2%). All of the simultaneous measurements agreed to within ± 10 mmHg, while 95% agreed to within ± 4 mmHg for both systolic and diastolic BP, and the consistency between two observers was satisfactory. The difference between the devices was -1.3 ± 3.6 mmHg for systolic BP and 0.7 ± 3.8 mmHg for diastolic BP and by AAMI method 1, which met this guideline. The average difference between two devices by AAMI method 2 was 1.4 ± 3.2 mmHg for systolic BP and 1.0 ± 3.9 mmHg for diastolic BP, which met this guideline. The professional BP monitor Omron HBP-1300 is desirable for measuring the BP for Chinese children and adults.
Lakhal, Karim; Ehrmann, Stephan; Perrotin, Dominique; Wolff, Michel; Boulain, Thierry
To assess whether invasive and non-invasive blood pressure (BP) monitoring allows the identification of patients who have responded to a fluid challenge, i.e., who have increased their cardiac output (CO). Patients with signs of circulatory failure were prospectively included. Before and after a fluid challenge, CO and the mean of four intra-arterial and oscillometric brachial cuff BP measurements were collected. Fluid responsiveness was defined by an increase in CO ≥10 or ≥15% in case of regular rhythm or arrhythmia, respectively. In 130 patients, the correlation between a fluid-induced increase in pulse pressure (Δ500mlPP) and fluid-induced increase in CO was weak and was similar for invasive and non-invasive measurements of BP: r² = 0.31 and r² = 0.29, respectively (both p area under the receiver-operating curve (AUC) of 0.82 (0.74-0.88), similar (p = 0.80) to that of non-invasive Δ500mlPP [AUC of 0.81 (0.73-0.87)]. Outside large gray zones of inconclusive values (5-23% for invasive Δ500mlPP and 4-35% for non-invasive Δ500mlPP, involving 35 and 48% of patients, respectively), the detection of responsiveness or unresponsiveness to fluid was reliable. Cardiac arrhythmia did not impair the performance of invasive or non-invasive Δ500mlPP. Other BP-derived indices did not outperform Δ500mlPP. As evidenced by large gray zones, BP-derived indices poorly reflected fluid responsiveness. However, in our deeply sedated population, a high increase in invasive pulse pressure (>23%) or even in non-invasive pulse pressure (>35%) reliably detected a response to fluid. In the absence of a marked increase in pulse pressure (<4-5%), a response to fluid was unlikely.
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Jujo, Kentaro; Saito, Katsumi; Ishida, Issei; Furuki, Yuho; Ouchi, Taisuke; Kim, Ahsung; Suzuki, Yuki; Sekiguchi, Haruki; Yamaguchi, Junichi; Ogawa, Hiroshi; Hagiwara, Nobuhisa
Percutaneous transluminal renal angioplasty (PTRA) improves patency in atherosclerotic renal artery stenosis (ARAS), but improvement in clinic blood pressure (BP) is seen in only 20-40% of patients who undergo PTRA. This study investigated the effects of PTRA on BP lowering, assessed on 24-h ambulatory BP monitoring (ABPM), and identified preoperative features predictive of satisfactory BP improvement after PTRA. Of 1,753 consecutive patients undergoing coronary angiography, 31 patients with angiographically significant ARAS and translesional pressure gradient (TLPG) >20 mmHg underwent PTRA. ABPM was performed before, at 1 month and at 1 year after PTRA; patients with average systolic ABPM-BP decrease >10 mmHg at 1 month from baseline were categorized as responders. There was no obvious relationship between clinic BP and ABPM-BP at baseline. ABPM-BP was significantly higher in responders at baseline (SBP: 148 vs. 126 mmHg, PABPM-BP achieved a larger decrease in ABPM-BP, but the severity of stenosis reflected by TLPG; renal duplex findings; and neurohumoral parameters other than baseline renal function, did not differ between the groups. Clinic BP does not represent daily hemodynamic status, whereas high ABPM-BP is a potent predictor of satisfactory BP response to PTRA. (Circ J 2016; 80: 1922-1930).
Moreira Leila B
Full Text Available Abstract Background Blood pressure (BP variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM. We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI. Methods and Results In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time, standard deviation (SD of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40 was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007. In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04. In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P Conclusion Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.
O'Brien, Eoin; Parati, Gianfranco; Stergiou, George; Asmar, Roland; Beilin, Laurie; Bilo, Grzegorz; Clement, Denis; de la Sierra, Alejandro; de Leeuw, Peter; Dolan, Eamon; Fagard, Robert; Graves, John; Head, Geoffrey A; Imai, Yutaka; Kario, Kazuomi; Lurbe, Empar; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Ogedegbe, Gbenga; Ohkubo, Takayoshi; Omboni, Stefano; Palatini, Paolo; Redon, Josep; Ruilope, Luis M; Shennan, Andrew; Staessen, Jan A; vanMontfrans, Gert; Verdecchia, Paolo; Waeber, Bernard; Wang, Jiguang; Zanchetti, Alberto; Zhang, Yuqing
Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a consensus meeting on ABPM in Milan in 2011 that the 34 attendees should prepare a comprehensive position paper on the scientific evidence for ABPM.This position paper considers the historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique. It examines the need for selecting an appropriate device, the accuracy of devices, the additional information and indices that ABPM devices may provide, and the software requirements.At a practical level, the paper details the requirements for using ABPM in clinical practice, editing considerations, the number of measurements required, and the circumstances, such as obesity and arrhythmias, when particular care needs to be taken when using ABPM.The clinical indications for ABPM, among which white-coat phenomena, masked hypertension, and nocturnal hypertension appear to be prominent, are outlined in detail along with special considerations that apply in certain clinical circumstances, such as childhood, the elderly and pregnancy, and in cardiovascular illness, examples being stroke and chronic renal disease, and the place of home measurement of blood pressure in relation to ABPM is appraised.The role of ABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined and finally the implementation of ABPM in practice is considered in relation to the issue of reimbursement in different countries, the provision of the technique by primary care practices, hospital clinics and pharmacies, and the growing role of registries of ABPM in many countries.
Gorostidi, Manuel; de la Sierra, Alejandro; González-Albarrán, Olga; Segura, Julián; de la Cruz, Juan J; Vinyoles, Ernest; Llisterri, José L; Aranda, Pedro; Ruilope, Luis M; Banegas, José R
Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68,045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of >1200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12,600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, P<0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, P<0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, P<0.001). Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, P<0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered.
Wittke, Estefânia; Fuchs, Sandra C; Fuchs, Flávio D; Moreira, Leila B; Ferlin, Elton; Cichelero, Fábio T; Moreira, Carolina M; Neyeloff, Jeruza; Moreira, Marina B; Gus, Miguel
Blood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI). In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses. Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.
Muehlsteff, J; Aubert, X A; Morren, G
There is an unmet need for cuff-less blood pressure (BP) monitoring especially, in personal healthcare applications. The pulse arrival time (PAT) approach might offer a suitable solution to enable comfortable BP monitoring even at beat-level. However, the methodology is based on hemodynamic surrogate measures, which are sensitive to patient activities such as posture changes, not necessarily related to blood pressure variations. In this paper, we analyze the impact of posture on the PAT measure and related hemodynamic parameters such as the pre-ejection period in well-defined procedures. Additionally, the PAT of a monitored subject is investigated in an unsupervised scenario illustrating the complexity of such a measurement. Our results show the failure of blood pressure inference based on simple calibration strategies using the PAT measure only. We discuss opportunities to compensate for the observed effects towards the realization of wearable cuff-less blood pressure monitoring. These findings emphasize the importance of accessing context information in personal healthcare applications, where vital sign monitoring is typically unsupervised.
Andreev-Andrievskiy, Alexander; Popova, Anfisa; Lloret, Jean-Christophe; Aubry, Patrick; Borovik, Anatoliy; Tsvirkun, Daria; Vinogradova, Olga; Ilyin, Eugeniy; Gauquelin-Koch, Guillemette; Gharib, Claude; Custaud, Marc-Antoine
Animals are an essential component of space exploration and have been used to demonstrate that weightlessness does not disrupt essential physiological functions. They can also contribute to space research as models of weightlessness-induced changes in humans. Animal research was an integral component of the 30-day automated Russian biosatellite Bion-M 1 space mission. The aim of the hemodynamic experiment was to estimate cardiovascular function in mice, a species roughly 3000 times smaller than humans, during prolonged spaceflight and post-flight recovery, particularly, to investigate if mice display signs of cardiovascular deconditioning. For the first time, heart rate (HR) and blood pressure (BP) were continuously monitored using implantable telemetry during spaceflight and recovery. Decreased HR and unchanged BP were observed during launch, whereas both HR and BP dropped dramatically during descent. During spaceflight, BP did not change from pre-flight values. However, HR increased, particularly during periods of activity. HR remained elevated after spaceflight and was accompanied by increased levels of exercise-induced tachycardia. Loss of three of the five mice during the flight as a result of the hardware malfunction (unrelated to the telemetry system) and thus the limited sample number constitute the major limitation of the study. For the first time BP and HR were continuously monitored in mice during the 30-day spaceflight and 7-days of post-flight recovery. Cardiovascular deconditioning in these tiny quadruped mammals was reminiscent of that in humans. Therefore, the loss of hydrostatic pressure in space, which is thought to be the initiating event for human cardiovascular adaptation in microgravity, might be of less importance than other physiological mechanisms. Further experiments with larger number of mice are needed to confirm these findings.
Carrera, Percivil Melendez; Lambooij, Mattijs S.
Out-of-office blood pressure monitoring is promoted by various clinical guidelines toward properly diagnosing and effectively managing hypertension and engaging the patient in their care process. In the Netherlands, however, the Dutch cardiovascular risk management (CVRM) guidelines do not
Prasad Krishnamurthy Narasimha
Full Text Available Takayasu′s arteritis (TA is rare, chronic progressive, pan-endarteritis involving the aorta and its main branches, with a specific predilection for young Asian women. Anaesthesia for TA patients is complicated by their severe uncontrolled hypertension, extreme arterial blood pressure differentials, aortic regurgitation (AR, end-organ dysfunction, stenosis/aneurysms of major blood vessels and difficulties encountered in monitoring arterial blood pressure. We present the usefulness of ultrasound during anaesthetic management of a 35-year-old woman posted for emergency caesarean section due to intra-uterine growth retardation, foetal tachycardia in active labour, who was already diagnosed to have TA along with moderate AR and uncontrolled hypertension, using epidural technique. The use of intra-operative doppler helped resolve the initial dilemma about the diagnosis and treatment of the differential blood pressure between the affected and the normal upper limb in the absence of prior arteriogram.
Tsivgoulis, Georgios; Pikilidou, Maria; Katsanos, Aristeidis H; Stamatelopoulos, Kimon; Michas, Fotios; Lykka, Aikaterini; Zompola, Christina; Filippatou, Angeliki; Boviatsis, Efstathios; Voumvourakis, Konstantinos; Zakopoulos, Nikolaos; Manios, Efstathios
The Framingham Stroke Risk Profile (FSRP) is a novel and reliable tool for estimating the 10-year probability for incident stroke in stroke-free individuals, while the predictive value of ambulatory blood pressure monitoring (ABPM) for first-ever and recurrent stroke has been well established. We sought to evaluate cross-sectionally the association of ABPM parameters with FSRP score in a large sample of 2343 consecutive stroke-free individuals (mean age: 56.0±12.9, 49.1% male) who underwent 24-hour ABPM. True hypertensives showed significantly higher FSRP (11.2±5.0) compared to the normotensives (8.2±5.0, pbest fitting model for predicting FSRP (R 2 =24.6%) on multiple linear regression analyses after adjustment for vascular risk factors not included in FSRP comprised the following parameters in descending order: 24-hour PP (β=0.349, p<0.001), daytime SBP variability (β=0.124, p<0.001), 24-hour HR variability (β=-0.091, p<0.001), mean 24-hour HR (β=-0.107, p<0.001), BMI (β=0.081, p<0.001) and dipping percentage (β=-0.063, p=0.001). 24-hour PP and daytime SBP variability are the two ABPM parameters that were more strongly associated with FSRP-score. Reverse dippers had the highest FSRP among all dipping status profiles. Copyright © 2017 Elsevier B.V. All rights reserved.
Haskin, Orly; Wong, Cynthia J; McCabe, Lonisa; Begin, Brandy; Sutherland, Scott M; Chaudhuri, Abanti
The blood pressure (BP) burden is high in pediatric hemodialysis (HD) patients and adversely affects prognosis. The aim of this study was to examine whether 44-h ambulatory BP monitoring (ABPM) provides additional relevant BP data compared with 24-h ABPM. ABPM was initiated at the end of the mid-week dialysis run in 13 stable pediatric HD patients and continued until the next run for 44 h. Day 1 was defined as the initial 24-h ABPM and Day 2 as the time period after that until the next dialysis run. All patients had an echocardiogram to calculate the left ventricular mass index (LVMI). A higher percentage of patients were diagnosed with hypertension from the 44-h ABPM than from the 24-h ABPM. All BP indexes and loads (except nighttime diastolic load) were significantly higher on Day 2 than on Day 1. Patients with BP loads of ≥ 25 % on 44-h ABPM had significantly higher LVMI than those patients with normal BP loads. No such association was found with 24-h ABPM and LVMI. Higher interdialytic weight gain was associated with higher Day-2 nighttime systolic BP load. The 44-h ABPM provides more information than the 24-h ABPM in terms of diagnosing and assessing the true burden of hypertension in pediatric HD patients. Elevated BP loads from 44-h ABPM correlate with a higher LVMI on the echocardiogram.
Shimbo, Daichi; Kent, Shia T; Diaz, Keith M; Huang, Lei; Viera, Anthony J; Kilgore, Meredith; Oparil, Suzanne; Muntner, Paul
The US Centers for Medicaid and Medicare Services reimburses ambulatory blood pressure monitoring (ABPM) for suspected white coat hypertension. We estimated ABPM use between 2007 and 2010 among a 5% random sample of Medicare beneficiaries (≥ 65 years). In 2007, 2008, 2009 and 2010, the percentage of beneficiaries with ABPM claims was 0.10%, 0.11%, 0.10%, and 0.09% respectively. A prior diagnosis of hypertension was more common among those with versus without an ABPM claim (77.7% versus 47.0%). Among hypertensive beneficiaries, 95.2% of those with an ABPM claim were taking antihypertensive medication. Age 75-84 versus 65-74 years, having coronary heart disease, chronic kidney disease, multiple prior hypertension diagnoses, and having filled multiple classes of antihypertensive medication were associated with an increased odds for an ABPM claim among hypertensive beneficiaries. ABPM use was very low among Medicare beneficiaries and was not primarily used for diagnosing white coat hypertension in untreated individuals. PMID:25492832
Davis, Marguerite L; Ferguson, Michael A; Zachariah, Justin P
Elevated blood pressure (BP) is rising in children. Significant proportions of children have reactive hypertension or masked hypertension, making ambulatory BP monitoring (ABPM) a valuable tool, although with potential economic implications. In youth referred for elevated BP, we sought clinic BP combinations that obviated the need for ABPM and to specify the economic role of ABPM. In a retrospective pediatric referral cohort (N = 170), we examine clinic systolic BP (SBP) predictors of components of ABPM hypertension and their combination. In economic analyses, we compared effectiveness and charges of three diagnostic pathways: (1) clinic BP alone; (2) abnormal clinic BP prompting ABPM; or (3) universal ABPM. ABPM hypertension occurred in 55 (32.4%) and reactive hypertension in 37 (21.8%), average automated (β = 0.208; 95% confidence interval, 0.027, 0.389; P = .03) and maximum auscultatory clinic SBP (β = 0.160; 95% confidence interval 0.022, 0.299; P = .02) were associated with ABPM SBP mean, but none predicted SBP load. No clinic SBP combination was associated with ABPM hypertension. Universal ABPM accrued the lowest average charge per hypertensive youth identified ($10,948). We did not identify a clinic SBP combination that predicted ABPM hypertension in youth referred for elevated BP. Universal ABPM, in this context, may be the most economically and clinically efficient diagnostic strategy. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.
Castilla-Guerra, Luis; Fernandez-Moreno, Maria del Carmen
Hypertension is the most important potentially reversible risk factor for stroke in all age groups; high blood pressure (BP) is also associated with increased risk of recurrent stroke in patients who have already had an ischemic or hemorrhagic event. Twenty-four hour ambulatory BP monitoring (ABPM) has become an important tool for improving the diagnosis and management of hypertension, and is increasingly used to assess patients with hypertension. Nevertheless, although ABPM devices are increasingly used for assessment of hypertension, their value in the chronic management of hypertension in patients with stroke has not been systematically studied. In fact, among large-scale randomized trials for secondary stroke prevention, only the Morbidity and Mortality After Stroke, Eprosartan Compared With Nitrendipine for Secondary Prevention trial included 24-hour ABPM. ABPM has demonstrated chronic disruption of the circadian rhythm of BP after acute phase of stroke and has shown higher sensitivity compared to office BP in evaluating the effectiveness of antihypertensive treatment among stroke survivors. High 24-hour BP is an independent predictor for cerebrovascular events, brain microbleeds, and subsequent development of dementia. Nevertheless, although stroke care guidelines endorse the importance of hypertension management, the specific role of ABPM among stroke survivors after the acute phase of disease has not been established. Further studies are needed to clarify whether routine application of ABPM among these patients should be recommended. PMID:26687120
Félez-Carrobé, Estel; Sagarra-Tió, Maria; Romero, Araceli; Rubio, Montserrat; Planas, Lourdes; Pérez-Lucena, María José; Baiget, Montserrat; Cabistañ, Cristina; Félez, Jordi
Background: Ambulatory blood pressure monitoring (ABPM) predicts cardiovascular risk and identifies white-coat and masked hypertension, efficacy of treatment and the circadian cycle of hypertensive patients. Objective: To analyze the effectiveness of ABPM implementation thoughtout a nurse-driven training program. Materials and Methodology: Twenty eight professionals were involved in the study carried out in the primary care center of the metropolitan area of Barcelona that serves 34,289 inhabitants. The ABPM implementation program was driven by two nurses that held four education sessions. After a 2-year follow-up period, we assessed the outcome of attendance at the educational sessions. First, we evaluated whether the program increased the number of orders of ABPM. Second, we used a survey to evaluate to what extent the input of our educational sessions was understood by attendants. Third, we analyzed the effect ABPM results had on the treatment of patients with a bad control of their hypertension. Results: After the training sessions we found a 6-fold increase in the number of patients undergoing ABPM. We analyzed 204 hypertensive individuals: 41% dippers, 34% were non-dippers, 20% were risers and 5% were extremely dippers. According to our survey, 100% of attendants had a good practice regarding ABPM management. However only 27% of riser patients were studied with a second ABPM. Conclusions: Specific training processes are needed for implementation of ABPM and an even more concentrated effort should be focused on training in the correct interpretation of ABPM results. PMID:23750185
Hill, James R
Recent studies have demonstrated that home blood pressure monitoring (HBPM), coupled with self-titration of medications is a viable intervention to control hypertension. There are currently no established criteria to evaluate patients for inclusion in such a program. The purpose of this discussion is to propose criteria for determining if a patient is appropriate to participate in a program of HBPM and self-titration. Inclusion criteria for two self-titration trials were examined, and additional factors in clinical practice were identified and discussed. Additional selection criteria were proposed to support the decision to enroll a patient in an antihypertensive self-titration program. Inclusion criteria from self-titration trials provide a reasonable starting point for choosing appropriate patients in clinical practice, but additional research is necessary. Adaptation of these criteria and consideration of the identified factors can be used to develop decision support instruments. Such instruments should be evaluated for effectiveness and reliability prior to use in clinical practice. HBPM combined with self-titration is an effective patient-centered approach for hypertension management. Decision support instruments to determine appropriate patients are necessary for safe and effective use in clinical practice. ©2015 American Association of Nurse Practitioners.
Wallace, Lorraine S; Keenum, Amy J
To evaluate the readability and related features of English language Quick Reference Guides (QRGs) and User Manuals (UMs) accompanying home blood pressure monitors (HBPMs). We evaluated QRGs and UMs for 22 HBPMs [arm (n=12); wrist (n=10)]. Using established criteria, we evaluated reading grade level, language availability, dimensions, text point size, use of illustrations, layout/formatting characteristics, and emphasis of key points of English-language patient instructions accompanying HBPMs. Readability was calculated using McLaughlin's Simplified Measure of Gobbledygoop. Items from the Suitability of Materials Assessment and User-Friendliness Tool were used to assess various layout features. Simplified Measure of Gobbledygoop scores of both QRGs (mean+/-SD=9.1+/-0.8) and UMs (9.3+/-0.8) ranged from 8th to 10th grade. QRGs and UMs presented steps in chronological order, used active voice throughout, avoided use of specialty fonts, focused on need to know, and used realistic illustrations. Seven sets of instructions included all seven key points related to proper HPBM use, whereas three sets of instructions included less than or equal to three key points (mean=4.8+/-1.9). Although most QRGs and UMs met at least some recommended low-literacy formatting guidelines, all instructional materials should be developed and tested to meet the needs of the patient population at large. Key points related to proper HBPM use should not only be included within these instructions, but highlighted to emphasize their importance.
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Full Text Available INTRODUCTION Renal scarring is the most common cause of arterial hypertension in children. High blood pressure (BP and microalbuminuria contribute to the progression of chronic renal disease. OBJECTIVE The aims of the study were: to assess BP in children with renal scarring by continuous ambulatory blood pressure measurement (ABPM in comparison to the casual method (CBP, and to determine the correlation between ambulatory blood pressure (ABP and/or casual blood pressure (CBP values and proteinuria in children with renal scarring. METHOD This forward-looking study comprised thirty-five children (26 girls and 9 boys, aged between 3-13 years, 10.4±3.9, X+SD. Blood pressure was measured using the casual method (CBP with a mercury manometer; BP was measured three times and the average was taken as a referent value. ABPM was performed using the oscillometric method with the Space Labs device, model 90207. RESULTS 45.71% of patients were classified as hypertensive by ABPM, while only 22.6% of CBP measurements were above the 95th percentile (p<0.01. "White coat hypertension" was present in 40% of the patients. Non-dipping BP alteration was detected in 37.14% of the patients. CONCLUSION Nocturnal systolic hypertension (systolic non-dipping alteration is very frequent in children with renal scarring. Nocturnal diastolic blood pressure, detectable only via ABPM, is positively correlated with proteinuria and may be an initial sign of the progression of renal scarring. ABPM is more sensitive than CBP in the evaluation of BP in children with renal scarring.
O'Brien, Eoin; Dolan, Eamon
This purpose of this article is to review the current recommendations for ambulatory blood pressure measurement (ABPM) and the use of ABPM in assessing treatment. We review current international guidelines and undertake a critical review of evidence supporting the clinical use of ABPM in effectively managing antihypertensive drug treatment. Current guidelines emphasize the diagnostic superiority of ABPM, mainly from the ability of the technique to identify sustained hypertension by allowing for the exclusion of white-coat hypertension and by demonstrating the presence of masked hypertension. ABPM also offers diagnostic insights into nocturnal patterns of blood pressure, such as dipping and nondipping, reverse dipping, and excessive dipping, and the presence of nocturnal hypertension; although less attention is given to the nocturnal behavior of blood pressure in clinical practice, the nocturnal patterns of blood pressure have particular relevance in assessing the response to blood pressure-lowering medication. Surprisingly, although the current guidelines give detailed recommendations on the diagnostic potential and use of ABPM, there are scant recommendations on the benefits and application of the technique for the initiation of blood pressure-lowering therapy in clinical practice and virtually no recommendations on how it might be used to assess the efficacy of drug treatment. In view of a deficiency in the literature on the role of ABPM in assess the efficacy of drug treatment, we put forward proposals to correct this deficiency and guide the prescribing physician on the most appropriate drug administration and dosage over time. Copyright © 2016 Elsevier HS Journals, Inc. All rights reserved.
Pedersen, Ole Lederballe; Mancia, Giuseppe; Pickering, Thomas
OBJECTIVE: The ambulatory blood pressure (ABP) monitoring substudy of the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial was carried out in a subset of patients from USA, Italy and Denmark. ABP was measured after 1 year in the trial, with the aim of evaluating comparability...... of ABP levels on valsartan (VAL) and amlodipine (AML)-based regimens. METHODS: ABP was measured every 20 min during a 25-h period after morning administration of medicine; 659 patients were available for intention-to-treat analysis. RESULTS: Office blood pressure (BP) differences were smaller than...
S. P. Zhemanyuk
Full Text Available Blood pressure (BP has been identified as a risk factor for various health disorders, including stroke onsets. Hypertension is one of the crucial health problem among adult Ukrainian. Due to the importance of elevated BP in stroke causality, BP measurement remains critical. However, it is limited information about value in clinical practice of ambulatory blood pressure monitoring (ABPM data in hypertensive patients with inadequately controlled BP with acute stroke compared with those individuals who has no vascular onset. The aim of the study was to determine ABPM parameters in essential hypertensive patients with ischaemic hemisphere stroke. Materials and methods. A total of 114 study participants were analyzed (mean age 62 (56;72 years, 40 % women. We divided them into two groups according to the level of 24-h systolic BP (SBP and diastolic BP (DBP, and the results of clinical examination. The first group (n=83 were inadequately controlled essential hypertensive individuals with high systolic or/and diastolic BP level according to the ABMP results, and the second one (n=31 were EH patients with an acute hemispheric ischaemic stroke (IS. Diagnosis of stroke was confirmed with clinical examination and computed tomography scan or magnetic resonance imaging results, and ABPM was conducted in 4.2±2.3 days after the stroke onset. Results. We had statistician difference (p<0.001 between groups of such parameters, as average SBP (diurnal, daytime, nighttime; diurnal pulse BP; SBP load (p<0.05; the diurnal AASI (p<0.05; circadian rhythm of DBP (p<0.05. No differences were found between the groups in morning surge calculated as speed and amplitude of the BP climbed in morning hours both for SBP (P=0.422 and P=0.395, respectively and DBP (P=0.860 and P=0.337, respectively. Conclusion. In the present study, we evaluated the ABPM parameters in inadequately controlled essential hypertensive individuals with and without acute ischaemic hemispheric stroke
Cappelleri, Claudia; Janoschka, Alin; Berli, Reto; Kohler, Sibylle; Braun-Dullaeus, Ruediger C.; Heuss, Ludwig T.; Wolfrum, Mathias
Abstract Elevated blood pressure (BP) is frequently diagnosed in very elderly hospitalized patients. Accurate diagnosis of hypertension is challenging in the hospital environment, due to the “white coat effect,” and both overtreatment and undertreatment can adversely affect clinical outcome. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) has the potential to avoid the “white coat effect” and accurately guide the management of hypertension. However, effects of the hospital environment on ABPM are unknown in the very elderly. We set out to enroll 45 patients, age ≥70 years, with elevated conventional BP during hospitalization in this observational study. It was prespecified by protocol to assess initially the difference between 24-hour BP during hospital-admission and home follow-up. Subsequent analysis should investigate the change in anxiety (Hospital Anxiety and Depression Scale-A [HADS-A]) after discharge, the correlation with change in 24-hour BP after discharge, and the prevalence of orthostatic hypertension. Thirty-one patients were included in the final analysis (age 83.5 ± 4.4 years; 71% female). Twenty-four-hour BP decreased significantly after hospital discharge (systolic from 133.5 ± 15.6 to 126.2 ± 14.4 mm Hg [millimeter of mercury], P = .008; diastolic from 71.0 ± 9.0 to 68.3 ± 8.6 mm Hg, P = .046). Anxiety level (HADS-A) decreased significantly after discharge, from 7.5 (interquartile range [IQR]: 4.0–13.8) to 5.0 (IQR: 4.0–8.0, P = .012). The change in anxiety was a predictor of change in systolic BP after discharge (F[1,20] = 5.9, P = .025). Sixty-one percent of the patients had significant orthostatic hypotension during hospital stay. In conclusion, 24-hour BP in very elderly patients is lower in the home environment than during hospitalization. This phenomenon seems to be directly linked to a lower anxiety-level at home. Reassessing hypertension at home may decrease the
Comparative effects of valsartan plus either cilnidipine or hydrochlorothiazide on home morning blood pressure surge evaluated by information and communication technology-based nocturnal home blood pressure monitoring.
Fujiwara, Takeshi; Tomitani, Naoko; Kanegae, Hiroshi; Kario, Kazuomi
The authors tested the hypothesis that a valsartan/cilnidipine combination would suppress the home morning blood pressure (BP) surge (HMBPS) more effectively than a valsartan/hydrochlorothiazide combination in patients with morning hypertension, defined as systolic BP (SBP) ≥135 mm Hg or diastolic BP ≥85 mm Hg assessed by a self-measuring information and communication technology-based home BP monitoring device more than three times before either combination's administration. This was an 8-week prospective, multicenter, randomized, open-label clinical trial. The HMBPS, which is a new index, was defined as the mean morning SBP minus the mean nocturnal SBP, both measured on the same day. The authors randomly allocated 129 patients to the valsartan/cilnidipine (63 patients; mean 68.4 years) or valsartan/hydrochlorothiazide (66 patients; mean 67.3 years) combination groups, and the baseline HMBPS values were 17.4 mm Hg vs 16.9 mm Hg, respectively (P = .820). At the end of the treatment period, the changes in nocturnal SBP and morning SBP from baseline were significant in both the valsartan/cilnidipine and valsartan/hydrochlorothiazide groups (P information and communication technology-based home BP monitoring device may become an alternative to ambulatory BP monitoring, which has been a gold standard to measure nocturnal BP and the morning BP surge. ©2018 Wiley Periodicals, Inc.
Markuszewski, Leszek; Ruxer, Monika; Szadkowska, Agnieszka; Bodalska, Joanna; Bissinger, Andrzej
The aim of this study was to evaluate usefulness of ambulatory blood pressure monitoring (ABPM) to examine circadian patterns of blood pressure (BP) alterations in young, normotensive patients with type I diabetes mellitus (DM1). We studied 43 patients with DM1 aged 18-28 years, with 9-23 years of DM1, without long-term complications. Control group consisted of 32 healthy persons, matched to the DM1 group. 24h ABPM was performed by a Spacelab 90207 device to obtain daytime (7 AM to 11 PM, readings at 20-min interval) and nighttime (11 PM to 7 AM, readings at 30-min interval) measurements in both groups. During the daytime systolic BP (sBP) and diastolic BP (dBP) were not significantly different from the control group. We noted nighttime sBP and dBP higher in DM1 group: sBE 119.7+/-12.6 mmHg vs. 103.817.1; p = 0.001 l dBP 65.5+/-6.2 vs. 61.5+/-3.1; p = 0.001. The loss of fall in BP ('non-dippers') was more prevalent in DM1 group: 49% vs. 9%; p = 0.003. Pulse pressure (PP) was significantly higher in DM1 patients: 50.9+/-6.9 mmHg vs. 44.8+/-5.6 mmHg; p = 0.0001. ABPM is a useful method in detecting early BP alterations in young normotensive patients with diabetes mellitus type 4 1. Increased PP and suppressed diurnal BP variations could represent a increased risk of cardiovascular complications in young patients with diabetes mellitus type 1.
McManus, Richard J.; Mant, Jonathan; Haque, M. Sayeed; Bray, Emma P.; Bryan, Stirling; Greenfield, Sheila M.; Jones, Miren I.; Jowett, Sue; Little, Paul; Penaloza, Cristina; Schwartz, Claire; Shackleford, Helen; Shovelton, Claire; Varghese, Jinu; Williams, Bryan
IMPORTANCE: Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups.\\ud \\ud OBJECTIVE: To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease.\\ud \\ud DESIGN, SETTING, AN...
Yip, Gabriel Wai-Kwok; So, Hung-Kwan; Li, Albert Martin; Tomlinson, Brian; Wong, Sik-Nin; Sung, Rita Yn-Tz
The A&D TM-2430 ambulatory blood pressure (BP) monitor has been validated in adults but not in a young population. We sought to validate the device monitoring in children and adolescents, according to the British Hypertension Society (BHS) protocol. The A&D TM-2430 is an automated oscillometric upper-arm device for ambulatory BP monitoring. Nine consecutive measurements were taken in 61 children (mean age, 9.8 years; range, 5-15 years) according to the BHS criteria. Overseen by an independent supervisor, measurements were recorded by two observers blinded from each other's readings and from the device readings. The mean difference ± SD between the observers and device measurements was 0.73 ± 1.64 mmHg for systolic blood pressure (SBP) and -1.23 ± 1.65 mmHg for diastolic blood pressure (DBP), respectively, with an interobserver difference of 4 mmHg. The cumulative percentages of differences within 5, 10, and 15 mmHg were 89, 95, and 98% for SBP and 67, 88, and 98% for DBP. The device achieved a grade A rating for SBP and a B grade for DBP. The A&D TM-2430 upper-arm BP monitor has fulfilled the required BHS standards and can be recommended for measuring ambulatory BP in children and adolescent populations.
Andreadis, Emmanuel A; Geladari, Charalampia V; Angelopoulos, Epameinondas T; Savva, Florentia S; Georgantoni, Anna I; Papademetriou, Vasilios
Automated office blood pressure (AOBP) measurement is superior to conventional office blood pressure (OBP) because it eliminates the "white coat effect" and shows a strong association with ambulatory blood pressure. We conducted a cross-sectional study in 146 participants with office hypertension, and we compared AOBP readings, taken with or without the presence of study personnel, before and after the conventional office readings to determine whether their variation in blood pressure showed a difference in blood pressure values. We also compared AOBP measurements with daytime ambulatory blood pressure monitoring and conventional office readings. The mean age of the studied population was 56±12 years, and 53.4% of participants were male. Bland-Altman analysis revealed a bias (ie, mean of the differences) of 0.6±6 mm Hg systolic for attended AOBP compared with unattended and 1.4±6 and 0.1±6 mm Hg bias for attended compared with unattended systolic AOBP when measurements were performed before and after conventional readings, respectively. A small bias was observed when unattended and attended systolic AOBP measurements were compared with daytime ambulatory blood pressure monitoring (1.3±13 and 0.6±13 mm Hg, respectively). Biases were higher for conventional OBP readings compared with unattended AOBP (-5.6±15 mm Hg for unattended AOBP and oscillometric OBP measured by a physician, -6.8±14 mm Hg for unattended AOBP and oscillometric OBP measured by a nurse, and -2.1±12 mm Hg for unattended AOBP and auscultatory OBP measured by a second physician). Our findings showed that independent of the presence or absence of medical staff, AOBP readings revealed similar values that were closer to daytime ambulatory blood pressure monitoring than conventional office readings, further supporting the use of AOBP in the clinical setting. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Omboni, Stefano; Costantini, Carlo; Pini, Claudio; Bulegato, Roberto; Manfellotto, Dario; Rizzoni, Damiano; Palatini, Paolo; O'brien, Eoin; Parati, Gianfranco
Although standard validation protocols provide assurance of the accuracy of blood pressure monitors (BPMs), there is no guidance for the consumer as to the overall quality of a device. The PA.NET International Quality Certification Protocol, developed by the Association for Research and Development of Biomedical Technologies and for Continuing Medical Education (ARSMED), a nonprofit organization, with the support of the Italian Society of Hypertension-Italian Hypertension League, and the dabl Educational Trust denotes additional criteria of quality for BPMs that fulfilled basic validation criteria, published in full in peer-reviewed medical journals. The certification is characterized by three phases: (i) to determine that the device fulfilled standard validation criteria; (ii) to determine the technical and functional characteristics of the device (e.g. operativity, display dimension, accessory functions, memory availability, etc.) and (iii) to determine the commercial characteristics (e.g. price-quality ratio, after-sale service, guarantee, etc.). At the end of the certification process, ARSMED attributes a quality index to the device, based on a scale ranging from 1 to 100, and a quality seal with four different grades (bronze, silver, gold and diamond) according to the achieved score. The seal is identified by a unique alphanumeric code. The quality seal may be used on the packaging of the appliance or in advertising. A quality certification is released to the manufacturer and published on www.pressionearteriosa.net and www.dableducational.org. The PA.NET International Quality Certification Protocol represents the first attempt to provide health care personnel and consumers with an independent and objective assessment of BPMs based on their quality.
Kang, In Sook; Pyun, Wook Bum; Shin, Jinho; Kim, Ju Han; Kim, Soon Gil; Shin, Gil Ja
Central obesity has been reported as a risk for atherosclerosis and metabolic syndrome. The influence of central obesity on diurnal blood pressure (BP) has not been established. In this study, we investigated the influence of central obesity on the circadian parameters of BP by 24 hr ambulatory BP monitoring. Total 1,290 subjects were enrolled from the Korean Ambulatory BP registry. Central obesity was defined as having a waist circumference≥90 cm in males and ≥85 cm in females. The central-obese group had higher daytime systolic BP (SBP), nighttime SBP and diastolic BP (DBP) than the non-obese group (all, P<0.001). There were no differences in nocturnal dipping (ND) patterns between the groups. Female participants showed a higher BP mean difference (MD) than male participants with concerns of central obesity (daytime SBP MD 5.28 vs 4.27, nighttime SBP MD 6.48 vs 2.72) and wider pulse pressure (PP). Central obesity within the elderly (≥65 yr) also showed a higher BP MD than within the younger group (daytime SBP MD 8.23 vs 3.87, daytime DBP 4.10 vs 1.59). In conclusion, central obesity has no influence on nocturnal dipping patterns. However, higher SBP and wider PP are associated with central obesity, which is accentuated in women.
Castro-Grattoni, Anabel L; Torres, Gerard; Martínez-Alonso, Montserrat; Barbé, Ferran; Turino, Cecilia; Sánchez-de-la-Torre, Alicia; Cortijo, Anunciacion; Duran-Cantolla, Joaquin; Egea, Carlos; Cao, Gonzalo; Sánchez-de-la-Torre, Manuel
The reduction in blood pressure (BP) with continuous positive airway pressure (CPAP) is modest and highly variable. In this study, we identified the variables that predict BP response to CPAP.24-h ambulatory BP monitoring (ABPM), C-reactive protein (CRP), leptin, adiponectin and 24-h urinary catecholamine were measured before and after 6 months of CPAP in obstructive sleep apnoea (OSA) patients.Overall, 88 middle-aged, obese male patients with severe OSA (median apnoea-hypopnoea index 42 events·h -1 ) were included; 28.4% had hypertension. 62 patients finished the study, and 60 were analysed. The daytime diastolic BP (-2 mmHg) and norepinephrine (-109.5 nmol·day -1 ) were reduced after CPAP, but no changes in the 24-h BP, night-time BP, dopamine, epinephrine, CRP, leptin or adiponectin were detected. The nocturnal normotension was associated with an increased night-time-BP (+4 mmHg) after CPAP, whereas nocturnal hypertension was associated with a reduction of 24-h BP (-3 mmHg). A multivariate linear regression model showed differential night-time BP changes after CPAP. Specifically, low night-time heart rate (CPAP and support the usefulness of 24-h ABPM for OSA patients before treatment initiation. These results need to be confirmed in further studies. Copyright ©ERS 2017.
Chen, Wan; Zeng, Zhao-Lin; Bing, Sen; Li, Lin-Yi; Wang, Rui; Wan, Yi
The aim of the present study was to validate the Grandway MD2301 digital automatic blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. The ESH-IP revision 2010 for the validation of blood pressure-measuring devices in adults was followed precisely. Systolic and diastolic blood pressure (SBP and DBP, respectively) were measured sequentially in 33 adult patients and compared with a standard mercury sphygmomanometer (two observers). A total of 99 comparison pairs were obtained. The device produced 78, 95 and 99 measurements within 5, 10, and 15 mmHg for SBP and 83, 96, and 99 for DBP, respectively. The average device-observer difference was -1.81±4.22 mmHg for SBP and -0.15±3.93 mmHg for DBP. All of the data were within the standards requirements to pass the testing. The Grandway MD2301 digital automatic blood pressure monitor meets the standards of the ESH-IP revision 2010 and can be recommended for self/home measurement in the general population.
Nuernberg, M; Lang, S; Curjol, A; Haddour, N; Ederhy, S; Asri, C El; Dufour-Soulat, L; Van Der Vynckt, C; Charbonnier, M; Cohen, A; Boccara, F
This study aimed to determine the utility of 24-hour ambulatory blood pressure monitoring (ABPM) in a priori normotensive and known hypertensive people living with HIV by quantifying new hypertension (HTN), masked hypertension, uncontrolled BP, and white coat effect. Data analysed was from the Register of cardiovascular Complications among people living with HIV (RECOVIH), including 263 HIV+ individuals with 1 or more CV risk factors who underwent 24-h ABPM in our cardiac centre.Diagnostic criteria:Elevated clinic BP: at or above 140/90 mmHgElevated mean 24-h ABPM: at or above 130/80 mmHg, systolic and/or diastolicNew hypertension: elevated clinic BP and/or elevated mean 24-h ABPMMasked hypertension: normal clinic BP and elevated mean 24-h ABPMUncontrolled BP: elevated clinic BP and/or elevated mean 24 h ABPM, in known HTNWhite coat effect: elevated clinic BP and normal mean 24-h ABPM, in a priori normotensives. The cohort had a mean age of 50.3 ± 7.7 years, was predominantly male (91%), had a long median HIV duration (15.3 years), and included 150 (57%) known HTN.In RECOVIH the prevalence of new HTN was 22% (n = 25), of which 50% masked hypertension diagnosed by 24-h ABPM solely. Uncontrolled HTN prevalence was 45% using clinic BP alone and 32% using 24-h ABPM alone. 24-h ABPM revealed that this masked uncontrolled HTN was frequently due to poor nocturnal BP control. White coat effect prevalence was not significantly different between the 2 groups (6.3% a priori normotensives vs. 9.3% known HTN, p = 0.37).HTN subjects were older, had higher BMI, and more frequently had a history of diabetes, coronary heart disease, and heart failure as compared to normotensives. Masked hypertension prevalence is high in RECOVIH, particularly among a priori normotensives. Suboptimal BP control is frequent among patients with treated and well-controlled clinic BP. Clinic BP monitoring alone is inadequate to diagnose HTN and assess true BP control because elevated
Full Text Available Li Li1, XinYu Zhang1, ChunHong Yan1, QingXiang Liang21Biomedical Engineering Lab, Faculty of Information Engineering, ShenZhen University, ShenZhen, China; 2Bao An People’s Hospital, ShenZhen, ChinaObjective: Extensive marketing of devices for self-measurement of blood pressure has created a need for purchasers to be able to satisfy themselves that such devices have been evaluated according to agreed criteria. The Oregon Scientific BPU 330 blood pressure monitor is an electronic device for upper arm measurement. This study assessed the accuracy of the Oregon Scientific BPU 330 blood pressure monitor according to the International Protocol by the Working Group on Blood Pressure Monitoring of the European Society of Hypertension for validation of blood pressure measuring devices.Method: 52 participants over 30 years of age were studied in the validation. Nine blood pressure measurements were taken alternately with a mercury sphygmomanometer by two observers, and by the supervisor, using the BPU 330 device. A total of 33 participants were selected for the analysis. The validation was divided into two phases. Phase 1 included 15 participants. If the device passed phase 1, 18 more participants were included. The 99 pairs of measurements were compared according to the International Protocol. The device was given a pass/fail recommendation based on its accuracy compared with the mercury standard (within 5, 10, and 15 mmHg, as well as the number met in the ranges specified by the International Protocol.Results: The mean and standard deviation of the difference between the mean of the observers and the BPU 330 device were 1.7 ± 4.7 mmHg and 2.8 ± 3.9 mmHg for systolic blood pressure (SBP and diastolic blood pressure (DBP, respectively. In phase 1, the device passed with a total of 33, 43, and 44 SBP readings; 38, 44, and 45 DBP readings were within 5, 10, and 15 mmHg, respectively. In phase 2.1, 81, 95, and 96 for SBP, and 83, 95, and 98 for DBP
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Ikama, M S; Nsitou, B M; Makani, J; Nkalla-Lambi, M; Passi-Louamba, C
To evaluate the rate control in the hypertensive patients and to identify the predictive factors of non-control. It was about a cross-sectional study with prospective collection of data over a period of 36 months. It has been held in Brazzaville, and included a consecutive series of 620 hypertensive patients known and treated for at least 6 weeks, having profited from an ambulatory blood pressure monitoring (ABPM) with therapeutic aiming. We used the TONOPORT V and the software Cardiosoft 6.51 of GE Health Care, respectively for the recording and the data analysis. The threshold fixed on the average of 24-hour was BP<130/80 mmHg, and the patients divided into two groups according to whether they were or not controlled. They were 352 men (56.8%) and 268 women (43.2%), old on average of 53.8 ± 9.7 years (ranges: 29 and 89 years). The standard of living of the patients was average in 330 cases (53.2%), weak in 132 cases (21.3%), and high in 71 cases (11.5%). The other associated risk factors were sedentariness in 275 cases (44.4%), overweight/obesity in 134 cases (21.6%), dyslipidemia in 121 cases (19.5%), diabetes mellitus in 90 cases (14.5%), and tobacco addiction in 25 cases (4%). The hypertension, old of 5.8 ± 5.7 years on average, was controlled among 215 patients (34.7%). The 24- hour BP average was 139 ± 14 mmHg for the SBP and 88.2 ± 10.2 mmHg for the DBP. The awake and asleep BP averages were respectively 141 ± 14 mmHg and 133 ± 16.2 mmHg for the SBP, 90.5 ± 10.5 and 81.2 ± 11.1 mmHg for the DBP. The antihypertensive protocol used was a monotherapy in 130 cases (21%), bitherapy in 287 cases (46.3%), tritherapy in 154 cases (24.8%), quadritherapy or more in 27 cases (4.3%). Prevalence of non-dipping was 43%. Age and male gender were the significant predictors of poor control. The rate control of hypertension in our study population remains low. Its improvement passes by the education of the hypertensive patients and the improvement of their living
... pressure is found. This is called essential hypertension. High blood pressure that is caused by another medical condition or medicine you are taking is called secondary hypertension. Secondary hypertension may be due to: Chronic ...
Luque-Ramírez, Manuel; Martí, David; Fernández-Durán, Elena; Alpañés, Macarena; Álvarez-Blasco, Francisco; Escobar-Morreale, Héctor F
Whether or not blood pressure (BP) and heart function of women with polycystic ovary syndrome (PCOS) are altered remains unclear, albeit subtle abnormalities in the regulation of BP observed in these women might suggest a mild masculinization of their cardiovascular system. To study the influence of obesity and androgen excess on BP and echocardiographic profiles of women with the syndrome, we conducted a cross-sectional case-control study comparing office and ambulatory BP monitoring, as well as echocardiographic assessments, in 63 premenopausal women with the classic phenotype, 33 nonhyperandrogenic women with regular menses, and 25 young men. Forty-nine subjects were lean and 72 had weight excess (body mass index ≥25 kg/m(2)). Participants had no previous history of hypertension and were nonsmokers. Men showed the highest BP readings, and the lowest readings were observed in control women, whereas women with PCOS had intermediate values. Undiagnosed hypertension was more common in subjects with weight excess irrespective of sex and hyperandrogenism. Women with PCOS and weight excess showed frequencies of previously undiagnosed hypertension that were similar to those of men with weight excess and higher than those observed in nonhyperandrogenic women. Lastly, male sex, weight excess and hypertension, the latter in men as well as in women with PCOS, increased left ventricular wall thickness. In summary, our results show that patients with classic PCOS and weight excess frequently have undiagnosed BP abnormalities, leading to target organ damage.
Lang, Sean M; Giuliano, John S; Carroll, Christopher L; Rosenkrantz, Ted S; Eisenfeld, Leonard
Blood pressure monitoring is an essential vital sign when caring for critically ill children. Invasive monitoring is considered the gold standard, but is not always feasible. The following study compared the CAS model 740 noninvasive blood pressure monitor with the Orion/MaxIQ NIBP module with the reference (invasive arterial measurement). We evaluated the validity of the system using the criteria provided by the Association for the Advancement of Medical Instrumentation. We performed paired measurements of 29 critically ill neonates and children. For individual paired comparisons, the mean difference in the systolic blood pressure was 2.42 mmHg (SD ± 6.3). The mean difference in the diastolic blood pressure was -1.29 mmHg (SD ± 5.45). The percentage of readings within 5, 10, and 15 mmHg for systolic blood pressure was 65.6, 86.0, and 96.8%, respectively. The percentage of readings within 5, 10, and 15 mmHg for diastolic blood pressure was 77.7, 93, and 95.5%, respectively. The CAS model 740 noninvasive blood pressure monitor with the Orion/MaxIQ NIBP module fulfills the accuracy performance criteria of the Association for the Advancement of Medical Instrumentation. This model may allow for rapid and accurate noninvasive blood pressure monitoring in neonates and children.
Marco A.M. Gomes
Full Text Available OBJECTIVE: To evaluate the influence of the siesta in ambulatory blood pressure (BP monitoring and in cardiac structure parameters. METHODS: 1940 ambulatory arterial blood pressure monitoring tests were analyzed (Spacelabs 90207, 15/15 minutes from 7:00 to 22:00 hours and 20/20 minutes from 22:01 to 6.59hours and 21% of the records indicated that the person had taken a siesta (263 woman, 52±14 years. The average duration of the siesta was 118±58 minutes. RESULTS: (average ± standard deviation The average of systolic/diastolic pressures during wakefulness, including the napping period, was less than the average for the period not including the siesta (138±16/85±11 vs 139±16/86±11 mmHg, p5%. CONCLUSION: The siesta influenced the heart structure parameters and from a statistical point of view the average of systolic and diastolic pressures and the respective pressure loads of the wakeful period.
Zehnder, Ashley M; Hawkins, Michelle G; Pascoe, Peter J; Kass, Philip H
To compare Doppler and oscillometric methods of indirect arterial blood pressure (IBP) with direct arterial measurements in anesthetized and awake red-tailed hawks. Prospective, randomized, blinded study. Six, sex unknown, adult red-tailed hawks. Birds were anesthetized and IBP measurements were obtained by oscillometry (IBP-O) and Doppler (IBP-D) on the pectoral and pelvic limbs using three cuffs of different width based on limb circumference: cuff 1 (20-30% of circumference), cuff 2 (30-40%), and cuff 3 (40-50%). Direct arterial pressure measurements were obtained from the contralateral superficial ulnar artery. Indirect blood pressure measurements were compared to direct systolic arterial pressure (SAP) and mean arterial pressure (MAP) during normotension and induced states of hypotension and hypertension. Measurements were also obtained in awake, restrained birds. Three-way anova, linear regression and Bland-Altman analyses were used to evaluate the IBP-D data. Results are reported as mean bias (95% confidence intervals). The IBP-O monitor reported errors during 54% of the measurements. Indirect blood pressure Doppler measurements were most accurate with cuff 3 and were comparable to MAP with a bias of 2 (-9, 13 mmHg). However, this cuff consistently underestimated SAP with a bias of 33 (19, 48 mmHg). Variability in the readings within and among birds was high. There was no significant difference between sites of cuff placement. Awake birds had SAP, MAP and diastolic arterial pressure that were 56, 43, and 38 mmHg higher than anesthetized birds. Indirect blood pressure (oscillometric) measurements were unreliable in red-tailed hawks. Indirect blood pressure (Doppler) measurements were closer to MAP measurements than SAP measurements. There was slightly better agreement with the use of cuff 3 on either the pectoral or pelvic limbs. Awake, restrained birds have significantly higher arterial pressures than those under sevoflurane anesthesia.
... other risk factors, like diabetes, you may need treatment. How does high blood pressure affect pregnant women? A few women will get ... HIV, Birth Control Heart Health for Women Pregnancy Menopause More Women's Health ... High Blood Pressure--Medicines to Help You Women and Diabetes Heart ...
Oświecimska, Joanna; Ziora, Katarzyna; Adamczyk, Piotr; Roczniak, Wojciech; Pikiewicz-Koch, Anna; Stojewska, Małgorzata; Dyduch, Antoni
Anorexia nervosa (AN) is characterized by marked neuroendocrine and autonomic dysfunctions. In the recent studies using automatic blood pressure monitoring (ABPM), lower BP values and lack of circardian variation of BP in anorectic patients were demonstrated. Unfortunately effects of hormonal changes, that may explain BP abnormalities were not analysed together. The aim of our study was the assessment of ABPM and hormonal status in anorectic girls. The study was performed on hospitalized 25 female anorectic adolescents aged 12-18 years. Control group was 17 age and height matched girls with normal weight and negative history for hypertension. ABPM was performed between 5 and 7 day of hospitalization, every 30 minutes during active period and every 60 minutes during sleep. Hormones (FSH, LH, estradiol, cortisol and fT4) serum concentrations were also evaluated. Mean systolic BP values were significantly lower in patients with AN in comparison to controls. Maximal diastolic and mean arterial pressure values for the whole day and active period but not for sleep were lower in AN than in controls. Anorectic girls showed tendency to night-time bradycardia. Moreover, there were no physiological circadian variations of BP in AN. We conclude that hormonal regulation of blood pressure and heart rate in anorectic patients is at least partially preserved. Lower blood pressure values, bradycardia and lack of physiological night fall of BP in anorectic patients may result from altered autonomic system function resulting from hormonal disturbances and other centrally mediated mechanisms.
Kao, Wei-Fong; Hou, Sen-Kuang; Huang, Chun-Yao; Chao, Chun-Chieh; Cheng, Chung-Chih; Chen, Yi-Jung
Atrial fibrillation (AF) is the most common arrhythmia. The most common diagnostic method, 12-lead electrocardiogram (ECG), can record episodes of arrhythmia from which the type and severity can be determined. The Heart Spectrum Blood Pressure Monitor (P2; OSTAR Meditech Corp., New Taipei City, Taiwan) is used to measure cardiovascular pressure change with fast Fourier transform (FFT) analysis to obtain heart rate frequency variability and accurate blood pressure data. We compared the diagnostic efficacy of the Heart Spectrum Blood Pressure Monitor to a 12-lead ECG (gold standard) for patients with AF. Three measurement methods were used in this study to analyze the heart index and compare the results with simultaneous 12-lead ECG: blood pressure; mean arterial pressure, which was calculated from individual blood pressure as a constant pressure; and a constant pressure of 60 mmHg. The physician used a 12-lead ECG and the Heart Spectrum Blood Pressure Monitor simultaneously. The Heart Spectrum Blood Pressure Monitor used FFT analysis to diagnose AF, and the findings were compared to the 12-lead ECG readings. This unblinded clinical trial was conducted in the emergency department of Taipei Medical University Hospital. Twenty-nine subjects with AF and 33 without AF aged 25 to 97 y (mean, 63.5 y) were included. Subjects who were exposed to high-frequency surgical equipment during testing, those with cardiac pacemakers or implantable defibrillators, and pregnant women were excluded. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 97%, 97%, 97%, and 97%, respectively, for method 1; 90%, 100%, 100%, and 91%, respectively, for method 2; and 100%, 94%, 94%, and 100%, respectively, for method 3. The sensitivity, specificity, PPV, and NPV for both methods ranged between 90% and 100%, indicating that the Heart Spectrum Blood Pressure Monitor can be effectively applied for AF detection.
Forestiero, Daniel; Mauad, Juliana Lustoza; Forestiero, Camila; Peixoto, Mario Lins; Ganassin, Fabio Peixoto; Gonzaga, Carolina; Cordeiro, Antonio Carlos; Rodrigues, Gabriel Doreto; Silveira, Tiago Bueno da; Amodeo, Celso
New recommendations on reference values for normal test results in ambulatory blood pressure monitoring (ABPM) were proposed by the V Brazilian Guidelines on Ambulatory Blood Pressure Monitoring, based mainly on the IDACO study. This epidemiological study is aimed at evaluating the impact of adopting these new standards in an arterial hypertension referral center. The results of 1,567 ABPM tests carried out between 2005 and 2010 were analyzed; 481 patients were excluded from the sample for not meeting minimum quality criteria of the test. Reference values from the IV Brazilian Guidelines on ABPM (2005) were used for the classification of these tests regarding the abnormality and compared with the changes proposed by the V Brazilian Guidelines on ABPM (2011). Statistical analysis was performed by Pearson's chi-square method and p values ABPM results, especially for the variable systolic pressure in the sleeping period: 49% when adopting the cutoff values of 2005 and 71% when adopting the values of 2011, with statistical significance, p ABPM test results in the study population. The question of thresholds of these tests for therapeutic targets of patients known to be hypertensive is still open and requires further studies, preferably national ones, for better definition of the subject.
Pessanha, Paulo; Viana, Manuel; Ferreira, Paula; Bertoquini, Susana; Pol?nia, Jorge
Background Hypertensive patients (HTs) are usually attended in primary care (PC). We aimed to assess the diagnostic accuracy and cost-benefit ratio of 24-hour ambulatory blood pressure monitoring (ABPM) in all newly diagnosed hypertensive patients (HTs) attended in PC. Methods In a cross-sectional study ABPM was recorded in all 336 never treated HTs (Office BP ?140 and/or???90?mm Hg) that were admitted during 16?months. Since benefits from drug treatment in white-coat hypertension (WCH) remai...
Beime, Beate; Deutsch, Cornelia; Krüger, Ralf; Wolf, Andreas; Müller, Peter; Hammel, Gertrud; Bramlage, Peter
The purpose of the study was to validate the ambulatory blood pressure monitoring (ABPM) device custo screen pediatric in children aged 3 to 12 years according to the International Protocol of the European Society of Hypertension (ESH-IP revision 2010). Thirty-three children were included and systolic and diastolic blood pressure measurements were performed according to the ESH-IP. The protocol was modified for children considering data from the German Health Interview and Examination Survey for Children and Adolescents (KIGGS). The custo screen pediatric met all the requirements of the ESH-IP. The mean difference between the test device and the reference was -1.4 ± 3.0 mmHg for systolic blood pressure (SBP) and -0.7 ± 3.2 mmHg for diastolic blood pressure (DBP). For SBP and DBP, all 99 measurements were within the absolute difference of 10 mmHg between the test device and the reference. As to part 2 of the protocol, for DBP in all subjects, two out of three measurements were within 5 mmHg between the device and the standard, whereas for SBP in 32 of 33 subjects, two out of three measurements were within this range. The custo screen pediatric met all criteria of the ESH-IP review 2010, modified for children from 3 to about 12 years, and can be recommended for ABPM in children. What is Known: • Validation of blood pressure measuring devices is essential to provide patients with an accurate blood pressure measuring device. • The majority of devices has not been validated in children. What is New: • Prior to the present validation, study protocol adjustments of ESH-IP review 2010 for children were defined according to German Health Interview and Examination Survey for Children and Adolescents 2013 (KIGGS). • The custo screen pediatric test device met all criteria of ESH-IP revision 2010, modified for children, and can be recommended for ABPM in children aged 3 to about 12 years.
... kidney disease, diabetes, or metabolic syndrome Read less Unhealthy lifestyle habits Unhealthy lifestyle habits can increase the risk of high blood pressure. These habits include: Unhealthy eating patterns, such as eating too much sodium ...
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Tucker, Katherine L; Sheppard, James P; Stevens, Richard; Bosworth, Hayden B; Bove, Alfred; Bray, Emma P; Earle, Kenneth; George, Johnson; Godwin, Marshall; Green, Beverly B; Hebert, Paul; Hobbs, F D Richard; Kantola, Ilkka; Kerry, Sally M; Leiva, Alfonso; Magid, David J; Mant, Jonathan; Margolis, Karen L; McKinstry, Brian; McLaughlin, Mary Ann; Omboni, Stefano; Ogedegbe, Olugbenga; Parati, Gianfranco; Qamar, Nashat; Tabaei, Bahman P; Varis, Juha; Verberk, Willem J; Wakefield, Bonnie J; McManus, Richard J
Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension. Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (-3.2 mmHg, [95% CI -4.9, -1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg [-3.3, 1.2]), to a 6.1 mmHg (-9.0, -3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic -0.2 mmHg [-2.2, 1.8]; ambulatory 1.1 mmHg [-0.3, 2.5]). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant
Katherine L Tucker
Full Text Available Self-monitoring of blood pressure (BP appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension.Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016. Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants. Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP compared to usual care at 12 months (-3.2 mmHg, [95% CI -4.9, -1.6 mmHg]. However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg [-3.3, 1.2], to a 6.1 mmHg (-9.0, -3.2 reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients, which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic -0.2 mmHg [-2.2, 1.8]; ambulatory 1.1 mmHg [-0.3, 2.5]. Results for diastolic blood pressure (dBP were similar. The main limitation of this work was that
Chin, K Y; Panerai, R B
Continuous recording of arterial blood pressure (ABP) has many applications in cardiovascular physiology, but existing alternatives rely on measurements performed in the fingers or radial artery. Peripheral recordings have significant differences from central ABP regarding the pattern of the waveform and corresponding systolic and diastolic values. To address the need for noninvasive measurements closer to the ascending aorta, a new device was constructed to measure ABP in the superficial temporal artery (STA) using photoplethysmography and the arterial volume clamping technique. The optoelectronic circuitry to generate the photoplethysmogram is contained in a specially designed probe placed over the STA and kept in place with a head frame. The prototype (STAbp) also includes original designs for the pneumatic, electronic, signal processing, control and display sub-systems. A self-calibration feature regularly updates the photoplethysmogram operating point to improve accuracy. The performance of the STAbp was compared against the Finapres in 19 healthy subjects. At rest, the bias (SD d ) was −23.1 (15.05), −10.8 (13.83) and −12.4 (12.93) mmHg for systolic, mean and diastolic pressures respectively, without significant differences in drift between the two devices. The 99% bandwidth (SD) for the spectral distribution of ABP waveforms was 5.3 (1.46) Hz for STAbp and 6.8 (0.73) Hz for the Finapres (p < 0.01). Handgrip manoeuvre showed a very similar response to the Finapres, including the rapid return to baseline on release. The new STAbp device has considerable potential as a new tool for clinical and research applications where continuous recording of more central ABP is advantageous compared to peripheral alternatives. (paper)
Hinderliter Alan L
Full Text Available Abstract Background Ambulatory blood pressure monitoring (ABPM is increasingly used to measure blood pressure (BP in research studies. We examined ease of use, comfort, degree of disturbance, reported adverse effects, factors associated with poor tolerability, and association of poor tolerability with data acquisition of 24-hour ABPM using the Oscar 2 monitor in the research setting. Methods Sixty adults participating in a research study of people with a history of borderline clinic BP reported on their experience with ABPM on two occasions one week apart. Poor tolerability was operationalized as an overall score at or above the 75th percentile using responses to questions adapted from a previously developed questionnaire. In addition to descriptive statistics (means for responses to Likert-scaled "0 to 10" questions and proportions for Yes/No questions, we examined reproducibility of poor tolerability as well as associations with poor tolerability and whether poor tolerability was associated with removal of the monitor or inadequate number of BP measurements. Results The mean ambulatory BP of participants by an initial ABPM session was 148/87 mm Hg. After wearing the monitor the first time, the degree to which the monitor was felt to be cumbersome ranged from a mean of 3.0 to 3.8, depending on whether at work, home, driving, or other times. The most bother was interference with normal sleeping pattern (mean 4.2. Wearers found the monitor straightforward to use (mean 7.5. Nearly 67% reported that the monitor woke them after falling asleep, and 8.6% removed it at some point during the night. Reported adverse effects included pain (32%, skin irritation (37%, and bruising (7%. Those categorized as having poor tolerability (kappa = 0.5 between sessions, p = 0.0003 were more likely to report being in fair/poor health (75% vs 22%, p = 0.01 and have elevated 24-hour BP average (systolic: 28% vs 17%, p = 0.56; diastolic: 30% vs 17%, p = 0.37. They were
Stens, Jurre; Oeben, Jeroen; Van Dusseldorp, Ab A; Boer, Christa
Nexfin beat-to-beat arterial blood pressure monitoring enables continuous assessment of hemodynamic indices like cardiac index (CI), pulse pressure variation (PPV) and stroke volume variation (SVV) in the perioperative setting. In this study we investigated whether Nexfin adequately reflects alterations in these hemodynamic parameters during a provoked fluid shift in anesthetized and mechanically ventilated patients. The study included 54 patients undergoing non-thoracic surgery with positive pressure mechanical ventilation. The provoked fluid shift comprised 15° Trendelenburg positioning, and fluid responsiveness was defined as a concomitant increase in stroke volume (SV) >10 %. Nexfin blood pressure measurements were performed during supine steady state, Trendelenburg and supine repositioning. Hemodynamic parameters included arterial blood pressure (MAP), CI, PPV and SVV. Trendelenburg positioning did not affect MAP or CI, but induced a decrease in PPV and SVV by 3.3 ± 2.8 and 3.4 ± 2.7 %, respectively. PPV and SVV returned back to baseline values after repositioning of the patient to baseline. Bland-Altman analysis of SVV and PPV showed a bias of -0.3 ± 3.0 % with limits of agreement ranging from -5.6 to 6.2 %. The SVV was more superior in predicting fluid responsiveness (AUC 0.728) than the PVV (AUC 0.636), respectively. The median bias between PPV and SVV was different for patients younger [-1.5 % (-3 to 0)] or older [+2 % (0-4.75)] than 55 years (P < 0.001), while there were no gender differences in the bias between PPV and SVV. The Nexfin monitor adequately reflects alterations in PPV and SVV during a provoked fluid shift, but the level of agreement between PPV and SVV was low. The SVV tended to be superior over PPV or Eadyn in predicting fluid responsiveness in our population.
Bambang Murdaka Eka Jati
Full Text Available ABSTRACT A blood monitoring system based on NMR method has been designed on constructed. This set-up of equipment used magnetic permanent, radio frequency (RF, receiver coil (RC, function generator (FG, amplifier which included the filter, as well as the oscilloscope digital storage. The background of this research was based on the sensitivity of NMR signal. The signal must be separated from signals background. This method was done by adjusting the frequency on FG, which was connected to radio frequency (RF coil, on empty sample. Subsequently, NMR signal was received by RC, and that signal could be shown on oscilloscope at resonance condition. The true frequency on NMR signal was Larmor frequency, and the other was background. The two variables of this experiment were the position of RF coil and the location temperature (20 up to 30oC. In conclusion, the resonance frequency of NMR signal (as Larmor frequency was 4.7 MHz (at static magnetic field of 1,600 gauss and it could be separated from background signals (3.4 and 6.2 MHz, and that signal was almost constant to room temperature. The equipment was used for sample testing. It gave systole/diastole data of 110/70 mmHg (on sphygmomanometer that was similar to 17/9 mV (on NMR signal. ABSTRAK Telah dikembangkan alat pemantauan tekanan darah berdasar prinsip NMR.
Wascher, Thomas C; Stechemesser, Lars
Self monitoring of blood glucose contributes to the integrated management of diabetes mellitus. It, thus, should be available for all patients with diabetes mellitus type-1 and type-2. Self monitoring of blood glucose improves patients safety, quality of life and glucose control. The current article represents the recommendations of the Austrian Diabetes Association for the use of blood glucose self monitoring according to current scientific evidence.
Shahbazian, Nahid; Shahbazian, Heshmatollah; Mohammadjafari, Razieh; Mousavi, Mahsan
Introduction: If the blood pressure of a pregnant woman is ≥140/90 mmHg at the clinic, but her ambulatory blood pressure is less coat hypertension. Objectives: To evaluate the value of ambulatory blood pressure monitoring in pregnant women. Patients and Methods: This prospective cohort study was conducted in Imam-Khomeini hospital of Ahwaz, Iran between 2011 to 2012. A total of 105 pregnant women who had blood pressure of higher than 140/90 mmHg during the third trimester of pregnancy were monitored. Thirty five women with white coat hypertension, 35 women with gestational hypertension and 35 women with normal blood pressure were followed. The data were analyzed using the Kolmogorov-Smirnov test, Pearson correlation coefficient and Chi-square tests. Results: The prevalence of white coat hypertension was 31.3%. The maternal and neonatal outcomes and laboratory examinations in white coat hypertension were similar to the normal blood pressure, but the frequency of caesarean section was more than the other two groups. Conclusion: The findings of the study indicate the efficacy of 24 hour holter monitoring of blood pressure and using it more comprehensively , compared to the limited visits.
Carrera, Pricivel M; Lambooij, Mattijs S
Out-of-office blood pressure monitoring is promoted by various clinical guidelines toward properly diagnosing and effectively managing hypertension and engaging the patient in their care process. In the Netherlands, however, the Dutch cardiovascular risk management (CVRM) guidelines do not explicitly prescribe 24-hour ambulatory blood pressure measurement (ABPM) and home BP measurement (HBPM). The aim of this descriptive study was to develop an understanding of patients' and physicians' acceptance and use of out-of-office BP monitoring in the Netherlands given the CVRM recommendations.Three small focus group discussions (FGDs) with patients and 1 FGD with physicians were conducted to explore the mechanisms behind the acceptance and use of out-of-office BP monitoring and reveal real-world challenges that limit the implementation of out-of-office BP monitoring methods. To facilitate the FGDs, an analytical framework based on the technology acceptance model (TAM), the theory of planned behavior and the model of personal computing utilization was developed to guide the FGDs and analysis of the transcriptions of each FGD.ABPM was the out-of-office BP monitoring method prescribed by physicians and used by patients. HBPM was not offered to patients even with patients' feedback of poor tolerance of ABPM. Even as there was little awareness about HBPM among patients, there were a few patients who owned and used sphygmomanometers. Patients professed and seemed to exhibit self-efficacy, whereas physicians had reservations about (all of their) patients' self-efficacy in properly using ABPM. Since negative experience with ABPM impacted patients' acceptance of ABPM, the interaction of factors that determined acceptance and use was found to be dynamic among patients but not for physicians.In reference to the CVRM guidelines, physicians implemented out-of-office BP monitoring but showed a strong preference for ABPM even where there is poor tolerance of the method. We found that
Su, Tin Tin; Majid, Hazreen Abdul; Nahar, Azmi Mohamed; Azizan, Nurul Ain; Hairi, Farizah Mohd; Thangiah, Nithiah; Dahlui, Maznah; Bulgiba, Awang; Murray, Liam J
Death rates due to hypertension in low and middle income countries are higher compared to high income countries. The present study is designed to combine life style modification and home blood pressure monitoring for control of hypertension in the context of low and middle income countries. The study is a two armed, parallel group, un-blinded, cluster randomized controlled trial undertaken within lower income areas in Kuala Lumpur. Two housing complexes will be assigned to the intervention group and the other two housing complexes will be allocated in the control group. Based on power analysis, 320 participants will be recruited. The participants in the intervention group (n = 160) will undergo three main components in the intervention which are the peer support for home blood pressure monitoring, face to face health coaching on healthy diet and demonstration and training for indoor home based exercise activities while the control group will receive a pamphlet containing information on hypertension. The primary outcomes are systolic and diastolic blood pressure. Secondary outcome measures include practice of self-blood pressure monitoring, dietary intake, level of physical activity and physical fitness. The present study will evaluate the effect of lifestyle modification and peer support home blood pressure monitoring on blood pressure control, during a 6 month intervention period. Moreover, the study aims to assess whether these effects can be sustainable more than six months after the intervention has ended.
Pini, Claudio; Pastori, Marco; Baccheschi, Jordan; Omboni, Stefano; Parati, Gianfranco
There is evidence that blood pressure measurement outside the doctor's office can provide valuable information for the diagnostic evaluation of hypertensive patients and for monitoring their response to treatment. Home blood pressure monitoring devices have a major role in this setting, provided that their accuracy in measuring blood pressure is demonstrated by validation studies. This study aimed at verifying whether the automatic electronic oscillometric blood pressure measuring device Artsana CSI 610 complied with the standard of accuracy indicated by the ESH International Protocol. Sequential measurements of systolic and diastolic blood pressure were obtained in 33 participants using the mercury sphygmomanometer (two observers) and the test device (one supervisor). A standard adult cuff was always employed during the study. According to the ESH validation protocol, 99 couples of test device and reference blood pressure measurements were obtained during the two phases of the study (three pairs for each of the 33 participants). The Artsana CSI 610 device successfully passed phase 1 of study validation with the number of absolute differences between test and reference device never validation study with a mean (+/-SD) device-observer difference of -1.4+/-4.8 mmHg for systolic and -0.9+/-3.5 mmHg for diastolic blood pressure. According to the results of the validation study on the basis of the ESH International Protocol, the Artsana CSI 610 can be recommended for clinical use in adults.
Ambulatory blood pressure monitoring (ABPM) can assess out-of-clinic blood pressure. ABPM is an underutilized resource in low-income and middle-income countries but should be considered a complementary strategy to clinic blood pressure measurement for the diagnosis and management of hypertension. Potential uses for ABPM in low-income and middle-income countries include screening of high-risk individuals who have concurrent communicable diseases, such as HIV, and in task-shifting health care strategies. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Segura, Julian; Banegas, Jose R; Ruilope, Luis M
1. Hypertension is one of the most important challenges for public health systems because of its high prevalence and its association with the risk of cardiovascular and renal diseases. 2. Adequate control of hypertension is low in population and medical settings, with physicians frequently misclassifying patients' blood pressure status based on readings taken in the clinic rather than ambulatory blood pressure measurements (ABPM). 3. Data from the Spanish Society of Hypertension ABPM registry support ABPM as a feasible option in the primary care setting, providing valuable information for the diagnosis and management of hypertension. By using ABPM rather than office BP monitoring, BP control can be doubled. This is an encouraging message to clinicians, although there is still a relatively large degree of undetected controlled and uncontrolled hypertension. 4. This short review describes the design, development and main results of the Spanish Society of Hypertension ABPM registry, a project based on a large-scale network of Spanish physicians trained in ABPM. © 2013 Wiley Publishing Asia Pty Ltd.
Macumber, Ian R; Weiss, Noel S; Halbach, Susan M; Hanevold, Coral D; Flynn, Joseph T
Obesity has been linked with abnormal nocturnal dipping of blood pressure (BP) in adults, which in turn is associated with poor cardiovascular outcomes. There are few data regarding abnormal dipping status in the obese pediatric population. The goal of this study was to further describe the relationship between obesity and non-dipping status on ambulatory blood pressure monitor (ABPM) in children. We conducted a cross-sectional study using a database of patients aged 5-21 years who had undergone 24-hour ABPM at Seattle Children's Hospital from January 2008 through May 2014. Subjects were grouped by body mass index (BMI) into lean (BMI 15th-85th percentile) and obese (BMI >95th percentile) groups. Compared to lean subjects (n = 161), obese subjects (n = 247) had a prevalence ratio (PR) for non-dipping of 2.15, adjusted for race (95% confidence interval (CI) = 1.25-3.42). Increasing severity of obesity was not further associated with nocturnal non-dipping. Nocturnal non-dipping was not associated with left ventricular hypertrophy (PR = 1.01, 95% CI = 0.71-1.44). These results suggest that in children, just as in adults, obesity is related to a relatively decreased dipping in nocturnal BP. © American Journal of Hypertension, Ltd 2015. All rights reserved. For Permissions, please email: email@example.com.
Fletcher, Benjamin R; Hinton, Lisa; Bray, Emma P; Hayen, Andrew; Hobbs, Fd Richard; Mant, Jonathan; Potter, John F; McManus, Richard J
Previous research suggests that most GPs in the UK use self-monitoring of blood pressure (SMBP) to monitor the control of hypertension rather than for diagnosis. This study sought to assess current practice in the use of self-monitoring and any changes in practice following more recent guideline recommendations. To survey the views and practice of UK GPs in 2015 with regard to SMBP and compare them with a previous survey carried out in 2011. Web-based survey of a regionally representative sample of 300 UK GPs. GPs completed an online questionnaire concerning the use of SMBP in the management of hypertension. Analyses comprised descriptive statistics, tests for between-group differences (z, Wilcoxon signed-rank, and χ 2 tests), and multivariate logistic regression. Results were available for 300 GPs (94% of those who started the survey). GPs reported using self-monitoring to diagnose hypertension (169/291; 58%; 95% confidence interval (CI) = 52 to 64) and to monitor control (245/291; 84%; 95% CI = 80 to 88), the former having significantly increased since 2011 (from 37%; 95% CI = 33 to 41; Pmonitoring for control. More than half of GPs used higher systolic thresholds for diagnosis (118/169; 70%; 95% CI = 63 to 77) and treatment (168/225; 75%; 95% CI = 69 to 80) than recommended in guidelines, and under half (120/289; 42%; 95% CI = 36 to 47) adjusted the SMBP results to guide treatment decisions. Since new UK national guidance in 2011, GPs are more likely to use SMBP to diagnose hypertension. However, significant proportions of GPs continue to use non-standard diagnostic and monitoring thresholds. The use of out-of-office methods to improve the accuracy of diagnosis is unlikely to be beneficial if suboptimal thresholds are used. © British Journal of General Practice 2016.
Kario, Kazuomi; Tomitani, Naoko; Matsumoto, Yuri; Hamasaki, Haruna; Okawara, Yukie; Kondo, Maiko; Nozue, Ryoko; Yamagata, Hiromi; Okura, Ayako; Hoshide, Satoshi
Asians have specific characteristics of hypertension (HTN) and its relationship with cardiovascular disease. The morning surge in blood pressure (BP) in Asians is more extended, and the association slope between higher BP and the risk for cardiovascular events is steeper in this population than in whites. Thus, 24-hour BP control including at night and in the morning is especially important for Asian patients with HTN. There are 3 components of "perfect 24-hour BP control": the 24-hour BP level, adequate dipping of nocturnal BP (dipper type), and adequate BP variability such as the morning BP surge. The morning BP-guided approach using home BP monitoring (HBPM) is the first step toward perfect 24-hour BP control. After controlling morning HTN, nocturnal HTN is the second target. We have been developing HBPM that can measure nocturnal BP. First, we developed a semiautomatic HBPM device with the function of automatic fixed-interval BP measurement during sleep. In the J-HOP (Japan Morning Surge Home Blood Pressure) study, the largest nationwide home BP cohort, we successfully measured nocturnal home BP using this device with data memory, 3 times during sleep (2, 3, and 4 am), and found that nocturnal home BP is significantly correlated with organ damage independently of office and morning BP values. The second advance was the development of trigger nocturnal BP (TNP) monitoring with an added trigger function that initiates BP measurements when oxygen desaturation falls below a variable threshold continuously monitored by pulse oximetry. TNP can detect the specific nocturnal BP surges triggered by hypoxic episodes in patients with sleep apnea syndrome. We also added the lowest heart rate-trigger function to TNP to detect the "basal nocturnal BP," which is determined by the circulating volume and structural cardiovascular system without any increase in sympathetic tonus. This double TNP is a novel concept for evaluating the pathogenic pressor mechanism of nocturnal BP
Hinton, Lisa; Tucker, Katherine L; Greenfield, Sheila M; Hodgkinson, James A; Mackillop, Lucy; McCourt, Christine; Carver, Trisha; Crawford, Carole; Glogowska, Margaret; Locock, Louise; Selwood, Mary; Taylor, Kathryn S; McManus, Richard J
Hypertensive disorders in pregnancy are a leading cause of maternal and fetal morbidity worldwide. Raised blood pressure (BP) affects 10% of pregnancies worldwide, of which almost half develop pre-eclampsia. The proportion of pregnant women who have risk factors for pre-eclampsia (such as pre-existing hypertension, obesity and advanced maternal age) is increasing. Pre-eclampsia can manifest itself before women experience symptoms and can develop between antenatal visits. Incentives to improve early detection of gestational hypertensive disorders are therefore strong and self-monitoring of blood pressure (SMBP) in pregnancy might be one means to achieve this, whilst improving women's involvement in antenatal care. The Blood Pressure Self-Monitoring in Pregnancy (BuMP) study aimed to evaluate the feasibility and acceptability of SMBP in pregnancy. To understand women's experiences of SMBP during pregnancy, we undertook a qualitative study embedded within the BuMP observational feasibility study. Women who were at higher risk of developing hypertension and/or pre-eclampsia were invited to take part in a study using SMBP and also invited to take part in an interview. Semi-structured interviews were conducted at the women's homes in Oxfordshire and Birmingham with women who were self-monitoring their BP as part of the BuMP feasibility study in 2014. Interviews were conducted by a qualitative researcher and transcribed verbatim. A framework approach was used for analysis. Fifteen women agreed to be interviewed. Respondents reported general willingness to engage with monitoring their own BP, feeling that it could reduce anxiety around their health during pregnancy, particularly if they had previous experience of raised BP or pre-eclampsia. They felt able to incorporate self-monitoring into their weekly routines, although this was harder post-partum. Self-monitoring of BP made them more aware of the risks of hypertension and pre-eclampsia in pregnancy. Feelings of
Grönvall, Erik; Verdezoto, Nervo
methods to understand existing challenges and uncover opportunities of self-monitoring technologies to support preventive healthcare activities among older adults. Emerging challenges from our study were: rule complexity for self-measuring, reliability of measurements, interpretation, understanding...... to support people’s preventive self-monitoring needs compared with existing solutions. Furthermore, supporting the active and informed citizen can improve older adult’s care abilities, awareness and activation towards preventive care....
Kang, Yuan-Yuan; Li, Yan; Huang, Qi-Fang; Song, Jie; Shan, Xiao-Li; Dou, Yu; Xu, Xin-Juan; Chen, Shou-Hong; Wang, Ji-Guang
We investigated accuracy of home blood pressure (BP) monitoring in the diagnosis of white-coat and masked hypertension in comparison with ambulatory BP monitoring. Our study participants were enrolled in the China Ambulatory and Home BP Registry, and underwent clinic, home, and 24-h ambulatory BP measurements. We defined white-coat hypertension as an elevated clinic SBP/DBP (≥140/90 mmHg) and a normal 24-h ambulatory (coat hypertension (13.1 vs. 19.9%), masked hypertension (17.8 vs. 13.1%), and sustained hypertension (46.4 vs. 39.6%) significantly (P ≤ 0.02) differed between 24-h ambulatory and home BP monitoring. In treated patients (n = 1201), only the prevalence of masked hypertension differed significantly (18.7 vs. 14.5%; P = 0.005). Regardless of the treatment status, home compared with 24-h ambulatory BP had low sensitivity (range 47-74%), but high specificity (86-94%), and accordingly low positive (41-87%), but high negative predictive values (80-94%), and had moderate diagnostic agreement (82-85%) and Kappa statistic (0.41-0.66). In untreated and treated patients, age advancing was associated with a higher prevalence of white-coat hypertension and a lower prevalence of masked hypertension defined by 24-h ambulatory (P ≤ 0.03) but not home BP (P ≥ 0.10). Home BP monitoring has high specificity, but low sensitivity in the diagnosis of white-coat and masked hypertension, and may therefore behave as a complementary to, but not a replacement of, ambulatory BP monitoring.
Bilo, Grzegorz; Zorzi, Cristina; Ochoa Munera, Juan E; Torlasco, Camilla; Giuli, Valentina; Parati, Gianfranco
The present study aimed to evaluate the accuracy of the Somnotouch-NIBP noninvasive continuous blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Systolic and diastolic blood pressures were sequentially measured in 33 adults (11 women, mean age 63.5±11.9 years) using a mercury sphygmomanometer (two observers) and the Somnotouch-NIBP device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the validation requirements were fulfilled. The Somnotouch-NIBP device fulfilled the requirements of the part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 75/99, 90/99, and 96/99, respectively, for systolic blood pressure and 90/99, 99/99, and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Twenty-seven and 31 participants had at least two of the three device-observers differences less than or equal to 5 mmHg for systolic and diastolic blood pressure, respectively. All three device-observer differences were greater than 5 mmHg in two participants for systolic and in one participant for diastolic blood pressure. The Somnotouch-NIBP noninvasive continuous blood pressure monitor has passed the requirements of the International Protocol revision 2010, and hence can be recommended for blood pressure monitoring in adults, at least under conditions corresponding to those investigated in our study.
In this study, a wireless blood pressure holter that can be used with smart mobile devices was developed. The developed blood pressure holter consists of two parts, which are a smart mobile device and a cuff. The smart mobile device is used as a recording, control and display device through a developed interface, while the cuff was designed to take measurements from the arm. Resistor-Capacitor (RC) and digital filters were used on the cuff that communicates with the smart mobile device via Bluetooth. The blood pressure was estimated using the Simple Hill Climbing Algorithm (HCA). It is possible to measure instantaneous or programmable blood pressure and heart rate values at certain intervals using this holter. The test was conducted with 30 individuals at different ages with the guidance of a specialist health personnel. The results showed that an accuracy at 93.89% and 91.95% rates could be obtained for systolic and diastolic pressure values, respectively, when compared with those obtained using a traditional sphygmomanometer. The accuracy level for the heart rate was measured as 97.66%. Furthermore, this device was tested day and night in the holter mode in terms of working time, the continuity of the Bluetooth connection and the reliability of the measurement results. The test results were evaluated separately in terms of measurement accuracy, working time, the continuity of the Bluetooth connection and the reliability of the measurement results. The measurement accuracy for systolic, diastolic blood pressure and heart rate values was obtained as 93.89%, 91.95% and 97.66%, respectively. The maximum number of measurements which can be conducted with four 1000 mA alkaline batteries at 20 min intervals was found approximately 79 (little more than 24 h). In addition, it was determined that the continuity of the Bluetooth connection and the reliability of the measurement results were automatically achieved through the features in the interface developed for the
Groen, Maarten; Brookhuis, Robert Anton; van Houwelingen, M.J.; Brouwer, Dannis Michel; Lötters, Joost Conrad; Wiegerink, Remco J.
We have designed and fabricated the first single-wafer proportional micro control valve with built-in capacitive dis-placement sensing. The displacement sensor can facilitate high-speed active proportional control of gas flow through the valve. This is an essential requirement for non-invasive blood
Chinnadurai, Sathya K; DeVoe, Ryan; Koenig, Amie; Gadsen, Nadia; Ardente, Amanda; Divers, Stephen J
The objective of this study was to compare an implanted direct blood pressure monitor and a non-invasive oscillometric unit for use in anesthetized and awake green iguanas. Prospective experimental trial. Four male and four female adult green iguanas (Iguana iguana) weighing 1833 +/- 534 g. For each animal, the carotid artery was surgically exposed and the catheter tip of the pressure transducer was placed in the aortic arch. Non-invasive blood pressure was measured using a cuff over the left femoral region. Pulse rate, respiratory rate and arterial blood pressure (ABP) measurements were taken every 5 minutes. Direct ABP measurements consisted of recording numerical values and graphic output. Simultaneous direct and indirect measurements were repeated in awake animals. The oscillometric device failed to provide a reading in over 80% of attempts, and failed to provide readings that correlated with direct measurements. The implanted direct transducer was capable of detecting blood pressures throughout all ABP ranges examined. The implantable transducer was a reliable means of determining blood pressure in this study, while the oscillometric device was unreliable and often failed to provide any reading. We do not recommend using the oscillometric device as described in a research or clinical setting for green iguanas. The advantages of an implantable device include the ability to monitor awake and anesthetized subjects remotely and continuously. These monitors are small, biocompatible and function across a wide range of ABP.
Wang, Qing; Zhao, Huadong; Chen, Wan; Li, Ni; Wan, Yi
The aim of this study was to validate the iHealth BP7 wireless wrist blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. A total of 99 pairs of test device and reference blood pressure measurements (three pairs for each of the 33 participants) were obtained for validation. The ESH-IP revision 2010 for the validation of blood pressure measuring devices in adults was followed precisely. The device produced 66, 87, and 97 measurements within 5, 10, and 15 mmHg for systolic blood pressure (SBP) and 72, 93, and 99 mmHg for diastolic blood pressure (DBP), respectively. The mean±SD device-observer difference was -0.7±6.9 mmHg for SBP and -1.0±5.1 mmHg for DBP. The number of participants with two or three device-observer differences within 5 mmHg was 25 for SBP and 26 for DBP; furthermore, there were three participants for SBP and one participant for DBP, with none of the device-observer differences within 5 mmHg. On the basis of the validation results, the iHealth BP7 wireless wrist blood pressure monitor can be recommended for self-measurement in an adult population.
Jardim, Thiago Veiga; Carneiro, Carolina de Souza; Morais, Polyana; Roriz, Vanessa; Mendonça, Karla Lorena; Nascente, Flávia Miquetichuc; Póvoa, Thaís Inácio Rolim; Barroso, Weimar Kunz Sebba; Sousa, Ana Luiza Lima; Jardim, Paulo César Veiga
Population-based studies estimating prevalence's of white-coat, masked and sustained hypertension in non-European adolescents are needed, particularly in developing countries. Aiming to determine these estimates and, additionally identify factors associated to these conditions this study was conducted. Cross-sectional study with a representative sample of secondary school students from a Brazilian state capital. Office measurements were performed with validated semi-automatic devices. Home BP (blood pressure) monitoring protocol included two day-time and two evening-time measurements over 6 days. Adolescents' were classified as: normotensives (office and home BP coat hypertensives (office BP ≥95th percentile and home BP coat, masked and sustained hypertension. In a sample of 1024 adolescents, prevalence of white-coat, masked and sustained hypertension was 7.5%, 2.2% and 1.7%, respectively. Male sex was positively associated with white-coat hypertension (OR 2.68; 95%CI 1.58-4.54; p coat (OR 1.23; 95%CI 1.16-1.30; p coat hypertension, masked and sustained hypertension in a population of non-European adolescents assessed by home BP monitoring was 7.5%, 2.2% and 1.7% respectively. Male sex was positively associated with white-coat hypertension in these adolescents while BMI was positively associated with both white-coat and sustained hypertension.
Kotovskaya, Yulia V; Kobalava, Zhanna D; Orlov, Artemy V
The objective of this study was to validate the novel integration of oscillometric (Vasotens(®)) technology into a BPLab(®) ambulatory blood pressure (BP) monitoring system to measure central BP, the aortic augmentation index, and pulse wave velocity (PWV) compared with the recommended and widely accepted tonometric method. The ARTERY Society guidelines for comparison of PWV measurement techniques were used as the basis for recruitment of 99 individuals (mean age 44±19 years, 52 males). The standard for comparison was the conventional "classic" SphygmoCor device. Accordance of the two methods was satisfactory (r=0.98, mean difference of 2.9±3.5 mmHg for central systolic BP; r=0.98, mean difference of -1.1±2.3 mmHg for central diastolic BP; r=0.83, mean difference of -2.6%±13% for aortic augmentation index; r=0.85, mean difference of 0.69±1.4 for PWV). The performance of Vasotens algorithms using an oscillometric ambulatory BP monitoring system is feasible for accurate diagnosis, risk assessment, and evaluation of the effects of antihypertensive drugs.
Stuebner, Eva; Vichayanrat, Ekawat; Low, David A.; Mathias, Christopher J.; Isenmann, Stefan; Haensch, Carl-Albrecht
Non-motor symptoms are now commonly recognized in Parkinson’s disease (PD) and can include dysautonomia. Impairment of cardiovascular autonomic function can occur at any stage of PD but is typically prevalent in advanced stages or related to (anti-Parkinsonian) drugs and can result in atypical blood pressure (BP) readings and related symptoms such as orthostatic hypotension (OH) and supine hypertension. OH is usually diagnosed with a head-up-tilt test (HUT) or an (active) standing test (also known as Schellong test) in the laboratory, but 24 h ambulatory blood pressure monitoring (ABPM) in a home setting may have several advantages, such as providing an overview of symptoms in daily life alongside pathophysiology as well as assessment of treatment interventions. This, however, is only possible if ABPM is administrated correctly and an autonomic protocol (including a diary) is followed which will be discussed in this review. A 24-h ABPM does not only allow the detection of OH, if it is present, but also the assessment of cardiovascular autonomic dysfunction during and after various daily stimuli, such as postprandial and alcohol dependent hypotension, as well as exercise and drug induced hypotension. Furthermore, information about the circadian rhythm of BP and heart rate (HR) can be obtained and establish whether or not a patient has a fall of BP at night (i.e., “dipper” vs. non-“dipper”). The information about nocturnal BP may also allow the investigation or detection of disorders such as sleep dysfunction, nocturnal movement disorders, and obstructive sleep apnea, which are common in PD. Additionally, a 24-h ABPM should be conducted to examine the effectiveness of OH therapy. This review will outline the methodology of 24 h ABPM in PD, summarize findings of such studies in PD, and briefly consider common daily stimuli that might affect 24 h ABPM. PMID:23720648
Full Text Available Non-motor symptoms are now commonly recognized in Parkinson’s Disease (PD and can include dysautonomia. Impairment of cardiovascular autonomic function can occur at any stage of PD but is typically prevalent in advanced stages or related to (anti-parkinsonian drugs and can result in atypical blood pressure (BP readings and related symptoms such as orthostatic hypotension (OH and supine hypertension. OH is usually diagnosed with a head-up-tilt test (HUT or an (active standing test (also known as Schellong test in the laboratory, but 24 hour Ambulatory Blood Pressure Monitoring (ABPM in a home setting may have several advantages, such as providing an overview of symptoms in daily life alongside pathophysiology as well as assessment of treatment interventions. This, however, is only possible if ABPM is administrated correctly and an autonomic protocol (including a diary is followed. which will be discussed in this review. A 24hr ABPM does not only allow the detection of OH, if it is present, but also the assessment of cardiovascular autonomic dysfunction during and after various daily stimuli, such as postprandial and alcohol dependent hypotension, as well as exercise and drug induced hypotension. Furthermore, information about the circadian rhythm of BP and heart rate (HR can be obtained and establish whether or not a patient has a fall of BP at night (i.e. ‘dipper’ vs. non-‘dipper’. The information about nocturnal BP may also allow the investigation or detection of disorders such as sleep dysfunction, nocturnal movement disorders and obstructive sleep apnea, which are common in PD. Additionally, a 24hr ABPM should be conducted to examine the effectiveness of OH therapy. This review will outline the methodology of 24 hr ABPM in PD, summarize findings of such studies in PD and briefly consider common daily stimuli that might affect 24 Hr ABPM.
Full Text Available Objectives: Our study aimed to estimate the rate of white coat hypertension (WCH and effect, and masked hypertension in patients attending a tertiary care hospital for 24 hour ambulatory blood pressure monitoring (24-h ABPM. Methods: A total of 231 adult patients were referred to the Department of Clinical Physiology at Sultan Qaboos University Hospital, Muscat, for ABPM, between January 2010 and June 2012. The following data were gathered and analyzed: demographic data, clinic blood pressure (BP measurements, and 24-h BP profile from ABPM. Thirty-two patients were excluded and the final analysis included 199 patients. Results: There were 105 (52.8% women and 94 (47.2% men studied. The mean age of patients was 46±15 years and most patients were overweight with a mean BMI of 29.6±5kg/m2. Around half of patients (53.8% were on one or more antihypertensive medications. WCH was found in 10.6% and white coat effect was found in 16% of patients. The majority of patients (57% with WCH were aged 40 years or above. Masked hypertension was present in 6% of patients and masked uncontrolled hypertension in 8.5% of patients. Conclusions: Our study showed that WCH and effect, and masked hypertension are common in hypertensive patients. Identifying these patients will have an impact on their management. However, the results of the study should be interpreted within the context of its limitations. Prospective randomized community and hospital-based studies should be conducted to estimate the true prevalence in the general population as well as in hypertensive patients.
Meza Contreras, Luís Gregorio; Llamosa R., Luis Enrique; Izquierdo, Natalia
El Laboratorio de Metrología - Variables Eléctricas, está en proceso de acreditar un laboratorio de calibración /ensayos de equipo electromédico en las áreas de: Seguridad Eléctrica, Electrocardiografía, electroencefalografía, Monitoría Fetal, Pulsioximetría SpO2, Electrobisturies, Desfibriladores/Marcapasos, Presión Arterial, Bombas de Infusión, Incubadoras, Flujo de Gas, Respiradores entre otros. En el contenido de éste artículo se hace referencia al procedimiento de calibración de in...
Sutherland, Scott M.; Begin, Brandy; Salsbery, Kari; McCabe, Lonisa; Potter, Donald; Alexander, Steven R.; Wong, Cynthia J.
Summary Background and objectives Pre- or postdialysis BP recordings are imprecise, can be biased, and have poor test–retest reliability in children on dialysis. We aimed to examine the possible differences between pre- and postdialysis BP levels and 24-hour ambulatory BP monitoring (ABPM) in diagnosis of hypertension (HTN). Design, setting, participants, & measurements Twenty-four children on dialysis had 24-hour ABPM in the interdialytic period, and values were compared with average pre- and postdialysis systolic BP (SBP) and diastolic BP (DBP) recordings that week. Each patient had an echocardiogram to determine presence of left ventricular hypertrophy (LVH). Results By ABPM, 8% of patients had white coat HTN and 12% had masked HTN. There was no significant difference in diagnosis of systolic HTN based on ABPM daytime SBP mean or load and postdialysis SBP. However, only 15% of patients had diastolic HTN based on postdialysis measures, whereas 46% of patients had significantly elevated daytime DBP loads and 71% had high nighttime DBP loads on ABPM. Forty-eight percent of patients were SBP nondippers. Children with LVH had higher daytime and nighttime SBP loads, significantly higher daytime and nighttime DBP loads, and lesser degree of nocturnal dipping of SBP compared with those who did not. Conclusion ABPM is more informative than pre- and postdialysis BPs and improves the predictability of BP as a risk factor for target organ damage. Diagnosis and treatment monitoring of HTN among pediatric dialysis patients is enhanced with addition of ABPM. PMID:21273374
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Webb, Alastair J S; Mazzucco, Sara; Li, Linxin; Rothwell, Peter M
Visit-to-visit and day-to-day blood pressure (BP) variability (BPV) predict an increased risk of cardiovascular events but only reflect 1 form of BPV. Beat-to-beat BPV can be rapidly assessed and might also be predictive. In consecutive patients within 6 weeks of transient ischemic attack or nondisabling stroke (Oxford Vascular Study), BPV (coefficient of variation) was measured beat-to-beat for 5 minutes (Finometer), day-to-day for 1 week on home monitoring (3 readings, 3× daily), and on awake ambulatory BP monitoring. BPV after 1-month standard treatment was related (Cox proportional hazards) to recurrent stroke and cardiovascular events for 2 to 5 years, adjusted for mean systolic BP. Among 520 patients, 26 had inadequate beat-to-beat recordings, and 22 patients were in atrial fibrillation. Four hundred five patients had all forms of monitoring. Beat-to-beat BPV predicted recurrent stroke and cardiovascular events independently of mean systolic BP (hazard ratio per group SD, stroke: 1.47 [1.12-1.91]; P =0.005; cardiovascular events: 1.41 [1.08-1.83]; P =0.01), including after adjustment for age and sex (stroke: 1.47 [1.12-1.92]; P =0.005) and all risk factors (1.40 [1.00-1.94]; P =0.047). Day-to-day BPV was less strongly associated with stroke (adjusted hazard ratio, 1.29 [0.97-1.71]; P =0.08) but similarly with cardiovascular events (1.41 [1.09-1.83]; P =0.009). BPV on awake ambulatory BP monitoring was nonpredictive (stroke: 0.89 [0.59-1.35]; P =0.59; cardiovascular events: 1.08 [0.77-1.52]; P =0.65). Despite a weak correlation ( r =0.119; P =0.02), beat-to-beat BPV was associated with risk of recurrent stroke independently of day-to-day BPV (1.41 [1.05-1.90]; P =0.02). Beat-to-beat BPV predicted recurrent stroke and cardiovascular events, independently of mean systolic BP and risk factors but short-term BPV on ambulatory BP monitoring did not. Beat-to-beat BPV may be a useful additional marker of cardiovascular risk. © 2017 The Authors.
... Disease Venous Thromboembolism Aortic Aneurysm More Types of Blood Pressure Medications Updated:Nov 6,2017 Prescription blood pressure ... This content was last reviewed October 2017. High Blood Pressure • Home • Get the Facts About HBP • Know Your ...
Takahashi, Hakuo; Yoshika, Masamichi; Yokoi, Toyohiko
Allowing patients to measure their blood pressure at home is recognized as being of clinical value. However, it is not known how often these measurements are taken correctly. Blood pressure monitors for home use fall into two types based on the position of the cuff, ie, at the upper arm or the wrist. The latter is particularly convenient, as measurements can be taken fully clothed. This study aimed to evaluate the performance of the wrist-type blood pressure monitors Omron RS8 (HEM-6310F-E), Omron RS6 (HEM-6221-E), and Omron RS3 (HEM-6130-E). A team of three trained doctors validated the performance of these devices by comparing the measurements obtained from these devices with those taken using a standard mercury sphygmomanometer. All the devices met the validation requirements of the European Society of Hypertension International Protocol revision 2010. The difference in blood pressure readings between the tested device and the standard mercury sphygmomanometer was within 3 mmHg, which is acceptable according to the European Society of Hypertension guidelines. All the home devices tested were found to be suitable for measuring blood pressure at home because their performance fulfilled the requirement of the guidelines.
Wu, Lili; Jiao, Yinghui; Wang, Chengdong; Chen, Lei; Di, Dalin; Zhang, Haiyan
This study aimed to validate the Andon KD-5851 upper arm blood pressure (BP) monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. A total of 33 eligible participants were included in the study. Sequential measurements of BPs were performed using a mercury sphygmomanometer and the device, and the data analysis was carried out following precisely the ESH-IP revision 2010. The device had 82, 98, and 99 measurements within 5, 10, and 15 mmHg for systolic blood pressure and 85, 95, and 99 measurements for diastolic blood pressure, respectively. The average device-observer difference was -0.53±4.00 mmHg for systolic blood pressure and -1.15±4.06 mmHg for diastolic blood pressure. The device passed all the criteria according to the ESH-IP revision 2010. According to the validation results on the basis of the ESH-IP revision 2010, the Andon KD-5851 upper arm BP monitor can be recommended for self/home measurement in adults. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Jenkins, Carolyn; Burkett, Nina-Sarena; Ovbiagele, Bruce; Mueller, Martina; Patel, Sachin; Brunner-Jackson, Brenda; Saulson, Raelle; Treiber, Frank
Mobile health, or mHealth, has increasingly been signaled as an effective means to expedite communication and improve medical regimen adherence, especially for patients with chronic health conditions such as stroke. However, there is a lack of data on attitudes of stroke patients toward mHealth. Such information will aid in identifying key indicators for feasibility and optimal implementation of mHealth to prevent and/or decrease rates of secondary stroke. Our objective was to ascertain stroke patients' attitudes toward using mobile phone enabled blood pressure (BP) monitoring and medication adherence and identify factors that modulate these attitudes. Sixty stroke patients received a brief demonstration of mHealth devices to assist with BP control and medication adherence and a survey to evaluate willingness to use this technology. The 60 participants had a mean age of 57 years, were 43.3% male, and 53.3% were White. With respect to telecommunication prevalence, 93.3% owned a cellular device and 25% owned a smartphone. About 70% owned a working computer. Regarding attitudes, 85% felt comfortable with a doctor or nurse using mHealth technologies to monitor personal health information, 78.3% believed mHealth would help remind them to follow doctor's directions, and 83.3% were confident that technology could effectively be used to communicate with health care providers for medical needs. Mobile device use is high in stroke patients and they are amenable to mHealth for communication and assistance in adhering to their medical regimens. More research is needed to explore usefulness of this technology in larger stroke populations.
Yu, Yu-Ning; Doctor, Faiyaz; Fan, Shou-Zen; Shieh, Jiann-Shing
During surgical procedures, bispectral index (BIS) is a well-known measure used to determine the patient's depth of anesthesia (DOA). However, BIS readings can be subject to interference from many factors during surgery, and other parameters such as blood pressure (BP) and heart rate (HR) can provide more stable indicators. However, anesthesiologist still consider BIS as a primary measure to determine if the patient is correctly anaesthetized while relaying on the other physiological parameters to monitor and ensure the patient's status is maintained. The automatic control of administering anesthesia using intelligent control systems has been the subject of recent research in order to alleviate the burden on the anesthetist to manually adjust drug dosage in response physiological changes for sustaining DOA. A system proposed for the automatic control of anesthesia based on type-2 Self Organizing Fuzzy Logic Controllers (T2-SOFLCs) has been shown to be effective in the control of DOA under simulated scenarios while contending with uncertainties due to signal noise and dynamic changes in pharmacodynamics (PD) and pharmacokinetic (PK) effects of the drug on the body. This study considers both BIS and BP as part of an adaptive automatic control scheme, which can adjust to the monitoring of either parameter in response to changes in the availability and reliability of BIS signals during surgery. The simulation of different control schemes using BIS data obtained during real surgical procedures to emulate noise and interference factors have been conducted. The use of either or both combined parameters for controlling the delivery Propofol to maintain safe target set points for DOA are evaluated. The results show that combing BIS and BP based on the proposed adaptive control scheme can ensure the target set points and the correct amount of drug in the body is maintained even with the intermittent loss of BIS signal that could otherwise disrupt an automated control system.
Full Text Available The objective of the present investigation was to study the effects of a 60-s interval of venous congestion between two noninvasive measurements of arterial blood pressure (ABP on the fluctuation of ABP, assessed by the standard deviation of the differences between two readings. ABP was measured in 345 successive patients, at rest, four times each. For 269 participants, one pair of readings was obtained with a 60-s interval and the other pair without an interval. For 76 patients, the first pair was read at the same interval, and the second pair had venous congestion interposed and there was no waiting interval. There was no increased ABP oscillation, either when there was no interval between ABP readings, or when venous congestion was interposed compared to pairs of ABP measurements performed with a 60-s interval. There was no increase in ABP oscillations when successive ABP readings were taken without an interval or even with venous congestion interposed. Contrary to the present belief, there seems to be no loss of reliability when blood pressure recordings are taken immediately one after another, in the clinical setting.
Yang, Wen-Yi; Staessen, Jan A
A significant association of office diastolic blood pressure with low-level blood lead exposure was reported in a Brazilian adult population. However, caution should be taken to interpret these results. The multivariable-adjusted association with blood pressure was positive for diastolic blood pressure, but inverse for systolic blood pressure. The association sizes were infinitesimal without clinical relevance. The outcome measures, i.e. blood pressure and the prevalence of hypertension were analysed across categories of the blood lead distribution - not in relation to blood lead as continuous variable. Blood pressure was the average of two oscillometric office readings, whereas ambulatory monitoring is the state-of-the-art.
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M. F. VALIM
Full Text Available
Blood pressure is the force of blood against artery walls. It is measured in millimeters of mercury (mm Hg and recorded as two numbers: systolic pressure (as the heart contracts over diastolic pressure (as the heart relaxes between beats. High blood pressure (hypertension is defined as chronically elevated high blood pressure, with systolic blood pressure (SBP of 140 mm Hg or greater, and diastolic blood pressure (DBP of 90 mm Hg or greater. High blood pressure (HBP, smoking, abnormal blood lipid levels, obesity and diabetes are risk factors for coronary heart disease, the leading cause of death in the US. Lifestyle modifications such as engaging in regular physical activity, quitting smoking and eating a healthy diet (limiting intake of saturated fat and sodium and increasing consumption of fiber, fruits and vegetables are advocated for the prevention, treatment, and control of HBP. As multiple factors influence blood pressure, the effects of each factor are typically modest, particularly in normotensive subjects, yet the combined effects can be substantial. Nutrition plays an important role in influencing blood pressure. Orange juice should be included as part of any low sodium diet and/or any blood pressure reducing eating plan, as it is sodium free, fat-free and can help meet recommended levels of potassium intake that may contribute to lower BP.
Issa, Zeinab; Seely, Ellen W; Rahme, Maya; El-Hajj Fuleihan, Ghada
Although hormone therapy remains the most efficacious option for the management of vasomotor symptoms of menopause, its effects on blood pressure remain unclear. This review scrutinizes evidence of the mechanisms of action of hormone therapy on signaling pathways affecting blood pressure and evidence from clinical studies. Comprehensive Ovid MEDLINE searches were conducted for the terms "hypertension" and either of the following "hormone therapy and menopause" or "selective estrogen receptor modulator" from year 2000 to November 2013. In vitro and physiologic studies did not reveal a clear deleterious effect of hormone therapy on blood pressure. The effect of oral therapy was essentially neutral in large trials conducted in normotensive women with blood pressure as primary outcome. Results from all other trials had several limitations. Oral therapy had a neutral effect on blood pressure in hypertensive women. Transdermal estrogen and micronized progesterone had a beneficial effect on blood pressure in normotensive women and, at most, a neutral effect on hypertensive women. In general, tibolone and raloxifene had a neutral effect on blood pressure in both hypertensive and normotensive women. Large randomized trials are needed to assess the effect of oral hormone therapy on blood pressure as a primary outcome in hypertensive women and the effect of transdermal preparations on both normotensive and hypertensive women. Transdermal preparations would be the preferred mode of therapy for hypertensive women, in view of their favorable physiologic and clinical profiles. The decision regarding the use of hormone therapy should be individualized, and blood pressure should be monitored during the course of treatment.
Mortensen, Rikke Nørmark; Gerds, Thomas Alexander; Jeppesen, Jørgen Lykke
Aims: To determine the added value of (i) 24-h ambulatory blood pressure relative to office blood pressure and (ii) night-time ambulatory blood pressure relative to daytime ambulatory blood pressure for 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events. Methods...... and results: A total of 7927 participants were included from the International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes. We used cause-specific Cox regression to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events....... Discrimination of 10-year outcomes was assessed by time-dependent area under the receiver operating characteristic curve (AUC). No differences in predicted risks were observed when comparing office blood pressure and ambulatory blood pressure. The median difference in 10-year risks (1st; 3rd quartile) was -0...
Shimbo, Daichi; Abdalla, Marwah; Falzon, Louise; Townsend, Raymond R.; Muntner, Paul
Ambulatory blood pressure monitoring (ABPM) is more commonly recommended for assessing out-of-clinic blood pressure than home blood pressure monitoring (HBPM). We conducted a systematic review to examine whether ABPM or HBPM is more strongly associated with cardiovascular disease events and/or mortality. Of 1,007 abstracts published through July 20, 2015, nine articles, reporting results from seven cohorts, were identified. After adjustment for blood pressure on HBPM, blood pressure on ABPM was associated with an increased risk of outcomes in two of four cohorts for systolic blood pressure and two of three cohorts for diastolic blood pressure. After adjustment for blood pressure on ABPM, systolic blood pressure on HBPM was associated with outcomes in zero of three cohorts; an association was present in one of two cohorts for diastolic blood pressure on HBPM. There is a lack of strong empiric evidence supporting ABPM or HBPM over the other approach for predicting cardiovascular events or mortality. PMID:26822864
Westland, R.; Schreuder, M.F.; Lof, D.F. van der; Vermeulen, A.; Meer, I.M. van der; Bokenkamp, A.; Wijk, J.A. van
BACKGROUND: Children with a solitary functioning kidney are at increased risk of developing chronic kidney disease. Hypertension may be an early indicator of renal dysfunction in these patients. We determined blood pressure (BP) profiles of children with a solitary functioning kidney by using
Boggia, José; Thijs, Lutgarde; Hansen, Tine W
To analyze sex-specific relative and absolute risks associated with blood pressure (BP), we performed conventional and 24-hour ambulatory BP measurements in 9357 subjects (mean age, 52.8 years; 47% women) recruited from 11 populations. We computed standardized multivariable-adjusted hazard ratios...
Zhao, Hairong; Qiao, Weichang; Zhang, Rui; Cui, Peng; Hou, Fanglin; Zhang, Wenli
The aim of this study was to validate the PG-800A36 automatic wrist blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010 and the British Hypertension Society (BHS) protocols. A total of 33 participants were initially included on the basis of the ESH-IP, followed by examination of 85 participants according to the BHS protocol. The procedures and analysis methods of the protocols were followed precisely with left arm/wrist sequential measurements by two trained observers using a mercury sphygmomanometer and one supervisor using the device. The device passed the ESH-IP with an average difference of 1.45±6.46 mmHg for systolic blood pressure and 1.25±5.10 mmHg for diastolic blood pressure. Furthermore, the A/A grade of the BHS protocol was achieved with an average difference of 1.84±6.94 mmHg for systolic blood pressure and 1.15±6.49 mmHg for diastolic blood pressure, and thus, the device also fulfilled the requirements of the Association for the Advancement of Medical Instrumentation. The Pangao PG-800A36 passed the requirements of the ESH-IP revision 2010 and achieved the A/A grade of the BHS protocol, which can be recommended for self-measurement in the general population.
Hermida, Ramón C; Smolensky, Michael H; Ayala, Diana E; Portaluppi, Francesco
New information has become available since the ISC, AAMCC, and SECAC released their first extensive guidedelines to improve the diagnosis and treatment of adult arterial hypertension. A critical assessment of evidence and a comparison of what international guidelines now propose are the basis for the following statements, which update the recommendations first issued in 2013. Office blood pressure (BP) measurements should no longer be considered to be the "gold standard" for the diagnosis of hypertension and assessment of cardiovascular risk. Relying on office BP, even when supplemented with at-home wake-time self-measurements, to identify high-risk individuals, disregarding circadian BP patterning and asleep BP level, leads to potential misclassification of 50% of all evaluated persons. Accordingly, ambulatory BP monitoring is the recommended reference standard for the diagnosis of true hypertension and accurate assessment of cardiovascular risk in all adults ≥18 yrs of age, regardless of whether office BP is normal or elevated. Asleep systolic BP mean is the most significant independent predictor of cardiovascular events. The sleep-time relative SBP decline adds prognostic value to the statistical model that already includes the asleep systolic BP mean and corrected for relevant confounding variables. Accordingly, the asleep systolic BP mean is the recommended protocol to diagnose hypertension, assess cardiovascular risk, and predict cardiovascular event-free interval. In men, and in the absence of compelling clinical conditions, reference thresholds for diagnosing hypertension are 120/70 mmHg for the asleep systolic/diastolic BP means derived from ambulatory BP monitoring. However, in women, in the absence of complicating co-morbidities, the same thresholds are lower by 10/5 mmHg, i.e., 110/65 mmHg for the asleep means. In high-risk patients, including those diagnosed with diabetes or chronic kidney disease, and/or those having experienced past
Goldberg, Lior; Bar-Aluma, Bat-El; Krauthammer, Alex; Efrati, Ori; Sharabi, Yehonatan
Familial dysautonomia (FD) is a rare genetic disease that involves extreme blood pressure fluctuations secondary to afferent baroreflex failure. The diurnal blood pressure profile, including the average, variability, and day-night difference, may have implications for long-term end organ damage. The purpose of this study was to describe the circadian pattern of blood pressure in the FD population and relationships with renal and pulmonary function, use of medications, and overall disability. We analyzed 24-h ambulatory blood pressure monitoring recordings in 22 patients with FD. Information about medications, disease severity, renal function (estimated glomerular filtration, eGFR), pulmonary function (forced expiratory volume in 1 s, FEV1) and an index of blood pressure variability (standard deviation of systolic pressure) were analyzed. The mean (± SEM) 24-h blood pressure was 115 ± 5.6/72 ± 2.0 mmHg. The diurnal blood pressure variability was high (daytime systolic pressure standard deviation 22.4 ± 1.5 mmHg, nighttime 17.2 ± 1.6), with a high frequency of a non-dipping pattern (16 patients, 73%). eGFR, use of medications, FEV1, and disability scores were unrelated to the degree of blood pressure variability or to dipping status. This FD cohort had normal average 24-h blood pressure, fluctuating blood pressure, and a high frequency of non-dippers. Although there was evidence of renal dysfunction based on eGFR and proteinuria, the ABPM profile was unrelated to the measures of end organ dysfunction or to reported disability.
Baumstark, Annette; Schmid, Christina; Pleus, Stefan; Haug, Cornelia; Freckmann, Guido
Partial pressure of oxygen (pO2) in blood samples can affect blood glucose (BG) measurements, particularly in systems that employ the glucose oxidase (GOx) enzyme reaction on test strips. In this study, we assessed the impact of different pO2 values on the performance of five GOx systems and one glucose dehydrogenase (GDH) system. Two of the GOx systems are labeled by the manufacturers to be sensitive to increased blood oxygen content, while the other three GOx systems are not. Aliquots of 20 venous samples were adjusted to the following pO2 values: oxygen sensitive. © 2013 Diabetes Technology Society.
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Raboel, P H; Bartek, J; Andresen, M
Monitoring of intracranial pressure (ICP) has been used for decades in the fields of neurosurgery and neurology. There are multiple techniques: invasive as well as noninvasive. This paper aims to provide an overview of the advantages and disadvantages of the most common and well-known methods...
Pereira, Telmo; Guimarães, João
This study aimed to evaluate the accuracy of the Beneware model ABP-021 oscillometric blood pressure monitor in the general population according to the European Society of Hypertension International Protocol (ESH-IP). The accuracy of the device was assessed in relation to various clinical variables, including age, sex, BMI, and arm circumference. Thirty-three individuals (18 men and 15 women), with a mean age of 36±14 years (age range: 20-68 years), were studied according to the recommendations of the ESH-IP. Sequential same-arm blood pressure measurements were performed, alternating between a mercury standard and the automatic device. The differences among the test-control measurements were assessed and divided into categorization zones of 5, 10, and 15 mmHg discrepancy. The device complied with the quality requirements of the ESH-IP. The device-observer disagreement was -1.2±4.7 mmHg for systolic blood pressure (SBP) and -1.7±4.3 mmHg for diastolic blood pressure (DBP). The device produced 77, 93, and 98 measurements, respectively, within the 5, 10, and 15 mmHg discrepancy limits for SBP. For DBP, 80, 97, and 99 measurements were observed within the 5, 10, and 15 mmHg discrepancy limits. The number of participants with two or three of the device-observer differences within 5 mmHg was 26 for SBP and 29 for DBP, whereas there were only two participants with no device-observer differences within 5 mmHg for DBP. These data show that the Beneware model ABP-021 monitor meets the requirements of the ESH-IP, in static conditions, indicating its suitability for measuring blood pressure in the general adult population.
Efimova, Nataliya Y; Chernov, Vladimir I; Efimova, Irina Y; Lishmanov, Yuri B
To investigate the regional cerebral blood flow, cognitive function, and parameters of 24-h arterial blood pressure monitoring in patients with metabolic syndrome before and after combination antihypertensive therapy. The study involved 54 patients with metabolic syndrome (MetS) investigated by brain single-photon emission computed tomography, 24-h blood pressure monitoring (ABPM), and comprehensive neuropsychological testing before and after 24 weeks of combination antihypertensive therapy. Patients with metabolic syndrome had significantly poorer regional cerebral blood flow compared with control group: by 7% (P = 0.003) in right anterior parietal cortex, by 6% (P = 0.028) in left anterior parietal cortex, by 8% (P = 0.007) in right superior frontal lobe, and by 10% (P = 0.00002) and 7% (P = 0.006) in right and left temporal brain regions, correspondingly. The results of neuropsychological testing showed 11% decrease in mentation (P = 0.002), and 19% (P = 0.011) and 20% (P = 0.009) decrease in immediate verbal and visual memory in patients with MetS as compared with control group. Relationships between the indices of ABPM, cerebral perfusion, and cognitive function were found. Data showed an improvement of regional cerebral blood flow, ABPM parameters, and indicators of cognitive functions after 6 months of antihypertensive therapy in patients with MetS. The study showed the presence of diffuse disturbances in cerebral perfusion is associated with cognitive disorders in patients with metabolic syndrome. Combination antihypertensive treatment exerts beneficial effects on the 24-h blood pressure profile, increases cerebral blood flow, and improves cognitive function in patients with MetS. © 2015 John Wiley & Sons Ltd.
Morrison, Shaun F.; Davis, Robert Patrick; Barman, Susan M.
5-Hydroxytryptamine (5-HT; serotonin) was discovered more than 60 years ago as a substance isolated from blood. The neural effects of 5-HT have been well investigated and understood, thanks in part to the pharmacological tools available to dissect the serotonergic system and the development of the frequently prescribed selective serotonin-reuptake inhibitors. By contrast, our understanding of the role of 5-HT in the control and modification of blood pressure pales in comparison. Here we focus on the role of 5-HT in systemic blood pressure control. This review provides an in-depth study of the function and pharmacology of 5-HT in those tissues that can modify blood pressure (blood, vasculature, heart, adrenal gland, kidney, brain), with a focus on the autonomic nervous system that includes mechanisms of action and pharmacology of 5-HT within each system. We compare the change in blood pressure produced in different species by short- and long-term administration of 5-HT or selective serotonin receptor agonists. To further our understanding of the mechanisms through which 5-HT modifies blood pressure, we also describe the blood pressure effects of commonly used drugs that modify the actions of 5-HT. The pharmacology and physiological actions of 5-HT in modifying blood pressure are important, given its involvement in circulatory shock, orthostatic hypotension, serotonin syndrome and hypertension. PMID:22407614
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Ashworth, Mark; Medina, Jibby; Morgan, Myfanwy
To determine levels of blood pressure monitoring and control in primary care and to determine the effect of social deprivation on these levels. Retrospective longitudinal survey, 2005 to 2007. General practices in England. Data obtained from 8515 practices (99.3% of all practices) in year 1, 8264 (98.3%) in year 2, and 8192 (97.8%) in year 3. Blood pressure indicators and chronic disease prevalence estimates contained within the UK quality and outcomes framework; social deprivation scores for each practice, ethnicity data obtained from the 2001 national census; general practice characteristics. In 2005, 82.3% of adults (n=52.8m) had an up to date blood pressure recording; by 2007, this proportion had risen to 88.3% (n=53.2m). Initially, there was a 1.7% gap between mean blood pressure recording levels in practices located in the least deprived fifth of communities compared with the most deprived fifth, but, three years later, this gap had narrowed to 0.2%. Achievement of target blood pressure levels in 2005 for practices located in the least deprived communities ranged from 71.0% (95% CI 70.4% to 71.6%) for diabetes to 85.1% (84.7% to 85.6%) for coronary heart disease; practices in the most deprived communities achieved 68.9% (68.4% to 69.5%) and 81.8 % (81.3% to 82.3%) respectively. Three years later, target achievement in the least deprived practices had risen to 78.6% (78.1% to 79.1%) and 89.4% (89.1% to 89.7%) respectively. Target achievement in the most deprived practices rose similarly, to 79.2% (78.8% to 79.6%) and 88.4% (88.2% to 88.7%) respectively. Similar changes were observed for the achievement of blood pressure targets in hypertension, cerebrovascular disease, and chronic kidney disease. Since the reporting of performance indicators for primary care and the incorporation of pay for performance in 2004, blood pressure monitoring and control have improved substantially. Improvements in achievement have been accompanied by the near disappearance of the
Stergiou, George S; Christodoulakis, George R; Nasothimiou, Efthimia G; Giovas, Periklis P; Kalogeropoulos, Petros G
Electronic devices that measure blood pressure (BP) at the arm level are regarded as more accurate than wrist devices and are preferred for home BP (HBP) monitoring. Recently, wrist devices with position sensors have been successfully validated using established protocols. This study assessed whether HBP values measured with validated wrist devices are sufficiently reliable to be used for making patient-related decisions in clinical practice. This randomized crossover study compared HBP measurements taken using validated wrist devices (wrist-HBP, Omron R7 with position sensor) with those taken using arm devices (arm-HBP, Omron 705IT), and also with measurements of awake ambulatory BP (ABP, SpaceLabs), in 79 subjects (36 men and 43 women) with hypertension. The mean age of the study population was 56.7 +/- 11.8 years, and 33 of the subjects were not under treatment for hypertension. The average arm-HBP was higher than the average wrist-HBP (mean difference, systolic 5.2 +/- 9.1 mm Hg, P or =10 mm Hg difference between systolic wrist-HBP and arm-HBP and twelve subjects (15%) showed similar levels of disparity in diastolic HBP readings. Strong correlations were found between arm-HBP and wrist-HBP (r 0.74/0.74, systolic/diastolic, P arm-HBP (r 0.73/0.76) than with wrist-HBP (0.55/0.69). The wrist-arm HBP difference was associated with systolic ABP (r 0.34) and pulse pressure (r 0.29), but not with diastolic ABP, sex, age, arm circumference, and wrist circumference. There might be important differences in HBP measured using validated wrist devices with position sensor vs. arm devices, and these could impact decisions relating to the patient in clinical practice. Measurements taken using arm devices are more closely related to ABP values than those recorded by wrist devices. More research is needed before recommending the widespread use of wrist monitors in clinical practice. American Journal of Hypertension doi:10.1038/ajh.2008.176American Journal of Hypertension (2008
Tian, Huiyong; Zeng, Sijian; Zhong, Xiaoyan; Gong, Wei; Liu, Wenjun
Transtek blood pressure monitor TMB-1491 is an automatic upper arm device designed for self/home measurement in adult populations. This study aimed to evaluate its accuracy according to the European Society of Hypertension International Protocol revision 2010. The protocol requirements were followed precisely with the recruitment of 33 adult individuals on whom same-left-arm sequential systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. According to the validation protocol, 99 pairs of test device and reference blood pressure measurements were obtained in this study (three pairs for each of the 33 participants). The device produced 74, 95 and 99 measurements within 5, 10, and 15 mmHg for SBP and 85, 97, and 99 for DBP, respectively. The mean±SD device-observer difference was -0.6±4.4 mmHg for SBP and -0.6±3.4 mmHg for DBP. The number of participants with two or three device-observer difference within 5 mmHg was 24 for SBP and 29 for DBP. In addition, none of the participants had a device-observer difference within 5 mmHg for SBP, and three of the participants had the same for DBP. Transtek TMB-1491 has passed all phases of European Society of Hypertension International Protocol revision 2010 and can be recommended for self/home measurement in adult populations.
Reed, D; McGee, D; Yano, K; Hankin, J
Recent reports of an inverse association between dietary calcium intake and hypertension stimulated this analysis of the relationship of blood pressure to more than 20 dietary factors among a group of 8000 Japanese men in Hawaii. Reported intakes of potassium, calcium, protein, and milk were all inversely associated with blood pressure levels when examined one at a time while controlling for other risk factors. Alcohol intake was directly associated with blood pressure, and was treated as a confounding variable in the analysis. The association of potassium intake with blood pressure was relatively stronger than the associations for other nutrients, but the intake of potassium was so highly correlated with intakes of calcium, milk, and protein that it was not statistically possible to identify the independent association of potassium and blood pressure. Calcium intake was strongly correlated with milk and potassium intakes, and only calcium from dairy sources was associated with blood pressure. These data thus indicate that several dietary factors are inversely related to blood pressure levels independently of other risk factors such as age, body mass, and alcohol intake. The high degree of intercorrelation (multicollinearity) among these dietary factors, however, indicates that the independent role of any specific nutrient cannot be conclusively separated from the possible effects of other nutrients in this type of study.
Comparison of the BPLab® sphygmomanometer for ambulatory blood pressure monitoring with mercury sphygmomanometry in pregnant women: validation study according to the British Hypertension Society protocol
Full Text Available Inna V Dorogova, Elena S Panina Penza Institute of Advanced Training for Physicians, Penza, RussiaAbstract: The purpose of this study was to validate the automated BPLab® sphygmomanometer for ambulatory blood pressure monitoring (ABPM in pregnant women according to Part II of the 1993 British Hypertension Society protocol. Pregnant women attending the antenatal clinic were randomly asked to participate (n=30. The BPLab sphygmomanometer was tested on pregnant women in this study and achieved A/A ratings according to the BHS protocol when compared with the “gold” standard of mercury sphygmomanometry. The device can therefore be recommended for use in pregnancy.Keywords: pregnancy, BPLab, blood pressure measuring
Younessi Heravi, M A; Khalilzadeh, M A; Joharinia, S
One of the main problems especially in operating room and monitoring devices is measurement of Blood Pressure (BP) by sphygmomanometer cuff. Objective :In this study we designed a new method to measure BP changes continuously for detecting information between cuff inflation times by using vital signals in monitoring devices. This will be achieved by extraction of the time difference between each cardiac cycle and a relative pulse wave. Finger pulse and ECG signals in lead I were recorded by a monitoring device. The output of monitoring device wasinserted in a computer by serial network communication. A software interface (Microsoft Visual C#.NET ) was used to display and process the signals in the computer. Time difference between each cardiac cycle and pulse signal was calculated throughout R wave detection in ECG and peak of pulse signal by the software. The relation between time difference in two waves and BP was determined then the coefficients of equation were obtained in different physical situations. The results of estimating BP were compared with the results of sphygmomanometer method and the error rate was calculated. In this study, 25 subjects participated among them 15 were male and 10 were female. The results showed that BP was linearly related to time difference. Average of coefficient correlation was 0.9±0.03 for systolic and 0.82±0.04 for diastolic blood pressure. The highest error percentage was calculated 8% for male and 11% for female group. Significant difference was observed between the different physical situation and arm movement changes. The relationship between time difference and age was estimated in a linear relationship with a correlation coefficient of 0.76. By determining linear relation values with high accuracy, BP can be measured with insignificant error. Therefore it can be suggested as a new method to measure the blood pressure continuously.
Younessi Heravi M. A.
Full Text Available Background: One of the main problems especially in operating room and monitoring devices is measurement of Blood Pressure (BP by sphygmomanometer cuff. Objective: In this study we designed a new method to measure BP changes continuously for detecting information between cuff inflation times by using vital signals in monitoring devices. This will be achieved by extraction of the time difference between each cardiac cycle and a relative pulse wave. Methods: Finger pulse and ECG signals in lead I were recorded by a monitoring device. The output of monitoring device was inserted in a computer by serial network communication. A software interface (Microsoft Visual C#.NET was used to display and process the signals in the computer. Time difference between each cardiac cycle and pulse signal was calculated throughout R wave detection in ECG and peak of pulse signal by the software. The relation between time difference in two waves and BP was determined then the coefficients of equation were obtained in different physical situations. The results of estimating BP were compared with the results of sphygmomanometer method and the error rate was calculated. Results: In this study, 25 subjects participated among them 15 were male and 10 were female. The results showed that BP was linearly related to time difference. Average of coefficient correlation was 0.9±0.03 for systolic and 0.82±0.04 for diastolic blood pressure. The highest error percentage was calculated 8% for male and 11% for female group. Significant difference was observed between the different physical situation and arm movement changes. The relationship between time difference and age was estimated in a linear relationship with a correlation coefficient of 0.76. Conclusion: By determining linear relation values with high accuracy, BP can be measured with insignificant error. Therefore it can be suggested as a new method to measure the blood pressure continuously.
De León-Robert, Arleen; Hidalgo-García, Isabel; Gascón-Cánovas, Juan; Antón-Botella, José; López-Alegría, Carmen; Campusano Castellanos, Heidi
To identify the most efficient measurement pattern of home blood pressure monitoring (HBPM) for the follow-up of hypertensive patients in primary care. Validation study of a diagnostic test. Primary care team in Murcia, Spain. One hundred and fifty three hypertensive patients younger than 80 years who met the inclusion criteria, who used HBPM and ambulatory blood pressure monitoring. Performing HBPM for 24hours. The HBPM protocol consisted of recording 2 measurements in the morning and 2 in the evening for 7 days. With the records obtained, the different HBPM patterns were established (7, 6, 5, 4, 3 days). The ROC curves were used for the analysis, together with the correlation coefficients and the Bland-Altman plots. The best areas under the curve for the systolic pressure of the different HBPM patterns corresponded to the 4-day pattern: 0.837 (0.77-0.90); and the 3 day one: 0.834 (0.77-0.90). As for diastolic pressure, the 7-day pattern had an area under the curve of 0.889 (0.84-0.94); followed by the 3 and 4 days patterns, which had the same statistical result both: 0.834 (0.83-0.94). There were no significant differences between correlation coefficients for systolic and diastolic blood pressures. The 3-day pattern showed a lower dispersion in the Bland-Altman plots. The 3 days HBPM pattern is proposed for the follow-up of the hypertensive patient, since it does not have an inferior efficiency to the other patterns. Copyright © 2018 The Author. Publicado por Elsevier España, S.L.U. All rights reserved.
... is known as gestational hypertension, a form of secondary hypertension caused by the pregnancy that usually disappears after delivery. If the mother is not treated, high blood pressure can be dangerous to both the mother ...
The effects of the spleen tyrosine kinase inhibitor fostamatinib on ambulatory blood pressure in patients with active rheumatoid arthritis: results of the OSKIRA-ABPM (ambulatory blood pressure monitoring) randomized trial.
Kitas, George D; Abreu, Gabriel; Jedrychowicz-Rosiak, Krystyna; Miller, Jeffrey L; Nakov, Roumen; Panfilov, Seva; Vencovsky, Jiri; Wang, Millie; Weinblatt, Michael E; White, William B
Clinical trials of fostamatinib in patients with rheumatoid arthritis showed blood pressure (BP) elevation using clinic measurements. The OSKIRA-ambulatory BP monitoring trial assessed the effect of fostamatinib on 24-hour ambulatory systolic BP (SBP) in patients with active rheumatoid arthritis. One hundred thirty-five patients were randomized to fostamatinib 100 mg twice daily (bid; n = 68) or placebo bid (n = 67) for 28 days. Ambulatory, clinic, and home BPs were measured at baseline and after 28 days of therapy. Primary end point was change from baseline in 24-hour mean SBP. Fostamatinib increased 24-hour mean SBP by 2.9 mm Hg (P = .023) and diastolic BP (DBP) by 3.5 mm Hg (P < .001) versus placebo. Clinic/home-measured BPs were similar to those observed with ambulatory BP monitoring. After treatment discontinuation (1 week), clinic BP values returned to baseline levels. Fostamatinib induced elevations in 24-hour mean ambulatory SBP and DBP. BP elevations resolved with fostamatinib discontinuation. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.
Salihbegovic, Eldina Malkic; Hadzigrahic, Nermina; Suljagic, Edin; Kurtalic, Nermina; Sadic, Sena; Zejcirovic, Alema; Mujacic, Almina
Psoriasis is a chronic skin ailment which can be connected with an increased occurrence of other illnesses, including high blood pressure. A prospective study has been conducted which included 70 patients affected by psoriasis, both genders, older than 18 years. Average age being 47,14 (SD= ±15,41) years, from that there were 36 men or 51,43 and 34 women or 48,57%. Average duration of psoriasis was 15,52 (SD=±12,54) years. Frequency of high blood pressure in those affected by psoriasis was 54,28%. Average age of the patients with psoriasis and high blood pressure was 53,79 year (SD=±14,15) and average duration of psoriasis was 17,19 years (SD=±13,51). Average values of PASI score were 16,65. Increase in values of PASI score and high blood pressure were statistically highly related (r=0,36, p=0,0001). Psoriasis was related to high blood pressure and there was a correlation between the severity of psoriasis and high blood pressure.
Baumstark, Annette; Schmid, Christina; Pleus, Stefan; Haug, Cornelia; Freckmann, Guido
Background Partial pressure of oxygen (pO2) in blood samples can affect blood glucose (BG) measurements, particularly in systems that employ the glucose oxidase (GOx) enzyme reaction on test strips. In this study, we assessed the impact of different pO2 values on the performance of five GOx systems and one glucose dehydrogenase (GDH) system. Two of the GOx systems are labeled by the manufacturers to be sensitive to increased blood oxygen content, while the other three GOx systems are not. Methods Aliquots of 20 venous samples were adjusted to the following pO2 values: pO2 ~70 mmHg, which is considered to be similar to pO2 in capillary blood samples, and the mean BG result at pO2 pO2 pO2 ≥150 mmHg. For both pO2 levels, relative differences of all tested GOx systems were significant (p pO2 values pO2 variations lead to clinically relevant BG measurement deviations in GOx systems, even in GOx systems that are not labeled as being oxygen sensitive. PMID:24351177
Polónia, Jorge; Madede, Tavares; Silva, José A; Mesquita-Bastos, José; Damasceno, Albertino
The aim of this study was to compare the 24-h ambulatory blood pressure (ABP) profile in never-treated black hypertensive patients living in Africa, Mozambique (20-80 years), versus never-treated white hypertensive patients living in Europe. ABP recordings of untreated black hypertensive patients and white hypertensive patients with 24-h ABP of 130/80 mmHg or more were retrospectively selected from two computerized database records of ABP and matched for age by decades, sex, and BMI. Black hypertensive patients were n=548, 47 ± 12 years, 52% women, BMI=28.0 ± 8.2 kg/m(2), 7% smokers, 7% diabetics; white hypertensive patients were n=604, 47 ± 15 years, 52% women, BMI=27.4 ± 5.1 kg/m(2), 8.4% diabetics, and 18% smokers (Pwhite hypertensive patients showed higher casual blood pressure (BP) 160/104 ± 19/14 versus 149/97 ± 18/12 mmHg, 24-h ABP 146/92 ± 16/13 versus 139/85 ± 11/10 mmHg, daytime ABP 150/95 ± 16/13 versus 143/88 ± 13/11 mmHg, night-time BP 139/84 ± 17/13 versus 130/78 ± 13/10 mmHg (all Pwhite hypertensive patients for all spectra of age distribution. This might be the reason for the worse cardiovascular prognosis described in black hypertensive patients compared with white hypertensive patients.
Grant, Sabrina; Hodgkinson, James A; Milner, Siobhan L; Martin, Una; Tompson, Alice; Hobbs, Fd Richard; Mant, Jonathan; McManus, Richard J; Greenfield, Sheila M
Self-monitoring of blood pressure is common but guidance on how it should be carried out varies and it is currently unclear how such guidance is viewed. To explore patients' and healthcare professionals' (HCPs) views and experiences of the use of different self-monitoring regimens to determine what is acceptable and feasible, and to inform future recommendations. Thirteen focus groups and four HCP interviews were held, with a total of 66 participants (41 patients and 25 HCPs) from primary and secondary care with and without experience of self-monitoring. Standard and shortened self-monitoring protocols were both considered. Focus groups and interviews were recorded, transcribed verbatim, and analysed using the constant comparative method. Patients generally supported structured schedules but with sufficient flexibility to allow adaptation to individual routine. They preferred a shorter (3-day) schedule to longer (7-day) regimens. Although HCPs could describe benefits for patients of using a schedule, they were reluctant to recommend a specific schedule. Concerns surrounded the use of different schedules for diagnosis and subsequent monitoring. Appropriate education was seen as vital by all participants to enable a self-monitoring schedule to be followed at home. There is not a 'one size fits all approach' to developing the optimum protocol from the perspective of users and those implementing it. An approach whereby patients are asked to complete the minimum number of readings required for accurate blood pressure estimation in a flexible manner seems most likely to succeed. Informative advice and guidance should incorporate such flexibility for patients and professionals alike. © British Journal of General Practice 2016.
Full Text Available The aim of the study was to determine correlation between arterial blood pressure daily rhythm and daily profile of arterial stiffness in male patients with chronic obstructive pulmonary disease (COPD and arterial hypertension. Materials et methods: Prospective investigation comprised 45 male patients with COPD and arterial hypertension. Individuals of 40 years younger and 80 years elder, patients with diabetes, stroke, angina pectoris, or heart infarction, vascular diseases, and exacerbation of chronic disease, bronchial and pulmonary diseases of other etiology were excluded from the analyses. Comparison group included 47 patients with essential arterial hypertension and without chronic respiratory diseases closely similar on general parameters with patients from main clinical series. Twenty-four-hour arterial blood pressure monitoring (ABPM and daily arterial stiffness monitoring were performed using BPLab® MnSDP-2 apparatus (Petr Telegin, Russian Federation. Results: Patients with COPD combined with arterial hypertension with raised arterial stiffness measures prevail over individuals in essential hypertension group. There is pathological alteration of the ABPM circadian rhythm and raised «Pressure load» values in raised arterial stiffness group. Conclusion: We found ABPM raised parameters in patients with COPD and arterial hypertension. It confirms necessity of ABPM in daily arterial stiffness assessment in patients with COPD.
Alcohol: Does it affect blood pressure? Does drinking alcohol affect your blood pressure? Answers from Sheldon G. Sheps, M.D. Drinking too much alcohol can raise blood pressure to unhealthy levels. Having ...
... of high blood pressure? Can anxiety cause high blood pressure? Answers from Sheldon G. Sheps, M.D. Anxiety doesn't cause long-term high blood pressure (hypertension). But episodes of anxiety can cause dramatic, ...
ANSWERS by heart Lifestyle + Risk Reduction High Blood Pressure What About African Americans and High Blood Pressure? African Americans in the U.S. have a higher prevalence of high blood pressure (HBP) than ...
... For Consumers Consumer Information by Audience For Women High Blood Pressure--Medicines to Help You Share Tweet Linkedin Pin ... Click here for the Color Version (PDF 533KB) High blood pressure is a serious illness. High blood pressure is ...
Bing, Sen; Zhang, Cunhai; Wang, Liping; Li, Linyi; Wan, Yi
The study aimed to determine the accuracy of the fully automated oscillometric upper-arm blood pressure (BP) monitor Pangao PG-800B11 according to the European Society of Hypertension-International Protocol (ESH-IP) revision 2010 and the British Hypertension Society (BHS) protocol 1993. Data from 33 participants were initially examined according to the ESH-IP revision 2010. Furthermore, 52 participants were then enrolled to fulfill the BHS protocol requirements. In all participants, sequential left arm measurements were performed by two trained observers using a mercury sphygmomanometer and one supervisor using the device. The protocols' requirements were followed precisely. The device passed all parts of the ESH protocol for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and was graded A according to the criteria of the BHS protocol for both SBP and DBP. The A/A grade was achieved in low (160/100 mmHg) BP categories. The mean BP difference between PG-800B11 and observers in the 85 participants was -0.6±5.0 mmHg for SBP and -0.6±4.5 mmHg for DBP; thus, the device also fulfilled the requirements of the Association for the Advancement of Medical Instrumentation (AAMI). The Pangao PG-800B11 passed all requirements of the ESH-IP revision 2010 and achieved A/A grade of the BHS protocol across a wide range of BPs.
Schmid, Christina; Baumstark, Annette; Pleus, Stefan; Haug, Cornelia; Tesar, Martina; Freckmann, Guido
The partial pressure of oxygen (pO2) in blood samples can affect glucose measurements with oxygen-sensitive systems. In this study, we assessed the influence of different pO2 levels on blood glucose (BG) measurements with five glucose oxidase (GOD) systems and one glucose dehydrogenase (GDH) system. All selected GOD systems were indicated by the manufacturers to be sensitive to increased oxygen content of the blood sample. Venous blood samples of 16 subjects (eight women, eight men; mean age, 52 years; three with type 1 diabetes, four with type 2 diabetes, and nine without diabetes) were collected. Aliquots of each sample were adjusted to the following pO2 values: ≤45 mm Hg, approximately 70 mm Hg, and ≥150 mm Hg. For each system, five consecutive measurements on each sample were performed using the same test strip lot. Relative differences between the mean BG value at a pO2 level of approximately 70 mm Hg, which was considered to be similar to pO2 values in capillary blood samples, and the mean BG value at pO2 levels ≤45 mm Hg and ≥150 mm Hg were calculated. The GOD systems showed mean relative differences between 11.8% and 44.5% at pO2 values ≤45 mm Hg and between -14.6% and -21.2% at pO2 values ≥150 mm Hg. For the GDH system, the mean relative differences were -0.3% and -0.2% at pO2 values ≤45 mm Hg and ≥150 mm Hg, respectively. The magnitude of the pO2 impact on BG measurements seems to vary among the tested oxygen-sensitive GOD systems. The pO2 range in which oxygen-sensitive systems operate well should be provided in the product information.
Drawz, Paul E.; Abdalla, Mohamed; Rahman, Mahboob
Blood pressure has traditionally been measured in the clinic setting using the auscultory method and a mercury sphygmomanometer. Technological advances have led to improvements in measuring clinic blood pressure and allowed for measuring blood pressures outside the clinic. This review outlines various methods for evaluating blood pressure and the clinical utility of each type of measurement. Home blood pressures and 24 hour ambulatory blood pressures have improved our ability to evaluate risk for target organ damage and hypertension related morbidity and mortality. Measuring home blood pressures may lead to more active participation in health care by patients and has the potential to improve blood pressure control. Ambulatory blood pressure monitoring enables the measuring nighttime blood pressures and diurnal changes, which may be the most accurate predictors of risk associated with elevated blood pressure. Additionally, reducing nighttime blood pressure is feasible and may be an important component of effective antihypertensive therapy. Finally, estimating central aortic pressures and pulse wave velocity are two of the newer methods for assessing blood pressure and hypertension related target organ damage. PMID:22521624
Shiraishi, Makoto; Watanabe, Hirofumi; Sakurai, Kenzo; Kato, Bunta; Hasegawa, Yasuhiro
Our goal was to investigate the utility of 24-hour ambulatory blood pressure monitoring (ABPM) for the risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts. A total of 175 hypertensive patients with MRI evidence of asymptomatic or symptomatic lacunar infarcts (92 men, mean age of 69±11 years old) were studied. Patients with symptomatic infarctions were included whose events occurred more than 6 months after the onset. ABPM was performed in all patients in the outpatient clinic. Parameters obtained from ABPM were related to the composite outcome which consisted of all death and fatal or non-fatal cardiovascular events by using the Cox proportional hazard model. Mean follow-up period was 4.8 years and the composite outcome was recorded in 38 patients. 34 of them (89%) had recurrence of lacunar infarcts. Significant association between sleep-time lowest systolic blood pressure and composite outcome was demonstrated by multivariate Cox hazard analyses (heart rate (HR) 1.025, 95% confidence interval (CI) 1.011-1.039, p<0.001). The risk for composite outcome in patients with the highest tertile of sleep-time lowest systolic blood pressure (≥133 mmHg) was significantly elevated when compared to the lowest tertile (<132 mmHg, HR 3.93, 95% CI 1.57-9.86, p=0.004). Sleep-time lowest systolic blood pressure in ABPM may be a useful parameter for the risk stratification of future cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts, especially for the recurrence of these events. (author)
Full Text Available Mikhail Y Ledyaev, Olga V Stepanova, Anastasia M Ledyaeva Department of Pediatric Disease, Volgograd State Medical University, Volgograd, Russian Federation Background: Automatic 24-hour ambulatory blood pressure (BP monitoring (ABPM is a basic procedure performed in adults with arterial hypertension, but ABPM monitors have become widely used in pediatric practice only recently. The main problem is the lack of common normative data sets for ABPM in children and the small number of appropriate monitors that can be used for analysis of the 24-hour BP profile in this age group. The aim of this study was to validate the BPLab® ABPM monitor according to the 1993 British Hypertension Society (BHS-93 protocol, as well as to work out solutions regarding the feasibility of this device in pediatric practice. Methods: Our study included 30 children of both sexes and aged 5–15 years, ie, “older” children according to the BHS-93 protocol. Before starting the study, we obtained ethical approval from the regional scientific ethics committee. All participants and their parents signed their written consent for participation in the study. The data were simultaneously obtained by three experts, who had completed a noninvasive BP measurement training course. BP values were measured using the Korotkoff auscultatory method (Phase I for systolic BP and Phase V for diastolic BP. Discrepancies in the systolic and diastolic BP measurements (n=180; 90 for each expert were analyzed according to the criteria specified in the BHS-93 protocol. Results: The device was graded “A” for both systolic BP and diastolic BP according to the criteria of the BHS-93 protocol. Conclusion: The BPLab ABPM device may be recommended for extensive pediatric use. Keywords: ambulatory blood pressure monitoring, children, device, validation
Hansen, Tine W; Li, Yan; Boggia, José
Numerous studies addressed the predictive value of the nighttime blood pressure (BP) as captured by ambulatory monitoring. However, arbitrary cutoff limits in dichotomized analyses of continuous variables, data dredging across selected subgroups, extrapolation of cross-sectional studies...... of conclusive evidence proving that nondipping is a reversible risk factor, the option whether or not to restore the diurnal blood pressure profile to a normal pattern should be left to the clinical judgment of doctors and should be individualized for each patient. Current guidelines on the interpretation...
Kiałka, Marta; Milewicz, Tomasz; Klocek, Marek
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder occurring in women of childbearing age. The literature describes the relationship between PCOS and high blood pressure levels and increased risk of arterial hypertension development, which is an important and strong risk factor for adverse cardiovascular events in the future. Among the main causes of hypertension in PCOS women insulin resistance, hyperandrogenism, greater sympathetic nerve activity and concomitance of obesity are stressed. Because PCOS may contribute to earlier development of hypertension, as well as pre-hypertension, therefore it is advisable to monitor blood pressure systematically, to control known risk factors, and to initiate the treatment of hypertension when the disease occur.
Erdem, Emre; Aydogdu, Türkan; Akpolat, Tekin
Standard validation protocols are objective guides for healthcare providers, physicians, and patients. The purpose of this study was to test validation of the Medisana MTP Plus upper arm blood pressure (BP) measuring monitor for self-measurement according to the European Society of Hypertension International Protocol (ESH-IP2) in adults. The Medisana MTP Plus monitor is an automated and oscillometric upper arm device for home BP monitoring. Nine consecutive measurements were made according to the ESH-IP2. Overseen by an independent supervisor, measurements were recorded by two observers blinded from both each other's readings and from the device readings. The Medisana MTP Plus device fulfills the validation criteria of the ESH-IP2 for the general population. The mean (standard deviation) of the difference between the observers and the device measurements was 0.6 mmHg (5.1 mmHg) for systolic and 2.7 mmHg (3.4 mmHg) for diastolic pressures, respectively. As the Medisana MTP Plus device has achieved the required standards, it is recommended for home BP monitoring in an adult population.
Full Text Available Peter Bramlage,1 Cornelia Deutsch,1 Ralf Krüger,1 Andreas Wolf,2 Peter Müller,2 Thomas Zwingers,1,4 Beate Beime,1 Thomas Mengden31Institut für Pharmakologie und Präventive Medizin, Cloppenburg, 2Müller and Sebastiani, Ottobrunn, 3Kerckhoff-Klinik, Bad Nauheim, 4Estimate, Augsburg, GermanyObjective: The aim of the present study was to validate the custo screen 400 ambulatory blood pressure-monitoring (ABPM device according to the 2010 International Protocol revision of the European Society of Hypertension (ESH-IP. The device can be used for ABPM for up to 72 hours.Materials and methods: Systolic and diastolic blood pressure (SBP and DBP, respectively were sequentially measured in 33 adult subjects (13 males and 20 females and compared with a standard mercury sphygmomanometer (two observers. A total of 99 comparison pairs were obtained.Results: The custo screen 400 met the requirements of parts 1 and 2 of the ESH-IP revision 2010. The mean difference between the device and reference sphygmomanometer readings was −0.5±4.5 mmHg for SBP and −0.1±3.3 mmHg for DBP. All but one measurement were within the absolute difference of 10 mmHg between the device and the observers for SBP and DBP. The number of absolute differences between the device and the observers within a range of 5 mmHg was 84 of 99 readings for SBP, and 93 of 99 readings for DBP.Conclusion: The custo screen 400 ABPM device met the requirements of the 2010 ESH-IP revision, and hence can be recommended for ABPM in adults. To our knowledge, the custo screen 400 is the first device to pass the revised ESH-IP 2010.Keywords: validation, ambulatory blood pressure monitoring, ESH
Mehlsen, Jesper; Wiinberg, Niels
The present study aimed at examining the interarm difference in blood pressure and its use as an indicator of peripheral arterial disease (PAD). Data were included from consecutive patients referred from their general practitioner to our vascular laboratory for possible PAD aged 50 years or older...... without known cardiac disease, renal disease, or diabetes mellitus. 824 patients (453 women) with mean age of 72 years (range: 50-101) were included. 491 patients had a diagnosis of hypertension and peripheral arterial disease (PAD) was present in 386 patients. Systolic blood pressure was 143 ± 24 mm......Hg and 142 ± 24 mmHg on the right and left arm, respectively (P = 0.015). The interarm difference was greater in patients with hypertension (P = 0.002) and PAD (P blood pressure was reproducible...
Full Text Available Background: More attention is being paid lately to polycystic ovary syndrome (PCOS not only in the aspect of fertility but also according to long-term metabolic and cardiovascular abnormalities. Observations of women with PCOS show that the occurrence of blood hypertension is more frequent after the menopause. There are few articles concerning the predictable symptoms of blood hypertension. It seems that twenty-four hour blood pressure monitoring and assessment of changes of diurnal rhythm could be useful in this group of patients.Aim of the study: The purpose of this study was to assess diurnal changes of blood pressure in women with polycystic ovary syndrome.Material and methods: 26 women with PCOS diagnosed according to Rotterdam consensus criteria and Androgen Excess Society (AES criteria were included in our study. The mean age of the examined women was 29.5 years and the mean BMI (body mass index was 24.7 kg/m2. The control group consisted of 12 age-matched women, without PCOS. Twenty-four hour Holter monitoring of ambulatory blood pressure was performed during normal daily activity in all patients. Halberg’s cosinor method was used to analyse daily biorhythm.Results: Results show the diurnal changes of systolic blood pressure in the preclinical phase in 30% and diastolic in 15% of PCOS women. In this group no physiological decrease of blood pressure at night time was observed.
Blood pressure monitoring is an essential component of neonatal intensive care. We compared invasive and noninvasive (Dinamap, Marquette, and Dash) recordings in newborns and also noninvasive values obtained from upper and lower limbs. Infants\\' blood pressure was recorded every 6 hours for 72 hours using three noninvasive devices and compared with invasive readings taken simultaneously. Twenty-five babies were enrolled in the study, with birth weights of 560 to 4500 g and gestation 24 + 1 to 40 + 5 weeks. Three hundred thirty-two recordings were obtained. Comparison between invasive and noninvasive readings revealed that all three noninvasive monitors overread mean blood pressure. There was no significant difference between the cuff recordings obtained from the upper or lower limbs. All three noninvasive devices overestimated mean blood pressure values compared with invasive monitoring. Clinicians may be falsely reassured by noninvasive monitoring. Mean blood pressure values obtained from the upper and lower limb are similar.
... patientinstructions/000770.htm DASH diet to lower high blood pressure To use the sharing features on this page, ... Hypertension. The DASH diet can help lower high blood pressure and cholesterol and other fats in your blood. ...
In the U.S., nearly one third of the adult population have high blood pressure, the leading risk factor for heart disease and stroke - two of the nation's leading causes of death. Created: 10/2/2012 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 10/17/2012.
Chen, Qi; Lei, Lei; Li, Yan; Wang, Ji-Guang
The present study aimed to evaluate the accuracy of the automated oscillometric upper-arm blood pressure monitor YuWell YE690A for blood pressure measurement according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressures were measured sequentially in 33 adult Chinese (12 women, 44.2 years of mean age) using a mercury sphygmomanometer (two observers) and the YE690A device (one supervisor). A total of 99 pairs of comparisons were obtained from 33 participants for judgments in two parts with three grading phases. All the blood pressure requirements were fulfilled. The YuWell YE690A device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10, and 15 mmHg was 79/99, 96/99, and 97/99, respectively, for systolic blood pressure and 72/99, 95/99, and 98/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Thirty-one and 25 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥24). No participant for systolic and two participants for diastolic blood pressure had all the three device-observer comparisons greater than 5 mmHg. The YuWell blood pressure monitor YE690A has passed the requirements of the International Protocol revision 2010 and hence can be recommended for blood pressure measurement in adults.
... our e-newsletter! Aging & Health A to Z High Blood Pressure Hypertension Unique to Older Adults This section provides ... Pressure Targets are Different for Very Old Adults High blood pressure (also called hypertension) increases your chance of having ...
Knudsen, Søren Tang; Poulsen, Per Løgstrup; Hansen, Klavs Würgler
retinopathy, nephropathy, macrovascular disease, PP, and diurnal BP variation in a group of type 2 diabetic patients. METHODS: In 80 type 2 diabetic patients we performed 24-h ambulatory BP (AMBP) and fundus photographs. Urinary albumin excretion was evaluated by urinary albumin/creatinine ratio. Presence...... or absence of macrovascular disease was assessed by an independent physician. RESULTS: Forty-nine patients had no detectable retinal changes (grade 1), 13 had grade 2 retinopathy, and 18 had more advanced retinopathy (grades 3-6). Compared to patients without retinopathy (grade 1), patients with grades 2......BACKGROUND: In nondiabetic subjects pulse pressure (PP) is an independent predictor of cardiovascular disease and microalbuminuria. Reduced circadian blood pressure (BP) variation is a potential risk factor for the development of diabetic complications. We investigated the association between...
Divisón-Garrote, Juan A; Banegas, José R; De la Cruz, Juan J; Escobar-Cervantes, Carlos; De la Sierra, Alejandro; Gorostidi, Manuel; Vinyoles, Ernest; Abellán-Aleman, José; Segura, Julián; Ruilope, Luis M
We aimed to determine the prevalence of hypotension and factors associated with the presence of this condition in treated hypertensive patients undergoing ambulatory blood pressure monitoring (ABPM). Data were taken from the Spanish ABPM Registry. Office blood pressure (BP) and ABPM were determined using validated devices under standardized conditions. Based on previous studies, hypotension was defined as office systolic/diastolic BP ABPM ABPM ABPM ABPM, 3.9% with nighttime ABPM, and 6.8% with 24-hour ABPM. Low diastolic BP values were responsible for the majority of cases of hypotension. Some 68% of the hypotension cases detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently and consistently associated with higher likelihood of office, daytime, and 24 hour-based hypotension were age, female gender, history of ischemic heart disease, and body mass index ABPM could be especially helpful for identifying ambulatory hypotension, in particular in patients who are older, women, or with previous ischemic heart disease where antihypertensive treatment should be especially individualized and cautious. Copyright © 2016 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.
Lewis, Cora E.; Diaz, Keith M.; Carson, April P.; Kim, Yongin; Calhoun, David; Yano, Yuichiro; Viera, Anthony J.; Shimbo, Daichi
BACKGROUND Several ambulatory blood pressure monitoring (ABPM) measures have been associated with increased cardiovascular disease risk independent of clinic blood pressure (BP). African Americans have higher clinic BP compared with Whites but few data are available on racial differences in ABPM measures. METHODS We compared ABPM measures between African American (n = 178) and White (n = 103) participants at the Year 5 Coronary Artery Risk Development in Young Adults study visit. BP was measured during a study visit and the second and third measurements were averaged. ABPM was conducted over the following 24 hours. RESULTS Mean ± SD age of participants was 29.8±3.8 years and 30.8±3.5 years for African Americans and Whites, respectively. Mean daytime systolic BP (SBP) was 3.90 (SD 1.18) mm Hg higher among African Americans compared with Whites (P ABPM was higher among African Americans compared with Whites. CONCLUSIONS These data suggest racial differences in several ABPM measures exist. PMID:25376639
Bramlage, Peter; Deutsch, Cornelia; Krüger, Ralf; Wolf, Andreas; Müller, Peter; Zwingers, Thomas; Beime, Beate; Mengden, Thomas
The aim of the present study was to validate the custo screen 400 ambulatory blood pressure-monitoring (ABPM) device according to the 2010 International Protocol revision of the European Society of Hypertension (ESH-IP). The device can be used for ABPM for up to 72 hours. Systolic and diastolic blood pressure (SBP and DBP, respectively) were sequentially measured in 33 adult subjects (13 males and 20 females) and compared with a standard mercury sphygmomanometer (two observers). A total of 99 comparison pairs were obtained. The custo screen 400 met the requirements of parts 1 and 2 of the ESH-IP revision 2010. The mean difference between the device and reference sphygmomanometer readings was -0.5±4.5 mmHg for SBP and -0.1±3.3 mmHg for DBP. All but one measurement were within the absolute difference of 10 mmHg between the device and the observers for SBP and DBP. The number of absolute differences between the device and the observers within a range of 5 mmHg was 84 of 99 readings for SBP, and 93 of 99 readings for DBP. The custo screen 400 ABPM device met the requirements of the 2010 ESH-IP revision, and hence can be recommended for ABPM in adults. To our knowledge, the custo screen 400 is the first device to pass the revised ESH-IP 2010.
Validation of the Omron HEM-7201 upper arm blood pressure monitor, for self-measurement in a high-altitude environment, according to the European Society of Hypertension International Protocol revision 2010.
Cho, K; Tian, M; Lan, Y; Zhao, X; Yan, L L
Few studies have been conducted on blood pressure monitors and their use at high altitude. This study is the first to evaluate the accuracy of an automatic blood pressure monitor in a high-altitude environment following a standard validation protocol. The Omron HEM-7201 upper arm blood pressure monitor was tested for accuracy in Lhasa, Tibet, China (3650 m above sea level) according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP2). Thirty-three participants received 9-10 sequential blood pressure measurements alternating between a mercury sphygmomanometer and the device. The mean device-observer measurement difference was 1.0±5.9 mm Hg for systolic blood pressure (SBP) and -3.1±4.6 mm Hg for diastolic blood pressure (DBP). Of the 99 measurement pairs analyzed, 72, 90 and 97 device readings were within 5, 10 and 15 mm Hg, respectively, of the observer measurements for SBP, and 68, 92 and 99 readings for DBP. The number of participants with at least two out of three measurements within 5 mm Hg was 27 for SBP and 25 for DBP. Three participants had no measurements within 5 mm Hg for either SBP or DBP. As a result, the Omron HEM-7201 passes the ESH-IP2 validation criteria and can therefore be recommended for use in adults in this setting.
Material and Methods ― Remote BP monitoring was organized on the basis of computer system which automatically in text messages send requests about BP level to Htn patients. Obtained BP results were stored in the system and automatically worked. A doctor corrected a patient’s therapy if necessary based on this information. To evaluate the effectiveness of a new technology one year observation of 97 Htn patients was organized (54.6% – male aged 49±11 years. Patients regularly responded to automated SMS requests the computer system about the level of blood pressure. The effectiveness was evaluated with the help of the following hypertension guidelines performance measures: 1 a part of patients with four or more BP results during the previous 12 months; 2 a part of patients with BP above the goal level who prescribed two or more antihypertensive drugs on the last visit during the previous 12 months; 3 a part of patients with BP above the goal level 140/90 mm Hg who prescribed two or more antihypertensive drugs on the last visit during the previous 12 months; 4 a part of patients with goal blood pressure (less than 140/90 mmHg on the last visit during the previous 12 months. To evaluate a performance of these measures before BP monitoring the data extracted from patients’ ambulatory cards were used. Results ― 62 patients completed one-year BP monitoring A part of patients with four or more BP results during the previous 12 months increased from 21% to 100% (p<0.001. From 70% to 82% increased the part of patients who were prescribed two or more antihypertensive drugs (p=0.091. From 31% to 15% reduced the part of hypertensives with uncontrolled BP who were prescribed less than two antihypertensive drugs on the last visit (p=0.044. After one-year monitoring a goal BP was registered in 77% of Htn patients versus 13% at the start of the observation (p<0.001. Conclusion ― Htn guidelines performance measures allowed evaluate quantitatively the positive influence
Mortensen, Rikke Nørmark; Gerds, Thomas Alexander; Jeppesen, Jørgen Lykke; Torp-Pedersen, Christian
To determine the added value of (i) 24-h ambulatory blood pressure relative to office blood pressure and (ii) night-time ambulatory blood pressure relative to daytime ambulatory blood pressure for 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events. A total of 7927 participants were included from the International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes. We used cause-specific Cox regression to predict 10-year person-specific absolute risks of fatal and non-fatal cardiovascular events. Discrimination of 10-year outcomes was assessed by time-dependent area under the receiver operating characteristic curve (AUC). No differences in predicted risks were observed when comparing office blood pressure and ambulatory blood pressure. The median difference in 10-year risks (1st; 3rd quartile) was -0.01% (-0.3%; 0.1%) for cardiovascular mortality and -0.1% (-1.1%; 0.5%) for cardiovascular events. The difference in AUC (95% confidence interval) was 0.65% (0.22-1.08%) for cardiovascular mortality and 1.33% (0.83-1.84%) for cardiovascular events. Comparing daytime and night-time blood pressure, the median difference in 10-year risks was 0.002% (-0.1%; 0.1%) for cardiovascular mortality and -0.01% (-0.5%; 0.2%) for cardiovascular events. The difference in AUC was 0.10% (-0.08 to 0.29%) for cardiovascular mortality and 0.15% (-0.06 to 0.35%) for cardiovascular events. Ten-year predictions obtained from ambulatory blood pressure are similar to predictions from office blood pressure. Night-time blood pressure does not improve 10-year predictions obtained from daytime measurements. For an otherwise healthy population sufficient prognostic accuracy of cardiovascular risks can be achieved with office blood pressure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: firstname.lastname@example.org.
... are below 100 mg/dL before meals and fasting and are less than 140 mg/dL two hours after meals. People with diabetes should consult their doctor or health care provider to set appropriate blood glucose goals. ...
Krzowski, Bartosz; Płatek, Anna E; Szymański, Filip M; Ryś, Anna; Semczuk-Kaczmarek, Karolina; Adamkiewicz, Karolina; Kotkowski, Marcin; Filipiak, Krzysztof J
Professional drivers are a group exposed to many cardiovascular risk factors. Non-systematic working hours, prolonged stress, low physical activity, along with irregular, and in most cases, unhealthy meals are common aspects of the normal working schedule of most of the professional drivers. These translate into high risk of cardiovascular disease (CVD). The aim of the current analysis was to establish the prevalence of dyslipidaemia in a group of continuous professional drivers. The RACER (Risk of Adverse Cardiovascular Events among professional dRivers in Poland - Ambulatory Blood Pressure Monitoring) study is a prospective study focused on assessing cardiovascular risk factors in professional drivers. Patients included in the study were screened for classical and non-classical cardiovascular risk factors and had an ambulatory blood pressure monitoring (ABPM) performed. Out of the whole RACER study population, 144 drivers were included into the RACER-ABPM study. Out of this group 135 (95.7%) were male, and the mean age was 50.2 ± 9.3 years, and mean body mass index was 32.3 ± 3.0 kg/m². A family history of CVD was noted in 21.3% of patients, 28.1% were current smokers, and 2.9% had diabetes mellitus. Out of those patients, 72.2% had low-density lipoprotein cholesterol (LDL-C) level > 115 mg/dL, 85.5% had LDL-C > 100 mg/dL, and 96.7% had LDL-C > 70 mg/dL. High-density lipoprotein cholesterol 150 mg/dL were found in 28.9% of cases. In conclusion, dyslipidaemia is highly prevalent in professional drivers. Obesity is one of the major contributors to the cardiovascular risk, and dyslipidaemia along with other risk factors highly prevalent in this subgroup accounts for poorer prognosis.
Full Text Available Several studies have suggested an association between ambient air temperature and blood pressure. However, this has not been reliably confirmed by longitudinal studies. Also, whether the reaction to temperature stimulation is modified by other factors such as antihypertensive medication is rarely investigated. The present study explores the relationship between ambient temperature and blood pressure, without and with antihypertensive medication, in a study of 1,831 hypertensive patients followed up for three years, in two or four weekly check ups, accumulating 62,452 follow-up records. Both baseline and follow-up blood pressure showed an inverse association with ambient temperature, which explained 32.4% and 65.6% of variation of systolic blood pressure and diastolic blood pressure (P<0.05 respectively. The amplitude of individual blood pressure fluctuation with temperature throughout a year (a 29 degrees centigrade range was 9.4/7.3 mmHg. Medication with angiotensin converting enzyme inhibitor benazepril attenuated the blood pressure fluctuation by 2.4/1.3 mmHg each year, though the inverse association of temperature and blood pressure remained. Gender, drinking behavior and body mass index were also found to modify the association between temperature and diastolic blood pressure. The results indicate that ambient temperature may negatively regulate blood pressure. Hypertensive patients should monitor and treat blood pressure more carefully in cold days, and it could be especially important for the males, thinner people and drinkers.
Antonelli, Lynn T
The invention as disclosed is a non-contact method and apparatus for continuously monitoring a physiological event in a human or animal, such as blood pressure, which involves utilizing a laser-based...
... and night. With Sheldon G. Sheps, M.D. Kaplan NM. Ambulatory blood pressure monitoring and white coat ... www.uptodate.com/home. Accessed Feb. 12, 2015. Kaplan NM, et al. Kaplan's Clinical Hypertension. 10th ed. ...
Conclusions: The prevalence of undiagnosed raised blood pressure and elevated blood sugar was high in Ethiopia and only very small percentage of people had been aware of their high blood pressure and elevated blood sugar. Policy makers in the health sector including other health development partners need to ...
... naturally increase your blood pressure, such as exercise, weightlifting or hard physical labor. To see if caffeine ... blood pressure and stress indices in healthy individuals. Nutrition Journal. 2016;15:26. Cano-Marquina A, et ...
... a medicine calendar. • Set a reminder on your smartphone. What types of medicine may be prescribed? One ... High Blood Pressure Medicine? What are their side effects? For many people, high blood pressure medicine can ...
Drug-induced hypertension is high blood pressure caused by using a chemical substance or medicine. ... of the arteries There are several types of high blood pressure : Essential hypertension has no cause that can be ...
To find out, the Medical Service's nurses are organising A HIGH BLOOD PRESSURE SCREENING AND PREVENTION CAMPAIGN from Monday, 26th to Thursday, 29th March 2007 at the Infirmary - Building 57 - ground floor A blood pressure test, advice, information and, if necessary, referral for specialist medical treatment will be offered to any person working on the CERN site. High blood pressure is a silent threat to health. So come and get your blood pressure checked.
To find out, the Medical Service's nurses are organising A HIGH BLOOD PRESSURE SCREENING AND PREVENTION CAMPAIGN from Monday, 26th to Thursday, 29th March 2007 at the Infirmary - Building 57 - ground floor A blood pressure test, advice, information and, if necessary, referral for specialist medical treatment will be offered to any person working on the CERN site. High blood pressure is a stealth threat to health. So come and get your blood pressure checked.
Lüders, Stephan; Krüger, Ralf; Zemmrich, Claudia; Forstner, Klaus; Sturm, Claus-Dieter; Bramlage, Peter
The present study aimed to validate the automated upper arm blood pressure (BP) measuring device BM 44 for home BP monitoring according to the 2002 Protocol of the European Society of Hypertension. The most important new feature of the new device was an integrated 'WHO indicator', which categorizes the patient's individual result within the WHO recommendations for target BP by a coloured scale. Systolic and diastolic BPs were measured sequentially in 35 adult participants (16 men, 19 women) using a standard mercury y-tubed reference sphygmomanometer (two observers) and the BM 44 device (one supervisor). Ninety-nine pairs of comparisons were obtained from 15 participants in phase 1 and a further 18 participants in phase 2 of the validation study. The BM 44 device passed phase 1 of the validation study successfully with a number of absolute differences between device and observers of 5, 10 and 15 mmHg for at least 28 out of 25, 35 out of 35 and 40 out of 40 measurements, respectively. The device also achieved the targets for phases 2.1 and 2.2, with 23 and 26 participants having had at least two of three device-observers differences within 5 mmHg for systolic and diastolic BP, respectively. The Beurer BM 44 upper arm BP monitor has passed the International Protocol requirements, and hence can be recommended for home use in adults. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Aberger, Edward W; Migliozzi, Daniel; Follick, Michael J; Malick, Tom; Ahern, David K
Effective management of hypertension in chronic kidney disease and renal transplantation is a clinical priority and has societal implications in terms of preserving and optimizing the value of scarce organs. However, hypertension is optimally managed in only 37% of people with chronic kidney disease, and poor control can contribute to premature graft loss in renal transplant recipients. This article describes a telehealth system that incorporates home electronic blood pressure (BP) monitoring and uploading to a patient portal coupled with a Web-based dashboard that enables clinical pharmacist collaborative care in a renal transplant clinic. The telehealth system was developed and implemented as a quality improvement initiative in a renal transplant clinic in a large, 700-bed, urban hospital with the aim of improving BP in posttransplant patients. A convenience sample of 66 posttransplant patients was recruited by the clinical pharmacist from consecutive referrals to the Transplant Clinic. Preliminary results show statistically significant reductions in average systolic and diastolic BP of 6.0 mm Hg and 3.0 mm Hg, respectively, at 30 days after enrollment. Two case reports describe the instrumental role of home BP monitoring in the context of medication therapy management. Optimizing BP control for both pre- and post-renal transplant patients is likely to benefit society in terms of preserving scarce resources and reducing healthcare costs due to premature graft failure. Connected health systems hold great promise for supporting team-based care and improved health outcomes.
Rafacz, W; McGill, S M
The purpose of this study was to determine the effect of wearing an abdominal belt on blood pressure (systolic and diastolic) and heart rate during a variety of tasks. The belt was typical of the elastic type with suspenders and Velcro tabs for cinching the belt snug. The tasks performed included sitting at rest, sitting with the torso inclined forward at 45 degrees, standing with the torso inclined forward at 45 degrees (with and without holding an 11-kg weight), a trunk axial rotation task, and squat lifting. Blood pressure was monitored noninvasively with a FINAPRES blood pressure monitor. Twenty healthy men performed each task with and without the abdominal belt. Although no significant increases in mean systolic blood pressure or heart rate were found, there was a significant increase in diastolic blood pressure in all conditions. All people considering wearing an abdominal belt should also consider the risks and liability associated with the additional cardiovascular load, particularly heart attack and stroke.
Khadilkar, Kranti Shreesh; Bandgar, Tushar; Shivane, Vyankatesh; Lila, Anurag; Shah, Nalini
Blood glucose monitoring has evolved over the last century. The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system. The search for an ideal blood glucose monitoring system still continues. This review explains the various blood glucose monitoring systems with special focus on the monitoring systems like self- monitored blood glucose (SMBG) and continuous glucose monitoring system (CGMS). It also focuses on t...
Giantin, Valter; Perissinotto, Egle; Franchin, Alessandro; Baccaglini, Kareen; Attanasio, Francesca; Maselli, Monica; Grosso, Giorgia; Luisa Corradin, Maria; Tramontano, Alessandra; Manzato, Enzo
The aim of this study was to test whether ambulatory blood pressure monitoring (ABPM) in elderly patients with atrial fibrillation (AF) is as feasible and reliable as ABPM is in patients with normal sinus rhythm (SR). Studies of ABPM in the elderly remain limited, and the use of this method in patients with AF remains controversial. The Italian SIIA 2008 guidelines consider ABPM 'absolutely contraindicated' for AF patients. This study was conducted on 200 hospitalized patients aged ≥ 65 years (68% females; mean age 82.4 ± 6.3 years): 100 patients with SR and 100 patients with permanent AF. Each patient completed serial blood pressure (BP) measurements with a clinical sphygmomanometer (Sphyg) and ABPM. Differences in mean heart rate (HR) between patient groups were not statistically significant. A total of 99.5% of patients were hypertensive. There were no significant differences between SR and AF patients in mean systolic BP (SBP) and diastolic BP (DBP) values, as measured with the Sphyg or by ABPM. Compared with the Sphyg, errors associated with BP measurements obtained by ABPM did not significantly differ between the two groups. ABPM proved to be as feasible as Sphyg measurements in both AF patients (intraclass correlation coefficients=0.73, 0.67 and 0.74 for SBP, DBP and HR, respectively) and SR patients (intraclass correlation coefficients=0.74, 0.58 and 0.67 for SBP, DBP and HR, respectively). A Bland-Altman plot analysis confirmed that there was good agreement between the two methods. Stable AF (HR 60-100 b.p.m.) should not be considered as an absolute contraindication for the use of ABPM, even in the elderly; it could be a 'relative' contraindication for very unstable AF patients.
Grezzana, Guilherme B; Stein, Airton T; Pellanda, Lucia C
Arterial hypertension is an important risk factor for cardiovascular outcomes. Blood pressure (BP) control levels remain largely out of target among primary healthcare (PHC) patients. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) may contribute toward the identification of cardiovascular risk groups. To assess concordance between conventional office BP measurements and 24-h ABPM of hypertension control in cardiovascular risk groups of PHC hypertensive patients. A cross-sectional study with 569 hypertensive patients was carried out. The evaluation of BP was performed by a PHC doctor, and the 24-h ABPM was performed by a different and blinded provider. The therapeutic targets for BP followed the guidance of The Eighth Joint National Committee, the Brazilian guideline, and the 2013 European Society of Hypertension. Considering the hypertension control therapeutic targets, the guidelines were not similar and were used to evaluate differences in BP value concordances compared with BP standard measurements. After a multivariate logistic regression analysis, a conventional BP was used in comparison with ABPM in different cardiovascular risk groups of hypertensive patients. According to the ABPM by European Society of Hypertension guideline, the subgroup of inactive patients (P=0.006), with altered glycemia (P=0.015) and over 30 mg/dl albuminuria (P=0.001), presented discordance among methods. When a conventional BP measurement in comparison with the ABPM results according to the Brazilian ABPM guideline was used, the discordance occurred significantly in inactive (P=0.001) and microalbuminuria more than 30 mg/dl (P=0.022) subgroups. However, in this comparison, a concordance between high-density lipoprotein more than 60 mg/dl (P=0.015) and obesity (P=0.035) subgroups occurred. Uncontrolled glucose levels, a sedentary lifestyle, and the presence of microalbuminuria correspond to some cardiovascular risk groups that would particularly benefit from 24-h
Full Text Available Diabetes mellitus (DM is now considered as the major cause of end-stage kidney failure, and hypertension (HTN is one of the main determinants of progression of renal disease. The aim of this study was to assess the role of blood pressure (BP by ambulatory blood pressure monitoring (ABPM in children and adolescents with type-1 DM and its correlation with micro-albuminuria (MA and diabetic control. Eighty-one patients with type-1 DM (mean age 13 ± 4 years, whose duration of DM was at least two years, were enrolled in this study. The prevalence of HTN based on ABPM was 28.4%, while by casual method it was 32.1%. The pattern of HTN was as follows: mean systolic HTN 27.2%, mean diastolic HTN 11.2%, daytime systolic HTN 17.3%, daytime diastolic HTN 6.2%, night systolic HTN 30.9%, and night diastolic HTN 29.7%. The systolic and diastolic BP loads were 33.4 and 27.2%, respectively. About 70.4% of the patients were non-dippers, 12.4% had masked HTN, and 3.7% had white coat HTN. The pre-valence of MA was 34.6% and that of abnormal HbA 1 c was 82.7%. There was no correlation bet-ween HTN and both MA and HbA 1 c; also, no correlation was found between the duration of dia-betes and HbA 1 c. Moreover, no significant correlation was found between the duration of diabetes and MA (P = 0.080. Despite the high prevalence of abnormal BP profile among diabetic children, prospective longitudinal studies considering the other major risk factors, particularly genetic factors, which have an impact on the progression to diabetic nephropathy, are recommended.
Abou-Dakn, M; Döhmen, C; Wenzel, S
The present study aims to examine the performance of the TONOPORT VI ambulatory blood pressure (BP) monitor in the inflation and deflation measurement methods, according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP 2010). Systolic and diastolic blood pressures (SBP and DBP, respectively) of 33 subjects (23 female, 10 male) were sequentially measured and compared with reference measurements obtained by two observers using a standard mercury sphygmomanometer. The subjects were selected according to the recruitment instructions of the ESH-IP 2010. Three comparative readings were performed per subject. Among the 99 readings in the inflation measurement method were 92/94 (SBP/DBP) with differences ⩽5, 97/99 ⩽10 and 98/99 ⩽15 mm Hg. All of the 33 subjects had at least 2 out of 3 comparative readings with differences ⩽5 mm Hg and 0/0 of the subjects had no reading ⩽15 mm Hg. The validation of the deflation measurement method resulted in differences where 93/91 were ⩽5, 98/98 were ⩽10, and 99/99 were ⩽15 mm Hg. Thirty-two of the 33 subjects had at least 2 out of 3 comparative readings ⩽5 mm Hg and 0/0 of the subjects had no reading ⩽15 mm Hg. In conclusion, the TONOPORT VI, respectively, in the inflation and deflation measurement methods met all requirements of Part 1 and 2 of the ESH-IP 2010. Based on the study results, the TONOPORT VI can be recommended for BP measurements in adults.
Methods. We measured the blood pressures of 650 healthy, randomly ... In addition, blood pressure measurement should be a part of the routine clinical examination of children. ... familial risk factors.2 ... common cause of elevated blood pressure in children.4 They ... sphygmomanometer (Accoson, hospital model BS 274,.
Chen, Liang; Li, Jiyu; Wen, Jing; Guo, Changfeng; Zhang, Jingying; Yu, Zhen
This study aimed to evaluate the accuracy of the automated oscillometric upper arm blood pressure monitor Pangao PG-800B26 for home blood pressure monitoring according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010 and the British Hypertension Society (BHS) protocols. Systolic and diastolic blood pressures were measured sequentially in 33 and 85 adults, respectively, on the basis of the ESH-IP and BHS protocols using a mercury sphygmomanometer (two observers) and the device (one supervisor). The procedures and analysis methods of the protocols were followed precisely. The device fulfilled the criteria of the ESH-IP, with device-observer differences of 1.01±5.16 and -0.58±4.17 mmHg for systolic and diastolic blood pressure, respectively. Furthermore, the A/A grade of the BHS protocol was also achieved for overall grading and for the three pressure levels, with average differences of 0.85±6.35 and -0.15±5.65 mmHg for systolic and diastolic blood pressure, respectively, which also fulfilled the requirements of the Association for the Advancement of Medical Instrumentation. The Pangao PG-800B26 fulfilled the criteria of the ESH-IP 2010 and achieved the A/A grade of the BHS protocol, and hence can be recommended for home use in adults.
N. A. Karoli
Full Text Available Aim. To study changes in the parameters of the 24-hour blood pressure (BP monitoring and arterial stiffness (AS in patients with arterial hypertension (HT and chronic obstructive pulmonary disease (COPD treated with angiotensin II receptors blocker, valsartan.Material and methods. Men with HT and COPD (n=23, who have been receiving valsartan with starting dose 80 mg/day for 6 months as antihypertensive therapy were included into the study. If target BP was not achieved, correction of the valsartan dose was carried out with the hydrochlorothiazide addition when needed. Clinical examination, 24-hour BP and AS monitoring using BPLab MnSDP-2 monitor ("Petr TELEGIN",Russia, clinical evaluation of COPD were performed.Results. Abnormal circadian BP profile and the elastic properties of arteries were diagnosed in the majority of hypertensive patients with COPD. Valsartan therapy allowed to achieve target BP levels in 100% of patients, normalization of circadian BP profile in 56.5%, improvement in AS parameters: a significant increase in PTT2 (from 89.6±14.3 to 94.4±18.4 ms, reduction of (dP/dtmax (from 566.6±117.9 to 518.8±146.2 mmHg/s, AIx (from -4.0±15.2 to -11.6±20.8 % as compared to the baseline. Circadian changes in daily parameters of AS in studied patients with the most obvious night-time abnormalities of the elastic properties of arteries were detected. Valsartan intake led to Alx reduction at night-time.Conclusion. Valsartan-based therapy in hypertensive patients with concomitant COPD demonstrated a high antihypertensive efficacy and favorable changes in the elastic properties of the vascular wall that confirm its organoprotective effect.
N. A. Karoli
Full Text Available Aim. To study changes in the parameters of the 24-hour blood pressure (BP monitoring and arterial stiffness (AS in patients with arterial hypertension (HT and chronic obstructive pulmonary disease (COPD treated with angiotensin II receptors blocker, valsartan.Material and methods. Men with HT and COPD (n=23, who have been receiving valsartan with starting dose 80 mg/day for 6 months as antihypertensive therapy were included into the study. If target BP was not achieved, correction of the valsartan dose was carried out with the hydrochlorothiazide addition when needed. Clinical examination, 24-hour BP and AS monitoring using BPLab MnSDP-2 monitor ("Petr TELEGIN",Russia, clinical evaluation of COPD were performed.Results. Abnormal circadian BP profile and the elastic properties of arteries were diagnosed in the majority of hypertensive patients with COPD. Valsartan therapy allowed to achieve target BP levels in 100% of patients, normalization of circadian BP profile in 56.5%, improvement in AS parameters: a significant increase in PTT2 (from 89.6±14.3 to 94.4±18.4 ms, reduction of (dP/dtmax (from 566.6±117.9 to 518.8±146.2 mmHg/s, AIx (from -4.0±15.2 to -11.6±20.8 % as compared to the baseline. Circadian changes in daily parameters of AS in studied patients with the most obvious night-time abnormalities of the elastic properties of arteries were detected. Valsartan intake led to Alx reduction at night-time.Conclusion. Valsartan-based therapy in hypertensive patients with concomitant COPD demonstrated a high antihypertensive efficacy and favorable changes in the elastic properties of the vascular wall that confirm its organoprotective effect.
Myers, Martin G
Manual blood pressure (BP) recorded in routine clinical practice is relatively inaccurate and associated with higher readings compared to BP measured in research studies in accordance with standardized measurement guidelines. The increase in routine office BP is the result of several factors, especially the presence of office staff, which tends to make patients nervous and also allows for conversation to occur. With the disappearance of the mercury sphygmomanometer because of environmental concerns, there is greater use of oscillometric BP recorders, both in the office setting and elsewhere. Although oscillometric devices may reduce some aspects of observer BP measurement error in the clinical setting, they are still associated with higher BP readings, known as white coat hypertension (for diagnosis) or white coat effect (with treated hypertension). Now that fully automated sphygmomanometers are available which are capable of recording several readings with the patient resting quietly, there is no longer any need to have office staff present when BP is being recorded. Such readings are called automated office blood pressure (AOBP) and they are both more accurate than conventional manual office BP and not associated with the white coat phenomena. AOBP readings are also similar to the awake ambulatory BP and home BP, both of which are relatively good predictors of cardiovascular risk. The available evidence suggests that AOBP should now replace manual or electronic office BP readings when screening patients for hypertension and also after antihypertensive drug therapy is initiated. Copyright © 2018. The Korean Society of Cardiology.
Ohno, Yoichi; Kanno, Yoshihiko; Takenaka, Tsuneo
In this review, we focused on the relationship between central blood pressure and chronic kidney diseases (CKD). Wave reflection is a major mechanism that determines central blood pressure in patients with CKD. Recent medical technology advances have enabled non-invasive central blood pressure measurements. Clinical trials have demonstrated that compared with brachial blood pressure, central blood pressure is a stronger risk factor for cardiovascular (CV) and renal diseases. CKD is characterized by a diminished renal autoregulatory ability, an augmented direct transmission of systemic blood pressure to glomeruli, and an increase in proteinuria. Any elevation in central blood pressure accelerates CKD progression. In the kidney, interstitial inflammation induces oxidative stress to handle proteinuria. Oxidative stress facilitates atherogenesis, increases arterial stiffness and central blood pressure, and worsens the CV prognosis in patients with CKD. A vicious cycle exists between CKD and central blood pressure. To stop this cycle, vasodilator antihypertensive drugs and statins can reduce central blood pressure and oxidative stress. Even in early-stage CKD, mineral and bone disorders (MBD) may develop. MBD promotes oxidative stress, arteriosclerosis, and elevated central blood pressure in patients with CKD. Early intervention or prevention seems necessary to maintain vascular health in patients with CKD. PMID:26788468
McManus, Richard J; Mant, Jonathan; Haque, M Sayeed; Bray, Emma P; Bryan, Stirling; Greenfield, Sheila M; Jones, Miren I; Jowett, Sue; Little, Paul; Penaloza, Cristina; Schwartz, Claire; Shackleford, Helen; Shovelton, Claire; Varghese, Jinu; Williams, Bryan; Hobbs, F D Richard; Gooding, Trevor; Morrey, Ian; Fisher, Crispin; Buckley, David
Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups. To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease. A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013. Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary. The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit. Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and
Chen, Can; Shang, Fujun; Wang, Jiepin; Chen, Jianghong; Ji, Na; Wan, Yi
This study aimed to evaluate the performance of the iHealth BP3 upper-arm blood pressure monitor, which is designed for clinic use and self-measurement of blood pressure using Apple touch devices as an interface. The European Society of Hypertension International Protocol (ESH-IP) revision 2010 for the validation of blood pressure measuring devices in adults was followed precisely. Ninty-nine couples of test device and reference blood pressure measurements were obtained during the study (three pairs for each of the 33 participants). The 33 participants, age 47.1±12.3 years (age range 27-69 years) and arm circumference 30.0±4.4 cm, had a mean systolic blood pressure (SBP) of 143.9±27.4 mmHg and a mean diastolic blood pressure (DBP) of 90.1±18.3 mmHg. The device passed all of the requirements fulfilling the standards of the protocol, and the mean±SD device-observer difference was 2.8±4.2 mmHg for SBP and -0.4±3.5 mmHg for DBP. According to the results of the validation study on the basis of the ESH-IP revision 2010, the iHealth BP3 can be recommended for clinic use and self-measurement in an adult population. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Yi, Jun; Wan, Yi; Pan, Feng; Yu, Xiaorong; Zhao, Huadong; Shang, Fujun; Xu, Yongyong
The validation of sphygmomanometer is important in accurate blood pressure measurement. This study presents the validation results by the Medipro MediCare 100f upper arm blood pressure monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. The ESH-IP revision 2010 for the validation of blood pressure measuring devices in adults was followed precisely. A total of 99 couples of test device and reference blood pressure measurements were obtained during the study (three pairs for each of the 33 participants). The device produced 73, 93, and 98 measurements within 5, 10, and 15 mmHg for systolic blood pressure (SBP) and 79, 93, and 96 for diastolic blood pressure (DBP), respectively. The mean standard deviation device-observer difference was 1.4 ± 5.2 mmHg for SBP and 0.02±5.8 mmHg for DBP. The number of participants with two or three of the device-observer differences within 5 mmHg was 24 for SBP and 30 for DBP, whereas there was no participant with none of the device-observer differences within 5 mmHg. According to the results of the validation study based on the ESH-IP revision 2010, the Medipro MediCare 100f can be recommended for self-measurement in an adult population.
Wang, Lulu; Zhao, Mingming; Liu, Wenjin; Li, Xiurong; Chu, Hong; Bai, Youwei; Sun, Zhuxing; Gao, Chaoqing; Zheng, Lemin; Yang, Junwei
Mechanisms underlying elevated blood pressure in dialysis patients are complex as a variety of non-traditional factors are involved. We sought to explore the association of circulating betaine, a compound widely distributed in food, with blood pressure in dialysis patients. We used baseline data of an ongoing cohort study involving patients on hemodialysis. Plasma betaine was measured by high performance liquid chromatography in 327 subjects. Blood pressure level was determined by intradialytic ambulatory blood pressure monitoring. The mean age of the patients was 52.6 ± 11.9 years, and 58.4% were male. Average interdialytic ambulatory systolic and diastolic blood pressure were 138.4 ± 22.7 mm Hg and 84.4 ± 12.5 mm Hg, respectively. Mean plasma betaine level was 37.6 μmol/L. Multiple linear regression analysis revealed significant associations of betaine with both systolic blood pressure (β = -3.66, P = .003) and diastolic blood pressure (β = -2.00, P = .004). The associations persisted even after extensive adjustment for cardiovascular covariates. Subgroup analysis revealed that the association between betaine and blood pressure was mainly limited to female patients. Our data suggest that alteration of circulating betaine possibly contributes to blood pressure regulation in these patients. ©2018 Wiley Periodicals, Inc.
Validation of the Andon KD-5917 automatic upper arm blood pressure monitor, for clinic use and self-measurement, according to the European Society of Hypertension International Protocol revision 2010.
Guo, Wan-Gang; Li, Bing-Ling; He, Yong; Xue, Yu-Sheng; Wang, Hai-Yan; Zheng, Qiang-Sun; Xiang, Ding-Cheng
To validate the Andon KD-5917 automatic upper arm blood pressure monitor according to the European Society of Hypertension International Protocol revision 2010. Sequential same-left-arm measurements of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were obtained in 33 participants using the mercury sphygmomanometer and the test device. According to the validation protocol, 99 pairs of test device and reference blood pressure measurements (three pairs for each of the 33 participants) were obtained in the study. The device produced 73, 98, and 99 measurements within 5, 10, and 15 mmHg for SBP and 86, 98, and 99 for DBP, respectively. The mean ± SD device-observer difference was 3.07 ± 3.68 mmHg for SBP and -0.89 ± 3.72 mmHg for DBP. The number of patients with two or three of the device-observer difference within 5 mmHg was 26 for SBP and 29 for DBP, and no patient had a device-observer difference within 5 mmHg. The Andon KD-5917 automatic upper arm blood pressure monitor can be recommended for clinical use and self-measurement in an adult population on the basis of the European Society of Hypertension International Protocol revision 2010.
Full Text Available Elevated blood pressure is an indicator of cardiovascular stress and increased risk of cardiovascular-related morbidity and mortality. There is emerging evidence suggesting air pollutants, including particulate matter (PM, could promote hypertension, thereby increasing cardiovascular disease risk. Repeated measurement analyses were conducted to examine the associations of three types of PM with systolic blood pressure (SBP, diastolic blood pressure (DBP, and pulse pressure (PP in 220 participants, (mean age = 58.5 years from the Community Assessment of Freeway Exposure and Health study (CAFEH, most of whom live near a major highway. Ambient levels of air pollutants including particle number concentration (PNC; a measure of ultrafine particle (UFP concentration, fine PM (PM2.5, Particle diameter <2.5 µm, and black carbon (BC were measured at a central site <7 km from the study areas. Central sites are good at capturing short-term temporal trends in pollution associated with meteorological changes over regional areas. Linear mixed-effect models that accounted for repeated measures within one person were used to examine the associations between blood pressure variables and daily average of ambient PNC, PM2.5, or BC, controlling for demographic characteristics and major confounders including temperature. Our PNC model predicted that a higher PNC of 10,000 particles/cm3 was associated with higher DBP of 2.40 mmHg (p = 0.03, independent of other factors in the model. There were no significant associations for PM2.5 or BC. Post hoc subgroup analyses by obesity status showed that positive associations of DBP with PNC were more pronounced among obese individuals than non-obese individuals. These results suggested that PNC levels are associated with increased blood pressure, which may contribute to cardiovascular disease risk. More research is needed to assess the relationship between PNC and blood pressure and to address possible residual confounding.
Full Text Available Abstract Background Insufficient blood pressure control is a frequent problem despite the existence of effective treatment. Insufficient adherence to self-monitoring as well as to therapy is a common reason. Blood pressure self-measurement at home (Home Blood Pressure Measurement, HBPM has positive effects on treatment adherence and is helpful in achieving the target blood pressure. Only a few studies have investigated whether adherence to HBPM can be improved through simple measures resulting also in better blood pressure control. Objective Improvement of self-monitoring and improved blood pressure control by using a new colour-coded blood pressure diary. Outcome Primary outcome: Change in systolic and/or diastolic blood pressure 6 months after using the new colour-coded blood pressure diary. Secondary outcome: Adherence to blood pressure self-measurement (number of measurements/entries. Methods/Design Randomised controlled study. Population: 138 adult patients in primary care with uncontrolled hypertension despite therapy. The control group uses a conventional blood pressure diary; the intervention group uses the new colour-coded blood pressure diary (green, yellow, red according a traffic light system. Expected results/conclusion The visual separation and entries in three colour-coded areas reflecting risk (green: blood pressure in the target range ≤ 140/≤ 90 mmHg, yellow: blood pressure >140/>90 mmHg, red: blood pressure in danger zone > 180 mmHg/>110 mmHg lead to better self-monitoring compared with the conventional (non-colour-coded blood pressure booklet. The colour-coded, visualised information supports improved perception (awareness and interpretation of blood pressure and triggers correct behaviour, in the means of improved adherence to the recommended treatment as well as better communication between patients and doctors resulting in improved blood pressure control. Trial registration ClinicalTrials.gov ID NCT01013467
Khadilkar, Kranti Shreesh; Bandgar, Tushar; Shivane, Vyankatesh; Lila, Anurag; Shah, Nalini
Blood glucose monitoring has evolved over the last century. The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system. The search for an ideal blood glucose monitoring system still continues. This review explains the various blood glucose monitoring systems with special focus on the monitoring systems like self- monitored blood glucose (SMBG) and continuous glucose monitoring system (CGMS). It also focuses on the newer concepts of blood glucose monitoring and their incorporation in routine clinical management of diabetes mellitus.
Khadilkar, Kranti Shreesh; Bandgar, Tushar; Shivane, Vyankatesh; Lila, Anurag; Shah, Nalini
Blood glucose monitoring has evolved over the last century. The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system. The search for an ideal blood glucose monitoring system still continues. This review explains the various blood glucose monitoring systems with special focus on the monitoring systems like self- monitored blood glucose (SMBG) and continuous glucose monitoring system (CGMS). It also focuses on the newer concepts of blood glucose monitoring and their incorporation in routine clinical management of diabetes mellitus. PMID:24910827
Kranti Shreesh Khadilkar
Full Text Available Blood glucose monitoring has evolved over the last century. The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system. The search for an ideal blood glucose monitoring system still continues. This review explains the various blood glucose monitoring systems with special focus on the monitoring systems like self- monitored blood glucose (SMBG and continuous glucose monitoring system (CGMS. It also focuses on the newer concepts of blood glucose monitoring and their incorporation in routine clinical management of diabetes mellitus.
de la Sierra, Alejandro; Banegas, José R; Segura, Julián; Gorostidi, Manuel; Ruilope, Luis M
Ambulatory blood pressure monitoring (ABPM) is superior to conventional BP measurement in predicting outcome, with baseline 24-h, daytime and night-time absolute values, as well as relative nocturnal decline, as powerful determinants of prognosis. We aimed to evaluate ABPM estimates on the appearance of cardiovascular events and mortality in a cohort of high-risk treated hypertensive patients. A total of 2115 treated hypertensive patients with high or very high added risk were evaluated by means of office and 24-h ABPM. Cardiovascular events and mortality were assessed after a median follow-up of 4 years. Two hundred and sixty-eight patients (12.7%) experienced a primary event (nonfatal coronary or cerebrovascular event, heart failure hospitalization or cardiovascular death) and 114 died (45 from cardiovascular causes). In a multiple Cox regression model, and after adjusting for baseline cardiovascular risk and office BP, night-time SBP predicted cardiovascular events [hazard ratio for each SD increase: 1.45; 95% confidence interval (CI) 1.29-1.59]. Values above 130 mmHg increased the risk by 52% in comparison to values less than 115 mmHg. In addition to clinical determinants of cardiovascular risk and conventional BP, ABPM performed during treatment adds prognostic significance on the development of cardiovascular events in high-risk hypertensive patients. Among different ABPM-derived values, night-time SBP is the most potent predictor of outcome.
Full Text Available Childhood hypertension’s increasing prevalence has generally been linked to the obesity epidemic. We observed that a significant proportion of children referred to our pediatric center with documented office hypertension are nonobese and have a history of attention deficit hyperactivity disorder (ADHD. To define the extent of this anecdotal observation, we performed a retrospective analysis of ambulatory blood pressure monitoring (ABPM tests which in our center are routinely performed in newly referred children suspected of hypertension. Twenty-one percent (48 of 227 new referrals had a history of ADHD, and 81% of them were treated with psychostimulant medications at the time of their ABPM test. Children in this group had a significantly lower average BMI z-score compared with the rest of the children (0.18 versus 0.75 and were significantly more likely to have abnormally elevated wake systolic loads on ABPM (38% versus 4%. The overall proportion of children with any abnormality on ABPM was comparable in both groups (46% versus 40%. Conclusion. A significant proportion of children suspected of hypertension have ADHD which may be related to higher wake systolic BP values. The prevalence of hypertension among children with ADHD will have to be determined in prospective studies.
She, Jin; Guan, Xizhou; Liu, Yanyong; Xiang, Haiyan
This study validated the RisingSun RS-651 blood pressure (BP) monitor based on auscultation in adults according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 standard. The RS-651 device was evaluated in a study of 97 participants. The same arm simultaneous method, as defined in the ANSI/AAMI/ISO standard, was used. The mean differences±standard deviation for criterion 1 were 0.8±2.3 mm Hg for systolic BP (SBP) and -0.1±2.9 mm Hg for diastolic BP (DBP). Analysis for criterion 2 resulted in values of 0.8±1.5 mm Hg for SBP and -0.1±2.1 mm Hg for DBP. All of the data fulfilled the ANSI/AAMI/ISO 81060-2:2013 standard requirements to pass the validation. The RisingSun RS-651 device can be recommended for both clinical and self/home use in adults according to the ANSI/AAMI/ISO 81060-2:2013 standard. © 2016 The Authors. The Journal of Clinical Hypertension Published by Wiley Periodicals, Inc.
Lanier, Gregg M; Orlanes, Khristine; Hayashi, Yacki; Murphy, Jennifer; Flannery, Margaret; Te-Frey, Rosie; Uriel, Nir; Yuzefpolskaya, Melana; Mancini, Donna M; Naka, Yoshifumi; Takayama, Hiroo; Jorde, Ulrich P; Demmer, Ryan T; Colombo, Paolo C
Doppler ultrasound is the clinical gold standard for noninvasive blood pressure (BP) measurement among continuous-flow left ventricular assist device patients. The relationship of Doppler BP to systolic BP (SBP) and mean arterial pressure (MAP) is uncertain and Doppler measurements require a clinic visit. We studied the relationship between Doppler BP and both arterial-line (A-line) SBP and MAP. Validity and reliability of the Terumo Elemano BP Monitor, a novel slow cuff-deflation device that could potentially be used by patients at home, were assessed. Doppler and Terumo BP measurements were made in triplicate among 60 axial continuous-flow left ventricular assist device (HeartMate II) patients (30 inpatients and 30 outpatients) at 2 separate exams (360 possible measurements). A-line measures were also obtained among inpatients. Mean absolute differences (MADs) and correlations were used to determine within-device reliability (comparison of second and third BP measures) and between-device validity. Bland-Altman plots assessed BP agreement between A-line, Doppler BP, and Terumo Elemano. Success rates for Doppler and Terumo Elemano were 100% and 91%. Terumo Elemano MAD for repeat SBP and MAP were 4.6±0.6 and 4.2±0.6 mm Hg; repeat Doppler BP MAD was 2.9±0.2 mm Hg. Mean Doppler BP was lower than A-line SBP by 4.1 (MAD=6.4±1.4) mm Hg and higher than MAP by 9.5 (MAD=11.0±1.2) mm Hg; Terumo Elemano underestimated A-line SBP by 0.3 (MAD=5.6±0.9) mm Hg and MAP by 1.7 (MAD=6.0±1.0) mm Hg. Doppler BP more closely approximates SBP than MAP. Terumo Elemano was successful, reliable, and valid when compared with A-line and Doppler.
Sheppard, James P; Martin, Una; Gill, Paramjit; Stevens, Richard; McManus, Richard J
The diagnosis and management of hypertension depends on accurate measurement of blood pressure (BP) in order to target antihypertensive treatment appropriately. Most BP measurements take place in a clinic setting, but it has long been recognised that readings taken out-of-office (via home or ambulatory monitoring) estimate true underlying BP more accurately. Recent studies have shown that the change in clinic BP over multiple readings is a significant predictor of the difference between clinic and out-of-office BP. Used in combination with patient characteristics, this change has been shown to accurately predict a patient's out-of-office BP level. The present study proposes to collect real-life BP data to prospectively validate this new prediction tool in routine clinical practice. A prospective, multicentre observational cohort design will be used, recruiting patients from primary and secondary care. All patients attending participating centres for ambulatory BP monitoring will be eligible to participate. Anonymised clinical data will be collected from all eligible patients, who will be invited to give informed consent to permit identifiable data to be collected for data linkage to external outcome registries. Descriptive statistics will be used to calculate the sensitivity, specificity, positive and negative predictive values of the out-of-office BP prediction tool. Area under the receiver operator characteristic curve statistics will be used to examine model performance. Ethical approval for this study has been obtained from the National Research. Ethics Service Committee South Central-Oxford A (reference; 15/SC/0184), and site-specific R&D approval has been acquired from the relevant NHS trusts. All findings will be presented at relevant conferences and published in peer-reviewed journals, on the study website and disseminated in lay and social media where appropriate. Published by the BMJ Publishing Group Limited. For permission to use (where not already
Fokkema, Dirk S.; Koolhaas, Jaap M.; Meulen, Jan van der; Schoemaker, Regien
A large amplitude blood pressure oscillation occurs during social defeat in a territorial fight between male rats, and during the application of a psychosocial stimulus associated with this defeat. Synchronous recording of blood pressure, intrathoracic pressure and diaphragm activity shows that the
... 2016 Print this issue Blood Pressure Matters Keep Hypertension in Check En español Send us your comments ... 1 in 3 adults in the U.S. has high blood pressure, but many don’t realize it. High blood ...
Booker, Corenthian J.; Dodson, William C.; Kunselman, Allen R.; Repke, John T.; Legro, Richard S.
We prospectively correlated the 24-hour ambulatory blood pressure measurements (ABPM) to conventional sphygmomanometer blood pressure measurements (CSM) in women at risk for gestational hypertensive disorders (GHTNDs) and identified predictive factors from ABPM for GHTND. We analyzed 73 women with ≥1 risk factor for developing a GHTND. Using both the CSM and ABPM, the systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), and heart rate (HR) were measured for 24 hours during three periods (14 to 24 weeks; 24 to 32 weeks; and 33 weeks to delivery). Correlation between the CSM and ABPM lessened as pregnancy progressed. Seventeen (25%) of women developed a GHTND. MAP variability increased in the GHTND group versus those without a GHTND. The odds of developing a GHTND increased 1.5 times for every 1 beat per minute increase in the ABPM 24-hour HR at visit 1 and reversed by visit 3. In women at risk for a GHTND, CSM and ABPM correlate less well as pregnancy advances. HR changes in at-risk women may be a marker for the development of a GHTND and may reflect increased sympathetic activity and/or decreased baroreceptor sensitivity. PMID:22147639
Hoffmann-Petersen, N; Lauritzen, T; Bech, J N
OBJECTIVE: Telemonitoring of home blood pressure measurements (TBPM) is a new and promising supplement to diagnosis, control and treatment of hypertension. We wanted to compare the outcome of antihypertensive treatment based on TBPM and conventional monitoring of blood pressure. DESIGN AND METHOD...... of the measurements and subsequent communication by telephone or E-mail. In the control group, patients received usual care. Primary outcome was reduction in daytime ambulatory blood pressure measurements (ABPM) from baseline to 3 months' follow-up. RESULTS: In both groups, daytime ABPM decreased significantly....../181), p = 0.34. Blood pressure reduction in the TBPM group varied with the different practices. CONCLUSIONS: No further reduction in ABPM or number of patients reaching blood pressure targets was observed when electronic transmission of TBPM was applied in the treatment of hypertension by GPs. Thus...
Weaver, Charles S.
Microprocessor circuits and a computer algorithm for automatically measuring blood pressure during ambulatory monitoring and exercise stress testing have been under development at SRI International. A system that records ECG, Korotkov sound, and arm cuff pressure for off-line calculation of blood pressure has been delivered to NASA, and an LSLE physiological monitoring system that performs the algorithm calculations in real-time is being constructed. The algorithm measures the time between the R-wave peaks and the corresponding Korotkov sound on-set (RK-interval). Since the curve of RK-interval versus cuff pressure during deflation is predictable and slowly varying, windows can be set around the curve to eliminate false Korotkov sound detections that result from noise. The slope of this curve, which will generally decrease during exercise, is the inverse of the systolic slope of the brachial artery pulse. In measurements taken during treadmill stress testing, the changes in slopes of subjects with coronary artery disease were markedly different from the changes in slopes of healthy subjects. Measurements of slope and O2 consumption were also made before and after ten days of bed rest during NASA/Ames Research Center bed rest studies. Typically, the maximum rate of O2 consumption during the post-bed rest test is less than the maximum rate during the pre-bed rest test. The post-bed rest slope changes differ from the pre-bed rest slope changes, and the differences are highly correlated with the drop in the maximum rate of O2 consumption. We speculate that the differences between pre- and post-bed rest slopes are due to a drop in heart contractility.
Steurer-Stey, Claudia; Zoller, Marco; Chmiel Moshinsky, Corinne; Senn, Oliver; Rosemann, Thomas
Insufficient blood pressure control is a frequent problem despite the existence of effective treatment. Insufficient adherence to self-monitoring as well as to therapy is a common reason. Blood pressure self-measurement at home (Home Blood Pressure Measurement, HBPM) has positive effects on treatment adherence and is helpful in achieving the target blood pressure. Only a few studies have investigated whether adherence to HBPM can be improved through simple measures resulting also in better blood pressure control. Improvement of self-monitoring and improved blood pressure control by using a new colour-coded blood pressure diary. Change in systolic and/or diastolic blood pressure 6 months after using the new colour-coded blood pressure diary.Secondary outcome: Adherence to blood pressure self-measurement (number of measurements/entries). Randomised controlled study. 138 adult patients in primary care with uncontrolled hypertension despite therapy. The control group uses a conventional blood pressure diary; the intervention group uses the new colour-coded blood pressure diary (green, yellow, red according a traffic light system). EXPECTED RESULTS/CONCLUSION: The visual separation and entries in three colour-coded areas reflecting risk (green: blood pressure in the target range 140/>90 mmHg, red: blood pressure in danger zone > 180 mmHg/>110 mmHg) lead to better self-monitoring compared with the conventional (non-colour-coded) blood pressure booklet. The colour-coded, visualised information supports improved perception (awareness and interpretation) of blood pressure and triggers correct behaviour, in the means of improved adherence to the recommended treatment as well as better communication between patients and doctors resulting in improved blood pressure control. ClinicalTrials.gov ID NCT01013467.
Asayama, Kei; Thijs, Lutgarde; Li, Yan
Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥14...
Schonberger, Robert B; Nwozuzu, Adambeke; Zafar, Jill; Chen, Eric; Kigwana, Simon; Monteiro, Miriam M; Charchaflieh, Jean; Sophanphattana, Sophisa; Dai, Feng; Burg, Matthew M
Blood pressure (BP) measurement during the presurgical assessment has been suggested as a way to improve longitudinal detection and treatment of hypertension. The relationship between BP measured during this assessment and home blood pressure (HBP), a better indicator of hypertension, is unknown. The purpose of the present study was to determine the positive predictive value of presurgical BP for predicting elevated HBP. We prospectively enrolled 200 patients at a presurgical evaluation clinic with clinic blood pressures (CBPs) ≥130/85 mm Hg, as measured using a previously validated automated upper-arm device (Welch Allyn Vital Sign Monitor 6000 Series), to undergo daily HBP monitoring (Omron Model BP742N) between the index clinic visit and their day of surgery. Elevated HBP was defined, per American Heart Association guidelines, as mean systolic HBP ≥135 mm Hg or mean diastolic HBP ≥85 mm Hg. Of the 200 participants, 188 (94%) returned their home blood pressure monitors with valid data. The median number of HBP recordings was 10 (interquartile range, 7-14). Presurgical CBP thresholds of 140/90, 150/95, and 160/100 mm Hg yielded positive predictive values (95% confidence interval) for elevated HBP of 84.1% (0.78-0.89), 87.5% (0.81-0.92), and 94.6% (0.87-0.99), respectively. In contrast, self-reported BP control, antihypertensive treatment, availability of primary care, and preoperative pain scores demonstrated poor agreement with elevated HBP. Elevated preoperative CBP is highly predictive of longitudinally elevated HBP. BP measurement during presurgical assessment may provide a way to improve longitudinal detection and treatment of hypertension. Copyright © 2018 American Heart Association. Published by Elsevier Inc. All rights reserved.
Mossello, Enrico; Simoni, David
High blood pressure and cognitive impairment often coexist in old age, but their pathophysiological association is complex. Several longitudinal studies have shown that high blood pressure at midlife is a risk factor for cognitive impairment and dementia, although this association is much less clear in old age. The effect of blood pressure lowering in reducing the risk of dementia is only borderline significant in clinical trials of older subjects, partly due to the insufficient follow-up time. Conversely, dementia onset is associated with a decrease of blood pressure values, probably secondary to neurodegeneration. Prognostic effect of blood pressure values in cognitively impaired older subjects is still unclear, with aggressive blood pressure lowering being potentially harmful in this patients category. Brief cognitive screening, coupled with simple motor assessment, are warranted to identify frail older subjects who need a more cautious approach to antihypertensive treatment. Values obtained with ambulatory blood pressure monitoring seem more useful than clinical ones to predict the outcome of cognitively impaired older subjects. Future studies should identify the most appropriate blood pressure targets in older subjects with cognitive impairment.
Daniel, Ana Carolina Queiroz Godoy; Machado, Juliana Pereira; Veiga, Eugenia Velludo
ABSTRACT Objective To analyze the frequency of blood pressure documentation performed by nursing professionals in an emergency department. Methods This is a cross-sectional, observational, descriptive, and analytical study, which included medical records of adult patients admitted to the observation ward of an emergency department, between March and May 2014. Data were obtained through a collection instrument divided into three parts: patient identification, triage data, and blood pressure documentation. For statistical analysis, Pearson’s correlation coefficient was used, with a significance level of α<0.05. Results One hundred fifty-seven records and 430 blood pressure measurements were analyzed with an average of three measurements per patient. Of these measures, 46.5% were abnormal. The mean time from admission to documentation of the first blood pressure measurement was 2.5 minutes, with 42 minutes between subsequent measures. There is no correlation between the systolic blood pressure values and the mean time interval between blood pressure documentations: 0.173 (p=0.031). Conclusion The present study found no correlation between frequency of blood pressure documentation and blood pressure values. The frequency of blood pressure documentation increased according to the severity of the patient and decreased during the length of stay in the emergency department. PMID:28444085
Larsson, L.E.; Lindahl, J.; Unsgaard, B.
Blood pressure and heart rate at rest in the supine and standing positions were followed before, during and after irradiation for malignant tumours in 114 patients. A statistically significant gradual reduction in blood pressure during the treatment period was established. This was more marked in older patients and in patients with higher initial blood pressure but was not related to the region irradiated or the type of tumour treated. Particularly if the patient experiences vertigo and nausea on change of position, it seems advisable to check the blood pressure during treatment. (author)
... individuals. American Journal of Physiology. Heart and Circulatory Physiology. 2016;311:H1024. Carlson DJ, et al. Isometric exercise training for blood pressure management: A systematic review ...
Lack of validation of the Dixtal (DX 2020) upper arm blood pressure monitor, in oscillometric mode, for clinical use in an intensive care unit, according to the European Society of Hypertension-International Protocol revision 2010.
Gothardo, Ana C L O; Savioli, Amanda F; Santos, Dayanna S; Lamas, José L T
The aim of the study was to evaluate the accuracy of the oscillometric blood pressure section in the DX 2020 Dixtal multiparametric monitor in adults according to the European Society of Hypertension-International Protocol as revised in 2010 (ESH-IP 2010). The blood pressure was sequentially verified in 33 individuals admitted to an adult ICU (18 men, mean age 44 years) with a mercury column sphygmomanometer (two observers) and the DX 2020 test device (one supervisor). Ninety-nine pairs of differences were obtained. Data analysis followed the ESH-IP 2010 requirements. In the first requirement, the DX 2020 device failed in the validation study in the 5, 10, and 15 mmHg ranges. From the 99 pairs of differences, only 43/73, 69/87, and 81/96 were obtained for systolic blood pressure and 29/65, 56/81, and 71/93 were obtained for diastolic blood pressure. In the second requirement, at least 24 individuals should have, from their comparisons, two under 0-5 mmHg ranges, which was observed only with 16 individuals in the systolic and nine in the diastolic range. Moreover, at maximum, only three readings could have differences of more than 5 mmHg, and this was observed in 10 individuals in the systolic range and 17 individuals in the diastolic range. The DX 2020 automatic multiparametric monitor for blood pressure measurement has not been recommended for clinical use according to the ESH-IP 2010. It is important to highlight that this work refers only to a blood pressure measurement module and that the same conclusion cannot be drawn for its other functions.
Guler, Elif; Col, Nilgun; Buyukcelik, Mithat; Balat, Ayse
In recent years, survival rates of childhood cancers have significantly increased, and occurrence of long-term adverse late effects (eg, insulin resistance, diabetes mellitus, metabolic syndrome, hypertension) has become increasingly important. Early diagnosis of obesity/hypertension in childhood is essential to avoid morbidity in the adulthood. Therefore, this study was aimed to determine the blood pressure (BP) profile by ambulatory BP monitoring (ABPM) method, and prevalence of hypertension, obesity, abdominal obesity among childhood cancer survivors. The study was carried out with 52 cancer survivors. The ABPM measurement was performed during 24 hours. The anthropometric measurements of patients were performed using standardized protocols. The body composition analysis was performed with bioelectrical impedance analysis (BIA) method. Statistical significance was considered at p < 0.05. The mean age of patients was 12.84 ± 3.88 years. Time off therapy ranged 24-125 month. The prevalence of prehypertension and hypertension were 57.7% and 9.6%, respectively. There was no statistically significant relationship between diagnosis and BP status (p = 0.59). The prevalence of obesity, and abdominal obesity were 1.9% and 30.4%, respectively. There was a positive correlation between waist circumference (WC) and time off therapy (p = 0.046). The WC was found to be higher in patients who received cranial irradiation (p = 0.048). Weight/WC were higher in patients who used corticosteroids in the treatment (p = 0.019). Careful follow up of BP, weight and WC is necessary for long-term cancer survivors to prevent complications. Especially patients who receive cranial radiotherapy and use corticosteroid are at increased risk of abdominal obesity.
Background Hypertensive patients (HTs) are usually attended in primary care (PC). We aimed to assess the diagnostic accuracy and cost-benefit ratio of 24-hour ambulatory blood pressure monitoring (ABPM) in all newly diagnosed hypertensive patients (HTs) attended in PC. Methods In a cross-sectional study ABPM was recorded in all 336 never treated HTs (Office BP ≥140 and/or ≥ 90 mm Hg) that were admitted during 16 months. Since benefits from drug treatment in white-coat hypertension (WCH) remain unproven, a cost benefit estimation of a general use of ABPM (vs absence of ABPM) in HTs was calculated comparing the cost of usual medical assistance of HTs only diagnosed in office with that based both on refraining from drug treatment all subjects identified as WCH and on the reduction by half of the frequency of biochemical exams and doctor visits. Results Women were 56%, age 51 ± 14 years and BMI 27 ± 4 Kg/m2. Out of these, 206 were considered as true HTs, daytime ABPM ≥ 135 and/or ≥85 mm Hg and 130 (38,7%) were identified as having white coat hypertension (WCH), daytime ABPM ABPM total medical expenses can be reduced by 23% (157.500 euros) with a strategy based on ABPM for 1000 patients followed for 2 years. Conclusions In PC, the widespread use of ABPM in newly diagnosed HTs increases diagnostic accuracy of hypertension, improves cardiovascular risk stratification, reduces health expenses showing a highly favourable benefit-cost ratio vs a strategy without ABPM. PMID:23937261
Divisón-Garrote, Juan A; Ruilope, Luis M; de la Sierra, Alejandro; de la Cruz, Juan J; Vinyoles, Ernest; Gorostidi, Manuel; Escobar-Cervantes, Carlos; Velilla-Zancada, Sonsoles M; Segura, Julián; Banegas, José R
Elderly patients can be particularly susceptible to the adverse effects of excessive blood pressure (BP) lowering by antihypertensive treatment. The identification of hypotension is thus especially important. Ambulatory BP monitoring (ABPM) is a more accurate technique than office for classifying BP status. This study examined the prevalence of hypotension and associated demographic and clinical factors among very old treated hypertensive patients undergoing ABPM. Cross-sectional study in which 5066 patients aged 80 years and older with treated hypertension drawn from the Spanish ABPM Registry were included. Office BP and 24-hour ambulatory BP were determined using validated devices under standardized conditions. Based on previous studies, hypotension was defined as systolic/diastolic BP ABPM, ABPM, and ABPM. Participants' mean age was 83.2 ± 3.1 years (64.4% women). Overall, 22.8% of patients had office hypotension, 33.7% daytime hypotension, 9.2% nighttime hypotension, and 20.5% 24-hour ABPM hypotension. Low diastolic BP values were responsible for 90% of cases of hypotension. In addition, 59.1% of the cases of hypotension detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently associated with office and ABPM hypotension were diabetes, coronary heart disease, and a higher number of antihypertensive medications. One in 3 very elderly treated hypertensive patients attended in usual clinical practice were potentially at risk of having hypotension according to daytime ABPM. More than half of them had masked hypotension; that is, they were not identified if relying on office BP alone. Thus, ABPM could be especially helpful for identifying ambulatory hypotension and avoiding overtreatment, in particular, in patients with diabetes, heart disease, or on antihypertensive polytherapy. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
Sirtori, Cesare R; Arnoldi, Anna; Cicero, Arrigo F G
Significant effects on blood pressure (BP) have been reported from large nutritional interventions, particularly the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet. In more recent years, numerous studies have investigated the possible BP-lowering effect of different nutraceuticals; these range from specific foods to minerals, lipids, whole proteins, peptides, amino acids, probiotics, and vitamins. While a very large body of evidence supports the use of potassium, L-arginine, vitamins C and D, cocoa flavonoids, beetroot juice, some probiotics, coenzyme Q10, controlled-release melatonin, aged garlic extract, and coffee, the use of other nutraceuticals, such as green tea, flaxseed, and resveratrol, has not as yet been supported by adequate evidence. In some cases, e.g. proteins/peptides, the responsible component needs also to be fully uncovered. Finally, while for most of the products only short-term studies are available, with no specific end-points, an ongoing very large prospective study on chocolate flavanols will answer the question whether this may reduce cardiovascular risk. Thus, in addition to data on long-term safety, further clinical research is advisable in order to identify, among active nutraceuticals, those with the best cost-effectiveness and risk-benefit ratio for a wide use in the general population with a raised cardiovascular risk consequent to uncomplicated hypertension.
Validation of the Microlife BP A200 Comfort and W2 Slim automated blood pressure monitors in a general adult population according to the European Society of Hypertension and the ANSI/AAMI/ISO 81060-2: 2013 protocols.
Bing, Sen; Chen, Kang; Hou, Hong; Zhang, Weijuan; Li, Linyi; Wei, Jiao; Shu, Chang; Wan, Yi
This study aimed to determine the accuracy of the Microlife BP A200 Comfort and W2 Slim automated blood pressure monitors according to the European Society of Hypertension International Protocol revision 2010 and the ANSI/AAMI/ISO 81060-2:2013 protocols. The devices were assessed on 33 participants according to the European Society of Hypertension requirements and were then tested on 85 participants according to the ANSI/AAMI/ISO 81060-2:2013 criteria. Procedures and data analysis were carried out following protocol guidelines precisely. The Microlife BP A200 Comfort and W2 Slim devices passed the criteria of the European Society of Hypertension International Protocol revision 2010 for both systolic blood pressure and diastolic blood pressure. The devices also fulfilled the ANSI/AAMI/ISO 81060-2:2013 criteria, with mean differences of SBP and DPB between the devices and observers of 0.38±5.12 and 0.28±4.29 mmHg for the BP A200 Comfort and 1.01±6.80 and 0.34±5.62 mmHg for the W2 Slim, respectively. The Microlife BP A200 Comfort and W2 Slim automated blood pressure monitors fulfilled the European Society of Hypertension revision 2010 and the ANSI/AAMI/ISO 81060-2:2013 protocols, and can be recommended for self-measurement in the general population.
Simultaneous validation of the Grandway MD2301 digital automatic blood pressure monitor by the British Hypertension Society and the Association for the Advancement of Medical Instrumentation/the International Organization for Standardization protocols.
Huang, Jinhua; Wang, Yun; Liu, Zhaoying; Wang, Yuling
The aim of this study was to determine the accuracy of the Grandway MD2301 digital automatic blood pressure monitor by the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI)/the International Organization for Standardization (ISO) protocols. A total of 85 participants were included for evaluation based on the requirements of the BHS and the AAMI/ISO protocols. The validation procedure and data analysis followed the protocols precisely. The device achieved A/A grading for the BHS protocol and maintained A/A grading throughout the low, medium and high blood pressure ranges. The device also fulfilled the requirement of the AAMI/ISO protocol with device-observer differences of -0.9±5.6 and 0.8±5.2 mmHg for systolic and diastolic blood pressure, respectively, for criterion 1, and -0.9±4.7 and 0.8±4.2 mmHg, respectively, for criterion 2. The Grandway MD2301 digital automatic blood pressure monitor achieved A/A grade of the BHS protocol and passed the requirements of the AAMI/ISO protocol in adults.
Marazzi, Giuseppe; Iellamo, Ferdinando; Volterrani, Maurizio; Lombardo, Mauro; Pelliccia, Francesco; Righi, Daniela; Grieco, Fabrizia; Cacciotti, Luca; Iaia, Luigi; Caminiti, Giuseppe; Rosano, Giuseppe
Self-monitoring home blood pressure (BP) devices are currently recommended for long-term follow-up of hypertension and its management. Some of these devices are integrated with algorithms aimed at detecting atrial fibrillation (AF), which is common essential hypertension. This study was designed to compare the diagnostic accuracy of two widely diffused home BP monitoring devices in detecting AF in an unselected population of outpatients referred to a hypertension clinic because of high BP. In 503 consecutive patients the authors simultaneously compared the accuracy of the Microlife(®) BP A200 Plus (Microlife) and the OMRON(®) M6 (OMRON) home BP devices, in detecting AF. Systolic and diastolic BP as well as heart rate (HR) values detected by the two devices were not significantly different. Pulse irregularity was detected in 124 and 112 patients with the OMRON M6 and Microlife BP A200 Plus devices, respectively. Simultaneous electrocardiogram (ECG) recording revealed that pulse irregularity was due to AF in 101 patients. Pulse irregularity detected by the OMRON M6 device corresponded to AF in 101, to supraventricular premature beats in 18, and to frequent premature ventricular beat in five patients, respectively. Pulse irregularity detected by the Microlife BP A200 Plus device corresponded to AF in 93, to supraventricular premature beats in 14, and to ventricular premature beats in five patients. The sensitivity for detecting AF was 100%, the specificity was 92%, and diagnostic accuracy 95% for the OMRON M6 and 100%, 92%, and 95 for the Microlife BP A200 Plus, respectively. AF was newly diagnosed by ECG recordings in 47 patients, and was detected in all patients by the OMRON device, and in 42 patients by the Microlife device. These results indicate that OMRON M6 is more accurate than Microlife BP A200 Plus in detecting AF in patients with essential hypertension. Widespread use of these devices in hypertensive patients could be of clinical benefit for the early
... Aortic Aneurysm More Managing Stress to Control High Blood Pressure Updated:Jan 29,2018 The importance of stress ... This content was last reviewed October 2016. High Blood Pressure • Home • Get the Facts About HBP • Know Your ...
Conclusion: The palpatory method would be very useful where frequent blood pressure measurement are being done manually like in wards, in busy OPD, patient on treadmill and also whenever stethoscope is not available. The blood pressure can be measured in noisy environment too.
Franx, A; Steegers, E A; de Boo, T; Thien, T; Merkus, J M
In non-pregnant individuals, a strong positive association of sodium intake with blood pressure has been established, but the relationship between sodium intake and blood pressure in human pregnancy remains obscure up to date. The aim of this prospective observational cohort study was to assess the relationship between urinary sodium excretion (as a measure for intake) and blood pressure from the early second trimester onwards throughout pregnancy. The study group consisted of 667 low-risk women with singleton pregnancies, of whom 350 were nulliparous and 317 parous. Blood pressure was measured in a standardised fashion at predetermined intervals from the first antenatal visit prior to 16 weeks gestation until delivery. Urinary sodium excretion was measured in 24-h urine collections on at least four occasions between 16 and 38 weeks gestation. Main outcome measures were the coefficients of correlation between changes in urinary sodium output and changes in blood pressure during six different gestational epochs. No significant correlations were found between changes in urinary sodium output and changes in blood pressure. Correlation coefficients were alike for nulliparous and parous women and for different gestational intervals. Prior to 32 weeks gestation, no differences were observed in sodium excretion between women who remained normotensive and those who developed gestational hypertension. These results suggest that changes in sodium intake are not associated with blood pressure changes in low-risk pregnant women. Blood pressure increases as observed in the second half of normotensive and hypertensive pregnancies are unlikely to be caused by changes in renal sodium handling.
Altorf-van der Kuil, W.
Elevated blood pressure is a major risk factor for cardiovascular diseases. Diet and lifestyle have a substantial impact on blood pressure, but the role of protein intake is not yet clear. This thesis focuses on total dietary protein, types of protein (i.e. plant and
Belva, F.; Roelants, M.; de Schepper, J.; Roseboom, T. J.; Bonduelle, M.; Devroey, P.; Painter, R. C.
Do young adolescents conceived by ICSI display a higher blood pressure than spontaneously conceived (SC) adolescents? In our study, 14-year-old male and female ICSI teenagers were not found to have increased blood pressure at rest. Only limited data are available regarding the cardiovascular risk of
Defective blood pressure responses to standing, exercise and epinephrine infusions have been demonstrated in diabetic patients with autonomic neuropathy. The circulatory mechanisms underlying blood pressure responses to exercise and standing up in these patients are well characterized: In both...... which may contribute to exercise hypotension in these patients. During hypoglycemia, blood pressure regulation seems intact in patients with autonomic neuropathy. This is probably due to release of substantial amounts of catecholamines during these experiments. During epinephrine infusions a substantial...... blood pressure fall ensues in patients with autonomic neuropathy, probably due to excessive muscular vasodilation. It is unresolved why blood pressure regulation is intact during hypoglycemia and severely impaired--at similar catecholamine concentrations--during epinephrine infusions....
Development of a New ICT-Based Multisensor Blood Pressure Monitoring System for Use in Hemodynamic Biomarker-Initiated Anticipation Medicine for Cardiovascular Disease: The National IMPACT Program Project.
Kario, Kazuomi; Tomitani, Naoko; Kanegae, Hiroshi; Yasui, Nobuhiko; Nishizawa, Masafumi; Fujiwara, Takeshi; Shigezumi, Takeya; Nagai, Ryozo; Harada, Hiroshi
We have developed a multisensor home and ambulatory blood pressure (BP) monitoring system for monitoring 24-h central and brachial BP variability concurrent with physical activity (PA), temperature, and atmospheric pressure. The new BP monitoring system utilizes our recently developed biological and environmental signal monitoring Information Communication Technology/Internet of Things system, which can simultaneously monitor the environment (temperature, illumination, etc.) of different rooms in a house (entryway, bedroom, living room, bathing room, and toilet), and a wrist-type high-sensitivity actigraph for identifying the location of patients. By collecting both data on BP and environmental parameters, the system can assess the brachial and central hemodynamic BP reactivity profiles of patients, such as actisensitivity (BP change with PA), thermosensitivity (with temperature), and atmospheric sensitivity (with atmospheric pressure). We used this new system to monitor ambulatory BP variability in outpatients with one or more cardiovascular disease (CVD) risk factors both in summer and winter. Actisensitivity (the slope of the regression line of ambulatory BP against the log-physical activity) was higher in winter than summer. By multi-level analysis using the parameters monitored by this system, we estimated the ambulatory BPs under different conditions. The individual time-series big data collected by this system will contribute to anticipation medicine for CVD. Copyright © 2017 Elsevier Inc. All rights reserved.
Engberg, Aase Worså; Kofoed, Klaus
In Danish health care, secondary prevention after stroke is currently handled mainly by general practitioners using office blood pressure (OBP) assessment of hypertension. The aim of this study was to compare the OBP approach to 24-hour assessment by ambulatory blood pressure (ABP) monitoring....... Furthermore, we aimed to record the degree of adherence to recommended therapy goals for blood pressure and plasma lipids....
Ciemins, Elizabeth L; Arora, Anupama; Coombs, Nicholas C; Holloway, Barbara; Mullette, Elizabeth J; Garland, Robin; Walsh Bishop-Green, Shannon; Penso, Jerry; Coon, Patricia J
The authors sought to determine if wireless oscillometric home blood pressure monitoring (HBPM) that integrates with smartphone technology improves blood pressure (BP) control among patients with new or existing uncontrolled hypertension (HTN). A prospective observational cohort study monitored BP control before and after an educational intervention and introduction to HBPM. Patients in the intervention group were instructed to track their BP using a smartphone device three to seven times per week. Cases were matched to controls at a 1:3 allocation ratio on several clinical characteristics over the same period and received usual care. The proportion of patients with controlled BP was compared between groups at pre- and postintervention, ∼9 months later. Results and Materials: The total study population included 484 patients with mean age 60 years (range 23-102 years), 47.7% female, and 84.6% Caucasian. Mean preintervention BP was 137.8 mm Hg systolic and 81.4 mm Hg diastolic. Mean BP control rates improved for patients who received HBPM from 42% to 67% compared with matched control patients who improved from 59% to 67% (p technology has the potential to improve HTN management among patients with uncontrolled or newly diagnosed HTN. Technology needs to be easy to use and operate and would work best when integrated into local electronic health record systems. In systems without this capability, medical assistants or other personnel may be trained to facilitate the process. Nurse navigator involvement was instrumental in bridging communication between the patients and provider.
Kruse, Anne; Mahler, Birgitte; Rittig, Soren; Djurhuus, Jens Christian
We investigated the association between nocturnal blood pressure and urine production in children with enuresis. A total of 39 consecutive children with a mean age of 9.8 years (range 6.2 to 14.9) with monosymptomatic nocturnal enuresis completed a bladder diary, including 2 weeks of basic documentation and 2 with desmopressin titration from 120 to 240 microg sublingually. Arterial blood pressure was measured every 30 minutes during 24 hours and during 4 additional nights using an ambulatory blood pressure monitor. Furthermore, 10 healthy children were recruited into the study who completed a bladder diary for 5 days while measuring arterial blood pressures with documentation of all intake and voided volumes. Patients with nocturnal polyuria had significantly higher nocturnal mean arterial pressure than patients without polyuria and controls (p polyuria than in children without polyuria. There was a significant positive correlation between average nocturnal mean arterial pressure and nocturnal urine volume in the whole study. The association between nocturnal blood pressure and urine volume, and the role of blood pressure should be investigated in a larger group of children with enuresis who have nocturnal polyuria.
Avaliação da pressão arterial em bombeiros militares filhos de hipertensos através da monitorização ambulatorial da pressão arterial Using ambulatory blood pressure monitoring to assess blood pressure of firefighters with parental history of hypertension
Carlos Eduardo de Mattos
Full Text Available OBJETIVO: Avaliar a influência do antecedente familiar de hipertensão arterial sistêmica (HASF sobre o efeito do estresse do trabalho em bombeiros militares comunicantes (BMC, através da monitorização ambulatorial da pressão arterial (MAPA. MÉTODOS: Estudo prospectivo caso-controle. Foi realizada a MAPA em 66 BMC saudáveis, durante 12 horas de trabalho na central de comunicações (CC, sendo 34 filhos de hipertensos (grupo 1 e 32 filhos de normotensos (grupo 2. RESULTADOS: O grupo 1 diferiu do grupo 2, pois apresentou, no trabalho, maiores médias sistólicas (134,1 ± 9,9 mmHg X 120,8 ± 9,9 mmHg p OBJECTIVE: To evaluate the influence of family history of systemic arterial hypertension (FSAH on the effect of stress from work in Uniformed Firefighters (BMCs through Ambulatory Blood Pressure Monitoring (ABPM. METHODS: A prospective case-control study. Sixty-six healthy BMC underwent ABPM during 12 hours of work at the Communication Center (CC. Thirty-four had hypertensive parents (group 1 and thirty-two had normotensive parents (group 2. RESULTS: Group I differed from group 2 in that it showed higher mean systolic (134.1 ± 9.9 mmHg X 120.8 ± 9.9 mmHg p < 0.0001 and diastolic (83.8 ± 8.3 mmHg X 72.9 ± 8.6 mmHg p < 0.001 blood pressure, in addition to greater systolic (31.4 ± 25.6 % X 9.4 ± 9.4 % p = 0.0001 and diastolic (28.3 ± 26.6 % X 6.1 ± 8.9 % p = 0.0001 loads. The prevalence of systemic arterial hypertension (SAH in group 1 at the workplace was 32.3%. Monitored away from the job, these subjects showed normal blood pressure (functionally hypertensive. Group 2 revealed normal blood pressure (BP at work. CONCLUSION: Higher blood pressure in BMC with hypertensive parents is explained independently by the SAH. Subjects who developed SAH during their work at the CC may be considered functionally hypertensive, whereas those with normotensive parents and who underwent psychological stress are free of blood pressure changes.
Clausen, Peter Vilhelm; Jensen, J S; Borch-Johnsen, K
UAER. Because 24-hour ambulatory blood pressure is a superior predictor of hypertensive target organ involvement, we aimed to investigate blood pressure profile in clinically healthy subjects with elevated UAER. Ambulatory blood pressure monitoring was performed with a portable recorder in 27 subjects...... loss of albumin could not be solely related to the higher blood pressure. In conclusion, apparently healthy subjects with elevated UAER had slightly but significantly higher 24-hour systolic and diastolic blood pressure levels in addition to increased blood pressure loads but normal circadian variation...
Gebuhr, Peter Henrik; Soelberg, M; Henriksen, Jens Henrik Sahl
Twenty-nine patients due to have a total hip replacement had their systemic systolic and segmental blood pressures measured prior to operation and 1 and 6 weeks postoperatively. No patients had signs of ischemia. The segmental blood pressure was measured at the ankle and at the toes. A significant...... drop was found in all pressures 1 week postoperatively. The decrease followed the systemic pressure and was restored to normal after 6 weeks. In a group of six patients with preoperatively decreased ankle pressure, a significant transient further decrease in the ankle-toe gradient pressure was found...... on the operated side. None of the patients had symptoms from the lowered pressure. We conclude that in patients without signs of ischemia, the postoperative segmental pressure decrease is reversible and therefore not dangerous....
Seki, Shingo; Taniguchi, Masayuki; Ohsawa, Shingo; Koga, Atsushi; Ito, Takashi; Kunoh, Mamoru; Imamoto, Satoshi; Miyazaki, Hidekazu; Takeda, Satoshi; Iwano, Keiji; Satoh, Chikashi; Kanae, Kiyoshi; Mochizuki, Seibu
It has been suggested that chronobiology can provide new insights into the evaluation and treatment of cardiovascular disease. In the present study the hyperbaric index (hyperBI) and hypobaric index (hypoBI) were compared with the mean blood pressure (BP) over 24 h to evaluate the antihypertensive effect of long-acting nifedipine on essential hypertension. Fourteen patients were treated with nifedipine CR (20-40 mg/day) for 6 months. Ambulatory BP monitoring was performed before and after treatment. The hyperBI (mmHg . h/day) was calculated as the integrated BP area above the conventional upper limit (140/90 mmHg for the daytime and 120/80 mmHg at night), and the hypoBI was calculated as the integrated BP area below the conventional lower limit (110/60 mmHg for the daytime and 100/50 mmHg at night). At baseline, both the systolic and diastolic 24-h hyperBI values closely correlated with the 24-h mean BP (r=0.994 and 0.935, p<0.0001). Treatment with nifedipine significantly lowered both the 24-h mean systolic and diastolic BP (143+/-14/89 +/-12 to 124+/-16/80+/-8 mmHg, p<0.001/p=0.001), as well as the casual BP (167+/-11/101 +/-8 to 140+/-13/86+/-10 mmHg, p<0.001/p<0.01). Reduction of both the systolic and diastolic hyperBI values was statistically significant over the 24-h period (274+/-266 to 90+/-155, p=0.009; 145+/-187 to 41+/-63, p=0.024), as well as during the daytime (200+/-181 to 66+/-116, p=0.014; 105+/-120 to 24+/-38, p=0.017) and at night (systolic, 74+/-106 to 24+/-52, p=0.021). The 24-h mean BP was normalized, but a small excess BP load persisted despite treatment. There was no significant increase of systolic hypoBI during the 24-h period (1+/-2 to 25+/-30, p=0.065), the daytime (0+/-0 to 14+/-38, p=0.20), or at night (1+/-3 to 11+/-19, p=0,052). Similar findings were obtained for diastolic hypoBI. Nifedipine CR improved the 24-h hyperBI and mean BP without causing excessive hypotension. These 2 parameters have a close relationship when assessment is
Asayama, Kei; Thijs, Lutgarde; Li, Yan; Gu, Yu-Mei; Hara, Azusa; Liu, Yan-Ping; Zhang, Zhenyu; Wei, Fang-Fei; Lujambio, Inés; Mena, Luis J; Boggia, José; Hansen, Tine W; Björklund-Bodegård, Kristina; Nomura, Kyoko; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp-Pedersen, Christian; Dolan, Eamon; Stolarz-Skrzypek, Katarzyna; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Luzardo, Leonella; Kawecka-Jaszcz, Kalina; Sandoya, Edgardo; Filipovský, Jan; Maestre, Gladys E; Wang, Jiguang; Imai, Yutaka; Franklin, Stanley S; O'Brien, Eoin; Staessen, Jan A
Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P=0.033), nighttime only (1.43; P=0.0074), 24 hours only (1.21; P=0.20), 24 hours plus daytime (1.24; P=0.18), 24 hours plus nighttime (1.15; P=0.39), and 24 hours plus daytime and nighttime (1.16; P=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (Pcoat hypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice. © 2014 American Heart Association, Inc.
Asayama, Kei; Thijs, Lutgarde; Li, Yan; Gu, Yu-Mei; Hara, Azusa; Liu, Yan-Ping; Zhang, Zhenyu; Wei, Fang-Fei; Lujambio, Inés; Mena, Luis J.; Boggia, José; Hansen, Tine W.; Björklund-Bodegård, Kristina; Nomura, Kyoko; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp-Pedersen, Christian; Dolan, Eamon; Stolarz-Skrzypek, Katarzyna; Malyutina, Sofia; Casiglia, Edoardo; Nikitin, Yuri; Lind, Lars; Luzardo, Leonella; Kawecka-Jaszcz, Kalina; Sandoya, Edgardo; Filipovský, Jan; Maestre, Gladys E.; Wang, Jiguang; Imai, Yutaka; Franklin, Stanley S.; O’Brien, Eoin; Staessen, Jan A.
Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P=0.033), nighttime only (1.43; P=0.0074), 24 hours only (1.21; P=0.20), 24 hours plus daytime (1.24; P=0.18), 24 hours plus nighttime (1.15; P=0.39), and 24 hours plus daytime and nighttime (1.16; P=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (Phypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice. PMID:25135185
Drasche, H.; Funk, L.; Herbolsheimer, R.
A description of a gas chromatography method for monitoring blood carboxyhaemoglobin (HbCO) levels in a very small quantity (100 mcl) of capillary blood: reagents and apparatus, procedures, calculation of results. To calculate HbCO content, an aliquot portion of water-diluted blood is saturated with CO; this saturation obviates the need to determine the haemoglobin or iron blood levels.
Ji, A-L; Chen, W-W; Huang, W-J
We investigated the effects of oral administration of enteric coated aspirin (ASA) on blood pressure and blood pressure variability of hypertension patients before sleep. We observed 150 hypertension cases, classified as Grade 1-2, from September 2006 to March 2008. They are divided into a control group with 30 cases, ASA I group with 60 cases and ASA II group with 60 cases randomly. Subjects in the control group had proper diets, were losing weight, exercising and maintaining a healthy mentality and were taking 30 mg Adalat orally once a day. Based on the treatment of control group, patients in ASA I group were administered 0.1 g Bayaspirin (produced by Bayer Company) at drought in the morning. Also, based on the treatment of control group, patients in ASA II group were administered 0.1 g Bayaspirin at draught before sleep. The course of treatment is 3 months and then after the treatment, decreasing blood pressure and blood pressure variability conditions in three groups will be compared. Through the comparison of ASA II group with the control group, they have differences in terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), decreasing range of blood pressure and blood pressure variability (p sleep has synergistic effects on decreasing blood pressure of hypertension patients and improving blood pressure variability.
Mar 21, 2006 ... While deaths due to fluid overload have ... of better fluid balance management, we have made .... systolic blood pressure plays a significant role in the .... one looks at the work of Martin et al.5 ... Promoting Healthy Life.
Aleixandre, A; Miguel, M
In the past few years, new strategies to control blood pressure levels are emerging by developing new bioactive components of foods. Fiber has been linked to the prevention of a number of cardiovascular diseases and disorders. β-Glucan, the main soluble fiber component in oat grains, was initially linked to a reduction in plasma cholesterol. Several studies have shown afterward that dietary fiber may also improve glycaemia, insulin resistance and weight loss. The effect of dietary fiber on arterial blood pressure has been the subject of far fewer studies than its effect on the above-mentioned variables, but research has already shown that fiber intake can decrease arterial blood pressure in hypertensive rats. Moreover, certain fibers can improve arterial blood pressure when administered to hypertensive and pre-hypertensive subjects. The present review summarizes all those studies which attempt to establish the antihypertensive effects of dietary fiber, as well as its effect on other cardiovascular risk factors.
... Gynecologists f AQ FREQUENTLY ASKED QUESTIONS FAQ034 PREGNANCY Preeclampsia and High Blood Pressure During Pregnancy • What is ... is chronic hypertension during pregnancy managed? • What is preeclampsia? • When does preeclampsia occur? • What causes preeclampsia? • What ...
This podcast is based on the September 2012 CDC Vital Signs report. A team-based approach by patients, health care systems, and health care providers is one of the best ways to treat uncontrolled high blood pressure.
Plichart, Matthieu; Seux, Marie-Laure; Caillard, Laure; Chaussade, Edouard; Vidal, Jean-Sébastien; Boully, Clémence; Hanon, Olivier
Home blood pressure measurement (HBPM) is recommended by guidelines for hypertension management. However, this method might be difficult to use in elderly individuals with cognitive disorders. Our aim was to assess the agreement and the feasibility of HBPM by a relative as compared with 24-h ambulatory blood pressure monitoring (ABPM) in elderly patients with dementia. Sixty outpatients with dementia aged 75 years and older with office hypertension (≥140/90 mmHg) were subjected successively to HBPM by a trained relative and 24-h ABPM. The order of the two methods was randomized. Current guidelines' thresholds for the diagnosis of hypertension were used. The mean (SD) age of the patients was 80.8 (6.1) years (55% women) and the mean (SD) mini-mental state examination score was 20.1 (6.9). The feasibility of relative-HBPM was very high, with a 97% success rate (defined by ≥12/18 measurements reported). The blood pressure measurements were highly correlated between the two methods (r=0.75 and 0.64 for systolic blood pressure and diastolic blood pressure, respectively; Pmethods for the diagnosis of sustained hypertension and white-coat hypertension was excellent (overall agreement, 92%; κ coefficient, 0.81; 95% CI, 0.61-0.93). Similar results were found for daytime-ABPM. In cognitively impaired elderly patients, HBPM by a relative using an automated device was a good alternative to 24-h ABPM.
Shang, Fujun; Zhu, Yizheng; Zhu, Zhenlai; Liu, Lei; Wan, Yi
The aim of this study was to validate the iHealth BP5 wireless upper arm blood pressure (BP) monitor according to the European Society of Hypertension International Protocol (ESH-IP) revision 2010. The ESH-IP revision 2010 for validation of BP measuring devices in adults was followed precisely. A total of 99 pairs of test device and reference BP measurements (three pairs for each of the 33 participants) were obtained in the study. The device produced 71, 89, and 97 measurements within 5, 10, and 15 mmHg for systolic blood pressure (SBP) and 73, 90, and 99 mmHg for diastolic blood pressure (DBP), respectively. The mean ± SD device-observer difference was -1.21 ± 5.87 mmHg for SBP and -1.04 ± 5.28 mmHg for DBP. The number of participants with two or three device-observer differences within 5 mmHg was 25 for SBP and 28 for DBP. In addition, three participants had no device-observer difference within 5 mmHg for SBP and none of the participants had the same for DBP. According to the validation results on the basis of the ESH-IP revision 2010, the iHealth BP5 wireless upper arm BP monitor can be recommended for self/home measurement in an adult population.
Bos, W. J.; van Goudoever, J.; van Montfrans, G. A.; Wesseling, K. H.
To evaluate the effect of blood pressure variability on Riva Rocci Korotkoff blood pressure determinations, we studied the intra-arterial pressure during Riva Rocci Korotkoff determinations in 25 patients. In 50 measurements with a cuff deflation rate of 2.5 mm Hg/sec, the systolic intra-arterial
Ferri, Claudio; Desideri, Giovambattista; Ferri, Livia; Proietti, Ilenia; Di Agostino, Stefania; Martella, Letizia; Mai, Francesca; Di Giosia, Paolo; Grassi, Davide
High blood pressure is an important risk factor for cardiovascular disease and cardiovascular events worldwide. Clinical and epidemiological studies suggest that cocoa-rich products reduce the risk of cardiovascular disease. According to this, cocoa has a high content in polyphenols, especially flavanols. Flavanols have been described to exert favorable effects on endothelium-derived vasodilation via the stimulation of nitric oxide-synthase, the increased availability of l-arginine, and the decreased degradation of NO. Cocoa may also have a beneficial effect by protecting against oxidative stress alterations and via decreased platelet aggregation, decreased lipid oxidation, and insulin resistance. These effects are associated with a decrease of blood pressure and a favorable trend toward a reduction in cardiovascular events and strokes. Previous meta-analyses have shown that cocoa-rich foods may reduce blood pressure. Long-term trials investigating the effect of cocoa products are needed to determine whether or not blood pressure is reduced on a chronic basis by daily ingestion of cocoa. Furthermore, long-term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events. A 3 mmHg systolic blood pressure reduction has been estimated to decrease the risk of cardiovascular and all-cause mortality. This paper summarizes new findings concerning cocoa effects on blood pressure and cardiovascular health, focusing on putative mechanisms of action and "nutraceutical " viewpoints.
... with blood pressure drugs? Is it true that calcium supplements may interact with blood pressure medications? Answers ... G. Sheps, M.D. Yes. In large amounts, calcium supplements may interact with some blood pressure medications. ...
Full Text Available Out of office blood pressure measurements, using either home monitors or 24 hour ambulatory monitoring, is widely recommended for management of hypertension. Though validation protocols, meant to be used by manufacturers, exist for blood pressure monitors, there is scant data in the literature about the accuracy of home blood pressure monitors in actual clinical practice. We performed a chart review in the blood pressure assessment clinic at a tertiary care centre.We assessed the accuracy of home blood pressure monitors used by patients seen in the nephrology clinic in Ottawa between the years 2011 to 2014. We recorded patient demographics and clinical data, including the blood pressure measurements, arm circumference and the manufacturer of the home blood pressure monitor. The average of BP measurements performed with the home blood pressure monitor, were compared to those with the mercury sphygmomanometer. We defined accuracy based on a difference of 5 mm Hg in the blood pressure values between the home monitor and mercury sphygmomanometer readings. The two methods were compared using a Bland-Altman plot and a student's t-test.The study included 210 patients. The mean age of the study population was 67 years and 61% was men. The average mid-arm circumference was 32.2 cms. 30% and 32% of the home BP monitors reported a mean systolic and diastolic BP values, respectively, different from the mercury measurements by 5 mm Hg or more. There was no significant difference between the monitors that were accurate versus those that were not when grouped according to the patient characteristics, cuff size or the brand of the home monitor.An important proportion of home blood pressure monitors used by patients seen in our nephrology clinic were inaccurate. A re-validation of the accuracy and safety of the devices already in use is prudent before relying on these measurements for clinical decisions.
Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Richart, Tom
Ambulatory blood pressure (BP) monitoring provides information not only on the BP level but also on the diurnal changes in BP. In the present review, we summarized the main findings of the International Database on Ambulatory BP in relation to Cardiovascular Outcome (IDACO) with regard to risk...
Bottenberg, Michelle M; Bryant, Ginelle A; Haack, Sally L; North, Andrew M
To compare student accuracy in measuring normal and high blood pressures using a simulator arm. In this prospective, single-blind, study involving third-year pharmacy students, simulator arms were programmed with prespecified normal and high blood pressures. Students measured preset normal and high diastolic and systolic blood pressure using a crossover design. One hundred sixteen students completed both blood pressure measurements. There was a significant difference between the accuracy of high systolic blood pressure (HSBP) measurement and normal systolic blood pressure (NSBP) measurement (mean HSBP difference 8.4 ± 10.9 mmHg vs NSBP 3.6 ± 6.4 mmHg; pdifference between the accuracy of high diastolic blood pressure (HDBP) measurement and normal diastolic blood pressure (NDBP) measurement (mean HDBP difference 6.8 ± 9.6 mmHg vs. mean NDBP difference 4.6 ± 4.5 mmHg; p=0.089). Pharmacy students may need additional instruction and experience with taking high blood pressure measurements to ensure they are able to accurately assess this important vital sign.
Bryant, Ginelle A.; Haack, Sally L.; North, Andrew M.
Objective. To compare student accuracy in measuring normal and high blood pressures using a simulator arm. Methods. In this prospective, single-blind, study involving third-year pharmacy students, simulator arms were programmed with prespecified normal and high blood pressures. Students measured preset normal and high diastolic and systolic blood pressure using a crossover design. Results. One hundred sixteen students completed both blood pressure measurements. There was a significant difference between the accuracy of high systolic blood pressure (HSBP) measurement and normal systolic blood pressure (NSBP) measurement (mean HSBP difference 8.4 ± 10.9 mmHg vs NSBP 3.6 ± 6.4 mmHg; pdifference between the accuracy of high diastolic blood pressure (HDBP) measurement and normal diastolic blood pressure (NDBP) measurement (mean HDBP difference 6.8 ± 9.6 mmHg vs. mean NDBP difference 4.6 ± 4.5 mmHg; p=0.089). Conclusions. Pharmacy students may need additional instruction and experience with taking high blood pressure measurements to ensure they are able to accurately assess this important vital sign. PMID:23788809
Gholamhosseini, Hamid; Meintjes, Andries; Baig, Mirza; Linden, Maria
The increasing availability of low cost and easy to use personalized medical monitoring devices has opened the door for new and innovative methods of health monitoring to emerge. Cuff-less and continuous methods of measuring blood pressure are particularly attractive as blood pressure is one of the most important measurements of long term cardiovascular health. Current methods of noninvasive blood pressure measurement are based on inflation and deflation of a cuff with some effects on arteries where blood pressure is being measured. This inflation can also cause patient discomfort and alter the measurement results. In this work, a mobile application was developed to collate the PhotoPlethysmoGramm (PPG) waveform provided by a pulse oximeter and the electrocardiogram (ECG) for calculating the pulse transit time. This information is then indirectly related to the user's systolic blood pressure. The developed application successfully connects to the PPG and ECG monitoring devices using Bluetooth wireless connection and stores the data onto an online server. The pulse transit time is estimated in real time and the user's systolic blood pressure can be estimated after the system has been calibrated. The synchronization between the two devices was found to pose a challenge to this method of continuous blood pressure monitoring. However, the implemented continuous blood pressure monitoring system effectively serves as a proof of concept. This combined with the massive benefits that an accurate and robust continuous blood pressure monitoring system would provide indicates that it is certainly worthwhile to further develop this system.
Monitorização ambulatorial da pressão arterial em indivíduos com resposta exagerada dos níveis pressóricos em esforço. Influência do condicionamento físico Ambulatory blood pressure monitoring in individuals with exaggerated blood pressure response to exercise, influence of exercise training
Eliudem Galvão Lima
Full Text Available OBJETIVO: Avaliar em indivíduos hiper-reatores ao teste ergométrico (TE, a influência de um programa regular de exercícios sobre os parâmetros ergométricos e da MAPA. MÉTODOS: Estudaram-se 22 indivíduos (44±1 anos, sedentários, assintomáticos, normotensos e que apresentavam elevação exagerada da pressão sistólica (PAS >220mmHg durante o TE, divididos, através de amostragem casual simples, em dois grupos: grupo hiper-reator sedentário (GHS e grupo hiper-reator condicionado (GHC. Os indivíduos do GHS foram orientados a não realizar qualquer tipo de exercício físico regular durante o período de 4 meses e o GHC composto de 10 indivíduos submetidos a programa de condicionamento físico aeróbico durante o mesmo período. RESULTADOS: Um programa de exercícios aeróbicos de moderada intensidade não promove redução significativa dos níveis pressóricos durante a monitorização (P>0,05; mas, durante a realização do TE nesses indivíduos, verificamos redução (pPURPOSE: To evaluate the effects of exercise training on ergometric test and Ambulatory Blood Pressure Monitoring (ABPM in normotensive individuals with exaggerated blood pressure response to exercise. METHODS: We studied 22 sedentary and normotensive subjects (mean 44±1 years old showing an exaggerated systolic blood pressure response (SBP>220mmHg during a cycloergometric test. These individuals were divided in two groups: sedentary hyperreactive group (SHG and trained hyperreactive group (THG. The THG was submitted to a 4 month aerobic exercise training program. RESULTS: A program of moderate aerobic exercise did not reduce (P>0.05 ABPM blood pressure levels. However, in the submaximal loads of dynamic exercise we observed a significant fall in the SBP and heart rate (P<0.05. CONCLUSION: Normotensive individuals with exaggerated blood pressure response to dynamical exercise submitted to physical training presented a reduction in their systolic blood pressure and
Ried, Karin; Fakler, Peter; Stocks, Nigel P
High blood pressure is an important risk factor for cardiovascular disease, contributing to about 50% of cardiovascular events worldwide and 37% of cardiovascular-related deaths in Western populations. Epidemiological studies suggest that cocoa-rich products reduce the risk of cardiovascular disease. Flavanols found in cocoa have been shown to increase the formation of endothelial nitric oxide which promotes vasodilation and therefore blood pressure reduction. Here we update previous meta-analyses on the effect of cocoa on blood pressure. To assess the effects on blood pressure of chocolate or cocoa products versus low-flavanol products or placebo in adults with or without hypertension when consumed for two weeks or longer. This is an updated version of the review initially published in 2012. In this updated version, we searched the following electronic databases from inception to November 2016: Cochrane Hypertension Group Specialised Register, CENTRAL, MEDLINE and Embase. We also searched international trial registries, and the reference lists of review articles and included trials. Randomised controlled trials (RCTs) investigating the effects of chocolate or cocoa products on systolic and diastolic blood pressure in adults for a minimum of two weeks duration. Two review authors independently extracted data and assessed the risks of bias in each trial. We conducted random-effects meta-analyses on the included studies using Review Manager 5. We explored heterogeneity with subgroup analyses by baseline blood pressure, flavanol content of control group, blinding, age and duration. Sensitivity analyses explored the influence of unusual study design. Thirty-five trials (including 40 treatment comparisons) met the inclusion criteria. Of these, we added 17 trials (20 treatment comparisons) to the 18 trials (20 treatment comparisons) in the previous version of this updated review.Trials provided participants with 30 to 1218 mg of flavanols (mean = 670 mg) in 1.4 to 105
Hara, Azusa; Tanaka, Kazushi; Ohkubo, Takayoshi; Kondo, Takeo; Kikuya, Masahiro; Metoki, Hirohito; Hashimoto, Takanao; Satoh, Michihiro; Inoue, Ryusuke; Asayama, Kei; Obara, Taku; Hirose, Takuo; Izumi, Shin-Ichi; Satoh, Hiroshi; Imai, Yutaka
The usefulness of ambulatory, home, and casual/clinic blood pressure measurements to predict subclinical cerebrovascular diseases (silent cerebrovascular lesions and carotid atherosclerosis) was compared in a general population. Data on ambulatory, home, and casual/clinic blood pressures and brain MRI to detect silent cerebrovascular lesions were obtained in 1007 subjects aged ≥55 years in a general population of Ohasama, Japan. Of the 1007 subjects, 583 underwent evaluation of the extent of carotid atherosclerosis. Twenty-four-hour, daytime, and nighttime ambulatory and home blood pressure levels were closely associated with the risk of silent cerebrovascular lesions and carotid atherosclerosis (all Ppressure values were simultaneously included in the same regression model, each of the ambulatory blood pressure values remained a significant predictor of silent cerebrovascular lesions, whereas home blood pressure lost its predictive value. Of the ambulatory blood pressure values, nighttime blood pressure was the strongest predictor of silent cerebrovascular lesions. The home blood pressure value was more closely associated with the risk of carotid atherosclerosis than any of the ambulatory blood pressure values when home and one of the ambulatory blood pressure values were simultaneously included in the same regression model. The casual/clinic blood pressure value had no significant association with the risk of subclinical cerebrovascular diseases. Although the clinical indications for ambulatory blood pressure monitoring and home blood pressure measurements may overlap, the clinical significance of each method for predicting target organ damage may differ for different target organs.
Full Text Available Objective: The prevalence of hypertension in childhood and adolescence is gradually increasing. We aimed to investigate the blood pressure (BP values of children aged 7-18 years. Methods: This study was conducted in a total of 3375 (1777 females, 1598 males children from 27 schools. Blood pressures of children were measured using sphygmomanometer appropriate to arm circumference. Results: A positive relationship was found between systolic blood pressure (SBP and diastolic blood pressure (DBP and the body weight, height, age and body mass index (BMI in male and female children. SBP was higher in males than females after the age of 13. DBP was higher in males than the females after the age of 14. The mean annual increase of SBP was 2.06 mmHg in males and 1.54 mmHg in females. The mean annual increase of DBP was 1.52 mmHg in males and 1.38 mmHg in females. Conclusion: In this study, we identified the threshold values for blood pressure in children between the age of 7 and 18 years in Erzurum province. It is necessary to combine and evaluate data obtained from various regions for the identification of BP percentiles according to the age, gender and height percentiles of Turkish children.
Chen, Zhi; Ivanov, Plamen Ch.; Hu, Kun; Stanley, H. Eugene
Stroke is is one of the leading cause of death and disability in the world. It is well believed that stroke is caused by the disturbance of cerebrovascular autoregulation. We investigate the blood flow on the left and right middle cerebral artery and beat-to-beat blood pressure simultaneously measured from the finger, for both subjects with stroke and healthy subjects. Synchronization technique is used to distinguish the difference between these two groups.
Pérez-Lahiguera, Francisco; Rodilla, Enrique; Costa, José Antonio; Pascual, José María
The aim of this study was to assess the relationship between central blood pressure and vascular damage. This cross-sectional study involved 393 never treated hypertensive patients (166 women). Clinical blood pressure (BP), 24h blood pressure (BP24h) and central blood pressure (CBP) were measured. Vascular organ damage (VOD) was assessed by calculating the albumin/creatinine ratio (ACR), wave pulse pressure velocity and echocardiographic left ventricular mass index (LVMI). Patients with VOD had higher values of BP, BP24h, and CBP than patients without ACR. When comparing several systolic BP, systolic BP24h had a higher linear correlation with CBP (Z Steiger test: 2.26; P=.02) and LVMI (Z Steiger test: 3.23; P=.01) than PAC. In a multiple regression analysis corrected by age, sex and metabolic syndrome, all pressures were related with VOD but systolic BP24h showed the highest correlation. In a logistic regression analysis, having the highest tercile of systolic BP24h was the stronger predictor of VOD (multivariate odds ratio: 3.4; CI 95%: 2.5-5.5, P=.001). CBP does not have more correlation with VOD than other measurements of peripheral BP. Systolic BP24h is the BP measurement that best predicts VOD. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Osvaldo Kohlmann Jr
Full Text Available OBJECTIVE: A double-blind, placebo-controlled multicenter study involving 34 centers from different Brazilian regions was performed to evaluate the antihypertensive efficacy and tolerability of trandolapril, an angiotensin I converting enzyme inhibitor, in the treatment of mild-to-moderate systemic arterial hypertension. METHODS: Of 262 patients enrolled in this study, 127 were treated with trandolapril 2 mg/day for 8 consecutive weeks, and the remaining 135 patients received placebo for the same period of time. Reduction in blood pressure (BP and the occurrence of adverse events during this period were evaluated in both groups. RESULTS: Significant reductions in both systolic and diastolic pressures were observed in patients treated with trandolapril when compared with those on placebo. Antihypertensive efficacy was achieved in 57.5% of the patients on trandolapril and in 42% of these normal values of BP were obtained. The efficacy of trandolapril was similar in all centers, regardless of the area of the country. In a subset of 30 patients who underwent ABPM, responders showed a significant hypotensive effect to trandolapril throughout the 24 hour day. The adverse event profile was similar in both trandolapril and placebo groups. CONCLUSION: Our results demonstrate, for the first time in a large group of hypertensive patients from different regions in Brazil, good efficacy and tolerability of trandolapril during treatment of mild-to-moderate essential systemic hypertension.
Musaeva, Z A; Khapaev, B A; Fedotova, A V; Oknin, V Iu
Clinical-psychologic study, spectral analysis of heart rate variability, 24-h monitoring of arterial pressure (AP) were performed in 20 patients with chronic constitutional arterial hypotension and in 18 patients with neurogenic syncopal states. Both groups were characterised by considerable manifestations of the syndrome of autonomic dystonia, by emotional-personal disorders that correlated with elevated level of slow-waves of the second order in heart rhythms' spectrum. That testified activation of supersegmental sympathetic-adrenal systems. Disorders in sympathetic-parasympathetic correlations were specific in each group. In patients with arterial hypotension disorder of circadian rhythm was observed in the form of superfluous decrease of diastolic AP during sleep. Circadian rhythms in patients with neurogenic syncopes have parameters characteristic for normals showing a preverved chronobiologic AP regulation. A role of the alterations revealed in pathogenesis of arterial hypotensionis discussed.
A. Hofman (Albert)
textabstractHigh arterial blood pressure takes a heavy toll in western populations (1 ). Its causes are still largely unknown, but its sequelae, a variety of cardiovascular and renal diseases, have been referred to as "a modern scourge" (2). High blood pressure of unknown cause, or
Verberk, Willem J.; Kroon, Abraham A.; Kessels, Alfons G. H.; Lenders, Jacques W. M.; Thien, Theo; van Montfrans, Gert A.; Smit, Andries J.; de Leeuw, Peter W.
Objective To determine how many self-measurements of blood pressure (BP) should be taken at home in order to obtain a reliable estimate of a patient's BP. Design Participants performed self blood pressure measurement (SBPM) for 7 days (triplicate morning and evening readings). In all of them, office
Di Daniele, Nicola; Fegatelli, Danilo Alunni; Rovella, Valentina; Castagnola, Veronica; Gabriele, Marco; Scuteri, Angelo
Hypertension is a major risk factor for chronic kidney disease (CKD), and CKD progression is associated with suboptimal blood pressure (BP) control. Here we evaluate the impact of CKD on the attainment of BP control and the circadian BP profile in older subjects. In this observational study, we studied 547 patients referred to the hypertension clinic, of whom 224 (40.9%) had CKD. Blood pressure (BP) control and circadian BP patterns were evaluated by 24-hour ambulatory BP monitoring. Circadian BP variability was measured as the within-subject SD of BP, the percentage of measurements exceeding normal values, hypotension, and dipping status. The attainment of adequate BP control was similar in subjects with or without CKD (around 31%). Logistic regression analysis indicated that CKD was not a determinant of adequate BP control (OR 1.004; 95% CI 0.989-1.019; p = 0.58). Patients with CKD presented as twice as higher prevalence of reverse dipper (night-time peak) for systolic BP and episodes of hypotension during daytime, independently of BP control. Knowledge of the circadian pattern of BP in hypertensive subjects with CKD could inform better than attainment of BP target about risky condition for CKD progression and cognitive decline and allow a more personalized antihypertensive treatment. Copyright © 2017 Elsevier B.V. All rights reserved.
Kamiński, Marek; Cieślik-Guerra, Urszula I; Kotas, Rafał; Mazur, Piotr; Marańda, Witold; Piotrowicz, Maciej; Sakowicz, Bartosz; Napieralski, Andrzej; Trzos, Ewa; Uznańska-Loch, Barbara; Rechciński, Tomasz; Kurpesa, Małgorzata
Atmospheric pressure is the most objective weather factor because regardless of if outdoors or indoors it affects all objects in the same way. The majority of previous studies have used the average daily values of atmospheric pressure in a bioclimatic analysis and have found no correlation with blood pressure changes. The main objective of our research was to assess the relationship between atmospheric pressure recorded with a frequency of 1 measurement per minute and the results of 24-h blood pressure monitoring in patients with treated hypertension in different seasons in the moderate climate of the City of Łódź (Poland). The study group consisted of 1662 patients, divided into 2 equal groups (due to a lower and higher average value of atmospheric pressure). Comparisons between blood pressure values in the 2 groups were performed using the Mann-Whitney U test. We observed a significant difference in blood pressure recorded during the lower and higher range of atmospheric pressure: on the days of the spring months systolic (p = 0.043) and diastolic (p = 0.005) blood pressure, and at nights of the winter months systolic blood pressure (p = 0.013). A significant inverse relationship between atmospheric pressure and blood pressure during the spring days and, only for systolic blood pressure, during winter nights was observed. Int J Occup Med Environ Health 2016;29(5):783-792. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
Ekbom, P; Damm, P; Nøgaard, K
To evaluate the value of 24-h blood pressure monitoring compared to office blood pressure and urinary albumin excretion in predicting pre-eclampsia in Type I (insulin-dependent) diabetes mellitus.......To evaluate the value of 24-h blood pressure monitoring compared to office blood pressure and urinary albumin excretion in predicting pre-eclampsia in Type I (insulin-dependent) diabetes mellitus....
A K Lipatenkova
Full Text Available Реферат по материалам статей 1. Gilbert K, Nian H, Yu C, Luther JM, Brown NJ. Fenofibrate lowers blood pressure in salt-sensitive but not salt-resistant hypertension. J Hypertens. 2013 Apr;31(4:820-9. doi: 10.1097/HJH.0b013e32835e8227. 2. Kwang K. K. Does Fenofibrate Lower Blood Pressure? Hypertension. 2013 Mar;61(3:e27. doi: 10.1161/HYPERTENSIONAHA.111.00792.
Wel, M.C. van der; Buunk, I.E.; Weel, C. van; Thien, Th.; Bakx, J.C.
PURPOSE: Current office blood pressure measurement (OBPM) is often not executed according to guidelines and cannot prevent the white-coat effect. Serial, automated, oscillometric OBPM has the potential to overcome both these problems. We therefore developed a 30-minute OBPM method that we compared
Tarkowska, A.; Misiunia, P.; Woytowicz, A.; Olewinski, T.
A method of measuring the skin blood pressure (SBP) evolved by Holstein and Lassen is described. The method is based on determination of the force of pressure causing blockade of Na 131 I clearance from the site of its intradermal injection. Using this method it was found that in the lower extremities in healthy subjects the SBP approached the diastolic pressure measured by the conventional method in the brachial artery. On the other hand in patients with obliterative arteriosclerosis and in Buerger's disease the SBP was considerably lower than the diastolic arterial pressure. The authors think that the method gives a good insight into the state of blood supply to the extremities in healthy subjects and in peripheral vascular failure. (author)
Krzesiński, Paweł; Stańczyk, Adam; Gielerak, Grzegorz; Piotrowicz, Katarzyna; Banak, Małgorzata; Wójcik, Agnieszka
Correct blood pressure (BP) measurement is crucial in the diagnosis of arterial hypertension (AH), and controversy exists whether supine BP should be treated as equal to sitting BP. The aim of this study was to evaluate the relation of supine BP to sitting BP and ambulatory BP with regard to identification of diagnostic cut-offs for hypertension. This study included 280 patients with AH (mean age: 44.3 ±10.6 years). The following measurements of BP were performed and analyzed: 1) sitting office blood pressure measurement (OSBP and ODBP); 2) supine BP (supSBP and supDBP), measured automatically (5 times with a 2-minute interval) during evaluation by the Niccomo device (Medis, Germany); 3) 24-hour ambulatory blood pressure (ABP) monitoring. The mean supSBP and supDBP were found to be lower than OSBP and ODBP (130.9 ±14.2 vs. 136.6 ±15.5 mm Hg and 84.8 ±9.4 vs. 87.8 ±10.2 mm Hg, respectively; p AUC: 0.820 vs. 0.550; sensitivity 80.7% vs. 57.4%; specificity 83.2% vs. 52.7%; p blood pressure during a 10-minute supine rest was lower than in the sitting position. The supine blood pressure ≥ 130/80 mm Hg was found to be a specific and sensitive threshold for hypertension.
Clausen, P; Feldt-Rasmussen, B; Ladefoged, Jens
The circadian pattern of blood pressure variation was investigated in 10 patients with advanced chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) and in an age-matched group of controls without renal disease with similar office blood pressure level. Monitoring was done using....... In patients with chronic renal failure undergoing CAPD, an otherwise unnoticed 24-h hypertension and nocturnal blood pressure elevation can be discovered by use of 24-h blood pressure monitoring and this may indicate a need of earlier start of antihypertensive treatment in CAPD patients with borderline...
Zhu, Y Q; Long, Q; Xiao, Q F; Zhang, M; Wei, Y L; Jiang, H; Tang, B
Objective: To investigate the association of blood pressure variability and sleep stability in essential hypertensive patients with sleep disorder by cardiopulmonary coupling. Methods: Performed according to strict inclusion and exclusion criteria, 88 new cases of essential hypertension who came from the international department and the cardiology department of china-japan friendship hospital were enrolled. Sleep stability and 24 h ambulatory blood pressure data were collected by the portable sleep monitor based on cardiopulmonary coupling technique and 24 h ambulatory blood pressure monitor. Analysis the correlation of blood pressure variability and sleep stability. Results: In the nighttime, systolic blood pressure standard deviation, systolic blood pressure variation coefficient, the ratio of the systolic blood pressure minimum to the maximum, diastolic blood pressure standard deviation, diastolic blood pressure variation coefficient were positively correlated with unstable sleep duration ( r =0.185, 0.24, 0.237, 0.43, 0.276, P Blood pressure variability is associated with sleep stability, especially at night, the longer the unstable sleep duration, the greater the variability in night blood pressure.
Lana, Alberto; Banegas, Jose R; Guallar-Castillón, Pilar; Rodríguez-Artalejo, Fernando; Lopez-Garcia, Esther
The aim was to examine the association between habitual consumption of dairy products and 24-h ambulatory blood pressure monitoring among older adults with hypertension. We conducted an analysis of 715 community-living hypertensive adults aged ≥60. Habitual dairy consumption was assessed with a validated diet history. Blood pressure was recorded by 24-hour ambulatory blood pressure monitoring; controlled blood pressure was defined as 24-hour blood pressure blood pressure 1.40 mm Hg higher (95% confidence interval: 0.01, 2.81) than consumers of blood pressure 1.74 mm Hg lower (95% confidence interval: -3.26, -0.23) than consumers of blood pressure was 1.83 (1.05-3.08) for those consuming ≥7 servings/wk of low-fat milk/yogurt, when comparing with consumers of blood pressure. Regular consumption of low-fat milk/yogurt was associated with lower 24-h diastolic blood pressure and with better blood pressure control among older adults with hypertension. Copyright © 2018. Published by Elsevier Inc.
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Blood pressure alarm. 870.1100 Section 870.1100...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1100 Blood pressure alarm. (a) Identification. A blood pressure alarm is a device that accepts the signal from a blood pressure...
Al-Shehri, Ahmed M.
Objective was to assess blood pressure BP control in patients with diabetes mellitus type 2 DM type treated in primary health care. A cross-sectional study was conducted in primary health care at King Fahd Military Complex Hospital in Dhahran, Kingdom of Saudi Arabia, between August 2003 and February 2004, to assess blood control in type 2 diabetics. A sample of 403 medical records of type 2 diabetic patients was selected using systematic random sampling after ordering the medical record numbers. The data were collected through the pre-coded checklist. Hypertension was found in 57.8% of diabetic patients with no statistically significant difference between males and females. The mean age of diabetic patients was significantly highly in hypertensive than non-hypertensive p=0.001. The mean duration of hypertension was significantly higher in females p=0.02. There were only 14.2% of hypertensive diabetic patients in whom blood pressure was controlled. Poor control was significantly associated with obesity and a high rate of complications. Blood pressure control correlated positively and significantly with the age of patients and negatively with duration of diabetes and hypertension. The most commonly prescribed antihypertensive were angiotensin converting enzyme inhibitors in 29.3%, followed by angiotensin receptors blockers in 24.1%, and the least prescribed drug was thiazide diuretic. Blood pressure in diabetic patients needs to be given particular attention from all health care professionals, especially primary care family physicians, who should follow the new guideline for better control of blood pressure, and fewer complications. Patient's awareness should be increased, through continuous health education with different modalities. (author)
VAN KATWIJK, C.
These pressure switches are located in the SCHe helium supply lines at the pressure bottles and upstream of the PRV. The switches monitor the SCHe supply bottle pressure and are set to alarm at 2200 psig. There is one switch for each SCHe supply (4). Electronic output signal is NON-SAFETY (GS)
Full Text Available Abstract Background Prediabetes (PreDM in asymptomatic adults is associated with abnormal circadian blood pressure variability (abnormal CBPV. Hypothesis Systemic inflammation and glycemia influence circadian blood pressure variability. Methods Dahl salt-sensitive (S rats (n = 19 after weaning were fed either an American (AD or a standard (SD diet. The AD (high-glycemic-index, high-fat simulated customary human diet, provided daily overabundant calories which over time lead to body weight gain. The SD (low-glycemic-index, low-fat mirrored desirable balanced human diet for maintaining body weight. Body weight and serum concentrations for fasting glucose (FG, adipokines (leptin and adiponectin, and proinflammatory cytokines [monocyte chemoattractant protein-1 (MCP-1 and tumor necrosis factor-α (TNF-α] were measured. Rats were surgically implanted with C40 transmitters and blood pressure (BP-both systolic; SBP and diastolic; DBP and heart rate (HR were recorded by telemetry every 5 minutes during both sleep (day and active (night periods. Pulse pressure (PP was calculated (PP = SBP-DBP. Results [mean(SEM]: The AD fed group displayed significant increase in body weight (after 90 days; p Conclusion These data validate our stated hypothesis that systemic inflammation and glycemia influence circadian blood pressure variability. This study, for the first time, demonstrates a cause and effect relationship between caloric excess, enhanced systemic inflammation, dysglycemia, loss of blood pressure control and abnormal CBPV. Our results provide the fundamental basis for examining the relationship between dysglycemia and perturbation of the underlying mechanisms (adipose tissue dysfunction induced local and systemic inflammation, insulin resistance and alteration of adipose tissue precursors for the renin-aldosterone-angiotensin system which generate abnormal CBPV.
Gupta, Hem Prabha; Singh, R K; Singh, Urmila; Mehrotra, Seema; Verma, N S; Baranwal, Neelam
AIMS #ENTITYSTARTX00026; To find out the circadian pattern of blood pressure in normotensive pregnant women and in women with preeclampsia. A cross-sectional prospective observational case control study. Blood pressure was sampled in thirty-five normotensive pregnant women (control) and thirty five preeclamptic women (study group) by using non-invasive automatic ambulatory blood pressure monitoring machine for 72 h. Blood pressure (BP) was not constant over 24 h period and it oscillated from time to time in control group. BP was maximum during early part of afternoon. However, in preeclampsia besides quantitative increase in BP, circadian BP oscillations were less pronounced and in around 50% subjects BP was maximum during evening and night hours. Both systolic and diastolic BP showed definite reproducible circadian pattern in both preeclamptic and normotensive pregnant women. This pattern both quantitatively and qualitatively was different in preeclamptic women. Standardized 24 h BP monitoring allows quantitative and qualitative evaluation of hypertensive status and is important for timing and dosing of antihypertensive medications.
Full Text Available Introduction. Home blood pressure monitoring has several advantages over blood pressure monitoring at a physician's office, and has become a useful instrument in the management of hypertension. Objective. To explore the rate and characteristics of patients who measure their blood pressure at home. Methods. A sample of 2,752 patients with diagnosis of essential arterial hypertension was selected from 12596 consecutive office visitors. Data of 2,639 patients was appropriate for analysis. The data concerning home blood pressure measurement and patients' characteristics were obtained from the patients' case histories. Results 1,835 (69.5% out of 2,639 patients measured their blood pressure at home. 1,284 (70.0% of home blood pressure patients had their own blood pressure measurement device. There were some important differences between these two groups: home blood pressure patients were more frequently male, of younger age, better educated, from urban area, mostly non-smokers, more likely to have diabetes mellitus and ischemic heart disease and had higher number of co-morbidities and were on other drugs beside antihypertensive medication. Using the logistic regression analysis we found that the most powerful predictors of home blood pressure monitoring had higher education level than primary school OR=1.80 (95% CI 1.37-2.37, non-smoking OR=2.16 (95% CI 1.40-3.33 and having a physician in urban area OR=1.32 (95% CI 1.02-1.71. Conclusion. Home blood pressure monitoring is popular in Slovenia. Patients who measured blood pressure at home were different from patients who did not. Younger age, higher education, non-smoking, having a physician in urban area and longer duration of hypertension were predictors of home blood pressure monitoring.
Stress and high blood pressure: What's the connection? Stress and long-term high blood pressure may not be linked, but taking steps to reduce your stress can improve your general health, including your blood ...
This podcast is based on the September 2012 CDC Vital Signs report. A team-based approach by patients, health care systems, and health care providers is one of the best ways to treat uncontrolled high blood pressure. Created: 9/4/2012 by Centers for Disease Control and Prevention (CDC). Date Released: 9/4/2012.
Cardiovascular diseases (CVD) are the main cause of death worldwide. In 2012, about 17.5 million people died from CVD, accounting for 30% of all deaths. High blood pressure (BP) is a major cardiovascular risk factor, which was responsible for 10.4 million deaths in 2013. Diet and lifestyle play
Cathorall, Michelle L.; Xin, Huaibo; Peachey, Andrew; Bibeau, Daniel L.; Schulz, Mark; Aronson, Robert
Purpose: To examine the extent to which neighborhood disadvantage accounts for variation in blood pressure. Methods: Demographic, biometric, and self-reported data from 19,261 health screenings were used. Addresses of participants were geocoded and located within census block groups (n = 14,510, 75.3%). Three hierarchical linear models were…
Background: Despite of the recommendations to use population specific blood pressure (BP) references which consider time, ethnicity and environmental factors, there is limited information regarding BP profile among Tanzanians. This cross sectional study was done to determine casual BP profile among healthy volunteer ...
hepatitis A antibody, and human immunodeficiency virus antibody), urine tests (drug screen I-abuse, marijuana, and a pregnancy test), and a 12-lead... sodium chloride; 250 mL over 2.5 minutes) were administered if systolic BP < 85 mmHg. Blood pressure, other hemodynamics, UO, and total amount of
C.O. Agyemang (Charles)
textabstractThe objective of the study was to review published evidence on whether blood pressure levels and the prevalence of hypertension are higher or lower in South Asian adults living in the UK as compared to white populations. A systematic literature review was carried out using MEDLINE
Objective: Blood pressure (BP) is one of the main cardiovascular risk indicators, but studies on its relationship with waist circumference, triglycerides and cholesterol are rare in low and middle income countries and even non-existent in some areas like the north of Cameroon. The aim of our study was to determine the ...
Zhang, G.; Shan, C.; Kirenko, I.; Long, X.; Aarts, R.M.
Blood pressure (BP) is critical in diagnosing certain cardiovascular diseases such as hypertension. Some previous studies have proved that BP can be estimated by pulse transit time (PTT) calculated by a pair of photoplethysmography (PPG) signals at two body sites. Currently, contact PPG (cPPG) and
Full Text Available Primary open angle glaucoma affects more than 67 million people. Elevated intraocular pressure (IOP is a risk factor for glaucoma and may reduce nutrient availability by decreasing ocular perfusion pressure (OPP. An interaction between arterial blood pressure and IOP determines OPP; but the exact contribution that these factors have for retinal function is not fully understood. Here we sought to determine how acute modifications of arterial pressure will affect the susceptibility of neuronal function and blood flow to IOP challenge. Anaesthetized (ketamine:xylazine Long-Evan rats with low (∼60 mmHg, sodium nitroprusside infusion, moderate (∼100 mmHg, saline, or high levels (∼160 mmHg, angiotensin II of mean arterial pressure (MAP, n = 5-10 per group were subjected to IOP challenge (10-120 mmHg, 5 mmHg steps every 3 minutes. Electroretinograms were measured at each IOP step to assess bipolar cell (b-wave and inner retinal function (scotopic threshold response or STR. Ocular blood flow was measured using laser-Doppler flowmetry in groups with similar MAP level and the same IOP challenge protocol. Both b-wave and STR amplitudes decreased with IOP elevation. Retinal function was less susceptible to IOP challenge when MAP was high, whereas the converse was true for low MAP. Consistent with the effects on retinal function, higher IOP was needed to attenuated ocular blood flow in animals with higher MAP. The susceptibility of retinal function to IOP challenge can be ameliorated by acute high BP, and exacerbated by low BP. This is partially mediated by modifications in ocular blood flow.
... about Bayer Consumer Health. HBP Resources Risk Calculator Animation Library Track Your Blood Pressure: Print (PDF) | Online ... Pressure Tracker Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...
Cornelissen, Véronique A; Fagard, Robert H
Previous meta-analyses of randomized controlled trials on the effects of chronic dynamic aerobic endurance training on blood pressure reported on resting blood pressure only. Our aim was to perform a comprehensive meta-analysis including resting and ambulatory blood pressure, blood pressure-regulating mechanisms, and concomitant cardiovascular risk factors. Inclusion criteria of studies were: random allocation to intervention and control; endurance training as the sole intervention; inclusion of healthy sedentary normotensive or hypertensive adults; intervention duration of > or =4 weeks; availability of systolic or diastolic blood pressure; and publication in a peer-reviewed journal up to December 2003. The meta-analysis involved 72 trials, 105 study groups, and 3936 participants. After weighting for the number of trained participants and using a random-effects model, training induced significant net reductions of resting and daytime ambulatory blood pressure of, respectively, 3.0/2.4 mm Hg (Phypertensive study groups (-6.9/-4.9) than in the others (-1.9/-1.6; Pendurance training decreases blood pressure through a reduction of vascular resistance, in which the sympathetic nervous system and the renin-angiotensin system appear to be involved, and favorably affects concomitant cardiovascular risk factors.
Andreeva, A V; Luchinin, V V; Lutetskiy, N A; Sergushichev, A N
The main idea of this research is the development of microoptomechanical sensor for intracranial pressure monitoring. Currently, the authors studied the scientific and technical knowledge in this field, as well as develop and test a prototype of microoptomechanical sensor for intracranial pressure (ICP) monitoring
Judith A Whitworth
Full Text Available Judith A WhitworthJohn Curtin School of Medical Research, Australian National University, Canberra, ACT, AustraliaAbstract: Two key early 20th century notions, the first the primacy of diastolic pressure in determining risk, and the second that hypertension is a discrete disorder, have proved to be incorrect. We now recognize the primacy of systolic pressure as a risk factor for cardiovascular disease and that hypertension is an arbitrary definition. In the early 21st century, we are moving away from a dichotomous approach to risk classification, and away from notions of hypertension and normotension towards an appreciation that blood pressure-related risk is continuous. In parallel, there has been a paradigm shift from a single risk factor approach to comprehensive cardiovascular disease risk prevention. Accordingly, prevention of cardiovascular disease requires a focus on lowering of blood pressure and modification of associated risk factors rather than simply treatment of hypertension. This emphasis is reflected in the World Health Organization (WHO – International Society of Hypertension (ISH 2003 statement on management of hypertension.Keywords: blood pressure, hypertension, cardiovascular risk, treatment
Steinhorst, Ana P; Gonçalves, Sandro C; Oliveira, Ana T; Massierer, Daniela; Gus, Miguel; Fuchs, Sandra C; Moreira, Leila B; Martinez, Denis; Fuchs, Flávio D
Obstructive sleep apnea (OSA) is a risk factor for the development of hypertension and cardiovascular disease. Apnea overloads the autonomic cardiovascular control system and may influence blood pressure variability, a risk for vascular damage independent of blood pressure levels. This study investigates the hypothesis that blood pressure variability is associated with OSA. In a cross-sectional study, 107 patients with hypertension underwent 24-h ambulatory blood pressure monitoring and level III polysomnography to detect sleep apnea. Pressure variability was assessed by the first derivative of blood pressure over time, the time rate index, and by the standard deviation of blood pressure measurements. The association between the apnea-hypopnea index and blood pressure variability was tested by univariate and multivariate methods. The 57 patients with apnea were older, had higher blood pressure, and had longer duration of hypertension than the 50 patients without apnea. Patients with apnea-hypopnea index (AHI) ≥ 10 had higher blood pressure variability assessed by the standard deviation than patients with AHI variability assessed by the time rate index presented a trend for association during sleep (P = 0.07). Daytime blood pressure variability was not associated with the severity of sleep apnea. Sleep apnea increases nighttime blood pressure variability in patients with hypertension and may be another pathway linking sleep abnormalities to cardiovascular disease.
VAN KATWIJK, C.
These 0-3000 psig range pressure indicators are located in the SCHe helium supply lines at the pressure bottles and upstream of the PRV. These accident monitoring local pressure indicators monitor the SCHe supply bottle pressure. There is one pressure indicator for each SCHe supply (4)
Full Text Available Systemic arterial blood pressures were measured in 30 dogs with acute babesiosis, 10 each with mild uncomplicated, severe uncomplicated and complicated disease. Ten healthy dogs were used as controls. Hypotension was defined as more than 3 standard deviations below the control mean. Normal mean pressures (Â±SD were: systolic arterial pressure 151 (Â±11 mm Hg, diastolic arterial pressure 89 (Â±8 mm Hg and mean arterial pressure 107 (Â±10 mmHg. Hypotension was the most frequent abnormality, and increased strikingly in incidence as disease severity increased, with 5/10 dogs in the complicated group being hypotensive for systolic, diastolic and mean arterial pressures, compared with 2/10 in the severe uncomplicated group and 0/10 in the mild uncomplicated group. Systolic, diastolic and mean arterial pressures in the complicated group and severe uncomplicated group, and systolic pressure in the mild uncomplicated group, were significantly lower than in the controls. There were no significant relationships between arterial pressures and age, pulse rate, respiratory rate, temperature, mucous membrane colour or haematocrit. There was a significant negative correlation between arterial pressures and white cell and immature neutrophil counts. Arterial pressures differed significantly between dogs that were clinically collapsed and those that were not, but not between survivors and non-survivors. Pulse pressure (systolic - diastolic was low in 7/10 complicated, 1/10 mild uncomplicated, and 1/10 severe uncomplicated cases, and differed significantly between the complicated and control groups. The high incidence of hypotension in clinically severe babesiosis has important implications for therapy.
David, V G; Yadav, B; Jeyaseelan, L; Deborah, M N; Jacob, S; Alexander, S; Varughese, S; John, G T
Blood pressure (BP) control at home is difficult when managed only with office blood pressure monitoring (OBPM). In this prospective study, the reliability of BP measurements in renal transplant patients with OBPM and home blood pressure monitoring (HBPM) was compared with ambulatory blood pressure monitoring (ABPM) as the gold standard. Adult patients who had living-related renal transplantation from March 2007 to February 2008 had BP measured by two methods; OBPM and ABPM at pretransplantation, 2(nd), 4(th), 6(th), and 9(th) months and all the three methods: OBPM, ABPM, and HBPM at 6 months after transplantation. A total of 49 patients, age 35 ± 11 years, on prednisolone, tacrolimus, and mycophenolate were evaluated. A total of 39 were males (79.6%). Systolic BP (SBP) and diastolic BP (DBP) measured by OBPM were higher than HBPM when compared with ABPM. When assessed using OBPM and awake ABPM, both SBP and DBP were significantly overestimated by OBPM with mean difference of 3-12 mm Hg by office SBP and 6-8 mm Hg for office DBP. When HBPM was compared with mean ABPM at 6 months both the SBP and DBP were overestimated by and 7 mm Hg respectively. At 6 months post transplantation, when compared with ABPM, OBPM was more specific than HBPM in diagnosing hypertension (98% specificity, Kappa: 0.88 vs. 89% specificity, Kappa: 0.71). HBPM was superior to OBPM in identifying patients achieving goal BP (89% specificity, Kappa: 0.71 vs. 50% specificity Kappa: 0.54). In the absence of a gold standard for comparison the latent class model analysis still showed that ABPM was the best tool for diagnosing hypertension and monitoring patients reaching targeted control. OBPM remains an important tool for the diagnosis and management of hypertension in renal transplant recipients. HBPM and ABPM could be used to achieve BP control.
V G David
Full Text Available Blood pressure (BP control at home is difficult when managed only with office blood pressure monitoring (OBPM. In this prospective study, the reliability of BP measurements in renal transplant patients with OBPM and home blood pressure monitoring (HBPM was compared with ambulatory blood pressure monitoring (ABPM as the gold standard. Adult patients who had living-related renal transplantation from March 2007 to February 2008 had BP measured by two methods; OBPM and ABPM at pretransplantation, 2 nd , 4 th , 6 th , and 9 th months and all the three methods : OBPM, ABPM, and HBPM at 6 months after transplantation. A total of 49 patients, age 35 ± 11 years, on prednisolone, tacrolimus, and mycophenolate were evaluated. A total of 39 were males (79.6%. Systolic BP (SBP and diastolic BP (DBP measured by OBPM were higher than HBPM when compared with ABPM. When assessed using OBPM and awake ABPM, both SBP and DBP were significantly overestimated by OBPM with mean difference of 3-12 mm Hg by office SBP and 6-8 mm Hg for office DBP. When HBPM was compared with mean ABPM at 6 months both the SBP and DBP were overestimated by and 7 mm Hg respectively. At 6 months post transplantation, when compared with ABPM, OBPM was more specific than HBPM in diagnosing hypertension (98% specificity, Kappa : 0.88 vs. 89% specificity, Kappa : 0.71. HBPM was superior to OBPM in identifying patients achieving goal BP (89% specificity, Kappa : 0.71 vs. 50% specificity Kappa : 0.54. In the absence of a gold standard for comparison the latent class model analysis still showed that ABPM was the best tool for diagnosing hypertension and monitoring patients reaching targeted control. OBPM remains an important tool for the diagnosis and management of hypertension in renal transplant recipients. HBPM and ABPM could be used to achieve BP control.
Middeke, M.; Schrader, J.
OBJECTIVE--To compare the mean nocturnal blood pressure of patients with various forms of renal and endocrine hypertension with that in patients with primary and white coat hypertension, and normal blood pressure. DESIGN--Ambulatory monitoring of blood pressure over 24 hours in a prospective study. SETTING--Two German centres for outpatients with hypertension and kidney diseases. SUBJECTS--176 normotensive subjects, 490 patients with primary hypertension including mild and severe forms, 42 wi...
Gosse, Philippe; Cremer, Antoine; Pereira, Helena; Bobrie, Guillaume; Chatellier, Gilles; Chamontin, Bernard; Courand, Pierre-Yves; Delsart, Pascal; Denolle, Thierry; Dourmap, Caroline; Ferrari, Emile; Girerd, Xavier; Michel Halimi, Jean; Herpin, Daniel; Lantelme, Pierre; Monge, Matthieu; Mounier-Vehier, Claire; Mourad, Jean-Jacques; Ormezzano, Olivier; Ribstein, Jean; Rossignol, Patrick; Sapoval, Marc; Vaïsse, Bernard; Zannad, Faiez; Azizi, Michel
The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure (BP) lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report here the effect of denervation on 24-hour BP and its variability and look for parameters that predicted the BP response. Patients with resistant hypertension were randomly assigned to denervation plus stepped-care treatment or treatment alone (control). Average and standard deviation of 24-hour, daytime, and nighttime BP and the smoothness index were calculated on recordings performed at randomization and 6 months. Responders were defined as a 6-month 24-hour systolic BP reduction ≥20 mm Hg. Analyses were performed on the per-protocol population. The significantly greater BP reduction in the denervation group was associated with a higher smoothness index ( P =0.02). Variability of 24-hour, daytime, and nighttime BP did not change significantly from baseline to 6 months in both groups. The number of responders was greater in the denervation (20/44, 44.5%) than in the control group (11/53, 20.8%; P =0.01). In the discriminant analysis, baseline average nighttime systolic BP and standard deviation were significant predictors of the systolic BP response in the denervation group only, allowing adequate responder classification of 70% of the patients. Our results show that denervation lowers ambulatory BP homogeneously over 24 hours in patients with resistant hypertension and suggest that nighttime systolic BP and variability are predictors of the BP response to denervation. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777. © 2017 American Heart Association, Inc.
Full Text Available This work deals with the development and characterization of a potentially implantable blood pressure telemetry system, based on an active Radio-Frequency IDentification (RFID tag, International Organization for Standardization (ISO 15693 compliant. This approach aims to continuously measure the average, systolic and diastolic blood pressure of the small/medium animals. The measured pressure wave undergoes embedded processing and results are stored onboard in a non-volatile memory, providing the data under interrogation by an external RFID reader. In order to extend battery lifetime, RFID energy harvesting has been investigated. The paper presents the experimental characterization in a laboratory and preliminary in-vivo tests. The device is a prototype mainly intended, in a future engineered version, for monitoring freely moving test animals for pharmaceutical research and drug safety assessment purposes, but it could have multiple uses in environmental and industrial applications.
Franco-Ayala, Marco; Martínez-Piñón, Fernando; Reyes-Barranca, Alfredo; Sánchez de la Peña, Salvador; Álvarez-Chavez, José A.
MEMS technology could be an option for the development of a pressure sensor which allows the monitoring of several electronic signals in humans. In this work, a comparison is made between the typical elasticity curves of several arteries in the human body and the elasticity obtained for MEMS silicon microstructures such as membranes and cantilevers employing Finite Element analysis tools. The purpose is to identify which types of microstructures are mechanically compatible with human arteries. The goal is to integrate a blood pressure sensor which can be implanted in proximity with an artery. The expected benefits for this type of sensor are mainly to reduce the problems associated with the use of bulk devices through the day and during several days. Such a sensor could give precise blood pressure readings in a continuous or periodic form, i.e. information that is especially important for some critical cases of hypertension patients.
Conlay, L. A.; Maher, T. J.; Wurtman, R. J.
The effect of L-alanine administration on blood pressure (BP) during haemorrhagic shock was investigated using anesthetized rats whose left carotid arteries were cannulated for BP measurement, blood removal, and drug administration. It was found that L-alanine, in doses of 10, 25, 50, 100, and 200 mg/kg, increased the systolic BP of hypotensive rats by 38 to 80 percent (while 100 mg/kg pyruvate increased BP by only 9.4 mmhg, not significantly different from saline). The results suggest that L-alanine might influence cardiovascular function.
Linneberg, Allan René; Sørensen, Thorkild I.A.
BACKGROUND: Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood...... pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. METHODS: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends...... from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. FINDINGS...
Blood pressure was also recorded according to the standard method. Systolic and diastolic blood pressure to height ratio were then calculated. Receiver operating curves was used to assess the ability of systolic blood and diastolic blood pressure height ratio to discriminate childhood prehypertension and hypertension.
de Jong, Mark R; Adiyaman, Ahmet; Gal, Pim; Smit, Jaap Jan J; Delnoy, Peter Paul H M; Heeg, Jan-Evert; van Hasselt, Boudewijn A A M; Lau, Elizabeth O Y; Persu, Alexandre; Staessen, Jan A; Ramdat Misier, Anand R; Steinberg, Jonathan S; Elvan, Arif
Blood pressure (BP) response to renal denervation (RDN) is highly variable and its effectiveness debated. A procedural end point for RDN may improve consistency of response. The objective of the current analysis was to look for the association between renal nerve stimulation (RNS)-induced BP increase before and after RDN and changes in ambulatory BP monitoring (ABPM) after RDN. Fourteen patients with drug-resistant hypertension referred for RDN were included. RNS was performed under general anesthesia at 4 sites in the right and left renal arteries, both before and immediately after RDN. RNS-induced BP changes were monitored and correlated to changes in ambulatory BP at a follow-up of 3 to 6 months after RDN. RNS resulted in a systolic BP increase of 50±27 mm Hg before RDN and systolic BP increase of 13±16 mm Hg after RDN (Pefficacy of RDN and predict BP response to RDN. © 2016 American Heart Association, Inc.
Full Text Available This paper presents an oscillometric blood pressure (BP measurement approach based on the active control schemes of cuff pressure. Compared with conventional electronic BP instruments, the novelty of the proposed BP measurement approach is to utilize a variable volume chamber which actively and stably alters the cuff pressure during inflating or deflating cycles. The variable volume chamber is operated with a closed-loop pressure control scheme, and it is activated by controlling the piston position of a single-acting cylinder driven by a screw motor. Therefore, the variable volume chamber could significantly eliminate the air turbulence disturbance during the air injection stage when compared to an air pump mechanism. Furthermore, the proposed active BP measurement approach is capable of measuring BP characteristics, including systolic blood pressure (SBP and diastolic blood pressure (DBP, during the inflating cycle. Two modes of air injection measurement (AIM and accurate dual-way measurement (ADM were proposed. According to the healthy subject experiment results, AIM reduced 34.21% and ADM reduced 15.78% of the measurement time when compared to a commercial BP monitor. Furthermore, the ADM performed much consistently (i.e., less standard deviation in the measurements when compared to a commercial BP monitor.
Laverman, Gozewijn Dirk; Andersen, Steen; Rossing, Peter
BACKGROUND: AT1-receptor blockade dose dependently lowers blood pressure (BP) and albuminuria. Reduction of BP and albuminuria are independent treatment targets for renoprotection, but whether this requires similar dose titration is unknown. METHODS: We tested this in two studies designed to find...... arterial pressure (MAP) were measured. Patients were divided into "good" and "poor" BP responders (BP+, BP-) according to BP response above or below group median. RESULTS: Baseline MAP in the BP- groups was 102 (97, 104) mm Hg in DM (median, 95% CI) and 91 (80, 108) mm Hg in ND. The top of the dose...
Sudano, Isabella; Flammer, Andreas J; Roas, Susanne; Enseleit, Frank; Ruschitzka, Frank; Corti, Roberto; Noll, Georg
The consumption of a high amount of fruits and vegetables was found to be associated with a lower risk of coronary heart disease and stroke. Epidemiologically, a similar relationship has been found with cocoa, a naturally polyphenol-rich food. Obviously, double blind randomized studies are difficult to perform with cocoa and chocolate, respectively. However, intervention studies strongly suggest that cocoa has several beneficial effects on cardiovascular health, including the lowering of blood pressure, the improvement of vascular function and glucose metabolism, and the reduction of platelet aggregation and adhesion. Several potential mechanisms through which cocoa might exert its positive effects have been proposed, among them activation of nitric oxide synthase, increased bioavailability of nitric oxide as well as antioxidant, and anti-inflammatory properties. It is the aim of this review to summarize the findings of cocoa and chocolate on blood pressure and vascular function.
Veerman, D. P.; van Montfrans, G. A.
Nurses are considered to evoke less white-coat hypertension, and might therefore be able to estimate average blood pressure as well as and more conveniently than ambulatory monitoring. The objective of the present study was to determine the correspondence between blood pressure measured by a doctor
SARI, Aysel; SELİM, Nevzat; DİLEK, Melda; AYDOĞDU, Turkan; ADIBELLİ, Zelal; BÜYÜKKAYA, Piltan; AKPOLAT, Tekin
Lemon juice has commonly been used by hypertensive patients in order to lower blood pressure (BP) acutely when BP is raised or as an alternative/complementary therapy for expectation of chronic improvement. Grapefruit, a citrus fruit like lemon, causes clinically significant interactions with a variety of drugs including calcium antagonists. The aims of this study were to investigate acute and chronic effects of lemon juice on BP among hypertensive patients. Ninty-eight patients were included...
Susan M. Wall
Full Text Available Type B and non-A, non-B intercalated cells are found within the connecting tubule and the cortical collecting duct. Of these cell types, type B intercalated cells are known to mediate Cl⁻ absorption and HCO₃⁻ secretion largely through pendrin-dependent Cl⁻/HCO₃⁻ exchange. This exchange is stimulated by angiotensin II administration and is also stimulated in models of metabolic alkalosis, for instance after aldosterone or NaHCO₃ administration. In some rodent models, pendrin-mediated HCO₃⁻ secretion modulates acid-base balance. However, the role of pendrin in blood pressure regulation is likely of more physiological or clinical significance. Pendrin regulates blood pressure not only by mediating aldosterone-sensitive Cl⁻ absorption, but also by modulating the aldosterone response for epithelial Na⁺ channel (ENaC-mediated Na⁺ absorption. Pendrin regulates ENaC through changes in open channel of probability, channel surface density, and channels subunit total protein abundance. Thus, aldosterone stimulates ENaC activity through both direct and indirect effects, the latter occurring through its stimulation of pendrin expression and function. Therefore, pendrin contributes to the aldosterone pressor response. Pendrin may also modulate blood pressure in part through its action in the adrenal medulla, where it modulates the release of catecholamines, or through an indirect effect on vascular contractile force. This review describes how aldosterone and angiotensin II-induced signaling regulate pendrin and the contributory role of pendrin in distal nephron function and blood pressure.
Full Text Available A growing body of evidence supports the concept of fetal programming in cardiovascular disease in man, which asserts that an insult experienced in utero exerts a long-term influence on cardiovascular function, leading to disease in adulthood. However, this hypothesis is not universally accepted, hence animal models may be of value in determining potential physiological mechanisms which could explain how fetal undernutrition results in cardiovascular disease in later life. This review describes two major animal models of cardiovascular programming, the in utero protein-restricted rat and the cross-fostered spontaneously hypertensive rat. In the former model, moderate maternal protein restriction during pregnancy induces an increase in offspring blood pressure of 20-30 mmHg. This hypertensive effect is mediated, in part, by fetal exposure to excess maternal glucocorticoids as a result of a deficiency in placental 11-ß hydroxysteroid dehydrogenase type 2. Furthermore, nephrogenesis is impaired in this model which, coupled with increased activity of the renin-angiotensin system, could also contribute to the greater blood pressure displayed by these animals. The second model discussed is the cross-fostered spontaneously hypertensive rat. Spontaneously hypertensive rats develop severe hypertension without external intervention; however, their adult blood pressure may be lowered by 20-30 mmHg by cross-fostering pups to a normotensive dam within the first two weeks of lactation. The mechanisms responsible for this antihypertensive effect are less clear, but may also involve altered renal function and down-regulation of the renin-angiotensin system. These two models clearly show that adult blood pressure is influenced by exposure to one of a number of stimuli during critical stages of perinatal development.
The systolic blood pressure intervention trial (SPRINT) published in 2015 has opened up new discussions on whether a lower blood pressure target as recommended by the current guidelines would be better for some patient groups. To review patient groups in which lower blood pressure targets would not be better. The results of SPRINT, its post-hoc and subgroup analyses, other studies and newer studies, as well as metaanalyses on the topic of blood pressure targets are reviewed and discussed. Studies with patients excluded from the SPRINT study were also analysed. The current international guidelines and recommendations of the Deutsche Hochdruckliga e. V. DHL® are included. Blood pressure monitoring methods differed considerably in the previously published studies. The low blood pressure value in SPRINT was mainly achieved due to the unusual method of blood pressure monitoring used and, as such, cannot be compared with blood pressure values in other studies. Based on current evidence, "the lower the better" should not be recommended in the following patient groups: older patients, in particular infirm older patients, patients with diabetes, patients without coronary heart disease or with low cardiovascular risk. When determining a blood pressure target, the method of blood pressure monitoring should be defined. A lower blood pressure target has been shown to be better in some well defined patient groups. However, adverse events due to antihypertensive medications should always be taken into account. Given the multiple exclusion criteria in trials and the results of many studies, "new" lower blood pressure targets could not be recommended in a large population of patients.
Roach, S.C.; Martin, O.J.D.; Owen, A.; Martin, D.F.
AIMS: To document blood pressure changes during barium enema examination and to determine at what point in the examination changes are likely to occur. METHODS AND RESULTS: Blood pressure measurements were taken at seven points during the course of barium enema examination in 107 consecutive patients. We found that patients over the age of 60 years had statistically significant decreases in blood pressure when they were stood up during the course of the examination. Many of these patients were asymptomatic. Patients who had symptoms (15/107, 14%) when standing up had a degree of hypotension. The duration of barium enema examination is longer in those patients who experience symptoms. CONCLUSION: During a barium enema examination hypotension occurs at the point of standing up more frequently in patients over 60 years and in those who suffer symptoms at this time. Patients who fall into one of these groups should be considered at risk of fainting at this point in the examination. A modified technique to avoid standing should be considered in at-risk patients. Roach, S.C. et al. (2001)
Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.
Selection of what blood glucose monitoring system to utilize has become an issue for physicians, diabetes educators, pharmacists, and patients. The field of competing makes and models of blood glucose monitoring systems has become crowded, with manufacturers touting improvements in accuracy, ease of use/alternate site options, stored results capacity, software evaluation tools, and/or price point. Personal interviews of 12 pharmacists from community and academic practice settings about monitor preference, as well as results from a national survey of pharmacist recommendations, were compared to actual wholesale sales data to estimate the impact of such recommendations on final monitor selection by the patient. Accu-Chek monitors were recommended 34.65% of the time and represented 28.58% of sales, with a success rate of 82.48% of being the monitor selected. OneTouch monitors had 27.72% of recommendations but represented 31.43% of sales, indicating possible patient brand loyalty or formulary preference for that product. FreeStyle(R) monitors came in third for pharmacist recommendations and were selected by the patient 61.68% of the time when recommended. The category of "other monitor" choices was selected 60.89% of the time by patients given those suggestions. Included in the "other monitor" category was the new disposable monitor marketed as the Sidekick. Based on sales data provided, the Sidekick made up 2.87% of "other monitor" category sales, representing 68% of the "other monitor" segment. While patients frequently follow pharmacist monitoring system suggestions, the ultimate deciding factor is most often the final out-of-pocket cost to the patient. As a result, cost of supplies often becomes the most important determining factor in final monitor selection at the patient level. If the patient cannot afford to perform the recommended daily testing intervals, all other determining factors and suggestions become moot.
Tranquilli, A L; Turi, A; Giannubilo, S R; Garbati, E
We assessed the correlation between the rhythm of melatonin concentration and circadian blood pressure patterns in normal and hypertensive pregnancy. Ambulatory 24-h blood pressure and blood samples every 4 h were monitored in 16 primigravidae who had shown an abnormal circadian blood pressure pattern (eight pre-eclamptic and eight normotensive) in pregnancy and 6-12 months after pregnancy. The circadian rhythm was analyzed by chronobiological measures. Eight normotensive women with maintained blood pressure rhythm served as controls. During pregnancy, melatonin concentration was significantly higher in pre-eclamptic than in normotensive women (pre-eclampsia, 29.4 +/- 1.9 pg/ml, normotensin, altered rhythm, 15.6 +/- 2.1; controls, 22.7 +/- 1.8; p lost in all pregnant women with loss of blood pressure rhythm. After pregnancy, normotensive women showed a reappearance of both melatonin and blood pressure rhythm, whereas pre-eclamptic women showed a reappearance of blood pressure but not melatonin rhythm. The loss of blood pressure rhythm in pregnancy is consistent with the loss of melatonin concentration rhythm. In pre-eclamptic women, the normalization of blood pressure rhythm, while melatonin rhythm remained altered, suggests a temporal or causal priority of circadian concentration of melatonin in the determination of blood pressure trend.
Farve Daneshvar Fard
Full Text Available Introduction Pressure ulcers are tissue damages resulting from blood flow restriction, which occurs when the tissue is exposed to high pressure for a long period of time. These painful sores are common in patients and elderly, who spend extended periods of time in bed or wheelchair. In this study, a continuous pressure and temperature monitoring system was developed for pressure ulcer prevention. Materials and Methods The monitoring system consists of 64 pressure and 64 temperature sensors on a 40×50 cm2 sheet. Pressure and temperature data and the corresponding maps were displayed on a computer in real-time. Risk assessment could be performed by monitoring and recording absolute pressure and temperature values, as well as deviations over time. Furthermore, a posture detection procedure was proposed for sitting posture identification. Information about the patient’s movement history may help caregivers make informed decisions about the patient’s repositioning and ulcer prevention strategies. Results Steady temporal behaviour of the designed system and repeatability of the measurements were evaluated using several particular tests. The results illustrated that the system could be utilized for continuous monitoring of interface pressure and temperature for pressure ulcer prevention. Furthermore, the proposed method for detecting sitting posture was verified using a statistical analysis. Conclusion A continuous time pressure and temperature monitoring system was presented in this study. This system may be suited for pressure ulcer prevention given its feasibility for simultaneous monitoring of pressure and temperature and alarming options. Furthermore, a method for detecting different sitting postures was proposed and verified. Pressure ulcers in wheelchair-bound patients may be prevented using this sitting posture detection method.
Alfie, J; Waisman, G D; Galarza, C R; Magi, M I; Vasvari, F; Mayorga, L M; Cámera, M I
Sex-related differences in systemic hemodynamics were analyzed by means of cardiac index and systemic vascular resistance according to the level of daytime ambulatory blood pressure. In addition, we assessed the relations between ambulatory blood pressure measurements and systemic hemodynamics in male and female patients. We prospectively included 52 women and 53 men referred to our unit for evaluation of arterial hypertension. Women and men were grouped according to the level of daytime mean arterial pressure: or = 110 mm Hg. Patients underwent noninvasive evaluation of resting hemodynamics (impedance cardiography) and 24-hour ambulatory blood pressure monitoring. Compared with women men with lower daytime blood pressure had a 12% higher systemic vascular resistance index (P = NS) and a 14% lower cardiac index (P < .02), whereas men with higher daytime blood pressure had a 25% higher vascular resistance (P < .003) and a 21% lower cardiac index (P < .0004). Furthermore, in men systemic vascular resistance correlated positively with both daytime and nighttime systolic and diastolic blood pressures, whereas cardiac index correlated negatively only with daytime diastolic blood pressure. In contrast, women did not exhibit any significant correlation between hemodynamic parameters and ambulatory blood pressure measurements. In conclusion, sex-related differences in systemic hemodynamics were more pronounced in the group with higher daytime hypertension. The relations between systemic hemodynamics and ambulatory blood pressure level depended on the sex of the patient. In men a progressive circulatory impairment underlies the increasing level of ambulatory blood pressure, but this was not observed in women.
Eisner, Alvin; Samples, John R.
The study had two main purposes: (1) to determine whether the foveal visual sensitivities of people treated for high blood pressure (vascular hypertension) differ from the sensitivities of people who have not been diagnosed with high blood pressure and (2) to understand how visual adaptation is related to standard measures of systemic cardiovascular function. Two groups of middle-aged subjects-hypertensive and normotensive-were examined with a series of test/background stimulus combinations. All subjects met rigorous inclusion criteria for excellent ocular health. Although the visual sensitivities of the two subject groups overlapped extensively, the age-related rate of sensitivity loss was, for some measures, greater for the hypertensive subjects, possibly because of adaptation differences between the two groups. Overall, the degree of steady-state sensitivity loss resulting from an increase of background illuminance (for 580-nm backgrounds) was slightly less for the hypertensive subjects. Among normotensive subjects, the ability of a bright (3.8-log-td), long-wavelength (640-nm) adapting background to selectively suppress the flicker response of long-wavelength-sensitive (LWS) cones was related inversely to the ratio of mean arterial blood pressure to heart rate. The degree of selective suppression was also related to heart rate alone, and there was evidence that short-term changes of cardiovascular response were important. The results suggest that (1) vascular hypertension, or possibly its treatment, subtly affects visual function even in the absence of eye disease and (2) changes in blood flow affect retinal light-adaptation processes involved in the selective suppression of the flicker response from LWS cones caused by bright, long-wavelength backgrounds.
Podell, Richard N.
Some physicians wonder if high blood pressure can be controlled without the use of drugs and their potential side effects. Current findings concerning nutrition and high blood pressure are presented. (RM)
... eating more whole-grain foods help lower my blood pressure? Answers from Sheldon G. Sheps, M.D. It might. Eating ... might help reduce your chance of developing high blood pressure (hypertension). Whole grains are grains that include the ...
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... it true that sleep deprivation can cause high blood pressure? Answers from Sheldon G. Sheps, M.D. Possibly. It's thought that ... hours a night could be linked to increased blood pressure. People who sleep five hours or less a ...
... medications: Can they raise my triglycerides? Can some blood pressure medications cause an increase in triglycerides? Answers from Sheldon G. Sheps, M.D. Yes, some blood pressure medications can affect triglyceride and cholesterol levels. Hydrochlorothiazide ...
What to ask your doctor about high blood pressure; Hypertension - what to ask your doctor ... problems? What medicines am I taking to treat high blood pressure? Do they have any side effects? What should ...
... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More High Blood Pressure, AFib and Your Risk of Stroke Updated:Aug ... have a stroke for the first time have high blood pressure . And an irregular atrial heart rhythm — a condition ...
Blood pressure pattern of adolescent offsprings of hypertensive fathers in Lagos ... in adults which emphasizes the need to track blood pressure in children. ... are hypertensive while among adolescents with normotensive parents, 11.0% for ...
Dewaele, F.; Kalmar, A. F.; Van Canneyt, K.; Vereecke, H.; Absalom, A.; Caemaert, J.; Struys, M. M. R. F.; Van Roost, D.
Background. Significant increases in intracranial pressure (ICP) may occur during neuroendoscopic procedures. To detect and prevent serious and sustained increases, ICP should be monitored. At present, controversy exists on the optimal location of the monitoring sensor. Therefore, we conducted an in
Guessous, Idris; Pruijm, Menno; Ponte, Belén; Ackermann, Daniel; Ehret, Georg; Ansermot, Nicolas; Vuistiner, Philippe; Staessen, Jan; Gu, Yumei; Paccaud, Fred; Mohaupt, Markus; Vogt, Bruno; Pechère-Bertschi, Antoinette; Pechère-Berstchi, Antoinette; Martin, Pierre-Yves; Burnier, Michel; Eap, Chin B; Bochud, Murielle
Intake of caffeinated beverages might be associated with reduced cardiovascular mortality possibly via the lowering of blood pressure. We estimated the association of ambulatory blood pressure with urinary caffeine and caffeine metabolites in a population-based sample. Families were randomly selected from the general population of Swiss cities. Ambulatory blood pressure monitoring was conducted using validated devices. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 hours urine using ultrahigh performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of urinary excretions with blood pressure although adjusting for major confounders. The 836 participants (48.9% men) included in this analysis had mean age of 47.8 and mean 24-hour systolic and diastolic blood pressure of 120.1 and 78.0 mm Hg. For each doubling of caffeine excretion, 24-hour and night-time systolic blood pressure decreased by 0.642 and 1.107 mm Hg (both P values theobromine excretion was not associated with blood pressure. Anti-hypertensive therapy, diabetes mellitus, and alcohol consumption modify the association of caffeine urinary excretion with systolic blood pressure. Ambulatory systolic blood pressure was inversely associated with urinary excretions of caffeine and other caffeine metabolites. Our results are compatible with a potential protective effect of caffeine on blood pressure. © 2014 American Heart Association, Inc.
Full Text Available Jean-Philippe Baguet1,21Department of Cardiology, University Hospital, 2Bioclinic Radiopharmaceutics Laboratory, INSERM U1039, Joseph Fourier University, Grenoble, FranceAbstract: Hypertension is an important risk factor for the development of cardiovascular disease, and is a major cause of morbidity and mortality worldwide. Traditionally, hypertension diagnosis and treatment and clinical evaluations of antihypertensive efficacy have been based on office blood pressure (BP measurements; however, there is increasing evidence that office measures may provide inadequate or misleading estimates of a patient’s true BP status and level of cardiovascular risk. The introduction, and endorsement by treatment guidelines, of 24-hour ambulatory BP monitoring and self (or home BP monitoring has facilitated more reliable and reproducible estimations of true BP, including the identification of white-coat and masked hypertension, and evaluation of BP variability. In addition, ambulatory BP monitoring enables accurate assessment of treatment effectiveness over 24 hours and both ambulatory and self BP monitoring may lead to better tailoring of therapy according to BP profile and concomitant disease. This review describes the clinical benefits and limitations of out-of-office assessments and their applications for effective management of hypertension and attainment of BP control.Keywords: ambulatory, ABPM, SBPM, blood pressure measurement, hypertension
Bartnik, Daniel J.; Rymut, Russell A.
We describe a bedside arterial blood gas (ABG) monitoring system which uses fluorescent optical sensors in the measurement of blood pH, PCO2 and PO2. The Point-of-Care Arterial Blood Gas Monitoring System consists of the SensiCathTM optical sensor unit manufactured by Optical Sensors Incorporated and the TramTM Critical Care Monitoring System with ABG Module manufactured by Marquette Electronics Incorporated. Current blood gas measurement techniques require a blood sample to be removed from the patient and transported to an electrochemical analyzer for analysis. The ABG system does not require removal of blood from the patient or transport of the sample. The sensor is added to the patient's existing arterial line. ABG measurements are made by drawing a small blood sample from the arterial line in sufficient quantity to ensure an undiluted sample at the sensor. Measurements of pH, PCO2 and PO2 are made within 60 seconds. The blood is then returned to the patient, the line flushed and results appear on the bedside monitor. The ABG system offers several advantages over traditional electrochemical analyzers. Since the arterial line remains closed during the blood sampling procedure the patient's risk of infection is reduced and the caregiver's exposure to blood is eliminated. The