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Abstract
Hypertension remains the largest modifiable cause of mortality worldwide despite the availability of effective medications and sustained research efforts over the past 100 years. Hypertension requires transformative solutions that can help reduce the global burden of the disease. Artificial intelligence and machine learning, which have made a substantial impact on our everyday lives over the last decade may be the route to this transformation. However, artificial intelligence in health care is still in its nascent stages and realizing its potential requires numerous challenges to be overcome. In this review, we provide a clinician-centric perspective on artificial intelligence and machine learning as applied to medicine and hypertension. We focus on the main roadblocks impeding implementation of this technology in clinical care and describe efforts driving potential solutions. At the juncture, there is a critical requirement for clinical and scientific expertise to work in tandem with algorithmic innovation followed by rigorous validation and scrutiny to realize the promise of artificial intelligence-enabled health care for hypertension and other chronic diseases.
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Affiliation(s)
- Sandosh Padmanabhan
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow
| | - Tran Quoc Bao Tran
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow
| | - Anna F Dominiczak
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow
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102
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Augustin A, Coutts L, Zanisi L, Wierzbicki AS, Shankar F, Chowienczyk PJ, Floyd CN. Impact of Therapeutic Inertia on Long-Term Blood Pressure Control: A Monte Carlo Simulation Study. Hypertension 2021; 77:1350-1359. [PMID: 33641362 DOI: 10.1161/hypertensionaha.120.15866] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Alexandry Augustin
- From the School of Physics and Astronomy, University of Southampton (A.A., L.C., L.Z., F.S.)
| | - Louise Coutts
- From the School of Physics and Astronomy, University of Southampton (A.A., L.C., L.Z., F.S.)
| | - Lorenzo Zanisi
- From the School of Physics and Astronomy, University of Southampton (A.A., L.C., L.Z., F.S.)
| | | | - Francesco Shankar
- From the School of Physics and Astronomy, University of Southampton (A.A., L.C., L.Z., F.S.)
| | - Phil J Chowienczyk
- Guy's & St Thomas' NHS Foundation Trust, London (A.S.W., P.J.C., C.N.F.).,King's College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, King's College London (P.J.C., C.N.F.)
| | - Christopher N Floyd
- Guy's & St Thomas' NHS Foundation Trust, London (A.S.W., P.J.C., C.N.F.).,King's College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, King's College London (P.J.C., C.N.F.)
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103
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Cheung AK, Chang TI, Cushman WC, Furth SL, Hou FF, Ix JH, Knoll GA, Muntner P, Pecoits-Filho R, Sarnak MJ, Tobe SW, Tomson CR, Mann JF. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int 2021; 99:S1-S87. [PMID: 33637192 DOI: 10.1016/j.kint.2020.11.003] [Citation(s) in RCA: 389] [Impact Index Per Article: 129.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
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104
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Miazgowski T, Miazgowski B, Kaczmarkiewicz A, Kopeć J. Associations of circulating irisin with 24-h blood pressure, total and visceral fat, and metabolic parameters in young adult hypertensives. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:137-143. [PMID: 33905629 PMCID: PMC10065315 DOI: 10.20945/2359-3997000000333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Some experimental and clinical studies suggest a possible role of irisin in central and peripheral regulation of blood pressure. The purpose of the study was to assess the associations between serum irisin levels, total and visceral fat, metabolic parameters, and blood pressure pattern during 24-h monitoring (ABPM). Methods In 206 patients with essential hypertension receiving standard antihypertensive treatments, we assessed anthropometric indices; serum irisin, blood lipids (total cholesterol, LDL-C, HDL-C, and triglycerides), glucose and insulin; body composition including lean mass and total, visceral, android and gynoid fat using a dual-energy x-ray absorptiometry; ABPM; and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR). Results Baseline irisin levels were within normal reference ranges and comparable between the genders. There were no significant correlations of irisin with age, anthropometric variables, lipids, HOMA-IR, body composition, as well as 24-h blood pressure and dipping status. In univariate analysis, age, fat mass and distribution, lipids and glucose, HOMA-IR, and nocturnal blood pressure fall were poor predictors of irisin levels. These neutral associations were not affected by age, gender, and treatment modality. Conclusion In young adult hypertensives, serum concentration of irisin was within a normal range and not associated with total and regional fat, blood lipids, insulin resistance, as well as 24-h blood pressure and the magnitude of its nocturnal fall.
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Affiliation(s)
- Tomasz Miazgowski
- Department of Propedeutics of Internal Diseases & Hypertension, Pomeranian Medical University in Szczecin, Poland,
| | | | | | - Jacek Kopeć
- Division of Epidemiology, Biostatistics and Public Health Practice, University of British Columbia, Vancouver, Canada
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105
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Wan TX, Wu YH, Wu YQ, Hu W, Su H. Differences in oscillometric blood pressure readings between unsupported and supported back conditions. Hypertens Res 2021; 44:528-532. [PMID: 33603172 DOI: 10.1038/s41440-020-00595-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/09/2022]
Abstract
Appropriate body posture is important for accurate blood pressure (BP) measurement. However, the impact of an unsupported back on BP readings is currently controversial. This study included 224 subjects (18-86 years old, 54.5 ± 15.5 years old, 105 males). BP was measured with an oscillometric BP device randomly following one of two protocols for back support conditions: (1) supported-unsupported-supported-unsupported, or (2) unsupported-supported-unsupported-supported. The average of the two systolic BP (SBP) and diastolic BP (DBP) readings in the same position was recorded as the final BP value. The differences in BP between the unsupported and supported back conditions were calculated as delta BP. Moreover, the percentage variation in BP (PV) was calculated with the formula delta BP/BP with an unsupported back. Multivariable regression analysis evaluated the impact of age, sex, hypertension history and supported BP level on PV. The SBP/DBP levels measured with an unsupported back were slightly higher than those when the back was supported (132.7 ± 19.5/79.6 ± 12.9 mmHg vs. 130.3 ± 20.0/78.5 ± 14.3 mmHg), and the delta SBP (2.3 mmHg) was statistically significant. The multivariable regression analysis showed that age was a positive factor but supported SBP level as a negative factor for systolic PV, while age and supported DBP level were positive factors, but hypertension history was a negative factor for diastolic PV. For a group participant, the mean difference in oscillometric SBP/DBP in the unsupported back position was 2.3/1.0 mmHg higher than that in the supported back position.
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Affiliation(s)
- Tai-Xuan Wan
- The Department of Cardiovascular Medicine, Second Affiliated Hospital and the Second Clinical Medical College, Nanchang University, No 1 Minde Road, Nanchang, 330006, China.,Queen Mary College of Medical College, Nanchang University, No 461 Bayi avenue, Nanchang, 330006, China
| | - Yuan-Hao Wu
- The Department of Cardiovascular Medicine, Second Affiliated Hospital and the Second Clinical Medical College, Nanchang University, No 1 Minde Road, Nanchang, 330006, China
| | - Yan-Qing Wu
- The Department of Cardiovascular Medicine, Second Affiliated Hospital and the Second Clinical Medical College, Nanchang University, No 1 Minde Road, Nanchang, 330006, China
| | - Weitong Hu
- The Department of Cardiovascular Medicine, Second Affiliated Hospital and the Second Clinical Medical College, Nanchang University, No 1 Minde Road, Nanchang, 330006, China
| | - Hai Su
- The Department of Cardiovascular Medicine, Second Affiliated Hospital and the Second Clinical Medical College, Nanchang University, No 1 Minde Road, Nanchang, 330006, China.
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106
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Runte K, Brosien K, Schubert C, Nordmeyer J, Kramer P, Schubert S, Berger F, Hennemuth A, Kuehne T, Kelm M, Goubergrits L. Image-Based Computational Model Predicts Dobutamine-Induced Hemodynamic Changes in Patients With Aortic Coarctation. Circ Cardiovasc Imaging 2021; 14:e011523. [PMID: 33591212 DOI: 10.1161/circimaging.120.011523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacological stress testing can help to uncover pathological hemodynamic conditions and is, therefore, used in the clinical routine to assess patients with structural heart diseases such as aortic coarctation with borderline indication for treatment. The aim of this study was to develop and test a reduced-order model predicting dobutamine stress induced pressure gradients across the coarctation. METHODS The reduced-order model was developed based on n=21 imaging data sets of patients with aortic coarctation and a meta-analysis of subjects undergoing dobutamine stress testing. Within an independent test cohort of n=21 patients with aortic coarctation, the results of the model were compared with dobutamine stress testing during catheterization. RESULTS In n=19 patients responding to dobutamine stress testing, pressure gradients across the coarctation during dobutamine stress increased from 15.7±5.1 to 33.6±10.3 mm Hg (paired t test, P<0.001). The model-predicted pressure gradients agreed with catheter measurements with a mean difference of -2.2 mm Hg and a limit of agreement of ±11.16 mm Hg according to Bland-Altman analysis. Significant equivalence between catheter-measured and simulated pressure gradients during stress was found within the study cohort (two 1-sided tests of equivalence with a noninferiority margin of 5.0 mm Hg, 33.6±10.33 versus 31.5±11.15 mm Hg, P=0.021). CONCLUSIONS The developed reduced-order model can instantly predict dobutamine-induced hemodynamic changes with accuracy equivalent to heart catheterization in patients with aortic coarctation. The method is easy to use, available as a web-based calculator, and provides a promising alternative to conventional stress testing in the clinical routine. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02591940.
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Affiliation(s)
- Kilian Runte
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.)
| | - Kay Brosien
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.)
| | - Charlotte Schubert
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.)
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.)
| | - Peter Kramer
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.)
| | - Stephan Schubert
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.).,Department of Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany (S.S.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (S.S., F.B., T.K.)
| | - Felix Berger
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (S.S., F.B., T.K.)
| | - Anja Hennemuth
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Fraunhofer Institute for Medical Image Computing-MEVIS, Bremen, Germany (A.H.)
| | - Titus Kuehne
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.).,German Center for Cardiovascular Research, Partner Site Berlin, Germany (S.S., F.B., T.K.)
| | - Marcus Kelm
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Germany (K.R., C.S., J.N., P.K., S.S., F.B., T.K., M.K.).,Berlin Institute of Health, Germany (M.K.)
| | - Leonid Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Germany (K.R., K.B., C.S., A.H., T.K., M.K., L.G.).,Einstein Center Digital Future, Berlin, Germany (L.G.)
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107
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Parker RA, Padfield P, Hanley J, Pinnock H, Kennedy J, Stoddart A, Hammersley V, Sheikh A, McKinstry B. Examining the effectiveness of telemonitoring with routinely acquired blood pressure data in primary care: challenges in the statistical analysis. BMC Med Res Methodol 2021; 21:31. [PMID: 33568079 PMCID: PMC7877114 DOI: 10.1186/s12874-021-01219-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, ‘white coat effect’, end digit preference, and missing data. Methods Four different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were “standardisation with stratification”, “standardisation with matching”, “regression adjustment for propensity score” and “random coefficient modelling”. The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6–12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data. Results The standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6–12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (− 5.96, 95% CI -8.36 to − 3.55 , p < 0.001) and (− 3.73, 95% CI− 5.34 to − 2.13, p < 0.001) respectively, even after assuming that − 5 of the difference was due to ‘white coat effect’. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year. Conclusions The four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01219-8.
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Affiliation(s)
| | - Paul Padfield
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Janet Hanley
- School of Health and Social Care. Edinburgh Napier University, Edinburgh, UK
| | | | - John Kennedy
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | | | | | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
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108
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Lamarre-Cliche M, Spacek E, Houde S, Furgé P, Lamarre C, Duong YN, Tran G, Beaudoin N. Performance of an automated blood pressure measurement device in a stroke rehabilitation unit. Blood Press Monit 2021; 26:65-69. [PMID: 32960837 DOI: 10.1097/mbp.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Valid blood pressure (BP) measurements are needed in post-stroke rehabilitation hospital units for the management of hypertension. Automated devices could be used to improve on usual care BP measurement. However, more information is needed about the performance of these devices in such a context. METHODS This prospective nonrandomized study was performed in stroke patients with hypertension hospitalized in a stroke rehabilitation unit. Two in-hospital BP assessment strategies were compared: usual care BP and in-hospital automated office BP (AOBP) standardized measurements. In-office AOBP and ambulatory BP monitoring (ABPM) were also performed on these patients. The main outcome was SBP. Study follow-up was until discharge, up to a maximum of 4 weeks. RESULTS Sixty-two patients with stroke hospitalized in a rehabilitation unit were included. Usual care BP was 130 ± 12/79 ± 9 mmHg and differed from an in-hospital AOBP of 117 ± 14/75 ± 12 mmHg (P < 0.001/P < 0.001). In-hospital and in-office AOBP measurements did not differ. Twenty percent of patients reached SBP therapeutic goals according to in-hospital AOBP but not according to usual care BP measurements. CONCLUSION This study shows that in a post-stroke rehabilitation unit, standardized in-hospital AOBP estimates are on average much lower than the usual care BP correlates and similar to the in-office AOBP estimates. In-hospital AOBP devices in a stroke rehabilitation unit could add important information for the management of hypertension.
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Affiliation(s)
- Maxime Lamarre-Cliche
- Department of Medicine, Institut de Recherches Cliniques de Montréal.,Institut de Réadaptation Gingras Lindsay de Montréal
| | - Elena Spacek
- Institut de Réadaptation Gingras Lindsay de Montréal
| | - Sylvie Houde
- Institut de Réadaptation Gingras Lindsay de Montréal
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109
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Is auscultation an issue when validating 24-h blood pressure monitoring devices? Blood Press Monit 2021; 25:301-302. [PMID: 32675476 DOI: 10.1097/mbp.0000000000000462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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110
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Alvarado Alvarez M, Padwal R, Ringrose J, Jalali A, Hiebert W. Optimum waveform envelopes and amplitude ratios in oscillometric blood pressure estimation. Blood Press Monit 2021; 26:53-59. [PMID: 32897911 DOI: 10.1097/mbp.0000000000000485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if, when using the oscillometric method, there is a specific range of amplitude ratios in the fixed-ratio algorithm that will result in blood pressure estimates that consistently fall within a mean error ≤5 mmHg and a SD of the error <8 mmHg. Additionally, to apply different representations of the oscillometric waveform envelope to verify if this will affect the accuracy of the results. METHODS SBP and DBP were obtained using the fixed-ratios method applied to a dataset of 219 oscillometric measurements obtained from 73 healthy volunteers and compared to their corresponding auscultation values. Ratio and envelope analysis were done on Matlab (The MathWorks, Inc., Natick, Massachusetts, USA). RESULTS Depending on the envelope representation, ratios between 0.44-0.74 for systolic pressure and 0.51-0.85 for diastolic pressure yield results within the limits mentioned above. When a set of optimum envelope representations and ratios are selected based on population mean, the highest percentage of subjects presenting blood pressure estimates within the limits were 72.6% for systolic and 69.9% for diastolic. CONCLUSION The range of ratios presenting optimum results appears to be independent of the degree of arterial stiffness given the wide range of ages of the subjects in the study. Different representations of the oscillometric waveform envelope may improve the accuracy of the method. However, there remains a considerable percentage of the population with unreliable results. It is therefore important to only use devices that have been properly validated according to standard protocol.
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Affiliation(s)
| | - Raj Padwal
- Nanotechnology Research Centre, National Research Council Canada, Edmonton, Alberta, Canada
| | - Jennifer Ringrose
- Nanotechnology Research Centre, National Research Council Canada, Edmonton, Alberta, Canada
| | - Afrooz Jalali
- Nanotechnology Research Centre, National Research Council Canada, Edmonton, Alberta, Canada
| | - Wayne Hiebert
- Medicine, University of Alberta
- Nanotechnology Research Centre, National Research Council Canada, Edmonton, Alberta, Canada
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111
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Michea L, Toro L, Alban N, Contreras D, Morgado P, Paccot M, Escobar MC, Lorca E. Attended Automated Office Blood Pressure Measurement Versus Ambulatory Blood Pressure Monitoring in a Primary Healthcare Setting in Chile. South Med J 2021; 114:63-69. [DOI: 10.14423/smj.0000000000001206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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112
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Kirhan İ, Kir S, Dilek M. Self-reported practices of doctors and nurses for the measurement of blood pressure. Blood Press Monit 2021; 26:8-13. [PMID: 32815923 DOI: 10.1097/mbp.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension is one of the most common health problems worldwide and can be diagnosed with an accurate blood pressure measurement (BPM). We aim to evaluate the self-reported practices of family physicians and nurses for BPM. METHODS This study was conducted in the form of a survey administered through face-to-face interviews with 131 physicians and 371 nurses. The survey included questions about devices, patients, and BPM techniques. RESULTS The mean age was 31 ± 7.4 years. The most commonly used device was the aneroid model (47.8%). The majority of participants reported that they had sufficient technical knowledge about the devices (81.1%), and the devices were regularly calibrated (77.5%). Only 44.8% reported that they had asked patients about caffeine or nicotine use. About half of those in both groups (54%) performed BPM only once during a presentation. The most commonly used position during BPM was sitting. BPM was performed mostly on one arm without preference for any side (67.5%). Approximately half of the respondents reported that they performed BPM by actively supporting the arm at the heart level. CONCLUSION We found physicians and nurses had lack of adherence to proper techniques related to the use of appropriate positions and other relevant situations that should be considered during BPM. Accurate BPM is the most important factor for proper diagnosis and treatment of hypertension. Thus, BPM should be performed in accordance with the designated guidelines and can be performed with accurate results only as a result of repeated comprehensive training programs.
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Affiliation(s)
- İdris Kirhan
- Department of Internal Medicine, Faculty of Medicine, Harran University, Sanliurfa
| | | | - Melda Dilek
- Internal Medicine, Nephrology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
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113
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Picone DS, Schultz MG, Armstrong MK, Black JA, Bos WJW, Chen CH, Cheng HM, Cremer A, Dwyer N, Hughes AD, Kim HL, Lacy PS, Laugesen E, Liang F, Ohte N, Okada S, Omboni S, Ott C, Pereira T, Pucci G, Schmieder RE, Sinha MD, Stouffer GA, Takazawa K, Roberts-Thomson P, Wang JG, Weber T, Westerhof BE, Williams B, Sharman JE. Identifying Isolated Systolic Hypertension From Upper-Arm Cuff Blood Pressure Compared With Invasive Measurements. Hypertension 2021; 77:632-639. [PMID: 33390047 DOI: 10.1161/hypertensionaha.120.16109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Isolated systolic hypertension (ISH) is the most common form of hypertension and is highly prevalent in older people. We recently showed differences between upper-arm cuff and invasive blood pressure (BP) become greater with increasing age, which could influence correct identification of ISH. This study sought to determine the difference between identification of ISH by cuff BP compared with invasive BP. Cuff BP and invasive aortic BP were measured in 1695 subjects (median 64 years, interquartile range [55-72], 68% male) from the INSPECT (Invasive Blood Pressure Consortium) database. Data were recorded during coronary angiography among 29 studies, using 21 different cuff BP devices. ISH was defined as ≥130/<80 mm Hg using cuff BP compared with invasive aortic BP as the reference. The prevalence of ISH was 24% (n=407) according to cuff BP but 38% (n=642) according to invasive aortic BP. There was fair agreement (Cohen κ, 0.36) and 72% concordance between cuff and invasive aortic BP for identifying ISH. Among the 28% of subjects (n=471) with misclassification of ISH status by cuff BP, 20% (n=96) of the difference was due to lower cuff systolic BP compared with invasive aortic systolic BP (mean, -16.4 mm Hg [95% CI, -18.7 to -14.1]), whereas 49% (n=231) was from higher cuff diastolic BP compared with invasive aortic diastolic BP (+14.2 mm Hg [95% CI, 11.5-16.9]). In conclusion, compared with invasive BP, cuff BP fails to identify ISH in a sizeable portion of older people and demonstrates the need to improve cuff BP measurements.
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Affiliation(s)
- Dean S Picone
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Martin G Schultz
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - Matthew K Armstrong
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
| | - J Andrew Black
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Willem Jan W Bos
- St Antonius Hospital, Department of Internal Medicine, Nieuwegein, the Netherlands (W.J.B.).,Department of Internal Medicine, Leiden University Medical Center, the Netherlands (W.J.B.)
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University School of Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., M.-H.C.)
| | - Hao-Min Cheng
- Department of Medicine, National Yang-Ming University School of Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., M.-H.C.)
| | - Antoine Cremer
- Department of Cardiology/Hypertension, University Hospital of Bordeaux, France (A.C.)
| | - Nathan Dwyer
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, United Kingdom (A.D.H., B.W.)
| | - Hack-Lyoung Kim
- Division of Cardiology, Seoul National University Boramae Hospital, South Korea (H.-L.K.)
| | - Peter S Lacy
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.S.L., B.W.)
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark (E.L.)
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, China (F.L.).,Institute for Personalized Medicine, Sechenov University, Moscow, Russia (F.L.)
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan (N.O.)
| | - Sho Okada
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan (S. Okada)
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy (S. Omboni).,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Russian Federation (S. Omboni)
| | - Christian Ott
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.E.S.)
| | - Telmo Pereira
- Department of Physiology, Polytechnic Institute of Coimbra, ESTES, Lousã, Portugal (T.P.)
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Italy (G.P.)
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany (C.O., R.E.S.)
| | - Manish D Sinha
- Department of Clinical Pharmacology and Department of Paediatric Nephrology, Kings College London, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, United Kingdom (M.D.S.)
| | - George A Stouffer
- Division of Cardiology, University of North Carolina at Chapel Hill (G.A.S.)
| | - Kenji Takazawa
- Center for Health Surveillance and Preventive Medicine, Tokyo Medical University Hospital, Japan (K.T.)
| | - Philip Roberts-Thomson
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.).,Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.)
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (J.W.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria (T.W.)
| | - Berend E Westerhof
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands (B.E.W.)
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, United Kingdom (A.D.H., B.W.).,Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research (NIHR) UCL/UCL Hospitals Biomedical Research Centre, United Kingdom (P.S.L., B.W.)
| | - James E Sharman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., M.K.A., J.A.B., N.D., P.R.-T., J.E.S.)
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114
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Kallioinen N, Hill A, Christofidis MJ, Horswill MS, Watson MO. Quantitative systematic review: Sources of inaccuracy in manually measured adult respiratory rate data. J Adv Nurs 2021; 77:98-124. [PMID: 33038030 PMCID: PMC7756810 DOI: 10.1111/jan.14584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 07/29/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
AIMS To identify the potential sources of inaccuracy in manually measured adult respiratory rate (RR) data and quantify their effects. DESIGN Quantitative systematic review with meta-analyses where appropriate. DATA SOURCES Medline, CINAHL, and Cochrane Library (from database inception to 31 July 2019). REVIEW METHODS Studies presenting data on individual sources of inaccuracy in the manual measurement of adult RR were analysed, assessed for quality, and grouped according to the source of inaccuracy investigated. Quantitative data were extracted and synthesized and meta-analyses performed where appropriate. RESULTS Included studies (N = 49) identified five sources of inaccuracy. The awareness effect creates an artefactual reduction in actual RR, and observation methods involving shorter counts cause systematic underscoring. Individual RR measurements can differ substantially in either direction between observations due to inter- or intra-observer variability. Value bias, where particular RRs are over-represented (suggesting estimation), is a widespread problem. Recording omission is also widespread, with higher average rates in inpatient versus triage/admission contexts. CONCLUSION This review demonstrates that manually measured RR data are subject to several potential sources of inaccuracy. IMPACT RR is an important indicator of clinical deterioration and commonly included in track-and-trigger systems. However, the usefulness of RR data depends on the accuracy of the observations and documentation, which are subject to five potential sources of inaccuracy identified in this review. A single measurement may be affected by several factors. Hence, clinicians should interpret recorded RR data cautiously unless systems are in place to ensure its accuracy. For nurses, this includes counting rather than estimating RRs, employing 60-s counts whenever possible, ensuring patients are unaware that their RR is being measured, and documenting the resulting value. For any given site, interventions to improve measurement should take into account the local organizational and cultural context, available resources, and the specific measurement issues that need to be addressed.
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Affiliation(s)
- Noa Kallioinen
- School of PsychologyThe University of QueenslandSt LuciaQLDAustralia
- Institute of Cognitive ScienceOsnabrück UniversityOsnabrückGermany
| | - Andrew Hill
- School of PsychologyThe University of QueenslandSt LuciaQLDAustralia
- Clinical Skills Development ServiceMetro North Hospital and Health ServiceHerstonQLDAustralia
- Minerals Industry Safety and Health CentreSustainable Minerals InstituteThe University of QueenslandSt LuciaQueenslandAustralia
| | - Melany J. Christofidis
- School of PsychologyThe University of QueenslandSt LuciaQLDAustralia
- Queensland Children’s HospitalChildren’s Health QueenslandSouth BrisbaneQLDAustralia
| | - Mark S. Horswill
- School of PsychologyThe University of QueenslandSt LuciaQLDAustralia
| | - Marcus O. Watson
- School of PsychologyThe University of QueenslandSt LuciaQLDAustralia
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115
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Caetano GM, Daniel ACQG, Costa BCP, Veiga EV. ELABORATION AND VALIDATION OF AN EDUCATIONAL VIDEO ON BLOOD PRESSURE MEASUREMENT IN SCREENING PROGRAMS. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to produce and validate an educational video on the procedure of indirect blood pressure measurement with the oscillometric technique to support actions of blood pressure screening programs in Brazil. Method: a methodological study consisting in three stages: 1) pre-production of a script/storyboard; 2) content validation by a committee of 16 experts recruited according to their degrees and training in the area of interest of the study; and 3) final production, recording and edition of the educational video. For data collection, three validated instruments were used that allowed the video to be assessed as to its functionality, usability, efficiency, relevance, verbal language, audiovisual technique, environment, content and proposed objectives. The analysis of the quantitative variables was performed by calculating absolute and relative frequencies, and the categorical variables were measured using means and standard deviations. Items that obtained a CVI > 0.75 were considered valid. Results: script validation was performed by eight experts and obtained a CVI of 0.93, while the technical assessment of the educational video and storyboard was performed by three experts and obtained a CVI of 0.97. After accepting the experts' suggestions, the educational video was produced and validated by eight experts, who considered the material valid for application (CVI = 0.94). Conclusion: the educational video produced and validated in this study was characterized as an appropriate strategy for teaching the indirect measurement of blood pressure with the oscillometric technique among health professionals who volunteer to participate in blood pressure screening programs in Brazil.
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116
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Elias MF, Goodell AL. Human Errors in Automated Office Blood Pressure Measurement: Still Room for Improvement. Hypertension 2020; 77:6-15. [PMID: 33296246 DOI: 10.1161/hypertensionaha.120.16164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this review of the literature and commentary, we examine the literature on automated blood pressure (BP) measurements in the office and clinic. Our purpose is to revisit issues as to the pros and cons of automated BP measurement published in Hypertension in June 2020 and to identify areas needing additional research. Despite initial reservations about automated BP, it is here to stay. A number of experts suggest that human error will be reduced when we move from the more complex skills required by aneroid sphygmomanometer measurement to the fewer skills and steps required by automated BP measurement. Our review indicates there is still need for reduction in errors in automated BP assessment, for example, retraining programs and monitoring of assessment procedures. We need more research on the following questions: (1) which classes of health care providers are least likely to measure BP accurately, usually by ignoring necessary steps; (2) how accurate is BP assessment by affiliated health care providers for example the dental office, the optometrist; and (3) why do some dedicated and well-informed health care professionals fail to follow simple directions for automated BP measurement? We offer additional solutions for improving automated BP assessment in the office and clinic.
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Affiliation(s)
- Merrill F Elias
- Department of Psychology (M.F.E., A.L.G.), The University of Maine, Orono.,Graduate School of Biomedical Science and Engineering (M.F.E.), The University of Maine, Orono
| | - Amanda L Goodell
- Department of Psychology (M.F.E., A.L.G.), The University of Maine, Orono
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117
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Sudharsanan N, Chen S, Garber M, Bärnighausen T, Geldsetzer P. The Effect Of Home-Based Hypertension Screening On Blood Pressure Change Over Time In South Africa. Health Aff (Millwood) 2020; 39:124-132. [PMID: 31905068 DOI: 10.1377/hlthaff.2019.00585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
There is considerable policy interest in home-based screening campaigns for hypertension in many low- and middle-income countries. However, it is unclear whether such efforts will result in long-term population-level blood pressure improvements without more comprehensive interventions that strengthen the entire hypertension care continuum. Using multiple waves of the South African National Income Dynamics Study and the regression discontinuity design, we evaluated the impact of home-based hypertension screening on two-year change in blood pressure. We found that the home-based screening intervention resulted in important reductions in systolic blood pressure for women and younger men. We did not find evidence of an effect on systolic blood pressure for older men or on diastolic blood pressure for either sex. Our results suggest that home-based hypertension screening may be a promising strategy for reducing high blood pressure in low- and middle-income countries, but additional research and policy efforts are needed to ensure that such strategies have maximum reach and impact.
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Affiliation(s)
- Nikkil Sudharsanan
- Nikkil Sudharsanan ( nikkil. sudharsanan@uni-heidelberg. de ) is lead of the Population Health and Development research group at the Heidelberg Institute of Global Health, Heidelberg University, in Germany
| | - Simiao Chen
- Simiao Chen is head of the research unit, Health and Population Economics, Heidelberg Institute of Global Health, Heidelberg University
| | - Michael Garber
- Michael Garber is a PhD candidate in the Department of Epidemiology, Rollins School of Public Health, Emory University, in Atlanta, Georgia
| | - Till Bärnighausen
- Till Bärnighausen is the Alexander von Humboldt University Professor and director of the Heidelberg Institute of Global Health, Heidelberg University. He is also senior faculty at the Africa Health Research Institute, in Somkhele, South Africa, and an adjunct professor of global health at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Pascal Geldsetzer
- Pascal Geldsetzer is an instructor in the Division of Primary Care and Population Health, Department of Medicine, Stanford University, in California
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118
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Bird K, Chan G, Lu H, Greeff H, Allen J, Abbott D, Menon C, Lovell NH, Howard N, Chan WS, Fletcher RR, Alian A, Ward R, Elgendi M. Assessment of Hypertension Using Clinical Electrocardiogram Features: A First-Ever Review. Front Med (Lausanne) 2020; 7:583331. [PMID: 33344473 PMCID: PMC7746856 DOI: 10.3389/fmed.2020.583331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/16/2020] [Indexed: 12/31/2022] Open
Abstract
Hypertension affects an estimated 1.4 billion people and is a major cause of morbidity and mortality worldwide. Early diagnosis and intervention can potentially decrease cardiovascular events later in life. However, blood pressure (BP) measurements take time and require training for health care professionals. The measurements are also inconvenient for patients to access, numerous daily variables affect BP values, and only a few BP readings can be collected per session. This leads to an unmet need for an accurate, 24-h continuous, and portable BP measurement system. Electrocardiograms (ECGs) have been considered as an alternative way to measure BP and may meet this need. This review summarizes the literature published from January 1, 2010, to January 1, 2020, on the use of only ECG wave morphology to monitor BP or identify hypertension. From 35 articles analyzed (9 of those with no listed comorbidities and confounders), the P wave, QTc intervals and TpTe intervals may be promising for this purpose. Unfortunately, with the limited number of articles and the variety of participant populations, we are unable to make conclusions about the effectiveness of ECG-only BP monitoring. We provide 13 recommendations for future ECG-only BP monitoring studies and highlight the limited findings in pregnant and pediatric populations. With the advent of convenient and portable ECG signal recording in smart devices and wearables such as watches, understanding how to apply ECG-only findings to identify hypertension early is crucial to improving health outcomes worldwide.
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Affiliation(s)
- Kathleen Bird
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gabriel Chan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Huiqi Lu
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Heloise Greeff
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - John Allen
- Research Center for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Derek Abbott
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia.,Center for Biomedical Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Carlo Menon
- School of Mechatronic Systems Engineering, Simon Fraser University, Burnaby, BC, Canada
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, NSW, Australia
| | - Newton Howard
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Wee-Shian Chan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Ribon Fletcher
- D-Lab, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States
| | - Aymen Alian
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Rabab Ward
- School of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Mohamed Elgendi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,School of Mechatronic Systems Engineering, Simon Fraser University, Burnaby, BC, Canada.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.,School of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada.,BC Children's & Women's Hospital, Vancouver, BC, Canada
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119
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Gerasimidi-Vazeou A, Birkebaek NH, Iotova V, Cherubini V, Piccini B, Biester T, Stipancic G, Jefferies C, Maffeis C, Stergiou GS. Blood pressure measurement methodology and technology in the SWEET diabetes centers: An international SWEET database survey. Pediatr Diabetes 2020; 21:1537-1545. [PMID: 32902910 DOI: 10.1111/pedi.13114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/28/2020] [Accepted: 08/28/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The accuracy of blood pressure (BP) measurement is a prerequisite for the reliable diagnosis and management of hypertension. OBJECTIVES This survey evaluated the use of office and out-of-office BP measurements and the antihypertensive pharmacological treatment in expert pediatric diabetes centers. METHODS A questionnaire was distributed in 78 reference pediatric diabetes centers of the SWEET international consortium. The methodology, devices, indications, and interpretation of office BP measurements (OBPM), 24-hour ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM), and the preference for antihypertensive drug treatment was assessed. A grading score was developed to evaluate centers for overall BP measurement performance. RESULTS Fifty-two centers responded. The average score for OBPM methodology was 72.5%, for technology 77.5% and the overall center score was 74.75%.The majority of the centers used appropriate methodology and technology, however, there was heterogeneity among them. Manual auscultatory or automated devices specifically validated for children were used by 26/52 centers. ABPM was recommended by 35/52 centers (27/35 had health insurance coverage) and HBPM by 18/52 centers. The BP measurement methodology and devices used for ABPM and HBPM were frequently inadequate. Angiotensin converting enzyme inhibitors were the most frequently prescribed drugs for treating hypertension. CONCLUSIONS The majority of SWEET pediatric diabetes centers use adequate methodology and devices for BP measurement. ABPM is recommended by two thirds of the centers, whereas HBPM is less widely used. Further improvement in the quality of office and out-of-office BP measurements and harmonization among centers is necessary according to current guidelines.
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Affiliation(s)
| | - Niels H Birkebaek
- Department of Pediatrics and Steno Diabetes Center Aarhus, Aarhus Universitetshospital, Aarhus, Denmark
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, Varna, Bulgaria
| | - Valentino Cherubini
- Department of Women's and Children's Health Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, G. Salesi Children's Hospital, Ancona, Italy
| | - Barbara Piccini
- Diabetology Unit, Fl, Meyer Children's Hospital, Florence, Italy
| | - Torben Biester
- Diabetes Center for Children and Adolescents, Children's Hospital, AUF DER BULT, Hannover, Germany
| | - Gordana Stipancic
- Department of Pediatrics, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia
| | | | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit,University of Verona, University City Hospital, Verona, Italy
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Farahani S, Farahani I, Burckhardt BB, Schwender H, Laeer S. Self-Instruction Video Versus Face-to-Face Instruction of Pharmacy Students' Skills in Blood Pressure Measurement. PHARMACY 2020; 8:pharmacy8040217. [PMID: 33207585 PMCID: PMC7711835 DOI: 10.3390/pharmacy8040217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/07/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023] Open
Abstract
A modern approach to clinical skill education is the use of educational videos, yet there is a shortage of literature investigating the effect of self-instruction videos (SIVs) in pharmacy students. Therefore, our objective was to investigate whether an SIV is non-inferior compared to face-to-face instruction (FTFI) in acquiring blood pressure measurement skills. The participants in this randomized controlled study were pharmacy students. The control group was taught by FTFI, while the intervention group watched an SIV. Before and after the instruction, the participants' performance was assessed by an objective structured clinical examination (OSCE). The participants completed a self-assessment survey before each OSCE session. Moreover, the participants' perception and satisfaction were assessed using another survey. The OSCE score and self-assessment score increased significantly from pre- to post-instruction in both groups. The SIV was non-inferior compared to FTFI in terms of the OSCE score, considering a predefined non-inferiority margin of -10%. The participants' self-assessment yielded inconclusive results for non-inferiority. Both instructional approaches were well received. Considering our findings, SIVs might be a valuable option for teaching pharmacy students' blood pressure measurement skills. However, depending on the skill intended to be taught, a combination of an instructional video with instructor-led teaching may be necessary.
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Affiliation(s)
- Samieh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
- Correspondence:
| | - Imaneh Farahani
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
| | - Bjoern B. Burckhardt
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
| | - Holger Schwender
- Mathematical Institute, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany;
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (I.F.); (B.B.B.); (S.L.)
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121
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Alfian SD, van Boven JFM, Abdulah R, Sukandar H, Denig P, Hak E. Effectiveness of a targeted and tailored pharmacist-led intervention to improve adherence to antihypertensive drugs among patients with type 2 diabetes in Indonesia: A cluster randomised controlled trial. Br J Clin Pharmacol 2020; 87:2032-2042. [PMID: 33085801 PMCID: PMC8056734 DOI: 10.1111/bcp.14610] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 01/31/2023] Open
Abstract
Aim To assess the effects of a targeted and tailored pharmacist‐led intervention among patients with type 2 diabetes (T2DM) who are nonadherent to antihypertensive drugs. Methods A cluster‐randomised controlled trial was conducted in 10 community health centres (CHCs) in Indonesia among T2DM patients aged ≥18 years who reported nonadherence to antihypertensive drugs according to the Medication Adherence Report Scale (MARS‐5). Patients in CHCs randomised to the intervention group received a tailored intervention based on their adherence barriers (eg, forgetfulness, lack of knowledge, lack of motivation and/or other drug‐related problems) using a simple question‐based flowchart at baseline and 1‐month follow‐up. Patients in control CHCs received usual care. Primary outcome was the between‐group difference in change in MARS‐5 score from baseline to 3‐month follow‐up. Secondary outcomes included changes in patients' blood pressure and their medication beliefs. Differences in difference in primary and secondary outcomes between groups were assessed using general linear models. Results In total, 201 patients were screened for eligibility, 113 met the inclusion criteria and participated, and 89 (79%) patients had complete follow‐up. Forgetfulness (42%) and lack of knowledge (18%) were the most common adherence barriers identified at baseline. The intervention improved medication adherence by 4.62 points on the MARS‐5 scale (95% CI 0.93 to 8.34, P value = 0.008). There were no significant changes in blood pressure levels and beliefs about antihypertensive drugs. Conclusion A tailored low‐cost pharmacist‐led intervention aimed at nonadherent T2DM patients resulted in an improvement in medication adherence to antihypertensive drugs. There were no significant changes in secondary outcomes.
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Affiliation(s)
- Sofa D Alfian
- University of Groningen, Groningen Research Institute of Pharmacy, Unit Pharmaco-Therapy, -Epidemiology & -Economics, Groningen, the Netherlands.,Universitas Padjadjaran, Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Jatinangor, Indonesia.,Universitas Padjadjaran, Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Jatinangor, Indonesia
| | - Job F M van Boven
- University of Groningen, University Medical Centre Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.,Medication Adherence Expertise Centre Of the northern Netherlands (MAECON), Groningen, the Netherlands
| | - Rizky Abdulah
- Universitas Padjadjaran, Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Jatinangor, Indonesia.,Universitas Padjadjaran, Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Jatinangor, Indonesia
| | - Hadyana Sukandar
- Universitas Padjadjaran, Faculty of Medicine, Department of Public Health, Bandung, Indonesia
| | - Petra Denig
- University of Groningen, University Medical Centre Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, the Netherlands.,Medication Adherence Expertise Centre Of the northern Netherlands (MAECON), Groningen, the Netherlands
| | - Eelko Hak
- University of Groningen, Groningen Research Institute of Pharmacy, Unit Pharmaco-Therapy, -Epidemiology & -Economics, Groningen, the Netherlands.,Medication Adherence Expertise Centre Of the northern Netherlands (MAECON), Groningen, the Netherlands
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122
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Zasler N, Haider MN, Grzibowski NR, Leddy JJ. Physician Medical Assessment in a Multidisciplinary Concussion Clinic. J Head Trauma Rehabil 2020; 34:409-418. [PMID: 31479079 PMCID: PMC7096076 DOI: 10.1097/htr.0000000000000524] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Concussive brain injury (CBI) is encountered by clinicians in sports medicine, pediatrics, neurosurgery, neurology, physiatry, and primary care. There is no gold standard diagnostic test for CBI, nor is there consensus on what neuromusculoskeletal physical examination tests should be performed on patients who have sustained CBI. This article presents an approach to the history and physical examination of the patient who has sustained a CBI that is based on a review of the literature evidence and the authors' extensive experience with this patient population. Suggested components include an elemental neurological examination that emphasizes the oculomotor/ophthalmologic and vestibular systems, as well as appropriate musculoskeletal assessment of the craniocervical and upper shoulder girdle complex. The use of supplementary tests for CBI, including assessment of exercise tolerance using the Buffalo Concussion Treadmill Test and tests of neurocognitive function, can aid in the differential diagnosis of CBI. The proposed protocol is envisioned for initial and follow-up assessments in the clinic after CBI, as well as for those with more protracted signs or symptoms. If symptoms persist beyond 2 weeks in adults or 4 weeks in adolescents, then referral to a multidisciplinary center that focuses on CBI is recommended.
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Affiliation(s)
- Nathan Zasler
- Concussion Care Centre of Virginia, Ltd, Richmond (Dr Zasler); Tree of Life Services, Inc, Richmond, Virginia (Dr Zasler); Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond (Dr Zasler); UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo (Drs Haider and Leddy); and Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo (Dr Haider and Mr Grzibowski)
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Knowledge, perception and practice of health professionals regarding blood pressure measurement methods: a scoping review. J Hypertens 2020; 39:391-399. [PMID: 33031184 DOI: 10.1097/hjh.0000000000002663] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Guideline-concordant performance of accurate blood pressure measurement (BPM), whether the modality is home (HBPM), ambulatory (ABPM), automated (AOBP) or office (OBPM), is dependent on proper technique. Knowledge, perception and practice of health professionals for BPM is crucial and has been partly studied, but a thorough review has never been reported. A scoping review of global studies was conducted to synthesize published data on this topic. METHODS An Arksey and O'Malley methodological framework was used. Keywords were identified and extraction was completed to April 2019 using CINAHL and MEDLINE. Studies were classified as positive for knowledge, perception and practice if the majority (>50%) of reported responses were favourable, and negative otherwise. If specific results were not reported, the author's conclusions were used to classified. RESULTS Seventy-two studies were identified: 25 HBPM, 14 ABPM, two AOBP, 40 OBPM. For knowledge, the percentage of negative studies were higher for HBPM (40%) and OBPM (68%) and lower for ABPM (14%) regarding BPM techniques. For perception, the number of negative studies were lower for HBPM (20%) and ABPM (7%) regarding usefulness of BPM methods in hypertension management. For practice, the number of negative studies were higher for HBPM (48%), ABPM (71%), OBPM (73%) and AOBP (50%) regarding implementation of hypertension guidelines. CONCLUSION The results of this scoping review demonstrate adequate perception of BPM but suboptimal knowledge and practice. Education is still needed to improve knowledge and practice. Future efforts should focus on improving what we know and what we do when measuring BP.
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Picone DS, Padwal R, Campbell NRC, Boutouyrie P, Brady TM, Olsen MH, Delles C, Lombardi C, Mahmud A, Meng Y, Mokwatsi GG, Ordunez P, Phan HT, Pucci G, Schutte AE, Sung KC, Zhang XH, Sharman JE. How to check whether a blood pressure monitor has been properly validated for accuracy. J Clin Hypertens (Greenwich) 2020; 22:2167-2174. [PMID: 33017506 DOI: 10.1111/jch.14065] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Abstract
Hypertension guidelines recommend that blood pressure (BP) should be measured using a monitor that has passed validation testing for accuracy. BP monitors that have not undergone rigorous validation testing can still be cleared by regulatory authorities for marketing and sale. This is the situation for most BP monitors worldwide. Thus, consumers (patients, health professionals, procurement officers, and general public) may unwittingly purchase BP monitors that are non-validated and more likely to be inaccurate. Without prior knowledge of these issues, it is extremely difficult for consumers to distinguish validated from non-validated BP monitors. For the above reasons, the aim of this paper is to provide consumers guidance on how to check whether a BP monitor has been properly validated for accuracy. The process involves making an online search of listings of BP monitors that have been assessed for validation status. Only those monitors that have been properly validated are recommended for BP measurement. There are numerous different online listings of BP monitors, several are country-specific and two are general (international) listings. Because monitors can be marketed using alternative model names in different countries, if a monitor is not found on one listing, it may be worthwhile cross-checking with a different listing. This information is widely relevant to anyone seeking to purchase a home, clinic, or ambulatory BP monitor, including individual consumers for use personally or policy makers and those procuring monitors for use in healthcare systems, and retailers looking to stock only validated BP monitors.
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Affiliation(s)
- Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Pierre Boutouyrie
- Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, Université de Paris, Paris, France
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbaek, Denmark.,Centre for Individualized Medicine in Arterial Diseases, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Azra Mahmud
- King Abdul Aziz Cardiac Center, King Abdul Aziz Medical City, Riyadh, Saudi Arabia.,National Guard Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center & King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaxing Meng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Gontse G Mokwatsi
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Hoang T Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Pham Ngoc, Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Giacomo Pucci
- Unit of Internal Medicine at Terni University Hospital, Department of Medicine, University of Perugia, Perugia, Italy
| | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.,School of Public Health and Community Medicine, University of New South Wales, The George Institute for Global Health, Sydney, Australia
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Campbell NRC, Khalsa T, Ordunez P, Rodriguez Morales YA, Zhang X, Parati G, Padwal R, Tsuyuki RT, Cloutier L, Sharman JE. Brief online certification course for measuring blood pressure with an automated blood pressure device. A free new resource to support World Hypertension Day Oct 17, 2020. J Clin Hypertens (Greenwich) 2020; 22:1754-1756. [PMID: 32882074 PMCID: PMC8029906 DOI: 10.1111/jch.14017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/21/2020] [Accepted: 08/07/2020] [Indexed: 11/28/2022]
Abstract
Detection, diagnosis, and treatment of hypertension require accurate blood pressure assessment. However, in clinical practice, lack of training in or nonadherence to measurement recommendations, lack of patient preparation, unsuitable environments where blood pressure is measured, and inaccurate and inappropriate equipment are widespread and commonly lead to inaccurate blood pressure readings. This has led to calls to require regular training and certification for people assessing blood pressure. Hence, the Pan American Health Organization in collaboration with Resolve to Save Lives, the World Hypertension League, Lancet Commission on Hypertension Group, and Hypertension Canada has developed a free brief training and certification course in blood pressure measurement. The course is available at www. The release of the online certification course is timed to help support World Hypertension Day. This year World Hypertension Day has been delayed to October 17 due to the COVID-19 pandemic. For 2020, the World Hypertension League calls on all health care professionals, health care professional organizations, and indeed all of society, to assess the blood pressure of all adults, measure blood pressure accurately, and achieve blood pressure control in those with hypertension.
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Affiliation(s)
| | | | - Pedro Ordunez
- Department of Non‐Communicable Diseases and Mental HealthPan American Health OrganizationWashingtonDCUSA
| | - Yenny A. Rodriguez Morales
- Department of Non‐Communicable Diseases and Mental HealthPan American Health OrganizationWashingtonDCUSA
| | | | - Gianfranco Parati
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Department of Cardiovascular, Neural and Metabolic SciencesIstituto Auxologico ItalianoIRCCSItaly
| | - Raj Padwal
- Department of MedicineUniversity of AlbertaEdmontonABCanada
| | - Ross T. Tsuyuki
- Departments of Pharmacology and Medicine (Cardiology)Faculty of Medicine and DentistryUniversity of AlbertaEdmontonABCanada
| | | | - James E. Sharman
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasAustralia
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126
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Albuquerque NLS, Padwal R, Araujo TL. Overview of blood pressure measurement by Brazilian health professionals. J Clin Hypertens (Greenwich) 2020; 22:1941-1944. [PMID: 32815660 PMCID: PMC8029905 DOI: 10.1111/jch.14010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022]
Abstract
Although automated monitors for blood pressure (BP) measurement are used increasingly worldwide, understanding of how such devices are used in Brazil is low. This study analyzed the status of BP measurement by Brazilian health professionals. A questionnaire regarding experience with BP measurement was sent electronically to Brazilian nurses, nursing assistants, and doctors. It had 2004 responses. Previous experience with use of automated monitors was most frequent in men (71.2%), nursing technicians (65.5%), specialists (61.1%), secondary care (71.9%), emergency care (70.6%), or the private sector (66.3%). The least complied aspects of the standardized measurement protocol were availability of various cuff sizes (53.9% and 72.9% for auscultatory and oscillometric methods, respectively) and proper calibration checks (21.5% and 46.8% for auscultatory and oscillometric methods, respectively). Brazilian health professionals report not adequately performing all the necessary aspects to measure BP in accordance with the standardized protocol in both methods, but mainly regarding the oscillometric.
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Affiliation(s)
| | - Raj Padwal
- Department of MedicineUniversity of AlbertaEdmontonABCanada
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127
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Strauss M, Leischik R, Jehn U, Padberg JS, Pistulli R, Kümpers P, Reinecke H. [The hypertensive emergency situation : Recommendations for initial drug therapy management]. Med Klin Intensivmed Notfmed 2020; 117:41-48. [PMID: 32940723 DOI: 10.1007/s00063-020-00728-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The hypertensive emergency situation is characterized by an acute-mostly life-threatening-blood pressure derailment with the risk of acute end organ damage. It is an acute manifestation of arterial hypertension, which manifests in a variety of symptoms. The etiology is in most cases long-term (chronic) hypertension as a result of low compliance or inadequate antihypertensive therapy. It can also occur as a first manifestation of arterial hypertension. It requires timely antihypertensive drug therapy, which should be initiated in an intensive or intermediate care unit. The choice of antihypertensive therapy regimen should be based on the underlying end organ damage. Fast-acting, easily controllable and intravenously administered substances should be preferred. The most commonly used substances (groups) are urapidil, nitroglycerin, beta blockers and short-acting calcium channel blockers. With a few exceptions, a deliberate, rapid reduction in blood pressure of no more than 20-25% of the initial value is sufficient for extracerebral causes. A subsequent systolic blood pressure target of 160/100 mm Hg should be aimed for within the next 2-6 h. An overly rapid drop in blood pressure can lead to reduced blood flow to the central nervous system due to changes in autoregulation. Exceptions to this rule are acute aortic dissection and flash pulmonary edema-in these cases, prompt blood pressure normalization should be achieved. The initial acute therapy should be followed by a more detailed investigation of the cause and a long-term therapy setting based on this.
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Affiliation(s)
- M Strauss
- Klinik für Kardiologie I: Koronare Herzerkrankung, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland. .,Klinik für Kardiologie, Lehrbereich Prävention und Gesundheitsförderung, Fakultät für Gesundheit, Universität Witten/Herdecke, Hagen, Deutschland.
| | - R Leischik
- Klinik für Kardiologie, Lehrbereich Prävention und Gesundheitsförderung, Fakultät für Gesundheit, Universität Witten/Herdecke, Hagen, Deutschland
| | - U Jehn
- Medizinische Klinik D, Allgemeine Innere Medizin und Notaufnahme sowie Nieren- und Hochdruckkrankheiten und Rheumatologie, Universitätsklinikum Münster, Münster, Deutschland
| | - J-S Padberg
- Klinik für Kardiologie I: Koronare Herzerkrankung, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - R Pistulli
- Klinik für Kardiologie I: Koronare Herzerkrankung, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - P Kümpers
- Medizinische Klinik D, Allgemeine Innere Medizin und Notaufnahme sowie Nieren- und Hochdruckkrankheiten und Rheumatologie, Universitätsklinikum Münster, Münster, Deutschland
| | - H Reinecke
- Klinik für Kardiologie I: Koronare Herzerkrankung, Herzinsuffizienz und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
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Shalfawi SAI. Bayesian Estimation of Correlation between Measures of Blood Pressure Indices, Aerobic Capacity and Resting Heart Rate Variability Using Markov Chain Monte Carlo Simulation and 95% High Density Interval in Female School Teachers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186750. [PMID: 32947985 PMCID: PMC7558932 DOI: 10.3390/ijerph17186750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/05/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022]
Abstract
Background: Several explanations regarding the disparity observed in the literature with regard to heart rate variability (HRV) and its association with performance parameters have been proposed: the time of day when the recording was conducted, the condition (i.e., rest, active, post activity) and the mathematical and physiological relationships that could have influenced the results. A notable observation about early studies is that they all followed the frequentist approach to data analyses. Therefore, in an attempt to explain the disparity observed in the literature, the primary purpose of this study was to estimate the association between measures of HRV indices, aerobic performance parameters and blood pressure indices using the Bayesian estimation of correlation on simulated data using Markov Chain Monte Carlo (MCMC) and the equal probability of the 95% high density interval (95% HDI). Methods: The within-subjects with a one-group pretest experimental design was chosen to investigate the relationship between baseline measures of HRV (rest; independent variable), myocardial work (rate–pressure product (RPP)), mean arterial pressure (MAP) and aerobic performance parameters. The study participants were eight local female schoolteachers aged 54.1 ± 6.5 years (mean ± SD), with a body mass of 70.6 ± 11.5 kg and a height of 164.5 ± 6.5 cm. Their HRV data were analyzed in R package, and the Bayesian estimation of correlation was calculated employing the Bayesian hierarchical model that uses MCMC simulation integrated in the JAGS package. Results: The Bayesian estimation of correlation using MCMC simulation reproduced and supported the findings reported regarding norms and the within-HRV-indices associations. The results of the Bayesian estimation showed a possible association (regardless of the strength) between pNN50% and MAP (rho = 0.671; 95% HDI = 0.928–0.004), MeanRR (ms) and RPP (rho = −0.68; 95% HDI = −0.064–−0.935), SDNN (ms) and RPP (rho = 0.672; 95% HDI = 0.918–0.001), LF (ms2) and RPP (rho = 0.733; 95% HDI = 0.935–0.118) and SD2 and RPP (rho = 0.692; 95% HDI = 0.939–0.055). Conclusions: The Bayesian estimation of correlation with 95% HDI on MCMC simulated data is a new technique for data analysis in sport science and seems to provide a more robust approach to allocating credibility through a meaningful mathematical model. However, the 95% HDI found in this study, accompanied by the theoretical explanations regarding the dynamics between the parasympathetic nervous system and the sympathetic nervous system in relation to different recording conditions (supine, reactivation, rest), recording systems, time of day (morning, evening, sleep etc.) and age of participants, suggests that the association between measures of HRV indices and aerobic performance parameters has yet to be explicated.
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Affiliation(s)
- Shaher A I Shalfawi
- Department of Education and Sports Science, University of Stavanger, 4036 Stavanger, Norway
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129
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Kadowaki S, Kadowaki T, Hozawa A, Fujiyoshi A, Hisamatsu T, Satoh A, Arima H, Tanaka S, Torii S, Kondo K, Kadota A, Masaki K, Okamura T, Ohkubo T, Miura K, Ueshima H. Differences between home blood pressure and strictly measured office blood pressure and their determinants in Japanese men. Hypertens Res 2020; 44:80-87. [PMID: 32863384 DOI: 10.1038/s41440-020-00533-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
Conventional office blood pressure (OBP) and home blood pressure (HBP) measurements are often inconsistent. The purpose of this research was (1) to test whether strictly measured OBP values with sufficient rest time before measurement (st-OBP) is comparable to HBP at the population level and (2) to ascertain whether there are particular determinants for the difference between HBP and st-OBP at the individual level. Data from a population-based group of 1056 men aged 40-79 years were analyzed. After a five-min rest, st-OBP was measured twice. HBP was measured after a 2-min rest every morning for seven consecutive days. To determine factors related to ΔSBP (HBP minus st-OBP measurements), multiple linear regression analyses and analyses of covariance were performed. While st-OBP and HBP were comparable (136.5 vs. 137.2 mmHg) at the population level, ΔSBP varied with a standard deviation of 13.5 mmHg. Smoking was associated with a larger ΔSBP regardless of antihypertensive usage, and BMI was associated with a larger ΔSBP in participants using antihypertensive drugs. The adjusted mean ΔSBP in the highest BMI tertile category was 4.6 mmHg in participants taking antihypertensive drugs. st-OBP and HBP measurements were comparable at the population level, although the distribution of ΔSBP was considerably broad. Smokers and obese men taking antihypertensive drugs had higher HBP than st-OBP, indicating that their blood pressure levels are at risk of being underestimated. Therefore, this group would benefit from the addition of HBP measurements.
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Affiliation(s)
- Sayaka Kadowaki
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan.
| | - Takashi Kadowaki
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Atsushi Hozawa
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Miyagi, Japan
| | - Akira Fujiyoshi
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Takashi Hisamatsu
- Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsushi Satoh
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Sachiko Tanaka
- Department of Biostatistics, Shiga University of Medical Science, Shiga, Japan
| | - Sayuki Torii
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
| | - Kamal Masaki
- Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawaii Manoa, Honolulu, HI, USA
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
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Mahmoud K, ElAroussy A, Baghdady Y, ElAroussy W, ElDeeb H. The use of automated sequential blood pressure in hypertension clinics compared with office and ambulatory blood pressure measurements. Egypt Heart J 2020; 72:50. [PMID: 32804322 PMCID: PMC7430128 DOI: 10.1186/s43044-020-00087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Office blood pressure (OBP) measurement is the most common method of blood pressure measurement. However, it is associated with several pitfalls as white coat effect and masked hypertension. Ambulatory blood pressure monitoring (ABPM) is usually used for diagnosis of hypertension and elimination of white coat effect. This study aimed to assess the correlation and degree of agreement of the automated sequential blood pressure (ASqBP) with OBP and ABPM. Patients presented to hypertension clinic were included. Each patient had his blood pressure recorded by three methods: OBP using a digital sphygmomanometer device, unattended ASqBP using sequential BP devices with recording of the readings over 30 min, and ABPM that was performed within 48 h of office visit using portable BP devices with BP recording over 24 h. RESULTS We recruited 64 patients (age 50.0 ± 15.0 years and female gender 53.1%). We found a strong positive correlation between ASqBP and OBP readings (r 0.81 for SBP and 0.83 for DBP, p < 0.001). We also found a strong positive correlation between ASqBP and ABPM readings (r 0.74, p < 0.001). The ASqBP readings were lower than OBP (137.0 ± 16.8/86.4 ± 13.8 vs. 142.7 ± 15.5/88.5 ± 12.3) and close to ABPM readings (average 24 h, 134.0 ± 15.4/88.5 ± 12.3, and daytime, 135.8 ± 15.7/82.1 ± 13.7). For SBP readings, there was moderate agreement between ASqBP and AMBP (both average and daytime). For DBP readings, there was fair agreement between ASqBP and AMBP (both average and daytime). CONCLUSION ASqBP measurement has good correlation with OBP and ABPM readings. Unattended automated office pressure has moderate degree of agreement with ABPM for the SBP& fair degree of agreement for the DBP. It can be used in the hypertension clinics to eliminate the problems of white coat effect and marked BP variability.
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131
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Is there something up your sleeve? J Hypertens 2020; 38:1699-1700. [PMID: 32769684 DOI: 10.1097/hjh.0000000000002475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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132
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Burger PM, Monpellier VM, Deden LN, Kooiman LBR, Liem RSL, Hazebroek EJ, Janssen IMC, Westerink J. Standardized reporting of co-morbidity outcome after bariatric surgery: low compliance with the ASMBS outcome reporting standards despite ease of use. Surg Obes Relat Dis 2020; 16:1673-1682. [PMID: 32859526 DOI: 10.1016/j.soard.2020.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/24/2020] [Accepted: 07/03/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Despite the publication of the American Society for Metabolic and Bariatric Surgery (ASMBS) Outcome Reporting Standards in 2015, there is still a great variety in definitions used for reporting remission of co-morbidities after bariatric surgery. This hampers meaningful comparison of results. OBJECTIVE To assess compliance with the ASMBS standards in current literature, and to evaluate use of the standards by applying them in a report on the outcomes of 5 co-morbidities after bariatric surgery. SETTING Two clinics of the Dutch Obesity Clinic, location Den Haag and Velp, and three affiliated hospitals: Haaglanden Medical Center in Den Haag, Groene Hart Hospital in Gouda, and Vitalys Clinic in Velp. METHODS A systematic search in PubMed was conducted to identify studies using the ASMBS standards. Besides, the standards were applied to a cohort of patients who underwent a primary bariatric procedure between November 2016 and June 2017. Outcomes of co-morbidities were determined at 6 and 12 months after surgery. RESULTS Ten previous studies applying ASMBS definitions were identified by the search, including 6 studies using portions of the definitions, and 4 using complete definitions for 3 co-morbidities or in a small population. In this study, the standards were applied to 1064 patients, of whom 796 patients (75%) underwent Roux-en-Y gastric bypass and 268 patients (25%) underwent sleeve gastrectomy. At 12 months, complete remission of diabetes (glycosylated hemoglobin <6%, off medication) was reached in 63%, partial remission (glycosylated hemoglobin 6%-6.4%, off medication) in 7%, and improvement in 28% of patients (n = 232/248, 94%). Complete remission of hypertension (normotensive, off medication) was noted in 8%, partial remission (prehypertensive, off medication) in 23% and improvement in 63% (n = 397/412, 96%). Remission rate for dyslipidemia (normal nonhigh-density lipoprotein, off medication) was 57% and improvement rate was 19% (n = 129/133, 97%). Resolution of gastroesophageal reflux disease (no symptoms, off medication) was observed in 54% (n = 265/265). Obstructive sleep apnea syndrome improved in 90% (n = 157/169, 93%). CONCLUSIONS Compliance with the ASMBS standards is low, despite ease of use. Standardized definitions provided by the ASMBS guideline could be used in future research to enable comparison of outcomes of different studies and surgical procedures.
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Affiliation(s)
- Pascal M Burger
- Department of Bariatric Surgery, Nederlandse Obesitas Kliniek, Utrecht, the Netherlands; Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Valerie M Monpellier
- Department of Bariatric Surgery, Nederlandse Obesitas Kliniek, Utrecht, the Netherlands
| | - Laura N Deden
- Department of Bariatric Surgery, Vitalys Obesity Center, Velp, the Netherlands
| | - Laurens B R Kooiman
- Department of Bariatric Surgery, Nederlandse Obesitas Kliniek West, Den Haag, the Netherlands
| | - Ronald S L Liem
- Department of Bariatric Surgery, Nederlandse Obesitas Kliniek West, Den Haag, the Netherlands
| | - Eric J Hazebroek
- Department of Bariatric Surgery, Vitalys Obesity Center, Velp, the Netherlands
| | - Ignace M C Janssen
- Department of Bariatric Surgery, Nederlandse Obesitas Kliniek, Utrecht, the Netherlands; Department of Bariatric Surgery, Nederlandse Obesitas Kliniek West, Den Haag, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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Padwal R, Campbell NRC, Schutte AE, Olsen MH, Delles C, Etyang A, Cruickshank JK, Stergiou G, Rakotz MK, Wozniak G, Jaffe MG, Benjamin I, Parati G, Sharman JE. Optimización del desempeño del observador al medir la presión arterial en el consultorio: declaración de posición de la Comisión Lancet de Hipertensión. Rev Panam Salud Publica 2020; 44:e88. [PMID: 32684918 PMCID: PMC7363287 DOI: 10.26633/rpsp.2020.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 03/11/2019] [Indexed: 01/17/2023] Open
Abstract
La hipertensión arterial es una causa modificable muy prevalente de enfermedades cardiovasculares, accidentes cerebrovasculares y muerte. Medir con exactitud la presión arterial es fundamental, dado que un error de medición de 5 mmHg puede ser motivo para clasificar incorrectamente como hipertensas a 84 millones de personas en todo el mundo. En la presente declaración de posición se resumen los procedimientos para optimizar el desempeño del observador al medir la presión arterial en el consultorio, con atención especial a los entornos de ingresos bajos o medianos, donde esta medición se ve complicada por limitaciones de recursos y tiempo, sobrecarga de trabajo y falta de suministro eléctrico. Es posible reducir al mínimo muchos errores de medición con una preparación adecuada de los pacientes y el uso de técnicas estandarizadas. Para simplificar la medición y prevenir errores del observador, deben usarse tensiómetros semiautomáticos o automáticos de manguito validados, en lugar del método por auscultación. Pueden ayudar también la distribución de tareas, la creación de un área específica de medición y el uso de aparatos semiautomáticos o de carga solar. Es fundamental garantizar la capacitación inicial y periódica de los integrantes del equipo de salud. Debe considerarse la implementación de programas de certificación de bajo costo y fácilmente accesibles con el objetivo de mejorar la medición de la presión arterial.
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Affiliation(s)
- Raj Padwal
- Departamento de Medicina, Universidad de Alberta, Edmonton (Canadá)
| | - Norm R. C. Campbell
- Departamento de Medicina, Fisiología y Farmacología y Salud Comunitaria, Instituto O’Brien de Salud Pública e Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Alberta (Canadá)
| | - Aletta E. Schutte
- Equipo de Investigación de la Hipertensión en África (HART), Unidad de Investigación MRC: Hipertensión y Enfermedades Cardiovasculares, Universidad del Noroeste, Potchefstroom (Sudáfrica)
| | - Michael Hecht Olsen
- Departamento de Medicina Interna, Hospital de Holbæk, Dinamarca; y Centro de Medicina Individualizada en Enfermedades Arteriales
(CIMA), Hospital Universitario de Odense, Universidad del Sur de Dinamarca, Odense (Dinamarca)
| | - Christian Delles
- Instituto de Ciencias Cardiovasculares y Médicas, Universidad de Glasgow (Reino Unido)
| | - Anthony Etyang
- Programa de Investigación KEMRI-Fundación Wellcome, Kilifi (Kenya)
| | - J. Kennedy Cruickshank
- Escuela de Ciencias de la Nutrición y del Curso de la Vida, King’s College, Hospitales St. Thomas & Guy, Londres (Reino Unido)
| | - George Stergiou
- Centro de Hipertensión STRIDE-7, Universidad Nacional y Capodistríaca de Atenas, Facultad de Medicina, Departamento de Medicina III, Hospital Sotiria, Atenas (Grecia)
| | - Michael K. Rakotz
- Asociación Médica Estadounidense (AMA), Chicago (Estados Unidos de América)
| | - Gregory Wozniak
- Asociación Médica Estadounidense (AMA), Chicago (Estados Unidos de América)
| | - Marc G. Jaffe
- Iniciativa de Estrategias Vitales “Resolve to Save Lives”, Nueva York (Estados Unidos de América); y Centro Médico Kaiser Permanente de South San Francisco (Estados Unidos de América)
| | - Ivor Benjamin
- Asociación Estadounidense del Corazón (AHA), Centro Cardiovascular, Facultad de Medicina de Wisconsin, Wauwatosa (Estados Unidos de América)
| | - Gianfranco Parati
- Departamento de Medicina y Cirugía, Universidad de Milán-Bicocca, Milán (Italia); e Instituto Auxológico Italiano, IRCCS, Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Hospital S. Luca, Milán (Italia)
| | - James E. Sharman
- Instituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart (Australia)
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Ringrose J, Sridar S. The elegance of simplicity. J Clin Hypertens (Greenwich) 2020; 22:1173-1176. [PMID: 32506641 PMCID: PMC8029699 DOI: 10.1111/jch.13900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Jennifer Ringrose
- Department of MedicineUniversity of AlbertaEdmontonABCanada
- WICHRIEdmontonABCanada
- mmHg Inc.EdmontonABCanada
| | - Sangita Sridar
- Department of MedicineUniversity of AlbertaEdmontonABCanada
- mmHg Inc.EdmontonABCanada
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135
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Optimizing observer performance of clinic blood pressure measurement: a position statement from the Lancet Commission on Hypertension Group. J Hypertens 2020; 37:1737-1745. [PMID: 31034450 PMCID: PMC6686964 DOI: 10.1097/hjh.0000000000002112] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
High blood pressure (BP) is a highly prevalent modifiable cause of cardiovascular disease, stroke, and death. Accurate BP measurement is critical, given that a 5-mmHg measurement error may lead to incorrect hypertension status classification in 84 million individuals worldwide. This position statement summarizes procedures for optimizing observer performance in clinic BP measurement, with special attention given to low-to-middle-income settings, where resource limitations, heavy workloads, time constraints, and lack of electrical power make measurement more challenging. Many measurement errors can be minimized by appropriate patient preparation and standardized techniques. Validated semi-automated/automated upper arm cuff devices should be used instead of auscultation to simplify measurement and prevent observer error. Task sharing, creating a dedicated measurement workstation, and using semi-automated or solar-charged devices may help. Ensuring observer training, and periodic re-training, is critical. Low-cost, easily accessible certification programs should be considered to facilitate best BP measurement practice.
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136
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Monte Carlo simulation of uncertainty to identify barriers to optimizing blood pressure control. J Hypertens 2020; 38:2318-2324. [DOI: 10.1097/hjh.0000000000002546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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137
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Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study. Br J Gen Pract 2020; 70:e472-e480. [PMID: 32366532 DOI: 10.3399/bjgp20x709589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/08/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Systolic inter-arm difference in blood pressure (IAD) and cognitive decline are both associated with cardiovascular disease; therefore, it was hypothesised that IAD may be predictive of cognitive decline. AIM To examine associations of IAD with cognitive decline in a community population. DESIGN AND SETTING A prospective study of older Italian adults enrolled in the InCHIANTI study. METHOD Univariable and multivariable associations of IAD were explored with declines in mini mental state examination (MMSE) scores, Trail Making Test A and B scores, and a composite outcome representing substantial decline in any of these scores. Backward stepwise regression was used to adjust observed associations of IAD with cognitive decline. RESULTS The rate of decline for MMSE scores in 1133 participants was greater with IAD ≥5 mmHg or ≥10 mmHg. On univariable analyses continuous IAD was associated with the composite outcome (odds ratio [OR] 1.16 per 5 mmHg of IAD, 95% confidence interval [CI] = 1.02 to 1.31). Substantial decline in MMSE score was seen with IAD ≥5 mmHg (OR 1.41, 95% CI = 1.03 to 1.93), and in the composite outcome with IAD ≥5 mmHg (OR 1.44, 95% CI = 1.10 to 1.89) or ≥10 mmHg (OR 1.39, 95% CI = 1.03 to 1.88). After multivariable adjustment, an IAD ≥ 5 mmHg remained associated with reductions in the composite outcome, reflecting declining cognitive performance (OR 1.46, 95% CI = 1.05 to 2.03). CONCLUSION An IAD ≥5 mmHg is associated with cognitive decline in a representative older population. Given that systolic inter-arm differences in blood pressure are easily measured, confirmation of these findings could inform individualised treatment for the prevention of cognitive decline and dementia.
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138
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Shimbo D, Artinian NT, Basile JN, Krakoff LR, Margolis KL, Rakotz MK, Wozniak G. Self-Measured Blood Pressure Monitoring at Home: A Joint Policy Statement From the American Heart Association and American Medical Association. Circulation 2020; 142:e42-e63. [PMID: 32567342 DOI: 10.1161/cir.0000000000000803] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The diagnosis and management of hypertension, a common cardiovascular risk factor among the general population, have been based primarily on the measurement of blood pressure (BP) in the office. BP may differ considerably when measured in the office and when measured outside of the office setting, and higher out-of-office BP is associated with increased cardiovascular risk independent of office BP. Self-measured BP monitoring, the measurement of BP by an individual outside of the office at home, is a validated approach for out-of-office BP measurement. Several national and international hypertension guidelines endorse self-measured BP monitoring. Indications include the diagnosis of white-coat hypertension and masked hypertension and the identification of white-coat effect and masked uncontrolled hypertension. Other indications include confirming the diagnosis of resistant hypertension and detecting morning hypertension. Validated self-measured BP monitoring devices that use the oscillometric method are preferred, and a standardized BP measurement and monitoring protocol should be followed. Evidence from meta-analyses of randomized trials indicates that self-measured BP monitoring is associated with a reduction in BP and improved BP control, and the benefits of self-measured BP monitoring are greatest when done along with cointerventions. The addition of self-measured BP monitoring to office BP monitoring is cost-effective compared with office BP monitoring alone or usual care among individuals with high office BP. The use of self-measured BP monitoring is commonly reported by both individuals and providers. Therefore, self-measured BP monitoring has high potential for improving the diagnosis and management of hypertension in the United States. Randomized controlled trials examining the impact of self-measured BP monitoring on cardiovascular outcomes are needed. To adequately address barriers to the implementation of self-measured BP monitoring, financial investment is needed in the following areas: improving education and training of individuals and providers, building health information technology capacity, incorporating self-measured BP readings into clinical performance measures, supporting cointerventions, and enhancing reimbursement.
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139
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Poon SJ, Roumie CL, O'Shea CJ, Fabbri D, R Coco J, Collins SP, D Levy P, McNaughton CD. Association of Elevated Blood Pressure in the Emergency Department With Chronically Elevated Blood Pressure. J Am Heart Assoc 2020; 9:e015985. [PMID: 32508176 PMCID: PMC7429032 DOI: 10.1161/jaha.119.015985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Emergency department (ED) visits for hypertension are rising, but the importance of elevated blood pressure (BP) measured during the ED visit is controversial. We evaluated the relationship between ED BP and mean BP over the subsequent year. Methods and Results We performed a retrospective cohort study from January 1, 2010 to December 31, 2013 of 8105 adult patients who made 1 visit to an academic medical center ED with ≥2 ED BPs and ≥2 BPs measured in the subsequent year. The primary exposure was lowest ED systolic BP. The primary outcome was mean systolic BP ≥140 mm Hg over the year following the index ED visit. Diastolic BP was examined as a secondary exposure and outcome. Multiple logistic regression was performed adjusting for several covariates, with interaction terms for hypertension diagnosis, ED disposition, pain-related ED chief complaint, and sex. Patients whose lowest ED systolic BP was 140 to 159 mm Hg had an adjusted odds ratio of having a mean SBP ≥140 mm Hg in the subsequent year of 10.9 (95% CI, 7.6-15.6). Patients without diagnosed hypertension and ED BP 140/90 to 159/99 mm Hg were more likely to have elevated BP in the following year. Hospitalization increased the likelihood of persistently elevated systolic BP but not diastolic BP. There was no effect modification by pain-related ED complaint. Conclusions When ED BP is consistently elevated, BP is highly likely to remain elevated in the subsequent year, regardless of pain, and particularly among patients without diagnosed hypertension. Further research is needed to determine the optimal management of elevated ED BP.
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Affiliation(s)
- Sabrina J Poon
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN
| | - Christianne L Roumie
- Department of Medicine Vanderbilt University Medical Center Nashville TN.,Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center HSR&D Center Nashville TN
| | - Colin J O'Shea
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN
| | - Daniel Fabbri
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN.,Department of Electrical Engineering and Computer Science Vanderbilt University Nashville TN
| | - Joseph R Coco
- Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN
| | - Sean P Collins
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN.,Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center HSR&D Center Nashville TN
| | - Phillip D Levy
- Department of Emergency Medicine and Integrative Biosciences Center Wayne State University Detroit MI
| | - Candace D McNaughton
- Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN.,Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center HSR&D Center Nashville TN
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140
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Li Y, Li F, Li Y, Cui X, Li J, Zhi H, Wang W, Sun Y, Cui W. Effect of cuff positioning on the accuracy of blood pressure measurement with automated electronic blood pressure monitors. J Clin Hypertens (Greenwich) 2020; 22:1163-1172. [PMID: 32516516 DOI: 10.1111/jch.13902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 11/27/2022]
Abstract
It is recommended that the cuff should be wrapped around the upper arm with the midline of the bladder placed over the brachial artery during blood pressure (BP) measurement. However, in practice, the cuff of sphygmomanometers is often incorrectly placed. The authors aimed to assess the effect on the accuracy of BP measurement as to the placement of the cuff bladder by using oscillometric devices. Participants aged 18 years or older were enrolled. The center of the cuff bladder was placed directly over the brachial artery as the standard position (correct position), which was rotated by 90°medially (medial position), 90°laterally (lateral position), and rotated by 180°(contralateral position), respectively. The main outcomes were non-invasive brachial BP in the four cuff positions, brachial artery pulse wave velocity, ankle-brachial index, and invasive radial BP. Of 799 participants, 56.4% were men (60.37 ± 12.73 years), and of the 104 intensive care unit participants, 60.57% were men (57.78 ± 15.89 years). There were no significant differences in non-invasive brachial BP among the four cuff positions (P > .1), and the mean BP differences between incorrect and standard cuff positions were within 1.0 mm Hg. BP of the incorrect positions was positively correlated with standard position (P < .001, r > .88) and showed good consistency. There was no effect on the accuracy of BP measurement as to the location of the midline of the cuff bladder by using oscillometric devices with a conventional cuff.
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Affiliation(s)
- Ya Li
- Department of Cardiology, The Second Hospital of Hebei Medical University and Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China
| | - Fang Li
- Department of Cardiology, The Second Hospital of Hebei Medical University and Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China
| | - Yi Li
- Department of Cardiology, The Second Hospital of Hebei Medical University and Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China
| | - Xiaoran Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University and Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China
| | - Jing Li
- Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Hua Zhi
- Affiliated Hospital of Hebei University of Engineering, Handan, China
| | | | - Yanyan Sun
- The Central Hospital of Handan, Handan, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University and Institute of Cardiocerebrovascular Disease of Hebei Province, Shijiazhuang, China
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141
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Agreement and Reliability of Clinician-in-Clinic Versus Patient-at-Home Clinical and Functional Assessments: Implications for Telehealth Services. Arch Rehabil Res Clin Transl 2020; 2:100066. [PMID: 33543092 PMCID: PMC7853394 DOI: 10.1016/j.arrct.2020.100066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To compare agreement and reliability between clinician-measured and patient self-measured clinical and functional assessments for use in remote monitoring, in a home-based setting, using telehealth. Design Reliability study: repeated-measure, within-subject design. Setting Trained clinicians measured standard clinical and functional parameters at a face-to-face clinic appointment. Participants were instructed on how to perform the measures at home and to repeat self-assessments within 1 week. Participants Liver transplant recipients (LTRs) (N=18) (52±14y, 56% men, 5.4±4.3y posttransplant] completed the home self-assessments. Interventions Not applicable. Main Outcome Measures The outcomes assessed were body weight, systolic and diastolic blood pressure (SBP and DBP), waist circumference, repeated chair sit-to-stand (STST), maximal push-ups, and the 6-minute walk test (6MWT). Intertester reliability and agreement between face-to-face clinician and self-reported home-based participant measures were determined by intraclass-correlation coefficients (ICCs) and Bland-Altman plots, which were compared with minimal clinically important differences (MCID) (determined a priori). Results The mean difference (95% confidence interval) and [limits of agreement] for measures (where positive values indicate lower participant value) were weight, 0.7 (0.01-1.4) kg [−2.2 to 3.6kg]; waist 0.4 (−1.2 to 2.0) cm [−5.9 to 6.8cm]; SBP 7.7 (0.6-14.7 ) mmHg [−19.4 to 34.9mmHg]; DBP 2.4 (−1.4 to 6.2 ) mmHg [−12.2 to 17.0mmHg]; 6MWT, 7.5 (−29.1 to 44.1) m [−127.3 to 142.4m]; STST 0.5 (−0.8 to 1.7) seconds [−4.3 to 5.3s]; maximal push-ups −2.2 (−4.4 to −0.1) [−10.5 to 6.0]. ICCs were all >0.75 except for STST (ICC=0.73). Mean differences indicated good agreement than MCIDs; however, wide limits of agreement indicated large individual variability in agreement. Conclusions Overall, LTRs can reliably self-assess clinical and functional measures at home. However, there was wide individual variability in accuracy and agreement, with no functional assessment being performed within acceptable limits relative to MCIDs >80% of the time.
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142
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Campbell NRC, Padwal R, Picone DS, Su H, Sharman JE. The impact of small to moderate inaccuracies in assessing blood pressure on hypertension prevalence and control rates. J Clin Hypertens (Greenwich) 2020; 22:939-942. [PMID: 32485090 DOI: 10.1111/jch.13915] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Norm R C Campbell
- Department of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Hai Su
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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143
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Blood pressure measurements on a bare arm, over a sleeve or below a rolled-up sleeve: a systematic review and meta-analysis. J Hypertens 2020; 38:1650-1658. [DOI: 10.1097/hjh.0000000000002460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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145
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Brady TM, Padwal R, Blakeman DE, Farrell M, Frieden TR, Kaur P, Moran AE, Jaffe MG. Blood pressure measurement device selection in low-resource settings: Challenges, compromises, and routes to progress. J Clin Hypertens (Greenwich) 2020; 22:792-801. [PMID: 32347665 DOI: 10.1111/jch.13867] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/29/2022]
Abstract
High blood pressure (BP) is the single leading preventable cardiovascular disease (CVD) risk factor across the world. In order to decrease the global burden of CVD, broad hypertension screening programs that facilitate early hypertension diagnosis and treatment are essential. Accurate BP devices are a key element of hypertension control programs. With the overwhelming number of devices available now on the market, most of which have not been tested for accuracy, it can be challenging to select the optimal BP measurement device for clinical settings. This review details essential factors to consider when selecting a good-quality BP device, particularly for use in low-resource settings. Barriers to the procurement and use of good-quality devices are reviewed and practical solutions proposed.
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Affiliation(s)
| | - Raj Padwal
- University of Alberta, Edmonton, AB, Canada
| | - Drew E Blakeman
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
| | - Margaret Farrell
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
| | - Thomas R Frieden
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
| | | | - Andrew E Moran
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
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146
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Elias MF, Goodell AL. The Need for Accurate Data on Blood Pressure Measurement in the Dental Office. Am J Hypertens 2020; 33:297-300. [PMID: 32124913 PMCID: PMC7523566 DOI: 10.1093/ajh/hpaa023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 01/09/2020] [Accepted: 02/11/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Merrill F Elias
- Department of Psychology, The University of Maine, Orono, ME, USA
- Graduate School of Biomedical Science and Engineering, The University of Maine, Orono, ME, USA
| | - Amanda L Goodell
- Department of Psychology, The University of Maine, Orono, ME, USA
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147
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Abstract
Accurate BP measurements are vital for determining appropriate medication and treatment regimens. This article describes a quality improvement project to increase compliance with the American Heart Association's guidelines for BP measurement.
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Affiliation(s)
- Emily Matheson
- Emily Matheson is a CRNA at the University of Washington Medical Center in Seattle, Wash. At Rush University Medical Center in Chicago, Ill., Michael Kremer is a professor at the Rush College of Nursing and co-director of the Rush Center for Clinical Skills and Simulation; Louis Fogg is an associate professor; and Gia Crisanti is the CICU nurse manager and unit director
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148
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Singh SB, Kumar D, Kashyap V, Singh S. A comparative study of automated blood pressure device and mercury-free LED blood pressure device using Lin's concordance correlation coefficient and other validity measures in Indian population. J Family Med Prim Care 2020; 9:1464-1469. [PMID: 32509634 PMCID: PMC7266193 DOI: 10.4103/jfmpc.jfmpc_796_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Automated blood pressure (BP) monitor is widely used to assess the blood pressure (BP) of the study subjects in community-based researches. This study aims at the detection of hypertension by automated BP device and examines the concordance and validity between automated and mercury-free LED BP devices. MATERIALS AND METHODS This cross-sectional study was conducted in the tribal state of Jharkhand in India from January 2017 to June 2017. A total of 300 study participants aged more than 18 years were enrolled in this study. BP of the patients in the sitting position was measured three times each by automated device and mercury-free LED BP device. The different sets of readings were assessed by concordance correlation coefficient (CCC) and other validity measures. RESULTS The CCC for systolic and diastolic BP measured by automated and mercury-free LED BP is 0.88 and 0.85, respectively. The mean difference between systolic and diastolic BP by both the instruments is statistically insignificant (P > 0.05). The sensitivity, specificity, PPV, NPV, and accuracy of automated BP devices to predict hypertension is 96.61%, 92.21%, 75%, 99%, and 93%. The area under ROC for systolic and diastolic BP is 0.984 and 0.97, respectively with P values < 0.0001 in both the cases. CONCLUSIONS This study concluded that the overall automated BP machine has fair degree of agreement (CCC) with a manual BP device. The validity of this monitor to screen hypertension may also be considered in field settings.
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Affiliation(s)
- Shashi B. Singh
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Dewesh Kumar
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Vivek Kashyap
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Surendra Singh
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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149
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Siaron KB, Cortes MX, Stutzman SE, Venkatachalam A, Ahmed KM, Olson DM. Blood Pressure measurements are site dependent in a cohort of patients with neurological illness. Sci Rep 2020; 10:3382. [PMID: 32099051 PMCID: PMC7042254 DOI: 10.1038/s41598-020-60414-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/03/2020] [Indexed: 11/18/2022] Open
Abstract
Blood pressure (BP) management is a crucial part of critical care that directly affects morbidity and mortality. While BP has become a mainstay in patient care, the accuracy and precision of BP measures across commonly used sites (left upper arm, right upper arm, etc.) and methods have not been established. This study begins to fill this gap in literature by testing the null hypothesis that BP measurement does not vary according to site. This is a prospective, non-randomized, cross-sectional study of 80 neurocritical care unit patients. Near simultaneous non-invasive blood pressure (NIBP) readings from 4 different locations (bilateral upper arm, bilateral wrist) and, when available, intra-arterial blood pressure readings (IABP) were included. Pearson correlation coefficients and one-way repeated measures ANOVA were used to observe the systolic, diastolic, and mean arterial pressure (MAP) correlations. The BP measured at the four most common sites (left upper arm, left wrist, right upper arm, right wrist) had adequate correlation coefficients but were statistically significantly different and highly unpredictable. The median inter-site systolic variability was 10 mmHg (IQR 2 to 10 mmHg). The median inter-site MAP variability was 6mmHg with an interquartile range (IQR) of 3 to 9 mmHg. As expected, the values correlated to show that patients with high BP in one site tended to have high BP in another site. However, the unpredictable inter-site variability is concerning within the clinical setting where oftentimes BP measurement site is not standardized but resulting values are nevertheless used for treatment. There is prominent inter-site variability of BP measured across the 4 most common measurement sites. The variability persists across non-invasive (NIBP) and invasive (IABP) methods of assessment.
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Affiliation(s)
| | | | - Sonja E Stutzman
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | - DaiWai M Olson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Zachwieja J, Neyman-Bartkowiak A, Rabiega A, Wojciechowska M, Barabasz M, Musielak A, Silska-Dittmar M, Ostalska-Nowicka D. Comparison of cuff-based and cuffless continuous blood pressure measurements in children and adolescents. Clin Exp Hypertens 2020; 42:512-518. [PMID: 31941385 DOI: 10.1080/10641963.2020.1714642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In recent times, new methods of blood pressure measurements have been introduced, including cuffless blood pressure (BP) measurement device using pulse transit time (PTT) for calculation of BP values. However, it is still unknown how values obtained with a new cuffless device compare with standard ambulatory measurements in children. The main aim of the study was to investigate whether BP values measured by a cuffless PTT device are comparable with measurements by a standard upper arm cuff-based BP device. METHODS Thirty children were prospectively included. Blood pressure measurements using the cuffless device (Somnotouch-NIBP) and cuff-based standard device (Omron 907) were performed simultaneously on the left and right arm. RESULTS Mean systolic BP of the standard measurements was 123,47 ± 14,91 mmHg and 127,48 ± 15,98 mmHg (p < .001) measured by cuffless method. Mean diastolic BP of the standard ABPM measurements was 66,88 ± 11,86 mmHg and 68,52 ± 12,36 mmHg (p < .001). There were significant positive correlations between standard and cuffless measurements. CONCLUSION The results show that the created PWV-BP function produces a significant correlation between BP derived from the PWV and the SBP measured by sphygmomanometry. When applying this device in clinical practice, one may keep in mind that the reported mean values over 24 hours, awake and asleep time are not directly interchangeable with cuff-based standard 24-hour BP values. The measured BP values were higher by the new technique. Although differences in SBP between both methods reached values up to 20 mmHg, we think that the development of a cuffless BP monitoring system will provide novel solutions in various medical situations.
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Affiliation(s)
- Jacek Zachwieja
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences , Poznan, Poland
| | - Anna Neyman-Bartkowiak
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences , Poznan, Poland
| | - Alina Rabiega
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences , Poznan, Poland
| | - Marta Wojciechowska
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences , Poznan, Poland
| | - Małgorzata Barabasz
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences , Poznan, Poland
| | - Anna Musielak
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences , Poznan, Poland
| | - Magdalena Silska-Dittmar
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences , Poznan, Poland
| | - Danuta Ostalska-Nowicka
- Department of Pediatric Nephrology and Hypertension, Poznan University of Medical Sciences , Poznan, Poland
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