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Pilz N, Picone DS, Patzak A, Opatz OS, Lindner T, Fesseler L, Heinz V, Bothe TL. Cuff-based blood pressure measurement: challenges and solutions. Blood Press 2024; 33:2402368. [PMID: 39291896 DOI: 10.1080/08037051.2024.2402368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 09/03/2024] [Accepted: 09/04/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE Accurate measurement of arterial blood pressure (BP) is crucial for the diagnosis, monitoring, and treatment of hypertension. This narrative review highlights the challenges associated with conventional (cuff-based) BP measurement and potential solutions. This work covers each method of cuff-based BP measurement, as well as cuffless alternatives, but is primarily focused on ambulatory BP monitoring. RESULTS Manual BP measurement requires stringent training and standardized protocols which are often difficult to ensure in stressful and time-restricted clinical office blood pressure monitoring (OBPM) scenarios. Home Blood pressure monitoring (HBPM) can identify white-coat and masked hypertension but strongly depends on patient adherence to measurement techniques and procedure. The widespread use of nonvalidated automated HBPM devices raises further concerns about measurement accuracy. Ambulatory blood pressure measurement (ABPM) may be used in addition to OBPM. It is recommended to diagnose white-coat and masked hypertension as well as nocturnal BP and dipping, which are the BP values most predictive for major adverse cardiac events. Nonetheless, ABPM is limited by its non-continuous nature and susceptibility to measurement artefacts. This leads to poor overall reproducibility of ABPM results, especially regarding clinical parameters such as BP variability or dipping patterns. CONCLUSIONS Cuff-based BP measurement, despite some limitations, is vital for cardiovascular health assessment in clinical practice. Given the wide range of methodological limitations, the paradigm's potential for improvement is not yet fully realized. There are impactful and easily incorporated opportunities for innovation regarding the enhancement of measurement accuracy and reliability as well as the clinical interpretation of the retrieved data. There is a clear need for continued research and technological advancement to improve BP measurement as the premier tool for cardiovascular disease detection and management.
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Affiliation(s)
- N Pilz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - D S Picone
- Sydney School of Health Sciences, University of Sydney, Sydney, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - A Patzak
- Institute of Translational Physiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - O S Opatz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T Lindner
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Fesseler
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - V Heinz
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T L Bothe
- Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Sydney School of Health Sciences, University of Sydney, Sydney, Australia
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Song YH. Aneroid Auscultatory Sphygmomanometers and Automated Oscillometric Devices as Mercury-Free Alternatives in Children. Korean Circ J 2024; 54:288-290. [PMID: 38767341 PMCID: PMC11109841 DOI: 10.4070/kcj.2024.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Young Hwan Song
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
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Gogiberidze N, Suvorov A, Sultygova E, Sagirova Z, Kuznetsova N, Gognieva D, Chomakhidze P, Frolov V, Bykova A, Mesitskaya D, Novikova A, Kondakov D, Volovchenko A, Omboni S, Kopylov P. Practical Application of a New Cuffless Blood Pressure Measurement Method. PATHOPHYSIOLOGY 2023; 30:586-598. [PMID: 38133143 PMCID: PMC10748083 DOI: 10.3390/pathophysiology30040042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
It would be useful to develop a reliable method for the cuffless measurement of blood pressure (BP), as such a method could be made available anytime and anywhere for the effective screening and monitoring of arterial hypertension. The purpose of this study is to evaluate blood pressure measurements through a CardioQVARK device in clinical practice in different patient groups. METHODS This study involved 167 patients aged 31 to 88 years (mean 64.2 ± 7.8 years) with normal blood pressure, high blood pressure, and compensated high blood pressure. During each session, three routine blood pressure measurements with intervals of 30 s were taken using a sphygmomanometer with an appropriate cuff size, and the mean value was selected for comparison. The measurements were carried out by two observers trained at the same time with a reference sphygmomanometer using a Y-shaped connector. In the minute following the last cuff-based measurements, an electrocardiogram (ECG) with an I-lead and a photoplethysmocardiogram were recorded simultaneously for 3 min with the CardioQVARK device. We compared the systolic and diastolic BP obtained from a cuff-based mercury sphygmomanometer and smartphone-case-based BP device: the CardioQVARK monitor. A statistical analysis plan was developed using the IEEE Standard for Wearable Cuffless Blood Pressure Devices. Bland-Altman plots were used to estimate the precision of cuffless measurements. RESULTS The mean difference between the values defined by CardioQVARK and the cuff-based sphygmomanometer for systolic blood pressure (SBP) was 0.31 ± 3.61, while that for diastolic blood pressure (DBP) was 0.44 ± 3.76. The mean absolute difference (MAD) for SBP was 3.44 ± 2.5 mm Hg, and that for DBP was 3.21 ± 2.82 mm Hg. In the subgroups, the smallest error (less than 3 mm Hg) was observed in the prehypertension group, with a slightly larger error (up to 4 mm Hg) found among patients with a normal blood pressure and stage 1 hypertension. The largest error was found in the stage 2 hypertension group (4-5.5 mm Hg). The largest error was 4.2 mm Hg in the high blood pressure group. We, therefore, did not record an error in excess of 7 mmHg, the upper boundary considered acceptable in the IEEE recommendations. We also did not reach a mean error of 5 mmHg, the upper boundary considered acceptable according to the very recent ESH recommendations. At the same time, in all groups of patients, the systolic blood pressure was determined with an error of less than 5 mm Hg in more than 80% of patients. While this study shows that the CardioQVARK device meets the standards of IEEE, the Bland-Altman analysis indicates that the cuffless measurement of diastolic blood pressure has significant bias. The difference was very small and unlikely to be of clinical relevance for the individual patient, but it may well have epidemiological relevance on a population level. Therefore, the CardioQVARK device, while being worthwhile for monitoring patients over time, may not be suitable for screening purposes. Cuffless blood pressure measurement devices are emerging as a convenient and tolerable alternative to cuff-based devices. However, there are several limitations to cuffless blood pressure measurement devices that should be considered. For instance, this study showed a high proportion of measurements with a measurement error of <5 mmHg, while detecting a small, although statistically significant, bias in the measurement of diastolic blood pressure. This suggests that this device may not be suitable for screening purposes. However, its value for monitoring BP over time is confirmed. Furthermore, and most importantly, the easy measurement method and the device portability (integrated in a smartphone) may increase the self-awareness of hypertensive patients and, potentially, lead to an improved adherence to their treatment. CONCLUSION The cuffless blood pressure technology developed in this study was tested in accordance with the IEEE protocol and showed great precision in patient groups with different blood pressure ranges. This approach, therefore, has the potential to be applied in clinical practice.
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Affiliation(s)
- Nana Gogiberidze
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Aleksandr Suvorov
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Elizaveta Sultygova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Zhanna Sagirova
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Natalia Kuznetsova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Daria Gognieva
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Petr Chomakhidze
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
| | - Victor Frolov
- Medical Center for Premorbid and Emergency Conditions, P.V. Mandryka Central Military Clinical Hospital, 121002 Moscow, Russia;
| | - Aleksandra Bykova
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Dinara Mesitskaya
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Alena Novikova
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Danila Kondakov
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Alexey Volovchenko
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
| | - Stefano Omboni
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
- Italian Institute of Telemedicine, Via Colombera 29, 21048 Solbiate Arno, Varese, Italy
| | - Philippe Kopylov
- Department of Cardiology, Functional and Ultrasound Diagnostics of N.V. Sklifosovsky Institute for Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (Z.S.); (D.G.); (P.C.); (A.B.); (D.M.); (A.N.); (D.K.); (A.V.); (S.O.); (P.K.)
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia; (A.S.); (E.S.); (N.K.)
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Duan B, He L, Zhang J, Fang L, Li G. Validation of the JOYTECH DBP-6279B blood pressure monitor in adults and adolescents according to the AAMI/ESH/ISO universal standard(ISO 81060-2:2018 + Amd.1:2020). Blood Press Monit 2023; 28:284-288. [PMID: 37434533 PMCID: PMC10484188 DOI: 10.1097/mbp.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
This study aimed to validate the accuracy of DBP-6279B, an automated inflationary oscillometric upper-arm blood pressure (BP) monitor, in the sitting position according to the AAMI/ESH/ISO (81060-2 : 2018 + Amd.1 : 2020) universal standard protocol. SBPs and DBPs were measured simultaneously on the same arm in 88 adults (female : male = 47 : 41) with a mean age of 56.85 years using a mercury sphygmomanometer (two observers) and a DBP-6279B device (one supervisor). The AAMI/ESH/ISO 81060-2 : 2018 and Amd.1 : 2020 universal standards for the validation of BP-measuring devices in adults and adolescents were followed. A total of 259 valid pairs of data were used in the analysis. According to Criterion 1, the mean difference of SBP between the test device (DBP-6279B) and the reference device (the mercury sphygmomanometer) was 0.75 mmHg, with a SD of 7.66 mmHg. The mean difference in DBP was 1.13 mmHg, with a SD of 6.14 mmHg. The mean difference of both SBP and DBP was less than 5 mmHg, and the SD was less than 8 mmHg, which met the requirements. According to Criterion 2, the mean difference of SBP between the test device and the reference device was 0.85 mmHg, and the SD was 6.56 mmHg, which was less than 6.88 mmHg and met the requirements. The mean difference in DBP was 1.27 mmHg, and the SD was 5.42 mmHg, which was less than 6.82 mmHg and met the requirements. DBP-6279B fulfilled the requirements of the AAMI/ESH/ISO universal standard (ISO 81060-2 : 2018 + Amd.1 : 2020); hence, it can be recommended for both clinical and self/home BP measurement in adults and adolescents.
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Affiliation(s)
| | - Le He
- Cardiovascular medicine, North China University of Science and Technology, Tangshan
| | - Jianling Zhang
- Cardiovascular medicine, Hebei Medical University Graduate School, Shijiazhuang, Hebei
| | - Lixiu Fang
- Department of medicine, Suzhou Care-Real Medical Technology Co., Ltd., Suzhou, Jiangsu, China
| | - Gang Li
- Department of pharmacy, Hebei General Hospital
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Li Y, Wang B, Fan F, Weng H, Zhang L, Jiang J, Zheng B, Zhang Y, Li J. Impact of atrial fibrillation on the accuracy of oscillometric blood pressure monitoring in ICU patients from a large real-world database. J Hypertens 2023; 41:838-844. [PMID: 36883447 DOI: 10.1097/hjh.0000000000003408] [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: 03/09/2023]
Abstract
OBJECTIVES Oscillometric blood pressure (BP) measurement in atrial fibrillation patients is controversial due to stroke volume variation. Here, we performed a cross-sectional study to investigate the impact of atrial fibrillation on the accuracy of oscillometric BP in the ICU setting. METHODS Adult patients with atrial fibrillation or sinus rhythm records were enrolled from Medical Information Mart for Intensive Care-III database. Concurrently recorded noninvasive oscillometric BPs (NIBPs) and intra-arterial BPs (IBPs) were classified as atrial fibrillation or sinus rhythm group according to heart rhythm. Bland-Altmann plots assessed bias and limits of agreement of NIBP to IBP. Pairwise comparison was performed on NIBP/IBP bias between atrial fibrillation and sinus rhythm. Linear mixed-effect model was used to assess the impact of heart rhythm on NIBP/IBP bias after adjusting confounders. RESULTS Two thousand, three hundred and thirty-five patients (71.95 ± 11.23 years old, 60.90% were men) were included. Systolic, diastolic, and mean NIBP/IBP biases were not clinically different between atrial fibrillation and sinus rhythm circumstances (SBP bias: 0.66 vs. 1.21 mmHg, P = 0.002; DBP: -5.29 vs. -5.17, P = 0.1; mean BP: -4.45 vs. -4.19, P = 0.01). After adjusting for age, sex, heart rate, arterial BP, and vasopressor usage, the effect of heart rhythm on NIBP/IBP bias was within ±5 mmHg for SBP and DBP [effect on SBP bias: 3.32 mmHg (95% confidence interval (CI) 2.89-3.74), P < 0.001; DBP: -0.89 (-1.17 to -0.60), P < 0.001], while the effect on mean BP bias was not significant [0.18 mmHg (-0.10 to 0.46), P = 0.2]. CONCLUSION Atrial fibrillation would not influence the agreement of oscillometric BP to IBP in ICU patients compared with sinus rhythm.
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Affiliation(s)
- Yuxi Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
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Dhamotharan V, Chandrasekhar A, Cheng HM, Chen CH, Sung SH, Landry C, Hahn JO, Mahajan A, Shroff SG, Mukkamala R. Mathematical Modeling of Oscillometric Blood Pressure Measurement: A Complete, Reduced Oscillogram Model. IEEE Trans Biomed Eng 2023; 70:715-722. [PMID: 36006885 PMCID: PMC9958264 DOI: 10.1109/tbme.2022.3201433] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Oscillogram modeling is a powerful tool for understanding and advancing popular oscillometric blood pressure (BP) measurement. A reduced oscillogram model relating cuff pressure oscillation amplitude ( ∆O) to external cuff pressure of the artery ( Pe) is: [Formula: see text], where g(P) is the arterial compliance versus transmural pressure ( P) curve, Ps and Pd are systolic and diastolic BP, and k is the reciprocal of the cuff compliance. The objective was to determine an optimal functional form for the arterial compliance curve. METHODS Eight prospective, three-parameter functions of the brachial artery compliance curve were compared. The study data included oscillometric arm cuff pressure waveforms and invasive brachial BP from 122 patients covering a 20-120 mmHg pulse pressure range. The oscillogram measurements were constructed from the cuff pressure waveforms. Reduced oscillogram models, inputted with measured systolic and diastolic BP and each parametric brachial artery compliance curve function, were optimally fitted to the oscillogram measurements in the least squares sense. RESULTS An exponential-linear function yielded as good or better model fits compared to the other functions, with errors of 7.9±0.3 and 5.1±0.2% for tail-trimmed and lower half-trimmed oscillogram measurements. Importantly, this function was also the most tractable mathematically. CONCLUSION A three-parameter exponential-linear function is an optimal form for the arterial compliance curve in the reduced oscillogram model and may thus serve as the standard function for this model henceforth. SIGNIFICANCE The complete, reduced oscillogram model determined herein can potentially improve oscillometric BP measurement accuracy while advancing foundational knowledge.
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Kumar R, Kumar M, Wander GS, Sahani AK. Concept, hardware development, and clinical trials of a Galinstan based Mercury free sphygmomanometer: Merkfree. Sci Rep 2022; 12:15813. [PMID: 36138083 PMCID: PMC9499926 DOI: 10.1038/s41598-022-19926-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022] Open
Abstract
The aim of this work is to develop Merkfree-a mercury-free sphygmomanometer that looks, feels, and operates just like a traditional mercury sphygmomanometer (MS). For this we use Galinstan as a substitute for mercury, which is a non-toxic alloy of Gallium, Indium and Tin. Galinstan is nearly half as dense as mercury and sticks to class. To work with the lower density, we designed an enclosure and scale that is nearly double the length of MS. The issue of stickiness with glass was resolved by maintaining a small meniscus of a reducing agent in the measuring tube and tank of Merkfree. Clinical trials to validate the accuracy of Merkfree against MS and oscillometric sphygmomanometer (OS) were conducted over 252 patients. The results show a good correlation of the systolic and diastolic BP measurements from Merkfree with respect to MS and the OS. The mean absolute percentage error is less than 10% for both SBP and DBP. We also found that Merkfree has lower rounding-off errors compared to MS. Merkfree can be a viable alternative to mercury sphygmomanometer that can help achieve the goal of WHO in eliminating mercury from healthcare, while simultaneously making sure that gold standard technique of sphygmomanometry continues to be available to the clinicians.
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Affiliation(s)
- Ravinder Kumar
- Department of Biomedical Engineering, Indian Institute of Technology, Ropar, India.
| | - Mohit Kumar
- Department of Biomedical Engineering, Indian Institute of Technology, Ropar, India
| | | | - Ashish Kumar Sahani
- Department of Biomedical Engineering, Indian Institute of Technology, Ropar, India
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Wang L, Ansari S, Cai Y, McCracken B, Tiba MH, Ward K, Najarian K, Oldham K. Tracking Peripheral Artery Motion and Vascular Resistance with a Multi-Modal Wearable Sensor Under Pressure Perturbations. J Biomech Eng 2022; 144:1133339. [PMID: 35079769 DOI: 10.1115/1.4053399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Indexed: 11/08/2022]
Abstract
Peripheral artery status is a key physiological indicator of the body's cardiovascular response to both acute and chronic medical conditions. In this paper, peripheral artery behavior is tracked non-invasively by combining a photo plethysmograph (PPG) sensor and a piezoelectric (polyvinylidene difluoride, PVDF) sensor, while applying an outside pressure-varying cuff. A simple mechanical model for the local artery and tissue captures time- and pressure-dependent features present in the PPG and PVDF signals with respect to applied cuff pressure, during maneuvers applied to multiple swine subjects to perturb blood pressure and vascular resistance. These behaviors provide insight into feasibility and robustness of cardiovascular property identification by multi-modal non-invasive wearable sensing. This is found to help refine non-invasive blood pressure measurements and estimation of systemic vascular resistance (SVR) and blood pressure (BP) using selected features of sensor amplitude versus applied cuff pressure.
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Affiliation(s)
- Lu Wang
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Yingjie Cai
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Kevin Ward
- University of Michigan, Ann Arbor, Michigan, USA
| | | | - Kenn Oldham
- University of Michigan, Ann Arbor, Michigan, USA
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Khosravi A, Behjati M, Mansouri A, Jozan M, Mohammadifard N, Taheri M, Khodarahmi S, Ansari R, Mansouri MH, Mansouri P, Sarrafzadegan N. Evaluation of correlation between digital vs. mercury sphygmomanometer in a middle-income country: The role of socio-economic situation. Clin Exp Hypertens 2021; 44:113-118. [PMID: 34923883 DOI: 10.1080/10641963.2021.1999047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Using manometer sphygmomanometers as standard measurement tool, there are controversial data regarding accuracy and validity of digital manometers for measurement of systolic (SBP) and diastolic blood pressure (DBP). Thus, we aimed to compare the accuracy of readings of digital sphygmomanometer in reference to mercury sphygmomanometer in a large population of healthy adults. METHODS AND MATERIALS This cross-sectional study was performed on 1119 healthy adults. We measured participant's blood pressure once with mercury sphygmomanometer, as gold standard and again with digital mercury sphygmomanometer. Blood pressure was measured in sitting position after 5 min of rest and preferentially from right arm unless deformed. RESULTS The mean ± standard deviation of age of participants was 37.25 ± 10.45 years. Majority of participants were male 588 (52.5%). The right/left SBP measured by digital sphygmomanometer were significantly higher compared with those measured by mercury sphygmomanometer: 115.37 ± 12.33 vs 110.95 ± 10.06/113.69 ± 11.77 vs 110.23 ± 10.34, respectively (P < .001), while an opposite result was observed about right/left DBP: 68.60 ± 8.55 vs 70.60 ± 8.31/69.39 ± 8.31 vs 70.75 ± 8.41, respectively (P < .001). In subgroup analysis in terms of marital status, education, and income, we observed similar findings. CONCLUSION According to the results of our data analysis, it was shown that the digital device measurements had significant incompatibility with the mercury sphygmomanometers and it seems that digital devices still cannot be used as the gold standard in blood pressure measurement.
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Affiliation(s)
- Alireza Khosravi
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohaddeseh Behjati
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asieh Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Jozan
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Taheri
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh Khodarahmi
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rezvan Ansari
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hadi Mansouri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pejman Mansouri
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Pan F, He P, Pu X, Gao H, Chen F, Feng J, Zheng D. Influence of aging and increased blood pressure on oscillometric cuff pressure waveform characteristics. J Hypertens 2021; 39:2157-2163. [PMID: 34149015 DOI: 10.1097/hjh.0000000000002921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The oscillometric blood pressure (BP) measurement technique estimates BPs from analyzing the envelop of oscillometric cuff pressure waveform. The oscillometric waveform envelope shape is associated with physiological changes and influences BP measurement accuracy. The aim of this study was to comprehensively quantify BP- and age-related changes of oscillometric waveform envelope characteristics. METHOD Manual systolic and diastolic BPs were measured from 472 patients (219 female, 253 male), and the cuff pressure were digitally recorded during linear cuff deflation that was used to derive oscillometric waveform envelopes. All patients were divided into different categories according to their BP level and age. The envelope width in high-pressure region (above mean arterial pressure, MAP) and low-pressure region (below MAP) were compared between different BP and age categories to qualify their changes with increased BP and aging. RESULTS The envelop widths increased significantly with increased BPs (P < 0.001 between optimal, normotensive and hypertensive groups) and aging (P < 0.001 for >50 years old group in comparison with younger groups). The envelope widths in high-pressure region were significantly larger than in low-pressure region in normal and hypertensive categories (all P < 0.05) and elderly patients aged over 60 years (all P < 0.001), and the envelope width ratios between them increased with increased BP and aging. CONCLUSION This study has concluded an asymmetrical oscillometric waveform envelope in normotensive and hypertensive categories, as well as in elderly group (aged over 60 years), and their asymmetrical features were significantly more obvious with increased BP and aging.
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Affiliation(s)
- Fan Pan
- College of Electronics and Information Engineering, Sichuan University
| | - Peiyu He
- College of Electronics and Information Engineering, Sichuan University
| | - Xiaobo Pu
- Department of Cardiology, West China Hospital
| | - Hu Gao
- Department of Emergency, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu
| | - Fei Chen
- Department of Electrical and Electronic Engineering, Southern University of Science and Technology, Shenzhen
| | - Junfeng Feng
- Brain Injury Center, Neurosurgery Department, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai China
| | - Dingchang Zheng
- Research Centre of Intelligent Healthcare, Faculty of Health and Life Science, Coventry University, Coventry, UK
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11
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Development and validation of a deep learning-based automatic auscultatory blood pressure measurement method. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Kumar R, Sahani AK, Wander GS. A survey to gauge confidence of Indian clinicians on three primary devices for blood pressure measurement. Blood Press Monit 2021; 26:196-199. [PMID: 33470647 DOI: 10.1097/mbp.0000000000000512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE As per its commitment at Minamata convention, and in line with other developed economies, the Indian government is set to ban the use of mercury sphygmomanometers by end of the year 2020. However, the Mercury sphygmomanometer is still widely used by clinicians in India. We conducted a survey to gauge the confidence of Indian clinicians on three primary devices of blood pressure (BP) measurement - mercury sphygmomanometer, aneroid sphygmomanometer and automatic digital BP monitor. MATERIALS AND METHODS We conducted an anonymous online survey through various clinician forums asking questions related to accuracy, reliability and expectations from BP monitors. RESULTS A total of 139 responses were received from clinicians across specialties. The results show that more than 80% of clinicians believe that mercury sphygmomanometers are the most accurate and nearly 50% find it most reliable. For most respondents, accuracy is the most important parameter and convenience of use and portability are secondary considerations. If a mercury-free sphygmomanometer is offered with the same accuracy and reliability, 88% of respondents said they are willing to buy it. CONCLUSIONS Mercury sphygmomanometer is still perceived favorably over other non-mercury alternatives by most Indian clinicians. Validated oscillometric devices should be promoted to bring about change in the perspectives of clinicians towards adopting non-mercury alternatives of BP measurement in India.
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Affiliation(s)
- Ravinder Kumar
- Center for Biomedical Engineering, Indian Institute Technology Ropar, Rupnagar
| | - Ashish Kumar Sahani
- Center for Biomedical Engineering, Indian Institute Technology Ropar, Rupnagar
| | - Gurpreet Singh Wander
- Hero DMC Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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13
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Solnceva TD, Sivakova OA, Chazova IE. From palpation of the pulse to cuff-free methods: evolution of arterial pressure measurement methods. TERAPEVT ARKH 2021; 93:526-531. [DOI: 10.26442/00403660.2021.04.200690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022]
Abstract
The arterial pressure is an important physiological indicator. The review describes the different techniques of measurement of arterial pressure, their advantages and limitations. Moreover, it also represents a historical reference about the main stage of the development of clinical sphygmomanometrya that nowadays is a relevant method for measuring arterial pressure. The emergence and the development of devices for daily monitoring of arterial pressure and modern techniques for non-invasive arterial pressure measurement are described too.
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14
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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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15
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Blood pressure management and perioperative myocardial injury. Int Anesthesiol Clin 2020; 59:36-44. [PMID: 33060430 DOI: 10.1097/aia.0000000000000301] [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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16
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Chandrasekhar A, Yavarimanesh M, Hahn JO, Sung SH, Chen CH, Cheng HM, Mukkamala R. Formulas to Explain Popular Oscillometric Blood Pressure Estimation Algorithms. Front Physiol 2019; 10:1415. [PMID: 31824333 PMCID: PMC6881246 DOI: 10.3389/fphys.2019.01415] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/31/2019] [Indexed: 01/20/2023] Open
Abstract
Oscillometry is the blood pressure (BP) measurement principle of most automatic cuff devices. The oscillogram (which is approximately the blood volume oscillation amplitude-external pressure function) is measured, and BP is then estimated via an empirical algorithm. The objective was to establish formulas to explain three popular empirical algorithms in the literature—the maximum amplitude, derivative, and fixed ratio algorithms. A mathematical model of the oscillogram was developed and analyzed to derive parametric formulas for explaining each algorithm. Exemplary parameter values were obtained by fitting the model to measured oscillograms. The model and formulas were validated by showing that their predictions correspond to measurements. The formula for the maximum amplitude algorithm indicates that it yields a weighted average of systolic and diastolic BP (0.45 and 0.55 weighting) instead of commonly assumed mean BP. The formulas for the derivative algorithm indicate that it can accurately estimate systolic and diastolic BP (<1.5 mmHg error), if oscillogram measurement noise can be obviated. The formulas for the fixed ratio algorithm indicate that it can yield inaccurate BP estimates, because the ratios change substantially (over a 0.5–0.6 range) with arterial compliance and pulse pressure and error in the assumed ratio translates to BP error via large amplification (>40). The established formulas allow for easy and complete interpretation of perhaps the three most popular oscillometric BP estimation algorithms in the literature while providing new insights. The model and formulas may also be of some value toward improving the accuracy of automatic cuff BP measurement devices.
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Affiliation(s)
- Anand Chandrasekhar
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI, United States
| | - Mohammad Yavarimanesh
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI, United States
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD, United States
| | - Shih-Hsien Sung
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ramakrishna Mukkamala
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI, United States
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Chandrasekhar A, Kim CS, Naji M, Natarajan K, Hahn JO, Mukkamala R. Smartphone-based blood pressure monitoring via the oscillometric finger-pressing method. Sci Transl Med 2019. [PMID: 29515001 DOI: 10.1126/scitranslmed.aap8674] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
High blood pressure (BP) is a major cardiovascular risk factor that is treatable, yet hypertension awareness and control rates are low. Ubiquitous BP monitoring technology could improve hypertension management, but existing devices require an inflatable cuff and are not compatible with such anytime, anywhere measurement of BP. We extended the oscillometric principle, which is used by most automatic cuff devices, to develop a cuff-less BP monitoring device using a smartphone. As the user presses her/his finger against the smartphone, the external pressure of the underlying artery is steadily increased while the phone measures the applied pressure and resulting variable-amplitude blood volume oscillations. A smartphone application provides visual feedback to guide the amount of pressure applied over time via the finger pressing and computes systolic and diastolic BP from the measurements. We prospectively tested the smartphone-based device for real-time BP monitoring in human subjects to evaluate usability (n = 30) and accuracy against a standard automatic cuff-based device (n = 32). We likewise tested a finger cuff device, which uses the volume-clamp method of BP detection. About 90% of the users learned the finger actuation required by the smartphone-based device after one or two practice trials. The device yielded bias and precision errors of 3.3 and 8.8 mmHg for systolic BP and -5.6 and 7.7 mmHg for diastolic BP over a 40 to 50 mmHg range of BP. These errors were comparable to the finger cuff device. Cuff-less and calibration-free monitoring of systolic and diastolic BP may be feasible via a smartphone.
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Affiliation(s)
- Anand Chandrasekhar
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Chang-Sei Kim
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA.,School of Mechanical Engineering, Chonnam National University, Gwangju 61186, South Korea
| | - Mohammed Naji
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Keerthana Natarajan
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - Ramakrishna Mukkamala
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48824, USA.
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18
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Pan F, He P, Chen F, Zhang J, Wang H, Zheng D. A novel deep learning based automatic auscultatory method to measure blood pressure. Int J Med Inform 2019; 128:71-78. [DOI: 10.1016/j.ijmedinf.2019.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/03/2019] [Accepted: 04/27/2019] [Indexed: 10/26/2022]
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Stala Ł, Tomczuk K. Calibration methods of new device for human blood pressure measurement. EPJ WEB OF CONFERENCES 2019. [DOI: 10.1051/epjconf/201920106003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The paper presents two methods of determining calibration curve of a new device for blood pressure measurement. The device was developed at Wrocław University of Science and Technology. First method is based on parallel measurement of systolic and diastolic pressure measurement with use of reference device such as sphygmomanometer and researched new device with pneumatic sensor equipped with voltage type output. Obtained data (systolic ps and diastolic pd pressure, maximum us and minimum ud voltage) was then used to determine individual pressure-voltage characteristic of the device, which can be represented as a linear equation. Second method is based on substitution of experimentally proved coefficient b with its analytical equivalent extracted from mathematical model of described pneumatic sensor. Described methods were verified experimentally and compared. Metrological parameters of the device were designated.
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20
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Postma MR, van Beek AP, Jönsson PJ, van Bunderen CC, Drent ML, Mattsson AF, Camacho-Hubner C. Improvements in Body Composition after 4 Years of Growth Hormone Treatment in Adult-Onset Hypopituitarism Compared to Age-Matched Controls. Neuroendocrinology 2019; 109:131-140. [PMID: 30844796 DOI: 10.1159/000499430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/05/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND/AIMS It is unknown whether long-term growth hormone replacement therapy (GHRT) affects body composition in an age- or sex-dependent manner. We aimed to study the effects of 4 years of GHRT on body composition in a large cohort of patients with hypopituitarism compared to a reference population matched by age and sex. METHODS A total of 964 GH-deficient adults from KIMS (Pfizer International Metabolic Database) with adult-onset hypopituitarism, adequately replaced with all pituitary hormones except for GH at baseline were included. A random sample of the general population (2,301 subjects) from a similar time period was used as reference. Patients and controls were grouped by sex in 5 age cohorts of 10 years. Main outcome measures were changes in BMI and waist circumference after 4 years of GHRT. RESULTS In younger patients (28-47 years), 4 years of GHRT resulted in a BMI increase similar to that observed in the reference population, but older patients (48-67 years) had significantly less BMI increase than age-matched healthy controls. Significant differences were seen in waist circumference in patients of all age cohorts who showed virtually no change after 4 years of GHRT compared to approximately 4 cm of increase in the reference population. CONCLUSION Four years of GHRT resulted in improvements in BMI and waist circumference in patients with adult-onset hypopituitarism compared to age-matched controls observed during the same follow-up time. Despite these beneficial effects on body composition, BMI and waist circumference remained higher in patients on GHRT compared to healthy controls.
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Affiliation(s)
- Mark R Postma
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - André P van Beek
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,
| | | | - Christa C van Bunderen
- Department of Internal Medicine, Section Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
| | - Madeleine L Drent
- Department of Internal Medicine, Section Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
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21
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Zakrzewski AM, Anthony BW. Noninvasive Blood Pressure Estimation Using Ultrasound and Simple Finite Element Models. IEEE Trans Biomed Eng 2018; 65:2011-2022. [PMID: 28613159 PMCID: PMC10615346 DOI: 10.1109/tbme.2017.2714666] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Many commercially available arterial blood pressure measurement devices suffer from a range of weaknesses. For example, common weaknesses include being inaccurate, invasive, and ad hoc; many also require explicit user calibration or cut off blood flow to a limb. A novel algorithmic approach is presented to accurately estimate systolic and diastolic blood pressure in a way that does not require any explicit user calibration, is noninvasive, and does not cut off blood flow. METHODS The approach uses ultrasound images of the arterial wall and corresponding contact force data to obtain blood pressure estimates. To acquire data, an ultrasound probe was placed on the patient's carotid artery and the contact force was increased from 1.5 to 12 N. The artery was then algorithmically segmented from the recorded DICOM B-Mode data. The segmentation data and the contact force were used as input into the Levenberg-Marquardt optimization method to solve for the parameters, including blood pressure, of a simple finite element model of the carotid artery. RESULTS The algorithm was validated on 24 healthy volunteers. Algorithm arterial blood pressure predictions were compared to oscillometric blood pressure cuff readings. Regression and Bland-Altman analyses were performed on the data. CONCLUSION Both systolic pressure and diastolic pressure can be estimated using this novel noninvasive ultrasound-based method (systolic accuracy/precision: $-$ 2.36 mmHg/10.21 mmHg; diastolic accuracy/precision: $-$ 0.32/8.23 mmHg). SIGNIFICANCE The method occupies a clinical middle ground between the arterial catheter and cuff-based techniques. It has the potential to give accurate results for patients with hypertension and atherosclerosis.
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22
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Validation of a smartphone auscultatory blood pressure kit Accutension XYZ-110 in adults according to the ANSI/AAMI/ISO 81060-2: 2013 standard. Blood Press Monit 2018; 22:290-294. [PMID: 28505014 DOI: 10.1097/mbp.0000000000000268] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to validate the accuracy of the Accutension XYZ-110 blood pressure (BP) kit according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 standard. PARTICIPANTS AND METHODS Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured simultaneously on the same arm in 85 Chinese adults (female : male=48 : 37) with a mean age of 43.2 years using the mercury sphygmomanometer (two observers) and the Accutension XYZ-110 device (one supervisor). The ANSI/AAMI/ISO 81060-2:2013 standard for the validation of BP-measuring devices in adults was followed precisely. A total of 255 comparison pairs were obtained for analysis. RESULTS The mean device-observer difference in the 255 separate BP data pairs was 2.45±2.24 mmHg for SBP and 0.69±2.09 mmHg for DBP. The data were in accordance with the criterion 1 of the ANSI/AAMI/ISO 81060-2:2013 standard requirements (≤5±8 mmHg). In addition, the mean device-observer difference of the 85 participants was 2.45±1.47 mmHg for SBP and 0.69±1.36 mmHg for DBP. The device accuracy also fulfilled the criterion 2 with the SD of less than or equal to 6.47 for SBP and less than or equal to 6.90 mmHg for DBP. CONCLUSION The Accutension XYZ-110 BP kit fulfilled the requirements of the ANSI/AAMI/ISO 81060-2:2013 standard, and hence could be recommended for both clinical and self/home BP measurement in adults.
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Mukherjee R, Ghosh S, Gupta B, Chakravarty T. A Literature Review on Current and Proposed Technologies of Noninvasive Blood Pressure Measurement. Telemed J E Health 2018; 24:185-193. [DOI: 10.1089/tmj.2017.0068] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ramtanu Mukherjee
- Department of Electronics & Communication Engineering, Birla Institute of Technology, Ranchi, India
| | - Sanchita Ghosh
- Department of Electronics & Communication Engineering, Birla Institute of Technology, Ranchi, India
| | - Bharat Gupta
- Department of Electronics & Communication Engineering, National Institute of Technology, Patna, India
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Watanabe N, Bando YK, Kawachi T, Yamakita H, Futatsuyama K, Honda Y, Yasui H, Nishimura K, Kamihara T, Okumura T, Ishii H, Kondo T, Murohara T. Development and Validation of a Novel Cuff-Less Blood Pressure Monitoring Device. JACC Basic Transl Sci 2017; 2:631-642. [PMID: 30062178 PMCID: PMC6058997 DOI: 10.1016/j.jacbts.2017.07.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022]
Abstract
As a joint project between industry and academia, we are developing a CLB that enables BP measurement continuously and noninvasively by capturing photoplethysmographical biosignals. To validate the estimation of BP using a CLB in accordance with the latest wearable device standard issued by the Institute of Electrical and Electronics Engineers (IEEE 1708-2014). We found that CLB is technically comparable to the ordinary cuff-based BP-measuring device. CLB will apply for wearable health care monitoring device that may change landscape of BP measurements in terms of continuous and stress-free monitoring.
Ordinary cuff-based blood pressure–monitoring devices remain a technical limitation that disturbs activities of daily life. Here we report a novel system for the cuff-less blood pressure estimation (CLB) that requires only 1 sensor for photoplethysmography. The present study is the first report to validate and assess the clinical application of the CLB in accordance with the latest wearable device standard (issued by the Institute of Electrical and Electronics Engineers, standard 1708-2014). Our CLB is expected to offer a flexible and wearable device that permits blood pressure monitoring in more continuous and stress-free settings.
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Key Words
- AAMI, Association for the Advancement of Medical Instrumentation
- ABPM, ambulatory blood pressure monitoring
- BP, blood pressure
- CB, cuff-based blood pressure measurement
- CI, confidence interval
- CLB, cuff-less blood pressure estimation
- DBP, diastolic blood pressure
- ECG, electrocardiogram
- HF, high-frequency
- HR, heart rate
- ICC, intraclass correlation coefficient
- IEEE, Institute of Electrical and Electronics Engineers
- LF, low-frequency
- MAD, mean absolute difference
- PTG, photoplethysmogram
- SBP, systolic blood pressure
- ambulatory blood pressure monitoring
- blood pressure
- diagnosis
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Affiliation(s)
- Naoki Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuko K Bando
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taiji Kawachi
- Healthcare Business Department, DENSO CORPORATION, Kariya, Japan
| | - Hiroshi Yamakita
- Healthcare Business Department, DENSO CORPORATION, Kariya, Japan
| | | | - Yoshikazu Honda
- Healthcare Business Department, DENSO CORPORATION, Kariya, Japan
| | - Hisae Yasui
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyuki Nishimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Kamihara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Phillips RA, Smith BE, Madigan VM. Stroke Volume Monitoring: Novel Continuous Wave Doppler Parameters, Algorithms and Advanced Noninvasive Haemodynamic Concepts. CURRENT ANESTHESIOLOGY REPORTS 2017; 7:387-398. [PMID: 29200974 PMCID: PMC5696447 DOI: 10.1007/s40140-017-0235-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Adequate oxygen delivery is essential for life, with hypoxia resulting in dysfunction, and ultimately death, of the cells, organs and organism. Blood flow delivers the oxygen bound in the blood, while haemodynamics is the science of blood flow. Stroke volume (SV) is the fundamental unit of blood flow, and reflects the interdependent performance of the heart, the vessels and the autonomic nervous system. However, haemodynamic management remains generally poor and predominantly guided by simple blood pressure observations alone. RECENT FINDINGS Doppler ultrasound measures SV with unequalled clinical precision when operated by trained personnel. Combining SV with BP measurements allows calculation of flow-pressure based measures which better reflect cardiovascular performance and allows personalised physiologic and pathophysiologic modelling consistent with Frank's and Starling's observations. SUMMARY Doppler SV monitoring and novel flow-pressure parameters may improve our understanding of the cardiovascular system and lead to improved diagnosis and therapy. This review examines the physics and practice of Doppler SV monitoring and its application in advanced haemodynamics.
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Affiliation(s)
- R. A. Phillips
- Ultrasound and Cardiovascular Monitoring, Critical Care Research Group, School of Medicine, The University of Queensland, Brisbane, Australia
| | - B. E. Smith
- Discipline of Intensive Care, University of Notre Dame Australia, Sydney, Australia
- Department of Anaesthetics and Intensive Care, Bathurst Base Hospital, Bathurst, NSW Australia
| | - V. M. Madigan
- University of Notre Dame Australia, Sydney, Australia
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Central Blood Pressure Monitoring via a Standard Automatic Arm Cuff. Sci Rep 2017; 7:14441. [PMID: 29089581 PMCID: PMC5663968 DOI: 10.1038/s41598-017-14844-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/07/2017] [Indexed: 11/08/2022] Open
Abstract
Current oscillometric devices for monitoring central blood pressure (BP) maintain the cuff pressure at a constant level to acquire a pulse volume plethysmography (PVP) waveform and calibrate it to brachial BP levels estimated with population average methods. A physiologic method was developed to further advance central BP measurement. A patient-specific method was applied to estimate brachial BP levels from a cuff pressure waveform obtained during conventional deflation via a nonlinear arterial compliance model. A physiologically-inspired method was then employed to extract the PVP waveform from the same waveform via ensemble averaging and calibrate it to the brachial BP levels. A method based on a wave reflection model was thereafter employed to define a variable transfer function, which was applied to the calibrated waveform to derive central BP. This method was evaluated against invasive central BP measurements from patients. The method yielded central systolic, diastolic, and pulse pressure bias and precision errors of -0.6 to 2.6 and 6.8 to 9.0 mmHg. The conventional oscillometric method produced similar bias errors but precision errors of 8.2 to 12.5 mmHg (p ≤ 0.01). The new method can derive central BP more reliably than some current non-invasive devices and in the same way as traditional cuff BP.
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Nitzan M, Slotki I, Shavit L. More accurate systolic blood pressure measurement is required for improved hypertension management: a perspective. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:157-163. [PMID: 28769596 PMCID: PMC5533571 DOI: 10.2147/mder.s141599] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The commonly used techniques for systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurement are the auscultatory Korotkoff-based sphygmomanometry and oscillometry. The former technique is relatively accurate but is limited to a physician's office because its automatic variant is subject to noise artifacts. Consequently, the Korotkoff-based measurement overestimates the blood pressure in some patients due to white coat effect, and because it is a single measurement, it cannot properly represent the variable blood pressure. Automatic oscillometry can be used at home by the patient and is preferred even in clinics. However, the technique's accuracy is low and errors of 10-15 mmHg are common. Recently, we have developed an automatic technique for SBP measurement, based on an arm pressure cuff and a finger photoplethysmographic probe. The technique was found to be significantly more accurate than oscillometry, and comparable to the Korotkoff-based technique, the reference-standard for non-invasive blood pressure measurements. The measurement of SBP is a mainstay for the diagnosis and follow-up of hypertension, which is a major risk factor for several adverse events, mainly cardiovascular. Lowering blood pressure evidently reduces the risk, but excessive lowering can result in hypotension and consequently hypoperfusion to vital organs, since blood pressure is the driving force for blood flow. Erroneous measurement by 10 mmHg can lead to a similar unintended reduction of SBP and may adversely affect patients treated to an SBP of 120-130 mmHg. In particular, in elderly patients, unintended excessive reduction of blood pressure due to inaccurate SBP measurement can result in cerebral hypoperfusion and consequent cognitive decline. By using a more accurate technique for automatic SBP measurement (such as the photoplethysmographic-based technique), the optimal blood pressure target can be achieved with lower risk for hypotension and its adverse events.
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Affiliation(s)
- Meir Nitzan
- Department of Applied Physics/Electro-Optics, Jerusalem College of Technology
| | - Itzchak Slotki
- Department of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Linda Shavit
- Department of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
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Samuel T, van Dyk D, Lombard CJ, Dyer RA. Observation of the pulse oximeter trace to estimate systolic blood pressure during spinal anaesthesia for Caesarean section: the effect of body mass index. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1349360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- T Samuel
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - D van Dyk
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - CJ Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - RA Dyer
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
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Allan PD, O'Donnell T, Tzeng YC. Agreement between finger plethysmography- and brachial oscillometry-derived blood pressure measurements. Clin Physiol Funct Imaging 2017; 38:439-446. [DOI: 10.1111/cpf.12435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/16/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Philip D. Allan
- Wellington Medical Technology Group; Department of Surgery & Anaesthesia; University of Otago, Wellington; Wellington New Zealand
- Centre for Translational Physiology; University of Otago, Wellington; Wellington New Zealand
| | - Terrence O'Donnell
- Wellington Medical Technology Group; Department of Surgery & Anaesthesia; University of Otago, Wellington; Wellington New Zealand
- Centre for Translational Physiology; University of Otago, Wellington; Wellington New Zealand
| | - Yu-Chieh Tzeng
- Wellington Medical Technology Group; Department of Surgery & Anaesthesia; University of Otago, Wellington; Wellington New Zealand
- Centre for Translational Physiology; University of Otago, Wellington; Wellington New Zealand
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Liu J, Cheng HM, Chen CH, Sung SH, Hahn JO, Mukkamala R. Patient-Specific Oscillometric Blood Pressure Measurement: Validation for Accuracy and Repeatability. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2016; 5:1900110. [PMID: 29018632 PMCID: PMC5477767 DOI: 10.1109/jtehm.2016.2639481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/07/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022]
Abstract
Oscillometric devices are widely used for automatic cuff blood pressure (BP) measurement. These devices estimate BP from the oscillometric cuff pressure waveform using population average methods. Hence, the devices may only be accurate over a limited BP range. The objective was to evaluate a new patient-specific method, which estimates BP by fitting a physiologic model to the same waveform. One-hundred and forty-five cardiac catheterization patients and normal adults were included for study. The oscillometric cuff pressure waveform was obtained with an office device, while reference BP was measured via brachial artery catheterization or auscultation, during baseline and/or nitroglycerin administration. Fifty-seven of the subject records were utilized for refining the patient-specific method, while the remaining 88 subject records were employed for evaluation. The precision errors for all BP levels of the patient-specific method ranged from 6.3 to 7.6 mmHg. These errors were significantly lower than those of the office device (by 29% on average) in subjects with high pulse pressure (>50 mmHg) while being comparable to those of the device in subjects with normal pulse pressure (<50 mmHg). The bias and precision of the differences in repeated estimates for all BP levels of the patient-specific method ranged from 0.1 to 1.1 and 2.1 to 5.9 mmHg, respectively. These precision differences were significantly lower than those of the office device (by 64% on average). The patient-specific method may afford more accurate automatic cuff BP measurement in patients with large artery stiffening while limiting the number of required cuff inflations/deflations per measurement.
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Affiliation(s)
- Jiankun Liu
- Department of Electrical and Computer EngineeringMichigan State University
| | - Hao-Min Cheng
- Department of MedicineSchool of MedicineNational Yang-Ming University
| | - Chen-Huan Chen
- Department of MedicineSchool of MedicineNational Yang-Ming University
| | - Shih-Hsien Sung
- Department of MedicineSchool of MedicineNational Yang-Ming University
| | - Jin-Oh Hahn
- Department of Mechanical EngineeringUniversity of Maryland
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Briggs R, Kenny RA, Kennelly SP. Systematic Review: The Association between Late Life Depression and Hypotension. J Am Med Dir Assoc 2016; 17:1076-1088. [DOI: 10.1016/j.jamda.2016.06.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 12/17/2022]
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Peng ZZ, Zhang MZ, Sun Y, Bai J, Gu HB, Liu PP, Li M, Cai MH. The agreement between oscillometric and intra-arterial technique for blood pressure monitoring in the lower extremities for infants and toddlers undergoing aortic coarctation repair. Paediatr Anaesth 2016; 26:1091-1096. [PMID: 27543444 DOI: 10.1111/pan.12989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Anesthetic management for patients undergoing surgical repair of aortic coarctation (CoA) should include constant blood pressure monitoring of the right upper extremity and a lower extremity. The delayed or absent pulse in the lower limbs often leads to unsuccessful arterial cannulation in infants and the oscillometric technique used for blood pressure measurement. The aim of this study was to evaluate the agreement between the oscillometric method and intra-arterial technique for blood pressure monitoring in the lower limbs of infants undergoing CoA. METHODS A total of 45 infants diagnosed with isolated CoA were initially enrolled in this study and five were excluded because of cannulation failure. Thus, 40 patients had their blood pressure measured simultaneously by both oscillometric technique on the thigh and femoral artery catheterization. After induction and intubation, five pairs of blood pressure readings from each patient were collected in an interval of 3 min. Statistical analysis was accomplished by revised Bland-Altman analysis. RESULTS There was a strong correlation between oscillometric and invasive blood pressure measurements [systolic blood pressure (SBP) r = 0.771, diastolic blood pressure (DBP) r = 0.704 and mean artery pressure (MAP) r = 0.850]. The mean difference and 95% limits of agreement (95% LOA) between oscillometric and femoral artery blood pressure readings was 3.830 mmHg (-19.297, 26.957) for SBP, -8.725 mmHg (-26.236, 8.786) for DBP, and -3.235 mmHg (-18.842, 12.372) for MAP. There were only one pair of MAP (1/40) and two pairs of SBP readings (2/40) out of range (95% LOA), and all of paired DBP readings were within 95% LOA. CONCLUSION There was a good agreement between oscillometric and invasive blood pressure measurements of lower extremities in infants with isolated CoA statistically. However, the oscillometry-measured SBP showed a tendency to overestimate the intra-arterial blood pressure reference, while oscillometry-measured DBP underestimated its reference. MAP measurement provided the most accurate and reliable results in this study.
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Affiliation(s)
- Zhe-Zhe Peng
- Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ma-Zhong Zhang
- Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Sun
- Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Bin Gu
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pei-Pei Liu
- Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Min Li
- Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mei-Hua Cai
- Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Abstract
Objective The aim of this study was to compare the values of a noninvasive blood pressure (NIBP) measurement during cuff inflation (inflationary NIBP) and deflationary NIBP measurements and to verify whether inflationary NIBP is equivalent to conventional deflationary NIBP and is acceptable for clinical use in the emergency room (ER). Materials and methods A total of 2981 NIBP data points were collected from 175 patients (age, 56.5±22.2 years; range, 7–92 years) who had been treated in the resuscitation area of the ER at Keio University Hospital. The data points were obtained using two alternate algorithms with a standard monitor (BSM-6000). One algorithm consisted of continuous inflationary and deflationary measurements in a single cycle (dual algorithm, 1502 data points); this algorithm was used to verify the success rate and the precision of the data. The second algorithm (1479 data points) consisted of only conventional deflationary measurements and was used to verify the duration of the measurement cycle. Results The success rate of the inflationary NIBP (completed using only the inflationary method) was 69.0%. Failures in the inflationary measurements were caused by arrhythmia and/or body motions. The mean difference and SD of the systolic pressure and the diastolic pressure between inflationary NIBP and deflationary NIBP were −0.6±8.8 and 3.5±7.5 mmHg, respectively. The confidence intervals were −0.6 (95% confidence interval=−1.1 to −0.1) and 3.5 (95% confidence interval=3.0 to 4.0) mmHg. The coefficients of correlation were 0.96 and 0.93. Inflationary NIBP was capable of determining the NIBP more quickly compared with deflationary NIBP (average of 15.9 vs. 34.2 s; P<0.05). Conclusion Inflationary NIBP measurements have a reasonable accuracy and a sufficient rapidity, compared with deflationary NIBP measurements, in ER patients.
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Wu H, Wang B, Zhu X, Chu G, Zhang Z. A new automatic blood pressure kit auscultates for accurate reading with a smartphone: A diagnostic accuracy study. Medicine (Baltimore) 2016; 95:e4538. [PMID: 27512876 PMCID: PMC4985331 DOI: 10.1097/md.0000000000004538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The widely used oscillometric automated blood pressure (BP) monitor was continuously questioned on its accuracy. A novel BP kit named Accutension which adopted Korotkoff auscultation method was then devised. Accutension worked with a miniature microphone, a pressure sensor, and a smartphone. The BP values were automatically displayed on the smartphone screen through the installed App. Data recorded in the phone could be played back and reconfirmed after measurement. They could also be uploaded and saved to the iCloud. The accuracy and consistency of this novel electronic auscultatory sphygmomanometer was preliminarily verified here. Thirty-two subjects were included and 82 qualified readings were obtained. The mean differences ± SD for systolic and diastolic BP readings between Accutension and mercury sphygmomanometer were 0.87 ± 2.86 and -0.94 ± 2.93 mm Hg. Agreements between Accutension and mercury sphygmomanometer were highly significant for systolic (ICC = 0.993, 95% confidence interval (CI): 0.989-0.995) and diastolic (ICC = 0.987, 95% CI: 0.979-0.991). In conclusion, Accutension worked accurately based on our pilot study data. The difference was acceptable. ICC and Bland-Altman plot charts showed good agreements with manual measurements. Systolic readings of Accutension were slightly higher than those of manual measurement, while diastolic readings were slightly lower. One possible reason was that Accutension captured the first and the last korotkoff sound more sensitively than human ear during manual measurement and avoided sound missing, so that it might be more accurate than traditional mercury sphygmomanometer. By documenting and analyzing of variant tendency of BP values, Accutension helps management of hypertension and therefore contributes to the mobile heath service.
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Affiliation(s)
- Hongjun Wu
- Department of Cardiology, Yixing No. 2 People's Hospital
| | - Bingjian Wang
- Department of Cardiology, Huai’an First People's Hospital, Nanjing Medical University, Jiangsu Province
| | - Xinpu Zhu
- Department of Neurology, Branch of Shanghai General Hospital
| | - Guang Chu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Zhi Zhang
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Brown RJ, Kumar A, McCullough LD, Butler K. A survey of blood pressure parameters after aneurysmal subarachnoid hemorrhage. Int J Neurosci 2016; 127:51-58. [PMID: 26822716 DOI: 10.3109/00207454.2016.1138952] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose/aim: Blood pressure (BP) regulation is recommended following aneurysmal subarachnoid hemorrhage (aSAH) to prevent re-bleeding and to treat delayed cerebral ischemia. However, optimal BP thresholds are not well established. There is also variation with regard to the BP component (e.g. systolic vs. mean) that is targeted or manipulated. MATERIALS AND METHODS An 18-question survey was distributed to physicians and advanced practitioner members of the Neurocritical Care Society. Respondents were asked which BP parameter they manipulated and what their thresholds were in different clinical scenarios. They were also asked whether they were influenced by the presence of incidental aneurysms. Answers were analyzed for differences in training background and treatment setting. RESULTS There were 128 responses. The majority were neurointensivists (47 neurology and 37 non-neurology) and treated patients in dedicated neurointensive care units (n = 98). Systolic BP (SBP) was preferred over mean arterial pressure (MAP). Prior to aneurysm treatment, SBP limits ranged from 140 to 180 mm Hg. After aneurysm treatment, SBP limits ranged from 160 to 240 mm Hg. The maximum and minimum MAPs varied by as much as 50%. Nearly two-thirds of the respondents were influenced by the presence of incidental aneurysms. Training background influenced tolerance to BP limits with neurology-trained neurointensivists accepting higher BP limits when treating delayed ischemia ( p = .018). They were also more likely to follow SBP ( p = .018) and have a limit of 140 mm Hg prior to aneurysm treatment ( p = .001). CONCLUSIONS There is large practice variability in BP management following aSAH. There is also uncertainty over the importance of incidental aneurysms. Further research could evaluate whether this variability has clinical significance.
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Affiliation(s)
- Robert J Brown
- a Department of Surgery, Division of Critical Care , Hartford Hospital , Hartford , CT , USA
| | - Abhay Kumar
- b Department of Neurology and Psychiatry , Saint Louis University , SaintLouis , MO , USA
| | - Louise D McCullough
- c Department of Neurology , University of Connecticut School of Medicine , Farmington , CT , USA
| | - Karyn Butler
- a Department of Surgery, Division of Critical Care , Hartford Hospital , Hartford , CT , USA
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When should we adopt continuous noninvasive hemodynamic monitoring technologies into clinical routine? J Clin Monit Comput 2015; 29:1-3. [PMID: 25246243 DOI: 10.1007/s10877-014-9619-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Liu J, Cheng HM, Chen CH, Sung SH, Moslehpour M, Hahn JO, Mukkamala R. Patient-Specific Oscillometric Blood Pressure Measurement. IEEE Trans Biomed Eng 2015; 63:1220-1228. [PMID: 26485351 DOI: 10.1109/tbme.2015.2491270] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Most automatic cuff blood pressure (BP) measurement devices are based on oscillometry. These devices estimate BP from the envelopes of the cuff pressure oscillations using fixed ratios. The values of the fixed ratios represent population averages, so the devices may only be accurate in subjects with normal BP levels. The objective was to develop and demonstrate the validity of a patient-specific oscillometric BP measurement method. METHODS The idea of the developed method was to represent the cuff pressure oscillation envelopes with a physiologic model, and then estimate the patient-specific parameters of the model, which includes BP levels, by optimally fitting it to the envelopes. The method was investigated against gold standard reference BP measurements from 57 patients with widely varying pulse pressures. A portion of the data was used to optimize the patient-specific method and a fixed-ratio method, while the remaining data were used to test these methods and a current office device. RESULTS The patient-specific method yielded BP root-mean-square-errors ranging from 6.0 to 9.3 mmHg. On an average, these errors were nearly 40% lower than the errors of each existing method. CONCLUSION The patient-specific method may improve automatic cuff BP measurement accuracy. SIGNIFICANCE A patient-specific oscillometric BP measurement method was proposed and shown to be more accurate than the conventional method and a current device.
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Abstract
Hypertension has become a serious global public health burden because of its high incidence and concomitant risk of cardiovascular disease. Many studies have verified that risk factors, such as hypertension and obesity which are responsible for cardiovascular disease, start in early childhood. In Asian countries, the prevalence of hypertension in the pediatric age group has become more prevalent than ever before with the increasing obesity epidemic. To tackle the epidemic of cardiovascular disease, a leading cause of death and disability of non-communicable diseases in Asian countries, population-based measures aiming at reducing harmful environmental factors to blood pressure and body weight must be applied to individuals in their early childhood, as early as the fetal stage. This review focused on the prevalence of pediatric hypertension in Asian countries and outlined several considerations for accurate blood pressure (BP) measurement and evaluation, along with an overview of pathophysiology of fetal programming and obesity related with childhood hypertension.
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Forouzanfar M, Dajani HR, Groza VZ, Bolic M, Rajan S, Batkin I. Oscillometric Blood Pressure Estimation: Past, Present, and Future. IEEE Rev Biomed Eng 2015; 8:44-63. [DOI: 10.1109/rbme.2015.2434215] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ghaffari S, Malaki M, Rezaeifar A, Abdollahi Fakhim S. Effect of peripheral edema on oscillometric blood pressure measurement. J Cardiovasc Thorac Res 2014; 6:217-21. [PMID: 25610552 PMCID: PMC4291599 DOI: 10.15171/jcvtr.2014.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/12/2014] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Blood pressure (BP) measurement is essential for epidemiological studies and clinical decisions. It seems that tissue characteristics can affect BP results and we try to find edema effect on BP results taken by different methods. METHODS BP of 55 children before open heart surgery were measured and compared according to three methods: Arterial as standard and reference, oscillometric and auscultatory methods. Peripheral edema as a tissue characteristic was defined in higher than +2 as marked edema and in equal or lower than +2 as no edema. STATISTICAL ANALYSES data was expressed as Mean and 95% of confidence interval (CI 95%). Comparison of two groups was performed by T independent test and of more than two groups by ANOVA test. Mann-Whitney U and paired T-test were used for serially comparisons of changes. P less than 0.05 was considered significant. RESULTS Fifty five children aged 29.4±3.9 months were divided into two groups: 10 children with peripheral edema beyond +2 and 45 cases without edema. Oscillometric method overestimated systolic BP and the Mean (CI 95%) difference of oscillometric to arterial was 4.8 (8/-1, P=0.02) in edematous and 4.2 (7/1, p=0.004) in non edematous. Oscillometric method underestimated diastolic BP as -9 (-1.8/-16.5, P=0.03) in edematous group and 2.6 (-0.7/+5, P= 0.2) in non edematous compared to arterial method. CONCLUSION Oscillometric device standards cannot cover all specific clinical conditions. It underestimates diastolic BP significantly in edematous children, which was 9.2 mmHg in average beyond the acceptable standards.
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Affiliation(s)
- Shamsi Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Malaki
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afshin Rezaeifar
- Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Measurement of blood pressure. Best Pract Res Clin Anaesthesiol 2014; 28:309-22. [DOI: 10.1016/j.bpa.2014.08.001] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/21/2014] [Accepted: 08/27/2014] [Indexed: 01/11/2023]
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Redon J, Lurbe E. Ambulatory Blood Pressure Monitoring Is Ready to Replace Clinic Blood Pressure in the Diagnosis of Hypertension. Hypertension 2014; 64:1169-74; discussion 1174. [DOI: 10.1161/hypertensionaha.114.03883] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Josep Redon
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
| | - Empar Lurbe
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
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Ribezzo S, Spina E, Di Bartolomeo S, Sanson G. Noninvasive techniques for blood pressure measurement are not a reliable alternative to direct measurement: a randomized crossover trial in ICU. ScientificWorldJournal 2014; 2014:353628. [PMID: 24616624 PMCID: PMC3926274 DOI: 10.1155/2014/353628] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/13/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Noninvasive blood pressure (NIBP) monitoring methods are widely used in critically ill patients despite poor evidence of their accuracy. The erroneous interpretations of blood pressure (BP) may lead to clinical errors. OBJECTIVES To test the accuracy and reliability of aneroid (ABP) and oscillometric (OBP) devices compared to the invasive BP (IBP) monitoring in an ICU population. MATERIALS AND METHODS Fifty adult patients (200 comparisons) were included in a randomized crossover trial. BP was recorded simultaneously by IBP and either by ABP or by OBP, taking IBP as gold standard. RESULTS Compared with ABP, IBP systolic values were significantly higher (mean difference ± standard deviation 9.74 ± 13.8; P < 0.0001). Both diastolic (-5.13 ± 7.1; P < 0.0001) and mean (-2.14 ± 7.1; P=0.0033) IBP were instead lower. Compared with OBP, systolic (10.80 ± 14.9; P < 0.0001) and mean (5.36 ± 7.1; P < 0.0001) IBP were higher, while diastolic IBP (-3.62 ± 6.0; P < 0.0001) was lower. Bland-Altman plots showed wide limits of agreement in both NIBP-IBP comparisons. CONCLUSIONS BP measurements with different devices produced significantly different results. Since in critically ill patients the importance of BP readings is often crucial, noninvasive techniques cannot be regarded as reliable alternatives to direct measurements.
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Affiliation(s)
- Sara Ribezzo
- School of Nursing, University of Trieste, 34100 Trieste, Italy
| | - Eleonora Spina
- Intensive Care Unit, University Hospital of Trieste, 34100 Trieste, Italy
| | - Stefano Di Bartolomeo
- Department of Anesthesia 1, University Hospital of Udine, 33100 Udine, Italy
- Emilia-Romagna Regional Agency for Health and Social Care, 40100 Bologna, Italy
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Choi SW, Kim MK, Han SW, Kim SH, Kim HJ, Kang SM, Kim DK, Kim BS, Kim WH, Kim JY, Kim HY, Rhew JY, Park KS, Cho KI, Jeong MH, Jeong YS, Ryu KH. Characteristics of hypertension subtypes and treatment outcome among elderly Korean hypertensives. ACTA ACUST UNITED AC 2014; 8:246-53. [PMID: 24568934 DOI: 10.1016/j.jash.2014.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/04/2014] [Accepted: 01/06/2014] [Indexed: 01/08/2023]
Abstract
There are limited data about characteristics of hypertension subtypes in Asian hypertensive patients and their impacts on treatment of hypertension. This prospective, multi-center, observational study evaluated 2439 hypertensive patients. (≥60 years) Inadequately controlled and drug-naïve patients were categorized into three hypertension subtypes (isolated systolic hypertension [ISH], combined systolic/diastolic hypertension [SDH], and isolated diastolic hypertension [IDH]), and proportions of each hypertension subtype were evaluated. After 6-month strict treatments, we compared the characteristics of patients who did not achieve target BP with those who did. In overall population, ISH was the most common subtype (53.2%; 1297/2439). However, in drug-naïve patients, SDH was the predominant hypertension subtype (59.6%; 260/436). Notably, the proportion of ISH was substantially lower than previously known data. Predictors associated with failure of reaching target BP were old age (>70 years), hypertension awareness, and baseline systolic blood pressure (≥160 mm Hg) for total patients. In drug naïve patients, hypertension awareness, ISH, and microalbuminuria were associated with treatment failure. These findings might have an impact on the evaluations and antihypertensive treatments of elderly Korean patients.
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Affiliation(s)
- Suk-Won Choi
- Division of Cardiology, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Min-Kyu Kim
- Division of Cardiology, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Seong-Woo Han
- Division of Cardiology, Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Sung Hea Kim
- Division of Cardiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyun Joong Kim
- Division of Cardiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Dae-Kyeong Kim
- Division of Cardiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Byung Soo Kim
- Department of Internal Medicine, Daedong Hospital, Busan, Republic of Korea
| | - Won Ho Kim
- Division of Cardiology, Eul Ji University Hospital, Seoul, Republic of Korea
| | - Jang-Young Kim
- Division of Cardiology, Wonju Christian Hospital, Wonju, Republic of Korea
| | - Hee-Yeol Kim
- Division of Cardiology, Bucheon St. Mary's Hospital, Bucheon, Republic of Korea
| | - Jay-Young Rhew
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Republic of Korea
| | - Keum-Soo Park
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Kyoung-Im Cho
- Division of Cardiology, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Myung Ho Jeong
- Division of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yong Suk Jeong
- Department of Internal Medicine, Sunlin Hospital, Busan, Republic of Korea
| | - Kyu-Hyung Ryu
- Division of Cardiology, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea.
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46
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Hayashi S, Yamada H, Bando M, Hotchi J, Ise T, Yamaguchi K, Iwase T, Soeki T, Wakatsuki T, Tamaki T, Sata M. Augmentation Index Does Not Reflect Risk of Coronary Artery Disease in Elderly Patients. Circ J 2014; 78:1176-82. [DOI: 10.1253/circj.cj-13-1422] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shuji Hayashi
- Ultrasound Examination Center, Tokushima University Hospital
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Mika Bando
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Junko Hotchi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Iwase
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Toshiaki Tamaki
- Department of Pharmacology, Institute of Health Biosciences, University of Tokushima Graduate School
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital
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47
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Sasaki J, Hori S. Validation of inflationary non-invasive blood pressure monitoring in emergency room patients. Crit Care 2014. [PMCID: PMC4068645 DOI: 10.1186/cc13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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48
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Lakhal K, Ehrmann S, Perrotin D, Wolff M, Boulain T. Fluid challenge: tracking changes in cardiac output with blood pressure monitoring (invasive or non-invasive). Intensive Care Med 2013; 39:1953-62. [PMID: 24061631 DOI: 10.1007/s00134-013-3086-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/19/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess whether invasive and non-invasive blood pressure (BP) monitoring allows the identification of patients who have responded to a fluid challenge, i.e., who have increased their cardiac output (CO). METHODS Patients with signs of circulatory failure were prospectively included. Before and after a fluid challenge, CO and the mean of four intra-arterial and oscillometric brachial cuff BP measurements were collected. Fluid responsiveness was defined by an increase in CO ≥10 or ≥15% in case of regular rhythm or arrhythmia, respectively. RESULTS In 130 patients, the correlation between a fluid-induced increase in pulse pressure (Δ500mlPP) and fluid-induced increase in CO was weak and was similar for invasive and non-invasive measurements of BP: r² = 0.31 and r² = 0.29, respectively (both p < 0.001). For the identification of responders, invasive Δ500mlPP was associated with an area under the receiver-operating curve (AUC) of 0.82 (0.74-0.88), similar (p = 0.80) to that of non-invasive Δ500mlPP [AUC of 0.81 (0.73-0.87)]. Outside large gray zones of inconclusive values (5-23% for invasive Δ500mlPP and 4-35% for non-invasive Δ500mlPP, involving 35 and 48% of patients, respectively), the detection of responsiveness or unresponsiveness to fluid was reliable. Cardiac arrhythmia did not impair the performance of invasive or non-invasive Δ500mlPP. Other BP-derived indices did not outperform Δ500mlPP. CONCLUSIONS As evidenced by large gray zones, BP-derived indices poorly reflected fluid responsiveness. However, in our deeply sedated population, a high increase in invasive pulse pressure (>23%) or even in non-invasive pulse pressure (>35%) reliably detected a response to fluid. In the absence of a marked increase in pulse pressure (<4-5%), a response to fluid was unlikely.
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Affiliation(s)
- Karim Lakhal
- Réanimation Chirurgicale Polyvalente, Service d'Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes Cedex 1, France,
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49
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Pagonas N, Schmidt S, Eysel J, Compton F, Hoffmann C, Seibert F, Hilpert J, Tschöpe C, Zidek W, Westhoff TH. Impact of Atrial Fibrillation on the Accuracy of Oscillometric Blood Pressure Monitoring. Hypertension 2013; 62:579-84. [DOI: 10.1161/hypertensionaha.113.01426] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of automated oscillometric blood pressure monitors was the basis for today’s widespread use of blood pressure self-measurement. However, in atrial fibrillation, there is a controversial debate on the use of oscillometry because there is a high variability of heart rate and stroke volume. To date, the accuracy of oscillometric blood pressure monitoring in atrial fibrillation has only been investigated using auscultatory sphygmomanometry as reference method, which may be biased by arrhythmia as well. We performed a cross-sectional study in 102 patients (52 sinus rhythm, 50 atrial fibrillation) assessing the accuracy of an automated and validated oscillometric upper arm (M5 Professional, Omron) and wrist device (R5 Professional, Omron) to invasively assessed arterial pressure. Blood pressure values were calculated as the mean of 3 consecutive measurements. Systolic and diastolic blood pressure did not significantly differ in patients with sinus rhythm and atrial fibrillation, independent of the method of measurement (
P
>0.05 each). The within-subject variability of the oscillometric measurements was higher in patients with atrial fibrillation compared with sinus rhythm (
P
<0.01 each). The biases of systolic and diastolic blood pressure, however, did not significantly differ in presence or absence of atrial fibrillation in Bland-Altmann analysis (
P
>0.05 each). In conclusion, atrial fibrillation did not significantly affect the accuracy of oscillometric measurements, if 3 repeated measurements were performed.
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Affiliation(s)
- Nikolaos Pagonas
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Sven Schmidt
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Jörg Eysel
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Friederike Compton
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Clemens Hoffmann
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Felix Seibert
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Justus Hilpert
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Carsten Tschöpe
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Walter Zidek
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
| | - Timm H. Westhoff
- From the Departments of Nephrology (N.P., S.S., J.E., F.C., C.H., F.S., W.Z., T.H.W.), Anaesthesiology (J.H.), and Cardiology (C.T.), Charité–Campus Benjamin Franklin, Berlin, Germany; and Department of Medicine I, Universitätsklinik Marienhospital, Ruhr University Bochum, Herne, Germany (N.P., T.H.W.)
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50
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Daley MF, Sinaiko AR, Reifler LM, Tavel HM, Glanz JM, Margolis KL, Parker E, Trower NK, Chandra M, Sherwood NE, Adams K, Kharbanda EO, Greenspan LC, Lo JC, O’Connor PJ, Magid DJ. Patterns of care and persistence after incident elevated blood pressure. Pediatrics 2013; 132:e349-55. [PMID: 23821694 PMCID: PMC3727670 DOI: 10.1542/peds.2012-2437] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Screening for hypertension in children occurs during routine care. When blood pressure (BP) is elevated in the hypertensive range, a repeat measurement within 1 to 2 weeks is recommended. The objective was to assess patterns of care after an incident elevated BP, including timing of repeat BP measurement and likelihood of persistently elevated BP. METHODS This retrospective study was conducted in 3 health care organizations. All children aged 3 through 17 years with an incident elevated BP at an outpatient visit during 2007 through 2010 were identified. Within this group, we assessed the proportion who had a repeat BP measured within 1 month of their incident elevated BP and the proportion who subsequently met the definition of hypertension. Multivariate analyses were used to identify factors associated with follow-up BP within 1 month of initial elevated BP. RESULTS Among 72,625 children and adolescents in the population, 6108 (8.4%) had an incident elevated BP during the study period. Among 6108 with an incident elevated BP, 20.9% had a repeat BP measured within 1 month. In multivariate analyses, having a follow-up BP within 1 month was not significantly more likely among individuals with obesity or stage 2 systolic elevation. Among 6108 individuals with an incident elevated BP, 84 (1.4%) had a second and third consecutive elevated BP within 12 months. CONCLUSIONS Whereas >8% of children and adolescents had an incident elevated BP, the great majority of BPs were not repeated within 1 month. However, relatively few individuals subsequently met the definition of hypertension.
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Affiliation(s)
- Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado;,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Alan R. Sinaiko
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Liza M. Reifler
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Heather M. Tavel
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Karen L. Margolis
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Emily Parker
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Nicole K. Trower
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Malini Chandra
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Nancy E. Sherwood
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Kenneth Adams
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Elyse O. Kharbanda
- HealthPartners Institute for Education and Research, Minneapolis, Minnesota
| | - Louise C. Greenspan
- Kaiser Permanente San Francisco Medical Center, San Francisco, California; and
| | - Joan C. Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - David J. Magid
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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