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Jung JY. Which blood pressure metrics should be used in patients on dialysis? Kidney Res Clin Pract 2024; 43:133-142. [PMID: 38062622 PMCID: PMC11016667 DOI: 10.23876/j.krcp.23.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 04/12/2024] Open
Abstract
Remarkable progress has recently been achieved in blood pressure (BP) control based on key research findings in the general population. It has been observed that maintaining BP slightly lower than previously recommended goals leads to better clinical outcomes, provided that patients can tolerate it. Previously, BP control targets for dialysis patients were extrapolated from studies conducted on the general population. However, dialysis patients are considered a distinct group with unique characteristics, which makes defining appropriate BP targets a matter of debate. Several observational studies measuring BP in hemodialysis (HD) patients within dialysis units have shown that lower peridialysis BP (pre-, post-, and interdialytic BP) is associated with worse clinical outcomes. However, this association is likely confounded by factors specific to dialysis patients. The relationship between BP and mortality appears to be more linear in patients with fewer underlying cardiovascular diseases and longer survival. Recent studies have indicated that BP measurements taken outside of dialysis sessions, such as standardized BP on nondialysis days, home BP, and ambulatory BP monitoring between HD sessions, are more predictive of clinical outcomes. Due to the varied effects of dialysis-related treatment practices on BP, there is a lack of data from large-scale clinical trials. As a result, it is challenging to provide strong recommendations for BP targets directly applicable to dialysis patients. This review addresses various factors influencing BP in dialysis patients, including the establishment of individualized target BP levels and discussions on maintenance strategies, while incorporating a recent literature review.
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Affiliation(s)
- Ji Yong Jung
- Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
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2
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Mouseli A, Sharafi M, Amiri Z, Dehghan A, Haghjoo E, Mohsenpour MA, Eftekhari MH, Fatemian H, Keshavarzian O. Prevalence and factors associated with inter-arm systolic and diastolic blood pressure differences: results from the baseline Fasa Adult's Cohort Study (FACS). BMC Public Health 2024; 24:345. [PMID: 38302901 PMCID: PMC10835907 DOI: 10.1186/s12889-024-17857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND One of the modifiable risk factors for cardiovascular diseases is the inter-arm blood pressure difference (IAD), which can be easily measured. This study aimed to determine the prevalence and factors related to the Iranian population's inter-arm differences in systolic and diastolic blood pressure. METHOD This cross-sectional study was conducted on the baseline data of participants who had Iranian nationality, were at least 1 year of residence in the area, aged within the age range of 35-70 years, and willed to participate from the Fasa Persian Adult Cohort Study (FACS). IAD for systolic and diastolic blood pressure was measured and categorized into two groups of difference < 10 and ≥ 10 mmHg. Logistic regression was used to model the association between independent variables and IAD. RESULTS The prevalence of systolic and diastolic IAD ≥ 10 mmHg was 16.34% and 10.2%, respectively, among 10,124 participants. According to the multivariable logistic regression models, age (adjusted odds ratio (aOR): 1.019 [95% CI: 1.013, 1.025]), body mass index (BMI) (aOR: 1.112 [95% CI: 1.016, 1.229]), having type 2 diabetes (aOR Yes/No: 1.172 [95% CI: 1.015, 1.368]), having chronic headaches (aOR Yes/No: 1.182 [95% CI: 1.024, 1.365]), and pulse rate (aOR: 1.019 [95% CI: 1.014, 1.024]) significantly increased the odds of systolic IAD ≥ 10 mmHg. Additionally, high socio-economic status decreased the odds of systolic IAD ≥ 10 mmHg (aOR High/Low: 0.854 [95% CI: 0.744, 0.979]). For diastolic IAD, age (aOR: 1.112 [95% CI: 1.015, 1.210]) and pulse rate (aOR: 1.021 [95% CI: 1.015, 1.027]) significantly increased the odds of diastolic IAD ≥ 10 mmHg. Moreover, high socioeconomic status decreased the odds of diastolic IAD ≥ 10 mmHg (aOR High/Low: 0.820 [95% CI: 0.698, 0.963]). CONCLUSION The noticeable prevalence of systolic and diastolic IAD in general population exhibits health implications due to its' association with the risk of cardiovascular events. Sociodemographic and medical history assessments have potentials to be incorporated in IAD risk stratification and preventing programs.
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Affiliation(s)
- Ali Mouseli
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehdi Sharafi
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
- Noncommunicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Iran.
| | - Zahra Amiri
- Social Determinants in Health Promotion Research Center, Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Azizallah Dehghan
- Noncommunicable Disease Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Elham Haghjoo
- Department of Persian Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohammad Ali Mohsenpour
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hassan Eftekhari
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Fatemian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Keshavarzian
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Lins LFTDS, do Nascimento EGC, da Silva Júnior JA, de Medeiros Fernandes TAA, de Andrade MF, de Mesquita Andrade C. Accuracy of wearable electronic device compared to manual and automatic methods of blood pressure determination. Med Biol Eng Comput 2023; 61:2627-2636. [PMID: 37405672 DOI: 10.1007/s11517-023-02869-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/16/2023] [Indexed: 07/06/2023]
Abstract
Blood pressure (BP) is the main biomarker for monitoring patients, as its lack of control above values considered normal is a modifiable risk factor for target organ damage. The aim of this study is to evaluate the accuracy of the wearable electronic device photoplethysmography technology (PPG) Samsung Galaxy Watch 4 in determining BP in young patients compared to manual and automatic methods of BP determination. This is a quantitative and cross-sectional study, following validation protocols for wearable devices and BP measurement. It was carried out with twenty healthy young adults, in which BP was measured using four instruments, namely, standard sphygmomanometer device (manual), automatic arm oscillometric device (reference), wrist oscillometric device, and Smartwatch PPG. Eighty systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings were observed. SBP means manual 118 ± 2.20,arm 113 ± 2.54, wrist 118 ± 2.51, and PPG (smartwatch) 113 ± 2.58. Among means, arm and PPG difference is 0.15, arm and wrist 4.95, arm and manual 4.45 wrist with PPG. The mean DBP manual 76.7 ± 1.84, arm 73.6 ± 1.92, wrist 79.3 ± 1.87, and PPG 72.2 ± 1.38. Among means, the difference between the arm and PPG is 1.4 and arm and hand 3.5 mmHg. The correlation shows PPG with manual, arm, and wrist. There was a strong SBP correlation and a moderate DBP correlation between the methods tested, evidencing the accuracy of the PPG smartwatch in relation to the reference method.
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Affiliation(s)
| | - Ellany Gurgel Cosme do Nascimento
- Faculdade de Ciências da Saúde, Universidade Do Estado Do Rio Grande Do Norte, Atirador Miguel Antonio da Silva St, Mossoró, RN, 59607-360, Brazil
| | - José Antonio da Silva Júnior
- Faculdade de Ciências da Saúde, Universidade Do Estado Do Rio Grande Do Norte, Atirador Miguel Antonio da Silva St, Mossoró, RN, 59607-360, Brazil.
| | | | | | - Cléber de Mesquita Andrade
- Faculdade de Ciências da Saúde, Universidade Do Estado Do Rio Grande Do Norte, Atirador Miguel Antonio da Silva St, Mossoró, RN, 59607-360, Brazil
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Martínez R, Soliz P, Campbell NRC, Lackland DT, Whelton PK, Ordúñez P. [Association between population hypertension control and ischemic heart disease and stroke mortality in 36 countries of the Americas, 1990-2019: an ecological studyAssociação entre controle populacional da hipertensão e mortalidade por doença cardíaca isquêmica e acidente vascular cerebral em 36 países das Américas, 1990-2019: um estudo ecológico]. Rev Panam Salud Publica 2023; 47:e124. [PMID: 37497153 PMCID: PMC10367117 DOI: 10.26633/rpsp.2023.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/06/2022] [Indexed: 07/28/2023] Open
Abstract
Objective To quantify the association between the prevalence of population hypertension control and ischemic heart disease (IHD) and stroke mortality in 36 countries of the Americas from 1990 to 2019. Methods This ecologic study uses the prevalence of hypertension, awareness, treatment, and control from the NCD-RisC and IHD and stroke mortality from the Global Burden of Disease Study 2019. Regression analysis was used to assess time trends and the association between population hypertension control and mortality. Results Between 1990 and 2019, age-standardized death rates due to IHD and stroke declined annually by 2.2% (95% confidence intervals: -2.4 to -2.1) and 1.8% (-1.9 to -1.6), respectively. The annual reduction rate in IHD and stroke mortality deaccelerated to -1% (-1.2 to -0.8) during 2000-2019. From 1990 to 2019, the prevalence of hypertension controlled to a systolic/diastolic blood pressure ≤140/90 mmHg increased by 3.2% (3.1 to 3.2) annually. Population hypertension control showed an inverse association with IHD and stroke mortality, respectively, regionwide and in all but 3 out of 36 countries. Regionwide, for every 1% increase in population hypertension control, our data predicted a reduction of 2.9% (-2.94 to -2.85) in IHD deaths per 100 000 population, equivalent to an averted 25 639 deaths (2.5 deaths per 100 000 population) and 2.37% (-2.41 to -2.33) in stroke deaths per 100 000 population, equivalent to an averted 9 650 deaths (1 death per 100 000 population). Conclusion There is a strong ecological negative association between IHD and stroke mortality and population hypertension control. Countries with the best performance in hypertension control showed better progress in reducing CVD mortality. Prediction models have implications for hypertension management in most populations in the Region of the Americas and other parts of the world.
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Affiliation(s)
- Ramón Martínez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | - Patricia Soliz
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
| | | | - Daniel T. Lackland
- Universidad Médica de Carolina del SurCharlestonEstados Unidos de AméricaUniversidad Médica de Carolina del Sur, Charleston, Estados Unidos de América.
| | - Paul K. Whelton
- Universidad TulaneNueva OrleansEstados Unidos de AméricaUniversidad Tulane, Nueva Orleans, Estados Unidos de América.
| | - Pedro Ordúñez
- Organización Panamericana de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
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Steichen O. [Hypertension: Who to treat, to what extent and how?]. Rev Med Interne 2023; 44:158-163. [PMID: 36710087 DOI: 10.1016/j.revmed.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/18/2022] [Accepted: 01/08/2023] [Indexed: 01/30/2023]
Abstract
Hypertension is the modifiable risk factor causing the largest loss in healthy life-years. The risk of cardiovascular events increases exponentially with the level of blood pressure (BP), starting from 115mmHg for systolic BP. Out-of-office BP measurements (self-measurements or ambulatory BP measurements) are now preferred for the diagnosis and follow up. In the absence of a preferred indication, antihypertensive treatment is based on thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. These treatments are associated with a significant reduction in morbidity and mortality in people with office BP ≥ 140/90mmHg (self-measurements ≥ 135/85mmHg). For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP ≥ 130/80mmHg is also beneficial (self-measurements ≥ 130/80mmHg as well). It is now common to start treatment with half-dose dual therapy, which is more effective and better tolerated than full-dose monotherapy. The clinical effect is assessed at 4 weeks and intensification, if required, is then usually done by switching to the same dual therapy at full-dose for both components.
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Affiliation(s)
- O Steichen
- Sorbonne université, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique, équipe Sentinelles, 75012 Paris, France; Assistance publique-Hôpitaux de Paris (AP-HP), Sorbonne université, CHU de Tenon, service de médecine interne, 4, rue de la Chine, 75020 Paris, France.
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Chen JX, Zhou YF, Geng T, Chen S, Chen S, Wang G, Zhang YB, Wang Y, Tu ZZ, Liu G, Wu S, Pan A. Low Concordance Between Blood Pressures Measured in Periodic Health Examinations and in a Workplace-Based Hypertension Management Program. Phenomics 2022; 2:419-429. [PMID: 36939804 PMCID: PMC9712859 DOI: 10.1007/s43657-022-00067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
Poor adherence to standard protocols of blood pressure (BP) measurement in routine clinical practice leads to higher readings than "research-quality" measurements. Whether this phenomenon exists in periodic health examinations was unknown. We aimed to explore the concordance between BP measurements in periodic health examinations and those measured following a standard measurement protocol. We used data from the Kailuan Study, an ongoing longitudinal cohort study in China, of which participants received biennial health examinations in health management centers. In addition, BPs were measured following standard protocols in a workplace-based hypertension management program nested in the Kailuan Study. We compared BP readings of the same person between the two settings using generalized linear mixed-effects models. A total of 3988 men (the mean age was 44.9 years) had at least two BP measurements both in health examinations and management program with a time interval between the two settings that less than 90 days. The mean systolic blood pressures (SBP) and diastolic blood pressures (DBP) in health examinations were 4.2 (95% CI 3.9-4.5) mm Hg and 3.3 (95% CI 3.1-3.5) mm Hg higher than those in the management program, respectively. Bland-Altman analyses showed the wide agreement intervals ranging from - 27.7- to 36.5-mm Hg for SBP and - 18.3- to 24.7-mm Hg for DBP. In conclusion, BP measurements in periodic health examinations were generally higher than BPs measured following a standard protocol. Our findings highlight the importance of standard BP measurement to avoid overestimation of hypertension prevalence and treatment initiation. Supplementary Information The online version contains supplementary material available at 10.1007/s43657-022-00067-w.
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Affiliation(s)
- Jun-Xiang Chen
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Yan-Feng Zhou
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Tingting Geng
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 44883 Heidelberg, Germany
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, 57 Xinhua East Road, Tangshan, 063000 Hebei China
| | - Guodong Wang
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, 57 Xinhua East Road, Tangshan, 063000 Hebei China
| | - Yan-Bo Zhang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Yi Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Zhou-Zheng Tu
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430040 Hubei China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, North China University of Science and Technology, 57 Xinhua East Road, Tangshan, 063000 Hebei China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030 Hubei China
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Abstract
Neonatal hypertension occurs in 1%-2% of neonates in the neonatal intensive care unit (NICU) although may be underdiagnosed. Blood pressure values in premature neonates change rapidly in the first days and weeks of life which may make it more difficult to recognize abnormal blood pressure values. In addition, the proper blood pressure measurement technique must be used to ensure the accuracy of the measured values as most blood pressure devices are not manufactured specifically for this population. In premature neonates, the cause of the hypertension is most commonly related to prematurity-associated complications or management while in term neonates is more likely to be due to an underlying condition. Both oral and intravenous antihypertensive medications can be used in neonates to treat high blood pressure although none are approved for use in this population by regulatory agencies. The natural history of most neonatal hypertension is that it resolves over the first year or two of life. Of concern are the various neonatal risk factors for later cardiovascular and kidney disease that are present in most NICU graduates. Prematurity increases the risk of adulthood hypertension while intrauterine growth restriction may even lead to hypertension during childhood. From neonates through to adulthood NICU graduates, this review will cover each of these topics in more detail and highlight the aspects of blood pressure management that are established while also highlighting where knowledge gaps exist.
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Affiliation(s)
- Kathleen Altemose
- Division of Pediatric Nephrology and Hypertension, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, USA
| | - Janis M Dionne
- Division of Nephrology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
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Danish M, Thakare AE, Salkar PS, Wakode SL. Clinical Utility of Blood Pressure Measurement Using the Newer Palpatory Method for Both Systolic and Diastolic Blood Pressure. Adv Biomed Res 2021; 9:51. [PMID: 33457334 PMCID: PMC7792885 DOI: 10.4103/abr.abr_254_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 06/20/2020] [Accepted: 07/08/2020] [Indexed: 11/04/2022] Open
Abstract
Background Blood pressure (BP) measurement being a part of clinical examination gives a fair idea about the hemodynamic status. The auscultatory method is considered as a gold standard, a simple, noninvasive way to measure BP in patients as well as in the healthy controls. The present study was designed to compare systolic BP (SBP) and diastolic BP (DBP) readings using a newer palpatory method with the standard auscultatory method and further assessing the reliability of the newer palpatory method. Materials and Methods A cross-sectional study comprising of a total of 400 (240 males and 160 females) individuals in the age range of 20-60 years were included in this study. BP measurement was done by the standard auscultatory method by one observer. Another observer blinded with BP records of the auscultatory method, measured BP using the newer palpatory method on the same individuals. The two methods were compared for the inter-rater reliability using intraclass correlation (ICC) statistics and agreement between two methods using Bland-Altman analysis. Results The present study observed excellent reliability of the newer palpatory method with the standard auscultatory method with an ICC value of 0.997 and 0.993 for SBP and DBP, respectively. Bland-Altman plot for both SBP and DBP using the auscultatory and newer palpatory method has shown minimum variability and good reliability when both methods are used by independent observers. Conclusions With practice and experience newer palpatory method can be used to assess BP with accuracy.
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Affiliation(s)
- Mohammad Danish
- MBBS IInd Year Student, AIIMS, Bhopal, Madhya Pradesh, India
| | | | - Pooja S Salkar
- Department of Oral Medicine and Radiology, Rishiraj College of Dental Sciences, Bhopal, Madhya Pradesh, India
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Xie ZY, Guo Z. [Study on the hydrodynamic mechanisms of the radial arterial blood pressure variation in response to arm elevation]. Zhonghua Yi Xue Za Zhi 2020; 100:3246-3249. [PMID: 33167112 DOI: 10.3760/cma.i.cn112137-2020313-00746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the mechanism of invasive blood pressure change in radial artery caused by arm elevation by observing pressure, velocity and diameter of radial artery. Methods: Twenty-six hemodynamically stable hepatobiliary surgery patients admitted to the intensive care unit from June to December 2018 after general anesthesia in Tsinghua Changgung Hospital were selected. When the arm was raised, the invasive blood pressure was recorded, and the inner diameter and blood flow velocity of the radial artery were measured by Doppler ultrasound. The data following a normal distribution were compared with paired t test. Results: After arm elevation for 30 s, systolic blood pressure of radial artery decreased and diastolic blood pressure increased significantly((107±16) mmHg vs (120±17) mmHg, (75±6) mmHg vs (71±9) mmHg, t=25.0, -12.6, both P<0.05), but there was no significant difference in mean arterial pressure ((87±10) mmHg vs (87±11) mmHg, t=1.1, P>0.05). The peak velocity, end-diastolic velocity and resistance index of the radial artery increased significantly, and the transverse and longitudinal inner diameters of the radial artery decreased significantly after the arm was elevated for 30 s (t=-63.4, -14.6, -22.5, 31.4, 25.3, all P<0.01). Conclusions: Kinetic pressure compensation and vascular resistance compensation may be the main mechanism of radial artery pressure change when the arm is elevated. Arm elevation can be used as a vascular resistance response test clinically.
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Affiliation(s)
- Z Y Xie
- Department of Critical Care Medicine, Clinical School of Medicine, Tsinghua University, Tsinghua Changgung Hospital, Beijing 102218, China
| | - Z Guo
- Department of Critical Care Medicine, Clinical School of Medicine, Tsinghua University, Tsinghua Changgung Hospital, Beijing 102218, China
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Yan QH, Yu J, Wang YH, Gao JB, Zhou F, Wang Y, Zhu DL, Shi Y, Cheng MN, Wang YJ. [Evaluation on the effect of clinic standardized blood pressure measurement model applying to first blood pressure measurement among community population aged 35 years old and above]. Zhonghua Yu Fang Yi Xue Za Zhi 2020; 54:416-419. [PMID: 32268650 DOI: 10.3760/cma.j.cn112150-20190618-00489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effect of clinic standardized blood pressure measurement model (SBPM) applying to first blood pressure measurement among community population aged 35 years old and above. Methods: SBPM was implemented in the community health service center of Dapuqiao street, Huangpu district of Shanghai from June 1, 2018, and the data between June 1 and December 31, 2018 was used as the SBPM data. The first-diagnosis blood pressure measurement data in this center between June 1 and December 31, 2017 was used as the conventional measurement (CM) model data. The detection rate of elevated blood pressure under SBPM was standardized according to the gender and age distribution of subjects in CM. The equilibrium of the value distribution of the end digit of blood pressure value in different pressure-measuring models and difference of elevated blood pressure rate of subjects with different characteristics and seasons were analyzed by using the χ(2) test, and the difference of standardized elevated blood pressure rate in different pressure-measuring models was analyzed by using the U test. Results: The SBPM included 1 548 subjects and 639 (41.28%) of them were males. The CM included 2 952 inpatients and 1 196 (40.51%) of them were males. The frequency of the end digit of blood pressure in SBPM ranged from 9.04% to 10.72%, and both systolic and diastolic blood pressure showed a balanced distribution of end digit (P values were 0.996 and 0.981 respectively). The frequency of blood pressure end digital in the CM ranged from 0.37% to 67.92%, and both systolic and diastolic blood pressure showed an unbalanced distribution (both P values <0.001). The crude rate and standardized elevated blood pressure rate in SBPM were 23.19% (359/1 548) and 23.05%, which were higher than that in CM, about 7.22% (213/2 952) (both P values <0.001). The elevated blood pressure rate in SBPM in summer, autumn and winter was 18.85% (141/748), 26.72% (152/591) and 31.58% (66/209), respectively, which was higher than that in CM, about 6.28% (91/1 450), 7.20% (82/1 139) and 11.02% (40/363), respectively (all P values <0.001). Conclusion: The quality of blood pressure data and the efficiency of hypertension screening of SBPM are better than those of CM when applying to first blood pressure measurement among community population aged 35 years old and above.
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Affiliation(s)
- Q H Yan
- Division of Chronic Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - J Yu
- Department of Cardiovascular & Cerebrovascular Disease and Diabetes Prevention, Huangpu District Center for Disease Control and Prevention, Shanghai 200023, China
| | - Y H Wang
- Division of Chronic Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - J B Gao
- Department of Prevention and Health Protection, Dapu Community Health Service Center of Huangpu District, Shanghai 200023, China
| | - F Zhou
- Department of Prevention and Health Protection, Dapu Community Health Service Center of Huangpu District, Shanghai 200023, China
| | - Y Wang
- Shanghai Institute of Hypertension, Shanghai 200025, China
| | - D L Zhu
- Shanghai Institute of Hypertension, Shanghai 200025, China
| | - Y Shi
- Division of Chronic Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - M N Cheng
- Division of Chronic Non-communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - Y J Wang
- Department of Cardiovascular & Cerebrovascular Disease and Diabetes Prevention, Huangpu District Center for Disease Control and Prevention, Shanghai 200023, China
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Dallmeier D, Denkinger MD. [Arterial hypertension in old age with the focus on 80]. Z Gerontol Geriatr 2018; 51:825-38. [PMID: 30402738 DOI: 10.1007/s00391-018-1454-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/31/2018] [Accepted: 09/18/2018] [Indexed: 10/27/2022]
Abstract
Untreated high blood pressure in old age increases the risk of secondary diseases, especially stroke, coronary heart disease, myocardial infarction and heart failure and should be treated according to the guidelines. For slightly frail people up to the age of 80 years, a systolic blood pressure of 130-139 mm Hg (measured in the doctors surgery) should be the aim. According to the current European guidelines the same values are recommended for those over the age of 80 years but treatment should start at a systolic blood pressure of ≥160 mm Hg. In physically disabled and very frail older people an individually tailored approach is recommended, regardless of age. The authors recommend a target systolic value <150 mm Hg but not below 130/70 mm Hg. In the event of poor tolerance the treatment should be adapted further as necessary. Antihypertensive medication should be selected under the aspects of polypharmacy. In many cases arterial hypertension in old age can be treated in accordance with the guidelines, taking multimorbidity and the interaction of medications into consideration.
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Abstract
BACKGROUND The systolic blood pressure intervention trial (SPRINT) published in 2015 has opened up new discussions on whether a lower blood pressure target as recommended by the current guidelines would be better for some patient groups. OBJECTIVES To review patient groups in which lower blood pressure targets would not be better. MATERIALS AND METHODS The results of SPRINT, its post-hoc and subgroup analyses, other studies and newer studies, as well as metaanalyses on the topic of blood pressure targets are reviewed and discussed. Studies with patients excluded from the SPRINT study were also analysed. The current international guidelines and recommendations of the Deutsche Hochdruckliga e. V. DHL® are included. RESULTS Blood pressure monitoring methods differed considerably in the previously published studies. The low blood pressure value in SPRINT was mainly achieved due to the unusual method of blood pressure monitoring used and, as such, cannot be compared with blood pressure values in other studies. Based on current evidence, "the lower the better" should not be recommended in the following patient groups: older patients, in particular infirm older patients, patients with diabetes, patients without coronary heart disease or with low cardiovascular risk. CONCLUSIONS When determining a blood pressure target, the method of blood pressure monitoring should be defined. A lower blood pressure target has been shown to be better in some well defined patient groups. However, adverse events due to antihypertensive medications should always be taken into account. Given the multiple exclusion criteria in trials and the results of many studies, "new" lower blood pressure targets could not be recommended in a large population of patients.
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Affiliation(s)
- U Hoffmann
- Klinik für Allgemeine Innere Medizin und Geriatrie/Angiologie, Diabetologie, Endokrinologie, Nephrologie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
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Valls Matarín J, del Cotillo Fuente M, Quintana Riera S, de la Sierra Iserte A. [The interarm blood pressure difference in the critically ill patient]. Med Clin (Barc) 2013; 142:103-6. [PMID: 23332625 DOI: 10.1016/j.medcli.2012.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/26/2012] [Accepted: 11/08/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the prevalence of a difference in systolic blood pressure (SBPd) ≥ 10 mmHg between arms in patients admitted in a Critical Care Unit and to examine the clinical characteristics associated with such blood pressure difference. METHODS Observational cross-sectional study. Two blood pressure measurements in each arm were carried out at unit admission. The firstly measured arm was chosen at random. RESULTS One-hundred and sixty-eight patients were studied, with a mean age of 61 (SD=16), 67.3% male and 45% with a previous hypertension diagnosis. On admission, 27.4% presented SBPd ≥ 10 mmHg. Among them, 54% had higher SBP in the right arm and 46% in the left one. A SBPd ≥ 10 mmHg was associated with a previous hypertension diagnosis (67.4 versus 36.9%; P<.001) and with reduced consciousness (76.1 versus 52.5%; P=.006). CONCLUSIONS Over a quarter of critically ill patients have a SBPd ≥ 10 mmHg between arms. This feature is associated with a previous hypertension diagnosis and reduced consciousness. It should be assessed in the future if the choice of a control arm would help improve patient's care as it would become a more accurate guide for hemodynamic management.
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Affiliation(s)
- Josefa Valls Matarín
- Enfermería, Servicio de Medicina Intensiva, Hospital Universitario Mútua Terrassa, Terrassa, Barcelona, España.
| | - Mercedes del Cotillo Fuente
- Enfermería, Servicio de Medicina Intensiva, Hospital Universitario Mútua Terrassa, Terrassa, Barcelona, España
| | - Salvador Quintana Riera
- Servicio de Medicina Intensiva, Hospital Universitario Mútua Terrassa, Terrassa, Barcelona, España
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