Abstract P338: Age and Gender Differences in Response to Repeat Blood Pressure Measurement after Brief Patient Rest Period

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Keerthana Karumbaiah ◽  
Bassam A Omar
Keyword(s):  
Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Measurement Data ◽  
Rest Period ◽  
The Elderly ◽  
Age And Gender ◽  
Significant Difference ◽  
Cardiology Clinic ◽  
And Gender

Background: Office-based blood pressure (BP) measurement is a snapshot of a patient’s ambulatory BP, and is subject to variations which may influence management. Objective: To assess the effect of age and gender on repeat BP measurement after a brief rest period in an outpatient cardiology clinic. Methods: Patient charts reviewed in University-based cardiology clinic identified 170 encounters which contained BP re-measurement data due to elevated initial BP of > 130/80 mmHg. BP was measured initially by a nurse, with the patient in a sitting position and the arm resting at the level of the heart. If BP was > 130/80 mmHg, it was repeated by physician after resting the patient for 15 minutes. There were 86 males (51%) and 84 females (49%); 113 (66%) elderly patients ≥ 60 years of age and 57 (34%) younger patients < 60 years of age. Results: Among all encounters, after a brief rest period, initial systolic BP (SBP) of 153 ± 27 mmHg decreased to 145 ± 27 mmHg (decrease of 8 mmHg; P = 0.003), and initial diastolic BP (DBP) of 87 ± 16 mmHg decreased to 83 ± 15 mmHg (decrease of 4 mmHg; P = 0.04). SBP decreased by 8 mmHg in both males (from 156 ± 30 to 148 ± 27 mmHg) and females (from 151 ± 23 to 143 ± 14) (NS, males versus females). DBP decreased by 5 mmHg in males (from 91 ± 18 to 86 ± 18 mmHg) and by 2 mmHg in females (from 83 ± 12 to 81 ± 12 mmHg) (P = 0.04, males versus females). SBP decreased by 11 mmHg in elderly (from 154 ± 23 to 143 ± 15 mmHg) and 2 mmHg in the young (from 153 ± 33 to 151 ± 30 mmHg) (P=0.02, old versus young). DBP decreased by 3 mmHg in elderly (from 82 ± 12 to 79 ± 12 mmHg) and 4 mmHg in the young (from 97 ± 18 to 93 ± 17 mmHg) (NS, old versus young). Discussion: Hypertension is a challenging public health problem. JNC 7 guidelines recommend that prior to BP measurement, patient should be seated quietly for at least 5 minutes in a chair, with feet on the floor, and arm supported at heart level. This resulted in a significant decrease in BP in our patients. In this study we show that while males and females decrease their systolic BP to the same extent after a brief rest period, males have a greater drop in their diastolic BP than females. Moreover, after the rest period, patients ≥ 60 years of age drop their systolic BP greater than patients < 60 years of age, while there was no significant difference in the drop of their diastolic BP. Given the high reported prevalence of White-coat hypertension in the elderly, between 15% and 25%, this is a clinically significant observation that reinforces that physicians should remeasure the blood pressure, especially the subset of males and the elderly, in whom a bigger decrement may be detected in blood pressure measurement after a brief rest period.

Abstract P007: Age and Gender Differences in Response to Repeat Blood Pressure Measurement After Brief Rest Period

Circulation ◽  
2019 ◽  
Vol 139 (Suppl_1) ◽  
Author(s):  
Sarina Sachdev ◽  
Hassan Tahir ◽  
Landai Nguyen ◽  
Bassam Omar ◽  
Christopher Malozzi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Gender Differences ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Rest Period ◽  
Age And Gender ◽  
Age And Gender Differences ◽  
And Gender

Abstract 106: Paradoxical Increase in Office-Based Blood Pressure Measurement After a Brief Patient Rest Period

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Keerthana Karumbaiah ◽  
Nidal Omar ◽  
Bassam A Omar
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Measurement Data ◽  
Rest Period ◽  
Public Health Problem ◽  
White Coat ◽  
White Coat Hypertension ◽  
Paradoxical Response ◽  
Minute Period ◽  
Cardiology Clinic

BACKGROUND: Office-based blood pressure (BP) measurement is a snapshot of a patient’s ambulatory BP, and is subject to variations which may influence management. OBJECTIVE: To assess the effect of a brief rest period on repeat BP measurement. METHODS: Patient charts reviewed in University-based cardiology clinic identified 170 encounters which contained BP re-measurement data due to elevated initial BP of > 130/80 mmHg. BP was measured initially by a nurse, with the patient in a sitting position and the arm resting at the level of the heart. If BP was > 130/80 mmHg, it was repeated by physician after resting the patient for 15 minutes. Mean age was 64 ± 12 years. Results: Among encounters with BP re-measurement, initial systolic BP (SBP) was 153 ± 27 mmHg, and diastolic BP was 87 ± 16 mmHg. Upon re-measurement, 106 of 170 patients (62%) had lower SBP of 143 ± 23 mmHg compared with initial SBP of 162 ± 28 mmHg; a mean drop of 18 mmHg. However, 53 of 170 patients (31%) had higher SBP of 149 ± 17 mmHg compared with initial SBP of 138 ± 14 mmHg; a mean increase of 10 mmHg. Eleven patients (7%) had no BP change. In 50% (85/170) of encounters, BP re-measurement necessitated hypertensive medication changes. Compared with the remaining patients, those with paradoxical increase in BP were younger (60 ± 9 years versus 66 ± 13 years; p < 0.01), more females (57% versus 47%), and with lower initial SBP (134 ± 14 versus 160 ± 28, p < 0.01). DISCUSSION: Hypertension is a challenging public health problem. JNC 7 guidelines recommend that prior to BP measurement, persons should be seated quietly for at least 5 minutes in a chair, with feet on the floor, and arm supported at heart level; this may decrease initially elevated BP. However, 30% of our patients exhibited a paradoxical response, with elevation of the SBP after a 15 minute period of rest. The cause of this paradox is not clear, but may have resulted from white-coat hypertension during the rest period, which may be more common in younger patients, especially females, as noted in our study. This underscores the importance of ambulatory BP monitoring, especially in subsets of patients prone to having labile or white coat hypertension, to avoid the cost and side effects of BP overtreatment.

Two Types of Anesthesia and Hemodynamic Changes in Patients Over 60 Years of Age Who Need Artificial Femoral Head Replacement: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Weiqi Ke ◽  
Yuting WANG ◽  
Xukeng GUO ◽  
Ronghua HUANG ◽  
Xiangdong ZHANG ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Femoral Head ◽  
Elderly Patients ◽  
The Elderly ◽  
Hemodynamic Changes ◽  
Medical College ◽  
Replacement Surgery ◽  
Elder Patients ◽  
Significant Difference ◽  
And Gender

Abstract Background:Artificial femoral head replacement is one of the most effective methods for treatment of severe diseases of femoral joint in the elderly. The ideal anesthetic effect is one of the key elements for the success of the operation because it brings fast recovery. However, the multiple comorbidities of the elder patients make them too weak to tolerate the hemodynamic changes after anesthesia. In this case, the most suitable anesthesia method for patients undergoing femoral head replacement surgery is of great significance.Objective:To compare the post-anesthetic hemodynamic changes between combined lumbar plexus and sciatic nerve block(CLPSB) and combined spinal and epidural anesthesia(CSEA) in elderly patients undergoing unilateral artificial femoral head replacement.Methods:We reviewed records of the patients who aged over 60 years old (age 62-103 years) and received unilateral artificial femoral head replacement between January 2015 and December 2020 in the first affiliated hospital of Shantou University Medical College. After adjustment according to the inclusion criteria, 477 patients were included and divided into CLPSB group (n=90) and CSEA group (n=387). The primary outcome was comparison of the hemodynamic changes after anesthesia, including the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). The second outcome was the comparison of the vasopressor used during the surgery.Results:We established three models to compare the two anesthesia methods on hemodynamic changes. Crude model included all variates for analysis, while model I adjusted age and gender. Model II adjusted other comorbidities in addition to model I. All three models exhibit that changes of MAP (∆MAP) after CSEA were higher than that after CLPSB(β= 6.88, 95% CI: 4.33 - 9.42, P < 0.0001), with significant difference, which indicated that CSEA causes higher fluctuation of MAP. Concurrently, the use of vasopressors increased by 137% (OR=2.37, 95%CI: 1.24-4.53, P=0.0091) in the CSEA group, which is statistically significant. However, the changes of HR (∆HR) between the CLPSB and CSEA was not significant(β= 0.50, 95% CI: 1.62 - 2.62, P = 0.6427). Conclusions:Both CLPSB and CSEA are ideal anesthesia methods for patients receiving femoral head eplacement, though CLPSB is more suitable for elderly patients with advanced hemodynamic stability.

scholarly journals PENINGKATAN DERAJAT KESEHATAN LANSIA PENDERITA HIPERTENSI MELALUI TERAPI TERTAWA

2020 ◽  
Vol 26 (1) ◽  
pp. 16
Author(s):  
Dene Fries Sumah ◽  
Lydia Maria Ivakdalam ◽  
Donny Japly Pugesehan
Keyword(s):  
Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
The Elderly ◽  
Comprehensive Treatment ◽  
Lifestyle Management ◽  
Counseling Training ◽  
Service Activity ◽  
Training Of Trainers ◽  
To Come

Periode lansia merupakan periode kehidupan yang rentan terhadap penyakit akibat mengalami perubahan fungsi tubuh dan berdampak pada terjadinya penyakitdegeneratif seperti Hipertensi. Hipertensi merupakan penyakit kronis yang jika tidak dikelola dengan tepat dapat menyebabkan komplikasi penyakit lainnya. Hipertensi membutuhkan penanganan yang komprehensif dalam mengontrol tekanan darah baik secara farmakologis dan nonfarmakologis, salah satunya adalah pendidikan kesehatan dan terapi tertawa.Kegiatan pengabdian masyarakat ini bertujuan untuk memperluas wawasan tentang pentingnya kesehatan bagi lansia melalui modifikasi faktor risiko atau pengelolaan gaya hidup serta pencegahan melalui terapi tertawa. Kegiatan ini dilaksanakan di Negeri Waai Kecamatan Salahutu Kabupaten Maluku Tengah. Metode yang digunakan yaitu mulai dari pengukuran tekanan darah, penyuluhan, training of trainer terapi tertawa bagi kader posyandudan lansia serta praktek terapi tertawa. Hasil dari kegiatan ini adalah lansia mengalami penurunan tekanan darah setelah diberikan terapi tertawa serta mampu melakukan terapi tertawa secara mandiri. Selain itu lansia semakin antusias untuk datang ke lokasi kegiatan, hal ini terbukti dari daftar kunjungan dan keaktifan lansia dalam mengikuti seluruh rangkaian kegiatan mulai dari registrasi, pengukuran tekanan darah, praktek terapi tertawa dan dilanjutkan dengan pemeriksaan kesehatan secara rutin.Kata kunci: Lansia; Penyuluhan; Training of trainer; Pengukuran Tekanan Darah; Terapi Tertawa.AbstractThe elderly period is a period of life that is susceptible to illness due to changes in bodily functions and has an impact on the occurrence of degenerative diseases such as hypertension. Hypertension is a chronic disease which, if not managed properly, can cause other complications. Hypertension requires comprehensive treatment in controlling blood pressure both pharmacologically and nonpharmacologically, one of which is health education and laughter therapy. This community service activity aims to broaden insights on the importance of health for the elderly through modification of risk factors or lifestyle management and prevention through laughter therapy. This activity was carried out in Waai Negeri Salahutu District, Central Maluku Regency. The method used is starting from measuring blood pressure, counseling, laughter therapy training for trainers for elderly cadres and practice of laughter therapy. The results of this activity are the elderly experiencing a decrease in blood pressure after being given a laugh therapy and being able to do laugh therapy independently. In addition, the elderly are more enthusiastic to come to the location of the activity, this is evident from the list of visits and activeness of the elderly in participating in a whole series of activities ranging from registration, blood pressure measurement, laughter therapy practice and continued with routine health checks.Keywords: Elderly; Counseling; Training of trainers; Blood Pressure Measurement; Laughter Therapy.

scholarly journals Evaluation of the Accuracy of the Delta Life DL 1000 Oscillometric Monitor for Blood Pressure Measurement in Anesthetized Dogs of Different Weight Ranges

2020 ◽  
Vol 48 ◽  
Author(s):  
Bárbara Silva Correia ◽  
Eduardo Raposo Monteiro ◽  
João Victor Barbieri Ferronatto ◽  
Luciana Branquinho Queiroga ◽  
José Ricardo Herrera Becerra
Keyword(s):  
Blood Pressure ◽  
Arterial Blood Pressure ◽  
Pressure Measurement ◽  
Elective Surgery ◽  
Blood Pressure Measurement ◽  
Measurement Data ◽  
Arterial Blood ◽  
Anesthetized Dogs ◽  
Group 2 ◽  
Group 1

Background: Arterial blood pressure is one of the most commonly variables monitored during anesthetic procedures in veterinary patients. The most reliable method for measuring arterial blood pressure in dogs and cats is the direct (invasive) method. However, the oscillometric method is less complex and more practical for clinical routine in small animals. Nevertheless, oscillometric monitors present great variability in accuracy. The present study aimed to determine the accuracy of the Delta Life DL 1000 oscillometric monitor for measurement of systolic, mean and diastolic blood pressures (SAP, MAP and DAP, respectively) in anesthetized dogs of different weight ranges.Materials, Methods & Results: This study was approved by the Institutional Ethics Committee of Animal Use. Fifteen female dogs of different breeds, weighing 11.6 ± 10.0 kg and with a mean age of 48 ± 51 months were used. All animals were scheduled for elective surgery under general anesthesia in the Institution Veterinary Hospital. Dogs were anesthetized with morphine, propofol and isoflurane and had one 20 or 22 gauge catheter introduced into the dorsal pedal artery for continuous, invasive monitoring of SAP, MAP and DAP. A blood pressure cuff was positioned over the middle third of the radius and connected to Delta Life DL 1000 monitor. Oscillometric readings of SAP, MAP and DAP were registered every 5 minutes, and invasive values were simultaneously recorded. Values obtained with both methods were compared (invasive versus oscillometric) by use of the Bland Altman method to determine the bias, standard deviation of bias and 95% limits of agreement. The percentages of errors between the methods within 10 mmHg and within 20 mmHg were calculated. The results obtained were compared with the criteria from the American College of Veterinary Internal Medicine (ACVIM) for validation of indirect methods of arterial blood pressure measurement. Data were stratified into two groups according to the weight: < 10 kg (Group 1; n = 9); and ≥ 10 kg (Group 2; n = 6). In Group 1, 119 paired measurements were obtained, four of which classified as hypotension (SAP < 90 mmHg), 98 as normotension (SAP from 90 to 140mmHg) and 17 as hypertension (SAP > 140 mmHg). Bias (± SD) values in Group 1 were as follows: SAP, 5.2 ± 18.1 mmHg; MAP, -3.4 ± 17.2 mmHg; and DAP, 12.0 ± 17.5 mmHg. The percentages of errors within 10 mmHg were 40.3% for SAP; 45.4% for MAP and 28.6% for DAP. The percentages of errors within 20 mmHg were 72.3% for SAP, 84.0% for MAP and 68.1% for DAP. In Group 2, 66 paired measurements were obtained, nine of which classified as hypotension, 56 as normotension and one as hypertension. Bias (± SD) in Group 2 were as follows: SAP, 13.6 ± 14.3 mmHg; MAP, -1.1 ± 13.5 mmHg; and DAP, 8.2 ± 16.0 mmHg. The percentages of errors within 10 mmHg were 33.3% for SAP, 77.3% for MAP and 33.3% for DAP. The percentages of errors within 20 mmHg were 65.1% for SAP, 92.4% for MAP and 83.4% for DAP.Discussion: Based on the results of this study and reference criteria from the ACVIM, the Delta Life DL 1000 monitor had a poor accuracy for SAP, MAP and DAP and did not meet the criteria from the ACVIM in anesthetized dogs under 10 kg. Measurements of MAP in dogs ≥ 10 kg met the ACVIM criteria, but measurements of SAP and DAP did not. Based on the findings in this study, the DL 1000 oscillometric monitor is not recommended for blood pressure measurement in anesthetized dogs < 10 kg. In dogs ≥ 10 kg, measurements of MAP yielded acceptable values, but SAP and DAP measurements did not.

Abstract 2742: The Comparison Of Direct Measurement Of Central Blood Pressure And Noninvasive Evaluation By Radial Artery Tonometry.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kenji Takazawa ◽  
hiroshi kobayashi ◽  
mineko kino ◽  
akira aizawa
Keyword(s):  
Blood Pressure ◽  
Pressure Measurement ◽  
Guide Wire ◽  
Blood Pressure Measurement ◽  
Regression Line ◽  
Aortic Pressure ◽  
Applanation Tonometry ◽  
Central Blood Pressure ◽  
Medical Systems ◽  
Significant Difference

Background and objectives: New devices including radial applanation tonometer have been developed for central blood pressure measurement. The devices can noninvasively calculate the central blood pressure. To investigate the accuracy of estimated central blood pressure, this study demonstrates the comparison of catheter based central blood pressure and radial applatnation tonometer based central blood pressure. Materials and Methods: Seventy two patients (64 ± 10 years old) underwent cardiac catheterization were recruited for this study. Ascending aortic pressure was measured using a pressure guide wire (RADI Medical Systems), and recorded on a laptop personal computer through a SEIREG polygraph (Siemens). Radial arterial pulse waves were simultaneously measured noninvasively using applanation tonometry technique by HEM-9000AI (Omron Healthcare Co.,Ltd.) and SphygmoCor (AtCor Medical Pty Ltd.). The measurements were performed before and after administration of vasodilator (nicorandil or glycerol trinitrate) or antihypertensive (nicardipine hydrochloride) drugs. The central blood pressure calculated by HEM-9000AI (cSBP) and SphygmoCor (aSBP Sphy) was compared respectively with that by catheter (aSBP). Results: cSBP and aSBP Sphy indicated significant correlation with aSBP (r=0.94, 0.93, respectively, p=0.001). The regression line slope of cSBP to aSBP was 0.92 and that of aSBP Sphy to aSBP was 0.76. A significant difference was observed between aSBP and aSBP Sphy, but was not observed between aSBP and cSBP. Bland-Altman test showed that the difference of cSBP to aSBP was - 0.4 ± 9.6 mmHg and that of aSBP Sphy to aSBP was -9.0 ± 10.3 mmHg. It shows significant difference between cSBP to aSBP error and aSBP Sphy to aSBP error (p<0.05). Conclusion: The central blood pressure measured by HEM-9000AI is very close to that by catheter. These findings indicate that noninvasive central blood pressure measurement by radial applanation tonometry is accurate enough for clinical applications.

Accuracy of the London School of Hygiene and Remler M2000 sphygmomanometers

1981 ◽  
Vol 61 (s7) ◽  
pp. 399s-401s ◽  
Author(s):  
D. J. Fitzgerald ◽  
W. G. O'Callaghan ◽  
K. O'Malley ◽  
E. T. O'Brien
Keyword(s):  
Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Calibration Error ◽  
London School ◽  
Lower Blood ◽  
Significant Difference ◽  
Blood Pressures ◽  
The Mean ◽  
Selection Of

1. The accuracy of the Remler M2000, a semiautomatic portable blood pressure recorder, was assessed with the London School of Hygiene (LSH) and Hawkesley random-zero sphygmomanometers used as reference standards. 2. The Remler gave higher recordings than the LSH sphygmomanometer, the mean systolic and diastolic differences being 5.9 mmHg (P &lt; 0.001) and 4.7 mmHg (P &lt; 0.001) respectively. No significant difference was demonstrated between paired Remler and Hawkesley recordings. 3. When simultaneous paired LSH and Hawkesley sphygmomanometer recordings were compared, the LSH gave lower blood pressures: 7.1 mmHg (P &lt; 0.001) for systolic and 3.6 mmHg (P &lt; 0.001) for diastolic recordings. 4. The LSH sphygmomanometer underestimates blood pressure, partly due to a calibration error but also because the selection of end points for this device differs from other methods of blood pressure measurement.

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