scholarly journals Effects of Different Rest Period Durations Prior to Blood Pressure Measurement: The Best Rest Trial

Hypertension ◽  
2021 ◽  
Author(s):  
Tammy M. Brady ◽  
Jeanne Charleston ◽  
Junichi Ishigami ◽  
Edgar R. Miller ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Rest Period ◽  
Absolute Difference ◽  
Unique Identifier ◽  
Screening Programs ◽  
Rest Periods ◽  
The Absolute ◽  
The Difference ◽  
Noninferiority Margin

A rest period of 3 to 5 minutes before blood pressure (BP) measurement is recommended in hypertension guidelines but can be challenging to implement. We conducted a randomized trial to determine the effects of resting for <5 minutes on BP. In a cross-over design, 113 participants (mean age 55 years, 36% male, 75% Black) had 4 sets of triplicate BP measurements with the order of rest for the first 3 sets (0 minutes, 2 minutes, 5 minutes 1 ) randomized. The fourth set was always a second 5-minute rest period (5 minutes 2 ), from which we calculated the difference between 5 minutes 1 and 5 minutes 2 (5 minutes 1 −5 minutes 2 ), a measure of intrinsic BP variability. To determine if there was no difference between BPs obtained after resting 0 minutes or 2 minutes versus 5 minutes 1 , we tested whether 5 minutes 1 −0 minutes or 5 minutes 1 −2 minutes was within a prespecified noninferiority margin of ±2 mm Hg compared with 5 minutes 1 −5 minutes 2 . Overall, mean BP was similar across 5 minutes 1 (128/75), 5 minutes 2 (127/76), 2 minutes (127/74), and 0 minutes (127/74). Compared with the average absolute 5 minutes 1 −5 minutes 2 difference (5.3/3.0 mm Hg), the absolute systolic BP difference of differences did not cross our noninferiority margin for 0 minutes rest (0.2 [95% CI, 0.8–1.2]) but did for 2 minutes rest (−1.7 [−2.8 to −0.6]). Among those with systolic BP <140, the absolute difference of differences for both 0 and 2 minutes did not cross the ±2 mm Hg margin; however, those with systolic BP ≥140 had differences that did exceed this threshold. Our findings suggest that shorter rest periods may be a reasonable alternative to 5 minutes for most individuals. Implementation could substantially improve the efficiency of hypertension screening programs. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04031768.

Abstract P154: Results From A Randomized Trial Of Different Rest Times Before Initiating BP Measurements

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Tammy M Brady ◽  
Junichi Ishigami ◽  
Edgar R Miller ◽  
Kunihiro Matsushita ◽  
Lawrence J Appel ◽  
...  
Keyword(s):  
Rest Period ◽  
Wait Time ◽  
Community Dwelling ◽  
Absolute Difference ◽  
Resource Constrained ◽  
Mean Absolute Difference ◽  
Rest Periods ◽  
The Difference ◽  
Mean Differences ◽  
Design And Methods

Background: BP measurement guidelines recommend ≥5 min of rest before initiation of readings; this wait time is challenging to implement, especially in resource-constrained settings. Objective: Compare the effects of resting 0 or 2 min vs. 5 min on BP. Design and methods: RCT of community-dwelling adults, 18-80yrs. Participants had 4 sets of BP measurements (Omron HEM 970XL). In a cross-over design, the order of rest for the 1 st 3 sets [0min, 2min, 5min 1 ] was random. The 4 th set was always a 2nd 5min rest period (5min 2 ) to estimate repeatability. Mean BP for each rest period, mean absolute difference between each participant’s mean BP after 5min 1 and the other rest periods were determined. To determine if resting 0min and/or 2min was non-inferior to 5min 1 , we calculated the difference of differences, with ≤ ±2 mmHg considered non-inferior. Analyses were for the population overall and stratified by SBP ≥ vs. < 140mmHg. Results: N=113, mean age 55yrs, 36% male (n=41), 74% AA (n=84), 28% SBP > 140mmHg (n=32). Overall, mean 5min 1 BP was 128/75 and 5min 2 BP was 127/76 (p=NS), similar to mean BP at 2min and 0min (127/74 for both). The absolute difference of differences between 2min and 5min 1 SBP for the population overall was > ±2 mmHg, but for those with SBP <140, resting 2min and 0min BP was ≤ ±2 mmHg (Table). Conclusion: In this RCT, mean differences in BP by rest period were small. BPs obtained after shorter rest periods were non-inferior than those obtained after 5min when SBP <140. This suggests shorter rest times, even 0 min, may be reasonable for screening when the initial SBP is <140. These findings could improve the efficiency of hypertension screening, especially in resource-constrained settings.

scholarly journals Combined deep CNN–LSTM network-based multitasking learning architecture for noninvasive continuous blood pressure estimation using difference in ECG-PPG features

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Da Un Jeong ◽  
Ki Moo Lim
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Patient Specific ◽  
Peak Time ◽  
Simultaneous Prediction ◽  
Deep Cnn ◽  
Pressure Estimation ◽  
The Difference ◽  
Blood Pressure Estimation ◽  
Continuous Blood Pressure

AbstractThe pulse arrival time (PAT), the difference between the R-peak time of electrocardiogram (ECG) signal and the systolic peak of photoplethysmography (PPG) signal, is an indicator that enables noninvasive and continuous blood pressure estimation. However, it is difficult to accurately measure PAT from ECG and PPG signals because they have inconsistent shapes owing to patient-specific physical characteristics, pathological conditions, and movements. Accordingly, complex preprocessing is required to estimate blood pressure based on PAT. In this paper, as an alternative solution, we propose a noninvasive continuous algorithm using the difference between ECG and PPG as a new feature that can include PAT information. The proposed algorithm is a deep CNN–LSTM-based multitasking machine learning model that outputs simultaneous prediction results of systolic (SBP) and diastolic blood pressures (DBP). We used a total of 48 patients on the PhysioNet website by splitting them into 38 patients for training and 10 patients for testing. The prediction accuracies of SBP and DBP were 0.0 ± 1.6 mmHg and 0.2 ± 1.3 mmHg, respectively. Even though the proposed model was assessed with only 10 patients, this result was satisfied with three guidelines, which are the BHS, AAMI, and IEEE standards for blood pressure measurement devices.

Measurement of digital blood pressure after local cooling

1977 ◽  
Vol 43 (5) ◽  
pp. 907-910 ◽  
Author(s):  
S. L. Nielsen ◽  
N. A. Lassen
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Proximal Phalanx ◽  
Systolic Pressure ◽  
Threshold Temperature ◽  
Local Cooling ◽  
The Difference ◽  
Arterial Tone ◽  
Percent Decrease ◽  
Finger Pressure

A double-inlet plastic cuff was designed for local cooling and systolic blood pressure measurement on the middle phalanx of the fingers. With a tourniquet on the proximal phalanx of one finger, cooling for 5 min made the digital artery temperature equal the skin temperature. The difference between the systolic pressure in a control finger and in the cooled finger give the reopening pressure in the digital arteries. At 30, 25, 20, 15, and 10 degrees C, respectively the percent decrease of the finger pressure was 0.2 (0.2), 1.5 (2.5), 8.5 (3.7), 11.4 (3.4), and 15.3 (3.1) in normal young women. In patients with primary or secondary Raynaud's phenomenon, the arterial tone showed an abrupt increase that most often led to complete closure of the digital arteries. The pathological response was expressed as an increased threshold temperature or a well-defined closing temperature that showed only small variations during standardized conditions.

scholarly journals Influence on Calculated Blood Pressure of Measurement Posture for the Development of Wearable Vital Sign Sensors

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Shouhei Koyama ◽  
Hiroaki Ishizawa ◽  
Akio Sakaguchi ◽  
Satoshi Hosoya ◽  
Takashi Kawamura
Keyword(s):  
Blood Pressure ◽  
Calibration Curve ◽  
Pressure Measurement ◽  
Pulse Wave ◽  
Blood Pressure Measurement ◽  
Wave Signal ◽  
Fbg Sensor ◽  
Pressure Calculation ◽  
Measurement Height ◽  
The Difference

We studied a wearable blood pressure sensor using a fiber Bragg grating (FBG) sensor, which is a highly accurate strain sensor. This sensor is installed at the pulsation point of the human body to measure the pulse wave signal. A calibration curve is built that calculates the blood pressure by multivariate analysis using the pulse wave signal and a reference blood pressure measurement. However, if the measurement height of the FBG sensor is different from the reference measurement height, an error is included in the reference blood pressure. We verified the accuracy of the blood pressure calculation with respect to the measurement height difference and the posture of the subject. As the difference between the measurement height of the FBG sensor and the reference blood pressure measurement increased, the accuracy of the blood pressure calculation decreased. When the measurement height was identical and only posture was changed, good accuracy was achieved. In addition, when calibration curves were built using data measured in multiple postures, the blood pressure of each posture could be calculated from a single calibration curve. This will allow miniaturization of the necessary electronics of the sensor system, which is important for a wearable sensor.

Covariation and Temporal Stability of Peripheral and Brachial Blood Pressure Responses to Mental and Static Stress

2001 ◽  
Vol 15 (3) ◽  
pp. 198-207 ◽  
Author(s):  
Andreas Hinz ◽  
Reingard Seibt ◽  
Klaus Scheuch
Keyword(s):  
Blood Pressure ◽  
Mental Arithmetic ◽  
Blood Pressure Measurement ◽  
Temporal Stability ◽  
Physiological Parameters ◽  
Brachial Blood Pressure ◽  
Change Scores ◽  
The Difference ◽  
Blood Pressure Responses ◽  
Promising Development

Abstract Peripheral blood pressure measurement (Finapres technique) is a promising development in activation research. This paper tests and compares the temporal stability and covariation of peripheral and brachial blood pressure responses. Forty healthy subjects were tested four times at intervals of 1 day, 1 week, and 1 month. The tasks employed were two mental tasks (mental arithmetic and a Color Word Test) and a static (fingergrip) task. Recorded physiological parameters were peripheral and brachial systolic (SBP) and diastolic blood pressure (DBP). Mean peripheral SBP was about 20 mmHg higher than brachial SBP, but the difference between the DBP measures was negligible. Correlations between peripheral and corresponding brachial BP resting levels were low, with coefficients below 0.30. The correlations between peripheral and brachial SBP and DBP were higher for reactivity (change) scores (0.46-0.82) than for resting scores. Several types of inter- and intraindividual covariation were calculated to provide a deeper understanding of the relationship between the physiological parameters with respect to their dynamics. Temporal stability of peripheral BP level scores was lower (0.37-0.57) than for brachial BP (0.59-0.77), but the stability of the change scores was similar for both BP techniques. The results show that it is important to distinguish between several aspects of the mutual relationship between peripheral and brachial BP measures. Peripheral BP measurements are not suited to assess the BP level of a subject, but they are very useful to assess cardiovascular reactivity.

Comparison of the effectiveness of captopril and olmesartan in hypertensive patients

2021 ◽  
pp. 97-100
Keyword(s):  
Blood Pressure ◽  
Emergency Services ◽  
Rest Period ◽  
Organ Damage ◽  
The Other ◽  
Pressure Measurements ◽  
Hypertensive Patients ◽  
Mortality And Morbidity ◽  
The Mean ◽  
The Difference

Purpose: Hypertensive conditions are situations that require immediate intervention in emergency services. Captopril is one of the most commonly used drugs in patients presenting to emergency departments with high blood pressure. In this study; we aimed to find an answer to the question of whether orally administered olmesartan could be an alternative to captopril in urgent hypertensive situations. Material and Method: In this study, blood pressure measurements were made after a 5-minute rest period in patients who presented to the emergency department of our hospital with the diagnosis of hypertension. Patients with a blood pressure of 180/100 mmHg and above and no signs of end-organ damage were followed up. Forty patients were given sublingual captopril 25 mg, and the other 40 patients were given 40 mg of olmesartan, and they were allowed to swallow the drug with some water. Afterward, the patients were followed for 3 hours (with blood pressure and pulse measurements), and their blood pressure was measured and recorded at five-minute intervals. Results: The mean age of the patients receiving captopril was 60.70±11.43 years, and the mean age of the patients receiving olmesartan was 57.02±13.86 years. Of the patients receiving captopril, 19 (57.5%) were male, 21 (52.5%) were female, 17 (42.5%) of the patients receiving olmesartan were male and 23 (57.5%) were female. In this study, patients treated with captopril and olmesartan were monitored for 3 hours and the differences between them in pulse and blood pressure measurements were evaluated. When the systolic blood pressures were compared, the difference at the tenth minute was significant, but the difference between the other minutes was not significant. Differences in diastolic blood pressure and heart rate were not significant. Conclusion: Oral administration of olmesartan in emergency hypertensive patients may be an alternative to captopril due to its effectiveness in reducing mortality and morbidity.

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.

Blood pressure variations and low blood pressure values at home after hospital discharge in older hypertensives

2011 ◽  
Vol 19 (3) ◽  
pp. 460-466
Author(s):  
Marco Astengo ◽  
Martina Bonetto ◽  
Gianluca Isaia ◽  
Monica Comba ◽  
Gianfranco Fonte ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hospital Discharge ◽  
Terminal Illness ◽  
Blood Pressure Measurement ◽  
University Teaching ◽  
Antihypertensive Regimen ◽  
Low Blood Pressure ◽  
Study Population ◽  
The Difference ◽  
At Home

Background: Blood pressure (BP) variations occurring after hospital discharge in a population of older hypertensives have not been previously investigated. Design: elderly (≥65 years) hypertensives admitted to the geriatric acute ward of a university-teaching hospital were enrolled in this prospective observational study. Methods: Exclusion criteria were terminal illness, discharge to institution, and changes in antihypertensive regimen. BP was recorded in the emergency room, at ward admission, daily during hospital stay, and at discharge. Home self blood pressure measurement was performed after discharge. Results: The study population included 106 patients. There was a significant decrease in systolic BP (SBP) and diastolic BP (DBP) throughout the study time points. SBP and DBP decreased after discharge (from 135.1 ± 15.0 to 131.5 ± 16.1 mmHg and from 77.2 ± 8.4 to 71.6 ± 8.7 mmHg, respectively), the difference being significant only for DBP ( p = 0.000). We further observed higher prevalence of critically low BP values (SBP <120 mmHg and DBP <70 mmHg) at home (23.6% and 48.1%, respectively) compared to discharge (8.5% and 9.4%, p = 0.006 and p = 0.000, respectively). Conclusions: We observed a decrease in BP values, and particularly DBP values, after hospital discharge, in a sample of older hypertensives. Critically low BP values were observed at home in a high proportion of subjects, suggesting wise use of antihypertensive therapy at discharge and early monitoring of BP values at home.

scholarly journals Automated Versus Manual Blood Pressure Measurement: A Randomized Crossover Trial in the Emergency Department of a Tertiary Care Hospital in Karachi, Pakistan: Are Third World Countries Ready for the Change?

2016 ◽  
Vol 4 (3) ◽  
pp. 404-409 ◽  
Author(s):  
Kanaan Mansoor ◽  
Saba Shahnawaz ◽  
Mariam Rasool ◽  
Huwad Chaudhry ◽  
Gul Ahuja ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
P Value ◽  
Care Hospital ◽  
Pressure Measurements ◽  
The Mean ◽  
The Difference ◽  
Manual Blood Pressure ◽  
Mercury Sphygmomanometer

BACKGROUND: Hypertension has proven to be a strong liability with 13.5% of all mortality worldwide being attributed to elevated blood pressures in 2001. An accurate blood pressure measurement lies at the crux of an appropriate diagnosis. Despite the mercury sphygmomanometer being the gold standard, the ongoing deliberation as to whether mercury sphygmomanometers should be replaced with the automated oscillometric devices stems from the risk mercury poses to the environment.AIM: This study was performed to check the validity of automated oscillometric blood pressure measurements as compared to the manual blood pressure measurements in Karachi, Pakistan.MATERIAL AND METHODS: Blood pressure was recorded in 200 individuals aged 15 and above using both, an automated oscillometric blood pressure device (Dinamap Procare 100) and a manual mercury sphygmomanometer concomitantly. Two nurses were assigned to each patient and the device, arm for taking the reading and nurses were randomly determined. SPSS version 20 was used for analysis. Mean and standard deviation of the systolic and diastolic measurements from each modality were compared to each other and P values of 0.05 or less were considered to be significant. Validation criteria of British Hypertension Society (BHS) and the US Association for the Advancement of Medical Instrumentation (AAMI) were used. RESULTS: Two hundred patients were included. The mean of the difference of systolic was 8.54 ± 9.38 while the mean of the difference of diastolic was 4.21 ± 7.88. Patients were further divided into three groups of different systolic blood pressure <= 120, > 120 to = 150 and > 150, their means were 6.27 ± 8.39 (p-value 0.175), 8.91 ± 8.96 (p-value 0.004) and 10.98 ± 10.49 (p-value 0.001) respectively. In our study 89 patients were previously diagnosed with hypertension; their difference of mean systolic was 9.43 ± 9.89 (p-value 0.000) and difference of mean diastolic was 4.26 ± 7.35 (p-value 0.000).CONCLUSIONS: Systolic readings from a previously validated device are not reliable when used in the ER and they show a higher degree of incongruency and inaccuracy when they are used outside validation settings. Also, readings from the right arm tend to be more precise.

scholarly journals An analysis of blood pressure measurement in a primary care hospital in Swaziland

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Ganizani Mlawanda ◽  
Michael Pather ◽  
Srini Govender
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Good Clinical Practice ◽  
Clinical Decision ◽  
Care Hospital ◽  
Correct Treatment ◽  
Primary Care Hospital ◽  
The Mean ◽  
The Difference ◽  
The Impact

Background: Measurement of blood pressure (BP) is done poorly because of both human and machine errors.Aim: To assess the difference between BP recorded in a pragmatic way and that recorded using standard guidelines; to assess differences between wrist- and mercury sphygmomanometerbased readings; and to assess the impact on clinical decision-making.Setting: Royal Swaziland Sugar Corporation Mhlume hospital, Swaziland.Method: After obtaining consent, BP was measured in a pragmatic way by a nurse practitioner who made treatment decisions. Thereafter, patients had their BP re-assessed using standard guidelines by mercury (gold standard) and wrist sphygmomanometer.Results: The prevalence of hypertension was 25%. The mean systolic BP was 143 mmHg (pragmatic) and 133 mmHg (standard) using a mercury sphygmomanometer; and 140 mmHg for standard BP assessed using wrist device. The mean diastolic BP was 90 mmHg, 87 mmHg and 91 mmHg for pragmatic, standard mercury and wrist, respectively. Bland Altman analyses showed that pragmatic and standard BP measurements were different and could not be interchanged clinically.Treatment decisions between those based on pragmatic BP and standard BP agreed in 83.3% of cases, whilst 16.7% of participants had their treatment outcomes misclassified. A total of 19.5% of patients were started erroneously on anti-hypertensive therapy based on pragmatic BP.Conclusion: Clinicians need to revert to basic good clinical practice and measure BP more accurately in order to avoid unnecessary additional costs and morbidity associated within correct treatment resulting from disease misclassification. Contrary to existing research,wrist devices need to be used with caution.

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