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.

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.

Reliability of single office blood pressure measurements

Heart ◽  
2018 ◽  
Vol 104 (14) ◽  
pp. 1173-1179 ◽  
Author(s):  
Thilo Burkard ◽  
Michael Mayr ◽  
Clemens Winterhalder ◽  
Licia Leonardi ◽  
Jens Eckstein ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Office Blood Pressure ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Short Term ◽  
Cross Sectional ◽  
Registration Number ◽  
The Mean ◽  
The Difference

ObjectivesStandard operating procedures for office blood pressure measurement (OBPM) vary greatly between guidelines and studies. We aimed to compare the difference between a single OBPM and the mean of the three following measurements. Further, we studied how many patients with possible hypertension may be missed due to short-term masked hypertension (STMH) and how many might be overdiagnosed due to short-term white coat hypertension (STWCH).Design and settingIn this cross-sectional, single-centre trial, 1000 adult subjects were enrolled. After 5 min of rest, four sequential standard OBPMs were performed at 2 min intervals in a quiet room in sitting position. We compared the first (fBPM) to the mean of the second to fourth measurement (mBPM). STMH was defined as fBPM <140 mm Hg systolic and <90 mm Hg diastolic and mBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg. STWCH was defined as fBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg and mBPM <140 mm Hg systolic and <90 mm Hg diastolic.ResultsComplete measurements were available in 802 subjects. Between fBPM and mBPM, 662 (82.5%), 441 (55%) and 208 (25.9%) subjects showed a difference in systolic and 531 (66.2%), 247 (30.8%) and 51 (6.4%) in diastolic blood pressure (BP) values of >2 mm Hg, >5 mm Hg and >10 mm Hg, respectively. In 3.4% of initially normotensives STMH and in 34.3% of initially hypertensives, STWCH was apparent.ConclusionsThere are significant differences between a single OBPM and the mean of consecutive BP measurements. Our study provides evidence that a single OBPM should not be the preferred method and should be discouraged in future guidelines.Trial registration numberNCT02552030;Results.

scholarly journals Self home blood pressure monitoring in pregnancy: how reliable is it?

2018 ◽  
Vol 7 (2) ◽  
pp. 419
Author(s):  
Hemapriya L. ◽  
Nagaraj Desai ◽  
Ambarish Bhandiwad
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
Self Monitoring ◽  
Medical College ◽  
The Mean ◽  
The Difference ◽  
A Prospective Study ◽  
The Impact ◽  
In Pregnancy

Background: The use of automated blood pressure monitors in pregnancy has become increasingly popular, as more women tend to get involved in their healthcare. Not only does it reduce clinician visits, it also helps to eliminate the white coat hypertension.Methods: We conducted a prospective study in the antenatal department of JSS Medical College and Hospital, Mysuru; over a period of one year, from July 2016 to June 2017. The blood pressures of 50 women were recorded at four different periods of gestation using the conventional ‘Diamond mercury Sphygmomanometer’ versus the automated ‘Omron HEM 7130’ home BP monitor and compared.Results: The recordings of systolic blood pressure at home were consistently less than the office measurements at all periods of gestation. However, the difference was not statistically significant. The comparison of diastolic pressures revealed minimal variations between the mean of the office and home blood pressure recordings. The mean arterial pressure also revealed a similar trend.Conclusions: Self-monitoring of blood pressure is a feasible and acceptable option to pregnant women. It might make antenatal care more effective, but we need further research to establish safety and efficacy, the impact on women and health professionals, and how best to use the results.

Validation of blood pressure measurement by the complex for daily monitoring of ECG and blood pressure “Medicom-Combi" by oscillometric and auscultatory methods in pediatric population (according to the BHS-93 protocol)

2021 ◽  
pp. 75-78
Author(s):  
I. G. Moreno
Keyword(s):  
Blood Pressure ◽  
Pediatric Population ◽  
Blood Pressure Measurement ◽  
Oscillometric Method ◽  
Daily Monitoring ◽  
Auscultatory Method ◽  
The Mean ◽  
The Difference ◽  
Study Participants ◽  
Sequential Measurements

Purpose. To assess the accuracy of blood pressure (BP) measurement by the complex for daily monitoring of ECG and blood pressure «MedicomCombi» in comparison with a mercury sphygmomanometer in pediatric patients.Materials and methods. The recruitment of study participants was carried out in accordance with the criteria outlined in the international protocol BHS-93 for the pediatric population. During the tests, repeated sequential measurements of blood pressure were carried out by experts (using mercury sphygmomanometers) and the tested complex (by oscillometric and auscultatory methods).Results. The mean SBP, determined by the oscillometric method, was 116.0 ± 13.6 mm Hg, DBP - 69.0 ± 11.8 mm Hg. The mean SBP according to the auscultatory method was 116.0 ± 14.6 mm Hg, DBP - 70.4 ± 11.9 mm Hg. In 66% of cases for SBP and in 62% of cases for DBP, the difference between expert and test measurements by the oscillometric method did not exceed 5 mm Hg. In 100% of cases for SBP and in 96% of cases for DBP, the differences were within 10 mm Hg. The average differences between the experts and the tested complex were - 0.2 ± 5.7 mm Hg for SBP and 1.6 ± 6.1 for DBP. In 68 % of cases for SBP and in 65 % of cases for DBP, the difference between expert and test measurements by the auscultatory method was no more than 5 mm Hg. In 100% of cases for SBP and in 95% of cases for DBP, the differences did not exceed 10 mm Hg. The average differences between the experts and the tested complex were - 0.3 ± 4.7 mm Hg for SBP and 0.1 ± 5.7 for DBP.Conclusion. The complex for daily monitoring of ECG and blood pressure «Medicom-Combi» has demonstrated compliance with the accuracy requirements specified in the BHS 1993 protocol (class «А/А»), and can be recommended for measuring blood pressure by oscillometric and auscultatory methods in pediatric practice.

scholarly journals Can blood pressure be measured without undressing patients ?

2021 ◽  
Vol 4 (1) ◽  
pp. 21-29
Author(s):  
Pierre-Yves Durand ◽  
Typhaine Le Hegarat ◽  
Thibault Gutter
Keyword(s):  
Blood Pressure ◽  
Diastolic Pressure ◽  
Statistical Significance ◽  
Blood Pressure Measurement ◽  
Winter Season ◽  
Routine Practice ◽  
Dialysis Patients ◽  
Arterial Blood ◽  
The Mean ◽  
The Difference

The guidelines recommend that the technique of measuring arterial blood pressure requires positioning the cuff on a bare arm, without rolled-up sleeve. These recommendations are sometimes difficult to apply in routine practice, as in dialysis centers where the measurement is repeated in fragile patients. In this study, we assess the validity of the blood pressure measurement with a cuff positioned on a bare arm, compared to a cuff positioned on several layers of clothing. A total of 1,224 blood pressure measurements were taken in 51 dialysis patients over a period of one month, 6 measurements per week, i.e. 24 measurements per patient. The patients wore their ordinary clothes suitable for a winter season. Thus, 612 measurements were taken with a cuff on a bare arm, and 612 measurements with a cuff on clothing. The mean systolic pressures were 121.9 and 123.5 mmHg, respectively when the cuff was placed on clothing and bare skin. The mean diastolic pressure was 60.1 and 60.5 mmHg, respectively. The observed difference does not reach the level of statistical significance with respectively p = 0.168 and p = 0.135. The same is true for mean arterial pressure, with 80.6 and 81.5 mmHg respectively (p = 0.142). The difference observed does not justify the undressing of patients for whom this procedure is difficult, uncomfortable or painful.

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.

scholarly journals Improved agreement and diagnostic accuracy of a cuffless 24-h blood pressure measurement device in clinical practice

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Thenral Socrates ◽  
Philipp Krisai ◽  
Annina S. Vischer ◽  
Andrea Meienberg ◽  
Michael Mayr ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Area Under The Curve ◽  
Pulse Transit Time ◽  
Hypertension Detection ◽  
Software Update ◽  
Reference Device ◽  
Cuffless Blood Pressure ◽  
The Impact ◽  
Blood Pressure Measurement Device

AbstractA cuffless blood pressure (BP) device (TestBP) using pulse transit time is in clinical use, but leads to higher BP values compared to a cuff-based 24 h-BP reference device (RefBP). We evaluated the impact of a recent software update on BP results and TestBP’s ability to differentiate between normo- and hypertension. 71 individuals had TestBP (Somnotouch-NIBP) and RefBP measurements simultaneously performed on either arm. TestBP results with software version V1.5 were compared to V1.4 and RefBP. Mean 24 h (± SD) BP for the RefBP, TestBP-V1.4 and TestBP-V1.5 were systolic 134.0 (± 17.3), 140.8 (± 20) and 139.1 (± 20) mmHg, and diastolic 79.3 (± 11.7), 85.8 (± 14.1) and 83.5 (± 13.0) mmHg, respectively (p-values < 0.001). TestBP-V1.5 area under the curve (95% confidence interval) versus RefBP for hypertension detection was 0.92 (0.86; 0.99), 0.94 (0.88; 0.99) and 0.77 (0.66; 0.88) for systolic and 0.92 (0.86; 0.99), 0.92 (0.85; 0.99) and 0.84 (0.74; 0.94) for diastolic 24 h, awake and asleep BP respectively. TestBP-V1.5 detected elevated systolic/diastolic mean 24 h-BP with a 95%/90% sensitivity and 65%/70% specificity. Highest Youden’s Index was systolic 133 (sensitivity 95%/specificity 80%) and diastolic 87 mmHg (sensitivity 81%/specificity 98%). The update improved the agreement to RefBP. TestBP was excellent for detecting 24 h and awake hypertensive BP values but not for asleep BP values.

Hypertension Secondary to Ingestion of Licorice Root Tea

2011 ◽  
Vol 27 (6) ◽  
pp. 266-268 ◽  
Author(s):  
Tony Joseph Eid ◽  
Amanda A Morris ◽  
Sachin A Shah
Keyword(s):  
Blood Pressure ◽  
Dietary Supplements ◽  
Blood Pressure Measurement ◽  
Plasma Renin ◽  
Licorice Root ◽  
African American Female ◽  
Lifestyle Modifications ◽  
Plasma Aldosterone Concentration ◽  
Serum Potassium Concentration ◽  
The Impact

Objective: To report a case of hypertension secondary to ingestion of licorice root tea. Case Summary: A 46-year-old African American female with newly diagnosed stage 1 hypertension presented with a blood pressure measurement of 144/81 mm Hg and a reduced plasma potassium level of 3.2 mEq/L. The patient attempted lifestyle modifications prior to initiating an antihypertensive agent, but at a follow-up appointment, her blood pressure remained elevated. A current laboratory panel revealed a depressed morning plasma aldosterone concentration (PAC) of 5 ng/dL and low morning plasma renin activity (PRA) of 0.13 ng/mL/h. Later it was revealed that the patient regularly (1–2 cups/day) consumed “Yogi Calming” tea, a blend of herbs, including licorice root. The patient was advised to discontinue consumption of the herbal tea, and at a subsequent appointment, her blood pressure was 128/73 mm Hg and her laboratory panel had improved, including serum potassium concentration of 4.1 mEq/L, PAC of 6 ng/dL, and PRA of 0.19 ng/mL/h. Discussion: Excessive consumption of licorice has been well documented to cause pseudohyperaldosteronism, characterized by hypertension, hypokalemia, and suppressed plasma renin and aldosterone levels. Glycyrrhizin, the active ingredient in licorice, inhibits 11β-hydroxysteroid dehydrogenase type 2, an oxidase responsible for the conversion and inactivation of cortisol to cortisone. Chronic ingestion of licorice-containing foods has been demonstrated to cause pseudohyperaldosteronism. These include soft candies, lozenges, and dietary supplements, but licorice-containing teas have been infrequently described. Based on the Naranjo probability score, our patient's hypertension appears to have been a probable licorice-induced reaction secondary to a licorice-containing tea. Conclusions: Herbal and dietary supplements are frequently consumed by patients without full knowledge of the contents of the products or the impact on their health. In clinical practice, when hypertension is accompanied by hypokalemia and reduced PRA and PAC, licorice consumption should be investigated and causal hypertension ruled out.

FC 096THE EFFECT OF INCREMENTAL START OF HAEMODIALYSIS ON BLOOD PRESSURE AND INTERDIALYTIC WEIGHT GAIN: PRELIMINARY FINDINGS FROM THE ENDURE STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Adil Hazara ◽  
Victoria Allgar ◽  
Maureen Twiddy ◽  
Sunil Bhandari
Keyword(s):  
Blood Pressure ◽  
Propensity Scores ◽  
Phase 1 ◽  
Tertiary Care ◽  
Residual Renal Function ◽  
Care Hospital ◽  
Interdialytic Weight Gain ◽  
Matching Criteria ◽  
The Impact

Abstract Background and Aims Mortality rates are high in patients starting haemodialysis/haemodiafiltration (HD) therapy. Incremental HD may help reduce this risk by reducing the burden of early treatment whilst patients are still adapting to long-term HD therapy. A feasibility study (ENDURE study – Clinical trials ID: NCT04268264) is being conducted with the primary objectives of evaluating the acceptability and tolerance of a new incremental HD regime. Its secondary aims are to evaluate the impact of this form of incremental HD on indicators of patient safety and wellbeing. These indicators include blood pressure (BP) control and interdialytic weight gains (IDWG) which are independently associated with adverse cardiovascular outcomes in patients on long-term HD. We present preliminary findings from the study related to systolic BP and IDWG. Method The ENDURE study is being carried out at a tertiary care hospital in the United Kingdom. Patients aged &gt; 18 years known to renal services for at least 90 days, referred for start of HD, were eligible for participation. Following approved consenting procedures, they are started on a new regime of incremental HD starting dialysis twice weekly with progressive increases in the duration and frequency of sessions over 15 weeks. This period is split in to four phases; phase 1 representing the first two days of dialysis (baseline) whereas phases 2 – 4 representing the pre-specified incremental steps. Propensity scores were calculated to match each participant (incremental HD group) with two controls from a database of patients who previously started HD at our centres using the standard protocol of 3 times weekly, 4hr long sessions. The matching criteria accounted for 14 key demographic, clinical and laboratory characteristics. Results were analysed as intention to treat. In comparing BP and IDWG between the two groups, only readings taken pre-dialysis at the first session of the week was considered. This study has been approved by the West of Scotland Research Ethics committee-4 (Ref: 19/WS/0019). Results Baseline characteristics of the first 15 participants (target 20) and their matched controls are presented in table 1. The proportion of females and duration of previous specialist input was higher in the incremental HD group. Conclusion The ENDURE study tests the feasibility of starting patients on a novel incremental HD regime. Early data suggest that control of systolic BP and IDWG are comparable to patients who start dialysis at 3 times weekly. Further work is needed to understand the impact of reducing dialysis frequency on BP control correlating the findings with changes residual renal function and objective measures of fluid overload.

Abstract P125: Hypertension, Awareness, Treatment, And Control In Nepal: Results From May Measurement Month 2020 Blood Pressure Screening

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Pawan Acharya ◽  
Sweta Koirala ◽  
Pabitra Babu Soti ◽  
Sneha Sharma ◽  
Abhishek Sapkota ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Smoking Status ◽  
Blood Pressure Measurement ◽  
Age Groups ◽  
Hypertension Status ◽  
Safety Measures ◽  
Treatment Of Hypertension ◽  
Hypertension Awareness ◽  
The Mean ◽  
And Control

Background: May Measurement Month (MMM) 2020 was not officially executed globally due to the COVID-19 pandemic. But in Nepal, the MMM 2020 was conducted by following COVID-19 safety measures. Methods: We used an opportunistic screening campaign for blood pressure measurement among individuals ≥18 years in Nepal. Of the three measurements, the second and third measurements were used to estimate the mean systolic and diastolic blood pressure(BP). We defined hypertension as the systolic BP ≥ 120 or diastolic BP≥90 mmHg and or currently taking antihypertensive medicine. Results: Among the total 11,486 participants, 57%(6568/11486) were females. The mean age of the screenees was 45years(SD=17.0). The mean systolic and diastolic BP were 125.8(SD= 18.0) and 81.6(SD=10.5) respectively. About 31.3%(3592/11481) participants had hypertension. Among the hypertensive persons, 40.2%(1444/3592) were aware of their hypertension status. Among these who were aware, 79.4%(1146/1444) were taking antihypertensive medicine. However, the overall proportion of hypertensive patients taking medicine was 32.0%(1146/3592). The BP was controlled among 46% ( 527/1444) of participants who were under medication. Logistic regression analysis adjusting age, sex, body mass index(BMI), and smoking status found males, higher age groups, higher BMI, and smokers had higher odds of being hypertensive. (Figure 1) Conclusion: The results suggest a need to address the gap in awareness, diagnosis, and treatment of hypertension in Nepal. The results are limited due to the non-random participation of screenees. Figure 1. Odds ratio plot

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