Blood Pressure Measurement Procedure Research Articles

O30 AVAILABILITY OF PROPERLY VALIDATED AUTOMATED BLOOD PRESSURE MEASURING DEVICES FOR CHILDREN: STRIDE BP SYSTEMATIC REVIEW

Background and Objective: Properly validated automated upper-arm cuff blood pressure (BP) measuring devices are currently recommended for office, home, and ambulatory BP measurement. However, the validation of BP devices in children presents additional challenges, necessitating separate studies. This study assessed the evidence on accurate automated BP devices in children. Methods: STRIDE BP (www.stridebp.org) performs periodic systematic PubMed searches to identify validation studies of automated cuff BP monitors. Validation studies including children (3-12 years) conducted using an established protocol, including the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018), ANSI/AAMI/ISO 2013/2009, ESH-IP 2010/2002, AAMI 2002/1992/1987, and BHS 1993/1990, were identified from the STRIDE BP database. Results: Of 569 validation studies included in the STRIDE BP database, 47 (33 devices) were identified including children. Among them, STRIDE BP rejected 29 studies of which 18 were reported as “device pass” in the published paper. Among studies rejected by STRIDE BP but published as “pass”, main reasons for rejection were violations in the BP measurement procedure (sequence, number, repeats) (50%), inadequate reference device or cuffs for reference and test device (16.6%), inadequate sample size (22.2%), and single observer for reference BP (22.2%). Eventually 18 studies in children (38.3%) fulfilled all the validation protocol requirements, and 16 devices (10 available on the market) met the validation requirements and can be recommended for use in children. When additional ‘equivalent’ devices were considered (devices lacking validation studies but with differences from validated devices not affecting the measurement accuracy), 21 devices were found to be accurate, with 13 of them available on the market (Table). Conclusions: This analysis highlight a serious shortage of properly validated BP devices for children available in the market, with published validation studies often having major methodological issues. There is an urgent call to manufacturers and investigators to develop and properly validate more BP devices for children. TABLE. Validated devices for office, home, and ambulatory BP measurement in children.

The Effect of Supine, Semi-Fowler’s, and Fowler’s Positions on the Blood Pressure Values of Patients Hospitalized in Surgical Clinics

<b>Aim:</b> Blood pressure measurement is an integral part of clinical practice in patient care and treatment, as well as being of critical importance in the early diagnosis, treatment, and prevention of the complications of hypertension. This study was carried out to determine the effect of supine, semi-Fowler’s, and Fowler’s positions on the blood pressure values of patients hospitalized in surgical clinics.<br /> <b>Material and methods:</b> This quasi-experimental study was carried out with 112 preoperative surgical patients hospitalized in the surgical clinics of a training and research hospital. Using a bedside monitor, the patients' systolic and diastolic blood pressures were measured in the supine, Fowler’s, and semi-Fowler’s positions. The Pearson correlation coefficient, Mauchly's sphericity, ANOVA, and Bonferroni correction were used in the data analysis.<br /> <b>Results:</b><i> </i>While systolic blood pressure values did not differ between the supine and semi-Fowler’s positions (F = .007, p = .934), there was a significant difference between the semi-Fowler’s and Fowler’s positions (F =5.534, p = .020). Diastolic blood pressure values differed significantly between the supine and semi-Fowler’s (F = 7.406, p = .008) and semi-Fowler’s and Fowler’s (F = 9.038, p = .003) positions.<br /> <b>Conclusions:</b> It is vital for nurses to establish procedures for blood pressure measurement and evaluation in the clinic and other team members and periodically revise the existing procedures.

Preventive Cardiovascular Measures in Children with Elevated Blood Pressure.

Cardiovascular diseases are the leading cause of morbidity and mortality in developed countries and are becoming increasingly significant in developing nations. Many cardiovascular risk factors originate early in life, even prenatally. Elevated blood pressure and hypertension are gaining attention in paediatrics due to their rising prevalence and impact on early cardiovascular risk in adulthood. Along with non-modifiable risk factors for hypertension, several modifiable factors can be addressed through primordial and primary prevention, emphasising lifestyle modifications. When these measures fail and elevated blood pressure develops, early detection is crucial (secondary prevention). Regular blood pressure measurement, a simple and non-invasive procedure, should be a standard practice in paediatric clinical settings. Diagnosing elevated blood pressure and hypertension should adhere to recommended guidelines. Lifestyle modifications are the first-line therapy for primary hypertension in children; if a secondary cause is identified, targeted treatment can be implemented, but a healthy lifestyle remains essential. The early detection and treatment of high-risk blood pressure enable timely interventions to prevent complications (tertiary prevention). Collectively, these preventive measures aim to reduce the incidence of cardiovascular disease in adulthood. Furthermore, quaternary prevention seeks to avoid unnecessary or harmful medical interventions including unwarranted examinations and pharmacotherapy. This underscores the importance of accurate diagnosis and treatment of elevated blood pressure and hypertension and emphasises the need for primordial and primary prevention to minimise unnecessary clinical interventions.

Pediatric hypertension based on Japanese Society of Hypertension Guidelines (JSH 2019) with actual school blood pressure screening data in Japan.

Blood pressure (BP) in children and adolescents is associated with their growth. BP is most strongly associated with height during height gain and with degree of obesity after reaching final height. BP in childhood and adolescence is correlated with BP in adulthood. The pathophysiology of pediatric essential hypertension is associated with obesity, excess salt intake, and a low birth weight. The common causes of pediatric secondary hypertension are renal parenchymal and renovascular diseases. The significance of diagnosing pediatric hypertension involves detecting secondary hypertension and preventing organ damage due to hypertension as well as tracking essential hypertension in adulthood. Appropriate BP measurement procedures are required for diagnosing pediatric hypertension. The inflatable bladder of an appropriately sized cuff should exceed 40% of the arm circumference. BP measurements should be performed consecutively at least 3 times using an appropriately sized cuff. The diagnosis of hypertension requires that all BP values measured on 3 or more occasions be above the reference value. The criteria for pediatric hypertension are determined based on the distribution of BP in healthy children and adolescents, with values above the 95th percentile of normal representing hypertension. Japanese criteria define pediatric hypertension as ≥120/70 mmHg for preschool children, ≥130/80 mmHg for 1st–3rd graders, ≥135/80 mmHg for 4th–6th graders, ≥140/85 mmHg for 7th–9th grade boys, ≥135/80 mmHg for 7th–9th grade girls, and ≥140/85 mmHg for senior high school boys and girls. The prevalence of Japanese pediatric hypertension was 0.9% based on proper measurement protocols. The basis of managing pediatric essential hypertension is healthy lifestyle modifications. Pharmacotherapy is indicated for persistent hypertension, symptomatic hypertension, secondary hypertension, the development of target organ damage, the presence of chronic kidney disease, and diabetes mellitus. Screening for pediatric hypertension is important; therefore, BP should be routinely measured in children and adolescents.

Retention of knowledge on blood pressure measurement among medical students within preparation for primary accreditation

Aim. To assess the retained knowledge of sixth year medical students on noninvasive blood pressure (BP) measurement.Material and methods. The study included 148 6th year medical students. According to the curriculum, in the fall semester, students studied the procedure of BP measurement according to checklists developed based on ROSOMED. In the spring semester, as part of the preparation course for accreditation, the retained knowledge of students was assessed. A completed skill was assessed at 1 point, not completed — 0 points. Thus, each student can score a maximum of 50 points. The teacher assessed the manipulations during their performing by filling in the checklist items for each student.Results. None of the students completed the full range of manipulations. The number of completed skills ranged from 15 (30%) to 49 (98%) and averaged 33 points on the checklist (66%). In addition, 74% of students (n=109) completed more than half of the required skills. Almost the only item completed by all students (99%, n=146) was a greeting, which was comparable with self-presentation (92%, n=136) and identification of a patient’s personal data (surname and first names) (80%, n=118). The rest of checklist items was performed in the range from 39% (n=57) for “remeasurement of BP on the other hand” to 87% (n=129) for “finding a radial pulse”. Thus, the average fulfillment rate was 67% (n=99). There were following most common mistakes in BP measurement: 39% of students did not measure a patient’s upper arm diameter and did not select the cuff size; every second student (51%) placed the phonendoscope diaphragm under the cuff; 40% of students reduced the cuff pressure with inadequate rate.Conclusion. The retention of knowledge on measuring BP within six months after a detailed analysis and passing a test remains insufficient, but comparable with foreign studies. The data obtained indicate the need for additional trainings both using simulators and in conditions closer to real ones, including with simulated patients.

PROPOSAL OF A UNIVERSAL OFFICE BLOOD PRESSURE MEASUREMENT PROCEDURE FOR CLINICAL AND SCIENTIFIC USE

Objective: Office blood pressure measurement (OBPM) procedures recommended in guidelines and applied in studies vary highly. The current European Societies of Cardiology/Hypertension (ESC/ESH) guidelines for OBPM are impractical to use in clinical settings and trials and lack scientific evidence. Our aim was to explore the meaning of the fourth BP measurement as recommended by ESC/ESH and to study whether a simplified OBPM procedure is feasible without loss of quality. Design and method: Four sequentially taken blood pressure measurements (BPMs) were used to calculate blood pressure (BP) as a mean of the second/third systolic/diastolic BPM (S2S3/D2D3), or as a mean of the third/fourth BPM (S3S4/D3D4). Patients were stratified according to the absolute difference between the first/second BPM (S1S2/D1D2) into >10 mmHg and < =10 mmHg. A linear model was used to predict S3S4/D3D4 from S2S3/D2D3. Results: Complete measurements were available in 802 patients. 206 patients (25.7%) had an absolute S1S2 difference >10 mmHg, 60 patients (7.5%) for D1D2. Correlation tests showed a median decrease from S2S3 to S3S4 of 0.5 mmHg and 0.5 mmHg for D2D3 to D3D4 (p < 0.0005 for both). For patients with S1S2 >10 mmHg the median decrease was 0.0 mmHg (p = 0.174), with S1S2 < = 10 mmHg 0.5 mmHg (p < 0.0005), with D1D2 >10 mmHg 1.0 mmHg (p = 0.269), with D1D2 <=10 mmHg 0.5 mmHg (p < 0.0005). There was a linear relationship between S2S3/S3S4 (R2 = 0.944, p < 0.0005, Figure(A); for patients with S1S2 >10 mmHg R2 = 0.958, p < 0.0005, Figure(B), with < =10 mmHg R2 = 0.953, p < 0.0005, Figure(C)) and D2D3/D3D4 (R2 = 0.911, p < 0.0005, Figure(D); for patients with D1D2 >10 mmHg R2 = 0.694, p < 0.0005, Figure(E), with < = 10 mmHg R2 = 0.968, p < 0.0005, Figure(F)). S3S4 and D3D4 could be predicted with an accuracy of 0.967/0.960 from S2S3 and D2D3. Conclusions: A fourth BPM does not provide any significant benefit in the context of a standardized OBPM procedure. Therefore, we propose a simplified procedure based on the mean of the second/third standardized OBPM measurement and refrain from a fourth measurement in both clinical practice and study protocols.

ELABORATION AND VALIDATION OF AN EDUCATIONAL VIDEO ON BLOOD PRESSURE MEASUREMENT IN SCREENING PROGRAMS

ABSTRACT Objective: to produce and validate an educational video on the procedure of indirect blood pressure measurement with the oscillometric technique to support actions of blood pressure screening programs in Brazil. Method: a methodological study consisting in three stages: 1) pre-production of a script/storyboard; 2) content validation by a committee of 16 experts recruited according to their degrees and training in the area of interest of the study; and 3) final production, recording and edition of the educational video. For data collection, three validated instruments were used that allowed the video to be assessed as to its functionality, usability, efficiency, relevance, verbal language, audiovisual technique, environment, content and proposed objectives. The analysis of the quantitative variables was performed by calculating absolute and relative frequencies, and the categorical variables were measured using means and standard deviations. Items that obtained a CVI > 0.75 were considered valid. Results: script validation was performed by eight experts and obtained a CVI of 0.93, while the technical assessment of the educational video and storyboard was performed by three experts and obtained a CVI of 0.97. After accepting the experts' suggestions, the educational video was produced and validated by eight experts, who considered the material valid for application (CVI = 0.94). Conclusion: the educational video produced and validated in this study was characterized as an appropriate strategy for teaching the indirect measurement of blood pressure with the oscillometric technique among health professionals who volunteer to participate in blood pressure screening programs in Brazil.

Behavioral and Physiological Pain Responses in Brain-Injured Patients Who Are Unable to Communicate in the Intensive Care Unit

BackgroundAssessing pain of critically ill patients with brain injuries who are unable to communicate is a challenge. Current behavioral scales are limited in accurate pain assessments for this population. AimsThis study sought to investigate the behavioral and physiological responses induced by routine painful procedures in patients with brain injuries who are unable to communicate. MethodsUsing a repeated-measure within-subject observational study design, 12 participants admitted to an intensive care unit were observed before, during, and 15 minutes after a nonnociceptive (noninvasive blood pressure measurement) procedure and three nociceptive (suctioning, turning, and trapezius pinch) procedures. During each assessment, patients’ behavioral and physiological responses were observed using video cameras and bedside monitors. ResultsIn the overall behavioral responses to the nociceptive procedures, clenched teeth with tense jaw, frowning, orbit tightening, closing of eyes, eye movement, fixation-staring, flushing, flexion withdrawal of arm, flexion withdrawal of leg, muscle rigidity, twitching, and coughing were more frequently observed during procedures than before and after procedures (p < .01). Regarding physiological responses, significant increases in systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and respiratory rate were identified across assessments (p < .001). ConclusionsThe findings can be used as a basis for pain assessment and the development of pain assessment tools for brain-injured patients who are unable to communicate. However, since physiological responses may be influenced by various factors besides pain, physiological changes may be used as a sign of the need for pain assessment rather than being used alone as a basis for pain assessment.

Experimental Subarachnoid Hemorrhage Drives Catecholamine-Dependent Cardiac and Peripheral Microvascular Dysfunction.

Subarachnoid hemorrhage (SAH) is a devastating cerebral event caused by an aneurysmal rupture. In addition to neurological injury, SAH has significant effects on cardiac function and the peripheral microcirculation. Since these peripheral complications may exacerbate brain injury, the prevention and management of these peripheral effects are important for improving the overall clinical outcome after SAH. In this investigation, we examined the effects of SAH on cardiac function and vascular reactivity in a well-characterized blood injection model of SAH. Standard echocardiographic and blood pressure measurement procedures were utilized to assess cardiac function and hemodynamic parameters in vivo; we utilized a pressure myography approach to assess vascular reactivity in cremaster skeletal muscle resistance arteries ex vivo. We observed that elevated catecholamine levels in SAH stun the myocardium, reduce cardiac output and augment myogenic vasoconstriction in isolated cremaster arteries. These cardiac and vascular effects are driven by beta- and alpha-adrenergic receptor signaling, respectively. Clinically utilized adrenergic receptor antagonists can prevent cardiac injury and normalize vascular function. We found that tumor necrosis factor (TNF) gene deletion prevents the augmentation of myogenic reactivity in SAH: since membrane-bound TNF serves as a mechanosensor in the arteries assessed, alpha-adrenergic signaling putatively augments myogenic vasoconstriction by enhancing mechanosensor activity.

Masked hypertension is associated with end organ damage in geriatric age: Geriatric MASked Hypertension and End organ damage (G-MASH-End organ Study)

Purpose: It is a question whether masked hypertension (MH) leads to end-organ damage in the geriatric age group. The aim of this study is to evaluate the associations between MH and end-organ damage such as left ventricular hypertrophy (LVH) and proteinuria in geriatric population.Materials and methods: One hundred and two patients who were admitted to the outpatient clinic were included in the study. These patients were also included in the GMASH-Cog study in 2016, which examined the relationship between MH and cognitive function. All patients underwent ambulatory blood pressure measurement procedures. Cardiac functions of all patients were determined by echocardiography. Spot urine albumin/creatinine ratio (ACR) was measured in all patients.Results: Forty four of 102 patients (43%) were diagnosed with MH. ACR was 9.61 mg/gr in the MH group and 7.12 mg/gr in the normal group (p = .021). In addition, left ventricular mass index (LVMI) was found to be higher in the MH group than in the normal group. Mean LVMI scores were 107.76 ± 16.37 in patients with MH and 100.39 ± 19.32 in the normotensive group (p = .046).Conclusion: MH is associated with end-organ damage in geriatric patients. Urinary albumin excretion and LVH which are the parameters of end-organ damage were significantly higher in MH patients. MH may cause end-organ damage and should not be overlooked in geriatric patients.

Considerations for Optimal Blood Pressure Goals in the Elderly Population: A Review of Emergent Evidence.

Recent hypertension clinical trials and national guideline updates have created a debate on the most appropriate treatment goals in elderly patients with hypertension. In 2014, recommendations by the Eighth Joint National Committee allowed a more lenient goal for patients 60years and older compared with previous guidelines. Since then, several large clinical trials and meta-analyses have added more information regarding strict versus lenient treatment goals. Most recently, the American College of Cardiology and American Heart Association Task Force published their highly anticipated hypertension guideline developed in conjunction with nine additional interdisciplinary organizations. This review discusses the culmination of emerging data to provide more insight into the treatment of hypertension in the elderly. A literature search was conducted using PubMed, the Cumulative Index of Nursing and Allied Health, the Cochrane database, and by hand-searching references from relevant articles. The following key terms were used: hypertension, blood pressure, systolic, and elderly. Available literature suggests that it is reasonable to target an office systolic blood pressure of less than 130mmHg in elderly patients with hypertension. An individualized approach is reasonable for those who are institutionalized, with high comorbidity burden, or have a short life expectancy. A diastolic blood pressure of less than 60mmHg should be avoided due to the potential for an increase in cardiovascular risk. The method of blood pressure measurement is extremely important to consider when determining the blood pressure goal, and proper procedures for accurate blood pressure measurement must be followed. Other factors important to consider may include the patient's comorbidities, frailty, as well as the patient's potential for adverse drug reactions.

Status of hypertension screening in the Korea National General Health Screening Program: a questionnaire survey on 210 screening centers in two metropolitan areas

BackgroundThe purpose of this survey was to evaluate the performance of hypertension screening in medical institutions conducting the national general health screening program of the Republic of Korea.MethodsWe contacted 700 medical institutions of Seoul and Incheon areas which performed the national general health screening program in 2016, and 210 of them completed telephone survey. The questions asked in the survey include equipment, environment, personnel and quality control procedures for blood pressure (BP) measurement, and interpretation of the measurements.ResultsA majority of the responding screening centers used oscilloscope sphygmomanometers (51.9%), had only one-sized cuff (65.2%), and measured BP in open space (54.3%). BP levels were measured mainly by nurses (62.0%) and doctors (25.0%), after a 1 to10 minutes (84.9%) of resting period. A 75.2% of screening centers regularly calibrated sphygmomanometers, 81.4% had a manual for BP measurement, and 59.0% had a training program. A 80.0% of respondents answered that they used averages of multiple BP measurements to determine an individual’s BP level, and 82.9% answered that criteria for hypertension was systolic BP ≥140 mmHg and/or diastolic BP ≥ 90 mmHg. If a screening finds an individual with hypertension, 82.9% of centers recommend revisiting for a second BP measurement rather than start medication immediately.ConclusionIn most medical institutions performing general health screening program, certified medical personnel measure BP and interpret the results according to established protocols. However, there is room for improvement in the equipment, environment and quality control procedures for BP measurement.

PP.06.05] IS OFFICE BLOOD PRESSURE MEASUREMENT RELIABLE FOR INDIVIDUAL DECISION MAKING – RESULTS OF THE IPARR TRIAL

Objective: Standard operating procedures (SOP) for office blood pressure measurement (OBPM) vary highly between different guidelines. Similarly, outcome studies have used different methods to measure office blood pressure. Until today OBPM is used for clinical decision making. We aimed to compare an OBPM procedure based on the one used in the SPRINT study, but attended by an operator, to a single OBPM as used in early outcome studies and many clinical settings. Design and method: In this cross-sectional, single-center trial, 1000 adult subjects were recruited until February 2016. Seven sequential blood pressure measurements were performed after five minutes of rest in a quiet room and in sitting position in the presence of an operator. The initial measurement was taken using a standard device (Omron HBP-1300 professional blood pressure monitor, appropriate cuff size), alternating with a tested smartphone app. Over all, 4 standard and 3 smartphone measurements were taken, however, only the standard measurements were used for this study. The standard OBPM were spaced 2 min apart. Additional information about cardiovascular risk factors, concomitant disease, and medication were collected. We compared the first measurement out of 4 to the mean of last three measurements. Results: Complete measurements were available in 802 subjects. The first measurement had a median of 129 mmHg (IQR 116–140) in comparison to the mean of the last 3 measurements of 123 mmHg (IQR 113–134), which were significantly different (p-value < 0.0005). The Bland-Altman plot showed a high variability between the measurement methods (Figure 1). 662 subjects (82.5%) showed a difference of >2 mmHg, 441 (55.0%) a difference of >5 mmHg and 208 (25.9%) of >10 mmHg between the methods. Both a decrease and increase of the values were observed and could not be predicted clinically.Conclusions: There are significant differences in the results of two different SOP leading to a discrepancy of more than 5 mmHg in more than half of the patients in one measurement session. This difference could not be predicted by clinical parameters obtained in the trial. Therefore OBPM seems to be unreliable for individual clinical decision making until there are proper SOP.

Treatment Targets in Hypertension

The optimal target blood pressure (BP) in the treatment of hypertensive patients remains controversial. Recently, the systolic blood pressure trial (SPRINT) has proposed that a target systolic blood pressure of < 120 mmHg provides prognostic benefit in elderly hypertensive patients at high cardiovascular risk. The results of SPRINT contrast with several other intervention trials which have investigated the effect of intense BP lowering (Secondary Prevention of Small Subcortical Strokes [SPS3], Action to Control Cardiovascular Risk in Diabetes [ACCORD], Heart Outcomes Prevention Evaluation [HOPE]-3). The differences in outcomes in SPRINT vs. other intervention trials are, to a large extend, due to an "unobserved" BP measurement procedure utilized in the SPRINT trial. Thus, a BP goal of < 120 mmHg, at least by conventional BP measurement, remains unproven. Independent of SPRINT the controversial evidence with respect to BP targets calls for further studies and, possibly, for more individualized treatment goals.

ЗАСТОСУВАННЯ ВІЗУАЛЬНОГО АНАЛІЗУ АРТЕРІАЛЬНИХ ОСЦИЛОГРАМ В ПРАКТИЦІ СІМЕЙНОГО ЛІКАРЯ

Запропоновані авторами інформаційні технології візуального аналізу артеріальних осцилограм значно підвищують інформативність процедури вимірювання артеріального тиску. Можуть бути використані для раннього виявлення донозологічних і преморбідних станів та функціональних резервів системи кровообігу, контролю ефективності лікування, які допоможуть лікарю більш ефективно спланувати профілактичний, діагностичний та терапевтичний процес.

Exploring the hypothesis of differential care for African immigrant and native women in France with hypertensive disorders during pregnancy: a qualitative study

To analyse whether prenatal care trajectories among women with hypertensive disorders during pregnancy in France differ between immigrants from sub-Saharan Africa (SSA) and native French women. Qualitative interview study. Three public maternity units in the Paris region. Women born in SSA or in France of French parents and treated for hypertension or pre-eclampsia during their pregnancy. A sociologist conducted semi-structured in-depth interviews of 33 women during their postpartum hospitalisation and collected data from their medical files. n'vivo 10 (QSR International) was used for line-by-line coding of the transcriptions, to identify emerging themes. Strauss's concept of illness trajectories was then applied to these data. Themes derived from interviews. Women reported during the interviews that the blood pressure measurement procedures used by hospital staff varied between the two groups, and their medical records supported this finding. Repeated urinary dipstick testing of proteinuria before laboratory testing was more frequent for African women, as was the failure to further test proteinuria levels requiring additional action. The two groups received similar standardised care after severe complications. Other findings showed that African women were less likely to rely on healthcare services. These results suggest non-medically justified differential prenatal care between African and native women that may have helped delay the diagnosis of hypertension or pre-eclampsia. This study suggests hypotheses for further quantitative studies to explore the potential involvement of this differential care in the higher frequency of severe complications in this subgroup, concordantly reported in European countries hosting SSA migrants. Differential prenatal care may delay diagnosis of pre-eclampsia among African compared with native French women.

PP.04.03] VALIDATION OF BLOOD PRESSURE MONITORS IN PEDIATRIC POPULATION

Objective: The prevalence of hypertension in children and adolescents is increasing. Electronic devices are frequently used in children for ambulatory, home and office blood pressure (BP) measurement. However, electronic BP monitors that have been successfully validated in adults might not be accurate in children, and separate validation is required. A review of validation studies in young individuals was performed, aiming to identify protocol violations, divergences and adaptations. Design and method: Published validation studies (PubMed) performed in infants, children and adolescents from 1996 till the end of 2015 using any of the established validation protocols (British Hypertension Society [BHS] protocol; US AAMI and/or International Standardization Organization [ISO]; European Society of Hypertension International Protocol [ESH-IP]) were included. All aspects of the protocols’ procedure were scrutinized using a standard checklist. Results: 37 studies were identified (sample size 18–529 subjects). Sixteen studies (43%) used the BHS, 16 (43%) the AAMI and/or ISO and 5 (14%) the ESH-IP. The number of studies published per year were 4-5-2-5-2-5-8-3-3 for years 1996-98-2000-06-08-09-11-12-15 respectively. 21 studies (57%) tested devices for clinic/hospital use, 11 (30%) for ambulatory and 5 (13%) for home use. 26 studies reported a ’pass’ result for systolic and diastolic BP, 7 ’fail’ for systolic and diastolic BP, and 4 a ’fail’ only for diastolic BP. Two studies included infant/neonatal populations, 31 studies included children and adolescents and 4 included also adults. Same-arm sequential BP measurement procedure was applied in 24 studies (65%), same-arm simultaneous measurements in 6 studies and intra-arterial method in 2 studies (3 articles did not report the method used). Fourteen studies used Korotkoff sound V to define diastolic BP, 2 studies used K4, and 2 used K4 or K5 depending on the subject (9 articles did not report the sound used). Conclusions: The validation of BP monitors in children has specific methodological issues and challenges which are not encountered in adults. The peer review process of scientific journals often misses important deficiencies of validation studies. Few validation studies of BP monitors in children have been published and more research is needed.

Estudio comparativo de tres tipos de esfingomanómetro, en sujetos con diferentes cifras de presión arterial.

El objetivo de este estudio es estimar las variaciones en las cifras de presion arterial, medidas en sujetos, utilizando diferentes esfingomanometros (auscultatorio y oscilometrico). Se evaluaron 5 esfingomanometros, dos de tipo oscilometrico (omron HEM-412CINT) y tres de tipo auscultatorio (Random zero Hawksley & Sons. Las mediciones se realizaron en 25 mujeres y 6 hombres, por una enfermera experimentada y con el procedimiento estandarizado. Los resultados mostraron que las variaciones fueron mayores en la presion sistolica, comparadas con la diastolica; de la misma manera en todos los casas la ultima medicion con esfingomanometro de mercurio siempre fue mas parecida a la realizada con cualquiera de los esfingomanometro. La R2 en todos los casas fue alta y el coeficiente B, asi como los intervalos de confianza mostraron una fuerte correlacion entre las cifras registradas con el esfigmomanometro de mercurio y los demas esfingomanometros. AI obtener la informacion sobre las variaciones, el personal de enfermeria podra ajustar las mediciones hechas con diversos esfingomanometros, en diferentes poblaciones.

ІНФОРМАЦІЙНІ ТЕХНОЛОГІЇ ВИВЧЕННЯ АДАПТАЦІЙНОЇ ЗДАТНОСТІ СЕРЦЕВО-СУДИННОЇ СИСТЕМИ ДО ФІЗИЧНОГО НАВАНТАЖЕННЯ ЗА МОРФОЛОГІЧНИМ, ЧАСОВИМ ТА СПЕКТРАЛЬНИМ АНАЛІЗОМ ОСЦИЛОГРАМ

Offer Author Information Technology morphological, temporal and spectral analysis of waveforms (recorded at rest and after exercise), the introduction of analytical treated for clinical interpretation of the results, evaluation and decision-making to doctors significantly increases the information content of the procedure of blood pressure measurement. Can be used for early detection and prenosological premorbid state and functional reserve of the circulatory system, help more effectively to plan preventive, diagnostic and therapeutic process.

Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years.

Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States). Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar. These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.