Differences In Blood Pressure Measurements Research Articles

Ambulatory Blood Pressure in Patients With Rheumatoid Arthritis: Association With Immune Activation.

The prevalence of hypertension, a major cardiovascular risk factor, is increased in patients with rheumatoid arthritis (RA) and may be driven by immune activation. The purpose of this study was to determine if ambulatory 24-hour blood pressure (BP) is elevated in RA vs control participants and whether it is associated with immune activation. We conducted a cross-sectional study of 46 patients with RA and 23 control participants. Participants wore an ambulatory BP monitor that obtained diurnal BP every 15-30 minutes and nocturnal BP every 30 minutes. Inflammatory mediators in plasma were measured using an inflammation proteomics panel. Differences in BP measurements were assessed by Mann-Whitney U test, and association with inflammatory mediators was assessed by Spearman correlation. Patients with RA and control participants had similar office BP, but median ambulatory systolic BP (SBP) measurements (24-hour [RA 121 mmHg vs control 116 mmHg; P = 0.01], diurnal [RA 128 mmHg vs control 120 mmHg; P = 0.003], and nocturnal [RA 112 mmHg vs control 103 mmHg; P = 0.002]) were higher in patients with RA. Patients with RA also had higher nocturnal diastolic BP (DBP; RA 63 mmHg vs control 57 mmHg; P = 0.02), but other DBP measurements were similar. Nocturnal BP dipping was less in patients with RA (12%) compared to control participants (16%; P = 0.02). In patients with RA, higher 24-hour and nocturnal SBPs and less nocturnal dipping were strongly correlated with a wide range of inflammatory mediators. Despite similar office measurements, 24-hour and nocturnal SBP measurements were higher in patients with RA than in control participants and were strongly associated with inflammation.

A Comparative Study on the Difference of Blood Pressure Criteria and the Difference in Blood Pressure Measurement Among Children and Adolescents in China, the United States, and Europe

Abstract OBJECTIVE To compare the difference of blood pressure criteria and the difference in blood pressure measurement among children and adolescents. METHODS The latest blood pressure criteria for children and adolescents in China, the normal blood pressure standard the United States, and Europe have been used to calculate blood pressure differences for the same age, gender, and height. Based on 3 blood pressure measurements of 45,314 Chinese and 15,279 American children and adolescents, the differences in blood pressure measurements were calculated through repeated measurement analysis of variance and compared with criteria differences. RESULTS More than 60% of the difference in blood pressure standard is distributed between −3 and 3 mm Hg. But the difference between Chinese standards and American standards can be 5–10 mm Hg in children aged 13. The difference between Chinese standards and European standards can be 6–9 mm Hg at the age of 16. The analysis of repeated blood pressure data shows that the maximum difference in systolic blood pressure measurement for Chinese boys and girls is 3.7 and 4.1 mm Hg, respectively, and the maximum difference in diastolic blood pressure measurement is 2.0 and 2.1 mm Hg. The difference between the 3 measurements of boys and girls in the United States is nearly 1 mm Hg. CONCLUSIONS The difference between blood pressure standards is smaller than the measurement difference, and accurate measurement and repeated measurement of blood pressure may be more important for evaluating blood pressure status than the selection of blood pressure standards.

Effects of beetroot-pineapple juice on hypertensive elderly in Depok

The prevalence of hypertension, based on measurement results among the population aged ? 18 in Indonesia, increased by 8.3% from 2013 to 2018. Due to this rise, there is an evident need for treatments to decrease this rate. Introducing non-pharmacological therapies, such as beetroot and pineapple juice, maybe a viable solution. This study aimed to assess the difference in blood pressure before and after the consumption of beetroot and pineapple juice among elderly hypertensive patients in the Abadijaya Public Health Center region of Depok City. The research followed an experimental design, specifically a pretest-posttest one-group format. The study involved 15 elderly individuals aged between 60-80 years with blood pressure readings of ? 140/90 mmHg. They consumed 300 ml of the juice daily for seven consecutive days. Data analysis included the Shapiro-Wilk test for normality, the paired t-test, and the Wilcoxon test for statistical significance. The findings revealed a significant reduction in blood pressure after the consumption of beetroot and pineapple juice, with a p-value for systolic pressure at 0,000 and diastolic pressure at 0,020 (p<0,05). The average decrease in systolic blood pressure was 13,03 mmHg, and for diastolic blood pressure, it was 4,8 mmHg. There was a discernible difference in blood pressure measurements before and after juice consumption among the elderly hypertensive patients.

Validation of self-reported hypertension in young adults in the US-based Growing Up Today Study (GUTS).

Self-reporting is often used in large epidemiologic research to identify hypertensive participants, but its validity in young adults has not been sufficiently assessed. We aimed to validate self-reported hypertension diagnosis from questionnaires by using medical records among a sample of young adults aged 22-39 years in the Growing Up Today Study (GUTS), during a time of transition in national hypertension definitions. A sample of 1,000 GUTS participants were asked for permission to access their medical records, to confirm their self-reported hypertension status on questionnaires from 2010 to 2019. Paired self-reported and medical record information was available for 318 participants. Medical records were reviewed by a clinical hypertension specialist. We evaluated agreement, kappa statistic, sensitivity and specificity of self-reporting. We assessed the correlations between blood pressure measurements self-reported on the 2019 questionnaire and those from medical records and compared the measurements using paired t-tests. The selected sample was generally representative of the full GUTS cohort. Agreement, kappa coefficient, sensitivity and specificity of self-reported hypertension were 85.5%, 0.72, 100%, and 75.3%. Although the absolute differences in blood pressure measurements between self-report and medical records were small (e.g., the average difference in typical recent blood pressures was 3.5/1.2 mm Hg), these measures were only moderately correlated. Validity of self-reported hypertension was high in GUTS, ensuring use as an endpoint in future studies with confidence. We demonstrated that young adults likely without formal medical training are able to report hypertension status with reasonable accuracy.

COMPARISON OF BLOOD PRESSURE MEASUREMENTS ON THE BARE ARM AND THE SLEEVED ARM - WHAT DOES IT COVER?

Objective: The question of blood pressure measuring on the bare arm was debated for many years. The updated guidelines recommend measuring on the bare arm, although former studies found no significant differences between measurements taken over a rolled-down or up sleeve compared to the bare arm. We aim to compare blood pressure measurements on the same patients over a bare and a sleeved arm. Design and method: We collected blood pressure measurements of 100 patients visiting the nephrology clinic between January 2019 and December 2022. Measurements were performed with and without sleeves on each arm for each patient (total of 400 arms) and taken simultaneously on both arms (exchanging the bare and the sleeved arm in the second measurement). Since most variables were not normally distributed, we proceeded to a non-parametric Wilcoxon test to compare each patient's measurements on each arm. Results: No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of systolic blood pressure measured on the left arm (p = 0.041). Although the actual values demonstrated no statistically significant difference, the absolute values of the differences demonstrated clinically significant higher median values on the sleeved arms, both in systolic blood pressure (7 mmHg on the right arm and 8 mmHg on the left arm) and diastolic blood pressure (5.5 mmHg for both arms). As demonstrated by the wide interquartile ranges in table 1 and seen in figure 1 for all variables, the values of all variables had high variance. Conclusions: We found no statistically significant difference in blood pressure measurements between sleeved and bare arms. However, measurement of blood pressure over sleeved arms provided unpredictable results, with up to 40-50 mmHg differences in some individuals. As clinicians, we believe that in order to standardize blood pressure measurements we should measure blood pressure on the bare arms.

Difference in Blood Pressure Measurements in Pregnant Women when using the Gold Standard Method versus Clinical Measurements

BackgroundThe World Health Organization lists hypertensive disorders in pregnancy as one of the leading causes of maternal death. It is also known that each year more than 10 million women worldwide suffer from preeclampsia, one of the hypertensive disorders in pregnancy. The accuracy of blood pressure measurement is crucial to making the correct diagnosis and treatment of hypertensive disorders of pregnancy. Taking a BPM is one of the most basic clinical assessments that is done by members of the healthcare team. However, it is often one of the most inaccurately performed assessments. Accurate measurement is critical for proper diagnosis, assess risk, and correct treatment. Inaccurate assessments can cause delay in diagnosis of a hypertensive disorder and increase risks to the mother and child. Conversely, falsely elevated measurements can lead to unnecessary treatments that may be harmful. The American College of Cardiology/American Heart Association recommended guidelines for performing Blood Pressure Measurements that include not smoking, exercising, or drinking caffeinated beverages for 30 minutes prior to measurement. Measurements are taken after 5‐minutes rest in a seated position with arms at the level of the heart without talking. Two measurements, one minute apart, should be taken, preferably with a stethoscope and manual blood pressure cuff, with the average of the values recorded as the blood pressure measurement. Our study aimed to fill a critical gap in knowledge of how blood pressure measurement using the ACC/AHA gold standard guideline compared to routinely taken clinical blood pressures of pregnant women.MethodsWe performed blood pressure measurements on 44 pregnant women following ACC/AHA guidelines. These results were compared to the closest clinical blood pressure measurement that we extracted from the medical record. Duplicate measurements were averaged and Student's t‐test was used to compare the measurement types. P<0.05 was considered significant.ResultsOur results demonstrated a significant statistical difference between blood pressure measurements taken using the AHA/ACC guidelines (N=44, systolic= 108.14 + 11.75 mmHg, diastolic = 66.93 + 8.81 mmHg,) compared to measurements recorded at clinic appointments (systolic = 116.29 + 9.47 mmHg (P<0.001), diastolic = 71.11 + 9.47 mmHg, P=0.004). The average maternal age was 32.2 +/‐ 4.1 years. The average gestational age of participants was 25.8 +/‐ 7.9 weeks, and the average body mass index was 26.7 +/‐ 4.2 kg/m2.ConclusionThese results reinforce the importance of following the ACC/AHA guidelines for blood pressure measurement in clinical practice. Clinic measurements may be falsely elevated in pregnancy.

Blood pressure as a risk factor for eclampsia and pulmonary oedema in pre-eclampsia.

We evaluated whether blood pressure and change in blood pressure measurements during pregnancy were associated with eclampsia or pulmonary oedema among women with pre-eclampsia. Observational study of women with eclampsia, pre-eclampsia complicated by pulmonary oedema and pre-eclampsia without end-organ complications (pre-eclampsia controls) at a large referral center in Cape Town, South Africa. Blood pressure measurements at presentation for antenatal care were compared to measurements after a diagnosis of pre-eclampsia. Mean blood pressures and changes in blood pressures were also calculated and compared between groups at different time points. A sub analysis including women who presented for antenatal care before 20weeks of gestation was performed. When diagnosed with pre-eclampsia, women with pulmonary oedema had increased systolic blood pressures and women with eclampsia had increased diastolic blood pressures compared to pre-eclampsia controls. There were no differences in blood pressure measurements in early pregnancy between women who later developed eclampsia or pulmonary oedema compared to pre-eclampsia controls. Blood pressure measurements in early pregnancy do not seem useful as a risk factor for the development of eclampsia or pulmonary oedema among women diagnosed with pre-eclampsia. Increased systolic or diastolic pressure at diagnosis of pre-eclampsia may be useful as a risk factor for the development of pulmonary oedema or eclampsia. Further research is needed to confirm these findings.

Effect of Controlled Breathing on Pain Tolerance during Local Anesthesia at Donor Site in Hair Transplant Strip Surgery—A Preliminary Study

<h3>Introduction:</h3> Pain during administration of local anesthesia during donor strip surgery in follicular unit transplantation (FUT) can cause discomfort for the patient. Controlled breathing, as a component of various relaxation techniques, has been shown to have a beneficial effect in acute pain tolerance. <h3>Objective:</h3> This study evaluates the relevance of controlled breathing as a technique to enhance pain tolerance throughout the administration of local anesthesia during donor strip excision in hair transplantation. <h3>Methods:</h3> A prospective, comparative study was undertaken between two groups of 30 patients each undergoing hair transplantation by strip FUT technique under local anesthesia (LA). One group was trained to use controlled breathing prior to surgery and during administration of local anesthesia at the donor site. The other group used routine breathing and was used as the control. Pain tolerance was measured subjectively using Visual Analog Score (VAS) for pain and objectively using the Objective Pain Comfort Score (OPCS). In addition, pulse and blood pressure were monitored. The results were compared and analyzed statistically. <h3>Results:</h3> The mean changes of VAS and OPC pain scores and vital parameters, such as pulse, in response to acute pain were significantly reduced in the test group, which used controlled and relaxed breathing, compared to the control group. However, there was no significant difference in blood pressure measurements between the two groups. <h3>Conclusion:</h3> Our study suggests that controlled breathing prior to hair transplantation and during LA injection at the donor site results in better pain perception and tolerance and, therefore, greater patient comfort. Patients can easily be taught to practice controlled breathing. Additional studies using larger groups of patients are needed to establish the routine role of this modality in pain management during hair transplantation.

POSSIBLE ROLE OF THE INVASIVE ARTERIAL BLOOD PRESSURE MEASUREMENT IN SEVERE RESISTANT HYPERTENSION AND GENERALISED ATHEROSCLEROSIS

Objective: In severe resistant hypertension, a generalised atherosclerosis with high arterial stiffness present significant challenge for clinicians to obtain the realistic non-invasive blood pressure measurements and adjust antihypertensive treatment successfully. Design and method: Several patients with generalised atherosclerosis and severe resistant hypertension of the renovascular and renoparenchymal aetiology were referred to our Excellence centre. After performing ambulatory blood pressure monitoring (ABPM) and testing for non-compliance, often we still don’t reach target blood pressure. Due to generally expressed atherosclerosis, daily oscillometer technique could not be reliable in these set of patients. Invasive arterial blood pressure measurements via intra-arterial radial line were recorded for 24-hours and the consecutive non-invasive blood pressure was measured on the ipsilateral arm by oscillatory method. Results: In 3 patients, hypertension was renovascular and renoparenchymal (serum creatinine 134–219 micromol/l, oGF CDK-EPI 47 ml/min). The blood pressure values obtained by oscillatory method ranged from 170/100 mmHg to 230/120 mmHg. Generalised atherosclerosis with obstructive coronary and carotid artery disease, stenosis of iliac arteries, a hemodynamically important renal artery stenosis and subclavian artery stenosis was present in all 3 patients; one had comorbid periaortitis. Two patients were treated with six and one with five antihypertensives in maximum doses, at least one being a diuretic, and with at least one antihypertensive drug exceeding maximum dose. The difference in blood pressure measurements by the invasive vs. non-invasive method ranged from -20/10 mmHg to -50/30 mmHg. In 2 patients, marked blood pressure elevations (+40/20 mmHg) were triggered by elevated sympathycotonus. At discharge, doses of antihypertensive drugs could be lowered or stayed in the same range and a short-acting anxiolytic was added. Conclusions: In patients with severe resistant hypertension and generalised atherosclerosis, after excluding non-adherence, invasive blood pressure technique could be helpful in determining the relative difference to non-invasive measurements and safely adjusting antihypertensive therapy.

The effect of ondansetron administration 20 minutes prior to spinal anaesthesia on haemodynamic status in patients undergoing elective caesarean section: A comparison between two different doses.

Background and Aims:Spinal anaesthesia is currently the most common method used for managing patients undergoing elective caesarean sections. Recent meta-analyses have been supporting the use of 5-HT3 antagonists, like ondansetron, to attenuate hypotension induced by spinal block. Various doses of ondansetron were given intravenously five minutes before spinal block. However, a consensus on definitive dose and timing for maximal benefit is yet to be agreed upon.Methods:Our prospective randomised clinical trial investigated a new approach by administrating intravenous ondansetron 20 minutes before spinal anaesthesia. This work investigated ondansetron effect on both haemodynamic changes and vasopressors use by dividing patients into three groups. The first group O4 (n = 51) received 4 mg ondansetron, the second group O6 (n = 51) received 6 mg ondansetron, and the control group C (n = 50) received normal saline. We recorded systolic blood pressure (SBP), diastolic blood pressure (DBP) and the mean blood pressure (MBP) at different time intervals.Results:There was no significant difference in blood pressure measurements among the study groups (P > 0.05). The consumption of ephedrine in the control group is higher than both of the ondansetron groups (P > 0.001), with a mean dose of 27.2 ± 20.5 mg of ephedrine for group C, compared to 17.8 ± 14.9 and 14.7 ± 11.3 in O4 and O6 groups, respectively. Episodes of hypotension and number of patients with hypotension were not significantly different among the studied groups (P = 0.07; P = 0.96, respectively).Conclusions:Prophylactic 4 and 6 mg ondansetron given 20 minutes before spinal anaesthesia in caesarean section does not reduce the incidence of hypotension.

The Potential of mHealth Applications in Improving Resistant Hypertension Self-Assessment, Treatment and Control.

To review the evidence supporting the use of mobile health (mHealth) apps to improve resistant hypertension self-assessment, treatment and control. mHealth apps have been used to directly measure blood pressure (BP) levels, either using the oscillometric method with automated inflatable cuffs or using pulse wave signals detected by smartphone technology without the need for cuffs. These app-based BP monitors tend to over or underestimate BP levels when compared to a gold standard aneroid sphygmomanometer. However, the differences in BP measurements are within the acceptable range of 5mmHg pre-defined by the European Society of Hypertension International Protocol Revision 2010. mHealth apps are also used as tools to support physicians in improving hypertension treatment. App-based clinical decision support systems are innovative solutions, in which patient information is entered in the app and management algorithms provide recommendations for hypertension treatment. The use of these apps has been shown to be feasible and easily integrated into the workflow of healthcare professionals, and, therefore particularly useful in resource-limited settings. In addition, apps can be used to improve hypertension control by facilitating regular BP monitoring, communication between patients and health professionals, and patient education; as well as by reinforcing behaviours through reminders, including medication-taking and appointment reminders. Several studies provided evidence supporting the use of apps for hypertension control. Although some of the results are promising, there is still limited evidence on the benefits of using such mHealth tools, as these studies are relatively small and with a short-term duration. Recent research has shown that mHealth apps can be beneficial in terms of improving hypertension self-assessment, treatment and control, being especially useful to help differentiate and manage true and pseudo-resistant hypertension. However, future research, including large-scale randomised clinical trials with user-centred design, is crucial to further evaluate the potential scalability and effectiveness of such mHealth apps in the resistant hypertension context.

The role of wrist monitors to measure blood pressure in older adults.

Arterial hypertension is a common condition in older adults with increasing data about blood pressure (BP) targets and antihypertensive treatment in this population. Recent studies have opened new discussions about the different usual and unusual methods of blood pressure monitoring. However, there are no evidence-based recommendations whether BP should be measured at upper arms or at wrist, which seems to be more comfortable in older and frail people. The purpose of this study was to test the quality of wrist BP monitors as diagnostic method in older adults. BP measurements at both upper arms and at both wrists were compared under standardized conditions in 605 patients ≥ 75years. Differences in wrist and upper arm BP were, furthermore, correlated with various diagnoses and parameters including ankle-brachial-index (ABI). In patients of 75-80 years, there were no differences in BP measurements at upper arms compared to wrists whereas in patients > 80 years, BP measurements at wrists were significantly lower than at upper arms. In both age groups BP measured at wrist was significantly lower in patients with ABI < 0.9. BP wrist monitors could be considered as a serious alternative in adults of 75-80years or in older persons with normal ABI values.

Differences in blood pressure by measurement technique in neurocritically ill patients: A technological assessment

Blood pressure data may vary by measurement technique. We performed a technological assessment of differences in blood pressure measurement between non-invasive blood pressure (NIBP) and invasive arterial blood pressure (ABP) in neurocritically ill patients. After IRB approval, a prospective observational study was performed to study differences in systolic blood pressure (SBP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) values measured by NIBP arm, ABP at level of the phlebostatic axis (ABP heart) and ABP at level of the external auditory meatus (ABP brain) at 30 and 45-degree head of bed elevation (HOB) using repeated measure analysis of covariance and correlation coefficients. Overall, 168 patients were studied with median age of 57 ± 15 years, were mostly female (57%), with body mass index ≤30 (66%). Twenty-three percent (n = 39) had indwelling intracranial pressure monitors, and 19.7% (n = 33) received vasoactive agents. ABP heart overestimated ABP brain for SBP (11.5 ± 2.7 mmHg, p < .001), MAP (mean difference 13.3 ± 0.5 mmHg, p < .001) and CPP (13.4 ± 3.2 mmHg, p < .001). ABP heart overestimated NIBP arm for SBP (8 ± 1.5 mmHg, p < .001), MAP (mean difference 8.6 ± 0.8 mmHg, p < .001), and CPP (mean difference 9.8 ± 3.2 mmHg, p < .001). Regardless of HOB elevation, ABP heart overestimates MAP compared to ABP brain and NIBP arm. Using ABP heart data overestimates CPP and may be responsible for not achieving SBP, MAP or CPP targets aimed at the brain.

Comparative Effectiveness of Intranasal Dexmedetomidine-Midazolam versus Oral Chloral Hydrate Targeting Moderate Sedation during Pediatric Transthoracic Echocardiograms.

Objective To compare efficacy and safety of two moderate sedation regimens for transthoracic echocardiography (TTE): intranasal dexmedetomidine-midazolam (DM) versus oral chloral hydrate (CH) syrup. Method This was a retrospective cohort of 93 children under 4 years of age receiving moderate sedation with either DM or CH for TTE from January 2011 through December 2014. Measurements and Main Results Forty-nine patients received oral CH and 44 received the intranasal combination of DM. The demographics between groups were similar except the DM patients were slightly older and heavier (each p < 0.05). Failure rate between groups did not reach statistical significance (CH 14.3% vs. DM 6.8%; p = 0.324). Total sedation to discharge time was similar between groups (CH 89.4 minutes vs. DM 89.6 minute; p = 0.97). Cardiopulmonary data did reveal a significantly lower heart rate (101.9 vs. 91.7; p < 0.001) and respiratory rate (23.4 vs. 21.0, p = 0.03) in the DM group, but no difference in blood pressure measurements or echo determined shortening fraction. Conclusion These data support the use of intranasal DM as a safe and efficacious method of moderate sedation for children undergoing TTE.

Obesity as a Mediator between Cardiorespiratory Fitness and Blood Pressure in Preschoolers

To analyze the relationships between body mass index (BMI), cardiorespiratory fitness (CRF), and blood pressure (BP), and to examine whether obesity acts as a mediator between fitness and BP in children. A cross-sectional analysis using a population-based sample of 1604 school children aged 4-7 years attending 21 schools from the provinces of Ciudad Real and Cuenca, Spain, was undertaken. Data on anthropometric variables, BP measurements, and CRF were collected. The relationships between body composition (BMI, percent body fat, and waist circumference), CRF, and mean arterial pressure was estimated using Pearson correlation coefficients. ANCOVA tested the differences in BP measurements by categories of BMI and CRF, controlling for different sets of confounders. The PROCESS macro developed by Preacher and Hayes was used for mediation analysis. BP values were significantly higher in school children with excess weight and poorer CRF. In addition, BMI acts as a full mediator in the association between CRF and mean arterial pressure in boys at 62.28% (z = -5.433; P ≤ .001) and a partial mediator in girls at 35.24% (z = -5.246; P ≤ .001). BMI mediates the relationship between CRF and mean arterial pressure. These findings highlight the importance of maintaining a healthy weight for the prevention of high BP levels in childhood. ClinicalTrials.gov: NCT01971840.

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Objective: We previously reported the association of inter-arm differences in blood pressure measurements (IAD) with increased cardiovascular and all-cause mortality. Several new large cohorts have been reported since our 2012 meta-analysis. We have therefore updated our meta-analyses to take account of these new data. Design and method: Systematic review and meta-analysis: Medline, Embase and CINAHL were searched for studies reporting survival data in association with IAD. Study level hazard ratios (HR) were extracted for systolic IADs >=10mmHg and >=15mmHg, and pooled using generic inverse variance in a random effects model. Statistical heterogeneity was assessed using the I2 statistic. Results: Searches to 12th November 2014 identified 3514 unique citations. Eighty full texts were assessed, and 13 studies (reporting data for 14 unique cohorts) contributed to the analyses, Median follow up ranged from 3 to 13 years. Five cohorts employed a simultaneous method of IAD measurement; the remainder used sequential measurements. Ten cohorts were recruited from community populations, including one hypertensive and one diabetic cohort. Four were selected hospital cohorts at increased vascular risk. Cardiovascular mortality was greater with an IAD >=10mmHg (HR 1.9 (95%CI 1.3 to 2.6; 7 cohorts, 13815 participants; I2 = 45%) and an IAD >=15mmHg (HR 1.7 (1.2 to 2.4; 9 cohorts; 18241 participants; I2 = 30%). For all-cause mortality HRs were 1.4 (1.2 to 1.8; 10 cohorts, 17709 participants; I2 = 62%) for IAD >=10mmHg and 1.4 (1.1 to 1.7; 12 cohorts, 18714 participants; I2 = 46%) for IAD >=15mmHg. Heterogeneity between studies could be accounted for by stratification according to underlying population cardiovascular risk, with higher HRs seen in populations at elevated risk; cardiovascular mortality with an IAD >=10mmHg: HR 1.4 (1.1 to 1.8; I2 = 0%) for community based cohorts compared to 3.8 (2.2 to 6.6; I2 = 0%) for those at elevated cardiovascular risk (p = 0.001; Figure).Conclusions: New studies confirming the association of an IAD with increased cardiovascular and all-cause mortality are consistent with previously published findings. Risks associated with an IAD rise in association with the underlying vascular risk of the population studied.

Availability and functionality of sphygmomanometers at health care institutions in Enugu, Nigeria.

Our aim was to investigate the availability of functional blood pressure monitors at health care institutions in Enugu, Nigeria. During repeated surveys of 15 (primary, secondary and tertiary) health care institutions in Enugu between 2007 and 2012, records were made of the availability and functional status of sphygmomanometers in the clinics and wards. We also assessed the degree of agreement between measurements by institutional staff and measurements by trained observers using the same or the standard sphygmomanometer. Apart from three institutions, there was inadequate availability of fully functional sphygmomanometers: 61 staff attending to outpatients were sharing 35 sphygmomanometers, 6 of which were faulty i.e. needing repairs. Wards invariably had only one or two functional sphygmomanometers, regardless of bed occupancy. Institutional staff ignored recommended guidelines for blood pressure measurement. The overall mean difference in blood pressure measurements between institutional staff and a trained observer (1.6 mmHg; 95% confidence interval, CI: -0.3 to 3.4; P=0.1) was greater and more significant than the mean difference between the two observers (0.1 mmHg; CI: -1.5 to 1.7; P=0.9) and the mean difference between institutional and standard sphygmomanometers (-0.2 mmHg; CI: -1.7 to 1.3; P=0.8). There has been a notable lack of reporting on the availability of blood pressure measuring devices in third world health care institutions. Our surveys have shown inadequate availability of functional sphygmomanometers in the institutions, but satisfactory agreement between measurements by institutional staff and trained observers. In view of recent guidelines and recommendations, there is need to supplement office readings with mercury devices with oscillometric home or automated office blood pressure recording.

Essential pediatric hypertension: defining the educational needs of primary care pediatricians.

BackgroundIn order to better understand the educational needs regarding appropriate recognition, diagnosis and management of pediatric hypertension (HTN), we asked practicing pediatricians questions regarding their educational needs and comfort level on this topic.MethodsWe conducted 4 focus group sessions that included 27 participants representing pediatric residents, adolescent medicine physicians, clinic based pediatricians and office based pediatricians. Each focus group session lasted for approximately an hour and 90 pages of total transcriptions were produced verbatim from audio recordings.ResultsFour reviewers read each transcript and themes were elucidated from these transcripts. Overall, 5 major themes related to educational needs and clinical concerns were found: utilization of resources to define blood pressure (BP), correct BP measurement method(s), co-morbidities, barriers to care, and experience level with HTN. Six minor themes were also identified: differences in BP measurement, accuracy of BP, recognition of HTN, practice pattern of care, education of families and patients, and differences in level of training. The focus group participants were also questioned on their preferences regarding educational methods (i.e. e-learning, small group sessions, self-study, large group presentations) and revealed varied teaching and learning preferences.ConclusionsThere are multiple methods to approach education regarding pediatric HTN for primary care pediatricians based on provider preferences and multiple educational activities should be pursued to achieve best outcomes. Based on this data, the next direction will be to develop and deliver multiple educational methods and to evaluate the impact on practice patterns of care for children and adolescents with HTN.

Differences in blood pressure measurements in the forearm and upper arm of obese otherwise healthy first year medical students

BackgroundThe prevalence of obesity is increasing in Indian youth and obesity is associated with complications like systemic hypertension. Often, due to the non-availability of appropriate sized cuffs, standard cuff bladders are used to measure blood pressure in the forearms of obese young adults.To compare the upper arm arterial blood pressure measured using an appropriate cuff with the forearm arterial blood pressure measured using a standard cuff and conventional sphygmomanometry in obese otherwise healthy first year medical students.Materials and MethodsBlood pressure was measured in 27 obese otherwise healthy first year medical students after five minutes of rest using a mercury sphygmomanometer with the subjects seated and the arm and forearm at heart level, using an appropriate sized cuff for the upper arm according to American Heart Association standards and a standard cuff for the fore arm.ResultsA statistically significant difference in both systolic [t-test (paired) = -6.921; df = 26; sig =.000 (2-tailed)] and diastolic blood pressure [t-test (paired) = 8.508; df = 26; sig =.000 (2-tailed)] was found, with the blood pressure readings being higher in the forearm. The correlations between upper arm and forearm systolic and diastolic blood pressure were 0.785 (p =.000) and 0.870 (p =.000).Both systolic and diastolic blood pressure measurements were significantly higher in the forearm. Further studies with larger sample size should be conducted to confirm that forearm blood pressure measurements using standard cuff bladders cannot be considered equal to upper arm measurements made using an appropriate sized cuff in all young obese individuals

Differences in Blood Pressure Measurement in Ambulatory Care Settings

Differences in Blood Pressure Measurement in Ambulatory Care Settings