Differences In Blood Pressure Measurements Research Articles

Differences in Blood Pressure Measurements Obtained Using an Automatic Oscillometric Sphygmomanometer Depending on Clothes-Wearing Status

BackgroundAccording to the current guidelines for blood pressure monitoring, clinicians are recommended to measure blood pressure by completely exposing the upper arm. However, it is a common practice that blood pressure is measured with the cuff placed over the sleeve or with the sleeve rolled up. We therefore conducted this study to examine whether there are any differences in blood pressure measurements among the three different settings: the sleeve group, the rolled sleeve group, and the bare arm group.MethodsWe conducted the current study in 141 male and female adult patients who visited our clinical department. In these patients, we took repeatedly blood pressure measurements using the same automatic oscillometric device on three different settings. Then, we analyzed the results with the use of randomized block design analysis of variance.ResultsThe mean values of systolic blood pressure (SBP) between the first reading and those of the second reading were 128.5 ± 10.6 mm Hg in the sleeve group, 128.3 ± 10.8 mm Hg in the rolled sleeve group, and 128.3 ± 10.7 mm Hg in the bare arm group. These results indicate that there were no significant differences among the three groups (P = 0.32). In addition, the mean values of diastolic blood pressure (DBP) between the first reading and those of the second reading were 80.7 ± 6.1 mm Hg in the sleeve group, 80.7 ± 6.1 mm Hg in the rolled sleeve group, and 80.6 ± 5.9 mm Hg in the bare arm group. These results indicate that there were no significant differences among the three groups (P = 0.77). In addition, based on the age, sex, past or current history of hypertension or diabetes mellitus, the thickness of sleeve, weight, a drinking history, and a smoking history, there were no significant differences in SBP and DBP among the three groups.ConclusionThere were no significant differences in blood pressure measurements between the three different settings (the sleeve group, the rolled sleeve group, and the bare arm group).

Validação do esfigmomanômetro aneroide Missouri para medir pressão arterial em pacientes com câncer

Auscultatory mercury sphygmomanometers to measure blood pressure (BP) have been banned from health services because of risk of pollution and environmental accidents with mercury. Aneroid appliances could be an alternative. To validate the Missouri aneroid device for blood pressure measurement in cancer patients according to the protocol of the European Society of Hypertension (ESH). 33 patients hospitalized or under outpatient care at the Cancer Institute of the State of São Paulo, FMUSP, were evaluated. Three trained and blinded observers performed nine sequential blood pressure measurements interspersed with the mercury sphygmomanometers. The differences between the values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) of the test device with the mercury sphygmomanometer were classified according to the ESH protocol. The Missouri equipment underwent all three phases required by the ESH Protocol for SBP and DBP, and it was approved in all of the phases. The average difference between the test device and the mercury sphygmomanometer was 0.62 (SD = 4.53) and 0.06 (SD = 6.57) mmHg for SBP and DBP, respectively. No association was found between the differences in BP measurements with sex, age, body mass index and arm circumference and length. The results revealed that the aneroid Missouri device meets ESH accuracy recommendations for the measurement of SBP and DBP, and it can be used to replace the mercury sphygmomanometer.

Blood pressure in the first year of life in healthy infants born at term

Neonatal hypertension occurs in up to 2% of neonatal intensive care survivors and in up to 3% of all neonates. Normal blood pressure (BP) measurements are required to diagnose and manage appropriately both hypotension and hypertension in the neonate and infant. The aim of this study was to provide normative BP measurements during the first year of life of healthy infants born at term, using an oscillometric method. Neonates were enrolled from August 2003 to August 2005. Exclusion criteria included: infants of mothers with hypertension or diabetes of any type, use of illicit substances, congenital or chromosomal anomaly, admission to the neonatal intensive care unit or possible sepsis. There were 406 infants enrolled, with 150 children followed at 6 months of age and 118 children at 12 months of age. There were no differences in BP measurements at 6 months or 12 months of age by gender, weight or height. A BP measurement above the 90th percentile on day 2 or at 6 months was not predictive of a BP above the 90th percentile at 12 months of age. Higher systolic and diastolic measurements at 6 months and 12 months were found, in comparison to those in previous studies using ultrasonic devices. The findings of this study provide normative BP values for infants during their first year of life, using the oscillometric method, the most frequently used method in paediatric, neonatal intensive care and emergency departments.

Analysis of Recent Papers in Hypertension

Analysis of Recent Papers in Hypertension

Sources of variability in blood pressure measurement using the Dinamap PRO 100 automated oscillometric device.

The Dinamap automated oscillometric device (GE Medical Systems Information Technologies, Inc., Milwaukee, Wisconsin) for blood pressure measurement is widely employed in epidemiologic studies because it is easy to use and because it eliminates observer variability. In this study, the authors assessed the variability in observed blood pressures associated with use of the Dinamap monitor and estimated the contributions of various factors to that variability. In 60 volunteers (30 aged 23-35 years and 30 aged 54-82 years) from New York, New York, the authors obtained 30 simultaneous paired blood pressure measurements in both arms at 1-minute intervals, using three separate Dinamap PRO 100 devices allocated to arm and subject according to a balanced incomplete block design. Variability, defined as the between-arm difference in blood pressure measurements, was analyzed using a mixed-effects linear regression model. A total of 1,800 paired blood pressure measurements were obtained between September 2001 and June 2002. The mean ages of the two groups were 28.3 years (standard deviation, 4.0) and 71.7 years (standard deviation, 8.0). A diagnosis of hypertension was present in 53% of the older subjects and none of the younger subjects. Fifty percent of paired simultaneous blood pressure measurements obtained were in agreement within 4 mmHg for systolic blood pressure or within 3 mmHg for diastolic blood pressure. Residual variability, attributable to the intrinsic inaccuracy of the device, accounted for 64-82% of the total systolic and diastolic blood pressure variability. The majority of variability in blood pressure measurement was due to the device as used under the study conditions.

Determinants of blood pressure in 7th grade Jerusalem school children.

The determinants of blood pressure level were analyzed in a group of 1154 Jerusalem school children aged 12. After controlling for age, significant differences in blood pressure measurements were found between three groups: boys, pre-menarche girls and post-menarche girls. A comparison of the means of selected biological variables showed that girls who have reached menarche have levels of systolic blood pressure, weight, height and Quetelet's index higher than boys and pre-menarche girls. However, levels of triceps skinfold thickness and pulse rate were similar in the two groups of girls and higher than in boys. Using multiple regression analysis, we found that much of the variance (boys 29%, post-menarche girls 21% and pre-menarche girls 15%) of systolic blood pressure could be explained by a combination of biological variables (Quetelet, pulse rate, triceps skinfold thickness and height) while these variables explained a much smaller proportion (boys 12%, post-menarche girls 17% and pre-menarche 9%) of diastolic blood pressure variance. The predictive power of systolic blood pressure by the measured biological variables was higher in boys than in girls. However, diastolic blood pressure was better predicted by the biological variables in the group of girls with menarche than in other groups. Elevated blood pressure was observed in 3.2% of the examined children. High values for Quetelet's index were observed in 6.4%. The prevalence of elevated measurements of blood pressure and Quetelet's index were significantly higher in girls with menarche. Among children aged 12, the association between sociodemographic characteristics and blood pressure level was weak, as measured in multiple regression analysis.

A role for steroid hormones in the variability of blood pressure determination.

Blood pressure variability was studied in eight patients with renovascular hypertension (group 1) and eight patients with hypertension and partial deficiency of adrenal zona fasciculata 11-hydroxylase (group 2). Systolic, diastolic and mean blood pressure were found to be higher in group 1 than in group 2 when measured at home (P less than 0.001), while no difference was measured when blood pressure was taken in the outpatient clinic. Heart rate was higher in group 1 than in group 2 both at home and in the clinic (P less than 0.005 and P less than 0.05, respectively); a significant increase was observed only in the hospital clinic for group 2 (P less than 0.001). No difference in systolic function and left ventricular mass was found between the two groups. Finally, group 2 exhibited a significant increase (P less than 0.0001) in systolic, diastolic and mean blood pressure in the clinic, compared with that found at home, while group 1 showed a poor increase (P less than 0.05) in systolic blood pressure only. It is suggested that the enzymatic impairment of adrenal glands in group 2 may play a role in the disparity of blood pressure levels determined at home and in the outpatient clinic. Furthermore, our data suggest that differences in blood pressure measurement at home and in the hospital clinic should be taken into account when screening patients with partial deficiency of 11-hydroxylase.