Limit Of Normal Blood Pressure Research Articles

Recognizing Cardiovascular Risk After Preeclampsia: The P4 Study.

BackgroundThere is increased risk of hypertension, early cardiovascular disease, and premature mortality in women who have had preeclampsia. This study was undertaken to determine the upper limit of normal blood pressure (BP) 6 months postpartum and the frequency of women with prior preeclampsia who had BP above these limits, as part of the P4 (Post‐Partum Physiology, Psychology and Pediatric) follow‐up study.Methods and ResultsBP was measured by sphygmomanometer, 24‐hour ambulatory BP monitoring, and non‐invasive central BP at 6 months postpartum in 302 women who had normotensive pregnancy and 90 who had preeclampsia. The upper limit of normal BP (mean+2 SD) for women with normotensive pregnancy was 122/79 mm Hg for routine BP, 115/81 mm Hg for central BP, and 121/78 mm Hg for 24‐hour ambulatory BP monitoring. Traditional normal values detected only 3% of women who had preeclampsia as having high BP 6 months postpartum whereas these new values detected between 13% and 19%. Women with preeclampsia had greater body mass index (27.8 versus 25.0, P<0.001) and left ventricular wall thickness but similar augmentation index. They also had lower high‐density lipoprotein (59±15 versus 65±16 mg/dL, P=0.002), higher triglycerides (77±51 versus 61±35 mg/dL, P=0.005), and higher homeostatic model assessment score (2.1±1.8 versus 1.3±1.9, P<0.001).ConclusionsClinicians wishing to detect high BP in these women should be aware of the lower than usual upper limit of normal for this young cohort and where possible should use 24‐hour ambulatory BP monitoring to detect these changes. This may define a subgroup of women who had preeclampsia for whom targeted BP lowering therapy would be successful.RegistrationURL: https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365295&isReview=true; Unique identifier: ACTRN12613001260718.

Informal allopathic provider knowledge and practice regarding hypertension in urban and rural Bangladesh.

ObjectivesDescribe informal allopathic practitioner (IAP) knowledge and practice about management of hypertension and identify gaps in IAP knowledge and practice amenable to interventions.MethodsA cross sectional descriptive survey of 642 IAPs in Kamalapur (urban) and Mirsarai (rural) Bangladesh was conducted from March to April, 2011. Using a structured, pre-tested questionnaire sociodemographic, training, knowledge and practice data about management of hypertension was collected. Comparative statistics were preformed to show differences between urban and rural practitioners using SAS 8.0.Findings99.4% of IAPs were male, mean age was 37.5 (12.5 SD) years. Greater than 65% correctly identified the upper limit of normal blood pressure. 50.2% underestimated lower limit of systolic hypertension. 79.8% allowed age to affect their treatment approach. As blood pressure increased, willingness to treat with medication decreased and tendency to refer increased. Sedative/sleeping pills, antidepressants, and beta blockers were the most commonly prescribed medications for prehypertension (58.7%, 50.3% and 53.7% respectively), stage I hypertension (55.0%, 38.6%, 49.8% respectively) and stage II hypertension (42.4%, 23.7%, and 28.8% respectively). Rural IAPs were more likely than urban IAPs to treat (84.7% vs 77.7%), order tests (27.1% vs 6.0%) and write prescriptions (60.4% vs 18.7%).ConclusionWhile IAPs are crucial to Bangladesh’s pluralistic healthcare system, gaps in knowledge and practice could cause unnecessary harm. To include IAPs in the public sector’s fight against the chronic disease epidemic, interventions aimed at standardizing IAPs knowledge and practice will be essential. Successfully utilizing IAPs will have beneficial implications not only for Bangladesh, but for all developing countries.

Significance of arterial hypertension in geriatric prevention

In Germany for decades the assessment and treatment of patients with high blood pressure is not satisfactory. As in other industrial countries only approximately 50% of hypertensive men and 60% of hypertensive women are diagnosed. Arterial hypertension bears the known risks on heart and vascular system also in old age when often target organ damages are already present. A sufficient number of clinical studies proves risk reduction by blood pressure lowering treatment. According to the criteria of WHO in old age the same limits of normal blood pressure and the same stages of the disease are valid as in younger patients. The probability of cardiovascular complications increases with the height of blood pressure. As small increases of blood pressure are far more prevalent than very high blood pressure values the cumulative risk in populations is predominantly linked to mild hypertension. In elderly patients systolic blood pressure has a better predictive value than diastolic blood pressure. A short review is given of work up and treatment of hypertension in the elderly instructed by the Guidelines of the German Hypertension Society.

Reference values of laboratory tests in elderly subjects--blood pressure

The upper limits of normal blood pressure have been considered to be 139 mmHg systolic and 89 mmHg diastolic for adults, but these values are not necessarily applicable to the elderly. This report presents blood pressure values of healthy persons aged 65 to 94 and estimates the upper limits of normal blood pressure in the elderly based on follow-up studies. The Blood Pressure Subgroup of the Study on Reference Values of Laboratory Tests in Elderly Subjects defined inclusion criteria for the healthy elderly as follows: (1) persons aged 65 to 94, (2) persons not complicated with cardiovascular diseases, (3) persons capable of living and walking freely, (4) persons without dementia, (5) persons without anemia, liver disease, renal failure, diabetes mellitus on drug treatment, lung disease, valvular disease or marked arrhythmias, (6) persons without neuromotor disease. The subgroup collected 2008 persons who fulfilled the criteria. Of the 2008 persons, 663 were not taking antihypertensive drugs, had body weight within an average Body Mass Index +/- standard deviation and had no abnormalities on ECG. The 663 persons were considered to be a group of most the normal elderly. Blood pressure values in this group were 133.3 +/- 18.9/77.0 +/- 10.6 mmHg for males (N = 318) and 134.3 +/- 18.7/75.7 +/- 10.2 mmHg for females (N = 345). Follow-up studies carried out by some members of the Blood Pressure Subgroup suggested that the upper limits of the normal blood pressure were 140 to 159 mmHg systolic and 80 to 89 mmHg diastolic for the elderly.

HYPERTENSION REDEFINED FOR CRITICALLY ILL NEONATES

The diagnosis of neonatal hypertension(HTN) has been complicated by the limited available normative data and hence, arbitrary assignment of the upper limit of normal blood pressure(BP). Our objective was to determine a normative data base. BPs were recorded every 8 hrs for up to 30 days in 121 preterm and 61 term infants who required an umbilical artery catheter(UAC). Dinamap was used after discontinuation of UAC. Infants were grouped as follows: <1.0 kg (n=17), 1.0-1.5 kg (n=41), 1.5-2.5 kg (n=63) and >2.5 kg (n=61). In each group, mean arterial pressure(MAP) rose steeply over the first 5 days. At all times, BP was higher in infants with the greater birth weight(BW). Predictive equations for MAP as a function of postnatal age(PNA) best fit a curvilinear relationship (MAP=a+b.ln[day]). The following tabulates the MAP(mmHg) and 95% confidence limits for single measurements. Both PNA and BW markedly influence BP values. By prior definition(MAP >70 × 3 days) 10% of these asymptomatic neonates would be hypertensive. The present criteria reduces the incidence to 2% which is in accordance with our previous report of symptomatic HTN. This dynamic definition of the range of BP with respect to BW and PNA more precisely identifies HTN in sick neonates.

Water, cations, and norepinephrine content of cardiovascular tissues of unilaterally nephrectomized dogs treated with deoxycorticosterone and NaCl.

Deoxycorticosterone pivalate (2.5 mg/kg) given intramuscularly on four occasions 10-15 days apart over a period of 45 days to unilaterally nephrectomized adult male mongrel dogs, receiving as drinking solution 0.9% NaCl in 5% dextrose, resulted in an average sustained rise in the mean arterial blood pressure of 30 mm Hg (1 mm Hg - 133 N/m2) in 60% of the animals. Hypertensive dogs had in their arterial tissues generally more sodium, potassium, magnesium, and calcium than the similarly treated but non-hypertensive dogs, but compared to the tissues of operated untreated or unoperated normotensive dogs, only sodium and calcium were significantly higher. The dogs who were similarly treated but did not develop hypertension had in their arterial tissues less sodium, potassium, and magnesium than operated untreated or unoperated normotensive dogs. Norepinephrine content in the branches of mesenteric arteries of all deoxycorticosterone- and NaCl-treated animals, irrespective of their blood pressure, was significantly lower, and in the myocardium significantly higher, than either the unoperated normotensive or operated but not further treated dogs. It is concluded, therefore, that in deoxycorticosterone + NaCl treatment the dogs which developed hypertension had more arterial sodium, potassium, magnesium, and calcium than those who were similarly treated but remained within the limits of normal blood pressure, and that there was no difference between hypertensive and non-hypertensive dogs in regard to their cardiovascular norepinephrine content.

PHRENIC OR POSTEMPHYSEMATOUS HYPERTENSION

THE EXTENT of the concept of essential hypertension, after subtracting secondary forms related to increased cardiac output, increased intracranial pressure, and lesions of the adrenals or anomalies of the kidney, is largely determined by the standards chosen for the upper limits of normal blood pressure. Bell 1 states that blood pressure of 140/90 mm. Hg or higher occurs in about 50% of men and 60% of women over the age of 40. On the other hand, Master and co-workers 2 found in patients of 44 years of age and over an incidence of hypertension varying from 22 to 35%, taking as the upper limits of normal 150/100 mm. Hg. The consensus of statistics indicates that the incidence of hypertension in the general population is between 20 and 25%, if 95 mm. Hg for the diastolic pressure is taken as the dividing line between normal and abnormal. Recently Master and co-workers

Normal Blood Pressure and Hypertension: New Definitions.

The authors of this excellent monograph are well qualified to deal with the problem of the limits of normal blood pressure. It is a vexing and important issue, the more important because physicians often fail to recognize that a measurement of blood pressure that seems abnormally high is not equivalent to a diagnosis of essential hypertension. As a result, many persons live out a normal life span and die of extravascular causes, beset by the doubts, fears, and social and economic inconveniences created by the too hasty diagnosis of "high blood pressure." What it comes to is that the authors show that the present day upper limits of "normal" have been arbitrarily set too low. Some physicians will recall that the view was promulgated some years ago that the upper limit of normal should be 120/80 mm. Hg. At that time, common sense indicated that this opinion was in error.

MEASUREMENTS OF RETINAL VESSELS IN EARLY HYPERTENSION

In connection with other investigations being carried on at the present time in hypertension, an attempt has been made to demonstrate a measurable change in the caliber of the retinal arteries before and during the administration of amyl nitrite, and to study by actual measurement the relation between the caliber of an artery and that of its associated vein in various degrees of hypertension. The patients studied were selected entirely on the basis of blood pressure readings from a group of persons who were in sufficiently good health to be carrying on their usual work. Arbitrarily, a systolic level of 140 mm. was set as the upper limit of normal blood pressure, and at the time of the study of the eyegrounds, the blood pressure of the patients so selected was often found to be normal. These patients were, nevertheless, included in this study as a control group. In the