Manual Blood Pressure Readings Research Articles

Perspectives of Primary Care Clinicians on the Diagnosis and Treatment of Pediatric Hypertension.

The purpose of this study was to contextualize the challenges of diagnosing and managing pediatric hypertension (pHTN) in federally qualified health centers. We conducted a survey among primary care clinicians (N = 72) who treat children (3-17 years old) in a national network of health centers. Clinicians reported practices of blood pressure (BP) measurement, barriers to diagnosis and management of pHTN, and use of population health tools. Most clinicians (83%) used electronic devices to measure BP, only 49% used manual BP readings for follow-up measurements, and more than half measured BP at each encounter. The highest-rated barrier to pHTN management was lack of comfort with antihypertensive medications (71% of respondents). Few clinicians (10%) had used population health tools, but most (78%) indicated they would like to use them for pHTN. These results offer clinician-level insights regarding implementation of the pHTN guideline in pediatric primary care settings.

Abstract P126: Self-management Program And Black Women With Hypertension

Introduction: Prevalence rates of hypertension (HTN) among Black adults (males 58.3% and females 57.6%) in the United States is among the highest in the world. Black females (46%) experience a higher incidence of Stage 2 HTN than Black males (42%) contributing to a greater risk of heart failure, stroke, and kidney disease. Levels of awareness, treatment, and control of HTN among Black women are decreasing. Effective strategies to combat these trends are imperative. Lifestyle changes and medication adherence are proven strategies to facilitate blood pressure (BP) control. Getting individuals with HTN to incorporate these strategies into the context of their everyday physical and social environments where they can be performed independently requires active individual engagement in healthcare behaviors and self-care activities. Aim: This study examined the effects of the Chronic Disease Self-Management Program (CDSMP) on self-care (maintenance, management, and confidence) and BP control in Black women with HTN at baseline and then 3-, 6-, and 9-months post CDSMP. Methods: The current study used data from the Interactive Technology Enhanced Coaching Intervention RCT for Black Women with HTN study. All participants completed a 6-week CDSMP at the beginning of the study. Self-care data were collected using the Self-Care of HTN Inventory along with manual BP readings at baseline, and repeated measures at 3-, 6-, and 9-months. Results: Of the 90 community-dwelling Black women enrolled in the study, 83 completed the CDSMP and 69 completed the study. The mean age was 53.57 ( SD = 10.07) years and the average number of years diagnosed with HTN was 11.06 ( SD = 8.47). All participants had BP readings greater than 130/80 mmHg at baseline and 44.92% (31 of 69) moved to less than 130/80 mmHg at 9-months. A weak negative correlation occurred at 9-months between systolic BP and self-care management, r (67) = -.26, p = .029, and confidence, r (67) = -.25, p = .035; and diastolic BP and self-care management, r (67) = -.31, p = .009, and confidence, r (67) = -.28, p = .018. Conclusion: The CDSMP was feasible, successfully delivered, and well-received by those enrolled in the study. Future studies should evaluate effective interventions for self-care strategies to improve long-term BP control.

Practice recommendations for the monitoring of renal function in pediatric non-renal organ transplant recipients.

The management of non-renal pediatric solid organ transplant recipients has become complex over the last decade with innovations in immunosuppression and surgical techniques. Post-transplantation follow-up is essential to ensure that children have functioning allografts for as long as possible. CKD is highly prevalent in these patients, often under recognized, and has a profound impact on patient survival. These practice recommendations focus on the early detection and management of hypertension, proteinuria, and renal dysfunction in non-renal pediatric solid organ transplant recipients. We present seven practice recommendations. Renal function should be monitored regularly in organ transplant recipients, utilizing assessment of serum creatinine and cystatin C. GFR should be calculated using the new Schwartz formula. Transplant physicians should also monitor blood pressure using automated oscillometric devices and confirm repeated abnormal measures with manual blood pressure readings and ambulatory 24-h blood pressure monitoring. Proteinuria and microalbuminuria should also be assessed regularly. Referrals to a pediatric nephrologist should be made for non-renal organ transplant recipients with repeated blood pressures >95th percentile using the Fourth Task Force reference intervals, microalbumin/creatinine ratio >32.5 mg/g (3.7 mg/mmol) creatinine on repeated testing and/or GFR <90 mL/min/1.73 m(2) .

Celebrate World Hypertension Day (WHD) on May 17, 2015, and Contribute to Improving Awareness of Hypertension

TheWorld Hypertension League (WHL), in partnership with the International Society of Hypertension (ISH) and other organizations, annually promotes World Hypertension Day (WHD). For the period 2013–2018, the theme of WHD is Know Your Numbers with the goal of increasing high blood pressure (BP) awareness in all populations around the world. This decision was based on global statistics, indicating that only 50% of individuals with hypertension were aware that they actually had high BP and that only a few populations have an awareness rate of more than 75%. Furthermore, in some populations, awareness is very low, at <10%. To increase awareness of hypertension diagnosis, there are two critical components: (1) establish high-capacity community screening programs for BP in those at risk, and (2) promote routine measurement of BP by health-care professionals at all clinical encounters. Moreover, an important initial step to control hypertension and help achieve the UnitedNations 2025 goal of a 25% reduction in uncontrolled hypertension is to improve hypertension diagnosis. Enhanced BP screenings through activities of WHD-2015 will contribute to achieving this goal. The WHL and ISH, with their member organizations and partners for national programs, will work to implement WHD screenings globally. In addition, the WHL is developing a partnership with the American Society of Hypertension (ASH) to develop a model for enhanced global WHD activities. In 2014, the inaugural WHD campaign encouraged WHL members and partners to screen and submit BP readings for more than 100,000 people. The 2014 goal was not only achieved but far-surpassed, with more than 300,000 being screened in more than 30 nations (http://www.whleague.org/index.php/features/worldhypertension-day-report-draft). Importantly, much of the 2014 WHL WHD program was based on the efforts of the ASH. Encouraged by the 2014 success, the WHD2015 challenge is to screen more than 1 million adults in alliance with heightened awareness of noncommunicable diseases (NCDs). Working together, the WHL and ISH are already partnering to meet this challenge. Plans for an even greater screening challenge are under way for 2016. The WHL and ISH encourage all members and affiliated organizations to contribute reports on BP screenings recorded between April 17 and May 17, 2015. An autofill template included as a supplement to the online version of this article for reporting WHD BP screening data will be sent to members and partners and will be made available on the WHL Web site (www.whleague.org). For the WHD-2015 screening reporting form, participants will be asked to provide general information on their team, location, number screened, and NCD education provided. Where or when feasible, participants may also report on proportion of known treated hypertensive people screened whose BPs are “controlled” (<140 mmHg systolic and <90 mmHg diastolic). Ultimately, a formal report onWHD-2015will be issued highlighting all contributors and key indicators. Together with the screening program, a student art competition will be launched in coordination with WHD-2015. Details will follow. Further information can be obtained by e-mailing the WHL office and Kimbree Redburn (kimbree.redburn@gmail.com) or the ISH office (secretariat@ish-world.com). Reports can also be submitted via e-mail to CEO@whleague.org. Furthermore, WHL and ISH encourage use of the WHD promotional posters produced by the ISH in 2014 in English and Spanish (http://ish-world.com/news/a/ World-Hypertension-Day-ISH-Posters/). Additional versions will be made available in advance of WHD 2015. Short videos compiled by the ISH New Investigator Committee (NIC) highlight Healthy Blood Pressure Tips and How to Maintain a Healthy Blood Pressure and can be viewed on the ISH Web site (http://ish-world.com/ news/a/ISH-World-Hypertension-Day-videos/). Further video coverage will follow for 2015. To assist sites in screenings, the WHL has developed a series of resources to aid community-based BP screening. These are available to all (http://www.whleague.org/index.php/j-stuff/blood-pressure-assessmenttrain-the-trainer). In addition to screening protocols, a Train the Trainer module for establishing an evidencebased BP screening site, supporting PowerPoint slide sets and YouTube videos, are available. The WHL has also developed a policy statement to strongly encourage the use of automated BP devices rather than manual BP readings in nearly all screening and clinical settings. These screening approaches are already in use in Cameroon, Republic of Congo, Nigeria, Haiti, Brazil, and Canada, with enhanced versions expected in 2016. The Web-based resources are currently being translated into Spanish, French and Portuguese. Address for correspondence: Mark Niebylski, PhD, MBA, MS, World Hypertension League, 415 Bass Lane, Corvallis, MT 59828 E-mail: mniebylski@yahoo.com

Differences in Automated and Manual Blood Pressure Measurement in Hospitalized Psychiatric Patients

Few studies have been conducted recently with noncritically ill patients evaluating commonly used automated blood pressure (BP) devices. The purpose of this study was to compare BP values obtained using a manual sphygmomanometer versus an oscillometric automated electronic BP device on an acute care psychiatry unit. A method-comparison design was used, and data were analyzed using the Bland-Altman method. Outliers were removed, resulting in 39 participants for analyses of systolic readings and 41 participants for diastolic readings. Paired t tests revealed a significant difference in manual versus automatic systolic BP readings (p < 0.05). Automated readings averaged 3.9 points higher. No significant differences in diastolic readings (p = 0.72) were found. Care must be taken in using automated or manual BP readings to make important clinical decisions. Based on these findings, a protocol was instituted in an acute care psychiatry unit indicating that BP must be measured manually for patients with medication-hold parameters for BP.

Intraclass correlation in practice: Assessment of reliability of manual blood pressure measurement among assessors in a clinical trial

Background : To ensure the reliability of manual blood pressure (BP) readings in a clinical trial, sources of error due to measurement must be reduced as much as possible. Apart from following standard procedure for BP measurement and ensuring good equipments, the measurement errors that come from the assessors themselves should be assessed. Objective : To demonstrate the use of two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) intraclass correlation coefficient (ICC) in the assessment of reliability of manual BP readings among assessors involved in a clinical trial using manual BP measurement, by using an interrater reliability study conducted by the authors as an example study. Methods : The steps involved in obtaining ICC in the study were discussed. Sample size given the number of assessors in the study was calculated. BP was measured using regularly maintained mercury sphygnomanometers, following recommendations by Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) for BP measurement in office setting. The outcomes were systolic and diastolic BP readings. A type of ICC, two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) ICC was chosen for the analysis and specifically discussed. Pre-requisite assumptions for ICC were meticulously checked and described. The interrater reliability for systolic and diastolic BP readings as expressed by ICC (single measure) were presented with confidence interval (CI). The ICCs obtained in the example study were discussed and concluded. The flaws of the study were also criticised. Results : The interrater reliability for systolic and diastolic BP measurements as expressed by ICC (single measure) were 0.87 (95% confidence interval [CI] 0.722, 0.956) and 0.77 (95% CI 0.560, 0.918) respectively. Conclusion : We demonstrated the steps required to obtain ICC. Since the use of manual BP measurement using mercury sphygmomanometer is still considered as gold standard of BP measurement, it is important that studies in which the BP outcome is measured using such method conduct interrater reliability studies properly.

Can sphygmomanometers designed for self-measurement of blood pressure in the home be used in office practice?

To examine the possibility of measuring automated office (AO) blood pressure (BP) using home BP recorders in place of the more expensive, fully automated devices designed specifically for professional use. Three groups of 100 patients each had five AOBP readings recorded with one of three home BP devices while resting alone in a quiet examining room. These devices were also used to obtain 24 home BP readings during 6 days. Five AOBP readings were also recorded using the BpTRU device and all patients had 24-h ambulatory BP and manual BP readings taken. Mean systolic AOBP was within 3-4 mmHg of the mean awake ambulatory BP for each of the three home BP recorders whether used in the office setting or at home. Diastolic readings tended to be higher than the corresponding awake ambulatory BP. For the 139 patients with hypertension, mean (±standard deviation) AOBP taken with the home BP devices (146±14/86±12) was higher (P<0.001) than the awake ambulatory BP (142±11/81±12) and AOBP taken with the BpTRU device (141±15/82±12). Systolic BP at home (142±14/85±10) was also similar to the awake ambulatory BP but diastolic BP was higher (P<0.001). There were no significant differences in correlation coefficients between each set of AOBP readings and awake ambulatory BP. Home BP devices may be used to record AOBP in selected patients. However, a fully automated sphygmomanometer is still the device of choice for obtaining AOBP readings similar to the awake ambulatory BP in patients with suspected hypertension.

Response to Measurement of Blood Pressure in the Office

The letter by Martin et al1 raises several interesting issues related to the office measurement of blood pressure (BP). As discussed in our article,2 the conditions under which manual BP readings are measured and characteristics of the patient population need to be taken into account when interpreting the results. Readings recorded as part of a research study are often not comparable to BP obtained in routine clinical practice. Thus, an algorithm derived from “research-quality” BP may not be appropriate for interpreting readings taken during routine clinical encounters.3 The …

Measurement of Blood Pressure in the Office

The widely accepted cut-point for normal blood pressure (BP) in the office setting evolved over several decades, based on data derived from a variety of sources. The Actuarial Society of America was one of the first organizations to publish BP data on thousands of community residents, followed by other classic studies such as Framingham, Western Electric Company, Kaiser Permanente, and the Multiple Risk Factor Intervention Trial.1,2 In every instance, BP readings were based on measurements taken by specially trained health professionals following guidelines for proper BP measurement. As a result of these and other population studies examining the association between different BP levels and cardiovascular outcomes, the importance of systolic and diastolic hypertension was recognized and an office BP of 140/90 mm Hg became the universally established cut-point for separating normal BP from hypertension. There are robust scientific data to support the use of 140/90 mm Hg to define hypertension in clinical practice guidelines. However, the guidelines do not take into account widely recognized problems associated with the quality of manual BP measurement in routine clinical practice.3 More recent recommendations4 for diagnosing hypertension clearly acknowledge that an increase in BP attributable to the “white coat response” is frequently associated with manual BP recordings performed in community-based practice. In recognizing this limitation of manual office BP, some guidelines have gone so far as to recommend that home BP and 24-hour ambulatory BP monitoring (ABPM) may need to be performed to obtain an accurate measure of a patient’s BP status. The greater reliance on 24-hour ABPM and home BP in the diagnosis and management of hypertension is the result of numerous clinical outcome studies5,6 that show that these measurement techniques are better predictors of cardiovascular events when compared to manual BP readings, even when manual readings are taken …

Recent advances in automated blood pressure measurement

During the past 15 years, clinical outcome studies have consistently reported that home and 24-hour ambulatory blood pressure recordings provide a significantly better measure of cardiovascular risk than do manual blood pressure readings taken in the office or clinic. The advent of automated sphygmomanometers that record blood pressure with the patient alone in the examining room will be the next major change in our approach to recording blood pressure. These automated devices virtually eliminate the white coat response and their readings correlate significantly better with the ambulatory blood pressure compared with manual office blood pressure readings. The principal finding from recent research into automated blood pressure measurement is that the presence of an observer during the actual reading in itself provokes the white coat response.

Comparison Between an Automated and Manual Sphygmomanometer in a Population Survey

An automated sphygmomanometer, the BpTRU, was used in a blood pressure (BP) survey of 2,551 residents in the province of Ontario. Automated BP readings were compared with measurements taken by a mercury sphygmomanometer under standardized conditions in a random 10% sample. BP was recorded in 238 individuals in random order using both a standard mercury device and an automated BP recorder, the BpTRU. All subjects rested for 5 min prior to the first BP reading, which was then discarded. The mean of the next three readings was obtained using the mercury device whereas the BpTRU was set to record a mean of five readings taken at 1 min intervals with subjects resting alone in a quiet room. The mean s.d. BP with the automated device was 115 +/- 16/71 +/- 10 mm Hg compared to 118 +/- 16/74 +/- 10 mm Hg for the manual BP (P < 0.001). A systolic BP > or = 140 mm Hg was present for 16 automated and 19 manual readings. Similarly, the diastolic BP was > or = 90 mm Hg for 9 automated and 14 manual readings. Linear regression analysis showed that automated BP was a significant (P < 0.001) predictor of both manual systolic and diastolic BP. Conventional manual BP readings can be replaced by readings taken using a validated, automated BP recorder in population surveys. The slightly lower readings obtained with the BpTRU device (in the context of reduced observer-subject interaction) may be a more accurate estimate of BP status.

Blood pressure inversely correlates with thrombin-evoked calcium rise in platelets.

Earlier investigations showed a positive correlation between basal cytosolic free calcium in human platelets and blood pressure; however, recent studies have failed to show this relation. We undertook the present work to examine which platelet cytosolic calcium parameters (namely, cytosolic calcium in resting or stimulated states in calcium-containing and calcium-free media) present the least variability and best correlation with blood pressure. We studied 17 healthy white men on three different occasions separated by 1- and 4-week intervals. Their manual and ambulatory automated 24-hour blood pressure measurements were correlated with cytosolic calcium in resting and stimulated (thrombin-treated) fura 2-loaded platelets. The following cytosolic calcium parameters were measured in 1 mmol/L calcium and calcium-free media: basal cytosolic calcium, peak thrombin-evoked cytosolic calcium, and post-transient cytosolic calcium 5 minutes after thrombin treatment. The highest and lowest coefficients of variation were respectively shown by the basal cytosolic calcium (22.8%) and peak thrombin-evoked cytosolic calcium (10.1%) in calcium medium. Basal cytosolic calcium did not correlate with any of the blood pressure parameters. Of the cytosolic calcium parameters, peak thrombin-evoked cytosolic calcium in calcium medium demonstrated consistent (negative) correlations with blood pressure, with better correlations shown with diastolic than systolic blood pressure of both automated and manual blood pressure readings. Peak thrombin-evoked cytosolic calcium in calcium medium showed similar correlations with nighttime and daytime automated blood pressure measurements. There were no correlations between peak thrombin-evoked cytosolic calcium in calcium-free medium and blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)