Manual Sphygmomanometer Research Articles

Abstract 56: High Blood Pressure Is Associated with Lower Brain Volume and Cortical Thickness in Healthy Young Adults

Background: High blood pressure (BP) in middle-aged and older adults is associated with lower brain volume and cortical thickness assessed with structural MRI. However, little evidence is available in young adults. Objective: We investigated the associations of high BP with brain volumes and cortical thickness in healthy young adults. We hypothesized that high BP is associated with lower brain volume and cortical thickness in young adults. Methods: This cross-sectional study included 1095 young adults (54% women, 22-37 years) from the Human Connectome Project (HCP) who self-reported not having a history of hypertension or taking antihypertensive medications. Brachial systolic (SBP) and diastolic BP (DBP) were measured with semi-automatic or manual sphygmomanometer during study visits. Structural MRI was used to measure gray matter (GM) and white matter (WM) volume and mean cortical thickness. Associations of BP and hypertension stage with total and regional brain volumes and cortical thickness were analyzed using linear regression and analysis of covariance (ANCOVA) after adjusting for age, sex, education years, body mass index (BMI), smoking, alcohol consumption history, zygosity, and total intracranial volume. Results: SBP and DBP were (mean ± SD) 123.6 ± 14.2 and 76.5 ± 10.6 mmHg, respectively (n = 1095). High DBP was associated with lower total GM ( p = 0.012), cortical GM ( p = 0.004), subcortical GM ( p = 0.012), and total WM volumes ( p = 0.031). There were no associations of SBP and hypertension stage with total brain volume and cortical thickness. High SBP and DBP were associated with lower regional cortical thickness in the parietal lobe and lingual gyrus, and lower regional cortical volume in the postcentral gyrus, inferior parietal lobe, lateral occipital gyrus, and middle temporal gyrus. Conclusion: Associations of high BP, particularly DBP, with lower total and regional brain volume and cortical thickness were observed in healthy young adults. These findings suggest the importance of prevention or control of high BP early in life for brain health.

Effectiveness of Aqueous Hibiscus Sabdariffa Extract on Reduction of Blood Pressure and Serum Lipids Among Prehypertensive Patients

ABSTRACT Pre-experimental one group pertest post-test research design was adopted to investigate the effectiveness of aqueous flower extract of Hibiscus sabdariffa in reduction of blood pressure, serum lipids among 60 prehypertensive patients. A self-structured questionnaire and manual sphygmomanometer and stethoscope monitored blood pressure levels before and after administering Hibiscus sabdariffa extract. Results showed a significant drop in blood pressure levels among prehypertensive patients with a mean difference score of 12.75, and a substantial decrease in total cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very low density lipoprotein (VLDL) levels. The calculated paired ‘t’ test value of 16.280 was statistically significant at P < 0.001 level, indicating that oral supplementation of Hibiscus sabdariffa’s flower extract is effective in reducing blood pressure and serum cholesterol in prehypertensive patients.

High Blood Pressure Is Associated With Lower Brain Volume and Cortical Thickness in Healthy Young Adults.

High blood pressure (BP) in middle-aged and older adults is associated with lower brain volume and cortical thickness assessed with structural magnetic resonance imaging (MRI). However, little evidence is available on young adults. We investigated the associations of high BP with brain volumes and cortical thickness in healthy young adults. This cross-sectional study included 1,095 young adults (54% women, 22-37 years) from the Human Connectome Project (HCP) who self-reported not having a history of hypertension or taking antihypertensive medications. Brachial systolic (SBP) and diastolic BP (DBP) were measured with a semi-automatic or manual sphygmomanometer during study visits. Structural MRI was used to measure gray matter (GM) and white matter (WM) volume and mean cortical thickness. Associations of BP and hypertension stage with total and regional brain volumes and cortical thickness were analyzed using linear regression and analysis of covariance (ANCOVA) after adjusting for age, sex, education years, body mass index (BMI), smoking, alcohol consumption history, zygosity, and total intracranial volume. SBP and DBP were (mean ± SD) 123.6 ± 14.2 and 76.5 ± 10.6 mm Hg, respectively, (n = 1,095). High DBP was associated with lower total GM (P = 0.012), cortical GM (P = 0.004), subcortical GM (P = 0.012), and total WM volumes (P = 0.031). High SBP and DBP were associated with lower regional cortical volume and cortical thickness. These findings suggest that high BP may have deleterious effects on brain health at the early stage of adulthood.

Association of Blood Pressure With Brain White Matter Microstructural Integrity Assessed With MRI Diffusion Tensor Imaging in Healthy Young Adults.

High blood pressure (BP) in middle-aged and older adults is associated with a brain white matter (WM) microstructural abnormality. However, little evidence is available in healthy young adults. We investigated the associations between high BP and WM microstructural integrity in young adults. This study included 1015 healthy young adults (542 women, 22-37 years) from the Human Connectome Project. Brachial systolic and diastolic BP were measured using a semiautomatic or manual sphygmomanometer. Diffusion-weighted magnetic resonance imaging was acquired to obtain diffusion tensor imaging metrics of free water (FW) content, FW-corrected WM fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity. Using whole-brain voxel-wise linear regression models and ANCOVA, we examined associations of BP and hypertension stage with diffusion tensor imaging metrics after adjusting for age, sex, education, body mass index, smoking status, alcohol consumption history, and differences in the b value used for diffusion magnetic resonance imaging. Systolic and diastolic BP of the sample (mean±SD) were 122.8±13.0 and 76.0±9.9 mm Hg, respectively. Associations of BP with diffusion tensor imaging metrics revealed regional heterogeneity for FW-corrected fractional anisotropy. High BP and high hypertension stage were associated with higher FW and lower FW-corrected axial diffusivity, FW-corrected radial diffusivity, and FW-corrected mean diffusivity. Moreover, associations of high diastolic BP and hypertension stage with high FW were found only in men not in women. High BP in young adults is associated with altered brain WM microstructural integrity, suggesting that high BP may have damaging effects on brain WM microstructural integrity in early adulthood, particularly in men.

Association between within-visit blood pressure variability, stroke, coronary heart disease, and cardiovascular mortality.

Long-term variability in systolic blood pressure (SBP) is associated with a higher risk of cardiovascular events. Little is known about any association between within-visit SBP variability, stroke, coronary heart disease (CHD), and cardiovascular (CV) death. Participants included adults ≥ 18 years who participated in the US National Health and Nutrition Examination Surveys from 1999 to 2012 linked to the national death index in 2012. Stroke was self-reported. SBP was obtained up to four times by a physician, using a manual sphygmomanometer according to standard procedures. Within-visit SBP variability was defined as the standard deviation of the BP measurements, stratified into quartiles. We evaluated the relationship between within-visit SBP variability and the odds of stroke or CHD using multivariable logistic regression, and with CV mortality, using multivariable Cox regression. Of the 27,987 adults, 16.4% were aged ≥ 65 years, 51.3% were female, 71.2% were white, and 10.7% were black. Factors associated with higher mean SBP variability included older age, hypertension, chronic kidney disease, peripheral artery disease, and smoking (all p < 0.05). The prevalence of stroke significantly increased across SBP variability quartiles, from 2.1% for quartile 1 to 3.7% for quartile 4 (p < 0.001). High SBP variability was associated with higher odds of stroke [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.4-2.2], coronary heart disease (OR 2.0, 95% CI 1.6-2.4), and increased risk of CV mortality [hazard ratio (HR) 2.7, 95% CI 2.3-3.1]. The relationships were not observed after adjusting for covariables. Within-visit variability in SBP is associated with increased risks of stroke, coronary heart disease, and cardiovascular mortality, but the relationship is confounded by age and covariates.

Knowledge regarding the accurate measurement of blood pressure among intern medical officers practising at three teaching hospitals in Sri Lanka: A cross-sectional analysis

Introduction: Hypertension is a major risk factor for cardiovascular and renal diseases. Accurate measurement of blood pressure as per existing guidelines is of paramount importance in the management of hypertension.Objective: To describe knowledge of current guidelines regarding the accurate measurement of blood pressure by an auscultatory method with a manual sphygmomanometer among Intern Medical Officers practising at the National Hospital of Sri Lanka, Teaching Hospital, Kandy and Teaching Hospital, Jaffna.Methods: A cross-sectional survey was carried out among newly qualified doctors, practicing at the National Hospital of Sri Lanka, Teaching Hospital, Kandy and Teaching Hospital, Jaffna. A self-administered questionnaire was used to collect data. Data were analyzed using SPSS 28.Results: Of 79 newly qualified doctors who partici-pated, the majority (64.6%) were males, and mean age was 28.24 (range of 24-32) years. A significant proportion (45.6%) answered less than 8 (8=median) questions correctly, out of 15 ques-tions intended to assess knowledge regarding accurate blood pressure measurement.Conclusions: Knowledge regarding accurate measurement of blood pressure among newly qualified doctors was suboptimal. Junior doctors should be motivated to improve their knowledge and skills of blood pressure measurement through regular in-service training.

White Coat Effect: Is It Because of the Hospital Setting, or Is It Physician-Induced?

White coat hypertension (WCH) patients are those individuals who have high blood pressure (BP) in the medical environment but are normal during their daily activities. White coat hypertensive patients with normal daytime ambulatory blood pressure monitoring (ABPM) rapidly progress to sustained hypertension. WCH is mainly treated with non-pharmacological methods. Alpha-1 agonists and beta blockers are logical treatment choices for patients with fixed hypertension with the White Coat Effect (WCE). Masked hypertension patients are those individuals who have normal values at the doctor's office but elevated BP at home or during 24-hour ABPM (24-hour or daytime). ABPM is a more practical and reliable method for detecting patients with WCH. This observational study was conducted at Dayanand Medical College & Hospital, Ludhiana, over the course of one year (December 2015 to November 2016). The primary objective of the study was to determine whether there was a difference in blood pressure readings between the home setting and the hospital setting. The secondary objective was to determine whether the difference, if present, between the hospital and home readings was due to the hospital setting, physician presence, or a combination of both. Patients with stage 1 hypertension were included in the study, irrespective of antihypertensive treatment. Patients with ischemic heart disease, chronic liver failure, and chronic kidney disease who could not follow protocol instructions were excluded. In our study, the mean age of patients was 53.91±12.86 years. The patient's mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings at the hospital were higher than their home readings (p-0.012; p-0.001, respectively). Mean hospital SBP and DBP readings recorded by the physician were higher than readings recorded by patients alone at home (p-0.002; p-0.014, respectively) and alone at the hospital (p-0.004; p-0.001, respectively). BP readings taken by the physician with a manual sphygmomanometer were significantly lower than those taken with a digital sphygmomanometer by patients and physicians in all settings (p<0.05). The mean rise in BP was significant in both the physician's presence and the hospital environment (p<0.05 for both), and this rise was more significantly associated with the hospital effect than the physician effect (p<0.05). Misdiagnosis of hypertension results in inappropriate prescription and overuse of antihypertensive medications for individuals who are not persistently hypertensive. So it is very important to rule out WCH in both the hospital setting and the physician's presence, more precisely by ABPM. WCH can be diagnosed with regular BP monitoring by a digital sphygmomanometer at home.

62. Effect of Dietary Pattern on the Incidence of Hypertension in Geriatric at Cawang, East Jakarta

Background: Geriatrics is the high-risk population to develop hypertension due to their physiology changes. One of the hypertension risk factors in the geriatric population is dietary habits. Poor dietary habits, such as frequent intake of high calories, low-fiber, high-sodium, and low-potassium food can develop hypertension in the geriatric population. Objectives: This study aims to investigate the effect of dietary patterns and the incidence of hypertension in geriatric living in Cawang, East Jakarta. Methods: This study is a quantitative cross-sectional study with a random sampling technique and uses the Chi-Square method to analyze the correlation between dietary patterns and blood pressure in the elderly. Blood pressure data were obtained using a manual sphygmomanometer to measure blood pressure and the dietary pattern was evaluated by using the Food Frequency Questionnaire. Hypertension criteria in this study were based on JNC VIII. Results: There are 65 elderly in Cawang selected by random sampling technique to be in this study. The amount of hypertension cases accounts for 78.5 percent of all subjects. The elderly with frequent and high sodium intake was identified to be 38 people (58.5%), high fat intake was identified in 36 people (55.4%), and low potassium intake was identified in 36 people (55.4%). The correlation between dietary sodium intake and hypertension is significantly shown by the p-value result (p = 0,000), between fat intake and hypertension (p = 0.023), and between potassium intake and hypertension (p = 0.004). Conclusion: This study shows there is a significant correlation between dietary patterns and hypertension among geriatrics.

Hypokalemic paralysis; an unusual presentation of Conn's Syndrome

Abstract Introduction Primary aldosteronism (PA) is the most common cause of secondary hypertension. It is caused by excessive aldosterone secretion in adrenal cortex. The typical presentation of PA at young patients, is resistant hypertension and hypokalemia. In recently published series, potassium levels are frequently reported normal. Normotension is also rare in these patients. We report a case of PA, presenting with hypokalemic paralysis and normal blood pressure, atypically. Clinical Case A 33-year-old female patient with fatigue, muscle weakness and difficulty walking, was admitted to the emergency department. She had muscle weakness and numbness, especially in the arms and hands for two months. Flaccid paralysis of the limbs was observed at the time of admission. She did not report vomiting, diarrhea, abdominal pain or drug use such as diuretics. There was no history of hypertension. None of her family had hypertension or sudden death at younger age. On physical examination, her blood pressure was less than 140/90 mmHg in repetitive measurements with a manual sphygmomanometer. Lower extremity motor strength was 2/5 and deep tendon reflexes were absent. Biochemical tests revealed that hypokalemia (2 mmol/L) with metabolic alkalosis (pH: 7.47 HCO3:30 mmol/L) and kaliuresis (24-h urinary potassium 87.89 mmol). Serum magnesium level and thyroid function tests were within the reference ranges. After the treatment of hypokalemia, neuromuscular symptoms regressed. Extremely high aldosterone levels (58.5 ng/dL) with suppressed renin activity (0.3 uIU/mL) were detected in blood tests. The diagnosis of PA was confirmed by unsuppressed aldosterone levels (44 ng/dL) after the saline infusion test. Adrenal contrast-enhanced CT identified a solid mass in the right adrenal gland which was 18×10 mm in size, consistent with adenoma (Figure 1). She was referred to surgery. Postoperatively, serum potassium and plasma aldosterone levels returned to normal without medication. Her home blood pressures remained between 110/70 and 120/80 mmHg. Conclusion Aldosterone-producing adenoma (APA) is one the most common cause of PA. In APA, aldosterone levels and blood pressures tend to be high. It has been reported that only 28% of patients with hyperaldosteronism have had hypokalemia and 3.1% may be normotensive. We described a patient with PA who presented with flaccid paralysis due to hypokalemia, moreover, she was normotensive. It is a rare condition for primary aldosteronism to present with hypokalemic paralysis. Delayed diagnosis and treatment can be life threatening. In conclusion, we should consider primary aldosteronism in the differential diagnosis of severe hypokalemia and to keep in mind that patients may rarely be normotensive.

Primary care physician beliefs and practices regarding blood pressure measurement: results from BP-CHECK qualitative interviews

BackgroundEarly identification and control of hypertension is critical to reducing cardiovascular disease events and death. U.S. Preventive Services Task Force guidelines recommend health care professionals screen all adults for hypertension, yet 1 in 4 adults with hypertension are unaware of their condition. This gap between guidelines and clinical practices highlights an important opportunity to improve blood pressure (BP) screening and hypertension diagnosis, including measurement outside of clinic settings. To identify targets for future diagnostic interventions, we sought to understand primary care physicians' (PCPs) beliefs and practices regarding use of common forms of BP measurement.MethodsStudy participants were PCPs (N = 27) who had patients enrolled in the BP-CHECK trial. The trial compared the accuracy of 24-h ambulatory BP monitoring (ABPM) to: 1) clinic-based monitoring, 2) home BP monitoring (HBPM), or 3) use of a BP kiosk in clinics or pharmacies. Physicians were interviewed by phone and compensated for their participation. Interviews were recorded, transcribed, and analyzed using a template analysis approach.ResultsOverall, PCPs preferred and trusted clinic BP measurement for diagnosing hypertension, particularly when measured with a manual sphygmomanometer. Concerns with HBPM included the belief that patients did not follow protocols for rest and body positioning at home, that home machines were not accurate, that home BPs could not be entered into the medical record, and that HBPM would make some patients anxious. Issues regarding kiosk measurement included beliefs that the public setting created stress for patients, that patients did not follow resting protocols when using kiosks, and concerns about the maintenance of these machines. ABPM was recognized as highly accurate but was not perceived as accessible. Additionally, some PCPs found it challenging to interpret the multiple readings generated by ABPM and HBPM, especially when these readings differed from clinic BPs.ConclusionsOur findings suggest that both additional physician education and training and investments in equipment and system-level processes are needed to increase the acceptance and utilization of out of office BP measurement for identification and treatment of hypertension. These changes are needed to improve ensure everyone in the U.S receive optimal care for hypertension.Trial registrationClinicalTrials.gov NCT03130257. Initial registration date: 4/21/2017.

Oscillometric measurement of the ankle-brachial index and the estimated carotid-femoral pulse wave velocity improves the sensitivity of an automated device in screening peripheral artery disease.

To overcome the time and personnel constraints of the Doppler method, automated, four-limb blood pressure monitors were recently developed. Their additional functions, such as measuring the estimated carotid-femoral pulse wave velocity (ecfPWV), have been, thus far, less studied. We aimed to compare the sensitivity and specificity of different ankle-brachial index (ABI), toe-brachial index (TBI), and ecfPWV measurement methodologies to evaluate their contribution to peripheral artery disease (PAD) screening. Among 230 patients (mean age 64 ± 14 years), ABI measurements were performed using a Doppler device and a manual sphygmomanometer. The Doppler ABI was calculated by taking the higher, while the modified Doppler ABI by taking the lower systolic blood pressure of the two ankle arteries as the numerator, and the higher systolic blood pressure of both brachial arteries as the denominator. The automated ABI measurement was carried out using an automatic BOSO ABI-system 100 PWV device, which also measured ecfPWV. TBI was obtained using a laser Doppler fluxmeter (Periflux 5000) and a photoplethysmographic device (SysToe). To assess atherosclerotic and definitive PAD lesions, vascular imaging techniques were used, including ultrasound in 160, digital subtraction angiography in 66, and CT angiography in four cases. ROC analysis exhibited a sensitivity/specificity of 70.6%/98.1% for the Doppler ABI (area under the curve, AUC = 0.873), 84.0%/94.4% for the modified Doppler ABI (AUC = 0.923), and 61.5%/97.8% for the BOSO ABI (AUC = 0.882) at a cutoff of 0.9. Raising the cutoff to 1.0 increased the sensitivity of BOSO to 80.7%, with the specificity decreasing to 79.1%. The ecfPWV measurement (AUC = 0.896) demonstrated a 63.2%/100% sensitivity/specificity in predicting atherosclerotic lesions at a cutoff of 10 m/s. Combining BOSO ABI and ecfPWV measurements recognized 89.5% of all PAD limbs. The combined BOSO ABI and ecfPWV measurements may help select patients requiring further non-invasive diagnostic evaluation for PAD. The user-friendly feasibility may make it suitable for screening large populations.

Effect of Moderate Exercise Training on Vitals and Peak VO2 in Different Age Categories of Adults in COVID-19 Pandemic

Objective: To determine the effect of moderate exercise training on vitals i-e., Blood pressure (Systolic and diastolic), Pulse Rate(PR), Respiratory Rate(RR) and Peak VO2 in different age categories of adults during COVID-19 pandemic.&#x0D; Study Design: Descriptive cross-sectional study.&#x0D; Place and Duration of Study: This study was carried out at a tertiary cardiac care center from Feb 2021 to May 2021.&#x0D; Methodology: It was a descriptive cross sectional study conducted generally for 6 months in tertiary care center. A total of 104 participants were included and divided into three groups i-e., Young adults (17-30 years), Middle age adults (31-45 years) and Old age (&gt;45 years) Participants were selected through non-probability convenient sampling technique and allocated in groups based on their age. Participant, after meeting inclusion criteria were supervised during moderate exercise training which includes walking for 23 minutes, cycling for 23 minutes and stepping for 5 minutes. Participants were assessed Pre and Post through Manual sphygmomanometer for BP, NMQ for muscle discomfort. Borg scale was used to assess exertional level and 6 Minute Walk test to assess Peak VO2.&#x0D; Results: Post intervention between the groups showed the significant effect on all three assessment factors of VO2,Borg Scale and SBP with Kruskal Wallis test (p&lt;0.05). Post intervention within the group showed significant effect on all three assessment factors of SBP,DBP,PR,RR,VO2 and Borg RPE scale with Friedman test (p&lt;0.05). Post assessment of muscle discomfort shows highest frequency i-e 13.8(4%) in shoulder, thigh, upper and lower back region.&#x0D; Conclusion: This study reported that disturbed vitals and reduced VO2 due to inactivity because of COVID-19 pandemic. Post COVID-19 affects can be recovered through 6 weeks of moderate training. Furthermore, this study reported that participants belonging to old age showed maximum improvement in vitals in response to training while showed maximum muscle discomfort frequency in shoulder, thigh, lower and upper back

Effects of Low-Impact Strengthening Exercises on Limb Pain and Strength in Diabetic Patients with End-Stage Renal Disease

Background: Diabetic nephropathy becomes a disease with a high mortality rate in this modern era of technology. Dialysis in diabetic patients affects kidney functioning is the most common treatment for end-stage renal failure but had different musculoskeletal complications due to bone mineral metabolisms like muscular cramping, atrophy and muscular weakness, restless leg syndrome and limb pain that lowers the quality of life and physical function. Objective: To evaluate the effects of low-impact strengthening exercises on limb pain, strength, glycemic control, hypertension and quality of life of patients with end-stage renal disease. Methods: The randomized controlled study was designed to check the effectiveness of low-impact strengthening exercises on patients involved in the treatment and control group. Using non-probability purposive sampling, data was collected from different hospitals in Faisalabad by providing treatment for six consecutive weeks. Outcomes of measures were pain, strength, glucose level, blood pressure and quality of life which were estimated through the numeric pain rating scale, manual muscle testing, glucometer, sphygmomanometer and kidney disease quality of life questionnaire respectively. Results: Low-impact strengthening exercises in the treatment group showed improvement in muscle strength, blood pressure, glycemic level, pain and quality of life in diabetic patients with end-stage renal disease as compared to the control group. Mean values showed that there was a statistically significant difference in different variables between both groups. Conclusion: It was concluded that there is a statistically significant difference between both groups in the improvement of limb pain and limb muscle strength by low-impact strengthening exercises. These exercises have positive effects on diabetic patients with end-stage renal disease in the treatment group as compared to the control group.

A Prospective Evaluation of Grip Strength Comparing a Low-Tech Method to Dynanometry in Preoperative Surgical Patients and Weak Intensive Care Patients.

Objective Grip strength testing offers a mechanism to identify patients in whom frailty might be present, discriminate between robust elderly and vulnerable younger patients, and can be used as a tool to track changes in muscle bulk over the course of an inpatient stay. We compared gold-standard quantitative grip strength measurement to a low-tech alternative, a manual bedside sphygmomanometer. Design Under supervision, subjects performed hand-grip strength testing with each instrument. A mean score is calculated from three measurements on the dominant and nondominant hand. Setting. Testing was performed in a tertiary centre in Perth, Western Australia, in both outpatient clinics and intensive care units. Participants. 51 adult pre-operative surgical outpatients were assessed, alongside 20 intensive care inpatients identified as being weak. Main outcome measures. A statistical correlation between the two measures was evaluated. Feasibility, safety, and convenience were also assessed in outpatient and bedside settings. Results Highly correlated results in both tertiary surgical outpatients (rs = 0.895, p ≤ 0.001, N = 102; r (100) = 0.899, p ≤ 0.001) and weak intensive care patients (rs = 0.933, p ≤ 0.001, N = 39 r (37) = 0.935, p ≤ 0.001) Conclusions Modifying a manual bedside sphygmomanometer to measure grip strength is feasible and correlates well with a formal dynamometer in preadmission surgical patients and weak patients in the intensive care unit. The use of an existing, safe, and available device removes barriers to the measurement of weakness in patients and may encourage uptake of objective measurement in multiple settings.

Can we boost screening for peripheral arterial disease?

Abstract Despite the high prevalence of peripheral artery disease (PAD), the diagnosis is often delayed. The delayed diagnosis is due in part to comorbidities which can mask PAD symptoms, and in large part to the low use of conventional diagnostic tools. For PAD diagnostics, the guidelines recommend Doppler-based ankle-brachial index (ABI). The method is time consuming and requires skills. The toe pressure measurement which helps to eliminate the falsely elevated ankle pressures due to mediasclerosis is an almost neglected method for screening. In recent years, automatic, oscillometric four-limb blood pressure monitors have become available that provide data within minutes. We aimed to compare an automatic four limb blood pressure monitor with devices regularly used in our department. Methods Blood pressure was measured in 92 individuals (mean age 65±14 years) using a Doppler device (Hadeco) and a conventional manual sphygmomanometer on all four limbs, as well as an automatic, four-limb pressure monitor (BOSO ABI system-100 PWV) which also measured pulse wave velocity (PWV). Toe pressure was measured with a laser Doppler fluxmeter (Periflux 5000) and a photophlethysmography based toe pressure monitor (Systoe). Patients without known PAD but with at least one abnormal test result underwent a vascular imaging including ultrasound, CT or digital subtraction angiography. Among the 92 individuals there were patients with confirmed PAD, persons at high or very high cardiovascular risk, patients with non-ischaemic cardial diseases and healthy volunteers. Results ABI values of the posterior tibial artery at the corresponding side measured by Doppler and BOSO showed a strong correlation with each other (Pearson's r: 0.8 and 0.7), while the Doppler ABI values of the dorsal pedal artery showed a moderate or weak correlation with BOSO ABI values (r: 0.63 and 0.27). The toe pressure measured by laser Doppler and Systoe did not differ significantly. The ROC curve analysis of the Periflux TBI values supported 0.6 as a cut-off level (91.6% sensitivity, 84% specificity). Of the 52 individuals with high or very high cardiovascular risk, 15 with Doppler, 12 with BOSO and 29 with Periflux could be considered as abnormal, the vascular imaging confirmed PAD in 12 of them. Doppler ABI was abnormal in 96%, BOSO ABI in 69%, BOSO ABI combined with PWV in 92%, Periflux and Systoe toe brachial index (TBI) in 100–100% in 72 limbs with confirmed PAD. In control subjects, ABI, TBI, and PWV were normal; in subjects with high or very high risk, PWV was 58% abnormal, in confirmed PAD, 85%. All patients with abnormal PWV showed atherosclerotic lesions by the vascular imaging. Summary For detection of PAD, the measurement of TBI had the highest sensitivity. PAD screening of a large population may be possible using automatic four limb blood pressure monitors. By combining with additional features (e.g. PWV) the detection ratio can be improved to the level of the Doppler ABI method. Funding Acknowledgement Type of funding sources: None.

Blood pressure trait in rural Bengal- impact of hard labour, poor economic condition and poor diet

Background: The aim of the present study was to observe the blood pressure trait of male population of rural Bengal, India as a part of community work. Physical characteristics and blood pressure of 699 adult male from a rural area of West Bengal, India were studied. Participants were from poor socioeconomic status, who do hard different manual works on the field for earning to feed their families for survival.Methods: Blood pressure was measured with manual sphygmomanometer in the morning. Physical characteristics were measured for predicting nutritional status in terms of BMI.Results: Nutritional status of 85% male villagers was either underweight or normal. Only 4.6 % were obese. Most of villagers possessed either optimal or normal blood pressure. Very few had hypertension. More than 99% of male villagers were without hypertension. Calorie intake of the villager were nominal due to poverty but had to work hard for economic survival. Nominal intake of calories along with hard labour might be the reason behind optimal or normal blood pressure.Conclusions: It could be concluded that survival efforts of the rural people make them less hypertensive.

Measurement of arterial blood pressure in special situations

Blood pressure measurement is one of the most frequently performed medical procedures. However, oscillometric BP measuring devices have some technical limitation and alternative techniques should be considered. Manual auscultatory measurement is the preferred technique in atrial fibrillation. The BP in patients with left ventricular assist device can be estimated using a manual sphygmomanometer combined with Doppler opening signal. In patients with stenosing arterial disease of the upper limbs, the systolic BP can be estimated at lower extremities using a manual sphygmomanometer on the leg combined with pulse oximetry on the toe.

A Digital Pressure Meter Equipped with Pressure Leak Detection

A manual sphygmomanometer is an instrument used to measure blood pressure, and consists of an inflatable cuff, a mercury manometer (or aneroid gauge) and an inflation ball and gauge. To assess the condition, accuracy and safety of mercury and anaeroid sphygmomanometers in use in general practice and to pilot a scheme for sphyg- momanometer maintenance within the district. Therefore, it must be calibrated periodically. Using the MPX 5050GP sensor as a positive pressure sensor. Requires a maximum pressure of 300 mmHg. This tool is also equipped with a SD Card as external storage. The display used in this module is TFT Nextion 2.8”. After conductings measurements of the three comparisons consisting of Multifunction, DPM and mercury tensimeter to 6 times, the smallest result 0 mmHg and the largest results 251.52 mmHg. While the error in mercury tensimeter’s of leak test to module and rigel is 0.56% and 0.404%.

Abstract P124: Repeat Manual Office Blood Pressure By A Physician Is Lower Than Automated Office Blood Pressure

Introduction: An accurate measurement of blood pressure (BP) is critical to diagnosing and treating hypertension (HTN). Manual office BP (MOBP) often results in higher readings than automated office BP (AOBP). In previous studies, a repeat MOBP by a physician resulted in a lower BP than the initial MOBP by nursing staff. We evaluated our hypothesis that a repeat MOBP by a physician is statistically equivalent to AOBP. Methods: In an ambulatory outpatient setting, patients were roomed and at least a 5-minute interval lapsed before an AOBP was performed using a Welch Allyn Connex Vital Signs Monitor. The physician was blinded to the AOBP. The physician then entered the room and obtained a MOBP with a manual aneroid sphygmomanometer. The difference between the AOBP and the MOBP was calculated. A Wilcoxon signed rank sum test was used to determine if a significant difference between AOBP and MOBP exists. Results: A total of 186 patients (112 females, 74 male) had BP measured with a mean age of 66 years. AOBP resulted in a median systolic BP (SBP) 136 mmHg (IQR 121-150 mmHg) and median diastolic BP (DBP) of 78 mmHg (IQR 72-85 mmHg). MOBP SBP had a median of 132 mmHg (IQR 120-142 mmHg) and DBP had a median of 76 mmHg (IQR 70-81 mmHg). SBP and DBP were significantly lower in the MOBP group with a mean difference between AOBP and MOBP of 4.0 and 2.7 mmHg respectively (p-value of &lt;0.0001). Conclusions: Repeat MOBP performed by the physician resulted in a significantly lower BP compared to AOBP. The lower BP may be due to an overall longer interval between the AOBP measurement and MOBP measurement. MOBP may be a viable option for accurate diagnosis and treatment of HTN clinics without access to a AOBP machine.

Prevalence of hypertension and its risk factors among obese adolescents in Yogyakarta, Indonesia

Obesity and overweight are considerable health problems with increasing prevalence among adolescents. In Indonesia, basic health research data from Riskesdas shows an increase in the prevalence of obesity in adolescents aged 13- 15 y.o, from 2.6% in 2010 to 6.7% in 2013. This high prevalence of overweight and obesity is related to various factors. This study aimed to determine the factors associated with hypertension and obesity in adolescents. This study was conducted on an overweight population, obese, and super-obese adolescents aged 13-15 year in the Yogyakarta City, Indonesia. Demographic data included the history of breastfeeding, birth weight, gender, history of premature birth, lifestyle, and physical activity were gathered. Anthropometric data included the weight, height, and body mass index (BMI) were also measured and gathered. Hypertension was measured using a manual sphygmomanometer. The relationship was analyzed using Pearson chi-square and the risk value was demonstrated from the odds ratio (OR). A significant relationship between gender and diastolic hypertension was observed (OR= 2.4; 95%CI = 1.23 – 5.09; p 0.05). in conclusion, there is a relationship between gender and diastolic hypertension incidence among obese adolescents. Boys are more at risk of obesity compared to girls.