Manual Sphygmomanometer Research Articles

Proprioceptive neuromuscular facilitation does not increase blood pressure of healthy elderly women

Proprioceptive neuromuscular facilitation (PNF) is an attractive method to increase strength and proprioception of elderly individuals. However, a major clinical concern about the prescription of PNF is the belief that it can cause a cardiovascular overload, because it involves close-to-maximal loads and isometric contractions. Yet the acute effect of a PNF training session on cardiovascular response in elderly individuals is still unknown. Hence, the objective of this study was to evaluate the effect of PNF on diastolic and systolic blood pressure of healthy elderly people. Fifteen older women (mean age 72.40 ± 6.82 years) performed three sets (five repetitions each) of three different PNF techniques (rhythmic initiation, dynamic reversion, and isotonic combination), executing a single movement pattern. Diastolic and systolic blood pressure (DBP and SBP) were evaluated by means of a manual sphygmomanometer immediately before and during the last two repetitions (last set) of each technique. A two-way ANOVA test (time and technique) was performed to investigate the PNF effect on blood pressure. No time (preexercise to postexercise) (p = 0.33 for DBP; p = 0.06 for SBP) or PNF technique (p = 0.75; p = 0.81) effect were observed. In conclusion, we can state that the execution of these PNF techniques is safe for the cardiovascular system of healthy elderly women, because no blood pressure increases were found.

Why Use Automated Office Blood Pressure Measurements in Clinical Practice?

Automated office blood pressure (AOBP) measurement with the patient resting alone in a quiet examining room can eliminate the white-coat effect associated with conventional readings taken by manual sphygmomanometer. The key to reducing the white-coat response appears to be multiple blood pressure (BP) readings taken in a non-observer office setting, thus eliminating any interaction that could provoke an office-induced increase in BP. Furthermore, AOBP readings have shown a higher correlation with the mean awake ambulatory BP compared with BP readings recorded in routine clinical practice. Although there is a paucity of studies connecting AOBP with organ damage, AOBP values were recently found to be equally associated with left ventricular mass index as those of ambulatory BP. This concludes that in contrast to routine manual office BP, AOBP readings compare favourably with 24-hour ambulatory BP measurements in the appraisal of cardiac remodelling and, as such, could be complementary to ambulatory readings in a way similar to home BP measurements.

SP1-69 Blood pressure and obesity in Emirati children and adolescents

ObjectivesAlthough obesity is fast increasing, there are few data on the prevalence of high-normal or elevated blood pressure in United Arab Emirates.MethodsWe conducted a school-based survey of a representative sample...

The Effect of Combined Exercise Training in Adolescents Who Are Overweight Or Obese With Intellectual Disability: The Role of Training Frequency

Data about effects of exercise training in adolescents with intellectual disability (ID) are very limited. This study investigated the effect of 2 different frequencies of the same intensity and total training volume of combined exercise training on indices of body composition, physical fitness, and lipid profile in overweight and obese adolescents with ID. A total of 45 overweight and obese adolescents with ID aged 14-22 years with a total IQ 45-70 received combined exercise training 3 times a week (CET3) for 30 sessions (10 weeks; n = 15), twice a week (CET2) for 30 sessions (15 weeks; n = 15), or no training (10 weeks; n = 15). Groups were matched for age, sex, and education form. Before and after the intervention period, indices of body composition, physical fitness and lipid profile have been evaluated. Compared to the control group, CET3 resulted in a significant improvement of physical fitness, obesity indices, and lipid profile of the participants. Comparing CET2 with CET3, no significantly different evolutions were noticed, except for lower limb strength in favor of exercising 3 times a week. In conclusion, exercising 2 times a week, which is more feasible and practical for participants and guidance, has the same health beneficial effects as 3 times per week in overweight and obese adolescents with ID in short-term training.

Prevalence of hypertension among the elderly Malays living in rural Malaysia.

We are living in an ageing world. The prevalence of hypertension which is an established risk factor for cardiovascular disease and stroke increases with age. The aim of the study was to determine the prevalence of hypertension among the elderly Malays living in rural parts of north Malaysia. This cross-sectional study was conducted among the elderly (aged ≥60) Malay residents living in 22 villages in a northwestern state called Kedah in Malaysia from 2007 to 2009. Kedah has one of the highest rates of elderly population in the country. Data was collected by trained research assistants. Besides the baseline demographic information, blood pressure was measured using standardised methods using a manual sphygmomanometer. The response rate was 97.7%. The prevalence of hypertension among the elderly in these villages was 54.5% (228), 118 (28.2%) were known to be hypertensive and were on medication and an additional 110 (26.3%) respondents were newly diagnosed. Elevated mean systolic (146.17 ± 25.23) and diastolic (89.68 ± 15.60) blood pressure was noted among the known hypertensive. There was an almost fourfold risk (OR 3.64) of having uncontrolled blood pressure among the known hypertensive on treatment. Those with malnutrition were at an almost twofold at risk of being hypertensive (OR 1.73). Binary logistics regression showed occupation (OR 1.65), marital status (OR 2.32) and body mass index (BMI) (OR 1.62) as significant predictor variables. Screening the elderly for hypertension will benefit this group of people by reducing the morbidity and mortality associated with this condition.

Intraocular pressure and ocular perfusion during hemodialysis

To evaluate the intraocular pressure and ocular perfusion pressure during a hemodialysis. Sixty-seven eyes from thirty-five patients were evaluated at the beggining of hemodialysis, 2 hours and 4 hours after initiation. Intraocular pressure was evaluated using a Tonopen. Systolic and diastolic arterial pressures were measured with a manual sphygmomanometer. The ocular perfusion pressure was estimated by measuring the difference between 2/3 of the mean arterial pressure and the intraocular pressure values. Generalized estimating equations were used to evaluate the difference between the repeated measurements using the appropriate correction for inter-eye dependency. There was no statistically significant difference in ocular perfusion pressure, in intraocular pressure (p=0.93) and in systolic arterial pressure (p=0.92) at the three time points (p=0.69). But, when analyzing the extreme values, some patients exhibited lower diastolic perfusion pressures at all time points. Our results did not support the view that significant changes in ocular perfusion pressure and intraocular pressure occur during hemodialysis session. However, we observed that some patients exhibited lower diastolic perfusion pressures, which could be a poor prognostic factor for glaucoma patients.

Age effects on the differences between Omron HEM 907 blood pressure monitor and manual mercury sphygmomanometer blood pressure readings

Background: To validate Omron HEM 907 XL blood pressure monitor (test device) against auscultatory mercury sphygmomanometer in children aged 7–18 years old in accordance with International Protocol of European Society of Hypertension revised in 2010 (ESH-IP2) and British Hypertension Society (BHS) protocol. Methods: Seventy-five children and adolescents were recruited for the study. A validation procedure was performed following the protocol which was prepared on the basis of ESH-IP2 and BHS protocol for children and adolescents. Each underwent 7 sequential blood pressure (BP) measurements alternatively with a mercury sphygmomanometer and the test device. The results were analyzed according to the validation criteria of ESH-IP2. Results: The mean BP (± standard deviation [SD]) difference of absolute value between the test device and mercury sphygmomanometer readings in all the 75 subjects was 3.26 ± 3.08 mm Hg for systolic BP and 4.11 ± 3.50 mm Hg for diastolic BP. These results fulfilled AAMI criterion of mean ± SD below 5 ± 8 mm Hg for both systolic and diastolic BP. The proportion of test device-observer mercury sphygmomanometer BP differences within 5, 10 and 15 mm Hg were 81%, 96%, 99% for SBP and 72%, 93%, 99% for diastolic blood pressure (DBP), respectively, in the part 1 analysis, so both systolic blood pressure (SBP) and DBP passed the part 1 criteria. As for the part 2 analysis, SBP passed the criteria, bur DBP failed. Conclusions: Omron HEM 907 XL BP monitor failed an adapted ESH-IP2, though SBP passed. When comparing the BP readings by oscillometers with mercury sphygmomanometer, the differences between them, particularly in diastolic BP, should be taken into account, because DBP can be underestimated. (J Korean Soc Hypertens 2011;17(3):114-124)

A new technique for simultaneous validation of two manual nonmercury auscultatory sphygmomanometers (A&D UM-101 and Accoson Greenlight 300) based on the International protocol

Auscultatory nonmercury manual devices seem good alternatives for the mercury sphygmomanometers in the clinic and for research settings, but individual internal validation of each device is time-consuming. The aim of this study was to validate a new technique capable of testing two devices simultaneously, based on the International protocol of the European Society of Hypertension. The concept of the new technique is to measure blood pressure alternatively by two observers using a mercury sphygmomanometer and by two observers using the A&D UM-101 and Accoson Greenlight 300 devices, connected by Y-tube to obtain simultaneous readings with both nonmercury devices. Thirty-three participants were enrolled (mean age 47.2±14.0 years). Nine sequential blood pressure measurements were performed for each participant. Both devices passed phase 1 using 15 participants. In phase 2.1 (n=33), on a maximum of 99 measurements, the Accoson device produced 81/95/99 measurements within 5/10/15 mmHg for systolic blood pressure (SBP) and 87/98/99 for diastolic blood pressure (DBP). The A&D device produced 86/96/99 for SBP and 94/99/99 for DBP. In phase 2.2 (n=33), 30 participants had at least 2 out of 3 SBP obtained with Accoson device within 5 mmHg of the mercury device, as compared with 29 of 33 participants with the A&D device. For DBP, this was 33 of 33 participants for both devices. Both the nonmercury devices passed the International protocol. The new technique of simultaneous device testing using a Y-tube represents a time saving application of the International protocol.

Control Rates of Hypertension in North America

Despite the extensive evidence from epidemiological studies showing that hypertension is a major risk factor for premature cardiovascular morbidity and mortality and from randomized clinical trials showing that this risk can be markedly reduced by antihypertensive drug therapy, hypertension is generally considered to be poorly managed. Surveys performed in the 1990s reported low rates for awareness, treatment, and control of hypertension. Since better once-daily antihypertensive drugs with less adverse effects have become available and both healthcare providers and the general public appear to place more emphasis on prevention of cardiovascular disease, one may expect these advances to translate not only into more awareness of the presence of hypertension but also into better treatment and control rates. Indeed, successive reports from National Health and Nutrition Examination Survey (NHANES) reported progressive improvement in awareness, treatment, and control rates, up to 80.7%, 72.5%, and 50.1%, respectively, for the 2007–2008 survey.1 Two recent Canadian surveys reported even more substantial improvements in treatment and control rates in the general hypertension population. First, a survey in Ontario, the largest province of Canada, with an adult population of ≈8 million, reported 86.3% awareness, 80.5% treatment, and 65.7% control rates.2 Then, a Canada-wide survey provided similar high rates: 83.4,% 79.9,% and 65.9% for awareness, treatment, and control rates for adults with hypertension, 20 to 79 years of age.3 These rates are only 10% to 25% below the “optimal” rates that one may expect in a cross-sectional survey. The results from NHANES and …

Comparison of methods of measurement of the finger flexor muscles' strength through dynamometry and modified manual sphygmomanometer.

To evaluate the reproducibility of the modified sphygmomanometer compared to hand dynamometer to measure muscle strength of the flexor muscles of fingers. We assessed 40 healthy volunteers of both genders, aged between 20 and 55 years, who underwent the muscle strength test in the finger flexor muscles on both hands using two instruments for which the comparison was made between them. After statistical analysis by the paired Student's ttest, there was no significant difference between the values obtained in modified sphygmomanometer and hand dynamometer tests in relation to right and left sides (p > 0.05). Pearson's coefficient of correlation observed good correlations between them. The modified sphygmomanometer proved to be a reproducible technique for measuring muscle strength of the finger flexor muscles.

Electrical Power Failure in the Operating Room

Electrical Power Failure in the Operating Room

The reliability of toe systolic pressure and the toe brachial index in patients with diabetes.

BackgroundThe Ankle Brachial Index is a useful clinical test for establishing blood supply to the foot. However, there are limitations to this method when conducted on people with diabetes. As an alternative to the Ankle Brachial Index, measuring Toe Systolic Pressures and the Toe Brachial Index have been recommended to assess the arterial blood supply to the foot. This study aimed to determine the intra and inter-rater reliability of the measurement of Toe Systolic Pressure and the Toe Brachial Index in patients with diabetes using a manual measurement system.MethodsThis was a repeated measures, reliability study. Three raters measured Toe Systolic Pressure and the Toe Brachial Index in thirty participants with diabetes. Measurement sessions occurred on two occasions, one week apart, using a manual photoplethysmography unit (Hadeco Smartdop 45) and a standardised measurement protocol.ResultsThe mean intra-class correlation for intra-rater reliability for toe systolic pressures was 0.87 (95% LOA: -25.97 to 26.06 mmHg) and the mean intra-class correlation for Toe Brachial Indices was 0.75 (95% LOA: -0.22 to 0.28). The intra-class correlation for inter-rater reliability was 0.88 for toe systolic pressures (95% LOA: -22.91 to 29.17.mmHg) and 0.77 for Toe Brachial Indices (95% LOA: -0.21 to 0.22).ConclusionDespite the reasonable intra-class correlation results, the range of error (95% LOA) was broad. This raises questions regarding the reliability of using a manual sphygmomanometer and PPG for the Toe Systolic Pressure and Toe Brachial Indice.

Practical procedures: recording blood pressure

In the second of a series on practical procedures, Phil Jevon explains how to accurately and reliably measure blood pressure using a manual mercury sphygmomanometer.

Cluster-Randomized Controlled Trial of Oscillometric vs. Manual Sphygmomanometer for Blood Pressure Management in Primary Care (CRAB)

Although mercury sphygmomanometers are seen as the gold standard instrument for blood pressure (BP) measurement, they are being withdrawn due to safety concerns. CRAB was a cluster-randomized controlled trial in 24 family practices in Tasmania, Australia, which aimed to determine the effect of an oscillometric device on BP management. Cluster-randomized controlled trial. Intervention practices were supplied with automated monitors and control (usual care) practices used mercury or aneroid sphygmomanometers. They were subsequently audited by a research nurse. Usual care practice audit periods were matched to intervention practices. All analyses were intention-to-treat and adjusted for potential clustering. Differences in BP were analyzed using generalized estimating equations. All other outcomes were analyzed using multilevel mixed-effects Poisson regression. Post hoc analyses were performed to determine the mediators of changes in prescribing behavior. A total of 3,355 records were reviewed (828 visits had BP recordings). The percentage of BP recordings ending in "0" was significantly lower in intervention vs. usual care practices (systolic BP (SBP) 18% (107/587) vs. 71% (233/329), diastolic BP (DBP) 20% (119/584) vs. 70% (229/328), P < 0.001). The mean of SBP recordings in the intervention group was 7.5 mm Hg (95% confidence interval (CI) 5.2, 9.9 mm Hg, P < 0.001) higher than in the usual care group. Patients taking BP lowering drugs were more likely (incidence rate ratio (IRR) 1.3, 95% CI 1.1, 1.7, P = 0.01) to have a BP lowering drug prescribed if they were in the intervention compared to the usual care. Although digit preference was largely eliminated by oscillometric measurement, prescribing behavior was mediated by SBP.

Use of automated office blood pressure measurement to reduce the white coat response

To examine the possibility of reducing the white coat response using an automated sphygmomanometer designed for office use, the BpTRU. Consecutive patients referred from physicians in the community to an ambulatory blood pressure (ABP) monitoring unit in an academic hospital were included in the study. A total of 309 patients referred for diagnosis or management of hypertension were studied. Differences between mean awake ABP and BP readings taken by the patient's own physician using a manual sphygmomanometer or the automated BpTRU device with the patient resting alone in the ABP monitoring unit were compared. BP recorded in the examining room using an automated device (132 +/- 19/75 +/- 12) was similar to the mean awake ABP (134 +/- 12/77 +/- 10) with both values being lower (P < 0.001) than the BP recorded on a routine visit to the patient's own family physician (152 +/- 18/87 +/- 11). The coefficient of correlation between the systolic/diastolic ABP and the automated office BP (r = 0.62/0.72) was higher (P < 0.001) than with the family physician's manual BP (r = 0.32/0.48). The prevalence of white coat hypertension in untreated patients (n = 146) was significantly (P < 0.001) lower with automated office BP (16%) compared with the routine family physician BP (55%). The white coat response associated with office BP measurements can be virtually eliminated by recording BP with the automated BpTRU device with patients resting alone in a quiet examining room.

Automated versus manual blood pressure measurement: A randomized crossover trial

This study evaluated the accuracy and reliability of the Dinamap 8100 automated blood pressure machine against three internationally recognized criteria. Systolic and diastolic blood pressures were taken concurrently by two nurses using the automated machine and a manual sphygmomanometer. Results demonstrated agreement between automated and manual readings on one set of criteria for both systolic and diastolic pressures, and support for systolic readings only on one other criterion. Comparison of mean differences between automated and manual measures showed the automated machine consistently under-read both systolic and diastolic blood pressures. The conclusion from this study was that the Dinamap 8100 machine can be used with some degree of confidence to assess systolic blood pressures in a general population of adult hospital inpatients, but with caution when taking diastolic readings.

Blood, semen, and an innocent man

In August, 2007, a 30-year-old doctoral student, from Nigeria but living in London, noticed bright red blood in his ejaculate. The problem persisted for 2 months, so he went to see his general practitioner. There was no history of injury to the genitals or the prostate; the patient had used barrier contraception with his current and previous two girlfriends. The patient was not physically examined, but was advised to attend a walk-in genitourinary clinic. When he did so, 3 days later, his blood pressure was 244/170 mm Hg. He was given 5 mg amlodipine, and sent to hospital. There, repeated measurements, with a manual sphygmomanometer, gave a blood pressure of around 239/141 mm Hg, in both arms. The patient’s blood pressure had last been measured 10 years before, when he had been told it was “a little high”. He had never taken antihypertensive drugs. He had been feeling entirely well, although, on close questioning, he described having had a nosebleed and headache 2 months before noticing the blood in his ejaculate. He had no other relevant medical history, and was a lifelong non-smoker. Inspection showed no signs of Cushing’s syndrome, acromegaly, or systemic sclerosis. Physical examination, including neurological, genital, and rectal examination, showed nothing abnormal— notably, radiofemoral delay and renal bruits were absent, and the patient scored 10/10 on the abbreviated mental test score. Dipstick testing of urine showed much protein, but not blood. Urine microscopy showed no casts. Blood tests showed nothing abnormal: notably, concentrations of calcium, creatinine, C-reactive protein, autoantibodies, and prostate-specifi c antigen were normal. Serological and immunological testing showed no evidence of HIV or tuberculosis, respectively. Microscopy and culture of urethral swabs showed no evidence of syphilis, chlamydia, or gonorrhoea. An electrocardiogram showed severe leftventricular hypertrophy; radiography of the chest showed no evidence of aortic coarctation. Fundoscopy showed bilateral papilloedema, but no haemorrhages. Ultrasonography showed kidneys of normal size, without cysts. CT of the abdomen showed nothing abnormal— and specifi cally, no adrenal masses. The patient’s blood pressure was lowered gradually, over several days, with amlodipine, ramipril, and intravenous glyceryl trinitrate; meanwhile, we took three 24-h urine collections: after the collections were done, we started treatment with atenolol, having stopped the glyceryl trinitrate. Urinary concentrations of catecholamines were normal, confi rming that the patient did not have a phaeochromocytoma. Retinal photography showed resolution of the papilloedema, but many cotton-wool spots and nerve-fi bre-layer (“fl ame”) haemorrhages (fi gure)—consistent with grade 3 hypertensive retinopathy. The plasma renin:aldosterone ratio is awaited. The diagnosis is essential hypertension or hyperaldosteronism. The patient was discharged 10 days after admission. When last seen by us, in late November, 2007, his blood pressure was around 150/96 mm Hg; he continued to feel well, and had no blood in his semen. Haematospermia is most commonly caused by infection or injury—including iatrogenic injury from taking biopsy samples of the prostate. Other causes include stones, cysts, vascular abnormalities—and severe hypertension, which causes an estimated 5% of cases. Malignant hypertension is defi ned as blood pressure over 180/100 mm Hg, with papilloedema or retinal haemorrhage. Although malignant hypertension can occur in essential hypertension, causes of secondary hypertension should always be sought. Apart from haemato spermia, our patient was asymptomatic—as are around 10% of people with malignant hypertension. Nonetheless, leftventricular hypertrophy, proteinuria, and retinopathy indicated pronounced end-organ damage, consistent with severe, longstanding hypertension.

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.

Association of pulse wave velocity with vascular and valvular calcification in hemodialysis patients

The recent Kidney Disease: Improving Quality Outcomes (KDIGO) recommendations called for an investigation of the relationship between various radiological methods to assess cardiovascular calcification and measures of arterial stiffness. Accordingly, in 131 adult maintenance hemodialysis patients, we investigated the association of aortic pulse wave velocity (PWV) with calcification of cardiac valves on echocardiography, coronary artery, and thoracic aorta calcium on computed tomography and a calcification score of the abdominal aorta obtained on a plain abdominal X-ray. All tests were performed within a week. Mean PWV increased as the severity of coronary artery, thoracic, and abdominal aorta calcium scores increased (each P<0.05). No trend was present for number of valves with calcification. After multivariable adjustment, abdominal aorta X-ray calcium scores remained associated with PWV (P=0.004), whereas the association of PWV with thoracic aorta and coronary artery calcium scores became marginal (P=0.308 and P=0.083, respectively). No association was found between number of calcified valves and PWV. This study demonstrates a strong association between abdominal aorta calcification on plain X-ray and PWV and a borderline association with thoracic aorta and coronary artery calcification. Sudden death and congestive heart failure, two frequent causes of death in hemodialysis, are likely caused by increased arterial stiffness that can be closely predicted by the presence of aortic calcification on plain X-rays.

Blood pressure levels and psychosocial stress in students of health sciences. University of Valle, Cali, Colombia, 2003-2004.

Objective: To evaluate the levels of family stress, social stress and the blood pressure levels in young people and the possible correlation. Materials and methods: A descriptive study was performed recruiting healthy students of health sciences in the University of Valle in Cali, Colombia during 2002-2003. The psychosocial stress inventory included evaluation of the family stress and the evaluation of social stress. The blood pressure was evaluated by physicians using standardized technique with calibrated manual sphygmomanometers. Results: 185 students were recruited with an average age of 21.2±2.6 years old, 178 (96%) were singles, 100 (54%) were women, 173 (93.5%) were of mixed ethnic background, 154 (83.2%) were from middle socioeconomic level (level 3-4). The family dysfunction was observed in 131 (70.8%) students, 66 (35.6%) had high cumulative social changes. The average blood pressure level in all students was normal (106.4/69.7) with high blood pressure levels in males than in females (p&lt; 0.001) associated with the body mass index (p&lt; 0.001) and the black race ( p&lt; 0.02). Family dysfunction was not associated with changes in blood pressure (p=0.80). Social stress was not associated with blood pressure levels (p=0.98). Conclusion: In young people psychosocial stress was high but did not affect blood pressure levels probably due to compensatory physiologic action of vascular endothelium.