Recommendations For Blood Pressure Measurement Research Articles

Recommendations for blood pressure measurement in large arms in research and clinical practice: position paper of the European society of hypertension working group on blood pressure monitoring and cardiovascular variability.

: Blood pressure measurement in obese individuals can be challenging because of the difficulty in properly cuffing large upper arms. Achieving a proper cuff fit can be problematic especially in people with a shorter arm length relative to circumference. This expert statement provides recommendations on blood pressure measurement in large arms for clinical use and research purposes. Tronco-conically shaped cuffs should be used in people with large arms, especially with arm circumferences greater than 42 cm as they better fit on the conical arm shape. Cuffs with frustum of the cone slant angle of 85° should satisfy most conditions. In individuals with short upper-arm that does not allow application of a properly sized cuff, wrist or forearm measurement might be used in clinical practice, but not for validation of automatic devices. Wide-range cuffs coupled to oscillometric devices provided with special software algorithms can also be used as alternatives to standard cuff measurement, provided they are independently validated per AAMI/ISO 81060-2 protocol. For validation studies, the intraarterial measurement is generally considered as the gold standard, yet for possible methodological pitfalls and ethical concerns, it is not recommended as the method of choice. Tronco-conical cuffs with inflatable bladder dimensions of 37-50 × 75-100% arm circumference should be used for reference auscultatory blood pressure measurement wherever the upper arm length allows a proper fit. There is a need for future studies that help identify the optimal shape of cuffs and bladders investigating the influence of sex, age, arm physical properties, and artery characteristics.

The Search for High-Impact Diagnostic and Management Tools for Low- and Middle-Income Countries: A Self-Powered Low-Cost Blood Pressure Measurement Device Powered by a Solid-State Vibration Energy Harvester.

The World Health Organization has established recommendations for blood pressure measurement devices for use in low-resource venues, setting the "triple A" expectations of Accuracy, Affordability, and Availability. Because of issues related to training and assessment of proficiency, the pendulum has swung away from manual blood pressure devices and auscultatory techniques towards automatic oscillometric devices. As a result of power challenges in the developing world, there has also been a push towards semiautomatic devices that are not dependent on external power sources or batteries. Beyond solar solutions, disruptive technology related to solid-state vibrational energy harvesting may be the next iterative solution to attain the ultimate goal of a self-powered low-cost validated device that is simple to use and reliable.

The 2014 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension

Herein, updated evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in Canadian adults are detailed. For 2014, 3 existing recommendations were modified and 2 new recommendations were added. The following recommendations were modified: (1) the recommended sodium intake threshold was changed from ≤ 1500 mg (3.75 g of salt) to approximately 2000 mg (5 g of salt) per day; (2) a pharmacotherapy treatment initiation systolic blood pressure threshold of ≥ 160 mm Hg was added in very elderly (age ≥ 80 years) patients who do not have diabetes or target organ damage (systolic blood pressure target in this population remains at < 150 mm Hg); and (3) the target population recommended to receive low-dose acetylsalicylic acid therapy for primary prevention was narrowed from all patients with controlled hypertension to only those ≥ 50 years of age. The 2 new recommendations are: (1) advice to be cautious when lowering systolic blood pressure to target levels in patients with established coronary artery disease if diastolic blood pressure is ≤ 60 mm Hg because of concerns that myocardial ischemia might be exacerbated; and (2) the addition of glycated hemoglobin (A1c) in the diagnostic work-up of patients with newly diagnosed hypertension. The rationale for these recommendation changes is discussed. In addition, emerging data on blood pressure targets in stroke patients are discussed; these data did not lead to recommendation changes at this time. The Canadian Hypertension Education Program recommendations will continue to be updated annually.

Prevalence of high blood pressure in Brazilian adolescents and quality of the employed methodological procedures: systematic review.

To review the literature on studies that estimated the prevalence of high blood pressure (HBP) or systemic arterial hypertension (SAH) in Brazilian adolescents, considering the employed methodological procedures. Bibliographical research of prevalence studies of HBP/SAH in adolescents from 1995 to 2010. The search was conducted in the electronic databases PubMed/Medline, Lilacs, SciELO, and Isi Adolec. The descriptors "hypertension", "BP", "teen", "students", "cross-sectional", "prevalence" and "Brazil" were used in Portuguese and English. Furthermore, a score ranging from 0 to 18 based on Recommendations for Blood Pressure Measurement in Humans and Experimental Animals and the VI Brazilian Guidelines of Hypertension was elaborated, in order to analyze the procedures used to measure BP in studies. Twenty-one articles were identified, mostly published in the last 10 years, and 90.5% were performed in school-based and regions of the Southeast, Northeast and South. The prevalence of HBP/SAH ranged from 2.5 to 30.9%. The score of the studies ranged from 0 to 16. A significant negative correlation (rho = -0.504; p = 0.020) was observed between the prevalence of HBP/SAH and the score of BP measurement quality. The great variability of PAE/SAH estimates appears to be influenced by methodological procedures used in the studies.

The 2013 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension

We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2013. This year's update includes 2 new recommendations. First, among nonhypertensive or stage 1 hypertensive individuals, the use of resistance or weight training exercise does not adversely influence blood pressure (BP) (Grade D). Thus, such patients need not avoid this type of exercise for fear of increasing BP. Second, and separately, for very elderly patients with isolated systolic hypertension (age 80 years or older), the target for systolic BP should be < 150 mm Hg (Grade C) rather than < 140 mm Hg as recommended for younger patients. We also discuss 2 additional topics at length (the pharmacological treatment of mild hypertension and the possibility of a diastolic J curve in hypertensive patients with coronary artery disease). In light of several methodological limitations, a recent systematic review of 4 trials in patients with stage 1 uncomplicated hypertension did not lead to changes in management recommendations. In addition, because of a lack of prospective randomized data assessing diastolic BP thresholds in patients with coronary artery disease and hypertension, no recommendation to set a selective diastolic cut point for such patients could be affirmed. However, both of these issues will be examined on an ongoing basis, in particular as new evidence emerges.

The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I – blood pressure measurement, diagnosis and assessment of risk

To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension. MEDLINE searches were conducted from November 2008 to October 2009 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only. Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Changes to the recommendations for 2010 relate to automated office blood pressure measurements. Automated office blood pressure measurements can be used in the assessment of office blood pressure. When used under proper conditions, an automated office systolic blood pressure of 135 mmHg or higher or diastolic blood pressure of 85 mmHg or higher should be considered analogous to a mean awake ambulatory systolic blood pressure of 135 mmHg or higher and diastolic blood pressure of 85 mmHg or higher, respectively. All recommendations were graded according to strength of the evidence and voted on by the 63 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. To be approved, all recommendations were required to be supported by at least 70% of task force members. These guidelines will continue to be updated annually.

The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 – blood pressure measurement, diagnosis and assessment of risk

To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension. The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, the degree of blood pressure elevation, the method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required. MEDLINE searches were conducted from November 2007 to October 2008 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only. Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes. All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations were required to be supported by at least 70% of task force members. These guidelines will continue to be updated annually.

Diabetes Mellitus and 24-Hour Ambulatory Blood Pressure Monitoring

Given the increase in prevalence of obesity, survival to older age, and urbanization, the projected global number of people with diabetes mellitus will double within decades (http://www.eatlas.idf.org/Prevalence). Physicians care for an ever-increasing load of elderly patients with diabetes mellitus. As a matter of fact, quality of care of patients with diabetes mellitus has become a measure of quality in internal medicine, and diabetes mellitus practice improvement modules are part of the American Board of Internal Medicine recertification program (http://www.abms.org/Maintenance\_of\_Certification). Recently it became clear that a major (and most reachable) intersection on the road to improving prognosis of patients with diabetes mellitus is the successful lowering of their blood pressure to levels well below those previously considered the goal for subjects without diabetes mellitus. The vast body of research regarding blood pressure of patients with (as well as without) diabetes mellitus relies on office blood pressure measurements. However, it is now clear that 24-hour ambulatory blood pressure (ABP) monitoring provides data that are more closely linked to patients’ daily behavior.1 Compared with office blood pressure, the 24-hour ABP average may be closer to the individual’s “true” blood pressure. This is the basis for the overall stronger links of the latter with target organ damage, cardiovascular events, and, ultimately, survival. Can we apply the vast knowledge generated from hypertensive and general populations with 24-hour ABP monitoring to patients with diabetes mellitus? Are …

The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 – blood pressure measurement, diagnosis and assessment of risk

To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension. The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, degree of blood pressure elevation, method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required. MEDLINE searches were conducted from November 2006 to October 2007 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed, full-text articles only. Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages in 2008 include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes. All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.

Left subclavian artery stenosis found by the interarm blood pressure difference during combined spinal-epidural anesthesia of patient with peripheral vascular disease - A case report -

In spite of the American Heart Association recommendations for blood pressure measurement, many physicians measure blood pressure in only one arm that is easy to access at the time of measurement. This practice can lead to incorrect management with significant interarm blood pressure difference. We report a case of a 51 years old man who was scheduled to undergo vascular bypass graft under combined spinal-epidural anesthesia . In 60 minutes after anesthesia, the blood pressure of left arm dropped from 110/65 mmHg to 74/45 mmHg. The blood pressure was still 80/50 mmHg after two injections of ephedrine. After checking radial pulse tone strength, we found significant interarm blood pressure difference. The blood pressure of right arm was 150/70 mmHg. Postoperative CT angiogram revealed significant stenotic portion in the left subclavian artery. This case emphasizes the importance of bilateral blood pressure measurement, especially in patients with peripheral vascular disease. (Korean J Anesthesiol 2008; 55: 229～32)

Unravelling perinatal programming of the kidney

to the editor: I read with great interest the paper of Baserga et al. ([1][1]), which describes the effect of uterine artery ligation in the pregnant rat on fetal cyclooxygenase-2 (COX-2) expression and blood pressure. This is an important subject and the study presents interesting results, but I

The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 – blood pressure measurement, diagnosis and assessment of risk

To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension. The diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the timely assessment of serially elevated readings, the degree of blood pressure elevation, the method of measurement (office, ambulatory, home) and any associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk, and to determine the urgency, intensity and type of treatment required. MEDLINE searches were conducted from November 2005 to October 2006 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed, full-text articles only. Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages in 2007 include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of assessing the risk of cerebrovascular events as part of global risk assessment, the need for ongoing reassessment of patients with high normal blood pressure, and reviews of recent studies involving laboratory testing and home monitoring. All recommendations were graded according to strength of the evidence and were voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.

Response to Recommendations for Blood Pressure Measurement in Human and Experimental Animals; Part 1: Blood Pressure Measurement in Humans and Miscuffing: A Problem With New Guidelines: Addendum

Since the recommendations for blood pressure measurement in humans were published,1 questions have been raised regarding the recommendations for cuff sizes in subjects with obese arms and how the width of the cuffs should relate to the length.2 In the 1993 recommendations,3 the largest recommended bladder width was 20 cm, whereas in the latest version it is 16 cm (Table). View this table: 1993 and 2005 Recommendations for Cuff Sizes in Obese and Overweight Subjects The 2005 document stated that, “the ‘ideal’ cuff should have a bladder length that is 80%, and a width that is at least 40% of arm circumference (a length to width ratio of 2:1). A recent study comparing intra-arterial and auscultatory blood pressure concluded that the error is minimized with a cuff width of 46% of the arm circumference.” The study that examined this issue was published by Marks and Groch,4 who measured blood pressure directly from the radial artery and indirectly from the brachial artery in 50 subjects who were in an intensive care unit and had intra-arterial lines as part of their routine care. The average arm circumference of these patients was 29.7 cm, and the published figure show that the highest circumference was 37 cm. Thus, only 2 of their 50 patients had arm circumferences in the 35 to 44 cm range, and none had circumferences …

Recommendations for Blood Pressure Measurement in Human and Experimental Animals; Part 1: Blood Pressure Measurement in Humans

To the Editor: The members of the Atherosclerosis, Hypertension, and Obesity in the Young Committee of the American Heart Association Council on Cardiovascular Disease in the Young believe it is of clinical importance to point out a discrepancy in the cuff size section of the recent American Heart Association Scientific Statement “Recommendations for Blood Pressure Measurement in Humans.”1 On page 705 of that document, the report states that “the ‘ideal’ cuff should have a …

The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I – Blood pressure measurement, diagnosis and assessment of risk

To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with high blood pressure. For persons in whom a high blood pressure value is recorded, a diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the level of the blood pressure elevation, the approach used to monitor blood pressure (office, ambulatory or home/self), and the duration of follow-up. In addition, the presence of cardiovascular risk factors and target organ damage should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, estimating the overall risk of adverse cardiovascular outcomes requires an assessment for other vascular risk factors and hypertensive target organ damage. MEDLINE searches were conducted from November 2004 to October 2005 to update the 2005 recommendations. Reference lists were scanned, experts were polled, and the personal files of the authors and subgroup members were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content and methodological experts. As per previous years, the authors only included studies that had been published in the peer-reviewed literature and did not include evidence from abstracts, conference presentations or unpublished personal communications. The present document contains recommendations for blood pressure measurement, diagnosis of hypertension, and assessment of cardiovascular risk for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for the diagnosis of hypertension and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory blood pressure monitoring, and the role of echocardiography for those with hypertension. Key features of the 2006 recommendations include continued emphasis on an expedited diagnosis of hypertension, an in-depth review of the role of global risk assessment in hypertension therapy, and the use of home/self blood pressure monitoring for patients with masked hypertension (subjects with hypertension who have a blood pressure that is normal in clinic but elevated on home/self measurement). All recommendations were graded according to the strength of the evidence and were voted on by the 45 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported herein received at least 95% consensus. These guidelines will continue to be updated annually.

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals: Part 1. Blood Pressure Measurement in Humans. A Statement for Professionals From the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals: Part 1. Blood Pressure Measurement in Humans. A Statement for Professionals From the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research

Normal Ambulatory Blood Pressure: A Clinical-Practice-Based Analysis of Recent American Heart Association Recommendations

Purpose The American Heart Association Council on High Blood Pressure Research recently issued recommendations for blood pressure measurement in humans. According to these recommendations, normal 24-hour ambulatory blood pressure is defined as less than 130/80 mm Hg. Concurrently, normal daytime and nighttime blood pressure levels are defined as less than 135/85 mm Hg and less than 120/70 mm Hg, respectively. Our aim was to investigate the intrinsic compatibility of these blood pressure cutoffs in clinical practice. Subjects and methods We analyzed 4121 consecutive ambulatory blood pressure measurement sessions. Age was 57 ± 7 years, 53% were female, and 64% and 9% were treated for hypertension and diabetes, respectively. Body mass index was 27 ± 4 kg/m 2, and manual blood pressure was 148 ± 22/85 ± 12 mm Hg. Subjects were classified as having normal 24-hour blood pressure if the corresponding value was less than 130/80 mm Hg. Normal awake-sleep blood pressure was diagnosed if awake blood pressure was less than 135/85 mm Hg and sleep blood pressure was less than 120/70 mm Hg. Results Concordance between the cutoffs was found in 92% of the subjects (kappa = 0.77). Among the 8% of discordant subjects, only 1% were hypertensive applying the 24-hour (but not awake-sleep) blood pressure values, whereas 7% were hypertensive according to awake-sleep but not 24-hour blood pressure values ( P <.0001). Conclusions In real-life ambulatory blood pressure measurement, a generally good agreement was found between the recently issued ambulatory blood pressure normality suggestions. However, some subjects are classified as hypertensive only according to one of these methods, more often by the awake-sleep cutoff of 135/85 and 120/70 mm Hg. This discordance may be significant in large-scale clinical blood pressure monitoring.

Recommendations for Blood Pressure Measurement in Animals

Accurate and meaningful measurements of blood pressure (BP) are often critical to the interpretation of studies of vascular biology, atherosclerosis, and other forms of cardiovascular disease. Although many research scientists have embraced advanced molecular technologies for studying cardiovascular function and disease pathogenesis, a surprising number of the same investigators continue to use suboptimal techniques for measuring BP in experimental animals. To address this problem and assist investigators in selecting optimal methods for BP monitoring, the American Heart Association (AHA) has developed a scientific statement on recommendations for BP measurement in experimental animals. These recommendations for BP measurement are briefly summarized in this article. The complete text and discussion of the recommendations are published online in Arteriosclerosis, Thrombosis, and Vascular Biology as well as in print in other AHA journals.1 Comprehensive recommendations for BP measurement in humans have also been developed and are published in the AHA journal Hypertension .2 See …

Comments on the New AHA Recommendations for Blood Pressure Measurement

Comments on the New AHA Recommendations for Blood Pressure Measurement

Recommendations for Blood Pressure Measurement in Humans: An AHA Scientific Statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee

Recommendations for Blood Pressure Measurement in Humans: An AHA Scientific Statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee