Screening Blood Pressure Measurements Research Articles

COMMUNITY EMPOWERMENT FOR PREVENTION AND SCREENING OF COVID-19 COMORBID DISEASE IN AYAPO VILLAGE

Public awareness in facing the Corona Virus Disease-19 (Covid-19) pandemic is decreasing, many are neglecting the use of masks, keeping a safe distance of 1-2 meters, washing hands with soap and the use of hand sanitizers has also decreased. This shows that the fact that the incidence of covid-19 cases is increasing. The surge in Covid-19 patients is still not under control by many countries, but some of them have experienced a decline. After almost recording 100,000 new Covid-19 patients in a day. Awareness in preventing covid-19 by implementing public health protocols is decreasing. Therefore, it is necessary to have the involvement of village community leaders, religious leaders, youth leaders, women leaders, youth coral cadets, heads of community health centers and local governments to make the village community aware. We will form a covid-19 task force team in Ayapo Village. The examination of Comorbid Diseases by screening blood pressure measurements, measuring cholesterol levels, and measuring uric acid levels in adult patients in Ayapo Village The purpose of this community service is to prevent the spread of Corona virus disease-19 in Ayapo Village. This community service method is with a quantitative approach by providing health counseling to the community, screening for comorbid corona virus disease-19. The results showed that the knowledge of the people of Ayapo village about Corona virus disease- 19 was most dominant knowledge with a total of 58 people (81.7%) and the least was good knowledge totaling 2 people (2.8%). Conclusion: Community knowledge and public awareness in preventing covid-19 in Ayapo Village are still lacking.

Comparison of Blood Pressure in Women with and without Premenstrual Syndrome

Background: Premenstrual syndrome is one of the common disorders in women, which occurs periodically in the luteal phase of the menstrual cycle. High blood pressure seems to be one of the problems that can occur with premenstrual syndrome. Objectives: This study aimed to compare blood pressure changes in two groups with and without premenstrual syndrome. Methods: This is a descriptive-comparative study. The population of the study was the students of Tehran Islamic Azad University of Medical Sciences. Data were collected using a premenstrual syndrome screening questionnaire and blood pressure measurement that were then analyzed with SPSS at a significance level of α = 0.05. Results: According to 1,408 questionnaires collected, 580 people had the premenstrual syndrome. Comparison of blood pressure before menstruation showed a significant difference between the two groups with and without premenstrual syndrome (P < 0.001). Conclusions: An increase in blood pressure in the group with premenstrual syndrome requires investigating hypertension and planning for educational programs for preventing and controlling blood pressure in people with premenstrual syndrome.

Screening blood pressure measurement in the Russian population (the results of the МММ17 activity)

Background. The International Society of Hypertension and World Hypertensive League therefore joined forces to organize a concerted global effort by expanding World Hypertension Day to May Measurement Month 2017 (MMM17). The campaign was aimed to improve hypertension awareness and blood pressure control in participants with hypertension. Russian Society of Cardiology supported initiative — blood pressure measurement was performed in 11 Russian cities.Objective. The aim of our study was to estimate Russian population awareness about blood pressure in terms of campaign MMM17.Design and methods. During May 2017 we screened 1532 participants in 11 Russian cities: St Petersburg (119 participants), Moscow (102), Belgorod (28), Bryansk (405), Kemerovo (142), Krasnoyarsk (154), Samara (67), Saratov (59), Stavropol (269), Ulyanovsk (50), Surgut (137). All subjects participated voluntarily. Inclusion criteria was age age older than 18 years old. Blood pressure (BP) was measured three times with automated and manual sphygmomanometers. Questionnaire regarding diabetes mellitus, cardiovascular diseases, smoking and alcohol intake was filled in. Respondents provided information about weight and height.Results. We examined 1532 participants aged 39,3 ± 18,7 years (from 18 to 90 years old), among them 509 (33,2 %) males and 1023 (66,8 %) females. All participants were divided into 3 groups according to the date of the last BP measurement: group 1 — BP has never been checked before (n = 188, 12,3 %), group 2 — less than one year ago (n = 630, 41,1 %), group 3 — more than one year ago (n = 714, 46,6 %).Conclusions. About half of Russian participants checked blood pressure last time more than one year ago. Insufficient awareness, low compliance to antihypertensive medication and poor blood pressure control were found in Russian population independently of gender and age in both primary and secondary prevention.

Hypertension management in rural primary care facilities in Zambia: a mixed methods study

BackgroundImproved primary health care is needed in developing countries to effectively manage the growing burden of hypertension. Our objective was to evaluate hypertension management in Zambian rural primary care clinics using process and outcome indicators to assess the screening, monitoring, treatment and control of high blood pressure.MethodsBetter Health Outcomes through Mentoring and Assessment (BHOMA) is a 5-year, randomized stepped-wedge trial of improved clinical service delivery underway in 46 rural Zambian clinics. Clinical data were collected as part of routine patient care from an electronic medical record system, and reviewed for site performance over time according to hypertension related indicators: screening (blood pressure measurement), management (recorded diagnosis, physical exam or urinalysis), treatment (on medication), and control. Quantitative data was used to develop guides for qualitative in-depth interviews, conducted with health care providers at a proportional sample of half (20) of clinics. Qualitative data was iteratively analyzed for thematic content.ResultsFrom January 2011 to December 2014, 318,380 visits to 46 primary care clinics by adults aged ≥ 25 years with blood pressure measurements were included. Blood pressure measurement at vital sign screening was initially high at 89.1% overall (range: 70.1–100%), but decreased to 62.1% (range: 0–100%) by 48 months after intervention start. The majority of hypertensive patients made only one visit to the clinics (57.8%). Out of 9022 patients with at least two visits with an elevated blood pressure, only 49.3% had a chart recorded hypertension diagnosis. Process indicators for monitoring hypertension were <10% and did not improve with time. In in-depth interviews, antihypertensive medication shortages were common, with 15/20 clinics reporting hydrochlorothiazide-amiloride stockouts. Principal challenges in hypertension management included 1) equipment and personnel shortages, 2) provider belief that multiple visits were needed before official management, 3) medication stock-outs, leading to improper prescriptions and 4) poor patient visit attendance.ConclusionsOur findings suggest that numerous barriers stand in the way of hypertension diagnosis and management in Zambian primary health facilities. Future work should focus on performance indicator development and validation in low resource contexts, to facilitate regular and systematic data review to improve patient outcomes.Trial registrationClinicalTrials.gov, Identifier NCT01942278. Date of Registration: September 2013.

Clinical and Epidemiological Implications of 24-Hour Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Kenyan Adults: A Population-Based Study.

BackgroundThe clinical and epidemiological implications of using ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension have not been studied at a population level in sub‐Saharan Africa. We examined the impact of ABPM use among Kenyan adults.Methods and ResultsWe performed a nested case–control study of diagnostic accuracy. We selected an age‐stratified random sample of 1248 adults from the list of residents of the Kilifi Health and Demographic Surveillance System in Kenya. All participants underwent a screening blood pressure (BP) measurement. All those with screening BP ≥140/90 mm Hg and a random subset of those with screening BP <140/90 mm Hg were invited to undergo ABPM. Based on the 2 tests, participants were categorized as sustained hypertensive, masked hypertensive, “white coat” hypertensive, or normotensive. Analyses were weighted by the probability of undergoing ABPM. Screening BP ≥140/90 mm Hg was present in 359 of 986 participants, translating to a crude population prevalence of 23.1% (95% CI 16.5–31.5%). Age standardized prevalence of screening BP ≥140/90 mm Hg was 26.5% (95% CI 19.3–35.6%). On ABPM, 186 of 415 participants were confirmed to be hypertensive, with crude prevalence of 15.6% (95% CI 9.4–23.1%) and age‐standardized prevalence of 17.1% (95% CI 11.0–24.4%). Age‐standardized prevalence of masked and white coat hypertension were 7.6% (95% CI 2.8–13.7%) and 3.8% (95% CI 1.7–6.1%), respectively. The sensitivity and specificity of screening BP measurements were 80% (95% CI 73–86%) and 84% (95% CI 79–88%), respectively. BP indices and validity measures showed strong age‐related trends.ConclusionsScreening BP measurement significantly overestimated hypertension prevalence while failing to identify ≈50% of true hypertension diagnosed by ABPM. Our findings suggest significant clinical and epidemiological benefits of ABPM use for diagnosing hypertension in Kenyan adults.

Screening blood pressure measurement in children: are we saving lives?

Blood Pressure screening in children and adolescents is currently recommended by several prominent medical organizations, including the American Heart Association, the National High Blood Pressure Education Program, the National Heart, Lung, and Blood Institute, the European Society of Hypertension, and the American Academy of Pediatrics. This practice was recently subject to intense scientific review by the U.S. Preventive Services Task Force. The conclusion of the Task Force was that "current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents." This commentary provides an alternate interpretation of current evidence for blood pressure screening in children and adolescents and highlights its importance as a part of routine medical care.

Blood pressure levels and prevalence of arterial hypertension in Irkutsk state of Russia

Purpose: Irkutsk state is a typical Siberian region characterized by large territory, small density of population, cold weather and medical aid shortage. All this conditions are stress factors that may influence to prevalence of hypertension. The aim of the study was to investigate blood pressure levels and prevalence of arterial hypertension in population of working people in rural and the farthest areas of Irkutsk state of Russia. Methods: Screening blood pressure measurements were taken of 1002 individuals (229 men, 773 women) 18-72 years old (average age was 46.5±12.6 years). Study sample was formed by randomization method. Results: Mean systolic blood pressure consisted of 140.6 mm Hg (95% CI=139.1-142.2 mm Hg), mean diastolic blood pressure consisted of 85.9 mm Hg (95% CI=85.1-86.7 mm Hg). Age and sex adjusted prevalence of arterial hypertension consisted of 48.1% (95% CI=45.0-51.3). ![Figure][1] Hypertension prevalence combined by age Conclusion: The prevalence of hypertension in Irkutsk state are high enough and exceed such rates in other regions of Russia and many other countries. [1]: pending:yes

Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study

The diagnosis of hypertension has traditionally been based on blood-pressure measurements in the clinic, but home and ambulatory measurements better correlate with cardiovascular outcome, and ambulatory monitoring is more accurate than both clinic and home monitoring in diagnosing hypertension. We aimed to compare the cost-effectiveness of different diagnostic strategies for hypertension. We did a Markov model-based probabilistic cost-effectiveness analysis. We used a hypothetical primary-care population aged 40 years or older with a screening blood-pressure measurement greater than 140/90 mm Hg and risk-factor prevalence equivalent to the general population. We compared three diagnostic strategies-further blood pressure measurement in the clinic, at home, and with an ambulatory monitor-in terms of lifetime costs, quality-adjusted life years, and cost-effectiveness. Ambulatory monitoring was the most cost-effective strategy for the diagnosis of hypertension for men and women of all ages. It was cost-saving for all groups (from -£56 [95% CI -105 to -10] in men aged 75 years to -£323 [-389 to -222] in women aged 40 years) and resulted in more quality-adjusted life years for men and women older than 50 years (from 0·006 [0·000 to 0·015] for women aged 60 years to 0·022 [0·012 to 0·035] for men aged 70 years). This finding was robust when assessed with a wide range of deterministic sensitivity analyses around the base case, but was sensitive if home monitoring was judged to have equal test performance to ambulatory monitoring or if treatment was judged effective irrespective of whether an individual was hypertensive. Ambulatory monitoring as a diagnostic strategy for hypertension after an initial raised reading in the clinic would reduce misdiagnosis and save costs. Additional costs from ambulatory monitoring are counterbalanced by cost savings from better targeted treatment. Ambulatory monitoring is recommended for most patients before the start of antihypertensive drugs. National Institute for Health Research and the National Institute for Health and Clinical Excellence.

Blood pressure levels and prevalence of arterial hypertension in the rural and the farthest areas of Irkutsk region

The aim of the study was to investigate blood pressure levels and the prevalence of arterial hypertension in population of working people in rural and the farthest areas of Irkutsk region. Screening blood pressure measurements were taken in 1002 individuals (229 men, 773 women) 18-72 years old (mean age was 46,5 ± 12,6 years). Mean systolic blood pressure was 140,6 mm Hg (95%CI = 139,1-142,2 mm Hg), mean diastolic blood pressure was 85,9 mm Hg (95%CI = 85,1-86,7 mm Hg). Age and sex adjusted prevalence of arterial hypertension was 48,1%.

Introversion associated with large differences between screening blood pressure and home blood pressure measurement: the Ohasama study

To explore the effect of personality on screening blood pressures measured in clinical settings and home blood pressure measurements. From 1997 to 1999, 699 participants underwent screening and home blood pressure measurements and completed the Japanese version of the short-form Eysenck personality questionnaire. An increased screening blood pressure was defined as screening blood pressure > or = 140/90 mmHg and an increased home blood pressure was defined as home blood pressure > or = 135/85 mmHg. Participants with lower extroversion scores (i.e., introversion) showed a greater difference between screening and home systolic blood pressure. The association between introversion and differences was statistically significant, even after adjustment for other possible factors (younger age, female, wide screening pulse pressure, never smoked, and no antihypertensive medication). The adjusted means of SBP differences were 7.3 and 4.4 mmHg among the lowest and highest extroversion quartiles, respectively (P for trend = 0.02). Other personality scores (psychoticism or neuroticism) were not associated with screening and home blood pressure differences. The incorporation of an extroversion score in the basic model consisting of the above factors that affected the difference between screening and home blood pressure slightly improved the prediction of a high home blood pressure. The area under the receiver operating characteristic curve increased by 0.037 among participants with high screening blood pressure and 0.006 for those with normal screening blood pressure compared with the basic model. Physicians may need to be aware of 'introverted' patients who have high blood pressure in clinic settings, because they have the potential for 'white-coat' hypertension.

Prediction of stroke by self-measurement of blood pressure at home versus casual screening blood pressure measurement in relation to the Joint National Committee 7 classification: the Ohasama study.

To compare the predictive power of self-measured home blood pressure (HBP) and casual blood pressure (CBP) for stroke risk in relation to the Joint National Committee 7 (JNC-7) classification. HBP and CBP measurements were taken in 1702 subjects (> or =40 years) without a history of stroke, who were followed up for an average of 11 years. Subjects were classified into 4 groups on the basis of either HBP or CBP, according to the JNC-7 criteria: group 1 (HBP <115/75 mm Hg; CBP <120/80 mm Hg); group 2 (115/75< or =HBP<135/85 mm Hg; 120/80< or =CBP<140/90 mm Hg); group 3 (135/85< or =HBP<150/95 mm Hg; 140/90< or =CBP<160/100 mm Hg); and group 4 (HBP> or =150/95 mm Hg; CBP > or =160/100 mm Hg). Groups 2, 3, and 4 were further divided into 2 subgroups (a and b): those without and with cardiovascular disease risks, respectively. The risk of the first stroke in these groups was examined by the Cox hazards model adjusted for age and sex. The stroke risk in groups 3b and 4b (defined by HBP and CBP) was 2 to 5x higher than that in group 1 with significant differences. The risk in groups 2a, 3a, and even 4a was not significantly different from that in group 1 by the CBP-based classification, but the risk in group 4a was significantly higher than that in group 1 by the HBP-based classification, which also showed a stepwise increase in risk from groups 2a to 4a. The JNC-7 classification had a stronger predictive power using HBP-based classification compared with CBP-based classification, suggesting the usefulness of HBP in the management of hypertension.

High screening blood pressure is related to sympathetic nervous system activity and insulin resistance in healthy young men

The cardiovascular metabolic syndrome is characterized by the presence of several cardiovascular risk factors, including blood pressure (BP) elevation. We aimed to study the relation between mental stress, plasma catecholamines, BP and BP responses to mental stress in healthy young Caucasian men selected from different levels of screening BP. We included 98 men with high and 22 men with normal screening BP. They were examined at baseline in the laboratory, during a hyperinsulinemic, isoglycemic glucose clamp and during mental stress. At baseline in the laboratory, the men with high screening BP were characterized by elevated BP (p < 0.005) and plasma catecholamines (p < 0.05), but unaltered serum lipid levels compared to men with normal screening BP. After 2 h rest the differences almost disappeared, but could be reproduced during a mental arithmetic stress test. The men with elevated screening BP had significantly higher fasting glucose (p = 0.01) and lower insulin sensitivity (p < 0.005). In a multiple regression model, norepinephrine during mental stress (R2 = 0.10, p < 0.05) was the main variable to retrospectively explain allocation to the normal or high screening BP group. In conclusion, young healthy men with elevated screening BP are characterized by increased sympathetic activity and insulin resistance. Norepinephrine during mental stress is the main variable to explain allocation to the normal or elevated screening BP group. We have shown that one single screening BP measurement predicts insulin resistance and elevated fasting glucose in this cohort.

Reproducibility of Home Blood Pressure Measurements Over a 1-Year Period

We compared the reproducibility over time of blood pressure measured at the health examinations (screening blood pressure) and blood pressure measured at home (home blood pressure). Both screening and home blood pressure were measured in subjects of a rural community. Subjects measured their own blood pressure at home once in the morning using a semiautomatic oscillometric blood pressure measuring device at least three times (on at least 3 days) in each of two 4-week periods separated by one year. Similarly, two screening blood pressure measurements were obtained from the subjects at each of two health examinations also taken 1 year apart. A total of 136 untreated subjects without cardiovascular complications (40 men and 96 women, 56 +/- 11.7 years, mean +/- SD) were analyzed in the study. The correlations between the first and second blood pressure measurements of the subjects were significantly higher for the home blood pressure measurements (systolic: r = 0.844 and diastolic: r = 0.830) than for the screening blood pressure measurements (systolic: r = 0.692 and diastolic: r = 0.570). The mean differences between the first and second home blood pressure (0.8 +/- 7.7 mm Hg for systolic BP and 0.9 +/- 5.5 mm Hg for diastolic BP) were significantly smaller than those for the screening blood pressure (-3.9 +/- 13.8 for systolic BP and -3.1 +/- 10.2 for diastolic BP) (P < .001 for both comparisons), suggesting that the reproducibility of home blood pressure over time is superior to that of screening blood pressure. Such reliable blood pressure measurements obtained at home have a clinical significance for the diagnosis and treatment of hypertension and as a tool for evaluating the efficacy of antihypertensive drugs. Home blood pressure measurements also may be more useful than screening blood pressure measurements in predicting future cardiovascular events.

Prevalence of hypertension and rate of blood pressure control as assessed by home blood pressure measurements in a rural Japanese community, Ohasama.

A cross-sectional community survey using home blood pressure measurements was performed in northern Japan to estimate the prevalence of definite hypertension, white coat hypertension and the success of blood pressure control in patients receiving antihypertensive drugs. A total of 1334 subjects (mean age +/- SD, 53.8 +/- 17.3 years; 8-91 years) participated in the screening and home blood pressure measurement program. They measured blood pressure at home at least 3 times (mean measurement frequency, 20.8 +/- 8.3 times). Of these 1334 subjects, 314 (65.1 +/- 8.9 years) were taking drugs (treated group) while 1020 (50.3 +/- 17.8 years) were not (untreated group). The WHO criteria were used to categorize screening blood pressure. Criteria for diagnosis of hypertension by home blood pressure measurements were as follows: definitely hypertensive (systolic blood pressure > or = 144 mmHg and/or diastolic blood pressure > or = 89 mmHg) and normotensive (104 < systolic blood pressure < or = 131 mmHg and 60 < diastolic blood pressure < or = 79 mmHg). Of the 1018 subjects identified as normotensive on screening measurements, home measurements indicated that 73 (7.2%) were hypertensive and 765 (74.7%) were normotensive or lower. Of the 112 subjects identified as hypertensive on screening measurements, home measurements showed that 42 (37.5%) were hypertensive and 30 (26.8%) were normotensive or lower. Of the 314 treated subjects, 45 (14.3%) were identified as hypertensive by screening measurements and 88 (28.0%) as hypertensive by home measurements. Only 20 (44.4%) of the former 45 subjects were also defined as definitely hypertensive by home measurements. Of the 1020 untreated subjects, 67 (6.6%) were hypertensive by screening measurements and 84 (8.2%) by home measurements. Only 22 (32.8%) of the former 67 subjects were classified as hypertensive by home measurements. Of the 67 untreated subjects identified as hypertensive by screening measurements, 20 (29.9%) were normotensive or lower by home measurements, suggesting that these subjects were "white coat" hypertensives. The study first confirmed based on the large community data that there are large discrepancies between screening (casual) blood pressure and home blood pressure measurements for recognition of hypertension and normotension. Determination of blood pressure levels by home blood pressure measurements may predict prognosis of hypertension differently from that by screening blood pressure measurements. Further prospectively study is needed to validate the prognostic value of home blood pressure measurements.

Ambulatory blood pressure monitoring in evaluating the prevalence of hypertension in adults in Ohasama, a rural Japanese community.

We estimated the prevalence of hypertension and evaluated the degree of blood pressure control on the basis of ambulatory blood pressure monitoring in patients receiving antihypertensive medication. A total of 969 adults (mean age +/- SD, 59.3 +/- 12.1 years old range: 20-79 yr) among 1,575 eligible persons (65.1%) recruited from a total adult population of 2,789 people living in a rural region of northern Japan underwent measurement of initial screening blood pressure; ambulatory blood pressure was measured subsequently. A total of 285 subjects (66.5 +/- 9.2 years old) were taking antihypertensive medication (treated group), while 684 (56.3 +/- 12.0 years old) were not (untreated group). The WHO criteria were used to categorize screening blood pressure. Ambulatory blood pressure levels were classified as follows: hypertension, systolic blood pressure > or = 144 mmHg and/or diastolic blood pressure > or = 85 mmHg; and normotension, systolic blood pressure < or = 133 and diastolic blood pressure < or = 78 mmHg. Of the 285 treated subjects, 49 (17.2%) were classified as hypertensive by screening measurements, while 36 (12.6%) were classified as such by ambulatory blood pressure monitoring. Only 12 (24.5%) of the former 49 subjects were also classified as hypertensive, while 20 (40.8%) were classified as normotensive by ambulatory blood pressure monitoring. Of the 684 untreated subjects, 34 (5.0%) were hypertensive by screening measurements and 43 (6.3%) were hypertensive by ambulatory blood pressure monitoring. Only 14 (41.2%) of the former 34 subjects were classified as hypertensive by ambulatory blood pressure monitoring. Of the 34 untreated subjects classified as hypertensive by screening measurements, ambulatory blood pressure monitoring showed 12 (35.3%) to be normotensive, suggesting that they were cases of "white coat" hypertension. The study first confirmed, based on community-derived data, that there are large discrepancies between screening (casual) blood pressure measurements and ambulatory blood pressure monitoring with respect to the recognition of hypertension and normotension. The determination of blood pressure levels by ambulatory blood pressure monitoring may result in a different prognosis of hypertension from that made on the basis of screening blood pressure measurements. The prognostic value of ambulatory blood pressure has to be further investigated.

Eye color and hypertension

We searched for predictors of essential hypertension in 1,031 persons aged 30–49 who were observed to progress from normotension to hypertension, as compared to an equal number of matched subjects who remained normotensive. Blood pressure status was well documented in both multiphasic screenings and clinical records. Compared to persons with each lighter eye color, those with brown eyes were more prone to develop hypertension, with relative risk of 1.5 (95% confidence interval 1.18–1.96) compared to all persons with nonbrown eyes. The association persisted after control for race, sex, body mass index, alcohol use, educational level, parental history of hypertension, and among whites, for ethnic origin as crudely estimated by last name. Partial confirmation was obtained in three largely independent study groups: 1) 25 pairs of eye-color-discordant dizygotic twins; 2) 894 pairs of incident hypertensives and controls selected only with multiphasic screening blood pressure measurements; and 3) cross-sectional analysis of 152,018 multiphasic screenees. The weak association of eye color with hypertension clearly requires futher confirmation. Although it has little potential for use in screening or clinical care, it may have implications regarding etiology. Areas for further exploration include the close metabolic relation of melanins to catecholamines, both derived from the amino acid tyrosine, and the possibility that dark-eyed persons react more quickly and strongly to stimuli than light-eyed persons.

Prevalence of “significant” hypertension in junior high school-aged children: The Children and Adolescent Blood Pressure Program

Blood pressure (BP) data obtained during a BP screening program were analyzed to determine the prevalence of "significant" hypertension, defined by the Second National Heart, Lung, and Blood Institute Task Force on Blood Pressure Control in Children-1987 as the level of BP above which medical evaluation and intervention are recommended. In 14,686 black and white St. Paul and Minneapolis schoolchildren aged 10 to 15 years, BP was measured twice during an initial screening examination. Children with systolic BP in the upper 30 percentiles of distribution after the initial screening had their BP remeasured two additional times at a rescreening examination. The prevalence of significant hypertension was determined according to BP criteria established by the Task Force report. After the two screening BP measurements were averaged, significant systolic hypertension was found in 1.0%, significant diastolic hypertension in 3.5%, and significant systolic or diastolic hypertension, or both, in 4.2% of the students. After the rescreening examination, the percentage of students remaining with significant hypertension was reduced to 0.3% for systolic, 0.8% for diastolic, and 1.1% for systolic or diastolic hypertension, or both. These results show that significant hypertension is uncommon in pre-high-school students and confirm the need for repeated BP measurements to make an accurate diagnosis of hypertension. However, the results should not detract from current recommendations to monitor BP in children on a yearly basis to detect longitudinal BP tracking patterns that may be consistent with early essential hypertension.

CHANGING RELATION BETWEEN HOME AND CLINIC BLOOD-PRESSURE MEASUREMENTS: DO HOME MEASUREMENTS PREDICT CLINIC HYPERTENSION?

Blood-pressure screening in a family health centre identified 114 patients (53 male, 61 female) with diastolic pressures of 95 mm Hg and greater after three readings in the seated position (mean 163 [SEM 2]/104 [1] mm Hg). All were instructed in the use of the 'Copal UA 231/251' electronic sphygmomanometer and produced a series of readings taken at home over 3 days. They were recalled after 2 weeks and 4 weeks for repeat clinic measurements of blood pressure. Blood pressure fell on successive clinic visits; at the final visit only 59 patients (31 male, 28 female) had diastolic pressures of 95 mm Hg or greater. Average day-time home blood-pressure measurements (155 [2]/94 [2] mm Hg) were significantly lower than the screening blood-pressure measurements but were not significantly different from those at the third clinic visit (154 [2]/97 [1] mm Hg). Home blood-pressure measurements were successful in predicting outcome at the third clinic visit in 90 (79%) patients; home-monitored pressures suggested normotension when the final clinic visit diastolic blood pressure was still above 95 mm Hg in only 16 (14%) patients. Only 2 of these had a final clinic diastolic pressure above 105 mm Hg. Home monitoring represents a practicable and acceptable alternative to repeated clinic measurements in the initial assessment of hypertensive patients.

VALUE OF BLOOD-PRESSURE MEASUREMENT IN RELATIVES OF HYPERTENSIVE PATIENTS

First-degree relatives of hypertensive patients are more likely to comply with a request to visit their general practitioner for a screening blood-pressure measurement than are the relatives of normotensive controls. On average they have higher blood-pressure levels and are more likely to be started on treatment as a result of screening. In the majority of cases treatment can be maintained long-term and blood pressure falls to acceptable levels. The relatives of people already on treatment for hypertension include a high proportion of potential candidates for treatment, and screening of this group may be worth while.