Single Blood Pressure Reading Research Articles

Abstract 15624: The Impact of One versus Three Readings on Pediatric Hypertension Diagnosis is Mediated via Diastolic Blood Pressure

Introduction: Blood pressure (BP) is affected by many factors. In pre-teen children, the hypertension (HTN) threshold is about 4 mmHg higher for systolic and about 3 mmHg for diastolic BP. Single BP reading is the norm in real life clinical practice even as HTN guidelines and research use multiple BP readings. There is limited data on the within-visit BP variability in children. The National Health and Nutrition Examination Survey (NHANES) is a population-based survey and 3 BP readings are obtained using a standardized protocol. We aimed to study the difference between single versus 3 BP readings using NHANES data. Methods: In the 2017-2018 NHANES, participants aged 8 years and older underwent BP measurement using 2 protocols. The auscultation protocol (AP) was administered by a physician using a mercury sphygmomanometer. The oscillometric protocol (OP) was administered by a health technician using an Omron HEM-907 XL device. We included participants 8 to 17 years old with 3 AP and 3 OP BP readings for comparison and excluded those with DBP of zero. Results: There were 1126 subjects who met inclusion criteria. The proportion of SBP readings with a difference of at least 5 mmHg between the initial and subsequent 2 BP readings was greater with OP but greater with AP for DBP (Table 2). Similar trend was noted with comparison of initial and mean of all 3 BP readings. Coefficient of variation was higher for DBP than SBP. The proportion of patients with hypertension range BP was significantly higher for DBP than for SBP (table 3). Conclusions: Diastolic BP shows more variability with multiple measurements. Hypertension range BP was noted more often with the initial DBP measurement than with 3 BP readings.

A Pheochromocytoma in an Elite Collegiate Athlete

HISTORY: A 22-Year-old rugby union player presented to the Sports Medicine clinic complaining of a sore throat and skin rash over his back and upper arms for the past week. Further symptoms included rhinorrhoea and dry cough for the previous week, feeling “hot” (especially at night) and constant fatigue. The occurrence of these symptoms coincided with a regional measles outbreak. The clinical symptomatology persisted at subsequent visits over a period of 12 months and ranged from diarrhoea, skin rash, dry cough, headaches, anxiety, night sweats, rapid heart rate and exercise intolerance. Despite follow-up visits when he was asymptomatic, constant weight loss occurred over the period since he first presented. Except for weight loss and a single blood pressure reading of 135/90mmHg previously his medical history was uncompromized. He had a history of various sport related musculoskeletal injuries and there was no family history of note. PHYSICAL EXAMINATION: At initial physical examination athlete was afebrile, HR 100 b/min with a blood pressure reading of 110/60mmHg. Palpable tender occipital lymph nodes were present. Except for the non-purulent pharyngitis and maculopapular rash over the back and upper arms, the remainder of systemic physical examination was normal. Although normal or low BP measurements were recorded occasionally, he remained tachycardic and BP mildly elevated (135/90 mmHg) with the skin rash located over the trunk at most visits. DIFFERENTIAL DIAGNOSIS: Viral infection (measles, rubella, coxaci, EBV), Viral infection unspecified, Hyperthyroidism, Pulmonary tuberculosis, Vasomotor response to immune activation, Essential Hypertension, Pheochromocytoma. TEST AND RESULTS: FBC’s-normal, ESR-normal, CRP-normal, Rubella/Measles IGM (-), s-Urea (7.7mmol/L), s-Creatinine (108μmol/L), S-ALKP (136μmol/L), s-GGT (140μmol/L), S-ALT (101μmol/L), Coxaci-B AB (+), EBV (+), U-VMA-24hrs (50112 nmol/L), MIBG Scan negative (left) indicated a left adrenal gland mass, CT Abd (Triphasic)-well defined mass left adrenal gland FINAL WORKING DIAGNOSIS: Benign pheochromocytoma-left adrenal gland TREATMENT AND OUTCOMES: Laparoscopic adrenalectomy (left), Uncomplicated post operative recovery,Full return to sport

Diagnostic value of a single blood pressure reading for the detection of latent hypertension in children with chronic kidney diseases

Hypertension is a modifiable risk factor for cardiovascular diseases. The data of 24-hour ambulatory blood pressure monitoring (ABPM) largely correlate with target organ lesions; however, the availability of 24-hour ABPM remains low in clinical practice. Objective. to determine the diagnostic value of a single office blood pressure measurement for the detection of latent hypertension in children with chronic kidney diseases Subjects and methods. A single office blood pressure measurement and 24-hour ABPM were carried out in 359 children (boys/girls, 0,51/0,49; median age, 13 years (5; 17) with chronic kidney diseases (a glomerular filtration rate of 84,18±29,6 ml min/1,73m2 (median, 86 ml/min/1,73m2 estimated using the Schwartz equation). To rule out the impact of antihypertensive and/or immunosuppressive therapy on the results of the study, the investigators identified a group of 108 patients (boys/girls, 0,52/0,48; median age, 12 years (5; 16), estimated median glomerular filtration rate, 84 ml/min/1,73m2 ) who did not receive the above treatment. Results. Office blood pressure measurements revealed prehypertension in 14,5% of cases, hypertension in 27,5%, which was consistent with white coat hypertension in 5% of cases. According to 24-hour ABPM, hypertension was present in 48,7% of the children, including those with latent hypertension (26%). Children with latent hypertension (56,4%) had more frequently elevated blood pressure only at night. The level of office blood pressure was weakly correlated with that of the mean diastolic blood pressure during the day, regardless of the presence/absence of antihypertensive and/or immunosuppressive therapy. Latent hypertension was detected in approximately one-fifth of children with different blood pressure levels in the normal range and its frequency significantly increased 1,5–2-fold in patients with higher-normal blood pressure (90‰ ≤ AP <95‰). The children who did not receive antihypertensive and/or immunosuppressive therapy showed a close correlation between the level of a single office blood pressure measurement and the parameters of 24-hour ABPM, as well as a lower frequency of latent hypertension. The risk of latent hypertension increases significantly when the level of a single office blood pressure is more than 75‰. Conclusion. The normal level of a single office blood pressure reading does not allow latent hypertension to be ruled out in children with chronic kidney diseases. The risk of latent hypertension was significantly higher in patients with a single systolic/diastolic blood pressure measurement of more than 75‰ by gender, age, and height. Regardless of the level of a single office blood pressure measurement, 24-hour ABPM should be therefore carried out in all children with chronic kidney diseases.

Optimising the accuracy of blood pressure monitoring in chronic kidney disease: the utility of BpTRU.

BackgroundAccurate blood pressure monitoring is critical for the management of chronic kidney disease, but changes in management in secondary care clinics may be based on a single blood pressure reading, with a subsequent lack of accuracy. The aim of this study was to evaluate a fully automated sphygmomanometer for optimising the accuracy of blood pressure measurements in the setting of secondary care renal clinics.MethodsPatients had routine blood pressure measurements with a calibrated DINAMAP PRO400 monitor in a clinical assessment room. Patients then underwent repeat assessment with a DINAMAP PRO400 monitor and BpTRU device and subsequent 24 hour ambulatory blood pressure monitoring (ABPM).ResultsThe BpTRU systolic (± SD) reading (117.3 ± 14.1 mmHg) was significantly lower than the routine clinic mean systolic blood pressure (143.8 ± 15.5 mmHg; P < 0.001) and the repeat blood pressure taken with a DINAMAP PRO400 monitor in a quiet room (129.9 ± 19.9 mmHg; P < 0.001). The routine clinic mean diastolic (82.4 ± 11.2 mmHg) was significantly higher than the BpTRU reading (78.4 ± 10.0 mmHg; P < 0.001). Clinic BpTRU measurements were not significantly different to the daytime mean or overall mean of 24 hour ABPM.ConclusionsIn patients with CKD, routine clinic blood pressure measurements were significantly higher than measurements using a BpTRU machine in a quiet room, but there was no significant difference in this setting between BpTRU readings and 24 hour ABPM. Adjusting clinic protocols to utilise the most accurate blood pressure technique available is a simple manoeuvre that could deliver major improvements in clinical practice.

Long-Term Observation on the Development of 24-Hour Ambulatory Blood Pressure Monitoring after Primary SPK with Special Regard to Antihypertensive Treatment and the Type of Exocrine Drainage

Introduction: Cardiovascular disease (CVD) is a leading cause of death in patients with type 1 diabetes. Regarding cardiovascular risk profile as well as patient survival SPK was shown to be superior to kidney transplantation alone or to dialysis therapy in type 1 diabetics. One major cardiovascular risk factor is arterial hypertension. Some but not all small studies with short-term observation and single blood pressure readings (RR) indicated that there might be a reduction of RR after successful SPK, which in addition might be influenced by the type of exocrine drainage of the pancreas secretion. We here present the longterm follow-up results of 24-hour ambulatory blood pressure monitoring (ABPM) in 90 SPK patients. Methods: In this retrospective study we analysed patient and graft survival as well as cardiovascular risk factors of 90 patients with type 1 diabetes who consecutively underwent primary SPK between 1995 and 2000 with a median follow-up of 9.4 years. Before and every year after SPK we analysed systolic, diastolic blood pressure (BP) and mean arterial pressure (MAP) by ABPM, antihypertensive medication and several possibly associated factors of influence on BP control. Results: Survival of patients/PTX/KTX was 87/75 /79 % after 9.4 years (not censored for death). BP regulation was significantly improved over the long-term follow-up after transplantation [87% with a BP level >130/80 mmHg before compared to an average of 30% in the followup period after SPK; median BP was 138/81 mmHg (MAP 100 mmHg) before and 123/72 mmHg (MAP 89 mmHg) during the follow-up period after SPK]. However the dipper/non-dipper ratio did not change. Compared to patients with enteric drainage (ED) of the exocrine pancreas secretion the subgroup of patients with bladder drainage (BD) showed significant lower systolic BP and took smaller numbers of antihypertensive agents. Further factors associated with BP control are shown in table 1.Conclusion: To our knowledge this is the first study, which confirms in a long-term follow-up and by ABPM the beneficial effects of SPK on BP and antihypertensive treatment. Furthermore there are indicators, that bladder drainage has more impact on lowering BP than enteric drainage of the exocrine pancreas secretion. Normalisation of glucose metabolism and its effects are probably the most important factors leading to these results.

Comparison of two oscillometric blood pressure monitors in subjects with atrial fibrillation

To compare blood pressure readings obtained with two commonly used oscillometric monitors: Omron HEM 711 AC (OM) and Welch-Allyn 52000 series NIBP/oximeter (WA) with mercury sphygmomanometers (Merc) in subjects with atrial fibrillation. We recruited 51 hemodynamically stable subjects with atrial fibrillation. Fifty four subjects in normal sinus rhythm served as controls. Supine blood pressure readings in each arm were recorded simultaneously using one monitor and Merc. The second monitor then replaced the first and readings were repeated. Merc was then switched to the opposite arm, and both monitors retested. Apical heart rates were ascertained with a stethoscope. We used the averaged, same arm Merc readings as "gold standard". Automated blood pressure readings were obtained in all control subjects and in all but three of those with atrial fibrillation. Both monitors, and operators, noted a difference between apical and radial/brachial pulse rates: apical-recorded: Merc 6.1 + or - 15.0; OM 5.5 + or - 13.7; WA 10.0 + or - 21.2 beats per minute. Both monitors were accurate in controls: over 90% of readings were within 10 mmHg of averaged Merc, and both achieved European Hypertension Society standards. In subjects with atrial fibrillation, about one quarter of all oscillometric readings differed from Merc by more than 10 mmHg. Both falsely high and falsely low readings occurred, some up to 30 mmHg. There was no relation between accuracy and heart rate. Single blood pressure readings, taken with oscillometric monitors in subjects with atrial fibrillation differ, often markedly, from those taken manually. Health care professionals should record multiple readings manually, using validated instruments when making therapeutic decisions.

17: Hypotension on Arrival in the Emergency Department: A Predictor of In-Hospital Mortality

Early clinical risk assessment in patients presenting to an emergency department (ED) is a key to prevent bad outcome. Risk assessment tools have to be simple and easy to use. A single non-invasive blood pressure (BP) measurement is quick and easy obtainable and is part of the standard initial assessment of ED patients. It is well recognized that sustained hypotension is indicative of profound physiological derangement and associated with high mortality in trauma or non-trauma patients. Very little is known about the usefulness of a single blood pressure reading taken on arrival in ED to predict bad outcome in unselected ED patients.

Efficacy and Tolerability of 5 mg of Cilazapril plus 12.5 mg of Hydrochlorothiazide in Mild-to-Moderate Hypertension

The efficacy and tolerability of a fixed combination of 5 mg of cilazapril and 12.5 mg of hydrochlorothiazide against hypertension was evaluated in 36 patients (26 men and 10 women) between 33-68 years old. Twenty-two had newly diagnosed hypertension and 14 had previously treated hypertension. Twenty-four-hour noninvasive ambulatory blood pressure monitoring (ABPM) was performed after a 2-week washout period. Measurements were taken at 20-min intervals during the day (from 8 a.m. to 10 p.m.) and at 30-min intervals during the night (from 10 p.m. to 8 a.m.). Patients with a mean diastolic daytime pressure of > or = 90 < 115 mg Hg were then given 5 mg of cilazapril plus 12.5 mg of hydrochlorothiazide once daily between 6 a.m. and 8 a.m. for 6 weeks. After this period, a second 24-h ABPM was performed. Office blood pressure measurements were taken at weeks -2, 0, 2, and 6. Routine laboratory blood samples were taken at weeks 0 and 6. Single blood pressure readings did not change significantly during the washout period (between weeks -2 and 0). The ABPM 24-h mean systolic pressure changed between weeks 0-6 from 143 +/- 13 to 126 +/- 11 mm Hg (p < 0.0001), and the mean diastolic pressure from 100 +/- 9 to 90 +/- 9 mm Hg (p < 0.0001). Twenty-eight patients (80) responded to treatment (response criteria: mean diastolic daytime pressure at week 6 < 90 mm Hg and/or a difference between weeks 0-6 > or = 5 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)

Reproducibility of non-invasive and intra-arterial blood pressure monitoring: implications for studies on antihypertensive treatment

Ambulatory blood pressure has been shown to be more reproducible than office blood pressure and thus to be more suited for studying the efficacy of antihypertensive drugs. In 34 untreated essential hypertensive subjects, we measured office and 24-h non-invasive or intra-arterial blood pressure twice over a 4-week interval; 24-h intra-arterial blood pressure was obtained by the Oxford method whereas 24-h non-invasive blood pressure was obtained by the automatic SpaceLabs 5300 device, with a 10 min (daytime) or 20 min (night-time) interval between measurements. The standard deviation of the mean difference (s.d.d.) between blood pressures obtained in each recording was taken as the reciprocal of blood pressure reproducibility. The s.d.d. was highest for office blood pressure and for single blood pressure readings taken from 24-h non-invasive recordings. The s.d.d. fell when the two 24-h average non-invasive blood pressures were considered. The fall was progressively greater as the number of ambulatory readings on which the average was calculated increased from two to 24, no further fall being observed when more than 24 values were considered. The maximal reduction in s.d.d. was 59% (systolic) and 42% (diastolic) as compared with the office s.d.d. The two 24-h mean values obtained by the intra-arterial approach were slightly more closely correlated than those obtained non-invasively. However, at comparable sampling rates, the s.d.d. was not substantially lower with 24-h intra-arterial blood pressure and including in the calculation the average of the thousand readings provided by this approach did not cause any further improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Glucose intolerance and hypertension in north London: the Islington Diabetes Survey.

In a general practice-based screening survey, 1040 (63.3%) of a randomly selected sample of 1644 people over the age of 40 years were examined for diabetes mellitus (DM) and hypertension (HT). Glucose intolerance was assessed by a single 2 h post-load blood glucose estimation and HT (diastolic blood pressure greater than or equal to 95mmHg by a single blood pressure reading) or being on anti-hypertensive treatment. The sample included 41 patients (2.1%) with known DM and 135 (12.5%) with known HT. Screening identified 27 (2.6%) new diabetics (16 women) and 43 subjects (4.1%) with impaired glucose tolerance (30 women). A further 30 known diabetics over the age of 40 and 12 diabetics under 40 were registered at the practice. The estimated prevalence of diabetes in the over 40s was 4.6% and in all ages was 1.6%. DM appeared to affect Afro-Caribbeans more commonly than Caucasians among those examined (5.9% versus 2.6%) though this difference did not reach statistical significance (z = 1.1106, p = 0.134). A total of 190 subjects (17.5%) were found to have HT, of whom 55 (5.1%) were newly diagnosed; 10.2% of the sample were on anti-hypertensive treatment, and in 79.3% of these the blood pressure was well controlled (diastolic less than 100 mmHg). HT was more common among known diabetics with a prevalence of 35.4%, of whom one-third were previously undiagnosed. HT affected Afro-Caribbeans significantly more commonly than Caucasians (z = 4.206, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Screening for hypertension in a middle-aged population in Southwest Finland

The occurrence and treatment of hypertension were investigated and the benefit of screening for hypertension was evaluated in a middle-aged population in two rural districts in southwest Finland. A total of 1223 (93.2%) of the women and 1042 (93.1%) of the men, 40–64 years of age, participated in the hypertension screening program. With the criterion of ⩾ 105 mm Hg, the prevalence of hypertension based on three separate measurements was 12.5 and 8.4% for the women and men, respectively, when those already being treated were included. If in the present study a single blood pressure reading had been considered sufficient, the prevalence of “hypertension” would have been almost twofold (20.4%) that based on three measurements for women and it would have been more than twofold for men (21.4%). Seventy-three percent of the female hypertensives and 59% of the male hypertensives were being treated. Only 10% of the female and 15% of the male hypertensives were unaware of their hypertension. The majority (75%) of these persons had consulted a doctor or a nurse during the previous year without their hypertension being detected. Because the majority of the hypertensives were already being treated and, moreover, most of those untreated were already aware of their disease, a systematic screening of the rural middle-aged population in southwest Finland is not considered necessary, especially since community plans for health care services in Finland should double the contact between the physicians in the community health centers and the residents during the next few years.

SCREENING FOR HYPERTENSION IN UNIVERSITY OF FLORIDA STUDENTS

College Students aged 18-30 years were screened for hypertension at the student infirmary. 550 students had a single blood pressure reading taken in the sitting position. 50 students (9%) fulfilled our definition of high blood pressure by having either a systolic pressure equal to or greater than 140 mm/Hg or a diastolic pressure equal to or greater than 90 mm/Hg. Of these students with abnormal blood pressures, 34 returned for 2 further determinations. 22/34 (65%) demonstrated persistent hypertension during each of the three visits. Of those with persistent hypertension, 6/22 (27%) had an elevation of the systolic pressure, 4/22 (18%) had an elevation of the diastolic pressure and 12/22 (54%) had an elevation of both when initially screened. Of the 12 students without persistence of hypertension (labile), 3/12 (25%) had an elevated systolic pressure, 4/22 (33%) had an elevated diastolic pressure, and 5/22 (43%) had an elevation of both.Only 3/22 (14%) of the students with persistent and none with labile hypertension had a diastolic pressure equal to or greater than 105 mm/Hg on the initial screening pressure, indicating hypertension is usually mild in this age group. The type of hypertension (systolic, diastolic, or both) does not allow the identification of those individuals who have labile or persistent hypertension.