Upper-arm Blood Pressure Research Articles

Assessment of nocturnal hypertension by ambulatory blood pressure monitoring at the forearm in people with morbid obesity.

Blood pressure (BP) measurement at the forearm (FA) has been proposed as alternative site to upper arm (UA) in people with morbid obesity (MO). We compared nocturnal BP readings simultaneously taken at FA and UA by ambulatory blood pressure monitoring (ABPM). Fourteen individuals with MO and seven normal-weight controls underwent nocturnal ABPM with two devices placed at the UA and contralateral FA, respectively. Agreement between FA-UA BP, diagnosis of nocturnal hypertension, and potential determinants of BP differences were evaluated. BP at the FA was significantly higher than UA in both people with MO and controls. FA-UA differences in systolic and diastolic BP were similar in people with MO and controls. Nocturnal hypertension was diagnosed in 10 subjects (48%) according to UA BP and in 13 subjects (62%) according to FA BP (concordance 76%, moderate agreement). ΔFA-UA systolic BP was associated with ratio between FA/UA circumferences (R=0.45, P<.05) and with cuff-UA slant angle difference (R=0.44, P<.05). In conclusions, in people with MO, the agreement between FA and UA nighttime BP measured by ABPM is sub-optimal. Our results raise uncertainty in using ABPM at the FA as an alternative to UA placement in people with MO for the diagnosis of nocturnal hypertension.

Validation of the Globalcare GCE603 automated blood pressure monitor for self-measurement according to the European Society of Hypertension International Protocol revision 2010.

To evaluate the accuracy of the automated oscillometric upper-arm blood pressure (BP) monitor Globalcare GCE603 for home BP monitoring according to the International Protocol of the European Society of Hypertension (ESH) revision 2010. BP was sequentially measured in 33 adult participants and compared with a standard mercury sphygmomanometer. A total of 99 comparison pairs were obtained and analyzed according to the ESH international protocol. For the 33 eligible participants, the device achieved 80/99, 98/99 and 99/99 measurements of absolute differences between device and observers within 5, 10 and 15 mmHg for systolic BP (SBP) and 87/99, 98/99 and 99/99 for diastolic BP (DBP), respectively. The average device-observer difference was 1.01 ± 4.11 mmHg for SBP and -0.69 ± 3.56 mmHg for DBP, respectively. The number of participants with two or three of the device-observer difference within 5 mmHg was 28 for SBP and 30 for DBP, and there was no subject with none of the device-observer difference within 5 mmHg. According to the validation results on the basis of the ESH international protocol revision 2010, the Globalcare GCE603 automated upper-arm BP monitor can be recommended for home measurement in general population.

Validation of the Rossmax AC1000f upper-arm blood pressure monitor in adults according to the British Hypertension Society Protocol.

To evaluate the accuracy of the Rossmax AC1000f oscillometric upper-arm blood pressure monitor in adults according to the British Hypertension Society Protocol. Eighty-five subjects (male 42 and female 43) with a mean age of 48.1 years were recruited to fulfill the blood pressure distribution criteria of the British Hypertension Society Protocol in general population using the same arm sequential blood pressure measurement method. For each subject, we sequentially measured blood pressure using a mercury sphygmomanometer (two observers) and the AC1000f device (one supervisor). Data analysis was carried out according to the British Hypertension Society Protocol. A total of 255 comparison pairs were obtained for analysis. The device achieved grade A. The percentage of blood pressure differences within 5, 10 and 15 mmHg was 66.7, 92.2 and 98.0%, respectively, for SBP, and 64.7, 90.2 and 98.4%, respectively, for DBP. The average (±SD) of the device-observer differences was -0.5 ± 6.0 mmHg for SBP and -1.4 ± 5.9 mmHg for DBP, respectively. The automated upper-arm blood pressure monitor Rossmax AC1000f has passed the requirements of the British Hypertension Society Protocol, and hence can be recommended for blood pressure measurement in adults.

Validation of the HL868ED upper-arm blood pressure monitor for clinical use and self-measurement according to the European Society of Hypertension International Protocol revision 2010.

The aim of this study was to evaluate the accuracy of the automated oscillometric upper arm blood pressure monitor HL868ED for clinical use and self-measurement according to the International Protocol of the European Society of Hypertension revision 2010. Systolic and diastolic blood pressure were measured sequentially in 43 adult Chinese (21 women, mean age 51.7 years) using a mercury sphygmomanometer (two observers) and the HL868ED device (one supervisor). A total of 99 pairs of comparisons were obtained from 43 participants for judgements in two parts with three grading phases. The HL868ED device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10 and 15 mmHg was 68/99, 91/99 and 97/99, respectively, for systolic blood pressure and 85/99, 95/99 and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Twenty-four and 30 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥24). Three participants for systolic and one participant for diastolic blood pressure had all the three device-observer comparisons greater than 5 mmHg. The Health & Life blood pressure monitor HL868ED has passed the requirements of the International Protocol revision 2010 and hence can be recommended for blood pressure measurements in adults.

Validation of the Omron HBP-9031C professional office blood pressure monitor in the general population according to the ANSI/AAMI/ISO 81060-2:2013 protocol.

The present study aimed to evaluate the accuracy of the Omron HBP-9031C automated oscillometric upper-arm blood pressure (BP) measurement device for professional office BP monitoring, according to the ANSI/AAMI/ISO 81060-2:2013 protocol (ANSI/AAMI/ISO) in the general population. The device was assessed by using it on 85 participants, who fulfilled our inclusion criteria involving the ranges of arm circumference and systolic and diastolic BP. The validation and data analysis were performed as per the protocol. In the ANSI/AAMI/ISO 81060-2:2013 validation procedure (criterion 1), the mean ± SD of the differences between the test device and reference BP was 1 ± 8/-2 ± 6 mmHg (systolic/diastolic). The mean differences between the two observers and the Omron HBP-9031C were 1 ± 7 mmHg for systolic BP and -2 ± 6 mmHg for diastolic BP, according to criterion 2. The two ANSI/AAMI/ISO criteria were fulfilled. The OMRON HBP-9031C professional BP monitor fulfilled the requirements of the ANSI/AAMI/ISO validation standard and can be recommended for clinical use.

QardioArm Upper Arm Blood Pressure Monitor Against Omron M3 Upper Arm Blood Pressure Monitor in Patients With Chronic Kidney Disease: A Validation Study According to the European Society of Hypertension International Protocol Revision 2010.

BackgroundHypertension is considered as a main risk factor for chronic kidney disease development and progression. Thus, the control and evaluation of this disease with new software and devices are especially important in patients who suffer from chronic kidney disease.ObjectiveThis study aimed to validate the QardioArm mobile device, which is used for blood pressure (BP) self-measurement in patients who suffer from chronic kidney disease, by following the European Society of Hypertension International Protocol 2 (ESH-IP2) guidelines.MethodsA validation study was carried out by following the ESH-IP2 guidelines. A sample of 33 patients with chronic kidney disease self-measured their BP by using the QardioArm and Omron M3 Intellisense devices. Heart rate (HR), diastolic BP, and systolic BP were measured.ResultsThe QardioArm fulfilled the ESH-IP2 validation criteria in patients who suffered from chronic kidney disease.ConclusionsThus, this study is considered as the first validation using a wireless upper arm oscillometric device connected to an app to measure BP and HR meeting the ESH-IP2 requirements in patients who suffer from chronic kidney disease. New validation studies following the ESH-IP2 guidelines should be carried out using different BP devices in patients with specific diseases.

P60 Invasive Validation of Antares, a New Algorithm to Calculate Central Blood Pressure from Oscillometric Upper Arm Pulse Waves

BackgroundAntares is an algorithm for pulse wave analysis (PWA) by oscillometric blood pressure monitors in order to estimate central (aortic) blood pressure (cBP). Antares aims to enable brachial cuff-based blood pressure (BP) monitors to be type II-devices, determining absolute cBP values independently of potential peripheral BP inaccuracies. The present study is an invasive validation of the Antares algorithm.MethodsWe followed entirely the 2017 ARTERY protocol for validation of non-invasive cBP devices, the 2013 ANSI/AAMI/ ISO 81060-2 and 2018 AAMI/ESH/ISO validation standard protocols. In total, 191 patients undergoing cardiac catheterization were included, of which 145 patients entered analysis. Invasive cBP recordings were prospectively compared to simultaneous non-invasive cBP estimations using Antares, integrated into an oscillometric BP monitor. Antares analyses pulse waves during deflation of the cuff (patent of Redwave Medical GmbH). Generally speaking, pulse waves of a normal oscillometric BP measurement are taken for PWA with no need for altering standard BP pump operation.ResultsMean difference between invasive and non-invasively estimated systolic cBP was 0.71 mmHg with standard deviation of 5.95 mmHg, fulfilling the highest validation criteria. Bland-Altman plot reveals good limits of agreement.ConclusionAntares is the first algorithm for estimation of cBP that entirely fulfills the 2017 ARTERY and AAMI/ESH/ISO validation protocols including criteria for high accuracy devices. The Antares algorithm turns the oscillometric upper arm blood pressure monitor into a type II-device for estimation of true cBP. Integration of Antares into BP monitors could enable the measurement of PWA parameters in virtually every practice in future.Bland altman of estimated vs. invasive central SBP

Validation of the YuWell YE680B upper-arm blood pressure monitor in adults according to the ANSI/AAMI/ISO 81060-2: 2013 standard.

To evaluate the accuracy of the YuWell YE680B oscillometric upper-arm blood pressure monitor for clinic and home blood pressure measurements in adults according to the American National Standards Institute/the Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 standard. Eighty-five subjects (male 46 and female 39) with a mean age of 44.6 years were recruited to fulfill the age, sex, blood pressure, and cuff distribution criteria of the ANSI/AAMI/ISO standard in the general population using the same arm sequential blood pressure measurement method. Two differently-sized cuffs were used for arm circumferences 22-32 cm (medium) and 22-45 cm (large), respectively, for the test device, and for arm circumferences ≤32 cm (standard) and >32 cm (large), respectively, for the mercury sphygmomanometer. A total of 255 comparison pairs were obtained for analysis. For validation criterion 1, the mean ± SD of the differences between the test device and reference systolic/diastolic blood pressure readings was -2.2 ± 7.2/-3.9 ± 5.2 mmHg. For validation criterion 2, the SD of the averaged systolic/diastolic blood pressure differences between the test device and reference blood pressure per subject was 5.70/4.67 mmHg. The automated upper-arm blood pressure monitor YuWell YE680B has passed the requirements of the ANSI/AAMI/ISO81060-2:2013 standard, and hence can be recommended for blood pressure measurement in the general population.

Validation of Transtek TMB-1776 according to European Society of Hypertension International Protocol revision 2010 in adults

In the present study, accuracy of Transtek TMB-1776 upper-arm blood pressure monitor in adult subjects was determined by comparing with a non-invasive (auscultatory) reference mercury sphygmomanometer, following the European Society of Hypertension International Protocol revision 2010 (ESH-IP 2010). All the validation requirement were reached: 74, 93, and 98 of systolic blood pressure measurements and 86, 97, and 99 of diastolic blood pressure measurements were within 5, 10, and 15 mmHg of absolute difference, respectively. The mean ± SD device-observer difference was -1.2 ± 4.9 mmHg for systolic blood pressure and -0.7 ± 3.5 mmHg for diastolic blood pressure. For systolic blood pressure and diastolic blood pressure, respectively, 25 and 30 of subjects had at least two of their three difference within 5 mmHg, and three and zero subject showed no difference within 5 mmHg. In conclusion, Transtek TMB-1776 has passed all phases of ESH-IP 2010 and is suitable for self/home blood pressure measurement of adults.

Validation of the HL868ED upper-arm blood pressure monitor for clinical use and self-measurement according to the British Hypertension Society Protocol.

The present study aimed to evaluate the accuracy of the Health & Life automated oscillometric upper-arm blood pressure monitor HL868ED for blood pressure monitoring according to the British Hypertension Society Protocol. We recruited individuals until there were 85 eligible participants and their blood pressure could meet the blood pressure distribution requirements specified by the British Hypertension Society Protocol. For each individual, we sequentially measured systolic and diastolic blood pressures using a mercury sphygmomanometer (two observers) and the HL868ED device (one supervisor). Data analysis was carried out according to the British Hypertension Society Protocol. The device achieved grade A. The percentage of blood pressure differences within 5, 10 and 15 mmHg was 68%, 91% and 98%, respectively, for systolic blood pressure, and 79, 96 and 99%, respectively, for diastolic blood pressure. The average (±SD) of the device-observer differences was -1.8 ± 6.0 mmHg for systolic and 0.1 ± 4.7 mmHg for diastolic blood pressures, respectively. The Health & Life automated upper-arm blood pressure monitor HL868ED has passed the requirements of the British Hypertension Society Protocol, and hence can be recommended for blood pressure measurement in adults.

Two cases of asymptomatic axillary artery occlusion difficult to diagnose preoperatively: pitfalls and its solution in endovascular therapy when approaching from the upper extremity

BackgroundApproaching from the left brachial artery is an important access route in endovascular therapy for complicated aortic and peripheral artery cases.Here, we report two cases of a poor access route from the left brachial artery because of asymptomatic axillary artery occlusion (AAO), despite no preoperative upper arm blood pressure laterality, a normal ankle brachial pressure index, and absence of occlusion of the subclavian artery on CT scan.Case 1Seventy-six-year-old female. We planned endovascular aneurysm repair (EVAR) for para-renal abdominal aortic aneurysm using the snorkel technique in the renal artery, but we failed to pass through the left subclavian artery when approaching from the left brachial artery because of AAO.Case 2Seventy-three-year-old female. We planned zone 2 thoracic endovascular aneurysm repair (TEVAR) for thoracic aortic aneurysm and embolization of the left subclavian artery via the left brachial artery, but we failed to pass through the left subclavian artery because of AAO, and therefore, we simply covered the orifice of the left subclavian artery using a stent graft without embolization.ConclusionsThe presence of an asymptomatic AAO may alter the treatment plan but may be difficult to diagnose preoperatively. In those cases in which a brachial or radial artery access is planned, contrast medium should be injected from the contralateral upper extremity during preoperative enhanced CT since the absence of halation of the ipsilateral subclavian/axillary vein provides improved visualization of the AAO which may lead to a better preoperative strategy including the choice of the side of upper extremity access.

Feasibility of Fingertip Oscillometric Blood Pressure Measurement: Model-Based Analysis and Experimental Validation.

The most commonly used oscillometric upper-arm (UA) blood pressure (BP) monitors are not convenient enough for ambulatory BP monitoring, given the large size of the arm cuff and the compression of UA during the measurement. Finger-worn oscillometric BP devices featuring miniaturized finger cuff have been developed and researched as an alternative solution to the UA-based measurement, yet the reliability of the finger-based measurement is still questioned. To investigate the feasibility of oscillometric BP measurements at the finger position, we performed model-based analysis and experimental validation to explore the underlying issues associated with extending the cuff-based oscillometric approach from UA to other alternative sites. The simulation results revealed that a larger bone-to-tissue volume ratio produced a lower pressure transmission efficiency, which can account for the inter-site measurement discrepancies of mean blood pressure (MBP). We also experimentally compared the oscillometric MBP measurements at UA, middle forearm, wrist, finger proximal phalanx, and finger distal phalanx (FD) of 20 young adults, and each position was matched with a cuff of appropriate size and kept at the same height with the heart. The experimental results demonstrated that FD could be a superior alternative position for oscillometric BP measurement, as it requires the smallest cuff size while providing the most consistent MBP with the UA. Our analysis also suggested that further study is demanded to identify the appropriate oscillometric algorithm for reliable systolic blood pressure and diastolic blood pressure measurements at FD.

Combined Intrahospital Remote Ischemic Perconditioning and Postconditioning Improves Clinical Outcome in ST-Elevation Myocardial Infarction.

Remote ischemic conditioning (RIC) or ischemic postconditioning (PostC) may protect the myocardium from ischemia-reperfusion injury in patients with ST-segment-elevation myocardial infarction. To determine whether combined intrahospital RIC and PostC or PostC alone in addition to primary percutaneous coronary intervention (PCI) reduce long-term clinical events after ST-segment-elevation myocardial infarction. The present study is a post hoc analysis of a prospective trial which randomized 696 ST-segment-elevation myocardial infarction patients with symptoms <12 hours 1:1:1 to either combined RIC and PostC in addition to primary PCI, PostC alone in addition to primary PCI, or conventional PCI (control). Three cycles of RIC were performed by inflation of an upper arm blood pressure cuff for 5 minutes followed by deflation for 5 minutes. PostC was performed after primary PCI via 4 cycles of 30 seconds balloon occlusions followed by 30 seconds of reperfusion. Major adverse cardiac events consisting of cardiac death, reinfarction, and new congestive heart failure were assessed during long-term follow-up. Follow-up data were obtained in 97% of patients in median 3.6 years after the index event (interquartile range, 2.9-4.2 years). Major adverse cardiac events occurred in 10.2% of patients in the combined RIC and PostC group and in 16.9% in the control group (odds ratio, 0.56; 95% CI, 0.32-0.97; P=0.04). The difference was driven by a significantly reduced rate of new congestive heart failure in the RIC and PostC group (2.7% versus 7.8%; odds ratio, 0.32; 95% CI, 0.13-0.84; P=0.02). In contrast, PostC alone did not reduce major adverse cardiac events compared with controls (14.1% versus 16.9%; odds ratio, 0.81; 95% CI, 0.48-1.35; P=0.41), and the reduction of new congestive heart failure was not statistically significant (3.5% versus 7.8%; odds ratio, 0.43; 95% CI, 0.18-1.03; P=0.05). Cardioprotection by combined intrahospital RIC and PostC in addition to primary PCI significantly reduced the rate of major adverse cardiac events and new congestive heart failure after ST-segment-elevation myocardial infarction. URL: http://www.clinicaltrials.gov . Unique identifier: NCT02158468.

Telemonitoring of 24-Hour Blood Pressure in Local Pharmacies and Blood Pressure Control in the Community: The Templar Project.

The analysis of ambulatory blood pressure monitorings (ABPMs) performed in 639 Italian pharmacies in the context of a telehealth-based service allowed to evaluate the level of blood pressure (BP) control in the community. Twenty-four-hour ABPMs were performed by a clinically validated, automated, upper-arm BP monitor. Recordings were uploaded on a certified web-based telemedicine platform (www.tholomeus.net) and remote medical reporting provided. In each subject, an automatic BP measurement was obtained in the pharmacy and clinical information collected before starting the ABPM. A total of 20,773 subjects (mean age 57 ± 15 years; 54% females; 28% receiving antihypertensive medications, 31% with any cardiovascular [CV] risk factor) provided valid ABPMs. BP control was poor, but better in ambulatory conditions (24-hour BP <130/80 mm Hg 54% vs. pharmacy BP < 140/90 mm Hg 43%; P < 0.0001) and in drug-treated subjects. Sustained normotension was reported in only 28% subjects. Isolated nocturnal hypertension (16%; nighttime BP ≥120/70 mm Hg with normal daytime BP) was more common (P < 0.0001) than isolated daytime hypertension (9%; daytime BP ≥ 135/85 mm Hg with normal nighttime BP). Sustained hypertension (43%) was more common in younger males at the lowest CV risk, with daytime hypertension. White-coat hypertension (14%) was more common in females. Masked hypertension was not uncommon (15%) and more often observed in older males with an elevated nocturnal BP. A telemedicine-based service provided to community pharmacies may facilitate access to ABPM, thus favoring a more accurate hypertension screening and detection. It may also help describe the occurrence of different 24-hour BP phenotypes and personalize the physician's intervention.

Difference in forearm and upper arm blood pressure measurements in prenatal women

Background: In health-care services, when bare upper arm blood pressure (BP) measurement is impractical, the forearm may be used as a surrogate for traditional upper arm BP. Objective: This exploratory study aimed to determine the significant difference and correlation between the upper versus forearm BP measurements among low-risk prenatal women. SMaterials and Methods: A total of 156 low-risk prenatal women in the third trimester of pregnancy attending antenatal clinics at Municipal Maternity Corporation Hospitals, Bengaluru, were recruited by purposive sampling. Upper and forearm noninvasive BP (NIBP) measurements obtained by mercury sphygmomanometer, thrice at an interval of 15 min were averaged. The main outcome measures were the significant difference and correlation between the upper arm and forearm BP measurements. Results: The mean systolic BP (SBP) (117.14 ± 3.041 mmHg) and diastolic BP (DBP) (69.31 ± 8.461 mmHg) in the forearm was significantly higher than the upper arm SBP (111.72 ± 5.53; P = 0.002) and DBP (61.46 ± 6.014 mmHg; P = 0.016). The mean difference in SBP between upper and forearm was 5.42 ± 2.016 mmHg and in DBP 7.85 ± 3.204 mmHg. Upper versus forearm BP measurements had revealed a significant positive linear correlation in SBP (r = 0.849; P = 0.013) and DBP (r = 0.816; P = 0.021) by Pearson product-moment correlation coefficient. Clinically 94 (72.31%) had a significant BP measurements difference in forearm versus upper arm by approximately 6–10 mmHg. None of the maternal characteristics were independent predictors for the mean difference in SBP and DBP measurement. Conclusion: Forearm NIBP measurements are higher than the BP obtained at the upper arm location. This must be taken into consideration whenever the forearm is used as an alternative site for the upper arm BP.

Wireless Electroencephalography Based Blood Pressure Monitoring

The number of cardiac patients and aged individuals are at a rise all around the world. Taking care of such individuals is a major challenge these days. In many cases, these patients require special care and regular monitoring of vital signs like blood pressure (BP). Focusing a prevalent idea of wireless brain-computer interface (WBCI), an innovative research work is considered to meet essential routine monitoring of BP for cardiac patients and aged people without any reliance. The research framework involves the use of wireless electroencephalogram (EEG) headset to control wrist BP and arm BP monitors to determine accurate BP readings in the proposed system. An Android application "Smart Home Monitor" is developed that screens the information from the headset. The research framework is tested on ten individuals to examine the precision in BP readings from two different BP monitors. Results specify that both upper arm blood pressure readings i.e. Systolic BP readings (SBP = 119.6 ±5.1 mmHg) and Diastolic BP (DBP = 79.5 ±7.4 mmHg) were found to be better than the wrist BP readings (SBP = 128.2 ±11.7 mmHg and DBP = 83.6 ±10.3 mmHg). This examination assessed that the designed system empowers the framework to be reliable, remote and compact.

Construction of Blood Pressure Monitor Using Photoplethysmography Calibrating with Upper-arm Blood Pressure Monitor

A photoplethysmography (PPG) is one of an alternative technique for monitoring personal health with the advantages of non-invasive, inexpensive, and easy to use. In this work, PPG is used to estimate blood pressure with the aim to construct a prototype of blood pressure monitor by photoplethysmography and calibrate with upper-arm blood pressure monitor. The NIR LED light source and detector is used to obtain PPG signals. The PPG signals from blood pressure prototype are recorded with band pass filter and used for calibration with upper-arm blood pressure monitor in 10 volunteers. It is found that the maximum and minimum values of PPG signals show linear dependence of systolic and diastolic blood pressure from the commercial blood pressure monitor with R2=0.72. The obtained linear relation is applied to calibrate the measured PPG signals and to test with 12 volunteers. From the test, the precision of systolic and diastolic blood pressure from the prototype are 8 mmHg and 6 mmHg respectively and the accuracy is equal to ±10 mmHg compared with that of commercial blood pressure monitor of ±3 mmHg. Thus, the prototype of blood pressure shows less accuracy than that of commercial blood pressure monitor and may not medically use for health monitoring. However, the prototype maybe practically use as a screening tool for monitoring blood pressure due to easy to use and fast measurement.

The role of wrist monitors to measure blood pressure in older adults.

Arterial hypertension is a common condition in older adults with increasing data about blood pressure (BP) targets and antihypertensive treatment in this population. Recent studies have opened new discussions about the different usual and unusual methods of blood pressure monitoring. However, there are no evidence-based recommendations whether BP should be measured at upper arms or at wrist, which seems to be more comfortable in older and frail people. The purpose of this study was to test the quality of wrist BP monitors as diagnostic method in older adults. BP measurements at both upper arms and at both wrists were compared under standardized conditions in 605 patients ≥ 75years. Differences in wrist and upper arm BP were, furthermore, correlated with various diagnoses and parameters including ankle-brachial-index (ABI). In patients of 75-80 years, there were no differences in BP measurements at upper arms compared to wrists whereas in patients > 80 years, BP measurements at wrists were significantly lower than at upper arms. In both age groups BP measured at wrist was significantly lower in patients with ABI < 0.9. BP wrist monitors could be considered as a serious alternative in adults of 75-80years or in older persons with normal ABI values.

Risk Factors Associated with Low Birth Weight

Neonatal deaths are associated with preterm birth complications. Preterm birth is also related to low birth weight (LBW), which can have multiple causes. The aim of this study was to analyze the risk factors associated with LBW. This was a cross-sectional study held in Bulu Primary Health Care, Temanggung, Central Java, Indonesia. The sample size required for this study was 69 based on the Slovin formula. Data were collected using questionnaires and semi-quantitative FFQ forms. Data on infant birth weight was taken from midwives’ delivery cohort records. Mid upper arm circumference (MUAC), hemoglobin level, blood pressure, maternal age, parity, nutritional intake, and serum transferrin receptor data were taken from the infant’s mother using a MUAC tape, automatic blood pressure monitor and blood laboratory analysis by Prodia. Data analysis procedures were carried out with quantitative methods. Descriptive statistics were analyzed as means and standard deviations. Inferential statistics used the chi-square test for bivariate analysis and binary logistic regression for multivariate analysis. The results of this study showed that mean infant birth weight was 2917.68 ± 374.673 kg. Inferential analysis showed that MUAC and pregnancy at a risky age are significant risk factors associated with LBW, while serum transferrin receptor levels, anemia, parity, energy and protein consumption levels, and systolic and diastolic blood pressure are nonsignificant risk factors. The probability of LBW in pregnant women with LILA under 23.5 cm and pregnancy at a risky age is 68.9%.

Automated blood pressure self-measurement station compared to office blood pressure measurement for first trimester screening of pre-eclampsia.

Preeclampsia is a serious medical disorder affecting pregnancy. Screening in early pregnancy can identify women at risk and enable effective prophylactic treatment. Accurate blood pressure (BP) measurement is an important element of the screening algorithm. Automated self-screening, while attending the first trimester ultra sound scan, using a BP self-measurement (BPSM) station, could be a low-cost alternative to office BP measurements (OBPM) on both arms performed by clinical staff, if the measurement quality can be ensured. The aim of this study was to compare automated BPSM using a self-measurement station on one arm, with OBPM performed by clinical staff on both arms. Primary outcome was the difference in mean arterial pressure (MAP) between the two methods and secondary outcomes were safety and practicality issues. Pregnant women attending ultrasound-examination at 12 weeks gestational age were recruited and randomized to start with having two OBPMs taken on both arms by staff, using two standard validated automatic upper arm BP devices, or self-measuring using an automated BPSM station following a crossover study design. The BPSM station consists of a validated blood pressure device, and an add-on sensor system capable of registering blood pressure values, rest-time, back-supported, legs-crossed, and ambient noise-levels respectively, and providing interactive guidance during the measurement process, for supporting the self-measurement process. A total of 80 complete BP measurement sets were obtained, for a total of 240 BPSM measurements and 320 OBPM measurements. We found no significant difference between the OBPM and BPSM methods (p=0.86) for mean arterial pressure (MAP). However, erroneous measurements were observed frequently during the experiment, mainly during the first of the 3 BPSM measurements (6%), secondary during the second BPSM measurement (3%). Only one data set (1%) was excluded due to OBPM errors. No significant difference in MAP between the two methods was found. Means for detecting and repeating erroneous BP measurements should be implemented. Measurement errors was found in 9 % of the measurement sets which is not acceptable for clinical use. Thus, several measures have been identified in order to properly identify and recover from such measurement errors in the future.