摘要:

BackgroundAccurate blood pressure measurement is dependent on using a blood pressure cuff that is appropriate to the patient's arm circumference.ObjectiveThis study identifies the change in distribution of arm circumferences in the United States and its impact on usage of the ‘standard adult’ cuff.MethodThe most current National Health and Nutritional Examination Survey (NHANES) data, available on the website (http://www.cdc.gov/nchswww/nchshome.htm), covers NHANES III (Cycle 1, 1988–1991; 8381 subjects and Cycle 2, 1991–1994; 8566 subjects) and NHANES 2000 (1999–2000; 4,444 subjects). The weighted change in arm circumference between NHANES III as a whole and NHANES 2000 was calculated. Correlates for increased arm circumference were obtained via multivariate analysis. The predicted change in blood pressure cuff usage based on the changing prevalence of arm circumferences was calculated.ResultsThe mean arm circumference for the whole population increased significantly from NHANES III to NHANES 2000 (31.83±0.08 cm versus 32.86±0.15 cm,p < 0.001) and in the hypertension population without reaching statistical significance (33.07±0.16 to 33.61±0.30 cm,p=0.11). When adjusted regressions were performed, the increases in arm circumference were due to increasing weight in both the whole population and the hypertensives. The numbers of Americans predicted to require the ‘standard adult’ cuff to accurately measure blood pressure decreased from 76.2% to 66.3% while the number of Americans increased from 42.2% to 45%.ConclusionsThe increasing prevalence of overweight and obese Americans found in NHANES III and NHANES 2000 has led to larger mean arm circumferences in hypertensives and the total population. This increased frequency of larger arm circumferences predicts that the ‘large adult’ cuff will be increasingly required in clinician's offices for accurate blood pressure measurement.

ISSN:1359-5237    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesThe aim of the study was to evaluate the efficiency of a position/activity monitoring system based on a dual-axis accelerometer strapped to the subject's thigh and a position sensor located within a monitor placed on the subject's belt.MethodsTwenty-six subjects wearing two monitors (one accelerometer on each thigh) were submitted to various activities and positions under the control of an observer. An analysis of each tracing was performed both manually by a technician and automatically by dedicated software before being compared with the information gathered during the study.ResultsThe accelerometer allowed accurate discrimination between the standing versus the sitting and lying positions. The sitting and lying positions were correctly detected by the built-in position sensor provided the unit was firmly attached. Walking was adequately detected by the accelerometer. The activity score was well correlated with treadmill speed. Changes in position and activity were detected with a mean error of less than 3 s.ConclusionsThe combination of an accelerometer placed on the subject's thigh and a position sensor located at the subject's waist appeared to be a suitable system for position/activity monitoring during ambulatory ECG and blood pressure monitoring.

ISSN:1359-5237    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundJob strain has been implicated in risk of cardiovascular disease, and there is evidence for increased blood pressure among men with job strain. It is unclear, however, to what degree job strain affects blood pressure in women. This study examined the relationships between job strain, norepinephrine and epinephrine excretion in the workplace, and ambulatory blood pressure variability during waking hours in women working as nurses or nurse's aides in Hilo, Hawaii.MethodsWomen from two ethnic groups, Filipino-Americans (n=36) and Euro-Americans (n=23), were measured on a workday, urinary catecholamine excretion and ambulatory blood pressure being measured over a 4-h period at work and home, and overnight over an 8-h period. The rates of catecholamine excretion were measured in timed urine samples using high-performance liquid chromatography with electrochemical detection, and ambulatory blood pressure was measured at 15-min intervals using a SpaceLabs 90207 monitor. The women filled out the Job Content Questionnaire prior to the physiological measurements.ResultsScores on the Job Content Questionnaire were not significantly associated with the physiological measures, although correlations were higher for Euro-American participants than Filipino-Americans. Catecholamine excretion rates in the workplace were significantly related to blood pressure variability throughout the day and to systolic blood pressure means, but catecholamine excretion rates in other daily settings were not significantly related to blood pressure.ConclusionsThese results support the idea that stress in the workplace has special significance for the prediction of cardiovascular health risk, and that catecholamine excretion at work is significantly associated with increased blood pressure variability during the day. Job strain, as measured by subscales from the Job Content Questionnaire, was not associated with any of the physiological measures. This lack of association may be the result of ethnic and circumstantial bias in the questionnaire, suggesting that job strain should be evaluated in a more critical manner in populations differing from the ones in which the concept was developed.

ISSN:1359-5237    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveIt is uncertain which blood pressure values (pre- or post-haemodialysis) best represent the average daily blood pressure in haemodialysis patients. The purpose of this study was to verify the power of peridialysis blood pressure to predict interdialytic blood pressure, and to ascertain the influence of blood pressure fluctuations during dialysis on this predictive ability.Methods and resultsWe performed ambulatory blood pressure monitoring during the interdialytic period on 60 stable haemodialysis patients (mean age 53±16 years, 33 male) between two mid-week haemodialysis sessions. Pre- and post-haemodialysis blood pressures were 154/82 and 142/77 mmHg, respectively, and 44-h interdialytic blood pressure was 136/77 mmHg. Overall, post-haemodialysis blood pressure values correlated with interdialytic ambulatory blood pressure marginally better than did pre-haemodialysis values (r=0.52 versus 0.61 for pre- and post-dialysis systolic pressure, respectively;r=0.67 versus 0.72 for pre- and post-dialysis diastolic pressure, respectively). The average of the pre- and post-haemodialysis values showed a slightly better correlation with interdialytic blood pressure (r=0.65 and 0.75 for systolic and diastolic pressure, respectively). When we stratified patients according to systolic blood pressure behaviour during dialysis, pre-dialysis blood pressure was the stronger predictor of interdialytic blood pressure in the quartile with greatest intradialytic blood pressure fall (r=0.67 versus 0.44 for pre- and post-dialysis systolic blood pressure, respectively), whereas post-dialysis values were substantially better in the group with a rise in systolic pressure during dialysis (r=0.26 versus 0.59 for pre- and post-dialysis systolic blood pressure, respectively).ConclusionsThese data demonstrate that peridialysis blood pressure values are of limited accuracy in predicting interdialytic blood pressure, post-dialysis values are minimally better predictors than pre-dialysis blood pressures, and the average of pre- and post-haemodialysis values is marginally better than both. In addition, blood pressure fluctuations during dialysis have a sizable impact on this predictive ability. Clinical decisions related to blood pressure management and research design in haemodialysis hypertension should take these factors into account.

ISSN:1359-5237    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundRecent studies suggest that the self-monitoring of blood pressure (SMBP) may improve the identification and control of hypertension. Although endorsed by the Joint National Committee VII guidelines, home monitoring is not currently part of the standard care of hypertension.ObjectiveTo assess community- and university-based primary care physicians' opinions of SMBP.MethodsA written, 5-point, Likert-scale questionnaire was mailed to physicians in a primary care research network.ResultsWe received completed surveys from 138 of 170 providers (81%). Physician ages ranged from 25 to 72 years. Half of the providers were female, and approximately half were residents. Most physicians (63%) reported having patients using SMBP. Physician opinions of SMBP were unrelated to age, gender and number of years in practice. Three key beliefs were expressed: SMBP could be useful, economical and problematic. Community-based physicians were more likely than university-based physicians to believe in the benefits of SMBP use, and to disagree that the use of SMBP could cause problems for them or their patients (P < 0.05). Compared with their peers, physicians with fewer than five patients using SMBP agreed more strongly with statements that SMBP use could cause problems for themselves and their patients in hypertension treatment.ConclusionsOverall, the providers responded that SMBP could be useful to them in managing hypertension but seem hesitant to endorse it fully at this time, possibly anticipating potential problems that could arise with SMBP use. Physicians with more patients using self-monitoring were more likely to endorse it.

ISSN:1359-5237    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIt is now accepted that blood pressure measuring devices should be subjected to an independent evaluation of their accuracy before they are marketed for clinical use. The results of validation of the TONOPORT V blood pressure monitor for the measurement of ambulatory blood pressure according to the European Society of Hypertension International Protocol for Validation of Blood Pressure Measuring Devices in Adults are presented in this paper.PopulationThirty-three subjects were recruited from among staff and patients at Beaumont Hospital, Dublin, Ireland.MethodsThe TONOPORT V monitor was connected to the Sphygmocorder, an audiovisual system for validation, which records blood pressure on tape and video for later analysis. Nine sequential same-arm measurements between the device and a standard mercury sphygmomanometer were recorded using the Sphygmocorder.ResultsIn phase 1, the TONOPORT V monitor produced 28 measurements within 5 mmHg, 37 within 10 mmHg and 40 within 15 mmHg for systolic blood pressure (SBP), and 26 within 5 mmHg, 38 within 10 mmHg and 44 within 15 mmHg for diastolic blood pressure (DBP). The mean differences were −2.2 (8.6) [mean (SD)] mmHg for SBP and +0.5 (7.2) mmHg for DBP. The TONOPORT V monitor passed all the criteria for both SBP and DBP. In phase 2.1, the TONOPORT V monitor had 56 measurements within 5 mmHg, 78 within 10 mmHg and 88 within 15 mmHg for SBP, and 60 measurements within 5 mmHg, 83 within 10 mmHg and 97 within 15 mmHg for DBP. The mean differences were −1.4 (8.7) mmHg for SBP and −0.2 (6.8) mmHg for DBP. The TONOPORT V monitor passed the criteria for DBP but failed to meet any of the criteria for SBP. In phase 2.2, 19 subjects had at least two of the differences within 5 mmHg and six subjects had no differences within 5 mmHg for SBP, and 22 subjects had at least two of the differences within 5 mmHg and six subjects no differences within 5 mmHg for DBP. The TONOPORT V monitor failed to meet the criteria for SBP and for DBP.ConclusionsThe TONOPORT V monitor cannot be recommended for clinical use in an adult population because it records SBP inaccurately and because it records DBP inaccurately in an unacceptably high proportion of people.

ISSN:1359-5237    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundIt is now accepted that blood pressure measuring devices should be subjected to an independent evaluation of their accuracy before they are marketed for clinical use. The results of validation of the ROSSMAX Blood Pressure Measuring Monitor for self-measurement according to the European Society of Hypertension International Protocol for Validation of Blood Pressure Measuring Devices in Adults are presented in this paper.PopulationThirty-three subjects were recruited from among staff and patients at Beaumont Hospital, Dublin, Ireland.MethodsThe ROSSMAX monitor was connected to the Sphygmocorder, an audiovisual system for validation, which records blood pressure on tape and video for later analysis. Nine sequential same-arm measurements between the device and a standard mercury sphygmomanometer were recorded using the Sphygmocorder.ResultsIn phase 1, the ROSSMAX monitor produced 21 measurements within 5 mmHg, 31 within 10 mmHg and 38 within 15 mmHg for systolic blood pressure (SBP), and 36 within 5 mmHg, 43 within 10 mmHg and 45 within 15 mmHg for diastolic blood pressure (DBP). The mean differences were –5.6 (10.2) [mean (SD)] mmHg for SBP and –0.5 (4.5) mmHg for DBP. The ROSSMAX monitor failed to meet any of the criteria for SBP but comfortably passed all of the criteria for DBP. In phase 2.1, the ROSSMAX monitor had 51 measurements within 5 mmHg, 73 within 10 mmHg and 86 within 15 mmHg for SBP, and 71 measurements within 5 mmHg, 93 within 10 mmHg and 98 within 15 mmHg for DBP. The mean differences were –4.5. (9.5) mmHg for SBP and –1.8 (5.0) mmHg for DBP. The ROSSMAX monitor failed to meet any of the criteria for SBP but comfortably passed all of the criteria for DBP. In phase 2.2, 16 subjects had at least two of the differences lying within 5 mmHg and 10 subjects had no differences within 5 mmHg for SBP; 26 subjects had at least two of the differences falling within 5 mmHg and three subjects no differences within 5 mmHg for DBP. The ROSSMAX monitor failed to meet the criteria for SBP but passed the criteria for DBP.ConclusionsThe ROSSMAX monitor cannot be recommended for clinical use in an adult population because it records SBP inaccurately.

ISSN:1359-5237    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

AimTo assess the agreement between the clinical information provided by the ambulatory daytime average and 24 h average blood pressure value for diagnosing hypertension and assessing the effects of antihypertensive treatment.MethodsWe analysed 261 24 h amublatory monitoring records (SpaceLabs 90207, SpaceLabs, Redmond, Washington, USA) obtained from hypertensives over 18 years of age (mean age 55.8 years) in order to make a diagnosis of hypertension or assess its control in response to treatment. Recording was programmed to occur every 20 min during waking periods and every 30 min during sleep, daily activity also being registered. The criteria compared in the diagnosis of hypertension were: (1) the evaluation criterion: an average blood pressure for the activity period of less than 135/85 mmHg (Joint National Committee VI); (2) the gold standard: an average blood pressure over 24 h of less than 125/80 mmHg (World Health Organization–International Society of Hypertension, 1999).ResultsIn 90% of the records, there was agreement between both criteria. In 7.2%, the awake blood pressure average was normal and the 24 h average high. Values obtained were: sensitivity, 89% (95% confidence interval 84–89%); specificity, 92% (95% CI 88–95%); positive predictive value, 95.6% (95% CI 93–98%); negative predictive value, 81% (95% CI 75–85%); pretest probability, 66% (95% CI 60–72%); positive likelihood ratio, 11; and negative likelihood ratio, 0.3. There were no significant differences in age, gender or percentage of treated subjects between the groups with and without agreement.ConclusionsDaytime and 24 h average blood pressure may indeed carry similar information for diagnosing hypertension and assessing the effects of antihypertensive treatment in clinical practice. Ambulatory blood pressure monitoring used only during the daytime period could be better tolerated and agreed to by patients than 24 h monitoring.

ISSN:1359-5237    

出版商:OVID    

年代:2003

数据来源: OVID