摘要:

Ambulatory blood pressure monitoring (ABPM) has become more widely used in the assessment of elevated blood pressure in children. The accurate diagnosis of white coat hypertension (WCH) is particularly important in children because detection of elevated blood pressure often results in expensive and invasive diagnostic procedures to detect underlying disease. Recent normative pediatric data have both enhanced our ability to interpret ABPM results in pediatric patients and increased awareness that children suffer from WCH as has already been reported in adults. The few studies of WCH in children report a prevalence ranging from 44–88%, depending on the choice of threshold values for normalcy. When persistent hypertension is confirmed by three blood pressure measurements on three different occasions, ABPM should be performed as part of the initial evaluation. If hypertension is confirmed by ABPM, further evaluation should be tailored to the individual patient depending on the age, severity of hypertension, associated risk factors, and presence of end-organ injury.

ISSN:1359-5237    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundBecause ambulatory blood pressure monitoring (ABPM) is not available everywhere, the objective of the study was to determine whether nurse-measured blood pressure could be an acceptable substitute to ABPM.MethodsWe analyzed the data of 2385 consecutive patients referred to our hypertension clinic for the performance of ABPM. Before ambulatory monitoring was performed, a nurse-measured BP was obtained three times using a Y-tube connecting the sphygmomanometer and the recorder. We compared the mean value of the three nurse-measured blood pressures with that of the 12 h daytime ambulatory monitoring, considered as the reference.ResultsThe difference between the nurse-measured and the ambulatory blood pressure was small but statistically significant, indicating that nurse-measured blood pressure tends to overestimate both diastolic and systolic blood pressure. The difference between the nurse blood pressure and ABPM was greater among treated hypertensive patients than untreated patients. To diagnose hypertension, defined as a blood pressure of over 140/90 mmHg by ABPM, the positive predictive value of the nurse blood pressure was 0.81 and the negative predictive value 0.63. However, these predictive values could be improved with less stringent cut-off values of blood pressure. Thus, for a diastolic blood pressure above 100 mmHg, the positive predictive value of nurse blood pressure was 0.55 and the negative predictive value 0.91. These figures were relatively similar for previously treated and untreated patients.ConclusionNurse blood pressure is less accurate than ABPM in diagnosing hypertension, defined as a blood pressure of over 140/90 mmHg. It could, however, be an acceptable substitute, especially to exclude people who do not need to be treated, in situations where lower resources require a less rigorous definition of hypertension.

ISSN:1359-5237    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundAmbulatory blood pressure monitoring (ABPM) is widely utilized for the evaluation and management of hypertension in adults but has not been routinely used in the care of hypertensive children.DesignTo examine the potential impact that the routine use of ABPM might have on the evaluation and management of hypertension in children, we reviewed our early experience with this technique, comparing management decisions based on ABPM with those based on casual blood pressure readings.MethodsTwenty children (4–17 years old) underwent ABPM for either the initial evaluation of suspected hypertension or the ongoing management of known hypertension. ABPM studies were considered abnormal if over 40% of both systolic and/or diastolic blood pressure readings were above the 95th percentile for the child's age and gender.ResultsOf 13 children studied for suspected hypertension, nine had abnormal ABPM studies and were treated, but four had normal results and were therefore not treated. Of seven children with known hypertension studied by ABPM to assess their blood pressure control further, three had normal results and no management changes were made, but four had abnormal studies, prompting a change in therapy or further diagnostic testing. Overall, eight out of 20 ABPM studies led to the initiation of further diagnostic evaluation or a change in planned or ongoing therapy.ConclusionsWe conclude that ABPM has the potential to become an important tool in the evaluation and management of childhood hypertension, and suggest that more widespread use of this technique in children is appropriate.

ISSN:1359-5237    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundIncreasing evidence documents the fact that individuals whose blood pressure drops or ‘dips’ relatively little at night have a higher risk of numerous cardiovascular illnesses.ObjectiveTo examine the reliability of various measures of nocturnal blood pressure dipping.MethodsThis study examined 17 individuals with ambulatory blood pressure monitoring on three 24 h recordings while they pursued a schedule similar to that of in-patients on a clinical research unit. Nocturnal dipping of blood pressure was scored three ways: as the drop in blood pressure between 10 p.m. and 6 a.m. (‘clocktime’), as the drop in blood pressure tailored to each individual's reported bedtime (‘bedtime’), and as the drop in blood pressure accompanying polysomnographically verified sleep (‘sleeptime’).ResultsAdequate reliability was obtained for all three measures of dipping. There was, in general, a significant correlation across testing occasions (P < 0.05). The correlation coefficient ranged from 0.5 to 0.8, depending on which criterion of dipping was selected and whether the endpoint was systolic blood pressure, diastolic blood pressure, or mean arterial blood pressure.ConclusionsThe reliability of systolic blood pressure dipping was somewhat lower than that of diastolic or mean arterial blood pressure dipping. Dipping appears to be a reliable construct. While no one definition of dipping was demonstrably better than another, the most sensible definition of dipping would allow some adjustment for defining ‘night’ on the basis of each individual's idiosyncratic bed time.

ISSN:1359-5237    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundWe present data from a cross-sectional study on consecutive non-randomized drug-treated mild-to-moderate essential hypertensives, whose blood pressure was ambulatorily monitored for 24 h to evaluate the presence of adequate control.DesignPrimary and secondary care physicians were invited to send to our clinic drug-treated patients with essential hypertension (JNC VI stages 1–2) to undergo 24-h ambulatory blood pressure monitoring (ABPM) while continuing their prescribed medications.MethodsThe 436 enrolled patients (255 males, 181 females, age 61 ± 11 years) were left on their therapeutic regime: monotherapy in 208 patients (47.7%) and combination therapy in 228 patients (52.3%). All the patients were divided into two care groups: primary care, 238 patients (54.6%) and secondary care, 198 patients (45.4%). A mean daytime blood pressure ≤135/85 mmHg was chosen as a definition of adequate blood pressure control.ResultsAdequate blood pressure control was found in 196/436 total patients (45%); 112/238 patients in primary care (47%) and 84/198 patients in secondary care (42.4%) (P = NS); 94/208 patients (45.2%) in monotherapy and 102/228 patients (44.7%) in combination therapy (P = NS); 125/255 male patients (49%) and 71/181 female patients (39.2%) (P = 0.0428). In the logistic regression model, female sex was associated with a higher risk of inadequate blood pressure control of about 50%.ConclusionsAdequate blood pressure control, as assessed by ABPM, is not different in the two settings of family doctor's office and specialist's clinic and is predicted by male gender. The figures of adequate blood pressure control remind us of the rule of halves, regardless of treatment regimes and medications.

ISSN:1359-5237    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BackgroundThe validation of self‐measurement devices has been recommended. Automatic monitor A&D UA‐767 (A&D Company, Ltd, Tokyo, Japan) is well known and widely used, but not tested according to the Association for Advancement of Medical Instrumentation (AAMI) and British Hypertension Society (BHS) recommendations.ObjectiveTo perform a clinical validation for use by adults of the A&D UA‐767 device according to the criteria of the AAMI and a modified BHS protocol.MethodsThe test concerned 101 subjects (57 men and 44 women) aged 15–85 years with arm circumferences of 22–39 cm, a systolic blood pressure (SBP) range of 89–206 mmHg, and a diastolic blood pressure (DBP) range of 53–122 mmHg. For each subject, three readings of the UA‐767 were compared with simultaneous auscultatory measurements by two trained independent observers who used a mercury manometer and dual stethoscope. The results were graded according to the BHS (1990 and 1993) and AAMI recommendations.ResultsObservers showed close agreement, with mean differences of 1.1 ± 2.4 mmHg for SBP and −0.7 ± 2.0 mmHg for DBP. The proportion of values agreeing to within 5, 10 and 15 mmHg were 93, 100, and 100% for SBP and 97, 100, and 100% for DBP for the two observers. The sphygmomanometer measurements were 132 ± 24/79 ± 14 mmHg (mean ± SD). The average difference between the mercury sphygmomanometer and A&D UA‐767 readings for SBP and DBP were, respectively, −0.4 ± 5.4 and –0.4 ± 4.8 mmHg. The proportion of values agreeing to within 5,10, and 15 mmHg were 82, 94, and 98% for SBP and 80, 95, and 98% for DBP for the observers and device (A/A grade for BHS).ConclusionsFor an adult population, the A&D UA‐767 device for the self‐measurement of blood pressure satisfied the AAMI criteria, achieved a BHS grade of A/A and can therefore be recommended for monitoring blood pressure in home and clinical conditions by patients with mild‐to‐moderate arterial hypertension.

ISSN:1359-5237    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo assess the clinical accuracy of the Mobil O Graph (version 12) ambulatory blood pressure monitor in an adult population.MethodsThe accuracy of the device was assessed by predefined criteria (British Hypertension Society, BHS) in 85 subjects recruited from the patients and staff in a teaching hospital. A series of same-arm sequential blood pressure measurements were taken: first two observers taking simultaneous mercury readings, followed by a reading with the Mobil O Graph ambulatory monitor. A total of seven readings were taken from each subject in the sitting position. The data were then analysed according to the BHS protocol and the criteria of the Association for the Advancement of Medical Instrumentation (AAMI).ResultsThe Mobil O Graph ambulatory monitor fulfilled the criteria of the BHS protocol, achieving a grade B for systolic blood pressure (SBP) and a grade A for diastolic blood pressure (DBP). The mean differences were −2 ± 8 mmHg for SBP and −2 ± 7 mmHg for DBP. The device therefore also passed the AAMI standard (the mean to be within 5 ± 8 mmHg).ConclusionThe Mobil O Graph ambulatory monitor performed in a satisfactory manner according to the BHS and the AAMI criteria and can therefore be recommended for clinical use in the general population.

ISSN:1359-5237    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

ObjectiveTo evaluate the overall performance of a new oscillometric wrist blood pressure monitor (Braun PrecisionSensor, Braun GmbH, Kronberg, Germany) as defined by the ANSI/AAMI SP10-1992 guidelines, and to analyze the data for the optimized selection of the algorithm that derives the blood pressure values from the oscillometric blood pressure curves.MethodsThe clinical trial was a multi-center, open, within-subject evaluation. Repeated sequential blood pressure measurements were taken on the left wrist using the Braun PrecisionSensor, and on the left upper arm using a T-tube stethoscope and a mercury sphygmomanometer as a standard auscultatory blood pressure measurement device. The reported results are based on a sample of 86 adult male and female subjects (57% female, 43% male). Three sets of measurements with each of both devices were evaluated for each individual.ResultsClose agreement was obtained between both observers in compliance with the ANSI/AAMI SP10–1992 guidelines. The mean values of the differences between the Braun PrecisionSensor and the mercury sphygmomanometer were 0.1 mmHg for systolic and 1.9 mmHg for diastolic blood pressure. The standard deviations were 7.1 mmHg for systolic and 7.0 mmHg for diastolic blood pressure. The use of an optimized algorithm improved the accuracy of the Braun PrecisionSensor, after which the standard deviations were 6.1 mmHg for systolic and 6.3 mmHg for diastolic blood pressure.ConclusionsThe Braun PrecisionSensor satisfies the Association for the Advancement of Medical Instrumentation's efficacy and safety criteria for both systolic and diastolic blood pressures with both algorithms analyzed.

ISSN:1359-5237    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1359-5237    

出版商:OVID    

年代:2000

数据来源: OVID