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GA Mansoor

Publications and source records attributed to GA Mansoor.

7 recordsLinked to original sources
PubMed1999

Modification of blood-pressure-measuring devices and the protocol of the british hypertension society

The market for blood-pressure-measuring devices is enormous and growing. Devices are required in a number of areas in hospitals, in doctors' offices, in paramedical areas and in the transport of patients; and there is a vast demand for self-measuring devices from the public. In Germany, for example, 12 million such devices are sold annually [1]. Only a fraction of the many hundreds of models available worldwide has been subjected to independent validation, though the number of devi E> 1359-5237 4 1 1999 February 1999 Paper alert 55 56 EN George A Mansoor Section of Hypertension and Clinical Pharmacology, University of Connecticut Health Center, Farmington, Connecticut, USA EDITORIAL http://www.cardiosite.com http://www. cardiosite.com

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PubMed1998

Nocturnal blood pressure epidemiology, determinants, and effects of antihypertensive therapy.

It has been established that blood pressure and heart rate have a reproducible circadian pattern characterized by a low period during sleep; an early morning, post-awakening rise; and a high plateau period while a subject is awake. This rhythm is influenced by extrinsic (lpar;environmental) and intrinsic (physiologic and pathophysiologic) factors. When hypertensive patients have the typical circadian pattern of blood pressure described above, they are referred to as 'dippers', whereas, when the normal nocturnal fall of blood pressure is diminished or blunted,s the term 'nondipper' is applied. Cross-sectional and prospective data have shown that nondippers have more target-organ damage than have dippers. Therefore, the prognostic implications of the nondipper status may be important since the overall 24 h blood pressure load is elevated in these individuals. Assessing the effects of antihypertensive therapy on 24 h blood pressure and heart rate using ambulatory monitoring has become routine in clinical trials. However, the methods of analysis and tyipes of trial design may significantly affect evaluation of therapeutic effects on nocturnal blood pressure. This article describes the influence of analysis on 24 h blood pressure measurement especially insofar as it pertains to nocturnal (or sleep) blood pressure values.

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PubMed1997

Evaluation of the Datascope Accutorr Plus according to the recommendations of the Association for the Advancement of Medical Instrumentation.

BACKGROUND: Automatic noninvasive blood pressure measurement devices should be clinically validated prior to marketing using standard criteria such as those published by the Association for the Advancement of Medical Instrumentation and the British Hypertension Society. OBJECTIVE: To assess a new bedside oscillometric device (Accutorr Plus, Datascope Inc., Montvale, New Jersey, USA). METHODS: We compared measurements obtained using the device with mercury column measurements for 90 subjects (448 measurements). In addition to calculation of the limits of agreement for the device versus observers, we determined the impact of age, the blood pressure level, the body mass, and the arm size on the levels of agreement. RESULTS: There was a good agreement between observers, with a mean difference of 0.38 +/- 4.47 mmHg for the systolic and 0.0 +/- 3.7 mmHg for the diastolic blood pressure. The observer-device agreement was -0.04 +/- 7.93 mmHg for the systolic and 0.35 +/- 5.75 mmHg for the diastolic blood pressure. Regression analyses showed that, as the systolic blood pressure and age increased, the level of disagreement for the systolic blood pressure also increased ( P < 0.001 for both). CONCLUSIONS: The Accutorr Plus satisfied the criteria of the Association for the Advancement of Medical Instrumentation for a general adult population with large ranges in age, blood pressure, body mass and arm circumference. Not unlike many oscillometric devices, for systolic blood pressures > 190 mmHg, the device error increased.

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PubMed1997

Clinical use of ambulatory blood pressure monitoring in a Veteran's Medical Center.

BACKGROUND: The lack of prospective data on the relative value of ambulatory blood pressure compared with office blood pressure as well as concern about increased costs have led to cautious endorsement of such monitoring in the clinical arena. Several consensus bodies have reviewed the scientific evidence and have suggested appropriate and limited clinical indications for ambulatory blood pressure monitoring. OBJECTIVE: To evaluate the ordering habits of the clinicians in regard to the recent introduction of such a monitoring service at our Veteran's Administration Medical Center and to assess its influence on practice.METHODS: During the 18 months after the introduction of ambulatory blood pressure monitoring, 95 successful blood pressure recordings were performed. These studies were requested for patients typical of the aging World War II veteran population in the USA. The blood pressure monitoring test was ordered mostly by attending physicians (44%) but physician extenders (34%) and medical residents (22%) also ordered a significant proportion of the tests. The main indication for ambulatory blood pressure monitoring was suspicion of white-coat hypertension in untreated patients and suspicion of white-coat effect in treated hypertensives (45%). RESULTS: The results had an important impact on the management of patients, 42% of untreated patients remained without pharmacologic treatment whereas, for 36% of treated patients, increases in medication were avoided. With the 73 patients for whom complete follow-up blood pressure data were obtained, there was a significant decline both in office systolic (by 8 +/- 15 mmHg, P = 0.001) and in office diastolic blood pressure (by 6 +/- 8 mmHg, P = 0.001) after 3 months. CONCLUSION: Clinical providers in a Veteran's Administration Medical Center used ambulatory blood pressure monitoring appropriately after its introduction and found the information provided to be of clinical value.

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PubMed1996

Comparison of office and ambulatory blood pressure measurements to assess the angiotensin II receptor antagonist eprosartan.

BACKGROUND: To determine the efficacy and dose-response of the new angiotensin II receptor antagonist eprosartan, we conducted a 4-week, double-blind, randomized, multicenter study in 114 men with essential hypertension using trough clinic and ambulatory blood pressure measurements.METHODS: Patients were included if the seated diastolic blood pressure was between 95 and 115 mmHg inclusive and 0-12 h diastolic blood pressure was at least 87 mmHg. The effects of twice daily eprosartan at 50, 100, 150 and 200 mg were compared with those of placebo. RESULTS: At trough, the clinic diastolic blood pressure was reduced significantly only by the 200 mg dose compared with placebo (mean placebo-subtracted change -6.0 mmHg, 95% confidence intervals -10.5, -1.5, P = 0.001). In contrast, the 12 h mean reduction in diastolic blood pressure was significant for both the 150 mg dose (mean change -5.3 mmHg, 95% confidence intervals -10.2, -0.1, P = 0.0075) and the 200 mg dose (mean change -5.5 mmHg, 95% confidence intervals -10.3, -0.6, P = 0.0049). Similar trends were observed for the systolic pressure and mean changes in 24 h pressures. Eprosartan significantly reduced adjusted mean daytime (0-12 h after dose) diastolic ambulatory pressure linearly with dose. CONCLUSION: These data demonstrate increased sensitivity of the ambulatory blood pressure over the research clinic blood pressure in evaluating the efficacy of the new antihypertensive agent eprosartan. Additionally, these findings demonstrate that higher doses of this drug will be necessary in future studies.

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PubMed1996

Effects of three methods of analysis on ambulatory blood pressure indices and the early morning rise in blood pressure.

OBJECTIVE: To study the effects of actigraphic, diary and fixed-time methods of analysis on ambulatory blood pressure, the day (awake)-night (asleep) difference and early morning blood pressure. METHODS: We analyzed 50 ambulatory blood pressure studies of patients who also underwent actigraphic activity studies. We divided each study into awake and sleeping intervals by three methods: a patient diary of sleep hours, actigraphically determined sleep hours and a fixed schedule of estimated sleep (2200-0700 h). We then calculated the overall ambulatory blood pressure averages, the awake-asleep differences and the average blood pressure for 4 h after awakening. RESULTS: We found that actigraphic division of the data and patient-kept diaries provided similar ambulatory blood pressure averages whereas fixed-time analysis (2200-0700 h as the sleeping period) was less similar to that using the diary method. The nocturnal decline in diastolic blood pressure calculated by the diary method tended to be higher than that obtained by the fixed time method (16+/-6 versus 14+/-7%, P = 0.037). The limits of agreement for the early morning blood pressure rise for diary and fixed-time analyses were wider than those for diary and actigraphic analyses (-9.5 to +10.0/-6.6 to +7.0) versus (-4.4 to +4.7/-4.1 to +4.0 mmHg). CONCLUSION: Actigraphic division of the ambulatory blood pressure data is more similar to the diary than it is to the fixed-time method studied here. Researchers studying the early morning rise in blood pressure should consider using either actigraphy or diary rather than fixed-time methods of analysis to identify times of awakening.

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