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Reproducibility of head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope.

Head-up tilt testing (HUTT) potentiated with sublingual nitroglycerin has gained acceptance as means of diagnosing neurally mediated syncope. To evaluate the reproducibility of HUTT potentiated with sublingual nitroglycerin, 48 patients with unexplained syncope prospectively underwent 2 consecutive tests 1 to 28 days apart. The initial test ended in syncope in 34 patients (71%). In 9 patients (19%) the test was positive during the drug-free phase, whereas 25 patients (52%) had syncope after nitroglycerin administration. Of these 34 patients with an initial positive test result, 27 (79%) had a reproducible outcome on repeat testing. Of 12 patients (25%) with an initial negative test result, 10 (83%) had a reproducible outcome on repeat testing. Of 2 patients (4%) with a first test ending in exaggerated response, both had a negative repeat test response. The overall reproducibility of sublingual nitroglycerin tilt-table testing was 77%. In a group of 23 patients with both positive tests, 19 (83%) had the same response modality (2 vasodepressor, 4 cardioinhibitory, 13 mixed response). In the same group of patients, individual trough heart rates correlated well with each other between tests. Finally, in the 27 patients with both positive tests, intrapatient time of onset of symptoms did not significantly correlate between tests. Thus, in patients with syncope of unknown origin, HUTT potentiated with sublingual nitroglycerin provides an adequate reproducibility when repeated on different days.

Administration, Sublingual↗

Reproducibility of retinal nerve fiber layer evaluation by dynamics scanning laser ophthalmoscopy.

Scanning laser ophthalmoscopy is a laser-based image acquisition technique, which greatly improves the quality of the examination of the fundus and the retinal nerve fiber layer. To assess retinal nerve fiber layer imaging by scanning laser ophthalmoscopy and evaluate intra- and interobserver reproducibility in the classification of retinal nerve fiber layer defects, three independent observers evaluated on two separate occasions the videotaped images of 150 eyes of 80 consecutive patients with ocular hypertension or glaucoma. Ophthalmoscopy was performed using argon blue light (488 nm), confocal apertures of 3 to 1 mm, and 40-degree and 20-degree field angles. Of 150 eyes, 20 (13.3%) were excluded from the study because of the poor quality of the images (clinically significant cataract or myopic peripapillary atrophy). The retinal nerve fiber layer was evaluated qualitatively according to a standard classification: normal pattern, slit, wedge, and diffuse defects. Intraobserver reproducibility, evaluated by kappa statistic, was excellent (> or = 0.75): observer A = 0.78 (95% confidence limits, 0.67-0.88); observer B = 0.84 (95% confidence limits, 0.72-0.96); and observer C = 0.79 (95% confidence limits, 0.67-0.91). Interobserver reproducibility was also excellent in all cases: observers A-B = 0.84 (95% confidence limits, 0.71-0.98); observers A-C = 0.76 (95% confidence limits, 0.65-0.87); and observers B-C = 0.80 (95% confidence limits, 0.69-0.92). Kappa values ranged between 0.59 and 0.69 for intraobserver reproducibility and between 0.55 and 0.69 for interobserver reproducibility when using only those eyes in which abnormalities were noted by at least one observer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Observer variation and reproducibility of endoscopic ultrasonography.

To investigate interobserver variation and reproducibility of endosonographic findings, both experienced and inexperienced endosonographers evaluated depth of tumor invasion (T stage) and presence of lymph node metastasis (N stage) in 50 patients with nonobstructing esophageal carcinoma. Results were compared with the findings by surgical pathology of the resected specimens. The kappa statistic (kappa) was used to assess interobserver and intraobserver agreement and consistency of accurate interpretation (reproducibility) for the two groups. Agreement between the experienced endosonographers was excellent (kappa = > .75) for T1 and T4 lesions, good (kappa = .61) for T3 lesions, but only poor (kappa = > .46) for T2 lesions. The overall agreement between the experienced endosonographers was equally good for both T and N stages. Agreement between the inexperienced endosonographers was poor for all T stages but was good for lymph node metastasis (kappa = .52). For experienced endosonographers, endosonographic reproducibility of histologically confirmed T4 lesions was excellent, followed closely by T3 and T2 lesions; T1 tumors were frequently interpreted differently by the same endosonographer. Reproducibility of N stage determinations was excellent for N0 lymph nodes and good for N1 nodes. Thus, for experienced endosonographers, interobserver agreement was excellent for all T stages except T2, whereas reproducibility of determination of depth of tumor invasion was good to excellent for T2, T3, and T4 lesions but poor for T1 lesions. As yet poorly defined operator and machine-dependent factors that cause misinterpretation of T1 and T2 tumors will require additional study.

Endoscopy↗

Clinical study of location and reproducibility of three mandibular positions in relation to body posture and muscle function.

Clinical studies have confirmed the adequate reproducibility of both centric occlusion and centric relation when used as reference positions during treatment; however, the reproducibility of the neuromuscular position has been found inadequate. This study evaluated the location and reproducibility of these three mandibular positions in relation to body posture, sitting and supine, and bilateral muscle activity before and after the insertion of a flat mandibular positioning device equilibrated to balance the muscle functions, as shown by two electromyography biofeedback instruments. Intraoral recordings were made in 11 young subjects with complete natural dentition. Acrylic resin clutches that supported a screw point in the maxillary arch and painted glass in the mandibular arch were used and positioned not to interfere with the occlusion. The distances of the screw scratch from two of the edges of the painted glass were used to measure the anteroposterior and mediolateral locations with a micrometer. The reproducibility was evaluated by measuring the scratch surface by measuring the weight of the print cutouts made from photographs of the scratches taken with a stereoscope. The location and reproducibility of centric occlusion and centric relation were not affected by body posture. A more precise posterior neuromuscular position was obtained in the supine position. The insertion of a mandibular positioning device did not affect centric occlusion but gave a more precise centric relation. Neuromuscular position became as precise as centric occlusion and was located anteroposteriorly between centric occlusion and centric relation.

Acrylic Resins↗

Reproducibility and condylar position of a physiologic maxillomandibular centric relation in upright and supine body position.

Better understanding of the physiologic features of the masticatory system has led to the evolution of the concept of maxillomandibular centric relation from the mechanical to physiological bases. However, the reproducibility of physiologic methods for centric relation determination has been criticized. In this clinical study the swallowing technique was modified to establish a physiologic centric relation in a reproducible manner. Condylar and disk positioning and reproducibility of the proposed modified swallowing technique (MST) were compared with the same parameters of a traditional technique, namely, the chin point guidance technique (CGT). Both techniques were studied with the patient in the upright and supine positions. Three interocclusal records were obtained for each technique-position combination for each of the 30 patients. The recorded maxillomandibular relations were analyzed on the three-dimensional analyzer. MST positioned the condyles in a more superoanterior position than did CGT, which was interpreted as a better seating of the condyles and disk in the articular fossae. There was no significant difference in reproducibility between MST and CGT on x, y, or z axes (p > 0.05), indicating that it is possible to establish a physiologic centric relation in a reproducible manner. The term "functional centric area" was proposed in this study to define a neuromuscularly determined centric occlusal scheme.

Adult↗

Reproducibility in monitoring nocturnal penile tumescence and rigidity.

The evaluation of sexual dysfunction has improved with the advent of methods to test nocturnal penile tumescence that also monitor penile rigidity. Earlier techniques may not have recorded abnormal rigidity despite normal tumescence. To test the reproducibility of penile tumescence and rigidity, the results of initial and repeat tracings performed a mean of 39 days apart were compared in 17 patients (median age 62 years). Three nocturnal patterns were identified. 1) Among the 17 patients the initial penile tumescence and rigidity pattern was reproduced on repeat testing in 15. 2) Patterns that were not reproduced in the other 2 patients were explained by the ingestion of alcohol or because of a febrile illness during the period monitored. 3) Nocturnal penile rigidity and tumescence tracings from these patients reproduced previous patterns. Monitoring of nocturnal penile tumescence and rigidity is a useful and reproducible tool in the evaluation of male sexual dysfunction.

Adult↗

Reproducibility of neuroendocrine lung tumor classification.

For a tumor classification scheme to be useful, it must be reproducible and it must show clinical significance. Classification of neuroendocrine lung tumors is a difficult problem with little information about interobserver reproducibility. We sought to evaluate the classification of typical carcinoid (TC), atypical carcinoid (AC), large-cell neuroendocrine carcinoma (LCNEC), and small-cell carcinoma (SCC) tumors as proposed by W.D. Travis et al (Am J Surg Pathol 15:529, 1991). Forty neuroendocrine tumors were retrieved from the Armed Forces Institute of Pathology (AFIP) files and independently evaluated by five lung pathologists and classified as TC, AC, LCNEC, or SCC (pure SCC, mixed small cell/large cell, and combined SCC). A single hematoxylin and eosin-stained slide from each case was reviewed. Each participant was provided a set of tables summarizing the criteria for separation of the four major categories. Agreement was regarded as unanimous if all five pathologists agreed, a majority if four agreed, and a consensus if three or more pathologists agreed. The kappa statistic was calculated to measure the degree of agreement between two observers. A consensus diagnosis was achieved in all 40 cases (100%), a majority agreement in 31 of 40 (78%), and unanimous agreement in 22 of 40 (55%) of cases. Unanimous agreement occurred in seven of SCC (70%), seven of TC (58%), four of AC (50%), and four of LCNEC (40%). A majority diagnosis was achieved in 11 of 12 (92%) of TC, 9 of 10 (90%) of SCC, 6 of 8 (75%) of AC, and 5 of 10 (50%) of LCNEC. Most of the kappa values were 0.70 or greater, falling into the substantial agreement category. The most common disagreements fell between LCNEC and SCC, followed by TC and AC, and AC and LCNEC. The highest reproducibility occurred for SCC and TC, with disagreement in 8% and 10% of the diagnoses, respectively. For TC, 10% of the diagnoses rendered were AC. For AC, 15% of the diagnoses were rendered as TC, with 2.5% called LCNEC and 2.5% called SCC. For LCNEC, 18% and 4% of the diagnoses were called SCC and AC, respectively. For SCC, 4% of the diagnoses were called AC and 4% were called LCNEC. Thus, using the classification scheme tested, a consensus diagnosis can be achieved for virtually all neuroendocrine lung tumors with substantial agreement between experienced lung pathologists. Classification of NE tumors is most reproducible for classification of TC and SCC but less reproducible for AC and LCNEC. These results indicate a need for more careful definition and application of criteria for TC versus AC and SCC versus LCNEC.

Carcinoid Tumor↗

Reproducibility of HTS-SQUID magnetocardiography in an unshielded clinical environment.

A new technology has been developed which measures the magnetic field of the human heart (magnetocardiogram, MCG) by using high temperature superconducting (HTS) sensors. These sensors can be operated at the temperature of liquid nitrogen without electromagnetic shielding. We tested the reproducibility of HTS-MCG measurements in healthy volunteers. Unshielded HTS-MCG measurements were performed in 18 healthy volunteers in left precordial position in two separate sessions in a clinical environment. The heart cycles of 10 min were averaged, smoothed, the baselines were adjusted, and the data were standardized to the respective areas under the curves (AUC) of the absolute values of the QRST amplitudes. The QRS complexes and the ST-T intervals were used to assess the reproducibility of the two measurements. Ratios (R(QRS), R(STT)) were calculated by dividing the AUC of the first measurement by the ones of the second measurement. The linear correlation coefficients (CORR(QRS), CORR(STT)) of the time intervals of the two measurements were calculated, too. The HTS-MCG signal was completely concealed by the high noise level in the raw data. The averaging and smoothing algorithms unmasked the QRS complex and the ST segment. A high reproducibility was found for the QRS complex (R(QRS)=1.2+/-0.3, CORR(QRS)=0.96+/-0.06). Similarly to the shape of the ECG it was characterized by three bends, the Q, R, and S waves. In the ST-T interval, the reproducibility was considerably lower (R(STT)=0.9+/-0.2, CORR(STT)=0.66+/-0.28). In contrast to the shape of the ECG, a baseline deflection after the T wave which may belong to U wave activity was found in a number of volunteers. HTS-MCG devices can be operated in a clinical environment without shielding. Whereas the reproducibility was found to be high for the depolarization interval, it was considerably lower for the ST segment and for the T wave. Therefore, before clinically applying HTS-MCG systems to the detection of repolarization abnormalities in acute coronary syndromes, further technical development of the systems is necessary to improve the signal-to-noise ratio.

Adult↗

The reproducibility of color Doppler duplex sonography in the measurement of renal arterial blood velocity.

In this study, the reproducibility of color Doppler duplex sonography for repeated measurements of renal blood flow was evaluated in 14 healthy subjects. We examined the reproducibility for different examiners and different time intervals between the examinations. Doppler frequency sonograms were analyzed with several parameters, and statistical evaluation was performed by calculating both the correlation coefficient (r) and coefficient of variation (CV). Peak systolic velocity (S), early diastolic velocity (D1) and mean velocity (MV) showed good reproducibility (r = 0.902-0.992, CV = 2.15-8.16%). On the other hand, end-diastolic velocity (D2), acceleration time (AT) and acceleration index (AI) showed poor reproducibility. We conclude that the reproducibility of this method is acceptable for repeated measurements of renal blood velocity, using suitable parameters S, D1 and MV.

Adult↗

Reproducibility of ultrasonographic measures in internal jugular veins of normal subjects.

OBJECTIVE: To assess the reproducibility of ultrasonographic quantitative parameters of internal jugular veins (IJV) in normal subjects. MATERIAL AND METHODS: Thirty IJV of 15 normal volunteers were prospectively evaluated by means of duplex Doppler ultrasonography (US). Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were registered in all cases. Two measures were performed in each subject. RESULTS: High reproducibility was encountered in jugular flow (R=0.95) and in area during Valsalva (R=0.90) in the left IJV. Low reproducibility was found in Valsalva flow speed of the left side (R=0.35). The remaining measurements had a good reproducibility (R=0.50-0.75). CONCLUSIONS: The ultrasonographic parameters of IJV in normal subjects show an adequate grade of reproducibility. Thus, duplex Doppler US can be used as a reliable method for evaluation or comparison of IJV in different situations of future studies.

Adult↗

Reproducibility--an important factor determining the quality of computer-aided detection (CAD) systems.

PURPOSE: To test the reproducibility of markings on mammography films set by a commercial computer aided detection (CAD) system. PATIENTS AND METHODS: One hundred unilateral mammography examinations (each in CC and MLO) of 100 patients with mammographically detected suspicious foci, which were histopathologically proven to be malignant, were scanned three times with the CAD system, retrospectively. Every fifth patient of the institutional tumor case sampler was enrolled in the study. Only cases with one visible lesion were included in the study. Reproducibility and sensitivity (in both the strict and the broader sense) were determined. Strict sensitivity means the correct set of markers in both images, whereas broader sensitivity means the correct set in at least one of the images. Sixteen of 100 malignancies were indicated by focal suspicious microcalcification clusters, 53 tumors by masses and 31 cases by both signs of breast cancer. The CAD evaluation was divided into only two different markers: one for microcalcifications and one for masses. Thus, 47 (16+31) tumor-induced microcalcifications and 84 (53+31) malignancy-related masses were checked using the CAD system. RESULTS: Eighteen of 100 unilateral mammography examinations revealed identical patterns in all three scans (18% reproducibility). Eleven of 47 suspicious focal microcalcification clusters and 43/84 masses were correctly marked on both mammographic views in all three CAD scans (strict and broader sensitivity, 23.4 and 51.1%, respectively). Six of 47 microcalcification clusters and 8/84 masses were totally missed in all images by the system (false negative rate, 12.8 and 9.6%, respectively). CONCLUSION: Reproducibility is essential for CAD systems. Currently, reproducibility of the used CAD system appears to be insufficient for clinical routine. Improvement of the system characteristics would make such systems valuable as a 'second reader' in clinical examination.

Breast Neoplasms↗

Long-term reproducibility of electrophysiologically guided therapy with sotalol in patients with ventricular tachyarrhythmias.

OBJECTIVES: Goal of this study was to assess the long-term reproducibility of electrophysiologic drug testing in patients with ventricular tachyarrhythmias (VT/VF). BACKGROUND: Programmed ventricular stimulation (PVS) is still widely used to guide antiarrhythmic therapy in patients with sustained ventricular tachycardia/fibrillation (VT/VF). Sotalol is considered as one of the most effective drugs for VT/VF. Because there is no proof of long-term reproducibility of a successful drug test with sotalol, we investigated the long-term reproducibility of drug testing with sotalol. METHODS: Thirty patients with VT/VF (age: 57+/-11 years, 20 patients with coronary heart disease, 7 patients with no structural heart disease, 3 with others) and reproducible induction of VT/VF (28 patients VT, two patients VF) in a baseline PVS, were suppressible with sotalol (mean dosage 395+/-137 mg) in a subsequent PVS. After a mean follow-up of 13+/-10 months a PVS was again performed in patients, who had no evidence of progressive cardiac disease, who did not experience any arrhythmia recurrences or who were drug compliant. Irrespective of the inducibility after long-term therapy with sotalol, all patients were kept on the initial sotalol regimen. All 30 patients had a stable cardiac condition, were free of VT/VF recurrences and were drug compliant. RESULTS: Despite the clinical efficacy of sotalol, in 12 patients (40%) VT/VF could again be induced after 13+/-10.2 months. Inducibility was independent of age, heart disease, ejection fraction and follow-up time. During a further follow-up of 22.1+/-10.9 months, five patients experienced nonfatal VT recurrences independently of the prior inducibility. CONCLUSIONS: This study shows a lacking long-term reproducibility of an initial effective PVS with sotalol. Despite an uneventful clinical follow-up, late electrophysiologic testing showed a VT/VF inducibility in a high portion of patients. Hence, electrophysiologic testing performed late after the initial drug test may no longer be predictive of outcome.

Anti-Arrhythmia Agents↗

Five-year reproducibility of natural head posture: a longitudinal study.

Natural head posture (NHP) is being increasingly used as the logical reference position for the evaluation of craniofacial morphology. The basic premise underlying its use is that the long-term clinical reproducibility (variability) of NHP is significantly less than the variability of conventional intracranial reference planes with respect to the vertical. This study reports the results of a 5-year longitudinal study evaluating the reproducibility over time of NHP lateral cephalometric radiographs. The subjects were 126 randomly selected Chinese children in Hong Kong who were first assessed at the age of 12 years. Thirty subjects were recorded after 5 years. NHP reproducibility deteriorated over time but showed signs of stabilizing after 1 to 1 1/2 years. The method error was 1.93 degrees after 1 to 2 hours, 2.34 degrees after 3 to 6 months, and 3.04 degrees after 5 years. The individual variability of NHP reproducibility also increased over time. The standard deviation of the SN/vertical angulation was 2.61 degrees after 1 to 2 hours, 3.16 degrees after 3 to 6 months, and 4.20 degrees after 5 years. Further longitudinal data are required to determine whether NHP reproducibility continues to deteriorate after 5 years. After 5 years, however, the variance of NHP (9.24 degrees [= 3.04(2)]) remains significantly less than the variance of intracranial reference planes to the vertical (25 degrees to 36 degrees).

Cephalometry↗

Sonicated echocardiographic contrast agents: reproducibility studies.

This article describes the production, analysis, and reproducibility of forming microbubbles for contrast ultrasound imaging. The sonication method used to generate microbubbles was tested by four independent observers, and a subsequent laser particle counter analysis of microbubble size and concentration determined the reproducibility of the method. The results indicated that the mean bubble size was 3.3 +/- 1.2 microns for the entire group, based on three trials of each of the four participants. The characteristics of the bubble size of the microbubbles between observers were assessed with a Poisson distribution with the reproducibility based on the sample mean for each observer's trials. Standardization and calibration of the laser particle counter was accomplished with commercially available latex spheres, sonicated albumin microspheres, and a Coulter counter analysis. Our results indicate that the sonication technique generates small microbubbles with a reproducible uniform size distribution. The method of microbubble production is reproducible and can be widely applied for use in contrast echocardiographic perfusion imaging of tissue in a variety of research and clinical studies.

Air↗

Mid- and long-term reproducibility of noninvasive measurements of spontaneous arterial baroreflex sensitivity in healthy volunteers.

Baroreflex sensitivity (BRS) is altered in a variety of circumstances and could be considered as a marker for the prognosis of some cardiovascular diseases. The present study was designed to evaluate the reproducibility of noninvasive measures of BRS, both at mid- and at long-term. Fourteen healthy volunteers were examined on three occasions (first interval = 1 week, second interval = 1 year). Each recording was performed using a noninvasive photoplethysmographic device (Finapres 2300, Ohmeda), both in supine and standing positions. Two different methods of measurement were used: the sequences method and cross spectral analysis. The reproducibility of BRS measures was as satisfactory at mid- as at long-term for the sequences method (intraclass coefficient [ICC] = 0.87 and 0.86, respectively), but it was better at mid- than at long-term for the cross-spectral analysis (ICC = 0.85 and 0.54, respectively). The measures performed in standing position were obviously more reproducible than those made in recumbent position (ICC = 0.87 and 0.70 for the sequences method, 0.85 and 0.71 for the cross-spectral analysis, respectively). Due to the high reproducibility of these noninvasive measures, the number of patients to be included in a pharmacological study was calculated as rather small: for example, only 20 patients are required for detecting a change in upright BRS of 3 msec/mm Hg, at long-term (sequences method). Likewise, the magnitude of the regression to the mean, which has to be expected in patients selected for a follow-up study, turned out to be low: for example, <15% of the difference between the patient group mean value and the reference value, both at mid- and at long-term (standing position, sequences method). We conclude that: 1) The noninvasive measures of BRS in standing position are reproducible enough to allow longitudinal studies to be conducted over either a short or a long period; 2) The long-term reliability of the sequences method seems to be higher than that of the cross-spectral analysis; and 3) Subtle changes in SBR may be noninvasively detected within small patient groups.

Adult↗

Reproducibility of heart rate measured in the clinic and with 24-hour intermittent recorders.

This study was undertaken to assess the reproducibility of office versus ambulatory heart rates in 839 hypertensive subjects participating in the Hypertension and Ambulatory Recording Venetia Study (HARVEST). A 24-hour heart rate was recorded twice; this procedure was repeated three months later. Reproducibility was better for ambulatory than for office measurement, and was greater for 24-hour than for daytime heart rate, and lowest for night-time heart rate. Reproducibility of office heart rate was impaired above 85 bpm, and was poorer in subjects with more severe office hypertension. A small but significant decrease in average daytime (-1 bpm, P < 0.0001) and virtually no change in night-time heart rate (-0.3 bpm, NS) were observed at repeat recording. Heart rate reproducibility indices were related to the extent of the heart rate and blood pressure white-coat effect, but did not vary according to age, gender, body mass index, day-night blood pressure difference, or alcohol or tobacco use. Results indicate that heart rate recorded over the 24 hours has a better reproducibility than office heart rate, and could thus be a better prognostic indicator than traditional measurement of resting heart rate in the hospital setting.

Adult↗

Comparison of three blood pressure measurement methods for the evaluation of two antihypertensive drugs: feasibility, agreement, and reproducibility of blood pressure response.

Our objective was to compare three different methods of blood pressure measurement through the results of a controlled study aimed at comparing the antihypertensive effects of trandolapril and losartan. Two hundred and twenty-nine hypertensive patients were randomized in a double-blind parallel group study. After a 3-week placebo period, they received either 2 mg trandolapril or 50 mg losartan once daily for 6 weeks. At the end of both placebo and active treatment periods, three methods of blood pressure measurement were used: a) office blood pressure (three consecutive measurements); b) home self blood pressure measurements (SBPM), consisting of three consecutive measurements performed at home in the morning and in the evening for 7 consecutive days; and c) ambulatory blood pressure measurements (ABPM), 24-h BP recordings with three measurements per hour. Of the 229 patients, 199 (87%) performed at least 12 valid SBPM measurements during both placebo and treatment periods, whereas only 160 (70%) performed good quality 24-h ABPM recordings during both periods (P < .0001). One hundred-forty patients performed the three methods of measurement well. At baseline and with treatment, agreement between office measurements and ABPM or SBPM was weak. Conversely, there was a good agreement between ABPM and SBPM. The mean difference (SBP/DBP) between ABPM and SBPM was 4.6 +/- 10.4/3.5 +/- 7.1 at baseline and 3.5 +/- 10.0/4.0 +/- 7.0 at the end of the treatment period. The correlation between SBPM and ABPM expressed by the r coefficient and the P values were the following: at baseline 0.79/0.70 (< 0.001/< .0001), with active treatment 0.74/0.69 (0.0001/.0001). Hourly and 24-h reproducibility of blood pressure response was quantified by the standard deviation of BP response. Compared with office blood pressure, both global and hourly SBPM responses exhibited a lower standard deviation. Hourly reproducibility of SBPM response (10.8 mm Hg/6.9 mm Hg) was lower than hourly reproducibility of ABPM response (15.6 mm Hg/11.9 mm Hg). In conclusion, SBPM was easier to perform than ABPM. There was a good agreement between these two methods whereas concordance between SBPM or ABPM and office measurements was weak. As hourly reproducibility of SBPM response is better than reproducibility of both hourly ABPM and office BP response, SBPM seems to be the most appropriate method for evaluating residual antihypertensive effect.

Angiotensin-Converting Enzyme Inhibitors↗

Reproducibility of resting blood pressure and heart rate measurements. The HERITAGE Family Study.

PURPOSE: This study determined the reproducibility of resting systolic and diastolic blood pressure, mean arterial pressure, and heart rate (the average of three measures/day). METHODS: The data were obtained on two separate days prior to an exercise training intervention in a sample of 822 subjects participating in the HERITAGE Family Study. The same protocol was conducted across three days in an intracenter quality control substudy, which included an additional 60 subjects. RESULTS: Reproducibility estimates included technical error, coefficient of variation within subjects, and intraclass correlation with results expressed by sex, race, age, cuff size, BMI, and %fat. Since the data were collected across four Clinical Centers, the reproducibility estimates were also computed separately for each Center. The systolic, diastolic, and mean arterial blood pressures were highly reproducible with technical errors less than 5.1 mmHg, coefficients of variation of less than 7. 0% and intraclass correlations > 0.75. The heart rates were slightly less reproducible. These results were fairly consistent across subject populations and across all four Clinical Centers. CONCLUSION: It is concluded that within subject day-to-day variations are small compared to between subject variance for resting systolic, diastolic, and mean arterial blood pressure and heart rate at each of the Clinical Centers for all of the HERITAGE Family Study data. This makes it appropriate to pool the data and analyze it for changes subsequent to endurance exercise training and to determine the possible genetic basis for these changes.

Adolescent↗