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At least 19 recordsLinked to original sources
PubMed1986

A role for steroid hormones in the variability of blood pressure determination.

Blood pressure variability was studied in eight patients with renovascular hypertension (group 1) and eight patients with hypertension and partial deficiency of adrenal zona fasciculata 11-hydroxylase (group 2). Systolic, diastolic and mean blood pressure were found to be higher in group 1 than in group 2 when measured at home (P less than 0.001), while no difference was measured when blood pressure was taken in the outpatient clinic. Heart rate was higher in group 1 than in group 2 both at home and in the clinic (P less than 0.005 and P less than 0.05, respectively); a significant increase was observed only in the hospital clinic for group 2 (P less than 0.001). No difference in systolic function and left ventricular mass was found between the two groups. Finally, group 2 exhibited a significant increase (P less than 0.0001) in systolic, diastolic and mean blood pressure in the clinic, compared with that found at home, while group 1 showed a poor increase (P less than 0.05) in systolic blood pressure only. It is suggested that the enzymatic impairment of adrenal glands in group 2 may play a role in the disparity of blood pressure levels determined at home and in the outpatient clinic. Furthermore, our data suggest that differences in blood pressure measurement at home and in the hospital clinic should be taken into account when screening patients with partial deficiency of 11-hydroxylase.

Adrenal Glands↗
PubMed1988

[Value of indirect 24-hour blood pressure determination and blood pressure self-control for the diagnosis of arterial hypertension].

For judgement of hypertension 24-hours-blood pressure readings and self recorded blood pressures are new, more sensitive techniques which help us to recognize patients with elevated cuff blood pressures who do not need drug-treatment. Furthermore these techniques help us to select those patients who are in need of treatment as well as to adjust the treatment more adequately to the patients real blood pressure. These new tools in judgement and treatment of hypertension help us to treat our patients with more safety and less side effects. Therefore we should force this new way of hypertension judgement.

Blood Pressure↗
PubMed1989

Effect of timing and number of baseline blood pressure determinations on postural blood pressure response.

We hypothesized that the blood pressure response to standing may depend on the method of establishing baseline blood pressure. Three hundred elderly subjects previously completed a postural blood pressure protocol with three supine baseline blood pressure readings obtained two minutes apart prior to standing. Comparison of the readings showed a significant drop between the first and the second (P less than .001) but not between the second and third supine systolic blood pressures. The difference between the first supine systolic blood pressure and the one minute standing blood pressure was significantly greater than that between the third supine systolic blood pressure and the one minute standing blood pressure (P less than .001). A second group was prospectively studied to determine whether the change in blood pressure after standing was greater if only a single baseline reading was taken rather than multiple readings, and whether the decline in blood pressure over three readings was related to duration supine or to the number of blood pressures taken. This group also demonstrated a decline in systolic blood pressure with three serial readings. We conclude that supine blood pressure declines significantly between the first and second readings taken two minutes apart and is secondary to the repetition of readings and not the duration supine. However, this change in supine blood pressure does not significantly alter the blood pressure response to standing. Thus, it appears that a single baseline supine blood pressure measurement is adequate for determining the postural blood pressure response, and that pooling of multiple baseline readings may not be appropriate.

Aged↗
PubMed1992

Variability of indirect methods used to determine blood pressure. Office vs mean 24-hour automated blood pressures.

Blood pressure is a cardiovascular measurement with dynamic characteristics that can be influenced by a number of internal and external factors. The preferred blood pressure determination method would be one that reduces variability between measurements and that reflects the true blood pressure level. In this article, we present the variability of, and agreement between, the blood pressures collected by two indirect methods on the same patients during a hypertensive research project. Data obtained on patients in a typical clinical setting are also provided. Twenty-four-hour diastolic pressures obtained by the automated method demonstrated no regression to a lower mean, while blood pressures obtained casually in the office exhibited such regression. The 95% confidence interval of repeated measures for casual office blood pressure on a patient in a research setting (35/17 mm Hg) or in typical clinic practice (26/19 mm Hg) were similar, while the range of the mean 24-hour automated blood pressure monitoring (21/11 mm Hg) was smaller and demonstrated less variability. The magnitudes of the differences in blood pressures obtained on separate occasions in the same subjects were significantly lower with automated vs casual blood pressure determination methods (7.9/4.6 vs 13.7/7.4 mm Hg for both systolic and diastolic pressures). The agreement (95% confidence interval) between blood pressures obtained by the two methods (19/12 mm Hg) was found to be similar to the repeatability of automated blood pressure monitoring alone, and superior to that for data recorded casually in the office (35/17 mm Hg). Thus, the variability in mean 24-hour automated blood pressures is less than that for casual office blood pressures. The clinician should understand that the variability of blood pressures measured on an individual may be much greater than that reported for populations of hypertensive patients, and must be considered when applying epidemiologic group data to a specific patient. Moreover, any methodology of indirect blood pressure measurement that may reduce the variability and improve repeatability of casual office blood pressures deserves further consideration.

Ambulatory Care↗
PubMed1997

Determining blood pressure in pregnancy. Positional hydrostatic effects.

OBJECTIVE: To evaluate positional hydrostatic effects on blood pressure determination during pregnancy. STUDY DESIGN: We studied 30 normotensive, pregnant women at 34-41 weeks of gestation. Blood pressures were taken in the sitting, left lateral, right lateral and supine positions with a two-minute stabilization period between positions. The bisacromial diameter was measured. Multivariate analysis of variance for repeated measures was used to evaluate the affect of position on blood pressure. RESULTS: Mean systolic pressure in the right arm was 2.6 mm Hg greater than that in the left arm (P < .05). There was no difference between the arms in diastolic blood pressure. Immediate blood pressure in the lower arm was no greater than in the higher arm in lateral positions, and there were no other significant positional effects. Observed blood pressures were significantly different than those theoretically expected on the basis of hydrostatic effects (P < .0001). CONCLUSION: Positional effects on blood pressure in the lateral positions do not appear immediately (within two minutes), indicating that hydrostatic pressure does not account for these changes. The well-documented blood pressure reduction from longer duration in the lateral position does not appear to be an artifact of hydrostatic effect. Repositioning pregnant women in the supine position to have the cuff at the level of the heart is unnecessary and often undesirable when fetal perfusion is an important consideration. We suggest that American Heart Association blood pressure guidelines stating that all measurements be taken with the cuff at the level of the heart to avoid hydrostatic pressure change be revised for pregnancy.

Adult↗
PubMed1991

Accuracy of ambulatory blood pressure determination: a comparative study.

This study was designed to discriminate, according to their accuracy, between three ambulatory pressurometers (Diasys 200R, Novacor; P IV, Del Mar Avionics; SpaceLab 90202, SpaceLab). The evaluation was performed against invasive arterial reference measurements. Accuracy was assessed by calculating the error on pressure (EOP) as the difference between invasive and non-invasive measurement of arterial blood pressure. For the systolic values, accuracy (mean of EOP differences) and uncertainty (SD of these differences) were -0.9 +/- 9.7, -4.3 +/- 10.1 and -16.7 +/- 10.1 mmHg for, respectively, Diasys, PIV and SpaceLab. For diastolic values, they were, respectively, 5.9 +/- 6.7, 6.8 +/- 8.5 and 9.1 +/- 6.6 mmHg. EOP was then separated in two different types of errors: (i) the error of dispersion appreciated by the index of homogeneity calculated by a Lehmann analysis and leading to a statistical classification (ii) the error due to the drift of EOP with the reference value, this last error being easier to correct. Two different behaviours were observed for the EOP: (i) the drift of EOP of systolic values was significantly larger for the oscillometric (SpaceLab) than for the auscultatory (Diasys and P IV) method, with no difference between Diasys and P IV (ii) the homogeneity index was not statistically different among these three devices. These data suggest that, in case the correction of the drift of EOP is carried out, there is no statistical significant difference in accuracy between these three pressurometers. However, in our experimental conditions, the two ambulatory pressurometers recording the Korotkoff sounds have a better accuracy than the one using the oscillometric approach.

Adult↗
PubMed1979

[Are automatic devices suitable for blood pressure determinations?].

Four automatic blood pressure recorders (Bosograph II, Bosch EBM 500, Elag BE 237R, and Physiometrics SR-2) were compared with the random zero sphygmomanometer. Since each of the automatic devices was calibrated for phase IV, diastolic blood pressure values were read off at phase IV and not phase V of Korotkow with the random zero sphygmomanometer. Blood pressure measurements were carried out in 80 patients with hypertension and in 20 normotensive healthy subjects. Readings with the automatic recorders and with the random zero sphygmomanometer correlated well in a wide range of systolic and diastolic blood pressure (r = 0.878--0.982, p less than 0.001). However, the automatic values were in most cases significantly lower than those obtained with the random zero device. For Physiometrics SR-2, where two diastolic readings were possible, only the first diastolic values correlated well with phase IV of Korotkow. The second values were significantly lower, with a difference of -11.1 mm Hg, and probably did not reflect the true diastolic blood pressure. These results show that each of the four automatic recorders is suitable for measuring blood pressure. However, with the Physiometrics SR-2, Only the higher diastolic reading should be used. The differences between the four automatic devices were minor and can therefore be ignored.

Automation↗
PubMed2003

[Blood pressure volatility--a new parameter for determining blood pressure variability in type-1 diabetes mellitus].

INTRODUCTION: In diabetes the heart rate variability is decreased because of the autonomic neuropathy and parallel with this phenomenon the overnight blood pressure fall is lost. Presumably this change in the hemodynamic parameters is connected with the fact that the cardiovascular complications in type 1 diabetic patients are 2-4 times more frequent than in healthy patients. The volatility, as a new factor, is the dispersion of the proportion of the blood pressure values following each other. It exactly reflects the 24-hour blood pressure fluctuation, while the dipper/non-dipper determination differentiates only between the daytime and night-time average blood pressure values. The volatility follows the changes of the measured values in accordance to the frequency of the measurements during the whole day. AIM: Our aim was to compare the blood pressure variability of type 1 diabetic patients (DM) and healthy controls (C). PATIENTS AND METHODS: The authors examined 43 diabetic patients from our outpatient clinic and 45 healthy people. The blood pressures were measured with Meditech ABPM 02 monitor on workdays. The measurements started in the mornings. The frequency of the measurements was 20 minutes during the day and 50 minutes at night-time. The authors took the history of all the patients and detailed laboratory results. The patients also had ophthalmology examination, ECG and echocardiography tests. RESULTS: During the Ambulatory Blood Pressure Monitoring we found that the systolic volatility of blood pressure values was significantly lower in DM compared to C patients. Systolic volatility: 0.133 +/- 0.011 vs. 0.175 +/- 0.014 p < 0.026. Comparing only the normotonic C and DM group systolic volatility of blood pressure values were significantly lower in DM. Systolic volatility: 0.128 +/- 0.016 vs. 0.177 +/- 0.021 p < 0.036. CONCLUSION: It is an important new finding that in type 1 diabetic patient the volatility--a new parameter for determining blood pressure variability--is lower than in the healthy control group. At normotension state other parameters describing the blood pressure variability (like diurnal index or standard deviation) could not show this change.

Adult↗
PubMed1995

[Hypertension diagnosis by the family physician: measurements according to the NHG-standard (Dutch College of General Practitioners) compared with ambulatory blood pressure determination].

OBJECTIVE: To compare the standard procedure (SP) for determining hypertension as described by the DCGP with the results of ambulatory blood pressure measurement (ABM). DESIGN: Prospective study. SETTING: Practices of 17 GPs in central and south Limburg, the Netherlands. METHOD: The SP of the DCGP was executed in 94 of 102 patients with possible hypertension. In each patient a 24-hour ABM was performed simultaneously as reference value. RESULTS: The correlation between the SP and the ABM was low (r = 0.51) and the blood pressure was mostly overestimated by the SP. Sensitivity and specificity of the SP were 0.67 and 0.52 respectively. When the first blood pressure measurement was high in a patient with probable hypertension (diastolic pressure 105-115 mmHg) SP correlated well with ABM. When the first blood pressure measured was relatively low (diastolic pressure 95-105 mmHg) correlation was also low. CONCLUSION: The difference in blood pressure measured by the physician in his office compared with measurement at home ('white coat effect') was observed in this study also. The results support the advice of the DCGP to check the blood pressure more often in hypertensive patients with low than in those with high initial diastolic values.

Blood Pressure Determination↗