Hypertension

Defining hypertension in pregnancy is challenging because blood pressure levels in pregnancy are dynamic, having a circadian rhythm and also changing with advancing gestational age. The accepted definition is a sustained systolic (sBP) of ≥140 mmHg or a sustained diastolic blood pressure (dBP) ≥90 mmHg, by office (or in-hospital) measurement. Measurement of blood pressure in pregnancy should follow standardised methods, as outside pregnancy. Blood pressure measurement may occur in three types of settings, which will dictate in part, which measurement device(s) will be used. The settings are (1) health care facility; and two types of settings outside the facility: (2) ‘ambulatory’ blood pressure measurement (ABPM); and (3) home blood pressure measurement (HBPM). Furthermore, blood pressure can be measured using auscultatory (mercury or aneroid devices) or automated methods. Factors to consider when selecting a blood pressure measurement device include validation, disease specificity, observer error and the need for regular recalibration. The accuracy of a device is repeatedly compared to two calibrated mercury sphygmomanometers (the gold standard), by trained observers, over a range of blood pressures and for women with different hypertensive disorders of pregnancy; only a few devices have been validated among women with pre-eclampsia. This chapter discusses the advantages and/or disadvantages of the various settings and devices. Low- and middle-income countries (LMICs) bear a disproportionate burden of maternal morbidity and mortality from the hypertensive disorders of pregnancy. While regular blood pressure monitoring can cost-effectively reduce this disparity, LMIC-health systems face unique challenges that reduce this capacity. Assessment of service gaps and programmatic responses to ensure access to blood pressure measurement are a priority, supported where appropriate by implementation research.Publisher PD

Pilot Application of Varied Equipment and Procedural Techniques to Determine Clinical Blood Pressure Measurements.

Second Place at the Denman Research Forum at The Ohio State University under the category of Drugs and Surgical Interventions to Improve Clinical OutcomesHigh blood pressure, screened through obtaining a patient's blood pressure (BP), is found in 1 out of 3 U.S. adults and is increasing in prevalence.6 A cohort of 39 subjects had their BP measured following American Heart Association (AHA) protocol, utilizing three different measurement devices: manual sphygmomanometer (MA), automated Midmark IQvitals (IQ), and an automated Omron home unit (OM). All subjects also had their BP measured with the IQ device while not adhering to the AHA protocol. The two protocol conditions were denoted PR (protocol following AHA guidelines) or TY (typical clinical measurement lacking protocol). The results demonstrated a mean systolic BP with IQ-TY (123.7mmHg) > OM-PR (118.3mmHg) > IQ-PR (114.8mmHg) > MA-PR (111.0mmHg), all statistically significant (p IQ-PR (71.15mmHg), OM-PR (71.05mmHg), and MA-PR (70.0mmHg), with IQ-TY significantly higher than the other 3 (p<0.01). When comparing the number of participants categorized in each hypertension stage, IQ-TY categorized 7participants as stage 1 hypertensive while OM-PR categorized 3, and both MA-PR and IQ-PR only categorized 1. These study results would suggest that there is a potential for possible misclassification of patients based on BP protocol.No embargoAcademic Major: Health Sciences Progra

Accuracy of automated blood pressure measurements in the presence of atrial fibrillation: systematic review and meta-analysis

This is the author accepted manuscript. The final version is available from Springer Nature via the DOI in this recordAtrial fibrillation (AF) affects ~3% of the general population and is twice as common with hypertension. Validation protocols for automated sphygmomanometers exclude people with AF, raising concerns over accuracy of hypertension diagnosis or management, using out-of-office blood pressure (BP) monitoring, in the presence of AF. Some devices include algorithms to detect AF; a feature open to misinterpretation as offering accurate BP measurement with AF. We undertook this review to explore accuracy of automated devices, with or without AF detection, for measuring BP. We searched Medline and Embase to October 2018 for studies comparing automated BP measurement devices to a standard mercury sphygmomanometer contemporaneously. Data were extracted by two reviewers. Mean BP differences between devices and mercury were calculated, where not reported and compared; meta-analyses were undertaken where possible. We included 13 studies reporting 14 devices. Mean systolic and diastolic BP differences from mercury ranged from −3.1 to + 6.1/−4.6 to +9.0 mmHg. Considerable heterogeneity existed between devices (I 2 : 80 to 90%). Devices with AF detection algorithms appeared no more accurate for BP measurement with AF than other devices. A previous review concluded that oscillometric devices are accurate for systolic but not diastolic BP measurement in AF. The present findings do not support that conclusion. Due to heterogeneity between devices, they should be evaluated on individual performance. We found no evidence that devices with AF detection measure BP more accurately in AF than other devices. More home or ambulatory automated BP monitors require validation in populations with AF.National Institute for Health Research (NIHR

Self home blood pressure monitoring in pregnancy: how reliable is it?

Background: The use of automated blood pressure monitors in pregnancy has become increasingly popular, as more women tend to get involved in their healthcare. Not only does it reduce clinician visits, it also helps to eliminate the white coat hypertension.Methods: We conducted a prospective study in the antenatal department of JSS Medical College and Hospital, Mysuru; over a period of one year, from July 2016 to June 2017. The blood pressures of 50 women were recorded at four different periods of gestation using the conventional ‘Diamond mercury Sphygmomanometer’ versus the automated ‘Omron HEM 7130’ home BP monitor and compared.Results: The recordings of systolic blood pressure at home were consistently less than the office measurements at all periods of gestation. However, the difference was not statistically significant. The comparison of diastolic pressures revealed minimal variations between the mean of the office and home blood pressure recordings. The mean arterial pressure also revealed a similar trend.Conclusions: Self-monitoring of blood pressure is a feasible and acceptable option to pregnant women. It might make antenatal care more effective, but we need further research to establish safety and efficacy, the impact on women and health professionals, and how best to use the results

Blood pressure and its correlates in children and adolescents in urban Nigeria

Background: A substantial increase in the incidence of chronic non-communicable diseases (NCDs) and a decline in communicable diseases and poverty-related diseases are occurring in developing countries (including Nigeria) as a result of an epidemiological transition. Given the burden and poor outcomes of NCDs related to hypertension or high blood pressure (BP) in adulthood, there is an urgent need for the identification of high risk individuals in early life. High BP has already been reported amongst young people worldwide, including Nigeria. High BP in childhood is predictive of high BP in adulthood. There is very little information available on the distribution of blood pressure in children and adolescents, and the factors which determine its distribution in Nigeria. Objectives: To determine the association between: socio-economic characteristics and blood pressure, pubertal maturation status and blood pressure, and anthropometric measures of adiposity and blood pressure in children and adolescents in Nigeria; and also to determine the overall prevalence of hypertension in the population of secondary school aged children and adolescents in Nigeria. Methods: A school-based stratified randomised cross-sectional survey of students aged 11 to 18 years was carried out in the urban area of Lagos, Nigeria. Blood pressure, body weight, height and waist measurements of the participants were obtained. A self-complete validated questionnaire was used to obtain sociodemographic information, health-related information, socio-economic characteristics (including living circumstances and parent/carer education level) and pubertal maturation status of the participants. Data analysis was carried out using descriptive statistics and multiple regression analysis. Results: 1086 students (538 males and 548 females) participated in the study, giving a total response rate of 90.5%. The overall mean systolic and diastolic blood pressure was 105.23±12.63mmHg and 57.87±8.09mmHg, respectively. The overall prevalence of hypertension was 2.5%. Socio-economic characteristics, pubertal maturation status, body mass index and waist circumference were statistically significantly associated with systolic and diastolic blood pressure (p<0.05). Conclusion: This study suggests that the epidemiological transition exists and is having measurable effects in school children in Nigeria. The findings highlight the presence of hypertension, and also the need for investigation of factors associated with blood pressure in children and adolescents so as to guide health policy, public health preventive interventions and health practice for child and adolescent hypertension. This study has long term implications for an extra burden of chronic non-communicable diseases related to hypertension in Nigeria

Comparison of two non-invasive arterial blood pressure monitoring techniques in brown bears (Ursus arctos)

Monitoring arterial blood pressure (BP), represents a more accurate evaluation of hemodynamics than heart rate alone and is essential for preventing and treating infra- and post-operative complications in wildlife chemical immobilization.The objectives of the study were to test the correlation between standard oscillometry and Korotkoffs technique in anesthetized free-ranging brown bears in Croatia and Scandinavia and to assess the blood pressure in both locations.Five bears were snared and darted with xylazine and ketamine in Croatia, and 20 bears were darted from a helicopter with medetomidine and tiletamine-zolazepam in Scandinavia. Blood pressure was simultaneously measured with both techniques every 5 minutes. Correlation between techniques, trends of BP variation, and the factors of the capture which likely influenced BP were assessed.Successful measurements of BP were achieved in 93% of all attempts with the Korotkoffs technique but in only 29% of all attempts with oscillometry. The latter method mostly provided lower values of BP compared to Korotkoffs technique in yearlings. Most bears showed a decreasing trend in systolic and mean BP over time, consistent between the two techniques. All bears were hypertensive: the auscultatory technique detected moderate to severe systolic hypertension in 25% and 84% of bears in Croatia and in Scandinavia, respectively, with significantly higher BP in subadults and adults compared to yearlings. Only Korotkoffs method resulted in a reliable and effective tool for BP assessment in brown bears. The anesthetic protocols used in the present study in association with the capture methods produced hypertension in all animals