How to measure office blood pressure?

peer reviewedaudience: professional, studentLa mesure de la pression artérielle de façon classique repose toujours sur l’auscultation des bruits de Korotkoff. Devenue un geste banal, elle est souvent mal pratiquée et, donc, source d’erreurs dans l’estimation du niveau réel de pression d’un patient. Elle exige rigueur et précision pour être utile en pratique médicale quotidienne. Cette vignette à destination des étudiants veut rappeler les grands principes de la mesure de la pression artérielle au cabinet de consultation, mais aussi au domicile du patient.Routinely measuring blood pressure is still performed according to the auscultatory method using recognition of Korotkoff sounds. This usual technique is, however, often mishandled and is thus a source of error in the estimation of the true blood pressure level. Accuracy of such measure is, however, of paramount importance to be useful in daily medical practice. This methodology paper more specifically written for medical students recalls the essential principles of blood pressure measurement at the medical office, but also at home

Reference values of central blood pressure and pulse wave velocity in relations with 24 hours ambulatory blood pressure monitoring in Belgian normotensive young subjects

The present study aimed to define reference values of central blood pressure (cBP) and Pulse Wave Velocity (PWV) together with 24H APPM in healththy normotensive young adults before starting a follow-up of their CV profile modifications over time

Optimal Blood Pressure Level and Best Measurement Procedure in Hemodialysis Patients

Hypertension occurs frequently among hemodialysis (HD) patients and can be due to many factors, such as salt intake, elevated sympathetic tone, and uremic toxins. It is responsible for the high cardiovascular risk associated with renal disease. Generally, in HD patients, while there is an elevation of systolic blood pressure (BP), diastolic BP seems to decrease, and the resultant effect is high pulse pressure, which can have a deleterious effect on the cardiovascular system. Although controversial, in the HD population the relationship between BP and risk of death seems to be U shaped, probably because of pre-existing cardiac disease in patients with the lowest BP. In chronic kidney disease, BP lower than 130/80 mmHg is recommended, but an appropriate target for BP in the HD population remains to be established. Moreover, there is no consensus regarding which routine peridialysis BP (pre- or post-dialysis BP, or both) can ensure the diagnosis of hypertension in this population. Ambulatory BP monitoring remains the gold standard to quantify the integrated BP load applied to the cardiovascular system. As well, home BP assessment could contribute to improve the definition of an optimal BP in the HD population. An ideal goal for post-dialysis systolic BP seems to be a value higher than 110 mmHg and lower than 150 mmHg. However, HD patients are generally old and often have cardiac complications, so a reasonable pre-dialysis target systolic BP could be 150 mmHg. It is prudent to suggest that an improvement in BP control is necessary in the HD population, first by slow and smooth removal of extracellular volume (dry weight) and thereafter by the use of appropriate antihypertensive medication

Assessment of field rolling resistance of manual wheelchairs

This article proposes a simple and convenient method for assessing the subject-specific rolling resistance acting on a manual wheelchair, which could be used during the provision of clinical service. This method, based on a simple mathematical equation, is sensitive to both the total mass and its fore-aft distribution, which changes with the subject, wheelchair properties, and adjustments. The rolling resistance properties of three types of front casters and four types of rear wheels were determined for two indoor surfaces commonly encountered by wheelchair users (a hard smooth surface and carpet) from measurements of a three-dimensional accelerometer during field deceleration tests performed with artificial load. The average results provided by these experiments were then used as input data to assess the rolling resistance from the mathematical equation with an acceptable accuracy on hard smooth and carpet surfaces (standard errors of the estimates were 4.4 and 3.9 N, respectively). Thus, this method can be confidently used by clinicians to help users make trade-offs between front and rear wheel types and sizes when choosing and adjusting their manual wheelchair.This material was based on work supported by the SACR-FRM project, French National Research Agency (ANR-06-TecSan-020) and the Centre d’Etudeset de Recherche sur l’Appareillage des Handicapés (loaned all MWCs required to fulfill this work

Blood Pressure Variability

peer reviewedBlood pressure variability is a physiological phenomenon influenced by many internal and external factors. This variability could be also influenced by pathological conditions such as arterial hypertension. Two forms must be mainly distinguished: the blood pressure variability at long but also short-term. The latter could only be studied by continuous recordings. From the initial invasive intraarterial approach, it can nowadays be explored by a non invasive system of beat to beat recordings using the infrared photo plethysmography (the FINAPRES system). In this paper, some important questions will be treated such as the interest of measuring blood pressure variability, its cardiovascular prognosis and how therapeutic tools can be applied when it is increased?La variabilité de la pression artérielle (PA) est un phénomène physiologique influencé par de nombreux facteurs intrinsèques et extrinsèques. Cette variabilité se voit cependant modifiée dans plusieurs conditions pathologiques dont l'hypertension artérielle. On distingue principalement la variabilité de PA à long terme et celle à court terme. Cette dernière ne peut être étudiée que par des enregistrements continus de la pression artérielle. De la localisation invasive intra-artérielle, on est passé actuellement à un mode non-invasif d'enregistrement grâce à la photopléthysmographie infrarouge (FINAPRES® ...). Dans cet article, nous abordons certaines questions cruciales à savoir quel est l'intérêt de la mesure de la variabilité tensionnelle. Son influence sur le pronostic cardio-vasculaire apparaît évident. Comment peut-elle influencer la prise en charge thérapeutique lorsqu'elle est accrue

New high-technology products for the treatment of haemophilia

This review will focus on new technologies in development that promise to lead to further advances in haemophilia therapeutics. There has been continued interest in the bioengineering of recombinant factor VIII (rFVIII) and factor IX (rFIX) with improved function to overcome some of the limitations in current treatment, the high costs of therapy and to increase availability to a broader world haemophilia population. Bioengineered forms of rFVIII, rFIX or alternative haemostatic molecules may ultimately have an impact on improving the efficacy of therapeutic strategies for the haemophilias by improving biosynthesis and secretion, functional activity, half-life and immunogenicity. Preventing and suppressing inhibitors to factor (F) VIII remain a challenge for both clinicians and scientists. Recent experiments have shown that it is possible to obtain anti-idiotypic antibodies with a number of desirable properties: (i) strong binding avidity to FVIII inhibitors; (ii) neutralization of inhibitory activity both in vitro and in vivo ; (iii) cross-reactivity with antibodies from unrelated patients, and (iv) no interference with FVIII function. An alternative, although complementary approach, makes use of peptides derived from filamentous-phage random libraries. Mimotopes of FVIII can be obtained, which bind to the paratope of inhibitory activity and neutralize their activity both in vitro and in vivo . In this paper, we review advanced genetic strategies for haemophilia therapy. Until recently the traditional concept for gene transfer of inherited and acquired haematological diseases has been focused on how best to obtain stable insertion of a cDNA into a target-cell genome, allowing expression of a therapeutic protein. However, as gene-transfer vector systems continue to improve, the requirement for regulated gene transcription and hence regulated protein expression will become more critical. Inappropriate protein expression levels or expression of transferred cDNAs in non-intended cell types or tissues may lead to target-cell toxicity or activation of unwanted host immune responses. Regulated protein expression requires that the transferred gene be transferred with its own regulatory cassette that allows for gene transcription and translation approaching that of the normal gene in its endogenous context. New molecular techniques, in particular the use of RNA molecules, now allow for transcription of corrective genes that mimic the normal state.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75577/1/j.1365-2516.2004.00996.x.pd

Does nocturnal decrease of blood pressure predict left ventricular hypertrophy?

Peer reviewe

HOME BLOOD PRESSURE IN KIDNEY TRANSPLANT RECIPIENTS (Ktr)-VALIDITY OF DIFFERENT SCHEDULES OF SELF-MONITORING

Office blood pressure (OBP) coupled with 24-h ambulatory monitoring (24-h ABPM) or home self-monitoring (HBPM) allow a more accurate assessment of BP control in treated hypertensive patients and identification of different phenotypes of BP. ESH/ESC guidelines (2013) recommended 7 days of home measurements (3 days at least) but that duration is questioned. The present study examined if we can reduce, and to what extent, the 7-days schedule for home measurements in treated hypertensive kidney transplant recipients (ktr) while keeping a reliable assessment of their BP status