Pitfalls in blood pressure measurement in daily practice

Background. Accurate blood pressure (BP) readings and correctly interpreting the obtained values are of great importance. However, there is considerable variation in the different BP measuring methods suggested in guidelines and used in hypertension trials. Objective. To compare the different methods used to measure BP; measuring once, the method used for a large study such as the UKPDS, and the methods recommended by various BP guidelines. Methods. In 223 patients with type 2 diabetes from five family practices BP was measured according to a protocol to obtain the following data: A = first reading, B = mean of two initial readings, C = at least four readings and the mean of the last three readings with less than 15% coefficient of variation difference, D = mean of the first two consecutive readings with a maximum of 5 mm Hg difference. Mean outcomes measure is the mean difference between different BP measuring methods in mm Hg. Results. Significant differences in systolic/diastolic BP were found between A and B [mean difference (MD) systolic BP 1.6 mm Hg, P < 0.001], B and C (MD 5.7/2.8 mm Hg, P < 0.001), B and D (MD 6.2/2.8 mm Hg, P < 0.001), A and C (MD 7.3/3.3 mm Hg), and A and D (MD 7.9/3.0 mm Hg, P < 0.001). Conclusion. Different methods to assess BP during one visit in the same patient lead to significantly different BP readings and can lead to overestimation of the mean BP. These differences are clinically relevant and show a gap between different methods in trials, guidelines and daily practice

The relationship between glycaemic control and mortality in patients with type 2 diabetes in general practice (ZODIAC-11)

Background The relationship between the degree of glycaemic control and mortality remains an important topic of discussion.Aim This study aimed to investigate this relationship.Design of study Prospective cohort study.Setting Primary care.Method A total of 1145 patients with type 2 diabetes were enrolled in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) in 1998. Their survival status was recorded in September 2004. Mortality ratios were calculated using standardised mortality ratios (SMRs). Associations between haemoglobin A1c (HbA1c) levels and mortality were studied with a Cox proportional hazard model. HbA1c levels were studied as continuous and as categorical variables.Results A total of 335 patients died after a median follow-up period of 5.8 years. The SMR (95% confidence interval [CI]) for total mortality was 1.86 (95% CI = 1.66 to 2.06) and 2.24(95% CI = 1.91 to 2.61) for cardiovascular mortality. For each 1% increase in HbA1c there was a 21% increase in the hazard ratio for total mortality. When compared with the target HbA1c group (HbA1c 6.5-7%), the group with very poor glycaemic control (HbA1c &gt;9%) had a hazard ratio of 2.21 (95% CI = 1.42 to 3.42) for total mortality. The group with normal glycaemic control (HbA1cConclusion HbA1c level was associated with mortality and this effect seemed largely attributable to patients who were in really poor glycaemic control. The absence of differences in mortality in the groups with lower HbA% levels supports the position that there is no basis for continually decreasing the therapeutic target HbA1c level in patients with type 2 diabetes mellitus.</p

STEREOLOGIC BASELINE DATA OF NORMAL HUMAN EPIDERMIS

Stereologic techniques for electron microscopic morphometry have been applied to normal human interfollicular epidermis of the submammary and iliac crest regions. The aim was to obtain objective baseline data for the study of epidermal morphometric pathology. The results, expressed mainly in surface, volume, and numerical densities of epidermal components and keratinocyte organelles, revealed ascending or descending gradients throughout the epithelial strata. The cytoplasmic ground substance remained almost constant in the four studied layers. No important regional differences were found between the epidermal morphometric parameters at either site. The epidermis showed striking volumetric composition similarities with other keratinizing epithelia