Automated office BP measurement: The new standard in HTN screening.

Obtain greater accuracy in blood pressure measurement with an automated office device.

The present situation of home blood pressure measurement among outpatients in Japan.

Objective: To clarify the present situation of home blood pressure (HBP) measurement among Japanese patients.Methods: A nationwide questionnaire survey regarding HBP measurement was conducted on patients aged 20 years or older who had visited 20 community pharmacies to have their prescriptions filled.Results: In total, 76.7% of 1,103 hypertensives and 40.9% of 1,106 normotensives had their own devices for HBP measurement. Compared with normotensives, a higher proportion of hypertensives recognized the guideline-based reference values for HBP and clinic BP. Compared with hypertensives who did not have a physician's recommendation, those who did more often had their own devices, recognized the guideline-based reference values for HBP, and measured HBP every day (70.4%, 1.5%, and 31.6% vs. 91.1%, 6.9%, and 65.4%, respectively). Among 793 hypertensives who measured HBP, a higher proportion of those with a physician's recommendation measured HBP according to optimal guideline-based procedures compared with those without. Among 560 hypertensives who recorded HBP readings, a higher proportion of those with a physician's recommendation (74.6%) showed all HBP readings to their physicians compared with those without (35.3%).Conclusions: Our findings suggest that physicians should recommend measuring HBP in accordance with the Japanese Society of Hypertension guidelines more aggressively, and provide more detailed explanations to patients regarding how to measure HBP.

Blood Pressure Measurement Error in Children: Lessons in Measurement Reliability.

BACKGROUND AND PURPOSE: Blood pressure measurement represents the pressure exerted during heart ejection and filling. There are several ways to measure blood pressure and a valid measure is essential. The purpose of this study was to evaluate the approach to noninvasive blood pressure measurement in children. METHODS: Blood pressure measurements were taken using the automatic Phillips MP30 monitor and compared against Welch Allyn blood pressure cuffs with Medline manual sphygmomanometers. RESULTS: A total of 492 measurements were taken on 82 subjects, and they demonstrated comparability between automatic and manual devices. CONCLUSIONS: Although our study indicated acceptable agreement between automatic and manual blood pressure measurement, it also revealed measurement error remains a concern, with sample size, study protocol, training, and environment all playing a role.

Home sphygmomanometers can help in the control of blood pressure: a nationwide field survey.

Home blood pressure monitoring (HBPM), which integrates patients into their treatment program, is a self-management tool. The prevalence of home sphygmomanometer ownership and patient compliance with HBPM guidelines are not well known, especially in developing and underdeveloped countries. The aims of this study were to measure the prevalence of home sphygmomanometer ownership among hypertensive subjects through a nationwide field survey (PatenT2), to investigate the validation of sphygmomanometers and consistency of the user arm circumference and cuff size of the upper-arm device owned, as well as to compare blood pressure (BP) readings between hypertensive subjects who have or do not have a sphygmomanometer. Sample selection was based on a multistratified proportional sampling procedure to select a nationally representative sample of the adult population (n = 5437). Of 1650 hypertensive subjects, 332 (20.1%) owned a device, but the percentage of patients who owned a sphygmomanometer was 28.8% among patients who were aware of their hypertension (260/902). The usage of wrist devices and nonvalidated devices is common, and selection of an appropriate cuff size is ignored. Linear-regression analysis showed that owning a BP monitor is associated with decreases of 3.7 mmHg and 2.8 mmHg for systolic and diastolic BPs, respectively. Many patients do not own a sphygmomanometer. The decrease of systolic and diastolic BPs among BP monitor owners is a striking finding. The implementation of a hypertension care program consisting of sphygmomanometer reimbursement and training of patients in its use for HBPM might be cost-effective.

Seasonal variation in home blood pressure: findings from nationwide web-based monitoring in Japan.

OBJECTIVES: Our aim was to assess seasonal variation in home blood pressure (BP) among free-living nationwide participants using home BP values accumulated from a web-based healthcare platform established in Japan. SETTINGS: An observational study. OMRON Healthcare Co., Ltd. has been developing web-based personal healthcare record systems in Japan since November 2010; over two million voluntary participants had joined this platform in September 2015. Nationwide home BP measurements made by oscillometric-type electronic sphygmomanometers from over 110 000 voluntary participants have been transmitted to the system from devices. PARTICIPANTS: Seasonal variation in home BP was evaluated among 64 536 (51 335 men, 13 201 women; mean age 52.9 years) free-living nationwide users for whom data were automatically and simultaneously transmitted to the system from devices. PRIMARY OUTCOME MEASURES: Mean monthly and weekly home BP. RESULTS: In multiple regression analysis, the relationship between BP and temperature was a significant inverse association, independent of age, gender and geological locations. Highest and lowest BP was observed in December and July, respectively. Substantial seasonal differences in the mean values of morning and evening home systolic BP between summer and winter were 6.2 mmHg and 5.5 mmHg in men, and 7.3 mmHg and 6.5 mmHg in women. Seasonal variation was a little greater in older (7.3 mmHg in men, 8.7 mmHg in women) than in younger individuals (5.8 mmHg in men, 6.5 mmHg in women). BP from February to July was approximately 1.5 mmHg lower than the value from August to December. CONCLUSIONS: A web-based healthcare platform has enabled easier monitoring of population-wide BP. Tighter BP control is necessary in winter than in summer, and especially in a colder climate toward winter than toward summer. New technologies using web-based self-monitoring systems for health-related indexes are expected to initiate a new phase of cardiovascular disease prevention and public health promotion.

Diagnostic performance of an automatic blood pressure measurement device, Microlife WatchBP Home A, for atrial fibrillation screening in a real-world primary care setting.

OBJECTIVE: To evaluate the diagnostic performance of a UK National Institute for Health and Care Excellence-recommended automatic oscillometric blood pressure (BP) measurement device incorporated with an atrial fibrillation (AF) detection algorithm (Microlife WatchBP Home A) for real-world AF screening in a primary healthcare setting. SETTING: Primary healthcare setting in Hong Kong. INTERVENTIONS: This was a prospective AF screening study carried out between 1 September 2014 and 14 January 2015. The Microlife device was evaluated for AF detection and compared with a reference standard of lead-I ECG. PRIMARY OUTCOME MEASURES: Diagnostic performance of Microlife for AF detection. RESULTS: 5969 patients (mean age: 67.2±11.0 years; 53.9% female) were recruited. The mean CHA2DS2-VASc ( C : congestive heart failure [1 point]; H : hypertension [1 point]; A2 : age 65-74 years [1 point] and age ≥75 years [2 points]; D : diabetes mellitus [1 point]; S : prior stroke or transient ischemic attack [2 points]; VA : vascular disease [1 point]; and Sc : sex category [female] [1 point])score was 2.8±1.3. AF was diagnosed in 72 patients (1.21%) and confirmed by a 12-lead ECG. The Microlife device correctly identified AF in 58 patients and produced 79 false-positives. The corresponding sensitivity and specificity for AF detection were 80.6% (95% CI 69.5 to 88.9) and 98.7% (95% CI 98.3 to 98.9), respectively. Among patients with a false-positive by the Microlife device, 30.4% had sinus rhythm, 35.4% had sinus arrhythmia and 29.1% exhibited premature atrial complexes. With the low prevalence of AF in this population, the positive and negative predictive values of Microlife device for AF detection were 42.4% (95% CI 34.0 to 51.2) and 99.8% (95% CI 99.6 to 99.9), respectively. The overall diagnostic performance of Microlife device to detect AF as determined by area under the curves was 0.90 (95% CI 0.89 to 0.90). CONCLUSIONS: In the primary care setting, Microlife WatchBP Home was an effective means to screen for AF, with a reasonable sensitivity of 80.6% and a high negative predictive value of 99.8%, in addition to its routine function of BP measurement. In a younger patient population aged <65 years with a lower prevalence of AF, Microlife WatchBP Home A demonstrated a similar diagnostic accuracy.

Accuracy of monitors used for blood pressure checks in English retail pharmacies: a cross-sectional observational study.

BACKGROUND: Free blood pressure (BP) checks offered by community pharmacies provide a potentially useful opportunity to diagnose and/or manage hypertension, but the accuracy of the sphygmomanometers in use is currently unknown. AIM: To assess the accuracy of validated automatic BP monitors used for BP checks in a UK retail pharmacy chain. DESIGN AND SETTING: Cross-sectional, observational study in 52 pharmacies from one chain in a range of locations (inner city, suburban, and rural) in central England. METHOD: Monitor accuracy was compared with a calibrated reference device (Omron PA-350), at 50 mmHg intervals across the range 0-300 mmHg (static pressure test), with a difference from the reference monitor of +/- 3 mmHg at any interval considered a failure. The results were analysed by usage rates and length of time in service. RESULTS: Of 61 BP monitors tested, eight (13%) monitors failed (that is, were >3 mmHg from reference), all of which underestimated BP. Monitor failure rate from the reference monitor of +/- 3 mmHg at any testing interval varied by length of time in use (2/38, 5% <18 months; 4/14, 29% >18 months, P = 0.038) and to some extent, but non-significantly, by usage rates (4/22, 18% in monitors used more than once daily; 2/33, 6% in those used less frequently, P = 0.204). CONCLUSION: BP monitors within a pharmacy setting fail at similar rates to those in general practice. Annual calibration checks for blood pressure monitors are needed, even for new monitors, as these data indicate declining performance from 18 months onwards.

Reliability and validity of the modified sphygmomanometer test for the assessment of strength of upper limb muscles after stroke.

OBJECTIVE: To investigate the reliability (test-retest and inter-rater) and criterion-related validity of the modified sphygmomanometer test (MST) for the assessment of upper limb muscle strength in subjects with chronic stroke, and to determine whether the results are affected by the number of trials. PATIENTS AND METHODS: The strength of 11 upper limb muscle groups of 57 subjects with stroke was bilaterally assessed with portable dynamometers and the MST (measured in mmHg). To investigate whether the number of trials would affect the results, 1-way analysis of variance was applied. For the test-retest/inter-rater reliabilities and criterion-related validity of the MST, intra-class correlation coefficients (ICCs), Pearson's correlation coefficients, and coefficients of determination were calculated. RESULTS: Different numbers of trials provided similar values for all assessed muscles (0.01 ≤ F ≤ 0.18; 0.83 ≤ p ≤ 0.99) with adequate test-retest (0.83 ≤ ICC ≤ 0.97; p < 0.0001) and inter-rater reliabilities (0.79 ≤ ICC ≤ 0.97; p < 0.0001) and validity (0.61 ≤ r ≤ 0.95; p < 0.0001). The values obtained with the MST were good predictors of those obtained with portable dynamometers (0.60 ≤ r2 ≤ 0.86), except for pinch strength (0.39 ≤ r2 ≤ 0.54). CONCLUSION: The MST showed adequate measurement properties for the assessment of the strength of the upper limb muscles of subjects with chronic stroke. After familiarization a single trial provided adequate strength values.

Availability and functionality of sphygmomanometers at health care institutions in Enugu, Nigeria.

OBJECTIVE: Our aim was to investigate the availability of functional blood pressure monitors at health care institutions in Enugu, Nigeria. METHODS: During repeated surveys of 15 (primary, secondary and tertiary) health care institutions in Enugu between 2007 and 2012, records were made of the availability and functional status of sphygmomanometers in the clinics and wards. We also assessed the degree of agreement between measurements by institutional staff and measurements by trained observers using the same or the standard sphygmomanometer. RESULTS: Apart from three institutions, there was inadequate availability of fully functional sphygmomanometers: 61 staff attending to outpatients were sharing 35 sphygmomanometers, 6 of which were faulty i.e. needing repairs. Wards invariably had only one or two functional sphygmomanometers, regardless of bed occupancy. Institutional staff ignored recommended guidelines for blood pressure measurement. The overall mean difference in blood pressure measurements between institutional staff and a trained observer (1.6 mmHg; 95% confidence interval, CI: -0.3 to 3.4; P=0.1) was greater and more significant than the mean difference between the two observers (0.1 mmHg; CI: -1.5 to 1.7; P=0.9) and the mean difference between institutional and standard sphygmomanometers (-0.2 mmHg; CI: -1.7 to 1.3; P=0.8). CONCLUSION: There has been a notable lack of reporting on the availability of blood pressure measuring devices in third world health care institutions. Our surveys have shown inadequate availability of functional sphygmomanometers in the institutions, but satisfactory agreement between measurements by institutional staff and trained observers. In view of recent guidelines and recommendations, there is need to supplement office readings with mercury devices with oscillometric home or automated office blood pressure recording.

Comparisons of auscultatory hybrid and automated sphygmomanometers with mercury sphygmomanometry in hypertensive and normotensive pregnant women: parallel validation studies.

OBJECTIVE: To find a suitable replacement for mercury sphygmomanometry to measure blood pressure (BP) accurately in normal and hypertensive pregnancy. METHODS: Two parallel validation studies were carried out in 340 pregnant women, 170 with a hypertensive disorder and 170 normotensive women. An auscultatory hybrid sphygmomanometer, A&D UM-101, and a professional automated oscillometric device for office and clinic use, Omron HEM-907, were tested. Using a modified British Hypertension Society (BHS) Protocol, nine sequential BP recordings were taken alternating between the mercury sphygmomanometer and the study device. The first readings for each device were discarded, and three differences between mercury and study device were calculated for each woman for SBP and DBP. Main outcome measures were the percentages of BP readings that were within 5, 10 and 15 mmHg absolute difference from mercury sphygmomanometry. RESULTS: Women in both studies were an average of 34 weeks' gestation and of similar ethnicity, age and BMI. In hypertensive women, 29% had preeclampsia and 73% were receiving antihypertensives. Amongst hypertensive women, SBP was within 5 mmHg of mercury BP in 94% of readings with the auscultatory device and 75% with the automated device (P = 0.021); DBP was within 5 mmHg in 97 and 61% readings, respectively (P = 0.001). Results were similar amongst normotensive pregnant women. Both devices achieved an A/A rating according to the BHS protocol. CONCLUSION: The auscultatory hybrid sphygmomanometer is more accurate than the automated oscillometric device in pregnancy, specifically in hypertensive pregnancies. It is an acceptable replacement for mercury sphygmomanometry in pregnancy.

[Evaluating diagnostic efficiency of vascular wall diseases via sphygmomanometry method].

The article covers study of 100 patients, supporting diagnostic efficiency of vascular wall pathology via sphygmomanometry in various age groups with various diseases.

The use of mercury-based medical devices across Croatian healthcare facilities.

In 2009, we conducted a survey to assess the use of mercury-based thermometers and sphygmomanometers and their disposal in Croatian healthcare facilities. The questionnaire addressing the use of mercury-based medical devices, waste management, preferences between mercury-based and electronic devices, and the knowledge on mercury toxicity was filled by ward nurses affiliated with 40 (71.4 %) out of 56 contacted healthcare facilities. Only one of these facilities had given up the use of mercury-containing medical devices at the time. As many as 84.6 % of the nurses believed that broken devices did not increase the risk of mercury exposure, even though 90 % claimed they were aware of mercury toxicity. In fact, 69.4 % of the nurses preferred mercury-containing devices on account of their precision and reliability and because they received little training in the use of electronic devices.Breaking of thermometers and sphygmomanometers is common in healthcare facilities. The number of broken thermometers and sphygmomanometers was estimated to 278 and five per month, respectively. Only 18 (46.2 %) of the surveyed healthcare facilities claimed to have had a proper disposal procedure for mercury from broken devices. Nurses, who most often handle these devices and collect mercury spills, are primarily exposed to mercury vapours via inhalation. Croatia has adopted the EU Directive 76/769/EEC intended to reduce mercury exposure in the living and working environment. Our survey suggests that all healthcare professionals need training in proper management of broken mercury-based medical devices, nurses in particular. To reduce the risk of exposure, all Croatian healthcare facilities should implement guidelines for staff protection and programmes to gradually replace mercury-based with electronic devices.

Use of home sphygmomanometers in Turkey: a nation-wide survey.

The purposes of this study were to detect the prevalence of ownership of a home sphygmomanometer among hypertensive subjects through a nation-wide survey, to investigate parameters affecting ownership of a sphygmomanometer, to compare how home blood pressure monitoring (HBPM) was actually used in daily practice with some aspects of the current guidelines, and to discuss what we implemented to increase the reliability of HBPM in a developing country. A total of 2747 hypertensive patients from 34 cities, representative of the Turkish population, were enrolled in the study. A multiple-choice questionnaire was administered to each participant using the computer-assisted telephone interviewing method. Among 2747 hypertensive patients, 1281 of them (46.6%) had a home sphygmomanometer. Most of the patients were using wrist devices. The factors associated with ownership of a sphygmomanometer were female gender, older age, obesity, higher educational status, higher income level, living in urban areas, awareness of hypertension and anti-hypertensive drug usage. Only 16% of the devices were used on the advice of a physician. The patients learned usage of their device mainly from the sellers and their relatives. The ownership of a home sphygmomanometer is common among hypertensive patients in Turkey, but regular monitoring of blood pressure before physician visits is rare despite common ownership of these devices. Daily practice of HBPM in Turkey was far from the recommendations of the current guidelines. More effort is needed to improve the reliability of HBPM.

A new reusable skin-protective sphygmomanometer cuff.

OBJECTIVE: Repeated blood pressure measurement with a sphygmomanometer often produces skin redness and subcutaneous bleeding in clinical settings. Recently, we have produced a new reusable skin-protective cuff with an additional sheet. METHODS: We evaluated skin damage and blood pressure measurement accuracy when using the new cuffs. We also evaluated upper arm deformity by CT scan during cuff inflation. Pulse wave amplitude evaluation was carried out with an NIBP simulator and our original system. RESULTS: The use of this cuff reduced subcutaneous bleeding and pain with cuff inflation and enabled accurate blood pressure measurement. CONCLUSION: We produced a new skin protective reusable sphygmomanometer cuff.

Hypertensive patients' use of blood pressure monitors stationed in pharmacies and other locations: a cross-sectional mail survey.

BACKGROUND: Blood pressure (BP) monitors are commonly stationed in public places such as pharmacies, but it is uncertain how many people with hypertension currently use them. We sought to estimate the proportion of hypertensive patients who use these types of monitors and examine whether use varies by demographic or health characteristics. METHODS: We conducted a cross-sectional mail survey of hypertensive adults enrolled in a practice based research network of 24 primary care practices throughout the state of North Carolina. We analyzed results using descriptive statistics and examined bivariate associations using chi-square and independent associations using logistic regression. RESULTS: We received 530 questionnaires (76% response rate). Of 333 respondents (63%) who reported checking their BP in locations other than their doctor's office or home, 66% reported using a monitor stationed in a pharmacy. Younger patients more commonly reported using pharmacy monitors (48% among those < 45 years vs 35% of those over 65, p = 0.04). Blacks reported using them more commonly than whites (48% vs 39%, p = 0.03); and high school graduates more often than those with at least some college (50% vs 37%, p = 0.02). In multivariate analysis, younger age (aOR 1.49; 95% CI 1.00-2.21 for those age 45 to 65 years vs those > 65 years old) and high school education (aOR 1.74; 95% CI 1.13-2.58) were associated with use of pharmacy-stationed monitors, but Black race was not. Patients with diabetes, heart disease, or stroke were not more likely to use pharmacy-stationed monitors. CONCLUSION: Hypertensive patients' use of BP monitors located in pharmacies is common. Younger patients, Blacks, and those with high school education were slightly more likely to report using them. Because use of these monitors is so common, efforts to ensure their accuracy are important.

Accuracy of automated blood pressure monitors.

PURPOSE: The purpose of this study is to determine if automated and aneroid manometers are as accurate a means of determining blood pressure as the mercury manometer. Obtaining vital signs for patients is considered standard of care, yet many dental offices do not routinely perform this health service because of technique inconsistencies and time constraints. The use of automatic blood pressure monitors addresses both concerns. The mercury column manometer, the control in this study, has long been considered the most accurate and preferred instrument for obtaining blood pressure measurements. METHODS: During this study, 94 participants (19 years of age and older) consented to having blood pressure taken by each of 4 different monitors. These included the mercury column manometer and stethoscope, the aneroid manometer and stethoscope, the automatic arm blood pressure monitor, and the automatic wrist blood pressure monitor. Each of 3 investigators was assigned to and calibrated for a specific monitoring device. All measurements were taken from the left arm with 5 minutes allowed between measurements. Identical stethoscopes were used with the manual monitors. Strict adherence to the manufacturers' directions and patient preparation was followed for all monitors. Investigators were not aware of readings obtained by other investigators during testing. Eighty-three subjects completed all tests. RESULTS: Review and analysis of data indicates little difference for pulse readings between the automated and digital methods. Systolic readings by automated wrist manometers were the most unreliable. Automated arm monitors tended to provide higher measures than the mercury standard on average, and demonstrated significantly different diastolic readings in one age group compared to the control. All monitors exhibited low reliability for participants over age 50 compared to the control. CONCLUSION: This study demonstrates there is inaccuracy in the use of automated blood pressure monitors and traditional aneroid manometers when compared to the gold standard mercury column manometer for subjects of all ages and blood pressure ranges.

Angina pectoris is a stronger indicator of diffuse vascular atherosclerosis than intermittent claudication: Framingham study.

OBJECTIVE: To compare implications of Angina Pectoris (AP) and Intermittent Claudication (IC) as indicators of clinical atherosclerosis in other vascular territories. STUDY DESIGN AND SETTING: Prospective cohort study of cardiovascular disease (CVD) in 5,209 men and women of Framingham, MA, aged 28-62 years at enrollment in 1948-1951, who received biennial examinations during the first 36 years of follow-up. Comparative 10-year incidence of subsequent atherosclerotic CVD in participants with IC and AP relative to a reference sample free of CVD was determined. RESULTS: On follow-up, 95 CVD events occurred in 186 participants with IC and 206 of 413 with AP. After age, sex, and risk-factor adjustment, the proportion acquiring other CVD was 34.0% for IC and 43.4% for AP. Relative to the reference sample, those with IC had a 2.73-fold higher age and sex-adjusted 10-year hazard of CVD (95% CI 2.21, 3.38) and for AP was 3.17 (95% CI 2.73, 3.69). CVD hazard ratios remained more elevated for AP and statistically significant after standard risk factor adjustment. Risk factors accounted for more of the excess CVD risk associated with IC (34.8%) than AP (9.5%). CONCLUSION: AP is as useful as IC as a hallmark of diffuse atherosclerotic CVD and an indication for comprehensive preventive measures.

Self-monitoring of blood pressure and the role of community pharmacists in Kuwait.

OBJECTIVE: To determine the types of devices for self-monitoring of blood pressure available to consumers in Kuwait and the pharmacists' knowledge and level of information provided to consumers when purchasing such devices. MATERIALS AND METHODS: It was possible to contact 196 of the 230 eligible pharmacies from five governorates in Kuwait. Ten of these were used to pretest the questionnaire and six declined to participate. Another six did not carry any blood pressure monitoring devices and hence were excluded. Data was then collected from pharmacists at the 174 remaining community pharmacies via face-to-face structured interview of the respondents at their work sites. RESULTS: Of the 174 pharmacists, 173 (99.4%) claimed to offer or provide advice to clients at the time of purchasing devices, 117 (67.1%) of them stating that they did so even if the patients did not ask. Although 147 (84.5%) respondents correctly identified the mercury sphygmomanometer as the most reliable device for measuring blood pressure, less than half (86, 49.4%) claimed to know how to check the accuracy of the devices they sold. Only 25 (14.4%) pharmacists could actually identify the correct procedure for checking the accuracy of the devices and only 25 (14.4%) pharmacists could correctly identify cutoff points for systolic and diastolic blood pressure delineating clinical hypertension. Only 1 pharmacist could correctly name a reference source for blood pressure measurement. CONCLUSION: There is a need for improvement of community pharmacists' competence in supporting patients and in providing them with information regarding devices for measuring blood pressure in Kuwait.

US demographic trends in mid-arm circumference and recommended blood pressure cuffs for children and adolescents: data from the National Health and Nutrition Examination Survey 1988-2004.

OBJECTIVE: Mid-arm circumference measurement is a prerequisite for the selection of properly sized blood pressure cuffs for accurate blood pressure readings in children and youth. This study examined recent trends in the mid-arm circumference distribution and the distribution of corresponding recommended blood pressure cuff sizes using National Health and Nutrition Examination Survey III (1998-1994) and National Health and Nutrition Examination Survey 1999-2004 data. DESIGN: Both studies were complex, cross-sectional surveys providing nationally representative samples of the civilian noninstitutionalized US population. PARTICIPANTS: Children of 7-17 years of age were studied. A total of 2515 boys and 2596 girls participated in National Health and Nutrition Examination Survey III, and 3941 boys and 3917 girls in National Health and Nutrition Examination Survey 1999-2004. STATISTICAL ANALYSIS: Mean mid-arm circumference and recommended National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents defined blood pressure cuff sizes were assessed by sex, age, and race/ethnicity. US boys aged 7-12 years and girls aged 7-12 and 13-17 years had significant increases in mid-arm circumference (P<0.05) across the two surveys. Moreover, from 1988-1994 to 1999-2004, there were statistically significant increases in the percentage of boys (age 7-12 and 13-17 years) and girls (age 13-17 years) needing large blood pressure adult cuffs (P<0.05). National Health and Nutrition Examination Survey 1999-2004 data show that both boys and girls aged 13-17 years had a mean mid-arm circumference > or =27 cm, which requires an adult blood pressure cuff fit. Furthermore, 52% boys and 42% girls aged 13-17 years, required a standard adult cuff fit. CONCLUSION: Mean mid-arm circumference has increased among US children and adolescents, with important implications for the accuracy of blood pressure measurement in clinical practice.

[Value of blood pressure of adults depending on method of measurement]. / Wartosci cisnienia tetniczego krwi u doroslych osób w zaleinosci od metody pomiaru.

UNLABELLED: Hypertension is currently one of the most common diseases of circulation system within Polish population. This fact implies an urgent need of introducing efficient prevention concerning proper blood pressure measurement not only in medical centers but at home of patients as well. Blood pressure measurement of brachial taking by mercurial sphygmomanometer is an advisable method recommended by World Health Organization and International Society of Hypertension. In practice, however, other methods are used by patients and blood pressure is often of measure wrist. THE AIM of the research was the comparison of results of different method of measurement blood pressure of adults. The measurement was taken with three types of instruments at different parts of upper limb: arm and wrist. MATERIAL AND METHODS: 105 persons, 75 men and 30 women at age 46,3+/-12,1 years, were examined by taking the measurement of vascular blood pressure at rest. The measurement was taken at left upper limb after fifteen minutes of rest. The first measurement was taken with mercurial sphygmomanometer. Subsequently, the automatic wrist vascular blood pressure instrument made by OMRON R-1 was used; third measurement: automatic brachial vascular blood pressure instrument made by OMRON M5-1. RESULTS: Average values of systolic vascular blood pressure measured with mercurial sphygmomanometer were 122,1+/-18,9 mmHg, diastolic pressure were 81,7+/-9,9 mmHg. Average values of systolic vascular blood pressure measured with automatic wrist vascular blood pressure instrument were higher 131,3+/-21,0 mmHg, diastolic pressure were 85,3 + 12,1 mmHg (p<0,05). Average values of systolic vascular blood pressure measured with automatic brachial vascular blood pressure instrument were higher too: 129,6+/-19,9 mmHg, diastolic pressure were 80,5+/-11,4 mmHg (p<0,05). Measurements taken with automatic instrument were considerably statistically higher than with mercurial sphygmomanometer. CONCLUSION: 1. Measurements of vascular blood pressure at rest taken with automatic instruments (wrist and brachial one) were considerably higher than with mercurial sphygmomanometer. The differences were mainly concerning the values of systolic vascular blood pressure. The place of measurement (arm and wrist) had no influence on the result. 2. In comparison to mercurial sphygmomanometer, the error statistically essential must be taken into account during the interpretation of results obtained by measurement taken with brachial and wrist instruments. The instruments may be used for comparison of the successive results of the same person only. 3. The measurements taken with mercurial sphygmomanometer should remain a basic tool in hypertension diagnosis and control.