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1.
Anesthesiology ; 133(5): 997-1006, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33048167

RESUMO

BACKGROUND: In most patients having noncardiac surgery, blood pressure is measured with the oscillometric upper arm cuff method. Although the method is noninvasive and practical, it is known to overestimate intraarterial pressure in hypotension and to underestimate it in hypertension. A high-fidelity upper arm cuff incorporating a hydraulic sensor pad was recently developed. The aim of the present study was to investigate whether noninvasive blood pressure measurements with the new high-fidelity cuff correspond to invasive measurements with a femoral artery catheter, especially at low blood pressure. METHODS: Simultaneous measurements of blood pressure recorded from a femoral arterial catheter and from the high-fidelity upper arm cuff were compared in 110 patients having major abdominal surgery or neurosurgery. RESULTS: 550 pairs of blood pressure measurements (5 pairs per patient) were considered for analysis. For mean arterial pressure measurements, the average bias was 0 mmHg, and the precision was 3 mmHg. The Pearson correlation coefficient was 0.96 (P < 0.0001; 95% CI, 0.96 to 0.97), and the percentage error was 9%. Error grid analysis showed that the proportions of mean arterial pressure measurements done with the high-fidelity cuff method were 98.4% in zone A (no risk), 1.6% in zone B (low risk) and 0% in zones C, D, and E (moderate, significant, and dangerous risk, respectively). The high-fidelity cuff method detected mean arterial pressure values less than 65 mmHg with a sensitivity of 84% (95% CI, 74 to 92%) and a specificity of 97% (95% CI, 95% to 98%). To detect changes in mean arterial pressure of more than 5 mmHg, the concordance rate between the two methods was 99.7%. Comparable accuracy and precision were observed for systolic and diastolic blood pressure measurements. CONCLUSIONS: The new high-fidelity upper arm cuff method met the current international standards in terms of accuracy and precision. It was also very accurate to track changes in blood pressure and reliably detect severe hypotension during noncardiac surgery.


Assuntos
Pressão Arterial/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Oscilometria/instrumentação , Oscilometria/métodos , Oscilometria/normas , Estudos Prospectivos , Adulto Jovem
2.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32817268

RESUMO

BACKGROUND: Although required for healing, sleep is often disrupted during hospitalization. Blood pressure (BP) monitoring can be especially disruptive for pediatric inpatients and has few clinical indications. Our aim in this pilot study was to reduce unnecessary overnight BP monitoring and improve sleep for pediatric inpatients. METHODS: The intervention in June 2018 involved clinician education sessions and updated electronic health record (EHR) orders that enabled the forgoing of overnight BP checks. The postintervention period from July 2018 to May 2019 examined patient-caregiver surveys as outcome measures. These surveys measured inpatient sleep and overnight disruptions and were adopted from validated surveys: the Patient Sleep Questionnaire, expanded Brief Infant Sleep Questionnaire, and Potential Hospital Sleep Disruptions and Noises Questionnaire. Uptake of new sleep-friendly EHR orders was a process measure. Reported patient care escalations served as a balancing measure. RESULTS: Interrupted time series analysis of EHR orders (npre = 493; npost = 1472) showed an increase in intercept for the proportion of patients forgoing overnight BP postintervention (+50.7%; 95% confidence interval 41.2% to 60.3%; P < .001) and a subsequent decrease in slope each week (-0.16%; 95% confidence interval -0.32% to -0.01%; P = .037). Statistical process control of surveys (npre = 263; npost = 131) showed a significant increase in sleep duration for patients older than 2, and nighttime disruptions by clinicians decreased by 19% (P < .001). Annual estimated cost savings were $15 842.01. No major adverse events in patients forgoing BP were reported. CONCLUSIONS: A pilot study combining EHR changes and clinician education safely decreased overnight BP checks, increased pediatric inpatient sleep duration, and reduced nighttime disruptions by clinicians.


Assuntos
Determinação da Pressão Arterial/normas , Criança Hospitalizada , Pessoal de Saúde/normas , Análise de Séries Temporais Interrompida/normas , Melhoria de Qualidade/normas , Sono/fisiologia , Adolescente , Determinação da Pressão Arterial/psicologia , Determinação da Pressão Arterial/tendências , Cuidadores/educação , Cuidadores/normas , Cuidadores/tendências , Criança , Criança Hospitalizada/psicologia , Pré-Escolar , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/tendências , Feminino , Pessoal de Saúde/educação , Pessoal de Saúde/tendências , Humanos , Lactente , Recém-Nascido , Análise de Séries Temporais Interrompida/tendências , Masculino , Projetos Piloto , Estudos Prospectivos , Melhoria de Qualidade/tendências
3.
Medicine (Baltimore) ; 99(17): e19769, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332617

RESUMO

INTRODUCTION: High blood pressure is the leading modifiable risk factor for cardiovascular disease, and is associated with high morbidity and mortality and with significant health care costs for individuals and society. However, fewer than half of the patients with hypertension receiving pharmacological treatment have adequate blood pressure control. The main reasons for this are therapeutic inertia, lack of adherence to treatment, and unhealthy lifestyle (i.e., excess dietary fat and salt, sedentary lifestyle, and overweight). Cardiovascular risk and mortality are greater in hypertensive patients who are receiving treatment but have suboptimal control of blood pressure. METHODS/DESIGN: This is a multicentre, parallel, 2-arm, single-blind (outcome assessor), controled, cluster-randomized clinical trial. General practitioners and nurses will be randomly allocated to the intervention group (self-management of antihypertensive medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and physical exercise) or the control group (regular clinical practice). A total of 424 patients in primary care centers who use 2 or more antihypertensive drugs and blood pressure of at least 130/80 during 24-hambulatory blood pressure monitoring will be recruited. The primary outcome is systolic blood pressure at 12 months. The secondary outcomes are blood pressure control (<140/90 mm Hg); quality of life (EuroQol 5D); direct health care costs; adherence to use of antihypertensive medication; and cardiovascular risk (REGICOR and SCORE scales). DISCUSSION: This trial will be conducted in the primary care setting and will evaluate the impact of a multifactorial intervention consisting of self-management of blood pressure, antihypertensive medications, and lifestyle modifications (hypocaloric and low sodium diet and physical exercise).


Assuntos
Anti-Hipertensivos/normas , Determinação da Pressão Arterial/normas , Hipertensão/tratamento farmacológico , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial/métodos , Restrição Calórica/métodos , Análise por Conglomerados , Dieta Hipossódica/métodos , Exercício Físico/fisiologia , Feminino , Humanos , Hipertensão/psicologia , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Autogestão/métodos , Autogestão/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Resultado do Tratamento
4.
Phys Ther ; 100(6): 1008-1019, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32232372

RESUMO

Hypertension (HTN) is among the leading global preventable risk factors for cardiovascular disease and premature mortality. Early detection and effective management of HTN have demonstrated significant reductions in mortality, morbidity rate, and health care costs. Furthermore, screening for HTN by nonphysician health care providers improves detection rates and medical management. As physical therapist practice advances to a more independent care model, physical therapists may serve as the first point of contact into the health care system, thereby necessitating a need for routine blood pressure (BP) monitoring. This is especially relevant in the outpatient physical therapist practice setting, where there is evidence for elevated BP measures among patients, yet omission of routine screening in this setting is well documented. Leading physical therapy professional organizations include statements in their guidelines that suggest that physical therapists have a duty to provide a standard of care that protects the safety and optimizes the overall health of patients under their care. Therefore, it is imperative not only that physical therapists include BP examination into routine practice protocols but that the knowledge and skills to accurately measure and interpret BP at rest and during exercise be integrated into the standard of care. The authors suggest that the profession of physical therapy proactively embrace their potential to address the national and worldwide HTN epidemic through routine assessment of BP, appropriate referral for elevated BP measures, and exploration of HTN management by physical therapists.


Assuntos
Assistência Ambulatorial , Determinação da Pressão Arterial , Hipertensão/diagnóstico , Fisioterapeutas , Assistência Ambulatorial/ética , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/ética , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/normas , Calibragem , Tomada de Decisão Clínica , Diagnóstico Precoce , Desenho de Equipamento , Exercício Físico/fisiologia , Terapia por Exercício , Humanos , Hipertensão/terapia , Fisioterapeutas/ética , Postura/fisiologia , Encaminhamento e Consulta , Padrão de Cuidado
5.
Arch Dis Child ; 105(8): 778-783, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32144092

RESUMO

OBJECTIVE: To produce a single 'growth-chart-style' blood pressure (BP) chart with clear diagnostic thresholds to assist paediatricians to make prompt and accurate diagnoses of hypertension. DESIGN: The well-established but complex published data on normal BP ranges in prepubertal children were identified and analysed to determine if it was possible to produce a single, user-friendly, colour-coded chart, showing diagnostic hypertension thresholds for systolic and diastolic BP without losing clinically important information. RESULTS: There were sufficient published normative childhood BP data available to define systolic and diastolic BP centiles from term onwards but only sufficient to determine systolic BP centiles from 28 weeks of gestation to term. Up to 13 years of age, it was possible to combine boys' and girls' data without loss of precision and to define the threshold between stage 1 and stage 2 (severe) hypertension as the 95th centile +12 mm Hg. This allowed the production of single colour-coded charts for systolic and diastolic BP and to advise on making simple adjustments for the impact of stature on individual children's results. CONCLUSIONS: A simplified, integrated BP chart with colour-coded diagnostic thresholds was produced to assist the prompt diagnosis of hypertension in prepubertal children. This information could be included into a Paediatric Early Warning System score.


Assuntos
Determinação da Pressão Arterial/normas , Hipertensão/diagnóstico , Adolescente , Fatores Etários , Estatura , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Padrões de Referência , Valores de Referência
6.
BMJ Open Qual ; 9(1)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32213548

RESUMO

The goal of the University of California Davis Health Blood Pressure (BP) Quality Improvement Initiative was to improve the diagnosis, management and control of high BP. Patients aged 18-85 years were included in the initiative. Lean A3 problem solving was used to implement the following evidence-based interventions based on stakeholder interviews, value stream mapping and the Centers for Disease Control and Prevention's Million Hearts Initiative: staff training on accurate BP measurement, visual cues and reminders for BP screening, virtual case-based videoconferences, standardised clinical management algorithm, academic detailing visits, clinical decision support tools, access to pharmacists for medication comanagement, clinician workflow modification, patient education and access to home BP monitors. Following implementation of interventions, accurate screening of BP increased from 14% to 87% and BP control increased from 62% to 75%. Strategies that contributed the most to improvements were using a team-based approach, adjusting clinic workflow and frequent communication of results to staff.


Assuntos
Determinação da Pressão Arterial/normas , Programas de Rastreamento/normas , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Centros Médicos Acadêmicos/tendências , Adolescente , Adulto , Idoso , Determinação da Pressão Arterial/tendências , California , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/tendências , Pessoa de Meia-Idade , Melhoria de Qualidade
7.
High Blood Press Cardiovasc Prev ; 27(3): 183-193, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32170711

RESUMO

Children are defined as hypertensive when their blood pressure values equal or exceed the 95th percentile of the blood pressure value distribution in a pediatric population, according to gender, age and height. The population on which reference tables are based is of fundamental importance to establish the threshold values for the diagnosis of hypertension in pediatric age. Before 2017, both American and European guidelines used nomograms created in the same reference population which included children of all weight classes. Given the close and well-known association between hypertension and excess weight in childhood, the 2017 American guidelines proposed new reference nomograms excluding subjects with overweight and obesity from the "historical" reference population. Furthermore, the new American guidelines suggested a fixed cut-off of 130/80 mmHg, starting from 13 years and regardless of gender and height, to make the diagnosis of hypertension. In this document, the Italian Hypertension Society (SIIA) and the Italian Pediatric Society (SIP) jointly discuss a number of issues raised by the new American guidelines that involve the entire medical community, and also address the definition of arterial hypertension in the transition phase between childhood and adulthood.


Assuntos
Pressão Arterial , Determinação da Pressão Arterial/normas , Hipertensão/diagnóstico , Adolescente , Fatores Etários , Estatura , Criança , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Itália/epidemiologia , Masculino , Nomogramas , Valor Preditivo dos Testes , Valores de Referência , Fatores Sexuais
8.
BMC Endocr Disord ; 20(Suppl 1): 27, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164691

RESUMO

BACKGROUND: Feel4Diabetes was a large-scale, multicenter lifestyle intervention aiming to prevent type 2 diabetes among families from vulnerable population groups in six European countries (Belgium, Bulgaria, Finland, Greece, Hungary and Spain). The current study aimed to describe the process that was followed to harmonize and standardize the measurement of anthropometric (weight, height and waist circumference) and blood pressure (systolic and diastolic) indices, as well as to assess the intra- and inter- observer reliability of these measurements. METHODS: A central training workshop was conducted prior to the baseline measurements of the Feel4Diabetes-intervention. One researcher from each intervention country, as well as 12 adults and 12 children (for the anthropometric measurements) and 21 adults (for the blood pressure measurements) participated in this workshop. Technical Error of Measurement (TEM) and reliability (%R) were calculated to assess the reliability of the indices which were assessed to evaluate the outcome of the Feel4Diabetes-intervention. The Feel4Diabetes-intervention is registered at https://clinicaltrials.gov/ (NCT02393872). RESULTS: Intra-observer reliability was found to be higher than 99.5% for all anthropometric measurements in both children and adults. Inter-observer reliability was found to be higher than 98% regarding the anthropometric measurements, while for blood pressure measurements %R was 76.62 and 91.38% for systolic and diastolic blood pressure measurements, respectively. CONCLUSION: The central training of the Fee4Diabetes-intervention ensured that the data collected for the outcome evaluation of the Feel4Diabetes-intervention in the six European countries at three different time points (baseline, follow-up 1 and follow-up 2) were valid and comparable.


Assuntos
Determinação da Pressão Arterial/métodos , Pesos e Medidas Corporais/métodos , Diabetes Mellitus Tipo 2/prevenção & controle , Serviços Preventivos de Saúde/métodos , Adulto , Pressão Sanguínea , Determinação da Pressão Arterial/normas , Determinação da Pressão Arterial/estatística & dados numéricos , Pesos e Medidas Corporais/normas , Pesos e Medidas Corporais/estatística & dados numéricos , Criança , Redes Comunitárias/organização & administração , Redes Comunitárias/normas , Diabetes Mellitus Tipo 2/etiologia , Educação , Europa (Continente)/epidemiologia , Feminino , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Promoção da Saúde/normas , Humanos , Masculino , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/patologia , Obesidade/fisiopatologia , Variações Dependentes do Observador , Estado Pré-Diabético/diagnóstico , Estado Pré-Diabético/epidemiologia , Estado Pré-Diabético/patologia , Estado Pré-Diabético/fisiopatologia , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Padrões de Referência , Reprodutibilidade dos Testes , Projetos de Pesquisa , Fatores de Risco , Serviços de Saúde Escolar/organização & administração , Serviços de Saúde Escolar/normas , Instituições Acadêmicas/estatística & dados numéricos
9.
Clin Exp Hypertens ; 42(6): 512-518, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31941385

RESUMO

OBJECTIVE: In recent times, new methods of blood pressure measurements have been introduced, including cuffless blood pressure (BP) measurement device using pulse transit time (PTT) for calculation of BP values. However, it is still unknown how values obtained with a new cuffless device compare with standard ambulatory measurements in children. The main aim of the study was to investigate whether BP values measured by a cuffless PTT device are comparable with measurements by a standard upper arm cuff-based BP device. METHODS: Thirty children were prospectively included. Blood pressure measurements using the cuffless device (Somnotouch-NIBP) and cuff-based standard device (Omron 907) were performed simultaneously on the left and right arm. RESULTS: Mean systolic BP of the standard measurements was 123,47 ± 14,91 mmHg and 127,48 ± 15,98 mmHg (p < .001) measured by cuffless method. Mean diastolic BP of the standard ABPM measurements was 66,88 ± 11,86 mmHg and 68,52 ± 12,36 mmHg (p < .001). There were significant positive correlations between standard and cuffless measurements. CONCLUSION: The results show that the created PWV-BP function produces a significant correlation between BP derived from the PWV and the SBP measured by sphygmomanometry. When applying this device in clinical practice, one may keep in mind that the reported mean values over 24 hours, awake and asleep time are not directly interchangeable with cuff-based standard 24-hour BP values. The measured BP values were higher by the new technique. Although differences in SBP between both methods reached values up to 20 mmHg, we think that the development of a cuffless BP monitoring system will provide novel solutions in various medical situations.


Assuntos
Determinação da Pressão Arterial , Hipertensão , Esfigmomanômetros , Adolescente , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Criança , Relógios Circadianos/fisiologia , Eletrocardiografia/métodos , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Fotopletismografia/métodos , Análise de Onda de Pulso/métodos , Esfigmomanômetros/classificação , Esfigmomanômetros/normas
10.
Blood Press Monit ; 25(1): 50-52, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31633518

RESUMO

OBJECTIVE: To evaluate the accuracy of the InBody BP170 oscillometric upper-arm home blood pressure (BP) monitor in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018). METHODS: Subjects were recruited to fulfill the age, gender, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumference 22-32 (medium) and 32-42 cm (large). RESULTS: One-hundred five subjects were recruited and 88 were analyzed. For validation Criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.9 ± 6.9/0.5 ± 5.5 mmHg (systolic/diastolic). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 5.77/4.80 mmHg (systolic/diastolic). CONCLUSION: The InBody BP170 oscillometric home BP monitor fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in general population and can be recommended for clinical use.


Assuntos
Pressão Arterial , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/normas , Monitores de Pressão Arterial/normas , Hipertensão/diagnóstico , Oscilometria/instrumentação , Oscilometria/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Diástole , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Referência , Sociedades Médicas , Sístole
12.
Anesth Analg ; 130(3): e71-e74, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31856006

RESUMO

We recently proposed continuous error grid analysis to describe the clinical relevance of measurement differences between a test and a reference method for arterial blood pressure (AP) measurement. Here, we present instructions on how to perform continuous error grid analysis in AP method comparison studies and provide a freely accessible computer program for automated computing of continuous error grids and calculation of the proportion of measurement pairs in the different risk zones.


Assuntos
Pressão Arterial , Determinação da Pressão Arterial , Software , Automação , Determinação da Pressão Arterial/normas , Humanos , Valor Preditivo dos Testes , Valores de Referência , Reprodutibilidade dos Testes
13.
Blood Press Monit ; 25(1): 34-38, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31764009

RESUMO

OBJECTIVE: For more than a century since its introduction, mercury sphygmomanometer (HgS) had been the mainstay for office measurement of blood pressure (BP). In light of the environmental and health hazards associated with mercury, there is a need to replace it with mercury-free alternatives all over the world. We aimed to validate the widely used aneroid sphygmomanometer (AnS) by comparing its BP readings against BP readings taken with an HgS. METHODS: We compared the BP readings using AnS vs. HgS on a sample of 300 patients of 18 years or older age admitted to a tertiary care hospital in Karachi, Pakistan. RESULTS: The differences between mean HgS and AnS BP readings were found to be statistically significant (P-value <0.01). The mean systolic blood pressure (SBP) readings of the two devices were still significantly correlated (r = 0.989; P < 0.01). Similarly, the mean diastolic blood pressure (DBP) readings were also significantly correlated (r = 0.988; P < 0.01). The aneroid device identified a higher proportion of hypertensive participants compared to the mercury device. CONCLUSION: The difference in the two devices used was found to be significant; however, the readings were correlated with each other. The AnS significantly overestimated BP readings, thereby identifying a higher proportion of hypertensives as compared to the HgS. There is a considerable room for improvement in the accuracy of the AnS, only then an accurate and a well-calibrated AnS could provide an acceptable alternative to the use of the HgS.


Assuntos
Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/normas , Pressão Sanguínea , Hipertensão/diagnóstico , Esfigmomanômetros/normas , Adulto , Calibragem , Diástole , Feminino , Humanos , Masculino , Mercúrio/toxicidade , Pessoa de Meia-Idade , Sístole , Adulto Jovem
14.
Trends Cardiovasc Med ; 30(3): 160-164, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31521481

RESUMO

The ACC/AHA hypertension guidelines cover virtually all aspects of the diagnosis, evaluation, monitoring, secondary causes as well as drug and non-drug treatment of hypertension. Substantial and appropriate emphasis has been given to the strategies necessary for accurate measurement of blood pressure in any setting where valid blood pressure measurements are desired. Most "errors" made during blood pressure measurement bias readings upwards resulting in over-diagnosis of hypertension and, amongst those already on drug therapy, underestimating the true magnitude of blood pressure lowering resulting in over-treatment. Hypertension is diagnosed when blood pressure is consistently ≥130 and/or ≥80 mm Hg. However, the majority of patients with hypertension between 130-139/80-89 mm Hg (stage 1 hypertension) do not qualify for immediate drug therapy. The guideline breaks new ground with some of its recommendations. Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89 mm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP ≥ 130/80 mm Hg. The exception amongst high-risk individuals is for secondary stroke prevention in drug naïve individuals as drug therapy is initiated when blood pressure ≥140/90 mm Hg. Non-high risk individuals will initiate drug therapy when BP is ≥140/90 mm Hg. Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80 mm Hg in most. However, target BP is <130 systolic amongst those 65 and older as the committee made no recommendation for a DBP target. Treatment should be initiated with two drugs having complementary mechanisms of action when blood pressure is >20/10 mm Hg above goal.


Assuntos
American Heart Association , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Anti-Hipertensivos/efeitos adversos , Determinação da Pressão Arterial/normas , Consenso , Quimioterapia Combinada , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
15.
Vasc Health Risk Manag ; 16: 571-575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33402825

RESUMO

Objective: The accuracy of the Omron HEM-1040 automated oscillometric upper-arm blood pressure (BP) monitoring device, designed for home self-measurements in adult populations, was tested according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 protocol. Methods: The requirements of this protocol were precisely followed with the recruitment of 85 individuals in whom sequential systolic BP (SBP) and diastolic BP (DBP) were measured in the same (left) arm and who fulfilled the inclusion criteria involving the ranges of arm circumference, SBP, and DBP. Results: The mean device-observer difference in the 255 separate pairs of BP data was -2.7 ± 7.14 mmHg for SBP and -3.3 ± 5.70 mmHg for DBP. The data were in accordance with criterion 1 of the ANSI/AAMI/ISO 81060-2:2013 standard requirements (≤ 5 ± ≤ 8 mmHg). In addition, the mean device-observer difference in the 85 participants was -2.7 ± 5.89 mmHg for SBP and -3.3 ± 4.99 mmHg for DBP, fulfilling criterion 2 with a standard deviation of ≤ 6.39 mmHg for SBP and ≤ 6.09 mmHg for DBP. Conclusion: The OMRON HEM-1040 BP monitor fulfilled the requirements of the ANSI/AAMI/ISO validation standard.


Assuntos
Braço/irrigação sanguínea , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/normas , Pressão Sanguínea , Adulto , Idoso , Feminino , Humanos , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Adulto Jovem
16.
BMJ Open ; 9(12): e032342, 2019 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-31831543

RESUMO

OBJECTIVES: The primary objective was to assess the accuracy (calibration and validation status) of digital blood pressure (BP) monitors used within community pharmacy in England and the secondary objectives were to assess the overall quality of the BP service by assessing service prevalence, service utilisation and other in-service considerations. DESIGN: A cross-sectional survey. SETTING: Primary-care retail-pharmacies. PARTICIPANTS: 500 pharmacies that contribute to government dispensing-data were invited by post to complete the survey. Private contractors were excluded. INTERVENTIONS: We conducted a questionnaire survey with a follow-up (September 2018 to December 2018). RESULTS: 109 responses were received. 61% (n=66) of responding pharmacies provided a free BP check to their patients. 40 (61%) pharmacies used recommended validated clinical metres, 6 (9%) had failed validation and 20 (30%) provided too little information to enable us to determine their monitor's status. CONCLUSIONS: Responding pharmacies were able to provide useful BP monitoring services to their patients, though quality enhancements need to be implemented. Majority of pharmacies use validated BP monitors, however, there was a lack of range of cuff sizes, variation in replacement and calibration of monitors and apparent absence of such practice in a minority of pharmacies alongside variation in training standards. We noted higher frequency of BP screening in the most deprived postcodes.We recommend in-service redesign and delivery improvements, and suggest professional bodies and researchers work together to create clearer frameworks for front-line practitioners, creating appropriate incentives to facilitate this service redesign.Funders and policy setters should consider the value added to the National Health Service and other healthcare agencies of such screening by pharmacy providers both nationally and internationally. It has the potential to reduce complications of undiagnosed hypertension and the medicines burden that it creates. Future work should examine the impact of pharmacist-led BP screening on patients.


Assuntos
Determinação da Pressão Arterial , Serviços Comunitários de Farmácia , Precisão da Medição Dimensional , Hipertensão/diagnóstico , Farmacêuticos/estatística & dados numéricos , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Serviços Comunitários de Farmácia/normas , Serviços Comunitários de Farmácia/estatística & dados numéricos , Inglaterra , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Papel Profissional , Qualidade da Assistência à Saúde , Medicina Estatal/normas , Inquéritos e Questionários
17.
Rev Bras Enferm ; 72(suppl 3): 162-169, 2019 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851249

RESUMO

OBJECTIVE: to compare blood pressure values obtained by auscultatory and oscillometric methods in different gestational periods, considering cuff width. METHOD: it is a cross-sectional and quasi-experimental study approved by the Research Ethics Committee. The sample consisted of 108 low-risk pregnant women. Blood pressure measurements were performed in gestational periods of 10-14, 19-22 and 27-30 weeks. RESULTS: The oscillometric device presented values similar to the auscultatory method in systolic blood pressure, but overestimated diastolic blood pressure. Underestimation of blood pressure occurred when using the standard width cuff rather than the correct width cuff in both measuring methods. CONCLUSION: Verification of brachial circumference and use of adequate cuffs in both methods are indispensable to obtain reliable blood pressure values in pregnant women. We recommend performance of additional studies to evaluate diastolic blood pressure overestimation by the Microlife 3BTO-A.


Assuntos
Determinação da Pressão Arterial/instrumentação , Oscilometria/instrumentação , Gestantes , Adulto , Auscultação/instrumentação , Auscultação/métodos , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Oscilometria/métodos , Oscilometria/normas , Gravidez
18.
High Blood Press Cardiovasc Prev ; 26(6): 509-534, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31667753

RESUMO

INTRODUCTION: Peripheral and aortic systolic blood pressure (pSBP and aoSBP) were measured using different methodological and calibration approaches to analyze the association and agreement between pSBP and/or aoSBP, and the association of pSBP and aoSBP with left ventricle (LV) and atrium (LA) structural-functional characteristics. METHODS: In healthy subjects (n = 269, age: 9-85 years; n = 147, age < 24 years) LV and LA parameters were echocardiography-derived. pSBP and aoSBP were obtained by brachial sub-diastolic (Mobil-O-Graph®) and supra-systolic oscillometry (Arteriograph®) and aortic diameter waveform re-calibration (RCD; ultrasonography), using three calibration schemes: systo-diastolic (SD), calculated mean (CM), and oscillometric mean (OscM). RESULTS: Always pSBP and aoSBP were positively associated; aoSBP obtained with the Mobil-O-Graph® and calibrated to CM or OscM were the ones that showed the lowest levels of association with the remaining forms of aoSBP and pSBP. Bland-Altman related mean errors varied noticeably (e.g. - 27, - 23, - 17, - 12 or 8 mmHg when aoSBP obtained with MOG (OscM) was compared with data from other methodological and calibration schemes). The aoSBP data obtained with Mobil-O-Graph® (calibration: CM and OscM) showed the highest levels of association with cardiac structural characteristics. aoSBP values obtained calibrating to OscM were higher than those obtained calibrating to SD or CM. CONCLUSIONS: aoSBP obtained with Mobil-O-Graph® and calibrated to CM or OscM showed (1) lower association with other forms of aoSBP and pSBP determination and (2) higher levels of association with LV and LA structural characteristics. Differences in aoSBP data between approaches were more sensitive to the calibration method than to the device used.


Assuntos
Aorta/fisiologia , Pressão Arterial , Função do Átrio Esquerdo , Determinação da Pressão Arterial/métodos , Função Ventricular Esquerda , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/normas , Calibragem , Criança , Estudos Transversais , Ecocardiografia Doppler , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Oscilometria , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sístole , Adulto Jovem
20.
Am J Vet Res ; 80(12): 1067-1073, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31763937

RESUMO

OBJECTIVE: To compare results of a commercially available device for oscillometrically measured blood pressure (OBP) with invasively measured blood pressure (IBP) in awake and anesthetized dogs. ANIMALS: 19 adult dogs (mean ± SD body weight, 17.8 ± 7.5 kg). PROCEDURES: Blood pressures were measured in dogs while they were awake and anesthetized with isoflurane. The OBP was recorded on a thoracic limb, and IBP was simultaneously recorded from the median caudal artery. Agreement between OBP and IBP was evaluated with the Bland-Altman method. Guidelines of the American College of Veterinary Internal Medicine (ACVIM) were used for validation of the oscillometric device. RESULTS: In awake dogs, mean bias of the oscillometric device was -11.12 mm Hg (95% limits of agreement [LOA], -61.14 to 38.90 mm Hg) for systolic arterial blood pressure (SAP), 9.39 mm Hg (LOA, -28.26 to 47.04 mm Hg) for diastolic arterial blood pressure (DAP), and -0.85 mm Hg (LOA, -40.54 to 38.84 mm Hg) for mean arterial blood pressure (MAP). In anesthetized dogs, mean bias was -12.27 mm Hg (LOA, -47.36 to 22.82 mm Hg) for SAP, -3.92 mm Hg (LOA, -25.28 to 17.44 mm Hg) for DAP, and -7.89 mm Hg (LOA, -32.31 to 16.53 mm Hg) for MAP. The oscillometric device did not fulfill ACVIM guidelines for the validation of such devices. CONCLUSIONS AND CLINICAL RELEVANCE: Agreement between OBP and IBP results for awake and anesthetized dogs was poor. The oscillometric blood pressure device did not fulfill ACVIM guidelines for validation. Therefore, clinical use of this device cannot be recommended.


Assuntos
Anestesia/veterinária , Determinação da Pressão Arterial/instrumentação , Monitores de Pressão Arterial/veterinária , Oscilometria/veterinária , Animais , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/normas , Monitores de Pressão Arterial/normas , Cães , Feminino , Membro Anterior , Masculino , Oscilometria/instrumentação , Oscilometria/normas , Vigília
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