BP reactivity to public speaking in stage 1 hypertension: influence of different task scenarios.

AIM: To investigate the blood pressure (BP) reaction to public speaking performed according to different emotionally distressing scenarios in stage 1 hypertension. METHODS. We assessed 64 hypertensive and 30 normotensive subjects. They performed three speech tasks with neutral, anger and anxiety scenarios. BP was assessed with the Finometer beat-to-beat non-invasive recording system throughout the test procedure. RESULTS: For all types of speech, the systolic BP response was greater in the hypertensive than the normotensive subjects (all p < 0.001). At repeated-measures analysis of covariate (R-M ANCOVA), a significant group-by-time interaction was found for all scenarios (p ≤ 0.001). For the diastolic BP response, the between-group difference was significant for the task with anxiety scenario (p < 0.05). At R-M ANCOVA, a group-by-time interaction of borderline statistical significance was found for the speech with anxiety content (p = 0.053) but not for the speeches with neutral or anger content. Within the hypertensive group, the diastolic BP increments during the speeches with anxiety and anger scenarios were greater than those during the speech with neutral scenario (both p < 0.001). CONCLUSIONS: These data indicate that reactivity to public speaking is increased in stage 1 hypertension. A speech with anxiety or anger scenario elicits a greater diastolic BP reaction than tasks with neutral content.

Biofeedback-assisted cardiovascular control in hypertensives exposed to emotional stress: a pilot study.

The study was aimed at examining the effect of a short Heart Rate-Biofeedback (HR-BF) protocol on systolic (SBP) and diastolic (DBP) blood pressure levels and BP emotional reactivity. Twenty-four unmedicated outpatients with pre- and stage 1 hypertension, were randomly assigned to active treatment (BF-Training) or control (BP-Monitoring) group. Subjects in BF-Training Group underwent four BF sessions. Guided imagery of stressful events was introduced during sessions 3 and 4. Control participants self-monitored their BP at home for 4 weeks. Subjects in both groups performed an emotional Speech Test before and after the training (or monitoring) period. SBP and mean arterial pressure responses to the emotional Speech Test were significantly smaller after the BF-training than the BP-monitoring. Moreover, clinic SBP and DBP were significantly reduced by about 10 mmHg in BF-Training Group, whereas they remained unchanged in control group. Self-monitored BP decreased significantly in the active treatment group and not in control group. A short BF-training, including guided imagery of stressful events, was effective in reducing BP reactions to a psychosocial stressor. BP measured in the clinic, and self-monitored at home were also significantly reduced in the BF-Training Group. HR-BF appears to be a suitable intervention for hypertensive patients, mostly when BP increase is associated with emotional activation.

Validation of the Microlife BP W200-1 wrist device for blood pressure measurement.

OBJECTIVE: The objective of the study was to determine the accuracy of the BP W200-1 device for blood pressure measurement at the wrist developed by the Microlife Company. The BP W200-1 model features a 'Microlife Average Mode', which uses a 'weighted' average of a minimum of three consecutive blood pressure (BP) readings taken 15 s apart. METHOD: Device evaluation was carried out using the International Protocol of the European Society of Hypertension. Monitor performance was assessed in relation to patients' sex, age, wrist circumference, and systolic (SBP) and diastolic blood pressures (DBP). RESULTS: The BP W200-1 comfortably passed all three phases of the protocol for SBP and DBP. The device performed well in all ranges of SBP and DBP. Mean blood pressure differences for the BP W200-1 monitor were -1.2+/-4.5 mmHg for SBP and -0.2+/-3.1 mmHg for DBP. In multivariable analyses, the SBP and DBP discrepancies between device and observer were unrelated to age, sex, wrist circumference, and blood pressure level. CONCLUSION: These data show that the Microlife BP W200-1 wrist monitor satisfies the recommended European Society of Hypertension accuracy levels for SBP and DBP and therefore can be recommended for clinical use in the adult population. Its performance is uniform across subgroups of patients with different clinical characteristics.

Autonomic nervous system function in chronic hypotension associated with Bartter and Gitelman syndromes.

Autonomic nervous system dysfunction has a major role in the blood pressure (BP) decrease associated with orthostatic hypotension and syncope. The clinical picture of Bartter and Gitelman syndromes includes reduced extracellular fluid volume and normotension or hypotension, but no study has explored autonomic nervous system status in patients with hypotensive episodes associated with these diseases. We tested sympathetic and parasympathetic nervous system function in 4 patients with Bartter and Gitelman syndromes with chronic hypotension. Each patient underwent a battery of autonomic reflex tests, including BP and heart rate response to orthostatism, Valsalva maneuver, cold-pressor test, hand-grip test, and deep breathing. Plasma catecholamines also were measured. BP was monitored during tests by means of continuous noninvasive finger BP recording. Orthostatic hypotension was observed in 1 patient who experienced syncope episodes. Valsalva ratio ranged from 1.21 to 1.61. During the cold-pressor test, the range of systolic and diastolic BP increases were 8 to 31 and 6 to 24 mm Hg, respectively. During the hand-grip test, systolic and diastolic BP increases ranged from 10 to 39 and 8 to 32 mm Hg, respectively. During hyperventilation, the difference between the highest and lowest heart rates was 12 or more beats/min in all patients. Patients' plasma norepinephrine concentrations increased during standing. Our preliminary results suggest that chronic hypotension in patients with Bartter and Gitelman syndromes is not associated with sympathetic and parasympathetic nervous system dysfunction, even when orthostatic hypotension is present. This normal autonomic function suggests that other pathophysiological mechanisms, such as the characteristic vasoconstrictor abnormal cell signaling, may account for hypotension in patients with Bartter and Gitelman syndromes.

Validation of Heine Gamma G7 (G5) and XXL-LF aneroid devices for blood pressure measurement.

OBJECTIVE: To determine the accuracy of the Gamma G7 (and G5 model) and XXL-LF aneroid sphygmomanometers developed by the Heine Company. DESIGN: Device evaluations were performed using the new protocol of the European Society of Hypertension. Monitor performance was assessed in relation to participants' sex, age, arm circumference, and systolic and diastolic blood pressures. METHODS: The two sphygmomanometers were assessed in two different samples according to European Society of Hypertension requirements, which are based on four zones of accuracy differing from the mercury standard by 5, 10, 15 mmHg, or more. RESULTS: Both sphygmomanometers passed all three phases of the protocol for systolic blood pressure and diastolic blood pressure. Mean blood pressure difference between Gamma G7 sphygmomanometer and observers was -0.4+/-3.3 mmHg for systolic blood pressure and -0.5+/-2.6 mmHg for diastolic blood pressure. Mean differences for the Gamma XXL-LF sphygmomanometer were -0.3+/-3.7 and -1.0+/-2.6 mmHg, respectively. In multivariable analyses, the SBP discrepancies between both aneroid sphygmomanometers and observers were unrelated to age, sex, arm circumference and systolic blood pressure. For diastolic blood pressure, a borderline relationship was found only for arm circumference (P=0.057) with the Gamma G7 device. CONCLUSIONS: These data show that the Heine Gamma G7 and Gamma XXL-LF aneroid sphygmomanometers satisfy the new recommended ESH accuracy levels for both SBP and DBP. Their performance is uniform across subgroups of participants with different clinical characteristics.

Effect of body weight loss on blood pressure after 6 years of follow-up in stage 1 hypertension.

BACKGROUND: Although it is known that weight reduction reduces blood pressure (BP) in overweight patients, the optimal body weight (BW) loss in terms of BP response is not yet established. We evaluated the relationship between decrease in BW and BP over time in 796 stage 1 hypertensives. METHODS: The 166 subjects who lost BW were divided into four groups according to percent of BW loss at the end of a 74-month follow-up (G1, >2% to 5%, G2, >5% to 9%, G3, >9% to 13%, and G4, >13%) and were compared to the 219 subjects without changes in BW (G0, -2% to +2%). The BW increased (>2%) in the remaining 411 subjects. RESULTS: Among subjects with BW loss there was a progressive decrease in final systolic BP associated with BW loss category up to G3 (P = .007), therefore at the end of follow-up G3 had systolic BP 6.2 mm Hg lower than G0 (P = .06). However, among G3 and G4 subjects systolic BP decrease was almost identical (-6.2 nu -5.7 mm Hg, respectively, P = not significant). Similar results were obtained for diastolic BP, which declined up to G3 (P = .013). G3 had final diastolic BP 3.6 mm Hg lower than G0 (P = .037), whereas change in diastolic BP in G4 subjects was similar to that in G0 (-0.9 nu +0.1 mm Hg, respectively, P = not significant). Similar results were obtained in the group with body mass index (BMI) >27 kg/m(2). CONCLUSIONS: Our results indicate that in stage 1 hypertensives followed for more than 6 years the dose-response relationship between BW loss and decrease in BP is not linear irrespective of initial BW. The BW loss >13% of initial weight did not elicit additional BP decrease.

Blood pressure control and treatment adherence in hypertensive patients with metabolic syndrome: protocol of a randomized controlled study based on home blood pressure telemonitoring vs. conventional management and assessment of psychological determinants of adherence (TELEBPMET Study).

BACKGROUND: Inadequate blood pressure control and poor adherence to treatment remain among the major limitations in the management of hypertensive patients, particularly of those at high risk of cardiovascular events. Preliminary evidence suggests that home blood pressure telemonitoring (HBPT) might help increasing the chance of achieving blood pressure targets and improve patient's therapeutic adherence. However, all these potential advantages of HBPT have not yet been fully investigated. METHODS/DESIGN: The purpose of this open label, parallel group, randomized, controlled study is to assess whether, in patients with high cardiovascular risk (treated or untreated essential arterial hypertension--both in the office and in ambulatory conditions over 24 h--and metabolic syndrome), long-term (48 weeks) blood pressure control is more effective when based on HBPT and on the feedback to patients by their doctor between visits, or when based exclusively on blood pressure determination during quarterly office visits (conventional management (CM)). A total of 252 patients will be enrolled and randomized to usual care (n = 84) or HBPT (n = 168). The primary study endpoint will be the rate of subjects achieving normal daytime ambulatory blood pressure targets (< 135/85 mmHg) 24 weeks and 48 weeks after randomization. In addition, the study will assess the psychological determinants of adherence and persistence to drug therapy, through specific psychological tests administered during the course of the study. Other secondary study endpoints will be related to the impact of HBPT on additional clinical and economic outcomes (number of additional medical visits, direct costs of patient management, number of antihypertensive drugs prescribed, level of cardiovascular risk, degree of target organ damage and rate of cardiovascular events, regression of the metabolic syndrome). DISCUSSION: The TELEBPMET Study will show whether HBPT is effective in improving blood pressure control and related medical and economic outcomes in hypertensive patients with metabolic syndrome. It will also provide a comprehensive understanding of the psychological determinants of medication adherence and blood pressure control of these patients. TRIAL REGISTRATION: Clinical Trials.gov: NCT01541566.

Validation of Panasonic EW3106 and EW3109 devices for blood pressure measurement according to the International Protocol.

To determine the accuracy of the EW3106 and EW3109 devices for blood pressure measurement at the upper arm developed by Panasonic. Device evaluations were performed according to the European Society of Hypertension requirements, which are based on four zones of accuracy differing from the mercury standard by 5, 10, 15 mmHg, or more. Both devices passed all three phases of the protocol for systolic blood pressure (SBP) and diastolic blood pressure (DBP). Mean blood pressure difference between the EW3106 monitor and observers was -0.9+/-5.8 mmHg for SBP and 0.1+/-4.8 mmHg for DBP. Mean differences for the EW3109 monitor were -2.1+/-6.5 mmHg and -0.3+/-4.7 mmHg, respectively. In multivariable analyses, the SBP and DBP discrepancies between both devices and observers were unrelated to age and arm circumference, and were inversely related to blood pressure level. These data show that the Panasonic EW3106 and EW 3109 monitors satisfy the recommended European Society of Hypertension accuracy levels for SBP and DBP.

Validation of the Visomat Comfort form device for home blood pressure measurement according to the International Protocol.

To evaluate the accuracy of the UEBE Visomat Comfort form device for home blood pressure measurement tested following the recommendations of the International Protocol of the European Society of Hypertension. Device evaluation was performed in 33 participants with a mean +/- standard deviation age of 56.5+/-18.3 years (range 30-91 years). Their systolic blood pressure (SBP) was 143.6+/-25.3 mmHg (range 94-180 mmHg), diastolic blood pressure (DBP) was 88.8+/-15.4 mmHg (range 64-116 mmHg), and upper arm circumference was 30.2+/-3.2 cm (range 24.5-39.0 cm). BP measurements were performed in the sitting position. The Visomat Comfort form passed all three phases of the European Society of Hypertension protocol for SBP and DBP. Mean BP differences for the Visomat Comfort form (device-observer) were -2.5+/-5.9 mmHg for SBP and -2.4+/-5.4 mmHg for DBP. Similar device-observer differences were observed in the participants divided into two subgroups according to whether their arm circumference was above or below the median in the group. In conclusion, these results indicate that the UEBE Visomat Comfort form monitor can be recommended for clinical use in the adult population over a wide range of arm circumferences.

Accuracy of a single rigid conical cuff with standard-size bladder coupled to an automatic oscillometric device over a wide range of arm circumferences.

Although the upper arm has the shape of a truncated cone, cylindrical cuffs and bladders are currently used for blood pressure (BP) measurement. The aims of this study were to describe upper arm characteristics and to test the accuracy of a standard adult-size conical cuff coupled to an oscillometric device over a wide range of arm circumferences. Arm characteristics were studied in 142 subjects with arm circumferences ranging from 22 to 45 cm (study 1). In a subset of 33 subjects with the same range of arm circumferences, a rigid conical cuff with standard-size bladder (12.6 × 24.0 cm) and a rigid cylindrical cuff (13.3 × 24.0 cm), both coupled to a Microlife BP A100 device, were tested according to the requirements of the protocol of the European Society of Hypertension (ESH; study 2). Study 1. In all subjects, upper-arm shape was tronco-conical with slant angles ranging from 89.5° to 82.2°. In a multiple linear regression analysis, only arm circumference was an independent predictor of conicity (P<0.001). Study 2. The rigid conical cuff passed all three phases of the ESH protocol for systolic and diastolic BPs. Mean device-observer BP differences obtained with the conical cuff were unrelated to arm circumference. When the rigid cylindrical cuff was used, ESH criteria were not satisfied, and the cuff overestimated systolic BPs in subjects with large arms. BP can be measured accurately with the use of a standard-size rigid conical cuff coupled to a BP A100 device for a wide range of arm circumferences.

Accuracy of the BP A100 blood pressure measuring device coupled with a single cuff with standard-size bladder over a wide range of arm circumferences.

The objective of this study was to determine the accuracy of the Microlife BP A100 blood pressure measuring device tested according to the requirements of the International Protocol of the European Society of Hypertension. The BP A100 model is designed to provide accurate blood pressure measurements over a wide range of arm circumferences using a single cuff with standard-size bladder. Device evaluation was performed on 33 patients with a mean +/- SD age of 59 +/- 19 years (range 30-89 years). Their systolic blood pressure (SBP) was 143 +/- 23 mmHg (range 108-180 mmHg), diastolic blood pressure (DBP) was 87 +/- 16 mmHg (range 60-108 mmHg), and arm circumference was 31 +/- 4 cm (range 22-42 cm). In nine patients, the arm circumference was at least 33 cm. Blood pressure measurements were performed in the sitting position. The BP A100 passed all three phases of the European Society of Hypertension protocol for SBP and DBP. Mean blood pressure differences between device and observer were -2.9 +/- 4.9 mmHg for SBP and -2.6 +/- 4.6 mmHg for DBP. Similar device-observer differences were observed in the patients divided into two subgroups according to whether their arm circumference was above or below the median in the group. In conclusion, the present results indicate that the Microlife BP A100 monitor coupled with a single cuff with standard size bladder provides accurate blood pressure readings over a wide range of arm circumferences.

Validation of the visocor HM40 wrist blood pressure measuring device according to the International Protocol.

The objective of this study was to determine the accuracy of the UEBE visocor HM40 device for blood pressure measurement at the wrist, tested according to the requirements of the International Protocol of the European Society of Hypertension (ESH). Device evaluation was performed in 33 patients whose age and blood pressure were within the intervals required by the ESH protocol. Their mean +/- SD age was 53.2 +/- 15.5 years (range 30-85 years), systolic blood pressure (SBP) was 142.8 +/- 21.8 mmHg (range 108-178 mmHg), diastolic blood pressure (DBP) was 87.0 +/- 15.4 mmHg (range 62-112 mmHg), and wrist circumference was 18.7 +/- 2.7 cm (range 15.5-21.5 cm). During the measurements, which were performed in the supine position, the patient's wrist was kept extended at the heart level with a support under the forearm. In total, 45 measurements were available for analysis in the first phase of the validation process, and 99 measurements in the second phase. The visocor HM40 passed all three phases of the ESH protocol for SBP and DBP. Mean blood pressure differences for the visocor HM40 monitor (device-observer) were -2.0 +/- 5.0 mmHg for SBP and -1.7 +/- 5.3 mmHg for DBP, respectively. These data show that the UEBE visocor HM40 wrist monitor met the requirements for validation by the International Protocol and can be recommended for clinical use in the adult population.

Validation of Microlife BP W100 wrist device assessed according to the European Society of Hypertension and the British Hypertension Society protocols.

The objective of this study was to determine the accuracy of the Microlife BP W100 device for blood pressure measurement. The device evaluations were performed in 85 participants, by using both the protocol of the European Society of Hypertension (ESH) and the protocol of the British Hypertension Society (BHS). Initially, the data from 33 participants were examined according to the ESH protocol. Furthermore, 52 participants were then enrolled to fulfill the BHS protocol requirements. In all participants, sequential same arm measurements were made by two trained observers. The device passed all three phases of the ESH protocol for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and was graded A according to the criteria of the BHS protocol for both SBP and DBP. The A/A grade was achieved in low (<130/80 mmHg), medium (130-160/80-100 mmHg) and high (>160/100 mmHg) blood pressure categories. Mean blood pressure difference between BP W100 and observers in the 85 participants was 0.1+/-5.3 mmHg for SBP and 1.1+/-3.4 mmHg for DBP, and thus, the device also met the requirements of the Association for the Advancement of Medical Instrumentation. In conclusion, these data show that the Microlife BP W100 wrist monitor satisfied the recommended ESH accuracy levels and achieved A/A grade of the BHS protocol across a wide range of blood pressure.

Validation of A&D UA-85X device for blood pressure measurement.

To determine the accuracy of the UA-85X (UA-851, 852, 853, 854, and 855) device developed by the A&D company. Device evaluations were performed using the protocol of the European Society of Hypertension (ESH). Monitor performance was assessed in relation to patients' age, arm circumference, and systolic and diastolic blood pressures (BPs). The device was assessed in two different samples according to ESH requirements, which are based on four zones of accuracy differing from the mercury standard by 5, 10, 15 mmHg, or more. The UA-85X passed all three phases of the protocol for systolic BP and diastolic BP. Mean BP difference between device and observers was -0.3+/-4.4 mmHg for systolic BP and -2.7+/-4.8 mmHg for diastolic BP. These passed the Association for the Advancement of Medical Instrumentation standard requirements. In multivariable analyses, systolic BP discrepancies between device and observers were related to age (P=0.03) and diastolic BP discrepancies were related to diastolic BP level (P<0.001). These data show that the UA-85X satisfies the recommended ESH and Advancement of Medical Instrumentation accuracy levels for both systolic BP and diastolic BP.