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Hypertension Research : Official... Aug 2023Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method....
Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Automated cuff BP and invasive brachial BP were recorded in 795 participants (74% male, aged 64 ± 11 years) receiving coronary angiography at five independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference -7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R = 19%). The accuracy of cuff SBP was greatest among participants with the lowest SBP amplification (p < 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.
Topics: Female; Humans; Male; Arterial Pressure; Blood Pressure; Blood Pressure Determination; Brachial Artery; Hypertension; Middle Aged; Aged
PubMed: 37217732
DOI: 10.1038/s41440-023-01311-0 -
Anesthesiology Feb 2021The optimal method for blood pressure monitoring in obese surgical patients remains unknown. Arterial catheters can cause potential complications, and noninvasive...
BACKGROUND
The optimal method for blood pressure monitoring in obese surgical patients remains unknown. Arterial catheters can cause potential complications, and noninvasive oscillometry provides only intermittent values. Finger cuff methods allow continuous noninvasive monitoring. The authors tested the hypothesis that the agreement between finger cuff and intraarterial measurements is better than the agreement between oscillometric and intraarterial measurements.
METHODS
This prospective study compared intraarterial (reference method), finger cuff, and oscillometric (upper arm, forearm, and lower leg) blood pressure measurements in 90 obese patients having bariatric surgery using Bland-Altman analysis, four-quadrant plot and concordance analysis (to assess the ability of monitoring methods to follow blood pressure changes), and error grid analysis (to describe the clinical relevance of measurement differences).
RESULTS
The difference (mean ± SD) between finger cuff and intraarterial measurements was -1 mmHg (± 11 mmHg) for mean arterial pressure, -7 mmHg (± 14 mmHg) for systolic blood pressure, and 0 mmHg (± 11 mmHg) for diastolic blood pressure. Concordance between changes in finger cuff and intraarterial measurements was 88% (mean arterial pressure), 85% (systolic blood pressure), and 81% (diastolic blood pressure). In error grid analysis comparing finger cuff and intraarterial measurements, the proportions of measurements in risk zones A to E were 77.1%, 21.6%, 0.9%, 0.4%, and 0.0% for mean arterial pressure, respectively, and 89.5%, 9.8%, 0.2%, 0.4%, and 0.2%, respectively, for systolic blood pressure. For mean arterial pressure and diastolic blood pressure, absolute agreement and trending agreement between finger cuff and intraarterial measurements were better than between oscillometric (at each of the three measurement sites) and intraarterial measurements. Forearm performed better than upper arm and lower leg monitoring with regard to absolute agreement and trending agreement with intraarterial monitoring.
CONCLUSIONS
The agreement between finger cuff and intraarterial measurements was better than the agreement between oscillometric and intraarterial measurements for mean arterial pressure and diastolic blood pressure in obese patients during surgery. Forearm oscillometry exhibits better measurement performance than upper arm or lower leg oscillometry.
Topics: Bariatric Surgery; Blood Pressure; Blood Pressure Determination; Catheterization, Peripheral; Female; Fingers; Humans; Male; Middle Aged; Monitoring, Intraoperative; Obesity; Oscillometry; Prospective Studies; Reproducibility of Results
PubMed: 33326001
DOI: 10.1097/ALN.0000000000003636 -
Sensors (Basel, Switzerland) May 2022Accurate estimation of blood pressure (BP) waveforms is critical for ensuring the safety and proper care of patients in intensive care units (ICUs) and for... (Review)
Review
Accurate estimation of blood pressure (BP) waveforms is critical for ensuring the safety and proper care of patients in intensive care units (ICUs) and for intraoperative hemodynamic monitoring. Normal cuff-based BP measurements can only provide systolic blood pressure (SBP) and diastolic blood pressure (DBP). Alternatively, the BP waveform can be used to estimate a variety of other physiological parameters and provides additional information about the patient's health. As a result, various techniques are being proposed for accurately estimating the BP waveforms. The purpose of this review is to summarize the current state of knowledge regarding the BP waveform, three methodologies (pressure-based, ultrasound-based, and deep-learning-based) used in noninvasive BP waveform estimation research and the feasibility of employing these strategies at home as well as in ICUs. Additionally, this article will discuss the physical concepts underlying both invasive and noninvasive BP waveform measurements. We will review historical BP waveform measurements, standard clinical procedures, and more recent innovations in noninvasive BP waveform monitoring. Although the technique has not been validated, it is expected that precise, noninvasive BP waveform estimation will be available in the near future due to its enormous potential.
Topics: Arterial Pressure; Blood Pressure; Blood Pressure Determination; Humans
PubMed: 35632360
DOI: 10.3390/s22103953 -
The Journal of Thoracic and... Nov 2019We sought to characterize the relationship between postoperative blood pressure on the day of surgery and metrics of bleeding. (Clinical Trial)
Clinical Trial
OBJECTIVE
We sought to characterize the relationship between postoperative blood pressure on the day of surgery and metrics of bleeding.
METHODS
In a preplanned secondary analysis of prospectively collected data from the Limiting IV Chloride to Reduce AKI trial (NCT02020538), univariate and multivariable regression analyses explored the association between peak systolic blood pressure, peak mean arterial pressure, and peak central venous pressure recorded postoperatively on the day of surgery and multiple metrics of bleeding. Patients at increased bleeding risk due to specific criteria were excluded from analysis. The primary outcome was chest tube drainage (milliliters per hour) on the day of surgery. Secondary outcomes included red blood cell transfusion, surgical re-exploration for bleeding, and hospital mortality.
RESULTS
The study cohort comprised 793 patients. Mean ± standard deviation peak systolic blood pressure, mean arterial pressure, and central venous pressure were 125 ± 15 mm Hg, 83 ± 9 mm Hg, and 12 ± 4 mm Hg, respectively. Median (interquartile range) chest tube drainage on the day of surgery was 33 mL/hour (interquartile range, 23 mL/hour-51 mL/hour). Adjusted for prespecified variables, there was no positive association between peak systolic blood pressure and bleeding outcomes, including chest tube drainage (-2.2 mL/10 mm Hg; 95% confidence interval, -3.9 to -0.5 mL/h/10 mm Hg; P = .01) or volume of transfusion (-15 mL/10 mm Hg; 95% confidence interval, -29 to -1 mL/h/10 mm Hg; P = .04). Results remained broadly consistent across multiple secondary outcomes and regardless of whether systolic blood pressure or mean arterial pressure was the explanatory variable.
CONCLUSIONS
The lack of positive association between peak systolic blood pressure or peak mean arterial pressure with metrics of bleeding after cardiac surgery promotes equipoise for testing the influence of higher blood pressure targets during the early postoperative period.
Topics: Arterial Pressure; Australia; Blood Pressure Determination; Cardiac Surgical Procedures; Central Venous Pressure; Chest Tubes; Drainage; Erythrocyte Transfusion; Female; Hospital Mortality; Humans; Male; Middle Aged; Mortality; Outcome and Process Assessment, Health Care; Postoperative Hemorrhage
PubMed: 30853233
DOI: 10.1016/j.jtcvs.2019.01.063 -
Hypertension (Dallas, Tex. : 1979) Jan 2022Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with...
Central (aortic) systolic blood pressure (cSBP) is the pressure seen by the heart, the brain, and the kidneys. If properly measured, cSBP is closer associated with hypertension-mediated organ damage and prognosis, as compared with brachial SBP (bSBP). We investigated 24-hour profiles of bSBP and cSBP, measured simultaneously using Mobilograph devices, in 2423 untreated adults (1275 women; age, 18-94 years), free from overt cardiovascular disease, aiming to develop reference values and to analyze daytime-nighttime variability. Central SBP was assessed, using brachial waveforms, calibrated with mean arterial pressure (MAP)/diastolic BP (cSBP), or bSBP/diastolic blood pressure (cSBP), and a validated transfer function, resulting in 144 509 valid brachial and 130 804 valid central measurements. Averaged 24-hour, daytime, and nighttime brachial BP across all individuals was 124/79, 126/81, and 116/72 mm Hg, respectively. Averaged 24-hour, daytime, and nighttime values for cSBP were 128, 128, and 125 mm Hg and 115, 117, and 107 mm Hg for cSBP, respectively. We pragmatically propose as upper normal limit for 24-hour cSBP 135 mm Hg and for 24-hour cSBP 120 mm Hg. bSBP dipping (nighttime-daytime/daytime SBP) was -10.6 % in young participants and decreased with increasing age. Central SBP dipping was less pronounced (-8.7% in young participants). In contrast, cSBP dipping was completely absent in the youngest age group and less pronounced in all other participants. These data may serve for comparison in various diseases and have potential implications for refining hypertension diagnosis and management. The different dipping behavior of bSBP versus cSBP requires further investigation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arterial Pressure; Blood Pressure; Blood Pressure Determination; Brachial Artery; Circadian Rhythm; Female; Humans; Male; Middle Aged; Reference Values; Young Adult
PubMed: 34775789
DOI: 10.1161/HYPERTENSIONAHA.121.17765 -
Clinical Interventions in Aging 2021Any single discrete blood pressure (BP) measurement is not enough to estimate adverse cardiovascular events. We aim to comprehensively investigate the association...
BACKGROUND AND AIM
Any single discrete blood pressure (BP) measurement is not enough to estimate adverse cardiovascular events. We aim to comprehensively investigate the association between BP indicators and stroke.
METHODS
An observational cohort study was conducted among 2888 Shanghai community-aged residents from 2014 to 2018, and a nested case-control study was designed to identify the association between BP indicators and stroke. In total 415 cases of stroke detected during the study period were selected as the case group and 415 non-stroke subjects, matched with factors of age and gender, were randomly selected from the cohort as control group.
RESULTS
Multivariate logistic regression analysis revealed that systolic blood pressure (SBP) (adjusted odds ratio [AOR] 1.02, 95% confidence interval [CI] 1.02-1.03), pulse pressure (PP) (AOR 1.03, 95% CI 1.02-1.04), mean arterial pressure (MAP) (AOR1.02, 95% CI 1.01-1.04) and pulse pressure index (PPI) (AOR 25.68, 95% CI 3.19-206.90) increased the risk of stroke, respectively. After fitting both BP indicators and covariates, isolated abnormal SBP (AOR 2.55, 95% CI 1.74-3.72) or PP ≥50 mmHg (AOR 1.66, 95% CI 1.08-2.56) independently increased risk of stroke.
CONCLUSION
Besides SBP, PP and multiple factors, assessment should be taken into account comprehensively for stroke prevention and management.
Topics: Aged; Arterial Pressure; Blood Pressure; Blood Pressure Determination; Case-Control Studies; China; Cohort Studies; Humans; Hypertension; Male; Middle Aged; Risk Assessment; Risk Factors; Stroke
PubMed: 34113085
DOI: 10.2147/CIA.S304847 -
The British Journal of General Practice... Nov 2016
Topics: Arm; Blood Pressure; Blood Pressure Determination; General Practice; Humans; Hypertension
PubMed: 27789487
DOI: 10.3399/bjgp16X687637 -
The Canadian Veterinary Journal = La... Apr 2020Arterial blood pressure is a common parameter evaluated in conscious and anesthetized veterinary species. Non-invasive blood pressure measurement techniques, such as... (Review)
Review
Arterial blood pressure is a common parameter evaluated in conscious and anesthetized veterinary species. Non-invasive blood pressure measurement techniques, such as Doppler ultrasonic flow detector and oscillometry, are attractive in certain animals due to their availability and ease of use. The greatest limitation to non-invasive blood pressure monitoring can be its inaccuracy, particularly in hypotensive or hypertensive patients and in certain species. Part 1 of this 2-part review summarizes the current techniques available to non-invasively measure arterial blood pressure in animals and discusses validation of non-invasive devices. Part 2 summarizes the veterinary literature that evaluates the use of non-invasive blood pressure measurement techniques in conscious and anesthetized species and develops general conclusions for proper use and interpretation of data from non-invasive blood pressure devices.
Topics: Animals; Arterial Pressure; Blood Pressure; Blood Pressure Determination; Hypotension; Oscillometry
PubMed: 32255821
DOI: No ID Found -
Arteriosclerosis, Thrombosis, and... May 2020Despite the wide recognition of larger artery stiffness as a highly clinically relevant and independent prognostic biomarker, it has yet be incorporated into routine... (Review)
Review
Despite the wide recognition of larger artery stiffness as a highly clinically relevant and independent prognostic biomarker, it has yet be incorporated into routine clinical practice and to take a more prominent position in clinical guidelines. An important reason may be the plethora of methods and devices claiming to measure arterial stiffness in humans. This brief review provides a concise overview of methods in use, indicating strengths and weaknesses. We classified and graded methods, highly weighing their scrutiny and purity in quantifying arterial stiffness, rather than focusing on their ease of application or the level at which methods have demonstrated their prognostic and diagnostic potential.
Topics: Arterial Pressure; Arteries; Blood Pressure Determination; Cardiovascular Diseases; Elasticity; Elasticity Imaging Techniques; Humans; Predictive Value of Tests; Prognosis; Pulse Wave Analysis; Reproducibility of Results; Risk Assessment; Risk Factors; Severity of Illness Index; Vascular Stiffness
PubMed: 31875700
DOI: 10.1161/ATVBAHA.119.313132 -
Canadian Journal of Veterinary Research... Oct 2018The objective of this study was to characterize arterial blood pressure (BP) measurements obtained by using 2 indirect methods, oscillometry and Doppler ultrasonic...
The objective of this study was to characterize arterial blood pressure (BP) measurements obtained by using 2 indirect methods, oscillometry and Doppler ultrasonic sphygmomanometry, in conscious goats. Agreement between systolic BP yielded by these 2 methods was then assessed. Sixty female dairy goats aged from 1.5 to 11.8 y (median: 5.5 y) were examined in a standing position with a cuff placed on the tail. All goats had a severe arthritic form of caprine arthritis-encephalitis. Three to 5 repeated measurements of each BP type were averaged for each goat and considered as a final measurement. With oscillometry, systolic blood pressure (O-SBP), diastolic blood pressure, and mean blood pressure, as well as heart rate (HR) were measured, while only systolic blood pressure was measured with Doppler (D-SBP). The O-SBP did not correlate with D-SBP [correlation coefficient = 0.24, = 0.067]; the mean difference (± standard deviation) was 24.5 ± 26.3 mmHg and limits of agreement were from -27.2 mmHg [95% confidence interval (CI): -39.0, -15.4 mmHg] to 76.1 mmHg (95% CI: 64.3, 87.9 mmHg). No significant linear correlation was found between any BPs and HR ( -0.10 to 0.22) or age ( -0.26 to 0.07) of the goats. The study showed that, while BP could be measured in conscious goats using both oscillometry and Doppler ultrasonic sphygmomanometry, the results obtained were so inconsistent that these methods could not be used interchangeably.
Topics: Animals; Blood Pressure; Blood Pressure Determination; Female; Goats; Heart Rate; Oscillometry; Sphygmomanometers; Ultrasonography, Doppler
PubMed: 30363283
DOI: No ID Found