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Scientific Reports Sep 2022The aim of this work is to develop Merkfree-a mercury-free sphygmomanometer that looks, feels, and operates just like a traditional mercury sphygmomanometer (MS). For...
The aim of this work is to develop Merkfree-a mercury-free sphygmomanometer that looks, feels, and operates just like a traditional mercury sphygmomanometer (MS). For this we use Galinstan as a substitute for mercury, which is a non-toxic alloy of Gallium, Indium and Tin. Galinstan is nearly half as dense as mercury and sticks to class. To work with the lower density, we designed an enclosure and scale that is nearly double the length of MS. The issue of stickiness with glass was resolved by maintaining a small meniscus of a reducing agent in the measuring tube and tank of Merkfree. Clinical trials to validate the accuracy of Merkfree against MS and oscillometric sphygmomanometer (OS) were conducted over 252 patients. The results show a good correlation of the systolic and diastolic BP measurements from Merkfree with respect to MS and the OS. The mean absolute percentage error is less than 10% for both SBP and DBP. We also found that Merkfree has lower rounding-off errors compared to MS. Merkfree can be a viable alternative to mercury sphygmomanometer that can help achieve the goal of WHO in eliminating mercury from healthcare, while simultaneously making sure that gold standard technique of sphygmomanometry continues to be available to the clinicians.
Topics: Humans; Alloys; Blood Pressure; Blood Pressure Determination; Gallium; Hypertension; Indium; Mercury; Metals, Heavy; Reducing Agents; Reproducibility of Results; Sphygmomanometers; Tin
PubMed: 36138083
DOI: 10.1038/s41598-022-19926-7 -
American Journal of Hypertension May 2022Hypertension is associated with more end-organ damage, cardiovascular events, and disability-adjusted life years lost in the United States compared with all other... (Review)
Review
Hypertension is associated with more end-organ damage, cardiovascular events, and disability-adjusted life years lost in the United States compared with all other modifiable risk factors. Several guidelines and scientific statements now endorse the use of out-of-office blood pressure (BP) monitoring with ambulatory BP monitoring or home BP monitoring to confirm or exclude hypertension status based on office BP measurement. Current ambulatory or home BP monitoring devices have been reliant on the placement of a BP cuff, typically on the upper arm, to measure BP. There are numerous limitations to this approach. Cuff-based BP may not be well-tolerated for repeated measurements as is utilized with ambulatory BP monitoring. Furthermore, improper technique, including incorrect cuff placement or use of the wrong cuff size, may lead to erroneous readings, affecting diagnosis and management of hypertension. Compared with devices that utilize a cuff, cuffless BP devices may overcome challenges related to technique, tolerability, and overall utility in the outpatient setting. However, cuffless devices have several potential limitations that limit its routine use for the diagnosis and management of hypertension. The review discusses the different approaches for determining BP using various cuffless devices including engineering aspects of cuffless device technologies, validation protocols to test accuracy of cuffless devices, potential barriers to widespread implementation, and future areas of research. This review is intended for the clinicians who utilize out-of-office BP monitoring for the diagnosis and management of hypertension.
Topics: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Humans; Hypertension; Reproducibility of Results; Sphygmomanometers
PubMed: 35136906
DOI: 10.1093/ajh/hpac017 -
The European Respiratory Journal Dec 2013Systolic blood pressure normally falls during quiet inspiration in normal individuals. Pulsus paradoxus is defined as a fall of systolic blood pressure of >10 mmHg... (Review)
Review
Systolic blood pressure normally falls during quiet inspiration in normal individuals. Pulsus paradoxus is defined as a fall of systolic blood pressure of >10 mmHg during the inspiratory phase. Pulsus paradoxus can be observed in cardiac tamponade and in conditions where intrathoracic pressure swings are exaggerated or the right ventricle is distended, such as severe acute asthma or exacerbations of chronic obstructive pulmonary disease. Both the inspiratory decrease in left ventricular stroke volume and the passive transmission to the arterial tree of the inspiratory decrease in intrathoracic pressure contribute to the occurrence of pulsus paradoxus. During cardiac tamponade and acute asthma, biventricular interdependence (series and parallel) plays an important role in the inspiratory decrease in left ventricular stroke volume. Early recognition of pulsus paradoxus in the emergency room can help to diagnose rapidly cardiac tamponade. Measurement of pulsus paradoxus is also useful to assess the severity of acute asthma as well as its response to therapy. Recent development of noninvasive devices capable of automatic calculation and display of arterial pressure variation or derived indices should help improve the assessment of pulsus paradoxus at the bedside.
Topics: Asthma; Blood Pressure; Cardiac Tamponade; Heart; Heart Ventricles; Humans; Lung; Respiration; Respiration Disorders; Sphygmomanometers; Stroke Volume; Systole; Vascular Resistance
PubMed: 23222878
DOI: 10.1183/09031936.00138912 -
Hong Kong Medical Journal = Xianggang... Oct 2020
Topics: Blood Pressure Determination; History, 20th Century; Humans; Medical Illustration; Oscillometry; Sphygmomanometers
PubMed: 33089799
DOI: 10.12809/hkmj-hkmms202010 -
The British Journal of General Practice... Dec 2012
Topics: Blood Pressure Determination; Calibration; Humans; Sphygmomanometers
PubMed: 23211243
DOI: 10.3399/bjgp12X659213 -
Anesthesiology Jan 2015
Topics: Arterial Pressure; Blood Pressure Monitoring, Ambulatory; Blood Pressure Monitors; Humans
PubMed: 25611657
DOI: 10.1097/ALN.0000000000000486 -
American Family Physician Sep 2021Home blood pressure monitoring provides important diagnostic information beyond in-office blood pressure readings and offers similar results to ambulatory blood pressure...
Home blood pressure monitoring provides important diagnostic information beyond in-office blood pressure readings and offers similar results to ambulatory blood pressure monitoring. Home blood pressure monitoring involves patients independently measuring their blood pressure with an electronic device, whereas ambulatory blood pressure monitoring involves patients wearing a portable monitor for 24 to 48 hours. Although ambulatory blood pressure monitoring is the diagnostic standard for measurement, home blood pressure monitoring is more practical and accessible to patients, and its use is recommended by the U.S. Preventive Services Task Force and the American College of Cardiology/American Heart Association. Home blood pressure monitoring generally results in lower blood pressure readings than in-office measurements, can confirm the diagnosis of hypertension after an elevated office blood pressure reading, and can identify patients with white coat hypertension or masked hypertension. Best practices for home blood pressure monitoring include using an appropriately fitting upper-arm cuff on a bare arm, emptying the bladder, avoiding caffeinated beverages for 30 minutes before taking the measurement, resting for five minutes before taking the measurement, keeping the feet on the floor uncrossed and the arm supported with the cuff at heart level, and not talking during the reading. An average of multiple readings, ideally two readings in the morning and again in the evening separated by at least one minute each, is recommended for one week. Home blood pressure readings can be used in hypertension quality measures.
Topics: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitors; Home Care Services; Humans; Hypertension; Reproducibility of Results
PubMed: 34523884
DOI: No ID Found -
Journal of Human Hypertension Feb 2023Clinically validated, automated arm-cuff blood pressure measuring devices (BPMDs) are recommended for BP measurement. However, most BPMDs available for purchase by... (Review)
Review
Clinically validated, automated arm-cuff blood pressure measuring devices (BPMDs) are recommended for BP measurement. However, most BPMDs available for purchase by consumers globally are not properly validated. This is a problem because non-validated BPMDs are less accurate and precise than validated ones, and therefore if used clinically could lead to misdiagnosis and mismanagement of BP. In response to this problem, several validated device lists have been developed, which can be used by clinicians and consumers to identify devices that have passed clinical validation testing. The purpose of this review is to describe the resources that are available for finding validated BPMDs in different world regions, to identify the differences between validated device lists, and describe current gaps and challenges. How to use validated BPMDs properly is also summarised.
Topics: Humans; Blood Pressure; Reproducibility of Results; Sphygmomanometers; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Hypertension
PubMed: 35778537
DOI: 10.1038/s41371-022-00718-5 -
Hypertension Research : Official... May 2023To measure blood pressure precisely and make the data comparable among facilities, measurement methods and devices must be standardized. Since the Minamata Convention on... (Review)
Review
To measure blood pressure precisely and make the data comparable among facilities, measurement methods and devices must be standardized. Since the Minamata Convention on Mercury, there is no metrological standard for sphygmomanometers. The current validation methods recommended by non-profit organizations in Japan, the US, and European Union countries are not necessarily applicable to the clinical setting, and no protocol for daily or routine performance of quality control has been defined. In addition, recent rapid technological advances have enabled monitoring blood pressure at home with wearable devices or without a cuff by using a smartphone app. A clinically relevant validation method for this recent technology is not available. The importance of out-of-office blood pressure measurement is highlighted by guidelines for the diagnosis and treatment of hypertension, but an appropriate protocol for validating a device is required.
Topics: Humans; Reproducibility of Results; Blood Pressure Determination; Blood Pressure; Sphygmomanometers; Hypertension
PubMed: 36810621
DOI: 10.1038/s41440-023-01234-w -
European Heart Journal Jul 2014Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk. However, systolic pressure... (Review)
Review
Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk. However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure.
Topics: Antihypertensive Agents; Aorta; Blood Pressure; Blood Pressure Determination; Brachial Artery; Cardiovascular Diseases; Humans; Hypertension; Risk Assessment; Sphygmomanometers
PubMed: 24459197
DOI: 10.1093/eurheartj/eht565