24-Hour Ambulatory Blood Pressure Monitoring in Hypertension: An Evidence-Based Analysis (original) (raw)
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American journal of hypertension, 2020
BACKGROUND The U.S. Preventive Services Task Force recommends the use of 24-hour ambulatory blood pressure monitoring (ABPM) as part of screening and diagnosis of hypertension. The optimal ABPM device for population-based surveys is unknown. OBJECTIVE Among three ABPM devices, we compared the proportion of valid BP readings, mean awake and asleep BP readings, differences between awake ABPM readings and initial standardized BP readings, and sleep experience. RESULTS The proportions of valid blood pressure readings were not different among the three devices ( p > 0.45). Mean awake and asleep systolic BP were significantly higher for STO device (WA vs. STO vs. SL: 126.65 mmHg, 138.09 mmHg, 127.44 mmHg; 114.34 mmHg, 120.34 mmHg, 113.13 mmHg; p <0.0001 for both). The difference between the initial average standardized mercury systolic BP readings and the ABPM mean awake systolic BP was larger for STO device (WA vs. STO. vs. SL: -5.26 mmHg, -16.24 mmHg, -5.36 mmHg; p <0.0001); di...
24-Hour ambulatory blood pressure monitoring
American Heart Journal, 2006
This paper reviews technical, methodological and clinical aspects of ambulatory blood pressure (aBP) monitoring. It describes deficits in the evaluation of available aBP devices and in the description and interpretation of slow (e.g. seasonal or circadian) and fast blood pressure variations. The ongoing discussion about the mere existence of circadian blood pressure rhythms is reflected, referring to the most recent data. Further methodological questions considered encompass the problem of centrality (how to describe an aBP profile with one numerical measure) and the question of variability (how to describe variance within an aBP profile). Good reasons for the use of MESOR or RMSSD parameters are given. Finally, the evidence behind a broad clinical application of aBP measurements is critically reviewed; except for 'white coat' hypertension, the clinical superiority of aBP values compared with office and home blood pressure readings is not well established on epidemiological grounds.
Innovations in Blood Pressure Monitoring
AJN, American Journal of Nursing, 2004
http://www.nursingcenter.com measurement or an ambulatory monitor that records around-the-clock readings for a day or longer. That patient may also enroll in a telemonitoring service that transmits stored readings and offers analytic reports to a provider and keeps the patient informed of average waking blood pressures. The convenience of these methods could make a crucial difference to the 50 million Americans with hypertension: nearly a third (30%) aren't aware they have it and only 34% of those who are aware they are hypertensive are controlling it-a percentage still well below the Healthy People 2000 goal of 50%. 1, 2 Some of the reasons for uncontrolled blood pressure include a lack of health care access and nonadherence to treatment. A recent metaanalysis of randomized trials in which patients self-monitored their blood pressure found "improved control of hypertension." 3 It's true that both ambulatory monitoring and self-monitoring offer more than convenience and the possibility of better control; they may also provide more accurate readings. 3 The use of a sphygmomanometer and stethoscope to listen for Korotkoff sounds can be compro-A lthough the virtual hypertension clinic does not yet exist, technology has been changing the way blood pressure is monitored. The traditional methodsphygmomanometer readings conducted in a clinical setting-requires patients to return to the office when closer monitoring is advisable or necessary. But today a patient with hypertension may receive a home monitor for self
This study evaluated the accuracy of blood pressure values provided by the Spacelabs 90202 and 90207 devices in comparison with intra-arterial recording in 19 subjects at rest and in nine subjects in ambulatory conditions (Oxford method). At rest Spacelabs monitors reflected intra-arterial systolic blood pressure values very closely but overestimated to a considerable extent intra-arterial diastolic blood pressure (Spacelabs-intra-arterial differences, -0.8±9.2, NS, and 9.1 ±8.8 nun Hg,p<0.01, for systolic and diastolic blood pressures, respectively). In ambulatory conditions Spacelabs-intra-arterial average differences in 24-hour values were +0.4±5.1 mm Hg for systolic blood pressure (NS) and +14.0±2.9 mm Hg for diastolic blood pressure (p<0.01) when group data were considered. The performance of both Spacelabs devices was worse when assessed in individual subjects or for each hourly interval. In spite of these differences between noninvasive and intra-arterial absolute blood pressure values, however, Spacelabs 90202 and 90207 monitors were able to faithfully reflect directional hour-to-hour changes in intra-arterial blood pressure (j*-2 =18.2 and x 2 =23.l for systolic and diastolic blood pressures, respectively, p< 0.01). No differences were found between the performance of the two Spacelabs devices. Thus, although the absolute accuracy of blood pressure values provided by these monitors in ambulatory subjects is still limited, they seem to be suitable for studies aimed at assessing 24-hour blood pressure profiles quantitatively as well as qualitatively. (Hypertension 1992;20:227-232) KEY WORDS • blood pressure monitors • blood pressure measurement • 24-hour blood pressure profiles • ambulatory blood pressure monitoring
AMBULATORY BLOOD PRESSURE MONITORING: THE NEED OF 7-DAY RECORD
Scripta medica
The need for systematic around-the-clock self-measurements of blood pressure (BP) and heart rate (HR), or preferably for automatic monitoring as the need arises and can be met by inexpensive tools, is illustrated in two case reports. Miniaturized unobtrusive, as yet unavailable instrumentation for the automatic measurement of BP and HR should be a high priority for both government and industry. Automatic ambulatorily functioning monitors already represent great progress, enabling us to introduce the concept of eventually continuous or, as yet, intermittent home ABPM. On BP and HR records, gliding spectra aligned with global spectra visualize the changing dynamics involved in health and disease, and can be part of an eventually automated system of therapy adjusted to the everpresent variability of BP. In the interim, with tools already available, chronomics on self-or automatic measurements can be considered, with analyses provided by the Halberg Chronobiology Center, as an alternative to "flying blind", as an editor put it. Chronomics assessing variability has to be considered.
Validation of an Automated and Adjustable Blood Pressure System for Use with a Public Health Station
Vascular Health and Risk Management, 2020
Objective: A new automated and adjustable blood pressure (BP) system has been developed to improve the accuracy of BP measurements on public-use health stations. This self-fitting BP system includes a mechanical cuff that wraps down to the user's arm prior to bladder inflation. The purpose of this study was to validate the adaptable BP system (ABPS) using the current standards from the Association for the Advancement of Medical Instrumentation (AAMI). Methods: The AAMI/ISO 81060:2013 standards for clinical validation of non-invasive automated arterial BP measurement devices were followed precisely using the same arm sequential method. For each participant, BP was measured over multiple trials by trained observers alternating a reference sphygmomanometer with the ABPS. All study requirements were met with 85 qualifying participants, each with 3 valid paired determinations. Results: The mean difference between ABPS BP and reference BP using all 255 paired determinations was −2.4 ± 7.7 mmHg for systolic and 1.7 ± 5.7 mmHg for diastolic. The standard deviation of the averaged paired determinations per participant was 6.3 mmHg for systolic and 5.2 mmHg for diastolic. Arm circumference measurements had a mean error of −2.1 ± 2.4 cm (R 2 = 0.87). A new prediction model for arm circumference was validated using a holdout dataset (R 2 = 0.94). Conclusion: The results of the study confirm that the ABPS met all benchmarks established by the AAMI. The device accurately measures BP across a wide range of arm circumferences (24-44 cm) and is suitable for use by individuals to self-monitor BP.
Ambulatory blood pressure measurement in the diagnosis and management of hypertension
Journal of human hypertension, 1991
Before the diagnostic potential of 24-hour non-invasive BP measurement can be assessed, the accuracy of ambulatory recorders must be established, and normal reference values determined. The accuracy criteria of four ambulatory BP measuring systems (the SpaceLabs 90207, the Novecor DIASYS 200, the Takeda TM-2420 and the Del Mar Avionics Pressurometer IV) have been assessed according to the British Hypertension Society (BHS) protocol, and the Medilog, Suntech Accutracker II and the SpaceLabs 90202 according to the standard of the Association for the Advancement of Medical Instrumentation (AAMI). The SpaceLabs 90202 and 90207, the DIASYS 200 and the Medilog fulfilled the AAMI criteria. The best devices with the BHS grading system are the SpaceLabs 90207 and the DIASYS 200. Normal reference values for daytime, night-time and 24-hour ambulatory BP have been provided by the Allied Irish Bank study of 815 healthy individuals, which showed clear age and sex differences. The mean 24-hour amb...