Is It Worth $50 Million?

PEDIATRICS ◽  
1977 ◽  
Vol 59 (5) ◽  
pp. 788-789
Author(s):  
A. Frederick North
Keyword(s):  
Blood Pressure ◽  
Physical Examination ◽  
Clinical Evaluation ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Pressure Measurements ◽  
Fundoscopic Examination

Dr. Shiela Mitchell and her distinguished committee recommended in the July 1975 issue that blood pressure measurements should be a regular and routine part of every physical examination of every child over the age of 2. They recommended that any child with a blood pressure over the 95th percentile for age have a fundoscopic examination and at least one repeated blood pressure measurement and clinical evaluation within a few weeks. They stated that repeated examinations and further investigations are indicated if the blood pressure persists at or above the 95th percentile.

Committee's Recommendations Challenged!

PEDIATRICS ◽  
1976 ◽  
Vol 58 (1) ◽  
pp. 141-141
Author(s):  
A. Frederick North
Keyword(s):  
Blood Pressure ◽  
Physical Examination ◽  
Clinical Evaluation ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Pressure Measurements ◽  
Fundoscopic Examination

Dr. Shiela Mitchell and her distinguished committee1 recommend that blood pressure measurements should be a regular and routine part of every physical examination of every child over the age of 2. They recommend that any child with a blood pressure over the 95th percentile for age have a fundoscopic examination and have at least one repeat blood pressure measurement and clinical evaluation within a few weeks. They state that repeated examinations and further investigations are indicated if the blood pressure persists at or above the 95th percentile.

Abstract P333: National Trends in the Quality of Office Blood Pressure Measurements, 2014-2019

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Kathryn Foti ◽  
Lawrence J Appel ◽  
Kunihiro Matsushita ◽  
Josef Coresh ◽  
G Caleb Alexander ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Practice ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Pressure Measurements ◽  
Hypertension Treatment ◽  
Digit Preference ◽  
Provider Characteristics ◽  
Over Time

Introduction: Clinical practice guidelines emphasize the importance of accurate blood pressure measurement and recording to diagnose and treat hypertension. Trends in terminal digit preference (typically manifest by a terminal digit of ‘0’) have not been examined nationally. The growing use of automated blood pressure devices may have reduced terminal digit preference and improved accuracy over time. Objective: To evaluate trends in terminal digit preference in office blood pressure measurements among adults with hypertension by patient and provider characteristics. Methods: We used IQVIA National Disease and Therapeutic Index (NDTI) data from January 2014 through June 2019. The NDTI is designed to be nationally-representative of all patient visits to office-based physicians and uses a two-stage stratified sampling design to sample ~4,000 physicians per quarter who report information on all patient visits on 2 random workdays. We included all hypertension treatment visits (~60M/year) among adults aged ≥18. We examined trends in the proportion of hypertension treatment visits with recorded systolic (SBP) and diastolic (DBP) blood pressure measurements with a terminal digit ‘0’. The expected percent of blood pressures with ‘0’ is 10% for automated and 20% for manual readings. Results: There was a decrease in the percent of visits with SBP (43.0% to 37.4%) or DBP (44.3% to 38.1%) recordings ending in zero ( Table ). The decrease in percent of SBPs with a terminal zero was similar by patient and provider characteristics, though the percentage of SBPs with a terminal ‘0’ was consistently higher among patients aged ≥60, when SBP ≥140 mmHg, and among cardiologists. Conclusions: Terminal digit preference is common indicating systematic error in blood pressure measurement and recording, despite some improvement over time. This may lead to under- and overtreatment of patients with hypertension. Improving the quality of blood pressure measurement is central to improving hypertension diagnosis and control in clinical practice.

Measuring Blood Pressure

Nursing OSCEs ◽  
2012 ◽  
Author(s):  
Kate Devis
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Pressure Measurement ◽  
Gold Standard ◽  
Blood Pressure Measurement ◽  
Maximum Pressure ◽  
Pressure Measurements ◽  
Health Care Settings ◽  
Pressure Cuff ◽  
The Uk

Blood pressure measurements are one part of a circulatory assessment (Docherty and McCallum 2009). Treatments for raised or low blood pressure may be initiated or altered according to blood pressure readings; therefore correct measurement and interpretation of blood pressure is an important nursing skill. Blood pressure should be determined using a standardized technique in order to avoid discrepancies in measurement (Torrance and Serginson 1996). Both manual and automated sphygmomanometers may be used to monitor blood pressure. The manual auscultatory method of taking blood pressure is considered the gold standard (MRHA 2006), as automated monitoring can give false readings (Coe and Houghton 2002), and automated devices produced by different manufacturers may not give consistent figures (MRHA 2006). So, although automated sphygmomanometers are in common use within health care settings in the UK, the skill of taking blood pressure measurement manually is still required by nurses. As a fundamental nursing skill, blood pressure measurement, using manual and automated sphygmomanometers, and interpretation of findings are often assessed via an OSCE. Within this chapter revision of key areas will allow you to prepare thoroughly for your OSCE, in terms of practical skill and understanding of the procedure of taking blood pressure. Blood pressure is defined as the force exerted by blood against the walls of the vessels in which it is contained (Docherty and McCallum 2009). A blood pressure measurement uses two figures—the systolic and diastolic readings. The systolic reading is always the higher figure and represents the maximum pressure of blood against the artery wall during ventricular contraction. The diastolic reading represents the minimum pressure of the blood against the wall of the artery between ventricular contractions (Doughetry and Lister 2008). You will need to be able to accurately identify systolic and diastolic measurements during your OSCE. When a blood pressure cuff is applied to the upper arm and inflated above the level of systolic blood pressure no sounds will be detected when listening to the brachial artery with a stethoscope. The cuff clamps off blood supply. As the cuff is deflated a noise, which is usually a tapping sound, will be heard as the pressure equals the systolic blood pressure —this is the first Korotkoff ’s sound.

Blood Pressure Measurement Error in Children: Lessons in Measurement Reliability

2019 ◽  
Vol 27 (1) ◽  
pp. 114-125 ◽  
Author(s):  
Esther J. Varney ◽  
Ashley M. Van Drunen ◽  
Emily F. Moore ◽  
Kristen Carlin ◽  
Karen Thomas
Keyword(s):  
Blood Pressure ◽  
Measurement Error ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Pressure Measurements ◽  
Noninvasive Blood Pressure ◽  
Measure Blood Pressure ◽  
Noninvasive Blood Pressure Measurement ◽  
Manual Blood Pressure ◽  
Acceptable Agreement

Background and PurposeBlood pressure measurement represents the pressure exerted during heart ejection and filling. There are several ways to measure blood pressure and a valid measure is essential. The purpose of this study was to evaluate the approach to noninvasive blood pressure measurement in children.MethodsBlood pressure measurements were taken using the automatic Phillips MP30 monitor and compared against Welch Allyn blood pressure cuffs with Medline manual sphygmomanometers.ResultsA total of 492 measurements were taken on 82 subjects, and they demonstrated comparability between automatic and manual devices.ConclusionsAlthough our study indicated acceptable agreement between automatic and manual blood pressure measurement, it also revealed measurement error remains a concern, with sample size, study protocol, training, and environment all playing a role.

scholarly journals Increase of Short-Term Heart Rate Variability Induced by Blood Pressure Measurements during Ambulatory Blood Pressure Monitoring

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Attila Frigy ◽  
Annamária Magdás ◽  
Victor-Dan Moga ◽  
Ioana Georgiana Coteț ◽  
Miklós Kozlovszky ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Ambulatory Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Monitoring ◽  
Blood Pressure Measurement ◽  
Pressure Measurements ◽  
Pressure Monitoring ◽  
Short Term

Objective.The possible effect of blood pressure measurements per se on heart rate variability (HRV) was studied in the setting of concomitant ambulatory blood pressure monitoring (ABPM) and Holter ECG monitoring (HM).Methods.In 25 hypertensive patients (14 women and 11 men, mean age: 58.1 years), 24-hour combined ABPM and HM were performed. For every blood pressure measurement, 2-minute ECG segments (before, during, and after measurement) were analyzed to obtain time domain parameters of HRV: SDNN and rMSSD. Mean of normal RR intervals (MNN), SDNN/MNN, and rMSSD/MNN were calculated, too. Parameter variations related to blood pressure measurements were analyzed using one-way ANOVA with multiple comparisons.Results.2281 measurements (1518 during the day and 763 during the night) were included in the analysis. Both SDNN and SDNN/MNN had a constant (the same for 24-hour, daytime, and nighttime values) and significant change related to blood pressure measurements: an increase during measurements and a decrease after them (p<0.01for any variation).Conclusion.In the setting of combined ABPM and HM, the blood pressure measurement itself produces an increase in short-term heart rate variability. Clarifying the physiological basis and the possible clinical value of this phenomenon needs further studies.

scholarly journals Automated Versus Manual Blood Pressure Measurement: A Randomized Crossover Trial in the Emergency Department of a Tertiary Care Hospital in Karachi, Pakistan: Are Third World Countries Ready for the Change?

2016 ◽  
Vol 4 (3) ◽  
pp. 404-409 ◽  
Author(s):  
Kanaan Mansoor ◽  
Saba Shahnawaz ◽  
Mariam Rasool ◽  
Huwad Chaudhry ◽  
Gul Ahuja ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
P Value ◽  
Care Hospital ◽  
Pressure Measurements ◽  
The Mean ◽  
The Difference ◽  
Manual Blood Pressure ◽  
Mercury Sphygmomanometer

BACKGROUND: Hypertension has proven to be a strong liability with 13.5% of all mortality worldwide being attributed to elevated blood pressures in 2001. An accurate blood pressure measurement lies at the crux of an appropriate diagnosis. Despite the mercury sphygmomanometer being the gold standard, the ongoing deliberation as to whether mercury sphygmomanometers should be replaced with the automated oscillometric devices stems from the risk mercury poses to the environment.AIM: This study was performed to check the validity of automated oscillometric blood pressure measurements as compared to the manual blood pressure measurements in Karachi, Pakistan.MATERIAL AND METHODS: Blood pressure was recorded in 200 individuals aged 15 and above using both, an automated oscillometric blood pressure device (Dinamap Procare 100) and a manual mercury sphygmomanometer concomitantly. Two nurses were assigned to each patient and the device, arm for taking the reading and nurses were randomly determined. SPSS version 20 was used for analysis. Mean and standard deviation of the systolic and diastolic measurements from each modality were compared to each other and P values of 0.05 or less were considered to be significant. Validation criteria of British Hypertension Society (BHS) and the US Association for the Advancement of Medical Instrumentation (AAMI) were used. RESULTS: Two hundred patients were included. The mean of the difference of systolic was 8.54 ± 9.38 while the mean of the difference of diastolic was 4.21 ± 7.88. Patients were further divided into three groups of different systolic blood pressure <= 120, > 120 to = 150 and > 150, their means were 6.27 ± 8.39 (p-value 0.175), 8.91 ± 8.96 (p-value 0.004) and 10.98 ± 10.49 (p-value 0.001) respectively. In our study 89 patients were previously diagnosed with hypertension; their difference of mean systolic was 9.43 ± 9.89 (p-value 0.000) and difference of mean diastolic was 4.26 ± 7.35 (p-value 0.000).CONCLUSIONS: Systolic readings from a previously validated device are not reliable when used in the ER and they show a higher degree of incongruency and inaccuracy when they are used outside validation settings. Also, readings from the right arm tend to be more precise.

Ambulatory versus clinic blood pressure measurement - more evidence

2018 ◽  
Vol 56 (10) ◽  
pp. 116-116
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure ◽  
Pressure Measurement ◽  
Blood Pressure Measurement ◽  
Pressure Measurements ◽  
Clinic Blood Pressure ◽  
Ambulatory Blood Pressure Measurements

Review of: Banegas J et al. Relationship between clinic and ambulatory blood pressure measurements and mortality. New Engl J Med 2018; 378: 1509–20.

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