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Mansoor K, Shahnawaz S, Rasool M, Chaudhry H, Ahuja G, Shahnawaz S. 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? Open Access Maced J Med Sci 2016; 4:404-409. [PMID: 27703563 PMCID: PMC5042623 DOI: 10.3889/oamjms.2016.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 01/19/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | - Gul Ahuja
- Dr. Ziauddin University Hospital, Karachi, Pakistan
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Validation of automated oscillometric versus manual measurement of the ankle–brachial index. Hypertens Res 2009; 32:884-8. [DOI: 10.1038/hr.2009.125] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Orthostatic hypotension: is it really associated with an increased risk of systemic hypertension? J Hum Hypertens 2008; 23:219-21. [PMID: 18987648 DOI: 10.1038/jhh.2008.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pérgola PE, White CL, Graves JW, Coffey CS, Tonarelli SB, Hart RG, Benavente OR. Reliability and validity of blood pressure measurement in the Secondary Prevention of Small Subcortical Strokes study. Blood Press Monit 2007; 12:1-8. [PMID: 17303981 PMCID: PMC3970705 DOI: 10.1097/mbp.0b013e3280858d5b] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE The Secondary Prevention of Small Subcortical Strokes study is a multicenter, international trial funded by the National Institutes of Health testing the role of lowering systolic blood pressure to <130 mmHg in the prevention of stroke recurrence and cognitive decline in patients with recent symptomatic small subcortical stroke. Reliable and unbiased blood pressure measurement is critical to successful completion of the trial. METHODS We looked at the reliability and validity of both the device used for blood pressure measurement and observer performance during measurement to assess the quality of blood pressure determination in the study. The Colin 8800C blood pressure device was tested for performance to Association for the Advancement of Medical Instrumentation standards and for presence of skipped digits. Observer performance was tested by examining adherence to the Secondary Prevention of Small Subcortical Strokes protocol. RESULTS The mean difference (in mmHg) between the Colin device and the average of the two observers was 3.9 (SD 6.7) and -2.1 (SD 6.1) for systolic and diastolic pressures respectively, thereby meeting Association for the Advancement of Medical Instrumentation requirements. No skipped digits were found between 82-230 and 40-120 mmHg for systolic and diastolic pressures, respectively. Observer performance was excellent with greater than 90% of patients having blood pressure measured consistently according to the protocol. CONCLUSIONS Device and observer performance in Secondary Prevention of Small Subcortical Strokes is excellent. Interpretation of the Secondary Prevention of Small Subcortical Strokes data for the effect of lowering systolic blood pressure on patient outcomes will not likely be adversely affected by these factors. Accuracy will be monitored throughout the remainder of the trial to ensure that this high quality is maintained.
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Affiliation(s)
- Pablo E. Pérgola
- Department of Medicine, Division of Nephrology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Carole L. White
- Division of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - John W. Graves
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Christopher S. Coffey
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Silvina B. Tonarelli
- Division of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Robert G. Hart
- Division of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Oscar R. Benavente
- Division of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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Pan CR, Staessen JA, Li Y, Wang JG. Comparison of Three Measures of the Ankle-Brachial Blood Pressure Index in a General Population. Hypertens Res 2007; 30:555-61. [PMID: 17664860 DOI: 10.1291/hypres.30.555] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The ankle-brachial blood pressure index (ABI) predicts cardiovasular disease. To our knowledge, no study has compared manual ABI measurements with an automated electronic oscillometric method in a population sample. We enrolled 946 residents (50.8% women; mean age, 43.5 years) from 8 villages in JingNing County, Zhejiang Province, P.R. China. We computed ABI as the ratio of ankle-to-arm systolic blood pressures from consecutive auscultatory or Doppler measurements at the posterior tibial and brachial arteries. We also used an automated oscillometric technique with simultaneous ankle and arm measurements (Colin VP-1000). Mean ABI values were significantly higher on Doppler than auscultatory measurements (1.15 vs. 1.07; p<0.0001) with intermediate levels on oscillometric determination (1.12; p<0.0001 vs. Doppler). The differences among the three measurements were not homogeneously distributed across the range of ABI values. Doppler and oscillometric ABIs were similar below 1.0, whereas above 1.2 Doppler and auscultatory ABIs were comparable. In Bland and Altman plots, the correlation coefficient between differences in Doppler minus oscillometric ABI and ABI level was 0.21 (p<0.0001). The corresponding correlation coefficient for Doppler minus auscultatory ABI was -0.13 (p<0.0001). In conclusion, automated ABI measurements are feasible in large-scale population studies. However, the small differences in ABI values between manual and oscillometric measurements depend on ABI level and must be considered in the interpretation of study results.
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Affiliation(s)
- Cheng-Rui Pan
- Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University Medical School, Shanghai, PR China
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Kraja AT, Borecki IB, North K, Tang W, Myers RH, Hopkins PN, Arnett D, Corbett J, Adelman A, Province MA. Longitudinal and age trends of metabolic syndrome and its risk factors: the Family Heart Study. Nutr Metab (Lond) 2006; 3:41. [PMID: 17147796 PMCID: PMC1697811 DOI: 10.1186/1743-7075-3-41] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Accepted: 12/05/2006] [Indexed: 01/13/2023] Open
Abstract
Background We report longitudinal changes in the metabolic syndrome (MetS) in 2,458 participants from 480 families in the Family Heart Study. Participants were examined between 1994–96 (FHS-T1) and 2002–03 (FHS-T2), about 7.4 years apart. Additionally, the impact of medication on estimates of MetS prevalence, and associations of MetS with prevalent coronary heart disease (CHD) and type 2 diabetes (T2D) were studied. Methods Three definitions for MetS prevalence were considered. One represented the original (o) National Cholesterol Education Program (NCEP) MetS criteria. Two others considered the confounding of medications effects, respectively (m) lipid medications constituted a categorical diagnostic criterion for lipids variables, and (c) lipids and blood pressure variables were corrected with average clinical trials medications effects. Logistic regression of MetS on CHD and T2D, as well as the trend analysis of MetS by age, were performed. Results MetS increased from 17.1% in FHS-T1(o) to 28.8% in FHS-T2(o); from 19.7% in FHS-T1(m) to 42.5% in FHS-T2(m); and from 18.4% in FHS-T1(c) to 33.6% in FHS-T2(c). While we observed adverse changes in all risk factors, the greatest increase was for waist circumference (25%). The percentages of MetS were about 2 to almost 3 times higher in ages 50 years and older than in younger ages. The odds of having prevalent CHD were about 2.5 times higher in the subjects classified with MetS than without. Conclusion MetS percentages increased noticeably longitudinally and cross-sectionally with older age. These conclusions were reached with and without considering medication use, but correcting risk factors for medications use affects the MetS prevalence estimates. As found in other studies, MetS was associated with increased odds for prevalent CHD.
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Affiliation(s)
- Aldi T Kraja
- From the Division of Statistical Genomics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ingrid B Borecki
- From the Division of Statistical Genomics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kari North
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Weihong Tang
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Richard H Myers
- Department of Neurology, Boston University Medical Center, MA, USA
| | - Paul N Hopkins
- Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Donna Arnett
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, AL, USA
| | - Jonathan Corbett
- From the Division of Statistical Genomics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Avril Adelman
- From the Division of Statistical Genomics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Michael A Province
- From the Division of Statistical Genomics, Washington University School of Medicine, Saint Louis, MO, USA
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Graves JW, Althaf MM. Utility of ambulatory blood pressure monitoring in children and adolescents. Pediatr Nephrol 2006; 21:1640-52. [PMID: 16823576 DOI: 10.1007/s00467-006-0175-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 04/02/2006] [Accepted: 04/03/2006] [Indexed: 01/01/2023]
Abstract
Diagnosis of hypertension is critically dependent on accurate blood pressure measurement. "Accurate" refers to carefully following the guidelines for blood pressure measurement laid out for children and adults to minimize observer and subject errors that commonly occur in clinical blood pressure measurement. Accurate blood pressure measurement is more important in children and adolescents as the misdiagnosis of hypertension may have a life-long adverse impact on insurability and employment. Automated blood pressure measurement offers multiple advantages in achieving high-quality blood pressure determinations by reducing observer errors. The most commonly used form of automated blood pressure measurement is 24-h ambulatory blood pressure measurement (ABPM). Information on ABPM in children has grown exponentially over the last decade. Normative data exists for diagnosis of hypertension in children using ABPM including a novel method for determining normal values with the LMS method. There is further information about the utility of different determinants of 24-h blood pressure such as dipping status, morning surge and blood pressure load. ABPM has been able to detect significant differences in blood pressure in many disease states in children including chronic renal failure, polycystic kidney disease, solitary functioning kidney, and after renal transplantation. Increasingly nonambulatory automated blood pressure determinations have been used in management of hypertension in children. Although nonambulatory automated readings lack information about nocturnal blood pressure or blood pressure during daily activity, studies have suggested that home automated blood pressure measurements are a helpful adjunct to the usual office blood pressure reading.
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Abstract
Lower extremity arterial disease affects approximately one third of individuals 66 years of age and older and has a high risk for nonhealing wounds, infection, and limb loss. Much wound care is given by or under the direction of nurses. Therefore, the assessment and management of these patients presents many opportunities and challenges. Assessment is the cornerstone of effective care, but traditional methods of lower extremity arterial assessment, such as pulse palpation and pain history, are insufficient to determine the presence and extent of ischemia. Recently published national guidelines for assessment and management of patients with lower extremity wounds have recommended using noninvasive tests such as the ankle brachial index and toe brachial index to rule out lower extremity arterial disease, which complicates wound healing. However, the ankle brachial index can be falsely elevated in patients with diabetes and renal failure because of calcification of the arteries, which causes them to be incompressible. In these situations, it has been advised to obtain a toe pressure or toe brachial index because digital arteries are usually less affected by calcification. There is a paucity of data about the knowledge of principles and performance of the ankle brachial index/toe brachial index by nurses, particularly in the United States, using pocket-sized portable Doppler equipment. Therefore, the purpose of this article is to provide an overview and synthesis of relevant studies and published expert opinion regarding noninvasive arterial assessment using ankle brachial and toe brachial indexes as a basis for developing protocols for performing the tests and identifying gaps in research where further investigation is needed.
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Affiliation(s)
- Phyllis A Bonham
- Wound Care Education Program, College of Nursing, Medical University of South Carolina, South Carolina, USA.
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Terra SG, Blum RA, Wei GC, Lew RA, Digenio AG, Rajman I, Kazierad DJ. Evaluation of methods for improving precision of blood pressure measurements in phase I clinical trials. J Clin Pharmacol 2004; 44:457-63. [PMID: 15102865 DOI: 10.1177/0091270004264167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Small sample sizes are typically incorporated in early Phase I clinical studies, which may lead to insignificant changes in safety parameters such as blood pressure. Therefore, it is paramount to identify an optimal, noninvasive method of accurately measuring blood pressure and an appropriate analysis strategy yielding the smallest variability. The goals of this study were (1) to compare the variability between automated and manual blood pressure measurements, (2) to determine whether triplicate blood pressure measurements were independent of one another, and (3) to assess how the number of blood pressure readings affects variability and study sample size. Twenty healthy volunteers were enrolled in this randomized, two-way crossover study. Each subject received three incremental infusions of phenylephrine or normal saline on separate days to simulate blood pressure variability. The mean systolic blood pressure readings with the automated device were consistently higher than the manual device by 3 to 5 mmHg. Conversely, the mean diastolic blood pressure readings with the automated device were consistently 3 to 5 mmHg lower than the manual device. However, the variability and absolute change in blood pressure were essentially identical with manual and automated methods. No systematic order effects such as the first blood pressure reading always being higher were detected, suggesting that the triplicate readings were independent of one another and that an interval of 2 minutes between readings is adequate. Compared to a single measurement, collecting blood pressure in triplicate results in a 40% lower sample size needed to detect a 5-mmHg difference in systolic blood pressure.
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Affiliation(s)
- Steven G Terra
- Pfizer Global Research & Development, 445 Eastern Point Road, BLDG 260/2505, Groton, CT 06340, USA
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Ochsenbein-Kölble N, Roos M, Gasser T, Huch R, Huch A, Zimmermann R. Cross sectional study of automated blood pressure measurements throughout pregnancy. BJOG 2004; 111:319-25. [PMID: 15008766 DOI: 10.1111/j.1471-0528.2004.00099.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To generate reliable new reference ranges for pregnancy blood pressure from a large population. DESIGN A prospective cross sectional study. SETTING Obstetric outpatient clinic, Zurich University Hospital. SAMPLE Accurately dateable singleton pregnancies (Caucasian: n= 3234; Asian [predominantly from Sri Lanka, Thailand and the Philippines]: n= 577; Black n= 212). METHODS Between January 1996 and February 2000 blood pressure was determined in 4023 pregnant women using an oscillometric automated device (Dinamap) according to British Hypertension Society recommendations. Women receiving antihypertensive medication were excluded. MAIN OUTCOME MEASURE Blood pressure. RESULTS Only the means of duplicate measures at the booking visit (5-42 weeks) were used in the analysis. Mean blood pressure decreased from early to mid pregnancy before increasing to levels 4 mmHg higher at term than in early pregnancy. Values >130/80 and <90/50 mmHg were above the 95th and below the 5th centiles, respectively. Parity, age and body mass index were significant determinants in Caucasians. Blood pressure was slightly lower in Asians and Blacks. CONCLUSIONS The current World Health Organisation definition of high diastolic blood pressure (>or=90 mmHg on two occasions) reflects values >2 standard deviations from the mean. This may be too conservative as threshold for detecting women at risk of pre-eclampsia. Further studies are required to determine the prognostic implications of gestational values >or=95th centile (>or=130/80 mmHg) and <or=5th centile (<or=90/50 mmHg).
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Robinson MT, Wilson TW, Nicholson GA, Grell GAC, Etienne C, Grim CM, Wilson D, Grim CE. AGT and RH blood group polymorphisms affect blood pressure and lipids in Afro-Caribbeans. J Hum Hypertens 2004; 18:351-63. [PMID: 14961043 DOI: 10.1038/sj.jhh.1001679] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Population blood pressure variation is most likely due to multiple genes. This is likely the reason why monogenic testing with the angiotensinogen (AGT) gene polymorphisms on chromosome 1 (1q42-43), especially M235T, has met with negative results, especially in those of African descent. The RH blood group system, also on chromosome 1 (1 p36.2-34), has likewise been associated with blood pressure variation in African-Americans and with the rise in blood pressure with age in whites. Using a random sample of the population, we investigated the combined effects of single and combined variation of the AGTN M235T and RH genotypes on blood pressure, lipids, and lipoprotein concentrations in Afro-Caribbeans aged 18-60 years from the island nation of Dominica. In monogenic analysis, AGT M235T was not associated with blood pressure. However, it was associated with HDL (MM 42+/-23, MT 44+/-12, TT 52+/-14 (P=0.002)). RH genotype was significantly associated with systolic blood pressure (P=0.006) and Apo-A (P=0.003). These effects remained after adjustment for age, gender, weight, and BMI. In the polygenetic analysis, AGT M235T and RH were significantly associated with systolic blood pressure (P=0.037; interaction effects, P=0.068). The association of the AGT M235T with blood pressure across RH blood group haplotypes was then tested. Of the five RH haplotypes available for analysis, the AGT M235T was significantly associated with blood pressure within the "D" haplotype (P=0.01). The RH blood group and gender were significantly associated with systolic blood pressure and Apo-A levels (P=0.005 and 0.012, respectively). All interactions were independent of age and weight. In conclusion, we demonstrate a significant association of AGT M235T with blood pressure and cholesterol metabolism in an Afro-Caribbean population in the "genetic context" of the RH blood group system. Further investigation of these interactions may help understand the effects of genetic factors on cardiovascular risk in African-derived and other populations.
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Affiliation(s)
- M T Robinson
- Department of Psychiatry, UC San Diego, La Jolla, CA, USA
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Butani L, Morgenstern BZ. Are pitfalls of oxcillometric blood pressure measurements preventable in children? Pediatr Nephrol 2003; 18:313-8. [PMID: 12755148 DOI: 10.1007/s00467-003-1075-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dekkers JC, Snieder H, Van Den Oord EJCG, Treiber FA. Moderators of blood pressure development from childhood to adulthood: a 10-year longitudinal study. J Pediatr 2002; 141:770-9. [PMID: 12461492 DOI: 10.1067/mpd.2002.128113] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the effect of ethnicity on the development of blood pressure (BP) from childhood into early adulthood within the context of height, sex, adiposity, and socioeconomic status (SES). STUDY DESIGN Individual growth curves of systolic BP (SBP) and diastolic BP (DBP) were created for 745 black and white male and female youths, with annual assessments over a 10-year period (age range, 4.9-27.5 years). RESULTS Blacks had higher SBP levels (P <0.01) than whites, respectively. Moreover, black female subjects showed a greater SBP increase over time (P <.05) than white female subjects. Black male and female subjects also showed higher DBP levels (P <.001) than white male and female subjects, respectively, but the rate of change of DBP did not differ. Ethnic differences in BP trajectories persisted after adjusting for SES and/or changes in height and/or adiposity in both male and female subjects. CONCLUSIONS Ethnic differences in SBP become manifest in childhood in girls, in early adolescence in boys, and tend to increase with age. Ethnic differences in DBP become manifest in childhood in both boys and girls and remain stable over time. The ethnic differences cannot be entirely explained by individual differences in SES, growth, or adiposity. Identification of mechanisms responsible for increase of BP in childhood will improve prevention of hypertension in adulthood.
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Affiliation(s)
- J Caroline Dekkers
- Georgia Prevention Institute, Medical College of Georgia, Augusta 30912, USA
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Rose KM, Holme I, Light KC, Sharrett AR, Tyroler HA, Heiss G. Association between the blood pressure response to a change in posture and the 6-year incidence of hypertension: prospective findings from the ARIC study. J Hum Hypertens 2002; 16:771-7. [PMID: 12444538 DOI: 10.1038/sj.jhh.1001482] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The association between the blood pressure response to a change from the supine to the standing position and the 6-year incidence of hypertension was studied in a bi-ethnic, middle-aged cohort of 6951 normotensive men and women free of coronary heart disease at baseline. Postural change in systolic blood pressure (SBP) was categorized into deciles, and the middle four deciles served as the referent (no change) group. In unadjusted analyses, the incidence of hypertension was higher among both those with SBP increases and decreases relative to those in the referent group. Associations were modestly attenuated after controlling for age, ethnicity, and gender and cardiovascular disease risk factors. However, after adjustment for baseline, seated SBP, a modest association with incident hypertension persisted only for SBP decreases. Orthostatic hypotension (upon standing) was associated with incident hypertension and isolated systolic hypertension and, unexpectedly, this increased risk was highest among those with the lowest levels of baseline, resting SBP.
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Affiliation(s)
- K M Rose
- Department of Epidemiology, School of Public Health, University of North Carolina, NC 27514, USA.
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Abstract
Control of blood pressure still relies on conventional office or clinical blood pressure measurement using mercury sphygmomanometry. However, it has long been known that office measurement, even when repeated, does not fully reflect usual blood pressure. The additional use of ambulatory devices for prolonged periods of blood pressure measurement is now clinically feasible. Previous research has indicated that ambulatory blood pressure measurement is better than office measurement at predicting individual cardiovascular risk. Guidelines for clinical use of ambulatory blood pressure measurement and for quality control of devices are available. Ambulatory measurement has revealed characteristics of circadian rhythm and variability that are promising with regard both to improving our understanding of the aetiology of high blood pressure and to individual risk assessment. Some of the latest developments in research on ambulatory blood pressure measurement are discussed.
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Affiliation(s)
- C S Uiterwaal
- Julius Center for General Practice and Patient Oriented Research, University Medical Center Utrecht, Utrecht, The Netherlands.
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