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Keyes LE, Sallade TD, Duke C, Starling J, Sheets A, Pant S, Young DS, Twillman D, Regmi N, Phelan B, Paudel P, McElwee M, Mather L, Cole D, McConnell T, Basnyat B. Blood Pressure and Altitude: An Observational Cohort Study of Hypertensive and Nonhypertensive Himalayan Trekkers in Nepal. High Alt Med Biol 2017; 18:267-277. [DOI: 10.1089/ham.2017.0001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Linda E. Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado
- Longmont United Hospital, Longmont, Colorado
| | | | - Charles Duke
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jennifer Starling
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado
- Colorado Permanente Medical Group, Saint Joseph Hospital, Denver, Colorado
| | | | - Sushil Pant
- Mountain Medicine Society of Nepal and Kunde Hospital, Kathmandu, Nepal
| | - David S. Young
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - David Twillman
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado
| | - Nirajan Regmi
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
| | | | - Purshotam Paudel
- Mountain Medical Society of Nepal and District Hospital, Dhading, Nepal
| | - Matthew McElwee
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Luke Mather
- Family Medicine Residency of Idaho, Boise, Idaho
- University of Washington School of Medicine, Seattle, Washington
| | - Devlin Cole
- Kapiolani Women and Children's Hospital, Honolulu, Hawaii
| | | | - Buddha Basnyat
- Oxford University Clinical Research Unit-Nepal, Nepal and Nepal International Clinic, Kathmandu, Nepal
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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Mingji C, Onakpoya IJ, Heneghan CJ, Ward AM. Assessing agreement of blood pressure-measuring devices in Tibetan areas of China: a systematic review. Heart Asia 2016; 8:46-51. [PMID: 27843497 PMCID: PMC5093356 DOI: 10.1136/heartasia-2016-010798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/19/2016] [Accepted: 09/30/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND The validity of blood pressure (BP)-measuring tools at very high altitudes is uncertain. Therefore, the objective of this review was to examine the degree of agreement of BP-measuring devices in Tibet. METHODS We conducted electronic searches in Medline, Embase, Cinahl, Cochrane Library, Global Health Library and the ISI Web of Science. Randomised and observational studies were considered for inclusion. The methodological characteristics of included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Our primary outcome was the difference in mean BP measurements between the new device and the gold standard. RESULTS We identified three eligible studies, out of which two with a total of 162 participants were included. The studies differed in their methodology. One study reported significantly higher systolic blood pressure (SBP) measurement with electronic sphygmomanometer (Omron) compared with mercury sphygmomanometer (mean difference 5.8±4.7 mm Hg; p<0.001), with no significant difference in diastolic blood pressure (DBP) measurement (0.4±3.9 mm Hg; p=0.23). The second study reported mean differences of 1.0±5.9 mm Hg and -3.1±4.6 mm Hg for SBP and DBP, respectively. CONCLUSION The limited evidence from published studies suggests that automated (Omron) BP monitors show a high degree of agreement for DBP when compared against mercury sphygmomanometer at high altitudes. However, the degree of such agreement for SBP is not consistent. Few studies assessing the validity of automated BP monitors at high altitudes have been conducted, and they differ in design and methodology. Further research assessing the suitability of BP-measuring instruments at high altitudes is therefore warranted.
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Affiliation(s)
- Cuomu Mingji
- Tibetan Medical College, Lhasa, Tibet; Austrian Academy of Science, Vienna, Austria
| | - Igho J Onakpoya
- Nuffield Department of Primary Care Health Sciences , Centre for Evidence-Based Medicine, University of Oxford , Oxford , UK
| | - Carl J Heneghan
- Nuffield Department of Primary Care Health Sciences , Centre for Evidence-Based Medicine, University of Oxford , Oxford , UK
| | - Alison M Ward
- Nuffield Department of Primary Care Health Sciences , Centre for Evidence-Based Medicine, University of Oxford , Oxford , UK
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Hughes S, Barry J, Russell J, Bell R, Gurung S. Neck length and mean arterial pressure in the sauropod dinosaurs. J Exp Biol 2016; 219:1154-61. [DOI: 10.1242/jeb.137448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/07/2016] [Indexed: 11/20/2022]
Abstract
How blood was able to reach the heads of the long-necked sauropod dinosaurs has long been a matter of debate and several hypotheses have been presented. For example, it has been proposed that sauropods either had exceptionally large hearts, multiple ‘normal’ sized hearts spaced at regular intervals up the neck, held their necks horizontal, or the siphon effect was in operation. By means of an experimental model, we demonstrate that the siphon principle is able to explain how blood was able to adequately perfuse the sauropod brain. The return venous circulation may have been protected from complete collapse by a structure akin to the vertebral venous plexus. We derive an equation relating neck height and mean arterial pressure, which indicates that with a mean arterial pressure similar to the giraffe, the maximum safe vertical distance between heart and head would have been about 12 m. A hypothesis is presented that the maximum neck length in the fossil record is due to the siphon height limit. The equation indicates that to migrate over high ground, sauropods would either have had to significantly increase their mean arterial pressure or keep their necks below a certain height dependent on altitude.
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Affiliation(s)
- S. Hughes
- Biomedical Engineering and Medical Physics, School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology (QUT), 2 George St, Brisbane, Queensland 4000, Australia
| | - J. Barry
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology (QUT), 2 George St,Brisbane, Queensland 4000, Australia
| | - J. Russell
- Department of Neurosurgery, Royal Brisbane & Women's Hospital, Herston, Brisbane, Queensland 4029, Australia
| | - R. Bell
- CSIRO Education, EcoSciences Precinct, 41 Boggo Road, Dutton Park, Queensland 4102, Australia
| | - S. Gurung
- School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology (QUT), 2 George St, Brisbane, Queensland 4000, Australia and Paro College of Education, Royal University of Bhutan, Bhutan
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Cho K, Tian M, Lan Y, Zhao X, Yan LL. Validation of the Omron HEM-7201 upper arm blood pressure monitor, for self-measurement in a high-altitude environment, according to the European Society of Hypertension International Protocol revision 2010. J Hum Hypertens 2013; 27:487-91. [PMID: 23466876 PMCID: PMC3709008 DOI: 10.1038/jhh.2013.4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/28/2012] [Accepted: 01/01/2013] [Indexed: 11/09/2022]
Abstract
Few studies have been conducted on blood pressure monitors and their use at high altitude. This study is the first to evaluate the accuracy of an automatic blood pressure monitor in a high-altitude environment following a standard validation protocol. The Omron HEM-7201 upper arm blood pressure monitor was tested for accuracy in Lhasa, Tibet, China (3650 m above sea level) according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP2). Thirty-three participants received 9-10 sequential blood pressure measurements alternating between a mercury sphygmomanometer and the device. The mean device-observer measurement difference was 1.0±5.9 mm Hg for systolic blood pressure (SBP) and -3.1±4.6 mm Hg for diastolic blood pressure (DBP). Of the 99 measurement pairs analyzed, 72, 90 and 97 device readings were within 5, 10 and 15 mm Hg, respectively, of the observer measurements for SBP, and 68, 92 and 99 readings for DBP. The number of participants with at least two out of three measurements within 5 mm Hg was 27 for SBP and 25 for DBP. Three participants had no measurements within 5 mm Hg for either SBP or DBP. As a result, the Omron HEM-7201 passes the ESH-IP2 validation criteria and can therefore be recommended for use in adults in this setting.
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Affiliation(s)
- KaWing Cho
- The George Institute for Global Health, Beijing, China
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Maoyi Tian
- The George Institute for Global Health, Beijing, China
| | - Yonghao Lan
- Department of Cardiology, Jishuitan Hospital, Beijing, China
| | - Xingshan Zhao
- Department of Cardiology, Jishuitan Hospital, Beijing, China
| | - Lijing L. Yan
- The George Institute for Global Health, Beijing, China
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Affiliation(s)
- Kelly Mieske
- Department of Medicine, National University of Ireland, Galway, Ireland.
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