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Eoin Obrien - One of the best experts on this subject based on the ideXlab platform.

  • recommendations for Blood Pressure Measurement in large arms in research and clinical practice position paper of the european society of hypertension working group on Blood Pressure monitoring and cardiovascular variability
    Journal of Hypertension, 2020
    Co-Authors: Paolo Palatini, Gianfranco Parati, Roland Asmar, Eoin Obrien, Raj Padwal, Josh Sarkis, George S Stergiou
    Abstract:

    : Blood Pressure Measurement in obese individuals can be challenging because of the difficulty in properly cuffing large upper arms. Achieving a proper cuff fit can be problematic especially in people with a shorter arm length relative to circumference. This expert statement provides recommendations on Blood Pressure Measurement in large arms for clinical use and research purposes. Tronco-conically shaped cuffs should be used in people with large arms, especially with arm circumferences greater than 42 cm as they better fit on the conical arm shape. Cuffs with frustum of the cone slant angle of 85° should satisfy most conditions. In individuals with short upper-arm that does not allow application of a properly sized cuff, wrist or forearm Measurement might be used in clinical practice, but not for validation of automatic devices. Wide-range cuffs coupled to oscillometric devices provided with special software algorithms can also be used as alternatives to standard cuff Measurement, provided they are independently validated per AAMI/ISO 81060-2 protocol. For validation studies, the intraarterial Measurement is generally considered as the gold standard, yet for possible methodological pitfalls and ethical concerns, it is not recommended as the method of choice. Tronco-conical cuffs with inflatable bladder dimensions of 37-50 × 75-100% arm circumference should be used for reference auscultatory Blood Pressure Measurement wherever the upper arm length allows a proper fit. There is a need for future studies that help identify the optimal shape of cuffs and bladders investigating the influence of sex, age, arm physical properties, and artery characteristics.

  • Blood Pressure Measurement anno 2016
    American Journal of Hypertension, 2017
    Co-Authors: Jan A. Staessen, Kei Asayama, Eamon Dolan, Azusa Hara, Eoin Obrien
    Abstract:

    The rational management of hypertension (HT) inevitably starts with accurate Measurement of Blood Pressure (BP). The recently published Systolic Blood Pressure Intervention Trial implemented automated office BP Measurement. However, event-driven studies have overwhelmingly indicated that out-of-the-office BP monitoring is a prerequisite for risk stratification and for identifying the need of initiating or adjusting antihypertensive drug treatment. 24-Hour ambulatory BP monitoring is the preferred method of BP Measurement and addresses major issues not covered by conventional or automated office BP Measurement or home BP monitoring, such as reliably diagnosing nocturnal HT (the time window of the day during which BP is most predictive of adverse cardiovascular outcome), hypotension, or masked HT, a condition that affects 15% of the general populations and carries a risk equal to that of HT on both office and out-of-the-office BP Measurement. Moreover, 24-hour ambulatory BP monitoring is cost-effective. Outcome-driven criteria support single BP thresholds that can be applied in both sexes and across the age range. In conclusion, the overall evidence now overwhelmingly shows that ambulatory BP monitoring is mandatory for the proper management of HT. Health care providers should therefore facilitate access to this technique in both primary and specialized care.

  • twenty four hour ambulatory Blood Pressure Measurement in clinical practice and research a critical review of a technique in need of implementation
    Journal of Internal Medicine, 2011
    Co-Authors: Eoin Obrien
    Abstract:

    This review presents evidence that ambulatory Blood Pressure Measurement (ABPM) should be used more widely in clinical practice and hypertension research. The technique, which should be mandatory in trials of antihypertensive drugs, is not being used in all studies of antihypertensive drug efficacy. ABPM is also being under-used in outcome studies. The failure to implement ABPM in primary care and hypertension research is impeding patient management and scientific advancement. ABPM offers so many advantages in assessing the efficacy of Blood Pressure (BP)-lowering drugs that it should be mandatory in pharmacological trials. Likewise, the technique provides a means of achieving BP control in clinical practice, which is essential if we are to halt the epidemic of the cardiovascular consequences of hypertension. However, if ABPM is to be implemented for these purposes, certain requirements will need to be fulfilled. These include the availability of accurate, patient-friendly and inexpensive devices; standardization of the presentation and plotting of data with summary statistics for day-to-day practice; provision of comprehensive data analysis for research; an interpretative report to facilitate use in busy clinical practice; a trend report to demonstrate efficacy or otherwise of treatment in clinical practice and online transmission of data to provide immediate real-time data analysis. The reasons why ABPM is not being implemented are reviewed, and proposals are made to make the technique more acceptable.

  • ambulatory Blood Pressure Measurement is indispensable to good clinical practice
    Hipertensión y Riesgo Vascular, 2009
    Co-Authors: Eoin Obrien
    Abstract:

    Summary Traditional clinic or office Blood Pressure Measurement (OBPM) is limited in the amount of information it can provide for the adequate management of hypertension; ambulatory Blood Pressure Measurement (ABPM), which can diagnose white coat hypertension in as many as 20% of people who appear to have hypertension with OBPM, and masked hypertension which may affect 10 and 20% of the population, is a vastly superior technique. Furthermore, nighttime BP measured by ABPM is superior to OBPM in predicting cardiovascular events. Perhaps the greatest value for ABPM will be to enable Blood Pressure control in the aging community, thereby leading to prevention of stroke. There should be an imperative to change contemporary clinical practice if we are to avert the burden of stroke and heart failure in an aged population. We have adequate drugs to achieve effective BP lowering in the vast majority of patients; what we lack is the determination to achieve effective BP control as early as possible.

  • ambulatory Blood Pressure Measurement the case for implementation in primary care
    Hypertension, 2008
    Co-Authors: Eoin Obrien
    Abstract:

    Since Riva-Rocci and Korotkoff gave us the technique of conventional Blood Pressure (BP) Measurement over a century ago, we have landed men on the moon, encircled Mars, invented the automobile and airplane, and, most importantly, revolutionized the technology of science with the microchip. Why, we might ask, has medicine ignored scientific evidence for so long so as to perpetuate a grossly inaccurate Measurement technique in both clinical practice and hypertension research? The same sentiment has been expressed by Floras: “As a society, we are willing to contemplate widespread genomic or proteomic subject characterization in pursuit of the concept of ‘individualized medicine.’ By contrast, Blood Pressure Measurement is one of the few areas of medical practice where patients in the twenty-first century are assessed almost universally using a methodology developed in the nineteenth.”1 It is generally accepted that traditional clinic or office BP Measurement (OBPM) is limited in the amount of information that it can provide for the adequate management of hypertension and that contemporary practice must turn to out-of-office Measurement to obtain additional information to guide the diagnosis and management of hypertension. The methods available for out-of-office Measurement are ambulatory BP Measurement (ABPM) and self- BP Measurement (SBPM). The purpose of this review is not to restate the criteria for Measurement by these techniques, which have been described in detail previously,2,3 but rather to present evidence to support the opinion that ABPM should be available to all primary care physicians who are responsible for the management of the majority of patients with hypertension. Hypertension is a major global risk for cardiovascular morbidity and mortality,4 and the World Health Organization, aware of the paucity of BP Measurement devices in low-resource countries is piloting studies to redress this serious deficiency.5 Clearly, therefore, the out-of-office techniques addressed in this …

Lyne Cloutier - One of the best experts on this subject based on the ideXlab platform.

  • hypertension canada s 2016 canadian hypertension education program guidelines for Blood Pressure Measurement diagnosis and assessment of risk of pediatric hypertension
    Canadian Journal of Cardiology, 2016
    Co-Authors: Kevin C Harris, Genevieve Benoit, Janis M Dionne, Janusz Feber, Lyne Cloutier, Kelly B Zarnke, Raj Padwal, Doreen M Rabi, Anne Fournier
    Abstract:

    We present the inaugural evidence-based Canadian recommendations for the Measurement of Blood Pressure in children and the diagnosis and evaluation of pediatric hypertension. Rates of pediatric hypertension are increasing concomitant with increased rates of childhood obesity. With this, there is growing awareness of the need to measure Blood Pressure in children. Consequently, the present recommendations have been developed to address an important gap and improve the clinical care of children. For 2016, a total of 15 recommendations are presented. These are categorized in a fashion similar to that of the existing adult recommendations. Specifically, we present recommendations on (1) accurate Measurement of Blood Pressure in children, (2) criteria for diagnosis of hypertension in children, (3) assessment of overall cardiovascular risk in hypertensive children, (4) routine laboratory tests for the investigation of children with hypertension, (5) ambulatory Blood Pressure Measurement in children, and (6) the role of echocardiography. We discuss the rationale for the recommendations and present additional supporting material for the clinician, including tables with standardized techniques for Blood Pressure Measurement and determination of normative Blood Pressure values for children. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will update the recommendations annually and develop future evidence-based recommendations to guide prevention and treatment of pediatric hypertension.

  • the 2015 canadian hypertension education program recommendations for Blood Pressure Measurement diagnosis assessment of risk prevention and treatment of hypertension
    Canadian Journal of Cardiology, 2013
    Co-Authors: Daniel G Hackam, Doreen M Rabi, Robert R Quinn, Pietro Ravani, Kaberi Dasgupta, Stella S Daskalopoulou, Nadia A Khan, Robert J Herman, Simon L Bacon, Lyne Cloutier
    Abstract:

    The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) Measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office Blood Pressure Measurement; (2) if the visit 1 mean Blood Pressure is increased but < 180/110 mm Hg, out-of-office Blood Pressure Measurements using ambulatory Blood Pressure monitoring (preferably) or home Blood Pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory Blood Pressure monitoring protocol and an update on automated office Blood Pressure are also presented. Several other recommendations on accurate Measurement of Blood Pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.

  • the 2014 canadian hypertension education program recommendations for Blood Pressure Measurement diagnosis assessment of risk prevention and treatment of hypertension
    Canadian Journal of Cardiology, 2013
    Co-Authors: Kaberi Dasgupta, Kelly B Zarnke, Doreen M Rabi, Robert R Quinn, Pietro Ravani, Stella S Daskalopoulou, Simon W Rabkin, Luc Trudeau, Ross D Feldman, Lyne Cloutier
    Abstract:

    The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) Measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office Blood Pressure Measurement; (2) if the visit 1 mean Blood Pressure is increased but < 180/110 mm Hg, out-of-office Blood Pressure Measurements using ambulatory Blood Pressure monitoring (preferably) or home Blood Pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory Blood Pressure monitoring protocol and an update on automated office Blood Pressure are also presented. Several other recommendations on accurate Measurement of Blood Pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.

Gianfranco Parati - One of the best experts on this subject based on the ideXlab platform.

  • recommendations for Blood Pressure Measurement in large arms in research and clinical practice position paper of the european society of hypertension working group on Blood Pressure monitoring and cardiovascular variability
    Journal of Hypertension, 2020
    Co-Authors: Paolo Palatini, Gianfranco Parati, Roland Asmar, Eoin Obrien, Raj Padwal, Josh Sarkis, George S Stergiou
    Abstract:

    : Blood Pressure Measurement in obese individuals can be challenging because of the difficulty in properly cuffing large upper arms. Achieving a proper cuff fit can be problematic especially in people with a shorter arm length relative to circumference. This expert statement provides recommendations on Blood Pressure Measurement in large arms for clinical use and research purposes. Tronco-conically shaped cuffs should be used in people with large arms, especially with arm circumferences greater than 42 cm as they better fit on the conical arm shape. Cuffs with frustum of the cone slant angle of 85° should satisfy most conditions. In individuals with short upper-arm that does not allow application of a properly sized cuff, wrist or forearm Measurement might be used in clinical practice, but not for validation of automatic devices. Wide-range cuffs coupled to oscillometric devices provided with special software algorithms can also be used as alternatives to standard cuff Measurement, provided they are independently validated per AAMI/ISO 81060-2 protocol. For validation studies, the intraarterial Measurement is generally considered as the gold standard, yet for possible methodological pitfalls and ethical concerns, it is not recommended as the method of choice. Tronco-conical cuffs with inflatable bladder dimensions of 37-50 × 75-100% arm circumference should be used for reference auscultatory Blood Pressure Measurement wherever the upper arm length allows a proper fit. There is a need for future studies that help identify the optimal shape of cuffs and bladders investigating the influence of sex, age, arm physical properties, and artery characteristics.

  • masked uncontrolled hypertension management based on office bp or on ambulatory Blood Pressure Measurement master study a randomised controlled trial protocol
    BMJ Open, 2018
    Co-Authors: Gianfranco Parati, Alejandro De La ,sierra, Enrico Agabitirosei, George L Bakris, Grzegorz Bilo, Giovanna Branzi, Franco Cecchi, Marzena Chrostowska, Monica Domenech, Maria Dorobantu
    Abstract:

    Introduction Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) Blood Pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory Blood Pressure Measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM. Methods and analysis MASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP Ethics and dissemination MASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal. Trial registration number NCT02804074; Pre-results.

  • practice guidelines of the european society of hypertension for clinic ambulatory and self Blood Pressure Measurement
    Journal of Hypertension, 2005
    Co-Authors: Eoin Obrien, Yutaka Imai, Roland Asmar, Giuseppe Mancia, Martin G Myers, L J Beilin, Thomas Mengden, Paul L Padfield, Paolo Palatini, Gianfranco Parati
    Abstract:

    Introduction Blood PressureMeasurement is the basis for the diagnosis, management, treatment, epidemiology and research of hypertension, and the decisions affecting these aspects of hypertensionwill be influenced, for better or worse, by the accuracyofMeasurement.AnaccurateBloodPressure reading is a prerequisite, therefore, regardless of which technique is used, yet all too often the accuracy of Measurement is taken for granted or ignored. This paper is a summary up-dated version of the recommendations published by the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring for conventional (CBPM), ambulatory (ABPM) and self (SBPM) Blood Pressure Measurement in 2003 ([1], from where further detailed information can be obtained).

  • task force ii Blood Pressure Measurement and cardiovacular outcome
    Blood Pressure Monitoring, 2001
    Co-Authors: Jan A. Staessen, Gianfranco Parati, Yutaka Imai, Roland Asmar, Marc De Buyzere, Kazayuki Shimada, George S Stergiou, Josep Redon, Paolo Verdecchia
    Abstract:

    To reach a consensus on the prognostic significance of new techniques of automated Blood Pressure Measurement. A Task Force on the prognostic significance of ambulatory Blood Pressure monitoring wrote this review in preparation for the Eighth International Consensus Conference (28–31 October 2001, Sendai, Japan). This synopsis was amended to account for opinions aired at the conference and to reflect the common ground reached in the discussions. (1) Prospective studies in treated and untreated hypertensive patients and in the general population have demonstrated that, even after adjusting for established risk factors, the incidence of cardiovascular events is correlated with Blood Pressure on conventional as well as ambulatory Measurement. Ambulatory monitoring, however, significantly refines the prediction already provided by conventional Blood Pressure Measurement. (2) White-coat hypertension is usually defined as an elevated clinic Blood Pressure in the presence of a normal daytime ambulatory Blood Pressure. Event-based studies in hypertensive patients have convincingly demonstrated that the risk of cardiovascular disease is less in patients with white-coat hypertension than in those with higher ambulatory Blood Pressure levels even after controlling for concomitant risk factors. Based on prognostic evidence, white-coat hypertension can now be defined as a conventional Blood Pressure that is persistently equal to or greater than 140/90 mmHg with an average daytime ambulatory Blood Pressure of below 135/85 mmHg. The issue of whether or not white-coat hypertension predisposes to sustained hypertension needs further research. (3) There is a growing body of evidence showing that a decreased nocturnal fall in Blood Pressure (<10% of the daytime level) is associated with a worse prognosis, irrespective of whether night-time dipping is studied as a continuous or a class variable. (4) Intermittent techniques of ambulatory Blood Pressure monitoring are limited in terms of quantifying short-term Blood Pressure variability. Proven cardiovascular risk factors such as old age, a higher than usual Blood Pressure and diabetes mellitus are often associated with greater short-term Blood Pressure variability. After adjusting for these risk factors, some − but not all − studies have nevertheless reported an independent and positive relationship between cardiovascular outcome and measures of variability of daytime and night-time Blood Pressure, for example standard deviation. (5) Reference values for ambulatory Blood Pressure Measurement in children are currently based on statistical parameters of Blood Pressure distribution. In children and adolescents, functional rather than distribution-based definitions of ambulatory hypertension have yet to be developed. (6) Several studies of gestational hypertension have shown that, compared with office Measurement, ambulatory Blood Pressure monitoring is a better predictor of maternal and fetal complications. Pregnancy is a special indication for ambulatory monitoring so that the white-coat effect can be measured and pregnant women are not given antihypertensive drugs unnecessarily. (7) Ambulatory pulse Pressure and the QKD interval are Measurements obtained by ambulatory monitoring that to some extent reflect the functional characteristics of the large arteries. The QKD interval is correlated with left ventricular mass, and ambulatory pulse Pressure is a strong predictor of cardiovascular outcome. (8) Under standardized conditions, the self-Measurement of Blood Pressure is equally as effective as ambulatory Blood Pressure monitoring in identifying the white-coat effect, but further studies are required to elucidate fully the prognostic accuracy of self-measured Blood Pressure in comparison with conventional and ambulatory Blood Pressure Measurement. Ambulatory Blood Pressure Measurement refines the prognostic information provided by conventional Blood Pressure readings obtained in the clinic or the doctor's office. Longitudinal studies of patients with white-coat hypertension should clarify the transient, persistent or progressive nature of this condition, particularly in paediatric patients, in whom white-coat hypertension may be a harbinger of sustained hypertension and target-organ damage in adulthood. Finally, the applicability, cost-effectiveness and long-term prognostic accuracy of the self-Measurement of Blood Pressure should be evaluated in relation to conventional Blood Pressure Measurement and ambulatory monitoring.

Romsai T. Boonyasai - One of the best experts on this subject based on the ideXlab platform.

  • a bundled quality improvement program to standardize clinical Blood Pressure Measurement in primary care
    Journal of Clinical Hypertension, 2018
    Co-Authors: Sarah J. Flynn, Katherine B. Dietz, Romsai T. Boonyasai, Kathryn A Carson, Jill A Marsteller, Gary Noronha, Yea Jen Hsu, Jeanne M Charleston
    Abstract:

    We evaluated use of a program to improve Blood Pressure Measurement at 6 primary care clinics over a 6-month period. The program consisted of automated devices, clinical training, and support for systems change. Unannounced audits and electronic medical records provided evaluation data. Clinics used devices in 81.0% of encounters and used them as intended in 71.6% of encounters, but implementation fidelity varied. Intervention site systolic and diastolic Blood Pressure with terminal digit "0" decreased from 32.1% and 33.7% to 11.1% and 11.3%, respectively. Improvement occurred uniformly, regardless of sites' adherence to the Measurement protocol. Providers rechecked Blood Pressure Measurements less often post-intervention (from 23.5% to 8.1% of visits overall). Providers at sites with high protocol adherence were less likely to recheck Measurements than those at low adherence sites. Comparison sites exhibited no change in terminal digit preference or repeat Measurements. This study demonstrates that clinics can apply a pragmatic intervention to improve Blood Pressure Measurement. Additional refinement may improve implementation fidelity.

  • Promoting sustainability in quality improvement: an evaluation of a web-based continuing education program in Blood Pressure Measurement
    'Springer Science and Business Media LLC', 2018
    Co-Authors: Lauren Block, Sarah J. Flynn, Lisa A. Cooper, Caroline Lentz, Tammie Hull, Katherine B. Dietz, Romsai T. Boonyasai
    Abstract:

    Abstract Background The accuracy of Blood Pressure Measurement is variable in office-based settings. Even when staff training programs are effective, knowledge and skills decay over time, supporting the need for ongoing staff training. We evaluated whether a web-based continuing education program in Blood Pressure Measurement reinforced knowledge and skills among clinical staff and promoted sustainability of an existing quality improvement program. Methods Medical assistants and nurses at six primary care clinics within a health system enrolled in a 30-min online educational program designed to refresh their knowledge of Blood Pressure Measurement. A 20-question pre- and post-intervention survey addressed learners’ knowledge and attitudes. Direct observation of Blood Pressure Measurement technique before and after the intervention was performed. Differences in responses to pre- and post-module knowledge and attitudes questions and in observation data were analyzed using chi-square tests and simple logistic regression. Results All 88 clinical staff members participated in the program and completed the evaluation survey. Participants answered 80.6% of questions correctly before the module and 93.4% afterwards (p 

Giuseppe Mancia - One of the best experts on this subject based on the ideXlab platform.

  • the un observed automated office Blood Pressure Measurement technique used in the sprint study points to a standard target office systolic Blood Pressure 140 mmhg
    Current Hypertension Reports, 2017
    Co-Authors: Sverre E Kjeldsen, Giuseppe Mancia
    Abstract:

    The SPRINT study investigators used the un-observed automated office Blood Pressure Measurement technique. When their achieved systolic Blood Pressure is corrected, target systolic Blood Pressure for most people remains unchanged: <140mmHg for prevention of cardiovascular diseases and death.

  • muscle and skin sympathetic nerve traffic during physician and nurse Blood Pressure Measurement
    Journal of Hypertension, 2013
    Co-Authors: Guido Grassi, Gino Seravalle, S Buzzi, Laura Magni, Gianmaria Brambilla, F Quartitrevano, Raffaella Delloro, Giuseppe Mancia
    Abstract:

    OBJECTIVE Previous studies have shown that Blood Pressure assessment by a nurse markedly attenuates the pressor and tachicardic responses triggered by the physician Blood Pressure Measurement. Whether and to what extent this attenuation reflects a different pattern of the neuroadrenergic responses to doctor or nurse Blood Pressure evaluation is unknown. METHODS In 19 lean untreated mild essential hypertensive patients (age 39.1 ± 2.4 years, mean ± SEM), we measured beat-to-beat mean arterial Pressure (Finapres), heart rate (ECG), and efferent postganglionic muscle and skin sympathetic nerve traffic [muscle sympathetic nerve activity (MSNA) and skin sympathetic nerve activity (SSNA), respectively, by microneurography], before, during, and following a 10-min sphygmomanometric BP Measurement by a doctor or by a nurse unfamiliar to the patients. Measurements were repeated at a 30-min interval to obtain, in separate periods, muscle and skin sympathetic nerve traffic recordings. Both the sequences (doctor vs. nurse and muscle vs. skin sympathetic nerve traffic) were randomized. RESULTS A doctor visit induced sudden, marked, and prolonged Blood Pressure and heart rate increases, accompanied by a muscle sympathetic nerve traffic inhibition (average response: -18.1 ± 4.3%, P < 0.01) coupled with a skin sympathetic nerve traffic excitation (average response: +46.1 ± 5.5%, P < 0.01). In contrast, a nurse visit elicited Blood Pressure and heart rate responses markedly and significantly reduced (-72.1 ± 11 and -81.7 ± 13% respectively, P < 0.01) as compared with those seen during the doctor's visit. This was the case also for muscle and skin sympathetic neural responses (-44.3 ± 9 and -65.6 ± 13%, P < 0.01). CONCLUSION These data provide the first evidence that the blunted pressor and tachicardic responses to nurse's Blood Pressure Measurements are accompanied by an attenuation of the adrenergic neural responses seen during the alerting reaction accompanying doctor's Blood Pressure Measurement.

  • practice guidelines of the european society of hypertension for clinic ambulatory and self Blood Pressure Measurement
    Journal of Hypertension, 2005
    Co-Authors: Eoin Obrien, Yutaka Imai, Roland Asmar, Giuseppe Mancia, Martin G Myers, L J Beilin, Thomas Mengden, Paul L Padfield, Paolo Palatini, Gianfranco Parati
    Abstract:

    Introduction Blood PressureMeasurement is the basis for the diagnosis, management, treatment, epidemiology and research of hypertension, and the decisions affecting these aspects of hypertensionwill be influenced, for better or worse, by the accuracyofMeasurement.AnaccurateBloodPressure reading is a prerequisite, therefore, regardless of which technique is used, yet all too often the accuracy of Measurement is taken for granted or ignored. This paper is a summary up-dated version of the recommendations published by the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring for conventional (CBPM), ambulatory (ABPM) and self (SBPM) Blood Pressure Measurement in 2003 ([1], from where further detailed information can be obtained).

  • european society of hypertension recommendations for conventional ambulatory and home Blood Pressure Measurement
    Journal of Hypertension, 2003
    Co-Authors: Eoin Obrien, Yutaka Imai, Roland Asmar, Giuseppe Mancia, Martin G Myers, L J Beilin, Jeanmichel Mallion, Thomas Mengden, Paul L Padfield, Paolo Palatini
    Abstract:

    IntroductionOver the past 20 years or so, the accuracy of the conventional Riva-Rocci/Korotkoff technique of Blood Pressure Measurement has been questioned and efforts have been made to improve the technique with automated devices. In the same period, recognition of the phenomenon of white-coat hype