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Oscar 2 Ambulatory Blood Pressure Monitor (ABPM)

Overview

The new standard in ambulatory blood pressure monitoring

The Oscar 2 system from SunTech Medical® sets the standard in ABPM by meeting the highest clinical standards, optimizing patient comfort through innovation, and giving clinicians practical interpretive analysis and reporting tools.

Highest standards of clinical accuracy

The Oscar 2 is clinically validated to all three internationally recognized standards.

Patient comfort

The Oscar 2 and the Orbit BP cuff make patient comfort a priority.

  • The SunTech Medical, Inc. patented Orbit cuff uses an innovative stretch-sleeve design to maintain cuff placement and promote patient comfort.
  • The Oscar 2 is a light, compact monitor that uses motion tolerant algorithms to reduce re-inflates and failed readings. The auto-intelligent inflation pressure also reduces measurement time, promoting patient comfort by controlling cuff inflation.

Practical interpretive analysis and reporting tools

AccuWin Pro is a user-friendly tool allowing maximum flexibility for configuring, analyzing, interpreting, and reporting of ABPM studies.

For an interactive tutorial of a complete demo of the Oscar 2 system and AccuWin Pro features, please view the Using the Oscar 2 tutorial.

The Oscar 2 system includes:

  • Oscar 2 ABP monitor
  • AccuWin Pro v3 CD
  • 2 Orbit ABP cuffs: Adult and Adult Plus
  • Carrying pouch and patient belt
  • USB PC interface cable
  • User Guide
  • Standard 2-year warranty
  1. BHS: British Hypertension Society (http://www.bhsoc.org/)
  2. ESH: European Society of Hypertension (http://www.eshonline.org/)
  3. AAMI: Association for the Advancement of Medical Instrumentation (http://www.aami.org/)
    Validation of the OSCAR 2 ambulatory blood pressure monitor according to the association for the advancement of medical instrumentation (AAMI) protocol. American Journal of Hypertension, Volume 18, Issue 5, Pages A31-A31, J. GOODWIN, P. FINN, M. BILOUS, S. WINSHIP, S. JONES

Product FAQs

Where can I find out more about US Reimbursement for my ABPM?

To obtain information about your US Reimbursement for your Ambulatory Blood Pressure Monitoring device, please click here.

Oscar 2

How do I register my Oscar 2?

To register, please fill out the product registration card provided with your SunTech® Product. You can also register by filling out our online product registration form under the Products Section of this website.

Does the Oscar 2 or its cables contain Latex?

All of our products, including the Oscar 2, hoses and cables, do not contain any Latex.

How do I turn the unit on/off?

To turn ON, press and hold the start/stop button until you hear a series of 3 quick beeps.
To turn OFF, press and hold the start/stop button until you hear a series of five beeps.

What is the difference between the Tracker NIBP2 and the Oscar 2?

Please see this Tracker NIBP2 information page.

AccuWin Pro

Which operating systems are compatible with AccuWin Pro (AWP)?

AWP software will run on Windows operating systems only. AWP is compatible with Windows 98, 2000, ME, XP, Vista, and Windows 7 (32- and 64-bit). AWP has not yet been validated for compatibility with Windows 8.

Can AccuWin Pro (AWP) export data to be used in a spreadsheet or database?

The AccuWin Pro software can export data to be used in a spreadsheet or database. Use the File >> Export function, AccuWin Pro can be exported into an ASCII text file for use by most spreadsheet and database programs. The export function is flexible enough to allow for only data of interest and be exported and various of delimiters can be chosen.

Does SunTech's AWP software allow for sending reports by e-mail or modem?

The AccuWin Pro software can send reports by email or by modem. The AccuWin Pro v3.3 and v3.3.1 software have a feature allowing you to email AWP files from within AccuWin Pro to other AccuWin Pro users. All AWP files from any of our AccuWin software products can be sent via email and be opened with the corresponding AccuWin program that originally downloaded them. Also, all AccuWin Pro Software products can send reports over a modem to a fax machine when used with a PC with a fax-printer driver installed.

How do I get my AWP software to work with my office EMR software?

AccuWin Pro v3 has a one button operation to create patient reports in PDF format. PDF files of patient reports can then be placed into the patient's folder for most EMR systems. This allows viewing of a patient's report without the need for AccuWin Pro.

I can’t get my computer to communicate with my monitor. Or, when trying to program or retrieve data, I receive the error, “Cannot communicate with ABP device.” How do I fix this?

Check the hardware settings under Configure, then Preferences. Select a configuration to Edit. Serial Port will show all ports available on the computer.

  1. If using the USB adapter, install the driver (mini CD included in USB adapter packaging).
  2. Ensure the Oscar 2 has battery power.
  3. Ensure that another device, such as a Holter monitor or PDA, is not connected to the specified port. Remove the device or change the serial port for your Oscar 2 to a port that is not being used.
  4. Check that the appropriate ABP device is connected. After you have changed the settings, connect your ABP device and select Test Port to confirm that the computer and monitor are communicating.

In which languages is AWP available?

AccuWin Pro is available in English, French, Italian, German, Spanish, Dutch, Czech, Polish, Turkish, Russian, Chinese, and Japanese. All of the languages are available on the software CD which is included in some Oscar 2 systems. The CD can also be purchased separately.

Parts & Accessories

DescriptionItem Number
Oscar 2 ABPM System99-0012-00
PowerPack Accessory Kit98-0056-00
AccuWin Pro v3 Software (CD)27-0037-A1
Oscar 2 USB Cable97-0090-02
Oscar 2 PC Interface Cable91-0056-00
USB Adapter91-0085-00
Small Adult Orbit Cuff (18–27 cm)98-0063-11
Adult Orbit Cuff (25–35 cm)98-0063-12
Adult Plus Orbit Cuff (33–40 cm)98-0063-13
Large Adult Orbit Cuff (39–46 cm)98-0063-14
Oscar 2 Pouch98-0032-00
Oscar 2 Belt98-0037-00
Oscar 2 Shoulder Strap98-0036-00
Battery Recharger + 4 NiMH AA batteries17-0007-00

Technical Specs

ValidationsBHS (A/A), ESH, ANSI/AAMI SP10:2002
BP TechniqueOscillometry with step deflation
BP Range25-260 mmHg
HR Range40-200 bpm
Sampling Periods3 adjustable (awake, asleep, and special)
Time Intervals5, 10, 15, 20, 30, 45, 60, 90 and 120 min.
Event KeyProgram to allow additional patient readings
Data StorageFlash memory stores up to 250 readings
Power SourceTwo AA batteries
Weight284 grams, including batteries
Dimensions12 x 7 x 3 cm
PC RequirementsSerial or USB port, Windows® 98 or later

White Papers

Please select one or more white papers to download.

Show Abstract
In recent years, ambulatory blood pressure monitoring (ABPM) has become a commonly used tool for the diagnosis and management of hypertension. Much of this growth was enhanced by the 2001 decision of the Center for Medicare and Medicaid Services (CMS) to begin reimbursement of ABPM for evaluation of “white-coat” hypertension. However, because of the focus on “white-coat” hypertension, there has been much confusion and misinformation as to whether ABPM is even a covered medical procedure. Understanding the clinical benefits and reimbursement of ABPM presents a valuable, yet often-missed opportunity for both physicians and sales representatives who might distribute these devices.
Show Abstract

by Bruce Alpert, MD

Twenty-four hour ambulatory blood pressure monitoring (ABPM) has become a routine procedure in adult medicine over recent years. It provides physicians with the best estimate of true blood pressure and blood pressure variability. In the February 1997 issue of the Journal of Pediatrics, I wrote an editorial with Stephen Daniels, M.D., Ph.D., expressing the opinion that pediatricians needed to “catch-up” with adult physicians in their awareness of the uses and benefits of 24-hour ABPM.1 In that same issue, the largest series of children undergoing ABPM research to date, including 1141 adolescents was published by Soergel et al.2 This article presented guidelines for classifying normal and elevated systolic and diastolic BP levels during awake, asleep, and 24- hour time periods for children and adolescents. With these published guidelines, it was our hope that ABPM would become the standard of care for identifying and managing hypertension in pediatric patients. Unfortunately, eleven years after my original editorial, ABPM is still widely under-utilized by the pediatric healthcare community.


Research Study Library

2011

Blood pressure monitoring in the assessment of old patients with acute stroke

Background Most patients have elevated blood pressure in the early phase of acute stroke that it often returns to normal within approximately seven-days. Most available data on the pattern of blood pressure in acute stroke are based on manual blood pressure measurements.

Aims The aims of the present study were to assess with 24 h blood pressure monitoring the pattern of blood pressure in acute stroke, and the change in blood pressure during the first week of event in very old patients.

Methods We studied 99 patients with acute stroke (58 males), mean age 83 ± 6 years (range 70–97). Casual blood pressure and 24 h blood pressure monitoring were recorded within 24 h of admission, and then after six- to seven-days.

Results Casual blood pressure before beginning the 24 h blood pressure monitoring was 154 ± 23/80 ± 15 mmHg and the average 24 h blood pressure was 147 ± 20/74 ± 11 mmHg. One-week after stroke, casual blood pressure decreased by 15/7 mmHg, whereas 24 h blood pressure decreased by only 7/2 mmHg (P<0·01). Blood pressure decreased remarkably only in those with admission elevated systolic blood pressure. The change in 24 h systolic blood pressure after one-week correlated to the 24 h admission systolic blood pressure (R=0·47; P<0·01).

Conclusions Casual blood pressure may overestimate blood pressure in stroke patients. Very old patients with stroke exhibit a mild increase in blood pressure during the acute phase, and blood pressure decreases spontaneously only in those with elevated blood pressure levels. Use of 24 h blood pressure monitoring may be helpful in elderly patients with acute stroke.

Avraham Weiss, Yichayaou Beloosesky, Riad Majadla, Ehud Grossman
International Journal of Stroke, Volume 6, Issue 3, pages 182–186, June 2011

2010

Blood pressure profile in renal transplant recipients and its relation to diastolic function: tissue Doppler echocardiographic study

Hypertension is a common complication after renal transplantation and is associated with increased risk of cardiovascular disease. The aim of the current study was to investigate the diurnal blood pressure pattern and its relation to structural and functional cardiac changes in renal transplant recipients. Sixty-six stable renal transplant patients (34 female, 32 male), aged 7 to 25 years (mean 17.4 ± 4.3 years) were enrolled in this study. Cardiac function assessed by tissue Doppler echocardiography and blood pressure measurement performed using both the ambulatory and the casual method. Hypertension was demonstrated in 57% of recipients by the casual method and in 75.7% by ambulatory blood pressure monitoring (ABPM). The efficacy of BP control among patients on antihypertensive drugs was 60%. The prevalence of non-dipping was 73%. There was significant inverse correlation between systolic or diastolic day-time or night-time BP index and post-transplant duration (p < 0.001, r =−0.386), but no correlation between ABP parameters and BMI, gender, and eGFR. There was a significant relationship between all ABP parameters and left ventricular mass index (LVMI) (p = 0.025–0.007, r = 0.28–0.38). LVMI was significantly higher in hypertensive than in normotensive cases (p = 0.034). There was no difference in diastolic function between hypertensive and normotensive patients or between patients with and without left ventricular hypertrophy (LVH). In conclusion, our study showed the advantage of ABPM over the casual method of diagnosis of hypertension. LVH is common in transplant patients and is likely associated with arterial hypertension. Hypertension and LVH cannot differentiate transplant patients with diastolic malfunction.

Mitra Basiratnia, Maryam Esteghamati, Gholam Hossein Ajami, Hamid Amoozgar, Cyrus Cheriki, Manoochehr Soltani, Ali Derakhshan and Mohammad Hossein Fallahzadeh
Pediatric Nephrology
Volume 26, Number 3, 449–457, DOI: 10.1007/s00467-010-1724-6

2009

The Mean Machine; Accurate Non-Invasive Blood Pressure Measurement in the Critically Ill patient

Objective Accurate indirect prehospital blood pressure measurement in the critically ill patient remains an important challenge to both patient management and prehospital research. Ambulatory blood pressure measuring devices have not been trialled for prehospital use in critically ill patients. Prior to prehospital validation where conditions are suboptimal, we aimed to test under favourable conditions in the Intensive Care Unit, a selection of ambulatory devices that may be suitable for use in the field.

Methods Systolic, diastolic and mean pressures of three ambulatory devices were compared to the average of 1 min of independently recorded, high fidelity intra-arterial reference pressures. Eighteen critically ill patients were recruited. Device performance was required to fulfil the Association for the Advancement of Medical Instrumentation (AAMI) protocol. Additionally, agreement between measure- ment methods was examined using Bland-Altman plots. Two-level linear mixed model analyses were under- taken.

Results For each device, 150 paired measurements (arterial reference and device) were analysed. According to the AAMI protocol, no device measured systolic pressures accurately. One device measured diastolic pressures accurately. Integrated mean pressures were accurately measured by all devices. Overall, SunTech Medical’s Oscar 2 performed best with mean pressure error not exceeding 17 mmHg. For this device, Bland-Altman plots showed uniform agreement across a wide range of mean pressures. Two-level linear mixed effects analyses showed that Oscar 2 mean error reduced during vasopressor use by (−) 3.9 mmHg (95% CI −5.9, −1.9; P < 0.001), and clinically, performance was little affected during␣mechanical ventilation. For the Oscar 2, there was up␣to (−) 7.0 mmHg (95% CI −10.3, −3.5; P < 0.001) l ess mean error during hypotension compared to normo- tension.

Conclusions In the Intensive Care Unit, the performance of one device, the Oscar 2, surpassed the others and fulfilled the AAMI protocol criteria for mean pressure measurement. This device is suitable for prehospital validation.

Sandy Muecke, Andrew Bersten, and John Plummer.
Journal of Clinical Monitoring and Computing, 23(5): 283 – 297.

Methylated arginine derivatives in children and adolescents with chronic kidney disease*

Asymmetric dimethylarginine (ADMA), a methylated L-arginine (Arg) derivative is associated with endothelial dysfunction, vasoconstriction, and hypertension in animals and humans. We examined the relationship between these derivatives, estimated glomerular filtration rate (eGFR), and awake (AW) and asleep (AS) blood pressure (BP) load in children and adolescents (n = 28) with stage 2–3 chronic kidney disease (CKD) and in matched intra-familial controls (n = 10). Plasma L-Arg, ADMA, and symmetric dimethylarginine (SDMA) levels were measured by high-performance liquid chromatography–tandem mass spectrometry. Subjects wore a 24-hr ambulatory BP monitor with BP load >95th percentile. ADMA, SDMA/ADMA ratio and SDMA were 38–200% higher in CKD patients while L-Arg/ADMA and L-Arg/SDMA ratios and the L-Arg level were 11–64% lower. The eGFR explained 42–60% of L-Arg/SDMA, SDMA/ADMA, and SDMA variability (n = 38). Using linear regression, SDMA and SDMA/ADMA separately explained 15–38% of AW and AS systolic (S) BP and diastolic (D) BP load variability (p  < 0.001–0.022). Using multivariate stepwise regression with eGFR held constant, SDMA/ADMA was a significant independent variable for AW DBP load (p = 0.03). In conclusion, BP load and a disproportionate elevation of SDMA are seen in children and adolescents with stage 2–3 (mild–moderate) CKD. SDMA is a strong marker for reduced eGFR and serves as a moderate but significant indicator of 24-hr BP load variability.

E Brooks, C Langman, S Wang, H Price, A Hodges, L Darling, A Yang, F Smith
Pediatric Nephrology, Vol 24: 129 – 134.

*Free access to download

Effects of Dietary Sodium Reduction on Blood Pressure in Subjects With Resistant Hypertension

Observational studies indicate a significant relation between dietary sodium and level of blood pressure. However, the role of salt sensitivity in the development of resistant hypertension is unknown. The present study examined the effects of dietary salt restriction on office and 24-hour ambulatory blood pressure in subjects with resistant hypertension. Twelve subjects with resistant hypertension entered into a randomized crossover evaluation of low (50 mmol/24 hoursx7 days) and high sodium diets (250 mmol/24 hoursx7 days) separated by a 2-week washout period. Brain natriuretic peptide; plasma renin activity; 24-hour urinary aldosterone, sodium, and potassium; 24-hour ambulatory blood pressure monitoring; aortic pulse wave velocity; and augmentation index were compared between dietary treatment periods. At baseline, subjects were on an average of 3.4±0.5 antihypertensive medications with a mean office BP of 145.8±10.8/83.9±11.2 mm Hg. Mean urinary sodium excretion was 46.1±26.8 versus 252.2±64.6 mmol/24 hours during low- versus high-salt intake. Low- compared to high-salt diet decreased office systolic and diastolic blood pressure by 22.7 and 9.1 mm Hg, respectively. Plasma renin activity increased whereas brain natriuretic peptide and creatinine clearance decreased during low-salt intake, indicative of intravascular volume reduction. These results indicate that excessive dietary sodium ingestion contributes importantly to resistance to antihypertensive treatment. Strategies to substantially reduce dietary salt intake should be part of the overall treatment of resistant hypertension.

Eduardo Pimenta; Krishna K. Gaddam; Suzanne Oparil; Inmaculada Aban; Saima Husain; Louis J. Dell'Italia; David A. Calhoun
Hypertension. 2009;54:475-481

Autonomic Effects of Controlled Fine Particulate Exposure in Young Healthy Adults: Effect Modification by Ozone

Background Human controlled-exposure studies have assessed the impact of ambient fine particulate matter on cardiac autonomic function measured by heart rate variability (HRV), but whether these effects are modified by concomitant ozone exposure remains unknown.

Objective In this study we assessed the impact of O3 and particulate matter exposure on HRV in humans.

Methods In a crossover design, 50 subjects (19–48 years of age) were randomized to 2-hr controlled exposures to filtered air (FA), concentrated ambient particles (CAPs), O3, or combined CAPs and ozone (CAPs + O3). The primary end point was change in HRV between the start and end of exposure. Secondary analyses included blood pressure (BP) responses, and effect modification by asthmatic status.

Results Achieved mean CAPs and O3 exposure concentrations were 121.6 ± 48.0 μg/m3 and 113.9 ± 6.6 ppb, respectively. In a categorical analysis, exposure had no consistent effect on HRV indices. However, the dose–response relationship between CAPs mass concentration and HRV indices seemed to vary depending on the presence of O3. This heterogeneity was statistically significant for the low-frequency component of HRV (p = 0.02) and approached significance for the high-frequency component and time-domain measures of HRV. Exposure to CAPs + O3 increased diastolic BP by 2.0 mmHg (SE, 1.2; p = 0.02). No other statistically significant changes in BP were observed. Asthmatic status did not modify these effects.

Conclusion The potentiation by O3 of CAPs effects on diastolic BP and possibly HRV is of small magnitude in young adults. Further studies are needed to assess potential effects in more vulnerable populations.

Asghar A. Fakhri, Ljubomir M. Ilic,  Gregory A. Wellenius, Bruce Urch, Frances Silverman, Diane R. Gold,  and Murray A. Mittleman
Environ Health Perspect. 2009 August; 117(8): 1287–1292.

2008

Salt loading increases urinary excretion of linoleic acid diols and triols in healthy human subjects

Increased dietary linoleic acid has been associated with reduced blood pressure in clinical and animal studies possibly mediated by prostaglandins. Urinary linoleate and prostaglandin metabolite excretion were investigated in subjects exposed to a salt-loading/salt-depletion regimen. Twelve healthy subjects were recruited from the New Orleans population (before Hurricaine Katrina) and admitted to the Tulane-Louisiana State University-Charity Hospital General Clinical Research Center after a 5-day outpatient lead-in phase on a 160-mmol sodium diet. On inpatient day 1, the subjects were maintained on the 160-mmol sodium diet, and a 24-hour urine specimen was collected. On day 2, the subjects received 2 L of IV normal saline over 4 hours and continued on a 160-mmol Na+ diet (total: 460 mmol of sodium). Two 12-hour urine collections were obtained. On day 3, the subjects received three 40-mg oral doses of furosemide, two 12-hour urine collections were obtained, and the subjects were given a 10-mmol sodium diet. Urinary oxidized lipids were measured by high-performance liquid chromatography-tandem quadrupole mass spectroscopy. The excretion of the urinary linoleate metabolites, dihydroxyoctadecamonoenoic acids, and trihydroxyoctadecamonoenoic acids increased significantly during intravenous salt loading as compared with day 1 and the salt-depleted periods. The urinary excretion of 6-keto- prostaglandin F1{alpha} was unaffected by salt loading but was dramatically increased 7- to 10-fold by salt depletion. Prostaglandin E2 excretion was positively correlated with sodium excretion. The salt-stimulated production of linoleic acid diols and triols may inhibit tubular sodium reabsorption, thereby assisting in the excretion of the sodium load.

Albert W. Dreisbach, Janet C. Rice, Shanker Japa, John W. Newman, Aster Sigel, Rajan S. Gill, Arthur E. Hess, Angela C. Cemo, Juan P. Fonseca, Bruce D. Hammock, Juan J.L. Lertora and L. Lee Hamm
Hypertension, Vol 51: 755-761

Effectiveness of the selective aldosterone blocker, eplerenone, in patients with resistant hypertension

Resistant hypertension is defined as uncontrolled hypertension despite intensive treatment with at least three antihypertensive agents, one of which ideally should be a diuretic. To determine the efficacy and safety of the selective aldosterone antagonist eplerenone in this population, we studied patients with resistant hypertension (clinic blood pressure [BP] >140 mm Hg systolic or >90 mm Hg diastolic on maximal doses of more than three antihypertensive agents, including a loop or thiazide diuretic). At baseline and after 12 weeks of eplerenone therapy (50 to 100 mg daily titrated to effect), patients underwent clinic and 24-hour BP measurements, serum potassium, plasma renin activity, and serum aldosterone measurements. Patients (n = 52) completing the trial averaged 62 ± 10 years of age, were overweight (mean body mass index, 32.1 ± 5.5 kg/m2), and had variable renal function (glomerular filtration rate, 106 ± 38 mL/minute); 70% were men and 74% were non-Black. The mean number of antihypertensive agents at baseline was 3.7 ± 0.8 (range, three to seven drugs) to achieve a clinic BP of 150.5/84.1 mm Hg. The mean serum aldosterone was 12.9 ± 7.6 ng/mL and plasma renin activity was 2.3 ± 2.7 ng/mL/hour. After eplerenone, the change from baseline in the clinic BP was −17.6/−7.9 mm Hg (P < .0001 for both systolic blood pressure [SBP] and diastolic blood pressure [DBP]) and in 24-hour BP was −12.2/−6.0 mm Hg (P < .0001 for both). The number of antihypertensive drugs decreased to 3.3 ± 0.9 (range, one to seven agents). Plasma potassium increased by 0.30 ± 0.45 mEq/L (P < .001), but there were only three instances in two patients of mild hyperkalemia (potassium >5.5 mEq/L, but <6.0 mEq/L), despite all patients being on a background therapy that included an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Reductions in clinic and ambulatory BP were related to baseline clinic and ambulatory BP values (r2 > 0.3 for both SBP and DBP, P < .0001), weakly related to baseline serum aldosterone (r = −0.30; P = .05), and unrelated to plasma renin activity, age, gender, or race. In conclusion, eplerenone demonstrated substantial efficacy in treatment-resistant hypertension and was well-tolerated with modest changes in plasma potassium. Serum aldosterone and plasma renin activity did not predict BP responses to eplerenone in this population.

David A. Calhoun, William B. White
Journal of the American Society of Hypertension - November 2008 (Vol. 2, Issue 6, Pages 462-468)

Renal resistive index and nocturnal non-dipping: Is there an association in essential hypertension?

Renal Doppler ultrasonography (RDU) is a useful method to determine renal resistive index (RRI). The RRI has been used to evaluate target organ damage (TOD) in essential hypertension. Nocturnal non-dipping of blood pressure (BP) in essential hypertension was also associated with TOD. The relationship between increased RRI and non-dipping has not been specifically studied before. Patients with newly diagnosed essential hypertension underwent 24-h ambulatory BP monitoring, biochemistry analysis, 24-h urine testing, and RDU. Totally, 198 patients (137 women, 61 men, aged 53.8 ± 11.4 years) were included. Sixty-two patients were non-dippers, and 56 patients had increased RRI. RRI was increased in 32.3% of non-dipper patients and in 26.5% of dipper patients (P = 0.402). The RRIs of dippers were lower than the RRIs of non-dippers (0.65 ± 0.06 vs. 0.68 ± 0.07, P = 0.036). Multivariate logistic regression analysis of potential factors predicting increased RRI disclosed that advanced age (OR 1.090, CI 1.042–1.140, P < 0.0001) and increased pulse pressure (OR 1.037, CI 1.012–1.062, P = 0.004) were independently associated with increased RRI. In multivariate linear regression analysis, using the same independent variables, we found that square root-transformed RRI was independently associated with age (Beta + 0.366, P < 0.0001) and pulse pressure (Beta + 0.222, P = 0.001). Increased RRI and nocturnal non-dipping are not independently associated with each other in newly diagnosed essential hypertensive patients. Possible different mechanisms, or the same mechanisms but with different activation levels, may be responsible for the increased RRI and non-dipping as discrete pathologies.

Baris Afsar, Nurhan F. Ozdemir, Rengin Elsurer and Siren Sezer
International Urology and Nephrology, Volume 41, Number 2 / June, 2009

2007

Validation of the Oscar 2 oscillometric 24-h ambulatory blood pressure monitor according to the British Hypertension Society protocol

Objectives: Accuracy of blood pressure measuring devices is of prime importance and should be validated before devices are used clinically. We carried out an independent evaluation of the Oscar 2 oscillometric ambulatory blood pressure monitor (SunTech Medical, Model 222) according to the British Hypertension Society (BHS) Protocol.

Methods: Validation of the Oscar 2 was carried out in accordance with Part 1 of the British Hypertension Society protocol. Having successfully completed the first three phases, in the static validation phase blood pressure measurements were made on 114 participants simultaneously by two observers blinded from each other's readings and those of the device, giving 255 data pairs for systolic and diastolic blood pressure. Readings were made using simultaneous same-arm measurement, each observer using a dual-head binaural stethoscope and a calibrated mercury sphygmomanometer. Data were recorded independently, to the nearest 2 mmHg and were checked by the supervisor who operated the device.

Results: The device mean and observer means (and standard deviations) were exceptionally close across a high range of pressures, with a mean difference for the better observer of 0±7 mmHg and -1±6 mmHg for systolic and diastolic blood pressure, respectively. With 62% of all systolic blood pressure standard vs. device differences equal or less than 5 mmHg, and 70% of all similar differences for diastolic blood pressure equal to or less than 5 mmHg, the device was categorized as Grade A for systolic and diastolic blood pressure.

Conclusion: The Oscar 2 was graded A for both systolic and diastolic blood pressure by the British Hypertension Society protocol and can be recommended for clinical use in an adult population.

James Goodwin, Mary Bilous, Susan Winship, Paul Finn, and Stephen C. Jones
Blood Pressure Monitoring, Vol 12(2): 113 - 117

Is HOMA index a predictor of nocturnal nondipping in hypertensives with newly diagnosed type 2 diabetes mellitus?

Objective: Insulin resistance is involved in glucose intolerance, type 2 diabetes mellitus and hypertension. We aimed to analyze relationship between insulin resistance and nocturnal nondipping.

Methods: Patients underwent physical and biochemical evaluation, clinic and ambulatory blood pressure measurements. The homeostasis model assessment (HOMA) index was calculated.

Results: Ninety-six essential hypertensive patients, of whom 42 were dippers, with newly diagnosed type 2 diabetes mellitus were included. Nighttime average heart rate and mean arterial pressure of nondippers were higher than dippers (P<0.0001 and 0.001). Nondippers had higher fasting plasma glucose, serum insulin levels and HOMA indices than dipper patients (P=0.006, <0.0001 and <0.0001). Ten dippers and 36 nondippers were insulin resistant (P<0.0001). Clinic (r=+0.22, P=0.031), daytime average (r=+0.27, P=0.007), nighttime average (r=+0.33, P=0.001), 24-h average systolic (r=+0.25, P=0.015) and nighttime average diastolic blood pressures (r=+0.31, P=0.002) were positively correlated with homeostasis model assessment index. Nighttime mean arterial pressure and heart rates (daytime, nighttime, 24-h average) showed positive correlation with homeostasis model assessment index. In multivariate analysis, high homeostasis model assessment index was associated with increased nondipping risk (odds ratio: 1.85, confidence interval: 1.24-2.76, P=0.003). After adjustment of several factors, average nighttime systolic (P<0.0001), diastolic (P<0.0001) and 24-h diastolic blood pressure (P=0.029) and heart rate (P=0.001) measurements of insulin resistant patients were higher than nonresistant patients.

Conclusions: Insulin resistance is related with diurnal blood pressure variation. The HOMA index may be a predictor of nocturnal nondipping in patients with essential hypertension and newly diagnosed type 2 diabetes mellitus.

Baris Afsar, Siren Sezer, Rengin Elsurer and Fatma Nurhan Ozdemir
Blood Pressure Monitoring, Vol 12(3): 133-139

Perceived Racism and Ambulatory Blood Pressure in African American College Students

Experiences with racial discrimination may contribute to stress-induced blood pressure (BP) elevations among African Americans. It was reported that perceived racism was associated with ambulatory BP (ABP) during waking hours. This study examined perceived racism and ABP among 40 African American college students, who completed an ABP assessment from which daytime and nighttime averages were computed. Perceived frequency of experiences with racism and racial discrimination was measured using the Perceived Racism Scale. Controlling for gender and body mass index, perceived racism in academic settings was associated with higher diastolic BP (DBP) during waking hours and nighttime sleep. Systolic BP (SBP) was unrelated to perceived racism, and perceived racism in the public realm and in statements from Whites was unrelated to ABP. Perceived racism in academic settings predicted ambulatory DBP among college students. Previous laboratory research has found stronger effects of perceived racism for DBP than SBP. The hemodynamic regulation of BP may explain this phenomenon. Future laboratory and ambulatory studies should assess the contributions of vascular resistance and cardiac output to BP elevations associated  with perceived racism.

Hill, LaBarron K., Kobayashi, Ihori, Hughes, Joel W.
Journal of Black Psychology 2007 33: 404-421

2006

Blood pressure (BP) as a biomarker for sorafenib (S), an inhibitor of the vascular endothelial growth factor (VEGF) signaling pathway.

Background: Hypertension is a commonly reported toxicity of agents that inhibit the VEGF signaling pathway (VSP). This new class of cancer therapeutics has broad activity, but optimal dosing methods and integration into established treatment regimens could be enhanced by identification of reliable biomarkers. S, a new treatment for advanced renal cell carcinoma, is an orally available inhibitor of multiple VSP kinases including Raf-1 and VEGFR2. To characterize the chronicity and interindividual variability of BP responses to VSP inhibition we collected serial, standardized measures of BP and concurrent steady-state plasma concentrations ([plasma]) of S, from 30 patients (pts).

Methods: Pts with advanced solid tumors, ECOG performance status < 2, and screening BP ≤ 140/90 mmHg on no more than one antihypertensive agent took 400mg S twice daily. Prior to therapy and at 3 time points after steady state [plasma] of drug was achieved, pts underwent 24-hour ambulatory BP monitoring with the SunTech Oscar PowerPack 2 (SunTech Medical, Morrisville, North Carolina). Readings were collected every 15 minutes during daytime hours and every 45 minutes overnight.

Results: Unweigthed mean and standard deviations (sd) of systolic (SBP) and diastolic (DBP) 24-hr BP measurements were calculated for each pt. for the sessions pre-therapy and when steady state [plasma] S was reached (between days 6–10 after starting treatment). The differences in mean BPs between the two sessions were compared with (and p values reported for) paired t-tests. Regression analysis of [plasma] of S with either DBP or SBP, or change in DBP or SBP, with main effect and interaction terms for albumin, age, and sex revealed no significant correlation between S [plasma] and BP response.

Conclusions: BP elevation is a biomarker for VSP inhibition. The known variability (coefficient of variation = 70%) in total S steady state plasma concentrations did not account for the observed variability in BP response.

M. L. Maitland, K. Moshier, J. Imperial, K. E. Kasza, T. Karrison, W. Elliott, S. D. Undevia, W. Stadler, A. A. Desai and M. J. Ratain
Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 24, No 18S (June 20 Supplement), 2006: 2035

A possible link between exercise-training adaptation and dehydroepiandrosterone sulfate- an oldest-old female study

The purpose of this study was to determine the association between the level of salivary dehydroepiandrosterone sulfate (DHEA-S) and the magnitude of adaptation to exercise training in insulin sensitivity for aged females. A group of 16 females, aged 80-93 years old, was divided into 2 groups according to their baseline DHEA-S levels: Lower Halves (N = 8) and Upper Halves (N = 8), and participated in a 4-month exercise intervention trial. Insulin response with an oral glucose tolerance test (OGTT), cholesterol, blood pressure (BP), motor performance, and DHEA-S were determined at baseline and 4 months after the training program. Glucose tolerance and body mass index (BMI) remained unchanged with training for both groups. Insulin, fasted cholesterol, diastolic blood pressure, reaction time, and locomotive function were significantly lowered by training only in the Upper Halves group. Changes in the area under curve of insulin (IAUC) were negatively correlated with the baseline DHEA-S level (R= - 0.60, P < 0.05). The current study provides the first evidence that oldest-old subjects with low DHEA-S level appear to be poor responders to exercise-training adaptations.

Yi-Jen Huang, Mu-Tsung Chen, Chin-Lung Fang, Wen-Chih Lee, Sun-Chin Yang, Chia-Hua Kuo
International Journal of Medical Science, 2006, Vol 3(4): 141 – 147

2005

Acute blood pressure responses in health adults during controlled air pollution exposures

Exposure to air pollution has been shown to cause arterial vasoconstriction and alter autonomic balance. Because these biologic responses may influence systemic hemodynamics, we investigated the effect of air pollution on blood pressure (BP) . Responses during 2-hr exposures to concentrated ambient fine particles (particulate matter < 2.5 µm in aerodynamic diameter ; PM2.5) plus ozone (CAP+O3) were compared with those of particle-free air (PFA) in 23 normotensive, nonsmoking healthy adults. Mean concentrations of PM2.5 were 147 ± 27 versus 2 ± 2 µg/m3, respectively, and those of O3 were 121 ± 3 versus 8 ± 5 ppb, respectively (p < 0.0001 for both) . A significant increase in diastolic BP (DBP) was observed at 2 hr of CAP+O3 [median change, 6 mm Hg (9.3%) ; binomial 95% confidence interval (CI) , 0 to 11 ; p = 0.013, Wilcoxon signed rank test] above the 0-hr value. This increase was significantly different (p = 0.017, unadjusted for basal BP) from the small 2-hr change during PFA (median change, 1 mm Hg ; 95% CI, -2 to 4 ; p = 0.24) . This prompted further investigation of the CAP+O3 response, which showed a strong association between the 2-hr change in DBP (and mean arterial pressure) and the concentration of the organic carbon fraction of PM2.5 (r = 0.53, p < 0.01 ; r = 0.56, p < 0.01, respectively) but not with total PM2.5 mass (r≤ 0.25, p≥ 0.27) . These findings suggest that exposure to environmentally relevant concentrations of PM2.5 and O3 rapidly increases DBP. The magnitude of BP change is associated with the PM2.5 carbon content. Exposure to vehicular traffic may provide a common link between our observations and previous studies in which traffic exposure was identified as a potential risk factor for cardiovascular disease.

Bruce Urch, Frances Silverman, Paul Corey, Jeffrey R. Brook, Karl Z. Lukic, Sanjay Rajagopalan, and Robert D. Brook
Environmental Health Perspectives, vol 113 (8): 1052 – 1055.

2004

Validation of the Oscar 2 oscillometric 24-h ambulatory blood pressure monitor according to the International Protocol for the validation of blood pressure measuring devices

Objectives: The accuracy of blood pressure measuring devices is of prime importance and should be validated before devices are used clinically. We carried out an independent evaluation of the OSCAR 2 oscillometric ambulatory blood pressure monitor (SunTech Medical model 222) according to the European Society of Hypertension International Protocol.

Methods: Adult subjects were recruited from patients and staff at The James Cook University Hospital, Middlesbrough, UK. Nine sequential same-arm blood pressure measurements were taken alternating between simultaneous readings by two independent, trained observers using mercury sphygmomanometers and the device operated by a third observer. In phase one, 15 subjects participated (five in each of the low, medium and high blood pressure ranges) with 18 subjects participating in phase two. Data from 33 subjects (11 in each of the three blood pressure ranges) were analysed for systolic (19 male, 14 female, mean age 56.0 years) and for diastolic (17 male, 16 female, mean age 51.1 years) blood pressure.

Results: The OSCAR 2 passed the first phase of the validation process. In phase 2.1, the OSCAR 2 monitor had 71 readings within 5 mmHg, 86 within 10 mmHg and 94 within 15 mmHg for systolic blood pressure (SBP) and 72 readings within 5 mmHg, 88 within 10 mmHg and 96 within 15 mmHg for diastolic blood pressure (DBP). Mean (±SD) differences between observers and device were 0.9±2.3 mmHg for SBP and -0.5±2.3 mmHg for DBP. In phase 2, 24 subjects had at least two of the differences within 5 mmHg and three subjects had no differences within 5 mmHg for SBP while for DBP 25 subjects had at least two of the differences within 5 mmHg and two subjects had no differences within 5 mmHg.

Conclusions: The OSCAR 2 passes all requirements for validation by the International Protocol and can be recommended for clinical use in an adult population.

Stephen C. Jones, Mary Bilous, Sue Winship, Paul Finn, and James Goodwin
Blood Pressure Monitoring, Vol 9(4): 219 - 223

Use of a mild sedative helps to identify true non-dippers by ABPM: a study in patients with diabetes mellitus and hypertension

Background: The interplay between the continuity or quality of sleep and diurnal variation in blood pressure has not been directly examined before. We examined the influence of a mild, non-hypotensive sedative on nocturnal dipping.

Design: This was a randomized, single-blind study.

Setting: The study took place in an out-patient clinic in an academic hospital.

Intervention: Zolpidem 10 mg or placebo was given randomly for the first or second night, and ambulatory blood pressure monitoring was instigated for 48 h.

Patients: The populuation under study comprised 96 male patients with type 2 diabetes mellitus and hypertension (mean age 54±6 years, mean blood pressure 158/94±9/6 mmHg).

Main outcome measure: Nocturnal dipping (nocturnal blood pressure ≥10% lower than daytime pressure) was found in 71% of the patients taking the sedative compared with 27% of those on placebo (P=0.001).

Results: On placebo, non-dippers and dippers had similar profiles of cardiovascular risk parameters. In contrast, non-dippers taking zolpidem had significantly higher values for most cardiovascular risk parameters compared with dippers: higher systolic blood pressure, higher low-density lipoproteins, lower high-density lipoproteins, higher serum creatinine, a higher urinary albumin : creatinine ratio, higher serum insulin and insulin resistance.

Conclusion: The use of a mild sedative during ambulatory blood pressure monitoring may help to identify the patients with a very high cardiovascular risk. These are the patients with a blunted nocturnal hypotension despite sedation.

Rachmani, Rita; Shenhav, Gilat; Slavachevsky, Inna; Levy, Zohar; Ravid, Mordchai
Blood Pressure Monitoring, Vol 9(1): 65-69

2003

Twenty-four hour ambulatory blood pressure monitoring pattern of resistant hypertension

Objective Ambulatory blood pressure monitoring (ABPM) is a tool to diagnose resistant hypertension (RH). The objective of this study is to describe the pattern of 24-h ABPM in patients using at least three anti hypertensive drugs without blood pressure (BP) control, classifying them as true RH or white-coat RH. Methods A cross-sectional study involving resistant hypertensives that were submitted to clinical, laboratory and 2D-echocardiographic evaluation. Ambulatory blood pressure monitoring was used to diagnose true or white-coat RH. The chi-squared test was used for comparisons among categorical variables and Kruskall-Wallis test for continuous ones. Results Of the 286 patients, 161 (56.3%) were classified as true RH and 125 (43.7%) as white-coat RH. Sex, age, office BP and the cardiovascular risk factors for both groups were similar. True resistant hypertensives had more target organ damage then white-coat resistant hypertensives; nephropathy (40.1 versus 23.9%, P=0.007) and left ventricular hypertrophy (83.3 versus 76.3%, P=0.05). In ABPM, the true RH group had a smaller nocturnal systolic and diastolic BP reduction (6.4 ′ 8.8 versus 9.8 ′ 7.5 mmHg, P=0.0004; 10.4′9.6 versus 13.6′9.2 mmHg, P=0.001) and 68.7% of them were non-dippers versus 49.6% in the white-coat RH group (P=0.001). True RH also had a larger 24 h pulse pressure (65.8′13.7 versus 51.5′10.0 mmHg, P < 0.0001). Conclusions Ambulatory blood pressure monitoring is a fundamental tool to diagnose RH, and to check treatment efficacy. The presence of a greater pulse pressure and a lower nocturnal blood pressure reduction in true RH patients may be responsible for this increased cardiovascular risk profile.

Muxfeldt, Elizabeth S.; Bloch, Katia V.; Nogueira, Armando R.; Salles, Gil F.
Blood Pressure Monitoring, Vol 8(5): 181-185