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Advice from the BP Measurement Experts

Cardiologists, Choose Your Weapons Wisely!

heart wrenchWhen all else fails, keep it simple. Isn’t this what we have been told since childhood? It seems that some cardiologists have gone back to this basic philosophy when it comes to diagnosing heart disease. Dr Martha Gulati, a cardiologist at the Ohio State Wexner Medical Center where she specializes in women’s heart disease, says that it is “simple stuff” like an exercise stress test that can “catch blockages and predict hypertension” that other more high-tech tests sometimes miss. She says that using an exercise stress test in a recent case allowed her to “find significant disease” that other tests like an MRI completely missed.

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Beat Down Blood Pressure Video Challenge

BP Beat Down Video Challenge With May being High Blood Pressure Awareness month, The Office of the National Coordinator for Health Information Technology (ONC) in partnership with Million Hearts (an HHS initiative) are holding a video challenge where folks share how they are using technology to help achieve and manage blood pressure control.

Contestants are asked to create short (<2 minutes long), compelling videos that illustrate how they are using health IT or other e-health tools to measure their BP, take their BP medications as prescribed and to maintain a healthy lifestyle that helps keep their blood pressure in control.

For more information, to submit your own video entry or to vote for your favorite, please visit:

http://bloodpressure.challenge.gov/

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Study Shows Off-Roading Can Improve Blood Pressure

ATV could help lower bpLooking for a good excuse for some outdoor adventure? A clinical study published in the European Journal of Applied Physiology found that regularly riding motorized off-road vehicles, like ATV's and dirt bikes, can improve health-related fitness, improve quality of life, and even reduce blood pressure. It goes without saying that for speed-crazed gearheads, tearing around the countryside like a banshee is fun. But who knew that it could also be so...well...healthy? As for me, I think a new ATV is just what the doctor ordered. Happy trails, everyone!

 

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You’re Doing It Wrong: New Study on BP Measurement

Taking Innacurate BP A new study1 published in the Journal of Clinical Hypertension has reached the conclusion that when it comes to proper blood pressure (BP) measurement technique, most clinicians just aren’t very good at it. According to the authors, Minor et al, the purpose of the study was to “assess BP measurement accuracy and the level of adherence to recommended techniques throughout a large academic health science center.” As it turns out, the results were poor on both fronts and their statistical analysis indicates that technique does indeed impact accuracy.

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Deflating Expectations

deflateWe’ve written quite a bit here on the SunTech blog about BP technique. And guess what? We’re going to talk about it again! Maybe it’s not the most fascinating topic in the world of non-invasive blood pressure, but I think there are few as important to the successful treatment of high blood pressure. I must not be the only one, because studies that look at blood pressure technique continue to be published at a pretty good clip.

One of the more recent ones is aptly titled, “Blood Pressure Monitoring Technique Impacts Hypertension Treatment”. Authored by Ray et al and published in the Journal of General Internal Medicine, this study compared the way that BP’s are normally taken during triage check-in on a population of 40 patients at the New Mexico Hospital Adult Internal Medicine Clinic. A study investigator observed the technique used by the clinician, and then took the patient’s BP using the AHA recommendations for blood pressure measurement published in 2005.

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Speculation over implementation of NICE Guidelines on ABPM begins

nice-guidelines-abpmThree months ago, the National Institute for Health and Clinical Excellence (NICE) in the UK released new guidelines for managing hypertension in adults. The new recommendations call for the use of Ambulatory Blood Pressure Monitoring (ABPM) to confirm a diagnosis of hypertension when a patient has a clinic BP reading of 140/90 mmHg or above. One of the major questions raised was how this would be implemented.

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Has My Physician Measured My BP in Both Arms?

Doctor taking a BP measurementThat’s the question I pondered while reading an article published earlier this year in the American Journal of Hypertension. In the article “Blood Pressure Measurement Method and Inter-Arm Difference: A Meta-Analysis,"* the authors reviewed studies where BP was measured in both the left and right arm of subjects. The results showed that on average, Systolic pressures differ by 5.4 mmHg between arms while Diastolic pressures showed an average inter-arm difference of 3.6 mmHg.

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Hypertension Diagnosis: Be confident and save money with an ABPM Study

Be confident with an ABPM studyHypertension is a prevalent condition globally and is quickly becoming a focus in the U.K., with particular emphasis on how to best diagnose the condition. In August, a study comparing blood pressure (BP) measurement methods, which was funded by the U.K.’s National Institute for Health and Clinical Excellence (NICE), was published on the same day that NICE announced the release of its new guidelines for hypertension management in adults.

In the study, Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study, the research found that “ambulatory monitoring is cost effective compared with further monitoring in the clinic or home for confirming the diagnosis of hypertension” for all age and gender groups considered. Specifically, ABPM provided cost savings ranging from £56 in men aged 75 years to £323 in women aged 40 years (Equivalent to $89 and $511 respectively). Additionally, it was determined that ambulatory blood pressure monitoring (ABPM) “resulted in improved health outcomes for male and female age groups older than 50.”

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In-Office Ambulatory Blood Pressure Monitoring: Could it replace traditional office BP assessment?

traditional doctors officeThat’s just the question Dr. Mark C. van der Wel and colleagues sought the answer to in an article published in the Annals of Family Medicine. As we at SunTech have mentioned in previous posts, two of the most prevalent problems with traditional in-office blood pressure assessment is improper observer technique and the white-coat effect.  As a way to overcome this, the authors developed a method of taking a series of in-office automated oscillometric blood pressure readings for 30 minutes by utilizing an ambulatory blood pressure monitor (ABPM) and compared those results with mean daytime ABPM results.

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Let's Bring in the New Year in Moderation

BP and alcoholAlthough some people like to “indulge” in alcoholic beverages to help bring in the New Year, you may want to take it easy if you have high blood pressure.  While it is common knowledge that high blood pressure increases your risk of cardiovascular diseases and that excessive drinking is not beneficial to your body; the combination of the two may be double trouble.

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The Psychology vs the Science of Blood Pressure

guessHave you ever been to a "Guess your age" booth at an amusement park?  If you are able to fool the person guessing the age of passers-by within a couple of years you win a stuffed animal or toy. Well believe it or not, clinicians occasionally do this to their patients.  Not for age, but for blood pressure.  Glenn Nyback, an EMT teacher, recounts a personal experience from one of his classes:

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Watching Your Favorite Sports May Be Bad for Your Blood Pressure

sports fan blood pressure riseHave you ever caught yourself yelling at the television when your favorite team drops a touchdown pass in the end zone or makes a fielding error late in the game?  We’re all guilty of it.  However, I feel obligated to share some bad news.  First, the coaches and players cannot hear you from the confines of your living room, and second, research shows that there is a direct link between spectator sports and an increased risk of cardiovascular (CV) events.  Dr. Franklin Zimmerman, from Phelps Memorial Hospital Center, recently published an article in the Journal of Clinical Hypertension investigating the blood pressure (BP) and heart rate (HR) response of baseball and football fans both before and during games.

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Does Your New Physician Make Your Blood Pressure Rise

High Blood Pressure MeasurementA recent article in the Journal of Clinical Hypertension does a colorful yet effective job of describing the transient effects of White Coat Hypertension (WCH) when meeting  a new physician.  Studies show that patients who are not hypertensive but show high BP readings when visiting a new doctor for their first time can continue to present with these elevated BP readings for three to six visits.  Although treatment for hypertension based on these measurements is not recommended, the gold standard diagnostic test for WCH, a 24-hour study with an ambulatory blood pressure (ABP) monitor, can more effectively determine whether treatment is, in fact, needed.

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Implantable blood pressure monitors: Science fiction or reality?

blue waveformAt SunTech Medical, we’re always thinking about blood pressure (BP) and how current measurement tools and techniques might be improved. In many ways, “routine” blood pressure measurement hasn’t changed much over the last 100 years. But innovative tools like ambulatory blood pressure monitoring (ABPM) have helped us learn about the importance of masked hypertension, overnight dipping, and blood pressure variability, their impact on clinical outcomes, and the subsequent guidance of hypertension treatment.

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Masked Hypertension: What You Don't Know Could Kill You!

Masked hypertensionWhite-coat hypertension is a familiar term to most clinicians.  Patients with white-coat typically have elevated blood pressure measurements in the clinician’s office, but display normal BP measurements in their everyday environment.  The prevalence of white-coat hypertension varies from 15% to 20% of patients.  Conversely, there is another group of individuals whose hypertension often goes unnoticed by traditional methods of BP measurement.  These patients have normal in-office BP but elevated out-of-office BP.  This phenomenon is referred to as “masked hypertension” and is defined as having in-office BP < 140/90 mm Hg but daytime ambulatory or home BP ≥ 135/85 mmHg.

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Automated BP vs Manual BP Measurement: Which is Better? (Part 2 of 2)

Doctor, nurse, and patientIn my last post, I discussed the importance of informed debate in helping determine effective clinical practice. Specifically, I mentioned two recent journal articles about automated oscillometric blood pressure devices that arrived at two different conclusions. In that post I also provided some comments from the SunTech perspective. Today, I’ll share the perspectives of an experienced, practicing physician on the subject of automated BP devices versus manual sphygmomanometers.

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Automated BP vs Manual BP Measurement: Which is Better? (Part 1 of 2)

Automated or manual BP debateWhat’s a clinician to do? Debates about clinical trials, patient populations, and statistical analyses can seem hollow and distant when looking at an anxious patient in an exam room. At that moment, all that matters is what’s best for your patient. Yet clinically relevant data, and more importantly, rigorous discussion of that data, is the means to the end. Professional clinicians quite often need the former in order to effectively deliver the latter. To wit, two similar journal articles were recently published that arrived at two very different conclusions. Let’s take a look:

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Correctly Diagnosing High BP In Children: Help Needed!

Child Having His Blood Pressure Measured

(Update 6/10/15: The video referenced in this article is no longer available)

We recently came across a video report that originally appeared shortly after an article on the underdiagnosis of hypertension in children and adolescents was published in the August 2008 issue of the Journal of the American Medical Association (JAMA). The focal point of the report was the fact that 3 out of every 4 children who have high blood pressure have not been correctly diagnosed with the condition. This certainly would prompt the question “Why not?”

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Canadian Blood Pressure Study of Obese Children Yields Unexpected Results

Child on scaleA recent Canadian blood pressure study discovered that high blood pressure does not directly correlate with the rising obesity rate in pediatric patient populations.  Contrary to expected research outcomes, while most pediatric patients (ages 6-19) with high blood pressure were obese, not all overweight adolescents (a mere 3%) suffer from high blood pressure.

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Guidelines for Ambulatory Blood Pressure Monitoring in Children

Child patientHaving covered the recently rising awareness of childhood hypertension, we thought it appropriate to highlight the guidelines of using ambulatory blood pressure monitoring (ABPM) in children. The American Heart Association has published comprehensive recommendations on this topic...


 

...Which can be found here.  Additionally, separate commentary by Dr. Bruce Alpert, one of the contributing authors, can be found on the SunTech White Papers section.

In some ways, the guidelines for its use on children is not so different than for adults.  However, you should be aware of the following nuances:

  • Check the monitor’s qualification: While clinical validation to the US standard (AAMI) and to the British standard (BHS) are mandatory before a product is allowed on the market, an ABPM specifically needs to be validated for use on children and adolescents.  Make sure to inquire with the manufacturer or representative that the ABPM has been tested to and passed the validation with children as subjects.
  • Use equipment tuned for children: The ABPM should be lightweight, small, quiet, and well-protected when it is worn by the child.  More importantly, an appropriately-sized cuff must be used.
  • Use ABPM software that analyzes children’s BP readings according to the previously discussed thresholds based on age, gender, and height.

The AHA statement goes into significantly more detail.  However, the three guidelines above are the most important to successfully using ABPM on children in a medical practice.

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