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Advice from the BP Measurement Experts

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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The Different Types of Blood Pressure Cuffs on the Market

Specialty CuffMost people think of a blood pressure (BP) cuff as simply, “just a cuff.” However, there are actually a number of BP cuffs that have been developed to meet the varying needs of patients and medical facilities. In an effort to shed more light on the different cuffs available for use, here is some detailed information on each type, how they are used and the typical environment in which each are used.

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SunTech Partner's Remote Patient Monitor Featured in the Economist

RDT logoWe love to highlight our partners’ achievements.  While some of these have been highly technical BP measurement endeavours in the pursuit of expanding scientific understanding such as experiments on the International Space Station or Mount Everest, the Economist trumpets one which may help anyone who travels by plane. Congratulations to our colleagues at RDT!

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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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Top 5 reasons your automated BP monitor gave an error code

The real problem is not whether machines think but whether men do.”  ~B.F. Skinner, Contingencies of Reinforcement, 1969

Sometimes, the more technology aims to help us, the more burden we take on to ensure it works. These days, automated blood pressure monitors are rapidly displacing mercury and aneroid sphygmomanometers in physician’s offices. As we move farther away from the 100 year old standard of listening for Korotkoff sounds to obtain a BP measurement, and towards the simple press of a button, there are a new set of usage factors that clinicians must remember when encountering problems.

Below is a list of the Top 5 reasons a clinician would encounter an error code when attempting to take an automated BP.

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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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Instrument Calibration Adds Error Potential in Manual BP Measurement

Blood pressure instrumentsIn previous posts, we have reviewed the 10 Steps to Accurate Manual Blood Pressure Measurement and 10 Factors That Can Affect Blood Pressure Readings.  As important as these details are, accurate measurement also requires two things:

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Blood Pressure Monitoring and Infection Control

Electron microscope imageInfection control has long been a hot topic for acute-care hospitals, and has been the focus of patient advocacy groups, the popular press, and legislators for some time. Old stories of sponges and instruments being left inside patients by harried doctors and nurses have been supplanted by nightmarish scenarios containing ominous-sounding names like Clostridium difficile and Methicillin-resistant Staphylococcus aureus. Unfortunately, for many patients in today's healthcare system, hypothetical scenarios and clinical studies have become a real matter of life and death. As a result, the spotlight is expanding to include other areas of the healthcare continuum-including long-term care facilities.

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Blood Pressure in your Medical Practice

SurveyThanks to the increasing concern regarding cardiovascular disease, blood pressure (BP) is one of the more well-known vital signs. Just about everyone has had their BP measured in a clinic. In the last few years, many track their own BP with the widespread availability and affordability of home monitors. Although experts in cardiology regard ambulatory blood pressure monitoring (ABPM) as the gold standard, it is not as frequently used in regular medical practice as in-office or home BP.
Each method has its benefits and disadvantages.

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Physician Acquired Blood Pressure Measurement is Higher than Nurse Acquired BP

Doctor takes patient's blood pressureThere are several different types of mild and/or episodic hypertension that ambulatory blood pressure monitoring (ABPM) can help a physician diagnose. However, the summary data that ABPM provides, the average daytime or 24-hour blood pressure as two examples, provides significantly different information than the one or two measurements taken in a clinic. Although this difference is one of the reasons that ABPM correlates better to cardiovascular outcomes than in-clinic BP, making it the gold standard for BP measurement, there are few detailed guidelines on the targets or thresholds for ABP like there are for in-clinic BPs like the popular 120/80 as a threshold for normal BP and 140/90 for hypertensive.*

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ASH 2010: A Focus on Improving Blood Pressure Measurement Technique

ASH logoAt the recent 25th annual scientific meeting for the American Society of Hypertension, there was a new program track targeted specifically to clinicians in primary care. The aim was to present the latest hypertension strategies and guidelines in a format that would be appropriate for the primary care physician but also for physician's assistants, nurse practitioners as well as seasoned hypertension specialists. While the session covered various current issues related to hypertension, one clear area of attention was a re-focus on blood pressure measurement methods.

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Damec Uses SunTech OEM NIBP Technology in Space

ABPM in the ISSSunTech Medical has had a long association with space research. Our first ambulatory blood pressure monitor, the Accutracker, and our stress BP monitor, Tango; have been used onboard the NASA space shuttle as far back as 1988. That association continued last year through an OEM partnership with advanced technology company, Damec.

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Ambulatory Blood Pressure Monitoring

Dr. William White interview video

An interview with Dr. William White from the 25th American Society of Hypertension Scientific Meetings

Over the course of the most recent American Society of Hypertension (ASH) Meetings held in New York City May 1 - 4th, outgoing ASH President Henry Black, MD had an opportunity to interview incoming ASH President William White MD. While their discussion covered many topics related to blood pressure monitoring, the focus was on ambulatory blood pressure monitoring (ABPM) and when and how to use it. This interview has been made available for viewing through WebMD's Medscape Cardiology page.

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International Hypertension Report Calls for Increased Awareness of Childhood Hypertension

Girl listening to teddy bears heartWe’ve already discussed how hypertension is a costly drain on worldwide health care systems and society in general, but this cost is only based on adult hypertension.  A recently published report advocates improving the awareness, identification, and treatment of pediatric hypertension and clearly describes the implications of continuing to neglect this problem in the pediatric population.  The prevalence of hypertension in children is about 3-5% of the population, but as obesity continues to rise in children, high blood pressure will likely increase making it even more important to raise the awareness of pediatric hypertension.

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CMEF 2010: China and Growing Awareness of Hypertension

SunTech Medical at CMEF 2010Earlier this year we wrote a blog post about the similarities of current healthcare challenges in both China and the US. Of particular note was the fact that Hypertension is the leading cause of premature deaths in China. We recently had an opportunity to meet and speak with many folks involved with the delivery of healthcare in this rapidly evolving market at the China Medical Equipment Fair (CMEF) held in Shenzhen April 18 - 21, 2010.

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