Study On Basic Issues Of Hypertension

Objective:It is recommended that the cuff should be wrapped around the upper arm with the midline of the bladder placed over the brachial artery during blood pressure measurement.However,in practice,the cuff of sphygmomanometer is often incorrectly placed.We aimed to assess the effect on the accuracy of blood pressure measurement as to the placement of the cuff bladder by using automated oscillometric sphygmomanometer.Methods:We enrolled patients who were admitted to the Department of Cardiology,Second Hospital of Hebei Medical University.All the participants were 18 years or older.The center of the cuff bladder was placed directly over the brachial artery as the standard position(correct position),which was rotated by 90°medially(medial position),90°laterally(lateral position),and rotated by 180°(contralateral position),respectively.The four cuff positions were numbered and the order of measurement was randomly determined by a lottery.A validated and calibrated oscillometric device was used to measure non-invasive brachial blood pressure.We took blood pressure measurements three times at each cuff position,with a 1-minute interval between each measurement.An arteriosc-lerosis diagnostic device was used for measuring brachial-ankle pulse wave velocity(ba PWV),and the ankle-brachial index(ABI).The higher value of the two sides for ba PWV and the lower value of the ABI were analyzed.Results:Of the 799 participants who were recruited from the Department of Cardiology,451(56.4%)were men.The mean age was 60.37 years(standard deviation,SD:12.73),and 380(47.6%)had hypertension.The mean(SD)height,weight,and body mass index were 166.24(7.84)cm,69.44(10.64)kg,and 25.10(3.27)kg/m~2,respectively.There were no significant differences in both systolic blood pressure(SBP)and diastolic blood pressure(DBP)among the four cuff positions in all the participants(SBP:P>0.05;DBP:P>0.05),and the mean blood pressure differences between the incorrect and standard cuff positions were within 1.0mm Hg.Blood pressure of the incorrect positions was positively correlated with that of the standard position(SBP:P<0.001,r>0.90;DBP:P<0.001,r>0.85),and showed good consistency.Based on age(<65,≥65 years old),SBP in the standard cuff position(<120,120–139.5,140–159.5,and≥160mm Hg),pulse pressure in the standard cuff position(20–39.5,40–59.5,60-79.5,and≥80mm Hg),ba PWV(≤1400,>1400cm/s),the ABI(≤0.9,>0.9),and the history of hypertension for subgroup analysis,there were no significant differences in both SBP and DBP among the four locations(SBP:P>0.05;DBP:P>0.05).Blood pressure of the incorrect positions was positively correlated with that of the standard position(SBP:P<0.001,r>0.78;DBP:P<0.001,r>0.78),and showed good consistency in each subgroup.Conclusions:There was no effect on the accuracy of blood pressure measurement as to the location of the midline of cuff bladder by using an oscillometric sphygmomanometer with a conventional cuff.Besides,we made subgroup analysis on age,SBP at the standard cuff position,pulse pressure at the standard cuff position,ba PWV,the ABI,and the history of hypertension,and found no significant difference of blood pressure measured on the four cuff positions in each subgroup.Objective: It is recommended that the cuff of sphygmomanometer should be wrapped around the upper arm with the midline of the cuff bladder placed over the brachial artery during blood pressure measurement.However,we cannot strictly follow the guidelines of blood pressure measurement.In practice,the cuff of sphygmomanometer is often incorrectly placed.At present,there is no clear conclusion about the influence of this kind of non-standard clinical practice on blood pressure measurement,especially for the patients in the intensive care unit.We aimed to assess the effect on the accuracy of blood pressure measurement as to the placement of the cuff bladder by using an oscillometric device.Furthermore,we compared noninvasive blood pressure with invasive blood pressure.Methods: Participants who underwent non-invasive brachial blood pressure and radial intra-arterial blood pressure measurement were patients who were admitted to the Department of the intensive care unit,Second Hospital of Hebei Medical University.We included patients who were 18 years or older.The center of the cuff bladder was placed directly over the brachial artery as the standard position(correct position),which was rotated by 90°medially(medial position),90°laterally(lateral position),and rotated by 180°(contralateral position),respectively.The four cuff positions were numbered and the order of measurements was randomly determined by a lottery.We took blood pressure measurements three times at each position,with a 1-minute interval between each measurement.The average value of the second and third measurements was recorded as the blood pressure value of the particular cuff position.The radial intra-arterial blood pressure was recorded before and after each non-invasive brachial blood pressure measurement,and the average value of the six recorded values was used as the invasive blood pressure value at the particular position.Results: Of the 104 participants recruited from intensive care unit who underwent radial artery catheterization to monitor radial intra-arterial blood pressure,63(60.57%)were men.The mean age was 57.78 years(SD:15.89).There were also no significant differences of non-invasive brachial blood pressure among the four previously described cuff positions in the intensive care unit patients(SBP: P=0.10,DBP: P=0.55),and the mean blood pressure differences between incorrect and the standard cuff position were within 5.0mm Hg.Blood pressure of the incorrect positions was positively correlated with that of the standard position(SBP: P<0.001,r>0.67;DBP: P<0.001,r>0.81),and showed good consistency.With regard to intra-arterial blood pressure variability,fluctuation in mean SBP was 22.36±15.82 mm Hg,the maximum value was 71 mm Hg,and the minimum value was 4 mm Hg.These values for DBP were 12.76±8.82,40,and 2mm Hg,respectively.Fluctuation in mean SBP in stable patients was 12.32±5.55 mm Hg,the maximum value was 26 mm Hg,and the minimum value was 4mm Hg.These values for DBP were 8.37±5.19,34,and 2mm Hg,respectively.Conclusions: There was no effect on the accuracy of blood pressure measurement as to the location of the midline of the cuff bladder by using an oscillometric device with a conventional cuff.The effect caused by the change of the cuff position is less than that of natural variation during blood pressure measurement.Objective: It is recommended that blood pressure should be measured on a bare upper arm with an appropriately sized cuff.However,in practice,it is more convenient and practical to measure blood pressure on sleeved arms.We examined the effect of sleeved arms on the accuracy of blood pressure measurement.Methods: We enrolled patients who were admitted to the Department of Cardiology,Second Hospital of Hebei Medical University.All the participants were 18 years or older.Participants underwent three blood pressure measurements in each of the following conditions in random order(bare arm;arm covered with a single-layer cotton shirt sleeve,1mm;arm covered with two layers sleeve containing cotton shirt and polar fabric sweater,3mm;arm covered with two layers sleeve containing cotton shirt and thick cardigan,4mm).Blood pressure under each sleeve condition was measured three times,with a 1-minute interval between each measurement,and the average value of the second and third measurements was recorded as the blood pressure value of the particular condition.Results: Of the 300 participants,155(52%)were men.The mean age was 62.9 years(SD:10.70),and 226(75%)had hypertension.There were no significant differences in both SBP and DBP among the four sleeve conditions in all the participants(SBP: P>0.05;DBP: P>0.05),and the mean blood pressure differences between measurements made on the sleeved arms and bare arm were within 1.0mm Hg.Blood pressure of sleeved arms was positively correlated with that of the bare arm(SBP: P<0.001,r>0.95;DBP: P<0.001,r>0.90),and showed good consistency.Based on sex(male,female),age(<65,≥65 years old),SBP measured in bare arm(<120,120–139.5,140–159.5,and ≥160mm Hg),pulse pressure(<60,≥60mm Hg),and the history of hypertension for subgroup analysis,there were no significant differences in both SBP and DBP among the four sleeve conditions in each subgroup(SBP: P>0.05;DBP: P>0.05).Both SBP and DBP of sleeved arms were positively correlated with the bare arm(P<0.001,r>0.80;P<0.001,r>0.80),and showed good consistency with the bare arm in each subgroup.Conclusions: There was no significant effect of sleeved arms on the accuracy of blood pressure measurement by using an automatic oscillometric device equipped with a conventional cuff.Besides,we made subgroup analysis on sex,age,SBP measured on the bare arm,pulse pressure,and the history of hypertension,and found no significant difference of blood pressure measured on sleeved arms compared with the bare arm in each subgroup.Objective: Hypertension treatment depends on the diagnostic criteria of hypertension.Although with the update of the guidelines,the threshold for the diagnosis of hypertension is gradually lowered.However,it is logically impossible to cover all patients with a single threshold.Even after the blood pressure reaches the goal,there are still residual cardiovascular risks,which inspires us to reconsider the individualized diagnosis of hypertension.Based on the distribution and composition ratio of nurses’ blood pressure,as well as the basic characteristics of nurses with low blood pressure(≤90/60 mm Hg),this study explored the individualized diagnostic criteria for hypertension and its significance.Methods: A census method was used to investigate blood pressure and related factors among registered nurses in Hebei Province.Collect subjects’ sex,age,height,weight,the history of hyperlipidemia,diabetes,and hypertension,family history of hypertension,history of daily life(smoking,drinking,and participation in exercise and fitness activities),average monthly night shift frequency in the past six months,and blood pressure values.Frequency distribution tables were made,and the basic characteristics of nurses with low blood pressure were analyzed.Results: A total of 128,009 registered nurses completed the survey.The ages ranged from 18 to 65 years old,the distribution range of SBP was from 70 to 250 mm Hg,and 30-180 mm Hg for DBP.There are 10,106 nurses with low blood pressure(≤90/60 mm Hg),and they are mainly young and middle-aged women,mostly thin or normal body mass index,no diabetes and hyperlipidemia,no history of smoking,less alcohol consumption and participation in exercise and fitness activities.According to the diagnostic criteria for perioperative hypertension,a low blood pressure(≤90/60 mm Hg)raised to 108-117/72-78 mm Hg was diagnosed as hypertension,which is still 23-32/12-18 mm Hg lower than 140/90 mm Hg.Conclusions: The blood pressure of nurses is widely distributed,and individualized diagnosis of hypertension is of great significance.Take the blood pressure at 12 years old as the individual’s baseline blood pressure,and take 20% higher than baseline blood pressure,and the typical symptoms,signs,or target organ damage caused by elevated blood pressure,as the individualized diagnostic criteria for hypertension.