Hypertension blood pressure measurement

DW, a 78-year-old Caucasian man, presents to the emergency room with complaints of a headache persisting over the last 3 days. Repeated blood pressure measurements average 200/11 0 mm Hg. He reports no other symptoms and physical examination and laboratory tests are unremarkable as is his past medical history with the exception of hypertension diagnosed in his early 60s. DW reports that he is struggling on a fixed retirement income with no prescription coverage and takes "what I can afford." Blood pressure medications are carvedilol 25 mg twice daily, amlodipine 10 mg once daily, torsemide (Demadex )... 

Pickering TG, Hall JE, Appel LJ, et al. Part I blood pressure measurement in humans a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension 2005 45 142-161. 

Hypertension (in people without diabetes) is defined as a sustained systolic blood pressure of (SBP) of >140 mmHg, or sustained diastolic blood pressure (DBP) of >90 mmHg (Clinical Knowledge Summaries, 2007). Note Hypertension is considered to be sustained if an initial raised blood pressure measurement persists at two or more subsequent consultations). 

Julius S, Kjeldsen SE, Weber M et al. (2004). Outcomes in hypertensive patients at high cardiovascular risk, treated with regimens based on valsartan or amlodipine the VALUE randomized trail. Lancet 363 2022-2031 Kearney PM, Welton M, Reynolds K et al. (2005). Global burden of hypertension analysis of worldwide data Lancet 365 217-223 Keli S, Bloemberg B, Kromhout D (1992). Predictive value of repeated systolic blood pressure measurements for stroke risk. 

By the time you finish reading this book, you ll have a very good grasp of just what blood pressure and hypertension are. You ll learn that the ideal level is about 115/75. Those numbers reflect blood pressure measured in millimeters of mercury either in your doctor s office or with a home unit. The top number, the systolic, is the pressure of the major and minor arteries at the time the heart beats. The lower number, the diastolic, is a measurement of pressure while the heart is at rest. 

Most men and women have had their blood pressure measured at one time or another. But, bearing in mind that without knowing it, many individuals have either pressure above optimal levels or frank hypertension, if you haven t had a test lately, call your doctor s office and schedule an appointment. While you re there, it would be a good idea to have your cholesterol levels checked as well. Elevated cholesterol counts are not only a major risk factor for heart attack and stroke, in and of themselves, but they also predispose a person to developing hypertension. 

Late in 2004, the American Heart Association advocated home monitoring in its revised guidelines for blood pressure measurements, published in the February 2005 issue of the journal Hypertension. The lead author of that report. Dr. Thomas Pickering of Columbia University in New York, said, We ve found that blood pressure measurements taken by doctors in their offices may actually be unreliable in many patients. For that reason, there is wider acceptance of blood pressure readings taken by patients in their homes, and of ambulatory blood pressure monitoring. ... 

The mineralocorticoid properties of carbenoxolone are probably exerted by displacement of aldosterone from non-specific receptor sites in cells, thus making it more available to affect mineral metabolism. What this means in practice is that in normal doses carbenoxolone can cause salt and water retention, with occasional hypokalemia. These effects are common but usually mUd they are detected more often during treatment if patients are weighed, their blood pressure measured, and serum potassium concentrations checked. Those who take prolonged courses, elderly patients, and those with hepatic, cardiac, or renal impairment are at special risk severe effects, with serious hypertension, heart failure, and hypokalemia of sufficient degree to induce myopathy and tubular necrosis, can usually be ascribed to ill-advised treatment of people in whom carbenoxolone is contraindicated, to its use in elderly patients, or to prolonged intake without supervision. 

Hypertension, shortness of breath, dizziness, inability to concentrate, a loud palpable fourth heart sound, "thrusting" apical pulse, and hypertensive changes on fundal examination were reported in a 39-yr-old man who had taken various ginseng products for 3 yr (Hammond and Whitworth, 1981). His blood pressure measured 140/100 mm Hg on three occasions over 6 wk, and when referred for management of his hypertension it was 154/106 mm Hg. He was advised to discontinue the ginseng products, and 5 d later was normotensive at 140/85 mm Hg. At 3 mo follow-up, he remained normotensive and his other symptoms had resolved. No attempt was made to confirm the identity or composition of the ginseng products. 

A role for lead in hypertension gains further credence from epidemiologic studies of low-level lead exposure (i.e., exposure too low in intensity to produce the classic symptoms of acute lead poisoning). The Second National Health and Nutrition Examination Survey performed between 1976 and 1980 included blood lead and blood pressure measurements in almost... 

For the treatment of hypertension and angina, the initial oral dose generally is 40-80 mg/day, titrated upward until the desired response is obtained, typically at <320 mg/day. In hypertension, the full antihypertensive effect may not develop for several weeks. If propranolol is taken twice daily for hypertension, blood pressure should be measured just prior to a dose to ensure that the duration of effect is sufficiently prolonged. Adequacy of adrenergic blockade can be assessed by measuring suppression of exercise-induced tachycardia. 

There has not been any prior analytical investigation of the arterial stiffening theory of pseudohypertension. The low arterial comphance theory is tested in this chapter via a mathematical model of oscillometric blood pressure measurement. The computational model will be used to evaluate measurement error introduced by arterial disease or alterations in arterial mechanics in general. Once these errors are established, the model will then be used to investigate the means by which automated blood pressure monitor may detect the occurrence of pseudo-hypertension or provide a correction method by which blood pressure accuracy is unproved even in the presence of arterial disease. 

In the cuff pressure VS area model, the c parameter was still the source of error, especially for diastolic pressure. It caused pseudo-systolic hypotension and pseudo-diastohc hypertension. By comparing a large pulse to a small one, we noticed that the derivative went low in the high-pressure zone for the diseased artery and this did not happen for the normal artery therefore, we came up with a new rule that we call the oscillometry of false hypertension. At high blood pressure zone with the derivative less than 0.1, the artery is diseased and stiff, and it collapses easily. As mentioned earlier, the true measurement of the blood pressure should be independent of the arterial mechanics. However, in every modeling experiment, it was found that c was the source of error and its related plot was very different from the rest. Other parameters like a, b, and d did not change the accuracy of blood pressure measurement before and after normalization. Normalization did not even correct the inaccuracy caused by the c parameter. In the case of the diseased artery, the arterial stiffness did increase diastolic pressure by almost 8% (Table 12.2) and this was consistent with the theory of pseudo-hypertension. 

Kurtz TW, Griffin KA, Bidani AK, Davisson RL, Hall JE (2005). Recommendations for blood pressure measurement in humans and experimental animals (part 2 blood pressure measurement in experimental animals). Hypertension 45 299-310. 

Bunag, R.D., Butterfield, J. (1982). TaU-cuff blood pressure measurement without external preheating in awake rats. Hypertension. 4(6) 898-903. 

Jauhiainen, T., Vapaatalo, H., Poussa, T., Kyrdnpalo, S., Rasmussen, M., Korpela, R. (2005). Lactobacillus helveticus fermented milk lowers blood pressure in hypertensive subjects in 24-ambulatory blood pressure measurement. American Journal of Hypertension, 18, 1600-1605. 

O Brien E (2012) First Thomas Pickering memorial lecture ambulatory blood pressure measurement is essential for the management of hypertension. J CUn Hypertens (Greenwich) 14 836-847... 

Daskalopoulou SS, Rabi DM, Zarnke KB, Canadian Hypertension Education Program et al (2015) The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol 31 549-568... 

Viera AJ, Tuttle LA, Voora R, Olsson E (2015) Comparison of patients confidence in office, ambulatory, and home blood pressure measurements as methods of assessing for hypertension. Blood Press Monit 20 335-340... 

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