Meaning When First Blood Pressure Reading Is Higher Than Second

J Hypertens. Author manuscript; available in PMC 2010 Sep 19.

Published in concluding edited form every bit:

PMCID: PMC2941726

NIHMSID: NIHMS233354

What is the optimal interval between successive home blood force per unit area readings using an automated oscillometric device?

Kazuo Eguchi

^a Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical Academy, Tochigi, Japan

Sujith Kuruvilla

^b Eye for Behavioral Cardiovascular Health, Columbia University Medical Middle, Columbia Academy Medical College, New York

Gbenga Ogedegbe

^b Center for Behavioral Cardiovascular Health, Columbia University Medical Eye, Columbia University Medical Higher, New York

William Gerin

^b Center for Behavioral Cardiovascular Wellness, Columbia University Medical Center, Columbia University Medical Higher, New York

Joseph E. Schwartz

^c Department of Psychiatry and Behavioral Science, Stony Brook Academy, Stony Beck, New York, U.s.

Thomas G. Pickering

^b Eye for Behavioral Cardiovascular Health, Columbia University Medical Middle, Columbia Academy Medical College, New York

Abstract

Objectives

To clarify whether a shorter interval between iii successive dwelling claret pressure level (HBP) readings (ten s vs. ane min) taken twice a day gives a better prediction of the average 24-h BP and better patient compliance.

Blueprint

We enrolled 56 patients from a hypertension dispensary (mean age: sixty ±14 years; 54% female patients). The study consisted of three clinic visits, with two 4-calendar week periods of self-monitoring of HBP between them, and a 24-h ambulatory BP monitoring at the 2nd visit. Using a crossover pattern, with order randomized, the oscillometric HBP device (HEM-5001) could exist programmed to take three consecutive readings at either x-s or one-min intervals, each of which was washed for 4 weeks. Patients were asked to measure out three HBP readings in the morning and evening. All the readings were stored in the memory of the monitors.

Results

The analyses were performed using the second–3rd HBP readings. The average systolic BP/diastolic BP for the 10-southward and i-min intervals at home were 136.1 ±15.8/77.5 ±nine.5 and 133.2 ±15.5/76.ix ±9.iii mmHg (P = 0.001/0.19 for the differences in systolic BP and diastolic BP), respectively. The 1-min BP readings were significantly closer to the average of awake convalescent BP (131 ±14/79 ±10 mmHg) than the ten-s interval readings. At that place was no pregnant departure in patients' compliance in taking acceptable numbers of readings at the different time intervals.

Conclusion

The i-min interval between HBP readings gave a closer agreement with the daytime boilerplate BP than the 10-southward interval.

Keywords: convalescent BP monitoring, home BP, measurement interval, multiple BP measurements

Introduction

Dwelling house claret pressure (HBP) measurement is increasingly used in clinical practice. A number of studies and reviews [1] have demonstrated that dwelling BP is superior to dispensary BP in its reproducibility [2–4], for predicting target organ impairment [5–7] and future cardiovascular events in general populations [eight,nine], hypertensive patients [10], and patients with kidney disease [xi]. The international BP guidelines for the use of domicile BP [12–14] have stated that when a series of readings is taken, a minimum of 2 readings should be taken at intervals of at least 1 min, and the average of those readings should exist used to represent the patient's claret force per unit area.

Almost of the currently bachelor abode monitors take only i reading when the device is triggered, but the latest generation of monitors will take multiple readings automatically at fixed intervals. However, doing this will take longer than taking a single reading, raising the possibility that compliance with the procedure will exist less. Although an interval of 1 min between readings has been recommended, there is some show that an interval of less than 15 due south may exist as accurate as the conventional ane-min interval [15,sixteen]. All the same, these studies were performed in clinical settings by trained research staff. Alternatively, in that location is the possibility that taking multiple BP measurements at shorter intervals is less authentic because of hyperemia of the upper arm [17], which has been investigated during measurements fabricated with the Korotkoff method, and this may exist the source of the recommendation to expect at to the lowest degree 1 min between measurements. In addition, it has been observed that in that location is a progressive fall of BP with multiple readings, the extent of which varies co-ordinate to the interval between successive readings. At the present time, there have been no studies comparing the feasibility and accuracy of short time intervals with the more conventional ane-min interval for readings taken by oscillometric home monitors. Nosotros performed this study to test the hypotheses that repeated oscillometric home BP measurement using 10-south intervals are equally authentic as those using the conventional 1-min intervals; and patient compliance is better when x-s intervals are used.

Methods

Patients were recruited from the hypertension clinic at Columbia University New York-Presbyterian Infirmary. The inclusion criteria were a diagnosis of known or suspected hypertension, and, if treated, having been on a stable dose of medication for at least 1 month with no plan to alter handling for the adjacent 2 months. 40-two out of 56 patients were taking antihypertensive medications. Patients with major arrhythmias or with arm circumference greater than 40 cm were excluded. The following variables were assessed at the initial visit: age, sex, race, trunk mass index, history of cardiovascular disease, and handedness. Arm circumference was measured, and the advisable cuff size was selected [12].

Clinic BP measurements

Dispensary BP was measured at baseline and at the 4th and 8th week visits. Patients saturday quietly with their backs supported, without crossing their legs, and with both arms supported at heart level for 5 min before the measurements were fabricated. Clinic BP was measured with auscultation by a doc (three readings) using a mercury sphygmomanometer and by an automated BP monitor [Omron HEM-5001 (Kyoto, Nippon), the dwelling monitor used in the study] with three readings at 1 min intervals, giving a total of six clinic readings at each visit. The sequence of the clinic BP measurements was randomly assigned at each visit. Thus, each of the two types of clinic BP measurements used in the analysis described beneath was based on the average of nine readings (three on three occasions over an 8-calendar week period) taken under rigorously standardized conditions.

Home BP measurement

The HBP monitor used for this study was an Omron HEM-5001 device, which can be set up to automatically accept iii readings, at either 10-s or 1-min intervals. Although this device has not been subjected to a formal validation test, information technology uses the aforementioned algorithm as the HEM-737, which has passed the Association for the Advancement of Medical Instrumentation (AAMI) validation protocol [18]. Patients were given a HBP monitor and instructed in its use. They were instructed to measure out habitation BP afterward a 5 min balance. It was preset by the investigators to take 3 readings at either 10-due south or 1-min intervals, based on random assignment, for the initial iv-week home monitoring period. The 1-min (or 10-due south) interval was between the end of the first reading and the offset of the next reading. They were asked to measure forenoon HBP and evening HBP on at least 4 days/week for eight weeks. The measurement results (appointment, time, BP, and pulse charge per unit) were automatically stored in the retention of the monitor. Patients were asked to visit the investigator'south office at the fourth and 8th week and bring the monitor, at which times the data were uploaded to a estimator. At the 4th calendar week visit, the interval setting of the home monitor was inverse by the inquiry staff from ane min to 10 s (H1 group) or from 10 s to 1 min (H2 group).

Ambulatory BP measurement

Convalescent BP (ABP) measurement over 24 h was performed at the second visit. Patients were asked to keep a diary that included the time of going to bed, waking-upwards, meals, and other events. ABP monitoring was performed with a Spacelabs 90207 device (SpaceLabs Medical, Inc., Redmond, Washington, Usa). Claret force per unit area was measured every fifteen min betwixt 0700 and 2300 h and every 30 min during the night. Patients were asked to transport the device and diary dorsum to the investigator'due south office after completion of ABP monitoring. The average awake and sleep ABP value were calculated based on the patients' diaries. This study was canonical by the Institutional Review Board of Columbia University, and written informed consent was obtained from all participants.

Statistical analyses

Nosotros used the mean of the start–second, 2d–third, and the kickoff–3rd readings for the analyses of the domicile BPs. BP readings labeled as 'morning' and 'evening' were used as morning and evening readings, but BP measurements taken at other times were excluded from the analyses. The averages and the differences betwixt home BP readings taken at 10-s and 1-min intervals were compared using paired t-tests. Morn and evening BP readings were combined when 10-s and 1-min intervals were compared and when home BP was compared with clinic BP or ABP measures. The associations between home BP, clinic BP and ABP were compared using the intraclass correlation coefficient (ICC) for agreement [19]. For all analyses, a significance level of P value less than 0.05, ii-tailed, was used. The preliminary information processing of the HBP and ABP information was performed in SAS 9.i (SAS Institute, Research Triangle, North Carolina, USA). All statistical analyses were performed with SPSS, 13.0 (SPSS, Inc., Chicago, Illinois, U.s.a.).

Results

Initially, 57 consecutive patients seen in the hypertension clinic were enrolled for the study. Because one patient withdrew from the study at the 2d visit, 56 patients completed the report protocol. As shown in Table 1, the hateful age of the patients was 60 years, two-thirds were White, and 75% were on antihypertensive treatment. Office BP level measured past the HEM-5001 (131 ±15/76 ±9 mmHg) was similar to awake BP (131 ± xiv/79 ±10 mmHg), but dwelling BP average (135 ±15/77 ±nine mmHg) calculated by both 10 and 1-min intervals) was higher than part and awake ABP. The average of all three successive readings (first to third), beyond morning and evening assessments, was 136/78 mmHg, the average of the showtime and second readings was 137/78 mmHg, and the boilerplate of the second and tertiary readings was 135/77 mmHg when they were calculated by the average of both measurement intervals. Effigy one shows the differences among the 3 consecutive dwelling house systolic BP readings in the morn, separately for the data assessed at ten-s and 1-min intervals. At both sampling intervals, the second readings were significantly lower than the first readings, and the third readings were significantly lower than the beginning and the second readings. The like trends were observed for forenoon diastolic BP (DBP) and evening systolic BP (SBP)/DBP.

Changes of morning BP by measurement times and a comparing of habitation systolic BP in the morning across three consecutive readings taken at ten-southward vs. 1-min intervals. *P <0.001 vs. first readings, ^† P <0.001 vs. second readings.

Table 1

Baseline characteristics

Variables	Average or percentage
Number of patients	56
Historic period (years)	threescore.0 ±14.iv
Sex [number (%) of men]	26 (46.4%)
White race (%)	34 (60.7%)
Body mass alphabetize (kg/grand2)	26.6 ± six.four
Diagnosed hypertension (%)	51 (91.1%)
History of hypertension (years)	8.3 ± 9.1
On antihypertensive treatments (%)	42 (75%)
Type II diabetes (%)	3 (five.iv%)
History of cardiovascular diseasea (%)	viii (xiv.3%)
Patients with large adult cuff (%)	8 (14.iii%)

Bland–Altman plots for the averages of awake ABP and home BP showed that the departure between awake and home SBP/DBP was similarly distributed across the BP range for both the 10-due south and i-min intervals and was less than xx mmHg for all but 1 participant (information are not shown).

Tabular array 2 shows the average domicile BP levels, the differences from abode BP to ambulatory awake BP, and the differences between the starting time and second, or the second and third readings. All of the information are combined BP measurements of morning and evening. As shown, the average SBPs measured at ten-s intervals were consistently higher than those measured at ane-min intervals. The values of readings averaged from the first to second were significantly college than those averaged from the 2nd to third (Table 2a). There were no significant differences in DBP levels between 10-s and i-min intervals. Tabular array 2(b) shows the comparisons between ABP and habitation BP readings. The boilerplate abode BP measured at 10-south and 1-min intervals was consistently college than the awake SBP, only at that place were no significant differences betwixt the home BP averages of the 2nd–third readings taken at 1-min intervals and the awake SBP. These differences between domicile SBP and ambulatory awake SBP were significantly higher in the x-south intervals. The intraclass correlations of understanding between 10-southward and one-min intervals of the home BP and awake SBP were 0.712/0.725 for SBP and 0.693/0.673 for DBP when two readings of the home BP were used each time. Table two(c) shows the comparisons of the beginning vs. 2d and second vs. third readings taken at ten-due south vs. 1-min intervals for the home BPs. The differences betwixt the first and second readings were significantly larger in 1-min intervals than in the x-s intervals. The differences between the 2d and third readings were significantly larger when the interval between them was 10-s than when it was i-min, for both systolic and diastolic BP.

Table ii

Comparison between dwelling BP readings taken at 10-s and 1-min intervals

	10-s intervals	i-min intervals	P
(a) Average dwelling BP levels
Starting time–3rd SBP (mmHg)	137.0 ± 15.6	134.seven ± 15.4	0.005
First–3rd DBP (mmHg)	77.nine ± nine.4	77.2 ± ix.1	0.15
Showtime–second SBP (mmHg)	138.0 ± 15.5††	135.6 ± xv.4††	0.005
First–second DBP (mmHg)	78.2 ± 9.4††	77.4 ± 9.2†	0.07
2d–third SBP (mmHg)	136.ane ± 15.eight	133.ii ± 15.five	0.001
2nd–tertiary DBP (mmHg)	77.5 ± 9.v	76.9 ± 9.3	0.19
(b) Differences from habitation BP to awake SBP/DBP
Kickoff–third SBP (mmHg)	half dozen.0 ± 10.iv***	iii.seven ± 10.vii*	0.005
First–3rd DBP (mmHg)	−i.two ± 7.seven	−i.9 ± 7.6	0.15
Showtime–second SBP (mmHg)	seven.0 ± 10.4***	4.six ± 10.7**	0.005
Beginning–second DBP (mmHg)	−0.9 ± seven.7	−1.eight ± 7.vi	0.07
2nd–3rd SBP (mmHg)	5.1 ± 10.v**	2.2 ± 10.nine	<0.001
Second–tertiary DBP (mmHg)	−ane.6 ± seven.vii	−2.2 ± 7.8	0.19
(c) Differences from start to second or 2d to third readings
Commencement minus 2d SBP	ane.iv ± 2.5 (4)	3.7 ± 3.2 (16)	<0.001
Get-go minus second DBP	0.7 ± i.8 (0)	0.7 ± 1.7 (1)	0.99
Second minus third SBP	2.three ± 1.5 (3)	1.two ± 1.4 (1)	<0.001
2nd minus third DBP	0.7 ± 0.9 (0)	0.2 ± 0.nine (0)	0.002

Automated measurement of dispensary BP

Additionally, we compared the clinic measurement of HEM-5001 and mercury sphygmomanometer. The average BP levels were 129 ± 15/77 ± x mmHg when taken by the mercury sphygmomanometer and 131 ± 15/76 ± ix mmHg for the HEM-5001. The interclass correlations of agreement betwixt mercury readings and HEM-5001 were 0.953 for SBP and 0.906 for DBP when three readings were taken each time.

Patient compliance

Compliance was measured as the number of each set of dwelling house BP readings taken per calendar week. The numbers of occasions per week that iii measurements were taken in the morning time were 5.2 ± 1.2 days for the reading taken with 10-south intervals and 5.3 ± 1.iv days for the 1-min intervals (P = 0.91). There were no differences in the evening BP readings. So, the difference in compliance between the 2 measurement intervals was negligible (and not statistically pregnant).

Give-and-take

This study has shown that BP readings of a 10-south interval of multiple home BP measurements were higher than readings taken using the conventional i-min interval. The 1-min interval of 3 measurements tended to give a improve estimate of the boilerplate daytime BP level, and, therefore, the 1-min interval would be amend for clinical use. This is the offset study testing the validity of using very short time intervals betwixt BP measurements made at domicile.

The validity of using very brusk intervals between oscillometric BP measurements in the clinic has been reported past two groups. Yarows et al. [15] reported that a fifteen-s interval between BP measurements was as authentic as a 1-min interval in normotensive volunteers. Koehler et al. [16] showed that multiple BPs measured over a catamenia of x–15 southward were similar to those taken at ane-min intervals using a sphygmomanometer and automatic devices (which were not cited every bit validated). Our results are consistent with these reports, simply the previous studies were performed only in clinical settings because abode monitors with preset measurement intervals were not available. In contrast, with the appearance of new applied science, nosotros accept been able to examine the results of using two different and standardized measurement intervals for readings taken at dwelling house. We used the awake ABP equally the comparator measure and as well compared the abode readings with readings taken in the dispensary under standardized conditions using both mercury sphygmomanometer readings and automatic device readings. The main finding of the report was that though the intraclass correlations of agreement for the x-due south and ane-min intervals at home with awake ABP were similar, the hateful SBP levels taken at 10-s intervals were significantly higher than SBP taken at 1-min intervals, and the boilerplate home BP with 1-min intervals was closer to the daytime ABP. Considering the BP measurements of 10-s and 1-min intervals were done in the same patients crossed over, the baseline BP level was like, and arm size, cuff size, and deflation time were exactly the aforementioned for the two measurement conditions. Therefore, we do non retrieve that these factors affected the differences between the 10-s and ane-min interval measurements.

The differences between the starting time and the second readings were larger for 1-min intervals than for 10-s intervals, and, conversely, the divergence of the second and the third readings were larger for ten-south intervals than for 1-min intervals. Recent dwelling house BP guidelines have stated that the average of the start and 2nd readings should exist used for clinical practise [13,14], just taking the average SBP of the second and third readings may all-time predict the awake SBP [xx]. Information technology should exist pointed out that the device we used had a relatively rapid inflation and deflation, and our findings exercise not necessarily apply to all other devices. There has hitherto been little investigation into how long the intervals between measurements should exist [15,xvi]. Hypertension guidelines have empirically recommended to wait for 1 or 2 min for the next measurement, which has been used for the Korotkoff technique [12]. Brook [21] has reported that the accuracy of HBP measurements, as adamant by their agreements with awake ABP, is like regardless of substantial variations in HBP monitoring schedules, though the measurement interval upshot was not discussed. Many of the patients in the present study could have started their measurements right later some activities without resting a few minutes. Consequently, their BP stabilized a few minutes afterward beginning the measurements. Namely, the second and the third readings of the 1-min interval might accept been measured in more stable weather than in the 2d and the tertiary readings of the x-s intervals during which the BP was nevertheless going downwardly. For keeping patients' rest, 3 successive measurements of 1-min intervals would be amend option in clinical practise. Our results can lead to a determination that the 1-min measurement interval is preferable to the 10-s interval for habitation BP measurement.

Accurateness of the HEM-5001

In the office BP measurement procedure, we compared the HEM-5001 with a mercury sphygmomanometer. The boilerplate part BP level taken past the HEM-5001 was very similar to function BP taken by a mercury manometer. The intraclass correlations of understanding in the HEM-5001 and mercury readings were splendid for both SBP and DBP. This is not an official validation study, but the HEM-5001 appears to exist as authentic as a mercury sphygmomanometer.

Rationale for taking a 1-min interval between readings

In the American Heart Association BP measurement guideline [12], the following statement was described without whatsoever commendation: 'three readings should be taken in succession, separated past at least 1 min. The start is typically the highest, and the average should be used as the blood pressure reading.' The rationale for taking 1 min intervals between multiple measurements appears arbitrary. Venous congestion or hyperemia has traditionally been thought to affect the BP measurement results when the Korotkoff method is used, but in recent reports, very short time intervals between readings did not produce different values from conventional intervals when oscillometric devices were used [fifteen,16]. Ischemia in an arm distal to the measurement gage can lower the recorded BP by five–15 mmHg if the ischemia is maintained at 20 mmHg above the systolic BP for 90 s, but it raises the BP much less if the ischemia is maintained for only 30 s [22]. As the proper technique is to inflate the cuff to twenty mmHg above the SBP and utilise a deflation charge per unit of 2 mmHg/s, the ischemia from total apoplexy of the cuff should but last 10 s, and is thus unlikely to alter the measurement of the BP.

Compliance

The compliance measure was, unexpectedly, not statistically different between the ten-s and 1-min intervals of BP measurement. We asked patients to mensurate their BP on as many days as possible and at least 4 days/week. Because the patients in this written report were from a hypertension clinic that commonly recommends that patients measure their domicile BP, the majority of them were used to taking frequent readings. All the same, if we had recruited patients who had never measured home BP, there might have been a difference in compliance betwixt the x-s and 1-min intervals, specially in the mornings when time is often almost pressing. A further study may be needed to resolve this upshot.

Study limitations

In this study, average daytime ABP (131/79 mmHg) was equal to role BP (131/76 mmHg), and home BP (135/77 mmHg using i min intervals and the average of morning time and evening readings) was higher than office BP. The reason for the lower level of office BP than domicile BP was that office BP was measured in the standard condition following the international guidelines after at least 5-min residue; measured by a research assistant (but a dr. in Japan) rather than by a doctor and multiple measurements (more than than 6 readings) were taken in 1 occasion after seeing a md. The BP levels in the normal range were another reason for the relatively lower level of office BP as was reported in previous studies which accept shown that role BP was the same or lower than the out-of-function BP when they were in normotensive range [23–26]. The use of large developed gage (N = 8) may be another limitation of this report because the time of inflation and deflation is unlike from that of regular size cuff.

Conclusion

Although both the 10-s and 1-min intervals between three successive home BP readings taken both in the forenoon and evening showed proficient correlations with the daytime average BP taken past ambulatory monitoring, and no difference in patient compliance taking the readings, the 1-min intervals gave average home BP levels that were closer to the daytime ABP and would therefore be recommended as optimal.

Acknowledgments

The study was supported in role by NHLBI grants PO1 HL 47540 and R24 HL76857 and Omron Healthcare.

Abbreviations

AAMI

the Association for the Advancement of Medical Instrumentation

ABP

Convalescent BP

ABPM

ambulatory BP monitoring

DBP

diastolic blood force per unit area

HBP

home BP

ICC

intraclass correlation coefficient

SBP

systolic blood pressure

References

1. Pickering T American Society of Hypertension Ad Hoc Panel. Recommendations for the use of home (self) and ambulatory blood pressure monitoring. Am J Hypertens. 1996;nine:one–11. [PubMed] [Google Scholar]

2. James GD, Pickering TG, Yee LS, Harshfield GA, Riva Southward, Laragh JH. The reproducibility of boilerplate convalescent, home, and clinic pressures. Hypertension. 1988;xi:545–549. [PubMed] [Google Scholar]

3. Sakuma M, Imai Y, Nagai K, Watanabe N, Sakuma H, Minami N, et al. Reproducibility of habitation blood pressure measurements over a 1-year period. Am J Hypertens. 1997;10(7 Pt 1):798–803. [PubMed] [Google Scholar]

iv. Stergiou GS, Baibas NM, Gantzarou AP, Skeva II, Kalkana CB, Roussias LG, et al. Reproducibility of home, convalescent, and clinic claret pressure: implications for the blueprint of trials for the assessment of antihypertensive drug efficacy. Am J Hypertens. 2002;15:101–104. [PubMed] [Google Scholar]

five. Mulè G, Caimi M, Cottone Southward, Nardi E, Andronico G, Piazza G, et al. Value of home blood pressures as predictor of target organ damage in mild arterial hypertension. J Cardiovasc Risk. 2002;9:123–129. [PubMed] [Google Scholar]

vi. Cuspidi C, Michev I, Meani Due south, Salerno M, Valerio C, Fusi V, et al. Left ventricular hypertrophy in treated hypertensive patients with good blood pressure control outside the dispensary, but poor clinic blood pressure control. J Hypertens. 2003;21:1575–1581. [PubMed] [Google Scholar]

7. Tachibana R, Tabara Y, Kondo I, Miki T, Kohara K. Dwelling house blood pressure is a better predictor of carotid atherosclerosis than office blood pressure level in community-dwelling subjects. Hypertens Res. 2004;27:633–639. [PubMed] [Google Scholar]

eight. Ohkubo T, Imai Y, Tsuji I, Nagai Chiliad, Kato J, Kikuchi Due north, et al. Habitation blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens. 1998;16:971–975. [PubMed] [Google Scholar]

9. Mancia G, Facchetti R, Bombelli G, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined peak in office, home, and ambulatory blood force per unit area. Hypertension. 2006;47:846–853. [PubMed] [Google Scholar]

x. Bobrie G, Chatellier G, Genes N, Clerson P, Vaur 50, Vaisse B, et al. Cardiovascular prognosis of 'masked hypertension' detected by blood pressure cocky-measurement in elderly treated hypertensive patients. JAMA. 2004;291:1342–1349. [PubMed] [Google Scholar]

11. Agarwal R, Andersen MJ. Claret pressure recordings inside and exterior the dispensary and cardiovascular events in chronic kidney illness. Am J Nephrol. 2006;26:503–510. [PubMed] [Google Scholar]

12. Pickering TG, Hall JE, Appel LJ, Falkner Be, Graves J, Hill MN, et al. Recommendations for claret force per unit area measurement in humans and experimental animals. Part i: blood pressure measurement in humans –a argument for professionals from the Subcommittee of Professional and Public Teaching of the American Centre Association Quango on Loftier Claret Pressure level Research. Circulation. 2005;111:697–716. [PubMed] [Google Scholar]

13. Pickering TG, Miller NH, Ogedegbe Yard, Krakoff LR, Artinian NT, Goff D, et al. Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Center Association, American Society Of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:1–ix. [PubMed] [Google Scholar]

fourteen. Parati G, Stergiou GS, Asmar R, Bilo M, de Leeuw P, Imai Y, et al. European Society of Hypertension guidelines for claret pressure monitoring at home: a summary study of the Second International Consensus Conference on Home Blood Pressure Monitoring. J Hypertens. 2008;26:1505–1526. [PubMed] [Google Scholar]

15. Yarows SA, Patel K, Brook R. Rapid oscillometric blood pressure measurement compared to conventional oscillometric measurement. Blood Printing Monit. 2001;6:145–147. [PubMed] [Google Scholar]

16. Koehler NR, Poli de Figueiredo CE, Mendes-Ribeiro Air conditioning. Time interval between pairs of arterial blood pressure level measurements: does information technology matter? Am J Hypertens. 2004;17:194–196. [PubMed] [Google Scholar]

17. Rabbany SY, Drzewiecki GM, Noordergraaf A. Peripheral vascular effects on auscultatory blood pressure measurement. J Clin Monit. 1993;9:9–17. [PubMed] [Google Scholar]

xviii. Anwar YA, Giacco S, McCabe EJ, Tendler BE, White WB. Evaluation of the efficacy of the Omron HEM-737 IntelliSense device for utilise on adults according to the recommendations of the Association for the Advancement of Medical Instrumentation. Blood Press Monit. 1998;3:261–265. [PubMed] [Google Scholar]

19. Shrout FE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–428. [PubMed] [Google Scholar]

twenty. Verberk WJ, Kroon AA, Kessels AG, Lenders JW, Thien T, van Montfrans GA, et al. The optimal scheme of cocky blood pressure measurement every bit determined from convalescent blood pressure recordings. J Hypertens. 2006;24:1541–1548. [PubMed] [Google Scholar]

21. Beck RD. Home blood pressure: accuracy is contained of monitoring schedules. Am J Hypertens. 2000;xiii:625–631. [PubMed] [Google Scholar]

22. Rabbany SY, Drzewiecki Thou, Melbin J, Noordergraaf A. The effect of peripheral resistance on the Korotkoff sound: experiments. AAMI 19th Annual Coming together; 1984. [Google Scholar]

23. Pickering TG, Harshfield GA, Kleinert Hard disk, Bare S, Laragh JH. Blood pressure during normal daily activities, sleep, and exercise. Comparison of values in normal and hypertensive subjects. JAMA. 1982;247:992–996. [PubMed] [Google Scholar]

24. James GD, Pickering TG, Yee LS, Harshfield GA, Riva Due south, Laragh JH. The reproducibility of boilerplate ambulatory, dwelling house, and clinic pressures. Hypertension. 1988;xi(6 Pt 1):545–549. [PubMed] [Google Scholar]

25. Kjeldsen SE, Hedner T, Jamerson Yard, Julius Due south, Haley WE, Zabalgoitia M, et al. Hypertension optimal treatment (HOT) study: dwelling house claret pressure in treated hypertensive subjects. Hypertension. 1998;31:1014–1020. [PubMed] [Google Scholar]

26. Stergiou GS, Thomopoulou GC, Skeva 2, Mountokalakis TD. Abode blood force per unit area normalcy: the Didima study. Am J Hypertens. 2000;thirteen(6 Pt 1):678–685. [PubMed] [Google Scholar]

martingoor1970.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941726/

Share this post