Rasvahapot valtimotaudin vaaran arvioinnissa Blood pressure measurement - EHES September 21, 2010...
-
Upload
maximillian-anderson -
Category
Documents
-
view
226 -
download
0
Transcript of Rasvahapot valtimotaudin vaaran arvioinnissa Blood pressure measurement - EHES September 21, 2010...
Rasvahapot valtimotaudin vaaran arvioinnissa
Blood pressure measurement - EHES
September 21, 2010
Antti Jula
Antti Jula 2
Developed Countries Deaths in 2000 Developed Countries Deaths in 2000 Attributable to Attributable to Selected Leading Risk FactorsSelected Leading Risk Factors
Number of deaths (000s)
Antti Jula 3
Hypertension as a cardiovascular risk factor
Antti Jula 4
Systolic and diastolic blood pressure and mean arterial pressure in different parts of circulation
Antti Jula 5
What is blood pressure?
• Systolic blood pressure, higher of the two values, represents the pressure while the heart contracts to pump blood to the body
– First appearance of a clear repetitive sounds (Phase I)
• Diastolic blood pressure, lower of the two values, represents the pressure when the heart relaxes between beats
– Disappearance of the repetitive sounds (Phase V)
19.04.23 6
Factors affecting the accuracy of BP measurementFactors affecting the accuracy of BP measurement
• Measurement circumstances
• Patient dependent factors
• Observer dependent factors
• Measurement technique– Auscultatory technique– Oscillometric technique
• Devices– Accuracy of the measurement device– Cuff size
Antti Jula 7
Factors affecting BP variability• Respiration – beat to beat oscillation• Emotions – sympathetic stimulation – white coat effect• Exercise• Meals• Tobacco• Caffeine• Alcohol• Temperature• Bladder distension• Pain• Diurnal variation
– Sleep, posture, BP-lowering medication
Antti Jula 8
Average effects on blood pressure of commonly occuring activites relative to BP while relaxing
• Meetings +20.2/+15.0 mmHg
• Work +16.0/+13.0 mmHg
• Walking +12.0/+9.2 mmHg
• Dressing +11.5/+9.5 mmHg
• Telephone +9.5/+7.2 mmHg
• Eating +8.8/+9.6 mmHg
• Talking +6.7/+6.7 mmHg
• Reading +1.9/+2.2 mmHg
• Sleeping -10.0/-7.6 mmHg
Clark LA et al. J Chronic Dis 1987;40:671-9
Antti Jula 9
Inter-room difference
with sphygmomanometer
8.7/3.5 mmHg
Kumpusalo et al. J Human Hypertens 2002;16:725-728
Antti Jula 10
Inter-room differences measured by patients with Omron IC device
5.9/2.8 mmHg
2.9/1.1 mmHg3.0/1.7 mmHgKumpusalo et al. J Human Hypertens 2002;16:725-728
Antti Jula 11
Watson et al, J Hypertens 1987, 5:207–11
Paired BP readings without careful preceding procedures and measurement techniques
Antti Jula 12
Jula et al, Hypertension 1999, 34:261–6
Paired BP readings with careful preceding procedures and measurement techniques
Antti Jula 13
Univariate correlates with the left ventricle and albuminuriaJula, Puukka, Karanko, Hypertension 1999;34:261-266
Systolic BP LVM LVMI LUA
Clinic 0.38*** 0.40*** 0.34***
Home 0.45*** 0.47*** 0.32***
Ambulatory awake 0.41*** 0.45*** 0.32***
Ambulatory asleep 0.32*** 0.35*** 0.26***
Ambulatory 24-hour 0.40*** 0.44*** 0.32***
*** P <0.001. LVM = left ventricular mass, LUA=log uri-nary albumin
Antti Jula 14
Univariate correlates with the left ventricle and albuminuriaJula, Puukka, Karanko, Hypertension 1999;34:261-266
Diastolic BP LVM LVMI LUA
Clinic 0.43*** 0.37*** 0.25***
Home 0.44*** 0.44*** 0.28***
Ambulatory awake 0.32*** 0.35*** 0.21**
Ambulatory asleep 0.31*** 0.32*** 0.17*
Ambulatory 24-hour 0.35*** 0.37*** 0.23**
*** P <0.001, ** P <0.01, * P <0.05. LVM = left ventricular mass, LUA=log urinary albumin
Antti Jula 15
Interarm differences
• BP measured from the right arm is 2.3/0.5 mmHg higher than that measured from the left arm (unpublished findings from 493 subjects aged 25-74 years, The Finrisk 2007 study)
• If reproducible differences greater than 10 mmHg are observed, the measurements should be done from the arm with higher readings
Antti Jula 16
Three categories of observer errorRose G et al. Lancet 1965; 1: 673-4.
1. Systematic error that leads to both intraobserver and interobserver error
2. Terminal digit preference, which results in the observer rounding of the pressure reading to a digit of his or her choosing, most often to zero
3. Observer prejudice or bias, whereby the observer adjust the pressure to meet his or her preconceived notion of what the pressure should be
Antti Jula 17
Mismatching of bladder and arm
Maxwell ym. Lancet 1982;2:33-36
Antti Jula 18
Use appropriate cuff size
• A too small cuff overestimates and a too large cuff underestimates BP
• Optimal size of the cuff: width >40% and length >80% of the arm circumference
• Finnish guidelines:
– Cuff width 13 cm (arm circumference 26-32 cm)– Cuff width 15 cm (arm circumference 33-41 cm)– Cuff width 18 cm (arm circumference > 41 cm)
Antti Jula 19
Different BP measurement devices
Antti Jula 20
Oscillometric vs auscultatory measurement technique
Antti Jula 21
Regression Equation for Converting Auscultatory to Automated Oscillometric (Omron M6) Systolic Blood Pressure
Finriski 2007, unpublished findings, n=493
Antti Jula 22
Regression Equation for Converting Auscultatory to Automated Oscillometric (Omron M6) Diastolic Blood Pressure
Finriski 2007, unpublished findings, n=493
Antti Jula 23
Corresponding oscillometric BP of five auscultory measured BP level
Auscultatory BP
120/80
140/90
160/100
180/110
200/120
Oscillometric BP
122.4/79.4
141.6/89.3
160.7/99.1
179.9/108.9
200.2/118.7
Finrisk 2007, junpublished findings, n=493
Antti Jula 24
Summary of the measurement I
• Participant conditions– Posture: the participant should sit queitly for 5 min
with the cuff around the arm, arm baired and supported at the level of the heart and the back resting againts a chair
• Circumstances– The participant should avoid a heavy meal, smoking,
heavy exercise and drinking caffeine containing beverages at least within 30 minutes preceding the reading
– A quiet, warm setting
Antti Jula 25
Summary of the measurement II
• Equipment– Appropriate cuff size– Either a mercury, a validated and recently calibrated aneroid or
validated electronic device– The bell of the stetoscope should be used (avoid excess bell
pressure!)
• Technique– At least two measurements (3) 1-2 minute apart of each other– Avoid observer error by training observers in the proper
technique of auscultatory BP measurements (manuals, binaural stethoscope, audio-tape training methods, video-films etc.)