Blood Pressure Measurement How can anything so simple
Blood Pressure Measurement How can anything so simple be so complex? © Continuing Medical Implementation …. . . bridging the care gap
Diseases Attributable to Hypertension Stroke Coronary heart disease Heart failure Cerebral hemorrhage Myocardial infarction Left ventricular hypertrophy Hypertension Chronic kidney failure Aortic aneurysm Retinopathy Peripheral vascular disease © Continuing Medical Implementation Adapted from: Arch Intern Med 1996; 156: 1926 -1935. Hypertensive encephalopathy All Vascular …. . . bridging the care gap
Awareness, Treatment and Control of High Blood Pressure in Canada 16% 42% 23% 19% Patients unaware of their high blood pressure 42% Aware but not treated and not controlled 19% Treated but not controlled 23% Treated and controlled 16% Adapted from: Am J Hypertens 1997; 10: 1097 -1102. © Continuing Medical Implementation …. . . bridging the care gap
© Continuing Medical Implementation …. . . bridging the care gap
© Continuing Medical Implementation …. . . bridging the care gap
© Continuing Medical Implementation …. . . bridging the care gap
© Continuing Medical Implementation …. . . bridging the care gap
BP Treatment Targets Condition 160/100 Treatment threshold if no risk factors, TOD or CCD < 140/90 Treatment target for office BP measurement < 135/85 Treatment target for ABP or HBP measurement < 130/80 Treatment target for Type 2 diabetics or non-diabetic nephropathy < 125/75 Treatment target for diabetic or non -diabetic nephropathy with …. . . bridging the care gap proteinuria © Continuing Medical Implementation
Automated Bp. TRU™ BP Devices © Continuing Medical Implementation …. . . bridging the care gap
Benefits of Automated Bp. TRU™ BP Devices – Standardizes BP readings from one operator to the next – Removes many of the errors associated with manual readings – Accurate, reliable and reproducible readings – Multiple readings with averaging – “Opportunistic screening” – Accurate, independently validated device © Continuing Medical Implementation – Automatically zeroes with each inflation – Performs full system check every time on powering-up • • Performs six readings Discards the first reading Averages the remainder Interval between readings from 1 -5 minutes apart • User can auscultate using the digital readout when desired …. . . bridging the care gap
180 – 174± 3 170 – Study Results 166± 4 158± 4 Blood Pressure (mm. Hg) 160 – 155± 5 150 – 146± 3 140 – 130 – 120 – 110 – 100 – 92± 2 80 – 0– Specialist 89± 3 90± 2 Research Family Physician Technician Myers M, Can. J. Cardiology; 2002; 18 (supp B): 113 B 88± 2 Bp. TRU 82± 2 Ambulatory BP
Study Conclusions • The patient’s presence in the doctor’s office or research unit in itself appears to be partly responsible for the white coat effect. • BP readings taken on the initial visit tend to be higher than other readings. • The white coat effect can be partly eliminated by the use of an automated BP recording device (Bp. TRU) • BP readings recorded by the Bp. TRU device are similar to readings taken by an experienced research technician using CHS Guidelines. Myers M, Can. J. Cardiology; 2002; 18 (supp B): 113 B
© Continuing Medical Implementation …. . . bridging the care gap
© Continuing Medical Implementation …. . . bridging the care gap
Validated BP Devices • BHS – BHS = British Hypertension Society • AAMI – AAMI = American Association of Medical Instruments • See British Hypertension Society Website © Continuing Medical Implementation • OMRON – – HEM-705 CP HEM-711 AC HEM-722 C HEM-773 • Life. Source AND – – UA-767 CN UA-767 Plus UA-779 UA-787 …. . . bridging the care gap
OMRON • Claims all devices with exception of wrist devices are validated © Continuing Medical Implementation …. . . bridging the care gap
OMROM HEM 711 AC $109. 99 © Continuing Medical Implementation …. . . bridging the care gap
Life. Source. UA-767 PC • For use with a PC and Monitor Pro software. • Stores and analyzes recorded blood pressure data directly from the UA 767 PC. • The software provides printable summary reports and graphing capabilities. • Remotely monitor patients and their blood pressure from their homes. © Continuing Medical Implementation Validated according to BHS* protocol and AAMI** approved. *BHS = British Hypertension Society **AAMI = American Association of Medical Instruments …. . . bridging the care gap
Life Source UA 779 CN $99. 99 © Continuing Medical Implementation …. . . bridging the care gap
No charge……? Validity © Continuing Medical Implementation …. . . bridging the care gap
When would you order ambulatory Blood pressure Monitoring? • • • For Dx mild to mod HTN For elderly women with ISH For apparent Rx resistance For anxiety prone patients When marked fluctuations in office BP present For symptoms suggestive of hypotension present on Rx • White coat HTN unlikely – If DM coexists – If TOD present © Continuing Medical Implementation …. . . bridging the care gap
© Continuing Medical Implementation …. . . bridging the care gap
© Continuing Medical Implementation …. . . bridging the care gap
Blood Pressure and Target Organ Damage (TOD) Current evidence suggests that: • 24 -h blood pressure correlates most closely with TOD (compared to clinic or casual BP) • Higher incidence of cardiovascular events when blood pressure remains elevated at night (non-dippers) • Blood pressure variability is an independent determinant of TOD • Highest incidence of cardiovascular events occurs in AM Adapted from: Sokolow, et al. 1966; Devereux, et al. 1983; Devereux, et al. 1987; Parati, et al. 1987; Mancia. 1990. © Continuing Medical Implementation …. . . bridging the care gap
24 -Hour Blood Pressure Profile: Two Patients with Hypertension Blood pressure (mm Hg) Sleep 175 Non-dipper 155 135 Dipper 115 95 75 55 7: 00 11: 00 15: 00 19: 00 Time of day © Continuing Medical Implementation 23: 00 7: 00 …. . . bridging the care gap Adapted from: Redman, et al. 1976; Mancia, et al. 1983; Kobrin, et al. 1984; Baumgart, et al. 1989; Imai, et al. 1990; Portaluppi, et al. 1991.
24 -Hour Blood Pressure Profile: The Morning Blood Pressure ‘Surge’ Blood pressure (mm Hg) 180 Sleep Time of awakening 160 140 120 100 80 18: 00 22: 00 02: 00 © Continuing Medical Implementation Adapted from: Millar-Craig, et al. 1978; Mancia, et al. 1983. 06: 00 Time of day 10: 00 14: 00 18: 00 …. . . bridging the care gap
Circadian Incidence of Cardiovascular Events: Myocardial Ischemia n=24 Ischemia (min) 300 250 200 150 100 50 0 01: 00 09: 00 13: 00 Time of day © Continuing Medical Implementation Adapted from: Rocco, et al. 1987. 05: 00 17: 00 21: 00 …. . . bridging the care gap
© Continuing Medical Implementation …. . . bridging the care gap
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