UNASSIGNED: Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality. There are limited global data on the characteristics of women during and after pregnancy hypertension.
UNASSIGNED: May Measurement Month is a global campaign to raise awareness of the importance of blood pressure. Adults (≥18 years) recruited through opportunistic sampling during May 2019 had blood pressure measured and comorbidities and lifestyle data collected. This secondary analysis included 16 519 pregnant women and 529 172 nonpregnant women (16 457 with previous raised blood pressure in pregnancy) from 64 countries.
UNASSIGNED: Almost half of the pregnant women (56.7%) reported not having had their blood pressure measured in the past year, and 14.3% (95% CI, 12.1-16.6) had hypertension (blood pressure ≥140/90 mm Hg or taking antihypertensive medication). Diabetes was self-reported in 7.6% (5.9-9.3) of pregnant women with hypertension and 2.8% (1.9-3.6) of pregnant women without hypertension. In nonpregnant women with and without a history of pregnancy hypertension, age-standardized proportions with current hypertension were 53.2% (50.8-55.7) versus 33.3% (29.3-37.3); with diabetes were 14.4% (11.8-17.0) versus 8.5% (6.3-10.9); and with body mass index ≥30 kg/m2 were 28.4% (23.5-33.3) versus 16.6% (13.0-20.2).
UNASSIGNED: Hypertension in pregnancy was common in this global sample but many cases had not previously been identified. There was a clustering of cardiovascular risk factors in both pregnant women with current hypertension and previously raised blood pressure in pregnancy. This work highlights the importance of screening pregnant women for hypertension, which remains a challenge in large parts of the world.

Standardized blood pressure (BP) measurements for patients with chronic kidney disease (CKD) are paramount in the management of hypertension. Evidence shows nursing staff adherence to best practice guidelines for BP measurement are suboptimal. A pre-/posttest pilot study implementing a six-week hybrid educational intervention for nursing staff was conducted in an outpatient nephrology office. The Evidence-Based Practice (EBP) Beliefs Scale was administered to participants (n = 6) to assess individual beliefs about EBP and implementing EBP guidelines for BP measurement. One Likert-type question measured participant change in BP measurement. Improvement was noted in EBP beliefs and ability to implement EBP guidelines post-intervention. A favorable response was present for participant change in BP measurement per guidelines post-intervention. The intervention is a feasible method to improve staff adherence to EBP guidelines for BP measurement.

暂无摘要。

Previous studies have reported that blood pressure variability (BPV) is associated with the risk of cardiovascular events independent of blood pressure (BP) levels. While there is little evidence from intervention trials examining whether suppressing BPV is useful in preventing cardiovascular disease, it is suggested that detection of abnormally elevated BPV may be useful in reducing cardiovascular events adding by complementing management of appropriate BP levels. Cuffless BP devices can assess beat-to-beat BPV. Although cuffless BP monitoring devices have measurement accuracy issues that need to be resolved, this is an area of research where the evidence is accumulating rapidly, with many publications on beat-to-beat BPV over several decades. Ambulatory BP monitoring (ABPM) can assess 24-hour BPV and nocturnal dipping patterns. Day-to-day BPV and visit-to-visit BPV are assessed by self-measured BP monitoring at home and office BP measurement, respectively. 24 h, day-to-day, and visit-to-visit BPV have been reported to be associated with cardiovascular prognosis. Although there have been several studies comparing whether ABPM and self-measured BP monitoring at home is the superior measurement method of BPV, no strong evidence has been accumulated that indicates whether ABPM or self-measured home BP is superior. ABPM and self-measured BP monitoring have their own advantages and complement each other in the assessment of BPV.

Accurate arm circumference (AC) measurement is required for accurate blood pressure (BP) readings. Standards stipulate measuring arm circumference at the midpoint between the acromion process (AP) and the olecranon process. However, which part of the AP to use is not stipulated. Furthermore, BP is measured sitting but arm circumference is measured standing. We sought to understand how landmarking during AC measurement and body position affect cuff size selection. Two variations in measurement procedure were studied. First, AC was measured at the top of the acromion (TOA) and compared to the spine of the acromion (SOA). Second, standing versus seated measurements using each landmark were compared. AC was measured to the nearest 0.1 cm at the mid-point of the upper arm by two independent observers, blinded from each other\'s measurements. In 51 participants, the mean (±SD) mid-AC measurement using the anchoring landmarks TOA and SOA in the standing position were 32.4 cm (±6.18) and 32.1 cm (±6.07), respectively (mean difference of 0.3 cm). In the seated position, mean arm circumference was 32.2 (±6.10) using TOA and 31.1 (±6.03) using SOA (mean difference 1.1 cm). Kappa agreement for cuff selection in the standing position between TOA and SOA was 0.94 (p < 0.001). The landmark on the acromion process can change the cuff selection in a small percentage of cases. The overall impact of this landmark selection is small. However, standardizing landmark selection and body position for AC measurement could further reduce variability in cuff size selection during BP measurement and validation studies.

Intra-arterial blood pressure (IABP) measurement, although considered the gold standard in critically ill children, is associated with certain risks and lacks widespread availability. This study was conducted to determine the differences and agreements between oscillometric non-invasive blood pressure (NIBP) and invasive IABP measurements in children. Inclusion criteria consisted of children (from 1 month to 18 years) admitted to the pediatric intensive care unit (PICU) of a teaching hospital who required arterial catheter insertion for blood pressure (BP) monitoring. The comparison between IABP and NIBP was studied using paired t -test, Bland-Altman analysis, and Pearson\'s correlation coefficient. In total, 4,447 pairs of simultaneously recorded hourly NIBP and IABP measurements were collected from 65 children. Mean differences between IABP and NIBP were -3.6 ± 12.85, -4.7 ± 9.3, and -3.12 ± 9.30 mm Hg for systolic, diastolic, and mean arterial BP, respectively ( p  < 0.001), with wide limits of agreement. NIBP significantly overestimated BP ( p  < 0.001) in all three BP states (hypotensive, normotensive, and hypertensive), except systolic blood pressure (SBP) during hypertension where IABP was significantly higher. The difference in SBP was most pronounced during hypotension. The difference in SBP was significant in children <10 years ( p  < 0.001), with the maximum difference being in infants. It was insignificant in adolescents ( p  = 0.28) and underweight children ( p  = 0.55). NIBP recorded significantly higher BP in all states of BP except SBP in the hypertensive state. SBP measured by NIBP tended to be the most reliable in adolescents and underweight children. NIBP was the most unreliable in infants, obese children, and during hypotension.

The latest guidelines for the management of arterial hypertension, the silent killer, were published in summer 2023. They particularly emphasize again the quality of blood pressure measurement which ideally should always be automated using oscillometric device and an arm cuff already in the consulting room. They remind you how to manage the blood pressure of a patient whose hypertension has been confirmed, to stimulate drug compliance and to avoid therapeutic inertia. A holistic view of the patient with all his or her risk factors is always required. The general practitioner is the key player in the diagnosis, treatment and monitoring of the hypertensive patient whose therapeutic education has been as complete as possible with practice of self-measurement of blood pressure at home if possible. The goal is to normalize blood pressure within the first three months of treatment initiation and to reduce as much as possible the cardiovascular risk of the treated patient in the frame of preventive medicine.
Les dernières directives de prise en charge de l’hypertension artérielle, le tueur silencieux, ont été publiées à l’été 2023. Elles insistent particulièrement, à nouveau, sur la qualité de la mesure de la pression artérielle qui, idéalement, doit être automatisée toujours à l’aide d’un brassard et ce, déjà au cabinet de consultation. Elles rappellent comment gérer la pression artérielle d’un patient dont l’hypertension a bien été confirmée, comment stimuler l’adhérence au traitement et éviter l’inertie thérapeutique. Une vue globale du patient avec tous ses facteurs de risque est toujours de rigueur. Le médecin généraliste est l’acteur-clé du diagnostic, du traitement et du suivi du patient hypertendu dont l’éducation thérapeutique a été la plus complète possible avec pratique de l’automesure tensionnelle à domicile si possible. Le but est de normaliser la pression artérielle dans les trois premiers mois de la prise en charge et de réduire le plus possible le risque cardiovasculaire et rénal du patient traité dans le cadre d’une médecine préventive.

暂无摘要。

BACKGROUND: International standards used for device validation protocols require that the reference cuff conform to a width and length that is 37 to 50% and 75 to 100% of the arm circumference, respectively. However, there is no published chart of appropriate width and length dimensions across the range of arm circumferences. Our objective was to create a chart that could be used to guide reference cuff selection and compare recommended dimensions with two common cuff systems.
METHODS: Arm circumferences, ranging from 22 to 52 cm were used to create a reference table for width and length requirements. Arm circumferences were grouped following the American Heart Association recommendation for cuff sizes. Cuff dimension data was extracted from the website of a cuff system commonly used for validations (the Baum Corporation) and compared both the American Heart Association recommendations and Baum sizes with the recommended reference dimensions.
RESULTS: There were discrepancies in size naming conventions between the Baum Corporation and the American Heart Association cuff systems. Moreover, there were gaps in both systems where the cuff would not be recommended for validation (31-32 cm for Baum and 30-31 cm for the American Heart Association). Neither system had cuffs that could be used for the largest arm circumferences.
CONCLUSIONS: Our chart highlights the need for more than one cuff system in validation studies and the critical need for cuffs that could be used for validation among larger arm circumferences.

Background: Musculoskeletal disorders (MSDs) occur as a result of long-term exposure to inappropriate working postures and repetitive use of body postures, leading to harmful consequences for patients, employees, and employers. Evaluating distinct working postures can contribute to effective interventions. Purpose: The aim of this study was to determine ergonomic risks of MSDs during repeated blood pressure measurement processes and to evaluate the effectiveness of a training on this topic. Methods: A pretest/posttest quasi-experimental design studied 64 nurses in a training and research hospital in Turkey. Participants were evaluated for the prevalence and risk of MSDs using the Nordic Musculoskeletal Questionnaire Extended Version and the Rapid Entire Body Assessment (REBA) Checklist, and by photographing them performing the procedure. Nurses with high risk for MSDs received an ergonomics training program and were followed up twice in 3 months. Results: Reduction in prevalence of MSDs in neck, shoulder, and hip/thigh areas, and in mean REBA scores after the training were statistically significant. Conclusion: Nurses should be trained about correct posture for specific high-risk activities that may cause MSDs, and offered exercise programs that support the musculoskeletal system.