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Effect of cuff design on auscultatory and oscillometric blood pressure measurements
Abstracts / Journal of the American Society of Hypertension 10(4S) (2016) e14–e18
e17
Figure 1.
The objective of this study was to examine the effectiveness of a physicianpharmacist collaborative management (PPCM) intervention in hypertensive subjects of comparatively low and high socioeconomic status from a recently completed clinical trial. The ‘‘Collaboration Among Pharmacist and Physicians to Improve Blood Pressure Now’’ (CAPTION) trial, was an cluster-randomized effectiveness study to implement PPCM for patients with uncontrolled hypertension from 32 medical offices in the United States. The primary hypothesis for this study was that blood pressure would be higher in patients of lower socioeconomic status. Research nurses enrolled 625 patients from March 2010 to June 2013. Minorities were well represented (n¼337; 53.9%). For this study, intervention participants’ (n¼ 394) outcomes were compared. Disparities in race, education, income and insurance coverage were investigated. After the PPCM intervention, the difference in mean BP (systolic/diastolic) between nonHispanic Caucasians and minorities was -3.42/-1.39 mmHg (p¼0.0694 and p¼0.2046, respectively) (Table 1). Education, dichotomized as 12 years, showed no difference in mean BP change (p¼0.1491 and p¼0.2703, respectively) (Table 2). Income, dichotomized as $25,000, showed no difference in mean BP change (p¼0.1291 and p¼0.5606, respectively) (Table 3). Finally, insurance status had no impact on effectiveness of the intervention (p¼0.2772 and p¼0.3650, respectively) (Table 4). The PPCM model led to significant mean BP reduction, regardless of any disparity. These findings show that team-based care models can overcome traditionally difficult patient barriers to BP control. Keywords: Disparities; Pharmacist; Collaboration; Socioeconomic FP-24 Effect of cuff design on auscultatory and oscillometric blood pressure measurements Raj S. Padwal,2 Donna McLean,2 Peter Ao,2 Farahnaz Yousefi,2 Sownd Sankaralingam,2 Jack Millay,1 Ringrose Jennifer.2 1 AccurateBloodPressure.com, Beaverton, OR, United States; 2 University of Alberta, Edmonton, AB, Canada
Background/Objectives: Two-piece blood pressure (BP) cuffs, which contain a removable bladder enclosed within a fabric shell, are the historical cuff standard. Use of one-piece cuffs, in which the bladder is formed by a potential space within the fabric shell, is increasing. Substituting onepiece for two-piece cuffs has an unknown effect on measurement accuracy. We compared these cuff types in a two-phase study using auscultatory (Phase 1) and oscillometric (Phase 2) techniques. Subjects/Methods: Community-dwelling, consenting subjects (aged 18y) with BP levels between 80-220 mmHg/50-120 mmHg and arm circumferences between 25-43 cm were studied using the International Standards Organization (ISO) 2013 protocol (with modifications). A Baum two-piece cuff was used as the reference standard, to which a one-piece Welch Allyn cuff was compared. In Phase 1 (two-observer auscultation with a mercury sphygmomanometer), 88 subjects were required to obtain 255 paired BP determinations. In Phase 2 (oscillometric measurement with a Spacelabs 90207 device), 85 subjects were studied. Each study phase was analyzed separately using paired t-tests. Results: For the auscultatory phase, mean age was 54.220.5 years, mean arm circumference was 29.93.7 cm, 60% were female and 32% had a past history of hypertension. Mean BP levels for the one-piece cuff were lower than the two-piece cuff (115.515.5/66.49.3 vs. 117.815.2/67.99.2; difference of -2.43.6/-1.52.4; p-values<0.0001 for both comparisons). For the oscillometric phase, mean age was 52.820.8 years, mean arm circumference was 29.43.9 cm, 67% were female, and 38% had hypertension. Mean BPs were lower for the one-piece compared to the two-piece cuff (116.512.8/67.18.1 vs. 120.813.5/70.48.5; difference of -4.43.6/-3.32.7; p-values<0.0001 for both). Conclusions: Mean BP is lower when one-piece cuffs are used instead of two-piece cuffs. Differences are greater with oscillometry. Therefore, when performing validation studies and measurements for clinical purposes, the potential effect of cuff type should be taken into account. Keywords: oscillometric; auscultatory; cuff type; blood pressure measurement
e17
Figure 1.
The objective of this study was to examine the effectiveness of a physicianpharmacist collaborative management (PPCM) intervention in hypertensive subjects of comparatively low and high socioeconomic status from a recently completed clinical trial. The ‘‘Collaboration Among Pharmacist and Physicians to Improve Blood Pressure Now’’ (CAPTION) trial, was an cluster-randomized effectiveness study to implement PPCM for patients with uncontrolled hypertension from 32 medical offices in the United States. The primary hypothesis for this study was that blood pressure would be higher in patients of lower socioeconomic status. Research nurses enrolled 625 patients from March 2010 to June 2013. Minorities were well represented (n¼337; 53.9%). For this study, intervention participants’ (n¼ 394) outcomes were compared. Disparities in race, education, income and insurance coverage were investigated. After the PPCM intervention, the difference in mean BP (systolic/diastolic) between nonHispanic Caucasians and minorities was -3.42/-1.39 mmHg (p¼0.0694 and p¼0.2046, respectively) (Table 1). Education, dichotomized as 12 years, showed no difference in mean BP change (p¼0.1491 and p¼0.2703, respectively) (Table 2). Income, dichotomized as $25,000, showed no difference in mean BP change (p¼0.1291 and p¼0.5606, respectively) (Table 3). Finally, insurance status had no impact on effectiveness of the intervention (p¼0.2772 and p¼0.3650, respectively) (Table 4). The PPCM model led to significant mean BP reduction, regardless of any disparity. These findings show that team-based care models can overcome traditionally difficult patient barriers to BP control. Keywords: Disparities; Pharmacist; Collaboration; Socioeconomic FP-24 Effect of cuff design on auscultatory and oscillometric blood pressure measurements Raj S. Padwal,2 Donna McLean,2 Peter Ao,2 Farahnaz Yousefi,2 Sownd Sankaralingam,2 Jack Millay,1 Ringrose Jennifer.2 1 AccurateBloodPressure.com, Beaverton, OR, United States; 2 University of Alberta, Edmonton, AB, Canada
Background/Objectives: Two-piece blood pressure (BP) cuffs, which contain a removable bladder enclosed within a fabric shell, are the historical cuff standard. Use of one-piece cuffs, in which the bladder is formed by a potential space within the fabric shell, is increasing. Substituting onepiece for two-piece cuffs has an unknown effect on measurement accuracy. We compared these cuff types in a two-phase study using auscultatory (Phase 1) and oscillometric (Phase 2) techniques. Subjects/Methods: Community-dwelling, consenting subjects (aged 18y) with BP levels between 80-220 mmHg/50-120 mmHg and arm circumferences between 25-43 cm were studied using the International Standards Organization (ISO) 2013 protocol (with modifications). A Baum two-piece cuff was used as the reference standard, to which a one-piece Welch Allyn cuff was compared. In Phase 1 (two-observer auscultation with a mercury sphygmomanometer), 88 subjects were required to obtain 255 paired BP determinations. In Phase 2 (oscillometric measurement with a Spacelabs 90207 device), 85 subjects were studied. Each study phase was analyzed separately using paired t-tests. Results: For the auscultatory phase, mean age was 54.220.5 years, mean arm circumference was 29.93.7 cm, 60% were female and 32% had a past history of hypertension. Mean BP levels for the one-piece cuff were lower than the two-piece cuff (115.515.5/66.49.3 vs. 117.815.2/67.99.2; difference of -2.43.6/-1.52.4; p-values<0.0001 for both comparisons). For the oscillometric phase, mean age was 52.820.8 years, mean arm circumference was 29.43.9 cm, 67% were female, and 38% had hypertension. Mean BPs were lower for the one-piece compared to the two-piece cuff (116.512.8/67.18.1 vs. 120.813.5/70.48.5; difference of -4.43.6/-3.32.7; p-values<0.0001 for both). Conclusions: Mean BP is lower when one-piece cuffs are used instead of two-piece cuffs. Differences are greater with oscillometry. Therefore, when performing validation studies and measurements for clinical purposes, the potential effect of cuff type should be taken into account. Keywords: oscillometric; auscultatory; cuff type; blood pressure measurement