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Effect of periphral vessel congestion on diastolic blood pressure measurements with auscultatory method
42A
POSTERS: Blood Pressure Measurement/Monitoring
P-38 EFFECT OF PERIPHRAL VESSEL CONGESTION ON DIASTOLIC BLOOD PRESSURE MEASUREMENTS WITH AUSCULTATORY METHOD Kazuhisa Tanabe, Yoshinori Miyawaki, Hirotoshi Egawa, Toshimitsu Kitajima, Junichi Minami, Hiroaki Matsuoka. 1Research And Development Center, Omron Institute of Life Science Co.,LTD., Kyoto, Kyoto, Japan, 2Anesthesiology I, Dokkyo University School of Medicine, Mibu, Tochigi, Japan, 3Department of Medicine, Dokkyo University School of Medicine, Mibu, Tochigi, Japan It is known well that Korotkoff sounds near diastole become difficult to be heard because of forearm congestion on the side where a cuff is wrapped. We evaluated relationships among cuff pressure, Korotkoff sounds, auscultatory blood pressure, intra-arterial pressure, and peripheral venous pressure during cuff deflation at different rates from 2 to 5.5 mmHg/sec. We enrolled Japanese volunteers in this study. An appropriate cuff was wrapped around the left arm for the auscultatory measurement. An arterial catheter was inserted into the left radial artery. A venous catheter was also inserted into the left forearm vein in order to measure peripheral venous pressure which was an index of forearm congestion on the side where a cuff was wrapped. Figure depicts Korotkoff sounds, cuff pressure, intra-arterial pressure, and venous pressure during deflation at a rate of 2.3mmHg/sec.
The venous pressure distal to the cuff began to increase soon after the cuff pressure decreased up to the intra-arterial systolic pressure and reached the maximum level. Then arterial pressure distal to the cuff increased above the venous pressure. When the venous pressure distal to the cuff and the cuff pressure balanced, the venous under the cuff opened and the return flow of the venous restarted. After that the venous pressure followed by the cuff pressure. In this case, the maximum level of the venous pressure exceeded the intra-arterial diastolic pressure. Korotkoff sounds disappeared a few seconds before the cuff pressure decreased up to the intra-arterial diastolic pressure. In contrast, Korotkoff sounds disappeared just when the cuff pressure reached the intra-arterial diastolic pressure during deflation at a rate of 5.5 mmHg/sec. These results suggest that diastolic auscultatory blood pressure is overestimated because of forearm congestion and elevation in peripheral artery and venous pressure on the side where a cuff is wrapped, especially during cuff deflation at a slow rate. Key Words: Auscultation, Korotkoff sound, Diastolic blood pressure
P-39 FEASABILITY OF AMBULATORY BLOOD PRESSURE MEASUREMENT AND HOME BLOOD PRESSURE MEASUREMENT IN THERAPEUTIC TRIALS Thierry Denolle, Bernard Vaisse, Franc¸ois Pe´rie´, Sophie NisseDurgeat, Jean-Marc Gandon. 1Broussais Hospital, St. Malo, France, 2 La Timone Hospital, Marseille, , France, 3Laboratoires Takeda, Puteaux, France, 4Biotrial S.A., Rennes, France The aim of this study was to compare the feasability of three methods of blood pressure measurement: clinical blood pressure (CBP), ambulatory blood pressure measurement (ABPM) and home blood pressure measurement (HBPM) during a therapeutic trial. One hundred non controlled hypertensive patients (aged 55 years, CBP: 158⫾ 15 / 96⫾ 7mmHg)
AJH–April 2001–VOL. 14, NO. 4, PART 2
treated with candesartan 8mg were randomized between candesartan 16mg and candesartan 8mg with hydrochlorothiazide 12.5mg for six weeks. The evaluation of the antihypertensive efficacy was assessed by each of the 3 methods before and after the 6-week treatment period. CBP was measured 3 times using a mercury sphygmomanometer, HBPM with an OMRON 705CP 3 measurements twice daily for one week and ABPM was recorded during 24h (one measure every 15 min) with a Spacelabs 90207 or a Dyasis Integra (Novacor). For HBPM, the recording had to contain at least 3 measurements per day and 8, 12 or 16 out of 30 measurements between D3 and D7 in order to be validated. Measurements taken outside the predefined times or abnormal values (SBP 60 ⬍ or ⬎ 250mmHg, DBP 40 ⬍ or ⬎ 150 mmHg, SBP-DBP ⬍ 10 mmHg if SBP ⬎ 110 mmHg) were eliminated. For ABPM, the recording had to last for at least 22 hours, begin between 7:00 and 11:00a.m., contain at least 48 measures and be devoid of breaks of more than 2 hours. The subject had to take the treatment within one hour following the installation of the device. The quality of the recording was controlled by BIOTRIAL (centralized analysis) as soon as the recording was finished and the cardiologist was immediately informed of the results by fax. patients with 2 validated recordings (over 100 patients) number of recordings validated (over 200 recordings)
ABPM
HBPM 16
HBPM 12
HBPM 8
CBP
85% (85)
40% (40)
69% (69)
72% (72)
98% (98)
90% (180)
57.5% (115)
77.9% (199)
82.9% (169)
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Reasons for non-validation: For ABPM (20/200: 10%); treatment taken outside scheduled times (9/20: 45%); more than two hours break (6/20: 30%); ⬍ 48/96 measurements (8/20: 40%) .For HBPM (if 16/30 measurements required for validation: 85/200: 42.5%); ⬍ 3 measures per day (82/85: 96.5%); ⬍ 16/30 measures (66/85: 77%). The mean ⫾ SD of SBP and DBP with HBPM were not modified when decreasing from 16 to 8 measurements in order to validate HBPM. In conclusion, this study demonstrated that ABPM performed by non-selected cardiologists and immediately quality controlled by an analysis centre are more frequently interpretable (90%) than HBPM. However, for HBPM, 8 measurements would appear sufficient to obtain validated recordings in 83% of the cases without modify the results. Key Words: ambulatory blood pressure, home blood pressure , clinical trial
P-40 HOME BLOOD PRESSURE MEASURED TELEMETRICALLY IN HYPERTENSIVE PREGNANT WOMEN T. Denolle, J.L. Weber, C. Calvez, J.C. Daniel, M.T. Cheve, M. Marechaud, P. Bessec, B. Carbonne, Y. Gestin, J.M. Gandon. 1 Broussais Hospital, St. Malo, France, 2TAM Te´le´sante´, Aix-enProvence, France, 3St. Brieuc, France, 4St. Malo, France, 5Le Mans, France, 6Poitiers, France, 7Rennes, France, 8St. Antoine, Paris, France, 9Lorient, France, 10Biotrial S.A, Rennes, France Objectives To study: - the cost saving when using home blood pressure (HBP) measured telemetrically compared with classical BP monitoring in hypertensive pregnant women - the feasability of HBP during pregnancy - the prevalence of white coat hypertension (WCH) in mild hypertensive pregnant women. Design and methods After informed consent, 57 mild hypertensive women (81% nulliparous; 27 ⫾3 yrs with office BP ⱖ 140/90 and ⱕ180/105mmHg and after
POSTERS: Blood Pressure Measurement/Monitoring
P-38 EFFECT OF PERIPHRAL VESSEL CONGESTION ON DIASTOLIC BLOOD PRESSURE MEASUREMENTS WITH AUSCULTATORY METHOD Kazuhisa Tanabe, Yoshinori Miyawaki, Hirotoshi Egawa, Toshimitsu Kitajima, Junichi Minami, Hiroaki Matsuoka. 1Research And Development Center, Omron Institute of Life Science Co.,LTD., Kyoto, Kyoto, Japan, 2Anesthesiology I, Dokkyo University School of Medicine, Mibu, Tochigi, Japan, 3Department of Medicine, Dokkyo University School of Medicine, Mibu, Tochigi, Japan It is known well that Korotkoff sounds near diastole become difficult to be heard because of forearm congestion on the side where a cuff is wrapped. We evaluated relationships among cuff pressure, Korotkoff sounds, auscultatory blood pressure, intra-arterial pressure, and peripheral venous pressure during cuff deflation at different rates from 2 to 5.5 mmHg/sec. We enrolled Japanese volunteers in this study. An appropriate cuff was wrapped around the left arm for the auscultatory measurement. An arterial catheter was inserted into the left radial artery. A venous catheter was also inserted into the left forearm vein in order to measure peripheral venous pressure which was an index of forearm congestion on the side where a cuff was wrapped. Figure depicts Korotkoff sounds, cuff pressure, intra-arterial pressure, and venous pressure during deflation at a rate of 2.3mmHg/sec.
The venous pressure distal to the cuff began to increase soon after the cuff pressure decreased up to the intra-arterial systolic pressure and reached the maximum level. Then arterial pressure distal to the cuff increased above the venous pressure. When the venous pressure distal to the cuff and the cuff pressure balanced, the venous under the cuff opened and the return flow of the venous restarted. After that the venous pressure followed by the cuff pressure. In this case, the maximum level of the venous pressure exceeded the intra-arterial diastolic pressure. Korotkoff sounds disappeared a few seconds before the cuff pressure decreased up to the intra-arterial diastolic pressure. In contrast, Korotkoff sounds disappeared just when the cuff pressure reached the intra-arterial diastolic pressure during deflation at a rate of 5.5 mmHg/sec. These results suggest that diastolic auscultatory blood pressure is overestimated because of forearm congestion and elevation in peripheral artery and venous pressure on the side where a cuff is wrapped, especially during cuff deflation at a slow rate. Key Words: Auscultation, Korotkoff sound, Diastolic blood pressure
P-39 FEASABILITY OF AMBULATORY BLOOD PRESSURE MEASUREMENT AND HOME BLOOD PRESSURE MEASUREMENT IN THERAPEUTIC TRIALS Thierry Denolle, Bernard Vaisse, Franc¸ois Pe´rie´, Sophie NisseDurgeat, Jean-Marc Gandon. 1Broussais Hospital, St. Malo, France, 2 La Timone Hospital, Marseille, , France, 3Laboratoires Takeda, Puteaux, France, 4Biotrial S.A., Rennes, France The aim of this study was to compare the feasability of three methods of blood pressure measurement: clinical blood pressure (CBP), ambulatory blood pressure measurement (ABPM) and home blood pressure measurement (HBPM) during a therapeutic trial. One hundred non controlled hypertensive patients (aged 55 years, CBP: 158⫾ 15 / 96⫾ 7mmHg)
AJH–April 2001–VOL. 14, NO. 4, PART 2
treated with candesartan 8mg were randomized between candesartan 16mg and candesartan 8mg with hydrochlorothiazide 12.5mg for six weeks. The evaluation of the antihypertensive efficacy was assessed by each of the 3 methods before and after the 6-week treatment period. CBP was measured 3 times using a mercury sphygmomanometer, HBPM with an OMRON 705CP 3 measurements twice daily for one week and ABPM was recorded during 24h (one measure every 15 min) with a Spacelabs 90207 or a Dyasis Integra (Novacor). For HBPM, the recording had to contain at least 3 measurements per day and 8, 12 or 16 out of 30 measurements between D3 and D7 in order to be validated. Measurements taken outside the predefined times or abnormal values (SBP 60 ⬍ or ⬎ 250mmHg, DBP 40 ⬍ or ⬎ 150 mmHg, SBP-DBP ⬍ 10 mmHg if SBP ⬎ 110 mmHg) were eliminated. For ABPM, the recording had to last for at least 22 hours, begin between 7:00 and 11:00a.m., contain at least 48 measures and be devoid of breaks of more than 2 hours. The subject had to take the treatment within one hour following the installation of the device. The quality of the recording was controlled by BIOTRIAL (centralized analysis) as soon as the recording was finished and the cardiologist was immediately informed of the results by fax. patients with 2 validated recordings (over 100 patients) number of recordings validated (over 200 recordings)
ABPM
HBPM 16
HBPM 12
HBPM 8
CBP
85% (85)
40% (40)
69% (69)
72% (72)
98% (98)
90% (180)
57.5% (115)
77.9% (199)
82.9% (169)
-----
Reasons for non-validation: For ABPM (20/200: 10%); treatment taken outside scheduled times (9/20: 45%); more than two hours break (6/20: 30%); ⬍ 48/96 measurements (8/20: 40%) .For HBPM (if 16/30 measurements required for validation: 85/200: 42.5%); ⬍ 3 measures per day (82/85: 96.5%); ⬍ 16/30 measures (66/85: 77%). The mean ⫾ SD of SBP and DBP with HBPM were not modified when decreasing from 16 to 8 measurements in order to validate HBPM. In conclusion, this study demonstrated that ABPM performed by non-selected cardiologists and immediately quality controlled by an analysis centre are more frequently interpretable (90%) than HBPM. However, for HBPM, 8 measurements would appear sufficient to obtain validated recordings in 83% of the cases without modify the results. Key Words: ambulatory blood pressure, home blood pressure , clinical trial
P-40 HOME BLOOD PRESSURE MEASURED TELEMETRICALLY IN HYPERTENSIVE PREGNANT WOMEN T. Denolle, J.L. Weber, C. Calvez, J.C. Daniel, M.T. Cheve, M. Marechaud, P. Bessec, B. Carbonne, Y. Gestin, J.M. Gandon. 1 Broussais Hospital, St. Malo, France, 2TAM Te´le´sante´, Aix-enProvence, France, 3St. Brieuc, France, 4St. Malo, France, 5Le Mans, France, 6Poitiers, France, 7Rennes, France, 8St. Antoine, Paris, France, 9Lorient, France, 10Biotrial S.A, Rennes, France Objectives To study: - the cost saving when using home blood pressure (HBP) measured telemetrically compared with classical BP monitoring in hypertensive pregnant women - the feasability of HBP during pregnancy - the prevalence of white coat hypertension (WCH) in mild hypertensive pregnant women. Design and methods After informed consent, 57 mild hypertensive women (81% nulliparous; 27 ⫾3 yrs with office BP ⱖ 140/90 and ⱕ180/105mmHg and after