Rasvahapot valtimotaudin vaaran arvioinnissa

1. Rasvahapot valtimotaudin vaaran arvioinnissa Blood pressure measurement - EHES September 21, 2010 Antti Jula

2. Developed Countries Deaths in 2000 Attributable to Selected 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) Antti Jula

6. Factors 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

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 mmHg 3.0/1.7 mmHg Kumpusalo et al. J Human Hypertens 2002;16:725-728 Antti Jula

11. Paired BP readings without careful preceding procedures and measurement techniques Watson et al, J Hypertens 1987, 5:207–11 Antti Jula

12. Paired BP readings with careful preceding procedures and measurement techniques Jula et al, Hypertension 1999, 34:261–6 Antti Jula

13. Univariate correlates with the left ventricle and albuminuriaJula, Puukka, Karanko, Hypertension 1999;34:261-266 Antti Jula

14. Univariate correlates with the left ventricle and albuminuriaJula, Puukka, Karanko, Hypertension 1999;34:261-266 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. • Systematic error that leads to both intraobserver and interobserver error • 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 • 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. 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 Corresponding oscillometric BP of five auscultory measured BP level 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.) Antti Jula