Auscultatory BP: still the gold standard.

1. Current research documents AusBP is more accurate and reliable than all other clinical methods. 2. All current OBPM devices make large errors in some patients requiring individual validation of accuracy. 3. The only method to detect individual errors is by AusBP. This takes training to mastery of BP measurement skills using our standardized protocol.

The Omron Elite 7300W home blood pressure monitor passes the European Society of Hypertension International Validation Protocol for women and men.

OBJECTIVE: To test the accuracy of the Omron Elite 7300W home blood pressure monitor using the European Society of Hypertension (ESH) Protocol. METHODS: The device was tested using the European Society of Hypertension International Protocol in 33 women and then in 10 men to satisfy the ESH for both men and women. RESULTS: The average error in all participants was 1.2+/-5.2 (SD) [(range -10 to 17)/3.29+/-5.5 (-6 to 17)] mmHg. This is the first device to have been tested using the ESH protocol for the special population of women only. The additional testing of men in the standard ESH protocol enables the validation of this device specifically in women but also in men. However, as with all automatic devices, it is important to validate its accuracy in each individual patient who uses it and to monitor its accuracy intermittently in each individual patient. CONCLUSION: The Omron Elite 7300W home blood pressure monitor passed the ESH validation protocol and can be recommended for patient use.

The HoMedics BPA-200 and BPA-300 home blood pressure devices fail the European Society of Hypertension International Protocol and cannot be recommended for patient use.

We have tested two home blood pressure monitors made by the HoMedics, Inc., 300 Pontiac Trail, Commerce Township, Michigan 48390, USA, using the European Society of Hypertension International Protocol. Both failed and we believe it is important to get this into the literature quickly to protect patients and practitioners.

Omron HEM-711 DLX home Blood pressure monitor passes the European Society of Hypertension International Validation Protocol.

The Omron HEM-711 DLX home Blood pressure monitor was tested using the European Society of Hypertension International Protocol in 33 patients. The average error was 0.9+/-5.2 (SD) (range: -12 to 10 mmHg)/-0.8+/-5.6 (-19 to 8). It can be recommended for use by patients. With all automatic devices it is, however, important to validate its accuracy in each individual patient who uses it.

The Republic of Georgia High Blood Pressure Control Program.

INTRODUCTION: 52% of adults have uncontrolled hypertension in the Republic of Georgia. We incorporated a blood pressure control program into an existing primary healthcare system in an attempt to improve the rate of blood pressure control. METHODS: We conducted standardized trainings of rural primary care providers--doctors and nurses--in accurate measurement of blood pressure according to the Shared Care Method of Training and Certification. Our attention was focused especially on patient management based on Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) guidelines. Antihypertensive treatment was implemented by a stepped-care approach; hydrochlorothiazide and atenolol were given to patients at follow-up visits at no cost. The treatment goal was < 140/ 90 mm Hg based on the office blood pressure. RESULTS: A total of 251 patients with uncontrolled hypertension were enrolled in the program; 32% had stage I hypertension, 41% had stage II hypertension, and 27% had stage III, as defined by JNC VI. During the first 30 months of followup, blood pressure decreased gradually from 170/95 to 140/ 82 mm Hg. The rate of high blood pressure control increased progressively up to 59%. CONCLUSIONS: We conclude that hypertension control can be improved in all groups of patients, even in a healthcare system with limited resources. We emphasize that Georgia or any other healthcare system should not wait for universal health care to improve high blood pressure control. It can be incorporated into whatever system exists today.

Genetic influences on the increase in blood pressure with age in normotensive subjects in Barbados.

The authors tested the single and combined effects of nuclear and mitochondrial DNA genotypes on the phenotypes of systolic blood pressure (SBP) and weight, and their changes over 5 years in normotensive subjects living in Barbados. The nuclear genotypes were gender (Y chromosome), haptoglobin (HP), and group specific component (Gc). A mitochondrial genotype was chosen as a marker for maternal lineage. Baseline clinic SBP and weight (N=78), 24-hour SBP (N=28) were measured. Five years later, clinic SBP and weight were measured again in 28 participants. Male participants generally had higher pressures than female participants. The HP genotype was associated with 5 of the 8 SBP phenotypes. The haptoglobin-1 (HP1) allele was associated with higher clinic (P=.024) and evening SBP at baseline (P=.020). The effect of HP1 appears to be dominant. Haptoglobin-2 (HP2) was associated with the increase in weight over 5 years (P=.002). Group specific component (Gc) genotype was associated with 6 of the 8 SBP phenotypes. The Gc polymorphism 2 was associated with higher 24-hour SBP, sleep SBP (midnight-6 AM), afternoon SBP (noon-6 PM) and evening SBP (6 PM to midnight). Furthermore, we found a significant association between the haptoglobin/mt-DNA and Gc/mt-DNA polymorphisms with SBP between 6 PM and midnight (P=.009 and P=.011, respectively). The 5-year changes in SBP were significantly associated with the haptoglobin/mt-DNA and Gc/mt-DNA polymorphisms (P=.005 and P=.011, respectively). Multivariate analysis for genetic effects on change in weight and change in BP suggested the rise in BP, but was not suggestive of change in weight. Furthermore, multivariate analysis was associated with Gc, but not Haptoglobin genotype. In normotensive subjects of African descent living in Barbados, the increase in blood pressure with age is significantly influenced by both nuclear and mitochondrial genotypes that are more common in African derived populations.

National Health and Nutrition Examination Survey 1999-2000: effect of observer training and protocol standardization on reducing blood pressure measurement error.

OBJECTIVE: We describe the National Health and Nutrition Examination Survey (NHANES) blood pressure (BP) observer training and protocol standardization and evaluate the quality of BP measurement. METHODS: The participants were persons aged 8 years and older who had their BP measured (n=7467) during NHANES 1999-2000. Cuff width/arm circumference ratio (CW/AC), end digit preference, and observer agreement were examined. RESULTS: In stepwise principal components multiple regression analysis, CW/AC accounted for less than 2% of variability R(2) in all readings. The frequencies for all end digits were close to 20% ("0" end digit=21% systolic and 23% diastolic). No overall observer effect was present for mean systolic BP readings. A significant observer effect (P<.0001) was detected for mean diastolic BP readings of <90 mm Hg. For readings of > or =90 mm Hg, there was no significant observer effect (P=.157). CONCLUSION: We conclude that NHANES BP measurements do not demonstrate the variability that is commonly caused by observer and technical error.