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1.
Brasília; CONITEC; mar. 2023.
Non-conventional in Portuguese | BRISA/RedTESA | ID: biblio-1437680

ABSTRACT

INTRODUÇÃO: A HAS é uma condição clínica multifatorial caracterizada por níveis elevados e sustentados de PA. Além de ser causa direta de cardiopatia e nefropatia hipertensivas, a HAS é fator de risco linear e contínuo para doenças decorrentes de aterosclerose e trombose, que se manifestam, predominantemente, por doença isquêmica cardíaca, cerebrovascular, vascular periférica e renal, assim como de morte prematura. Embora as diretrizes atuais recomendem o uso de monitorização ambulatorial da pressão arterial (MAPA) ou MRPA para detecção de hipertensão do jaleco branco, hipertensão mascarada, entre outras condições clinicamente relevantes. No SUS, os indivíduos dispõem de MAPA e medida da PA de consultório para o diagnóstico de HAS que pode, entretanto, estar superestimado (hipertensão do jaleco branco) pelo uso apenas da medida da PA de consultório ou subestimado (hipertensão mascarada ou subdiagnóstico) pelo não comparecimento do indivíduo para consultas e medidas da PA de consultório sequenciais e pela falta de acesso e acessibilidade à MAPA. Nesse contexto, MRPA foi priorizada para avaliação de incorporação para diagn


Subject(s)
Humans , Blood Pressure Monitors/supply & distribution , Hypertension/drug therapy , Unified Health System , Brazil , Cost-Benefit Analysis/economics
2.
Circ Res ; 128(7): 808-826, 2021 04 02.
Article in English | MEDLINE | ID: mdl-33793340

ABSTRACT

In recent decades low- and middle-income countries (LMICs) have been witnessing a significant shift toward raised blood pressure; yet in LMICs, only 1 in 3 are aware of their hypertension status, and ≈8% have their blood pressure controlled. This rising burden widens the inequality gap, contributes to massive economic hardships of patients and carers, and increases costs to the health system, facing challenges such as low physician-to-patient ratios and lack of access to medicines. Established risk factors include unhealthy diet (high salt and low fruit and vegetable intake), physical inactivity, tobacco and alcohol use, and obesity. Emerging risk factors include pollution (air, water, noise, and light), urbanization, and a loss of green space. Risk factors that require further in-depth research are low birth weight and social and commercial determinants of health. Global actions include the HEARTS technical package and the push for universal health care. Promising research efforts highlight that successful interventions are feasible in LMICs. These include creation of health-promoting environments by introducing salt-reduction policies and sugar and alcohol tax; implementing cost-effective screening and simplified treatment protocols to mitigate treatment inertia; pooled procurement of low-cost single-pill combination therapy to improve adherence; increasing access to telehealth and mHealth (mobile health); and training health care staff, including community health workers, to strengthen team-based care. As the blood pressure trajectory continues creeping upward in LMICs, contextual research on effective, safe, and cost-effective interventions is urgent. New emergent risk factors require novel solutions. Lowering blood pressure in LMICs requires urgent global political and scientific priority and action.


Subject(s)
Developing Countries , Hypertension , Alcohol Drinking/adverse effects , Blood Pressure Monitors/standards , Blood Pressure Monitors/supply & distribution , COVID-19/complications , COVID-19/epidemiology , Cardiovascular Physiological Phenomena , Developing Countries/statistics & numerical data , Diet/adverse effects , Environment , Environmental Pollution/adverse effects , Health Behavior , Heart Diseases/mortality , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Hypertension/etiology , Life Course Perspective , Life Style , Nurses/supply & distribution , Obesity/complications , Physicians/supply & distribution , Prevalence , Research , Risk Factors , Sedentary Behavior , Social Determinants of Health , Stroke/mortality , Tobacco Use/adverse effects , Urbanization
3.
Rev. panam. salud pública ; 44: e88, 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1127118

ABSTRACT

RESUMEN La hipertensión arterial es una causa modificable muy prevalente de enfermedades cardiovasculares, accidentes cerebrovasculares y muerte. Medir con exactitud la presión arterial es fundamental, dado que un error de medición de 5 mmHg puede ser motivo para clasificar incorrectamente como hipertensas a 84 millones de personas en todo el mundo. En la presente declaración de posición se resumen los procedimientos para optimizar el desempeño del observador al medir la presión arterial en el consultorio, con atención especial a los entornos de ingresos bajos o medianos, donde esta medición se ve complicada por limitaciones de recursos y tiempo, sobrecarga de trabajo y falta de suministro eléctrico. Es posible reducir al mínimo muchos errores de medición con una preparación adecuada de los pacientes y el uso de técnicas estandarizadas. Para simplificar la medición y prevenir errores del observador, deben usarse tensiómetros semiautomáticos o automáticos de manguito validados, en lugar del método por auscultación. Pueden ayudar también la distribución de tareas, la creación de un área específica de medición y el uso de aparatos semiautomáticos o de carga solar. Es fundamental garantizar la capacitación inicial y periódica de los integrantes del equipo de salud. Debe considerarse la implementación de programas de certificación de bajo costo y fácilmente accesibles con el objetivo de mejorar la medición de la presión arterial.(AU)


ABSTRACT High blood pressure (BP) is a highly prevalent modifiable cause of cardiovascular disease, stroke, and death. Accurate BP measurement is critical, given that a 5-mmHg measurement error may lead to incorrect hypertension status classification in 84 million individuals worldwide. This position statement summarizes procedures for optimizing observer performance in clinic BP measurement, with special attention given to low-tomiddle- income settings, where resource limitations, heavy workloads, time constraints, and lack of electrical power make measurement more challenging. Many measurement errors can be minimized by appropriate patient preparation and standardized techniques. Validated semi-automated/automated upper arm cuff devices should be used instead of auscultation to simplify measurement and prevent observer error. Task sharing, creating a dedicated measurement workstation, and using semi-automated or solar-charged devices may help. Ensuring observer training, and periodic re-training, is critical. Low-cost, easily accessible certification programs should be considered to facilitate best BP measurement practice.(AU)


RESUMO A hipertensão é uma causa altamente prevalente de doença cardiovascular, acidente vascular cerebral e morte. A medição precisa da pressão arterial (PA) é um aspecto crítico, uma vez que erros de mensuração da ordem de 5 mmHg podem levar a uma classificação incorreta do status de hipertensão em 84 milhões de pessoas em todo o mundo. O presente posicionamento resume os procedimentos para otimizar o desempenho do observador (o indivíduo responsável pela mensuração da PA) na mensuração clínica da PA, com atenção especial para contextos de baixa a média renda, onde recursos limitados, cargas de trabalho pesadas, restrições de tempo e falta de energia elétrica tornam mais desafiadora a tarefa de medir a PA. Muitos erros de mensuração podem ser minimizados pela preparação adequada do paciente e pelo uso de técnicas padronizadas. Para simplificar a mensuração e evitar erros do observador, devem-se utilizar dispositivos semiautomatizados ou automatizados validados, com manguito para braço, ao invés de auscultação. O compartilhamento de tarefas, a criação de uma estação de trabalho dedicada à mensuração e o uso de dispositivos semiautomatizados ou com carga solar podem ajudar. É essencial que seja assegurado o treinamento e retreinamento periódico do observador. Programas de certificação de baixo custo e de fácil acesso devem ser considerados para facilitar a adoção das melhores práticas na mensuração da PA.(AU)


Subject(s)
Humans , Oscillometry , Blood Pressure Monitors/supply & distribution , Global Health/trends , Risk Measurement Equipment , Hypertension/prevention & control
4.
J Clin Hypertens (Greenwich) ; 21(6): 853-858, 2019 06.
Article in English | MEDLINE | ID: mdl-30803128

ABSTRACT

There is growing evidence of the clinical significance of daytime masked hypertension (MHT) and blood pressure (BP) variability (BPV). Recently, watch-type wearable devices for self-BP measurement have become available. Such devices might be promising tools to identify patients with daytime MHT or large BPV in their real-life conditions. The present study aimed to validate the accuracy of the Omron HEM-6410T-ZM and the Omron HEM-6410T-ZL, which are automatic watch-type wearable devices for self-BP measurement, according to the American National Standards Institute, Inc/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 guideline. Watches were held with the wrist at heart level. The mean differences between reference BPs and HEM-6410T-ZM readings were -0.9 ± 7.6/-1.1 ± 6.1 mm Hg for systolic BP (SBP)/diastolic BP (DBP) for criterion 1, and -0.9 ± 6.8/-1.1 ± 5.5 mm Hg for SBP/DBP for criterion 2. The mean differences between reference BPs and HEM-6410T-ZL readings were 2.4 ± 7.3/0.7 ± 7.0 mm Hg for SBP/DBP for criterion 1, and 2.4 ± 6.5/0.7 ± 6.5 mm Hg for SBP/DBP for criterion 2. The Omron HEM-6410T-ZM and the Omron HEM-6410T-ZL both fulfilled both validation criteria 1 and 2 of the ANSI/AAMI/ISO 81060-2:2013 guidelines.


Subject(s)
Blood Pressure Monitoring, Ambulatory/instrumentation , Blood Pressure Monitors/supply & distribution , Equipment Design/instrumentation , Masked Hypertension/diagnosis , Wearable Electronic Devices/supply & distribution , Aged , Biological Variation, Population , Blood Pressure Monitors/trends , Case-Control Studies , Equipment Design/statistics & numerical data , Female , Guidelines as Topic , Humans , Japan/epidemiology , Male , Masked Hypertension/physiopathology , Middle Aged , Reproducibility of Results , Wearable Electronic Devices/trends
5.
Trop Doct ; 42(2): 101-3, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22431828

ABSTRACT

Regular blood pressure (BP) monitoring is a cost-effective means of early identification and management of hypertensive disease in pregnancy. In much of rural sub-Saharan Africa, the ability to take and act on accurate BP measurements is lacking as a result of poorly functioning or absent equipment and/or inadequate staff education. This study describes the feasibility of using validated automated BP devices suitable for low-resource settings (LRS) in primary health-care facilities in rural Tanzania. Following a primary survey, 19 BP devices were distributed to 11 clinics and re-assessed at one, three, six, 12 and 36 months. Devices were used frequently with high levels of user satisfaction and good durability. We conclude that the use of automated BP devices in LRS is feasible and sustainable. An assessment of their ability to reduce maternal and perinatal morbidity and mortality is vital.


Subject(s)
Ambulatory Care Facilities , Automation , Blood Pressure Monitors/statistics & numerical data , Hypertension/diagnosis , Poverty , Pregnancy Complications, Cardiovascular/diagnosis , Blood Pressure Determination/instrumentation , Blood Pressure Monitors/supply & distribution , Feasibility Studies , Female , Health Resources , Humans , Pregnancy , Primary Health Care , Rural Population , Tanzania
6.
J Reprod Med ; 41(8): 581-5, 1996 Aug.
Article in English | MEDLINE | ID: mdl-8866385

ABSTRACT

OBJECTIVE: To compare the accuracy of three commercially available blood pressure monitoring devices having cuffs placed at different anatomic sites on obese pregnant women with large arms. STUDY DESIGN: Fifty-five obese pregnant women (body mass index > 27.3) were eligible for participation; each had an upper arm circumferences > 35 cm. The three different portable devices compared had cuffs that fit easily around either the index finger, wrist or large arm. Two recordings using each device were compared with those obtained simultaneously using a well calibrated monitor. RESULTS: Systolic, diastolic and mean arterial pressure recordings did not correlate between the monitor and devices with the cuff around the finger (r2 = .17, .17, .22), wrist (.30, .24, .33) or large arm (.44, .26, .40). The percentages of measurement differences within 5 mm Hg for the systolic, diastolic and mean arterial pressure were low for the device with the cuff around the finger (11.0%, 25.5%, 23.6%), wrist (33.0%, 46.4%, 35.5%) or large arm (38.5%, 29.4%, 46.7%). CONCLUSION: Despite their commercial appeal, none of these portable blood pressure monitoring devices was accurate for use by obese pregnant patients with large arms.


Subject(s)
Blood Pressure Monitors/standards , Hypertension/diagnosis , Obesity/complications , Pregnancy Complications, Cardiovascular/diagnosis , Adolescent , Adult , Arm/pathology , Bias , Blood Pressure Monitors/supply & distribution , Female , Humans , Hypertension/complications , Obesity/pathology , Pregnancy , Pregnancy Complications, Cardiovascular/pathology , Reproducibility of Results
7.
Crit Care Med ; 24(5): 879-82, 1996 May.
Article in English | MEDLINE | ID: mdl-8706469

ABSTRACT

OBJECTIVE: To determine the bedside accuracy of direct patient pressure monitoring when used with new and clinically used disposable blood pressure (BP) transducers. DESIGN: Prospective study. SETTING: Laboratory bench and critical care units in an adult and children's hospital. SUBJECTS: Seventy-five bedside patient monitors (25 Marquette Electronics, 25 Spacelab Medical, and 25 Hewlett-Packard), and 100 disposable transducers (50 from Utah Medical Products and 50 from Abbott Critical Care Systems [25 new, 25 clinically used of each manufacturer]) were tested. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A +/- 2% accuracy requirement for bedside monitors and the +/- 3% American National Standards Institute accuracy standard for disposable BP transducers were used. To test the accuracy of the bedside monitors, a certified transducer simulator was used to apply 100 mm Hg to each bedside monitor. To test the accuracy of the disposable BP transducers, a very accurate (+/- 0.05%) pneumatic dead weight tester was used to apply pressures to the transducer. A digital power supply and a 6 1/2 digit voltmeter were used. The average output of the bedside monitors when 100 mm Hg was applied was 99.90 +/- 0.83 mm Hg, with the worst cases being 98 and 103 mm Hg. For all 100 disposable pressure transducers, the average output was 100.03 +/- 0.55 mm Hg, with the worst cases being 98.53 and 101.36 when 100 mm Hg was applied. There was no important difference in the accuracy of the transducers obtained from the two vendors nor whether the transducers had been used clinically. CONCLUSIONS: All disposable BP transducers tested were much more accurate than the American National Standards Institute standard for accuracy. Even the worst case transducers were twice as accurate as required by the American National Standards Institute standard. Only one bedside monitor was outside the +/- 2% accuracy range (103 mm Hg). Based on these findings, this author recommends that fixed calibration disposable transducers and fixed calibration bedside pressure monitoring systems be used. The clinical risks of air embolism and infection from the calibrating mercury manometer and the complexity of the calibration task are the overriding factors for making these recommendations.


Subject(s)
Blood Pressure Determination/instrumentation , Blood Pressure Monitors/standards , Disposable Equipment/standards , Transducers, Pressure/standards , Adult , Blood Pressure Monitors/adverse effects , Blood Pressure Monitors/supply & distribution , Calibration , Child , Cross Infection/etiology , Disposable Equipment/supply & distribution , Embolism, Air/etiology , Humans , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Transducers, Pressure/adverse effects , Transducers, Pressure/supply & distribution
8.
Intensive Care World ; 12(3): 89-102, 1995 Sep.
Article in English | MEDLINE | ID: mdl-10157893

ABSTRACT

Noninvasive blood pressure (NIBP) is one of the most common vital signs monitored by today's bedside and transport monitors. A variety of NIBP measurement methods has been used in these monitors. Some of the methods provide intermittent measurements over a period of time, while others provide continuous measurement on a beat-to-beat basis. Most of the monitors provide for on-demand measurement as well as automatic measurement at user-selected intervals. The measurement accuracy of an NIBP monitor is typically established by clinical evaluation. Generally safe and easy to use, NIBP monitors play a very important role in patient care.


Subject(s)
Blood Pressure Determination/instrumentation , Blood Pressure Determination/methods , Blood Pressure Monitors/standards , Automation , Bias , Blood Pressure Monitors/supply & distribution , Equipment Design , Humans
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