Alerting reaction and rise in blood pressure during measurement by physician and nurse.

Abstract

SUMMARY Blood pressure was monitored by a continuous intra-arterial recording in 46 subjects to investigate whether the alarm reaction and the blood pressure and heart rate increases that occur during cuff blood pressure measurement made by a physician 1) attenuate when the physician's visit is repeated several times and 2) are less pronounced if a nurse measures the blood pressure. In 16 subjects the peak mean blood pressure and heart rate rises that occurred in the early part of the physician's first visit (22.6 ± 1.8 mm Hg and 17.7 ± 1.7 beats/min) were virtually identical to those occurring during three subsequent visits by the same physician throughout a 2-day intra-arterial blood pressure monitoring. The less pronounced pressor and tachycardie responses observed in the last part of the physician's visit also were virtually identical among the four visits. In contrast, in 30 other subjects the blood pressure and heart rate rises that occurred during the nurse's visit were 46.7% and 42.1% less (p<0.01) than those occurring during the physician's visit. The late and less pronounced pressor and tachy cardie responses to the visit were also significantly less (p<0.01) in the former than in the latter condition. These results indicate that the error of overestimation of blood pressure inherent in cuff blood pressure measurement by a physician cannot be avoided by repeated visits by the physician over a short time span. It clearly can be reduced, however, if blood pressure measurements are performed by a nurse. (Hypertension 9: 209-215, 1987) KEY WORDS * alerting reaction • invasive blood pressure monitoring measurements • hypertension • blood pressure • stress cuff blood pressure W E have previously shown that blood pressure measurements made by a physician may trigger an alerting reaction that is responsible for a rise in blood pressure that lasts several minutes.1 As hypertension usually is defined in terms of the blood pressure level measured by the physician, this rise can lead to a misdiagnosis of hypertension, particularly of so-called mild hypertension, and to incorrect decisions about when and how much to treat. It is therefore clinically important to investigate the conditions in which the alerting reaction and the accompanying blood pressure rise can be reduced or abolished.In the present study we directed our attention to two possibilities that have been widely discussed but not

Monitorização residencial da pressão arterial e monitorização ambulatorial da pressão arterial versus medida de pressão arterial no consultório

“…No entanto, apesar de ser o método mais freqüentemente utilizado, tem sido demonstrado que a própria presença do médico pode influenciar a leitura obtida da PA 1 .…”

“…Mais recentemente, foi demonstrado em pacientes com a pressão monitorizada intra-arterialmente que a pressão intra-arterial se eleva no momento que o médico realiza a medida da pressão pelo método indireto com técnica auscultatória 1 . Esta reação frente à medida da PA dificulta tanto o diagnóstico da HA quanto a avaliação da terapêutica.…”

Is there an effect of perioperative blood pressure on intraoperative complications during phacoemulsification surgery under local anaesthesia?

“…[16][17][18][19] It is clear that in many surgical patients, the admission arterial pressure will not equate to the patient's usual arterial pressure. 20 Recent studies suggest maintaining arterial pressure perioperatively at 70-100% of baseline and avoiding tachycardia is a key factor in the optimal management of hypertensive surgical patients. 17,21 In our series, none of the patients developed perioperative systemic complications requiring anaesthetic intervention.…”

The role of nurses in hypertension care and research

“…pleted by nurses (see Appendix) and nursing experts are also discussing in print some of the methodological difficulties confronting researchers. [148][149][150][151][152][153] ment values to relate to intra-arterial readings, 154 Control of blood pressure in Scotland: the rules of and mean daytime ambulatory BP values. [155][156][157] halves.…”