Casual and Basal Blood Pressures Ii. In Essential Hypertension

Alam, Golam; Smirk, F. H.

doi:10.1136/hrt.5.3.156

Cited by 32 publications

(23 citation statements)

References 2 publications

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“…1314 This information is not available for blood pressures that are obtained partially or totally free from the effects of the alerting reaction. However, in a study performed many years ago, Smirk and Alam 15 ' l6 reported that the lowest blood pressure measurable during a prolonged visit (the "basal" blood pressure) correlates better than the initial one with the complications of hypertension. 16 Furthermore, recent cross-sectional studies have suggested that 24-hour or daytime mean blood pressure relates to the target organ damage of hypertension more closely than the higher blood pressure obtained by casual measurements.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 1987

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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

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Section: Discussionmentioning

confidence: 99%

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

et al. 1987

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“…1929;Houston, 1929;Brown, 1929-30;Alkan, 1930;Mueller and Brown, 1930;Stieglitz, 1930;Kronfeld, 1932;Schultz, 1932;Ayman and Goldshine, 1940;Alam andSmirk, 1943a, 1943b;Ehrstr6m, 1945). Emotional rises of pressure of 10 or 20 mm.…”

Section: Transient Blood Pressure Increasesmentioning

confidence: 99%

“…That most of these transient rises are due to emotion, tenseness, alertness, or some such mental state is very highly probable, because nearly all subside, sometimes in a few minutes, if the subject can be put at ease (Weitz and Sieben, 1926;Mueller and Brown, 1930;Ayman and Pratt, 1931;Alam andSmirk, 1943a, 1943b;Smirk, 1944Smirk, , 1947Kilpatrick, 1948). The pressure often can be made to rise promptly again if emotion be provoked, for example, by a tactless remark or the entry of a nurse with a tray of instruments (Alam and Smirk, 1943a;Kilpatrick, 1948). Those who exhibit such transient blood-pressure elevations have a much greater chance of developing permanent arterial hypertension later (von Monakow, 1920;Frost, 1926;Palmer, 1930;Stieglitz, 1930;Robinson and Brucer, 1939;Hines, 1940).…”

Section: Transient Blood Pressure Increasesmentioning

confidence: 99%

Pathogenesis of Essential Hypertension

Smirk¹

1949

BMJ

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“…These findings are in line with the view held by one of the forefathers of the field of hypertension research, Sir Frederick Horace Smirk, who believed that there are 2 components of BP. 43 He defined the basal component essentially as the lowest achieved at the maximum relaxation state before rising and the supplemental one as the difference between the casual and basal values. These components roughly correspond with sleep BP and dipping magnitude in 24-hour ABPM.…”

Section: Perspectivesmentioning

confidence: 99%

Predictors of All-Cause Mortality in Clinical Ambulatory Monitoring

et al. 2007

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Abstract-The prognostic value of sleep blood pressure reported by recent studies is variable. Our aim was to examine the relationship of sleep blood pressure, measured by 24-hour ambulatory blood pressure monitoring, with all-cause mortality. We studied a cohort of 3957 patients aged 55Ϯ16 (58% treated) referred for ambulatory monitoring (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005) Key Words: ambulatory blood pressure monitoring Ⅲ dipping Ⅲ mortality Ⅲ cohort Ⅲ sleep blood pressure D ata generated by 24-hour ambulatory blood pressure monitoring (ABPM) have been used to predict cardiovascular morbidity, as well as cardiovascular and all-cause mortality. [1][2][3][4][5][6][7][8][9] There is mounting evidence that this predictive ability is in part unrelated to clinic blood pressure (BP) measurements. Conceivably, ABPM reflects physiological states that are not captured by resting clinic measurements. 9 Moreover, ABPM reduces the influence of the measurement itself on BP values, namely the white-coat effect. In addition, ambulatory monitoring may unmask abnormal BP values that were not detected in the office. Thus, it is expected that ABPM would predict mortality above and beyond clinic measurements. There is still debate, however, whether in reality this is indeed the case and whether the use of this burdensome technique in clinical care is justified and contributes to patient management. 5 Another issue under debate concerns which component of the 24-hour ambulatory monitoring incorporates the most valuable prognostic information. Measurements taken during the waking state reflect, in part, physical activity, which may differ within and between patients. Thus, we hypothesized that, compared with awake BP, sleep measurements would relate to prognosis in a more profound way. Indeed, some 1,3,5,7,10,11 but not all 2 of the outcome studies have suggested this previously.In this study, we investigated all-cause mortality among patients who underwent ambulatory monitoring in a single center since 1991. We highlight sleep BP data identified by recorded sleeping periods, including afternoon naps. 12 We show that sleep BP, as well as nocturnal BP reduction (dipping, a somewhat controversial and infrequently studied topic 7,9,10,13 ) have independent predictive power. Methods Study PopulationData were extracted from our entire ABPM service database, from 1991 through 2005. All of the patients were included, except those Ͻ16 years old, pregnant women, and subjects with poor-quality ABPM (Ͻ50 valid measurements). Patients were referred for standard clinical indications at the discretion of the referring physician (mainly primary care practitioners, who have been shown to use ABPM for appropriate indications 14 ). We were not involved in the clinical care of these patients. Baseline data collected included demographic characteristics (age: 55 years [range: 16 to 93 years], sex (53% female), ethnicity (94% Jewish and 6% non-Jewish, predominantly Moslem Arabs), height (1.67 m; range...

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Casual and Basal Blood Pressures Ii. In Essential Hypertension

Cited by 32 publications

References 2 publications

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

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

Pathogenesis of Essential Hypertension

Predictors of All-Cause Mortality in Clinical Ambulatory Monitoring

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