Impact of equipment and handling on systolic blood pressure measurements in conscious dogs in an animal hospital environment

Abstract

Background: Situational hypertension and differences between devices complicate interpretations of systolic blood pressure (SBP) measurements in dogs. Hypothesis/Objectives: To evaluate if time point of in-clinic SBP measurement, type of oscillometric device, and operator affect SBP measurements in conscious dogs. Animals: Sixty-seven privately owned dogs with or without chronic kidney disease, divided into 2 study samples (A and B). Methods: Cross-sectional diagnostic study. In part A, SBP measurements in dogs were performed using 2 different devices (HDO and petMap) after acclimatization at 3 standardized time points during a clinical visit. In part B, SBP measurements (HDO) were performed in dogs by a trained final year veterinary student and by the owner alone, at the same occasion. Results: For all dogs, there was no difference in mean SBP (mSBP) among the 3 time points for HDO (P = .12) or petMAP (P = .67). However, intraindividual mSBP differences of up to 60 mm Hg between time points were documented. Mean SBP obtained with petMAP was on average 14 (95% CI: 8-20) mm Hg higher than mSBP obtained with HDO, and this difference increased with increasing SBP. Mean SBP measurements obtained by the trained student were 7 (95% CI: 2-11) mm Hg higher than mSBP measurements obtained by the owner. Conclusions and Clinical Importance: According to the results of this study, time point of in-clinic SBP measurement in dogs is of minor importance, and instructing owners to perform measurements might reduce suspected situational hypertension. Abbreviations: ACVIM, American College of Veterinary Internal Medicine; BP, blood pressure; CKD, chronic kidney disease; mSBP, mean systolic blood pressure calculated from multiple measurements with a variation of ≤20%; mSBPowner, mean systolic blood pressure calculated from measurements performed by the owner; mSBPowner_adjusted, mean systolic blood pressure calculated from measurements performed by the owner after exclusion of unreliable measurements as indicated by the HDO software; mSBPvet, mean systolic blood pressure calculated from measurements performed by the trained veterinary student; mSBPvet_adjusted, mean systolic blood pressure calculated from measurements performed by the veterinary student after exclusion of unreliable measurements as indicated by the HDO software; SBP, systolic blood pressure; TP, standardized time point during a clinical visit.

Systolic blood pressure measurements with Doppler ultrasonic flow detector and high-definition oscillometry are comparable on population level but show large intra-individual differences in apparently healthy elderly dogs

“…Operator (student vs owner) effect on SBP value was previously shown for in-clinic measurements. 9 This was not addressed in the current study due to the study design (ie, only a single operator was involved in BP measurement). In human medicine, ambulatory (assessing day-and nighttime BP during routine daily activities, over one 24-hour period) and home (measured by the patient themself on specific time points being seated, over a longer period of time) BP monitoring are considered to provide complementary information and should ideally be combined in clinical practice.…”

“…[1][2][3][4][5][6][7] Measurement of direct BP, the gold standard in dogs, is often not applicable in practice, due to the need for sedation/anesthesia and high degree of technical skills required. 8,9 Noninvasive BP (NIBP) measurement devices are easy to use and routinely available. The most commonly used NIBP measurement techniques in practice and research settings Systolic blood pressure measurements with Doppler ultrasonic flow detector and high-definition oscillometry are comparable on population level but show large intra-individual differences in apparently healthy elderly dogs…”

“…[22][23][24] Besides age, environment, and method, other factors that can influence SBP measurements are operator experience, breed, sex, dog's temperament, and owner's presence. 8,9 The main aim of this prospective study was to compare SBP measurements obtained with Doppler versus HDO in conscious, apparently healthy elderly dogs. A secondary aim was to assess the impact of situational hypertension in the in-clinic hypertensive dogs by repeating measurements in the dog's home environment.…”

Hipertensão arterial sistêmica e as diretrizes para identificação, avaliação, controle e manejo hipertensivo em cães e gatos

“…Valores pressóricos apresentam grande variabilidade, seja por questões relacionadas aos operadores, aos métodos utilizados, ao tipo de mensuração, aos animais, entre outros fatores (1) a padronização da técnica. Alguns fatores podem ser capazes de interferir nos valores como ambiente, idade, sexo, questões raciais, obesidade, entre outros (1,2). O papel da idade na variabilidade pressórica sistêmica e de pulso já é algo mais definido para humanos com relatos desde 1990.…”

“…Frequentemente, cães e gatos são expostos a situações estranhas à realidade do ambiente domiciliar, de forma que acabam sendo submetidos a condições de estresse contínuo. O ambiente dos estabelecimentos veterinários, bem como as etapas desde o acondicionamento em caixas de transporte até o momento da consulta e retorno para casa são fatores que condicionam aumentos pressóricos temporários (2). Vários podem ser os fatores relacionados à hipertensão situacional como: ambiente estranho à rotina; barulho excessivo ou diferente do usual; odores do ambiente e de outros animais; contenção para exame clínico; entre outros.…”