Muscle and skin sympathetic nerve traffic during physician and nurse blood pressure measurement

Seravalle, Gino; Buzzi, S; Magni, L; Brambilla, Gianmaria; Quartı-Trevano, Fosca; Mancia, Giuseppe

doi:10.1097/hjh.0b013e3283605c71

Cited by 30 publications

(30 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Palatini et al [23] found that BP changes during a doctor's visit were associated with higher urinary epinephrine levels and BP changes during a public speech. Subsequent studies using direct measurement of sympathetic nerve activity with direct microneurography technique showed that cuff inflation elicited marked sympathetic activation, particularly when obtained by physicians [4,24]. Presence of high alerting reaction in our study are likely to reflect presence of white coat effect or white coat hypertension.…”

Section: Discussionmentioning

confidence: 53%

See 1 more Smart Citation

Target organ complications and prognostic significance of alerting reaction

Velasco¹,

Ayers

Das

et al. 2016

Journal of Hypertension

View full text Add to dashboard Cite

Objective Noninvasive BP measurement often triggers a transient rise in BP, known as an alerting reaction. However, the prevalence and prognostic significance of the alerting reaction has never been assessed in the general population. Methods We evaluated the association between the alerting reaction and left ventricular mass (LVM) by magnetic resonance imaging and urinary-albumin-to-creatinine ratio (UACR) in the Dallas Heart Study, a large population sample of 3,069 subjects. Participants were categorized into 4 groups based on levels of consecutive BP: 1.normal 1st BP and average 3rd to 5th (avg3-5) BP of <140/90 mmHg (control group), 2.high 1st BP of ≥140/90 mmHg and normal (avg3-5) BP (HN), 3.normal 1st BP and high (avg3-5) BP, and 4.high 1st to 5th BP. Then, associations between BP categories with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9.4 years were assessed. Results The sample-weighted prevalence of isolated hypertension during the first BP measurement was 9.6%. Presence of an alerting reaction was independently associated with increased LVM, UACR, cardiovascular events after adjustment for traditional cardiovascular risk factors and baseline BP (adjusted HR 1.24, 95%CI 1.07-1.43). Conclusions Our study indicated that the alerting reaction is independently associated with increased cardiovascular and renal complications.

show abstract

Section: Discussionmentioning

confidence: 53%

“…The transient initial rise in BP, known as an alerting reaction , is proposed to be related to overactivation of sympathetic nervous system when patients encounter physicians or nurses in the medical environment [4]. The alerting reaction has been identified in both normotensive and hypertensive men and women [5].…”

Section: Introductionmentioning

confidence: 99%

Target organ complications and prognostic significance of alerting reaction

Velasco¹,

Ayers

Das

et al. 2016

Journal of Hypertension

View full text Add to dashboard Cite

show abstract

“…Although in a research setting the auscultatory method remains the standard approach for testing new BP measurement devices, it is now accepted that it can be relatively inaccurate in routine clinical practice 39,40 . In fact, the last ESH/ESC and ACC/AHA hypertension guidelines 1,2 Significant evidence, including a recent meta-analysis 42 , indicates that BP values taken by physicians are systematically higher than those recorded by nurses 43,44 . In our meta-analysis we found that Office BP values, even when measured by nurses (or technicians), were significantly higher than AOBP ones, making it possible to assume that the BP rise induced by nurses is enough to overestimate BP in many patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Automated Office Blood Pressure With Office and Out-Off-Office Measurement Techniques

et al. 2019

View full text Add to dashboard Cite

Automated office blood pressure (AOBP) has emerged as valuable tool to assess patient's blood pressure (BP) status, but the lack of strong evidences to establish a threshold value for hypertension diagnosis limits its use in clinical practice. We aimed at synthesizing the published literature through a meta-analysis of studies comparing AOBP with other BP measurement techniques and at analysing the differences between AOBP and physician's office BP, non-physician's office BP, daytime ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). We searched PubMed database for articles published up to April 2018; eligible studies compared AOBP with office and/or out-of-office measurement techniques and reported the BP differences or BP values obtained. Twenty-six studies, for a total of 7,116 patients were included in the analysis. AOBP values were lower than physician (systolic blood pressure, SBP-10.48 mmHg [95% CI-13.15 to-7.81] / diastolic blood pressure, DBP-4.44 mmHg [95% CI-6.07 to-2.80]) and non-physician office ones (SBP-6.89 mmHg [95% CI-8.75 to-5.04] / DBP-3.82 mmHg [95% CI-4.86 to-2.78]). No significant differences were detected between AOBP and daytime ABPM (SBP-1.85 mmHg [95% CI-4.50 to 0.79] / DBP 0.12 mmHg [95% CI-1.42 to 1.66]) and HBPM (SBP-2.65 mmHg [95% CI-8.42 to 3.12]) / DBP-1.67 mmHg [95% CI-4.20 to 0.87]). AOBP readings did not differ significantly from out-of-office blood pressure, still remaining an office technique; it may improve hypertension diagnosis by overcoming some of office BP limitations, including the white-coat effect.

show abstract

“…WCH is proposed to result from stress-induced activation of the sympathetic nervous system during encounters with health care providers, (27) whereas MH is potentially induced by mental stress at home, excessive consumption of alcohol, caffeine consumption, and cigarette smoking, among other potential confounders (14). Furthermore, MH while on drug treatment is proposed to reflect a shift of phenotype from sustained hypertension to inadequately-treated hypertension (14).…”

Section: Discussionmentioning

confidence: 99%

Target Organ Complications and Cardiovascular Events Associated With Masked Hypertension and White-Coat Hypertension

Tientcheu

Ayers

Das

et al. 2015

Journal of the American College of Cardiology

174

View full text Add to dashboard Cite

Background Multiple epidemiological studies from Europe and Asia have demonstrated increased cardiovascular risks associated with isolated elevation of home blood pressure (BP) or masked hypertension (MH). Previous studies have not addressed cardiovascular outcomes associated with MH and white coat hypertension (WCH) in the general population in the United States. Objectives The goal of this study was to determine hypertensive target organ damage and adverse cardiovascular outcomes associated with WCH (high clinic BP ≥140/90 mm Hg, normal home BP of <135/85 mm Hg), MH (high home BP ≥135/85 mm Hg, normal clinic BP <140/90 mm Hg), and sustained hypertension (SH, high home and clinic BP) in the Dallas Heart Study, a large, multiethnic probability-based population cohort. Methods We evaluated associations between WCH, MH, SH and aortic pulse wave velocity (APWV) by magnetic resonance imaging; urinary albumin to creatinine ratio (UACR); and cystatin C at study baseline. Then, associations between WCH and MH with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9 years were assessed. Results The study cohort comprised 3,027 subjects (50% African Americans). The sample-weighted prevalence of WCH and MH were 3.3% and 17.8%, respectively. Both WCH and MH were independently associated with increased APWV, cystatin C, and UACR. Both WCH and MH were independently associated with higher cardiovascular events compared with the NT group, even after adjustment for traditional cardiovascular risk factors (adjusted HR: 2.09; 95% CI: 1.05 to 4.15 and adjusted HR: 2.03; 95% CI: 1.36 to 3.03, respectively). Conclusions In a multiethnic U.S. population, both WCH and MH were independently associated with increased aortic stiffness, renal injury, and incident cardiovascular events. Because MH is common and associated with an adverse cardiovascular profile, home BP monitoring should be routinely performed among U.S. adults.

show abstract

Muscle and skin sympathetic nerve traffic during physician and nurse blood pressure measurement

Abstract: These data provide the first evidence that the blunted pressor and tachicardic responses to nurse's blood pressure measurements are accompanied by an attenuation of the adrenergic neural responses seen during the alerting reaction accompanying doctor's blood pressure measurement.

Cited by 30 publications

References 17 publications

Target organ complications and prognostic significance of alerting reaction

Target organ complications and prognostic significance of alerting reaction

Comparison of Automated Office Blood Pressure With Office and Out-Off-Office Measurement Techniques

Target Organ Complications and Cardiovascular Events Associated With Masked Hypertension and White-Coat Hypertension

Contact Info

Product

Resources

About