Validation study of an automated wrist monitor, omron model HEM-608, compared with the standard methods for blood pressure measurement

OBJECTIVE - The aim of our study was to assess the profile of a wrist monitor, the Omron Model HEM-608, compared with the indirect method for blood pressure measurement. METHODS - Our study population consisted of 100 subjects, 29 being normotensive and 71 being hypertensive. Participants had their blood pressure checked 8 times with alternate techniques, 4 by the indirect method and 4 with the Omron wrist monitor. The validation criteria used to test this device were based on the internationally recognized protocols. RESULTS - Our data showed that the Omron HEM-608 reached a classification B for systolic and A for diastolic blood pressure, according to the one protocol. The mean differences between blood pressure values obtained with each of the methods were -2.3 +7.9mmHg for systolic and 0.97+5.5mmHg for diastolic blood pressure. Therefore, we considered this type of device approved according to the criteria selected. CONCLUSION - Our study leads us to conclude that this wrist monitor is not only easy to use, but also produces results very similar to those obtained by the standard indirect method.

Devices and Techniques for Blood Pressure Measurement and Criteria for Hypertension Adopted by Brazilian Physicians: Exploratory Study

OBJECTIVE: To determine technical procedures and criteria used by Brazilian physicians for measuring blood pressure and diagnosing hypertension. METHODS: A questionnaire with 5 questions about practices and behaviors regarding blood pressure measurement and the diagnosis of hypertension was sent to 25,606 physicians in all Brazilian regions through a mailing list. The responses were compared with the recommendations of a specific consensus and descriptive analysis. RESULTS: Of the 3,621 (14.1%) responses obtained, 57% were from the southeastern region of Brazil. The following items were reported: use of an aneroid device by 67.8%; use of a mercury column device by 14.6%; 11.9% of the participants never calibrated the devices; 35.7% calibrated the devices at intervals < 1 year; 85.8% measured blood pressure in 100% of the medical visits; 86.9% measured blood pressure more than once and on more than one occasion. For hypertension diagnosis, 55.7% considered the patient's age, and only 1/3 relied on consensus statements. CONCLUSION: Despite the adequate frequency of both practices, it was far from that expected, and some contradictions between the diagnostic criterion for hypertension and the number of blood pressure measurements were found. The results suggest that, to include the great majority of the medical professionals, disclosure of consensus statements and techniques for blood pressure measurement should go beyond the boundaries of medical events and specialized journals.

Assessment of the DIXTAL DX-2710 Automated Oscillometric Device for Blood Pressure Measurement with the Validation Protocols of the British Hypertension Society (BHS) and the Association for the Advancement of Medical Instrumentation (AAMI)

OBJECTIVE: To assess the Dixtal DX2710 automated oscillometric device used for blood pressure measurement according to the protocols of the BHS and the AAMI. METHODS: Three blood pressure measurements were taken in 94 patients (53 females 15 to 80 years). The measurements were taken randomly by 2 observers trained to measure blood pressure with a mercury column device connected with an automated device. The device was classified according to the protocols of the BHS and AAMI. RESULT: The mean of blood pressure levels obtained by the observers was 148±38/93±25 mmHg and that obtained with the device was 148±37/89±26 mmHg. Considering the differences between the measurements obtained by the observer and those obtained with the automated device according to the criteria of the BHS, the following classification was adopted: "A" for systolic pressure (69% of the differences < 5; 90% < 10; and 97% < 15 mmHg); and "B" for diastolic pressure (63% of the differences < 5; 83% < 10; and 93% < 15 mmHg). The mean and standard deviation of the differences were 0±6.27 mmHg for systolic pressure and 3.82±6.21 mmHg for diastolic pressure. CONCLUSION: The Dixtal DX2710 device was approved according to the international recommendations.

Assessment of the techniques of blood pressure measurement by health professionals

OBJECTIVE: To assess blood pressure measurement by health professionals of a public hospital in São Paulo State. METHODS: Semi-structured interviews and direct observation were performed with a verification list according to the criteria reported by Perloff et al. One hundred and five health professionals took part in the study. After measuring blood pressure, the level of concordance between the way the procedure was performed and the recommended one was assessed. RESULTS: Nurses and nurse's aides abided by 40% of the recommended procedures for adequate blood pressure measurement. The other categories of health professionals (nursing and medicine teachers, physicians, residents, and nursing students) abided by approximately 70%. CONCLUSION: Permanent educational activities aiming at standardizing blood pressure measurement should be implemented among the different categories of health professionals.

Relevance to Home Blood Pressure Monitoring Protocol of Blood Pressure Measurements Taken Before First- Morning Micturition and in the Afternoon

Background: The importance of measuring blood pressure before morning micturition and in the afternoon, while working, is yet to be established in relation to the accuracy of home blood pressure monitoring (HBPM). Objective: To compare two HBPM protocols, considering 24-hour ambulatory blood pressure monitoring (wakefulness ABPM) as gold-standard and measurements taken before morning micturition (BM) and in the afternoon (AM), for the best diagnosis of systemic arterial hypertension (SAH), and their association with prognostic markers. Methods: After undergoing 24-hour wakefulness ABPM, 158 participants (84 women) were randomized for 3- or 5-day HBPM. Two variations of the 3-day protocol were considered: with measurements taken before morning micturition and in the afternoon (BM+AM); and with post-morning-micturition and evening measurements (PM+EM). All patients underwent echocardiography (for left ventricular hypertrophy - LVH) and urinary albumin measurement (for microalbuminuria - MAU). Result: Kappa statistic for the diagnosis of SAH between wakefulness-ABPM and standard 3-day HBPM, 3-day HBPM (BM+AM) and (PM+EM), and 5-day HBPM were 0.660, 0.638, 0.348 and 0.387, respectively. The values of sensitivity of (BM+AM) versus (PM+EM) were 82.6% × 71%, respectively, and of specificity, 84.8% × 74%, respectively. The positive and negative predictive values were 69.1% × 40% and 92.2% × 91.2%, respectively. The comparisons of intraclass correlations for the diagnosis of LVH and MAU between (BM+AM) and (PM+EM) were 0.782 × 0.474 and 0.511 × 0.276, respectively. Conclusions: The 3 day-HBPM protocol including measurements taken before morning micturition and during work in the afternoon showed the best agreement with SAH diagnosis and the best association with prognostic markers.

A vegetação no município de Ilhéus Estado da Bahia: IV - Caracaterísticas analíticas e periodicidade sociológica

It is well-known that diverse groups of vegetation with an analogous but not identical floristic composition show an ecological similarity which leads to a determined type of vegetation. Starting from this fact it becomes evident that the scope of phytosociological work is the establishing of the significance of the species within the association and the discovery of the rules which govern associations. The floristic surveys made in the field have to be analysed statistically so as to obtain satisfactory results. The usefulness of this method depends largely on the possibilities of comparing the results with previous studies of the same kind, in the same country, or elsewhere. The method used in this paper is that of measuring circumferences and counting individuals in the different associations studied because it permits the presentation of the results in tables which show the phytosociological complexity of the Brazilian rain-forests. The classical method of characteristics is valuable because the more evolved an association is the less sociable are the species it contains, so that such groups do not show clear differences between species but rather between sinusia or strata of individuals. Five tables are presented in which several of the qualitative and quantitative characteristics are studied with a view to discussing their value in relation to groups and species. They are: I - Abundance (number of individuals). II - Density (distance in meters between the individuals belonging to each stratum). III - Basal coverture (circles measured in square meters of the mean projection of the individuals on the surface). IV - Basal area (mean circle in square meters occupied by individuals on the surface). V - Frequency, abundance and sociability in relation to occurrence. TABLE I. This table indicates first the number of individuals in relation to the sinusia studied: next, the sum total of the individuals belanging to the strata are given for each association, thus providing the numeric value of the sinusia: finally, the relation between the total number of individuals in the association and the total for the sinusium thus fursnishing the abundance per sinusium, in the classic sence, that is the percentage, or rather the relative number, of the elements which compose the group. CONCLUSIONS. The general character of abundance of the regional vegetation of Ilheos may be summed up in the following way: as an association evolves towards permanent equilibirum the number of individuals the inferior strata diminishes in relation to those of the superior strata which increase. For the shrub sinusium, two important facts were observed: a) in a given association the number of elements of the inferior strata diminishes as the diameter of the individuals increases; b) the percentage of individuals belonging to the shrub sinusium in the sere diminishes as the association evolve. In the subarboreal sinusium it is seen that: in the sere the number of subarboreal individuals does not vary much; whereas in the climax or the prisere there is a fall owing to the equilibrum of the biologic forms. In the arboreal sinusium the following conclusion can be deduced from analogous facts: the number of individuals of the lower strata diminishes as circumference increases. Also, in the sere there is a progressive sequence for the individuals belonging to the superior strata. TABLE II. The relation between the mean distances of individuals belonging to the same stratum and the area of an association is equal to the density. The table shows that the mean density of the association and the distance between the individuals belonging to the strata of the same sinusium in relation to the total number of individuals belonging to the association. CONCLUSIONS. As rule, the density of individuals in the associations studied follows a very general character or at least a regional one: the distance between the individuals in the diverse strata varies according to their abundance and sociability. Two other facts of some sociological importance are: a) in identical strata of the same sere the density of individuals oscillates in an analogous manner in teh subclimaces and varies in the stages which have reached equilibrium. b) the density of individuals varias in accordance with the sinusium and the distances between individuals of the same sinusium varg in accordance with the strata. TABLE III. This table presents the mean basal individual coverture, that is the mean projection of the frond of the various individuals belonging to the same stratum. The means were obtained by measurement in the field, of 100 individuals belonging to each stratum and their projection on the surface. In the latoratory these measurements were converted into mean circles (in square meters) and the result was multiplied by the individuals belonging to the strata corresponding to the sinusium of each association. The result obtained is named basal coverture. CONCLUSIONS. As a rule, the basal coverture of the vegetation of the county of Ilhéus indicates that: in the evolution of the vegetation the basal coverture of the arbustive sinusium diminishes progressively whereas that of the arboreal one increases. The special norms obtained are: 1) in the shrub sinusium the basal coverture seems to follow a uniform norm, that is, in stages of evolution of the subclimax the basal coverture oscillates with a certain uniformity. 2) in the subarboreal sinusium this fact is related to the vitality and age of the species, as in the subclimax the number of young trees is large and the vitality of the species very variable. This permits the conclusion that: in the sere the basal coverture increases with the evolution of the vegetation and diminishes when an equilibrium is reached. 3) in the tree sinusium the climax association of the prisere and subsere seem to obey a binomial rule, as the coverture (density-abundance) increases until a determined stratum is reached and...

In vitro measurement of enzymatic markers as a tool to detect mouse cardiomyocytes injury

Primary cultures of cardiomyocytes represent a useful model for analyzing cardiac cell biology as well as pathogenesis of several cardiovascular disorders. Our aim was to standardize protocols for determining the damage of cardiac cells cultured in vitro by measuring the creatine kinase and its cardiac isotype and lactate dehydrogenase activities in the supernatants of mice cardiomyocytes submitted to different protocols of cell lysis. Our data showed that due to its higher specificity, the cardiac isotype creatine kinase was the most sensitive as compared to the others studied enzymatic markers, and can be used to monitor and evaluate cardiac damage in in vitro assays.