Hypertension guidelines recommend that blood pressure (BP) should be measured using a monitor that has passed validation testing for accuracy. BP monitors that have not undergone rigorous validation testing can still be cleared by regulatory authorities for marketing and sale. This is the situation for most BP monitors worldwide. Thus, consumers (patients, health professionals, procurement officers, and general public) may unwittingly purchase BP monitors that are non-validated and more likely to be How to cite this article: Picone DS, Padwal R, Campbell NRC, et al. How to check whether a blood pressure monitor has been properly validated for accuracy.
Background Blood pressure associates with arterial stiffness, but the contribution of blood pressure at different life stages is unclear. We examined the relative contribution of childhood, young‐ and mid‐adulthood blood pressure to mid‐adulthood large artery stiffness. Methods and Results The sample comprised 1869 participants from the Cardiovascular Risk in Young Finns Study who had blood pressure measured in childhood (6–18 years), young‐adulthood (21–30 years), and mid‐adulthood (33–45 years). Markers of large artery stiffness were pulse wave velocity and carotid distensibility recorded in mid‐adulthood. Bayesian relevant life course exposure models were used. For each 10‐mm Hg higher cumulative systolic blood pressure across the life stages, pulse wave velocity was 0.56 m/s higher (95% credible interval: 0.49 to 0.63) and carotid distensibility was 0.13%/10 mm Hg lower (95% credible interval: −0.16 to −0.10). Of these total contributions, the highest contribution was attributed to mid‐adulthood systolic blood pressure (relative weights: pulse wave velocity, childhood: 2.6%, young‐adulthood: 5.4%, mid‐adulthood: 92.0%; carotid distensibility, childhood: 5.6%; young‐adulthood: 10.1%; mid‐adulthood: 84.3%), with the greatest individual contribution coming from systolic blood pressure at the time point when pulse wave velocity and carotid distensibility were measured. The results were consistent for diastolic blood pressure, mean arterial pressure, and pulse pressure. Conclusions Although mid‐adulthood blood pressure contributed most to mid‐adulthood large artery stiffness, we observed small contributions from childhood and young‐adulthood blood pressure. These findings suggest that the burden posed by arterial stiffness might be reduced by maintaining normal blood pressure levels at each life stage, with mid‐adulthood a critical period for controlling blood pressure.
Background: Within-visit systolic blood pressure variability is associated with age and systolic blood pressure, but its long-term clinical significance is unknown. We examined the association between child, adult and life-time within-visit systolic blood pressure variability with markers of end-organ damage using data from a 31-year longitudinal study.Methods: Within-visit systolic blood pressure variability was calculated as the standard deviation of three sitting systolic blood pressure readings among up to 3010 participants aged 6-18 years (childhood) who were re-measured up to 7 times to mid-adulthood.Markers of cardiovascular end-organ damage in adulthood were carotid intima-media thickness, brachial flow mediated dilatation, carotid distensibility, pulse wave velocity, left ventricular mass index, carotid plaque and coronary artery calcification. Results:The mean (standard deviation) cumulative within-visit systolic blood pressure variability was 2.7 (1.5) mmHg in childhood, 3.9 (1.9) mmHg in adulthood and 3.7(1.5) mmHg across the observed life-time. Childhood within-visit systolic blood pressure variability was not correlated with its subsequent values measured from 3-to 31-years later. With adjustment for age, sex, cumulative systolic blood pressure, body mass index and serum lipids, neither child, adult or life-time cumulative within-visit systolic blood pressure variability associated with markers of cardiovascular end-organ damage. However, higher child, adult, and life-time cumulative systolic blood pressure significantly associated with higher carotid intima-media thickness, higher pulse wave velocity, lower brachial flow mediated dilatation, lower carotid distensibility in adulthood. of 38Conclusion: Within-visit systolic blood pressure variability from childhood to adulthood does not provide additional predictive utility over systolic blood pressure over the same period of the life-course.
Objective: To assess the association between the variability of blood pressure (BP) readings within an initial clinic visit, the variability within subsequent visits and the variability between visits over 1 week in a general population.Methods: This study included 1401 adult residents, who were not taking antihypertensive drugs, having BP measurements at three visits over 1 week. The difference between maximal and minimal BP readings (DBP), DBP/ BPm (the mean BP value in a visit), the standard deviation (SD) and coefficient of variation (coefficient of variation ¼ SD Â 100/mean) of three BP values in each visit were used to estimate the within-visit BP variability (BPV). The SD and coefficient of variation of all nine BP readings over the three visits were calculated as SD9 or CV9 to reflect the overall BPV during the study visits. The SD and coefficient of variation on the mean BP values (BPm) of three visits were computed as SD-3 or CV-3, whereas the difference between maximal and minimal BP in three visits was computed as DBP-3 to estimate visit-to-visit BPV. The average BP or HR was the mean values of nine BP or HR readings over three visits. Results:The systolic and diastolic mean BP (SBP and DBP) decreased from the first to the third visit. The DBP, SD and coefficient of variation for both SBP and DBP at the first visit were positively and significantly correlated with the corresponding variables computed at the second and third visits, as well as with overall BPV (DBP9, SD9 and CV9). A positive correlation was also found between overall BPV and visit-to visit BPV (SD-3, CV-3 and DBP9). Multivariate analysis showed: no association between average SBP and systolic coefficient of variation or DBP/BPm but a negative association between average DBP and coefficient of variation or DBP/BPm for DBP at the first visit, DBP-3 and DBP9. Age was positively correlated with coefficient of variation or DBP/BPm for SBP at the first visit, SBP-3 and SBP9, and correlated with coefficient of variation and DBP/ BPm for DBP only at the first visit. Conclusion:In a general population, within-visit BPV at an initial visit is associated with within-visit BPV at subsequent visits and with visit-to-visit BPV over three visits within 1 week.
Background and aims Most international guidelines recommend that repeat blood pressure (BP) readings are required for BP classification. Two international guidelines diverge from this by recommending that no further BP measurements are required if the first clinic BP is below a hypertension threshold. The extent to which within-visit BP variability patterns change over time, and whether this could impact BP classification is unknown. We sought to examine this. Methods Data were from the Cardiovascular Risk in Young Finns study, a prospective cohort study. Up to 2799 participants were followed from childhood (9-15 years) to adulthood (18-49 years) over up to 6 visits. Patterns of within-visit systolic BP (SBP) variability were defined as no-change, a decrease, increase between consecutive readings (with 5 mmHg change thresholds). Classification of SBP (normal, high-normal, hypertension) using the first reading was compared with repeat readings. Results On average, SBP decreased with subsequent measures, but with major individual variability (no-change: 56.9%-62.7%; decrease: 24.1%-31.6%; increase: 11.5%-16.8%). Patterns of SBP variability were broadly similar from childhood to adulthood, with the highest prevalence of an increase among participants categorised with normal SBP (12.6%-20.3%). The highest prevalence of SBP reclassification occurred among participants with hypertension (28.9%–45.3% reclassified as normal or high-normal). The prevalence of reclassification increased with the magnitude of change between readings. Conclusion There is major individual variation of within-visit SBP change in childhood and adulthood and can influence BP classification. This highlights the importance of consistency among guidelines recommending that repeat BP measurements are needed for BP classification.
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