| For medical practitioners and the general public - High Blood Pressure Journal Article Catalog. |
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| Chronic tuberculous meningitis and arterial hypertensions; high blood pressure due to blocking of the afferent pressoreceptive tracts. Lampen, H. (1951), Med Welt 20(23): 779-81. |
| CIBA's commitment--the high blood pressure revolution Davis, F., Jr. (1974), J Am Pharm Assoc 14(4): 200-1. |
| Circadian cycles of lactic dehydrogenase in urine and blood plasma: response to high pressure Jacey, M. and K. E. Schaeffer (1968), Aerosp Med 39(4): 410-2. |
| Circannual modulation of blood pressure enhanced by paternal history of high blood pressure Saito, Y., G. Cornelissen, et al. (1992), Chronobiologia 19(1-2): 75-9. |
| Clearance tests in diagnostic and prognostic examination of high blood pressure. Watschinger, B. (1950), Wien Z Inn Med 31(11): 467-73. |
| Clinical importance of the electrocardiogram in high blood pressure; changes of the ventricular complex in thoracic leads CR1 and CR6. Presniakov, D. F. (1950), Ter Arkh 22(3): 38-46. |
| Clinical notes - on blood-pressure, high and low Horder (1952), Med Illus 6(8): 375. |
| Clinical observations on the effects of debrisoquine sulphate in patients with high blood-pressure Athanassiadis, D., W. I. Cranston, et al. (1966), Br Med J 2(516): 732-5. |
| Closure of digital arteries in high vascular tone states as demonstrated by measurement of systolic blood pressure in the fingers Krahenbuhl, B., S. L. Nielsen, et al. (1977), Scand J Clin Lab Invest 37(1): 71-6. Abstract: Finger systolic blood pressure (FSP) was measured indirectly in normal subjects and patients with primary Raynaud phenomenon by applying a thin-walled plastic cuff around the finger and a strain gauge more distally to detect volume changes. Inducing a high vascular tone in one or more fingers by direct cooling or intra-arterial noradrenaline infusion caused a marked drop in FSP in the exposed fingers, but not in the non-exposed fingers of the same hand. The fact that the non-exposed fingers retained the normal (arm systolic) pressure level is taken to indicate that palmar arch blood pressure also remained normal. In the high vascular tone state, a large transmural pressure difference must apparently be established before the digital arteries are forced open. The lowered opening pressure constitutes a manifestation of the closure phenomenon of the digital arteries described in patients with vasospastic arterial disease. It implies an underestimation of palmar arch systolic pressure measured indirectly on the fingers. FSP measured under these circumstances may be taken as an estimate of the vascular tone, and can be employed in diagnosis and quantification of vasospastic disorders. |
| Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging Tzourio, C., C. Dufouil, et al. (1999), Neurology 53(9): 1948-52. Abstract: OBJECTIVE: To examine whether baseline high blood pressure and antihypertensive treatment predicts cognitive decline in elderly individuals. METHODS: A longitudinal population-based study of elderly individuals (n = 1,373) in Nantes (western France) was undertaken. Individuals 59 to 71 years of age were selected from electoral rolls. High blood pressure at baseline was defined as systolic blood pressure > or =160 mm Hg or diastolic blood pressure > or =95 mm Hg. Cognitive decline was defined as a drop of 4 points or more on the Mini-Mental State Examination between baseline and the 4-year assessment. RESULTS: There is an association between high blood pressure at baseline and cognitive decline at the 4-year assessment (odds ratio, 2.8; 95% CI, 1.6 to 5.0). In participants with high blood pressure, the risk of cognitive decline was 4.3 (95% CI, 2.1 to 8.8) in those without antihypertensive therapy and 1.9 (95% CI, 0.8 to 4.4) in those being treated. In participants with high blood pressure both at baseline and at the 2-year assessment, the risk for untreated participants was 6.0 (95% CI, 2.4 to 15.0) compared with 1.3 (95% CI, 0.3 to 4.9) in treated participants. CONCLUSIONS: High blood pressure was associated with cognitive decline. In individuals with high blood pressure, cognitive decline occurred in a relatively short time period and the risk was highest in untreated hypertensive patients. |
| Cognitive response to a cold pressor challenge in high and low blood pressure reactive subjects Heiden, L. A., K. T. Larkin, et al. (1991), J Psychosom Res 35(6): 679-85. Abstract: To examine the relationship between cognitive and cardiovascular reactions to a cold pressor challenge, 20 high and 20 low blood-pressure-reactive males were identified. Subjects were trained using a think-aloud procedure and asked to report their thoughts aloud during task presentation. In comparison to low-reactors, high-reactive subjects exhibited greater increases in systolic and diastolic blood pressure, but not heart rate, in response to the task. High-reactive subjects reported fewer distracting self-statements than low-reactors during the task. No group differences in positive, neutral, or negative self-statements were observed. These findings corroborate the importance of distraction strategies in mediating acute cardiovascular reactions to stress. |
| Colloidal blood volume expansion during high intracranial pressure Kirkeby, O. J., J. R. Pettersen, et al. (1999), Acta Neurochir (Wien) 141(1): 37-43; discussion 44. Abstract: This study tested the hypothesis that colloidal blood volume expansion could improve the cerebral circulation during high intracranial pressure. We studied cerebrovascular haemodynamic variables during high intracranial pressure with and without colloidal blood volume expansion in 12 pigs, whereas five pigs served as controls with intracranial pressure increase twice without colloidal blood volume expansion. Cerebral blood flow was measured with ultrasonic flowmetry on the internal carotid artery, and cerebral microcirculation with laser Doppler flowmetry. High intracranial pressure was induced by infusion of artificial cerebrospinal fluid into the cisterna magna. Blood volume expansion was obtained by infusion of albumin, 1 gram/kg. Albumin infusion caused increases in internal carotid artery blood flow (P < 0.05) and cerebral perfusion pressure (P < 0.005), while cerebral microcirculation and cerebrovascular resistance was unchanged. High intracranial pressure albumin infusion caused internal carotid artery blood flow (P < 0.05) and cerebral perfusion pressure (P < 0.001) to increase compared to high intracranial pressure without albumin infusion, while cerebrovascular resistance was unchanged. Cerebral micro-circulation tended to increase, but this was not statistically significant (P = 0.07). Augmentation of the intravascular blood volume during high intracranial pressure increased the arterial inflow to the brain and possibly the cerebral microcirculation by increasing the cerebral perfusion pressure. Our results tend to support that the effect of colloidal blood volume expansion is beneficial for the cerebral circulation during high intracranial pressure. |
| Combined hemodynamic overload of the left and right ventricles as a possible cause of interventricular septum preponderance in high blood pressure Fiorentini, C., C. Galli, et al. (1988), Am Heart J 116(2 Pt 1): 509-14. Abstract: We tested whether overload of the two ventricles may be associated with a preponderance of interventricular septum in patients with high blood pressure. The rationale is that the septum is shared by the greater and lesser circulation and that in hypertension the latter shows the same qualitative hemodynamic alterations as the former. Among 65 hypertensive patients, 40 (group 1) showed (echo) posterior wall thickness within the mean +/- 1 SD of 62 normal subjects, and 25 (group 2) had a posterior wall thickness exceeding the mean + 1 SD of the normal population. Both groups were subdivided into subgroups A and B, which included patients whose ventricular septum was similar to (within the mean + 1 SD) and thicker than (exceeding the mean + 1 SD) the posterior wall thickness in the corresponding group, respectively. Resting differences in systemic and pulmonary pressure and vascular resistance among subgroups 1A, 1B, and 2A were not significant; however, in subgroup 2B these variables exceeded those in the other subgroups to a significant extent. During cold pressor testing (CPT) the levels reached and the changes in pressure and resistance from baseline values in both circuits were much greater in subgroups B than in subgroups A. The baseline plasma norepinephrine value showed a trend toward an increase from subgroup 1A to 1B and from subgroup 2A and 2B; during CPT norepinephrine invariably changed and in subgroups B it rose significantly more than in subgroups A. It was not determined whether this caused the hemodynamic overload in subgroups B.(ABSTRACT TRUNCATED AT 250 WORDS) |
| Combined high blood pressure and glucose in type 2 diabetes: double jeopardy. British trial shows clear effects of treatment, especially blood pressure reduction Mogensen, C. E. (1998), Bmj 317(7160): 693-4. |
| Combined low-dose medication and primary intervention over a 30-month period for sustained high blood pressure in childhood Berenson, G. S., C. L. Shear, et al. (1990), Am J Med Sci 299(2): 79-86. Abstract: Studies of the pathobiologic consequences of high blood pressure in childhood, as well as those following blood pressure levels into young adulthood, indicate that early intervention in the natural history of essential hypertension is warranted. In an exploratory study of the concept, 95 children out of 1604 (aged 8 to 18 years), who persistently scored higher than the 90th percentile for blood pressure over a 4-month period, considering the race, sex, and height of the children, were studied. Five series of replicate measurements with 30 total observations were obtained. Children with evidence of secondary hypertension were excluded. The study children were randomly divided into treatment (n = 48) and high-comparison (n = 47) groups. Treatment consisted of low-dose combined drug therapy (propranolol and chlorthalidone) with an educational program directed towards hypertension and dietary and exercise modification. Monthly follow-up was continued for 30 months. Significant systolic (-3.59 mm Hg) and diastolic (-1.73 mm Hg) changes were noted up to 30 months (p less than 0.05) with minimal side effects. Furthermore, analyses suggested that the blood pressure change, at least in the first month, was mostly attributable to drug therapy. Moreover, the mechanism of blood pressure change appeared to be race-specific, with whites having pulse rate changes and blacks having significant weight changes, which were associated with blood pressure change. This trial shows further research is warranted to determine optimum approaches for early treatment of essential hypertension to prevent future hypertensive disease. |
| Combined use of antihypertensive agents and treatment of high blood pressure Orita, Y., Y. Fujiwara, et al. (1985), Nippon Rinsho 43(5): 1000-5. |
| Combining repeated blood pressure measurements to obtain prevalences of high blood pressure Wietlisbach, V., M. Rickenbach, et al. (1988), Acta Med Scand Suppl 728: 165-8. Abstract: Blood pressure (BP) levels may be classified as normal, borderline, or high with respect to the World Health Organization (WHO) criteria, but most studies like the MONICA project require at least two BP measurements and must tackle the problem of combining the results of the different readings into a single value for classification. The Swiss MONICA project measured the blood pressure of 1872 individuals in the areas of Vaud and Fribourg. Second BP readings were, on average, lower than the first by 3.2 mmHg for systolic and 1.1 mmHg for diastolic BP. These differences, while trivial at the individual level, nevertheless generate significant effects on prevalences of high BP. The first reading, the second, the mean, and the lowest yield prevalences of 14%, 10%, 11% and 9% respectively. Therefore, any published prevalence of high blood pressure should specify the method of measurement, the number of readings taken, and the way results were combined. |
| COMMENTARY ON Screening for High Blood Pressure: Recommendations and Rationale Newland, J. A. (2004), Am J Nurs 104(11): 88. |
| Commentary on the 6th Report of the American National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure Valles Belsue, F. (1999), Rev Esp Cardiol 52(1): 1-4. Abstract: Systemic hypertension is present world-wide and it is a leading cause of cardiovascular morbidity and mortality. A great number of different drugs have been used in the treatment. Many other drugs are being developed, but evidence upon their effect on morbidity and mortality is not always present. In this setting, the sixth report of the National Committee on Detection, Evaluation, and Treatment of High Bloos Pressuere, review the safety and efficacy of therapies in hypertension. In the absence of counter-indications diuretics and beta-blockers should be used as first-line agents. Treatment must be based, not only on the level of blood pressure. Risk factors, target organ disease, and other comorbid diseases are considered. Not all the recommendations are solidly based. |
| Commentary: Role of salt intake in the development of high blood pressure Elliott, P. (2005), Int J Epidemiol 34(5): 975-8. |
| Common Questions and Answers in the Management of Hypertension - Everyday Practice in Hypertension: Herbal Remedies for High Blood Pressure Townsend, R. R. (2000), J Clin Hypertens (Greenwich) 2(1): 54-55. |
| Common Questions and Answers in the Management of Hypertension - Fish Oil for High Blood Pressure: Another Fish Story? Townsend, R. R. (2000), J Clin Hypertens (Greenwich) 2(2): 143-143. |
| Common questions and answers in the management of hypertension: Am I more likely to develop diabetes if I have high blood pressure? Townsend, R. R. (2003), J Clin Hypertens (Greenwich) 5(2): 175-6. |
| Community control of high blood pressure Steinbach, M., M. Constantineanu, et al. (1978), Med Interne 16(4): 425-9. |
| Community control of high blood pressure in Portugal Mota, J. C., J. P. Miguel, et al. (1987), Bibl Cardiol(42): 77-9. |
| Community involvement in high blood pressure control--the Bamberg model Watson, M. C. (1980), J S C Med Assoc 76(9 Suppl): 83-6. |
| Community-based high blood pressure programs in sub-Saharan Africa Pobee, J. O. (1993), Ethn Dis 3 Suppl: S38-45. Abstract: We studied residents of urban and rural areas of Ghana from 1972 through 1987 to evaluate the health burden of cardiovascular diseases, especially high blood pressure, in these African communities. Among urban adults, the prevalence of hypertension was 8% to 13%, compared to only 4.5% among rural adults. Overall, rates were higher among men than among women. However, the rate of hypertension was the same for men and women over 40 years old. The prevalence of hypertension was 29% for persons aged 35 and older, compared to 3.9% for persons under 35 years of age. Of the 24% of the study participants who were aware of their hypertension status, only a third were undergoing treatment, and only half of those were receiving adequate treatment. The determinants of hypertension include age, family history, body mass index, parity, and alcohol use. On a continent where over 80% of the health budget is spent on communicable diseases such as malaria, this study represents one of the few early attempts to understand the magnitude of the health burden of noncommunicable diseases in Africa. |
| Comparison among blood pressure instruments for self-measurements by high school students Ahlgren, A. (1974), Chronobiologia 1(2): 172-8. |
| Comparison of blood pressure, sodium intake, and other variables in offspring with and without a family history of high blood pressure Watt, G. C., C. J. Foy, et al. (1983), Lancet 1(8336): 1245-8. Abstract: The blood pressure, body weight, mean 24 hour urinary electrolyte excretion, and plasma renin activity in offspring whose parents both belonged to the top third of the distribution of blood pressure in their 5-year age-group were compared with those in offspring whose parents belonged to the bottom third. Altogether 116 offspring, aged 10-43 years, took part in the study. Systolic pressure was higher in the offspring with a family history of high blood pressure, but there was no difference in 24-h urinary electrolyte excretion or plasma renin activity. The study had a power of over 80% to detect a 20 mmol difference in sodium excretion, and it provides evidence against the hypothesis that hypertensives have an avidity for sodium. |
| Comparison of casual blood pressure and twenty-four-hour ambulatory blood pressure in high school students Nishibata, K., M. Nagashima, et al. (1995), J Pediatr 127(1): 34-9. Abstract: OBJECTIVE: To perform ambulatory blood pressure monitoring (ABPM) in high school students and to compare the 24-hour values with casual blood pressure (BP). METHODS: Ambulatory BP monitoring was carried out in 190 high school students, 15 or 16 years of age, with elevated casual BP during the first examination at school for hypertension; 66 had elevated casual BP at both the first and the second examinations (group H1), and 124 students were normotensive at the second examination (group H2). Sixty-two students who were consistently normotensive served as control subjects (group N). Average BPs for the 24-hour period, the awake period (10 AM to 10 PM), and the sleeping period (1 AM to 6 AM) were calculated. RESULTS: Average BP for each period was significantly higher in group H1 than in group N. Average BP in group H2 for these periods was intermediate between those of group H1 and of group N. The casual BP had a significant positive correlation with the average BP during the awake period (r = 0.55, p < 0.01 for systolic BP; r = 0.37, p < 0.01 for diastolic BP). In most subjects the casual BP readings were higher than BP during ABPM. CONCLUSIONS: Casual BP measurements correlated with 24-hour BP, but they tended to be higher than the measurements obtained during 24-hour ABPM. |
| Comparison of energy and nutrient intakes in women with high and low blood pressure levels Thulin, T., M. Abdulla, et al. (1980), Acta Med Scand 208(5): 367-73. Abstract: The present study found no link between the intake of energy and various nutrients, on the one hand, and high or low blood pressure (BP) in women, on the other. Sixty women not on treatment for hypertension were selected from a defined population and examined, applying the duplicate portion technique, with respect to the relationships between BP and the intake of energy and nutrients. They were selected from above the 95th percentile for BP (group A) and from below the 30th (group B). The two groups were age-matched. The food sampling comprised six days, divided into three periods of two consecutive days within a period of four weeks. Twenty-four hour urine specimens were collected in each period and on two other occasions. The mean values for intake of energy, fat, protein, carbohydrates, minerals and electrolytes did not differ between the two groups despite the large differences in BP and obesity. The mean values for urinary excretion of minerals, electrolytes and nitrogen (calculated as crude protein) did not differ between groups. The present findings for the effect of salt on BP do not justify restriction of the salt intake as a means for decreasing BP in the population. |
| Comparison of high-risk and mass strategies for the prevention of high blood pressure Watt, G. (1989), J Hypertens Suppl 7(1): S29-32. Abstract: A mass strategy for the prevention of high blood pressure and its complications is likely to be more effective than high-risk strategies for several reasons: there is no practicable way of identifying in advance a large proportion of future hypertensives; a minority of hypertensive complications occur in individuals with pressures high enough to warrant treatment; and treatment has little or no effect on the incidence of the major hypertensive complication, coronary heart attacks. The effect of a broad-based dietary prevention programme is not proven, but such a strategy offers a reasonable prospect of a broad range of benefits, and is likely to prove acceptable to the general public. A family-based approach may contribute to aetiological research, and make pragmatic sense in clinical practice, but does not provide a scientific basis for a high-risk strategy of prevention. |
| Comparison of nasal pH values in black and white individuals with normal and high blood pressure Ireson, N. J., J. S. Tait, et al. (2001), Clin Sci (Lond) 100(3): 327-33. Abstract: Salt-sensitive hypertension is common in people of African origin, and may be caused by increased transepithelial sodium absorption. The pH of nasal secretions is negatively correlated with the difference in Na(+) concentration between nasal secretions and plasma, and may be a marker of transepithelial sodium absorption. Nasal pH was measured using a probe sited under the inferior turbinate. Measurements of nasal pH were reproducible, with a coefficient of variation of 3.3% for repeated measurements on the same day and of 2.7% between measurements on different days. Nasal pH did not correlate with nasal potential difference, a measure of transepithelial sodium absorption. Nasal pH was significantly lower in 89 black individuals (24 normotensive and 65 hypertensive) than in 51 white individuals (26 normotensive and 25 hypertensive) (black normotensive. 6.44+/-0.08; black hypertensive, 6.62+/-0.05; white normotensive, 6.91+/-0.06; white hypertensive, 6.98+/-0.06), after adjustment for age, gender, current smoking status, body mass index and 24 h urinary sodium excretion (P=0.002), but was not significantly different between the normotensive and hypertensive individuals. Nasal pH was more acidic in black than in white individuals, which may represent generalized up-regulation of sodium transport in black people. However, the lack of correlation between nasal pH and potential difference suggests that nasal pH is, at best, only weakly related to transepithelial sodium absorption. Ethnic differences in nasal pH may be of direct relevance in the airways, as many of the functions of airway surface liquid are dependent on pH. |
| Comparison of oral and subcutaneous administration of methonium salts in the treatment of high blood-pressure Kilpatrick, J. A. and F. H. Smirk (1952), Lancet 1(1): 8-12. |
| Comparison of serum calcium levels between junior high school children with high-normal and low-normal blood pressure. The child and adolescent blood pressure program Sinaiko, A. R., O. Gomez-Marin, et al. (1994), Am J Hypertens 7(12): 1045-51. Abstract: The objective of this study was to compare serum calcium levels, dietary calcium intake, and urinary calcium excretion between junior high students with high-normal and low-normal blood pressure. The study was conducted in 11- to 14-year-old children recruited after blood pressure screening of 5th to 8th grade Minneapolis and St. Paul Public School students. Comparisons were made between a group of 243 children selected from the upper 15 percentiles of the blood pressure distribution (high-normal group) and 40 children randomly selected from the lowest 10% of the blood pressure distribution (low-normal group). Blood samples were obtained from the participants at clinic visits conducted after school. Calcium measurements were based on the principle that serum calcium is found in three forms: 1) an ionized fraction; 2) a fraction complexed with organic anions such as citrate, phosphate, and lactate; and 3) a protein-bound fraction. Dietary calcium intake was determined from food diaries, and urinary electrolytes were determined in 24-h urine collections. Serum total calcium levels were not significantly different between groups. However, serum ultrafilterable, true ionized, ionized normalized for pH, and complexed calcium levels were significantly greater in the low-normal group. There was no significant difference in 24-h intake of calcium or other nutrients between the groups. The low-normal group excreted significantly more calcium than the high-normal group, but there were no significant differences in sodium, potassium, or chloride excretion. This report of the relation between calcium and blood pressure represents the first study in children or adolescents to include serum, dietary, and urine data.(ABSTRACT TRUNCATED AT 250 WORDS) |
| Comparison of the hemodynamic and metabolic effects of low-dose hydrochlorothiazide and lisinopril treatment in obese patients with high blood pressure Reaven, G. M., C. Clinkingbeard, et al. (1995), Am J Hypertens 8(5 Pt 1): 461-6. Abstract: Patients with high blood pressure tend to be insulin resistant, glucose intolerant, hyperinsulinemic, and dyslipidemic. Since these metabolic defects are accentuated by obesity, we thought it important to compare the effects of 3 months' treatment with either lisinopril (20 mg/day) or low dose hydrochlorothiazide (12.5 mg/day) on blood pressure and glucose, insulin, and lipoprotein metabolism in obese patients with hypertension. There were 14 patients in each group, and they were similar (mean +/- SE) in age (54 +/- 3 v 50 +/- 4 years), gender (nine men/five women), and body mass index (33.4 +/- 0.8 v 33.9 +/- 0.9 kg/m2). Patients treated with lisinopril had a somewhat greater fall in both systolic (18 +/- 3 v 10 +/- 3 mm Hg) and diastolic (12 +/- 2 v 8 +/- 1 mm Hg) blood pressure, but only the change in systolic pressure was statistically significant (P <.05). Plasma glucose, insulin, and triglyceride concentrations were measured at hourly intervals from 8 AM to 4 PM (breakfast at 8 AM and lunch at 12 PM), and there was a modest increase in all three variables following hydrochlorothiazide treatment (P <.05 to P <.09). However, daylong plasma glucose, insulin, and triglyceride concentration did not change with lisinopril treatment. Finally, neither the ability of insulin to mediate glucose disposal nor fasting lipid and lipoprotein concentrations, changed with either treatment. In conclusion blood pressure decreased significantly following treatment with either lisinopril (20 mg/day) or hydrochlorothiazide (12.5 mg/day).(ABSTRACT TRUNCATED AT 250 WORDS) |
| Connecticut high blood pressure program: the first three years D'Atri, D. A. (1978), Conn Med 42(12): 795-7. |
| Conserved smooth muscle contractility and blood pressure increase in response to high-salt diet in mice lacking the beta3 subunit of the voltage-dependent calcium channel Murakami, M., H. Yamamura, et al. (2000), J Cardiovasc Pharmacol 36 Suppl 2: S69-73. Abstract: Voltage-dependent calcium channels are crucially important for calcium influx and the following smooth muscle contraction. Beta subunits of these channels are known to modify calcium currents through pore-forming alpha subunits. Among the four reported independent beta subunits, the beta3 subunit is expressed in smooth muscle cells and thought to compose L-type calcium channels in the tissue. To determine the role of the beta3 subunit in the cardiovascular system, we have analyzed beta3-null mice. Electrophysiological examinations proved the existence of dihydropyridine (DHP)-sensitive. L-type calcium channels in the smooth muscle cells. Beta3-null mice show no apparent changes in smooth muscle contraction and sensitivity to DHP, and normal blood pressure when they are raised on a normal diet, but the 13 subunit deficient mice show elevated blood pressure in response to a high-salt diet, with significant reductions in plasma catecholamine concentrations. Our finding strongly suggests a close relationship between voltage-dependent channels and high blood pressure. |
| Considerations for evaluating community high blood pressure control programmes Roccella, E. J. (1996), J Hum Hypertens 10 Suppl 1: S17-9. Abstract: A major reason for building evaluation procedures into community high blood pressure control programmes is the potential to influence programme planning and operation positively. Evaluation can assist smooth, successful implementation of programme plans on a continuous basis. Evaluation can provide for staff development and training and help administrators be accountable to themselves, their staffs, and their clients. Three basis types of evaluation are relevant to hypertension control programmes: process, outcome, and impact. Process evaluation measures programme efforts by assessing, modifying, and reassessing daily operations. This type of evaluation examines the use of resources, patterns of staff interaction, processes used in planning, decision making, or organization of staff to carry out these efforts. Outcome evaluation measures programme effects and extent to which programme achieve results in the target population. This activity helps determine how well programme objectives are achieved and whether activities should be continued, expanded, or redirected. Impact evaluation provides information on the long-term effects of the hypertension control programme on the community at large, such as morbidity and mortality changes. Because of the need for large sample sizes to detect these changes, impact evaluation is not usually conducted by a single community programme. As community programmes grow in number, the competition for resources becomes greater. Legislators will demand more information about programme costs and effectiveness, which will be needed to justify expenditures and compete for additional resources. |
| Continuous non-invasive blood pressure monitoring by brachial artery displacement method in high-risk surgical patients Weiss, B. M., D. R. Spahn, et al. (1995), Eur J Anaesthesiol 12(6): 555-63. Abstract: Continuous non-invasive blood pressure (CNBP) measurements were compared to invasive radial artery pressure recordings in 26 patients with cardiac, vascular and/or pulmonary disease. Patients were studied during general anaesthesia (n = 6), regional anaesthesia (n = 10), or combined technique (n = 10) for abdominal or transurethral surgery. CNBP was obtained from a cuff placed around the upper arm and simultaneously compared to invasive pressure from the ipsilateral radial artery. A CNBP device (7001 Cortronic) used intermittent oscillometric measurement for calibration. Through a cuff continuously inflated to a pressure of 20 mmHg, a microprocessor-controlled electro-pneumatic acquisition system sensed displacements of the brachial artery wall. Amplified, digitally converted, filtered and transformed data were displayed as a continuous pulse pressure waveform and digital pressure values on the screen. The CNBP method functioned without disturbances before surgery in all patients. Intra-operative use of electrocautery or a spontaneous occurrence of warning on the screen repeatedly triggered oscillometric recalibration, hence CNBP measurements were discontinued in nine patients. Coefficients of correlation (r) of all invasive and CNBP pairs (n = 1111) were 0.68, 0.58 and 0.70 for systolic, diastolic, and mean blood pressures, respectively. Prediction errors (bias, mean +/- SD) were -13.6 +/- 22.5 mmHg (on average CNBP < invasive pressure) for systolic, +13.0 +/- 12.4 mmHg (CNBP > invasive pressure) for diastolic and +5.0 +/- 13.9 mmHg (CNBP > invasive pressure) for mean CNBP, as compared to radial artery pressure values. Absolute errors (precision) were 25.3 +/- 9.4 mmHg for systolic, 17.4 +/- 4.5 mmHg for diastolic, and 13.9 +/- 4.6 mmHg for mean CNBP. During anaesthesia induction (n = 672) the difference between consecutive measurements (trend of pressure changes) with invasive and CNBP method exceeded 20 mmHg in 90 (13.3%) instances for systolic, in 33 (4.9%) instances for diastolic, and in 45 (6.6%) instances for mean blood pressure. In conclusion, the CNBP method by brachial artery wall displacement failed to measure the blood pressure reliably and to display the trend of pressure changes correctly during anaesthesia induction. In its present form this CNBP method should not replace invasive blood pressure monitoring in high-risk patients neither for anaesthesia induction nor during non-thoracic surgical procedures. |