Emre Erdem

Inaccuracy of home sphygmomanometers: a perspective from clinical practice.

ObjectiveHome blood pressure monitoring requires a precise blood pressure measurement technique and an accurate sphygmomanometer. The oscillometric sphygmomanometers have some drawbacks including inaccuracy. The aims of this study were to assess the inaccuracy of home sphygmomanometers using a method first proposed in 2009 and to compare validated devices with other devices. Materials and methodsThree hundred and eighty-two home sphygmomanometers that had been brought by individuals to the University Hospital were included in this study. This method has three stages (general evaluation, quick screening, final assessment) and sequential measurement of blood pressure is used for assessment. The devices were categorized into two groups for comparisons: validated and ‘others’. ResultsOne hundred and fourteen (30%) of the 382 devices were validated. Final assessment showed 91 (24%) of the 382 devices to be inaccurate. Inaccuracy among the ‘others’ and wrist devices were more common than for the validated and upper arm devices (P<0.0001 for both comparisons). The categorization of upper arm devices into validated and ‘others’ showed that the validated devices were more accurate than the ‘others’ (94 vs. 79%) (P=0.002). The frequency of inaccurate and very inaccurate devices was 3% (three of 114) and 4% (four of 114) for the validated devices, respectively. ConclusionValidated and upper arm devices were more accurate than the ‘others’ and wrist devices. Validation did not guarantee individual accuracy. Active involvement of hypertension centers is required to improve the quality and reliability of home blood pressure monitoring.

Home sphygmomanometers: validation versus accuracy.

ObjectiveThe validation and accuracy of sphygmomanometers are important issues in the home sphygmomanometer market and in clinical practice. The aims of this study are to assess the frequency of validated home sphygmomanometers and to evaluate the relationship between the validation and accuracy of the devices. MethodsEight hundred and ninety-six home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic for this study, and 870 (97%) of the devices were in adequate working condition and suitable for analysis. The relationship between accuracy and validation was investigated only in automated sphygmomanometers (n = 554). ResultsBoth the manufacturer and model were known in 500 devices (90%), and these devices were eligible for evaluation of validation. We found 74 devices listed in the dabl Educational Trust website. Twenty-two of the 74 (30%) devices were validated. Four hundred (72%) of the 554 automated sphygmomanometers were inaccurate. The frequency of accuracy was higher among validated devices compared with nonvalidated devices (68 vs. 15%) (P<0.01). ConclusionOur study showed that the frequency of accurate devices was higher among validated sphygmomanometers compared with nonvalidated sphygmomanometers. To our knowledge, our study is the first to demonstrate the relationship between accuracy and validation of home sphygmomanometers. The frequency of device-related errors can be decreased by training patients and supervising the blood pressure device market. Nonprofit organizations can help patients to overcome some of the problems in the blood pressure device market.

Validation of the Omron M3 Intellisense (HEM-7051-E) Upper Arm Blood Pressure Monitor, for Self-Measurement, according to the European Society of Hypertension International Protocol Revision 2010 in a Stage 3–5 Chronic Kidney Disease Population

Background: Encouragement of home blood pressure (BP) monitoring has a great potential to improve hypertension control rates. The purpose of this study was to test validation of the Omron M3 Intellisense (HEM-7051-E) upper arm BP measuring monitor for self-measurement according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP2) in stage 3–5 chronic kidney disease (CKD) patients. Methods: 66 patients having CKD stage 3–5 were included in the study. Nine consecutive measurements were made according to the ESH-IP2 protocol. Results: The Omron M3 Intellisense device fulfills the validation criteria of the ESH-IP2 for stage 3–5 CKD patients. Conclusion: Although arterial stiffness can affect accurate BP measurement, there are limited data regarding the use of automated oscillometric devices in CKD. To our knowledge, this is the first study investigating validation of an oscillometric device in stage 3–5 predialysis CKD patients. This study validates the Omron M3 Intellisense upper arm device for stage 3–5 CKD patients. New validation studies investigating other oscillometric sphygmomanometers for CKD patients and involvement of nephrologists in these studies have great potential to increase patient care in CKD.

Red Cell Distribution Width and Mean Platelet Volume in Amyloidosis

We aimed to determine whether red cell distribution width (RDW) and mean platelet volume (MPV) values differ between patients with reactive amyloid A (AA) amyloidosis due to chronic inflammatory disease and in healthy participants. In this study, 33 patients with AA amyloidosis and 40 age- and sex-matched healthy controls were enrolled. Erythrocyte sedimentation rate (ESR), RDW, platelet count (PLT), and MPV levels were retrospectively obtained from our computerized patient database. We found RDW, ESR, and PLT levels to be significantly higher in patients with AA amyloidosis compared with the controls (P < .0001). Mean platelet volume was significantly lower in patients with amyloidosis (P < .0001). Inflammatory diseases such as AA amyloidosis may demonstrate low MPV and high RDW levels.

Validation of the Medisana MTP Plus upper arm blood pressure monitor, for self-measurement, according to the European Society of Hypertension International Protocol revision 2010.

ObjectivesStandard validation protocols are objective guides for healthcare providers, physicians, and patients. The purpose of this study was to test validation of the Medisana MTP Plus upper arm blood pressure (BP) measuring monitor for self-measurement according to the European Society of Hypertension International Protocol (ESH-IP2) in adults. MethodsThe Medisana MTP Plus monitor is an automated and oscillometric upper arm device for home BP monitoring. Nine consecutive measurements were made according to the ESH-IP2. Overseen by an independent supervisor, measurements were recorded by two observers blinded from both each others readings and from the device readings. ResultsThe Medisana MTP Plus device fulfills the validation criteria of the ESH-IP2 for the general population. The mean (standard deviation) of the difference between the observers and the device measurements was 0.6 mmHg (5.1 mmHg) for systolic and 2.7 mmHg (3.4 mmHg) for diastolic pressures, respectively. ConclusionAs the Medisana MTP Plus device has achieved the required standards, it is recommended for home BP monitoring in an adult population.

Accuracy of Sphygmanometers at Pharmacies

Background/Aims: The aims of this study are to assess the reasons of using sphygmomanometers at pharmacies and to evaluate their accuracy. Methods: 135 devices (118 aneroid, 1 mercury, and 16 automated) from 125 pharmacies (located in Samsun city center) were included in the study. A non-randomized, cross-sectional design was used for the study protocol which had two parts: assessment of devices and a questionnaire about the pharmacy and present sphygmomanometer(s). Results: 40 (30%) of the 135 sphygmomanometers were inaccurate. 65 (48%) of the devices were older than 1 year and there was no correlation between the duration of the ownership of the sphygmomanometers and their inaccuracy (p > 0.05). Blood pressure measurement is a frequent practice at pharmacies. The aneroid type of sphygmomanometers was common. A limited number of devices were checked for accuracy before. The number of validated devices was low. Conclusion: Training programs for pharmacists including the accuracy of sphygmomanometers and regular checks of sphygmomanometers for accuracy will be beneficial to the community and to the subjects requesting measurement of blood pressure at the pharmacies.

Hipertansiyon hastalarında bitkisel ürün kullanımı

Gunumuzde hastaliklarin tani ve tedavisinde saglanan gelismelere ragmen, kronik hastaliga sahip bireyler, bitkisel urunleri daha sik kullanmaktadirlar. Calismamizin amaci bolgemizde hipertansiyon hastalarinin bitkisel urun kullanim oranini, kullanilan urunleri, bilgi kaynaklarini, doktorlarina bu konuda bilgi verip vermediklerini, kullanilan urunlerin maliyetini arastirmaktir. Arastirma, poliklinigimize kontrole gelen 100 hipertansiyon hastasi ile yapilmistir. Hastalarla ilgili veriler 9 sorudan olusan bir anket formu kullanilarak toplanmistir. Calismamizda hipertansiyon hastalarinda bitkisel urun kulanim oraninin % 53 oldugunu saptadik. En sik kullanilan bitkisel urunler limon ve sarimsakti. Hastalarin buyuk bir kismi (% 83) kullandigi bitkisel urun hakkinda bilgi kaynagini komsu, akraba, arkadas ya da televizyon, radyo olarak belirtmisti. Hastalarin % 28’i urunu hergun duzenli olarak alirken, % 34’u sadece kan basinclari yukseldigi zaman bitkisel urun kullaniyorlardi. Urun kullanan hastalarin 46’si (% 87) ise kullandigi bitkisel urun hakkinda doktoruna bilgi vermemisti. Hastalarin % 87’si kullandiklari urunun maliyetinin aylik 50 TL’nin altinda oldugunu belirttiler. Hipertansiyon hastalarinin onemli bir kismi bitkisel urun kullanmaktadir ve bu konuda doktorlarina bilgi vermemektedirler. Hastalarin bitkisel urunlerin etkilerini ve yan etkilerini bilmeden kullanmalari istenmeyen sonuclara yol acabilir. Herbal product use in hypertension patients Despite recent developments in diagnosis and treatment of diseases, individuals with chronic disease use herbal products much more than others. Our study aims to examine the rates of herbal product use, the kinds of used products, source of information, whether the doctors are being informed and cost of the products used in patients with hypertension in our region. The study has been performed with 100 hypertension patients referred to our outpatient clinic. A questionnaire consisted of 9 questions has been used to gather the data about the patients. In our study, the herbal product use in hypertension patients was 53% . The most frequently used herbal products were lemon and garlic. Majority of the patients (83%) reported the source of information about the product as neighbours, relatives, friends or television and radio. While 28% of the patients were using the herbal product regularly everyday, 34% of them were only using these products if their blood pressure increased. Fourty six (87%) patients used these products did not give information to the clinician about the product. Eighty seven per cent of the patients told that the monthly cost of the product they used was less than 50 TL. A significant proportion of the patients with hypertension uses herbal product and they do not give information to the clinicians about the subject. The use of these kind of products without knowing the effects and side-effects may cause undesirable results. J. Exp. Clin. Med., 2012; 29:109-112