Kevin O'Malley

Accuracy of the SpaceLabs 90207 determined by the british hypertension society protocol

Results: The three recorders passed the before-use interdevice variability assessment, after which 84% of inflations recorded with these devices during the in-use phase gave valid readings, and the three devices subsequently passed the after-use interdevice variability assessment. The main validation test was carried out on one device in 86 subjects with a wide range of pressures, the results being analysed according to a grading system from A to D. The SpaceLabs 90207 acheived B rating for both systolic and diastolic pressures and also satisfied the criteria for accuracy of the Association for the Advancement of Medical lnstrumentation (AAMI), with an average difference (f s.d.1 of 1 f 7 and 3 f 6 mmHg for systolic and diastolic pressure, respectively. Subject acceptability was good. The manufacturers manual was satisfactory overall, but contained a number of errors and omissions.

TWENTY-FOUR-HOUR AMBULATORY BLOOD PRESSURE IN MEN AND WOMEN AGED 17 TO 80 YEARS : THE ALLIED IRISH BANK STUDY

In order to determine reference values for ambulatory blood pressure, a sample of 815 healthy bank employees (399 men and 416 women), aged 17-79 years, were investigated. Ambulatory blood pressure was recorded over 24 h, taking measurements at 30-min intervals. Blood pressure was also measured by trained observers in the clinic. Ambulatory blood pressure in the 815 subjects averaged 118/72 mmHg over 24 h, 124/78 mmHg during the day (1000-2259 h) and 106/61 mmHg at night (0100-0659 h). Office blood pressure, measured by an observer, was 4/2 mmHg lower (p less than 0.0001) than daytime ambulatory pressure. The 95th centiles for the daytime ambulatory pressure in men were: 114/88 mmHg for the age group 17-29 years (n = 107); 143/91 mmHg from 30-39 years (n = 123); 150/98 mmHg from 40-49 years (n = 109); and 155/103 mmHg in 50-79 year old men (n = 60); for the corresponding age groups in women, the 95th centiles of the daytime pressure were: 131/83 mmHg (n = 174); 132/85 mmHg (n = 149); 150/94 mmHg (n = 55); and 177/97 mmHg (n = 38).

Individual quality of life in the healthy elderly

Quality of life research with the elderly has usually focused on the impact of decline in function, and used a pre-determined model of quality of life in old age. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) allows individuals to nominate, weigh and assess those domains of greatest relevance to their quality of life. The SEIQoL was administered to 56 healthy elderly community residents at baseline and 12 months later. Quality of life levels were significantly higher at baseline (t=−2.04; p=0.04) than that of a previously studied sample of healthy adults below 65 years of age, and did not change significantly over the study period. The domains nominated by both samples as relevant to their quality of life differed notably. Health status was not correlated with the perceived importance of health at baseline, and showed only a low correlation (r=0.27) at 12 months. The weight placed on health did not increase over the study period despite a significant decline in health status. The value of allowing the individual to define personal quality of life values in a research context is explored.

Prescribing for the Elderly: Part II Prescribing Patterns: Differences Due to Age

or a variety of reasons, the extent of drug prescribing for patients of all ages is an important issue. Overprescribing can lead to increased F morbidity rather than an improvement in the quality of life. Furthermore, concurrent prescription of several drugs increases the risk of adverse reactions and drug interactions,2 and multiple drug therapy with complex drug regimens can lead to poor ~ompliance.~ Finally, the financial cost of drugs is a significant component of health expenditure. Because of alterations in pharmacokinetics and pharmacodynamics with age and the increased prevalence of ill health, these problems may be accentuated in elderly patients. Indeed numerous reports and reviews have been published on the putative hazards of drug therapy in this age group4-l1 Again cost is an important factor since the elderly as a group are responsible for a disproportionate amount of the health bill in developed countries.5 While the consequences of extensive drug therapy have attracted much attention, few definitive studies have been carried out to examine the number and types of drugs prescribed for patients in different age groups. A detailed examination of the evidence reveals that our concept of extensive, inappropriate drug use in the elderly may be based on assumption rather than scientific fact. Analysis and interpretation of the data is facilitated by examination of the pattern of prescribing in the various health care settings and by taking into account the population samples studied. To this end, we classify

Age and beta adrenoceptor–mediated function

Beta adrenoceptor–mediated responsiveness to isoproterenol was compared in young and old subjects using the production of cyclic adenosine monophosphate (cyclic AMP) by lymphocytes as an index. The mean log dose‐response curve for the elderly group was displaced to the right and the mean maximum response was less than that for the young subjects. The results corroborate evidence of a decreased response to isoproterenol‐induced increases in heart rate in the elderly and raise the possibility of a generalized decrease in beta adrenoceptor–mediated functions in old age.

Management of Hypertension in the Elderly

THERE is much confusion over what constitutes appropriate management of hypertension in the elderly.1 2 3 4 5 Indeed, there is controversy about how one should define the terms elderly and hyperten...

Inaccuracy of the Hawksley random zero sphygmomanometer

To examine the accuracy of the Hawksley random zero sphygmomanometer two studies were done with subjects with a wide range of blood pressure. When readings made by one observer on the UK model of the Hawksley sphygmomanometer were compared with readings by two independent observers on separate mercury sphygmomanometers, the Hawksley device underestimated systolic readings by a mean (SD) of 2.0 (2.4) and 0.5 (3.6) mm Hg and diastolic readings by a mean of 3.7 (2.7) and 2.8 (2.9) mm Hg. When readings made on the UK and US models of the Hawksley sphygmomanometer were compared with those made on mercury sphygmomanometers, with observers exchanging devices half way during the experiment, the UK Hawksley device underestimated systolic pressure by a mean of 3.8 (SD 3.5) mm Hg and diastolic blood pressure by 7.5 (3.8) mm Hg; and the US model by 2.6 (3.4) mm Hg for systolic pressure and 6.2 (3.7) mm Hg for diastolic pressure. There was better agreement between two observers using standard sphygmomanometers than between an observer using the Hawksley random zero sphygmomanometer and an observer using a standard sphygmomanometer. Thus, the quantitative aspects of blood pressure in epidemiological and intervention studies in which the Hawksley random zero sphygmomanometer was used need re-evaluation. Moreover, the Hawksley random zero sphygmomanometer, in its present design, should not be used in hypertension research.

Sphygmomanometers in hospital and family practice: problems and recommendations.

The accuracy and working condition of 210 sphygmomanometers were tested: 100 (50 and mercury and 50 aneroid) models were used in family practices and 100 mercury models in hospitals. Faults in the inflation-deflation system were common and caused mainly by dirt or wear in the control valves. Leakage occurred in 48% of the hospital and 33% of the family practice sphygmomanometers. In the mercury models the mercury or air vents were often in an unsatisfactory condition or the calibrated glass tube dirty. The accuracy of the gauges was examined at 90 and 150 mm Hg: fewer than 2% of the mercury sphygmomanometers but 30% of the aneroid models had errors greater than +/- 4 mm Hg at either pressure. Over half of the cuffs examined had bladders widths less than the recommended size, and 94% had bladders shorter than the length recommended for use on normal adults. Mercury sphygmomanometers should be bought in preference to aneroid models as they are more accurate, less expensive in the long term, and can be maintained by the owner; they should be checked every six to 12 months depending on usage. Replacement parts should be kept readily available.

Comparative accuracy of six ambulatory devices according to blood pressure levels

Objective: To assess the accuracy of six ambulatory blood pressure measuring systems at low, medium and high blood pressures. Results: The CH-Druck, Profilomat, SpaceLabs 90207 and Novacor DIASYS 200R, having previously achieved A to C grading for systolic and diastolic blood pressures according to the British Hypertension Society (BHS) protocol and having fulfilled the criteria of the Association for the Advancement of Medical Instrumentation, have been recommended for measurement of ambulatory blood pressure in clinical practice; the Pressurometer IV and Takeda TM-2420, achieved only C and D grades and failed to satisfy the Association for the Advancement of Medical Instrumentation criteria. In this study the data from the original validations are re-analysed for three pressure ranges of systolic and diastolic blood pressures: low range ≤ 130/80 mmHg, medium range 130-160/80-100 mmHg and high range ≥ 160/100 mmHg. All six devices maintained their overall grading or improved them slightly in the low and medium blood pressure ranges, but in the high blood pressure range the CH-Druck slipped from an overall A/A grading to B/C, the Profilomat from B/A to C/D, the SpaceLabs from B/B to C/C and the Pressurometer IV from C/D to D/D. The Takeda remained unchanged with a D grading, but the results within this grading were worse in the higher blood pressure range, and the Novacor rose from C/C to C/B. Conclusions: This analysis suggests that the CH-Druck is the most accurate ambulatory system across the pressure range, although it does not perform as well in the high blood pressure range as in the medium and low blood pressure ranges. The SpaceLabs 90207 is accurate in the low and medium blood pressure ranges and reasonably accurate in the high blood pressure range. If blood pressures only in the low and medium ranges are to be measured, a wider selection of ambulatory systems becomes available because, in addition to the CH-Druck and SpaceLabs 90207, the Profilomat and Novacor DIASYS 200R are accurate.

Measurement error in the Hawksley random zero sphygmomanometer : what damage has been done and what can we learn ?

The Hawksley random zero sphygmomanometer is used in all aspects of blood pressure research, from clinical trials to evaluation of new blood pressure recorders. It is designed to reduce observer bias in blood pressure measurement. The problem is that it also underestimates blood pressure. Furthermore, this was first reported more than two decades ago. In this paper Rónán Conroy and colleagues explore the consequences of using an inaccurate instrument for important research and why prestigious organisations like the World Health Organisation continue to use it.