With high blood pressure as the most important treatable risk factor for diseases of the heart and the arterial system, it turns out that blood pressure recorded over 24 hours predicts these complications more accurately than blood pressure measured on a single occasion. This conclusion was made by an international study published in the Journal of the American Medical Association and coordinated by Professors Jan A. Staessen and Zhen-Yu Zhang of KU Leuven in Belgium. The researchers compared the predictive accuracy of blood pressure measurements made by a healthcare provider in an office setting to repeated blood pressure measurements recorded for 24 hours during both day and night.
The results showed that the probability of heart and vascular disease during follow-up was closely associated with the blood pressure measured over a 24-hour period. "Although heart and vascular disease are strongly associated with blood pressure, irrespective of how it is measured, until now we did not know which type of blood pressure measurement captured risk in the most accurate way," says Dr. Gladys Maestre from the University of Texas, Rio Grande Valley School of Medicine, who supervised the study in Venezuela. The study followed 11,135 individuals for 14 years, and participants included residents of 12 countries in Europe, East Asia, and Latin America.
For the study, investigators made individual blood pressure measurements using all available approaches, and determined other risk factors. Blood pressure was also recorded over a 24-hour period using automated portable blood pressure monitors. The number of blood pressure measurements averaged 30 during daytime and 10 during sleep. One of the advantages of measuring blood pressure during sleep, with individuals lying down in bed, is that the results are not influenced by daytime activities or meals. This at least partly explains the accuracy of nighttime blood pressure in predicting cardiac and vascular illness.
The study is unique in its large sample size and long follow-up period. The characteristics of participants were similar to those of the populations from which they were enrolled, so the results can be generalized. "Our research highlights the necessity of using 24-hour measurements to diagnose high blood pressure and to institute and fine tune its treatment," Dr. Maestre added. "Nevertheless, most health insurers in the U.S. reimburse 24-hour ambulatory blood pressure monitoring only when blood pressure is found to be high in the clinical setting, but is suspected to be normal otherwise, or if undetected or masked hypertension is suspected. However, 24-hour, ambulatory blood pressure monitoring is cost effective because it enables the prevention of cardiovascular disease by starting treatment in a timely manner."
Prevention and improved control of high blood pressure is also cost effective, because hospital-based treatment of the complications of high blood pressure, such as chest pain caused by narrowing of the arteries of the heart, myocardial infarction, and stroke, is expensive. Furthermore, prevention reduces the risk of premature disability and death, thereby avoiding suffering of patients and their families. About 30 percent of all adults and 60 percent of people age 60 and over have high blood pressure. Therefore, ambulatory blood pressure monitoring should be available at all levels of the healthcare delivery chain.
Measuring Blood Pressure With A Wearable Patch
Researchers are breaking barriers using ultrasound waves emitted from flexible patches which accurately measure central blood pressure and help detect cardiovascular problems earlier. Researchers have stepped up a notch doing this as smart wearable devices previously had the ability to measure heart rate and capture how many steps we take in a day.
The concept is using ultrasound to measure blood pressure, explains Randy King, Ph.D., director of Program in Ultrasound at the National institute of Biomedical Imaging and Bioengineering. “In this research, the scientists have taken an innovative approach to coupling ultrasound with wearables to engineer their prototype,” King says. “Other blood pressure ultrasound methods are limited by a handheld probe operated by a technician, which can lead to inaccurate and variable readings.”
When blood pressure is mentioned, the first thing that comes to mind is an infallible cuff that is wrapped around the upper arm to measure peripheral blood pressure. Instead of assessing the normal measurement of blood pressure at peripheral sites, the central blood measurement requires measuring the blood flow in the aorta near the heart. This central blood pressure is a critical vital signal for helping with detecting and diagnosing health challenges.
We have been hearing of the central blood pressure but we have to understand that obtaining its position is not easy. Other devices - non-invasive - are inaccurate as they can only measure the flow of blood in vessels around the aorta. These devices are required to be held at a particular angle and pressure to obtain the best measurement - making it vary between test and technician. The most accurate of measurements require invasive procedures where a sensor has to be inserted into the aorta through the artery in the groin or the wrist.
Scratching The Surface
Irrespective of the development of wearable devices which measure blood pressure, Sheng Xu, Ph.D., said that they have only been scratching the surface and the team of engineers are ready to tackle the challenge ahead. Sheng Xu’s team published their work in Natural Biomedical Engineering.
A simple silicone patch capable of emitting ultrasound waves at a depth of about 1.5 inches can monitor blood pressure from a wave-like form by a continuous record of the diameter of a pulsating blood vessel. Graduate student Chonghe Wang added that the approach to the patch design was an unconventional one. “In order to make our device flexible and stretchable, we needed to bridge rigid, electronic ‘islands’ with spring-like copper wires,” Wang said. “This design is named an island-bridge structure. As electricity passes through the ‘islands’, transducers emit the ultrasound waves.”
Customized software translates the recorded measurements into a blood pressure waveform to show changes in blood pressure. The peaks and valleys of a waveform represent heart activity which is used to indicate cardiovascular problems, such as hypertension, heart disease, and valve dysfunctions.
The patch has had a successful outcome when tested on the forearm, neck wrist and foot of study participants and was similar when the participants were stationary or exercising. This was attributed to the flexibility of the design.
Presently, electricity to the patch is delivered through external wires hooked up to a power source with readings sent back to a data processing unit. Optimism is shared amongst scientists that the device will improve public healthcare while empowering patients irrespective of barriers to get this to the bedside. Currently an attempt to make this device wireless is the major concern alongside a stable power source and a wireless communication and data processing unit into the patch.
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Lisa S. Jones is a certified nurse, nutritionist, fitness coach and health expert. Her training credentials include a B.Sc. in Nursing from California State University in 2013 and Youth Nutrition Specialist Certification from the American Fitness Professionals and Associates in 2015. In 2017, she also received Holistic Nutrition Certification from the American Fitness Professionals and Associates.
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