geoffrey modest medical blogs

  A recent article affirmed that the arm position was important in measuring blood pressure, in a crossover trial (see  htn arm position important JAMA2024  in dropbox, ordoi:10.1001/jamainternmed.2024.5213)   Details: -- 133 participants aged 18-80yo in Baltimore Maryland from 2022-2023 -- individuals excluded: those with rashes, gauze dressings, casts, edema, paralysis, tubes, open sores or wounds, or AV shunts on both arms, “mental impairment”, pregnancy, or mid to upper arm circumference of more than 55 cm -- in order to replicate a more typical clinical scenario, participants walked for two minutes and then underwent a five-minute seated rest period with their back and feet supported prior to having their blood pressure measured by an automated device. -- patients were randomly assigned to a set of triplicate blood pressure measurements, with the following measurements performed in random order:     -- arm supported on the desk, with midcuff ...

  A recent study found that blood pressure variability itself was associated with cardiovascular disease, independent of the measured blood pressure, and that assessing home-based blood pressure variability was superior to ambulatory blood pressure variability (see htn home BP better than ABPM HTN2023 in dropbox, or DOI: 10.1161/HYPERTENSIONAHA.123.2089 )       Details :   -- 1314 hypertensive patients  from 71 institutions in Japan having office BP> 140/90 mmHg underwent both home and ambulatory blood pressure measurements in the J-HOP (Japan Morning-Surge Home Blood Pressure) study in this post hoc analysis, between 2005-2012   -- mean age 65, 47% male, BMI 24.6   -- current smoking 12%, habitual drinking 22%   -- 86% on antihypertensive meds: ARBs 57%, calcium channel blockers 55%, diuretics 31%, b-blockers 16%, ACE 8%, a-blockers 7%, MRAs 4%   -- comorbidities: diabetes 24%, CKD 27...