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Medida de la presión arterial en la oficina de farmacia

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Objective To compare blood pressure levels measured in the pharmacy with those obtained in the patient's home or Primary Care centres (doctor's surgery or treatment room). Method Multicentre, open-label, observational, and medium-term follow-up study. Location: Primary Care in the Spanish healthcare system. Participants: 206 general or family practitioners who consecutively selected a maximum of 10 patients each; 1,588 patients were recruited. Interventions and main measurements: home blood pressure (BP)monitoring, measurements taken in clinics (doctor's surgery and treatment room) and pharmacies (usual apparatus and validated Omrom M4); ambulatory monitorization was performed on 190 patients (model Spacelab 90207). Results 1,399 patients were included (50.4% women), with a mean age of 60.1 (standard deviation [SD]: 9.7) years. BP values obtained in doctor's surgeries were significantly higher than those obtained in treatment rooms, pharmacies and at home (P < 0.01 in all cases). The smallest differences were observed between the pharmacy and home measurements, with 0.69 (SD: 8.1) for the systolic BP (p = 0.007) and 0.15 (SD: 5.48) for diastolic BP (p = 0.370). Discussion The ZANyCONTROL study supports the idea that BP measurements taken on hypertensive patients in the pharmacy properly reflect their real BP; it is an accessible and effective method for measuring blood pressure. It is important that the sphygmomanometer in the pharmacy is validated and works correctly.
Article
Blood pressure measurement is one of the commonestactivities in the clinic. Hypertension managementusually depends on its values.Blood pressure measurement by a physiciancharacteristically triggers an alerting reaction that isresponsible for a transitory rise in blood pressure andheart rate. This pressor response, named “white coateffect”, is also induced when blood pressure ismeasured by a nurse, but its magnitude is considerablylower than that provoked by a physician. White coat effect is not reduced by repeated visits tothe same physician, at least for a short period of time,but it has been suggested (although not shown) thepossibility of a long-term attenuation.Nurse-measured blood pressure levels are moreclosely related to ambulatory blood pressure andseveral organ damage markers (left ventricle mass,microalbuminuria, etc.) than physician-measuredblood pressure, and may therefore reflect out-ofclinicblood pressure and, potentially, target organdisease better than the latter.Systematic nurse-measured blood pressure couldreduce the percentage of cases diagnosed withwhite-coat hypertension, therefore avoiding anunnecessary pharmacological treatment.These data support that nurses (instead of physicians)should routinely measure blood pressure in theclinic.
Article
Objectives To assess reliability in terms of inter-observer agreement of blood pressure (BP) readings. Various health professionals and measuring systems. Influence of observer's experience. Design Observational, descriptive, cross-sectional study. Setting Urban health centre, Córdoba. Participants 131 hypertense, randomised patients, belonging to a functional care unit. 11 were excluded. Measurements To reduce variability: course on the right way to take blood pressure, otoscope and verification of visual sharpness of observers, calibration and validation of measuring devices, limited time and blinding of measurements. 4 BP measurements per patient: 3 with mercury sphygmomanometer (2 simultaneously, one individual) and one with an automatic device. Descriptive, clinical and somatometric variables were gathered. Inter-observer agreement was evaluated through the intraclass correlation coefficient (ICC), the mean of differences method (MDM) and the simple concordance index (CI). An ICC > 0.75 was thought acceptable. A difference > 5 mmHg was thought clinically relevant (MDM and CI). Main results Acceptable consistency for MDM: alone, systolic and diastolic pressure of OBS 1/ OBS 2, bi-auricular, –6.1/+8.9 mmHg and –6.8/+5.8 mmHg. Less favourable results: for systolic and diastolic pressure: OBS 1/AUTO –20.9/25.0 and –16.4/15.1; OBS 2/AUTO –22.8/24.4 and –16.6/15.2. Remaining intervals always > 10 mmHg; CI > 0.75 in all comparisons except diastolic pressure OBS 1/AUTO and diastolic pressure OBS 2/AUTO (0.69 in both cases). 41% of comparisons were > 5 mmHg. No differences in less expert professionals were found. Conclusions Inaccuracy of the standard BP measurement method (mercury sphygmomanometer) for MDM and CI. Contradictory conclusions according to method of measurement. Differences not clinically acceptable.
Article
Objective To evaluate concordance between blood-pressure (BP) measurements at the pharmacy office (PhO) and the nurse office (NO) in the health care centre (HCC). Design Descriptive study. Setting Community. Methods 36 PhO have voluntarily participated in the province of Albacete, where they have done 3 BP measures, without previous instructions and with their usual measurements devices, for 3–5 subjects, who were referred to their HCC so that they were taken another 3 BP measures in the NO with their Hg sphymomanometer and in their usual measure conditions (blind measures in relation to those taken at the PhO). These subjetcs were given a stamped envelope to send the BP measurements (taken at the NO), to the Official Pharmacy College. Results. The 6 BP measurements have beeen completed to 96 subjects with an average of 57.3 years old (women 63%). The differences between PhO and NO were > 5 mmHg in 58 subjects (60.4%) in the case of SBP and in 45 subjects (46.9%) in the case of DBP, and it was more than 15 mmHg in the 17 subjects (17.7%) with SBP and in 9 subjects (9.4%) with DBP. The difference average was 9.5 mmHg (SD, 8.4 mmHg) and 6.4 mmHg (SD, 5.3 mmHg) respectively. The use rate of digit 0 was 22% at the PhO and 46.5% at the NO. In most of PhO, measurement electronic devices have been used for the BP, but not validated for clinical use. Conclusions. The PhO can be a good place for the hypertension screening, but the chemist must be trained in the BP correct measurement and use validated electronic devices. Standardization measurement conditions and the use of validated electronic devices must be extended to the NO.
Article
Objective . To evaluate the degree of inter-observer concordance in the blood pressure figures taken by a nurse and a doctor with a mercury sphygmomanometer and by the patient with a semi-automatic device. Design . Observational, crossover study. Setting . A rural health centre. Patients . 318 people selected by systematic sampling. Interventions . Pressure was taken in different ways by 3 different «observers» (0): the patient with a semi-automatic device (01), a nurse (02) and a family doctor (03). Inter-observer concordance was assessed through the Intra-class Correlation Coefficient (ICC) and the kappa index. Measurements and main results . 42.1%, 41.8% and 44.3% of patients had high blood pressure (≥ 140/90 mmHg) according to 01, 02 and 03, respectively. 33% were known to be hypertense. The ICC for systolic pressure was 0.81 (95% CI, 0.75-0.87) between 01 and 02; 0.84 (CI, 0.78- 0.90) between 01 and 03; and 0.87 (CI, 0.82-0.92) between 02 and 03. The ICC for diastolic pressure was 0.67 (CI, 0.59-0.75), 0.72 (CI, 0.64-0.79) and 0.79 (CI, 0.72-0.86) for 01-02, 01- 03 and 02-03, respectively. The kappa index was 0.53 (CI, 0.43-0.62) for 01-02; 0.60 (CI, 0.51- 0.68) for 01-03; and 0.67 (CI, 0.58-0.75) for 02-03. Conclusions . Inter-observer concordance was good, with no substantial differences between the measurements made by the different observers. As the figures determined by the semiautomatic device were reliable, this is a good option for the follow-up and monitoring of hypertense patients.
Determinación de la presión arterial por médico o enfermera: relación con la presión ambulatoria y masa ventricular izquierda
  • M A Martínez
  • A Aguirre
  • M Sánchez
  • A Nevado
  • I Laguna
Martínez MA, Aguirre A, Sánchez M, Nevado A, Laguna I, Torre A. Determinación de la presión arterial por médico o enfermera: relación con la presión ambulatoria y masa ventricular izquierda. Med Clin (Barc) 2000; 20: 770-775.