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Cutting edge research from a leading consultant cardiologist. High blood pressure is on the increase and is expected to rise by 24% in developed countries, affecting one in three of the world's adult population by 2025. As it is, hypertension is already a fact of life for around half of people in the UK over 65, and for some 70% of those in their 70s. It has a strong correlation with obesity and diabetes, levels of which are also soaring, and is strongly linked to lifestyle factors such as lack of exercise, fatty diets and high salt consumption. On the positive side, lifestyle modifications can be very effective, and even small changes can be beneficial. This book looks at how blood pressure is diagnosed and treated.

The relationship between individual modernization and elevated arterial blood pressure was examined in a study in urban Brazil. We hypothesized that elevated blood pressure would result from the discrepancy between an individual's style of life and his or her economic resources; specifically, we suggested that when modern life‐style acquisition exceeded economic resources, a circumstance referred to as "life‐style stress," blood pressure would be elevated. This factor was related to diastolic, but not systolic, blood pressure, independently of a variety of biologic, dietary, and sociocultural confounding factors. The perceived change associated with life events also predicted diastolic, but not systolic, blood pressure. Other predictors of diastolic blood pressure were calcium intake, fat intake, race, age, and the body mass index. We argue that sociocultural risk factors emerge in the modernization process as a result of social structural imbalances generated by economic development and represent independent risk factors for elevated arterial blood pressure.

The benefit and implications of blood pressure (BP) measurement in dental patients are a standard curricular component of most physical evaluation courses in dental schools. However, previous research has indicated that preventive procedures such as oral cancer examinations frequently are not completed or documented. A survey of practicing dentists was conducted in a Midwest metropolitan area to determine the frequency of BP measurement and conditions under which this vital sign is likely to be measured. Two hundred four responses were obtained from a telephone survey which included questions characterizing BP measurement on the basis of patient age and medical diagnosis. The results of the survey indicated that 57.4% of respondents do not check the BP of new patients over the age of 65, while 74% do not check the BP of new patients under 30 years of age. Fourteen percent admitted never measuring BP. The results varied by graduation years and by dentist's completion of AEGD or GPR programs. The results suggest great variation in the recording of BP and the criteria which are applied to those decisions. Further study should investigate factors contributing to low compliance with screening procedures such as the clinical measurement of BP and other health‐promotion measures.

Background: Ambulatory blood pressure monitoring (ABPM) is considered the gold standard for proper diagnosis of hypertension. Yet, access to ABPM in the U.S. is limited, and the extent of coverage by commercial health plans remains uncertain, potentially limiting access to ABPM among commercially insured patients. Objective: This study aims to assess the net cost impact of using ABPM in comparison to clinical blood pressure monitoring (CBPM) in the U.S. over a 5-year time period. Design methods: Using a Markov Model, we estimate the 5-year cumulative cost impact of using ABPM to confirm a prior diagnosis of primary hypertension using CBPM to avoid treatment for white-coat hypertension (WCH) in a hypothetical cohort of 1000 patients from a U.S. healthcare system perspective. The probability and cost inputs for the model were derived from available literature. Base-case model parameters were varied to account for different scenarios. Results: Base-case results indicate using ABPM instead of CBPM over 5 years saves a total of $348,028, reflecting an average per-person-per-year (PPPY) cost saving of $70. In sensitivity analyses, almost all cases reveal ABPM as a cost-saving approach compared to CBPM, with cost savings reaching up to $228 PPPY in the highest hypertension treatment cost model. Regression results reveal that ABPM was cost-saving compared to CBPM if ABPM annual payment rates are $100 or less and annual hypertension treatment costs are ⩾$300. Conclusion: The potential cost-savings of using ABPM instead of CBPM found in our simulation model underscores the need for confirmatory research using real-world data to support increased use of ABPM as the standard diagnostic approach for hypertension.

Blood pressure is one of the key measurements taken in standard clinical examinations. Its importance has long been associated with the instrumental precision offered by the sphygmomanometer, which is supposed to have replaced other, more imprecise methods of blood pressure measurement, such as feeling the pulse with the finger. Drawing on ethnographic fieldwork in a neurosurgical clinic, this paper explores the co-existence of the sphygmomanometer and the finger methods in practice. I argue that in neurosurgery these methods are both independent from and interdependent with each other: independent in the way they achieve different assessments of the patient's blood pressure at the same time; and interdependent in the way the surgeon's and anaesthetist's measurements are dynamically linked with each other. The paper suggests that this particular form of coordination through heterogeneity might be described, borrowing from Michel Serres' work, as mutual parasitism, and that this metaphor might be useful in rethinking the role of science - research, or 'evidence' - in medical practice.

Background: Inter-arm difference in blood pressure is the difference in the systolic and the diastolic blood pressure between arms of an individual. According to American heart association, interarm Blood Pressure difference of more than 10 mm of Hg are associated with peripheral vascular disease. The present study aims to determine the magnitude of interarm difference in young healthy individuals and to assess whether family history of hypertension, age, sex and Body mass index is related to higher interarm differenceMethods: A cross-sectional study was carried out among 270 students of Manipal College of Medical Sciences, Pokhara, Nepal. Blood pressure was measured in both the arms using a mercury sphygmomanometer. (Elko 300) Statistical analysis was done using paired t test, chi-square and Pearson's correlation test using SPSS 23. Results: The absolute mean Inter-arm difference for systolic blood pressure was 11.03±0.67mm Hg and for diastolic blood pressure was 6.020 ±0.21 mm Hg. There is significant inter-arm difference for systolic blood pressure and diastolic blood pressure (p<0.001). Inter-arm systolic blood pressure difference was significantly associated with family history of hypertension, age and Body Mass Index (p<0.001) Meanwhile, there was no statistically significant association of sex, family history of hypertension, age and Body Mass Index with inter-arm difference for diastolic blood pressure.Conclusions: Significant inter-arm systolic and diastolic blood pressure differences was found in the young, healthy population. Positive correlation of increased Inter-arm difference in Blood Pressure with family history of hypertension was confirmed. This emphasizes the importance of measuring blood pressure in both arms to be a routine practice as we aim for early diagnosis and prompt treatment of hypertensive disorders.Keywords: Blood pressure; healthy adults; interarm difference

The salt hypothesis is that higher levels of salt in the diet lead to higher levels of blood pressure, increasing the risk of cardiovascular disease. Intersalt, a cross-sectional study of salt levels and blood pressures in 52 populations, is often cited to support the salt hypothesis, but the data are somewhat contradictory. Four of the populations (Kenya, Papua, and 2 Indian tribes in Brazil) do have low levels of salt and blood pressure. Across the other 48 populations, however, blood pressures go down as salt levels go up, contradicting the hypothesis. Experimental evidence suggests that the effect of a large reduction in salt intake on blood pressure is modest, and health consequences remain to be determined. Funding agencies and medical journals have taken a stronger position favoring the salt hypothesis than is warranted, raising questions about the interaction between the policy process and science.

Aim To identify service side factors associated with access to antenatal blood pressure measurement at health facilities in Malawi. Methods Secondary data analysis of 1499 observations of antenatal consultations undertaken in the Service Provision Assessment survey 2013-14, a census of all formal health facilities in the country. Results Differentials in access to antenatal blood pressure measurements by client age or educational status and provider gender or in-service training did not reach statistical significance although clinically important effects cannot be excluded. There was substantial variation among districts, ranging from 14% to 100% of observed consultations. Facilities in the Central and Southern regions had lower odds of providing blood pressure measurement relative to the Northern region (OR 0.17, 95% CI 0.03 to 0.30 and 0.11, 95% 0.04 to 0.31 respectively). Facilities affiliated to the Christian Health Association of Malawi and facilities under private management had higher odds of provision relative to government facilities (OR 3.24, 95% CI 1.71 to 6.11 and 5.77, 95% CI 1.87 to 17.79 respectively). Where observed consultations included taking the client's weight and measuring the symphysis-fundus height, the odds of blood pressure measurement were significantly increased (OR 6.4, 95% CI 3.32 to 12.34 and 1.71, 95% CI 1.01 to 2.88 respectively). Conclusion An indicator for effective coverage, the proportion of antenatal visits that included blood pressure measurement, recorded in health passports examined at the time of admission for delivery, should be tested for incorporation into the District Health Information System to enable tracking of quality improvement in antenatal care. Further research is needed to elucidate the reasons for the variations identified here.

Hypertension is a chronic disease that is a risk factor for impaired cognition, stroke and heart attacks, among other diseases. Previous studies suggest that not accounting for the use of antihypertensive medication in genetic and population studies may confound results. Thus, identifying a model to correct for Blood Pressure- lowering medications is important. We assessed BP and antihypertensive medications in 1,237 male twins from the Vietnam Era Twin Study of Aging (VETSA). We used three approaches to correct BP measurements for antihypertensive treatment: (1) the addition of a fixed value of 10 mmHg and 5 mmHg to measured systolic and diastolic BP, respectively, for subjects on antihypertensive medication, (2) an incremented addition of mmHg to BP based on the number of different medications used, and (3) the addition of mmHg according to antihypertensive drug class and ethnicity. We used the classical twin design to estimate heritability of the corrected BPs. We also assessed whether the relationship between BP traits and Body-Mass Index (BMI) changed with corrections. The corrections for antihypertensive treatment did not significantly affect the heritability of BP measurements in VETSA data. However, corrections for antihypertensive treatments resulted in higher correlations between BP and BMI. We also analyzed demographic data on twins to compare prevalence of hypertension, prescribed BP medications, and BMI in regions across the United States, stratified by (1) geographic location, (2) political affiliation and (3) stress levels. The prevalence of hypertension significantly differed between regions of high stress and regions of low stress, suggesting a correlation between stress and hypertension