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Biomedical subjects

K O'Malley

Publications and source records attributed to K O'Malley.

At least 91 records · Page 5Linked to original sources
PubMed1991

Clinical application of ambulatory blood pressure measurement in pregnancy.

Eclampsia and pre-eclampsia are the most important obstetric causes of maternal mortality in the Western world. The current definitions of hypertensive disorders in pregnancy rely on arbitrary blood pressure limits based on intermittent clinic readings which are subject to bias and error. Twenty-four-hour ambulatory blood pressure monitoring can overcome many of these deficiencies but has only recently been introduced into antenatal care. Five pregnancy studies using ambulatory blood pressure monitoring are currently underway in Birmingham, Glasgow, Grenoble, Oxford and Dublin. The results so far indicate that ambulatory blood pressure monitoring is an acceptable method of measuring blood pressure in pregnancy. It is also concluded that ambulatory blood pressure monitoring may have several roles in the future antenatal management of hypertension, including modification of existing classification systems, a clinical confirmatory role and a possible predictive role for pre-eclampsia.

Blood Pressure↗
PubMed1991

Ambulatory blood pressure measurement in the elderly.

A number of problems relating to clinic measurements of blood pressure may be particularly relevant to elderly patients with isolated systolic hypertension. First, there are large discrepancies in the blood pressure levels measured by these two techniques in the elderly population. Second, while blood pressure is universally accepted as one of the most important risk factors for the development of cardiovascular morbidity, its predictive value in the individual is relatively poor. Clinic and 24-h ambulatory recordings from 318 patients aged 17-80 years, diagnosed as having isolated systolic hypertension on clinic measurement, were compared with reference values determined from 815 healthy bank employees. In the isolated systolic hypertension group, mean systolic blood pressure by daytime ambulatory measurement was 27 mmHg lower than that recorded in the clinic, while diastolic pressure was similar (151 +/- 17/87 +/- 11 versus 178 +/- 28/84 +/- 9 mmHg). This discrepancy was greater in women than men, increased slightly but significantly with age (r = 0.12, P less than 0.05) and raised the crucial question as to which of the two measurements might best predict prognosis in this population. In a further study of the association between electrocardiographic (ECG) voltages and blood pressure measured in the clinic and by ambulatory monitoring in 216 patients with isolated systolic hypertension, the sum of SV1 + RV5 and the sum of SV1 + RV6 were significantly and positively related to systolic pressure both in the clinic and with daytime and night-time ambulatory measurement.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Evaluation of the SpaceLabs 90202 non-invasive ambulatory recorder according to the AAMI Standard and BHS criteria.

The SpaceLabs 90202, a non-invasive ambulatory blood pressure recorder for the measurement of 24 hr blood pressure, was assessed according to the standard of the Association for the Advancement of Medical Instrumentation (AAMI) and the grading criteria of the British Hypertension Society (BHS) protocol were applied to the results. Two observers measured BP simultaneously in the same arm with the SpaceLabs 90202 and a standard mercury sphygmomanometer at 4 mmHg deflation steps in 85 subjects [age range 22-79 years, BP range 96-212 mmHg (systolic) and 52-134 mmHg (diastolic)]. The mean difference was -2 +/- 5 mmHg (systolic) and -2 +/- 5 mmHg (diastolic). The mean difference (+/- SD) between observers was 1 +/- 3 (systolic) and -2 +/- 3 (diastolic). The SpaceLabs 90202 fulfills the criteria of the AAMI standard (5 +/- 8 mmHg) and a B grading for both systolic and diastolic pressure is achieved with the BHS criteria.

Adult↗
PubMed1991

Ambulatory blood pressure measurement: therapeutic implications.

Conventional clinic measurement of blood pressure has many deficiencies, among which the most significant are its inability to indicate the duration of drug effect, or the influence of antihypertensive drugs on nocturnal blood pressure. The technique is, therefore, unreliable for assessing antihypertensive drug efficacy, either in clinical practice or hypertension research. Non-invasive 24 h ambulatory blood pressure measurement has a number of advantages over conventional measurement. In clinical practice it provides a profile of blood pressure over the 24 h period permitting the selection of the most appropriate antihypertensive drug for the individual patient. In studies of antihypertensive drug effect, ambulatory measurement detects white coat responders and, being free of regression to the mean and the placebo response, it is possible to consider efficacy studies which need not have a placebo phase. By providing considerably more observations than can be obtained with clinic measurement, ambulatory measurement increases the power of studies making it likely that fewer numbers of patients are needed for antihypertensive drug studies. 24 h ambulatory blood pressure measurement offers the opportunity to study antihypertensive drugs in fewer patients with greater accuracy than is possible with conventional clinic measurement and should be a mandatory requirement for such studies.

Ambulatory Care↗
PubMed1991

A comparison of the twenty-four-hour blood pressure profile in normotensive and hypertensive subjects.

The aim of this study was to assess the relationship between blood pressure measured conventionally ('conventional' pressure) and 24 h ambulatory blood pressure measured with the SpaceLabs 90202 recorder, in a control population with normal blood pressure, and in patients with hypertension. Reference values for 24 h ambulatory blood pressure had been determined previously in a control population of 776 healthy bank employees (396 men and 380 women), aged 17-80 years, and were compared with those from a clinic population which comprised 805 patients referred to a blood pressure clinic for evaluation of hypertension. The clinic population was divided into two groups: 'normotensive' patients, whose conventional blood pressure was less than 160/90 mmHg (n = 168), and 'hypertensive' patients, whose conventional blood pressure was greater than or equal to 160/90 mmHg (n = 637). The clinic population had higher conventional (156/87 versus 119/76 mmHg), daytime (147/90 versus 125/79 mmHg) and night-time (129/75 versus 106/61 mmHg) ambulatory pressures compared with the control population. The clinic 'hypertensive' patients had higher conventional (175/97 versus 136/77 mmHg), daytime (153/93 versus 140/87 mmHg) and night-time (133/78 versus 124/72 mmHg) ambulatory pressures than the clinic normotensive population. Daytime ambulatory pressure was higher than conventional pressure (125/79 versus 119/76 mmHg) in the control population and in the clinic normotensive population (140/87 versus 136/77 mmHg). However, this relationship was reversed in the clinic hypertensive patients (153/93 versus 175/97 mmHg). It is concluded that while conventionally measured blood pressure tends to be lower than ambulatory daytime pressure in normotensive populations, this relationship is reversed in patients with hypertension.

Adult↗
PubMed1991

Training and assessment of observers for blood pressure measurement in hypertension research.

Eight nurses were re-trained in the technique of measuring blood pressure firstly with an audiotape and secondly with a video and expert instruction. They were then assessed for accuracy in measurement in subjects with a range of BP. In the first session with the audiotape, criteria for accuracy were that the difference in readings (systolic and diastolic) between each pair of observers was to be 5 mm Hg or less in at least 85% and 10 mm Hg or less in at least 95% of the readings. Five out of the 28 observer pairs (18%) fulfilled these criteria for both systolic and diastolic pressures, six (21%) satisfied the criteria for systolic pressure and nine (32%) for diastolic pressure with eighteen pairs (64%) failing to meet the criteria for both systolic and diastolic pressure. In the second training session seven of the original eight observers underwent further training in which the audio-tape was replaced by the British Hypertension Society video and instruction was also given by an expert. The same requirements for accuracy were used except that, in addition, the difference between the trainee observer and the expert had to be within 5 mm Hg in at least 90% and within 10 mm Hg in at least 95% of the readings. Eighteen of the 21 observer pairs (86%) achieved the accuracy criteria, with the remaining three (14%) failing on diastolic pressure only. All seven observers were within the required criteria when assessed against the expert observer. It is concluded that training of observers is more effective with a video and expert instruction than by using audio-tapes.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure Determination↗
PubMed1990

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.

Adolescent↗
PubMed1990

Ethnic differences in cyclic AMP accumulation: effect on alpha 2, beta 2, and prostanoid receptor responses.

Platelet alpha 2- and lymphocyte beta 2-adrenergic receptor density and responsiveness and platelet responses to prostaglandin E2 (PGE2) were measured in black subjects and white subjects. Mean (+/- SEM) alpha-receptor density was greater in white subjects (248 +/- 29 versus 392 +/- 31 fmol/mg protein; p less than 0.005), whereas beta-receptor densities were similar (black subjects, 19.2 +/- 2.2 fmol/mg protein; white subjects, 15.2 +/- 1.4 fmol/mg protein). Basal platelet cyclic AMP levels (black subjects, 7.8 +/- 1.1 pmol/mg protein; white subjects, 14.5 +/- 2.4 pmol/mg protein; p less than 0.05) and PGE2-induced increases in platelet cyclic AMP levels were higher in white subjects (black subjects, 47.1 +/- 3.3 pmol/mg protein; white subjects, 65.5 +/- 3.4 pmol/mg protein; p less than 0.001). Basal lymphocyte cyclic AMP levels (black subjects, 1.2 +/- 0.3 pmol/10(6) cells; white subjects, 2.8 +/- 0.6 pmol/10(6) cells; p less than 0.05) and mean isoproterenol-induced cyclic AMP increases were also higher in white subjects (black subjects, 6.2 +/- 0.6 pmol/10(6) cells; white subjects, 8.5 +/- 0.8 pmol/10(6) cells; p less than 0.05). Responses to isoproterenol as fold stimulation of basal were not significantly higher in black subjects (8.51 +/- 0.97 versus 6.16 +/- 0.86 fold-stimulation of basal). Platelet responses to PGE2 as fold stimulation of basal (black subjects, 7.9% +/- 0.7%; white subjects, 8% +/- 1.3%) and alpha 2-receptor-mediated inhibition of PGE2 responses by UK-14304 (black subjects, 38.2% +/- 1.7%; white subjects, 40.6% +/- 2.3%) were also similar in the two groups.

Adult↗
PubMed1990

Serum concentrations of prilocaine following retrobulbar block.

Retrobulbar block for eye surgery is associated with adverse reactions. We performed retrobulbar block in 10 patients using prilocaine (Citanest) and found mean (SD) peak serum concentrations of 851 (165.6) ng ml-1 (range 540-1100 mg ml-1). Peak serum concentrations occurred 3-7 min after the end of administration of the block, and in all cases were less than those associated with toxicity.

Aged↗
PubMed1990

The British Hypertension Society protocol for the evaluation of automated and semi-automated blood pressure measuring devices with special reference to ambulatory systems.

With the increasing manufacture of expensive systems for the measurement of ambulatory blood pressure there is a need for potential purchasers to be able to satisfy themselves that the systems have been evaluated according to agreed criteria. The British Hypertension Society has, therefore, drawn up a protocol of requirements for the evaluation of these devices. This protocol incorporates many features of the American National Standard for Non-Automated Sphygmomanometers but includes many additional features, such as strict criteria for observer training, interdevice variability testing before and after a month of ambulatory use, and a new system of analysis which permits the test system to be graded. It is recommended that manufacturers of ambulatory blood pressure measuring devices should obtain an unbiased evaluation according to a recognized standard before a device is marketed.

Blood Pressure Monitors↗
PubMed1990

Inaccuracy of seven popular sphygmomanometers for home measurement of blood pressure.

Seven models, available commercially for the self-measurement of blood pressure, were subjected to a validation procedure in which three devices of each model were tested by observers who were trained to a high standard of accuracy. The models were the Omron HEM-400C, the Philips HP5308, the Healthcheck 'Cuffless' CX-5 060020, the Nissei Analogue Monitor, the Philips HP5306/B, the Systema Dr MI-150 and the Fortec Dr MI-100. The validation programme had a number of unique features which included assessment of interdevice variability before and after 1 month of home use, and a new form of analysis, which we term 'clinical', based on the likely influence of three grades of device inaccuracy on patient management. In the main validation phase, one device of each model was compared with simultaneous measurements made by two 'blinded' observers using a standard mercury sphygmomanometer (PyMaH Corporation, New Jersey, USA) in the same arm in 85 subjects with a wide range of blood pressures. Three models (the Healthcheck 'Cuffless' CX-5 060020, the Systema Dr MI-150 and the Fortec Dr MI-100) failed the interdevice variability tests and did not reach the main validation test. Two models (the Omron HEM-400C and the Philips HP5306/B) failed on the criteria set down by the American National Standard for Electronic or Automated Sphygmomanometers, as well as the 'clinical' criteria. The remaining two models (the Nissei Analogue Monitor and the Philips HP5308) were acceptable for the measurement of systolic blood pressure by both methods of analysis but failed in the 'clinical' analysis for diastolic blood pressure. The mercury sphygmomanometer was comfortably within the criteria for both methods of analysis.

Blood Pressure Determination↗
PubMed1990

Clinical pharmacokinetics of the newer ACE inhibitors. A review.

The orally active angiotensin-converting inhibitors (ACE inhibitors) such as captopril and enalapril represent a significant therapeutic advance in the treatment of hypertension and congestive heart failure. Enalapril differs from captopril in several respects. It is a prodrug converted by hepatic esterolysis to the active (but more poorly absorbed) diacid, enalaprilat. Enalaprilat is more potent than captopril, more slowly eliminated and does not possess a sulfhydryl (SH) group. Enalapril was rapidly followed by a number of newer ACE inhibitors, the majority of which are similar to enalapril in that they are prodrugs, converted by hepatic esterolysis to a major active but poorly absorbed diacid metabolite. In one case (delapril) there are 2 active metabolites; in another (alacepril) the prodrug is converted in vivo to captopril. Lisinopril is an exception in that it is an enalaprilat-like diacid but with acceptable oral bioavailability, so that the prodrug route is not employed. The newer ACE inhibitors are at widely different stages of development, and it is not yet clear how many will reach regular clinical use. Of these newer drugs, lisinopril is the longest established and is the subject of the widest published literature. For a number there is as yet little published pharmacokinetic information. A variety of assay methods have been employed to characterise the pharmacokinetics of the ACE inhibitors, including enzymatic techniques, radioimmunoassay and chromatography. The peak plasma concentrations of the prodrugs are generally observed at around 1 hour and those of the diacid metabolites at about 2 to 4 hours. However, there is considerable variation within and between drugs, with benazepril and benazeprilat reaching peak concentrations early and enalapril and enalaprilat typical of later times to peak. Absorption of the active diacids is generally poor, and moderate (typically 30 to 70%) for the prodrugs. The bioavailability of lisinopril is about 25%. It is difficult to talk meaningfully about half-lives of the active drugs. The declines in their plasma concentrations are polyphasic and, if analytical sensitivity allows, active drug may be found at 48 hours or more following administration. This may reflect binding to ACE in plasma. Half-lives of accumulation are of the order of 12 hours; protein binding varies from little (lisinopril) to 90% (benazeprilat). Elimination is mostly renal but there may be biliary elimination for some, such as benazeprilat and fosinopril. The half-lives of the prodrugs are short. Impaired renal function decreases the elimination rate of the diacids.(ABSTRACT TRUNCATED AT 400 WORDS)

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1990

Twenty-four-hour ambulatory blood pressure monitoring: a review of validation data.

As the clinical applications for 24-h ambulatory blood pressure monitoring expand, market demands increase, and there are now at least 13 manufacturers producing elaborate and expensive systems for recording 24-h ambulatory pressures. It is often difficult to assess the accuracy and performance characteristics of these devices and failure to standardize validation makes it difficult to compare one system with another. The standard of the Association for the Advancement of Medical Instrumentation (AAMI) and the recently published protocol of the British Hypertension Society (BHS) provide standardized validation procedures which allow comparisons to be made between ambulatory devices. Thirty-three published reports on 18 ambulatory systems are listed. Five of these systems have been validated according to the AAMI standard; of these, the SpaceLabs 90202 and the Medilog have satisfied the standard, and the Pressurometer IV, the Accutracker II and the Takeda TM-2420 did not satisfy the AAMI standard. The results of recent validations of the SpaceLabs 90207, the Diasys 200, the Takeda TM-2420 and the Pressurometer IV according to the BHS protocol are awaited and should provide further data that will allow comparisons of the performance and the accuracy of different ambulatory systems.

Blood Pressure Monitors↗