Nurses′ Hypertension Association - Newsletter - Autumn 2002 edition/title> <style type="text/css" media="all">  </style> </head> <body> <div id="wrapper" class="news"> <a class="hidden" href="#maincontent">Skip Navigation</a> <a name="top"></a> <div id="siteheader">Nurses′ Hypertension Association, www.nha.uk.net </div> <div id="navigation"> <ul> <li id="home"><a href="index.shtml">Home</a></li> <li id="activities"><a href="activities.shtml">Activities</a></li> <li id="news"><a href="news.shtml">Newsletters</a></li> <li id="links"><a href="links.shtml">Weblinks</a></li> <li id="joinus"><a href="joinus.shtml">Join NHA</a></li> <li id="contact"><a href="contactus.shtml">Contact Us</a></li> <li id="stoppress"><a href="stoppress.shtml">Stop Press</a></li> </ul> </div> <div id="maincontent"> <h1>Newsletter - Autumn 2002 edition</h1> <p>Jump to:</p> <p class="tiny"><a href="#editor">Letter from the Editor</a> | <a href="#ascot">News on ASCOT</a> | <a href="#ntresearch">NT Research Awards 2002</a> | <a href="#conference">Conference report</a> | <a href="#esh">European Society of Hypertension</a> | <a href="#diary">Diary Dates</a> | <a href="#bpa">Blood Pressure Association - Update</a> | <a href="#automated">Review article - How do automated blood pressure devices work?</a> | <a href="#sbpm">Review article - Self Blood Pressure Measurement - who is monitoring the changes?</a> | <a href="#ambulatory">Situations to consider ambulatory BP monitoring or home BP</a> | <a href="#references">Some Useful References</a> | <a href="#funding">Sources of Funding for Nurses</a> | <a href="#bhs">BHS Live!</a> </p> <div class="panel"> <h2>Letter from the Chair - Susan Kennedy</h2> <p> Following the Annual General Meeting on the 11th September I have been appointed as the Chairperson of the Nurses Hypertension Association for the next two years. I am delighted to accept this role and look forward to working with an excellent committee. I will of course also need the membership to feed back ideas and respond to any new initiatives that are proposed. </p> <p>The NHA must raise its profile to meet the challenge of hypertension, now a key issue within a number of the National Frameworks that are being introduced throughout the UK and Ireland. The NHA was initially the brainchild of specialist nurses involved in research and fundamentally the membership still reflects this focus. As so many primary care nurses run hypertension clinics the NHA should be able to respond to any needs that they may have. </p> <p>The committee will be seeking to develop training issues for their own membership as well as the wider nurse community this year. Another point to consider will be nurse prescribing and a small group will develop an NHA response to this for hypertension drugs. Finally the measurement of blood pressure has always been an important aspect of the NHA and this too will be considered in a separate subgroup. This should allow us to promote best practice. If you are interested in becoming involved in the work of these groups please contact myself initially to discuss. My email address is <a href="mailto:sk53f@clinmed.gla.ac.uk">sk53f@clinmed.gla.ac.uk</a></p> <p> Unfortunately much of the work of previous committees has been connected with fund raising to allow 50 nurses to attend the Scientific Meeting once a year. This was discussed at some length at the AGM and the poor current financial position explained. Unless the NHA is sponsored by up to £10,000 we will be unable to continue to do this after next year. Therefore this year the committee will need to consider other solutions to this problem. The rise in subscription next year to £40 will only help to cover the costs of administrating the association. There are more details of what was discussed in the minutes of the AGM and if you were unable to attend this year but would like to put your point of view please write to Sally Brett, the new newsletter editor and she will publish your letter. </p> <p> Finally I would like to thank Bernie Stribling who is the retiring Chairperson and Sally Armstrong as the retiring Secretary as both have given us much time and effort and we wish them well. </p> <p> <em>Susan Kennedy</em></p> <p><a href="#top">^ Back to top</a></p> </div> <div id="editor" class="panel"> <h2>Letter from the Editor </h2> <p> This is the first of the new look newsletters. These will come to you twice a year, in autumn and spring. At the moment the decision has been made to continue to send these out by post. As yet we still do not have a complete list of email details from all NHA members and it was thought that if we relied on modern technology to distribute the newsletter then some people would be missed. We will keep you informed of any developments on this. </p> <p> The response to my plea for articles for this edition was mixed. Hopefully this will grow as more people realise that in the newsletter they have a golden opportunity to reach a wider audience and let them know of work that they are doing, courses that are going on in their area etc. I will also continue to ask individuals for articles that I think members may be interested in. A big thank you to all those people that did send me in information/articles that they wanted to be included in this edition. I hope that my suspect word processing skills did not let you down! </p> <p> This month I have tried to concentrate on the use of automated devices for measuring blood pressure at home and in the hospital. Annemarie Reinders has expanded on the presentation that she gave to the Scientific Meeting and written an article for the newsletter on how automated devices work. Susan Kennedy is the author of a review an self blood pressure measurement. In addition I have included a summary of the latest information on automated blood pressure monitors from the British Hypertension Society Information Service. </p> <p> Hopefully the NHA newsletter will continue to grow, and with a bit of luck my IT skills may improve along with your new look newsletter! I am currently working on how to include photographs. I hope you enjoy reading it and if anybody has anything that they would like me to include in the next edition please let me know. My email address is <a href="mailto:sally.brett@kcl.ac.uk">sally.brett@kcl.ac.uk</a> </p> <p> <em>Sally Brett</em> </p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="ascot"> <h2>News on ASCOT </h2> <p> It has been announced that the lipid arm of the ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) has been stopped early due to a significant reduction in MI and stroke seen in patients treated with atorvastatin versus placebo. </p> <p> ASCOT is a multi centre study of 18,000 patients and many nurses within the NHA are involved in ASCOT in one way or another. Antihypertensive treatment with thiazides and beta blockers is compared to treatment with ACE inhibitors and calcium channel blockers in a 2x2 factorial design in which patients in a lipid lowering arm are treated with atorvastatin 10mg versus placebo (in addition to the antihypertensive treatment). </p> <p> Further news on the ASCOT trial will be published in the November issue of The British Journal of Cardiology which members should receive soon (if they have not already!) </p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="ntresearch"> <h2>NT Research Awards 2002 </h2> <p> Research presented at the NHA annual scientific meeting in September by Dr Sarah Wilson, Research Fellow in Clinical Pharmacology at St Bartholomew's and the Royal London School of Medicine and Dentistry was recently nominated for a national research award organised by the Nursing Times and sponsored by NTresearch. This ambitious research designed to evaluate the National Service Framework for coronary heart disease guidelines for cholesterol measurement and to propose a new nurse-led screening strategy has been awarded a runners up prize in this annual competition. If this research is accepted it would see cholesterol measurement in everyone aged 50 years and over. Still at the mathematical model stage, the judges applauded the overall ambition of this proposal, which could have national implications for CHD prevention. </p> <p> The Nursing Times research awards are run annually and not only include an 'award' section for completed work but also scholarships. Notices for the 2003 awards go out in the Nursing Times in May/June of next year. This early notification of the awards may be of interest to NHA members interested in putting together a proposal for one of the scholarships next year. </p> <p class="tiny"><strong>References</strong></p> <ol class="tiny"> <li><em> Wilson S, Poulter N.</em> <br /> <strong>Assessment of cardiovascular risk in clinical practice. </strong><br /> British Journal of Biomedical Science 2001:58; 248-251. </li> <li><em> Wilson S, Collier D, Johnston A, Poulter N, Feder G, Robson J, Caulfield M. </em><br /> <strong>A Sub-study of the ASCOT Trial: Evaluation of cardiovascular risk equations using the ASCOT cohort. </strong><br /> Journal of Human Hypertension 2001: 15; S31-S33 </li> <li><em> Wilson S, Johnston A, Collier D, Feder G, Robson J, Poulter N, Caulfield M. </em><br /> <strong>The Impact of High Density Lipoprotein and Left Ventricular Hypertrophy on risk assessments made using the Framingham coronary heart disease risk equation.</strong><br /> British Journal of Clinical Pharmacology 2001; 51: 369-370. </li> <li><em>Wilson S, Collier D.</em> <br /> <strong>Cardiovascular Risk Assessment in Clinical Practice. </strong><br /> Nephrology and Hypertension. 1999; 5: 57-60 </li> </ol> <p class="tiny"> </p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="conference"> <h2>Conference Report: Annual Scientific Meeting, September 2002, Queens College Cambridge </h2> <p> Once again the Annual Scientific Meeting was held in the beautiful setting of Queens College Cambridge. The sun shone and we could really make the most of our surroundings with many trips to The Anchor for drinks beside the river. </p> <p> This year a particularly strong NHA programme meant the venue for our meeting was changed to the Old Hall across the Mathematical Bridge. This enabled us to accommodate many BHS members who decided to attend our sessions. We were also very lucky to have 3 excellent guest speakers this year. Dr Kennedy Cruickshank from Manchester gave an excellent talk on Tuesday morning on CHD risk, ethnicity and blood pressure, and on Tuesday afternoon Professor Jim Ritter gave us an overview on Research Ethics Committee submissions. The NHA sessions were rounded off by a talk by Dr Phil Chowienczyk from London on Hyperaldosteronism, putting forward the argument that this may be a common cause of "essential" hypertension. </p> <p> As usual the social side of the meeting was a huge success culminating in a lovely dinner on Tuesday night. Surprisingly almost everyone made it in for the AGM on Wednesday morning - although some looked a little the worse for wear. </p> <p> Many thanks must go to Hampton Medical who, as usual, did such an excellent job in organising the meeting. </p> <p> This year, due to generous sponsorship from Sanofi, who offered a prize of £200, we were again able to hold a competition for the best abstract submitted for the Annual Scientific Meeting by an NHA member. As with last year this competition was judged on the abstracts submitted for the meeting not the presentations given at the meeting. The competition is designed to encourage people to get writing about their research - particularly those who have never presented their work before at a scientific meeting and need a friendly forum to get them started. This year the standard of abstracts was excellent but it should also be mentioned that the standard of the presentations themselves was fantastic, perhaps as members of the NHA are gaining in confidence regarding initiating, carrying out and presenting their own work.</p> <p> Abstracts were scored separately by two people independent of the NHA - one medical and one nursing - prior to the conference and the scores amalgamated. The winning abstract was chosen because it covered an important topic of clinical relevance that had been addressed in a systematic way.</p> <p> Congratulations to Christine Carney and her abstract titled "Mercury poisoning replaced by electronic confusion".</p> <p> Minutes of the AGM held at the Annual Scientific Meeting attached at the end of the newsletter.</p> <p> Attendance certificates available from Alison Cox, NHA secretary. Email her on <a href="mailto:alison.cox@chelwest.nhs.uk">alison.cox@chelwest.nhs.uk</a></p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="esh"> <h2>The European Society of Hypertension</h2> <p> The ESH now publish their newsletter on their website, <a href="http://www.eshonline.org">www.eshonline.org</a></p> <p> This newsletter is in journal form and is full of original articles and relevant information. In fact the website in general is excellent as a source of information regarding recent research, Guidelines, updates on clinical trials and conference reports. You do have to register to receive much of the information (although not the newsletter) but it is certainly worth a look. </p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="diary"> <h2>Diary Dates 2002/2003</h2> <p><strong>NHA Spring Update Meeting 2003</strong></p> <p> Friday 11th April 2003 Charing Cross Hospital Post Graduate Centre </p> <p> Programme to be confirmed and 2nd notification will be sent out to NHA members in the New Year. This is advanced warning for members to pencil the date in their diary! </p> <p><strong>DICE</strong></p> <p> The next course for 'Managing Cardiovascular Risk Factors' will take place on the 29th January 2003 in the Postgraduate Centre, City Hospital, Birmingham. This one year long level 3 course is designed to assist nurses to run risk factor clinics for both primary and secondary prevention of cardiovascular disease. More information and application forms are available from Susan Kennedy, Nursing & Midwifery School, 59 Oakfield Ave, Glasgow g12 8LW (email <a href="mailto:sk53f@clinmed.gla.ac.uk">sk53f@clinmed.gla.ac.uk</a> Tel 0141 330 3901). If you think there could be a demand in your area for such a course and would like to consider holding an Introductory Day this could be possible in May, please contact Susan. </p> <p><strong>Blood Pressure Unit, St Georges Hospital Medical School, London SW17 0RE, Meetings for Nurses, 2003:</strong></p> <p> 18th March 2003 - Prevention and Management of Stroke and Heart Attacks <br /> cost: £40 </p> <p> 7th October - Hypertension for Nurses <br /> cost: to be advised </p> <p> For further information contact: <br /> Nirmala Markandu, Hon senior Lecture/Clinical Manager at the above address Tel: 020 8725 2849, Fax: 020 8725 2959. </p> <p><strong>American Society of Hypertension <br /> 18th Annual Meeting and Scientific Exposition</strong></p> <p> 13th - 17th May 2003 New York Marriot Marquis New York, New York </p> <p> Deadline for abstract submission paper - 2nd December 2002 <br /> electronic - 6th December 2002 </p> <p> Abstract submission and registration details on the ASH website. <a href="http://www.ash-us.org">www.ash-us.org</a> </p> <p><strong>European Society of Hypertension <br /> 13th European Meeting on Hypertension</strong></p> <p>13th - 17th June 2003 Milan, Italy </p> <p> Deadline for abstract submission 15th January 2003 <br /> Deadline for registration at reduced fee 31st March 2003 </p> <p> Abstract submission and registration details on the ESH website <a href="http://www.eshonline.org">www.eshonline.org</a></p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="bpa"> <h2>Blood Pressure Association - an update </h2> <p> The Association has been busy over the last few months with our annual national blood pressure testing week. During the week (16th - 22nd September) we had 1350 pressure testing stations set up throughout the UK testing members of the public free of charge. The media interest was amazing, the event was covered in over 180 regional newspapers, 30 radio programmes, 4 national newspapers and twice on TV. There were some unusual pressure stations as well; Paddington Station, a north sea oil rig, a mosque and temple, pub, The National Theatre, prisons and a bookmakers! We also had support from a number of different areas, the Prime Minister and Department of Health, Manchester United, MP's, other heart and stroke charities and of course the NHA. </p> <p> We are now evaluating the week, and have had about a quarter of all the survey forms sent back from pressure stations. So far we know that just under 50,000 people were tested. Once all the forms are back we hope that the figure will be more like 100,000. This means that five times as many people will have been tested this year as were last year, and most importantly that we have raised awareness of the risks of hypertension and picked up quite a few hypertensives along the way. </p> <p> We are already starting work on next year's event, which will be from 17th-23rd September 2003. The testing week is a huge administrative task for us, so if you know that you will be taking part please let us know as soon as you can. You can email me at <a href="mailto:s.ransome@sghms.ac.uk">s.ransome@sghms.ac.uk</a> with your details. Please do sign up, and encourage others to join; we can't do it without your help. To all of you who took part this year, a huge thanks. </p> <p> The Association's web site has recently been updated, redesigned and enlarged. It now contains information on all the main aspects of managing high blood pressure, the Association's news and services, research and a form for you to use when ordering any publications you need. Please have a look at the site and let us have any feedback, or ideas for developing our services for health professionals. The address is <a href="http://www.bpassoc.org.uk">www.bpassoc.org.uk</a> </p> <p> We also have a new publication - a 14 page booklet titled Healthy eating and high blood pressure. It is aimed at members of the public with hypertension who would like to change their diet and contains information on salt, fat and healthy eating. The feedback from people who have read and used it has so far been excellent. If you would like a sample copy please email me at the address above. </p> <p> Finally, the Association recently contacted the Department of Health on the issue of impotence, and treatments for it, for men with hypertension. As it stands at present, even though men with hypertension are more likely to be impotent, and may also suffer impotence as a result of their medications, they are not eligible to receive treatment for this with an NHS prescription. We would like to hear from you about this issue, whether you feel that the problem is widespread and the impact on patients. Please email me at the above address. </p> <p> <em>Sarah Ransome - Information and Support Manager</em></p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="automated"> <h2>Review article - How do automated blood pressure devices work?</h2> <p><em>Annemarie Reinders</em> <br /> Blood Pressure Measurement Group, Maternal and Fetal Research Unit, St Thomas' Hospital</p> <p> The Blood Pressure Measurement Group is part of the Maternal and Fetal Research Unit at St Thomas' Hospital. Our work mainly involves the validation of blood pressure devices according to the British Hypertension Society protocol and also the new International Protocol, published recently. We evaluate these devices in an adult population as well as in pregnancy and pre-eclampsia and described below is some of our findings.</p> <p> <strong>Introduction</strong> </p> <p> Blood pressure measurement is one of the most frequently performed clinical investigations. It is used not only in the daily assessment, diagnosis and management of patients, but also as an indicator of future cardiovascular and overall health(1). Various devices are currently available to measure blood pressure and they include the use of mercury independent alternatives, such as automated devices. Interest in these devices has increased, especially as mercury will soon be phased out of the clinical environment due to health and environmental concerns. The British Hypertension Society has set a standard for the assessment of new devices and recent review(2) showed that only 5 devices for self-measurement and 2 devices for hospital use passed validation and can be recommended. </p> <p> <strong>Automated devices and oscillometry</strong> </p> <p> Most automated devices make use of oscillometry. During cuff inflation, the artery is occluded and when pressure is released from the cuff, bloodflow resumes through the artery. This causes vibrations in the arterial wall, which is detected by a pressure transducer in the device. Pressure changes in the artery are recorded with every heartbeat and displayed as an oscillogram. </p> <p> The oscillogram consists of two parts: </p> <ol> <li>pressure curve as the cuff inflates and deflates</li> <li>oscillations/vibrations of the arterial wall</li> </ol> <p> The device then uses a mathematical formula (algorithm), which is unique to that specific device, to derive the blood pressure (Fig 1). </p> <p class="tiny"> <img alt="Figure 1: Showing the way the patient’s blood pressure reading is derived from the measured signal and transformed by an aglorithm." width="460" height="100" src="images/nl2002bfig1.gif" /><br /> Figure 1: Showing the way the patient’s blood pressure reading is derived from the measured signal and transformed by an aglorithm. </p> <p> The mean arterial pressure is usually equal to the cuff pressure at the point of maximum oscillation (Fig 2).</p> <p><img alt="Figure 2: A graph showing cuff pressure and pulse signal over the time of reading." src="images/nl2002bfig2.gif" width="320" height="170" /><br /> <span class="tiny">Figure 2: A graph showing cuff pressure and pulse signal over the time of reading. </span></p> <p> <strong>Factors influencing the accuracy of the device</strong> </p> <p> Several factors can influence the accuracy of an automated device. They include: </p> <ul> <li>Observer errors: Although the observer does not determine the blood pressure by listening to Korotkoff sounds, errors such as selecting the incorrect cuff size and/or not keeping the arm at heart level when a measurement is taken, can still occur. </li> <li>Movement, arrhythmia or heart valve disease: If the patient moves during measurement or has a cardiac arrhythmia or heart valve disease, this leads to the device recording a distorted signal. This in turn leads to inaccurate analysis. </li> <li>Arterial disease: Patients with arterial disease such as SLE (Systemic Lupus Erhythematosis) or Raynaud's syndrome have a decreased elasticity of the arterial wall. Restricted movement/vibration of the arterial wall causes a 'flattened' signal, which complicates analysis. </li> <li>High systolic or diastolic pressures: It is well known that automated devices are more inaccurate at higher pressures. This could be due to various factors including a higher resistance in the vessels and needs further investigation. </li> </ul> <p> <strong>Conclusion</strong> </p> <p> Using a validated blood pressure device does not guarantee an accurate reading. The observer as well as the patient can influence accuracy and this needs to be taken into account during blood pressure measurement. </p> <p class="tiny"> <strong>References:</strong> </p> <ol class="tiny"> <li><strong>Jones DW, Frohlich ED, Grim CM, Grim CE, Taubert KA</strong>, for the Professional Education Committee, Council for High Blood Pressure Research. <br /> Mercury sphygmomanometers should not be abandoned: An advisory statement from the Council for High Blood Pressure Research, American Heart Association. <br /> Hypertens 2001; 37(2):185-186</li> <li><strong>O’Brien E.</strong> <br /> State of the market in 2001 for blood pressure measuring devices. <br /> Blood Pressure Monitoring 2001; 6:171-176 </li> <li><strong>Geddes LA, Voelz M, Combs C, Reiner D, Babbs CF. </strong><br /> Characterization of the oscillometric method for measuring indirect blood pressure. <br /> Ann Biomed Eng 1982; 10:271-80. </li> </ol> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="sbpm"> <h2>Review article</h2> <p> This article was a firstdraft for publication in Cardiodiabetes. Copies can be requested from A&M Publishing Ltd, First House, Park St, Guildford, Surrey GU1 4XB. Why not consider writing your own article for them or send them a letter if you have any comments. The NHA must try to raise its profile. </p> <h2>Self Blood Pressure Measurement - who is monitoring the changes?</h2> <p> <em>Susan Kennedy</em> <br /> DICE, Nursing and Midwifery School, University of Glasgow </p> <p> The advent of automated sphygmomanometers that are portable, relatively inexpensive and simple to use has changed the market for blood pressure monitors from mainly health care providers to the general public. Eckert et al report that 1.2 million self blood pressure measurement (SBPM) devices were purchased in Germany annually (1997). Advertisements encouraging the general public to invest in such a device subtly suggest that there is benefit in doing so. The reasons for the general public's demand for SBPM are multiple and complex. It is possible that the power of this new market could change not only the type and style of blood pressure measurement devices but also the communication between patient and health care provider when diagnosing and treating hypertension. </p> <p> <strong>Introduction</strong> </p> <p> Prior to the development of automatic devices patients who wished to monitor their blood pressure out with a health related clinic required to learn the technique using either a mercury or aneroid blood pressure device. This requires teaching a skill to the user and takes time to do well as discussed elsewhere (Kennedy 1991). Now most people can buy an automated machine, costing between £50 to £160. Instructions for use are included allowing the user to obtain a reading without supervision. Whether these readings are accurate, representative or interpretable is debatable. </p> <p> <strong>Accuracy</strong> </p> <p> The accuracy of some automatic devices is in doubt (O'Brien, Beevers G, Lip G 2001). Only a few models have been subjected to independent validation by their manufacturers and subsequently passed the standards set by both the British Hypertension Society and the American Association for the Advancement of Medical Instrumentation. The names of these models are not readily available to the purchasing public as they are listed in limited places such as the BHS website and by the European Society of Hypertension in the BMJ (O'Brien E, Waeber B, Parati et al 2001). Currently there is no obligation by the manufacturers to have their devices tested in this way but if they are to be supplied for clinical use they should carry the CE mark to show compliance with the Medical Devices Directive 93/42/EEC. There are devices that are supplied as an aid to exercise or diet programmes that may not need a CE mark (Medical Devices Agency 2000). The European Society for Hypertension is working with other hypertension organisations worldwide to have a simplified independent validation procedure introduced. Until then health professionals should advise patients about obtaining a validated device or at the very least choose one with CE markings. Although the automatic devices reduce observer error other recommendations for accurate blood pressure measurement still apply (The British Hypertension Society 1998). The BHS guidelines for accurately measuring blood pressure should be explained to the user. In particular the correct cuff size should be used i.e. the bladder within the cuff should cover 80% of the upper arm. This may not be possible with some of the cheaper models. Maintenance can also be a problem, the devices should be routinely calibrated, approximately once / year usually by sending back to the manufacturer.</p> <p> <strong>Standardised readings</strong> </p> <p> The reason for undertaking SBPM can vary from the health conscious to a household tool for screening to monitoring the treatment of hypertension. Readings can be taken for any reason perhaps opportunistically, routinely, or when BP is thought to be low or high. Comparison of these readings to personal clinic readings is unreliable and presumes knowledge about normal blood pressure variability. Therefore health professionals should advise patients' who undertake SBPM to interpret their findings with care and to seek medical advice. International bodies have endorsed the use of SBPM to be used as supplementary information for making treatment decisions (World Hypertension League 1988, WHO/ISH 1993). O'Brien et al suggest some other potential clinical uses for SBPM as shown in Table 1 but stress that there is little or no evidence base for these (2001). Further research is needed to determine standards. Stergiou, Skeva, Zourbaki et al showed in a study of 189 patients that there was no difference between daytime ambulatory blood pressure readings and standardised home blood pressure readings. The first day's readings in SBPM should be discounted and thereafter a minimum of the average of 3 days readings taken twice / day. </p> <p> <strong>Interpretation of SBPM</strong> </p> <p> Interpreting SBPM can be difficult for the health professional let alone for most patients with little or no medical knowledge. At the First International Consensus Conference on SBPM it was agreed that 135/85 mmHg could be considered as a diagnostic threshold (Staessen et al 2000). Target blood pressures have not been established for SBPM but the recommendations for ambulatory blood pressure monitoring may be used as a guide (Ramsay et al 1999). Some problems associated with SBPM have been outlined. Nevertheless the benefits may outweigh the potential problems. Mullen et al in a meta-analysis of trials evaluating patient education and counselling found that both these techniques were effective for increasing preventive behaviours in people who were healthy (1997). In particular it was shown that health care personnel should focus on certain behavioural techniques such as teaching self-monitoring. SBPM is potentially such a tool. If it is to be used in this way it is important to encourage the patients to take control of this process and allow them to report the results of this monitoring. Certain devices can print out a number of previous SBPM readings but if the patient empowerment model of health counselling is to be used effectively monitoring should involve a degree of trust. Edmonds et al suggest that SPBM monitoring can augment a structured patient education programme (1985). Research trials using SBPM monitoring to improve BP control are required before this can be promoted widely. </p> <p> Table 1. Possible Uses for SBPM </p> <ul> <li><strong>White coat hypertension </strong><br /> In white coat hypertension the blood pressure differences between home and consulting rooms is sustained. This can be demonstrated by SBPM. </li> <li><strong>The elderly </strong><br /> The prevalence of systolic hypertension is higher in the older population and should be identified as treatment is effective at reducing mortality and morbidity associated with it. </li> <li><strong>Identification of hypotension. </strong></li> <li><strong>Pregnancy</strong> <br /> Regular BP monitoring is useful in pregnancy to identify rising blood pressure in at risk patients. </li> <li><strong>Hypertensive patients with diabetes mellitus </strong><br /> Good blood pressure control in diabetes has been shown to substantially reduce macrovascular complications. </li> <li><strong>Resistant hypertension </strong><br /> Defined as failure to reduce BP satisfactorily with three or more hypotensive agents. SBPM to establish whether the patient has white coat hypertension. </li> <li><strong>Improving compliance to treatment </strong><br /> Self empowerment model </li> <li><strong>As a guide to drug treatment </strong><br /> May be useful in monitoring response to treatment. </li> </ul> <p> <strong>Conclusion</strong> </p> <p> Despite the relative lack of evidence for the widespread use of monitoring home blood pressure in hypertension it is clear that the market is growing for such devices. The greater availability and advertising has resulted in an increasing interest by the general public. As a result cheaper, lighter and easier to use devices have been produced. The introduction of wrist and the low cost digit devices is perhaps a reflection of this despite concerns about their accuracy and ease of use by independent experts in this field (O'Brien et al 2001). It is not known how many patients with hypertension use these devices nor how they are using the information they yield. Health professionals need research evidence about ways to support patients while they undertake SBPM to ensure that their treatment is optimised to reduce their cardiovascular risk. </p> <p> <span class="tiny"><strong>References</strong> </span></p> <p class="tiny"> <strong>British Hypertension Society (1998) </strong><br /> Blood pressure measurement. <br /> CD-ROM London: BMJ Books. </p> <p class="tiny"> <strong>Eckert S, Gleichmann U, Zagorski O, Klapp A. (1997) </strong><br /> Validation of the Omron R3 blood pressure self-measuring device through simultaneous comparative invasive measurements according to protocol 58130 of the German Institute for Validation. <br /> Blood Pressure Monit; 2: 189-92. </p> <p class="tiny"> <strong>Edmonds D, Foerster E, Groth H, et al (1985) </strong><br /> Does self-measurement of blood pressure improve patient compliance in hypertension. <br /> J Hypertens Suppl 3:s31-s34. </p> <p class="tiny"> <strong>Kennedy S. (1991) </strong><br /> A measure of independence. <br /> Professional Nurse; 6: 730-733. </p> <p class="tiny"> <strong>Medical Devices Agency (2000) </strong><br /> Device Bulletin. Blood pressure measurement devices - mercury and non-mercury. <br /> MDA DB2000(03) July 2000. </p> <p class="tiny"> <strong>Mullen P, Simons-Morton D, Ramirez G, et al (1997) </strong><br /> A meta analysis of trials evaluating patient education and counselling for three groups of preventive health behaviours. <br /> Patient Educ Couns 32: 157-173. </p> <p class="tiny"> <strong>O'Brien E, Waeber B, Parati G, Staessen J, Myers M (2001) </strong><br /> Blood pressure measuring devices: recommendations of the European Society of Hypertension. <br /> BMJ; 322: 531-536. </p> <p class="tiny"> <strong>O'Brien, Beevers G, Lip G (2001) </strong><br /> ABC of hypertension. Blood Pressure Measurement. Part iv- Automated sphygmomanometry: self blood pressure measurement. <br /> BMJ; 322: 1167-1170. </p> <p class="tiny"> <strong>Ramsay L, Williams B, Johnston GD, et al (1999)</strong> <br /> British Hypertension Society guidelines for hypertension management 1999: summary. <br /> BMJ 319: 630 - 635. </p> <p class="tiny"> <strong>Staessen J, Thijs L and the participants of the First International Consensus Conference on SBPM. (2000) </strong><br /> Developments of diagnostic thresholds for automated sel-measurement of blood pressure in adults. <br /> Blood Press Monitor 5:111-29. </p> <p class="tiny"> <strong>Stergiou G, Skeva I, Zourbaki A, Mountokalakis D (1998) </strong><br /> Self-monitoring of blood pressure at home: how many measurements needed? <br /> Journal of Hypertension 16:6; 725-731. </p> <p class="tiny"> <strong>WHO / ISH (1993) </strong><br /> Guidelines for the management of mild hypertension: memorandum from a World Health Organisation/International Society of Hypertension meeting. <br /> J Hypertens 11:905 -918. </p> <p class="tiny"> <strong>World Hypertension League (1988) </strong><br /> Self measurement of blood pressure: a statement by the World Hypertension League. <br /> J Hypertens 6: 257-261. </p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="ambulatory"> <h2>Situations to consider ambulatory BP monitoring or home BP</h2> <ul> <li>Unusual variability of BP (same or different visits) </li> <li>'White coat' hypertension in subjects with low cardiovascular risk </li> <li>Symptoms suggesting hypotensive or transient hypertensive episodes </li> <li>Hypertension resistant to drug treatment </li> </ul> <p> adapted from 1999 WHO/ISH Guidelines</p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="references"> <h2>Some Useful References </h2> <p> Evidence from epidemiological studies and clinical trials </p> <ol> <li><strong>Guidelines subcommittee: 1999 World Health Organization </strong><br /> International Society of Hypertension guidelines for the management of hypertension. <br /> J Hypertens 1999;17:151-183 </li> <li><strong>UK Prospective Diabetes Study Group. </strong><br /> Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. <br /> BMJ 1998;317:703-13 </li> <li><strong>Hansson I, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S et al. </strong><br /> Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. <br /> Lancet 1998;351:1755-1762. </li> <li><strong>The Heart Outcomes Prevention Evaluation Study Investigators. </strong><br /> Effects of and angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high risk patients. <br /> N Engl J Med 2000;342:145-153. </li> </ol> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="funding"> <h2>Sources of Funding for Nurses </h2> <p> The RCN and other boards administer awards and scholarships for nurses, midwives and health visitors for study, research, travel, conferences etc. Brief details are given below but this is not an exhaustive list of sources! Information was obtained from the various institutions web sites and promotional literature. At the time of writing this information was believed to be correct however closing dates and deadlines that were given for 2002 may not be the same for 2003 despite being listed as annual. These dates should be checked before finally submitting proposals. </p> <p> <strong>Alun Islwyn Giles Memorial Nursing Scholarship</strong> <br /> RCN Welsh Board, Ty Maeth, King George V Drive, Cardiff, CF4 4XZ. Tel: 029 2075 1373. <br /> For RCN members nursing in Wales to pursue project or course of study to promote the advancement of the art and science of nursing. <br /> Closing date: annually May 31. </p> <p> <strong>Hettie C. Hopkins Care of the Elderly Nursing Scholarship</strong> <br /> RCN Welsh Board, Ty Maeth, King George V Drive East, Cardiff, CF4 4XZ. Tel: 029 2075 1373. <br /> Open to nurses in Wales who hold statutory qualifications in nursing and wish to pursue a project associated with the care of the elderly. <br /> Closing date: March 31 every year. </p> <p> <strong>HSA Charitable Trust Scholarships for Nurses and Midwives </strong><br /> RCN Direct on 0845 7726100 (quoting ref 001088) <br /> Annual scholarships for nurses and midwives in clinical practice in the NHS for course fees for post registration study or research. <br /> Closing date November 1. Application forms available from August until October 20 each year. Completed applications must be received back by November 1. Outcome notified by end February. </p> <p> <strong>Johnson & Johnson/Ethicon Nurses Education Trust Fund</strong> <br /> C/o Fitwise on 01506 811077. <br /> For members of RCN, NATN or ICNA to further their education and enhance standard of expertise in chosen field of nursing. Closing date annually on 1st April. </p> <p> <strong>Rea Bequest Fund </strong><br /> Royal College of Nursing, Northern Ireland Board, 17 Windsor Avenue, Belfast, Northern Ireland BT9 6EE. Tel: 028 9066 8236. <br /> For RCN members working in Northern Ireland undertaking further education. Not available for Higher Education Awards (other than Conversion Courses through a University). </p> <p> <strong>RCN Grants </strong><br /> Grants of up to £250 to assist RCN members to enhance their professional skills, knowledge and competence. Pre-registration nursing students in RCN membership are also eligible for these awards. <br /> Closing date: Annually, the beginning of August. </p> <p> <strong>Edwina Mountbatten Trust </strong><br /> The Trustees, The Edwina Mountbatten Trust, The Estate Office, Broadlands, Romsey, SO51 9ZE. <br /> Grants for specific, complete projects e.g. equipment, teaching aids, books, which advance nursing, midwifery or health visiting in the UK or the Commonwealth. Not for individuals undertaking courses. </p> <p> <strong>Florence Nightingale Foundation</strong> <br /> 9 Grosvenor Crescent, London SW1X 7EH. <br /> <a href="http://www.florence-nightingale-foundation.org.uk">www.florence-nightingale-foundation.org.uk</a> <br /> TRAVEL SCHOLARSHIPS are awarded in the autumn for projects to be undertaken during the following year. The project must be connected with the applicant's field of work and be of benefit to their patients/clients and the professions more widely. The amount awarded to each individual depends on the scope of the project to be undertaken, its length and the country or countries proposed for the particular study. <br /> RESEARCH SCHOLARSHIPS are awarded in the summer for the following academic year and are available to undertake a course in research methods, a research module as part of a degree course, or a dissertation as part of a degree course. All of these must involve clinically focused research and be academically supervised. Due to limited resources, these are the only courses funded by the Foundation. <br /> These scholarships are available to all British and Commonwealth Nurses, Midwives and Health Visitors registered with the UKCC and working in the UK, who have at least three years' professional experience subsequent to registration. Full details, including application forms, are available on the Foundation's website. </p> <p> <strong>King's Fund Educational Bursaries Grants Dept</strong> <br /> King's Fund, 11-13 Cavendish Square, London W1M 0AN (enclose A4 SAE). <br /> Awards for those working within Thames RHA area for professional development beyond basic training and bursaries for study leave to undertake research into service development. <br /> Advertised: Annually in February. </p> <p> <strong>National Board for Nursing Midwifery and Health Visiting for Scotland</strong>, <br /> Registry, NBS, 22 Queen Street, EDINBURGH EH2 1NT. Tel : 0131 226 7371, fax : 0131 225 9970, email <a href="mailto:leigh.willocks@nbs.org.uk">leigh.willocks@nbs.org.uk</a> <br /> Annual awards from the General Nursing Council for Scotland (Education) Fund 1983 (incorporating the Margaret Callum Rodger Midwifery Award) for qualified nurses, midwives and community care practitioners resident in Scotland for small-scale research projects, pilot studies and study tours of relevance to the NBS. <br /> Applications to be received by end January for awards to be paid out from April. </p> <p> <strong>The Nightingale Fund Council</strong> <br /> The Hon Secretary, The Nightingale Fund Council, 108 Brancaster Lane, Purley, Surrey CR8 1HH <br /> Post registration education of nurses, midwives and others who are working in a clinical, educational or possibly research field. Any recognised study that will enhance clinical or tutorial skills may be considered. </p> <p> <strong>Nursing Standard / Smith & Nephew Clinical Practice & Management Awards</strong> <br /> RCN Publishing Company, 17-19 Peterborough Road, Harrow, Middx HA1 2AX. Tel: 020 8423 1066. <br /> Funding for nurses, midwives and health visitors to develop their management skills in clinical practice at residential management course at Sundridge Park Management Centre in Kent. <br /> Awarded every 18 months. </p> <p> <strong>PPP Healthcare Medical Trust</strong> <br /> 13 Cavendish Square, London W1G 0PQ. Tel: 020 7307 2622 or <a href="http://www.ppptrust.org.uk">www.ppptrust.org.uk</a> <br /> Mid Career Awards for research, training or projects for nurses, midwives and health visitors who have been qualified for more than ten years. Apply anytime. Also grants between £1,000 and £20,000 for arranging meetings and events. <br /> Two rounds of grants each year in May and November. </p> <p> <strong>Smith & Nephew Foundation</strong> <br /> Tel 020 7960 2276 or <a href="http://www.snfoundation.org.uk">www.snfoundation.org.uk</a> <br /> The foundation's nursing awards consist of fellowships of up to £30,000 for PhD related research and scholarships of up to £5,000 for practice based projects undertaken as part of a masters degree. Also new postdoctoral nursing research fellowship worth up to £120,000 </p> <p> <strong>The Wellcome Trust </strong><br /> 020 7611 8888 or <a href="http://www.wellcome.ac.uk">www.wellcome.ac.uk</a> <br /> The world's largest medical research charity provides health services research project grants for research into health care needs. However the research needs to be multidisciplinary and of a very high academic standard. </p> <p> <strong>Foundation of Nursing Studies</strong> <br /> <a href="http://www.fons.org/projects/awards.htm">www.fons.org/projects/awards.htm</a> <br /> Financial support for nurses, midwives and health visitors who have an idea for developing existing practice or nurse-led initiatives or promoting evidence based research. </p> <p> <strong>NHS Management Executive Bursary Scheme</strong> <br /> Apply directly to the Research and Development Directorate in your region, details <a href="http://www.doh.gov.uk/research/rd3/regions.htm">www.doh.gov.uk/research/rd3/regions.htm</a> <br /> This scheme has previously supported education and training in nursing research through the regional offices of the NHS Executives research and development directorates. </p> <p> <strong>Mary Seacole Leadership Award for Nurses, Midwives and Health Visitors</strong> <br /> RCN Awards, 20 Cavendish Square, London W1G 0RN. Tel 020 7647 3731 <br /> This is a single award of £25,000 for a research and development project related to health service needs of black and minority ethnic communities </p> <p> <strong>Primary Care</strong> <br /> <a href="http://www.doh.gov.uk/research/whatsnew.htm">www.doh.gov.uk/research/whatsnew.htm</a> Department of Health's National Primary Care Awards, Primary Care Researcher Development Awards, Primary Care Career Scientist Awards and new Primary Care Postdoctoral Awards </p> <p class="tiny" ><a href="#top">^ Back to top</a></p> </div> <div class="panel" id="bhs"> <h2>BHS Live! </h2> <p> The British Hypertension Society are working with a PR agency Ketchum to organise BHS Live! - a webcast imediately following the publication of the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). </p> <p> ALLHAT is the biggest antihypertension trial ever undertaken. New data from over 42,000 patients are due to be published on 18th December 2002, providing important information on the use of antihypertensives to prevent cardiovascular outcomes. Critique and analysis will be essential to apply the findings of this major NIH study to blood pressure management in the UK. </p> <p> BHS Live! will see a group of leading UK experts presenting ALLHAT results and discussing their implications for UK practice. </p> <p> The site <a href="http://www.bhslive.org.uk">www.bhslive.org.uk</a> will be live from 12/11/02 </p> </div> <div id="footer"> <p class="toplink"><a href="#top">^ Top</a></p> <p>Copyright © 2007 Nurses′ Hypertension Association<br /> <a href="mailto:nha_email@yahoo.co.uk">nha_email at yahoo.co.uk</a></p> </div> </div> </div> </body> </html>