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Fulltext Intraclass correlation in practice: assessment of reliability of manual blood pressure measurement among assessors in a clinical trial

Wan Nor Arifin, Wan Arfah Nadiah, Muhammad Irfan, Chen, Xin Wee, Nani Draman, Nyi, Nyi Naing

Education in Medicine Journal, 2011;3(2):44-52.
MyJurnal

To ensure the reliability of manual blood pressure (BP) readings in a clinical trial, sources of error due to measurement must be reduced as much as possible. Apart from following standard procedure for BP measurement and ensuring good equipments, the measurement errors that come from the assessors themselves should be assessed. Objective: To demonstrate the use of two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) intraclass correlation coefficient (ICC) in the assessment of reliability of manual BP readings among assessors involved in a clinical trial using manual BP measurement, by using an interrater reliability study conducted by the authors as an example study. Methods: The steps involved in obtaining ICC in the study were discussed. Sample size given the number of assessors in the study was calculated. BP was measured using regularly maintained mercury sphygnomanometers, following recommendations by Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) for BP measurement in office setting. The outcomes were systolic and diastolic BP readings. A type of ICC, two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) ICC was chosen for the analysis and specifically discussed. Pre-requisite assumptions for ICC were meticulously checked and described. The interrater reliability for systolic and diastolic BP readings as expressed by ICC (single measure) were presented with confidence interval (CI). The ICCs obtained in the example study were discussed and concluded. The flaws of the study were also criticised. Results: The interrater reliability for systolic and diastolic BP measurements as expressed by ICC (single measure) were 0.87 (95% confidence interval [CI] 0.722, 0.956) and 0.77 (95% CI 0.560, 0.918) respectively. Conclusion: We demonstrated the steps required to obtain ICC. Since the use of manual BP measurement using mercury sphygmomanometer is still considered as gold standard of BP measurement, it is important that studies in which the BP outcome is measured using such method conduct interrater reliability studies properly.

Matched MeSH terms: Sphygmomanometers
Fulltext The relationship between tooth loss, body mass index, and hypertension in postmenopausal female

Al-Ahmad BEM, Kashmoola MA, Mustafa NS, Hassan H, Arzmi MH

Eur J Dent, 2018 4 17;12(1):120-122.
PMID: 29657536 DOI: 10.4103/ejd.ejd_322_17

Objective: This study aimed to investigate the relationship between tooth loss and the level of blood pressure with the hypothesis that tooth loss is associated with the increase of hypertension in postmenopausal women.
Materials and Methods: Sixty postmenopausal female patients aged 51-68 years were included in the study to assess the relationship between tooth loss and the level of blood pressure. The information including sociodemographics, last menstruation period, hypertension history, and the duration of having tooth loss was recorded. Blood pressure was measured using sphygmomanometer and the number of tooth loss was determined.
Results: The results showed a more significant tooth loss in hypertension (median: 23 + 4; interquartile range [IQR]: 6) compared to the normotension postmenopausal women (median: 18 + 6; IQR: 12; P < 0.05). Furthermore, obese patients had more tooth loss (median: 23 + 5; IQR: 8) than the overweight patients (median: 19 + 8; IQR: 8).
Conclusion: Tooth loss is associated with the increase of hypertension in postmenopausal women which may have a role in the development of vascular diseases.

Matched MeSH terms: Sphygmomanometers
Important Decision for an Oral Physician to Make in High-Risk Chronic Kidney Disease Patients: It is Not Only to Recordthe Associated Resistant Hypertension, but Whether to Use Manual Sphygmomanometer or Automated Blood Pressure Device?

Chidambaram R

J Coll Physicians Surg Pak, 2018 Feb;28(2):169.
PMID: 29394983 DOI: 10.29271/jcpsp.2018.02.169
Matched MeSH terms: Sphygmomanometers*
Fulltext Prevalence of prehypertension and its associated factors among adults visiting outpatient clinic in Northeast Malaysia

Rafan SN, Zakaria R, Ismail SB, Muhamad R

J Taibah Univ Med Sci, 2018 Oct;13(5):459-464.
PMID: 31435362 DOI: 10.1016/j.jtumed.2018.06.005

Objectives: Prehypertension refers to a systolic blood pressure of 120-139 mmHg systolic or a diastolic blood pressure of 80-89 mmHg. Estimation of the prevalence of prehypertension in the population and identification of cardiovascular associated factors are important to reduce progression to hypertension. This study aimed to determine the prevalence of prehypertension and its associated factors among Malaysian adults.
Methods: In 2015, a cross-sectional study was conducted among adults visiting an outpatient clinic in Northeast Malaysia. Face-to-face interviews were conducted using Malay and English versions of the Malaysia Non-Communicable Disease surveillance questionnaire. This instrument captured information about sociodemographic, lifestyle status, and anthropometric data. Blood pressure was measured three times with a sphygmomanometer, the first measurement value was discarded, and an average of blood pressure from the second two readings was recorded for further data analysis. Logistic regression was performed to analyse factors associated with prehypertension.
Result: A total 151 adults participated in the study, and the prevalence of prehypertension was 37.1% (95% confidence interval [CI]: 29.29, 44.69). Factors associated with prehypertension in this study were age (adjusted odds ratio [aOR] = 1.06 95% CI: 1.02, 1.11; p = 0.007), male sex (aOR = 4.44 95% CI: 1.58, 12.44; p = 0.005), and abnormal waist circumference (aOR = 31.65 95% CI: 11.25, 89.02; p

Matched MeSH terms: Sphygmomanometers
Fulltext Prevalence of hypertension among Malay adolescents in Putrajaya secondary schools, Malaysia, 2010

Rampal L, Ng KC, Nur Izzati I, Farah Izzati Z, Mohammad Nazrul I, Faisal I, et al.

Malaysian Journal of Medicine and Health Sciences, 2011;7(2):53-60.
MyJurnal

Background: In Malaysia, the prevalence of hypertension amongst adults aged 30 years and above has increased from 32.9% in 1996 to 40.5% in 2004 and to 42.6% in 2006. Information on the prevalence of hypertension among adolescents is lacking.
Objective: to determine the prevalence of hypertension among Malay secondary school students in Putrajaya.
Methods: A cross sectional study was carried out in Putrajaya, Malaysia. The sampling frame consisted of a list of all the 12 secondary schools in Putrajaya. Three schools were selected using table of random numbers. All Malay students aged 13 years old to 17 years old from the three selected school students were included in the study. Blood pressure was measured after the respondents had rested for at least 5 minutes using a standard mercury sphygmomanometer. Three blood pressure measurements were taken for each respondent. Systolic blood pressure [SBP] was defined as the average of three SBP readings and diastolic blood pressure [DBP] was defined as the average of three DBP readings. Data was analyzed using SPSS 18.
Results: The overall mean SBP and DBP were 108.9 mmHg and 63.2 mmHg respectively. The prevalence of pre-hypertension and hypertension among the male was 16.2% and 12.9% respectively as compared to 5.8% and 10.2% respectively in the females. The overall prevalence of prehypertension and hypertension was 11.1% and 11.6% respectively. The prevalence increased with age (p<0.05). There was a significant positive correlation between BMI and SBP (r = 0.52, r2 = 0.27, p= 0.001) and BMI and DBP (r = 0.38, r2 = 0.15, p= 0.001). The mean SBP was significantly higher in males (111.7 mmHg) as compared to 106 mmHg in females (p<0.001). The mean DBP in males (63.5 mmHg) was slightly higher as compared to 62.9 mmHg in females but the difference was not significant.
Conclusions: Prevalence of hypertension and pre-hypertension is high. There is an urgent need for implementation of a comprehensive CVD prevention program and routine blood pressure measurements should be taken in school children to improve the detection, prevention and treatment of hypertension
Keywords: Prevalence, Hypertension, Adolescents, Putrajaya, Malaysia

Matched MeSH terms: Sphygmomanometers
Fulltext Arterial stiffness and its association with dyslipidemia

Razman, M.R., Jamaluddin, A.R., Ellyda, M.N., Seikh, F.A.

International Medical Journal Malaysia, 2013;12(2):59-66.
MyJurnal

Cardiovascular diseases (CVD) are the leading cause of mortality in Malaysia as well as in other countries. It is associated with many risk factors, such as increasing age, hypertension, diabetes, dyslipidemia, oxidative stress and autonomic dysfunction and arterial stiffness. The objectives of this study were to measure the prevalence of arterial stiffness and to assess its association with dyslipidemia. Methods: A cross sectional study was conducted in a rural community in Malaysia involving 146 subjects. Data were collected using an interviewer administered questionnaire which included three sections – sociodemographic characteristics, personal profile, and past medical history. In addition, Seca Body Meter (Seca 220) was used to measure height and weight. Sphygmomanometer (OMRON Automatic Blood Pressure Monitor HEM 907) and SphygmoCor-AtCor MM3 SERIAL/RS-232 were used for blood pressure and augmentation index (AIx) measurement. Data were analysed using the SPSS for Windows, Version 18.0. Results: The mean age of respondents was 49.5 years, SD±15.6. The prevalence of arterial stiffness was 23.3% (95% Confidence Interval (CI): 16.44 – 30.16). The prevalence of dyslipidemia was 82.9% (95% CI: 76.79 – 89.01). Multivariate logistic regression revealed that total cholesterol was significantly associated with arterial stiffness (OR=4.56, CI 1.10-18.90). Conclusion: The prevalence of dyslipidemia was high. Despite an insignificant association between dyslipidemia and AIx, there is a significant association between TC level and AIx.

Matched MeSH terms: Sphygmomanometers
Fulltext Psychological determinants of pre-hypertension among first year undergraduate students in a public university in Malaysia

Balami AD, Salmiah MS, Nor Afiah MZ

Malaysian Journal of Public Health Medicine, 2014;14(2):67-76.
MyJurnal

Pre-hypertension increased the risk of morbidity and mortality from non-communicable diseases. Whereas, psychological factors such as depression, anxiety and stress have been associated with increased in blood pressure. However, previous studies more focuses on psychological determinants of hypertension than prehypertension. Thus, this study aims to determine the association between these psychological factors with pre-hypertension. A cross-sectional study was conducted in 2012 among first year students of a public Malaysian university. A random cluster sampling was used to select 5 out of 15 faculties and a total of 495 students participated in this study. The Malay version of DASS-21 was used to elicit their levels of depression, anxiety and stress. Blood pressures were measured twice using sphygmomanometer and the averages were taken. Data analyses used chi-square test and binary multiple logistic regression. The prevalence of pre-hypertension was 30.1%. The percentage of severe and extremely severe depression was 3.8% and 1.2%; both severe and extremely severe anxiety was 16.4%; and severe and extremely severe stress was 4.2% and 0.2% respectively. Severe/extremely severe depression had more than 3 times higher in getting pre-hypertension than no depression. In conclusions, almost one third of respondents had pre-hypertension and only severe/extremely depression was associated with pre-hypertension.

Matched MeSH terms: Sphygmomanometers
Fulltext The prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia

Syer, Ree Tee, Xin, Yun Teoh, Wan Abdul Rahman Wan Mohd Aiman, Ahmad Aiful, Siu, Calvin Yee Har, Zi, Fu Tan, et al.

International e-Journal of Science, Medicine & Education, 2010;4(2):-.
MyJurnal

Background: Hypertension is estimated to cause4.5% of the global disease burden. The prevalence of hypertension in Malaysia is 32.2%.
Objective: To determine the prevalence of hypertension and its associated risk factors in two rural communities in Penang, Malaysia.
Methods: This cross sectional study was conducted among all consenting residents aged 18 years and above from two villages in Penang. Besides the baseline demographic information, blood pressure was measured using a manual sphygmomanometer according to the American Heart Association Guidelines.
Results: 50 out of 168 people were hypertensive, giving a prevalence rate of 29.8%. 50.0% of those found with hypertension were undiagnosed and 48.0% of those who were diagnosed with hypertension had uncontrolled blood pressure. Logistic regression analysis showed that age, history of alcohol consumption and BMI were found to be independently associated with hypertension.
Conclusions: Age, education level, alcohol consumption and BMI are important risk factors associated with the prevalence of hypertension among the villagers. These risk factors are comparable to those reported in National Health and Morbidity Survery 2006 in Malaysia.

Matched MeSH terms: Sphygmomanometers
Fulltext Rationale and design for the Asia BP@Home study on home blood pressure control status in 12 Asian countries and regions

Kario K, Tomitani N, Buranakitjaroen P, Chen CH, Chia YC, Divinagracia R, et al.

J Clin Hypertens (Greenwich), 2018 Jan;20(1):33-38.
PMID: 29265725 DOI: 10.1111/jch.13145

Home blood pressure (BP) monitoring is endorsed in multiple guidelines as a valuable adjunct to office BP measurements for the diagnosis and management of hypertension. In many countries throughout Asia, physicians are yet to appreciate the significant contribution of BP variability to cardiovascular events. Furthermore, data from Japanese cohort studies have shown that there is a strong association between morning BP surge and cardiovascular events, suggesting that Asians in general may benefit from more effective control of morning BP. We designed the Asia BP@Home study to investigate the distribution of hypertension subtypes, including white-coat hypertension, masked morning hypertension, and well-controlled and uncontrolled hypertension. The study will also investigate the determinants of home BP control status evaluated by the same validated home BP monitoring device and the same standardized method of home BP measurement among 1600 or more medicated patients with hypertension from 12 countries/regions across Asia.

Matched MeSH terms: Sphygmomanometers
Fulltext Highlights of the 2019 Japanese Society of Hypertension Guidelines and perspectives on the management of Asian hypertensive patients

Hoshide S, Kario K, Tomitani N, Kabutoya T, Chia YC, Park S, et al.

J Clin Hypertens (Greenwich), 2020 03;22(3):369-377.
PMID: 31891452 DOI: 10.1111/jch.13763

Unlike other international guidelines but in accord with the earlier Japanese Society of Hypertension (JSH) guidelines, the 2019 JSH guidelines ("JSH 2019") continue to emphasize the importance of out-of-office blood pressure (BP) measurements obtained with a home BP device. Another unique characteristic of JSH 2019 is that it sets clinical questions about the management of hypertension that are based on systematic reviews of updated evidence. JSH 2019 states that individuals with office BP

Matched MeSH terms: Sphygmomanometers