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The association between systolic blood pressure and in-hospital mortality in older emergency department patients who are hospitalised with a suspected infection
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  • Published on:
    methodological variables involved in the measurement of blood pressure

    The conclusion that there is an association between systolic blood pressure and in-hospital mortality requires further qualification in view of the multiciplicity of variables which impact on the measurement of blood pressure in the older patient first evaluated in the emergency department. Firstly, blood pressure measurement in the Post-SPRINT era specifies that the blood pressure should be measured after 5 minutes rest in a quiet room, and that 3 readings should be taken at 1-minute intervals(1). Is that feasible at A & E?. Secondly, "It is axiomatic that ...measurement should be recorded in both arms.....the higher of the two readings should be used for diagnosis and management...."(2). Is that feasible at A & E?. Finally, allowance should be made for seasonal differences in blood pressure, given the fact that many hypertensive patients have higher blood pressure levels in winter than in summer(3). Those who "buck" this trend experience worse cardiovascular outcomes than those who conform to this trend(3).
    References
    (1) Myers MG., Cloutier L., Gelfer M., Padwai RS., Kaczorowski J
    Blood pressure measurement in the Post-SPRINT Era
    Hypertension doi.org/10.1161/HYPERTANSIONAHA.116.07598
    (2)Giles TD., Egan P
    Inter-arm differences in blood pressure may have serious research and clinical implications
    The Journal of Clinical Hypertension 2012;14:491-492
    (2) Giles TD., Egan P
    Inter-arm dif...

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    Conflict of Interest:
    None declared.