Background: To interpret blood pressure (BP) data appropriately, healthcare providers need to be knowledgeable of the factors that can potentially impact the accuracy of BP measurement and contribute to variability between measurements. Methods: A systematic review of studies quantifying BP measurement inaccuracy. Medline and CINAHL databases were searched for empirical articles and systematic reviews published up to June 2015. Empirical articles were included if they reported a study that was relevant to the measurement of adult patients' resting BP at the upper arm in a clinical setting (e.g. ward or office); identified a specific source of inaccuracy; and quantified its effect. Reference lists and reviews were searched for additional articles. Results: A total of 328 empirical studies were included. They investigated 29 potential sources of inaccuracy, categorized as relating to the patient, device, procedure or observer. Significant directional effects were found for 27; however, for some, the effects were inconsistent in direction. Compared with true resting BP, significant effects of individual sources ranged from -23.6 to R33 mmHg SBP and - 14 to R23 mmHg DBP. Conclusion: A single BP value outside the expected range should be interpreted with caution and not taken as a definitive indicator of clinical deterioration. Where a measurement is abnormally high or low, further measurements should be taken and averaged. Wherever possible, BP values should be recorded graphically within ranges. This may reduce the impact of sources of inaccuracy and reduce the scope for misinterpretations based on small, likely erroneous or misleading, changes.

Sources of inaccuracy in the measurement of adult patients' resting blood pressure in clinical settings: a systematic review.

Effects of yogic breath regulation: A narrative review of scientific evidence.

Cardiovascular functions are controlled by neural factors, temperature, hormones, etc., Of these, neural factors primarily concern the autonomic nervous system, which plays a major role in maintaining and regulating cardiac functions, e.g., blood pressure and heart rate. Prāṇāyāma is one of the most important yogic practices. There are various review articles on Yoga and its effects but, though Prāṇāyāma is a part of yoga, there is lack of review articles. To the best of our knowledge there is no known review article on effect of various Prāṇāyāma on cardiovascular and autonomic variables. To provide a general overview about the effect of various prāṇāyāma (breathing techniques) on cardiovascular and autonomic variables. A narrative review was performed based on the available scientific literature. An electronic data search was performed in Medline/PubMed database to review relevant articles, using keywords such as "Prāṇāyāma, Yogic breathing techniques, Unilateral nostril breathing, Alternate nostril breathing, Kapalbhati, Bhastrika and Bhramari Pranayama". All the relevant articles published from 1988 to 06-04-2016 were included in this review. Slow type of yogic breathing technique was reported to produce beneficial effect on cardiovascular and autonomic variables while fast breathing techniques do not produce such effects. There is lack of consistency in the results of specific nostril yogic breathing techniques and the mechanisms behind the effects of various prāṇāyāma. This review suggests that different types of Prāṇāyāma techniques produce different effects and the mechanisms behind these effects are not fully understood.

Effects of Various Prāṇāyāma on Cardiovascular and Autonomic Variables

Clinical relevance of blood pressure variability

This study aims to determine the effectiveness of Isometric Handgrip Exercise and Slow Respiratory Respiratory Exercise. Quasi Experimental Research design with research design Two Group Pretest Postest Design on 32 respondents. The results showed that there was systolic and diastolic after Handgrip Isometric Exercise intervention (t = 8,279, p = 0,000), (t = 6,154, p = 0,000), and the importance was done after Slow Deep Slow Deep Respiratory Exercise (t = 3,632 , p = 0.002), (t = 4.226, p = 0.001). Thus, it can be concluded that good or slow isometric exercise exercises in breathing exercises can reduce blood pressure. The results of the study were handgrip isometric training and slow slow breathing exercises as nursing interventions that can be carried out independently in providing nursing care for patients with hypertension. 
Keywords: Hypertension, Isometric Handgrip Exercise, Slow Deep Breathing Exercise,   Blood Pressure.

/pdf/efektivitas-isometric-handgrip-exercise-dan-slow-deep-1054noq2i1.pdf

Efektivitas Isometric Handgrip Exercise dan Slow Deep Breathing Exercise terhadap Perubahan Tekanan Darah pada Penderita Hipertensi

In 2:1 breathing exhalation is twice of inhalation. The study was performed to study the influence of 2:1 yogic breathing technique on patients of essential hypertension. 30 patients of essential hypertension between ages of 20-50 years were selected. After a rest of 15-20 minutes in a comfortable sitting posture their baseline physiological parameters recorded on a digital polygraph were, Electromyogram (EMG), Galvanic skin response (GSR), Finger tip temperature (FTT), Heart rate(HR) and Respiratory rate(RR). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded by automated digital Sphygmomanometer. Then they were guided to do 2:1 breathing maintaining respiratory rate of around 6/min. Subjects were then instructed to do 2:1 breathing twice a day for 5-7 minutes for next 3 months. Subjects reported back weekly for recording of BP. The physiological parameters of the subjects were assessed again by polygraph at the end of three months of practicing 2:1 yogic breathing. The mean fall of SBP over 12 weeks was 12 mm Hg (8%) and DBP was 7 mm Hg (7%). P value < 0.001 in both. After practicing 2:1 breathing for 3 months there was statistically significant reduction of SBP, DBP, HR RR, EMG, GSR and rise in FTT. The study showed that 2:1 breathing technique caused a comprehensive change in body physiology by altering various parameters that are governed by the autonomic nervous system. It is an effective modality for management of essential hypertension.

/pdf/the-influence-of-the-2-1-yogic-breathing-technique-on-1z84kqa1jl.pdf

The influence of the 2:1 yogic breathing technique on essential hypertension.

Context: Accumulated moderate physical activity (PA) for 30 min in a day is the only recommended treatment of prehypertension. Objective: We investigated autonomic modulation as a possible mechanism for the decrease in blood pressure (BP) during the rest periods in each 10 min session of PA. Design, Setting, and Participants: We conducted a single-blind randomized multi-arm control trial on 40 prehypertensive (pre-HT) young male adults. Methods: Participants were randomly divided by using random number table into four groups. Control (no intervention); Group 1 (walking at 50% of predicted VO2peak); Group 2 (walking at 60% of predicted VO2peak); Group 3 (walking at 70% of predicted VO2peak). BP, heart rate variability (HRV), and heart rate recovery 1 min (HRR 1 min) were measured at baseline and during the rest period after each session of 10 min over 30 min of accumulated physical activity (PAcumm). Results: Significant diastolic BP (DBP) reduction (P

Blood pressure reduction following accumulated physical activity in prehypertensive.

Recent concerns about the mercury toxicity and its ill effects on the environment and health has led to widespread use of aneroid manometers. Present study was conducted to analyse whether this change would lead to any systematic shift in measured blood pressure or consistency of blood pressure measurement in clinical setting. The clinical accuracy of the Welch Allyn aneroid sphygmomanometer model 7670-04 was studied against the mercury sphygmomanometer on 83 volunteers from Dehradun. Two blood pressure reading of each study subject was recorded with pretested instruments (aneroid and mercury sphygmomanometer). Data analysis showed the difference of means between the reading of two devices against mean of the observer reading for both systolic (-3.62 +/- 4.88) and diastolic (-2.36 +/- 3.77) blood pressure were not statistically different. The corresponding values of the SBP and DBP from both the instruments showed significant correlation. Regression analysis of mercury versus aneroid showed regression line (Y = 9.52 + 0.95X for SBP, Y = 0.36 + 0.96X for DBP) significantly different from line of equality (P < 0.001). The study has demonstrated that the aneroid device (model: 7670-04) achieved grade B performance according to the British Hypertensive Society criteria.

/pdf/clinical-validation-of-aneroid-sphygmomanometer-47hvdgknz6.pdf

Clinical validation of aneroid sphygmomanometer.

: : : : The study was conducted in St. John's Medical College Hospital and Department of Physiology, with the aim of studying the serum nitrate levels in pre-eclampsia and normal pregnancy. The total number of subjects studied in various groups were 159, control (n = 55), first trimester (n = 13), second trimester normal (n = 42), second trimester pre-eclampsia/PET (n = 5), third trimester normal (n = 32), third trimester pre-eclampsia/PET (n = 12). The serum nitrate was measured by one step enzymatic assay using Nitrate reductase from Aspergillus species. The nitrate levels in the third trimester pre-eclamptic group was found to be significant lower (P = 0.02), as compared to normal subjects, however the renal functions were normal in all the subjects.

/pdf/serum-nitrate-levels-as-an-index-of-endothelial-function-in-4t3gtoj9n6.pdf

Serum nitrate levels as an index of endothelial function in pre-eclamsia and normal pregnancy.

Pre-hypertensives are at increased risk for rise in blood pressure and cardio vascular morbidities. Autonomic dysfunction is both a cause and effect of high blood pressure. Considering its serious prognosis the current study was undertaken with an aim to assess autonomic functions in pre-hypertensive young adult males. Male volunteers of 20-40 years were divided into normotensives (n=44) and clinically healthy pre-hypertensives (n=44). They were subjected to anthropometric measurements, Heart Rate variability (HRV) analysis along with Standard Isometric Handgrip Test (HGT) and Sinus arrhythmia test. Analysis showed a significant increase in sympathetic activity among prehypertensives characterized by lower rise in DBP (mmHg) in response to HGT: [11.27±3.76 mmHg vs 23.95±6.29 mmHg, (p<0.05)]. Parasympathetic activity was significantly decreased among prehypertensives (HFnu: 30.02±14.43 vs 41.62±14.91, p<0.05); E/I ratio: 1.20±0.10 vs 1.32±0.10, p<0.05). Sympathovagal balance showed prominent sympathetic activity (2.85±1.78 vs 1.75±0.98; (p<0.01) among prehypertensives. Salt intake among prehypertensives was significantly higher than normotensives (21.2±1.2 gm/day vs 9.0±0.5 gm/day: P<0.001). Conclusion: Autonomic dysfunction is evident in prehypertensives with an enhanced sympathetic activity, decreased parasympathetic activity and an altered sympathovagal balance in prehypertensives, salt intake was found on a higher side. Thus lifestyle changes in the form of balanced diet and moderate exercise may be advised to attenuate the risk progression of prehypertension to hypertension.

Autonomic Function Tests in Prehypertensive Young Adult Males of Uttarakhand Region.

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