Dissertations / Theses on the topic 'Blood pressure determination'

Abstract This thesis describes the development of pressure sensor arrays and a range of methods suitable for the long-term measurement of heart rate and blood pressure determination using a cuff and a pressure sensor array on the radial artery. This study also reviews the historical background of noninvasive blood pressure measurement methods, summarizes the accuracies achieved and explains the requirements for common national and international standards of accuracy. Two prototype series of pressure transducer arrays based on electro-mechanical film (EMFi) were designed and tested. By offering high (∼TΩ) resistance, EMFi is an excellent material for low-current long-term measurement applications. About 50 transducer arrays were built using different configurations and electrode materials to sense low-frequency pressure pulsations on the radial artery in the wrist. In addition to uniform quality, essential requirements included an adequate linear response in the desired temperature range. Transducer sensitivity was tested as a function of temperature in the range of 25–45 °C at varying static and alternating pressures. The average sensitivity of the EMFi used in the transducers proved adequate (∼2.2 mV/mmHg and ∼7 mV/mmHg for normal and high sensitive films) for the intended purpose. The thesis also evaluates blood pressure measurements by the electronic palpation method (EP) and compares the achieved accuracy to that of the oscillometric method (OSC) using average intra-arterial (IA) blood pressure as a reference. All of these three measurements were made simultaneously for each person. In one test group, measurements were conducted on healthy volunteers in sitting and supine position during increasing and decreasing cuff pressure. Another group, comprising elderly cardiac patients, was measured only in the supine position during cuff inflation. The results showed that the EP method was approximately as accurate as the OSC method with the healthy subjects and slightly more accurate with the cardiac patient group. The advantage of the EP method is that also the wave shape and velocity of arterial pressure pulses is available for further analysis, including the assessment of arterial stiffness.

This study was designed to determine which method of measuring the systolic blood pressure is more accurate when determining the ankle/brachial index (ABI), which is an important tool in assessing graft patency for patients who have had peripheral vascular surgery. The accuracy of the stethoscope diaphragm was compared with the stethoscope bell and Doppler methods used to measure the brachial systolic pressure. These pressures were then used in the calculation of the ABI and then the ABI was compared by method and time since surgery. The theoretical framework for this study was drawn from theories on sound generation, transmission and measurement. This study used a two-repeated measures design in which the subjects served as their own control. The results were then analyzed using an ANOVA specific to a two-repeated measures design. The sample consisted of 31 subjects which comprised 80% of all peripheral vascular surgery patients admitted over a two month period to a large tertiary care hospital in Western Canada. The subjects ranged in age from 47 to 82 years, the majority had at least one other medical condition in addition to peripheral vascular disease, were on a variety of medications, and 35% had had previous vascular surgery. The subjects had their brachial systolic blood pressure measured by the three methods on the third, fourth and fifth postoperative day. At the same time they also had their dorsalis pedis and posterior tibial pressures measured by the Doppler method. There was no significant difference in the brachial systolic blood pressure related to the methods used to take the blood pressure, the postoperative day that the blood pressure was measured, nor was there any interaction between method and occasion. Also, there was no significant difference in either the dorsalis pedis or posterior tibial ankle/brachial indices related to method used to measure the brachial systolic blood pressure, the postoperative day the measurement was taken, nor any interaction between method and occasion. The findings suggest that peripheral vascular surgery patients often have systolic pressures that differ between the right and left arm which would make a major difference in the calculation of the ABI. Therefore, the pressures should be measured in both arms, followed by documentation and consistent use of the arm with the highest pressure when determining the ABI. The findings also suggest that inservice education and periodic skill checking be implemented when the nurse is required to employ the Doppler method owing to the number of variables to consider when operating this instrument.
Applied Science, Faculty of
Nursing, School of
Graduate

Direct measurement of blood pressure using a fluid-filled catheter and an electromechanical transducer is widely accepted in clinical practice. However, errors associated with the measurement are often not appreciated and these catheter-manometer systems are frequently unable to accurately reproduce applied pressures. To assess the accuracy of catheter-manometer systems used for invasive arterial blood pressure measurements, in vitro and in vivo evaluations were performed. The frequency response (described in terms of damped natural frequency and damping factor) for a variety of cannulae, pressure tubing and stopcocks (and combinations thereof) and their dependence on various parameters (catheter length, lumen diameter, fluid temperature and catheter material) were measured using an hydraulic pressure generator. The design and construction details of the pressure generator are presented. It was found that the damped natural frequency of the catheter-manometer system is directly proportional to lumen diameter of the pressure tubing/catheter. Furthermore, damping factor is inversely related to the damped natural frequency and stiffer catheter material (for identical radius ratios) results in higher damped natural frequency. Catheter length is inversely related to damped natural frequency and the resonant frequency decreases for an increase in fluid operating temperature. It was established that all catheter-manometer systems tested were under-damped (0.15 < β < 0.37) and that the damped natural frequency ranged from 10.5 Hz for 1500 mm to 27.0 Hz for pressure tubing of 300 mm in length. Furthermore, catheter-manometer systems which had pressure tubing in excess of 300 mm in length did not comply with the bandwidth requirements for accurate dynamic blood pressure measurement. For the in vivo assessment of the catheter-manometer system, the blood pressure waveform was analysed in the time and frequency domains. It was established that in 60 percent of the cases, the systolic pressure peak was higher when measured by a narrow bandwidth catheter-manometer system compared to that measured by a wide bandwidth system. Furthermore, values of dp/dt maximum were lower for wide bandwidth catheter-manometer systems than those measured by narrow bandwidth systems for heart rates above 90 beats per minute. In the frequency domain analysis, artifact was sometimes found to occur at frequencies higher than the bandwidth of the catheter-manometer system. This high frequency artifact was found to distort the blood pressure waveform and resulted in false high dp/dt and peak systolic pressures.

L'hypertension artérielle (HTA) est un problème de santé sérieux qui affecte 22% des canadiens et dont les complications sont nombreuses. Ces complications peuvent être diminuées par un diagnostic précoce et un traitement efficace et plusieurs auteurs affirment que l'exactitude de la mesure de la pression artérielle (PA) est la pierre angulaire pour établir le diagnostic et assurer un suivi adéquat. Quoique cette mesure soit réalisée très fréquemment, des études réalisées ailleurs qu'au Québec indiquent que les connaissances des infirmières à l'égard de la mesure de la PA sont insuffisantes pour des éléments reconnus comme ayant une influence significative sur les résultats de la mesure de la PA. À notre connaissance, aucune étude concernant les connaissances des infirmières n'a été publiée au Canada. Cette étude a donc pour but de décrire les connaissances théoriques et pratiques des infirmières pour la mesure de la PA en regard des recommandations du Programme éducatif canadien pour le contrôle de l'hypertension artérielle (2004) et comparer les relations entre ces variables. Une enquête par questionnaire auto administré pour décrire les connaissances théoriques ainsi qu'une observation directe par échantillonnage exhaustif pour décrire les connaissances pratiques ont été utilisées pour un premier échantillon de 50 infirmières. Une enquête postale transversale par échantillonnage aléatoire a été utilisée pour décrire les connaissances théoriques auprès d'un deuxième échantillon de 307 infirmières. Les outils ont été testés pour leur validité et leur fidélité dans le cadre de cette étude. L'étude a été approuvée par le comité d'éthique du centre de recherche clinique du CHUS. Les résultats quant aux données sociodémographiques démontrent que les infirmières ayant participé à l'une ou l'autre partie de l'étude sont semblables aux autres infirmières du Québec à l'égard du genre, de l'âge, du type d'emploi et de l'expérience. Elles sont toutefois statistiquement différentes pour le niveau de formation. Le score obtenu par les infirmières des deux échantillons pour le questionnaire sur les connaissances théoriques est de moins de 60%. On peut donc conclure qu'il existe des lacunes importantes en regard des connaissances théoriques acquises. Par ailleurs, ces infirmières croient dans de très fortes proportions posséder les connaissances théoriques et pratiques nécessaires à une mesure exacte de la PA. Pour les connaissances pratiques, le score global des infirmières est de 38%. Force est de croire que malgré le processus de mise à jour annuel et d'implantation des recommandations canadiennes, les connaissances pratiques des infirmières ne sont pas équivalentes au contenu de ces recommandations. Les infirmières qui détiennent un niveau de formation supérieur, celles qui ont lu les recommandations et celles qui ont suivi une formation continue sur la mesure de la PA obtiennent de résultats légèrement supérieurs aux autres infirmières. Considérant la fréquence avec laquelle les infirmières mesurent la PA et l'impact que peut avoir une mesure inexacte, il est important d'entreprendre dès maintenant des actions concrètes pour améliorer cette situation en mettant en place des formations continues régulières sur le sujet et en s'assurant que les programmes de formation initiale incluent une formation théorique et pratique fondée sur les recommandations en vigueur. Il semble également crucial de stimuler l'implantation des recommandations du PECH auprès des infirmières et d'évaluer l'impact de ces mesures par la suite.

Blood pressure measurements provide information regarding the status of the cardiovascular system to aid in diagnosing pathological conditions, maintaining patient stability during surgery, and adapting tourniquet pressures. However, the performance of commercially available techniques of measuring blood pressure is often degraded during clinical measurements in the presence of motion artifacts. A prototype system based on oscillometry that uses algorithms which take advantage of a multi-bladder cuff has the potential to improve measurements of blood pressure in noisy environments by detecting noise and rapidly estimating blood pressure using only data uncorrupted by noise. This system and strategy, implemented in one version to track limb occlusion pressure (the minimum cuff pressure required to occlude underlying arteries), was evaluated along with a typical commercial, JLV available oscillometric blood pressure monitor to compare their ability to track limb occlusion pressure in the presence of varying noise conditions encountered during lab trials and clinical trials. Results showed that the prototype consistently estimated limb occlusion pressure more rapidly, more accurately, and more reliably than the oscillometric monitor in noise conditions typical of surgical procedures. The results also indicate that the prototype is feasible for incorporation into an adaptive tourniquet.
Applied Science, Faculty of
Electrical and Computer Engineering, Department of
Graduate

Orientador: José Luiz Tatagiba Lamas
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem
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Resumo: As síndromes hipertensivas específicas da gestação são uma das mais importantes causas de mortalidade materna e perinatal no Brasil e no mundo. Surgem, geralmente, após a 20ª semana de gestação e se caracterizam por hipertensão arterial e proteinúria, sendo esta condição denominada de pré-eclâmpsia, e na ocorrência de crise convulsiva, eclâmpsia. Medir a pressão, entretanto, a despeito de sua grande utilidade para o diagnóstico de hipertensão, pode resultar em conclusões inapropriadas se normas técnicas básicas e indispensáveis não forem obedecidas. Este estudo teve como objetivo comparar as medidas da pressão arterial na posição sentada e em decúbito lateral esquerdo, em ambos os braços, de gestantes normotensas do último trimestre. Trata-se de um estudo transversal, cuja amostra foi composta por 70 gestantes, com idade média de 25 anos, em acompanhamento pré-natal em uma Unidade Básica de Saúde, e com idade gestacional entre 28 e 39,5 semanas. Foram realizadas medidas de pressão arterial em ambas as posições e braços utilizando-se manômetro de mercúrio. Os dados foram analisados por meio de análise estatística descritiva e inferencial e para as comprarações entre as posições e braços, foram propostos modelos lineares de efeitos mistos. Os resultados mostraram diferenças estatisticamentes significativas (p< 0,05) para as comparações entre o mesmo braço em posições diferentes (sentado e lateral esquerdo), e entre os braços no decúbito lateral esquerdo. Em decúbito lateral esquerdo a pressão foi maior quando medida no braço esquerdo. Além disso, a variação da pressão arterial na posição sentada para o decúbito lateral esquerdo foi maior no braço direito em relação ao esquerdo. Conclui-se que, em decúbito lateral esquerdo, a pressão arterial de gestantes do último trimestre apresenta valores menores para o braço direito e que o braço esquerdo apresenta valores mais próximos aos obtidos na posição sentada
Abstract: The hypertensive disorders originated from pregnancy are one of the leading causes of mother and preborn mortality in Brazil and worldwide. Usually, arise after the 20th week of pregnancy and are characterized by arterial hypertension and proteinuria, being this condition defined as pre-eclampsia or eclampsia, in the appearance of seizures. Blood pressure measurement is the most important way of hypertension diagnosis, however, it can lead to inadequate conclusions if essential technical standards are not followed. This study is aimed on comparing the blood pressure measures in the sitting position and in the left lateral recumbent position, on both arms for normotensive pregnant women in the last trimester of pregnancy. This is a cross-sectional study, which samples consisted of 70 pregnant women averaging the age of 25, with gestational age between 28 and 39.5 weeks, receiving prenatal care in a public health service. Blood pressure was measured on both arms and positions using a mercury manometer. The data were analyzed by using descriptive and inferential statistical analysis and for the comparison between positions and arms, linear mixed-effects models were used. The results showed statistically significant differences (p < 0.05) for comparisons between the same arm in different positions (sitting and left lateral recumbent), and between both arms in the left lateral recumbent position. In the left lateral recumbent position the blood pressure was higher when measured in the left arm. Furthermore, the blood pressure variation for the sitting position to left lateral recumbent position was higher on the right arm than on the left. It was concluded that, in the left lateral recumbent, the blood pressure for normotensive pregnant women on their last trimester present lower values for the right arm and that the left arm present similar values to the one that was produced on the sitting position
Mestrado
Enfermagem e Trabalho
Mestra em Ciências da Saúde

A prevalência da hipertensão arterial aumenta a cada ano, é uma doença silenciosa, influenciada por fatores de risco, alguns decorrentes de hábitos e estilo de vida. Ao considerar a atual proposta mundial de tornar o paciente agente do seu próprio cuidado, participando a família do seu processo saúde-doença, faz-se necessário considerar esse contexto para propor estratégias de baixo custo, que contribuam para a redução dos valores de pressão arterial. O objetivo deste estudo foi avaliar o efeito da associação entre MRPA e intervenção de ensino (IE) na redução dos valores de pressão arterial. Foi realizado estudo piloto, para identificar as dificuldades e facilitar a operacionalização da coleta de dados, assim como propor estratégias para a melhor execução do planejamento do estudo. Foi realizado estudo clínico randomizado e definiu-se como variáveis a serem estudadas: \"MRPA\", \"IE\" e \"MRPA+IE\". A pressão arterial (PA) foi aferida antes e pós as intervenções. O fato de que todas as comparações realizadas no estudo não apontaram diferenças entre o grupo que participou da pesquisa e o que tendo recusado, teve suas características anotadas, foi o principal resultado. E quando comparou-se a magnitude do efeito da intervenção entre os grupos que receberam a associação das intervenções (grupo 1) e o grupo 2, que recebeu somente a intervenção de ensino, evidenciou-se uma diferença (p = 0,0155) entre eles, o que mostra que o grupo 1 teve uma melhora nos valores de pressão arterial sistólica (PAS) enquanto que no grupo 2 foi observado uma piora nos valores de PAS. O grupo 1 teve uma melhora nos valores de PAS enquanto que no grupo 4, novamente foi observado uma piora nestes valores (p = 0,0040). O grupo 1 foi o único que apresentou redução dos valores de PA tanto na PAS quanto na pressão arterial diastólica (PAD). Assim a associação da MRPA com uma IE sobre a doença hipertensão arterial sistêmica (HAS) é recomendada, pois resultou em consequências positivas na implementação de cuidados de saúde, o que leva a crer ser uma adequada estratégia para redução dos valores de PA em pessoas com HAS em tratamento. Essa sugestão é baseada na análise do efeito e da efetividade das intervenções apresentadas nesse estudo, que evidenciou redução nos valores de PAS e PAD quando aplicada a associação das duas intervenções propostas nesse estudo onde os resultados se diferenciaram significativamente do grupo controle, o qual não sofreu nenhuma intervenção. Tais resultados permitem afirmar que a MRPA associada à IE reduz os valores de PA e que tal associação, poderá contribuir sobremaneira para a melhoria do controle dos valores de PA entre indivíduos com hipertensão arterial em tratamento nas ESF
The prevalence of hypertension is increasing every year , and know that it is a silent disease , influenced by habits and lifestyle . Considering the new global proposal to make the patient agent of their own care, attending to your family health-disease process , it is necessary to propose low-cost strategies that contribute to the reduction of blood pressure values . The aim of this study was to evaluate the association between HBPM and teaching intervention in reducing blood pressure levels . Pilot study , where it was possible to identify the difficulties in the operationalization of data collection and propose strategies for the implementation of the project was conducted . In the methodology it was decided to conduct a randomized clinical trial . We defined the variables to be studied : \" HBP \" , \" EI \" and \" HBP + EI \" , which will be the interventions of the study . The PA variable was measured before and after the interventions . The main result of the fact that all comparisons showed no differences between the group that participated in the survey and who has refused , had noted its features appear . And when we compare the magnitude of the effect of the intervention between the groups who received the combination of interventions (group 1 ) and group 2 , which received only the educational intervention , we observed a difference ( p = 0.0155 ) between them , showing that the group 1 had an improvement in SBP while in group 2 a worsening was observed in these values . When the magnitude of the effect of the intervention compared between groups and 1 control group ( 4 ) evidenced a difference ( p = 0.0040 ) between them , showing that group 1 had an improvement in SBP while in group 4 , was again observed a worsening in these values . Group 1 was the only one that showed a reduction in BP values in both SBP and DBP . Association of HBPM with IE on the disease , its consequences and health care as a strategy for reducing the pressure values is recommended. This suggestion is based on analysis of the effect and effectiveness of interventions presented in this study, which showed a reduction in SBP and DBP when applied to combination of both interventions proposed in this study where the results differed significantly from the control group, which did not suffer no intervention. These results allow us to affirm that HBPM associated with IE reduces the values of PA and that this association may contribute greatly to improving the control of blood pressure values among individuals with hypertension in treatment in the FHS

Orientador: José Luiz Tatagiba Lamas
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: A medida da pressão arterial é o procedimento mais realizado pelos profissionais de saúde de todo o mundo. O valor dessa medida determina cuidados a serem prestados aos indivíduos e conduz medidas preventivas e curativas relacionadas à hipertensão. Por esse motivo os valores devem ser acurados. Erros na medida resultam em dados incorretos preocupantes e expõem indivíduos a riscos de saúde. Entretanto, a medida da pressão arterial tornou-se uma ação rotineira e desprovida de conhecimento e atenção ao ser realizada. O objetivo deste estudo é verificar se existem diferenças nos valores de pressão arterial quando ocorre reinflação do manguito antes de seu esvaziamento completo. Foi utilizada uma amostra populacional conveniente não probabilística, de sujeitos encontrados nas enfermarias. Cada sujeito foi submetido à medida da pressão arterial pelo método auscultatório por nove vezes. As três primeiras medidas foram feitas seguindo corretamente a técnica proposta nas VI Diretrizes Brasileiras de Hipertensão. Nas seis medidas seguintes, intercalou-se a medida correta e a medida com a introdução de um erro, que foi a reinflação do manguito antes de seu esvaziamento completo. Respeitando os trâmites administrativos e éticos, a coleta de dados ocorreu após aprovação do projeto pelo Comitê de Ética em Pesquisa e obtenção do consentimento de cada sujeito. Foi realizada análise estatística descritiva e inferencial dos dados obtidos, utilizando teste de Mann-Whitney. Os resultados obtidos neste estudo evidenciaram que o erro introduziu uma diferença estatisticamente significativa nos valores de PAS e PAD entre homens e mulheres jovens. Essa diferença foi maior para os homens, mas não atingiu relevância clínica. Não foram coletados dados que pudessem esclarecer as causas dessas alterações. Também não foram encontradas informações na literatura que contribuíssem para a elucidação deste efeito. Conclui-se que a reinflação do manguito antes de seu completo esvaziamento introduziu uma diferença estatisticamente significativa nos valores de PAS e PAD entre homens e mulheres jovens, o que demonstra a importância de seguir corretamente a técnica auscultatória
Abstract: Blood pressure measurement is the procedure that is most often performed by health professionals around the world. Obtained values determine how to take care of individuals and preventive measures against possible hypertension. Because of these reasons results must be accurate. Errors in this measurement result in incorrect data related to the patients and can expose these individuals to health risks. However measuring blood pressure has become such a routine procedure that not much attention is given to how it is performed. The objective of this study is to determine the level of the differences in the results of blood pressure when the tension cuff is re-inflated before it has been completely deflated. A convenient sample was selected from the wards of the hospital. Subjects had their blood pressure measured nine times by auscultation. The first three measurements were made following the correct technique as described by the VI Brazilian Guidelines on Hypertension. In the following six measurements, the blood pressure was measured with the introduction of an error to the standard procedure, namely re-inflation of the cuff before its complete deflation. This test was carried out in compliance with the correct ethical and administrative procedures and with the full consent of each patient involved. Statistical analysis was made by means of Mann- Whitney test. The results of this study showed that the error introduced a statistically significant difference in systolic and diastolic blood pressure between young men and women. This difference was greater for men, but did not reach clinical significance. However data was not sufficient to clarify the causes of these changes. Existing studies failed to provide information which could explain the observed changes. Re-inflation of the cuff before it has been completely deflated introduced a statistically significant difference in systolic and diastolic blood pressure between young men and women, which demonstrates the importance of following the correct auscultation technique
Mestrado
Enfermagem e Trabalho
Mestra em Ciências da Saúde

A medida da pressão arterial é um procedimento simples e imprescindível na avaliação do sistema cardiovascular, porém sua realização sofre influências de diversos fatores que podem comprometer os valores obtidos. As estratégias de ensino da técnica de medida da pressão arterial utilizam as aulas expositivas e filmes de treinamento, porém o ambiente digital ainda não foi explorado. O ambiente digital de aprendizagem tem-se constituído em uma poderosa ferramenta do processo de ensino aprendizagem, pois acrescenta significado e concretude aos conteúdos que precisam ser aprendidos. A graduação em enfermagem tem sido beneficiada pelo uso da tecnologia de informação no ensino de seus procedimentos e técnicas, embora as iniciativas nesta área sejam ainda incipientes. O objetivo deste trabalho foi construir uma hipermídia educacional para o ensino da técnica de medida da pressão arterial para graduandos de enfermagem e descrever as etapas do processo de construção. O referencial pedagógico adotado para nortear a elaboração do conteúdo foi de Robert Gagné, e seguiu-se o modelo em três fases proposto por Price para a construção da hipermídia. O produto final contou com quatro tópicos, agrupando 12 módulos, no qual se apresenta todas as questões que envolvem a realização do procedimento de medida da pressão arterial, discorrendo sobre aspectos fisiológicos, métodos e técnica de medida. A hipermídia utiliza os recursos de áudio, vídeo, animações bidimensionais, fotos, ilustrações e simulações. A avaliação foi realizada simultaneamente por três grupos de juízes técnicos em informática; docentes de enfermagem e profissionais da saúde; e por alunos de graduação em enfermagem, utilizando instrumentos de avaliação específicos para cada grupo. Estas avaliações foram analisadas separadamente, os resultados apresentaram semelhanças entre os grupos que se detiveram em questões organizacionais, estéticas e informacionais. De maneira geral, os grupos avaliaram bem a hipermídia, com comentários positivos a respeito da estratégia e da qualidade final do ambiente desenvolvido. O uso da hipermídia e do ambiente digital de aprendizagem pode representar uma importante estratégia para o ensino da enfermagem, porém o desenvolvimento de ferramentas educacionais adequadas a este ambiente é um campo novo em franca expansão que necessita de avaliação e adequação periódicas
Arterial blood pressure measurement is a simple and essential conduct to evaluate the condition of the cardiovascular system; however, it is afected by several factors that can change the obtained results. Lectures and training movies are used as teaching strategies of blood pressure measurement technique, but digital environment has not been explored so far. Digital teaching environment is a powerful tool for the teaching-learning process, because it adds meaning and concreteness to the subjects to be learned. The use of information technology in the teaching of nursing procedures and techniques has benefit Nursing Undergraduate courses, although the iniciatives in this area are still incipients. This work intended to build an educational hypermedia to the arterial blood pressure measurement teaching for undergraduate nursing students, and to describe the steps of the building process. The development of the content used a pedagogical reference by Robert Gagné as guidance, and followed the three-phase model proposed by Price for the hypermedia construction. The final product has 12 modules within 4 topics, and presents all questions concerning the procedure to the arterial blood pressure measurement, considering methods, measurement technique and physiological aspects. Hypermedia uses resources as audio, video, two-dimensional animations, photos, pictures and simulations. The evaluation was made simultaneously by three groups of judges: computer science technicians; teachers of nursing and health professionals´ courses, and nursing undergraduate students, using specific evaluation tools for each group. The evaluations were analysed on an individual basis; the results showed some similarities, mainly in organizational, aesthetical and informational issues. On the whole, the groups made an approving evaluation of the hypermedia, with positive comments about the strategy and final quality of the developed environment. The use of hypermedia and digital learning environment can represent an important strategy to nursing teaching; however, the development of teaching tools that are suitable to this environment is a new and expanding field that requires periodical evaluation and adjustments

INTRODUÇÃO: Não se sabe se o ajuste da terapia anti-hipertensiva baseado na Monitorização Residencial da Pressão Arterial (MRPA) pode melhorar o controle da pressão arterial em pacientes em hemodiálise. OBJETIVOS: Comparar a redução da pressão arterial (PA) e do índice de massa ventricular esquerda (IMVE) obtido com o uso da MRPA em relação às medidas da PA pré-diálise em pacientes em hemodiálise. MÉTODOS: Pacientes hipertensos em hemodiálise foram randomizados para ter a terapia anti-hipertensiva ajustada em dois grupos: controle, baseado na PA pré-diálise, e intervenção, baseada na MRPA. Antes e após 06 meses de acompanhamento, os pacientes realizaram Monitorização Ambulatorial da Pressão Arterial (MAPA) por 24 horas, MRPA durante uma semana e ecocardiograma transtorácico. RESULTADOS: 34 e 31 pacientes completaram o estudo no grupo intervenção e controle, respectivamente. As pressões arteriais sistólica (PAS) e diastólica (PAD) no período interdialítico pela MAPA foram significativamente menores no grupo intervenção em relação ao grupo controle no final do estudo (média 24 horas: 135 ± 13mmHg / 76 ± 7mmHg versus 147 ± 15mmHg / 79 ± 8mmHg, respectivamente - p<0,05). Na análise da MRPA, o grupo intervenção apresentou redução significativa somente para a PAS em comparação ao grupo controle (média semanal: 144 ± 21mmHg versus 154 ± 22 mmHg, respectivamente - p<0,05). Não houve diferenças entre os grupos intervenção e controle em relação ao IMVE ao final do estudo (108 ± 35 g/m2 versus 110 ±33 g/m2, respectivamente - p>0,05). CONCLUSÕES: O uso sistemático da MRPA no ajuste da terapia anti-hipertensiva em pacientes em hemodiálise propiciou maior controle da PA no período interdialítico em comparação às medidas da PA pré-diálise. A MRPA pode ser usada como um instrumento adjuvante útil no controle da pressão arterial em pacientes em hemodiálise
INTRODUCTION: It is not known whether the adjustment of the antihypertensive therapy based on Home Blood Pressure Monitoring (HBPM) can improve blood pressure (BP) control in hemodialysis patients. OBJECTIVES: To compare the reduction in BP and in the left ventricular mass index (LVMI) obtained with the use of HBPM in relation to that achieved with predialysis BP measurements in hemodialysis patients. METHODS: Hypertensive patients on hemodialysis were randomized to have the antihypertensive therapy adjusted according two groups: control, based on the predialysis BP measurements, and intervention, based on HBPM. Before and after 06 months of follow-up, patients were submitted to Ambulatory Blood Pressure Monitoring (ABPM) for 24 hours, HBPM during one week and transthoracic echocardiogram. RESULTS: 34 and 31 patients completed the study in the intervention and control groups, respectively. The systolic (SBP) and diastolic (DBP) blood pressure in the interdialytic period by ABPM were significantly lower in the intervention group compared with the control group at the end of the study (mean 24-hours BP: 135 ± 13 mm Hg / 76 ± 7 mmHg versus 147 ± 15 mm Hg / 79 ± 8 mmHg, respectively - p <0.05). When the interdialytic BP was analysed by HBPM, the intervention group showed significant reduction only for the PAS in comparison with control group (mean weekly BP: 144 ± 21 mm Hg versus 154 ± 22 mm Hg, respectively - p <0.05). There were no differences between intervention and control groups in relation to LVMI at the end of the study (108 ± 36 g/m2 versus 110 ± 33 g/m2, respectively - p> 0.05). CONCLUSIONS: The systematic use of HBPM in the adjustment of antihypertensive therapy in patients on hemodialysis has led to better control of BP during interdialytic period compared to that achieved with the predialysis BP measurements. The HBPM can be used as a useful adjunct instrument to control blood pressure in hemodialysis patients

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Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico
This study aimed to validate tools for evaluating the ability and knowledge about blood pressure (BP) among nursing students. It is a cross-sectional, descriptive, quantitative and methodological study accomplished at the Universidade Federal do Rio Grande do Norte (UFRN), Universidade do Estado do Rio Grande do Norte (UERN) and a private university of the state. The sample consisted of 27 judges of research selected from the inclusion criteria: nursing, teachers of the semiology and/or semiotics discipline, with at least 1 year of experience, being from UFRN, EEN, UERN and private university of the state and and agree to participate voluntarily with the signing of the consent form. The research was development in three stages: construction of two instruments based on the scientific literature, resulting in a structured checklist consists of 28 items and a knowledge questionnaire with 12 questions; submission of the instruments to the judges, in the period from June to September 2012, which should evaluate each item in appropriate , appropriate with changes and inappropriate , addition to making an overall assessment of each instrument based on 10 requirements; validation and verification to the level of agreement among the judges, through the application of Kappa and Content Validity Index (CVI). Was used the consensus level greater than 0.61 (good) to the Kappa index and greater than 0.75 for CVI. Was approved by the Ethics in Research / HUOL. After being coded and tabulated, the data were analyzed using descriptive statistics. Of the 27 judges who evaluated the instrument, 77.8% are female, with a mean age of 36.6 (? 9.0) years, 63.0% worked in UFRN, 74.1% had academic master and 63.0% worked exclusively on teaching. Average length of teaching experience was 7.9 (? 8.0) years and in the semiology and/or semiotics discipline of 5.5 (? 6.7) years. In the judgment of structured checklist and questionnaire of knowledge about blood pressure mensurement any item/question was considered inappropriate since all obtained level of agreement within the indices established (CVI> 0,75 E Kappa> 0.61). In relation to structured checklist, of those 28 items present, 9 showed perfect concordance index (CVI = 1.00, Kappa = 1.00) and another 19 were considered appropriate with changes, especially with regard to clarity and vocabulary. In the questionnaire of knowledge, among the 12 questions that comprised, 7 had perfect concordance index and the others were considered appropriate with changes as requirements as clarity, vocabulary, and feasible sequence of instructional topics. In terms of a overall evaluating of instruments, the structured checklist got CVI of 0.94 and Kappa of 0.89 and the knowledge questionnaire, CVI of 0.97 and a kappa of 0.94. Both instruments proved to be valid as to their content, configuring it as clear and objective tools of assessment of knowledge and ability on blood pressure, being of nursing students as well as others students and health professionals, since the use of valid measures seeking to reduce the risk of distorting the results
Este estudo teve como objetivo validar instrumentos para avalia??o da habilidade e do conhecimento acerca da medida da press?o arterial (PA) entre os graduandos de enfermagem. Estudo transversal, descritivo, quantitativo e metodol?gico realizado na Universidade Federal do Rio Grande do Norte/UFRN, Universidade do Estado do Rio Grande do Norte/UERN e em uma universidade privada do estado. A amostra composta por 27 ju?zes da pesquisa selecionados a partir dos crit?rios de inclus?o: enfermeiros, docentes da disciplina de semiologia e/ou semiot?cnica, m?nimo de um ano de experi?ncia nas disciplinas, ser da UFRN, UERN ou de uma universidade privada do Rio Grande do Norte e aceitar participar voluntariamente com a assinatura do Termo de Consentimento Livre Esclarecido. A pesquisa foi desenvolvida em tr?s etapas: constru??o de dois instrumentos com base na literatura cient?fica, resultando em um roteiro de observa??o estruturado composto por 28 itens e um question?rio do conhecimento com 12 quest?es; submiss?o dos instrumentos aos ju?zes, no per?odo de junho a setembro de 2012, os quais deveriam avaliar cada item em adequado , adequado com altera??es e inadequado , al?m de fazer uma avalia??o geral de cada instrumento baseada em 10 requisitos; e valida??o com a verifica??o do n?vel de concord?ncia entre os ju?zes, atrav?s da aplica??o do ?ndice Kappa e do ?ndice de Validade de conte?do (IVC). Utilizou-se o n?vel de consenso maior que 0,61 (bom) para o ?ndice Kappa e maior que 0,75 para o IVC. Obteve parecer favor?vel do Comit? de ?tica em Pesquisa/HUOL. Ap?s serem codificados e tabulados, os dados foram analisados por meio de estat?stica descritiva. Dos 27 ju?zes que avaliaram o instrumento, 77,8% s?o do sexo feminino, com m?dia de idade de 36,6 (? 9,0) anos, 63,0% atuavam na UFRN, 74,1% possu?am mestrado acad?mico e 63,0% atuavam exclusivamente na doc?ncia. A m?dia de tempo de experi?ncia na doc?ncia foi de 7,9 (? 8,0) anos e nas disciplinas de semiologia e/ou semiot?cnica da enfermagem foi de 5,5 (? 6,7) anos. No julgamento do roteiro de observa??o estruturado e do question?rio do conhecimento acerca da medida da PA nenhum item/quest?o foi considerado inadequado, uma vez que todos obtiveram n?vel de concord?ncia dentro dos ?ndices estabelecidos (IVC > a 0,75 E Kappa > 0,61). Em rela??o ao roteiro estruturado, dos 28 itens presentes, 9 apresentaram ?ndice de concord?ncia perfeito (IVC=1,00; Kappa= 1,00) e outros 19 foram considerados adequados com altera??es, principalmente no que diz respeito ? clareza e vocabul?rio. No question?rio do conhecimento, dentre as 12 quest?es que o compunham, 7 apresentaram ?ndice de concord?ncia perfeito e as demais foram consideradas adequadas com altera??es quanto requisitos clareza, vocabul?rio, exequ?vel e sequ?ncia instrucional dos t?picos. Em se tratando da avalia??o geral dos instrumentos, o roteiro estruturado obteve IVC de 0,94 e Kappa de 0,89 e o question?rio do conhecimento, IVC de 0,97 e Kappa de 0,94. Os dois instrumentos mostraram-se v?lidos quanto ao seu conte?do, configurando-se como ferramentas objetivas e claras de avalia??o dos conhecimentos e habilidades acerca da press?o arterial, seja dos graduandos de enfermagem como tamb?m de outros estudantes e profissionais da sa?de, uma vez que a utiliza??o de medidas v?lidas busca a redu??o do risco de distor??o dos resultados

by Cathy Yui Hung.
Thesis (M.Phil.)--Chinese University of Hong Kong, 1997.
Includes bibliographical references (leaves 129-152).
Abstract --- p.i
List of A bbreviations --- p.iv
Table of Contents --- p.vii
Chapter CHAPTER 1 --- INTRODUCTION
Chapter 1. --- Definitions & Morbid implication of PIH
Chapter 1.1. --- Definition of PIH --- p.1
Chapter 1.2. --- Classification --- p.2
Chapter 1.3. --- Background --- p.3
Chapter 2. --- Aetiology PIH --- p.4
Chapter 2.1. --- Anatomy of placenta --- p.4
Chapter 2.2. --- Physiology of placenta --- p.4
Chapter 2.3. --- The placenta as the cause of PIH --- p.6
Chapter 2.4. --- Pathology of the placental bed --- p.7
Chapter 3. --- Epidemiology of PIH --- p.9
Chapter 3.1. --- Maternal risk factors --- p.9
Chapter 3.2. --- Fetal risk factors --- p.10
Chapter 3.3. --- Genetics of PIH --- p.10
Chapter 3.4. --- Maternal outcome --- p.12
Chapter 3.5. --- Fetal outcome --- p.13
Chapter 4. --- Pathophysiologic changes in PIH --- p.14
Chapter 4.1. --- Important Pathophysiologic changes in PIH --- p.14
Chapter 4.1.1. --- Hyperdynamic circulation --- p.14
Chapter 4.1.2. --- Changes in Intravascular volume --- p.15
Chapter 4.1.3. --- Loss of resistance to Angiotensin II and catecholamines --- p.16
Chapter 4.1.4. --- Coagulation abnormalities --- p.16
Chapter 4.1.5. --- Platelets --- p.17
Chapter 4.2. --- Multisystem disorder in PIH --- p.18
Chapter 4.2.1. --- The kidney --- p.18
Chapter 4.2.2. --- The liver --- p.19
Chapter 4.2.3. --- The brain and nervous system --- p.19
Chapter 4.2.4. --- Cardiovascular and renin-angiotensin systems --- p.20
Chapter 4.2.5. --- Placenta --- p.21
Chapter 5. --- Prediction of PIH --- p.22
Chapter 5.1. --- Standard methods of antental care --- p.22
Chapter 5.1.1. --- Blood pressure increase in antenatal period --- p.22
Chapter 5.1.2. --- Second Trimester Mean Arterial Pressure --- p.23
Chapter 5.1.3. --- Proteinuria --- p.25
Chapter 5.1.4. --- Excessive weight gain and edema --- p.26
Chapter 5.1.5. --- Platelet count --- p.27
Chapter 5.2. --- Vasoconstriction tests --- p.27
Chapter 5.2.1. --- The Isometric Handgrip Exercise Test --- p.27
Chapter 5.2.2. --- Roll-Over Test --- p.28
Chapter 5.2.3. --- Infusion of Angiotensin II --- p.31
Chapter 5.3. --- Biochemical tests --- p.33
Chapter 5.3.1. --- Urinary Calcium excretion --- p.33
Chapter 5.3.2. --- Prostacyclin & throboxane A2 --- p.33
Chapter 5.3.3. --- Platelet Angiotensin II receptors --- p.34
Chapter 5.4. --- Ultrasougographic evaluation --- p.36
Chapter 5.4.1. --- Doppler waveforms of uteroplacental circulation --- p.36
Chapter 6. --- Prevention & treatment of PIH --- p.38
Chapter 6.1. --- Antihypertensive drugs --- p.40
Chapter 6.2. --- Antithrombotic agents --- p.40
Chapter 6.2.1. --- Low-dose aspirin --- p.40
Chapter 6.3. --- Calcium supplementation --- p.44
Chapter CHAPTER 2 --- General Methodology
Chapter 1.1 --- Introduction --- p.48
Chapter 1.2. --- Materials --- p.48
Chapter 2. --- Studies --- p.51
Chapter 2.1. --- Validation of Cor-7000 Sphygmomanometer --- p.51
Chapter 2.1.1. --- Patients --- p.51
Chapter 2.1.2. --- Methods --- p.51
Chapter 2.1.3. --- Statistics --- p.52
Chapter 2.1.4. --- Results --- p.53
Chapter 2.2. --- Platelet ANG II receptor status and systemic vascular resistance --- p.58
Chapter 2.2.1. --- Control subjects --- p.58
Chapter 2.2.2. --- Patient subjects --- p.58
Chapter 2.2.3. --- Platelet preparation and platelet angiotensin II binding site assay --- p.60
Chapter 2.2.3.1. --- Statistical analysis --- p.62
Chapter 2.2.3.2. --- Results --- p.63
Chapter 2.2.4. --- Using impedance techniques to measurement of systemic vascular resistance --- p.74
Chapter 2.2.4.1. --- Measurement of Cardiac Output by impedance cardiography --- p.74
Chapter 2.2.4.2. --- Validity of transthoracic electrical bioimpedance technique --- p.81
Chapter 2.2.4.3. --- Measurement of mean arterial pressure --- p.87
Chapter 2.2.4.3.1. --- Experimental technique --- p.87
Chapter 2.2.4.3.2. --- Statistical analysis --- p.92
Chapter 2.2.4.4. --- Results --- p.92
Chapter 2.2.4.5. --- Data analysis --- p.93
Chapter 2.2.4.6. --- Relationship between platelet ANG II binding and haemodynamic indices --- p.110
Chapter 2.2.4.7. --- pregnancy outcome --- p.115
Chapter CHAPTER 3. --- RESULTS
Chapter 1. --- Study 1 Validation of Cor 7000 sphygmomanometer --- p.116
Chapter 2. --- Study 2 Platelet ANG II receptor status and systemic vascular resistance --- p.118
Chapter 2.1. --- Platelet Angiotensin II binding Assay --- p.118
Chapter 2.2. --- Limitation of the TEB technique --- p.121
Chapter 2.3. --- Changes in blood pressure and other cardiovascular indices --- p.122
Chapter 2.4. --- Relationship between Platelet ANG II binding and Haemodynamic indices --- p.124
Chapter CHAPTER 4 --- CONCLUSION
Chapter 4.1. --- Conclusion --- p.126
References --- p.129
Acknowledgments

Cardiovascular disease is the leading global cause of mortality and morbidity and high blood pressure (BP) is the single greatest risk factor. Cuff measured BP is used in clinical practice to diagnose and guide management of high BP, with treatment of high BP resulting in a reduction of cardiovascular risk. For these reasons, BP measurement is among the most important medical tests performed, yet the conventional cuff method may be inaccurate. The overall aims of this research were to determine: the accuracy of cuff measured BP; if distinct BP phenotypes exist that relate to cuff BP accuracy and; haemodynamic factors that influence estimation of BP. In study 1 (Chapter 2), the accuracy of cuff measured BP compared with intra-arterial brachial and aortic BP was examined via three individual participant data meta-analyses among data from the 1950’s to 2016. Intra-arterial brachial systolic BP was higher than aortic values. Cuff BP had variable accuracy for measuring intra-arterial brachial and aortic BP, and this significantly influenced correct BP classification. Indeed, the concordance of cuff BP across hypertension categories (normal, pre-hypertension, hypertension stages 1 and 2) compared with intra-arterial brachial BP was 60%, 50%, 53% and 80%, and compared with intra-arterial aortic BP was 79%, 57%, 52% and 76%. In study 2 (Chapter 3), cuff measured BP and intra-arterial BP waveforms from the aorta, brachial and radial arteries were examined in 126 patients undergoing coronary angiography. Four novel BP phenotypes were discovered based on variability in aortic-to-brachial and brachial-to-radial systolic BP amplification. Cuff BP was unable to discriminate between the phenotypes (p>0.5 all comparisons), and among two phenotypes completely missed patients at potentially higher risk due to raised aortic BP. The key findings were confirmed by additional data in 255 patients, supplied by four independent, international collaborators. In study 3 (Chapter 4), intra-arterial BP from 107 individuals undergoing coronary angiography was used to determine the best peripheral BP waveform calibration method for the estimation of aortic BP, as well as haemodynamic factors that may influence accuracy. BP waveforms calibrated with brachial mean arterial BP/diastolic BP estimated aortic systolic BP more accurately than brachial systolic BP/diastolic BP calibration. However, systolic BP amplification had a major influence on the accuracy of estimated aortic systolic BP. In summary, this thesis revealed the extent of inaccuracy in cuff measured BP compared to intra-arterial BP. Moreover, distinct BP phenotypes were discovered which were related to cuff inaccuracy. Finally, systolic BP amplification was found to influence the accuracy of estimated aortic BP from peripheral BP waveforms. Altogether, these studies substantially advance understanding of the strengths and limitations of current BP measurement methods. Novel reasons for measurement inaccuracy have been identified that may lead to tangible improvements in the accuracy of BP measurement.

Gu, Wenbo.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2009.
Includes bibliographical references.
Abstract also in Chinese.
Acknowledgment --- p.i
Abstract --- p.ii
摘要 --- p.iii
List of Figures --- p.vi
List of Tables --- p.vii
List of Abbreviations --- p.viii
Contents --- p.ix
Chapter 1. --- Introduction --- p.1
Chapter 1.1. --- Arterial blood pressure and its importance --- p.1
Chapter 1.2. --- Current methods for non-invasive blood pressure measurement --- p.4
Chapter 1.2.1. --- The auscultatory method (mercury sphygmomanometer) --- p.4
Chapter 1.2.2. --- The oscillometric method --- p.5
Chapter 1.2.3. --- The tonometric method --- p.7
Chapter 1.2.4. --- The volume-clamp method --- p.7
Chapter 1.3. --- Blood pressure estimation based on pulse arrival time --- p.8
Chapter 1.4. --- Objectives and structures of this thesis --- p.10
Chapter 2. --- Hemodynamic models: relationship between PAT and BP --- p.14
Chapter 2.1. --- The generation of arterial pulsation --- p.14
Chapter 2.2. --- Pulse wave velocity along the arterial wall --- p.15
Chapter 2.2.1. --- Moens-Korteweg equation --- p.15
Chapter 2.2.2. --- Bergel wave velocity --- p.18
Chapter 2.3. --- Relationship between PWV and BP --- p.19
Chapter 2.3.1. --- Bramwell-Hill´ةs model --- p.20
Chapter 2.3.2. --- Volume-pressure relationship --- p.20
Chapter 2.3.3. --- Hughes' model --- p.22
Chapter 2.4. --- The theoretical expression of PAT-BP relationship --- p.23
Chapter 3. --- Estimation and calibration of arterial BP based on PAT --- p.25
Chapter 3.1. --- PAT measurement --- p.25
Chapter 3.1.1. --- Principle of ECG measurement --- p.25
Chapter 3.1.2. --- Principle of PPG measurement --- p.26
Chapter 3.1.3. --- Calculation of PAT --- p.28
Chapter 3.2. --- Calibration methods for PAT-BP estimation --- p.29
Chapter 3.2.1. --- Calibration based on cuff BP readings --- p.30
Chapter 3.2.2. --- Calibration by hydrostatic pressure changes --- p.31
Chapter 3.2.3. --- Calibration by multiple regression --- p.33
Chapter 3.3. --- Model-based calibration with PPG waveform parameters --- p.34
Chapter 3.3.1. --- Model-based equation with parameters from PPG waveform --- p.34
Chapter 3.3.2. --- Selection of parameters from PPG waveform --- p.36
Chapter 4. --- Cuffless calibration approach using PPG waveform parameter for PAT-BP estimation --- p.43
Chapter 4.1. --- Introduction --- p.43
Chapter 4.2. --- Experiment I: young group in sitting position including rest and after exercise states --- p.43
Chapter 4.2.1. --- Experiment protocol --- p.43
Chapter 4.2.2. --- Data Analysis --- p.44
Chapter 4.2.3. --- Experiment results --- p.46
Chapter 4.3. --- Experiment II: over-month observation using wearable device in sitting position --- p.48
Chapter 4.3.1. --- Body sensor network for blood pressure estimation --- p.49
Chapter 4.3.2. --- Experiment protocol and data collection --- p.50
Chapter 4.3.3. --- Experiment results --- p.50
Chapter 4.4. --- Experiment III: contactless monitoring in supine position --- p.51
Chapter 4.4.1. --- The design of the contactless system --- p.52
Chapter 4.4.2. --- Experiment protocol and data collection --- p.53
Chapter 4.4.3. --- Experiment results --- p.53
Chapter 4.5. --- Discussion --- p.55
Chapter 4.5.1. --- Discussion of Experiments I and II --- p.55
Chapter 4.5.2. --- Discussion of Experiments II and III --- p.57
Chapter 4.5.3. --- Conclusion --- p.58
Chapter 5. --- Cuff-based calibration approach for BP estimation in supine position --- p.61
Chapter 5.1. --- Introduction --- p.61
Chapter 5.2. --- Experiment protocol --- p.61
Chapter 5.2.1. --- Experiment IV: exercise experiment in supine position in lab --- p.61
Chapter 5.2.2. --- Experiment V: exercise experiment in supine position in PWH --- p.63
Chapter 5.3. --- Data analysis --- p.65
Chapter 5.3.1. --- Partition of signal trials and selection of datasets --- p.65
Chapter 5.3.2. --- PPG waveform processing --- p.66
Chapter 5.4. --- Experiment results --- p.68
Chapter 5.4.1. --- Range and variation of reference SBP --- p.68
Chapter 5.4.2. --- PAT-BP individual best regression --- p.69
Chapter 5.4.3. --- Multiple regression using ZX and arm length --- p.72
Chapter 5.4.4. --- One-cuff calibration improved by PPG waveform parameter --- p.72
Chapter 5.5. --- Discussion --- p.74
Chapter 6. --- Conclusion --- p.76

Yan, Renfei.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2009.
Includes bibliographical references (leaves 69-77).
Abstract also in Chinese.
ABSTRACT --- p.I
ACKNOWLEDGEMENT --- p.V
LIST OF FIGURES --- p.VI
LIST OF TABLES --- p.VIII
LIST OF ABBREVIATIONS --- p.IX
Chapter CHAPTER 1. --- INTRODUCTION TO BLOOD PRESSURE MEASURING DEVICES AND EVALUATION STANDARDS --- p.1
Chapter 1.1. --- Current situation on hypertension --- p.1
Chapter A. --- Prevalence of hypertension --- p.1
Chapter B. --- Low awareness of hypertension --- p.1
Chapter 1.2. --- Calls for better management of hypertension --- p.2
Chapter 1.3. --- Blood pressure measuring devices --- p.3
Chapter A. --- Conventional devices and their limitations --- p.3
Chapter B. --- Wearable cuff-less devices --- p.4
Chapter 1.4. --- Evaluation of the wearable cuff-less devices --- p.6
Chapter 1.5. --- Objectives of the thesis --- p.7
Chapter 1.6. --- Structure of the thesis --- p.7
Chapter CHAPTER 2. --- REVIEW ON CURRENT STANDARDS --- p.8
Chapter 2.1. --- Introduction to current standards --- p.8
Chapter A. --- AAMI standard --- p.8
Chapter B. --- BHS protocol --- p.8
Chapter C. --- ESH protocol --- p.9
Chapter 2.2. --- Comparison of current standards --- p.9
Chapter A. --- Evaluation scope --- p.9
Chapter B. --- Validation protocol --- p.10
Chapter C. --- Accuracy criteria --- p.10
Chapter D. --- Testing reference --- p.13
Chapter E. --- Recruitment of subjects --- p.13
Chapter F. --- Ambulatory monitors --- p.14
Chapter G. --- Special groups of population --- p.15
Chapter H. --- Statistical considerations --- p.16
Chapter 2.3. --- Major challenges for the evaluation of cuff-less devices --- p.17
Chapter A. --- Lack of experimental data --- p.19
Chapter B. --- Re-examination of the statistical considerations --- p.19
Chapter C. --- Feature oriented design of the validation protocol --- p.19
Chapter D. --- Selection of testing reference --- p.79
Chapter CHAPTER 3. --- ERROR DISTRIBUTION MODEL --- p.21
Chapter 3.1. --- Distribution assumption in current standards --- p.21
Chapter 3.2. --- Distribution analysis from published reports --- p.22
Chapter A. --- Methodology --- p.22
Chapter B. --- Data analysis --- p.23
Chapter C. --- Results --- p.23
Chapter 3.3. --- Distribution analysis on a cuff-less device --- p.29
Chapter A. --- Experiment --- p.29
Chapter B. --- Data analysis --- p.31
Chapter C. --- Results --- p.31
Chapter 3.4. --- Discussion --- p.33
Chapter A. --- Supporting evidence for t4 distribution --- p.33
Chapter B. --- Implications for the application of t4 distribution --- p.34
Chapter 3.5. --- Section Summary --- p.35
Chapter CHAPTER 4. --- EVALUATION SCALE TO ASSESS THE ACCURACY --- p.36
Chapter 4.1. --- Considerations for parameter selection --- p.37
Chapter A. --- Outlying errors and system bias --- p.37
Chapter B. --- Accuracy at different levels of blood pressure --- p.37
Chapter 4.2. --- Description of selected parameters --- p.38
Chapter 4.3. --- Theoretical relationship between “new´ح and “old´ح parameters --- p.38
Chapter A. --- Mathematical relationship --- p.39
Chapter B. --- Mapping relationship --- p.40
Chapter 4.4. --- Assessment of accuracy at increasing blood pressure levels --- p.41
Chapter A. --- Data transformation --- p.41
Chapter B. --- Experimental study --- p.41
Chapter 4.5. --- Discussion and application --- p.43
Chapter A. --- Parameter selection --- p.43
Chapter B. --- Sample size --- p.45
Chapter C. --- Accuracy criteria --- p.46
Chapter 4.6. --- Section summary --- p.47
Chapter CHAPTER 5. --- FEATURE ORIENTED PROTOCOL DESIGN --- p.48
Chapter 5.1. --- Rationale of accuracy assessment with BP change --- p.48
Chapter 5.2. --- Experiment one --- p.49
Chapter 5.3. --- Experiment two --- p.49
Chapter 5.4. --- Data analysis --- p.49
Chapter 5.5. --- Results --- p.50
Chapter A. --- Experiment one --- p.50
Chapter B. --- Experiment two --- p.52
Chapter 5.6. --- Discussion --- p.58
Chapter A. --- Difference between cuff-less and cuff-based devices --- p.58
Chapter B. --- Correlation between accuracy and blood pressure changes --- p.58
Chapter C. --- Inducement of blood pressure change --- p.59
Chapter D. --- Other factors affect the accuracy --- p.60
Chapter 5.7. --- Section summary --- p.61
Chapter CHAPTER 6. --- PROPOSAL FOR THE EVALUATION OF WEARABLE CUFF-LESS DEVICES --- p.62
Chapter 6.1. --- Scope --- p.62
Chapter 6.2. --- Purpose --- p.62
Chapter 6.3. --- Subject selection --- p.63
Chapter 6.4. --- Main validation --- p.64
Chapter A. --- Static test --- p.64
Chapter B. --- Test with blood pressure change --- p.65
Chapter C. --- Test after a certain period of time --- p.65
Chapter 6.5. --- Data analysis and reporting --- p.66
Chapter A. --- Statistical report --- p.66
Chapter B. --- Graphical representation --- p.67
Chapter 6.6. --- Conclusion and future work --- p.67
REFERENCES --- p.69
LIST OF PUBLICATIONS AND AWARDS --- p.78

Lee Chi Man.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2004.
Includes bibliographical references (leaves 112-121).
Abstracts in English and Chinese.
Chapter Chapter 1 --- Introduction --- p.1
Chapter 1.1 --- Objectives --- p.1
Chapter 1.2 --- Blood Pressure --- p.2
Chapter 1.3 --- Hypertension --- p.3
Chapter 1.3.1 --- Definition of Hypertension --- p.3
Chapter 1.3.2 --- Causes and Symptoms of Hypertension --- p.3
Chapter 1.3.3 --- Complication of Hypertension --- p.4
Chapter 1.3.4 --- Prevalence of Hypertension --- p.4
Chapter 1.4 --- Blood Pressure Measurement --- p.5
Chapter 1.4.1 --- History --- p.5
Chapter 1.4.2 --- Techniques and Methods --- p.7
Chapter 1.4.3 --- Current Devices --- p.13
Chapter 1.5 --- Organization of the Thesis --- p.16
Chapter Chapter 2 --- Theory --- p.18
Chapter 2.1 --- Introduction --- p.18
Chapter 2.2 --- Blood Rheology --- p.18
Chapter 2.2.1 --- Blood Composition --- p.18
Chapter 2.2.2 --- Flow Properties of Blood --- p.19
Chapter 2.2.3 --- Blood Vessels --- p.21
Chapter 2.3 --- Principle of the PTT-Based Blood Pressure Measurement --- p.22
Chapter 2.3.1 --- Wave Propagation in Blood Vessels --- p.22
Chapter 2.3.2 --- Pulse Transit Time (PTT) --- p.27
Chapter 2.3.3 --- Blood Pressure Measurement Based on PTT --- p.31
Chapter 2.4 --- Effects of Temperature on Blood Pressure --- p.34
Chapter 2.4.1 --- Human Body Temperature Regulation --- p.34
Chapter 2.4.2 --- Physiological Responses to Decreased Temperature --- p.36
Chapter 2.4.3 --- Effects of Temperature on Blood Pressure --- p.38
Chapter 2.5 --- Possible Effects of Temperature on PTT-Based Blood Pressure Measurement --- p.47
Chapter 2.5.1 --- Windkessel Model --- p.47
Chapter 2.5.2 --- Phase Velocity --- p.49
Chapter 2.5.3 --- Effects of temperature on PTT --- p.52
Chapter 2.5.4 --- Possible Effects of temperature on PTT-based Blood Pressure Measurement --- p.53
Chapter 2.6 --- Conclusion --- p.54
Chapter Chapter 3 --- Algorithms in Calculating Pulse Transit Time: Wavelet-Based and Derivative-Based --- p.55
Chapter 3.1 --- Introduction --- p.55
Chapter 3.1.1 --- Wavelet Transform (WT) --- p.56
Chapter 3.1.2 --- Wavelet Transform Modulus Maxima (WTMM) --- p.58
Chapter 3.2 --- Experiment --- p.60
Chapter 3.2.1 --- Subjects --- p.60
Chapter 3.2.2 --- Equipment and Sensors --- p.61
Chapter 3.2.3 --- Protocol --- p.61
Chapter 3.3 --- Methods --- p.62
Chapter 3.3.1 --- Wavelet-Based Algorithm of PTT Calculation --- p.62
Chapter 3.3.2 --- Derivative-Based Algorithm of PTT Calculation --- p.65
Chapter 3.3.3 --- PTT-Based Blood Pressure Estimation --- p.67
Chapter 3.4 --- Results --- p.68
Chapter 3.5 --- Discussion --- p.70
Chapter 3.6 --- Conclusion --- p.72
Chapter Chapter 4 --- Effects of Ambient Temperature on PTT-Based Blood Pressure Estimation --- p.74
Chapter 4.1 --- Introduction --- p.74
Chapter 4.2 --- Experiment --- p.74
Chapter 4.2.1 --- Subjects --- p.74
Chapter 4.2.2 --- Equipment --- p.75
Chapter 4.2.3 --- Protocol --- p.76
Chapter 4.3 --- Methods --- p.77
Chapter 4.3.1 --- Features of Photoplethysmographic Signals --- p.78
Chapter 4.3.2 --- Calculation of Pulse Transit Time (PTT) --- p.78
Chapter 4.4 --- Results --- p.79
Chapter 4.4.1 --- "Effects of Ambient Temperature on Blood Pressure, Heart Rate and Finger Skin Temperature" --- p.79
Chapter 4.4.2 --- Effects of Ambient Temperature on the Features of Photoplethysmographic Signals --- p.82
Chapter 4.4.3 --- Effects of Ambient Temperature on Pulse Transit Time --- p.84
Chapter 4.4.4 --- PTT-Based Blood Pressure Estimation --- p.85
Chapter 4.4.6 --- Evaluation of the Modified Equations of the PTT-Based Blood Pressure Measurement Approach --- p.89
Chapter 4.5 --- Discussion --- p.94
Chapter 4.6 --- Conclusion --- p.98
Chapter Chapter 5 --- Effects of Local Temperature on PTT-Based Blood Pressure Estimation --- p.99
Chapter 5.1 --- Introduction --- p.99
Chapter 5.2 --- Methods --- p.99
Chapter 5.3 --- Results --- p.100
Chapter 5.3.1 --- "Effects of Local Temperature on Blood Pressure, Heart Rate and Finger Skin Temperature" --- p.100
Chapter 5.3.2 --- Effects of Local Temperature on Pulse Transit Time --- p.102
Chapter 5.3.3 --- Effects of Local Temperature on the Features of Photoplethysmographic Signal --- p.103
Chapter 5.3.4 --- Effects of Local Temperature on PTT-Based Blood Pressure Estimation --- p.104
Chapter 5.4 --- Discussion --- p.105
Chapter 5.5 --- Conclusion --- p.107
Chapter Chapter 6 --- Conclusion and Future Study --- p.108
Chapter 6.1 --- Major Contributions --- p.108
Chapter 6.2 --- Future Study --- p.110
References --- p.112
Chapter Appendix A --- Motion Artifact Reduction from PPG signal Based on a Wavelet Approach --- p.122
Chapter A.l --- Introduction --- p.122
Chapter A.1.1 --- Motion Artifact --- p.122
Chapter A.1.2 --- Stationary Wavelet Transform (SWT) --- p.123
Chapter A.2 --- Experiment --- p.124
Chapter A.2.1 --- Subjects --- p.124
Chapter A.2.2 --- Equipment --- p.124
Chapter A.2.3 --- Protocol --- p.125
Chapter A.3 --- Methods --- p.126
Chapter A.3.1 --- Algorithm --- p.126
Chapter A.3.2 --- Data Analysis --- p.128
Chapter A.4 --- Results --- p.129
Chapter A.5 --- Discussion --- p.131
Chapter A.6 --- Conclusion --- p.133
Reference --- p.133
Appendix B Derivation of the Moens-Korteweg Equation --- p.134
Reference --- p.136

Liu, Yinbo.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2008.
Includes bibliographical references (leaves 74-79).
Abstracts in English and Chinese.
Abstract --- p.i
List of Figures --- p.iv
List of Tables --- p.viii
Introduction --- p.1
Chapter 1.1 --- Current status of Blood Pressure Management --- p.1
Chapter 1.2 --- Current Status of Noninvasive Blood Pressure Measurement Techniques --- p.4
Chapter 1.3 --- Motivations and Objectives of This Thesis --- p.9
Chapter 1.4 --- Organization of This Thesis --- p.9
Backgrounds --- p.11
Chapter 2.1 --- Principle of the Pulse Transit Time-based Approach for BP Measurement --- p.11
Chapter 2.1.1 --- General Descriptions --- p.11
Chapter 2.1.2 --- Pressure Wave Propagation in Cylindrical Arteries --- p.13
Chapter 2.1.3 --- Determining the PTT for BP Measurement --- p.14
Chapter 2.2 --- Backgrounds for Pressure Related Elastic Properties of Artery --- p.17
Chapter 2.2.1 --- Transmural Pressure and Its Components --- p.17
Chapter 2.2.2 --- Volume-pressure Models --- p.19
Chapter 2.2.3 --- Types and Structure of the Artery and Its Properties --- p.20
Chapter 2.3 --- Literature Review on the Calibration Methods for Cuffless Blood Pressure Measurements --- p.22
Chapter 2.4 --- Section Summary --- p.25
Investigations on Factors Affecting PTT or BP --- p.26
Chapter 3.1 --- The Effects of External Pressure --- p.26
Chapter 3.1.1 --- Background --- p.26
Chapter 3.1.2 --- Experimental protocol --- p.28
Chapter 3.1.3 --- Analysis for the Effects of External Pressure on PTT --- p.30
Chapter 3.1.4 --- Section Discussions --- p.31
Chapter 3.2 --- The Effects of Hydrostatic Pressure --- p.32
Chapter 3.2.1 --- Experimental protocol --- p.33
Chapter 3.2.2 --- Analysis for the Effects of Hydrostatic Pressure on PTT --- p.34
Chapter 3.2.3 --- Section Discussions --- p.37
Chapter 3.2.4 --- Section Summary --- p.38
Modeling the Effect of Hydrostatic Pressure on PTT for A Calibration Method --- p.39
Chapter 4.1 --- Current Status of Hydrostatic Calibration Approaches --- p.39
Chapter 4.2. --- Modeling Pulse Transit Time under the Effects of Hydrostatic Pressure for A Hydrostatic Calibration Method: --- p.40
Chapter 4.2.1 --- Basic BP-PTT model --- p.40
Chapter 4.2.2 --- V-P relationship Represented by a Sigmoid Curve --- p.40
Chapter 4.2.3 --- Relating PTT with Hydrostatic Pressure --- p.41
Chapter 4.2.4 --- Implementing the Hydrostatic Calibration Method for BP Estimation --- p.43
Chapter 4.3. --- Preliminary Experiment --- p.44
Chapter 4.3.1. --- Experimental Protocol and Methodology --- p.44
Chapter 4.3.2. --- Experimental Analysis --- p.46
Chapter 4.4. --- Section Discussions --- p.48
Chapter 4.5. --- A Novel Implementation Algorithm of Hydrostatic Calibration Method for Cuffless BP Estimation --- p.49
Chapter 4.6. --- Section Summary --- p.50
Experimental Studies for the Hydrostatic Calibration Approach --- p.51
Chapter 5.1 --- Experimental Analysis --- p.51
Chapter 5.1.1 --- Experimental Protocol --- p.51
Chapter 5.1.2 --- Methodology --- p.53
Chapter 5.1.3 --- Preparations --- p.54
Chapter 5.1.4 --- Experimental Results --- p.56
Chapter 5.2 --- Section Discussions --- p.63
Chapter 5.3 --- Section Summary --- p.70
Conclusions and Suggestions for Future Works --- p.71
Chapter 6.1 --- Conclusions --- p.71
Chapter 6.2 --- Suggestions for Future Works --- p.72
Reference --- p.71

Cardiovascular diseases (CVD) are the leading cause of death. It is also one of the major factors resulting sudden deaths in exercises. Blood pressure (BP) is one of the vital diagnostic parameters to reflect the functionality of cardiovascular system and evaluate the conditions of CVD. However, current BP measuring devices usually require the occlusion of cuff that causes inconvenience to users during measurement. They are neither suitable nor practical for long-term monitoring. Pulse transit time (PTT), the duration for a pressure pulse wave to travel from one arterial site to another, has been proposed as a potential parameter for cuffless BP measurement in recent decades. Because of its cuffless and non-invasive measuring features, the aim of the present study is to develop a novel PTT-based BP estimation for cuffless and non-invasive monitoring of BP under resting and exercise conditions.
The accuracy of proposed method for continuous BP monitoring has been evaluated on seventeen subjects during cycling. Brachial BP was measured by FinapresRTM (Fin. BP) and a trained nurse (Nur. BP). In approximate 22000 beats, the differences between predictions and Fin. BP were 1.3+/-13.0 mmHg for SBP and -1.5+/-6.1 mmHg for DBP respectively. The intermittent BP measurements using the proposed method were compared to the readings from FinapresRTM and nurse separately. The differences between proposed method and Nur. BP were 0.9+/-9.9 mmHg for SBP and -1.2+/-5.2 mmHg for DBP respectively. The differences between proposed method and Fin. BP were -0.1+/-12.6 mmHg for SBP and -1.4+/-5.9 mmHg for DBP respectively. The predictions using the proposed method were more consistent with the nurse readings. Furthermore, thorax impedance signal was proposed for cuffless BP estimation and it was examined on twenty-two subjects. The results illustrated that proposed parameters, measured from Q wave of electrocardiogram to the peaks of thorax impedance signal and its derivative, were highly correlated with BP. They were potential parameters to provide non-invasive and cuffless BP estimation.
To conclude, the accuracy of proposed method was comparable to the cuff-based approaches under resting and exercise conditions. This work is potential to solve the problems due to prevalence of CVD and rising aging population. (Abstract shortened by UMI.)
Wong, Yee Man.
Adviser: Y. T. Zhang.
Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3650.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2008.
Includes bibliographical references.
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts in English and Chinese.
School code: 1307.

Consequently, this study aims to develop novel technologies that can measure BP non invasively and continuously without a cuff. The proposed method estimates BP using features including pulse transit time (PTT), which is defined as the time interval from R wave of electrocardiogram to onset of photoplethysmogram within the same heart cycle.
Despite the importance of controlling blood pressure (BP) to our health, BP remains inadequately managed worldwide. Due to global ageing and change of human lifestyles, the number of hypertensives is anticipated to continue rising from approximately 1 billion in 2000 to 1.56 billion by 2025. A stumbling block to BP management is high BP usually develops without obvious symptoms. As a result, many people are unaware of their condition until severe problems such as a stroke, a heart attack or kidney failure have occurred. In China, over 100 million people do not know they have developed hypertension and are living under a potential risk to their health. In addition to high BP, variations of BP are also independent indicators of morbidity and mortality of severe diseases. Yet, sudden changes in BP are difficult to be detected by state-of-the-art BP meters, which operate on principles that require an inflatable cuff to give only a snapshot of BP.
Lastly, since the technology required information from several sensors that are placed on different body parts of a person, development of body area network (BAN) has been an important research focus. The concluding chapter of this thesis presents a new concept in this area, namely the hybrid body area network (h-BAN). In particular, the use of biological channels (bio-channels) for intra-BAN communication and securing wireless intra-BAN communication is discussed.
Nevertheless, a major challenge of this approach is its requirement of a calibration procedure. One possible solution is to calibrate against a cuff-based device, but this is inconvenient particularly when calibration has to be refreshed from time to time. Therefore, a bio-model is proposed and developed for PTT along an artery where the hydrostatic component of BP varies. The model can be applied to calibrate the cuffless PTT-based approach and estimate BP by simple movements such as hand elevation. Several experiments were conducted to validate the assumptions of this model and the results were found to be promising.
The proposed PTT-based technology was evaluated on 85 subjects (aged 57+/-29 yrs., including 39 hypertensives) whilst they were at rest in a sitting posture. A total of 999 pairs of systolic BP (SBP) and diastolic BP (DBP) estimations were made with reference to conventional cuff-based devices (i.e. a mercury sphygmomanometer and an oscillometric device) over a period of 6.4 weeks. The results of the study show that reference and estimated BP differed by 0.4+/-9.3 mmHg and 0.8+/-5.8 mmHg for SBP and DBP respectively (AAMI required mean and SD to be less than 5 and 8 mmHg correspondingly).
The results of both studies show that the accuracy of the PTT-based technique is comparable to the cuff-based approaches. This technique is potentially useful to measure BP continuously.
To conclude, this work developed a non-invasive and cuffless approach for BP measurement and addressed several key issues of this approach, i.e. the analysis, calibration, and implementation of it. The work can help to realise new BP management schemes in mobile health (m-Health) and personalised healthcare systems, which are developed to cater for the needs of the increasing aging population world-wide and to prevent and control chronic diseases like hypertension.
To further the investigation, a second study which was to investigate in a clinical setting for post-operation condition, was carried out on 8 patients (aged 55+/-18 yrs.) using the averaged invasive arterial-line and cuff readings taken at intervals of 40.0+/-24.7 min. as reference. After calibrating the new approach on each individual, it can estimate SBP and DBP within 3.3+/-6.5 mmHg and 4.3+/-6.4 mmHg of the reference for the complete set of 89 estimations.
Poon, Chung Yan Carmen.
"December 2007."
Adviser: Yuon-Ting Zhang.
Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4888.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2007.
Includes bibliographical references (p. 91-103).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts in English and Chinese.
School code: 1307.

Xiang Xiaoyan.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2006.
Includes bibliographical references.
Abstracts in English and Chinese.
Chapter Chapter 1 --- Introduction --- p.1
Chapter 1.1 --- Background of Hypertension --- p.1
Chapter 1.1.1 --- Definition of Blood Pressure --- p.1
Chapter 1.1.2 --- Hypertension and Its Prevalence --- p.2
Chapter 1.2 --- Blood Pressure Measurement Techniques --- p.5
Chapter 1.2.1 --- Invasive Blood Pressure Measurement Techniques --- p.5
Chapter 1.2.2 --- Non-invasive Blood Pressure Measurement Techniques --- p.6
Chapter 1.3 --- Accurate BP Measurements --- p.12
Chapter 1.3.1 --- Error Source for BP Measurement by Conventional Techniques --- p.12
Chapter 1.3.2 --- Accurate BP Measurement --- p.13
Chapter 1.4 --- Objectives of the Thesis --- p.15
Chapter 1.5 --- Organization of the Thesis --- p.16
References --- p.17
Chapter Chapter 2 --- Current Standards for the Conventional Blood Pressure Measurement Devices --- p.20
Chapter 2.1 --- Introduction --- p.20
Chapter 2.2 --- Current Standards for the Cuff-based BP Measurement Devices --- p.21
Chapter 2.2.1 --- AAMI Standard --- p.21
Chapter 2.2.2 --- BHS Protocol --- p.22
Chapter 2.2.3 --- Other Protocols --- p.23
Chapter 2.3 --- Comparison of the 2002 AAMI and 1993 BHS Protocols - Protocol Setup --- p.25
Chapter 2.4 --- Comparison of the 2002 AAMI and 1993 BHS Protocols 一 Accuracy Criteria --- p.29
Chapter 2.5 --- Relationship between the AAMI Accuracy Criteria and the BHS Grading System --- p.31
Chapter 2.5.1 --- Theoretical Mapping Relationship --- p.31
Chapter 2.5.2 --- Application of the Mapping Model: Estimate the BHS Grades from the Reported Sample ME and SD --- p.34
Chapter 2.5.3 --- Application of the Mapping Model: Explain the Evaluation of the Results from the Clinical Survey by the ESH --- p.36
Chapter 2.6 --- Discussion --- p.36
References --- p.40
Chapter Chapter 3 --- Distribution Analysis of the Blood Pressure Measurement Errors --- p.42
Chapter 3.1 --- Introduction --- p.42
Chapter 3.2 --- Error Distribution Estimated from the Published Data --- p.43
Chapter 3.2.1 --- Methodology --- p.43
Chapter 3.2.2 --- Data Analysis --- p.44
Chapter 3.2.3 --- Session Summary --- p.46
Chapter 3.3 --- Error Distribution Estimated from the Experimental Data --- p.46
Chapter 3.3.1 --- BP Measurement Error Obtained from Automatic BP Meter --- p.46
Chapter 3.3.2 --- Distribution Analysis by the Normal Quantile-Quantile Plot --- p.47
Chapter 3.3.3 --- Background of Student's t Distribution --- p.48
Chapter 3.3.4 --- Parameter Estimation - Maximum Likelihood Method --- p.50
Chapter 3.3.5 --- Goodness-of-fit Test - Kolmogorov-Smirnov Test --- p.53
Chapter 3.3.6 --- Goodness-of-fit Test ´ؤ Chi-Square Test --- p.56
Chapter 3.4 --- Discussion --- p.63
References --- p.65
Chapter Chapter 4 --- A Model Based Study of the Parameters Used by Existing Standards --- p.67
Chapter 4.1 --- Introduction --- p.67
Chapter 4.2 --- Background of Method Comparison Study --- p.68
Chapter 4.2.1 --- Four Areas in Method Comparison Study --- p.68
Chapter 4.2.2 --- Analysis of Previous Methodology and Statistical Parameters --- p.70
Chapter 4.3 --- Theoretical Mapping Relationship: Based on the General t Distribution --- p.72
Chapter 4.3.1 --- "Relationship among CP5, CP10 and CP15 in Each Grade for the 1993 BHS Protocol" --- p.76
Chapter 4.3.2 --- Relationships between the Criteria in Each Grade for the 1993 BHS Protocol and the AAMI Standard --- p.77
Chapter 4.3.3 --- Comparison of Parameters --- p.80
Chapter 4.4 --- Mean of the Absolute Errors (MAE) and Its Estimation --- p.81
Chapter 4.4.1 --- The Relationship between MAE and Other Parameters --- p.81
Chapter 4.4.2 --- Analysis of the Example Data --- p.84
Chapter 4.4.3 --- Estimation of MAEt --- p.84
Chapter 4.5 --- Discussion --- p.88
References --- p.90
Chapter Chapter 5 --- Experimental Study and an Evaluation Protocol Proposed for the Wearable BP Measurement Devices --- p.92
Chapter 5.1 --- Introduction --- p.92
Chapter 5.2 --- Description of the Experiment --- p.93
Chapter 5.3 --- Data Analysis --- p.95
Chapter 5.3.1 --- Data Used for the Study --- p.95
Chapter 5.3.2 --- Error Distribution Analysis --- p.96
Chapter 5.3.3 --- Evaluation of the Automatic BP Meter and the PTT-Based BP Measurement Device by AAMI and 1993 BHS Standards --- p.99
Chapter 5.3.4 --- Evaluation the Automatic BP Meter and the PTT-Based BP Measurement Device by the Proposed Parameter --- p.101
Chapter 5.4 --- Proposed Evaluation Procedure --- p.101
Chapter 5.4.1 --- Introduction --- p.101
Chapter 5.4.2 --- Determination of Parameters and Criteria --- p.102
Chapter 5.4.3 --- Proposed Evaluation Procedure --- p.103
Chapter 5.5 --- Discussion --- p.105
References --- p.108
Chapter Chapter 6 --- Conclusion and Future Work --- p.110
Chapter 6.1 --- Conclusion and Major Contributions --- p.110
Chapter 6.2 --- Future Works --- p.113
References --- p.115
Appendix A Deviation of Some Equations --- p.116
Chapter A.1 --- CP for Certain Limit of L as a Function of ME and SD --- p.116
Chapter A.2 --- MAE as a Function of Location and Scale Parameters --- p.119
Chapter A.3 --- "Relationship between ME, MAE and Root Mean Squared Error (RMSE) if the error distribution is unknown" --- p.121
Appendix B List of Publications and Awards Related to This Study --- p.123

心血管疾病持續成為世界上第一大死亡原因。在眾多危險因素中，動脈血壓，尤其是夜間血壓和血壓變化率，是心血管疾病發病率和死亡率的關鍵指標。
由於需要用到充氣式袖帶，現有的血壓測量技術只能提供瞬時血壓，並且使用起來極不舒適。因此，本文致力於研究另一種無袖帶式血壓測量方法。此方法的原理基於血壓波在血管上的傳導速度，即脈搏波傳導速度（PWV）取決於血壓作用下的血管力學特性。因此，血壓可以從脈搏波傳導速度，或者其倒數：脈搏波傳輸時間（PTT）估計得到。由於脈搏波傳導時間可以方便的從心電信號及光電容積描記信號獲取，這種新型的無袖帶式血壓測量技術近年來備受關注。
現有的基於脈搏波傳輸時間的血壓估計方法建立於一個被動的，薄壁的和均質的血管模型。但是，真實的血管卻是由彈性蛋白，膠原纖維和平滑肌共同組成的具有特殊層次結構的管道。事實上，以往許多研究已經表明了血管緊張度（VSM tone），即血管壁平滑肌細胞的激活程度，能顯著改變血管力學特性進而使脈搏波傳輸時間與血壓的關係惡化。特別地，血管緊張度主要受控于自主神經系統，尤其是交感神經系統。因此，本論文的目的在於研究自主神經系統對基於脈搏波傳輸時間的血壓估計的影響。
首先，基於血管微結構力學模型和Bramwell-Hill公式，本文建立了一個基於血管組分的脈搏波傳輸時間-血壓模型。并在此基礎上，推導出一個融合了血管結構和功能特性的解析數學公式來表徵脈搏波傳導時間和血壓的關係。仿真結果顯示，隨著血管緊張度增高，脈搏波傳輸時間-血壓曲綫會移向右上方，造成滯變現象（hysteresis）。
其次，爲了研究自主神經系統對血壓，脈搏波傳輸時間及心率的調節機制，本文利用時頻分析技術，對來自9個健康測試者跑步運動前後的實驗數據進行了分析。結果顯示，僅心率這一參數表現出運動中首先迷走神經活動減弱，然後交感神經增強的機制。此外，分析結果表明脈搏波傳輸時間與血壓的關係是頻率相關的。
爲了進一步研究自主神經系統在吞咽動作過程中對心血管參數的調控作用，本文設計了喝水實驗。對32個健康測試者的實驗數據分析結果表明，在喝水過程中，心率和血壓顯著上升，脈搏波傳輸時間顯著下降。另一方面，基於之前脈搏波傳輸時間與血壓的頻變關係的研究發現，本文設計了一種新的基於脈搏波傳輸時間，利用頻段特定的序列技術，來估計壓力反射敏感性（BRS）的新方法，並利用喝水實驗數據進行了驗證。結果顯示，利用此方法估計和利用傳統的利用血壓計算出的壓力反射敏感性具有高相關性（喝水前，中，后過程中，相關係數分別為0.90，0.70和0.81）。
最後，爲了驗證自主神經系統調控下的血管緊張度對脈搏波傳輸時間和血壓關係的影響，本文對來自46名測試者，其中包括17名心血管疾病患者，在人體仰臥姿態下的漸進式腳踏車運動實驗中的數據進行了分析。結果證實了仿真實驗中顯示的脈搏波傳輸時間和血壓的滯變現象。另外，本文提出了兩個新型量化指標衡量此滯變現象，即AreaN和ΔSBP20。結果顯示，相比于健康人，心血管疾病患者的滯變現象幅度顯著減弱，這與此類患者通常伴隨有交感神經系統過度活躍相關。基於以上發現，本文進一步提出利用AreaN和ΔSBP20來評估交感神經系統功能的建議。
綜上所述，本論文從理論和實驗的雙重角度研究了自主神經系統對脈搏波傳輸時間和血壓關係的影響。此工作將有利於提高基於脈搏波傳輸時間的血壓估計技術的準確度，并進一步對控制心血管疾病做出貢獻。
Cardiovascular diseases (CVDs) remain the number one cause of death worldwide. Amongst various risk factors, arterial blood pressure (BP), especially BP measured during nighttime, and BP variability are major indicators of cardiovascular morbidity and mortality.
Most of the state-of-the-art BP meters are designed with an inflatable cuff, which provide snapshots of BP and are uncomfortable during measurements. An alternative cuffless BP measurement approach is therefore studied in this work. The estimation principle is derived based on the fact that velocity of a pressure wave propagating along an artery, i.e., pulse wave velocity (PWV) is related to the pressure-dependent mechanical property of the artery. Thus, BP can be possibly estimated from PWV, or its reciprocal, pulse transit time (PTT), which can be conveniently acquired from electrocardiogram and photoplethysmogram without using an inflatable cuff.
The current PTT-based BP estimation was built on a model that assumes the artery to be a passive, thin-wall and homogeneous tube. However, arterial wall in reality exhibits a specific layered structure and consists of elastin, collagen fibers and smooth muscles. In fact, the PTT-BP relationship was found by many studies to be easily deteriorated by vasoconstriction/dilation, which reflects the vascular smooth muscle (VSM) activation level, i.e., VSM tone. In particular, innervating most blood vessels, the autonomic nervous system (ANS), primarily sympathetic nervous system, plays an important role in determining the arterial mechanical behavior thus PTT-BP relationship via regulating the VSM tone. It is therefore the aim of this thesis to investigate the effects of ANS on the PTT-based BP estimation.
Firstly, a constituent-based PTT-BP model was developed in the thesis, based on the micro-structurally motivated arterial mechanical model and Bramwell-Hill equation. Specifically, analytic PTT-BP relationship incorporating arterial structural and functional properties was deduced. Theoretical effects of various arterial properties on the relationship have been evaluated by simulation. The results revealed that PTT-BP curve will shift to the top right when VSM tone elevates, producing PTT-BP hysteresis.
Next, the mechanism of regulation of BP, PTT as well as heart rate (HR) by ANS was evaluated in 9 normotensive subjects in treadmill exercise by using time-frequency technique. Vagal withdrawal and subsequent sympathetic activity enhancement by exercise have been observed in only HR. In addition, the results indicate a frequency-dependent PTT-BP relationship.
Then we conducted water drinking experiments in a total of 32 healthy subjects to investigate the ANS controlled cardiovascular responses by the act of swallowing. Significant increment in HR and BP, and decrease in PTT were observed during drinking. On the other hand, considering the frequency-dependent nature of PTT-BP relationship, a novel method that estimates baroreflex sensitivity (BRS) from PTT based on the band-specified sequence technique has been proposed. The results showed high correlations between BRS estimated from BP and PTT. (γ=0.90, 0.70 and 0.81 before, during and after drinking respectively).
Lastly, the effects of ANS mediated VSM tone on the PTT-BP relationship were validated in 46 subjects including 17 patients with CVDs in graded bicycle exercise stress test in supine position. The results demonstrated PTT-BP hysteresis as predicted by the simulation. Furthermore, two novel parameters, i.e., AreaN and ΔSBP20 were proposed to evaluate the hysteresis phenomenon. Significant attenuation was observed in CVD patients with sympathetic overactivity. The two quantifications were proposed accordingly to be indices for assessing sympathetic function.
To conclude, this work addressed the effects of ANS on the PTT-BP relationship from both theoretical and experimental aspects. The work can help to improve the accuracy of PTT-based BP estimation and CVD control.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Detailed summary in vernacular field only.
Liu, Qing.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references.
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts also in Chinese.
Abstract --- p.i
Acknowledgement --- p.v
List of figures --- p.vi
List of tables --- p.x
List of abbreviations --- p.xi
Chapter Chapter 1. --- Introduction --- p.1
Chapter 1.1. --- Current Status of Blood Pressure Management --- p.1
Prevalence of Cardiovascular Diseases --- p.1
Healthcare System Transformation --- p.2
Blood Pressure A Crucial Role in CVD Control --- p.4
Chapter 1.2. --- Overview of Blood Pressure Measurement Techniques --- p.7
Chapter 1.3. --- Motivations and Objectives of the Thesis --- p.15
Chapter 1.4. --- Organization of the Thesis --- p.16
References: --- p.17
Chapter Chapter 2. --- Basics of Cardiovascular System, Autonomic Nervous System and PTT-BP Relationship --- p.20
Chapter 2.1. --- Cardiovascular System --- p.20
Heart Physiology --- p.20
Arterial Physiology --- p.24
Chapter 2.2. --- Autonomic Nervous System --- p.35
Autonomic Histology and Pharmacology --- p.35
Autonomic Nervous Control of Cardiovascular System --- p.37
Assessment of ANS Activity --- p.41
Chapter 2.3. --- PWV and Its Relationship with BP --- p.43
Pulse Wave Velocity --- p.44
PWV-BP Relationship --- p.50
Chapter 2.4. --- Section Summary --- p.54
References: --- p.55
Chapter Chapter 3. --- A Model-based Study on the Effects of Arterial Properties on the Relationship between Pulse Transit Time and Blood Pressure --- p.62
Chapter 3.1. --- Introduction to Constitutive Modeling of Arteries --- p.62
Experimental Methods --- p.63
Modeling of Mechanical Behavior: Pressure-Radius Relationship --- p.64
Chapter 3.2. --- A Novel Constitutive Model of the Relationship between PTT and BP --- p.76
Chapter 3.3. --- Simulation Study of Effects of Arterial Properties on the PTT-BP Relationship --- p.82
Chapter 3.4. --- Section Summary --- p.93
References: --- p.94
Chapter Chapter 4. --- Evaluation Study on the Autonomic Nervous System Control of Heart Rate, Blood Pressure and Pulse Transit Time Before and After Dynamic Exercise --- p.96
Chapter 4.1. --- Introduction --- p.96
Chapter 4.2. --- Methodology --- p.98
Experiment Protocol --- p.98
Signal Processing and Spectral Estimation --- p.99
Chapter 4.3. --- Results --- p.101
Chapter 4.4. --- Discussion --- p.104
Chapter 4.5. --- Section Summary --- p.108
References: --- p.110
Chapter Chapter 5. --- Investigation on Autonomic Nervous System Control of Heart Rate, Blood Pressure and Pulse Transit Time During Water Drinking --- p.113
Chapter 5.1. --- Responses of HR, BP and PTT during Water Drinking --- p.113
Chapter 5.1.1. --- Introduction --- p.113
Chapter 5.1.2. --- Methodology and Results --- p.115
Chapter 5.1.3. --- Discussion and Conclusion --- p.118
Chapter 5.2. --- Potential Application of PTT in Baroreflex Sensitivity Assessment --- p.121
Chapter 5.2.1. --- Introduction --- p.121
Chapter 5.2.2. --- Methodology --- p.122
Chapter 5.2.3. --- Discussion and Conclusion --- p.125
Chapter 5.3. --- Section Summary --- p.127
References: --- p.129
Chapter Chapter 6. --- Experimental Validation of the ANS Effects on the Relationship between Pulse Transit Time and Blood Pressure in Human Stress Test --- p.131
Chapter 6.1. --- Introduction --- p.131
Chapter 6.2. --- Methodology --- p.133
Chapter 6.3. --- Results --- p.137
Chapter 6.4. --- Discussion and Conclusion --- p.139
Chapter 6.5. --- Section Summary --- p.144
References: --- p.145
Chapter Chapter 7. --- Conclusions and Suggestions for Future Work --- p.148
Chapter 7.1. --- Summary --- p.148
Chapter 7.1.1. --- A model-based study on the effects of arterial properties on the PTT-BP relationship --- p.148
Chapter 7.1.2. --- Evaluation study on the ANS control of HR, BP and PTT before and after dynamic exercise --- p.149
Chapter 7.1.3. --- Investigation on ANS control of HR, BP and PTT during water drinking --- p.150
Chapter 7.1.4. --- Experimental validation of the ANS mediated VSM tone on the PTT-BP relationship --- p.151
Chapter 7.2. --- Suggestions for Future Work --- p.152
Chapter 7.2.1. --- Modifications on the constituent-based PTT-BP model --- p.152
Chapter 7.2.2. --- Improvement of PTT-based BP estimation by considering VSM tone effects --- p.153
Chapter 7.2.3. --- Improvement of PTT-based BP estimation by considering the frequency-dependent PTT-BP relationship --- p.154
Chapter 7.2.4. --- Validation of the PTT-BP hysteresis quantifications to be indicators of sympathetic function --- p.154
References: --- p.155
Appendix --- p.156
List of Publications --- p.156

Teng Xiaofei.
"June 2004."
Thesis (Ph.D.)--Chinese University of Hong Kong, 2004.
Includes bibliographical references.
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Mode of access: World Wide Web.
Abstracts in English and Chinese.

Chan Ka Wing.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2002.
Includes bibliographical references.
Abstracts in English and Chinese.
Chapter Chapter 1 --- Introduction --- p.1
Chapter 1.1 --- Objectives --- p.1
Chapter 1.2 --- Definitions --- p.2
Chapter 1.2.1 --- Definition of blood pressure --- p.2
Chapter 1.2.2 --- Definition of hypertension --- p.3
Chapter 1.3 --- Problems related to hypertension --- p.4
Chapter 1.4 --- The importance of measuring blood pressure --- p.4
Chapter 1.4.1 --- Self-measurement of blood pressure --- p.5
Chapter 1.4.2 --- Ambulatory blood pressure measurement --- p.5
Chapter 1.5 --- Review of blood pressure measurement techniques --- p.7
Chapter 1.5.1 --- The invasive method --- p.7
Chapter 1.5.2 --- Noninvasive methods --- p.8
Chapter 1.6 --- Review of currently available blood pressure meters --- p.15
Chapter 1.7 --- Prevalence of hypertension --- p.19
Chapter 1.7.1 --- Hong Kong --- p.19
Chapter 1.7.2 --- Worldwide --- p.20
Chapter 1.8 --- The market for blood pressure meters --- p.21
Chapter 1.9 --- Organization of the thesis --- p.22
References --- p.24
Chapter Chapter 2 --- Measurement of the ECG-PPG interval --- p.30
Chapter 2.1 --- Introduction --- p.30
Chapter 2.1.1 --- Pulse transit time (PTT) --- p.30
Chapter 2.1.2 --- Electrocardiogram (ECG) --- p.36
Chapter 2.1.2.1 --- Measurement of the ECG signal --- p.37
Chapter 2.1.3 --- Photoplethysmography (PPG) --- p.38
Chapter 2.1.3.1 --- Measurement of the PPG signal --- p.41
Chapter 2.1.4 --- Measurement of blood pressure by ECG-PPG interval --- p.43
Chapter 2.2 --- Source of errors for measurement of the ECG-PPG interval --- p.44
Chapter 2.2.1 --- Effects of variability of ECG-PPG intervals --- p.44
Chapter 2.2.2 --- Effects of bending the arm --- p.49
Chapter 2.2.3 --- Effects of an external force --- p.54
Chapter 2.3 --- Conclusion --- p.60
References --- p.62
Chapter Chapter 3 --- Cuffless and Noninvasive Measurement of Blood Pressure --- p.68
Chapter 3.1 --- Introduction --- p.68
Chapter 3.2 --- Effects of subject-dependent calibration --- p.74
Chapter 3.3 --- Effects of different time intervals --- p.81
Chapter 3.4 --- The impact of using different Q-P intervals --- p.96
Chapter 3.5 --- Real-time measurement of blood pressure --- p.104
Chapter 3.6 --- Conclusion --- p.108
References --- p.110
Chapter Chapter 4 --- Motion Artifact Reduction from PPG Recordings in Ambulatory Blood Pressure Measurement --- p.114
Chapter 4.1 --- Introduction --- p.114
Chapter 4.2 --- Previous works --- p.115
Chapter 4.3 --- Theory --- p.116
Chapter 4.3.1 --- The adaptive filter --- p.117
Chapter 4.3.2 --- Variation of step-size parameters --- p.119
Chapter 4.3.3 --- Effects of filter length --- p.120
Chapter 4.4 --- Experiment --- p.121
Chapter 4.5 --- Results --- p.123
Chapter 4.6 --- Discussion --- p.131
Chapter 4.7 --- Conclusion --- p.133
References --- p.135
Chapter Chapter 5 --- Measurement of Blood Pressure using the PPG signal --- p.138
Chapter 5.1 --- Introduction --- p.138
Chapter 5.2 --- Theory --- p.138
Chapter 5.3 --- Experiment --- p.142
Chapter 5.3.1 --- Multiple linear regression (MLR) --- p.142
Chapter 5.3.2 --- Artificial neural networks (ANNs) --- p.146
Chapter 5.3.3 --- Results --- p.149
Chapter 5.3.4 --- Discussion --- p.152
Chapter 5.4 --- The implementation of the Q-P interval --- p.153
Chapter 5.4.1 --- Results --- p.154
Chapter 5.4.2 --- Discussion --- p.156
Chapter 5.5 --- Conclusion --- p.157
References --- p.158
Chapter Chapter 6 --- Conclusion and Future Studies --- p.160
Chapter 6.1 --- Major contributions --- p.160
Chapter 6.2 --- Future studies --- p.162
References --- p.165
Appendix I --- p.166

Gu Yingying.
Thesis (M.Phil.)--Chinese University of Hong Kong, 2004.
Includes bibliographical references (leaves 155-164).
Abstracts in English and Chinese.
Chapter 1 --- Introduction --- p.1
Chapter 1.1 --- IPFM Model --- p.1
Chapter 1.1.1 --- Description of IPFM Model --- p.1
Chapter 1.1.2 --- Background of IPFM Related Modeling --- p.3
Chapter 1.2 --- Windkessel Model --- p.8
Chapter 1.2.1 --- Background of the Windkessel Model --- p.8
Chapter 1.2.2 --- Windkessel Related Modeling --- p.13
Chapter 1.3 --- Photoplethysmogram (PPG) --- p.14
Chapter 1.3.1 --- Principle of PPG --- p.14
Chapter 1.3.2 --- Characteristics of PPG Signal --- p.16
Chapter 1.4 --- A Study on the Beat-to-Beat BPV --- p.18
Chapter 1.5 --- Main Purposes of the Study --- p.19
Chapter 1.6 --- Organization of the Thesis --- p.20
Chapter 2 --- Spectral Analysis on the IPFM Process --- p.22
Chapter 2.1 --- Introduction --- p.22
Chapter 2.2 --- A Theoretical Study on the Neural Firing Rate Function --- p.23
Chapter 2.2.1 --- Mathematical Derivation of the Neural Firing Rate --- p.23
Chapter 2.2.2 --- Spectral Analysis of the IPFM Process --- p.27
Chapter 2.2.3 --- Reconstruction of Neural Firing Rate through LPF --- p.30
Chapter 2.3 --- Effects of Neural Dynamics --- p.33
Chapter 2.4 --- Discussion & Conclusion --- p.35
Chapter 3 --- A New Model for the Generation of PPG --- p.37
Chapter 3.1 --- Introduction --- p.37
Chapter 3.2 --- Principles of PPG --- p.38
Chapter 3.2.1 --- Relationship between Pressure and Flow --- p.38
Chapter 3.2.2 --- Peripheral Pressure and Flow Curves --- p.41
Chapter 3.2.3 --- Generation of PPG signal --- p.43
Chapter 3.3 --- Model Description --- p.44
Chapter 3.3.1 --- IPFM model --- p.45
Chapter 3.3.2 --- Windkessel model --- p.46
Chapter 3.3.3 --- New Model for the Generation of PPG --- p.49
Chapter 3.4 --- Simulation --- p.51
Chapter 3.4.1 --- Generation of ECG --- p.51
Chapter 3.4.2 --- Generation of PPG --- p.57
Chapter 3.4.3 --- Effects of the Modulation Depth on the Output --- p.65
Chapter 3.4.4 --- Effects of Mean Autonomic Tone on HRV --- p.72
Chapter 3.5 --- Discussion & Conclusion --- p.75
Chapter 4 --- A Correlation Study on the Beat-to-Beat Features of Photoplethysmographic Signals --- p.80
Chapter 4.1 --- Introduction --- p.80
Chapter 4.2 --- Methodology --- p.81
Chapter 4.2.1 --- Experimental Conditions --- p.81
Chapter 4.2.2 --- Definition of the Parameters --- p.82
Chapter 4.3 --- Data Analysis --- p.85
Chapter 4.3.1 --- At Normal Relaxed State --- p.85
Chapter 4.3.2 --- At Different Levels of Contacting Force --- p.87
Chapter 4.3.3 --- At Different Levels of Local Skin Finger Temperature --- p.90
Chapter 4.3.4 --- At Dynamic State --- p.93
Chapter 4.3.5 --- Repeatability Study --- p.95
Chapter 4.3.6 --- Spectral Analysis --- p.96
Chapter 4.4 --- Discussion --- p.98
Chapter 5 --- The Estimation of the Beat-to-Beat Blood Pressure Variability --- p.103
Chapter 5.1 --- Introduction --- p.103
Chapter 5.2 --- BP Estimation using FY Interval --- p.104
Chapter 5.2.1 --- Multi-Beat BP Estimation under Different Levels of Contacting Force --- p.104
Chapter 5.2.2 --- Beat-to-Beat BP Estimation --- p.108
Chapter 5.2.3 --- Repeatability Study --- p.112
Chapter 5.3 --- A Study on the Beat-to-Beat BPV --- p.113
Chapter 5.3.1 --- Background of the Beat-to-Beat BPV --- p.113
Chapter 5.3.2 --- Analysis of the Beat-to-Beat BPV --- p.115
Chapter 5.4 --- Improving the PPG Model with the Time-Varying BP --- p.120
Chapter 5.4.1 --- Modification of the Model --- p.121
Chapter 5.4.2 --- Simulation --- p.127
Chapter 5.4.3 --- Application of the PPG Model --- p.132
Chapter 5.5 --- Discussion & Conclusion --- p.134
Chapter 6 --- A Novel Biometric Approach --- p.139
Chapter 6.1 --- Introduction --- p.139
Chapter 6.2 --- Human Verification by PPG Signal --- p.140
Chapter 6.2.1 --- Experiment --- p.141
Chapter 6.2.2 --- Feature Extraction --- p.142
Chapter 6.2.3 --- Decision-making --- p.143
Chapter 6.2.4 --- Results --- p.146
Chapter 6.3 --- Discussion --- p.149
Chapter 7 --- Conclusions --- p.151
Chapter 7.1 --- Conclusions of Major Contributions --- p.151
Chapter 7.2 --- Work to Be Done --- p.154

High blood pressure (BP) is the single greatest risk factor for death from cardiovascular diseases (CVD). High BP is conventionally defined by the systolic BP and diastolic BP, which are the peak and nadir points on the BP waveform, but cannot comprehensively represent systemic arterial haemodynamics. The reservoir-excess pressure model, which was proposed to analyse the BP waveform, provides potentially new information regarding arterial haemodynamics. The reservoir-excess pressure model interprets the BP waveform into a reservoir pressure (RP), which is related to the buffering capacity of elastic arteries, and into an excess pressure (XSP), which is ascribed to wave propagation in the arterial system. Furthermore, reservoir pressure parameters (e.g. RP, XSP and the associated systolic rate constant) have been shown to predict cardiovascular events independent of standard BP and other conventional cardiovascular risk factors. However, non-invasive measurement of reservoir pressure parameters is technically challenging, which limits the widespread application of reservoir pressure parameters. Thus, the overall aims of this research programme were to determine whether reservoir pressure parameters could be non-invasively measured in the human upper arm using an oscillometric cuff device, and further to determine whether cuff device-measured reservoir pressure parameters were clinically relevant – this was assessed by association with cardiovascular risk markers. In chapter 2, the change in reservoir pressure parameters from the aorta to the brachial and radial arteries was invasively investigated in 51 participants undergoing coronary angiography. A relatively constant RP and an amplified XSP were observed from the aorta to the brachial and radial arteries. These observations provide a new understanding on arterial reservoir pressure parameters and large artery BP physiology. In chapter 3, the performance of an oscillometric cuff device for measuring the central BP was investigated in 182 people with treated hypertension. The central BP parameters derived from the cuff device were substantially equivalent to the central BP parameters measured using the non-invasive reference standard (radial tonometry) method. This finding is the basis of accurately deriving the reservoir pressure parameters from cuff-based device-measured central BP waveforms. In chapter 4, whether reservoir pressure parameters could be non-invasively derived from the cuff device-measured brachial or central BP waveform was examined in comparison to true invasive aortic measures among 163 participants undergoing coronary angiography. The brachial-cuff method estimated reservoir pressure parameters had higher concordance with the intra-aortic measures than did the central-cuff method estimated reservoir pressure parameters. In chapter 5, brachial-cuff reservoir pressure parameters were applied in a large population of Australian adults (n=1874) to examine the potential clinical relevance. Brachial-cuff reservoir pressure parameters were significantly associated with cardiovascular risk markers, indicating their potential clinical significance for predicting cardiovascular risk. In summary, this thesis determined that reservoir pressure parameters could be reliably estimated on the brachial artery using the non-invasive cuff device, and that these cuff reservoir pressure parameters were related to cardiovascular risk markers. Overall, this research program provides novel information that increases understanding of the reservoir-excess pressure model in humans.

Yes
This study investigated the relationship of ethnicity to the differences between blood pressure (BP) measured in a clinic setting and by ambulatory blood pressure monitoring (ABPM) in individuals with a previous diagnosis of hypertension (HT) and without a previous diagnosis of hypertension (NHT). A cross-sectional comparison of BP measurement was performed in 770 participants (white British (WB, 39%), South Asian (SA, 31%), and African Caribbean (AC, 30%)) in 28 primary care clinics in West Midlands, United Kingdom. Mean differences between daytime ABPM, standardized clinic (mean of 3 occasions), casual clinic (first reading on first occasion), and last routine BP taken at the general practitioner practice were compared in HT and NHT individuals. Daytime systolic and diastolic ABPM readings were similar to standardized clinic BP (systolic: 128 (SE 0.9) vs. 125 (SE 0.9) mm Hg (NHT) and 132 (SE 0.7) vs. 131 (SE 0.7) mm Hg (HT)) and were not associated with ethnicity to a clinically important extent. When BP was taken less carefully, differences emerged: casual clinic readings were higher than ABPM, particularly in the HT group where the systolic differences approached clinical relevance (131 (SE 1.2) vs. 129 (SE 1.0) mm Hg (NHT) and 139 (SE 0.9) vs. 133 (SE 0.7) mm Hg (HT)) and were larger in SA and AC hypertensive individuals (136 (SE 1.5) vs. 133 (SE 1.2) mm Hg (WB), 141 (SE 1.7) vs. 133 (SE 1.4) mm Hg (SA), and 142 (SE 1.6) vs. 134 (SE 1.3) mm Hg (AC); mean differences: 3 (0-7), P = 0.03 and 4 (1-7), P = 0.01, respectively). Differences were also observed for the last practice reading in SA and ACs. BP differences between ethnic groups where BP is carefully measured on multiple occasions are small and unlikely to alter clinical management. When BP is measured casually on a single occasion or in routine care, differences appear that could approach clinical relevance.

Zhang Ye.
"October 2001."
Thesis (Ph.D.)--Chinese University of Hong Kong, 2001.
Includes bibliographical references (p. 200-224).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Mode of access: World Wide Web.
Abstracts in English and Chinese.

Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
Introdução: A medição adequada da pressão arterial (PA) é essencial para diagnóstico e controlo da hipertensão arterial (HTA). Vários estudos sugerem que a técnica de medição de PA nos cuidados de saúde primários (CSP) é insatisfatória.Objetivos: Verificar o cumprimento das boas práticas de medição da pressão arterial nos cuidados de saúde primários.Métodos: Criaram-se dois questionários baseados em recomendações nacionais e internacionais para uma correta medição da PA. Um com 10 itens, a ser respondido por hipertensos, outro a ser respondido por médicos e enfermeiros com 15 itens. Realizou-se um pré-teste para avaliar o tempo de resposta e identificar dificuldades no preenchimento dos questionários. Aplicaram-se os questionários finais em 5 unidades de CSP. Para análise dos resultados realizou-se estatística descritiva e inferencial.Resultados: No questionário para hipertensos (n=156), das respostas válidas, 61% dos respondentes tinham mais de 60 anos e 62,2% teve um(a) enfermeiro(a) a medir a PA pela última vez. Foi assinalada a recomendação de ter o braço apoiado na secretária com braçadeira à altura do coração como a mais cumprida (99,4%) e a pergunta sobre a vontade de urinar como a menos cumprida (15,7%). Na análise consoante o grupo etário, descobrimos diferença estatisticamente significativa em 5 recomendações. No questionário para profissionais de saúde (n=46), nas respostas válidas, 62,8% dos respondentes eram médicos, 69,8% do género feminino. A recomendação com mais respostas “Sempre” foi “Havia posicionamento correto da braçadeira” e a que mais responderam “Nunca” foi “O doente não tinha vontade de urinar”. Na análise segundo a profissão encontramos diferença significativa em 4 recomendações e na análise segundo o género em 3 recomendações.Discussão: Aos hipertensos com mais de 60 anos a PA foi medida mais vezes com braço desnudado, disseram menos para terem as pernas descruzadas, os pés assentes no chão e não usarem o telemóvel e a segunda medição falhou mais vezes. Os enfermeiros consideram medir mais vezes a PA após repouso de 5 minutos, com o doente sentado, pés assentes no chão, em silêncio e com braço apoiado ao nível do coração. O género feminino considera fazer mais vezes a medição após repouso de 5 minutos, com o doente sentado, em silêncio e com braço apoiado ao nível do coração.Conclusão: A medição da PA nas unidades estudadas não seguiu regularmente muitas das recomendações existentes. É importante realizar estudos mais aprofundados que permitam perceber se esta será a realidade nos CSP a nível nacional.
Background: Adequate blood pressure (BP) measurement is essential for the diagnosis and management of arterial hypertension. Several studies suggest that the BP measurement technique in primary health care (PHC) is inaccurate. Objectives: To verify compliance with BP measurement recommendations in primary health care.Methods: Two questionnaires were created based on national and international recommendations for the correct measurement of BP. One with 10 items, to be answered by hypertensive patients, another to be answered by doctors and nurses with 15 items. A pre-test was performed to evaluate the response time and identify difficulties in completing the questionnaires. The final questionnaires were applied to 5 PHC units. Descriptive and inferential statistics were performed to analyze the results.Results: In the patients’ questionnaire (n = 156), within the valid answers, 61% of the respondents were over 60 years old and 62.2% had a nurse measuring their BP for the last time. The recommendation to have the arm resting on the desk with the cuff at heart-level was the most fulfilled (99.4%) and the question about urge to urinate was the least fulfilled (15.7%). In the analysis according to age group, we found a statistically significant difference in 5 recommendations. In the health professionals’ questionnaire (n = 46), within the valid answers, 62.8% of the respondents were physicians, 69.8% female. The recommendation with the most "Always" answers was "There was correct positioning of the cuff" and with the most "Never" answers was "The patient had no urge to urinate." In the analysis according to the profession we found a significant difference in 4 recommendations and in the analysis according to sex in 3 recommendations. Discussion: Hypertensive patients over 60 years old had their BP measured more often with bare arm, were said less to have their legs uncrossed, feet on the floor and abstain from using their mobile phone and the second measurement failed more often. Nurses consider measuring BP more often after a 5-minute rest, with the patient sitting, feet flat on the floor, in silence and with arm resting at heart-level. Female professionals consider measuring BP more often after 5-minute rest, with the patient sitting quietly and with his arm supported at heart-level.Conclusion: In the accessed PHC units BP measurement often failed to comply with many of the existing recommendations. It is important to conduct more in-depth studies to verify if this reality is seen in CSPs at national level.

Le décès d’une personne sur cinq à travers le monde est associé à l’hypertension artérielle (HTA). Or, près de la moitié des individus avec HTA ignorent leur condition : ils n’ont pas été dépistés. Cette thèse a pour objectif, principalement à travers la présentation de deux articles originaux, de contribuer à l’amélioration du dépistage de l’HTA. Avant la présentation des deux articles de cette thèse, les résultats d’un examen de la littérature sur les effets des démarches de dépistage de l’HTA en milieux hors hospitaliers sont exposés. On y constate notamment qu’une telle démarche permet d’identifier près d’un adulte sur trois comme ayant une pression artérielle (PA) élevée. La pratique infirmière dans la prise en charge de l’HTA est également explorée. Il en ressort que leurs interventions non pharmacologiques et leurs interventions directes sur le traitement pharmacologique permettent à la fois une amélioration des habitudes de vie ainsi qu’un abaissement de la PA au moins équivalente aux soins médicaux usuels. Le premier article de cette thèse consiste en une revue systématique effectuée en utilisant le protocole Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Diagnostic Test Accuracy (PRISMA-DTA). Les objectifs de cette revue systématique étaient de décrire la performance (valeur prédictive positive, taux de suivi) de la stratégie de dépistage de l’HTA qui consiste à tirer profit de la mesure de la PA effectuée d’emblée auprès des millions de personnes qui se présentent annuellement dans les départements d’urgence. Les méthodes de mesure de la PA utilisées lors de la consultation initiale à l'urgence, les moyens utilisés pour assurer un suivi, ainsi que les méthodes utilisées pour confirmer un diagnostic de l’HTA sont également décrits. À la suite d’une recension initiale de 1030 articles, 10 de ceux-ci répondaient aux critères d’inclusion. L’outil Quality Assessment of Diagnostic Accuracy Studies-2 (Quadas-2) a été utilisé pour l’évaluation de la qualité des études. L’âge moyen des participants est de 51,6 ± 6,4 ans. Pour effectuer la mesure de la PA au département d’urgence, un appareil au mercure a été utilisé dans la moitié des études, quatre ont utilisé un appareil électronique et pour deux études, cette information n’était pas disponible. Parmi ceux ayant eu un dépistage positif, le taux de suivi moyen est de 61,9 %. Parmi eux, 50,2 % ont reçu la confirmation d’un diagnostic d’HTA à la suite d’une démarche de suivi. L’on retrouve dans seulement deux études une méthode de confirmation diagnostique correspondant aux standards des sociétés savantes en HTA. Une autre solution pour l’amélioration du dépistage de l’HTA est d’augmenter la validité de la méthode de mesure de la PA. Le second article de cette thèse avait pour objectif d’évaluer la performance (valeurs prédictives, sensibilité, spécificité, coefficient de kappa et taux de suivi) d’une nouvelle stratégie de dépistage de l’HTA au moment d’une consultation pour urgence mineure. La stratégie consiste, à la suite d’une mesure initiale de la PA dont le résultat est élevé, en l’ajout d’une seconde méthode de mesure de la PA : la mesure oscillométrique en série. Un monitorage ambulatoire de la pression artérielle (MAPA) d’une durée de 24 heures a été fait pour chaque participant afin d’évaluer la performance de la combinaison des deux méthodes de mesures cliniques. Le MAPA constitue la mesure étalon en HTA. Effectuée dans une clinique GMF de Laval, 50 des 80 participants (62,5 %) inclus ont complété l’étude en se présentant au rendez-vous de suivi pour un MAPA. L’âge moyen des participants est de 51,9 ans. À la suite d’une mesure initiale de la PA dont le résultat est élevé, l’ajout de la mesure oscillométrique en série a été associé à une valeur prédictive positive de 62,5 % et une valeur prédictive négative de 83,3 % (sensibilité, 87 %; spécificité 56 %; coefficient de kappa 0,41). Cette thèse permet d’offrir des pistes de réponses qui pourront contribuer à l’amélioration du dépistage de l’HTA. Tout d’abord, le premier article met en lumière le fait que les consultations au département d’urgence représentent une excellente opportunité pour le dépistage de l’HTA. En effet, cela permet de rejoindre un nombre très important d’individus. Une mesure de la PA est effectuée à chacun d’eux, ils sont plutôt jeunes et lorsque le résultat de la mesure est élevé, cela correspond réellement à une HTA pour la moitié des cas. Le taux de suivi se situe à environ 60 %. La démarche de dépistage à l’urgence consiste essentiellement à reconnaitre une PA élevée, puis d’effectuer une référence afin d’obtenir une prise en charge. Cela implique qu’à chaque 100 adultes avec une PA élevée à l’urgence et pour qui une démarche de dépistage serait effectuée, 30 individus pourraient avoir un diagnostic d’HTA confirmé ainsi qu’une prise en charge subséquente. Malgré cela, le défi de la validité de la mesure et du suivi demeure. La contribution originale du deuxième article s’attarde à cette question. À la suite d’une mesure initiale de la PA dont le résultat est élevé, l’ajout de la mesure oscillométrique en série permet d’augmenter la validité de la démarche de dépistage. En effet, ceux pour qui le résultat de cette mesure est normal peuvent être considérés, d’une façon sécuritaire, comme étant non hypertendus. Ainsi, les individus dirigés afin d’effectuer un examen de confirmation diagnostique seront mieux ciblés, les ressources existantes mieux utilisées. Enfin, des recommandations sont présentées relativement au dépistage de l’HTA, à sa prise en charge, mais également sur la pratique infirmière.
One out of five people worldwide dies from causes linked to hypertension (HTN). Yet, nearly half of individuals with HTN are unaware of their condition as they have not been screened. The goal of this thesis, mainly through the presentation of two original articles, is to help improve HTN screening. Before presenting the two articles, the results of a literature review on the effects of the HTN screening process in an out-of-hospital setting are outlined. In particular, it is noted that such a process helps to identify nearly one out of three adults as having elevated blood pressure (BP). The nursing practice in HTN management is also explored. It is concluded that their non-pharmacological interventions and direct interventions on the pharmacological treatment help to improve lifestyles and lower BP by at least the same amount as customary medical care. The first article of this thesis consists in a systematic review conducted with the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Diagnostic Test Accuracy (PRISMA-DTA) protocol. The purposes of this systematic review are to describe the performance (positive predictive value, follow-up rate) of the HTN screening strategy, which consists in drawing on the BP measurement taken on millions of people who show up in the emergency department (ED) annually. The BP measurement methods used during the initial ED consultation, the methods used to ensure follow-up, and the methods used to confirm an HTN diagnosis are also described. Following an initial review of 1030 articles, 10 of these met the inclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies-2 (Quadas-2) tool was used to evaluate the quality of the studies. The average age of participants is 51.6 ± 6.4 years. To take a BP measurement in the ED, a mercury device was used in half of the studies, four used an electronic device and for two studies, this information was unavailable. Among those with a positive screen, the average monitoring rate is 61.9%. Among them, 50.2% received confirmation of an HTN diagnosis following the follow-up process. Only two studies mention a diagnosis confirmation method that meets the standards of learned HTN societies. Another solution to improve HTN screening is to increase the validity of the BP measurement method. The goal of the second article of this thesis was to evaluate the performance (predictive values, sensitivity, specificity, kappa coefficient and monitoring rate) of a new HTN screening strategy when consulting for a minor emergency. Following the initial high BP measurement, the strategy consists in adding a second BP measurement method: the automated office blood pressure measurement (AOBP). Each participant underwent 24-hour ambulatory blood pressure monitoring (ABPM) to evaluate the performance of the combination of both clinical measurement methods. ABPM is the gold standard for BP measurement. Conducted in a GMF clinic in Laval, Quebec, 50 of the 80 participants (62.5%) included completed the study by showing up to the follow-up ABPM appointment. The average age of participants is 51.9 years old. Following an initial high BP measurement, adding the AOBP is linked to a positive predictive value of 62.5% and a negative predictive value of 83.3% (sensitivity 87%, specificity 56%, kappa coefficient 0.41). This thesis offers possibilities that can help improve HTN screening. The first article highlights the fact that ED consultations are an excellent opportunity to screen for HTN. Indeed, this helps to reach many individuals: BP measurement is taken on each one, they are rather young, and when the measurement is high, this actually corresponds to an HTN for half of the cases. The follow-up rate is about 60%. The ED screening process mainly consists in recognizing high BP, and then making a referral to obtain treatment. This implies that for every 100 adults with high BP in the ED and on whom a screening process would be conducted, 30 people could have a confirmed HTN diagnosis and subsequent treatment. And yet, the validity of the measurement and follow-up remains a challenge. The original contribution of the second article examines this question. Following an initial high BP measurement, adding the AOBP helps to increase the validity of the screening process. Indeed, those for whom the result of this measurement is normal can safely be considered as non-hypertensive. As such, those referred to complete a diagnosis confirmation exam will be better targeted and the existing resources better used. Lastly, recommendations are made regarding HTN screening, its management, and the related nursing practice.