Blood pressure in children using correct cuff width: hypertension, cardiovascular and gestational complications in longitudinal study of 25 years / Pressão arterial em crianças com o manguito de largura correta: hipertensão, complicações cardiovasculares e gestacionais em estudo longitudinal de 25 anos

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

To avoid hyper or hypo-estimated Blood Pressure (BP) readings, from 1951 to 1993 the American Heart Association (AHA) recommended a cuff width to arm circumference (CW/AC) ratio of 0.40, In 2005 this association emphasized the importance of cuff length to guarantee accurate BP measurements. In 1982, the traditional AHA recommendation was employed to check BP in 99 children, 10-14 years old (50 female), at the University of São Paulo campus. Objective: To evaluate rates of hypertension cardiovascular and gestational disorders in 2007 on subjects that had presented high BP values when using the recommended cuffs in 1982. Method: To attend the AHA 0.40 ratio we measured AC of each child calculating the correct cuff width to be employed. This cuff was chosen from a cuff kit with several widths, varying at each centimeter (cuff length = 80% AC). The sample in 2007 included 38 subjects. Nineteen of them had presented SBP ≥ 115 mmHg and DBP ≥ 80 mm in 1982. For each female or male of this risk group (RG), we also checked the status for hypertension in a subject that had presented lower BP values in 1982 (<115/80 mmHg), totalizing 19 subjects in the control group (CG: same sex, ethnic and age: 35-39 years). Results: Significant differences (p = 0.02) was observed between risk and control groups. We found in the RG six subjects presenting hypertension. Only three were under drug treatment. Another three subjects from the RG present normal BP levels nowadays. They stayed under non pharmacological treatment during many years, making exercises at least three times a week. Three females informed five pregnancy events. One had two episodes of pre-eclampsia and is currently under treatment. Another had eclampsia in the first pregnancy and pre-eclampsia in the second one, resulting in two miscarriages. She stayed under hypertension treatment during her 3rd ad 4th successful pregnancies. One male (25 y.o.) died after an atrial fibrillation crisis. BP values in 1982 (10 years old) were 126/89 mmHg and heart rate = 96. In the CG one subject has presented arrhythmia not associated with hypertension and another had only one episode of hypertension. Discussion and Conclusions: The analysis of the AHA guidelines from 1951 to 2005 indicates discrepancies between the theoretical framework and the recommendation for cuff size to be used in the clinical practice. The use of the traditional AHA 0.40 CW/AC ratio in our research protocol of 1982 enabled us to detect alarming BP levels. We speculate that if a correct cuff had been used also in clinical practice in those 9 subjects, their problems could have been better addressed. We thus suggest attendance to the AHA CW/AC 0.40 ratio in clinical and research protocols, despite the polemic discussion regarding the cuff width or cuff length effect in the BP readings

ASSUNTO(S)

manguito largura correta pressão arterial enfermagem correct cuff size cardiovascular complications complicações cardiovasculares children blood pressure crianças

ACESSO AO ARTIGO

Documentos Relacionados