Category: Blood Pressure

Undiagnosed High Blood Pressure – The Silent Killer

According to new estimates produced by The British Heart Foundation, four million people under the age of 65 in the UK are living with untreated high blood pressure with further analysis finding that 1.3 million of these people are under the age of 45. 

As well as significantly raising the risk of heart attack and stroke, it can also be the cause of an increased risk of vascular dementia, raised cholesterol and diabetes.

Getting your blood pressure under control is one of the most important things you can do to reduce your risk of having a heart attack or stroke.

Checking your own blood pressure with an A&D Medical clinically validated BP monitor is an easy and inexpensive way to understand if you are one of the millions of people across the UK living with undiagnosed high blood pressure and giving you the information needed to get the correct treatment and advice.

Taking a blood pressure reading takes less than 5 minutes and can be done in the comfort of your own home not just in a doctor’s surgery or pharmacy.   

Many people assume that high blood pressure is generally associated with older, overweight or unfit people. Though these conditions can lead to a high risk of heart attack and stroke, many people with an active lifestyle can also fall victim to this silent killer.

A considerable number of young people in the UK aged 16 to 24 unknowingly have risky high blood pressure too.

Stessful workplace environments are a major cause of high blood pressure with busy people all too easily putting the issue to the back of their minds.

Ordering an A&D Medical clinically validated BP monitor and getting your blood pressure under control is one of the most important things you can do to reduce your risk of having a heart attack or stroke.

With waiting lists at an all time high and the NHS under more pressure than ever before, acting now could give you the greatest opportunity to receive the life-saving treatmment you may need.

PMS Instruments stock a vast range of blood pressure monitors with different cuffs sizes to suit every individual.

So don’t become a statistic, order yours today and give yourself the best chance of taking the necessary steps to avoid long-term harm.

Cuff Size Matters

Blood pressure monitors with an upper arm cuff provide the most accurate blood pressure readings but using the correct cuff size is really important in order to avoid inaccurate results.

Ensure the cuff is the correct size

If the cuff you use is too small for the arm, your blood pressure reading will be artificially high. If your cuff is too large, you may get a lower-than-actual reading. This is known as miscuffing.

On people with big arms, a large cuff is needed and as a general rule the inflatable bladder in the cuff needs to encircle at least 80% of the arm. The width of the cuff should be at least 40% of the arm circumference.

Measure your arm

To make sure you are using the correct size cuff for your arm place a tape measure around the bicep, at mid-arm to measure the arm circumference in cm. The left arm is typically used.

Typical cuff sizes

Not all blood pressure monitors can use different sizes of cuffs. Check with us first to make sure your digital A&D Medical UA and UM series or Meditech ABPM device can.

Typical cuff size ranges are as follows but can vary by manufacturer. For A&D UA series monitors the following cuff sizes are available.

  • Small fits an upper arm between 16-24 cm
  • Adult fits an upper arm between 22-32 cm
  • Semi-large fits an upper arm between 23-37 cm
  • Wide range fits an upper arm between 22-42 cm
  • Large adult fits an upper arm between 31-45 cm

Wide range cuffs like that supplied with the A&D Medical UA-1020-W are becoming popular with clinicians as one cuff can be used across a wider arm circumference range. This monitor can also use a small cuff.

All A&D Medical and Meditech cuffs have visual range markers to make cuff positioning easier and ensure the correct size is used. When applied correctly the cuff should wrap snugly around the arm with just enough space to slide two fingertips underneath.

One cuff does not fit all and using the correct cuff size is important both for healthcare professionals in a clinical setting and the public when buying monitors for home use.

Does It Matter What Time You Take Your BP Medication?

The Treatment in Morning versus Evening (TIME) study has recently been published. The study compared the morning dosing of blood pressure lowering medication with evening dosing of the same medication for people with high blood pressure.

Previously it was thought that the time of day you took your medication influenced how effective it was.

However, the results of the TIME Study by the University of Dundee has shown that the time of day you take your medication does not have any impact in terms of heart attacks, strokes or cardiovascular death.

The study included 21,104 patients over the age of 18 with high blood pressure from across the UK (England, Wales, Scotland and Northern Ireland). Each participant was randomly instructed when to take their medication.

There were slight differences in side effects. Patients who took their medication in the morning were more likely to report feelings of dizziness, light-headedness, indigestion, upset stomach, diarrhoea and muscle aches. Those who took their medication in the evening were more likely to report an increase of visits to the toilet.

These results mean that a patient, with their doctor can choose which time of day to take their medication to minimise side effects and which time of day suits them the best.

The TIME study was sponsored by the University of Dundee and funded by the British Heart Foundation (CS/14/1/30659). In addition, the study was supported by the British and Irish Hypertension Society, SHARE, UK Biobank, and UK Clinical Research Networks (UKCRN).

Identify More Hypertensives With A Waiting Room Blood Pressure Monitor

Guidance on preventing cardiovascular disease (CVD) was originally published in 2019 and was updated this year.  Optimal treatment of AF, high blood pressure and raised cholesterol is highly effective in preventing CVD events.

Over 40% of people with high blood pressure remain undiagnosed and of those diagnosed with high blood pressure, only 67% are optimally managed.

How do we diagnose and manage more effectively?

GP Practices are encouraged to actively screen patients and seek out hidden hypertensives. To the average practice this could mean hundreds of extra appointments for a simple blood pressure measurement.

They need help in the form of the easy to use, clinically validated A&D Medical TM-2657P waiting room blood pressure monitor.

Originally the idea of allowing patients to measure their own blood pressure was greeted with scepticism by some clinicians, but practice managers were quick to see the advantages.

Ideally located in a quiet corner of the waiting room, this type of monitor is designed for professional high volume use and automatically prints a reading, with the date and time, on a small slip of paper.

The patient usually shows this reading to the doctor or nurse at the beginning of the consultation and if the readings are too high or low they can then re-measure. In some practices patients hand results to a member of the reception team, who record it electronically for later review.

For practice managers, they offer good management and effective use of resources freeing clinical staff for other roles where they may be better utilised. Some practices report they ‘save’ up to 100 appointments per month on average.

For patients the feedback is positive and the monitors promote understanding and compliance.

Recently we have been involved in a couple of projects looking to target patients who don’t visit a GP regularly or have access to another healthcare provider. TM-2657P blood pressure monitors have been placed in public access buildings like Libraries and Pharmacies.

They have identified new undiagnosed hypertensives with elevated blood pressure and helped manage existing hypertensive patients promoting medication compliance.

PMS Instruments. Expertise, Experience and Trust for service, calibration and support.

These are the key words our customers associate with PMS Instruments, as well as being the fundamental foundations of our calibration and service department.

Back in 2016 I posted an article with a picture of an A&D Medical TM-2655P waiting room blood pressure monitor that had recorded a staggering 103,366 readings since we originally supplied it in 2004!

Since then, we have calibrated and serviced a number of A&D Medical waiting room blood pressure monitors that have recorded in excess of one hundered thousand readings!

At PMS Instruments as an ISO-9001 Quality Assured company we keep detailed service and calibration records for every item of equipment we service and repair.

What’s the secret of this reliability and low cost of ownership?

I am convinced it is regular, preventative and routine servicing by PMS Instruments which extends the ‘in service’ life of the monitors and prolongs the investment our customers make in their equipment.

How does the service you get from PMS Instruments differ?

The A&D Medical TM-2655P and TM-2657P waiting room blood pressure monitors are specialist instruments, requiring specialist knowledge and test equipment.

With every service and calibration PMS Instruments carries out, each monitor is subjected to an approved individual ISO-9001 quality assured Work Instruction. This comprises a series of up to 70 detailed steps our service engineers must follow, and which the product must pass, in accordance with the manufacturer’s service manuals.

You get so much more from PMS Instruments than the basic 10 minute on site functional test some companies offer.

Our popular Fixed Price Service and Support Plan includes:

  • Annual calibration of your device and detailed calibration certificate issued.
  • Priority unlimited telephone and technical support.
  • Fixed price servicing cost.
  • Fast priority response for all servicing and repairs.
  • 20% discount off non standard service items including pumps
  • Standard service parts and consumables including filters.
  • Replacement of the cotton cuff inner.
  • Supply of premium packing box and material included.
  • Courier collection and return included.
  • Priority turnaround time typically 3-5 working days from receipt of equipment.
  • Inclusive annual service and calibration to manufacturer’s specification.

You get what you pay for…

PMS Instruments’ service and calibration team are certified to ISO-9001 and use only genuine manufacturer approved spare parts.

Depending on the model it can take up to 90 minutes for our Service Engineers to adjust, calibrate and service an A&D Medical waiting room blood pressure monitor and we are the experts at it! Rapid turnaround time means minimum downtime and a full service and calibration certificate is issued.

Not convinced and still want to use another company?

Can the company you use tell you how many readings your waiting room blood pressure monitor has taken during its lifetime? If they can’t schedule your service and calibration with PMS Instruments and we will.

Community Pharmacies to Offer Hypertension Case Finding ABPM Service

According to the Pharmaceutical Services Negotiating Committee (PSNC) Hypertension is one of the biggest risk factors for CVD (Cardio Vascular Disease) affecting 7 million people and represents a financial burden of approximately £9 billion a year to the NHS.  

The NHS Long Term Plan commits the NHS to reducing morbidity and mortality due to CVD, tackling inequalities and a shift towards prevention strategies. It specifically states that community pharmacy, in collaboration with other providers, will provide opportunities for the public to check on their health through tests for high BP and other high-risk conditions.

The 2019-2024 Community Pharmacy Contractual Framework agreed to pilot a model for detecting undiagnosed CVD in community pharmacies through NHS England and NHS improvement’s Pharmacy Integration Fund (NHSE&I). The majority of the pilot scheme started after March 29th when Covid restrictions were eased. The scheme covered 6 Primary Care Networks (PCN). 35 pharmacies participated in 4 geographies. The pilot sites included rural and urban areas, areas of high ethnicity and areas of mixed deprivation/affluence. The pilot scheme ended in September 2021.

As a result of the, success of the pilot scheme, from 1st October 2021 a new Hypertension case finding service can be offered by UK pharmacies.

Which monitor should a pharmacist purchase?

The Meditech ABPM-06 ABPM monitor meets and exceeds the list of considerations the PSNC suggests pharmacists consider when purchasing an ABPM on their website. The non-exhaustive list includes;                 

  • Is maintenance and training included in the purchase price?

PMS Instruments includes remote support and training. We can also provide a standard operating procedure (SOP)

  • Calibration versus replacement cost and the carbon footprint of both activities;

As a Meditech Official Service Partner we offer a fixed price service and calibration plan after the first two years

  • Frequency/cost of cuff replacement and other consumables;

Meditech cuffs are latex free wipeable and hygienic. Meditech ABPM monitors can use re-chargeable batteries reducing running costs

  • Complexity of use – time taken to use (and explain use, in the case of ABPM);

The easy-to-use Meditech ABPM-06 monitor has been designed with comfort in mind and based on feedback from thousands of customers worldwide

  • For ABPM, the usability of any inclusive software to support set up for the patient and interpretation of readings. Additionally, software and hardware compatibility with existing pharmacy IT systems needs to be considered, e.g., can you plug the meter into a USB port on a PC in the pharmacy.

Meditech ABPM-06 has automatic textual analysis to the latest NICE guideline classifies into 1 of 3 hypertension classifications, as well as number of successful readings determines if recording has been successful. It automatically generates average readings for rapid standard assessment. Comes with a standard USB PC cable for genuine plug and play operation.

  • ABPM must be validated by the British and Irish Hypertension Society (BIHS)

Meditech ABPM-06 is listed on the BIHS website and is FDA and CE approved with an AA grade

The Meditech-06 from PMS Instruments has a whole list of features including free 2 Year Premier Support including remote training and technical support. The Meditech-06 is Supplied with

• Adult (25-32cm) cuff
• Large adult (32-42cm) cuff
• USB PC cable
• CardioVisions analysis software
• Carry pouch, shoulder strap, waist belt
• Quick start user instructions
• 3-year warranty on monitor

To discover even more reasons to purchase a Meditech ABPM-06 from PMS Instruments click HERE

Monitoring Your BP At Home

Monitoring your blood pressure at home and can be a way to feel more in control of your own health and wellbeing. Your GP may even have recommended you take your own BP measurements at home so that you know your numbers.

But which home BP monitor to buy? There are so many now on the market, available from anywhere from your local supermarket to large online retailers. The options can seem over whelming. It needn’t be.

When choosing a BP monitor we would recommend you check for 3 things 

  1. Has it been clinically validated? This means it has been tested and approved by the British and Irish Hypertension Society (BIHS) and will it provide arcuate and reliable readings.
  2. Is it fully automatic as these are the easiest monitors to use at home.
  3. The cuff fits your arm. Cuffs come in a range of sizes but most monitors are supplied with a standard adult cuff which will fit an arm measuring 22-32cm. The cuff should wrap snugly around your upper arm, with just enough space to slide two fingertips underneath.

You can purchase an additional cuff which will fit your arm if your arm is either smaller or larger than a standard cuff size.

Or look for a monitor with a wider range cuff such as the A&D Medical UA 767S-W which is supplied with a wide ranging cuff which will fit an arm measuring 22-42 cm. For more of the monitors features Click here

The A&D Medical UA 767S + AFib is a popular choice for its proven record of reliability and wide use across the UK with GP surgeries and within the NHS. It also comes with a 5 year warranty. For more of the monitors features Click here 

PMS Instruments can supply you with a BP monitor to suit you, your needs and your budget.

Disposable Hand and Arm Hygienic BP Covers

A&D Medical protective hand and arm covers are specially designed for use with the TM-2655P and TM-2657P waiting room blood pressure monitors.

They demonstrate to your patients that when they use your waiting room blood pressure monitor, you take any safety and hygiene concerns they may have seriously. This gives them the confidence to use the monitor after post COVID lockdown.

They are manufactured from thin polyethylene and cover the upper arm and hand to prevent a patients arm coming in to direct contact with the inside of monitor. These single patient use hygienic arm and hand covers are easy to apply and comfortable to wear.

With a length of 75cm they accommodate most arms and fit an arm circumferences of up to 44cm. Each overarm and hand cover is perforated making them easy to detach. Each batch/bundle of 200 has a convenient attachment string which means the covers can be hung neatly near the waiting room monitor or anywhere keeping the waiting room tidy.

They are designed for single patient use and are easy to apply. Simply pull one over sleeve off, insert your arm fully in to the cover, take a blood pressure measurement, remove the cover and dispose of. They are hygienic and cost effective providing effective protection to a patients arm. Free samples are available from PMS Instruments. Further information is available on our website https://www.pmsinstruments.co.uk/acatalog/A-D-Medical-Arm-and-Hand-Cover-for-TM-2655P-TM-2657P-703.html#SID=42

The ISO 80369-5 BP Cuff Standard

ISO80369-5 was developed as an international standard to prevent cuff connection errors with different types of medical devices that use the same or similar connectors. Whilst connection errors were few and far between they could have fatal consequences.

The US Food & Drug Administration (FDA) reported several real life incidents involving misconnections.

In one a blood pressure cuff was accidentally connected to an Intra Venous (IV) catheter.

A patient had an IV catheter in their arm but no IV fluids had been started. The patient also had an automatic BP cuff fitted on the same arm for continuous monitoring. The BP cuff tubing was disconnected from the blood pressure monitor while the patient went to the bathroom.

When she returned, her spouse accidentally connected the BP cuff tube to the IV catheter and approximately 15 mL of air was delivered to the IV catheter by the blood pressure monitor.

Unfortunately the patient died from a fatal air embolus, despite resuscitation efforts.

As a precaution and so this can’t happen again new ISO connectors are being introduced on blood pressure cuffs to ensure correct device connections, even in complex working environments and avoiding fatal consequences.

Japanese company A&D Medical are one of the first manufacturers of clinically validated digital blood pressure monitors to have introduced ISO-80369-5 connectors to their blood pressure cuffs and monitors.

The latest UA-651SL Plus is compliant with the ISO80369-5 regulation. It features A&D Medicals latest 4th generation Electric Control Exhaust Valve (ECEV) which precisely controls cuff deflation.

This low cost digital monitor can use 4 different cuff sizes for arm sizes ranging between 16cm – 45cm, including small, adult and large cuffs.

In the UA-651SL Plus A&D Medical are one of the few manufacturers to have a model that can use small, adult and large adult cuffs.

It’s important to note that ISO80369-5 cuffs cannot be used with non-compliant ISO80369-5 blood pressure monitors and they are not interchangeable with earlier models.

Life Goes On

It’s very easy to forget that life, although not as we knew it, is still going on. Covid 19 has dominated our lives for the last 6 months and it looks set to continue that way for at least the next 6.

Many GP surgeries have put a temporary hold on offering 24 hour ABPM services

Some are using waiting room BP monitors in place of face to face measurements. Others are not using them at all to reduce the number of patients in the waiting room.

Some are not using the waiting room at all requesting that their patients wait outside the surgery until called directly into the consulting room.

There are so many different ways and we are all trying to provide the best service we can during these strange unprecedented times.

Now could be the perfect time to get your Surgeries BP monitors serviced, if they are not currently being used, so they are ready for when things return to a more normal service.

Some surgeries have decided to wait until they feel comfortable in offering monitoring again.

Either way however you are dealing with the current pandemic we will continue to offer service and calibration of A&D Medical waiting room BP monitors, Meditech ABPM monitors and ECG monitors.

I am pleased to report that for the 27th year running we recently passed the ISO9001 quality standard audit. We are registered to provide repairs and support services for a range of specialised medical instruments.

With us you can be assured that when your monitors are serviced they go through a  comprehensive assessment of up to 70 tests carried out by our own manufacturer trained engineers.

As all monitors are collected and returned by our courier the engineer does not have to enter your premises, therefore maintaining all of your existing covid-19 safety measures.

Despite the Pandemic we are maintaining our fast turnaround time which remains at 3-5 working days. All it to takes to arrange is a quick call or email to us and we will do the rest.

Nothing is normal right now but life does go on and you can be assured we are still here offering you our support and service.

Review of the Meditech ABPM-06

It’s not that often that Meditech introduce a new ABPM. The last one, the ABPM-05 was introduced in 2007 the year the iPhone was launched. When they do it’s worth the wait.

There is a lot of thought that goes into the design and features customers really want in a new monitor. As well as good design it is important the technical elements are addressed so that the 30 year plus reputation for reliability and accuracy that Meditech have and customers from around the world expect, is maintained.

We’re proud that Meditech chose PMS Instruments and the UK as their first launch partner for the new ABPM-06 so what’s it really like to wear, use and operate?

First impressions are good. It’s got the same familiar look as the ABPM-05 which means it’s compact and light.

It uses the same size and type of wipeable cuffs which means users of the old ABPM-04 and ABPM-05 can use their existing cuffs interchanging between units. The cuffs are durable and easy to wipe clean which is important for patient hygiene.

One major improvement is the type of PC interface cable the new ABPM-06 is supplied with. The old ABPM-04 and ABPM-05 used either a serial interface or USB optoelectronic fibre optic cable which was unique to Meditech. Although repairable these old cables are expensive to replace or purchase new.

As customers frequently want to use their ABPM in more than one treatment room the new ABPM-06 is now supplied with a standard mini USB A mini to USB B PC cable. This resolves any potential cable comms issues as there is only one way the cable will go in.

Meditech have taken the wise decision to integrate the ABPM-06 into their popular CardioVisions analysis software rather than offer a completely new software platform. This means the look and feel of the software, programming, downloading and printing will be familiar to users of the old ABPM-04 and ABPM-05 with no new software to learn.

Programming the ABPM-06 takes seconds and key patient information like name, date of birth and ID is retained in the monitor so there is no doubt who has worn the monitor.

In the interests of customers I have worn a new ABPM-06 twice now and found the monitor comfortable and unobtrusive throughout.

I programmed the monitor to record every 30 minutes during the day and hourly during the night as recommended by the latest NICE guideline NG136.

Of the 40 readings taken over 24 hours all were successful with no errors. I was aware of the monitor going off at night but the new SleepWell® function added to the new AA grade algorithm meant the device wasn’t uncomfortable and the measurement inflation and deflation time was quick.

Downloading the results took seconds and the automatic text reporting, trend graph and presentation of key metrics like average daytime reading value are clear.

Feedback from new and existing customers who have purchased the ABPM-06 since we introduced it has been very positive. For a free demonstration, loan or for more information just call or email us.

Save time and money one measurement at a time

At around £1,500.00 is the A&D TM-2657P waiting room blood pressure still worth the money?

Self patient blood pressure measurement devices like the A&D TM-2657P are not new and there are now several hundred in use in the UK since they were first introduced by PMS Instruments 17 years ago in 2002.

Sited in the waiting room, for many Practices they are an integral part of their long term medical conditions clinics allowing them to work smarter, not harder, whilst helping patients take ownership of their conditions and play a more active role in their treatment.

A number of GP practices have adapted established protocols whereby patients pass their blood pressure results to the reception team and are then advised as to whether there is a need for further clinical follow up.

The protocol needs to be easy to follow and comprehensive to ensure that the receptionist is taking no responsibility for a clinical decision. When implemented correctly, after suitable training the process works very well.

Why is all this relevant to Primary Care and the NHS?

When this type of service is introduced anecdotal evidence from PMS Instruments GP customers suggests that waiting room BP monitors are used by up to 240 patients every month and only 80 of them require any further intervention. This represents a potential “saving” of over 160 face to face GP clinical appointments. 

Let’s do some maths!

According to NHS England, the average GP appointment costs £30 so in the example above that’s a saving of £4800 to the NHS every month.

So the payback period in terms of time saved and the initial £1500 cost of the monitor is established but what are the other benefits?

It’s about time.

According to a report published in Pulse in August 2019, over half of GPs have said the average waiting time for non-urgent appointments at their practice is now over two weeks.

Anything that can help reduce this must be a good thing and waiting room blood pressure monitors like the TM-2657P can.  

With the protocol above Doctors and nurses who want to monitor a patient’s blood pressure ask the patient to use the waiting room BP monitor and they only need to see a Doctor if their readings move out of an agreed range. Patients can do this at any time the practice is open freeing up valuable appointment time.

Nurses who run chronic disease clinics can also ask patients to monitor their blood pressure before coming to their clinic. Apart from saving nursing time it gives an immediate focus to the consultation.

Public Health England and NHS England have agreed ambitions and a goal over a 10 year period to improve the detection and treatment of high blood pressure with the following targets

  • 80% of the expected number of people with high BP are diagnosed by 2029
  • 80% of the total number of people diagnosed with high BP are treated to target as per NICE guidelines by 2029

How do we achieve these objectives when Primary Care is already overstretched?

In this instance the technology, in the form of waiting room BP monitors, already exists we just need to encourage wider adoption and not be afraid to adopt new approaches.

Time is money as the saying goes and the A&D TM-2657P saves time and money one measurement at a time.

ERKA The Original Aneroid?

With an established reputation for quality, Erka has been developing and manufacturing sphygmomanometers as well as stethoscopes since 1889.

The ERKA name has a worldwide reputation and represents a guarantee of quality for services and quality goods that are designed, produced and Made in Germany. 130 years of experience means the highest precision, trust and innovation and are just some of the reasons why so many consumers purchase.

PMS Instruments have been their UK Distributor since 2001.

Designed for manual blood pressure measurement the ERKA Switch Comfort Aneroid Sphygmomanometer offer outstanding quality, precision and ease of use as standard.

The sensitive deflation screw valve of the ERKA Switch allows the user to make precise adjustments to the deflation speed.

The innovative design of the SWITCH allows the device to be switched from a right-handed to a left-handed device in a single step.

Buy with confidence direct from PMS Instruments an official authorised Distributor or via the NHS Supply Chain NPC code FFE1244.

Features include

•             Shock resistant to AAMI SP10

•             Special tempered copper-beryllium membrane

•             Easy to read 56 mm diameter polycarbonate head

•             Weight without cuff 120g

•             Latex free, DEHP free, PVC free single tube cuff

•             Manufactured in Germany for precision

•             5 year warranty after registration

•             Wide range of cuff sizes available

The New Meditech ABPM-06

PMS Instruments are pleased to announce the UK launch of the new ABPM-06 24 hour ABPM.

The ABPM-06 is the latest generation premium ambulatory blood pressure monitor from Meditech, technology leaders worldwide in the manufacturing of ambulatory blood pressure monitors since 1990.

It builds on the near 30 year plus reputation and experience of Meditech’ s engineers and maintains the tradition of reliability and accuracy that thousands of customers around the world have come to expect.

The ABPM-06 has all the features customers like in the ABPM-04 and ABPM-05 plus some important new innovations

  1. AA grade Independent clinical validation to 3 separate protocols
  2. Built in voice recording (max 8 x 15 seconds)
  3. Free, all-inclusive software packages
  4. Unique SleepWell® function
  5. Dual valve system for patient safety
  6. Proven technology and long-life reliability

With both the ABPM-04 and ABPM-05 patients could trigger additional measurements by pressing a button. This feature is retained but with the ABPM-06 they can now also record up to 8 x 15 second voice memos.

For the first time patients can now record voice memos of symptoms during the recording for example if they are feeling dizzy and give detailed feedback to their Doctor over the monitoring period. This voice memos are downloaded and stored with the recording on the PC.

The ABPM-06 is A/A clinically validated to the ESH-IP, BIHS and AAMI protocols so accuracy is assured. The extended measurement range gives the doctor a more precise BP profile and overnight dipping and morning surges can easily be identified.

Meditech have designed a unique SleepWell® function to disturb the patient as little as possible during the night. The ABPM-06 won’t repeat failed readings unless necessary. This helps avoid measurements being taken uncomfortably close together.

The ABPM-06 comes with a standard USB cable. Cuff compatibility with earlier versions is maintained.

As you would expect the ABPM-06 is supplied with the popular CardioVisions analysis software which provides detailed automatic reporting and textual analysis.

For existing customers there is no new software to learn. Demonstrations are available and you can buy with confidence direct from PMS Instruments, the exclusive UK and Ireland Meditech authorised distributor since 1997.

Detecting Irregular Heartbeats (IHB)/AFib Using A&D’s Latest Blood Pressure Monitors.

A&D have a long history and pedigree in pioneering innovation and the development of blood pressure monitors with leading edge functions. With over 40 years of patient-focused thinking it has made them one of the leading blood pressure manufacturers in the world. Their latest clinically validated digital monitors feature a new 2nd generation IHB/AFib algorithm to detect an irregular rhythm during a measurement. 

It is currently available in the latest 2019 versions of the UA-767S AFib+ and UA-767S-W AFib+ from leading distributor PMS Instruments and will be available in more models soon.

It’s the latest development of an Irregular Heartbeat (IHB) detector and algorithm originally pioneered by A&D in 2014. With this feature as well as the existing World Health Organisation (WHO) blood pressure classification index introduced in 2003, A&D monitors really are at the Heart of Healthcare Technology.  

Why is the detection of Atrial Fibrillation important?

AFib is an irregular heart beat that can lead to strokes and other heart related conditions.

The NHS long term plan (NHSLTP) recently published ambitious targets for Atrial Fibrillation (AFib) and high Blood Pressure detection over the next 10 years.

For Atrial Fibrillation the targets are

That 85% of the expected number of people with AF are detected by 2029

That 90% of people with AF who are known to be at high risk of stroke to be adequately anti-coagulated by 2029.

The A&D UA 767S Afib+ and UA-767S-W Afib+ with %IHB/AFib detection could help with these aims.

The monitors classify the %IHB into 4 different grades showing how often an IHB has been detected during the measurement and illustrated by an icon.

0% no indication

1 – 9% grade 1

10 – 24% grade 2

25 – 100% grade 3

This feature is for monitoring purposes only and we recommend contacting your doctor if the grade is high.  

This new feature has been clinically validated and published in the Journal of Clinical Hypertension J Clin Hypertens. 2017;19:1143–1147 Tomoyuki Kabutoya et al. The paper concludes that the new algorithm had high diagnostic accuracy for detecting AF and a low false-positive rate.

Cardiovascular disease a national call to action

The fight begins against the nation’s biggest killer. Prevention is better than cure.

That’s the message from the latest guidance jointly released today by Public Health England and NHS England.

They have agreed ambitions and a goal over a 10 year period to improve the detection and treatment of (A) atrial fibrillation, (B) high blood pressure and (C) high cholesterol the A-B-C of major causes of cardiovascular disease (CVD) in England.

It is estimated CVD costs the wider economy £15.8 billion per year and causes 1 in 4 deaths.

It’s well known that many people are living with undiagnosed CVD or if diagnosed it is badly managed. These conditions often carry no symptoms meaning millions of people are unaware they are at risk and in need of treatment. It is believed that over 5 million are currently living with undiagnosed high blood pressure in England alone.

Today CVD causes 1 in 4 deaths in England or 1 every 4 minutes. In 2016 heart disease was the leading cause of death for men and the second biggest for women after dementia.

The NHS long term plan (NHSLTP) has the ambition to prevent 150,000 cases of Strokes, heart attacks and dementia over the next 10 years.

The old adage prevention is better than cure is the mantra and Health Secretary Matt Hancock is on record as saying

“Prevention is at the heart of our vision for improving the health of the nation, empowering people to stay healthy, not just treating them when they’re ill. Millions of people are needlessly at risk of heart attacks or strokes when it could be prevented. So I want to help more people take the time out to protect their future health and get checked.”

These are the ambitions for Atrial Fibrillation (AFib) and Blood Pressure.

Atrial Fibrillation

  • 85% of the expected number of people with AF are detected by 2029
  • 90% of people with AF who are known to be at high risk of stroke to be adequately anti-coagulated by 2029.

Blood Pressure

  • 80% of the expected number of people with high BP are diagnosed by 2029
  • 80% of the total number of people diagnosed with high BP are treated to target as per NICE guidelines by 2029

How do we achieve these objectives when Primary Care is already overstretched?

By using the NHS Health Check to support early diagnosis and management can encourage people to make healthy life style choices such as eating well, reducing alcohol and taking more exercise is one approach.

New technology and new approaches can also help.

I’ve written previously on this Blog about opportunistic screening in different settings including community settings. Pharmacists for instance are already using new technologies and products like the AliveCor Kardia Mobile ECG and A&D UA-767 S blood pressure monitor with AFib + technology to actively and opportunistically identify at risk patients.

Already used extensively throughout the NHS the Kardia Mobile ECG monitor is clinically validated and automatically detects AFib in 30 seconds. Its quick uses a smartphone App and costs under £99.

Published today the CVD goals and ambitions Public Health England and NHS England hope to achieve by 2029 should be welcomed. If made a reality, the prospects of millions of at risk people will be transformed for the good.

New Fixed Price Service Package.

We are pleased to announce the introduction of new Fixed Price Service Plans for selected A&D Medical and Meditech devices including the Meditech ABPM-04/ABPM-05 and A&D TM-2655P/TM-2657P waiting room blood pressure monitors.

PMS Instruments are an approved A&D Medical and Meditech service and repair centre and our new Fixed Price Service Plan includes:-

  • 12 months priority software telephone and remote technical support
  • 12 months remote assist training and installation where applicable
  • Fixed price servicing cost including labour and service parts
  • Fast priority response for all servicing and repairs
  • Loan equipment (subject to availability)
  • FREE preventative maintenance and calibration check
  • Up to 70 point test procedure verifies equipment accuracy, patient safety and reliability
  • Fully insured courier collection and return included
  • Priority turnaround time typically 3-5 working days from receipt of equipment
  • Inclusive annual service and calibration to manufacturer’s specification
  • ISO-9001 Quality Assured service centre and Practice Index approved supplier
  • No need to pay to get this equipment serviced by 3rd party

We use genuine manufacturer approved spare parts, and adhere to recommended preventative and service procedures.

For pricing and to protect your equipment investment and ensure it is accurate, safe and reliable act today by calling 01628 773233 or email support@pmsinstruments.co.uk

Just one call or email is all it takes and we will do the rest.

Why Buy A Clinically Validated Blood Pressure Monitor?

The sales team at PMS often get asked the same questions from customers wanting to purchase a blood pressure monitor. Questions like which one would you recommend and which is the best one we sell will depend on the features a user is looking for and their budget.

One question we are always happy to answer is “What does clinical validation mean?”

Many customers are familiar with the CE mark on consumer electrical items.

Medical devices like blood pressure monitors must also have a CE mark by law. The CE mark means that, provided you use it correctly, the device will work properly and is safe but doesn’t mean it will necessarily give accurate readings or that it is clinically validated.

Whether you are going to record your blood pressure at home or in a clinical setting surely accuracy is the whole point of buying a monitor in the first place!

When a manufacturer like Meditech or A&D Medical state their product is “clinically validated” it means an independent validation of the device has been performed by a professional group

The most common validation protocols are the British and Irish Hypertension Society (BIHS), formerly British Hypertension Society, the European Society of Hypertension International Protocol (ESH-IP), and the Association for the Advancement of Medical Instrumentation (AAMI).

While each of the protocols may have many similarities, there are some differences in their testing requirements. In many cases, however, a product that passes one protocol may also satisfy the criteria of other protocols as well. Recently, the AAMI, ESH, and ISO experts agreed to develop a single universally acceptable standard (AAMI/ESH/ISO), which will replace all previous protocols.

Often, the clinical validation report is published in a peer-reviewed journal like Blood Pressure Monitoring.  Publication in a peer-reviewed journal is essential because of the rigorous review processes a clinical validation must go through to make sure there are no protocol violations and the chosen validation protocol has been adhered to.

The time and conditions demanded by the various protocols are extremely difficult to fulfil as a large number of subjects have to be recruited, a wide range of blood pressures are required and it can be difficult to recruit skilled staff . They can also be expensive.

There is a great overview of the detailed process involved from the Working Group on Blood Pressure Monitoring of the European Society of Hypertension here.

For these reasons not every blood pressure manufacturer will conduct a clinical validation.

PMS Instruments only distribute blood pressure monitors from manufacturers that do. Clinical validation provides so much more than a CE mark!

Whether you are a healthcare professional, or someone looking to keep a check on their blood pressure at home a clinically validated blood pressure monitor from Meditech or A&D Medical gives you the confidence to know you’re using a reliable, accurate device to make a clinical decision.

A&D Medical clinical validation studies

Validation of the A&D UM-211 device for office blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010
Fania, Claudio; Albertini, Federica; Palatini, Paolo
Blood Pressure Monitoring, October 2017,22(5):302-305

Validation of the A&D UM-201 device for office blood pressure measurement according to the European Society of Hypertension International Protocol Revision 2010
Fania, Claudio; Albertini, Federica; Palatini, Paolo
Blood Pressure Monitoring, August 2017,22(4):234-237

Validation of the fully automated A&D TM-2656 blood pressure monitor according to the British Hypertension Society Protocol (equivalent to TM-2657P)
Zeng, Wei-Fang; Liu, Ming; Kang, Yuan-Yuan; Li, Yan; Wang, Ji-Guang
Blood Pressure Monitoring, August 2013,18(4):223-226

Validation of the A&D BP UA-651 device with a wide-range cuff for home blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010
Benetti, Elisabetta; Fania, Claudio; Palatini, Paolo
Blood Pressure Monitoring, June 2015,20(3):164-167

Validation of the A&D BP UA-651 device for home blood pressure measurement according to the European Society of Hypertension International Protocol revision 2010
Benetti, Elisabetta; Fania, Claudio; Palatini, Paolo
Blood Pressure Monitoring, February 2014,19(1):50-53

Validation of the A&D UA-1020 upper-arm blood pressure monitor with six different-shaped or different-sized cuffs according to the British Hypertension Society protocol
Zeng, Wei-Fang; Kang, Yuan-Yuan; Liu, Ming; Li, Yan; Wang, Ji-Guang
Blood Pressure Monitoring, October 2013,18(5):272-277

Validation of the A&D UA-1020 upper-arm blood pressure monitor for home blood pressure monitoring according to the British Hypertension Society Protocol
Zeng, Wei-Fang; Kang, Yuan-Yuan; Liu, Ming; Li, Yan; Wang, Ji-Guang
Blood Pressure Monitoring, June 2013,18(3):177-181

Validation of A&D UA-778 blood pressure monitor in children
Narogan, Marina V.; Narogan, Marina I.; Syutkina, Elena V.
Blood Pressure Monitoring, October 2009,14(5):228-231

Validation of A&D UA-85X device for blood pressure measurement
Bonso, Elisa; Ragazzo, Fabio; Palatini, Paolo
Blood Pressure Monitoring, December 2008,13(6):339-341

Validation of A&D TM-2430 upper-arm blood pressure monitor for ambulatory blood pressure monitoring in children and adolescents, according to the British Hypertension Society protocol
Yip, Gabriel Wai-Kwok; So, Hung-Kwan; Li, Albert Martin; Tomlinson, Brian; Wong, Sik-Nin; Sung, Rita Yn-Tz
Blood Pressure Monitoring, April 2012,17(2):76-79

Validation of the A&D UM-101 professional hybrid device for office blood pressure measurement according to the International Protocol
Stergiou, George S.; Giovas, Periklis P.; Gkinos, Charilaos P.; Tzamouranis, Dimitris G.
Blood Pressure Monitoring, February 2008,13(1):37-42

Meditech clinical studies

Reproducibility of 24-h ambulatory blood pressure and measures of autonomic function
Morrin, Niamh M.; Stone, Mark R.; Henderson, Keiran J.
Blood Pressure Monitoring, June 2017,22(3):169-172
Brief Report

Obstructive sleep apnea increases systolic and diastolic blood pressure variability in hypertensive patients
Shi, Jing; Piao, Jingyan; Liu, Bin; Pan, Yujiao; Gong, Yongtai; Deng, Xianzhu; Sun, Weiyan; Lu, Shuang; Li, Yue
Blood Pressure Monitoring, August 2017,22(4):208-212
Clinical Methods and Pathophysiology

The influence of physical training status on postexercise hypotension in patients with hypertension: a cross-sectional study
Imazu, Alexandre A.; Goessler, Karla F.; Casonatto, Juliano; Polito, Marcos D.
Blood Pressure Monitoring, August 2017,22(4):196-201
Clinical Methods and Pathophysiology

Clinical practice of ambulatory versus home blood pressure monitoring in hypertensive patients
Paolasso, Jorge A.; Crespo, Florencia; Arias, Viviana; Moreyra, Eduardo A.; Volmaro, Ariel; Orías, Marcelo; Moreyra, Eduardo Jr
Blood Pressure Monitoring, December 2015,20(6):303-309
Clinical Methods and Pathophysiology

The association of night-time systolic blood pressure with ultrasound markers of subclinical cardiac and vascular disease
O’Flynn, Anne Marie; Ho, Emily; Dolan, Eamon; Curtin, Ronan J.; Kearney, Patricia M.
Blood Pressure Monitoring, February 2017,22(1):18-26
Clinical Methods and Pathophysiology

Myocardial ischemia during everyday life in patients with arterial hypertension: prevalence, risk factors, triggering mechanism and circadian variability
Uen, Sakir; Un, Ismail; Fimmers, Rolf; Vetter, Hans; Mengden, Thomas
Blood Pressure Monitoring, August 2006,11(4):173-182

Development of normative ambulatory blood pressure data in children: Marianne Soergel and the Arbeitsgruppe Pädiatrische Hypertonie
Blood Pressure Monitoring, June-August 1999,4(3):121-126

Making ambulatory blood pressure monitoring accessible in pharmacies
James, Kirstyn; Dolan, Eamon; O’Brien, Eoin
Blood Pressure Monitoring, June 2014,19(3):134-139

Simultaneous recording of blood pressure and ST-segment with combined, triggered ambulatory 24-h devices
Uen, Sakir; Vetter, Hans; Mengden, Thomas
Blood Pressure Monitoring, February 2003,8(1):41-44

Silent myocardial ischaemia in treated hypertensives with and without left ventricular hypertrophy
Stojanovic, Milos M.; O’Brien, Eoin; Lyons, Simon; Stanton, Alice V.
Blood Pressure Monitoring, February 2003,8(1):45-51

Ideal Professional BP Package

Up until now many Hospitals and GP Practices have purchased low cost digital blood pressure monitors designed originally for home or retail use. As good as some of these monitors are they are not necessarily designed for repeated use on a daily basis or designed to stand up to the rigours of Hospital or Primary Care use.

Monitors in these environments can be subjected to drops and knocks associated with a busy ward or unit.

Expensive vital signs type monitors are available but with extra features not necessarily needed by all.

The A&D Medical UM-201 aims to sit somewhere between these two camps and is aimed at the clinician looking for simple one button operation, accurate readings, cost effectiveness whilst anticipating heavy daily use. It concentrates on features customers actually want, like a large LCD display, long cuff tube, fast measurement times and simple one button operation.

The durable and chemical resistant body and cuffs are easy to clean and disinfect with common antiseptic agents and the low whole life running costs make this suitable for the Hospital environment. The UM-201 features A&D’s latest Electronic Constant Exhaust Valve (ECEV) for enhanced measurement accuracy as well as Irregular Heartbeat Detection (IHB) technology.

We recently introduced a UM-201 Pro package which includes a small (16-24 cm), adult (22-32cm) and large (31-45cm) cuffs as well as a mains adaptor. At £99 it is proving a popular package and for most the complete professional blood pressure solution.

 

What’s the future for manual blood pressure measurement devices?

Since 10 April 2014 and the implementation of EU Commission regulation no 847/2012 the sale of new Mercury sphygmomanometers to the healthcare sector has been banned.

The alternative? Electronic manual sphygmomanometers like the A&D UM-102A mimic the Mercury sphygmomanometer but have none of the inherent disadvantages. These devices blend the best of modern, reliable vertical LCD technology, with the traditional advantage and reassurance of a manual measurement whilst listening to Korotkoff sounds with a stethoscope.

Unlike Mercury sphygmomanometers, devices like the A&D UM-102A sphygmomanometer don’t require routine cleaning or maintenance and can be used at any angle with a wide range of cuffs sizes and on patients with arrhythmias.

There is no oxidisation of the LCD which could alter the dynamic response and readings can be read to a single digit mm/Hg. Most importantly, if a product like the A&D UM-102A gets dropped you won’t end up with a contaminated treatment room and an expensive and time consuming mercury spill to clean up!

Alternative clinically validated Mercury free sphygmomanometers are available, so clinicians do still have a choice as to whether they use a manual method to record blood pressure with a stethoscope or an automatic device.

Manual devices, like the A&D UM-102A, are more tactile to use and can provide the clinician with additional useful information, like regularity or strength of pulse, provided they are used correctly and users have proper training.

Are we doing enough to diagnose high blood pressure?

How often do you “Think BP”?

Did you know that in the UK alone, according to the British Heart Foundation (BHF), there are an estimated 7 million people with undiagnosed high Blood Pressure who don’t know they are at risk. Over 24% of people in England are estimated to have high Blood Pressure. At least half of all heart attacks and strokes are associated with high BP and it is a major risk factor for chronic kidney disease, heart failure and cognitive decline.

If these are the challenges facing Primary and Secondary Care the question is what can GP Practices, Hospitals and Clinical Commissioning Groups do to diagnose more patients with high blood pressure?

Can we do BP better and “Think BP”?

The BHF Guidance recommends key areas and stresses that clinicians should “Think BP” at every opportunity. I have separated their recommendations into a couple of key areas below where I think existing technology available from PMS Instruments could help.

Think BP in the Waiting Room— Consider giving patients access to a self-test blood pressure station in GP waiting rooms and Hospital Outpatient clinics. Professional, clinically validated monitors like the A&D Medical TM-2657P are designed for high volume use have been popular with GPs for many years and are now being used in Hospitals. They save both time and money in the long run and especially in a Hospital setting like a Renal Unit free up members of staff for other clinical duties.

Think BP during a consultation-Think BP and increase opportunistic screening in your GP Practice or Hospital. Make blood pressure testing routine for all patients attending clinics such as Renal, Sexual Health, Asthma, COPD, Diabetes, weight management, smoking cessation and other clinics. Patients can record their blood pressure in the GP or Hospital waiting room before they attend the clinic. The printed results can then be handed to the clinician during consultation saving time and staff resources.

For a trial, demonstration or to find out more about the TM-2657P call us today on 01628 773233.

Is 24 Hour ABPM Still An Indispensable Tool In The Management Of Hypertension?

Ambulatory Blood Pressure Measurement (ABPM) has been used increasingly in clinical practice over the last 30 years. With the rise and adoption of low cost home blood pressure monitoring is it still an indispensable tool in the management of hypertensives in General Practice?

I first asked this question in an article I wrote for Practice Management magazine in 2010. I concluded that it was but in the intervening years is this still the case?

In the light of clinical developments and the publication of guidelines like NICE Guideline CG127 on Hypertension in 2011 and latest update in November 2016 is it still relevant?

Some background

In recognition of the importance of ABPM, the British Hypertension Society (now the British and Irish Hypertension Society), the European Society of Hypertension and NICE CG127 have all published guidelines for the use and interpretation of ABPM in clinical practice.

Traditionally, hypertensive patients had been assessed using clinic based blood pressure readings by a Nurse or Doctor. This changed in 2011 and recognition was formally given to the importance of using 24 hour ABPM monitoring.

The old “snapshot” approach to blood pressure measurement could give inconsistencies and over-estimate a patient’s blood pressure by anything up to 30mmHg.

The so called White Coat Hypertension, leading to elevated blood pressure is well documented and can lead to unnecessary prescription of hypertensive medicines. This has a profound clinical and financial relevance to Primary Care and can lead to inappropriate diagnosis and treatment. Ambulatory Blood Pressure Monitors provide much more consistent readings over a 24-hour period and give multiple measurements throughout the day and night.

CardioVisions NICE Software keeps it simple.

Modern ABPM software can produce a plethora of statistics and data which even for experienced clinicians can be overwhelming.

As a response to this and in view of the 2011 NICE guidelines we introduced our CardioVisions NICE software. This provided a meaningful textual analysis ensuring clinicians got reporting continuity to a recognised clinical standard as well as importantly saving Doctor and Nurse time. It’s compatible with the Meditech ABPMs and a typical report may read something like this.

“The ABPM was worn by the patient for 24 hours. During this period the average daytime blood pressure was 169/118 and the pulse rate was 88 beats per minute. According to NICE guidelines the patient exhibits stage 2 hypertension. The examination was divided into day 06:00-22:00, night 22:00-06:00. 64 successful readings were taken during the daytime period and the NICE key quality requirement for 14 has been met. During the daytime there were 64 readings (100.0%) above the NICE guideline figure of 135/85. The highest reading was 202/134 recorded at 9:15 22/05/1997. During the night time period 24 successful readings were taken and the average blood pressure was 135/87.”

The detailed stats, graphs and readings are still there for those that want them but the textual analysis summary can be copied and pasted into the patient notes and also attached to popular clinical management systems like EMIS Web and SystmOne. There is no annual licence fee and multiple copies can be installed.

What about home blood pressure monitoring?

The cost of clinically validated home blood pressure monitors has fallen since 2010 and a number of GP Practices have been loaning monitors like the UA-767S-W to patients. Home monitoring is great for the small number of patients that find ambulatory blood pressure monitoring inconvenient or difficult tolerate but it’s not ideal for everyone and can be difficult to manage in practice.

For home blood pressure monitoring NICE recommend patients should measure their blood pressure twice a day, ideally once in the morning and once in the evening, while sitting down. Each time they do this, they should take two readings, 1 minute apart. They should continue to measure their blood pressure twice daily for at least 4 days and ideally for 7 days. Some patients may find this onerous and patient compliance can vary. A 24 hour monitor is only worn for 24 hours!

All the measurements taken after the first day are used to work out average day time blood pressure but again this can be time consuming and may be subject to error.

Whilst home blood pressure monitoring gives multiple readings, it relies on proper patient technique, patient training and compliance for up to seven days to give meaningful results.

As a complementary technique to 24 hour ABPM it can be useful to monitor patients with long term chronic conditions such as diabetes and coronary heart disease.

On the flip side the detail, automatic analysis and reporting, 24 hour ABPM provides with very little user or patient input just isn’t available with home blood pressure monitoring.

Night time readings cannot be recorded and for many 24 hour ABPM remains the “Gold Standard”.

So why doesn’t everyone use 24 hour ABPM?

For some the initial cost is off putting but the cost of 24 hour ABPM monitors has fallen since 2010.

The latest 24 hour BP monitors like the Meditech ABPM-04 and ABPM-05 are reliable with low running costs, long warranties and a low overall cost of ownership.

PMS Instruments now offer a flexible rental ABPM service which means cost can be spread over several months and for a low monthly fee service and calibration is covered.

“Is 24 Hour ABPM Still An Indispensable Tool In Management Of Hypertension?” my answer would still be yes.

To arrange a free trial of one of our latest ABPM monitors and find out for yourself please contact us on 01628 773233.

PMS Instruments. Expertise, Experience and Trust for service, calibration and support.

These are the key words our customers associate with PMS Instruments as well as being the fundamental foundations of our calibration and service department.

I recently posted on Facebook a picture of an A&D Medical TM-2655P waiting room blood pressure monitor that had recorded a staggering 103366 readings since we originally supplied it in 2004!

Having visited the R&D centre in Japan I know the engineering quality, research and development that A&D Medical put into the design and manufacturer of their products but was intrigued and asked one of our service engineers to give me the service history of the monitor over the last 12 years.

We keep detailed service and calibration records for every item of equipment we service and repair. The monitor had a new cuff mechanism fitted in 2007 which we replaced under warranty but other than that had had no other parts fitted just regular, routine and preventative maintenance.

What’s the secret of this reliability and low cost of ownership?

I am convinced it is regular, preventative and routine servicing by PMS Instruments which extends the in service life of the monitors and prolongs the investment our customers make in their equipment.

Why do I think this? There are any number of medical companies that visit GP surgeries in the UK offering to service and calibrate a wide range of blood pressure monitoring equipment. That may be the case but the TM-2655P and TM-2657P waiting room blood pressure monitors are specialist instruments, requiring specialist knowledge and test equipment.

So what are you actually getting from us and how does our service differ?

With our service and calibration service each monitor is subjected to an approved individual ISO-9001 quality assured Work Instruction. This comprises a series of up to 70 detailed steps our service engineers must follow and which the product must pass in accordance with the manufacturer’s service manuals. You get so much more from PMS Instruments than the basic 10 minute on site functional test some companies offer.

You get what you pay for?

Depending on the model it can take up to 90 minutes for our Service Engineers to adjust, calibrate and service an A&D Medical waiting room blood pressure monitor and we are the experts at it! Rapid turnaround time means minimum downtime and a full service and calibration certificate is issued.

Not convinced and want to use another company?

To ensure you are getting a proper and professional service for your A&D Medical waiting room blood pressure monitor and compare like for like ask your current service provider these questions.

  • Are you authorised by A&D Medical to work on this equipment?
  • Have the service engineers working on your equipment been on an A&D training course?
  • Do you follow a preventative service and maintenance schedule?
  • Do you perform an internal inspection of the equipment?
  • Do you check and replace routine original service parts?
  • Do you use an A&D Medical BP Checker?

Was it yes to all of these?

I was happy for the customer that their A&D Medical waiting room blood pressure monitor had provided so many years of reliable and trouble free service.

Has your TM-2655P monitor reached 100000 + readings during its lifetime yet? If your current service company can’t tell you call us on 01628 773233 and we will.

The secret by the way is Test Mode 41 or is it 42!

The missing 5.5 million with undiagnosed high BP.

A new resource – Blood Pressure – How Can We Do Better? – has just been launched and can be accessed at the British Heart Foundation website.

It has been developed by stakeholders including GPs, nurses and pharmacists working with organizations including NHS England, Public Health England, the British Heart Foundation, the Stroke Association and the Royal College of General Practitioners.

It is well known that high blood pressure affects one in four adults in England and is one of the leading causes of premature death in England. At least half of all heart attacks and strokes are associated with high blood pressure.

Treatment thankfully is very effective – for every 10mmHg reduction in blood pressure, the risk of a life changing heart attack or stroke is reduced by 20%.

What’s the challenge?

Finding undiagnosed hypertensives, around 25000 in the average CCG or 5.5 million in England, unaware of their increased risk and not receiving treatment is the challenge. It’s also worth remembering that of those diagnosed with high BP, one in three, are not treated to target.

GP Practices and Clinical Commissioning Groups (CCGS) need to do things differently to improve detection and increase opportunistic screening.

What practical steps should GP Practices take?

Think BP! Whether in routine consultations, or in nurse led clinics, like COPD, asthma and diabetes. Encourage opportunistic screening and ensure identification of poor BP control is the responsibility of all clinicians.

Think BP! In accordance with NICE CG127 guideline on Hypertension always offer ambulatory 24 hour blood pressure monitoring or when appropriate home blood pressure monitoring to confirm a diagnosis of high BP. Ensure BP equipment is serviced and calibrated regularly by reputable third parties with experience of the devices you use.

Think BP! Use clinically validated waiting room self-test BP monitors like the A&D Medical TM-2657P to make it easier to collect BP data, save appointment time and empower patients to actively use this equipment.

Think BP! Advise patients of the option to buy clinically validated low cost blood pressure monitors like the UA-767S from established suppliers so they can monitor their blood pressure at home.

There is also a role for Clinical Commissioning Groups (CCGs) who need to do things differently to improve detection, support GP Practices and increase opportunistic screening.

They can use the BHF website to see how many people in their CCG have undiagnosed high blood pressure.

How do we diagnose more patients with high blood pressure?

Time pressured consultations and other clinical priorities are a factor and simply mean in many instances there isn’t enough time to record a blood pressure. The answer is the wider adoption of technology like the A&D Medical TM-2657P waiting room BP monitor and doing things differently.

How does it work?

Patient self-measurement of blood pressure using A&D waiting room blood pressure monitors have been used in the UK since PMS Instruments introduced them in 2002. They are an established part of many GP Practices hypertension diagnosis and management pathways. Put simply the patient records their blood pressure which is printed on a paper slip. This is then shown to the clinician during the consultation. The readings can be input to the patient’s clinical record.

What does the future for detection and management of high BP hold?

With no extra capacity at present the situation won’t be improved by GP’s working harder. It may be improved by doing things differently, changing the system and the wider adoption of new technology. If you are a GP Practice, CCG or GP Federation and want to find out more about the latest BP measuring technology contact me.

SysToe – Putting your Patient’s Feet First

In this digital day and age, you might not be surprised to hear me ask if you’ve had your digital pressure taken recently? Of course, I mean your toe and finger pressure – simple to forget but important not to ignore.

Today, we’re specifically talking about Peripheral Arterial Disease (PAD), which is when the arteries to the legs get either completely or partially blocked, most commonly due to atherosclerotic (cholesterol) plaques. These blockages lead to intermittent claudication, a leg pain in the patient’s calf as a result of walking, which eases at rest. Many might consider this calf pain as fairly normal, and ignore the symptoms, especially if they felt normal again when resting. If Peripheral Arterial Disease is left unchecked, it may become more advanced, eventually leading to pain at rest, leg ulcers and even gangrene.

PAD has previously been diagnosed with a physical examination by a GP, who would compare blood pressure in the patient’s arm and ankle. A difference in the two readings would be a possible indication of PAD. Whilst this technique has been in use for over half a century, it comes with problems; most notably the need for operator training and that the patient can experience some discomfort throughout the process. We now have the ‘SysToe’ machine, meaning PAD can be quite easily diagnosed with a simple reading of the Toe Brachial Index (TBI). This reading can also be used following diagnosis to track disease and help aid recovery.

So why is the SysToe system so great?

The SysToe system is a fully automated clinically validated patented device. It is not operator dependent so gives reliable and repeatable measurements. This not only saves on NHS time and money, but also helps to create more accurate diagnosis than ever before. It’s the full automation which make the SysToe so great; once the cuff and the sensor are placed on the toe (an easy job for anyone to do), just press the START button for cuff inflation and deflation to take place at the data value displayed within three minutes.

For the quick assessment of lower limb arterial diseases, the SysToe is a must have piece of equipment. Fast measurements, accurate and reproducible results, time & money saving; can your surgery or clinic not afford to have one?

Know Your Numbers Week 12 – 18th September

The 12th to the 18th of September this year sees the return of ‘Know your Numbers’, a Blood Pressure UK run awareness campaign to promote blood pressure testing. KYN was first launched in 2001 and has since gone on to encourage around 1.5 million people to have their blood pressure checked. The idea is that we should all know our blood pressures like we know our height and weight.

For me, that’s a great analogy. If you weigh yourself and realise you’ve put on a few pounds, then you might start eating a bit differently or moving a bit more. The difference, however, is that with weight gain you have a visual clue before anything else. Blood Pressure is only known once tested, but knowing those figures and tracking the changes could one day save your life.

As part of KYN week, ‘Pressure Stations’ will be setup all around the country at the more obvious venues such as GP surgeries, hospitals and health clubs, but also shopping centres and supermarkets, so it should be easy for everyone to get checked out.

At P.M.S (Instruments), we think this is a great initiative, and hope it does it a lot of good, but we can’t forget that we’re here to supply both surgeries with the equipment they need and also those at home or in the private healthcare sector. With that in mind, we’d like to share some news on two great new products.

The A&D TM-2657P is the follow up to the TM-2655P, popular with GPs as it saves consultation time. This is particularly useful at this time of year when it comes to screening elderly patients who are having the flu jab in large volumes. My favourite new feature of this machine is the added value of the Irregular Heartbeat Indicator (IHB) function – a highly useful new feature. Check out the write up below for some more specs!

The other great new Blood Pressure Monitor is the A&D UA-767-S, which is the latest in a generation of models of the same name. This is a really portable BPM, which makes it perfect for either home use, those who are regularly out and about on home visits or just in the surgery. Another brilliant bit of kit from A&D, again, check below for full specs!

Here at PMS, we’re proud to have a 40 year plus history of supplying technology you can trust. We’ve been the main A&D UK distributer since 1990 (A&D have been making Blood Pressure Monitors since 1979) so we can guarantee the best equipment and a genuine pedigree. For is, this is the perfect marriage to support the upcoming Know Your Numbers week.

 

A&D TM-2657PA&D TM-2657P – For Waiting Room Use

Key features

  • User-friendly with small footprint
  • BHS AA grade clinical validation 
  • Simple one-touch fully automatic measurement
  • Accurate and reliable Torque Controlled Belt drive Method
  • Antibacterial inner arm cuff cover
  • Easy load paper tray
  • Reliable high speed printer with easy paper replacement
  • Irregular Heart Beat (IHB) indicated on printout

 

The TM-2657P is the latest waiting room blood pressure monitor from A&D Medical. It builds on the speed, reliability and accuracy of the previous TM-2655P, which it replaces, but now features a new ergonomic, modern, compact design. The new integrated armrest helps ensure the patient’s arm is comfortable and in the correct position during a measurement.

A new antibacterial arm cuff cover is also now fitted as standard with the TM-2657P. Designed and engineered in Japan, the new TM-2657P has a faster printout speed and offers added optional connectivity features including Bluetooth.

The “Torque Controlled Belt drive Method” (TCBM) cuff mechanism in the TM-2657P provides sophisticated automatic cuff size adjustment, ensuring the arm is positioned correctly for accurate high speed measurement, first time, every time.

With a centrally located simple one-button operation, it can be used on children (13 years or above) and adults with either the left or right arm. After the reading, the results are output to the inbuilt thermal printer with the date, time systolic, diastolic and pulse rate clearly displayed. New printing options also permit the inclusion of a barcode or QR code on the print out.

The printout will also display (if present) an irregular heartbeat symbol. An irregular heartbeat is defined as a heartbeat that varies by 25% from the average of all heartbeats during the blood pressure measurement.

Like the previous model, the TM-2657P looks set to be popular with GP Practices looking for a clinically validated, easy to use professional waiting room blood pressure monitor.

 

 

Key features

  • Compact size and weight (140(w) x 60(h) x 105(d) mm weighs (245g) ex batteries
  • Advanced Oscillometric method for hospital accuracy
  • 60 reading memory with average
  • Correct cuff fit and movement detector
  • Irregular heartbeat indicator with frequency detected
  • WHO blood pressure classification index
  • European Society of Hypertension International Protocol clinical validation
  • Five- year warranty
  • Battery or mains (optional extra) operation

The frequency of IHB (Irregular Heart Beat) detection is divided into different grades and shown by icons.

  • 0-24% : No Indication
  • 25-49% : Grade 1
  • 50-74% : Grade 2
  • 75-100% : Grade 3

The latest A&D Medical UA-767S builds on the popularity, accuracy and reliability of the original UA-767 series but it adds additional new advanced features. It is a popular upper arm blood pressure monitor with a 60 reading memory with averaging function, cuff fit and movement error functions and a simple one-button operation. This model features a new Irregular Heartbeat Indicator (IHB) function, which identifies the frequency of IHB by dividing the number of IHBs by the total number of readings taken to grade the occurrence of IHB accordingly. The more frequent the IHB appears the greater the risk. This feature is for monitoring purposes only. The UA-767S is supplied with a standard 22-32cm cuff. For customers with a larger arm we recommend the UA-767S-W, which has a 22-42cm cuff. It has a proven reliability record and is used extensively in the UK.

 

24/7 ABPM Guidelines Revisited

NICE clinical guideline 127 states that ABPM monitoring is the most accurate method for confirming a diagnosis of hypertension, and its use should reduce unnecessary treatment in people who do not have true hypertension. Originally published in 2013 it was updated in September 2015.

In a recent review with our technical support team I asked them what were the practical questions they were most frequently asked about the guideline and ABPM in general.

I thought I would share the results on our Blog as they may be of interest to other ABPM customers. In no particular order this is what they told me.

Continue reading “24/7 ABPM Guidelines Revisited”

Blood Pressure And Diabetes

Having diabetes can increase your risk of developing high blood pressure and other cardiovascular problems, because diabetes adversely affects the arteries and can cause atherosclerosis – a narrowing of the arteries. This can cause high blood pressure, which if not treated, can lead to further blood vessel damage, stroke, heart failure, heart attack or kidney failure.

High blood pressure can also increase the risk of diabetes complications such as diabetic eye and kidney problems.

What are the symptoms of high blood pressure?

Usually, high blood pressure causes no symptoms. This is why it is so important to have your blood pressure checked on a regular basis, either during a visit to your doctor or diabetic nurse, or through home blood pressure monitoring – using equipment such as A&D’s UA-767S device ideal for consumer home use.

This model makes it easy to track you blood pressure over time and features an Irregular Heartbeat Indicator and World Hypertension Society blood pressure classification index.

Information on how to correctly measure blood pressure can be found on the British Hypertension Society website. At £36 the monitor can be purchased here

The right monitor for the job?

All blood pressure monitors are really all the same aren’t they? Which is the most accurate? I’m confused as all BP monitors seem to be the same. What about reliability and durability?

These are some of the questions our sales team are frequently asked and it’s true many digital blood pressure monitors offer similar features and claim to offer similar “clinically validated accuracy”.

But what about durability and reliability?

Continue reading “The right monitor for the job?”

Waiting Room Blood Pressure Monitors Rebooted

The TM-2657P is the latest waiting room blood pressure monitor from A&D Medical. It builds on the speed, reliability and accuracy of the previous TM-2655P, which it replaces, but now features a new ergonomic, modern, compact design.

The new integrated arm rest helps ensure the patient’s arm is comfortable and in the correct position during a measurement. A new antibacterial arm cuff cover is also now fitted as standard with the TM-2657P.

Designed and engineered in Japan, the new TM-2657P has a faster printout speed and offers added optional connectivity features including Bluetooth.

The “Torque Controlled Belt drive Method” (TCBM) cuff mechanism in the TM-2657P provides sophisticated automatic cuff size adjustment, ensuring the arm is positioned correctly for accurate high speed measurement, first time, every time.

With a centrally located simple one button operation, it can be used on children (13 years or above) and adults with either the left or right arm.

After the reading, the results are output to the inbuilt thermal printer with the date, time systolic, diastolic and pulse rate clearly displayed. New printing options also permit the inclusion of a barcode or QR code on the print out.

The printout will also display (if present) an irregular heartbeat symbol. An irregular heartbeat is defined as a heartbeat that varies by 25% from the average of all heartbeats during the blood pressure measurement.

Like the previous model, the TM-2657P looks set to be popular with GP Practices looking for a clinically validated, easy to use professional waiting room blood pressure monitor.

Does anyone still use Mercury Sphygmomanometers?

The UM-102A is the latest second generation Mercury free sphygmomanometer from Japanese company A&D Medical. It builds on the reliability and accuracy of the previous model, which it replaces, but now features a new ergonomic, modern, lightweight design.

Designed for professional use, it allows clinicians to record accurate blood pressure measurements using the “Gold Standard” Auscultatory measurement technique whilst listening for Korotkoff sounds with a stethoscope.

An extensive range of latex free compatible cuffs, with “quick fit” connectors and inflation bulbs already attached, make swapping cuffs quick and simple.

The adjustable, clear, anti-glare LCD screen is graduated just like Mercury so it is easy to read from any angle.

Sales of new Mercury sphygmomanometers were banned in the UK in 2014, but the UM-102A is an alternative clinically validated modern interpretation of the traditional Mercury sphygmomanometer.

Measurements Made Easy

The demise of the mercury sphygmomanometer in clinical practice has been discussed and debated for over 10 years.

Until recently they could still be sold for professional use in the healthcare sector. However, since 10 April 2014 and the implementation of EU Commission regulation no 847/2012 the sale of mercury-containing sphygmomanometers to the healthcare sector, is now prohibited.

The exception is where new sphygmomanometers will be used in ongoing epidemiological studies or as reference standards in clinical validation studies of mercury-free sphygmomanometers.

Despite this and as recently as December 2013, the MHRA were still recommending that calibrated, non-mercury devices, which are not automatic, should be made available in all clinical areas.

They should be used to check automatic device results and should also be used in clinical conditions where automatic monitors may be inappropriate e.g. arrhythmia, pre-eclampsia or specific vascular disease.

This presents the Practice Manager and Clinician with a potential dilemma. How do they comply with the MHRA guidelines?

Fortunately for Clinicians with the right training and skillset, there are a number of manual devices available which include shock resistant aneroid sphygmomanometers (ERKA Switch) and manual electronic devices like the A&D Medical UM-101A which have the same look and feel as Mercury.

Assuming Clinicians are comfortable using the Auscultation (manual) technique of recording blood pressure with a stethoscope, then a new generation of hybrid devices like the  Omron HBP-1300 are now also available.

These new devices are designed specifically with the professional user in mind. During an automatic measurement if the Irregular Pulse Wave symbol feature is indicated, the user can switch to manual mode and use a stethoscope to verify a reading is accurate without having to change device or cuff.

This is in line with MHRA recommendations.

Conclusion

Mercury sphygmomanometers have not been banned but new ones cannot now be purchased for general clinical use. That doesn’t mean the end of manual readings which in certain clinical situations may be required.

Suitable alternative clinically validated mercury free sphygmomanometers are available, so clinicians do still have a choice.

New hybrid automatic and manual blood pressure monitors specifically designed for the professional market are now available. They offer the advantage of a clinically validated automatic measurement or back up of a manual measurement where circumstances dictate.

Ambulatory blood pressure monitors. Are you getting good value?

The cost of ABPM monitors has fallen considerably in recent years but purchasers should check that there are no hidden extras and that the supplier is able to offer free technical support, installation training and advice to nurses who generally fit the monitor.

As some manufacturers offer expensive additional warranties or support contracts the true “whole life” running costs including maintenance should be factored in to the purchasing decision.

All modern 24-hour monitors like the Meditech ABPM-04, Meditech ABPM-05 and TM-2430 now use PC-based software and in most instances it is possible to attach the patient’s report to popular clinical management systems, such as EMIS and SystmOne.

Again it is worth checking that this is included and that there are no expensive annual licence fees or dongles required, as well as checking that multiple copies can be installed without additional cost.

An ABPM report should include, as a minimum, daytime and night-time averages, a list of BP data and trend graph on one or 2 sheets of A4 paper.

Normal mean levels for ABPM in adults are slightly lower than surgery readings at 135/85 for daytime average and 120/70 when asleep.

The results can usually be interpreted by suitably qualified clinicians. The latest version of CardioVisions that works with the Meditech ABPM-04 and Meditech ABPM-05 provides additional automatic analysis to the NICE 2011 guidelines and this can save time and ensure consistent reporting.

Ideally, the monitor should be able to use rechargeable batteries to minimise costs. A wide range of cuff sizes should be available but the adult and large adult will probably be used the most popular. Cuff barriers like those from TIDI can help keep cuffs hygienic and prevent soiling.

Most but not all companies will offer additional training if required.

As with any piece of medical equipment used in patient diagnosis, routine calibration and servicing is important. This should only be undertaken by authorised service technicians that have access to original manufacturer parts and test equipment.

With any ABPM this should be available in the UK from the supplier to avoid unnecessary downtime.

As with all things it’s unwise to pay too much but sometimes risky to pay too little.

Undiagnosed OSA increases the risk of high blood pressure

Obstructive Sleep Apnoea (OSA) is a sleep related breathing disorder which occurs if airflow through the nose and mouth is obstructed. Having undiagnosed OSA increases the risk of high blood pressure, and is associated with other serious conditions such as strokes and heart attacks, type II diabetes and depression as well as traffic collisions. OSA affects men, women and children.

A growing amount of evidence suggests that OSA is the most common type of secondary hypertension, however, an estimated 70-90 percent of cases are undiagnosed.

The Meditech apneABP is ideal as an opportunistic outpatient screening tool for OSA and can help diagnose at risk patients prior to referral to specialist sleep labs.

Blood pressure is recorded automatically at pre-set intervals and SP02 data is recorded continuously.

The easy to use CardioVisions software displays 24-hr blood pressure chart, histogram, correlations, blood pressure statistics, oxygen saturation overview, plethysmograph pulse wave, pulse oximetry statistics and activity.

As a result, apneABP gives information not only about blood pressure and general pulse oximetry data, but also about the condition of the arterial system through plethysmograph and pulse wave.

The apneABP e will allow CCGs and GPs to take an active role in OSA screening and referral pathways which is beneficial to the patient, the GP and the sleep clinic.

PMS algorithm for blood pressure measurement

The CG127 2011 NICE Hypertension guidelines includes generic guidance on the measurement of blood pressure, including the key recommendation that 24 hour ambulatory blood pressure measurement be used before anti-hypertensive treatment is initiated. However out of the entire 317 page document, there is only one 6 page section on measuring blood pressure.

This section focuses on the different ways and methods of measuring blood pressure and the different types of devices available. The question is could the selection of the latest devices       streamline the blood pressure measurement process and save time, as well as clinical resources?

Is there a case for developing a suggested PMS algorithm for blood pressure measurement and what form should this take?

Step One Use a Waiting Room BP Monitor

Monitors like the TM-2655P waiting room monitor for patient self-measurement have been available for some time. They are convenient, easy to use and cost effective. They can be effective opportunistic screening devices and may identify patients with undiagnosed Hypertension.

Many also provide additional clinical information such as whether an Irregular Heartbeat is present. Many GP practices utilize them as part of a drop in service as they allow patients to monitor their own BP without making an appointment. This frees up clinicians for other duties. As with any BP monitor, it is important to check the monitor is listed on the BHS web site (www.bhsoc.org). Monitors that measure from the upper arm are recommended.

Step 2 Confirmation with a manual measurement

If it is felt that a reading from a waiting room blood pressure monitor needs clarification, an additional measurement should be taken. The BHS provide “best practice” guidance on the correct way to record blood pressure using an automatic or manual device. Most clinicians will rely on a clinically validated automatic monitor.

Most of these low cost devices like the UA-1010 feature an irregular heartbeat indicator and some have a “Tricheck” feature, which will automatically repeat a measurement three times, in accordance with BHS recommendations.

For patients identified with an irregular heartbeat, non-Mercury manual devices like the UM-101 are available.

Step 3 Use ABPM – The Gold Standard

The cost of ambulatory blood pressure monitors has fallen considerably over the last few years.  Like spirometers and ECG machines, the latest models such as the Meditech ABPM-05 feature software that provides automatic analysis of the results for consistent, time saving reporting to NICE Guidelines.

No More New Mercury Sphygmomanometers

The confusion that has surrounded the use of Mercury in medical devices has been rumbling on for several years. It’s use was restricted in thermometers some years ago but 2014 now finally sees the banning of it in new Mercury sphygmomanometers for environmental reasons.

The sale of Mercury Sphygmomanometers is now banned under EU directive no 847/2012 which also bans the use of Mercury strain gauges.

Alternatives to the Mercury sphygmomanometer and Mercury strain gauge are widely available, in the case of strain gauges they now use Indium Gallium.

The highly popular validated A&D UM-102A offers Auscultatory manual blood pressure measurement without Mercury in a compact design it even looks like a Mercury sphygmomanometer! Hybrid automatic and manual sphygmomanometers like the A&D Medical  UM-211 are also available.

Interestingly enough the directive does allow the use of Mercury as a reference standard for the validation of new blood pressure monitors and for research. So the Gold Standard still lives on since it’s invention over 130 years ago in 1881!