ABPM screen 300/400 Risk Assessment

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Transcription:

ABPM screen 300/400 Risk Assessment

Highlights of custo screen400 ABPM 24 hours Synchronized ABPM and Holter ECG recordings in combination with custo guard 3 72 hours for ABPM recordings alone To our knowledge, the custo screen 400 device is the first to pass the revised ESH-IP 2010 26.05.2014 custo med GmbH 2

Block diagram of the device screen 400 RF-Link SD-Card screen 300 Pressure Sensor Signal Conversion Mikrocontroller Blood Pressure Monitor Pressure Sensor Signal Conversion Pump Power Display, Button, Buzzer Mikrocontroller IrDA linear Valve Power Step Valve Power F-RAM clock 26.05.2014 custo med GmbH 3

Pressure signal Cuff temperature compensated resolution of 0.01 mmhg 1000 Hz 100 Hz inner tube Sensor electronics FIR-Filter kills noise of the pump Analysis Algorithm outer tube Linear Valve Valve Control: allows constant pressure drop no turbulence caused by air flowing hardly interference by valve movement or pump 26.05.2014 custo med GmbH 4

oszillation amplitude Envelope curve for calculation of BP pressure in mmhg 26.05.2014 custo med GmbH 5

Internal Validation, 318 Measurements 20 15 10 5 0 50,00-5 60,00 70,00 80,00 90,00 100,00 110,00 120,00 130,00 140,00 150,00 160,00 170,00 180,00 190,00 200,00-10 -15-20 -25 Adding new blood pressure recording with raw data and reference values to a database automatic optimizer Check the improvement optional manual correction Recalculation of the blood pressure Validation by a testing institute Systole Diastole 26.05.2014 custo med GmbH 6

Validation Results (ESH-IP 2010) http://www.dovepress.com/articles.php?article_id=16808 http://www.dovepress.com/getfile.php?fileid=20019 26.05.2014 custo med GmbH 7

Comparison with other ABPM devices 99 Measurements Values in: DIFFERENCE 5 MEAN DIFFERENCE STANDARD DEV. SBP DBP SBP DBP SBP DBP custo screen 300/400 (ESH-IP 2010) absolut 84 93-0,4-0,4 4,1 2,7 Device 2 (ESH-IP 2002, Mallion 2005 ) absolut 78 70-0,7-3 4,7 4,1 Device 3 (ESH-IP 2002, Ragazzo 2010) absolut 68 79-1,7-1,1 6,9 4,3 Device 5 (ESH-IP 2002, Denchev 2007) absolut 68 63 N/A N/A N/A N/A Device 6 (ESH-IP 2002, Haensel 2005) absolut 83 80-0,7-0,8 4,6 4,4 Device 7 (ESH-IP 2002, Jones 2004) absolut 71 72 N/A N/A N/A N/A Device 8 (ESH-IP 2002, Langewitz 2009 ) absolut 87 85-0,12 1,11 3,41 3,94 http://www.dableducational.org/sphygmomanometers/devices_3_abpm.html 26.05.2014 custo med GmbH 8

Why ABPM? Hypertension is one of the most important preventable causes of premature morbidity and mortality in the UK [ ] If the clinical blood pressure is 140/90 mmhg or higher, offer ambulatory blood pressure monitoring to confirm the diagnosis of hypertension National Institute for Health and Clinical Excellence (NICE), clinical guideline, 127, 2011 26.05.2014 custo med GmbH 9

Treatment of Hypertension Know Your Blood Pressure ABPM as a Gold Standard Know Your cardio-vascular Risks Risk Assessment: A tool to predict a person s chance of having a heart attack in the next 10 years Know how both variables are changing over time 26.05.2014 custo med GmbH 10

Risk Assessment Blood pressure Risk factors cardio - vascular Risk 26.05.2014 custo med GmbH 11

Blood Pressure Stages - DHL 26.05.2014 custo med GmbH 12

Blood Pressure Stages - NICE 150-169 170 26.05.2014 custo med GmbH 13

Comparison of NICE and DHL RANGE NICE -SYS NICE - DIA DHL-SYS DHL-DIA Optimum - - < 115 < 75 Normal < 135 < 85 115 124 75 79 High-Normal - - 125-134 80 84 Grade 1 135-149 85 94 135-146 85 89 Grade 2 150-169 95 109 147-156 90 95 Grade 3 > = 170 <= 110 > = 157 > = 96 Isolated Systolic Hyp. > = 135 < 85 > = 135 < 85 26.05.2014 custo med GmbH 14

Hypertension: Risk factors target organ damage cardiovascular risk factors Hypertension cardiovascular diseases Diabetes mellitus 26.05.2014 custo med GmbH 15

Cardio-vascular risk factors Systolic and diastolic blood pressure Smoking Dyslipidaemia Family history Abdominal obesity Glucose level Life style related factors 26.05.2014 custo med GmbH 16

Target Organ Damage Heart Kidney Blood vessels Retina Hypertrophy Proteinuria Arteriosclerosis Hypertensive retinopathy 26.05.2014 custo med GmbH 17

Diabetes mellitus (type II) Metabolic disorder Causes impairment of the kidneys, which is a central part of the blood pressure regulation Negative impact on the Renin-Angiotensin II complex, which has vasoconstructive effects mid-term to long-term effects on BP 26.05.2014 custo med GmbH 18

chronic diseases Cerebro-vascular impairments Stroke, TIA,. Heart related impairments Heart attack, H. insufficiency, angina pectoris Nephropathy Diabetic induced nephropathy Renal insufficiency 26.05.2014 custo med GmbH 19

Setting the risk factors 26.05.2014 custo med GmbH 20

Risk Assessment: custo diagnostic view 26.05.2014 custo med GmbH 21

Report Doctors view Patients view 26.05.2014 custo med GmbH 22

Benefits of Risk Assessment Identify patients with high risks Start with intervention asap Direct patients attention on possible risks AND options of intervention Risk Assessment could be an effective and efficient tool for making prevention real 26.05.2014 custo med GmbH 23

thank you for your attention Dipl. Ing. Andreas Wolf R&D Project Manager & Dr. Peter Rumm Medical Project Consultant custo med GmbH Leibnizstraße 7 85521 Ottobrunn Germany fon: +49 (0) 89-710 98 243 fax: +49 (0) 89-710 98 10 mobile: +49 (0) 171-560 4818 e-mail: peter.rumm@customed.de www: www.customed.de 26.05.2014 custo med GmbH 24

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