1. Fasting blood glucose assay must be performed in laboratories subjected to periodic quality control controls
2. the blood sample must be taken after at least 12 hours fasting
3. the sample taken must be venous and not capillary
4. by diabetic we mean any individual whose fasting blood glucose level, in at least two subsequent measurements over a one-week period, is equal to or higher than 126 mg/dl or who is undergoing oral pharmacological or insulin treatment or has a personal clinical history of diabetes.
Two measurement of the systolic blood pressure need to be performed, several minutes one after the other. The pressure value to be used for risk assessment is the mean between the two measurements.
1. Any clothing compressing the arm must be removed before fitting the cuff. The measurement is performed on the right arm, that should be held at a 45 degree angle rispetto al tronco. After having placed the cuff (for adult or for obese), the person needs to remain seated and relax for about five minutes before the measurement. The cuff must be at heart level. During the measurement both the person and the operator should be seated.
2. Feel the pulse of the radial artery and pump the cuff for a further 20-30mmHg after the disappearance of the pulse. Questo è il livello massimo a cui deve essere mandata la colonnina di mercurio durante la misurazione. Deflate the cuff e scollegarlo dallo sfigmomanometro. Wait a few seconds.
3. Inflate the cuff. Place the stethoscope diaphragm on the brachial artery at the antecubital fossa and slowly deflate the cuff, allowing the mercury column to descend at a rate of 2mmHg per second. Do not place the stethoscope membrane below the cuff.
4. Record the first audible sound followed by an identical one, corresponding to the systolic blood pressure; record the last audible sound, corresponding to the diastolic blood pressure. Blood pressure must be measured to an approximation of 2 mmHg. Write the value of measurement.
5. Completely deflate the cuff, then perform a second measurement several minutes later; following the procedure from point 3.
The mercury sphygmomanometer is preferable to aneroid or automatic instruments. Deve essere collegato al manicotto con sistema a vite. È importante che le due parti siano separate in quanto esistono in commercio manicotti di diverse misure (per bambini, per adulti, per adulti obesi). La parte gonfiabile del manicotto deve ricoprire almeno due terzi della circonferenza del braccio.
Frequent causes of inaccuracy
1- Faulty equipment
2- failure to zero mercury column
3- air outlet blocked
4- losses in the connecting tubes
5- incorrectly sized cuff.
1- Cuff not at heart level, i.e. incorrectly positioned
2- uncomfortable position
3- cuff deflated too quickly
4- hearing impairment of measurer (hypoacusis)
5- preference for last digit (zero in particular): observer-related inaccuracy as sphygmomanometer is calibrated in 2 mmHg intervals.
Total blood cholesterol and HDL levels
1. Blood sample must be taken after at least 12 hours fasting
2. the sample taken must be venous and not capillary
3. it is particularly important to have the total and HDL cholesterol assay performed in laboratories subjected to periodic quality controls.
A smoker is anyone who smokes regularly every day (even only one cigarette) or has stopped less than 12 months previously. A non smoker is anyone who has never smoked or has stopped more than 12 months previously.