ARCHETYPE Blood pressure (openEHR-EHR-OBSERVATION.blood_pressure.v2)

Name: Blood pressure
License: http://creativecommons.org/licenses/by-sa/3.0/

ARCHETYPE ID	openEHR-EHR-OBSERVATION.blood_pressure.v2
Concept	Blood pressure
Description	The local measurement of arterial blood pressure which is a surrogate for arterial pressure in the systemic circulation.
Use	Use to record all representations of systemic arterial blood pressure measurement, no matter which method or body location is used to record it. The archetype is intended to capture blood pressure measurements in all clinical scenarios - for example: - self-measurement with a home blood pressure machine; - an emergency assessment of systolic using palpation and a sphygmomanometer; - measurements taken in clinical consultations or during exercise stress testing; and - a series of measurements made by a machine in Intensive Care. There is a rich state model that supports interpretation of measurements through identifying patient position, exercise, confounding factors and angle of a tilt table in research. Named events have been limited to average over a 24 hour period, however templates can further constrain the default 'any event' to cater for specific requirements for blood pressure measurements such as recording Blood Pressure against specific points in time, or over a range of intervals (+/- mathematical functions).
Misuse	Not to be used to record the measurement of arterial blood pressure which is NOT a surrogate for arterial pressure in the systemic circulation eg specific measurement of right pulmonary artery pressure. Use OBSERVATION.intravascular_pressure in this situation. Not to be used to record measurements of intravenous pressure. Use the appropriate specialisations of OBSERVATION.intravascular_pressure in this situation.
Purpose	To record the systemic arterial blood pressure of an individual.
References	O'Brien E, Asmar R, Beilin L, et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. Journal of Hypertension [Internet]. 2003 [cited 2009 Jul 30] ; 21(5):821-848. Available from http://www.bhsoc.org/bp_monitors/ESH_BP_rec.pdf Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation [Internet]. 1993 [cited 2009 Jul 29] 88 (5): 2460. Available from: http://circ.ahajournals.org/cgi/reprint/88/5/2460
Copyright	© openEHR Foundation
Authors	Author name: Sam Heard Organisation: Ocean Informatics Email: sam.heard@oceaninformatics.com Date originally authored: 2006-03-22
Other Details Language	Author name: Sam Heard Organisation: Ocean Informatics Email: sam.heard@oceaninformatics.com Date originally authored: 2006-03-22
OtherDetails Language Independent	{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/., custodian_organisation=openEHR Foundation, references=O'Brien E, Asmar R, Beilin L, et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. Journal of Hypertension [Internet]. 2003 [cited 2009 Jul 30] ; 21(5):821-848. Available from http://www.bhsoc.org/bp_monitors/ESH_BP_rec.pdf Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation [Internet]. 1993 [cited 2009 Jul 29] 88 (5): 2460. Available from: http://circ.ahajournals.org/cgi/reprint/88/5/2460, current_contact=Heather Leslie, Atomica Informatics, original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=AF140E8608CE51F3E3E74F5F5F96AEA1, build_uid=e2eaf4ef-be3b-4513-8060-9449718125a5, ip_acknowledgements=This artefact includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyrighted material of the International Health Terminology Standards Development Organisation (IHTSDO). Where an implementation of this artefact makes use of SNOMED CT content, the implementer must have the appropriate SNOMED CT Affiliate license - for more information contact http://www.snomed.org/snomed-ct/get-snomedct or info@snomed.org., revision=2.0.7-alpha}
Keywords	observations, measurement, bp, vital signs, mean arterial pressure, pulse pressure, systolic, diastolic, RR, NIBP
Lifecycle	in_development
UID	1811b084-29c0-4bec-bde3-c70b7a5bc28e
Language used	en
Citeable Identifier	1013.1.4200
Revision Number	2.0.7-alpha
All	Archetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=The local measurement of arterial blood pressure which is a surrogate for arterial pressure in the systemic circulation., archetypeConceptComment=Most commonly, use of the term 'blood pressure' refers to measurement of brachial artery pressure in the upper arm., otherContributors=Karin Aarsheim, Helse Førde, Norway Tomas Alme, DIPS ASA, Norway Vebjørn Arntzen, Oslo universitetssykehus HF, Norway (Nasjonal IKT redaktør) Koray Atalag, University of Auckland, New Zealand Silje Ljosland Bakke, Nasjonal IKT HF, Norway (openEHR Editor) Knut Bernstein, MEDIQ, Denmark Lars Bitsch-Larsen, Haukeland University Hospital, Bergen, Norway Fredrik Borchsenius, Oslo universitetssykehus, Norway Pål Brekke, OUS Rikshospitalet, Norway Marja Buur, Medisch Centrum Alkmaar, Netherlands Rong Chen, Cambio Healthcare Systems, Sweden Lisbeth Dahlhaug, Helse Midt - Norge IT, Norway Beatriz de Faria Leão, Zilics, Brazil Paul Donaldson, Nursing Informatics Australia, Australia Torsten Eken, Oslo universitetssykehus HF, Ullevål, Norway Jose Florez Arango, Universidad de Antioquia, Colombia Einar Fosse, UNN HF, Norwegian Centre for Integrated Care and Telemedicine, Norway Gerard Freriks, ERC, Netherlands Sebastian Garde, Ocean Informatics, Germany Soon Ghee Yap, Singapore Health Services Pte Ltd, Singapore Anneke Goossen, Results 4 Care, Netherlands Mikkel Gaup Grønmo, Helse-Nord, Norway (openEHR Editor) Bjørn Grøva, Diretoratet for e-helse, Norway Johan Gustav Bellika, Norwegian Centre for Integrated Care and Telemedicine, Norway Atle Hansen, Universitetssykehuset Nord-Norge, Norway Sam Heard, Ocean Informatics, Australia Kristian Heldal, Telemark Hospital Trust, Norway Karsten Heusser, Hannover Medical School, Germany Omer Hotomaroglu, Turkey Evelyn Hovenga, EJSH Consulting, Australia Derek Hoy, United Kingdom Pieter Hummel, Medisch Centrum Alkmaar, Netherlands Eugene Igras, IRIS Systems, Inc., Canada Lars Ivar Mehlum, Helse Bergen HF, Norway Sundaresan Jagannathan, Scottish NHS, United Kingdom Andrew James, University of Toronto, Canada Tom Jarl Jakobsen, Helse Bergen, Norway Sabine Leh, Helse Bergen, Norway Heather Leslie, Atomica Informatics, Australia (Editor) Rikard Lovstrom, Swedish Medical Association, Sweden Hallvard Lærum, Direktoratet for e-helse, Norway Luis Marco Ruiz, NST, Spain Rohan Martin, Ambulance Victoria, Australia Ian McNicoll, FreshEHR, United Kingdom Jeroen Meintjens, Medisch Centrum Alkmaar, Netherlands Udo Müller-Oest, CompuGROUP Software, Germany Bjørn Næss, DIPS ASA, Norway Anne Pauline Anderssen, Helse Nord RHF, Norway Rune Pedersen, Universitetssykehuset i Nord Norge, Norway Melvin Reynolds, United Kingdom Steinar Sandvik, Helse Vest IKT, Norway Thomas Schopf, University Hospital of North-Norway, Norway Tony Shannon, NHS, United Kingdom Thor-Einar Stemland, Helse Bergen, FOU Seksjon for e-helse, Norway Line Sæle, Nasjonal IKT HF, Norway Hwei-Yee Tai, Tan Tock Seng Hospital, Singapore Micaela Thierley, Helse Bergen/Haraldsplass sykehus, Norway Kevin Thon, SKDE, Norway John Tore Valand, Haukeland Universitetssjukehus, Norway (Nasjonal IKT redaktør) Karl Trygve Kalleberg, Oslo Universitetssykehus, Norway Camilla Tøndel, Haukeland University Hospital, Norway Stef Verlinden, Vivici, Netherlands Ole Øyen, Oslo University Hospital, Norway, originalLanguage=en, translators= German: Sebastian Garde, Jasmin Buck, Ocean Informatics, University of Heidelberg Russian: Igor Lizunov, i.lizunov@infinnity.ru Swedish: Kirsi Poikela, Tieto Sweden AB, ext.kirsi.poikela@tieto.com Finnish: Vesa Peltola, Tieto Finland, vesa.peltola@tieto.com Korean: Seung-Jong Yu, NOUSCO Co.,Ltd., seungjong.yu@gmail.com, Certified Board of Family Medicine in South Korea Portuguese (Brazil): Jussara Rözsch, OpenEHR Foundation, jussara.macedo@gmail.com, Medical Doctor, Psychiarist, Clinical Modeller, openEHR Diretor, ehealth infostructuture WG ccoordinator- brazilian ehealth program Arabic (Syria): Mona Saleh Chinese (PRC): Chunlan Ma; Lin Zhang, Ocean Informatics; Taikang Insurance Group, chunlan.ma@oceaninformatics.com; linforest@163.com Spanish (Spain): Pablo Pazos, CaboLabs, Computer Engineer Spanish (Argentina): Domingo Liotta, Universidad de Morón, domingo_liotta@hotmail.com, Universidad de Morón Norwegian Bokmål: Lars Bitsch-Larsen, Haukeland Uinversity Hospital, Bergen, Norway, lbla@helse-bergen.no, MD, DEAA. specialist in anaesthesia and tropical medicine. Japanese: Shinji Kobayashi, Kyoto University, skoba@moss.gr.jp Farsi: Shahla Foozonkhah, Ocean Informatics, shahla.foozonkhah@oceaninformatics.com Dutch: Marja Buur, M.C.A., m.buur-krom@mca.nl , subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={source=[], identities=[], contacts=[], ism_transition=[], provider=[], protocol=[ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at0013], code=at0013, itemType=ELEMENT, level=2, text=Cuff size, description=The size of the cuff used for blood pressure measurement., comment=Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation 1993;88;2460-2470. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=[SNOMED-CT::722471002 \| Size of blood pressure cuff], values= at0015::Adult Thigh [A cuff used for an adult thigh.] [SNOMED-CT::720740000 \| Blood pressure cuff, adult thigh type] at0016::Large Adult [A cuff for adults with larger arms.] [SNOMED-CT::720738005 \| Blood pressure cuff, adult size large] at0017::Adult [A cuff that is standard for an adult.] at1008::Small Adult [A cuff used for a small adult.] [SNOMED-CT::720739002 \| Blood pressure cuff, adult size small] at1009::Paediatric/Child [A cuff that is appropriate for a child or adult with a thin arm.] [SNOMED-CT::720736009 \| Blood pressure cuff, paediatric size] at1018::Infant [A cuff used for infants.] at1019::Neonatal [A cuff used for a neonate, assuming cuff is the appropriate size for maturity and birthweight of the neonate.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at0014], code=at0014, itemType=ELEMENT, level=2, text=Location of measurement, description=Simple body site where blood pressure was measured., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=[SNOMED-CT::397987002 \| Measurement site], values=Choice of: Coded Text at0025::Right arm [The right arm of the person.] [SNOMED-CT::368209003 \| Structure of right upper arm] at0026::Left arm [The left arm of the person.] [SNOMED-CT::368208006 \| Structure of left upper arm] at0027::Right thigh [The right thigh of the person.] [SNOMED-CT::11207009 \| Structure of right thigh] at0028::Left thigh [The left thigh of the person.] [SNOMED-CT::61396006 \| Structure of left thigh] at1020::Right wrist [The right wrist of the individual.] [SNOMED-CT::9736006 \| Structure of right wrist] at1021::Left wrist [The left wrist of the individual.] [SNOMED-CT::5951000 \| Structure of left wrist] at1026::Right ankle [The right ankle of the individual.] [SNOMED-CT::6685009 \| Structure of right ankle] at1031::Left ankle [The left ankle of the individual.] [SNOMED-CT::51636004 \| Structure of left ankle] at1032::Finger [A finger of the individual.] [SNOMED-CT::7569003 \| Finger structure] at1051::Toe [A toe of the individual.] [SNOMED-CT::29707007 \| Toe structure] at1056::Dorsum of foot [The individual's dorsum of the foot.] [SNOMED-CT::2402003 \| Structure of dorsum of foot] at1053::Artery [An artery of the individual.] [SNOMED-CT::51114001 \| Arterial structure] Text , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1057], code=at1057, itemType=SLOT, level=2, text=Structured measurement location, description=Structured anatomical location of where the measurement was taken., comment=null, uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:* openEHR-EHR-CLUSTER.anatomical_location.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1035], code=at1035, itemType=ELEMENT, level=2, text=Method, description=Method of measurement of blood pressure., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=[SNOMED-CT::370129005 \| Measurement method], values= at1036::Auscultation [Method of measuring blood pressure externally, using a stethoscope and Korotkoff sounds.] at1037::Palpation [Method of measuring blood pressure externally, using palpation (usually of the brachial or radial arteries).] at1039::Machine [Method of measuring blood pressure externally, using a blood pressure machine.] at1040::Invasive [Method of measuring blood pressure internally ie involving penetration of the skin and measuring inside blood vessels.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1038], code=at1038, itemType=ELEMENT, level=2, text=Mean arterial pressure formula, description=Formula used to calculate the Mean Arterial Pressure (if recorded in data)., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1054], code=at1054, itemType=ELEMENT, level=2, text=Systolic pressure formula, description=Formula used to calculate the systolic pressure from from mean arterial pressure (if recorded in data)., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1055], code=at1055, itemType=ELEMENT, level=2, text=Diastolic pressure formula, description=Formula used to calculate the diastolic pressure from mean arterial pressure (if recorded in data)., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1010], code=at1010, itemType=ELEMENT, level=2, text=Diastolic endpoint, description=Record which Korotkoff sound is used for determining diastolic pressure using auscultative method., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at1011::Phase IV [The fourth Korotkoff sound is identified as an abrupt muffling of sounds.] at1012::Phase V [The fifth Korotkoff sound is identified by absence of sounds as the cuff pressure drops below the diastolic blood pressure.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1025], code=at1025, itemType=SLOT, level=2, text=Device, description=Details about sphygmomanometer or other device used to measure the blood pressure., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.device.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1058], code=at1058, itemType=SLOT, level=2, text=Extension, description=Additional information required to capture local context or to align with other reference models/formalisms., comment=For example: Local hospital departmental infomation or additional metadata to align with FHIR or CIMI equivalents., uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:* All not explicitly excluded archetypes, extendedValues=null]], description=[], events=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006], code=at0006, itemType=EVENT, level=2, text=Any event, description=Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time., comment=null, uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=EVENT, bindings=null, values=null, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at1042], code=at1042, itemType=INTERVAL_EVENT, level=2, text=24 hour average, description=Estimate of the average blood pressure over a 24 hour period., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=INTERVAL_EVENT, bindings=null, values=Math. function: Mean Interval width: 24 hours , extendedValues=null]], details=[], context=[], target=[], capabilities=[], items=[], other_participations=[], content=[], state=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/state[at0007]/items[at0008], code=at0008, itemType=ELEMENT, level=4, text=Position, description=The position of the individual at the time of measurement., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=[SNOMED-CT::397155001 \| Body position], values= at1000::Standing [Standing at the time of blood pressure measurement.] [SNOMED-CT::10904000 \| Orthostatic body position] at1001::Sitting [Sitting (for example on bed or chair) at the time of blood pressure measurement.] [SNOMED-CT::33586001 \| Sitting position] at1002::Reclining [Reclining at the time of blood pressure measurement.] [SNOMED-CT::272580008 \| Semi-recumbent position] at1003::Lying [Lying flat at the time of blood pressure measurement.] at1014::Lying with tilt to left [Lying flat with some lateral tilt, usually angled towards the left side. Commonly required in the last trimester of pregnancy to relieve aortocaval compression.] [SNOMED-CT::414585002 \| Left lateral tilt] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/state[at0007]/items[at1052], code=at1052, itemType=ELEMENT, level=4, text=Confounding factors, description=Comment on and record other incidental factors that may be contributing to the blood pressure measurement. For example, level of anxiety or 'white coat syndrome'; pain or fever; changes in atmospheric pressure etc., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/state[at0007]/items[at1030], code=at1030, itemType=SLOT, level=4, text=Exertion, description=Details about physical activity undertaken at the time of blood pressure measurement., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:* openEHR-EHR-CLUSTER.level_of_exertion.v0 and specialisations or openEHR-EHR-CLUSTER.level_of_exertion.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/state[at0007]/items[at1043], code=at1043, itemType=ELEMENT, level=4, text=Sleep status, description=Sleep status - supports interpretation of 24 hour ambulatory blood pressure records., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=[SNOMED-CT::27625002 \| Wakefulness], values= at1044::Awake [The individual is fully conscious.] [SNOMED-CT::248218005 \| Awake] at1045::Sleeping [The individual is in the natural state of bodily rest.] [SNOMED-CT::248220008 \| Asleep] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/state[at0007]/items[at1005], code=at1005, itemType=ELEMENT, level=4, text=Tilt, description=The craniocaudal tilt of the surface on which the person is lying at the time of measurement., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_QUANTITY, bindings=null, values=Property: Angle, plane Units: -90.0..90.0 deg Limit decimal places: 0, extendedValues=null]], activities=[], data=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/data[at0003]/items[at0004], code=at0004, itemType=ELEMENT, level=4, text=Systolic, description=Peak systemic arterial blood pressure - measured in systolic or contraction phase of the heart cycle., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_QUANTITY, bindings=[SNOMED-CT::271649006 \| Systolic blood pressure], values=Property: Pressure Units: 0.0..<1000.0 mm[Hg] Limit decimal places: 0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/data[at0003]/items[at0005], code=at0005, itemType=ELEMENT, level=4, text=Diastolic, description=Minimum systemic arterial blood pressure - measured in the diastolic or relaxation phase of the heart cycle., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_QUANTITY, bindings=[SNOMED-CT::271650006 \| Diastolic blood pressure], values=Property: Pressure Units: 0.0..<1000.0 mm[Hg] Limit decimal places: 0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/data[at0003]/items[at1006], code=at1006, itemType=ELEMENT, level=4, text=Mean arterial pressure, description=The average arterial pressure that occurs over the entire course of the heart contraction and relaxation cycle., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_QUANTITY, bindings=[SNOMED-CT::6797001 \| Mean blood pressure], values=Property: Pressure Units: 0.0..<1000.0 mm[Hg] Limit decimal places: 0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/data[at0003]/items[at1007], code=at1007, itemType=ELEMENT, level=4, text=Pulse pressure, description=The difference between the systolic and diastolic pressure., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_QUANTITY, bindings=[SNOMED-CT::87179004 \| Arterial pulse pressure], values=Property: Pressure Units: 0.0..<1000.0 mm[Hg] Limit decimal places: 0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/data[at0003]/items[at1059], code=at1059, itemType=ELEMENT, level=4, text=Clinical interpretation, description=Single word, phrase or brief description that represents the clinical meaning and significance of the blood pressure measurement., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=[SNOMED-CT::243814003 \| Interpretation of findings], values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0006]/data[at0003]/items[at0033], code=at0033, itemType=ELEMENT, level=4, text=Comment, description=Additional narrative about the measurement, not captured in other fields., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=[SNOMED-CT::703852005 \| Narrative comment section], values=, extendedValues=null]], relationships=[], credentials=[]}, topLevelItems={protocol=ResourceSimplifiedHierarchyItem [path=ROOT_/protocol[at0011], code=at0011, itemType=ITEM_TREE, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=0.., subCardinalityText=Minimum of 0 items (Cardinality: 0.., unordered), dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null], state=ResourceSimplifiedHierarchyItem [path=ROOT_/data[at0001]/events[at0006]/state[at0007], code=at0007, itemType=ITEM_TREE, level=2, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=0.., subCardinalityText=Minimum of 0 items (Cardinality: 0.., unordered), dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null], data=ResourceSimplifiedHierarchyItem [path=ROOT_/data[at0001]/events[at0006]/data[at0003], code=at0003, itemType=ITEM_TREE, level=2, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=0.., subCardinalityText=Minimum of 0 items (Cardinality: 0.., unordered), dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null]}, addHierarchyItemsTo=protocol, currentHierarchyItemsForAdding=[ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at0013], code=at0013, itemType=ELEMENT, level=2, text=Cuff size, description=The size of the cuff used for blood pressure measurement., comment=Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation 1993;88;2460-2470. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=[SNOMED-CT::722471002 \| Size of blood pressure cuff], values= at0015::Adult Thigh [A cuff used for an adult thigh.] [SNOMED-CT::720740000 \| Blood pressure cuff, adult thigh type] at0016::Large Adult [A cuff for adults with larger arms.] [SNOMED-CT::720738005 \| Blood pressure cuff, adult size large] at0017::Adult [A cuff that is standard for an adult.] at1008::Small Adult [A cuff used for a small adult.] [SNOMED-CT::720739002 \| Blood pressure cuff, adult size small] at1009::Paediatric/Child [A cuff that is appropriate for a child or adult with a thin arm.] [SNOMED-CT::720736009 \| Blood pressure cuff, paediatric size] at1018::Infant [A cuff used for infants.] at1019::Neonatal [A cuff used for a neonate, assuming cuff is the appropriate size for maturity and birthweight of the neonate.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at0014], code=at0014, itemType=ELEMENT, level=2, text=Location of measurement, description=Simple body site where blood pressure was measured., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=[SNOMED-CT::397987002 \| Measurement site], values=Choice of: Coded Text at0025::Right arm [The right arm of the person.] [SNOMED-CT::368209003 \| Structure of right upper arm] at0026::Left arm [The left arm of the person.] [SNOMED-CT::368208006 \| Structure of left upper arm] at0027::Right thigh [The right thigh of the person.] [SNOMED-CT::11207009 \| Structure of right thigh] at0028::Left thigh [The left thigh of the person.] [SNOMED-CT::61396006 \| Structure of left thigh] at1020::Right wrist [The right wrist of the individual.] [SNOMED-CT::9736006 \| Structure of right wrist] at1021::Left wrist [The left wrist of the individual.] [SNOMED-CT::5951000 \| Structure of left wrist] at1026::Right ankle [The right ankle of the individual.] [SNOMED-CT::6685009 \| Structure of right ankle] at1031::Left ankle [The left ankle of the individual.] [SNOMED-CT::51636004 \| Structure of left ankle] at1032::Finger [A finger of the individual.] [SNOMED-CT::7569003 \| Finger structure] at1051::Toe [A toe of the individual.] [SNOMED-CT::29707007 \| Toe structure] at1056::Dorsum of foot [The individual's dorsum of the foot.] [SNOMED-CT::2402003 \| Structure of dorsum of foot] at1053::Artery [An artery of the individual.] [SNOMED-CT::51114001 \| Arterial structure] Text , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1057], code=at1057, itemType=SLOT, level=2, text=Structured measurement location, description=Structured anatomical location of where the measurement 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(usually of the brachial or radial arteries).] at1039::Machine [Method of measuring blood pressure externally, using a blood pressure machine.] at1040::Invasive [Method of measuring blood pressure internally ie involving penetration of the skin and measuring inside blood vessels.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1038], code=at1038, itemType=ELEMENT, level=2, text=Mean arterial pressure formula, description=Formula used to calculate the Mean Arterial Pressure (if recorded in data)., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1054], code=at1054, itemType=ELEMENT, level=2, text=Systolic pressure formula, description=Formula used to calculate the systolic pressure from from mean arterial pressure (if recorded in data)., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1055], code=at1055, itemType=ELEMENT, level=2, text=Diastolic pressure formula, description=Formula used to calculate the diastolic pressure from mean arterial pressure (if recorded in data)., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1010], code=at1010, itemType=ELEMENT, level=2, text=Diastolic endpoint, description=Record which Korotkoff sound is used for determining diastolic pressure using auscultative method., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at1011::Phase IV [The fourth Korotkoff sound is identified as an abrupt muffling of sounds.] at1012::Phase V [The fifth Korotkoff sound is identified by absence of sounds as the cuff pressure drops below the diastolic blood pressure.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0011]/items[at1025], code=at1025, itemType=SLOT, level=2, text=Device, description=Details about sphygmomanometer or other device used to measure the blood pressure., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, 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