Kumari and Jayalakshmi: Acomparative study on the effect of cross legged sitting with flat feet sitting position on blood pressure reading among normotensive young adults in selected college, Guwahati, Assam


Introduction

Blood pressure is an important parameter to rule out the risk of health problems in the future.1, 2 If the blood pressure is high, it puts extra strain on the arteries and to the heart. Over the time, this strain can cause the arteries to become thicker and less flexible, or to become weaker.If arteries become thicker and less flexible, they will become more narrow ,making them more likely to clogged up. If an artery becomes completely clogged up that can lead to a heart attack, a stroke, kidney disease or dementia , also cause heart attack or stroke.3 An individual’s blood pressure measurement is influenced by many factors including age, weight, physical conditioning, past illness, time of day, alltitudee, activity and climate. In daily clinical practice, body position is neglected while taking blood pressure reading and considering that as baseline drug dosage are adjusted. One of the ignored factor while recording blood pressure is crossing of legs which causes pooling of blood in legs due to compression of veins , thus affecting the correct BP recording.4 The main purpose of the study is to find how significantly blood pressure reading changes with crossing the legs at knee level while blood pressure is being recorded.

Aim

To compare the effect of cross-legged sitting position with flat feet sitting position on blood pressure reading among normotensive young adults.

Objectives

  1. To compare the mean systolic and diastolic blood pressure recorded in the flat feet sitting position and cross-legged sitting position among normotensive young adults.

  2. To examine association of systolic and diastoilc blood pressure recorded in flat feet and cross-legged sitting position with selected demographic and clinical variables among normotensive young adults.

Hypotheses

Hypotheses will be tested at .05 level of significance.

  1. H01: There will be no difference in the average systolic blood pressure reading when BP recorded in flat feet and cross legged sitting positions.

  2. H02: There will be no difference in the average diastolic blood pressure reading when BP recorded in flat feet and cross legged sitting positions.

  3. H1: There is a significant difference in the systolic blood pressure recorded in the flat feet sitting position and cross legged sitting position.

  4. H2:There is a significant difference in the diastolic blood pressure recorded in the flat feet sitting position and cross legged sitting position.

  5. H3: There is a significant association of systolic blood pressure recorded in flat feet sitting position with selected demographic and clinical variables.

  6. H4: There is a significant association of systolic blood pressure recorded in cross-legged sitting position with selected demographic and clinical variables.

  7. H5: There is a significant association of diastolic blood pressure recorded in flat feet sitting position with selected demographic and clinical variables.

  8. H6: There is a significant association of diastolic blood pressure recorded in cross-legged sitting position with selected demographic and clinical variables.

Material and Methods

This comparative study was carried out on the normotensive young adults of Army Institute of Nursing, Guwahati, Assam from25th june 2020 to 8th july 2020.A total of 60 Normotensive Young Adults(both males and females)of age 19 to 40 years were taken for this study.

Study design

Descriptive comparative design.

Study location

This was done on Army Institute of Nursing ,C/O- 151 Base Hospital ,Basistha, Guwahati, Assam.

Study duration

25th june 2020 to 8th july 2020

Sample size

Normotensive young adults

Sample size calculation

The sample size based on the previous study done by Piner R, Sabuncu N, Oksay A. Effects of crossed leg on blood pressure 2004 ;13:252-254.5 After calculation with 1% effect size and 95%power, the sample size obtained for this study was 50. A sample of 60 was planned to study the difference in the blood pressure measurement in two different position .

Subjects & selection method

Purposive sampling technique was adopted after random selection of the participants from Army Institute of Nursing and according to the purpose of the study 60 normotensive young adults were chosen.

Inclusion criteria

  1. Individuals who do not had injury in left arm.

  2. Male and female individuals

  3. Individual in the age group 19 to 40 years

Exclusion criteria

  1. Individuals under medication for blood pressure control .

  2. Individuals who are having breathing difficulty and giddiness at the time of data collection procedure.

  3. Individuals in acute pain.

  4. Individuals unable to cross legs at knee level due to trauma, limb amputation or any other medical reason.

  5. Individuals with trauma in left arm.

  6. Individuals known to have peripheral arterial disease or diabetes.

  7. Any serious health problem arises at the of data collection.

Variables

Independent variables

Positions(flat feet sitting position and cross-legged sitting position)

Dependent variables

Blood pressure measurement

Demographic variables

Age, gender, chew tobacco, consumption of alcohol, cigarette smoking, food habits, family history of hypertension , chronic health problem at the time of data collection for the study.

Clinical variable

Height , Weight, BMI

Ethical consideration

Ethical consideration obtained on 29th May 2019 from the institutional committee, Army Institute of Nursing, C/O151Base Hospital, Guwahati. The participants had been informed about the anonymity and confidentiality of their information. Informed written consent were obtained from the participants.

Content Validity and Reliability of The tool

For the validation of the content, it was submitted to 7 specialist and experts from the field Medical - Surgical Nursing . They were requested to verify the items for its clarity, relatedness and meaningfulness and give their opinions and suggestions regarding the items in the tool. The experts were choosen on the basis of their clinical expertise and experience. Suggestions were given by the experts to modify and were incorporated in the tool accordingly.

For validation of the blood pressure instrument OMRON HEM -8712,SERIAL NO 20190604417VG is purchased newly on 09/12/19 to eliminate the observer bias , a copy of signed and stamped warranty card from retailer will be produce by the researcher. The accuracy of this blood pressure monitor has been carefully tested and is designed for a long service life and generally recommended to have the device inspected every two years to ensure correct functioning and accuracy

Pilot study

The setting of the study was Handigue college, Guwahati Assam. For the pilot study data collection period was 11th December 2019 to 18th December 2019. The study was conducted on 6 samples (Normotensive Young Adults). Collected data were tabulated, analyzed and statistically calculated. The study was found to be effective and feasible to conduct the final study. The reliability was established by using Inter-item Correlation Cronbach’s Alpha Based on standardized Items. The reliability of the tool was found r = 0.889 which was considered to be reliable and adequate.

Data collection Procedure

After written informed consent, a self structured questionnaire was used to collect the data from the participants. The questionnaire includes demographic characteristics such as age, gender, chew tobacco, consume alcohol, cigarette smoking, food habits, presence of family history of hypertension, any other chronic health problem at present and clinical characteristics such as height ,weight, body mass index.

The blood pressure recorded in both the positions (flat feet and cross leg) after giving instruction for participation informed written consent was obtained from the individuals. Height and Weight were measured using standardized method. The body mass index (BMI) was calculated as the weight in kilograms (with 1 kg subtracted to allow for clothing) divided by height in meters squared.

The blood pressure was recorded by Automated sphygmomanometer, to eliminate the observer bias blood pressure was measured using a validated, newly purchased and fully automated sphygmomanomete, the adult cuff circumference 22-32cm(9-13inch) was available for use. records systolic pressure, diastolic pressure and pulse rate. The machine was reset after each reading6, 7

Statistical Analysis

The data were coded and organized in a master sheet and were analyzed by using the SPSS Version 24. The comparison of mean (paired t –test) to compare the means of blood pressure recorded in flat feet sitting position with cross-legged sitting position. F-Anova test, t — Independent t -test was computed in order to determine the significance of association between the systolic and diastolic blood pressure in flat feet and cross-legged sitting position with demographic and clinical variables. The level P < 0.05 was considered as the cutoff value or significance.

Organization and Presentataion of Data

The data collected from the subjects were organized and presented for analysis according to the objectives of the study under the following sections-

  1. Section — I Description of demographic and clinical variables

  2. Section –II Description of the mean systolic and diastolic blood pressure recorded in flat feet and cross-legged sitting position among normotensive young adults.

  3. Section -III To examine association of systolic and diastolic blood pressure recorded in flat feet and cross-legged sitting position with selected demographic and clinical variables among normotensive young adults.

Results

Description of variables

Demographic variables

In the present study, the collected data shows that majority 23 (38.3%) of the participants were in the age group 36-40years, 16 (26.7%) of the participants belonged to 31-35 years, 14(23.3%)of the participants belonged to 25-30 years, 7(11.7%) belong to 19 -24 years, male 32(51.6 %) and females 28(45.2%), young adults chew tobacco 12(20%) and 48(80%) do not chew tobacco, young adults consume alcohol 8(12.9%) and 52(83.9%) do not consume alcohol 4(6.5%), young adults do cigarette smoking and 56 (90.3%) ,young adults do not do cigarette smoking , 58(93.5%) young adults take non — vegetarian and 2(3.2%) take vegetarian diet, 14(23.3%) young adults having family history of hypertension and46(76.7%) young adults do not have family history of hypertension , 6(10%) having any chronic health problem at present and 54(90%) do not have any chronic health problem at present.

Clinical variables

Data revealed that height of the majority of the young adults i.e. 29 (48.3%) belong to 149 -160 cms , 14( 23.3%) belong 173-184 cms,13(21.7%) belong to 161-172cms and 4(6.7%) belong 136 – 148 ,weight of the majority of the young adults i.e .25 (40.3%) belong to 51-60 kgs ,12(19.4%) belong to 40-50kgs, 11(17.7%) belongs to 61-70kgs, 9(14.5 %) belongs 71-80 kgs and 3(4.8%) belongs to 81-90 kgs, body mass indexBMI of the majority of young adults i.e.40(66.7%)belong to normal weight, 15(25%)belong to overweight ,5(8.3%)underweight category.

Description of the mean systolic and diastolic blood pressure

The mean difference of systolic blood pressure in flat feet position 109.08±7.510mmHg was lower as compared to mean systolic blood pressure in cross-legged sitting position 111.27±8.809mmHg with mean difference of 2.19 and calculated value (t=4.730, p=0.001) was found statistically significant at p<.05. Hence it is concluded that there is significant difference in average of systolic blood pressure reading recorded in flat feet and cross-legged sitting position so null hypotheses H01 is rejected and research hypotheses H1 is accepted.

Mean diastolic blood pressure in flat feet position 73.49±5.066mmHg was lower as compared to mean diastolic blood pressure in cross-legged sitting position 73.82±6.325mmHg with mean difference of 0.33 and calculated value (t=0.308, p=0.225) was found statistically non significant at p<.05. Hence, it is concluded that there is no significant difference in average diastolic blood pressure reading recorded in flat feet and cross-legged sitting position so null hypotheses H02 is accepted and research hypotheses H2 is rejected.

Examining Association of Blood Pressure with Selected Demographic and Clinical Variables Among Normotensive Young Adults in Flat Feet and Cross-Legged Sitting Positions

There is a significant association between systolic blood pressure in flat feet sitting position with gender (t=3.612,p=0.001), chew tobacco (t=2.600,p=0.012) and height (F=3.296,p=0.027) at p<.05 level of significance The other demographic and clinical variables were found non significant so H3 is accepted.

There is a significant association between systolic blood pressure in cross-legged sitting position with gender (t=3.556,p=0.001) and chew tobacco (t=2.629,p=0.011) at p<.05 level of significance. The other demographic and clinical variables were found non significant so H4 is accepted

There is a significant association between diastolic blood pressure in flat feet sitting position with chew tobacco (t=2.125,p=0.038), height (F=3.535,p=0.021) and BMI (F=5.943,p=0.005) at p<.05 level of significance. The other demographic and clinical variables were found non significant so H5 is accepted.

Table 1

Estimation of mean systolic and diastolic blood pressure recorded in flat feet and cross-legged sitting position among normotensive young adults.

Blood pressure

Position

Mean

SD

Mean-Diff

t value

df

P value

Systolic

Flat feet

109.08

7.510

2.19

4.730

59

0.001 S**

Cross legged

111.27

8.809

Diastolic

Flat feet

73.49

5.066

0.33

0.308

59

0.225 NS

Cross legged

73.82

6.325

Table 2

Association between systolic blood pressure in flat feet sitting position with demographic and clinical variables.

Demographic and clinical variables

N

Mean

SD

F/t value

df

p value

Age in years

a. 19-24 years

7

106.76

7.492

F=1.036

3

0.384 NS

b. 25-30 years

14

108.43

7.534

c. 31-35 years

16

107.67

9.279

d. 36-40 years

23

111.16

5.977

Gender

a. Male

32

112.06

5.355

t=3.612

58

0.001

b. Female

28

105.67

8.227

S **

Chew tobacco

a. Yes

12

113.89

5.526

t=2.600

58

0.012

b. No

48

107.87

7.501

S*

Consume alcohol

a. Yes

8

111.54

4.840

t=0.997

58

0.323

b. No

52

108.70

7.805

NS

Cigarette smoking

a. Yes

4

115.42

0.833

t=1.779

58

0.080

b. No

56

108.62

7.571

NS

Food habit

a. Vegetarian

2

110.67

5.185

t=0.302

58

0.764

b. Non vegetarian

58

109.02

7.603

NS

Family history of HTN

a. Yes

14

109.43

6.406

t=0.198

58

0.844

b. No

46

108.97

7.876

NS

Chronic health problems

a. Yes

6

108.72

6.347

t=0.121

58

0.904

b. No

54

109.12

7.679

NS

Table 0

Demographic and clinical variables

N

Mean

SD

F/t value

df

p value

Height

a. 136-148

4

108.33

8.278

F=3.296

3

0.027

b. 149-160

29

108.06

7.722

S*

c. 161-172

13

106.15

7.917

d. 173-184

14

114.12

3.928

e.

Weight

a. 40-50

12

109.47

6.716

F=2.008

4

0.106

b. 51-60

25

106.92

7.656

NS

c. 61-70

11

108.48

9.252

d. 71-80

9

114.81

2.545

e. 81-90

3

110.44

6.801

BMI

a. Underweigh

5

107.40

7.466

F=2.985

2

0.059

b. t

40

107.80

7.755

NS

c. Normal

15

113.04

5.626

d. Overweight

Table 3

Association between systolic blood pressure in cross legged sitting position with demographic and clinical variable.

Demographic and clinical variables

N

Mean

SD

F/t value

df

p value

Age in years

a. 19-24 years

7

109.10

9.361

F=0.992

3

0.403

b. 25-30 years

14

110.48

9.806

c. 31-35 years

16

109.44

9.381

NS

d. 36-40 years

23

113.70

7.542

Gender

a. Male

32

114.73

6.703

t=3.556

58

0.001

b. Female

28

107.32

9.361

S*

Chew tobacco

a. Yes

12

116.97

7.076

t=2.629

58

0.011

b. No

48

109.85

8.679

S*

Consume alcohol

a. Yes

8

115.33

5.360

t=1.412

58

0.163

b. No

52

110.65

9.102

NS

Cigarette smoking

a. Yes

4

118.75

2.167

t=1.790

58

0.079

b. No

56

110.74

8.867

NS

Food habit a. Vegetarian

2

112.83

6.364

t=0.253

58

0.801

b. Non vegetarian

58

111.22

8.918

NS

Family history of HTN

a. Yes

14

111.95

8.414

t=0.327

58

0.745

b. No

46

111.07

9.006

NS

Chronic health problems

a. Yes

6

108.72

9.100

t=0.745

58

0.460

b. No

54

111.56

8.818

NS

Demographic and clinical variables

N

Mean

SD

F/t value

df

p value

Height

a. 136-148

4

113.92

7.923

F=2.578

3

0.063

b. 149-160

29

110.07

9.401

c. 161-172

13

107.87

9.194

NS

d. 173-184

14

116.17

5.154

Weight

a. 40-50

12

113.39

7.180

F=2.260

4

0.074

b. 51-60

25

108.59

9.218

c. 61-70

11

110.15

10.72

NS

d. 71-80

9

117.85

2.996

e. 81-90

3

109.56

7.183

BMI

a. Underweight

5

112.33

7.721

F=2.054

2

0.138

b. Normal

40

109.73

9.338

c. Overweight

15

115.0

6.714

NS

Table 4

Association between diastolic blood pressure in flat feet sitting position with demographic and clinical variables.

Demographic and clinical variables

N

Mean

SD

F/t value

df

P value

Age in years

a. 19-24 years

7

73.57

4.122

F=0.109

3

0.955

b. 25-30 years

14

72.83

4.408

c. 31-35 years

16

73.56

6.926

NS

d. 36-40 years

23

73.83

5.028

Gender a. Male b. Female

32 28

74.34 72.52

4.929 5.133

t=1.400

58

0.167 NS

Chew tobacco

a. Yes

12

76.19

2.443

t=2.125

58

0.038

b. No

48

72.82

5.338

S*

Consume alcohol

a. Yes

8

74.54

3.385

t=0.625

58

0.535

b. No

52

73.33

5.284

NS

Cigarette smoking

a. Yes

4

76.92

2.699

t=1.410

58

0.164

b. No

56

73.25

5.120

NS

Food habit

a. Vegetarian

2

71.83

4.950

t=0.469

58

0.641

b. Non vegetarian

58

73.55

5.102

NS

Family history of HTN a. Yes

14

73.31

5.739

t=0.155

58

0.878

b. No

46

73.55

4.911

NS

Chronic health problems

a. Yes

6

72.11

4.350

t=0.702

58

0.485

b. No

54

74.65

5.152

NS

Table 0

Demographic and clinical variables

N

Mean

SD

F/t value

df

P value

Height

a. 136-148

4

67.67

7.741

F=3.535

3

0.02

b. 149-160

29

73.29

5.405

1

c. 161-172

13

72.90

4.444

S*

d. 173-184

14

76.14

1.743

Weight

a. 40-50

12

72.92

7.588

F=0.908

4

0.46

b. 51-60

25

72.53

4.524

6

c. 61-70

11

73.76

5.145

NS

d. 71-80

9

75.74

1.516

e. 81-90

3

76.11

2.524

BMI

a. Underweight

5

67.53

6.711

F=5.943

2

0.00

b. Normal

40

73.36

5.100

5

c. Overweight

15

75.84

2.039

S*

Table 5

Association between diastolic blood pressure in cross legged sitting position with demographic and clinical variables.

Demographic and clinical variables

N

Mean

SD

F/t value

df

P value

Age in years

a. 19-24 years

7

72.21

4.648

F=0.277

3

0.841

b. 25-30 years

14

73.02

7.175

c. 31-35 years

16

73.75

6.665

NS

d. 36-40 years

23

74.68

6.253

Gender

a. Male

32

75.12

5.773

t=1.742

58

0.087

b. Female

28

72.32

6.693

NS

Chew tobacco

a. Yes

12

77.75

3.397

t=2.515

58

0.015

b. No

48

72.83

6.525

S*

Consume alcohol

a. Yes

8

74.04

5.184

t=0.107

58

0.915

b. No

52

73.78

6.525

NS

Cigarette smoking a. Yes

4

81.0

6.538

t=2.449

58

0.017

b. No

56

73.30

6.046

S*

Food habit

a. Vegetarian

2

70.0

1.886

t=0.866

58

0.390

b. Non vegetarian

58

73.95

6.386

NS

Family history of HTN

a. Yes

14

75.33

7.072

t=1.025

58

0.310

b. No

46

73.36

6.088

NS

Chronic health problems

a. Yes

6

70.33

6.157

t=1.435

58

0.157

b. No

54

74.20

6.279

NS

Table 0

Demographic and clinical variables

N

Mean

SD

F/t value

df

P value

Height

a. 136-148

4

71.33

7.855

F=2.061

3

0.116

b. 149-160

29

73.07

7.062

c. 161-172

13

72.49

5.429

NS

d. 173-184

14

77.31

3.826

Weight

a. 40-50

12

73.58

6.662

F=1.199

4

0.322

b. 51-60

25

72.67

6.878

NS

c. 61-70

11

72.91

6.054

d. 71-80

9

77.56

3.543

e. 81-90

3

76.44

6.336

BMI

a. Underweight

5

70.73

6.934

F=2.748

2

0.073

b. Normal

40

73.07

6.650

NS

c. Overweight

15

76.84

4.104

There is a significant association between diastolic blood pressure in cross-legged sitting position with chew tobacco (t=2.515,p=0.015) and cigarette smoking (t=2.449,p=0.017) at p<.05 level of significance. The other demographic and clinical variables were found non significant so H6 is accepted.

Discussion

Sitting flat feet position while Blood pressure recording is essential for young adults ,the systolic blood pressure is significantly associated with gender and chewing tobacco in both the positions and the diastolic blood pressure is significantly associated with chewing tobacco and cigarette smoking.and BMI in both the positions.

A study conducted by Pinar R, Sabuncu N,Oksay A(2004) on the effects of crossed leg on blood pressure among an unmedicated high –normal blood pressure stage 1 or stage 2 hypertensive subjects, mean± SD systolic BP in leg uncrossed 145.12±20.33mmHg and leg crossed was 153.62±20.20mmHgrespectively,diastolic blood pressure in leg uncrossed =86.38±10.81mmHg and leg crossed was 92.10 ±11.20 mmHg respectively.8

Also, a study done by Das N, Sharma A(2019) on a comparative a study to assess the effect of standing position and sitting crossed leg position on blood pressure among faculties of Charusat Changa Gujrat, mean ±SD systolic BP standing and crossed leg position was 121.9±7.2mmHg and 123.9±7.6mmHg respectively, diastolic blood pressure in standing position and crossed leg position was 81.2±5.9mmHg and 84.3±4.4mmHg respectively.9

The present study evaluated the mean systolic and diastolic blood pressure recorded in flat feet and cross-legged sitting position among normotensive young adults, the result indicates mean, SD systolic blood pressure found in flat feet = 109.07±7.44mmHg, cross-legged = 111.27±7.44mmHg, distolic blood pressure in flat feet = 73.49±5.02mmHg, distolic blood pressure in cross-legged = 73.81±6.2mmHg.

In a study conducted by Peters GL, Binder SK, Campbell NR (1999) on the effect of crossing legs on blood pressure among fifty healthy volunteers and 53 patients with hypertension. The study shows crossing legs increased systolic blood pressure but little effect on diastolic blood pressure. The cardiovascular risk class increased for a large number of the hypertensive patients but for fewer of the normotensive patients.

Fitzpatrick FL, Ortiz A, Sibilant H, MarcantonioR, Braun TL (1999) on the effects Of Crossed Leg On Blood Pressure Measurement.the result indicate both systolic and diastolic blood pressure increased significantly (p<0.0001)with the crossed leg position.9

The physiological mechanism for the rise in BP with leg crossing is a translocation of blood volume from the dependent vascular beds to the thoracic compartment Although there is a theoretical basis for crossing legs to increase BP, there are controversial published data addressing this question.10

In the present study, the mean systolic blood pressure compared by using Paired t-test shows significant difference in systolic blood pressure recorded in flat feet and crossed leg sitting position.

Present study findings are consistent with the study conducted by AvvampatoCS (2001)on effect of one leg crossed over the other at knee on blood pressure in hypertensive patients among 90 patient who regularly scheduled clinic visit. The study showed no statistically significant difference in BP readings of subjects with one leg crossed over the other versus both feet on floor.11

In the present study, the mean diastolic blood pressure Paired t-test shows no significant difference in diastolic blood pressure recorded in flat feet and crossed leg sitting position.

Present study findings are supported by study conducted by Nickson Das and Dr. AnilSharma(2018) on a comparative study to assess the effect of standing position and sitting crossed leg position on blood pressure among faculties of Charusat, Changa, Gujrat. The study revealed that the variables age, gender, height, BMI, diet habit, consumption of junk food has significant association with standing position and sitting crossed leg position.8

In the present study, while assessing the association between flat feet blood pressure and cross-legged sitting position blood pressure with selected demographic and clinical variables among normotensive young adults result the association between systolic and diastolic blood pressure in flat feet and cross-legged sitting position with demographic and clinical variables which was tested by using Anova test and independent t test.

Conclusion

There is a significant difference in systolic blood pressure but insignificant difference in diastolic blood pressure when legs were crossed at knee level while taking blood pressure among normotensive young adults.

Source of funding

None

Conflict of Interest

None

References

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Received : 09-05-2021

Accepted : 24-05-2021

Available online : 14-07-2021


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https://doi.org/10.18231/j.ijpns.2021.012


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