bluuebunny/crossref_metadata_2025 huggingface dataset:
POSTERIOR REVERSIBILE LEUKOENCEPHALOPATHY SYNDROME AND HYPERTENSIVE CRISIS DUE TO OBSTRUCTIVE SLEEP APNEA:SEARCHING FOR A LINK
Authors: Torin Gioia , Schiavon Laura , Molinari Leonardo , Pontesilli Giulia Maria , Napoli Ettore , Milan Marta , Rizzati Silvia , Moroldo Alessandro , Cerbo Anna , Roversi Rossella , Martire Giuseppe , Cuppini Stefano , Mazza Alberto
Published: May 2024

Objective:

Posterior Reversible Encephalopathy Syndrome(PRES) is a clinic-radiological syndrome characterized by headache, nausea/vomiting, confusion, cognitive changes, seizures,cortical blindness. MRI shows bilateral hyper-intense lesions at the parieto-occipital sub-cortical level on T2 and FLAIR sequences. PRES is associated with severe hypertension, while obsstructive sleep apnesa(OSA) is a common cause of secondary hypertension but rarely causes hypertensive encephalopathy. We present a case of a 42-year-old woman who suffered of hypertensive emergency during hospitalization for dyspnea.

Design and method:

Clinical history revealed obesity, COPD, OSA in treatment with CPAP, HF with depressed EF (44%), adrenal hyperplasia and retroduodenal lesion under investigation. She was active smoker and BP was uncontrolled by valsartan 160 mg, furosemide 25 mg,bisoprolol 2,5 mg.

During the hospitalization in November 2023, patient presented headache, seizures, respiratory distress with high BP values (220/120 mmHg, HR 78 bpm).

Results:

Laboratory tests revealed only a mild increase of plasma cortisol levels (27.5 mcg/dL, range 0-24); low-dose overnight dexamethasone suppression test was normal (1.5 mcg/dl). Despite anti-hypertensive therapy with B-blocker urinary metanephrine levels were normal (184 mcg/24 h, range 0-320) and 18f-FDG PET-TAC for retroduodenal lesion was normal.

Cerebral CT did not show ischemic or hemorrhagic lesions while MRI documented radiological characteristics compatible with PRES (Figure 1). Electroencephalogram showed no epileptic abnormalities.

Antihypertensive intravenous treatment with urapidil (25 mg as bolus injection followed by 25 mg/h as continuous infusion) was performed for 36h and followed by oral treatment with canrenoate 25 mg, amlodipine 5 mg and doxazosin 4 mg, added to the above therapy. At discharge, BP was normalized (120/84 mmHg).

Checking the electronic card of CPAP, the patient used the device for more than four hours only in 35% of the nights.

Conclusions:

OSA is a risk factor for acute cardiovascular and cerebrovascular diseases like PRES.

CPAP application has been shown to induce small reductions (about 3 mmHg) in BP, but in clinical practice the adherence of treatment is very low (30-60%). On the other hand, the improvement of BP values during hospitalization, raises the suspicion that adherence to pharmacological treatment at home was in the same way poor.
MISSION 70/26 HAS SUCCESSFULLY STARTED IN CROATIA. DO YOU KNOW YOUR NUMBERS?
Authors: Jelakovic Bojan , Capak Krunoslav , Bubas Marija , Pajic Ivana Portolan , Pecin Ivan , Reiner Zeljko , Lang Valerija Bralic , Milicic Davor , Soldo Dragan , Rahelic Dario , Budincevic Hrvoje , Demarin Vida , Soldo Ana , Jelakovic Ana , Josipovic Josipa , Mihalic Mirjana , Vrkic Tajana Zeljkovic , Bilajac Lovorka
Published: May 2024

Objective:

Approximatively 50% of Croatia's adult population suffers from arterial hypertension (AH). One-fifth of patients do not know that they have AH, and control has been achieved in less than 50% of treated patients. It is our aim to achieve controlled values of blood pressure (BP) in 70% of treated patients with AH by 2026. This mission is part of the permanent campaign of the Croatian Hypertension League called “The Hunt for the Silent Killer”.

Design and method:

The whole mission is devoted to increase health literacy in both health care workers and in general population (including patients with AH).

Results:

For the general population we will organize: 1) classical public-health activities; BP will be measured and educative materials will be distributed at the public places; 2) using Croatian Hypertensive League educative web platform (Hunting the Silent Killer) and social networks; and 3) via different media (Vecernji list, the biggest daily newspaper in Croatia is partner of the League). For health care workers 1) school for communication in hypertension; 2) monthly newsletters with information about therapeutic inertia, promotion of health literacy, and education on treatment persistence. For this purpose, we have developed special educative sub-portal 70/26. All healthcare workers will be invited to visit our scientific educative web portal Healthmed with plenty of recent information on cardio-kidney-metabolic syndrome where members of the editorial board are key opinion leaders in hypertension, nephrology, cardiology, neurology, diabetology and family physicians. In parallel with hypertension we will analyze success in treatment of dyslipidemia in our sister mission “Do you know your numbers?”

Conclusions:

At the end of this program, we are going to organize a nationwide study (EHUH 3) where a representative sample of random adult population will be enrolled. In this study we will use the same methodology as in recently ended nationwide EHUH 2 study where we obtained current information on hypertension and dyslipidemia prevalence, awareness, treatment and control. Using the same methods we will be able to make conclusion about our success following evidence-based medicine postulates.

Acknowledgement: This program is supported by a grant from Servier.
OBSTRUCTIVE SLEEP APNEA IN RELATION TO BEAT-TO-BEAT, READING-TO-READING, AND DAY-TO-DAY BLOOD PRESSURE VARIABILITY
Authors: Cheng Yi-Bang , Guo Qian-Hui , Xia Jia-Hui , Zhang Jin , Li Yan , Wang Ji-Guang , Xu Ting-Yan
Published: May 2024

Objective:

We investigated blood pressure (BP) variability as assessed by beat-to-beat, reading-to-reading and day-to-day BP variability indices in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).

Design and method:

In 786 hospitalized hypertensives (mean age, 53.2 years; 42.2% women), we performed 10-minute beat-to-beat (n=705), 24-hour ambulatory (n=779), and 7-day home BP (n=445) measurements and the full overnight polysomnography. Mild, moderate and severe OSAHS were defined as an apnea-hypopnea index of 5-14, 15-29, and >= 30 events per hour, respectively. BP variability indices including variability independent of the mean (VIM), average real variability (ARV), and maximum–minimum difference (MMD), were compared across the OSAHS severity groups.

Results:

In univariate analysis, beat-to-beat systolic VIM and MMD, reading-to-reading asleep systolic and diastolic ARV and MMD increased from patients without OSAHS, to patients with mild, moderate and severe OSAHS. This increasing trend for beat-to-beat systolic VIM and MMD remained statistically significant after adjustment for confounders (P <=0.047). There was significant (P <=0.039) interaction of the presence and severity of OSAHS with age and body mass index in relation to the beat-to-beat systolic VIM and MMD and with the presence of diabetes mellitus in relation to asleep systolic ARV. The association was stronger in younger (age < 50 years) and obese (body mass index >= 28 kg/m2) and diabetic patients. None of the day-to-day BP variability indices reached statistical significance (P>=0.16).

Conclusions:

BP variability, in terms of beat-to-beat recordings, were higher with the more severe OSAHS, especially in younger and obese and diabetic patients.
COMPARISON OF OFFICE-BASED BLOOD PRESSURE TO DAYTIME CUFFLESS BLOOD PRESSURE IN A POPULATION-BASED STUDY
Authors: Zahnd Joachim , Chelbi Sonia T. , Gagliano Jvan Gianini Vanessa , Marot Peggy , Ackermann Daniel , Durer Isabelle , Beuschlein Felix , Suter Paolo , Vogt Bruno , Gabutti Luca , Bochud Murielle , Wuerzner Gregoire
Published: May 2024

Objective:

The latest ESH 2023 guidelines still recommend the use of office blood pressure (BP) measurement for the diagnosis and the follow-up of arterial hypertension. Although cuffless (BP) devices are attractive for patients due their practicality and easy to use, they are not yet recommended by international guidelines. The aim of this project was to test the diagnostic performance of a cuffless device in the adult Swiss population.

Design and method:

This was a multicentric sub-study nested within a nationwide population-based survey on dietary salt intake in Switzerland. Blood pressure was measured 5 times with a validated oscillometric device (Omron HEM-907) on two separate visits according to a standardized protocol. Cuffless blood pressure using the Aktiia® bracelet was measured intermittently over 24 hours in between visits. The device was calibrated on the first visit using an independent oscillometric device. The average of the last four office BP at each visit was compared to the daytime average BP from the cuffless device with a Bland-Altman plot.

Results:

Of the 863 individuals included in the study, 511 (46% women, age: 48.6±15.8 years) had their BP taken with both devices. The median number of BP measurements with the cuffless device was 46(IQR 28-90)). Bland and Altman analysis revealed a difference of 0.015 (CI -0.734 to 0.763) in systolic BP and of 0.380 (CI -0.216 to 0.975) in diastolic BP (Figure 1). The agreement for the diagnosis of hypertension was 92.4% with a kappa of 0.61±0.04 for systolic BP and 94.7% with a kappa of 0.50±0.04.

Conclusions:

In this adult population-based study, the accuracy and the diagnostic performance of a cuffless device were promising. The differences may be secondary to either accuracy or to white coat/masked effect reflecting the different environments of BP measures.
SLEEP BLOOD PRESSURE MEASURED WITH A HOME BLOOD PRESSURE MONITOR WAS INDEPENDENTLY ASSOCIATED WITH INCIDENCE OF CARDIOVASCULAR DISEASES: THE NAGAHAMA STUDY
Authors: Tabara Yasuharu , Matsumoto Takeshi , Murase Kimihiko , Setoh Kazuya , Kawaguchi Takahisa , Wakamura Tomoko , Hirai Toyohiro , Chin Kazuo , Matsuda Fumihiko
Published: May 2024

Objective:

Nocturnal blood pressure (BP) was reported to be associated with cardiovascular diseases. However, nocturnal BP measured using ambulatory monitoring device usually includes BP without sleep. We investigated an association between sleep BP measured using a timer-equipped home BP monitor and cardiovascular diseases in a general population.

Design and method:

Study population was 6,037 middle-aged and older community residents (mean age: 57.8 years old, men: 30.9%). Participants were required to sleep with wrapping cuffs in the upper-arm and sleep BP was measured automatically at 0:00, 2:00, and 4:00. Actigraph was used to determine BP measured during sleep. Participants were also measured home morning BP manually using a same device. Incidence of cardiovascular diseases including stroke and myocardial infarction were assessed by reviewing personal hospital records.

Results:

Mean morning systolic and diastolic BP was 126 ± 18 and 77 ± 11 mmHg, respectively, while sleep systolic and diastolic BP was 112 ± 15 and 66 ± 9 mmHg. During 5.0 years mean follow-up period, we observed 80 cases of cardiovascular diseases (stroke and myocardial infarction). Morning hypertension (>135/85 mmHg) [hazard ratio (HR) = 3.22, P < 0.001] and sleep hypertension (>120/70 mmHg) [HR = 2.21, P = 0.002], but not office hypertension (>140/90 mmHg) [HR = 1.44, P = 0.127], was significantly associated with incidence of cardiovascular diseases independently of age, sex, and body mass index. Clinical characteristics including sleep efficiency (normotension: 91 ± 4%, sleep hypertension: 89 ± 5%, morning hypertension: 90 ± 4%, sleep and morning hypertension: 89 ± 5%, P< 0.001) and oxygen desaturation index (5.9 ± 4.8, 8.3 ± 6.6, 9.3 ± 7.1, 11.1 ± 9.0 times/h, P < 0.001) differed significantly by the hypertension status. However, sleep hypertension [HR = 2.94, P = 0.015], morning hypertension [HR = 4.81, P < 0.001], and sleep and morning hypertension [HR = 4.71, P < 0.001] was identified as significant factors for cardiovascular diseases after adjustment of covariates including the sleep parameters.

Conclusions:

High sleep BP measured home BP monitoring device was independently associated with incidence of cardiovascular disease in a general population.
PROGNOSTIC SIGNIFICANCE OF 24-H AMBULATORY SYSTOLIC AND PULSE PRESSURE LOAD AND VARIABILITY IN OCTOGENARIANS WITH ARTERIAL HYPERTENSION
Authors: Curcio Rosa , Giacinti Chiara , Turri Paolo , Poliseno Chiara , Pucci Giacomo , Vaudo Gaetano , Sarzani Riccardo , Spannella Francesco
Published: May 2024

Objective:

Limited data exist on the prognostic implications of blood pressure (BP) components derived from ambulatory BP monitoring (ABPM) in octogenarians with arterial hypertension. This study aimed at investigating whether metrics of 24-h BP load and variability are significantly associated with all-cause mortality.

Design and method:

Octogenarian outpatients (>80 years) undergoing ABPM at two ESH Hypertension Excellence Centers (Ancona, Terni) for a better assessment of BP status between April 2019 and December 2022 were enrolled. ABPM was performed with SpaceLabs 90217 at both centres. Patients with atrial fibrillation or with inadequate number of measurements (<20 valid awake or <7 asleep BP) were excluded. The primary end-point was all-cause mortality. Prognostic significance was assessed for 24-h mean systolic and diastolic BP, as well as 24-h BP variability metrics (24-h standard deviation (SD), weighted SD and average real variability).

Results:

174 patients (mean age 83±3 years, 46% men, mean 24-h BP 129/67±16/8 mmHg) were analyzed. Most (94%) received anti-hypertensive treatment (76% ACEi-ARBs, 50% CCBs, 42% diuretics, 36% beta-blockers, 11% other drugs). Main comorbidities were previous cardio-/cerebrovascular events (34%), chronic kidney disease (20%), type 2 diabetes mellitus (15%), and heart failure (12%). During a median follow-up of 26 [20-38] months, 17 deaths (10%) occurred. Deceased patients were older (85 vs 83 years), predominantly male (78% vs 43%), and exhibited higher 24-h SBP (133 vs 128 mmHg), 24-h PP (67 vs 61 mmHg), and Charlson Comorbidity Index (CCI, 7.6 vs 6.4, all p<0.05). In a multivariate Cox-regression model adjusted for age, sex, CCI and renal function, only 24-h SBP (aHR 1.053, 95% CI 1.004-1.104, p=0.03) and 24-h PP (aHR 1.067, 95%CI 1.011-1.126, p=0.02) predicted prognosis. Conversely, neither 24-h SD of SBP (p=0.06), DBP (p=0.09), nor other short-term BP variability metrics showed significant association with mortality.

Conclusions:

In this cohort of octogenarians attending outpatient hypertensive clinics, 24-h SBP and 24-h PP emerged as independent predictors of all-cause mortality. These findings suggest that targeting 24-h SBP could be a priority in the treatment of hypertensive octogenarians. While 24-h BP variability exhibited marginal associations, further data are warranted to establish their prognostic significance.
AN UPDATED REPORT FROM THE HUNGARIAN AMBULATORY BLOOD PRESSURE MONITORING REGISTRY
Authors: Pásztor Dorottya Tímea , Nemcsik János , Takács Johanna , Kekk Zsófia , Farsang Csaba , Simon Attila , Páll Dénes , Torzsa Péter , Dolgos Szilveszter , Koller Ákos , Járai Zoltán
Published: May 2024

Objective:

Ambulatory blood pressure monitoring (ABPM) is recommended by current European guidelines for the early diagnosis of hypertension and to monitor the efficacy of antihypertensive treatments. The Hungarian Society of Hypertension has initiated a 5-year, nationwide program in 2021 to promote the routine use of ABPM and to improve the motivation of doctors and patients. This is an updated report on the Hungarian ABPM Registry.

Design and method:

This is an ongoing, multicenter, open-label, observational study. Adult (age >18 years) patients with known hypertension(HT), or with suspected/newly diagnosed hypertension(nHT) can be involved in the study. ABPM monitoring is performed by GPs, internists, and cardiologists using validated Meditech ABPM-06 monitors. Current report analyzed ABPM data between 21.02.2021-16.11.2023, that were collected into an electronic case report. Overall, 40621 ABPMs were performed, due to protocol deviation 1901 patients were excluded from the analysis.

Results:

26315 patients were HTs(68.3%), 12193 patients were nHTs(31.5%). In the HT group 95.5%, in the nHT group 21.5% were treated. 63.6% of all patients were hypertensives according to the 24-hour average blood pressure(BP) values. Mean 24-hour systolic and diastolic BP was 133.84±14.5 mmHg and 79.2±10.3 mmHg, respectively. There was no difference in the 24-hour mean systolic BP between HT and nHT patients (133.75±13.96mmHg vs. 133.86±14.72mmHg, respectively, p=NS). Obesity(BMI >30 kg/m2) increased the risk of hypertension(OR=1.82[1.73;1.92]for 24-hour average). Coffee consumption(more than 3/day)(OR=1.22[1.16;1.29]for 24-hour average), snoring(OR=1.39[1.33;1.46]for 24-hour average)and smoking(OR=1.10[1.03;1.18]for 24-hour average)all increased the risk of hypertension, primarily affecting more the daytime BP values(OR=1.24[1.18;1.31]for daytime in coffee consumption, OR=1.13[1.07;1.19]for nighttime in coffee consumption; OR=1.42[1.36;1.49]for daytime in snoring, OR=1.31[1.25;1.38]for nighttime in snoring; OR=1.09[1.01;1.16]for daytime in smoking, OR=1.01[0.94;1.08]for nighttime in smoking (NS)). Lack of regular sport(less than 3x30 minutes weekly)increased the risk of hypertension(OR=1.11[1.05;1.18]for 24-hour average), primarily affecting more the nighttime values(OR=1.19[1.12;1.26]for nighttime, OR= 1.02[0.96;1.07]for daytime(NS)).

Conclusions:

Hypertension is highly prevalent in both HT and nHT patients, irrespectively of gender or treatment. Obesity, lack of regular sport, coffee consumption, snoring and smoking are all significant risk factors in developing hypertension, latter ones affecting more the daytime BP values, whereas lack of regular sport affects more the nighttime BP values.
COMPARATIVE EVALUATION OF THE AKTIIA CUFFLESS MONITOR AND STANDARD 24-H AMBULATORY BLOOD PRESSURE MONITOR
Authors: De Almeida Tiago Paggi , Perruchoud David , Alexandre Jérémy , Vermare Pascale , Sola Josep , Shah Jay , Marques Luisa , Pellaton Cyril
Published: May 2024

Objective:

Cuffless blood pressure (BP) monitors provide an innovative approach for BP assessment, transcending the episodic nature of traditional cuff-based, oscillometric modalities like ambulatory BP monitors (ABPM). However, the performance of these cuffless devices compared to their cuff-based counterparts remains debated. In this study, BP readings from a continuous cuffless BP monitor were compared against those from a standard 24-hour ABPM.

Design and method:

The study enrolled 63 subjects (NCT04548986, 53.1±7.2 years, 21.2% female, arm circumference 29.0±2.5 cm) participating in a 12-week cardiac rehabilitation (CR) program (Réseau Hospitalier Neuchâtelois, Switzerland). Comparisons encompassed 24-h, daytime (9am– 9pm), and night-time (11pm–7am) systolic and diastolic BP (SBP, DBP) using a 7-day average BP measurement from a cuffless monitor (Aktiia SA, Switzerland) overlapping with a 1-day average from the ABPM (Dyasis 3, Novacor, France), both recorded at the start and end of the CR program. Two sessions were analyzed: session 1 compared the first day's ABPM data with the first week's Aktiia data; session 2 compared the last day's ABPM data with the last week's Aktiia data. Only sessions with at least 20 daytime and 7 night-time valid measurements from both monitoring modalities were included in this analysis.

Results:

From the initial cohort, 51 subjects fulfilled the requirements of data availability of this analysis (Figure 1, 44 in session 1, 35 in session 2). No significant differences were found between Aktiia and ABPM monitors in 24-h and daytime SBP readings (24-hour: mean ± SD [95% CI] 2.6±12.3 [-0.2, 5.4] mmHg, correlation r=0.57, P=0.06; daytime: 1.2±12.4 [-1.6, 4.0] mmHg, r=0.60, P=0.38). However, night-time SBP readings showed more pronounced differences (12.5±14.4 [9.3, 15.8] mmHg, r=0.39, P<0.001). DBP readings were significantly different but within clinical acceptance for 24-h and daytime (24-hour: -2.9±7.9 [-4.7, -1.1] mmHg, r=0.63, P=0.002; daytime: -3.1±8.2 [-5.0, -1.3] mmHg, r=0.64, P=0.001), with notable night-time differences (4.1±8.5 [2.2, 6.0] mmHg, r=0.57, P<0.001).

Conclusions:

The findings reveal the Aktiia monitor's promising performance in continuous, long-term BP monitoring, especially during daytime, while noting important differences at night. Further research is underway to investigate nocturnal measurements.
BLOOD PRESSURE DIGIT PREFERENCE IN HYPERTENSIVE PATIENTS ATTENDING PRIMARY HEALTH CARE IS ASSOCIATED WITH FUTURE CARDIOVASCULAR EVENTS
Authors: Norrman Anders , Schiöler Linus , Carlsson Axel C , Boström Kristina Bengtsson , Hjerpe Per , Ljungman Charlotta , Mourtzinis Georgios , Qvarnström Miriam , Wettermark Björn , Wändell Per , Kahan Thomas , Hasselström Jan
Published: May 2024

Objective:

Digit preference refers to rounding blood pressure (BP) values more often than would occur by chance. Studies show that practices with high digit preference are linked to fewer antihypertensive prescriptions, and patients attending such practices have an increased cardiovascular (CV) event risk.

The objective is to investigate how the fraction BP digit preference in hypertensive patients in primary health care centres relates to future CV events.

Design and method:

From the Swedish Primary Care Cardiovascular Database, 74,751 patients (41,728 women) in 48 primary care centers in Sweden with a recorded diagnosis of hypertension during 2001–2008 were included. The fraction of systolic and diastolic BP values ending in 5 or 10 during 2007–08 at each center was calculated. Cox regression analysis assessed the relation between digit preference at each primary health care center and CV events (ischemic heart disease, cerebrovascular disease, CV death) during 2009–2013, i.e. follow-up was 1–5 years. Covariates included age, gender, income, diabetes, ischemic heart disease cerebrovascular disease, and region.

Results:

Patient mean age in 2008 was 70±14 years. The fraction of digit preference varied between 32% and 100% between centres (Figure 1). There was a significant association between the utilization of digit preference at a primary health care centre and risk for future CV events for these patients (Figure 2). A proxy for quality of care by centre was estimated as fractions of patients with lipids, creatinine, and microalbuminuria assessed during 2007–2008. This revealed no association between markers of quality of care and prevalence of digit preference.

Conclusions:

BP digit preference is associated with future CV events. This may be attributed to inaccurate measurements procedures for BP measurements, faulty evaluation of actual BP levels and risk, treatment not offered appropriately, or other means of possible inappropriate quality of care.
DIAGNOSTIC ACCURACY OF ATTENDED AND UNATTENDED BLOOD PRESSURE MEASUREMENTS IN PATIENTS WITH ARTERIAL HYPERTENSION
Authors: Mancusi Costantino , Maloberti Alessandro , Fucile Ilaria , Manzi Maria Virigina , Pengo Martino , Bertacchini Fabio , Monticone Silvia , Pucci Giacomo
Published: May 2024

Objective:

Purpose: To evaluate the concordance between the measurement of blood pressure values in unattended, OBP and ABPM modes.

Design and method:

Methods: 232 patients were enrolled in 6 hypertension centers belonging to the Italian society of arterial hypertension, as part of a research coordinated by the SIIA youth group. Patients underwent blood pressure measurement in AOBP and OBP modes before and after ABPM. AOBP and OBP measurements were performed in alternating mode before and after ABPM, and the mean values were calculated. Blood pressure was defined as controlled if the 24-hour average blood pressure was <130/80 mmHg on the ABPM.

Results:

Results: The mean age of the patients was 59±13.6 years, with a female prevalence of 49% and a duration of hypertensive disease of 11.6±8.4 years. The AOBP and OBP blood pressure values were 137.1±17.3/ 78.5±12.4 mmHg and 139.8±19.5/ 83.1±12.8 mmHg, respectively (p<0.01). In ROC curve analysis, the AOBP measurement mode showed an accuracy in correctly identifying patients with controlled hypertension equal to 0.71, higher than that shown by the OBP measurement equal to 0.67 (p<0.05). This difference was higher for older patients (>65 years old) (AUC of 0.73 versus an AUC of 0.65, (p<0.05)) and for diabetic patients (AUC of 0.73 versus an AUC of 0.65, (p<0.05)) the OBP modality.

Conclusions:

Conclusions: Our data suggest that AOBP may be particularly useful in identifying patients with more accurately controlled blood pressure than OBP mode. This advantage, due to a virtual elimination of the white coat effect, is more marked in older and diabetic patients.
A SCOPING REVIEW ON BLOOD PRESSURE TIME AT TARGET AND ITS PROGNOSTIC VALUE FOR CARDIOVASCULAR OUTCOMES
Authors: Li Wansha , Gnanenthiran Sonali , Schutte Aletta E , Tan Isabella
Published: May 2024

Objective:

The amount of time blood pressure (BP) is at target levels, commonly referred to as time at target (TTR), has been shown to be a useful measure for evaluating hypertension management effectiveness and assessing longitudinal BP control. This scoping review was conducted to identify and describe measurement methodologies used for determining BP-TTR and the association between BP-TTR and cardiovascular outcomes.

Design and method:

We followed the PRISMA extension for scoping review protocol. Literature was systematically searched from five databases (Embase, PubMed, Scopus, Web of Science and CINAHL). Search terms included “hypertension”, “blood pressure”, “time at target”, “time in therapeutic range”, “cardiovascular outcome∗”, “cardiovascular event∗”, and “clinical outcome∗”. Clinical trials, observational studies, cohort studies, cross-sectional studies, and systematic reviews related to TTR and cardiovascular outcomes were included, excluding conference proceeding and abstracts. Only English language articles were included.

Results:

Of the 369 articles identified, 17 articles were included in this scoping review. Majority of the studies (n=11, 65%) adopted the linear interpolation method for BP-TTR calculation, whereby a linear increase/decrease is assumed between two consecutive BP readings and TTR is determined as the proportion of time (in days) BP was in range. Four studies reported TTR determined as the proportion of BP readings in target range. Office BP readings was the dominant BP measurement method (n=15) in the selected studies, while 24-hour ambulatory BP monitoring (n=1) and home BP monitoring (n=1) were used in two studies. Studies differed in the time range over which BP-TTR was determined (range 13 days to 15 years) as well as frequency and total number of BP measurements (range 2 to 28). All studies demonstrated that a higher BP-TTR was associated with a reduced risk of cardiovascular outcomes, reflecting better BP control.

Conclusions:

This scoping review identified two main categories of BP-TTR calculation methods, the linear interpolation method and the proportion of BP readings method. All studies demonstrated the value of BP-TTR as a measure of BP control regardless of the calculation method, with lower TTR being associated with higher risk of poorer cardiovascular outcomes.
COMPARISON OF CALIBRATION METHODS IN THE PRECISION OF A RING-TYPE CUFFLESS BLOOD PRESSURE MEASUREMENT DEVICE
Authors: Lee Huijin , Lee Hae-YOUNG
Published: May 2024

Objective:

This study aimed to compare the efficacy of two calibration methods for a ring-type cuffless blood pressure (BP) measurement device, CART-I Plus, to assess if regular calibration with a traditional brachial arm cuff device enhances its precision.

Design and method:

The study involved 40 patients, with 28 completing the study. Participants underwent calibration in three different positions (sitting, standing, supine). Prior to the initial calibration, they were seated quietly for 3–5 minutes. Calibration was executed using a conventional brachial arm cuff device on the same arm. In each position, calibration was performed twice, separated by a minimum interval of one minute. A rest period exceeding two minutes was allowed between position changes for stabilization. BP estimates from the CART-I Plus, derived from photoplethysmography signals, were then compared with corresponding conventional 24-hour ambulatory BP monitoring (ABPM) measurements.

Results:

The mean differences between the CART-I Plus and ABPM, when calibrated using the sitting position alone (twice), were -2.12±8.53/2.36±7.82 mmHg (awake/sleep SBP) and -4.11±7.73/0.27±7.99 mmHg (awake/sleep DBP), respectively. When calibration included all three positions (six total calibrations), the mean differences remained similar; -2.14±8.95/2.17±8.53 mmHg (awake/sleep SBP) and -4.10±7.91/0.25±7.73 mmHg (awake/sleep DBP) (p > 0.5). Neither the standing nor the supine position, nor a combination of sitting and supine positions, significantly improved precision. In both standing and supine positions, the devices demonstrated a strong correlation for systolic blood pressure (SBP) (r=0.86 and r=0.90, respectively) and diastolic blood pressure (DBP) (r=0.90 for both), with all correlations being statistically significant (p < 0.001).

Conclusions:

Provided that patient stabilization is adequately ensured, and precise brachial BP measurements are taken by medical personnel, a single sitting position calibration appears to be sufficient. The addition of dynamic three-point calibration involving standing and supine positions did not significantly enhance precision.
FEASIBILITY AND EFFECTIVENESS OF A RING-TYPE BLOOD PRESSURE MEASUREMENT DEVICE COMPARED WITH 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING DEVICE
Authors: Lee Huijin , Lee Hae-YOUNG
Published: May 2024

Objective:

This investigation aimed to assess the feasibility and accuracy of the CART-I Plus, a novel ring-type cuffless blood pressure (BP) measuring device and compare its performance with standard 24-hour ambulatory BP monitoring (ABPM).

Design and method:

The study recruited 40 patients, of which 33 were included in the final analysis. Participants were instructed to wear both the CART-I Plus and the ABPM devices on the same arm for a duration of approximately 24 hours. The BP readings obtained from the CART-I Plus, which utilizes photoplethysmography (PPG) signals for measurement, were compared against those from the ABPM.

Results:

In terms of systolic/diastolic blood pressure (SBP/DBP) readings, the CART-I Plus recorded values of 131.4±14.1 / 81.1±12.0 mmHg, 132.7±13.9 / 81.9±11.9 mmHg, and 128.7±14.6 / 79.3±12.2 mmHg for the 24-hour, daytime, and nighttime periods, respectively. In comparison, the ABPM showed readings of 129.7±11.7 / 84.4±11.2 mmHg, 131.9±11.6 / 86.3±11.1 mmHg, and 124.5±13.6 / 80.0±12.2 mmHg for the same intervals. The mean variances in SBP/DBP between the CART-I Plus and ABPM were 1.74±6.69 / -3.24±6.51 mmHg, 0.75±7.44 / -4.41±7.42 mmHg, and 4.15±6.15 / -0.67±5.23 mmHg for the 24-hour, daytime, and nighttime measurements, respectively. Furthermore, a significant correlation was observed between the devices, with correlation coefficients of r=0.725 for SBP and r=0.750 for DBP during the transition from daytime to nighttime (both p <0.001).

Conclusions:

The CART-I Plus device, with its innovative ring-type design, demonstrates considerable accuracy in BP measurement, aligning closely with the established ABPM method. These findings indicate that the CART-I Plus could be an effective tool for continuous BP monitoring in clinical settings. Its ability to provide consistent and reliable measurements, along with the convenience of its cuffless design, highlights its potential as a valuable addition to current BP monitoring practices.
NUMBER OF HOME BLOOD PRESSURE MEASUREMENT AND COGNITIVE IMPAIRMENT
Authors: Hoshide Satoshi , Nishizawa Masafumi , Kanegae Hiroshi , Kario Kazuomi
Published: May 2024

Objective:

The advantage of home blood pressure (BP) measurement compared to office BP measurement can only be achieved if the patients remember to take the measurements as instructed. Cognitive function tends to decline with age, and individuals with mild cognitive impairment (MCI) often have difficulty completing established self-management tasks.

Design and method:

The aim of this study was to investigate the association between the number of days within a 5-and-a-half-day period that patients took their home BP as instructed and MCI assessed by the Japanese version of the Montreal Cognitive Assessment (MoCA-J) in an elderly clinical population.

Results:

We analyzed 303 ambulatory patients (mean age 77.3±8.2 years) in whom MoCA-J had been assessed, who were instructed to take home BP for 1 evening and twice a day for the next five days, and who had at least one morning home BP measurement. The average total MoCA-J score was 18.5±6.0 points. After accounting for patient characteristics including age, sex, body mass index, drinking, smoking, prevalent cardiovascular disease, morning systolic BP and diastolic BP, and the use of antihypertensive drugs, the number of days home BP was measured was independently associated with both total MoCA-J score (estimate, 0.82; 95% confidence interval [CI], 0.43–1.21; P<0.001) and the lowest quartile of MoCA-J score (13 or below) (odds ratio [OR], 0.72; 95%CI, 0.59–0.87; P=0.001). Home BP measurement noncompliance (< 5 days’ measurement) was also independently associated with the total MoCA-J score (estimate, -2.56; 95%CI, -4.09 to -1.03; P=0.001) and the lowest quartile of MoCA-J score (OR, 3.32; 95%CI, 1.59–6.96; P=0.001).

Conclusions:

Poor compliance with home BP monitoring was associated with cognitive impairment in elderly cases who had been specifically instructed to perform home BP monitoring during a designated period.
DIPPING STATUS OF BLOOD PRESSURE AND PROGNOSIS
Authors: Gaspar Ludovit , Kmetova Iveta , Filipova Slavomira
Published: May 2024

Objective:

Ambulatory blood pressure monitoring (ABPM) plays an important role in monitoring the effectiveness of antihypertensive treatment. It enables to obtain clear information about absolute values and variability of blood pressure in time-defined periods. The aim of our work was to evaluate the clinical benefit not only from the point of view of BP control, but also from the prognostic aspect by determining the diurnal index.

Design and method:

To control the effectiveness of antihypertensive treatment, we used ABPM - Cardiosoft-Tonoport V, General Electric (USA) with oscillometric blood pressure measurement. We analyzed 206 ABPM records in hospitalized patients. There were 93 men (45%) and 113 women (55%). The monitored group of patients was divided into 4 groups according to age. There were 31 persons in the age group of 18-44 years, 78 persons in the age group of 45-64 years, 52 persons in the age group of 65-74 years and 45 persons in the oldest age group (75 years and over). In 15 patients (7.3%), we did not determine the diurnal sign for night waking.

Results:

The group of dippers consisted of 79 people (38.3%), there were also 79 people (38.3%) in the group of non-dippers, there were 30 risers (14.6%) and 3 extreme dippers (1.5%). Following the further fate of the investigated persons, we found that 19 persons (9.2%) died within 2 years, of which 14 were from groups with a disturbed diurnal index (9 non-dippers and 5 risers).

Conclusions:

Our results point to the fact that in addition to the basic parameters of BP used as an indicator of blood pressure control, the analyses of diurnal character disturbances has a importance in prognostic aspect. Identifying these patients may therefore be helpful in the management of hypertension and comorbidities.
BLOOD PRESSURE SURGE DURING THE EARTHQUAKE IN CITY OF PETRINJA, BANIJA REGION IN CROATIA
Authors: Crnojevic Ivana , Josipovic Josipa , Mirosevic Gordana , Gabric Ivo Darko , Jelakovic Bojan
Published: May 2024

Objective:

Stress is known to contribute to other well-known environmental risk factors to hypertension leading to sympathetic overactivity. While usual environmental factors can be easily measured, exposure to stress is difficult to objectivize, especially during catastrophic events which are recognized as main stressors. There are several reports about earthquakes, blood pressure (BP) and cardiovascular events.

Design and method:

We are reporting a case on ambulatory blood pressure monitoring (ABPM) in 42-year-old women during Croatian earthquake.

Results:

A 42-year-old women with multiple genetic and environmental risk factors for hypertension was evaluated for secondary hypertension, and adult autosomal polycystic kidney disease was diagnosed. Kidney function was normal and there were no signs of target organ damage. She was treated with a fixed dose combination perindopril/amlodipine 4/5 mg (morning). ABPM revealed mildly uncontrolled systolic-diastolic hypertension with extreme nocturnal dip. Average 24-hour, daytime and nighttime BP values were 130±20,4/79±19,9 mmHg, 137±16,2 /85±17,9 mmHg, 100±11,8 /55±11,7 mmHg, respectively. White coat effect was present, and masked hypertension was ruled out. Average 24-hour, daytime and nighttime heart rate were: 88b/min, 93b/min, and 79b/min. A significant surge in BP and heart rate (200/130 mmHg,140 b/min) was recorded at 12:30 p.m. exactly at the time when earthquake occurred in city Petrinja, also felt in Zagreb city. The earthquake was clearly stated in the blood pressure diary (Figure 1).

Conclusions:

Although chronic stress is emphasized to affect human health more than acute, catastrophic events such as earthquakes can have deleterious effect such as enormous elevation of BP. It is necessary to have strategies for BP management in disaster-related diseases to prevent organ damage.
MAY MEASUREMENT MONTH 2017-2023 IN CHINA
Authors: Chen Xin
Published: May 2024

Objective:

We investigated status of hypertension in a large opportunistic screening study in China from 2017 to 2023.

Design and method:

Data was derived from May Measurement Month (MMM). MMM China project strictly followed the international MMM protocol. Study participants had to be >= 18 years of age and had ideally not taken blood pressure for >= 1 year. Blood pressure was measured three times consecutively in the sitting position with a 1-minute interval, using a validated electronic BP monitor or mercury sphygmomanometer. Trained volunteer investigators administered a questionnaire to collect information on medical history, lifestyle, and use of medications.

Results:

Since 2017, more than 1600 measurement sites have been set up, and 1.7 million adult blood pressure measurements have been completed. Mean systolic blood pressure and diastolic blood pressure over the years is around 119-124mmHg, and 74-81 mmHg, respectively. From the results of MMM program, about 30% (24.7% to 29.2%) had hypertension. Through 3 years of efforts, the awareness (46.9% in 2017 to 51.5% in 2019), treatment (40.7% in 2017 to 48.4% in 2019), and control (15.3% in 2017 to 29.1% in 2019) rates of hypertension in China have improved. However, after COVID-19, the awareness (45.3% in 2020 to 16.0% in 2023), treatment (39.7% in 2020 to 14.3% in 2023) and control (24.2% in 2020 to 7.1% in 2023) rate of hypertension have declined. The main barriers to blood pressure awareness in China included age, gender, and body mass. The awareness of hypertension was higher in patients with comorbid diseases, such as diabetes mellitus, coronary heart disease, stroke or TIA, or the use of statins, than those without. The main barriers affecting hypertension control in China included age, gender, smoking and low proportion of combination therapy.

Conclusions:

The situation of low control rate of hypertension needs to be changed as soon as possible. Several modifiable factors as barriers to blood pressure control in China, such as current smoking, and the under-use of combination therapy warrants attention.
TRANSIENT HYPOTENSION IN AN ELDERLY HYPERTENSIVE PATIENT
Authors: Alibhai Alyzeh , Kumar Nikhil
Published: May 2024

Objective:

A 60 year old hypertensive female presented to the office with fatigue and pre syncope lasting for 6 hours after a home blood pressure reading showed her systolic was 60. This happened several times a week. A 24 hr ABP was done & the patient woke up early hours feeling terrible & her SBP was below 70 mm Hg & the 24 hr ABP which showed 2 hypotensive readings between 6 and 7am. The BP came up slowly in a few hours & she recovered several hours later.

Design and method:

The patient was originally on Ramipril for hypertension prescribed by a local cardiologist, and then Nifedipine was added. Both short acting agents. She got these attacks weekly. She was switched over to long acting Perindopril & Amlodipine taken 12 hours apart. The frequency of the attacks reduced considerably to less than one per month. There was no orthostatic drop in pressure or any relationship to meals or exercise.

Results:

Systolic blood pressure below 70mmHg can lead to reduced perfusion to the brain. Low SBP can present as symptoms or manifestations of decreased cardiac or cerebrovascular circulation. It is important to differentiate orthostatic and postprandial hypotension from this transient cause. It is still unclear if the probability of organ damage is the same in symptomatic vs asymptomatic patients. Some patients have short term, or transient, symptomatic hypotension that has an poor prognosis.

Conclusions:

Managing hypertension in elderly is a challenge & must take into consideration to avoid orthostatic hypotension. It is important to do ambulatory monitoring on them to be able to register symptomatic episode. In this situation the drop in pressure was not Orthostatic or Post prandial. The mechanism is not easily explained but cases have been documented and in patients complaining of fatigue & Presyncope or Syncope, ambulatory monitoring is the key. When treating hypertension in elderly patients, the goal of treatment should not be to meet target but treating to lowest level tolerated without causing hypotension. A med review should be done to optimize on the class of drugs being taken.
CARDIOVASCULAR RISK FACTORS HAVE DIFFERENT EFFECTS ON TOTAL BRAIN VOLUME AND CEREBRAL WHITE MATTER LESIONS OVER TIME: THE HELIUS STUDY
Authors: Vriend Esther M.C. , De Sitter Alexandra , Bouwmeester Thomas A. , Franco Oscar H. , Galenkamp Henrike , Van Charante Eric P. Moll , Collard Didier , Nederveen Aart , Van Den Born Bert-jan H.
Published: May 2024

Objective:

Cardiovascular risk factors have been associated with brain volume reduction and the development of cerebral white matter lesions (WML), both early markers of cognitive decline and cerebrovascular disease. Most studies, however, are cross-sectional in design and involve older populations. We examined the prognostic value of cardiovascular risk factors on brain and WML volumes in a middle-aged, multi-ethnic population.

Design and method:

We use baseline data and 3T brain magnetic resonance imaging (MRI) scans in 562 participants of Moroccan, South-Asian Surinamese, and Dutch descent from the HELIUS study. Brain volume and WML volumes were determined using automated segmentation pipelines based on MP-RAGE and 3D-FLAIR scans. Linear regression analyses, adjusted for age, sex, and ethnicity, were performed to assess the association between (change in) cardiovascular risk factors and brain and WML volumes.

Results:

Mean age was 58.5 (standard deviation 7.7) years, 45% was female. Median follow-up time was 8.4 [interquartile range 7.4; 9.5] years. Both elevated BMI and presence of diabetes at baseline as well as increases in BMI and HbA1C levels over time were significantly associated with reduced brain volume at follow-up. Hypertension, systolic and diastolic blood pressure levels, the use of antihypertensive medication, new-onset hypertension and history of cerebrovascular disease were all independently and positively associated with WML volume.

Conclusions:

Elevated body weight and diabetes mellitus significantly contribute to decreased brain volumes, whereas hypertension and cerebrovascular disease are key risk factors for the development of WML. The present findings underscore the importance of obesity and hypertension in mid-life as predictors of future risk of cerebrovascular disease.
IMPAIRED BETA-ADRENERGIC VASODILATOR FUNCTION IN HYPERTENSIVE PATIENTS WITH SYMPTOMS OF DEPRESSION
Authors: Farukh Bushra , Faconti Luca , Mcnally Ryan , Chowienczyk Phil
Published: May 2024

Objective:

Hypertension and depression are amongst the most common chronic physical and mental conditions worldwide. The two conditions cluster, however the mechanisms underlying the association are not well understood. Hypertension complicated by affective disorders may be characterised by high sympathetic activity. We investigated whether symptoms of depression may be associated with impaired endothelium-dependent beta2-adrenergic vasodilator responses.

Design and method:

Hypertensive subjects with no previous history of diabetes or cardiovascular disease were recruited from the hypertension outpatient service at St. Thomas’ Hospital, London. Detailed medical history and baseline characteristics including blood pressure (BP), heart rate (HR), routine biochemistry including C-reactive protein (CRP) and low-density lipoprotein (LDL) were obtained during a single study visit. Plasma concentrations of normetadrenaline were measured as a marker of resting sympathetic activity. Depression symptom severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). The pulse wave response to the beta2-adrenergic vasodilator salbutamol (PWRS) was assessed using radial tonometry to measure the change in augmentation index after inhalation of 200μg salbutamol from a metered dose inhaler with spacer device.

Results:

100 subjects (62% male, mean ± SD age 41.0±11.6 years) were recruited. 79% were on pharmacological treatment for hypertension. Mean PHQ-9 depression score was 8.8±6.2, consistent with a high prevalence of depression. After adjusting for confounders (age, sex, smoking status, body mass index, BP, HR, CRP, LDL, treatment for hypertension), PWRS was significantly related to depression score (Beta= 0.447, P=0.002). Depression score was also significantly associated with plasma concentrations of normetadrenaline (Beta= 0.605, P<0.001) and after adjusting for plasma normetadrenaline level, the association between PWRS and depression score was no longer significant (Beta= 0.343, P=0.102).

Conclusions:

These results suggest that in hypertensive subjects with depression, an impaired endothelium-dependent beta2-adrenergic vasodilator response is mediated by a high level of sympathetic activity which could contribute to cardiovascular complications.