bluuebunny/crossref_metadata_2025 huggingface dataset:
PATIENTS’ BELIEFS, MEDICATION ADHERANCE AND CONTROLLED HYPERTENSION AMONG HYPERTENSIVE PATIENTS IN VIETNAM
Authors: Ho Hien , Nguyen Minh Tam , Huynh Van Minh , Vo Tam , Tran Binh Thang , Heytens Stefan , Devroey Dirk , Vo Nu Hong Duc , Dang Thi Thanh Nha , Doan Pham Phuoc Long , Nguyen Vu Phong , Le Phuoc Hoang , Hoang Anh Tien
Published: May 2024

Objective:

Medication adherence and controlled hypertension have low prevalence rates in Vietnam. Global research has highlighted associations between patients’ beliefs, hypertension knowledge, and medication adherence. Despite this, limited information exists on these aspects among Vietnamese hypertensive patients. This study aims to investigate patient beliefs and medication adherence among hypertensive individuals in community health centers in Vietnam.

Design and method:

In this cross-sectional study, patient beliefs and medication adherence among hypertensive patients were examined using the Belief about Medicine Questionnaire (BMQ) and Medication Adherence Report Scale (MARS-5). Additionally, demographic information, patients’ knowledge about hypertension, and data on controlled hypertension were collected. Descriptive, analytical, and multivariate logistic regression analyses were conducted using SPSS 29 software.

Results:

The study involved 761 hypertensive patients, with 55.7% being men. Findings revealed a mean medication adherence score of 21.8 (SD: 4.6). The MARS-5 score was higher in the ethnic majority (22 ± 4.3) and older patients (22.1 ± 4.1). The mean score for BMQ-Specific Necessity was 18.3 (SD 3.8), while BMQ-Specific Concern was relatively low at 14.4 (SD: 3.8). BMQ-General Overuse and BMQ-General Harm mean scores were 10.8 (SD: 2.6) and 9.9 (SD: 2.8), respectively. The BMQ-Specific Necessity score in older patients and those in urban areas had significantly higher scores than their counterparts in rural areas (p < 0.05). However, no difference was observed in patient beliefs and medication adherence based on gender. Patients with higher education or a high mean score for BMQ-Specific Necessity exhibited greater hypertension knowledge and better medication adherence (p < 0.001). Furthermore, patients with a higher mean score of medication adherence exhibited more controlled hypertension.

Conclusions:

Hypertensive patients in Vietnam exhibit high scores of necessity and low scores of concern regarding medication, with associations noted between patients’ knowledge and medication adherence. This study also revealed a low mean score of medication adherence among hypertensive patients. These findings highlighted the requirement for a holistic approach to deal with this concern. Healthcare planners and general practitioners should actively explore patients’ beliefs, enhance hypertension knowledge, and promote medication adherence for effective hypertension management.
A DIRECT COMPARISON OF TWO OBJECTIVE METHODS FOR DETECTION OF NON-ADHERENCE IN PATIENTS WITH UNCONTROLLED HYPERTENSION
Authors: Hamsund Ida Regine Bilet , Waldum - Grevbo Bård , H⊘ieggen Aud , Amro Amin , Olsvold Nina , Halvorsen Lene Vernås
Published: May 2024

Objective:

Uncontrolled hypertension remains a major health challenge leading to premature death and cardiovascular morbidity. We have previously reported a prevalence of non–adherence to antihypertensive drugs from 8-30% of patients studied by either directly observed therapy (DOT) or serum drug concentrations (S- conc.) of antihypertensive medication. We aimed to investigate the prevalence of non–adherence in patients with uncontrolled hypertension consecutively referred to our outpatient clinic and to compare results from DOT and s-conc. in the same patient.

Design and method:

Nine, of planned 20 patients referred to 24-hour ambulatory blood pressure measurement (ABPM) were included in these preliminary results. Inclusion criteria was uncontrolled blood pressure (office SBP >140 mmHg) despite the use of three antihypertensive drugs. ABPM were measured at baseline and repeated after 3-4 weeks, the second time following DOT. S-conc. of antihypertensive drugs were measured by ultra-high-performance-liquid-chromatography tandem mass spectrometry at baseline and 24 hours after DOT. Patients with s-conc. of at least one drug below a predefined reference level were considered to be non–adherent. At the final visit patients evaluated how they experienced the DOT and s-conc. measurements by a visual analogue scale (VAS score) from 0 –10.

Results:

Of nine patients (age 36-79), five adherent (54,5%) and four (45,5%) non-adherent were detected by s-conc. Baseline mean for Ambulatory systolic blood pressure (ASBP) at visit one was 138±19 mmHg and mean ASBP after DOT 134±14 mmHg (p = 0,33). ASBP fell by 12±9 mmHg after DOT in the non-adherent group compared to a rise by 2±10 mmHg in the adherent group (p=0,079). Five patients completed the VAS evaluation, none of them experienced DOT or measuring s-conc. unpleasant.

Conclusions:

The difference in ASBP after DOT in the two groups showed a clear trend. Preliminary data in patients with uncontrolled hypertension show that both DOT and measurement of serum concentrations of antihypertensive drugs are reliable methods for detecting non–adherence and are well accepted by the patients. These methods may be used complementary in the outpatient clinic.
VALUE OF THE PROGNOSTIC MODEL FOR THE DIAGNOSIS OF HYPERTENSION USING AI ALGORITHMS
Authors: Abdullaev Akbar , Alyavi Anis , Alyavi Bakhromkhon , Uzokov Jamol , Iskhakov Sherzod , Muminov Shovkat , Ashirbaev Sherzod , Virkhov Igor
Published: May 2024

Objective:

Hypertension is a prevalent cardiovascular condition associated with significant morbidity and mortality. While various prognostic models exist for predicting hypertension, incorporating artificial intelligence (AI) algorithms may enhance diagnostic accuracy and prognostication. However, the value of such AI-based prognostic models in hypertension diagnosis and risk stratification remains to be fully elucidated. This study aimed to evaluate the value of a prognostic model for the diagnosis of hypertension using AI algorithms by assessing biomarkers, predictors for worse prognosis, and clinical outcomes with Kaplan-Meier analysis and Cox regression models.

Design and method:

A retrospective cohort study was conducted on 256 smoker individulas with a mean age of 56.2 ± 12.8 years. Participants were followed up for a median duration of 6.5±2.6 years. Clinical and laboratory data, including cardiovascular biomarkers and predictors of hypertension, were collected at baseline. An AI-based prognostic model was developed using machine learning algorithms to predict hypertension diagnosis and prognosis. Kaplan-Meier analysis was performed to evaluate the cumulative incidence of hypertension, while Cox regression models were utilized to assess predictors of worse prognosis.

Results:

During the follow-up period, 42% of patients developed hypertension. The AI-based prognostic model demonstrated excellent diagnostic accuracy in predicting hypertension development, with 78% sensitivity and 75% specificity. Additionally, several predictors were identified for worse prognosis in hypertensive patients, including abdominal obesity, glucose intolerance, dyslipidemia. Cox regression models confirmed the independent association between high-risk classification by the prognostic model and cumulative incidence of hypertension (hazard ratio [HR], [1.15]; 95% confidence interval [CI], [1.05-1.26]; p < 0.05).

Conclusions:

Our findings suggest that an AI-based prognostic model holds promise for the diagnosis of hypertension and risk stratification. Incorporating AI algorithms into prognostic models may enhance diagnostic accuracy and improve outcomes in patients with hypertension. Further research is warranted to validate these findings in larger cohorts and optimize the AI-based prognostic model for clinical implementation.
BLOOD PRESSURE ESTIMATION FROM PPG-BASED PULSE ARRIVAL TIME
Authors: Villeneuve Emma , Anglade Daniel , Sandre-ballester Caroline , Auclair Loïc , Fuchs Olivier , Blandin Pierre
Published: May 2024

Objective:

Cuff blood pressure monitoring is uncomfortable, limited for daily-routine and it provides sparse measurements in time. To enable continuous non-invasive monitoring, a new cuffless blood pressure (BP) meter based on photoplethysmography (PPG) is assessed in a first clinical trial. It aims at exploring the relationship between BP variations and optical features, including a wide range of intra-individual BP variations.

Design and method:

The cohort of the clinical trial (NCT05393401, approved by Human Research Review Board (CPP SM I)) includes 11 healthy subjects (5F/6M, age [19-60] years). Each subject undertakes a sequence of physical / mental activities and relaxation. The subject is monitored with PPG and ECG sensors at a sampling rate of 1 kHz. Measurements are realized with PPG sensors on the wrist, directly above the radial artery that was located by ultrasound. All these signals are collected and synchronised by a custom-built multi-sensing platform that was designed in-house. The Pulse Arrival Times (PAT) are computed from ECG R-peaks and PPG signals for each heartbeat, and then averaged every 20 s. In parallel, the subject's BP is measured every 20 s with a medical-grade continuous meter.

Results:

The collected dataset provides a wide range of variations of the PAT (0.23 +/- 0.19 s) and of the systolic BP (132 +/- 19 mmHg). Based on this dataset, a Gaussian process model is trained with cross-validation to predict the systolic BP from PAT values. The Root Mean Square Error (RMSE) is 18 mmHg. The Bland-Altman plot shows the distribution of residuals as a function of the mean of both measured and predicted BP. 95% of predicted values are within +/- 32 mmHg around the target.

Conclusions:

Thanks to the measurement protocol based on both active periods and relaxation, it is possible to measure a wide range of PAT and BP values with healthy subjects. Such variations are necessary to build a reliable prediction model. Future work will improve this preliminary model by taking into account instant heartrate and individual physiological parameters.
UNATTENDED AUTOMATIC BLOOD PRESSURE MEASUREMENTS VS. CONVENTIONAL OFFICE READINGS IN PREDICTING HYPERTENSION-MEDIATED ORGAN DAMAGE
Authors: Stopa Marek , Zieba Katarzyna , Tofilska Anna , Bilo Grzegorz , Rajzer Marek , Olszanecka Agnieszka
Published: May 2024

Objective:

Hypertension, a major cardiovascular risk, requires accurate blood pressure measurement. Conventional office measurements (OBPM) are error-prone and systematically biased by the white coat effect. Unattended office blood pressure measurement (UOBPM) is emerging as an alternative to mitigate this bias. However, its ability to predict hypertension-mediated organ damage (HMOD), indicating disease progression, remains debated. This study compares UOBPM with OBPM in terms of their association with various HMODs, including left ventricular hypertrophy (LVH), left atrial enlargement (LAE), left ventricular systolic and diastolic dysfunction, intima-media complex (IMT) thickening, microalbuminuria and abnormal pulse wave velocity (PWV).

Design and method:

Hypertensive patients without overt cardiovascular disease were recruited, interviewed, and examined. Subsequently, blood pressure measurements were conducted in standard conditions in a randomized sequence in each patient:

1) UOBPM: After 5 minutes of solitary rest in the examination room, blood pressure was automatically measured three times at 1-minute intervals with OMRON HEM 907 device.

2) OBPM: After 5 minutes of rest, a physician performed three automated measurements at 1-minute intervals with the same device.

Subsequent evaluations aimed to detect HMODs, including echocardiography, carotid artery ultrasound, PWV assessment, and laboratory tests. Receiver operating characteristic (ROC) analysis was performed for each HMOD in both measurement groups, and the areas under the ROC curves were compared.

Results:

The study enrolled 219 patients(55% females, mean age 55 ±14 years). The average systolic blood pressure in UOBPM was lower by 4,2 mmHg (p<0,001) compared to OBP while the difference in diastolic pressure was 1,9 mmHg (p<0,001). Both measurement methods were associated with the presence of the following HMODs: LAE, IMT thickening, and abnormal PWV. Neither method allowed for the prediction of LVH, systolic and diastolic dysfunction of the left ventricle, elevated ACR, or the presence of atherosclerotic plaques in the carotid arteries. Furthermore, ROC curve analyses revealed no difference between the two methods in predicting HMOD (Table 1).

Conclusions:

Both measurement techniques exhibited satisfactory predictive ability for the presence of certain HMOD. However, based on the study results, no significant differences could be inferred between the two methods with respect to their predictive performance.
IMPACT OF THE NUMBER OF OFFICE BLOOD PRESSURE MEASUREMENTS ON THE CLASSIFICATION OF BLOOD PRESSURE IN PATIENTS WITH ATRIAL FIBRILLATION
Authors: Ntousopoulos Vasileios , Menti Ariadni , Tsiachris Dimitrios , Stergiou George , Kollias Anastasios
Published: May 2024

Objective:

To investigate the impact of the number of auscultatory or oscillometric blood pressure (BP) measurements taken in the office on the classification of BP in patients with atrial fibrillation (AF).

Design and method:

Patients with permanent AF were evaluated in a single office visit with consecutive alternating BP measurements using a mercury sphygmomanometer (5 measurements, 2 observers simultaneously) and an automated oscillometric upper-arm cuff BP monitor (4 measurements; Microlife BP B3 AFIB). BP was stratified according to the 2023 European Society of Hypertension (ESH) guidelines.

Results:

53 participants were analyzed (mean age [SD] 76±9.8 years, 62% men, 91% with treated hypertension). The mean±SD of systolic/diastolic BP with the auscultatory and oscillometric method were 118.2±20.4/69.2±10.4 and 122.3±19.2/73.1±11.7 mmHg respectively (p<0.05/0.05). Systolic office BP based on the increasing number of measurements is shown in the graph. The prevalence of individuals with optimal, normal, high-normal BP, grade 1, and grade 2 hypertension based on the auscultatory technique was: 51/17/8/17/8% (1 measurement), 59/8/15/11/8% (average of 2 measurements), 59/13/9/11/8% (3 measurements), 62/9/6/15/8% (4 measurements), and 59/13/8/15/6% (5 measurements) (p=NS for all comparisons with the single measurement). Correspondingly, with the oscillometric method: 40/21/11/19/9% (1 measurement), 43/17/15/17/8% (2 measurements), 49/15/15/13/8% (3 measurements), and 53/11/15/15/6% (4 measurements) (p=NS for all comparisons with the single measurement). The agreement in diagnosing individuals with BP >120/80 mmHg between the 1st and the average of 1st-3rd measurements was 92/91% (kappa=0.85/0.81) with the auscultatory and the oscillometric method respectively.

Conclusions:

These preliminary results indicate that the standard ESH recommendation to perform triplicate office BP measurements is also applicable in patients with AF.
NIGHT-TO-DAY BLOODE PRESSURE RATIO FROM 7 DAY/24H AMBULATORY BLOOD PRESSURE MONITORIN IN PATIENTS WITH CORONARY HEART DISEASE
Authors: Siegelova Jarmila , Havelkova Alena , Dusek Jiri , Pohanka Michal , Dunklerova Leona , Dobsak Petr , Cornelissen Germaine
Published: May 2024

Objective:

Impairment of night-to-day blood pressure (BP) ratio led to an increase in cardiovascular outcomes. The aim of the present study was to examine night-to-day BP ratio variability in two repeated 7 day/2h ambulatory BP monitoring (AMBP) in patients with coronary heart disease (CHD).

Design and method:

The 20 patients with CHD were under therapy with ACE inhibitors, beta blockers and statins. The AMBP was in every patient provided twice and AMBP lasted 7 days/ 24-h repeatedly. The 20 patients were divided in subgroup 1 and 2. Subgroup 1 was monitored before and after 3months of cardiovascular rehabilitation 3 times a week. Subgroup 2 was monitored before and after usual every day activity. We evaluated night-to-day BP ration in 24-h in BP profile and 7 day mean value before and after cardiac RHB in SBP and DBP in subgroup 1 and also subgroup 2.

Results:

The mean values of night-to-day in SBP ration evaluated from 7 day/24-h AMBP in subgroup 1 with cardiovascular rehabilitation in the 1st monitoring: was 12.0±1.85%, in 2nd AMBP 8.4±1.89% (not significant).

The mean values of night-to-day DBP ratio evaluated from 7 day/24-h AMBP in subgroup 1was in 1st monitoring: was 13.7±1.54%, in 2nd monitoring was 11.4±1.34% (not significant).

The mean value of night to day SBP ratio evaluated from 7 day/24 hour AMBP in subgroup 2 was 1st monitoring was 17.3±2.23%, in 2nd monitoring was: 18.8±1.16% (not significant). The mean values of night to day DBP ratio evaluated from 7 day /24 hour AMBP in subgroup 2 was in 1st monitoring was 19.6±2.66%; 2nd monitoring: 20.7±1.33% (not significant).

Conclusions:

In patients with CAD night-to-day BP ration from 7 day/24 h AMBP varied in one BP in 24-h profile and also in mean values from 7 day/24-h AMBP in both subgroups in values from1st and 2nd BP measurement. We have not found significant difference between the subgroup 1 before and after cardiac rehabilitation. We have not found significant difference in repeated measurement in subgroup 2 with usual activities between repeated measurements.
UNATTENDED VERSUS ATTENDED BLOOD PRESSURE MEASUREMENT: PREDICTIVE VALUE FOR NORMAL 24-HOURS BP VALUES
Authors: Aggiusti Carlo , Paini Anna , Bertacchini Fabio , Stassaldi Deborah , Capellini Sara , Buso Giacomo , Gatta Roberto , Muiesan Maria Lorenza , Salvetti Massimo
Published: May 2024

Objective:

Background: It has been suggested that measurement of “unattended” (UA) instead of “attended” (A) blood pressure (BP) values may provide advantages. Little is known on the relationship between UA, A and 24 hours BP.

Design and method:

Methods In 846 patients attending the outpatient clinic at an ESH Excellence Centre, BP values were measured by the physician with an automated oscillometric device (Omron HEM 9000Ai, mean of 3 measurements), after 5 minutes of rest. After the measurement of BP by the physician, the patient was left alone in the room, and the device was programmed to automatically perform 3 BP measurements after 5 minutes (UA). Ambulatory blood pressure monitoring (ABPM) was performed in all subjects within ± 3 days.

Results:

Mean age was 60±13 yrs, 48% females, BMI 26±4, 74% hypertensives (82% treated). Mean BP values were as follows: UA 126±14/76±10, A 133±16/78±10mmHg, 24 hours 125±11/76±9mmHg. UA and A SBP were similarly correlated to 24 hours SBP, daytime SBP, nighttime SBP (Steiger's Z Test p ns). Similar results were obtained for DBP.

At Receiver Operator Curves (ROC) analysis UA SBP, as compared to A SBP, was superior in predicting a normal 24 hours SBP (defined as 24 hours SBP < 130 mmHg) (AUC, 0.803; 95% CI, 0.775–0.830 versus AUC, 0.784; 95% CI, 0.754–0.811; p for the comparison<0.05). Similar results were observed for the predictive value of UA DBP for a normal 24 hours DBP (defined as 24 hours DBP< 80 mmHg) (AUC, 0.864; 95% CI, 0.839–0.886 versus AUC, 0.844; 95% CI, 0.817–0.867; p for the comparison<0.05).

Conclusions:

Our findings suggest that “unattended BP” measurement might be slightly, but significantly superior in predicting normal values of 24 hours systolic and diastolic BP.
TRACKING NOCTURNAL BLOOD PRESSURE DIPPING WITH THE AKTIIA CUFFLESS MONITOR
Authors: De Almeida Tiago Paggi , Perruchoud David , Alexandre Jérémy , Vermare Pascale , Sola Josep , Shah Jay , Marques Luisa , Pellaton Cyril
Published: May 2024

Objective:

Previous studies have highlighted the prognostic importance of night-time blood pressure (BP) dipping, associating non-dipping BP patterns with cardiovascular risk. Standard 24-h ambulatory BP monitors (ABPM) often show inconsistent reproducibility in nocturnal dipping. Cuffless BP monitors present a promising approach for continual measurement of night-time BP, yet their effectiveness is to be assessed. This study compares nocturnal BP dipping as recorded by a cuffless BP monitor with readings from a conventional 24-h ABPM.

Design and method:

63 subjects (NCT04548986, mean age 53.1±7.2 years, 21.2% female, arm circumference 29.0±2.5 cm) were enrolled in a 12-week cardiac rehabilitation program at RHNE – Réseau Hospitalier Neuchâtelois, Switzerland. Systolic BP (SBP) night-time dipping was assessed by comparing same-day daytime (9am–9pm) and night-time (11pm–7am) averages using both cuffless BP monitor (Aktiia SA, Switzerland) and ABPM (Dyasis 3, Novacor, France). Two sessions were analyzed: session 1 compared first day's ABPM and Aktiia data; session 2 compared final day's readings from both devices. Only sessions with >=20 daytime and >=7 night-time measurements for ABPM, and >=12 daytime and >=8 night-time measurements for Aktiia were considered for analysis. The performance of night dipping identification was evaluated as the area under the curve (AUC) of a Receiver Operating Characteristic (ROC) curve (reference: -10% ABPM night-dip), and as the concordance rate (CR, accuracy) of a Four-Quadrant Plot (FQP, ±6% exclusion zone around -10% ABPM night dips).

Results:

30 subjects fulfilled the data availability requirements per BP modality (26 in session 1, 12 in session 2). Figure 1A illustrates the ROC curve (AUC=0.72). The optimal operating point for Aktiia's night-time dip was found at -2.96% (red dot, 91% sensitivity, 63% specificity). Figure 1B shows the FQP comparing night-dips recorded by ABPM and Aktiia (78.9% CR, 83.3% precision).

Conclusions:

The Aktiia monitor effectively identifies nocturnal BP dipping with 78.9% accuracy, consistent with ABPM readings, despite some scaling differences. This indicates that the Aktiia monitor is sensitive to nocturnal BP dipping and holds potential for future use in continuous night-time monitoring. Further research is focused on improving nocturnal measurement accuracy.
ANALYSIS OF CIRCADIAN RHYTHM AND DETECTION RATE OF EARLY EVENING ELEVATED BLOOD PRESSURE IN HYPERTENSIVE PATIENTS
Authors: Ma Zhiyi , Zhang Yuqing , Xu Yang
Published: May 2024

Objective:

The aim of the study is to investigate the circadian rhythm and detection rate of early evening elevated blood pressure (EEE) in treated and untreated hypertensive patients by ambulatory blood pressure monitoring.

Design and method:

From February 1, 2020 to February 28, 2023, the total of 1413 hypertensivs underwent ambulatory blood pressure monitoring in 13 medical institutions through the National 13th Five Year Plan Major Cooperation Group for Chronic Disease Prevention and Control (Research on the Application of Lifestyle and Nutritional Intervention Techniques and Strategies for Obesity and Hypertension, No. 2016YFC1300100). Among them, 1026 had taken antihypertensive drugs and 387 had not taken antihypertensive drugs. EEE is defined as average systolic blood pressure is higher or equal to 135mmHg or average diastolic blood pressure is higher or equal to 85mmHg from 6PM to 10PM. The definitions of dipper, non-dipper, super-dipper, and reverse-dipper blood pressure refer to the 2020 China Ambulatory Blood Pressure Monitoring Guidelines.

Results:

1. The detection rate of EEE in treated hypertensive patients was 60.4% (620 patients), while the detection rate of EEE in untreated hypertensive patients was 70.5% (273 patients); 2. The detection rate of dipper type in treated hypertensive patients was 21.7% (223 patients), while the detection rate of dipper type in untreated hypertensive patients was 21.7% (84 patients); 3. The detection rate of non-dipper type in treated hypertensive patients was 51.4% (527 patients), while the detection rate of non-dipper type in untreated hypertensive patients was 53.5% (207 patients); 4. The detection rate of super-dipper type in treated hypertensive patients was 1.6% (16 patients), while the detection rate of super-dipper type in untreated hypertensive patients was 1.8% (7 patients); 5. The detection rate of reverse-dipper type in treated hypertensive patients was 25.3% (260 patients), while the detection rate of reverse-dipper type in untreated hypertensive patients was 23% (89 patients).

Conclusions:

The detection rate of EEE is significantly higher than that of traditional non-dipper, super-dipper, and reverse-dipper blood pressure; It is possible that EEE become a new target for antihypertensive treatment.
BLOOD PRESSURE VARIABILITY AND HISTORY OF CARDIOVASCULAR EVENTS IN MAY MEASUREMENT MONTH 2019 PARTICIPANTS
Authors: Kerr Gabriele , Beaney Thomas , Schlaich Markus , Schutte Aletta , Stergiou George , Poulter Neil
Published: May 2024

Objective:

Increased blood pressure variability (BPV) is associated with negative health outcomes, but its determinants, and how best to measure it, remain unclear. We aimed to explore differences in four commonly used measures of BPV by clinical factors in the May Measurement Month (MMM) 2019 global survey.

Design and method:

We performed an observational analysis of BP readings from MMM 2019 survey participants. Volunteer adult (18 years or older) participants were surveyed via convenience sampling from 92 countries in May 2019. Each participant had three seated BP readings. Four indices of diastolic and systolic BPV were calculated for participants with all three BP readings: the standard deviation (SD), coefficient of variation (CV), absolute difference between the second and first BP readings (AR), and the variation independent of the mean (VIM). Factors examined included use of antihypertensive medication, being obese (body mass index greater than 29 kg/m2), and having a diagnosis of diabetes, myocardial infarction, or stroke. For each BPV index and factor, a regression model was created with the index as the outcome. Each model was adjusted for mean BP (based on the average of the second and third BP readings), age, sex, an interaction between age and sex, and antihypertensive medication use. Age and mean BP were each included as natural cubic splines with five knots.

Results:

Data from for 1,133,008 (75.1%) participants were included. The mean age was 45.6 (SD 16.6) and 52.0% were female. Coefficient estimates were similar for SD, VIM, and CV (Figure 1). Lower systolic and diastolic BPV were seen in participants who reported use of antihypertensive medication, and in those with a previous history of stroke, diabetes, or MI. There were small but statistically significant differences by obesity status.

Conclusions:

Diabetes, a history of myocardial infarction or stroke and the use of antihypertensive medication were associated with lower within-visit BPV, independent of age or sex. This may reflect underlying physiological differences between groups or differences in BPV-lowering effects resulting from different lifestyle choices or medication usage of these participants.
WHITE-COAT EFFECT AND MASKED HYPERTENSION IN HIGH-NORMAL OFFICE BLOOD PRESSURE: RESULTS OF THE HUNGARIAN ABPM REGISTRY
Authors: Nemcsik János , Takács Johanna , Farsang Csaba , Simon Attila , Páll Dénes , Torzsa Péter , Dolgos Szilveszter , Koller Ákos , Járai Zoltán
Published: May 2024

Objective:

White-coat hypertension refers to the untreated condition in which BP is elevated in the office but is normal when measured by ambulatory blood pressure monitoring (ABPM), home blood pressure monitoring (HBPM) or both. However, white-coat effect can be present in high-normal blood pressure (BP) category as well. The aims of this study were to evaluate the presence of white-coat effect and masked hypertension in high-normal office BP (OBP) and also to explore the prevalence of untreated very high CV risk (CVD) patients with high-normal OBP.

Design and method:

Data of the Hungarian ABPM Registry were used in our analysis.

Results:

From 14 817 uploaded ABPM curves with clinical data 1 255 subjects were categorized as having high-normal OBP. 999 (79.6%) were on antihypertensive treatment. Based on the ABPM recordings apparent high-normal BP was found in 35.9% (n=450), white-coat effect was present in 28.5% (n=358) and masked hypertension was diagnosed in 35.6% (n=447). Similar results were found in treated and untreated subjects as well. Independent predictors of white-coat effect were age (OR: 1.014 (95%CI:1.006-1.023), p=0.001), male sex (OR: 0.565 (0.432-0.739), p<0.001), and obesity (OR: 1.994 (1.480-2.687), p<0.001). Independent predictors of masked hypertension were age (OR: 1.014 (95%CI:1.005-1.023), p=0.003), heart rate (OR: 1.028 (1.011-1.044), p=0.01) and obesity (OR:1.679 (1.262-2.234), p<0.001). 142 subjects had very high CV risk with high-normal OBP and only 7 of them were untreated. With ABPM only one of them had apparent high-normal BP.

Conclusions:

In high-normal OBP ABPM is a useful tool to diagnose white-coat effect and masked hypertension. Untreated high-normal OBP with very high CV risk is a very rare condition in the general practitioner practice when ABPM is also recommended to evaluate the true blood pressure phenotype before therapeutic decisions.
CUFFLESS BLOOD PRESSURE IN CLINICAL PRACTICE: CHALLENGES, OPPORTUNITIES AND CURRENT LIMITS
Authors: Henry Benoit , Merz Maxime , Hoang Harry , Ghaith Abdul Karim , Wosik Jedrek , Schoettker Patrick
Published: May 2024

Objective:

Cuffless blood pressure measurement technologies have attracted significant attention for their potential to transform cardiovascular monitoring. This updated narrative review thoroughly examines the challenges, opportunities, and limitations associated with the implementation of cuffless blood pressure monitoring systems. By summarizing the current state of the art and identifying future directions, this article aims to participate in the debate around cuffless BP measurement while contributing substantial scientific value to this rapidly evolving field.

Design and method:

The search procedure involved using Google Scholar and PubMed databases. During the initial search, a substantial number of articles unrelated to this literature survey were retrieved. Authors then selected the articles that were relevant for this review on cuffless noninvasive BP measurement.

Results:

Diverse technologies, including photoplethysmography, tonometry, and ECG waveform analysis, enable cuffless blood pressure measurement and are integrated into devices like smartphones and smartwatches. Signal processing emerges as a critical aspect, dictating the accuracy and reliability of readings. Despite its potential, the integration of cuffless technologies into clinical practice faces obstacles, including the need to address concerns related to accuracy, calibration, and standardization across diverse devices and patient populations. The development of robust algorithms to mitigate artifacts and environmental disturbances is essential for extracting clear physiological signals. Based on extensive research, this review emphasizes the necessity for standardized protocols, validation studies, and regulatory frameworks to ensure the reliability and safety of cuffless blood pressure monitoring devices and their implementation in mainstream medical practice. Interdisciplinary collaborations between engineers, clinicians, and regulatory bodies are crucial to address technical, clinical, and regulatory complexities during implementation.

Conclusions:

While cuffless blood pressure monitoring holds immense potential to transform cardiovascular care. The resolution of existing challenges and the establishment of rigorous standards are imperative for its seamless incorporation into routine clinical practice. The emergence of these new technologies shifts the paradigm of cardiovascular health management, presenting a new possibility for non-invasive continuous and dynamic monitoring. The concept of cuffless blood pressure measurement is viable and more finely tuned devices are expected to enter the market, which could redefine our understanding of blood pressure and hypertension.
ENHANCING NOCTURNAL BLOOD PRESSURE ASSESSMENT THROUGH HYDROSTATIC PRESSURE CORRECTION: A CLINICAL STUDY
Authors: Heinz Viktor , Pilz Niklas , Bothe Tomas Lucca , Patzak Andreas
Published: May 2024

Objective:

The evaluation of nocturnal blood pressure (BP) and corresponding dipping patterns is pivotal in understanding and managing arterial hypertension and cardiovascular health. However, poor reproducibility in determining dipping patterns is attributed to sleep-related positional changes and resultant variations in hydrostatic pressure. This study aimed to delve into the impact of hydrostatic pressure on nocturnal BP assessment and considering its clinical relevance.

Design and method:

52 subjects (26 aged 18-30 and 26 aged 50 or older) underwent nocturnal oscillometric BP measurements. The hydrostatic pressure difference between the heart and the BP cuff as well as the current body position was continuously monitored.

Results:

The study's results revealed a strong effect of correcting hydrostatic pressure differences between the cuff and the heart level on the nocturnal mean BP levels and dipping patterns. The mean nocturnal BP and the change in dipping pattern correlated strongly with the size of hydrostatic effects. Combining biometrical data with body position measurements allowed to partly estimate the direction and amplitude of hydrostatic effects on single measurements.

Conclusions:

This study underscores the influence of hydrostatic pressure variations on nocturnal BP assessment and dipping patterns. Our findings highlight the necessity of correcting for hydrostatic pressure differences between the heart level and the cuff, especially during the night while sleep-related positional changes might occur. Integrating biometric data and body position monitoring into nocturnal BP measurement protocols might pave the way for more accurate BP assessments and personalized hypertension management, catering to individual patient characteristics.
MEASUREMENT OF BLOOD PRESSURE OF VISITORS IN PRIMARY CARE UNITS BY MEDICAL STUDENTS: A QUALITATIVE ANALYSIS OF THEIR VIEWS ON THE ACTION
Authors: Triantafyllou Areti , Evangelidis Nikolaos , Kavvadas Dimitrios , Evangelidis Paschalis , Manti Sofia , Giormezi Anastasia , Gavana Magdalini , Ouzouni Styliani , Staikos Ioannis , Theodoropoulos Ilias , Vitoris Ioannis , Vlachopoulos Nikolaos , Haidich Anna-Bettina , Smyrnakis Emmanouil
Published: May 2024

Objective:

Arterial Hypertension is a major public health issue, and its proper measurement is a key clinical skill for medical students. In this context, during the lesson of Primary Health Care (PHC) of the School of Medicine of Aristotle University of Thessaloniki, 6th-year students performed blood pressure (BP) measurements in adults visitors of the PHC facilities during 1 week. The purpose of this study was to record the views and experiences of the students who participated in the above action.

Design and method:

44 medical students participated in the action. Measurements have been done on 289 persons. The students recorded their experiences in a short open report. Two independent researchers analysed the reports using Braun and Clarke's qualitative analysis method.

Results:

The qualitative analysis resulted in 5 themes: facilitators and obstacles to action, benefits for students, patients and health care system. The good organization, preparation, and support from the staff of the PHC settings contributed positively to the implementation of the action. Although in most cases, patients showed willingness, there were also cases of refusal to participate either due to time pressure, or fear of identifying their BP increased, and due to stereotypes-perceptions if measurements performed by the students could be correct. Significant obstacles were the lack of certified BP monitors in several structures. The analysis revealed benefits for students, among which were the acquisition of knowledge for the diagnosis of hypertension, the development of BP measurement skills, communication skills with patients and attitudes, and most importantly, the recognition of their role in PHC hypertension screening. The benefits for patients were significant, as they found people undiagnosed or unregulated but also, through the action, patients increased their knowledge about the measurement procedure and the risks of increased pressure. Finally, multiple benefits for the health care system itself were identified.

Conclusions:

This action highlights the importance of students’ active participation in prevention programs in PHC structures. Testing people for AH is a modern medical education tool with multiple benefits for both students and public health.
EVALUATION OF SELF-MONITORING OF BLOOD PRESSURE ACCORDING TO THE PERHIT STUDY AND THE IMPACT ON GLOMERULAR FUNCTION
Authors: Ekholm Mikael , Andersson Ulrika , Nilsson Peter M , Kjellgren Karin , Midlöv Patrik
Published: May 2024

Objective:

The relationship between hypertension and chronic kidney disease (CKD) is bidirectional. Although intensive blood pressure (BP) control has not been shown to slow the progression of CKD, intensive BP control has been shown to reduce the risk for adverse cardiovascular outcomes in the CKD population. The aim of this study was to help us understand the interplay between self-monitored BP and progress of kidney disease.

Design and method:

This study is a post-hoc analysis of data from our previous randomised controlled study, PERson-centredness in Hypertension management using Information Technology (PERHIT). We included 949 hypertensive participants who underwent visits at baseline, eight weeks and 12 months. Blood samples were taken at every visit. Half of the participants received a BP monitor and installed a mobile phone program. During eight weeks they daily measured and reported their BP values. Systolic BP (SBP) and diastolic BP (DBP) were used to calculate pulse pressure (PP) and mean arterial pressure (MAP) The association between estimated glomerular filtration rate (eGFR) and BP components were analysed in mixed linear regression models.

Results:

BP for the intervention and the control group were similar at baseline. Within the intervention group BP and SBP decreased from baseline to eight weeks and 12 months (P<0.001). Also, PP and MAP decreased from baseline to eight weeks (P=0.021 and P=0.004) and 12 months (P=0.035 and P=0.008). Within the control group, a decrease was observed from baseline to 12 months for SBP, DBP and PP (P=0.025, P=0.023 and P=0.036). In the intervention group we observed an association between a decrease in SBP, DBP, PP and MAP and a decline in eGFR (P<0.001, P<0.001, P=0.013 and P<0.001), (table). In the control group similar results was observed only for PP (P=0.027). eGFR decreased significantly (P<0.001) within the intervention group, but not within the control group (P=0.051).

Conclusions:

In this randomised study we observed an association between a decrease in all BP component and an eGFR decline. Improved BP reduction in the intervention group was associated with a greater reduction in eGFR within the normal range.
STUDY OF ARTERIAL PRESSURE LEVELS AT CONSULTATION IN TREATED HYPERTENSIVE ALGERIAN PATIENTS (PACT II STUDY)
Authors: Belhamidi Sofiane , Nibouche  , Amara  , Larbi  , Ziani
Published: May 2024

Objective:

The main objective was to describe the management of arterial hypertension in Algeria through the distribution of patients treated for HTN, according to predefined arterial pressure levels reached under treatment. Secondary objectives were: To estimate the mean of systolic blood pressure and diastolic blood pressure according to the 6 levels of AP, to evaluate the frequency of BP target reaching according to the s ESC 2018, both in all hypertensive patients treated, as well as in diabetic hypertensive patients treated and in hypertensive patients treated with renal failure.

Design and method:

The PACT II study is a national, observational, descriptive, cross-sectional, multicenter and noninterventional study of therapeutic strategy, conducted in Algeria on hypertensive patients treated for at least 3 months, followed by 100 specialists and general practitioners.

Results:

2000 eligible patients were recruited in the study. 63.5% and 36.4% of patients were female and male respectively. The average age was 62.4 years +/- 10.7. The most affected age group (65.2%) was between 55 to 75 years old. Most of the patients had an elevated blood pressure (BP) with 49.30% at level III AP (130 – 139 mmHg of SBP or 80 – 89 mmHg of DBP), with 49.6% for diabetic patients and 48.8% for nondiabetic patients, then followed by 20.35% at the level IV AP (140 – 159 mm Hg of SBP or 90 – 99 mm Hg of DBP) with 21.4% for diabetic and 18.3% for non-diabetic patients. Also, 47.32% were at AP level III in patients with renal failure. Regarding the achievement of the blood pressure target, it was 17.4% for the overall population with 18,3% for diabetic's patients and only 12.64% for renal failure patients.

Conclusions:

The PACT II study updated national data on hypertension in Algeria, highlighting important information's on the reality of the management of this disease in routine medical practice.
AN EXPLANATION FOR UNDERESTIMATION OF SYSTOLIC PRESSURE IN CUFF-BASED MEASUREMENT
Authors: Bassil Kate , Agarwal Anurag , Celler Branko
Published: May 2024

Objective:

Auscultatory blood pressure measurement is the gold standard used to calibrate other measurement devices. However, auscultatory tests systematically underestimate systolic blood pressure (SBP) and overestimate diastolic blood pressure (DBP). While there is some literature explaining overestimation, there is no physical understanding of the underestimated SBP.

Our objective is to understand why auscultatory measurement results in the underestimation of SBP. The SBP is recorded when the artery first begins to reopen, during cuff deflation. Prior to this, the cuff cuts off the blood supply and the pressure in the distal part of the artery drops to the venous pressure. We propose this low pressure as a cause of underestimation and investigate this through a controlled variation of the downstream pressure in an experimental rig.

Design and method:

Figure 1 shows a schematic of the rig. The tube representing the artery is compressed under an inflatable cuff. The downstream pressure is varied between tests. The upstream pressure is fixed with a header tank for simplicity. Therefore, the ‘blood pressure’ measured in the rig is constant rather than oscillatory, resulting in only a single opening of the artery as the cuff is deflated, rather than repeated opening and closing. This single opening is equivalent to the first opening of the artery in the body and so represents the systolic measurement.

Figure 2 depicts an example test run. The cuff around the artery is gradually deflated, and the reopening of the artery is indicated by the rise of the downstream pressure (point a). The cuff pressure at this timestamp is recorded (point b), representing the measured SBP.

Results:

Figure 3 shows that the recorded cuff pressure is a function of downstream pressure, with the cuff reading giving greater underestimation of SBP when the downstream pressure is lowered.

Conclusions:

The delay in artery reopening which results from lowering the downstream pressure provides an explanation for the systematic underestimation of SBP. This information may lead to recommendations for new measurement protocol which avoid a drop in the pressure distal to the cuff, and the resulting underestimation of SBP.
THE ASSOCIATION BETWEEN LONG-TERM BLOOD PRESSURE MANAGEMENT AND THE DEVELOPMENT OF CHRONIC KIDNEY DISEASES IN PATIENTS WITH PRIMARY ALDOSTERONISM FOLLOWING TREATMENT
Authors: Abuduheilili Zulihumaer , Luo Qin , Wang Menghui , Li Nanfang
Published: May 2024

Objective:

The effect of optimal blood pressure control on the decline of renal function in patients with primary aldosteronism (PA) following treatment are still needed to confirm in large sample cohort studies. The present study aimed to investigate the association between long-term blood pressure management and the development of chronic kidney disease in patients with PA following treatment.

Design and method:

In this retrospective chort study, patients with confirmed PA,and aged >20 years who visited the hypertension center of People's hospital of Xinjiang Autonomous Region between 2011 to 2022 were enrolled and were followed up until June 2023. We analyzed the association between the mean blood pressure control and the development of CKD. The mean blood pressure control depended on the mean of three follow-up visits,in-office BPs after diagnosis of PA and treatment at least three months. Multifactorial analysis was performed using logistic regression, with demographic variables (age, sex, and body mass index,etc.), and clinical characteristics (including smoking, alcohol consumption,etc.) as adjusted. Restricted cubic spline regression was used to find the optimal blood pressure cut-off point. SPSS 27.0 and R4.3.1 were used for the above statistical analysis.

Results:

This study finally included 4406 PA patients with at least three follow-up blood pressure visits at intervals greater than three months, and after adjusting related confounders, the mean follow-up time was 5.08 years, the mean age was 49.5 years,mean systolic blood pressure was significantly associated with CKD (OR: 1.018 [1.008-1.029], P < 0.001). Compared with the group with SBP >=140 mmHg, 120 =< SBP <130 mmHg(OR: 0.561 [0.406-0.777],P<0.001), 130 =<SBP<140 mmHg(OR: 0.593 [0.445-0.791], P<0.001). The RCS showed that systolic blood pressure in the 119-133 mmHg range.

Conclusions:

Control of SBP at 120-130 mmHg in patients with PA is associated with better renal outcome. Compared with the group with SBP >=140 mmHg, the risk was reduced by 44% and 41% in the groups with 120 =<SBP<130 mmHg and 130 =<SBP<140 mmHg, respectively.
WHO IS MORE ACCURATE AT MEASURING BLOOD PRESSURE, A GP OR A SPECIALIST? IS OFFICE BLOOD PRESSURE CORRELATED WITH BETTER MANAGEMENT OF ARTERIAL HYPERTENSION?
Authors: Vachulova Anna , Simkova Adriana , Sidlo Rastislav
Published: May 2024

Objective:

The measurement of blood pressure (BP) is the key to diagnosing and managing arterial hypertension (AH). Despite this, there is still a lack of studies evaluating and comparing the accuracy of measurement of office BP (OBP) in the GP and specialist offices.

The aim was to evaluate the accuracy of OBP measurement in various types of offices.

Design and method:

This project was conducted from April to June 2023 at 103 general physicians’ offices (GPO) and 51 specialists’ offices (SPO) (cardiology, internal medicine) in Slovakia. We have enrolled all 18-year-old pts with AH who are willing to complete a short questionnaire and take office BP based on 2018 ESC/ESH.

Results:

3147 pts with AH were enrolled (1652 women, 48%), from GPOs, and 514 pts (215 women, 42%), from SPOs. The mean OBP was higher in SPO (134,9 ± 10,9/ 80,3 ± 7,2 mmHg), vs GPO (133,3±7,2/ 80,1 ± 6,2 mmHg). All 3 OBP measurements (M) were higher in SPO. The differences in OBP in SPO were in M1 vs Ø M23 8,01/4,75 mmHg. Even with the correct measurement technique, up to 28% of pts in SPO did not reach the target BP. Adjusting to the age and comorbidities even up to 63% of pts in SPO did not reach the target BP. At GPO, up to 26% of pts did not reach the target BP, even up to 62% of pts in GPO did not reach the target BP adjusting to the age.

Conclusions:

In our study, the office BP levels were higher in SPO compared to GPO. A single BP measurement assessed more pts as not reaching BP targets Our study revealed that therapy optimization needs to be rigorous, in both GP and SPO, and we would subsequently achieve an increased BP control rate in Slovakia to meet, not only the main goal of the initiative Charter 70/2023, 70% of patients with BP lower than 140/90 mm Hg), which was achieved by both GP (74%) and SPE (72%), but tight BP control adjusted to the age of patients.