bluuebunny/crossref_metadata_2025 huggingface dataset:
RADIAL ARTERY PHENOTYPING IN SYSTEMIC SCLEROSIS THROUGH ULTRA-HIGH FREQUENCY ULTRASOUND: A RADIOMIC APPROACH
Authors: Poli Federica , Boleto Goncalo , Khettab Hakim , Boutouyrie Pierre , Allanore Yannick , Bruno Rosa Maria
Published: June 2023

Objective:

Systemic sclerosis (SSc) is a disorder characterized by a massive vascular involvement. Imaging biomarkers of vascular involvement in SSc may have potential clinical implications for prediction of the pathogenesis of vascular complications. This study is aimed at identifying possible patterns of vascular wall disarray and remodeling in radial arteries of SSc patients, by means of ultrahigh frequency ultrasound (UHFUS).

Design and method:

5 end-diastolic frames of the right radial arteries of 41 patients with SSc and 41 healthy controls were obtained by VevoMD (70 MHz probe, FUJIFILM, VisualSonics, Toronto, Canada). 74 radiomic features and 4 engineered parameters were extracted: inner and outer layer thickness, and presence of adjunctive acoustic interfaces (triple signal). A feature selection algorithm was applied to reduce the number of features. The selected features were used to train classification model, using Linear Support Vector Machine (SVM).

Results:

The SVM classification model showed good performance (sensitivity = 0.63, specificity = 0.88, accuracy = 0.75, AUC = 0.75) to discriminate SSc patients from controls using fifteen selected features. Inner layer (208±61 vs 179±47 μm, p = 0.04) and outer layer thickness (104±22 vs 120±36 μm, p = 0.03) were significantly higher in SSc than in controls, triple signal pattern more frequent in patients (p = 0.002).

Conclusions:

Wall ultrastructure of radial arteries of SSc patients is altered: inner and outer layer thickened, showing frequently a triple signal pattern. Radiomic approach allow to distinguish between radial images from SSc patients and controls with a 75% accuracy.
IDENTIFYING HYPOKALEMIA RISK IN HYPERTENSIVE PEOPLE: USING MACHINE LEARNING IN THE UNITED STATES NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY 1999-2018
Authors: Lin Ziying , Cheng Yuen Ting , Cheung Bernard Man Yung
Published: June 2023

Objective:

Hypokalemia is a side-effect of diuretics. We aimed to use machine learning to identify features predicting hypokalemia risk in hypertensive patients.

Design and method:

Participants with hypertension in the United States National Health and Nutrition Examination Survey 1999-2018 were included for analysis. To choose the optimal algorithm, we tested five machine learning algorithms (Logistic Regression, k-Nearest Neighbor, Random Forest, Recursive Partitioning and Regression Trees, and eXtreme Gradient Boosting) with 38 screened features. We selected the most appropriate model according to the area under the receiver operating characteristic curve (AUROC). We then selected the key hypokalemia-associated features in the hypertension group and their cardiovascular diseases (CVD) subgroup using the SHapley Additive exPlanations (SHAP) values. Using SHAP values, the key features and their impact pattern on hypokalemia risk were determined.

Results:

21,096 hypertensive participants, of whom 3,540 had known CVD, were included for analysis. The Random Forest algorithm had the highest AUROC (hypertension dataset: 0.73 [95%CI, 0.70-0.75], P<0.001; CVD subgroup: 0.76 [95%CI, 0.70-0.82], P<0.001) and sensitivity (hypertension dataset: 0.62; CVD subgroup: 0.72) based on 38 features screened. Moreover, the nomogram based on the top fifteen key features screened by random forest retained good performance (hypertension dataset: 0.73 [95%CI, 0.70-0.75], P<0.001; CVD subgroup: 0.74 [95%CI, 0.68-0.81], P<0.001): gender, race, age, poverty income ratio, smoking status, body mass index, systolic and diastolic blood pressure, non-potassium-sparing diuretics use and duration, duration of renin-angiotensin blockers, potassium-sparing diuretics use, polypharmacy, and comorbid arthritis and diabetes in hypertension dataset; while in CVD subgroup, renin-angiotensin blockers use replaced potassium-sparing diuretics use.

Conclusions:

Our predictive model shows good performance, and hypokalemia-associated key features have been identified in hypertensive patients and the subgroup with CVD. These findings from machine learning facilitate the development of artificial intelligence to highlight hypokalemia risk in hypertension patients.
THE RELATIONSHIP BETWEEN SERUM GALECTIN-3 LEVEL AND CAROTID FEMORAL PULSE WAVE VELOCITY IN PATIENTS WITH ACROMEGALY
Authors: Ozturk Huseyin Ali , Sumbul Hilmi Erdem
Published: June 2023

Objective:

To the best our knowledge, there are no studies showing the relationship between galectin-3 level and carotid femoral pulse wave velocity (CF-PWV) in acromegaly and more studies are needed. We aimed to investigate the relationship between galectin-3 level, which is thought to change due to early inflammation and atherosclerosis, and CF-PWV in patients with acromegaly.

Design and method:

In our study, forty patients between the ages of 18 and 65 who were diagnosed with acromegaly in Adana City Training and Research Hospital and 40 healthy controls were included. Insulin-like growth factor-1 (IGF-1), GH levels, hemogram and biochemistry values of the patients were evaluated. Galectin-3 level was measured using Human galectin-3 kits and Enzyme-Linked Immuno Sorbent Assay method. CF-PWV measurements of the patients were performed using doppler ultrasonography and simultaneous electrocardiography.

Results:

In our study; we found that galectin-3 level, which is an indicator of fibrosis and inflammation, and CF-PWV, which is the gold standard indicator of arterial stiffness, were higher in the acromegaly patient group than in the control group and were statistically significant. In correlation analysis, we found that serum galectin-3 level was associated with IGF-1 level and CF-PWV measurements. In the linear regression analysis, we found that the level of IGF-1 was independently associated with galectin-3 level.

Conclusions:

Galectin-3 may be a new diagnostic, prognostic biomarker and a new promising therapeutic target for cardiovascular disease development in patients with acromegaly. Galectin-3 level and CF-PWV measurement can be used to detect and predict cardiovascular disease in acromegaly patients at an early stage.
PULSE WAVE VELOCITY 8.2 M/S AS A THRESHOLD ASSOCIATED WITH CARDIOVASCULAR TARGET ORGAN DAMAGE
Authors: Inuzuka Sayuri , Vitorino Priscila , Camargo Adriana , Magalhaes Fabricio , Sousa Andrea , Alves Robson , Melo Victoria , Mesquita Gustavo , Valle Deborah , Silva Eduarda , Sousa Ana , Coca Antonio , Jardim Paulo Cesar , Sebba-Barroso Weimar
Published: June 2023

Objective:

Identify from which PWV value, there is a greater possibility of identifying association with the presence of left ventricular hypertrophy (LVH), increased intima-media thickness (IMT) and presence of carotid plaque in hypertensive patients.

Design and method:

This is a cross-sectional study of 119 patients. ROC curves were performed for each cardiovascular biomarker. The analyses were performed considering the significance level of 0.05.

Results:

ROC curves were performed for each cardiovascular biomarker and the PWV values of 8.1m/s for LVH, 8.2m/s for increased IMT and 8.7 for the presence of carotid plaque were found, respectively. The PWV value of 8.2m/s identified the best parameter to find the three TOD outcomes. PWV above 8.2ms was associated with increased IMT (p = 0.004), with the presence of carotid plaque (p = 0.003) and with LVH (p<0.001). PWV above 8.2 showed greater sensitivity for IMT (AUC = 0.678, sensitivity 62.2), LVH (AUC = 0.717, sensitivity 87.2) and presence of plaque (AUC = 0.649, sensitivity 74.51) in the ROC curve.

Conclusions:

The 8.2m/s value is more sensitive in identifying the existence of cardiovascular biomarkers prematurely.
NOVEL BIOMARKERS OF KIDNEY CELL PATHOLOGY, INFLAMMATION AND FIBROSIS IN CONTROLLED AND UNCONTROLLED HYPERTENSION
Authors: Brobak Karl Marius , Halvorsen Lene Vernås , Aass Hans Christian D. , Høieggen Aud , Liestøl Knut , Norvik Jon Viljar , Blom Kjersti B. , Birkeland Jon Arne Kro , Søraas Camilla Lund , Bergland Ola Undrum , Aune Arleen , Olsen Eirik , Rognstad Stine , Hjørnholm Ulla , Kjær Vibeke Norheim , Rostrup Morten , Larstorp Anne Cecilie K , Solbu Marit Dahl
Published: June 2023

Objective:

A significant reduction in kidney function is needed to detect a decrease in estimated glomerular filtration rate (eGFR), and only a minority of patients with hypertension (HT) have elevated urinary albumin excretion (UAE), leaving these biomarkers insensitive for early hypertensive organ damage. Low-grade inflammatory processes and fibrosis may have a key role in the pathogenesis of HT and HT-mediated kidney damage. Finding a panel of biomarkers related to HT and kidney damage at an early stage, that varies with modifiable risk factors, may aid targeted treatment. Several biomarkers of kidney cell pathology, markers of inflammation and fibrosis are of interest.

In this nationwide cross-sectional multicentre study, we aimed to assess the associations between biomarkers and hypertension in four groups of patients; (1) healthy controls, (2) controlled HT, (3) uncontrolled HT, (4) uncontrolled HT with presence of kidney damage based on UAE and eGFR. We hypothesized that: (1) plasma levels of biomarkers are different between the 4 groups, (2) plasma levels of biomarkers are associated with the different HT groups.

Design and method:

Hypertensive patients (n = 183) were > = 18 years old with eGFR >30 mL/min/1.73m2, prescribed > = 2 antihypertensive agents and on a stable treatment regimen for at least 4 weeks. Age and sex matched healthy controls had undergone kidney donation assessment (n = 39). Biomarkers were analyzed in duplicate by a custom made Luminex bead-based immunoassay. The ethics committee approved the studies. All patients signed written informed consent.

Results:

Plasma levels of IL-1RA, NGAL and uromodulin were significantly different between healthy controls (n = 39) and hypertensive patients (n = 183). Levels of IL-1RA and NGAL were significantly different between the three groups of hypertensive patients. In multivariable models on hypertensive subjects none of the biomarkers were associated with uncontrolled HT (n = 126). IL-18, vWF-A2, NGAL and uromodulin were associated with uncontrolled HT with presence of kidney damage (n = 65). None of the biomarkers were associated with any of the HT groups after adjustment for eGFR.

Conclusions:

Selected biomarkers may add information to identify hypertensive patients at risk for kidney damage, but further and longitudinal analysis are needed.
DECREASED SERUM LEVELS OF IRISIN PREDICTED HEART FAILURE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Berezin Alexander , Fushtey Ivan , Berezin Alexander
Published: June 2023

Objective:

Type 2 diabetes mellitus (T2DM) is a powerful risk factor for heart failure (HF) contributing to untoward clinical course of the condition. Although natriuretic peptides are validated biomarkers to rule out HF, the accuracy of them in prediction of HF in T2DM is not optimal. The aim of the study was to investigate whether serum irisin has additional discriminative capacity for HF in patients with T2DM.

Design and method:

We prospectively included 183 T2DM patients with aged 41 to 65 years (153 patients with any phenotypes of HF and 30 patients without HF) in the study. The following criteria such as age > 18 years, established T2DM regardless of HF, and the levels of HbAc1 less 6.9% were used as inclusion ones. All patients underwent general examination, echocardiography and Doppler. The plasma levels of NT-proBNP and irisin were measured using ELISA

Results:

The Receive Operation Characteristics curve analysis showed that the well-balanced cut-off point for serum concentration of irisin (HF vs non-HF) were 10.4 ng/mL (area under curve [AUC] = 0.96 (95% CI = 0.88 – 1.00), sensitivity = 81.0%, specificity = 88.0%; P = 0.0001). Cutoff point of NT-proBNP (HF vs non-HF) was 750 pmol/L (AUC = 0.96; 95% CI = 0.59 - 0.98; sensitivity = 72.7%, specificity 76.5%, p = 0.0001). Multivariate logistic model yielded that the serum levels of irisin < 10.4 ng/mL (OR = 1.30; P = 0.001) and NT-proBNP > 750 pmol/mL (OR = 1.17; P = 0.042), left atrial volume index (LAVI) > 34 mL/m2 (OR = 1.06; P = 0.042) remained to be strong predictors for HF, whereas LAVI did not. Add-on of irisin levels < 10.4 ng/mL to the predictive model constructed from NT-proBNP (> 750 pg/mL) significantly improved discriminatory potency of the whole model for HF.

Conclusions:

We found that decreased serum levels of irisin significantly predicted HF in T2DM patients. This finding may open a new approach for HF risk stratification in T2DM patients.
CONCENTRATION OF CYSTATIN C AND ITS RELATIONSHIP WITH DAILY BLOOD PRESSURE MONITORING INDICATORS IN PATIENTS WITH ESSENTIAL HYPERTENSION
Authors: Ivankova Anastasiia , Kuzminova Nataliia
Published: June 2023

Objective:

Cystatin C (CysC) acts as an early and most informative marker of renal dysfunction. It has been proven that the indicator is a more sensitive marker of a decrease in glomerular filtration rate than creatinine.

Aim. To evaluate changes of cystatin C concentration and its relationship with daily blood pressure monitoring indicators in patients with hypertension.

Materials and methods. The study included 156 patients with stage II essential hypertension (EH) and 30 people without any cardiovascular pathology. All patients underwent an examination, which included: 1) general clinical examination; 2) ECG; 3) daily blood pressure monitoring (DM BP); 4) level of CysC.

The results. To form analysis groups based on the level of cystatin C, 3 categories of patients were conventionally selected: 1st - with a conditionally low (CL) level, 2nd - with an intermediate level, and 3rd - conditionally high (CH) level of CysC in the examined sample of patients with EH.

Having evaluated DM BP indicators depending on the level of CysC, it can be asserted that the average values of systolic and pulse BP at night were significantly higher in patients with a CH level of CysC, which was significantly different from the corresponding values in patients with intermediate and CL levels of CysC (148 vs. 140 and vs. 139 mm Hg, p<0.03; 70 vs. 60 and against 59 mm Hg, respectively, p<0.02). The analysis of the circadian regulation showed fundamental differences only in the daily profile of the night-peaker. 22.5% of patients with a CH level of CysS had nocturnal hypertension, which was significantly different from patients with an intermediate level of the indicator, which was 7.9% (p = 0.03).

Conclusions. A relatively high level of cystatin C (more than 1.37 mg/l) was associated with higher BP values, higher frequency of night-peaker. An intermediate level of cystatin C (1.00-1.37 mg/l) was associated with a higher frequency of registration of a non-dipper daily profile on BP. A relatively low level (less than 1.00 mg/ml) was associated with a higher frequency of registration of the daily profile dipper.
PHYSICAL AND BIOCHEMICAL RISK FACTORS OF HYPERTENSION: FINDINGS FROM MULTI-SITED POPULATION-BASED STUDY FROM INDIA
Authors: Devi Naorem Kiranmala
Published: June 2023

Objective:

Studies have shown variations in the degree of association between hypertension and its risk factors in different populations. Both genetic and environmental factors are thought to play roles in modulating the relationship between hypertension and its physical and biochemical risk factors/markers. The present study aims to investigate the association of hypertension with body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density density lipoprotein (VLDL), and apolipoprotein B (Apo B) in three tribal (Liangmai, Mizo, and Bhil) and two non-tribal (Jat and Meitei) populations of India.

Design and method:

The present study is an outcome of four cross-sectional studies undertaken among three tribal, Liangmai (n = 339), Mizo (n = 269) and Bhil (n = 407), and two non-tribal, Jat (n = 1447) and Meitei (n = 1142), populations of India (total sample size = 3604). Recruited participants were adults (age range 18-86 years; mean age = 47.3±11.0 years) of both sexes (55.5% females). Socio-demographic data was collected using a pretested and modified interview schedule. Height, weight, waist and hip circumference, and hypertension were measured using standard techniques. Hypertension was defined as per ACC/AHA High Blood Pressure Guidelines. Values of TC, TG, and HDL levels were obtained using commercial kits (Randox, USA) through spectrophotometry. Values of LDL, VLDL, and Apo B were calculated. Statistical analysis was performed using SPSS version 22.

Results:

The overall prevalence of hypertension stage-1 and stage-2 was found to be 37.9% and 34.0%, respectively. The highest prevalence of hypertension (stage-1+sage-2) was found in Meitei community and the lowest in the Bhil community. Studied physical and biochemical risk factors showed variations in the degree of association with hypertension in different populations. Of the studied risk factors, BMI and WC showed most consistent and statistically significant positive association with systolic and diastolic blood pressure. Though hypertension was found to be associated with some of the lipid variables in some populations, the pattern was not consistent across populations.

Conclusions:

The study suggests that physical variables (BMI and WC) may be better markers of hypertension than biochemical variables.
IMPACT OF OSCILLOMETRIC MEASUREMENT ARTEFACTS IN AMBULATORY BLOOD PRESSURE MONITORING ON ESTIMATES OF AVERAGE BLOOD PRESSURE AND OF ITS VARIABILITY: A PILOT STUDY
Authors: Bothe Tomas L. , Bilo Grzegorz , Parati Gianfranco , Haberl Ralph , Pilz Niklas , Patzak Andreas
Published: June 2023

Objective:

Ambulatory blood pressure monitoring (ABPM) plays an important role in the diagnosis of hypertension. However, methodological factors and the measurement conditions affect the results and may lead to incorrect classification of the patient. We performed a pilot study to evaluate the impact of oscillometric measurement artefacts on ABPM-derived variables.

Methods:

Four classes of artefacts have been detected: motor activity artefacts, cuff errors, cardiovascular arousals, and arrhythmias. These artefacts were identified via simultaneous recording of actigraphy, cuff pressure, and an ECG. The data consisted of uncorrected measurements (all data), corrected measurements (all artefact free data), and artefact affected data.

Design and method:

A total of 30 individuals (9 female / 21 male, aged between 36 and 86 years, mean: 65.5 (SD: 9.5) were included in the study. The 24h average blood pressure (BP) was higher in artefacts-affected measurements compared the artefact-free measurements both for systolic (4.6 mmHg) and diastolic (1.3 mmHg) measurements. Further, artefact-affected systolic BP (SBP) was 6.4 mmHg higher than artefact-free measurements during daytime. On average, nocturnal measurements showed no artefact-depended differences. However, individual comparisons yielded that 23% of the subjects crossed the threshold for BP classification for either 24-h, daytime or nocturnal hypertension when comparing uncorrected and artefact-free measurements. Dipping classification changed in 24% of subjects. BP variability was 21% and 12% higher for SPB and DBP, respectively, during daytime when comparing uncorrected and artefact-free measurements. These differences were even higher (27% for SBP and 21% for DPB) when focussing on night-time BP variability.

Conclusions:

The study reveals that measurement artefacts are frequently present during cuff-based ABPM and do relevantly affect measurement outcome. Exclusion of measurement artefacts is a promising approach to improving cuff-based ABPM accuracy.
VISUAL ASSESSMENT OF KOROTKOFF SOUNDS FURTHER IMPROVES THE ACCURACY OF A VALIDATED PROFESSIONAL AUTOMATED AUSCULTATORY BLOOD PRESSURE MONITOR – INBODY BPBIO480KV
Authors: Ntineri Angeliki , Menti Ariadni , Theodosiadi Aikaterini , Ntousopoulos Vasileios , Stathopoulou Panagiota , Kyriakoulis Konstantinos , Kollias Anastasios , Stergiou George S.
Published: June 2023

Objective:

A novel automated auscultatory upper-arm cuff blood pressure (BP) monitor for office use (InBody BPBIO480KV, Seoul, S Korea) has been recently validated, which allows healthcare professionals to visually review the Korotkoff sounds curves generated for each BP reading. This study investigated whether this feature could further improve the accuracy of the device by identifying unreliable BP readings.

Design and method:

Three observers assessed independently the morphology of Korotkoff sound curves generated during a validation study according to the ISO 81060-2:2018 standard, and classified them as having good, fair, or poor signal quality (low signal amplitude or sound intensity, aberrant signal morphology, interference of background noise or other signal artifact, presence of auscultatory gap, or irregular rhythm), separately for the systolic and diastolic BP area. The observers were blinded to the automated and the reference BP measurement results. Disagreement among observers was resolved by a supervisor. Factors associated with poor quality signal were also investigated.

Results:

A total of 255 Korotkoff sound curves (test BP readings) by 85 participants (mean age 57.3±15.0 years, 53 men) were analyzed. For systolic BP, 82.0/12.2/7.5% were classified as good/fair/poor quality and for diastolic 76.9/12.2/11.0%. Inter-observer agreement in detecting poor quality curves was 84.7/83.1% (systolic/diastolic). Of poor quality curves 10.5/60.7% (systolic/diastolic) clustered in the same individuals. Young age and female sex increased the odds for poor quality signal. ISO validation Criterion 1 (mean BP difference ±SD) was satisfied for readings with good (0.1±4.9/0.3±3.8 mmHg, systolic/diastolic) and fair (-0.4±6.4/0.2±5.0) quality curves, good/fair quality curves (0.1±5.1/0.2±4.0 mmHg, systolic/diastolic), but not for those with poor quality signal (2.7±8.8/3.6±8.1 mmHg). In the ISO validation study, excluding readings with poor quality signal (systolic and/or diastolic area; 40 of 255) Criterion 1 was improved (0.2±4.9/0.2±3.9 mmHg versus 0.3±5.5/0.6±4.7 mmHg).

Conclusions:

The visual assessment of Korotkoff sounds generated by automated auscultatory BP measurement using the InBody BPBIO480KV professional office BP monitor is useful in identifying unreliable readings and further improves the device accuracy.
POOR AGREEMENT BETWEEN CAROTID-FEMORAL PULSE WAVE VELOCITY (C-F PWV) AND 24 HOUR PWV DETERMINED WITH TWO DIFFERENT METHODS
Authors: Prelevic Vladimir , Jelakovic Ana , Radunovic Danilo , Gallineo Lana , Domislavic Marija , Gasparovic Kristina , Josipovic Josipa , Jelakovic Bojan
Published: June 2023

Objective:

The gold standard of arterial stiffness determination is measurement of the carotide-femoral pulse wave velocity (cf-PWV). It was suggested that 24 hour measurement might give addition or more insights in the estimation of the global cardiovascular (CV) risk

Our aim was to analyze association/concordance between cf-PWV values (SphygmoCor) with the values obtained with 24h measurments (Mobil-o-Graph and Arteriograph).

Design and method:

This study included 154 patients with the primary hypertension (women 69.5%, mean age 38.5). In all of them we collected various clinical and laboratory data and antroplogical paramaters. Parameters of arterial stiffness were measured with the SphygmoCor and 24h using Mobil-o-Graph and Arteriograph devices during the regular working day. Concordance correlation coefficient (CCC) was calculated. the Bland Altman method was used to estimate the deviation of methods Limits of agreement (LoA) are defined as the mean difference ± 1.96 SD difference.

Results:

Statistically significant correlation was observed between cf-PWV and data obtained with Arteriograph: 24h, day, night; and Mobilograph: 24h, day and night (r = 0.500, p < 0.001; r = 0.485, p < 0.001; r = 0.519, p < 0.001); r = 0.697, p < 0.001, r = 0.691, p < 0.001) r = 0.665, p < 0.001, respectively). cf-PWV shared 25% and 49% of the variance (R2) with the Arteriograph and Mobilograph, respectively. CCC was weak for both methods, Arteriograph and Mobilograph (CCC 0.49 95%CI 0.36-0.60; 0.50 95% CI 0.41-0.58, respectively). Large difference was observed for both methods, being larher for Arteriograph than with Mobilograph (-0.31 m/s (LoA -4.8 to 4.8) ; 1.6 m/s (LoA -1.69 to 4.89, respectively).

Conclusions:

In the group of young treated hypertensive patients with mild CV risk we found week agreement between cf-PWV and 24h PWV data. Better concordance was found between cf-PWV and Mobilograph than with Arteriograph. It could be concluded that cf-PWV and 24h PWV could not be used intercheangable. More results are needed to answer whether 24 h PWV has the same clinical value as cf-PWV
DAYTIME BLOOD PRESSURE MEASUREMENTS PERFORMED BY AKTIIA CUFFLESS MONITOR AND 24-H AMBULATORY BLOOD PRESSURE MONITOR: PRELIMINARY COMPARATIVE RESULTS OF A SINGLE-CENTRE STUDY
Authors: Almeida Tiago Paggi de , Cortés Meritxell , Perruchoud David , Alexandre Jérémy , Vermare Pascale , Sola Josep , Shah Jay , Marques Luisa , Pellaton Cyril
Published: June 2023

Objective:

Ambulatory blood pressure (BP) monitors (ABPM) measure systolic and diastolic BP (SBP, DBP), limited to 24-48-hour snapshots, using uncomfortable cuff-based oscillometric sphygmomanometers. Some cuffless BP devices overcome these limitations, supporting continual BP monitoring. However, there is intense debate whether cuffless devices generate data comparable to ABPM. Here, we present preliminary results of daytime BP measurements performed by Aktiia cuffless BP monitor (Aktiia SA, Switzerland) compared to 24-hour ABPM.

Design and method:

52 out of 63 estimated total patients (NCT04548986, age 53.2±7.1 years, 18.9% female, arm circumference 28.5±2 cm) had been enrolled in a 12-week cardiac rehabilitation (CR) program (Réseau Hospitalier Neuchâtelois, Switzerland). The patients used the Aktiia monitor during the entire CR program, while 24-hour ABPM (Dyasis 3, Novacor, France) was performed on the first and last day of the CR program. For each patient, average daytime (9am-9pm) SBP and DBP were calculated – and compared – for 1 day of ABPM and 7 days of Aktiia monitor (session 1: ABPM first day vs. Aktiia first week; session 2: ABPM last day vs. Aktiia last week). Only sessions that had 20 or more valid daytime measurements on both modalities were included in the study.

Results:

50 patients (35 in session 1, 15 in session 2) had 20 or more valid daytime measurements on both modalities, and were included in the study. Bias between Aktiia monitor and ABPM for daytime DBP was (mean ± SD [95% CI]) -2.2±8.0 [-4.5, 0.1] mmHg (Figure 1A), with agreements of 78% and 96% within ±10 mmHg (dark grey) and ±15 mmHg (light grey) regions of interest (ROI), respectively. Bias between Aktiia monitor and ABPM for daytime SBP was 1.6±10.5 [-1.5, 4.6] mmHg (Figure 1B), with agreements of 60% and 84% within the ±10/±15 mmHg ROI, respectively.

Conclusions:

The results suggest that 1-week Aktiia monitor yields equivalent daytime BP values to 24-h ABPM, which supports the use of Aktiia monitor for long-term, continual daytime BP monitoring. The present preliminary study is limited by the partially recruited population and daytime measurements only. Night-time analysis will be covered in subsequent studies.
TIME OF DAY, WEEKDAY, AND SEASON ARE ASSOCIATED WITH BLOOD PRESSURE MEASURED IN THE EMERGENCY DEPARTMENT
Authors: Oras Pontus , Olbers Joakim , Svensson Per
Published: June 2023

Objective:

Elevated blood pressure is often observed in the emergency department. Although it sometimes is explained by factors such as pain, anxiety, or white coat syndrome, it is nevertheless associated with incident atherosclerotic CVD and should not be disregarded. However, the impact of other factors on blood pressure in this setting is largely unknown. Therefore, we aimed to investigate whether season, weekday, or time of day is associated with patients’ systolic blood pressure in the emergency department.

Design and method:

In this electronic health record study, we selected all visits by adult patients with at least one measured blood pressure from a university hospital emergency department between 2010 to 2016. Systolic and diastolic blood pressure, age, sex, time of day, weekday, and month of the visit were derived from the hospital's electronic health records. Linear regression was used to estimate the relationship between time factors and blood pressure. Sex, age with restricted cubic splines, inclusion year, and emergency desk were included as covariates in the analysis.

Results:

A total of 604,091 ED-visits were included in the study. The systolic blood pressure was higher in visits during winter; 2.3 mm Hg (95% CI: 2.1-2.4), spring; 1.6 mmHg (95% CI: 1.4–1.7) and autumn; 1.7 mmHg (95% CI 1.5–1.9) compared to visits in the summer. When accounting for confounders, the systolic blood pressure was higher in visits during evening; 2.8 mm Hg (95% CI: 2.7–3.0) and night; 2.2 mmHg (95% CI: 2.0–2.5) compared to visits in the morning. Minor differences were observed in the afternoon (+0.3 mm Hg, 95% CI 0.1-0.4) and on the weekend (+0.3 mmHg, 95% CI 0.2–0.5).

Conclusions:

The time and season of the visit are associated with blood pressure measured in the emergency department. The systolic blood pressure on a winter evening was 5 mm Hg higher on average compared to a summertime morning visit. Our findings suggest that these factors should be considered while assessing the patient's future risk associated with a high blood pressure reading in the emergency department.
COMPARISON OF BLOOD PRESSURE MEASUREMENTS ON THE BARE ARM AND THE SLEEVED ARM - WHAT DOES IT COVER?
Authors: Leiba Adi , Ishay Rotem Tal-Ben , Rapoport Vladimir , Katzir Zeev
Published: June 2023

Objective:

The question of blood pressure measuring on the bare arm was debated for many years. The updated guidelines recommend measuring on the bare arm, although former studies found no significant differences between measurements taken over a rolled-down or up sleeve compared to the bare arm. We aim to compare blood pressure measurements on the same patients over a bare and a sleeved arm.

Design and method:

We collected blood pressure measurements of 100 patients visiting the nephrology clinic between January 2019 and December 2022. Measurements were performed with and without sleeves on each arm for each patient (total of 400 arms) and taken simultaneously on both arms (exchanging the bare and the sleeved arm in the second measurement). Since most variables were not normally distributed, we proceeded to a non-parametric Wilcoxon test to compare each patient's measurements on each arm.

Results:

No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of systolic blood pressure measured on the left arm (p = 0.041).

Although the actual values demonstrated no statistically significant difference, the absolute values of the differences demonstrated clinically significant higher median values on the sleeved arms, both in systolic blood pressure (7 mmHg on the right arm and 8 mmHg on the left arm) and diastolic blood pressure (5.5 mmHg for both arms).

As demonstrated by the wide interquartile ranges in table 1 and seen in figure 1 for all variables, the values of all variables had high variance.

Conclusions:

We found no statistically significant difference in blood pressure measurements between sleeved and bare arms. However, measurement of blood pressure over sleeved arms provided unpredictable results, with up to 40-50 mmHg differences in some individuals. As clinicians, we believe that in order to standardize blood pressure measurements we should measure blood pressure on the bare arms.
FEASIBILITY AND MEASUREMENT STABILITY OF SMARTWATCH-BASED CUFFLESS BLOOD PRESSURE MONITORING
Authors: Lee Hae-Young , Cho Myeong-Chan
Published: June 2023

Objective:

Cuffless wearable devices are currently being developed for long-term monitoring of blood pressure (BP) in patients with hypertension and in apparently healthy people. This study evaluated the feasibility and measurement stability of smartwatch-based cuffless BP monitoring in real-world conditions.

Design and method:

Users of the first smartwatch-based cuffless BP monitor approved in Korea (Samsung Galaxy Watch) were invited to upload their data from using the device for 4 weeks post calibration.

Results:

A total of 760 participants (mean age 43.7±11.9, 80.3% men) provided 35,797 BP readings (average monitoring 22±4 days [SD]; average readings 47±42 per participant [median 36]). Each participant obtained 1.5±1.3 readings/day and 19.7% of the participants obtained measurements every day. BP showed considerable variability, mainly depending on the day and time of the measurement. There was a trend towards higher BP levels on Mondays than on other days of the week and on workdays than in weekends. BP readings taken between 00:00 and 04:00 tended to be the lowest, whereas those between 12:00 and 16:00 the highest. The average pre-post calibration error for systolic BP (difference in 7-day BP before and after calibration), was 6.8±5.6 mmHg, and was increased with higher systolic BP levels before calibration.

Conclusions:

Smartwatch-based cuffless BP monitoring is feasible for out-of-office monitoring in the real-world setting. The stability of BP measurement post calibration and the standardization and optimal time interval for recalibration need further investigation.
COMPARISONS OF THE PREDICTIVE VALUE OF MORNING AND EVENING BLOOD PRESSURE FOR NOCTURNAL HYPERTENSION AND MORNING BLOOD PRESSURE SURGE
Authors: Lee Chun-Wei , Chang Wei-Lun , Lee Yu-Hsuan , Chuang Shao-Yuan , Chiang Chern-En , Chen Chen-Huan , Cheng Hao-Min
Published: June 2023

Objective:

Evidences showed that morning blood pressure (BP) surge (MS) and nocturnal hypertension (NH) may increase the risk of cardiovascular events. The purpose of this study is to determine whether morning and evening hypertension can be used to predict NH and MS in hypertensive patients.

Design and method:

Participants with BP over 140/90 mmHg from 11 medical centers in Taiwan were included in the cohort. Every participant had ambulatory BP monitoring (ABPM) and home blood pressure values that were taken twice daily (morning and evening). According to the ABPM data, MS and NH were characterized as overnight BP 120 and/or 70 mmHg and sleep-trough morning (6AM-8AM) BP rise larger than 43.67 mmHg, respectively. The cut point of both morning home BP hypertension (MHBP) and evening home BP hypertension (EHBP) were 135/85 mmHg. We used MHBP and EHBP separately and together in logistic regression models to analyze the predictive value for NH and MS, adjusting for potential confounders, such as age, sex, alcohol usage, and smoking.

Results:

A total of 1621 individuals were included, with a median age of 58.9 years. MHBP and EHBP were present in 17.93% and 15.8% respectively. NH was present in 76.25% (n = 1361) and MS was present in 9.69% (n = 173) of the cohort. The accuracy of MHBP to predict NH, MS and NH or MS were 0.843, 0.889 and 0.865 respectively. The accuracy of EHBP to predict NH, MS and NH or MS were 0.837, 0.887 and 0.862 respectively. After adjusting for potential confounders, both MHBP and EHBP can significantly predict NH, MS and the combination of both. EHBP outperformed MHBP of predicting NH (OR 5.57 vs 1.65). The relationship between EHBP and NH or MS was also stronger for EHBP than for MHBP (OR 10.44 vs 2.37). Nevertheless, MHBP had a marginally higher predictive value for MS than EHBP (OR 2.40 vs 1.88).

Conclusions:

EHBP showed more predictive of NH and MHBP has a better predictive value of MS in hypertensive subjects. Both MHBP and EHBP are useful for detecting NH or MS and should not be overlooked for overall BP control.
PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION IN TREATED HYPERTENSIVE PATIENTS
Authors: Hamdani Achref , Ajra Zaineb , Bayar Mohamed Fehmi , Gheni Refaat , Rashikou Lamia , Hmida Riadh Ben , Ounissi Taha , Elhadj Zied Ibn
Published: June 2023

Objective:

There are limited data in Tunisia on the quality of treated blood pressure (BP) control, and in particular, masked uncontrolled hypertension (MUCH) in treated hypertensive patients defined as controlled office BP but uncontrolled out-of-clinic BP. The objective of the study is to define the prevalence of MUCH in treated hypertensive patients.

Design and method:

An analytical cross-sectional study including 84 treated hypertensive patients aged > 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). The BP measurement in the office was performed on the day of inclusion.

Patients were asked to measure BP at home as instructed by the physician using validated blood pressure self-measurement devices ( MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). These devices were loaned to the patient who had to return them on the day of the ABPM installation. Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical.

The comparisons of percentages were carried out by the Chi-square test.

Results:

The mean age of our population was 59.37±13.10 years (range 21-92 years), composed of 43 women and 41 men. The prevalence of MUCH was 6% in HBPM and 8.3% in ABPM. The difference between these two methods was not statistically significant for the detection of masked uncontrolled hypertension (p = 0.320). The prevalence of MUCH was higher in women detected by HBPM (11.6% versus 0%; p = 0.055) and by ABPM (14% versus 2.4%; p = 0.110), the difference according to gender was not statistically significant. ABPM detected also masked uncontrolled nocturnal hypertension in 14.3% of cases.

Conclusions:

Office BP monitoring alone is thus inadequate to ascertain optimal BP control because of BP variation. HBPM and mainly ABPM which can detect elevated nocturnal BP were needed to confirm proper BP control especially in patients with high cardiovascular risk in whom the prevalence of MUCH is higher.
IMPACT OF OUTDOOR TEMPERATURE ON BLOOD PRESSURE PHENOTYPES: A LARGE MULTICENTER HOME BLOOD PRESSURE MONITORING STUDY
Authors: Duarte Barbosa Costa , Feitosa Audes Diogenes. M. , Sentalin Monizze V. R. , Mota-Gomes Marco Antonio , Barroso Weimar Sebba , Miranda Roberto Dischinger , Brandão Andrea Araújo , Farina Giovani , Filho José Lima , Albuquerque Jones , Nascimento Maria L. S. , Paula Isabel C.G. , Barros Beatriz , Freitas Maria C.V. , Silva Hernade P. , Sposito Andrei , Babkowski Miguel C. , Coca Antonio , Nadruz Wilson
Published: June 2023

Objective:

Blood pressure (BP) increases in colder seasons, but the impact of outdoor temperature on BP phenotypes derived from office BP (OBP) and home BP monitoring (HBPM) is not is not completely established due to the scarcity of data. This study evaluated the relationship of outdoor temperature with normotension (NT), white-coat hypertension (WCH), masked hypertension (MH) and sustained hypertension (SH) in a large multicenter Brazilian sample.

Design and method:

This cross-sectional study evaluated 57,606 individuals [39% men, mean age = 57.4±15.6 years, OBP = 131.4±19.8/83.9±11.8 mmHg, HBPM = 125.0±15.8/79.4±9.6 mmHg, 51% using antihypertensive medications (AH)] from 13 cities/metropolitan regions of the 5 Brazilian regions (North, Northeast, Central-West, Southeast and South) who underwent OBP and HBPM measurements from 2018 to 2022. Data on daily outdoor mean temperature (OMT), wind velocity and atmospheric pressure, and outdoor monthly humidity were collected from meteorological stations located in the studied cities. BP phenotypes were defined as: NT (OBP<140/90mmHg and HBPM<135/85mmHg), WCH (OBP > = 140/90mmHg and HBPM<135/85mmHg), MH (OBP<140/90mmHg and HBPM> = 135/85mmHg) and SH (OBP> = 140/90mmHg and HBPM> = 135/85mmHg). All regression analyses were adjusted for age, sex, BMI, calendar time, region, AH use and city altitude, wind velocity, atmospheric pressure and humidity.

Results:

Adjusted linear regression analysis showed a direct relationship of OMT with the difference in systolic OBP minus systolic HBPM (beta = 0.153±0.025; p<0.001) and the difference in diastolic OBP minus diastolic HBPM (beta = 0.066±0.015; p<0.001). Adjusted logistic regression analysis showed that each 1oC OMT increase was associated with a higher risk of WCH (OR [95%CI] = 1.011 [1.001–1.021]; p = 0.025) and NT (OR [95%CI] = 1.059 [1.051–1.066; p<0.001], and lower risk of MH (OR [95%CI] = 0.965 [0.950–0.975]; p<0.001) and SH (OR [95%CI] = 0.945 [0.937–0.952]; p<0.001).

Conclusions:

Higher OMT is associated with greater difference in OBP levels relative to HBPM levels and is related to greater risk of WCH and NT and lower risk of MH and SH. These findings suggest that outdoor temperature should be considered in the evaluation and management of hypertension and BP phenotypes.
COMPARISON OF BLOOD PRESSURE MEASUREMENT WITH A CUFFLESS TONOMETRIC WRIST-WORN DEVICE AND CONVENTIONAL BRACHIAL CUFF SPHYGMOMANOMETRY FOR AMBULATORY BLOOD PRESSURE MONITORING
Authors: Butlin Mark , Cox James , Tan Isabella , Avolio Alberto
Published: June 2023

Objective:

Ambulatory blood pressure monitoring (ABPM) is used for confirmation of diagnosis of hypertension. However, conventional cuff-based blood pressure (BP) measurement involves the obtrusive procedure of cuff inflation, making multiple measurements over extended periods uncomfortable. This study aims to compare BP measurement using the unobtrusive procedure of radial applanation tonometry with that of the conventional brachial cuff sphygmomanometer for ABPM.

Design and method:

ABPM (24 hour) was conducted in 16 participants (53±14 years, 4 female) using validated brachial cuff devices (Microlife WatchBPO3, n = 6; BPLab, n = 10) with BP measurements every 15 minutes during daytime and every 30 minutes during nighttime. BP measurements were obtained with a wrist-worn tonometric device (BPro, Healthstats) every 15 minutes, using an initial calibration obtained with the ABPM device.

Results:

Averaged over 24 hours, tonometric BP estimates correlated with brachial cuff systolic BP (SBP, r = 0.89, p<0.001) but not with diastolic BP (DBP, r = 0.48, p = 0.059) with mean differences (bias) of -4±14 mmHg (SBP) and 16±17 mmHg (DBP). Daytime and night-time correlations and mean difference were, day: SBP (r = 0.92, p<0.001), -1±13 mmHg; DBP (r = 0.44, p = 0.089), 18±21 mmHg; night: SBP (r = 0.66, p = 0.007), 6±22 mmHg; DBP (r = 0.64, p = 0.010); 15±13 mmHg. Over 24 hours, the total number of successful readings from the tonometric device was 52% less than that from the brachial cuff devices. The average correlation between SBP and DBP using only cuff readings was 0.29±0.40 (range -0.47 to 0.86). The average correlation between SBP and DBP for the tonometric device was 0.99±0.01 (range 0.97 to 1.00).

Conclusions:

The cuffless tonometric method employed in the BPro device enables unobtrusive monitoring of BP. In comparison to conventional cuff ABPM devices, the BPro device showed low mean differences for SBP but large differences in DBP in both day and night measurements with consistently low precision. The large differences for DBP may be due to the high correlation between tonometric DBP and SBP, suggesting that waveform features are used for SBP estimation only, from which DBP is directly calculated.
THE RELATIONSHIP BETWEEN LEFT VENTRICULAR HYPERTROPHY AND HYPERTENSION PHENOTYPES IN UNTREATED HYPERTENSIVE POPULATION
Authors: Antza Christina , Chovarda Eleni , Anagnostis Panagiotis , Kitsios Konstantinos , Trakatelli Christina , Stabouli Stella , Kotsis Vasilios
Published: June 2023

Objective:

The aim of this study was to investigate which hypertension phenotype can be better correlated with left ventricular hypertrophy in the untreated hypertensive population.

Design and method:

175 consecutive subjects (42% male) aged 57.9±14.9 years were included in the study. Subjects were never treated before for hypertension. All subjects underwent 24h-ABPM on a usual working day, while office BP was measured in the clinic using a mercury sphygmomanometer. Left ventricular hypertrophy was evaluated by a cardiologist with the use of a 3D echocardiography.

Results:

Regarding patients with left ventricular hypertrophy, 45% of the population were confirmed hypertensives and 36, 7% were masked hypertensives. Only 10% presented a white coat phenotype and 8.3% normal values of blood pressure. Of those presenting a non-dipping status, 55.3% found to have left ventricular hypertrophy, while of those presenting a dipping status, only 33.3% found to have left ventricular hypertrophy.

Conclusions:

These results indicate that the confirmed and masked hypertensive population as well as the non-dipping population present higher percentages of left ventricular hypertrophy. This population have to be monitored and followed up more often to prevent heart failure.
HOME BLOOD PRESSURE MONITORING IN SLOVAKIA IN 2022. WHO MANAGES THE PATIENTS WITH ARTERIAL HYPERTENSION THE BEST?
Authors: Vachulova Anna , Filipova Slavomira , Goncalvesova Eva , Simkova Adriana , Hatala Robert
Published: June 2023

Objective:

Home blood pressure monitoring (HBPM) is a reliable, convenient method for the diagnosis and management of arterial hypertension (AH). Moreover, HBPM can help improve the control of blood pressure in patients (pts).

Design and method:

To evaluate HBPM and office blood pressure (BP) measurements. To compare the efficacy of the AH treatment according to doctors‘ and patients‘ age and gender.

Results:

4375 pts with AH were enrolled (2089 women, 51,8%), mean age 61,1 ± 19,1 years. The mean office BP was higher in male pts 136,7 ± 10,9/ 81,9 ± 7,2 mmHg, vs in female pts 135±7,2/ 80,2 ± 6,2 mmHg. Mean HBPM was also higher in male pts 134,1± 7,2/ 81,1± 6,3 mmHg. In our program participated 129 female doctors (72%), mean age of 49,6 ± 10,1 years, and the mean age of male doctors was 44,9 ± 7,2 years. The reduction in BP for 7 days of HBPM was documented. A greater reduction of HBPM was achieved when the female doctor treated female patients 132,01/78 mmHg p = 0,0081, contrary to a smaller reduction of BP when the female doctor treated male pts 134,18/81,32 mmHg p = 0,026. The highest office BP was measured in male pts treated by male doctors 136,59/81,59 mmHg, beyond the lowest office BP was measured when the female doctor treated female pts 132,01/78,74 mmHg p = 0,0081. Male doctors treated more frequently with a higher number of AH drugs. The proportion of use of fixed-dose AH drugs combination was highest when the male doctor treated male pts (70,7%), and the lowest use of fixed-dose combination was when the female doctor treated female patients 52,1%.

Conclusions:

In our project with HBPM and office BP measurement in 2022 in Slovakia we found that the most precise BP control both in the office and in HBPM was reached when female patients were treated by female doctors. On the other hand, male doctors have preferred to use fixed-dose AH combinations. These data show that better involvement and engagement of doctors, and patients could lead to better implementation of guidelines and better BP control.