bluuebunny/crossref_metadata_2025 huggingface dataset:
PRESENT RECOMMENDED REGIMEN FOR HOME BLOOD PRESSURE MONITORING MAY NEED REVISION FOR ACCURATE MONITORING AND DIAGNOSIS OF HYPERTENSION
Authors: Carlsson Martin , Brudin Lars , Darwiche Gassan
Published: April 2021

Objective:

Recent NICE guidelines for management of hypertension stress the importance of home blood pressure management (HBPM) to confirm a diagnosis of hypertension. The objectives were to investigate the difference in two subsequent blood pressure (BP) measurements, evaluate diurnal variation using home blood pressure measurement and assess change in BP levels during a standard measurement period in home environment.

Design and method:

A total of 758 (male 372/female 386, mean age 57.9 ± 8.2 years) treated for primary hypertension were investigated. No intervention was given during the trial period. BP values were obtained by self-measurement at home using a Bluetooth-equipped oscillometric BP monitor connected to a smartphone application (Accumbo AB). For the first two weeks of the trial, participants were asked to measure HBPM on at least seven days in the morning (before breakfast) and at least seven days in the evening. Each measurement consisted of two BP measurements at 1-minute intervals.

Results:

The second/subsequent BP measurement showed lower values for both systolic BP (mean SBP 135 ± 12 mmHg vs. 134 ± 12 mmHg) and diastolic blood pressure (mean DBP 88 ± 9 mmHg vs. 87 ± 9 mmHg) compared with the first measurement (p < 0.001). Difference was more pronounced for SBP in males (-0.65 mmHg) than females (-0.52 mmHg), (p < 0.05). Diurnal BP variation was non-significant for SBP (p = 0.18) while DBP showed higher values in the morning (89 ± 9 mmHg) compared with evening values (86 ± 9 mmHg), (p < 0.001). The BP morning surge was more pronounced for males vs. females (p < 0.001). Mean BP was lower during the second week (134/87 ± 12/9 mmHg) compared with the first week (135/88 ± 12/9 mmHg, p < 0.001). This difference was driven by a reduction in BP significant for women (p < 0.001), but not for men (p = 0.37).

Conclusions:

The results indicate significant gender related differences in subsequent blood pressure values over time which might affect decision for treatment. The guidelines for home blood pressure monitoring may need to be revised to include more measurements over a longer period considering gender affiliation.
HYPERTENSION IN THE UNITED ARAB EMIRATES: A REGISTRY OF EMIRATI REPRESENTATIVE POPULATION
Authors: Shehab A. , Bhagavathula A.S.
Published: April 2021

Objective:

We aimed to present the characteristics of Emirati patients, newly diagnosed with hypertension and registered for treatment in the 52 ambulatory clinics across Abu Dhabi, United Arab Emirates.

Design and method:

A retrospective assessment of the clinical data of Emirati patients who are newly diagnosed with hypertension and initiated treatment in ambulatory settings, January to December, 2017. Data was collected including socio-demographic and clinical characteristics, blood pressure, cardiovascular risk factors, and comorbidities were collected.

Results:

A total of 5308 patients were identified. The mean age was 54.8 (95% confidence interval (CI): 54.5, 55.1 years), and more than half (53.7%) are women. Overall, 1375 subjects (25.9%) were overweight, and 2343 (44.1%) are obese. Around 35.5% are smokers, a quarter (26.6%) of hypertension patients had diabetes, and dyslipidemia (24.5%). The mean systolic blood pressure (SBP) was 133.9 ± 17.1 mmHg and diastolic blood pressure (DBP) 72.9 ± 12.7 mmHg and around 40% of the patients are on two or more antihypertensive medications

Conclusions:

Most of the hypertension patients are middle-aged females, obese (44.1%), smokers (44.1%), and using at least two antihypertensive medications.
AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENTS RECORDED WITH AND WITHOUT PRECEDING REST AND ITS ASSOCIATION WITH AWAKE AMBULATORY BLOOD PRESSURE
Authors: Andreadis Emmanuel , Geladari Charalampia , Angelopoulos Epameinondas
Published: April 2021

Objective:

Automated office blood pressure (AOBP) measurement, attended or unattended, eliminates the white-coat effect (WCE) showing a strong association with awake ambulatory blood pressure (ABP).

This study examined the difference in AOBP readings, with and without 5 min of rest prior to 3 readings recorded at 1-min intervals and their relation to awake ABP levels.

Design and method:

This was a method comparison study performed in 100 consecutive hypertensive patients referred for suspected hypertension. Inclusion criteria: a. individuals aged > / = 18 years who had never taken or who had not received antihypertensive medication for at least the previous 6 months, b. subjects on stable antihypertensive medication for at least 4 weeks. Hypertension was obtained by an average office reading of systolic BP (SBP) > / = 140 mmHg or diastolic BP (DBP) / = 90 mmHg on three consecutive visits, based on semi-automated oscillometric technique. Exclusion criteria: secondary hypertension, atrial fibrillation, gross proteinuria, renal failure with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 or heart failure (HF) with ejection fraction < 30%. Written informed consent was obtained from all patients and the study was approved by the scientific board of the hospital.

Results:

Cross-sectional data from 100 randomized selected hypertensives, 61 men and 39 women, with a mean age of 52.2+/-10.8 years, 82% treated, were analyzed. The mean systolic AOBP values without preceding rest was 127.0+/-18.2 mmHg and the mean systolic AOBP values with 5 minutes of preceding rest was 125.7+/-17.9 mmHg, (p = 0.05). A significant order effect was observed for the mean systolic BP values when AOBP without 5 min of preceding rest was performed as the first measurement (130.0+/-17.7 versus 126.5+/-16.2, p = 0.008). When we used a target systolic AOBP > / = 130 mmHg awake ABP yielded lower readings while at a target systolic AOBP value of < 130 mmHg higher awake ABP values were obtained.

Conclusions:

Our findings indicate that systolic AOBP can be initially checked without any preceding rest and if readings are normal can be accepted. Otherwise when AOBP is > / = 130 mmHg, measurements should be rechecked with 5 min of rest.
ALBUMINURIA IN PATIENTS WITH WHITE COAT EFFECT IS ASSOCIATED WITH OFFICE BLOOD PRESSURE
Authors: Andreadis Emmanuel , Geladari Charalampia , Angelopoulos Epameinondas
Published: April 2021

Objective:

The aim of this study is to investigate whether microalbuminuria observed in subjects with white coat effect (WCE) is a result of higher office blood pressure (BP).

Design and method:

We analyzed data in untreated and treated subjects assessed by office and ambulatory BP (ABP). Individuals aged > / = 18 years were included. Office BP measurements were taken using a digital oscillometric BP electronic device. ABP was monitored on a routine working day using validated oscillometric arm device. WCE was defined as OBP > / = 140/90 mmHg and 24 h mean ABP < 130/80 mmHg (daytime < 135/85 mmHg and nighttime < 120/70 mmHg). Urine albumin excretion (UAE) was measured in one 24-h urine collection.

Results:

A total of 151 subjects with WCE and 100 normotensives (mean age 58+/-12 years, 47.8% males) were analyzed. Their characteristics are shown in the Table.

Patients with WCE were significantly younger than normotensives (p = 0.035). Subjects with WCE had increased incidence of albuminuria compared to normotensives. Among patients with WCE 7.9% with albuminuria had both higher mean systolic OBP and systolic daytime ABP values compared to those without albuminuria (171+/-24mmHg vs 152+/-13mmHg, p = 0.019 and 127+/-6mmHg vs 123+/-8mmHg, p = 0.038, for the systolic OBP and systolic daytime ABP values, respectively). This association was not present in normotensive individuals.

Conclusions:

Microalbuminuria observed in subjects with WCE resulted from higher office and ambulatory BP values, underlining that the WCE phenotype is not innocent.
IMPACT OF USING INAPPROPRIATE CUFF SIZE IN BLOOD PRESSURE CLASSIFICATION: ANALYSIS FOR AUSCULTATORY AND OSCILLOMETRIC METHODS
Authors: Albuquerque Nila , Sheppard James , Araujo Thelma
Published: April 2021

Objective:

This study aims to identify how using an inappropriate cuff size in auscultatory and oscillometric methods changes blood pressure (BP) classification according American hypertension guidelines.

Design and method:

In this diagnostic accuracy study, 60 adult subjects were recruited. After ten-minutes of rest, six sequential BP measurements were performed. First measurement was considered the reference measurement as it was performed using a calibrated aneroid sphygmomanomether and a cuff size appropriate to participant's arm circumference. Second measurement was also performed with an appropriate cuff size, but using a HBP-1100 atuomatic monitor. The next four measurement were test measurements so they were taken using a standard adult cuff size (16 × 30 cm). Participants with upper arm circumference between 27 and 34 cm were excluded as the standard adult cuff size was the appropriate size for them. Third and fifth measurements were auscultatory and fourth and sixth were oscillometric measurements. Hypertension was considered present when BP readings were classified as stage 1 or 2. Stata/SE 15.0 was used to calculated performance measurements of diagnostic tests.

Results:

360 complete measurements were performed. Mean upper arm circumference was 30.01 (±6.74). According to ACC/AHA classification, the automatic monitor with an appropriate cuff size had a sensitivity of 0.9, a specificity of 0.82 and a diagnostic accuracy of 83%, compared to the aneroid with the same cuff size. When a smaller or larger cuff was used instead of an appropriate cuff, the automatic monitor had a sensitivity of 0.9, a specificity of 0.8 and a diagnostic accuracy of 81,66% and the aneroid had a sensitivity of 0.9, a specificity of 0.92 and a diagnostic accuracy of 91,66%.

Conclusions:

According to ACC/AHA hypertension guidelines, the automatic monitor was not as sensitive, specific and accurate as the aneroid to classify hypertension when BP is measured with an appropriate cuff size. In addition, when an inappropriate cuff size is used, the automatic monitor was also relatively less accurate than aneroid for classifying BP according to the ACC/AHA guidelines. Based on the findings, auscultatory measurements are most appropriate when only the standard adult cuff size is available.
EFFECT OF UNDERCUFFING ON AUSCULTATORY AND OSCILLOMETRIC BLOOD PRESSURE MEASUREMENT
Authors: Albuquerque Nila , Padwal Raj , Araujo Thelma
Published: April 2021

Objective:

The objective of the present investigation was to identify the effect of using a blood pressure (BP) cuff size smaller than that appropriate for patient's arm circumference (undercuffing) on auscultatory and oscillometric measurements.

Design and method:

It was a single-centre equivalence trial that recruited 47 adult subjects with upper arm circumferences between 35 and 44 cm. After ten minutes rest, six sequential BP measurements were performed 30 and, at most, 60 seconds apart while seated. First, third and fifth measurements were performed using blinded, simultaneous, two-observer auscultation using a calibrated anaeroid sphygmomanometer and requiring a between-observer agreement equal to or less than 4 mmHg. Second, fourth and sixth were performed with the Omron HBP-1100 oscillometric monitor. The first two measurements (one auscultatory and one oscillometric) were performed using a large adult cuff (16 x 36 cm), which represented appropriate cuffing for the study subjects. Third, fourth, fifth and sixth measurements were performed with a standard adult cuff size (16 × 30 cm). BP differences were calculated using device – observer measurement. A paired t-test was used to identify statistically significant differences between BP readings in each method.

Results:

282 complete measurements were available. Mean upper arm circumference size was 38.38 (±2.85) cm. Mean SBP and DBP when the appropriate cuff was used was 115.08 ± 18.32/70.25 ± 12.3 mmHg using the auscultatory method vs. 120.91 ± 17.15/72.57 ± 11.74 mmHg using the oscillometric method (p-value < 0.005). When smaller cuff size was used, mean SBP and DBP was 119.97 ± 15.88/76.78 ± 12.03 mmHg in the auscultatory method vs. 126.95 ± 16.17/74.56 ± 10.97 mmHg in the oscillometric method (p-value < 0.005). The mean device-observer disagreement for SBP (Fig 1) was 5.82 (±9.12) when appropriate cuff size was used and 6.98 (±8.06) with a smaller cuff size (p-value = 0.79). For DBP (Fig 2), the disagreement was 2.31 (±6.28) vs. -2.22 (±5.88) (p-value < 0.005).

Conclusions:

Using a smaller cuff size overestimates SBP and DBP, in both auscultatory and oscillometric methods and also results in a greater systolic disagreement between these two measurement methods.
CUFFLESS DEVICES CAN OPEN A NEW CHAPTER IN AMBULATORY BLOOD PRESSURE MONITORING ONLY IF VALIDATED RIGOROUSLY: DESIGN OF A CHALLENGING PROTOCOL FOR AKTIIA BRACELET
Authors: Vybornova Anna , Sola Josep , Fallet Sibylle , Olivero Elisa , De Marco Bastien , Grossenbacher Olivier , Ignatovic Natalia , Ignatovic Blagoje , Favre-Bulle Matthieu , Levinson Nora , Siutryk Nadège , Chapuis Valentin , Bertschi Mattia , Alpert Bruce
Published: April 2021

Objective:

Cuffless wrist-based blood pressure (BP) monitors have a great potential to make ambulatory monitoring more appealing to patients and provide clinicians with better BP profiling. Investigators must be vigilant to validate these devices properly, as little guidance has been published.

We propose a protocol that addresses ambulatory environment challenges, such as body posture changes and variable arm position. In addition to reporting the accuracy, we suggest reporting the number of successful automated measurements – the acceptance rate.

Design and method:

We tested the Aktiia Bracelet, a cuffless automated device that records optical signals at the wrist and requires an initial calibration, with the proposed protocol on 10 healthy volunteers. We simultaneously recorded the signals from the Aktiia Bracelet and a reference volume-clamp device positioned on the contralateral arm during the following interventions: sitting, lying supine, standing with both arms positioned at heart level; sitting with the Aktiia bracelet wrist positioned 30 cm lower than heart level; isometric leg extension inducing large BP changes. We calculated the mean and standard deviations of the error between Aktiia bracelet and the reference, as well as the acceptance rates in different measurement scenarios.

Results:

The figure illustrates the mean and standard deviation (STD) of the error between Aktiia bracelet and the reference, as well as the acceptance rate (Acc) for the diastolic BP (DBP). The dashed area illustrates the expected hydrostatic bias. The mean and the standard deviation of the error fell within ISO81060-2 limits. Aktiia bracelet readings were not affected by the hydrostatic bias intervention, even though one could expect an error of more than 20 mmHg.

The maximum of the accepted measurements was achieved when patients were lying supine (67%) and sitting (52%). Thus, the user can expect a high density of measurements during night-time. However, when standing, the acceptance dropped (27%).

Conclusions:

This protocol provides more realistic testing of cuffless wrist-based BP monitors and suggests a way to improve the validation of this new family of devices.
AMBULATORY CENTRAL BLOOD PRESSURE OBTAINED BY BPLAB IS QUESTIONABLE
Authors: Posokhov Igor
Published: April 2021

Objective:

Reference intervals of ambulatory (24-h) central blood pressure (ACBP) obtained from large healthy population are lacking in Russia. ACBP and 24-h BP amplification percentile for each age would be potentially useful for medical practice. This was an attempt to obtain reference values.

Design and method:

Database consisted of 8987 ABPM files was received by the BPLab device (Russia) during a survey of few districts in Russia. 1st, ABPM-files that corresponded to the normal ambulatory BP according to 2018 ESC/ESH Guidelines for the management of arterial hypertension were selected from database. 2nd, files that indicate antihypertensive treatment, elevated BMI and any disease in extended BPLab-diary were excluded. 3rd, age-specific percentiles ACBP-curves were generated with Vasotens (Russia) and LMS Chartmaker Pro (UK) software.

Results:

As a result, a selection of 2510 records was suitable for analysis. 24-h BP amplification is shown schematically in the figure below.

In the figure: A: Well-known data that are combined from the Framingham Study, from the US National report on high BP in children and adolescents, from the Sydney Group study (2010) and from the Anglo-Cardiff Collaborative Trial II. B: Data from the present study (amplification adapted to a similar systolic pressure).

The 24-h BP amplification obtained by the test method is too high, especially in people over the age of 40.

Conclusions:

The obtained values cannot be recommended for routine medical practice as a reference. The method for calculating central BP used in the device-under-test is likely questionable.
PULSE ARRIVAL TIME CAN TRACK CHANGES IN SYSTOLIC BLOOD PRESSURE
Authors: Heimark Sondre , Rindal Ole Marius Hoel , Seeberg Trine , Stepanov Alexey , Boysen Elin Sundby , Søraas Camilla Lund , Stenehjem Aud -Eldrid , Elmula Fadl Elmula Mohamed Fadl , Waldum-Grevbo Bård
Published: April 2021

Objective:

Automated cuff-based blood pressure (BP) monitoring is limited to intermittent measurements vulnerable to movement. Pulse arrival time (PAT), calculated using electrocardiography (ECG) and photo plethysmography (PPG), has shown promise for non-invasive, continuous BP monitoring. The precise relationship between BP parameters and PAT under varying conditions remains to be fully understood. This study aimed to investigate the correlation between PAT and BP under different exercise modalities.

Design and method:

Data was analyzed on 33 volunteers aged 18 years or older with and without hypertension. The test protocol consisted of isometric leg exercise, an incremental ergometer bicycle test and seated periods of rest before, in-between and after. PAT was measured with an easy-to-use chest belt consisting of a 1-channel ECG and PPG sensor. PAT was calculated and averaged using a gliding average over 200 cycles from the R-wave in the ECG signal to the foot of the PPG waveform. Reference BP was measured every minute manually with an aneroid sphygmomanometer. Systolic- and diastolic BP was recorded to the nearest second for optimal synchronicity.

Results:

Subjects were aged 42.3 ± 13.3 years, ranging from 18–70. 48.5% were males, 18.2% had a prior diagnosis of hypertension and 15.2 % used antihypertensive medication. Systolic- and diastolic BP at inclusion were 123.6 ± 16.1 and 76.4 ± 8.4 mmHg with ranges from 98–168 and 66–100 mmHg respectively. Pearson's correlation between systolic BP and PAT was -0.86 ± 0.08, -0.84 ± 0.14 and -0.81 ± 0.14 for the full protocol, isometric exercise and dynamic exercise respectively. Corresponding correlation for diastolic BP was 0.43 ± 0.31, -0.75 ± 0.20 and 0.39 ± 0.35. For diastolic BP, correlation with PAT was positive in most subjects for the full protocol (94%) and dynamic exercise (79%), and negative in all subjects for isometric exercise. Systolic BP showed negative correlation inn all subjects for all analyses. Figure 1 shows test protocol and results for one subject.

Conclusions:

The results suggest that pulse arrival time can track changes in systolic blood pressure. The relationships between diastolic blood pressure and pulse arrival time varied between exercise modalities and remains to be further elucidated.
HYPERTENSION AND BLOOD PRESSURE CONTROL AMONG RESPONDENTS LIVING IN DHAKA DIVISION, BANGLADESH
Authors: Hasan Mehedi , Khan Md Showkat Ali , Sutradhar Ipsita , Hossaine Moyazzam , Yoshimura Yukie , Choudhury Sohel Reza , Sarker Malabika , Mridha Malay Kanti
Published: April 2021

Objective:

In Bangladesh, 67% of all deaths are due to non-communicable diseases (NCDs), of which17% are attributable to cardiovascular diseases (CVD). Hypertension is a major risk factor for CVD. We conducted a baseline survey titled SHASTO (Strengthening Health Systems through Organizing Communities) to estimate the prevalence of hypertension, their risk factors, health care seeking behaviour among residents living in Dhaka division of Bangladesh.

Design and method:

This cross-sectional study was conducted among residents aged >30 years living in Dhaka north, Dhaka south, Narsinghdi and Gazipur district of Dhaka division. The respondents were interviewed using a modified version of STEPS questionnaire and physical measurements were taken following a standard operating procedure. Hypertension was defined as systolic blood pressure (BP) > = 140 mm of Hg and/or diastolic BP > = 90 mm of Hg and/or persons with already diagnosed hypertension.

Results:

A total of 4930 respondents participated in the study and mean age of male and female respondents was 48 and 45 years respectively. Overall, 31% of the respondents were hypertensive and the prevalence was higher among urban (37%) and female (38%) respondents than their rural (31%) and male (24%) counterparts. A higher prevalence of hypertension was also observed among respondents currently not working (not working: 47% vs working: 30%), consumed inadequate fruits and vegetables (inadequate: 32% vs adequate: 28%), performed inadequate physical activities (inadequate: 43% vs adequate: 28%) and overweight or obese (overweight/obese: 39% vs not overweight/obese: 24%). About 75% of hypertensive patients were aware of their status and 64% of them sought care. More than half (54%) of them were taking medication, however, 44% of them had uncontrolled BP. The prevalence of uncontrolled BP was found higher among female (63%), rural (89%), overweight or obese (60%), and nuclear family (63%) respondents.

Conclusions:

The prevalence of hypertension and uncontrolled BP was high among respondents living in Dhaka division of Bangladesh. The government should implement hypertension control and prevention programmes to tackle the burden and its associated complications.
SPECIAL FEATURES OF HYPERTENSION IN CHRONIC RENAL DISEASE: WHAT WE LEARN FROM AMBULATORY BLOOD PRESSURE MEASUREMENT
Authors: Zahidi Hatim Amine , Anass Maaroufi , Mehdi Aqli , Hajar Bendahou , Imad Nouamou , Sali Arous , Ghali Bennouna , Drighil Abdenacer , Leila Azzouzi , Habbal Rachida
Published: April 2021

Objective:

High blood pressure (hypertension) is frequently encountered in chronic kidney disease (CKD). Whether responsible for CKD or secondary, hypertension constitutes an important and modifiable risk factor in the course of CKD. The appropriate assessment of BP in CKD therefore becomes crucial to establish the diagnosis of hypertension and to consider appropriate therapies. Recent studies including ambulatory blood pressure measurement (ABPM) in CKD rather than office measurement allows early diagnosis of hypertension and identification of high risk patients

Design and method:

This is a prospective study carried out within the explorations unit, the objective of which was to assess the contribution of MAPA, its peculiarities and its prognostic elements in MRC. The study included two groups of hypertensive patients: a group of patients with stage 3, 4 and 5 CKD and a control group. CKD was defined according to the KDIGO classification, hypertension is defined is defined according to the French society of hypertension and the WHO In group 1.

Results:

the average age is 57.10 +/- 3.55 years vs. 51.28 +/- 9.36 years in group 2. In CKD the hypertension is older (6.34 +/- 6, 18 years vs. 4.71 +/- 4.37 years). Compared to group 2, the ABPM evaluation of hypertension associated with CKD highlights the unbalanced, severe nature with loss of physiological dipping. In multivariate analysis, CKD and male sex are the predictors of no dipping and nocturnal hypertension in group 1

Conclusions:

Several studies highlight the peculiarities of hypertension in CKD. 6 to 50% of patients with CKD are non-dippers and 10 to 35% have nocturnal hypertension. These changes in BP are accompanied by cardiac and renal events in CKD. This underscores the value of continuous assessment of BP in patients with CKD.
BLOOD PRESSURE FROM THE OPTICAL AKTIIA BRACELET: A ONE MONTH VALIDATION STUDY USING AN ADAPTED ISO81060-2 PROTOCOL
Authors: Vybornova Anna , Wurzner-Ghajarzadeh Arlene , Polychronopoulou Erietta , Fallet Sybille , Sola Josep , Wuerzner Gregoire
Published: April 2021

Objective:

Cuffless Blood Pressure (BP) monitoring is an emerging new technology with the potential to improve patients’ experience while providing physicians with a more comprehensive set out of office blood pressure measurements. The Aktiia Bracelet is a non-invasive BP monitor intended to measure optical photo-plethysmographic signals on the wrist and to calculate Systolic (SBP) and Diastolic (DBP) values using a pulse wave analysis technique. The Aktiia Bracelet requires an initialization procedure to be performed once per month. The objective of this study (NCT04027777) was to validate the accuracy and precision of the Aktiia Bracelet in the sitting position and over a period of one month.

Design and method:

A representative cohort of male and female, hypotensive, normotensive and hypertensive participants, aged 21 to 65 years, presenting different skin pigmentations (Fitzpatrick scale from 1 to 5) and different hair follicle densities were included. Four visits were scheduled for each participant. After initialization, the optical signals measured from the Aktiia Bracelet were used to calculate SBP and DBP values and were compared to auscultatory measurements obtained simultaneously by two double-blinded trained observers. The clinical investigation (including data analysis) was conducted by adapting the methods of ISO81060-2 to the requirements of a multi-visit validation of a cuffless device.

Results:

Data from a total of 91 participants in sitting position were included in the current analysis. For SBP, a mean difference (± SD) of 0.46 ± 7.74 mmHg between reference and Aktiia Bracelet values was found (criterion 1), with measured standard deviation of the averaged differences per subject of 3.9 mmHg (criterion 2). For DBP, a mean difference (± SD) of 0.39 ± 6.86 mmHg between reference and Aktiia Bracelet values was found, with measured standard deviation of the averaged differences per subject of 3.6 mmHg. Bland-Altman plots for SBP and DBP are shown in the following figure.

Conclusions:

The Aktiia Bracelet fulfilled the requirements of criterion 1 and 2 of the adapted ISO81060-2 protocol. The use of the Aktiia Bracelet could facilitate widespread use of accurate, longitudinal and easy out-of-office blood pressure measurements.
BLOOD PRESSURE MEASUREMENT METHODS AND KNOWLEDGE, PERCEPTION, PRACTICE OF NURSES: ARE WE THERE YET?
Authors: Todkar Shweta , Padwal Raj , Cloutier Lyne
Published: April 2021

Objective:

Accurate Blood pressure measurement (BPM) is a fundamental aspect of hypertension management. Guidelines regarding BPM methods, namely home (HBPM), ambulatory (ABPM), office (OBPM) and automated (AOBP) are published by Hypertension Canada. Nurses commonly perform BPM, but little is known regarding their knowledge, perception and practice when considering all BPM methods. A recent scoping review concluded that insufficient data was available for all professionals, but specifically nurses. This descriptive study assessed knowledge, perception and practice of nurses regarding all BPM methods.

Design and method:

All nurses licensed to practice in primary care settings across Québec were targeted for this survey. A personalized email invitation, and 2 reminders, including a link to a secured platform was send between in December 2019. Data was collected using a validated and pretested questionnaire consisting of 48 questions for knowledge, perception and practice for all BPM methods in English and French.

Results:

A total of 447 nurses participated, with a response rate of 11%. The median age was 40.5 ± 11,5 years old and 92% were women. For knowledge and perception, the mean percentage score obtained are presented in Table 1. For practice, the most frequently recommended method was HBPM (47%), followed by ABPM (18%). One third (35%) nurses reported education for HBPM was frequently provided to their patients, while for ABPM it was only 18%. While AOBP is the preferred method in Canada, more than half (52%) never use it and only 57% use oscillometric device for OBPM, meaning that there are still a large number of measurements being performed manually by auscultation.

Conclusions:

Although nurses had positive perceptions about the use of out-of-office measurements there is still much room for improvement for knowledge and practice. Our results show that a gap remains between what is recommended, what is known, and what is actually done in the field. Further strategies should involve optimal use of educational resources such as BPM algorithm posters and booklets, optimizing patient centered care using team-based approach, incorporating HBPM and encouraging participation in certification programme offered by hypertension societies.
VALIDATION OF THE INBODY BPBIO750 OSCILLOMETRIC BLOOD PRESSURE MONITOR FOR PUBLIC SPACES (KIOSK) ACCORDING TO THE AAMI/ESH/ISO UNIVERSAL STANDARD
Authors: Ntineri Angeliki , Prapa Sofia , Bountzona Ioanna , Menti Ariadni , Stergiou George
Published: April 2021

Objective:

To evaluate the accuracy of the upper-arm cuff oscillometric blood pressure (BP) monitor InBody BPBIO750 developed for self-measurement by adults in public spaces (kiosk) in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018).

Design and method:

Subjects were recruited to fulfil the age, gender, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. The device has a fixed hole to insert the user's arm with a single implanted upper-arm cuff.

Results:

A total of 102 subjects were recruited and 85 were analyzed (mean age 56.7 ± 15.4 [SD] years, 40 men, arm circumference 32.3 ± 5.3 cm, range 22–42 cm). For validation Criterion 1, the mean ± SD of the differences between the test device and reference BP readings (N = 255) was 2.2 ± 6.1/-2.2 ± 5.2 mmHg (systolic/diastolic). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per individual (N = 85) was 5.00/4.63 mmHg (systolic/diastolic).

Conclusions:

The InBody BPBIO750 oscillometric device for BP measurement in public spaces fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in general population and can be recommended for clinical use in adults.
PREVALENCE OF ARTERIAL HYPERTENSION IN THE UNORGANIZED POPULATION in ONE OF THE REGIONS OF KAZAKHSTAN
Authors: Chernokurova Yelena , Assembeko Batyrbek , Davletov Kairat , Amirov Baurzhan
Published: April 2021

Objective:

The objectives of the study were to assess:

Design and method:

A cross-sectional study was conducted to assess the prevalence and risk factors of CVDs using the WHO STEPS questionnaire survey, physical measurements and biochemical measurements. Sample size was 1,500 people aged 18–69 years. Samples composition: 900 urban and 600 rural population according to the overall urban/rural residents ratio specific for the region.

Results:

Respondents were asked whether they have ever had blood pressure measurement and whether they had been diagnosed with high blood pressure. Among all age groups, 4.1% reported that their blood pressure had never been measured; 59.8% had undergone blood pressure measurement but had not been diagnosed with hypertension; 6.9 % had been diagnosed with high blood pressure more than a year before; and 31.3% had been diagnosed with hypertension within the 12 months prior to the interview. Some statistically significant differences emerged in terms of raised blood pressure history between the sexes. A total of 6.0% of men had never had their blood pressure measured, compared to3.5% of women. The percentage of women diagnosed with high blood pressure during the previous 12 months was higher (31.9%) than that of men (29.2%) (Table 1).

Compliance with high blood pressure treatment was found to be very low. Among all respondents aged 18–69 years diagnosed with high blood pressure, less than half were taking medication prescribed by a doctor or a health worker. The age group difference was statistically significant, with an increase in the proportion of those taking medication from 25.6% among the age group 18–34 years to 78.0% in the age group 55–69 years (Table 2).

Conclusions:

Coverage with blood pressure measurement was quite high among the respondents (over 95%, at almost twice higher proportion of males who never had measured their blood pressure). Almost third of respondents had been diagnosed with hypertension while compliance with proper treatment was insufficient.
THE SAFETY OF ANTIHYPERTENSIVE AGENTS ON PERIOPERATION OF CARDIAC SURGERY: A SYSTEMATIC REVIEW BASED ON META-ANALYSIS
Authors: Li Caie , Ma Liping , Wang Qiongying , Zhao Xu , Ma Ruixin , Li Ningyin , Yu Jing
Published: April 2021

Objective:

To assess the safety of anti-hypertensive agents including calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists (ACEIs/ARBs), and beta blockers during perioperation of cardiac surgery.

Design and method:

We included randomized controlled trials investigating perioperative application of CCBs, ACEIs/ARBs or beta blockers in cardiac surgery. We extracted data for in-hospital mortality and serious side effects, among which atrial fibrillation (AF), stroke and acute renal failure (ARF) were assessed independently.

Results:

Twenty-three trials with 5378 patients were included. There were no significant differences between CCBs and placebo, nitroglycerin, or nitroprusside in terms of side effects, AF and ARF. Incidences of side effects (RR [95% CI] 0.55 [0.38, 0.80], I2=0, p < 0.01) and ARF (RR [95% CI] 0.16 [0.05, 0.53], I2=0, p < 0.01) were significantly reduced in ACEIs/ARBs group, compared with placebo, while differences in the incidences of AF and stoke were not found. No differences were found in the incidences of in-hospital death, side effects, ARF and stroke between beta blockers and placebo. However, use of beta blockers significantly reduced the incidence of AF (RR [95% CI] 0.51 [0.39, 0.67], I2=48%, p < 0.01).

Conclusions:

Perioperative use of CCBs, ACEIs/ARBs or beta blockers does not increase incidences of side effects in patients undergoing cardiac surgery and beta blockers are more appropriate in patients with high risk of postoperative atrial tachycardia. Large randomized trials are needed to confirm these findings.
DUAL INHIBITION OF ANGIOTENSIN II RECEPTOR- NEPRILYSIN COULD POSTPONE THE OXIDATIVE STRESS AND FIBROSIS IN THE GENITALTRACT OF FEMALE SPONTANEOUS HYPERTENSIVE RATS
Authors: Yu Jing
Published: April 2021

Objective:

Hypertension-mediated organ damage(HMOD) usually refers to the heart, brain, kidney and peripheral blood vessels. Our previous study proved that female hypertensive patients are more likely to develop sexual dysfunction than women with normal blood pressure, female genital tract can also be described as one of the HMOD. In this study, we investigated the effects of AT1 receptor and neprilysin double blocker (Sacubitril / valsartan) on oxidative stress and fibrosis in the genital tract of female spontaneously hypertensive rats (SHR) rats.

Design and method:

16-week-old SPF-grade SHR rats were randomly divided into sacubitril / valsartan group, valsartan group, diuretic group (chlorothiazone),SHR group, and WKY group with 10 rats in each group. The systolic blood pressure(SBP), diastolic blood pressure(DBP) and mean arterial blood pressure(MBP) were obtained by measuring rat tail artery pressure. After 12 weeks, all the rats were operated, and their vaginal tissues were taken. The oxidative stress index (eNOS, nNOS protein expression) was measured by Western blotting, and the degree of vaginal fibrosis was observed by HE staining and Masson staining.

Results:

Sacubitril/valsartan, valsartan and chlorothiazone could all significantly reduce blood pressure, including SBP, DBP and MBP in SHR rats, and compared with valsartan and chlorothiazone groups, the decrease of SBP insacubitril / valsartan group was more significant.(p < 0.01). Compared with WKY group, the relative expression of eNOS, nNOS protein in vaginal tissue of SHR group was significantly lower than that of the control group, and there was significant difference between two groups (P < 0.01). In SHR, the relative expression of eNOS, nNOS protein in sacubitril / valsartan group and valsartan group was significantly up-regulated (P < 0.01). In SHR group, the thickness of vaginal epithelium was significantly increased, the collagen fibers increased significantly, and arranged disorder. The small artery wall in vaginal was thickened and stenoses.

Conclusions:

The gentital tract fibrosis in female SHR rats are related to oxidative stress. Sacubitril / valsartan is able to inhibit oxidative stress and inflammation, to reduce the fibrosis, and thus ameliorate the gentital tract remodeling in female SHR rats.
EFFECT OF MENOPAUSE ON BLOOD PRESSURE VARIABILITY AND CAROTID INTIMA-MEDIA THICKNESS IN WOMEN
Authors: Ye Runyu , Zhang Xin , Chen Xiaoping
Published: April 2021

Objective:

To investigate the characteristics of blood pressure variability and carotid intima-media thickness in middle-aged hypertensive women during premenopausal, early perimenopausal, late perimenopausal and postmenopausal. And the effect of menopause status on them.

Design and method:

A total of 340 middle-aged hypertensive women were enrolled in this cross-sectional study. Each subject underwent anthropometric measurements, serum biochemistry evaluation, 24-h ambulatory blood pressure monitoring, and carotid ultrasound. According to their menstrual status, they were divided into four groups: group 1 (premenopausal), group 2 (early perimenopausal), group 3 (late perimenopausal) and group 4 (post menopausal).

Results:

There was no difference in mean blood pressure between the 4 groups, but a statistical difference in systolic blood pressure variability (standard deviation, coefficient of variation). On multiple linear regression analysis, SDs (all-day SBP, daytime SBP, nighttime SBP), CVs (all-day SBP, daytime SBP, nighttime SBP) were influenced by late peri-menopausal and postmenopausal status. And IMT was influenced by postmenopausal status. On logistic regression analysis, the risk of IMT thickening in postmenopausal women was 3.217 times higher than premenopausal (OR = 3.217 (1.325–7.811)), and the risk of plaque is 2.793 times higher than premenopausal (OR = 2.793 (1.443–5.404)).

Conclusions:

Late perimenopausal and menopausal status can increase blood pressure variability independently of age and BMI. Menopause status can significantly increase the risk of carotid intima-media thickening and carotid plaque.
THE EFFECT OF FREQUENT CONSUMPTION OF ENERGY DRINKS ON BLOOD PRESSURE, HEART RATE AND BLOOD GLUCOSE IN HEALTHY ADULTS WORKING OUT IN THE GYMNASIUM
Authors: Verma Abhinav , Vemra Narsingh , Siddiqui Mohd Ehsan
Published: April 2021

Objective:

To assess the effect of frequent consumption of energy drinks on blood pressure, heart rate and blood glucose in healthy adults working out in the gymnasium.

Design and method:

200 healthy young adults, were divided into two groups: the first consumed at least three energy drinks at one-hour intervals, and the second drank the same amount of water. Systolic blood pressure (SBP), diastolic blood pressure(DBP),heart rate (HR) and blood glucose (BG) were measured before consumption of energy drink (250 ml per can)/ water (250 ml) and before working out. After working out for 45 minutes (treadmill, cycling and elliptical cross trainer) 1 hr of rest was given to both groups. SBP, DBP, HR and blood glucose were then measured. All participants could report any health problems before and after consuming each portion of energy drink. All parameters were measured thrice weekly for 3 months.

Results:

Having consumed three portions of ED (150 to 180 mg of caffeine), the participants presented a significant increase in DBP (p = 0.033), by over 10.32%, no significant change in SBP (p = 0.715). HR increased in adults drinking 3 energy drinks (p = 0.040). Consumption of EDs caused a significant increase (p < 0.001) in BG, by 23.5 %, on average. Some participants reported of palpitations and disturbed sleep which increased after 2 and 3 energy drinks.

Conclusions:

Increased diastolic blood pressure, blood glucose, no significant change in systolic blood pressure occurred in healthy young people as compared to their controls drinking water.
EFFECT OF SHIFT-WORK ON 7-DAY/24-H AMBULATORY BLOOD PRESSURE MONITORING
Authors: Siegelova Jarmila , Havelkova Alena , Pohanka Michal , Dusek Jiri , Dunklerova Leona , Dobsak Petr , Cornelissen Germaine
Published: April 2021

Objective:

Poor health outcomes associated with shift work include increased risks of diabetes mellitus, dyslipidemia, hypertension, heart disease, peptic ulcer disease, depression and cancer.

The aim of the study was to compare the 7-day/24-h blood pressure ambulatory monitoring in healthy subjects and nurses working in day and night work shifts.

Design and method:

We examined 297 healthy subjects and 6 women (age 33 ± 2 years, body weight 70 ± 21 kg, mean height 165 ± 5 cm) and 4 men (age 28 ± 7 years, body weight 93 ± 11 kg, mean height 185 ± 5 cm), in days with day work, days with night work and free days, using Medical Instruments TM2431 (A and D, Japan).

Results:

The mean (±SD) of sleep hours in the week in 10 nurses during 7-day/24-h blood pressure monitoring was 37.75 ± 2.75 h per week. The mean of 7-day/24-h ambulatory blood pressure monitoring was SBP 126 ± 7.6 mmHg, of DBP 76 ± 5 mmHg, of HR 74 ± 5 bpm. Contrary to healthy subjects, in all shift workers we have found the disturbences in circadian rhythm according the day and night shifts. The seven day/24-hour systolic blood pressure profiles vary from 110 to 140 mmHg and we can not use reference values for 24-h ambulatory blood pressure monitoring, while there is impairment in circadian rhythm because of irregular night work. The similar condition is valid for diastolic blood pressure. Longitudinal monitoring could be implemented more generally to assess inter-individual responds to shift work.

Conclusions:

Seven day/24-h ambulatory blood pressure monitoring in night shift workers showed impairment of circadian rhythm and BP vary according to the work depending on different working shifts, and decrease of sleep hours. Further work is also needed to determine whether there may be shift work schedules that are less detrimental than others.
NEW CONCEPT OF TRIGGER-SPECIFIC BLOOD PRESSURE SENSITIVITY “THERMOSENSITIVITY” MEASURED BY ICT-BASED MULTISENSOR ABPM IN PATIENTS WITH HEART FAILURE
Authors: Narita Keisuke , Hoshide Satoshi , Kario Kazuomi
Published: April 2021

Objective:

A sudden elevation of blood pressure (BP) by cold temperatures in winter is widely recognized as one of causes in exacerbation of heart failure. A reactivity of BP against changes in temperature in ambulatory setting remains unclear in patients with heart failure. We assessed the BP reactivity against changes of temperature using a newly developed device ICT-based Multisensor Ambulatory BP Monitoring (IMS-ABPM) in patients with heart failure.

Design and method:

The IMS-ABPM has accelerometer, thermometer and atmospheric barometer, which enable to measure physical activity, temperature and atmospheric pressure with measuring ambulatory BP. In this study, we evaluated trigger-specific BP sensitivity according to the ambulatory BP reactivity based on the slope of BP change against the triggers using the IMS-ABPM, which was “thermosensitivity” defined as the slope of BP change against temperature in the BP measurement. This study was a cross-sectional study to assess relationship between “thermosensitivity” and cardiac function by using IMS-ABPM in patients who had been admitted to a medical facility due to heart failure.

Results:

Among 103 patients with heart failure (mean ± SD age, 76.4 ± 14.4 years; 47.6% men), 55.6% of patients was heart failure with preserved ejection fraction (HFpEF). Although mean 24-hour systolic BP level and ambulatory BP variability evaluated coefficient of variation, average real variability had not significant difference between patients with HFpEF and heart failure with reduced ejection fraction (HFrEF), the thermosensitivity was significantly lower (hyperthermosensitive) in patients with HFpEF compared to HFrEF (HFpEF, –1.59 ± 3.22 vs. HFrEF, 0.08 ± 4.14, p = 0.038). After adjusted age and sex, the thermosensitivity was significantly associated with HFpEF. Moreover, the thermosensitivity tended to be correlated with ejection fraction in echocardiography (r = –0.21, p = 0.052 in Spearman's correlation).

Conclusions:

Based on the results of this study, patients with HFpEF showed lower thermosensitivity (hyperthermosensitive), which suggested BP strongly elevated with cold temperature, compared to patients with HFrEF. The new concept of trigger-specific BP sensitivity “thermosensitivity” might be associated with the exacerbation of heart failure in HFpEF.
LEFT VENTRICULAR GLOBAL FUNCTION INDEX AND BLOOD PRESSURE PARAMETERS IN UNTREATED PATIENTS WITH HYPERTENSION
Authors: Minushkina Larisa , Brazhnik Victoria , Chumakova Olga , Alekhin Michail
Published: April 2021

Objective:

The left ventricular global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance.Typically, LVGFI is assessed with MRI, but recently proposed a technique for calculating this index by echocardiography. It was previously shown that a decrease in LVGFI may be a predictor of adverse outcomes in young patients with hypertension and a preserved ejection fraction. The study aimed to elucidate the association between LVGFI and the features of the daily profile of blood pressure in untreated patients with essential hypertension (EH).

Design and method:

We included in the study 104 patients with EH (51 men (49%) and 53 women (51%)). Mean age 58,7 ± 11,73 years. All patients had no history of blood pressure-lowering treatment.

All patients underwent echocardiography and ambulatory blood pressure monitoring (ABPM). LVGFI (%) was defined as left ventricular (LV) stroke volume/LV global volume∗100% where LV global volume was calculated as the sum of the LV mean cavity volume ((LV end-diastolic volume + end-systolic volume)/2) and myocardium volume (LV mass/density). End-diastolic and end-systolic volume were obtained using Teichholz method.

Results:

The mean LVGFI was 30,21 ± 7,32%. We performed a correlation analysis of the main clinical characteristics and parameters of ABPM with LVGFI. We found slight correlation between age (r = -0,215, p = 0,028) and body mass index (r = -0,378, p < 0,0001) with the LVGFI. There were no significant associations between office blood pressure and echocardiography parameters. Also mean daily, daytime and night systolic and diastolic blood pressure were not correlated with LVGFI. The most significant associations were found between ABPM systolic (r = -0,307, p = 0,002) and diastolic (r = -0,355, p < 0,0001) blood pressure variability. Patients with the impaired circadian rhythm of blood pressure by type of over-dipper had the lowest LVGFI (26,84 ± 3,301%) compared with patients with normal circadian rhythm (32,43 ± 6,908%) and non-dipper patients (30,49 ± 7,773%), p = 0,041.

Conclusions:

Lowering of LVGFI is associated with high blood pressure variability and over-dipper circadian rhythm of blood pressure.