bluuebunny/crossref_metadata_2025 huggingface dataset:
CUFFLESS BLOOD PRESSURE DEVICES AND INCONSISTENT TRACKING OF BLOOD PRESSURE CHANGES
Authors: Tan Isabella , Barin Edward , Gueguen Cindy , Head Geoff , Avolio Alberto , Butlin Mark
Published: April 2021

Objective:

Single point calibration is common in cuffless blood pressure (BP) measurement devices. Consequently, they may be apt at re-assessing BP at that same calibration BP but have potential for increased error as BP changes from that calibration point. This study investigates one pulse waveform-based (BPro, HealthStats) and one pulse arrival time-based (Maisense Freescanâ) cuffless device in their tracking of BP changes as compared to that of conventional cuff-based oscillometric devices.

Design and method:

14 participants had 24-hour assessment of BP using BPro and a validated cuff-based oscillometric device (BPLab, Petr Telegin). Nocturnal BP dipping as measured by both devices was compared. In a separate study, six participants had BP measured with a validated cuff-based oscillometric device (OMRONâ HEM-7121) and either the BPro (n = 3) or Freescanâ device (n = 3) before and during a 2-minute cold-pressor challenge. BP change from baseline as reported by the devices were compared.

Results:

Average nocturnal fall in BP (mean ± SD) as reported by the cuff-based device and BPro were -15 ± 8% and -10 ± 6% (p = 0.061), respectively, for systolic BP; -19 ± 8% and -10 ± 7% (p = 0.008), respectively, for diastolic BP. Nocturnal dipping (defined as nocturnal fall > 10% in either systolic or diastolic BP) was detected in 6 participants with the BPro device as opposed to 14 as detected with the cuff-based device. During cold-pressor challenge, Freescanâ reported a systolic BP change of -4 ± 8 mmHg compared to the cuff measured change of 12 ± 8 mmHg (p = 0.017). BPro followed a similar trend to the Freescanâ device and reported a systolic BP change of -2 ± 2 mmHg compared to the cuff measured change of 14 ± 4 mmHg (p = 0.002).

Conclusions:

The BPro device was able to track nocturnal dipping in some but not all participants, with significant underestimation of nocturnal dipping in diastolic BP. Cold-pressor challenge induced BP changes that were unable to be detected by the cuffless devices. Whilst single point calibration may permit a cuffless device to assess when BP returns to that calibration point, tracking of BP changes appears to be inconsistent. Further investigation is required to understand the underlying factors that contribute to this inconsistency.
EFFECTS OF PHOTOPERIODISM ON DAILY RHYTHMS OF BLOOD PRESSURE AND HEART RATE IN DIFFERENT SEASONS OF THE YEAR IN THE ARCTIC
Authors: Vetoshkin Aleksandr , Shurkevich Nina , Gapon Lyudmila , Simonyan Ani
Published: April 2021

Objective:

To study the effect of the rhythm of natural light on circadian rhythms of blood pressure (BP) and heart rate (HR) in the Arctic.

Design and method:

Analysis of 24-hour BP monitoring was performed in 373 male patients with arterial hypertension (AH) stage II engaged in rotational shiftwork in the Arctic compared with the group of the same type of 144 patients living in moderate climate (Tyumen, 57 N) 93 randomly selected patients of the Northern group and 64 patients of the Tyumen group. Based on 24-hour ambulatory blood pressure monitoring chronobiological and standard parameters, daily BP profile, circadian BP and HR indices, percentage contribution value (PC), amplitude of a rhythm (RA), acrophase and BP MESOR in different seasons were analyzed.

Results:

In the conditions of Arctic shift work circadian BP and HR rhythms in patients with AH differed significantly compared with Tyumen patients regardless of season and were characterized by the absence of seasonality signs of BP and HR rhythms and the presence of inside desynchronosis of rhythms. Lack of natural light during the polar day and polar night leads to flattened HR and circadian BP in patients with AH in the Far North. The major differences were the loss of 24-hour period components and low-amplitude spectrum profile. Seasonal changes in the HR parameters were not significant in the comparison group versus northern group with a clear flattening of HR in the polar day period. In the main group of patients the worst condition for 24-hour BP profile was winter period (polar night) characterized by the peak flattening of circadian rhythms and the prevalence of high-frequency oscillations in the spectrum.

Conclusions:

In patients with AH in the conditions of Arctic shift work, formation of daily rhythm and absence of seasonality signs of HR and BP is associated with nature of work and climate factors, including natural light rhythm in the northern latitude.
THE IMPACT OF BLOOD PRESSURE MANAGEMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE: A MULTICENTER PROSPECTIVE COHORT STUDY IN JAPAN
Authors: Nishiwaki Mariko , Uchida Haruhito A , Otaka Nozomu , Hada Yoshiko , Onishi Yasuhiro , Uchiyama Natsumi , Okamoto Shugo , Takemoto Rika , Kitagawa Masashi , Sugiyama Hitoshi , Saito Chie , Yamagata Kunihiro , Wada Jun
Published: April 2021

Objective:

The effect of intensive blood pressure (BP) lowering on kidney and cardiovascular outcomes among the patients with chronic kidney disease (CKD) remains unclear. We aimed to examine a preferable BP level to manage the patients with CKD.

Design and method:

We recruited patients with CKD under consultation with general physicians (GPs), a total of 489 GPs in 49 local medical associations. The outcomes were the renal and cardiovascular events. The renal event was defined as a doubling of the serum creatinine level, a 50 % reduction in estimated GFR or a diagnosis of end stage renal disease. We classified patients into 6 groups according to the systolic BP (SBP) level at the registration (<120, 120–129, 130–139, 140–149, 150–159, > = 160). The relationship between SBP and renal and cardiovascular events were statistically analyzed.

Results:

A total of 2033 patients aged 40 to 74 were participated with written informed consent. A strong correlation between SBP and the renal event was identified after adjustments for confounders. The 120–129 group had the lowest renal events, as well as <120 group (reference 120–129; <120: hazard ratio (HR) 1.30 (95% confidence interval 0.80–2.11); 130–139: HR 1.49 (1.03–2.17); 140–149; HR 1.61 (1.33–2.85); 159–160: HR 2.50 (1.68–3.78); > = 160: HR 2.17 (1.42–3.33)). Unexpectedly, regarding cardiovascular events, the 130–139 and 140–149 groups had no significant difference compared with 120–129 group, however, 150–159 and > = 160 groups had significantly large number of events (reference 120–129; <120: HR 1.29 (0.67–2.42); 130–139: HR 0.82 (0.47–1.45); 140–149: HR 1.46 (0.86–2.53); 159–160: HR 2.08 (1.20–3.66); > = 160: HR 2.80 (1.20–8.15)). Interestingly, the patients who achieved SBP levels <130 mmHg after one-year had significantly lower renal events compared with those did not (HR 0.62, (0.46–0.84)), among the patients with SBP levels > = 130 mmHg at registration.

Conclusions:

The SBP level <130 mmHg was associated with the lowest renal events in the patients with CKD. Furthermore, this study indicated that the patient with SBP levels > = 130 mmHg should be reduced SBP to less than 130 mmHg within a year.
THE VALUE OF EMERGENCY DEPARTMENT BLOOD PRESSURE MEASUREMENT FOR THE SCREENING OF HYPERTENSION. PAIN IS A SIGNIFICANT FACTOR? SEEMS NOT
Authors: Michaud André , Vadeboncoeur Alain , Lamarre-Cliche Maxime , Cloutier Lyne
Published: April 2021

Objective:

The value of emergency department (ED) blood pressure measurement for the screening of hypertension remains unclear. A systematic review was conducted to assess the performance of a screening strategy in adults using blood pressure (BP) measurement at the time of an ED consultation. The link between pain and high blood pressure is also described.

Design and method:

A systematic literature search on Embase, CINHAL and Medline was carried out. This systematic review was conducted in accordance with the PRISMA-Diagnostic Test Accuracy. Intervention studies with adults including at least one BP measurement for all participants were included. A repeat blood pressure assessment had to have been carried out to assess the validity of the elevated BP value within the next few days after the ED initial visit.

Results:

After review of 1,030 articles published between 1985 and 2018, 10 articles met the inclusion criteria. Mean age of participants was 51.6 years. A single study reports that BP screening was measured according to all the recommendations within the HTN guidelines referred to in the study. Half of the patients (50.2%) with elevated BP during the ED visit had BP corresponding to uncontrolled elevated blood pressure at follow-up measurement. Data about pain and blood pressure is reported in six of the included studies. None of these found a significant relationship between the concomitant presence of pain and an elevated BP measurement, and the fact of having an elevated or normal BP in a subsequent measurement without the presence of pain.

Conclusions:

The value of the blood pressure measurement in the ED is far from useless because it allows recognizing a true hypertension in one in two adults presenting with elevated BP. Moreover, it would be a mistake to attribute to pain alone the fact of presenting with an elevated OBPM in ED. Such patients could just as well be hypertensive when an ambulatory measurement is performed later without the presence of pain.
MAY MEASUREMENT MONTH 2018: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS FROM BOTSWANA
Authors: Masupe Tiny , Tlhakanelo John Thato , Tiro Mary Banyana , Motlhatlhedi Keneilwe , Mamela Abraham , Makwati Obuile , Kololo Masego , Phuswane Orapeleng , Lesetedi Onalethata , Motlhagodi Amogelang , Beaney Thomas , Ster Ancha Chis , Poulter Neil R , Xia Xin , Mosepele Mosepele
Published: April 2021

Objective:

During the May Measurement Month 2018 (MMM18) campaign, we aimed to raise hypertension awareness and measure blood pressure across different communities in Botswana.

Design and method:

Study sites were four large villages and Gaborone (capital city). Screening sites included shopping malls, train stations, churches and workplaces. Individuals aged over 18 years were recruited through fliers, word of mouth and volunteer walk-ins at the sites. Demographic and risk factor data were collected through a questionnaire prior to measuring three blood pressure (BP) readings per participant. Weight was measured while height was usually estimated. Hypertension was defined as: SBP above 140 mmHg or DBP above 90 mmHg or taking antihypertensive medication. The mean of readings 2 and 3 was used, and was estimated using multiple imputation where missing. Ethical clearance was obtained from the Ministry of Health and University of Botswana.

Results:

Amongst 4,599 participants whose BPs were measured, 54.5% were female, mean age was 35.9 years. A total of 1,510 (32.8%) participants were hypertensive with 712 (47.1%) aware of the hypertension. In participants not taking antihypertensive medication, the association between age and sex with SBP showed a linear increase, with the mean BP in males prominently higher than the mean BP in females across ages below 85–90 years, where they became equal. The DBP association showed an inverted U curve, with the mean DBP in males exceeding the mean DBP in females at age of 25 years, and the peak on the male curve at ages 45–50 years, while in females it was at ages 50–55 years. Only 35.2% of hypertensives were on anti-hypertensive treatment with 54.4% having controlled BP. Amongst all hypertensives, only 19.1% had controlled BP. Factors associated with higher BP included obesity, more than 1unit of alcohol/week and BP measured on Sunday.

Conclusions:

Less than half (52.9%) of those identified to have hypertension during MMM18 campaign were aware of their condition, despite the escalating prevalence of hypertension in the country. Regular BP awareness and opportunistic BP measurement campaigns like the MMM are recommended to improve detection and control of hypertension and other cardiovascular risk factors.
PREVALENCE OF MASKED ORTHOSTATIC HYPOTENSION MEASURED BY HOME BLOOD PRESSURE MONITORING IN ELDERLY HYPERTENSIVE SUBJECTS: RESULTS OF THE HYPAUTTENS STUDY
Authors: Le Jeune Sylvain , Suhl Jaehyo , Feit Bertrand , Bally Stephane , Lequeux Benoit , Le Coz Sylvie , Gil Bertrand , Delsart Pascal , Pointeau Odile , Boulestreau Romain , Lopez-Sublet Marilucy , Mourad Jean Jacques
Published: April 2021

Objective:

Orthostatic hypotension (OH) is a common disease in the elderly, associated with an increased risk of falls and cardiovascular morbi-mortality. Its reproducibility in clinical setting is low. A recent, single-center study has shown the feasibility of home blood pressure monitoring (HBPM) for the detection of OH in subjects older than 65 years referred for a memory complaint, and reported a prevalence of 12% and 42% of HO in the office and ambulatory settings respectively. The prevalence of masked OH detected with HBPM in treated hypertensive elderly subjects is still not known.

Design and method:

42 hypertensive patients older than 65 years without office OH were included in 8 specialized hypertension centers. Their treatment has not been changed for at least 1 month. An ambulatory OH was sought according to the following protocol: 3 measurements in sitting position at 1 minute intervals after 5 min of rest, followed by 3 measurements in standing position at 1 minute intervals, every morning and evening for 3 consecutive days, recorded by an automated device with humeral cuff. HBPM was considered valid if more than 4 out of 6 series of measurements were completed. Ambulatory OH was defined as a fall of more than 20mmHg in SBP between one of the 3 measurements in orthostatism compared to the average of the 3 measurements taken while sitting.

Results:

100% of HBPM sessions were considered valid. The main characteristics of the patients were: 72 ± 6 years, 39% women, SBP/ DBP: 149 ± 20/82 ± 10 mmHg, 2.4 ± 0.9 antihypertensive drugs, 9.3% history of falls. 20 (47.6%) included patients had a masked OH according to the protocol detailed above, with an average of 2 ± 1.2 episodes and a maximum of 5 episodes. 86% of patients had at least one episode in the morning, and 57% in the evening. In multivariate analysis, no factor identified in the study was significantly associated with the existence of a masked OH.

Conclusions:

OH detection with HBPM in treated hypertensive elderly subjects is feasible and reveals a significant prevalence of masked OH. Prospective studies are needed to clarify the prognostic value of masked OH.
CONCORDANCE BETWEEN THE DIAGNOSIS OF HYPERTENSION BY OFFICE BLOOD PRESSURE AND HOME BLOOD PRESSURE MONITORING IN A FAMILY HEALTH CARE UNIT- LAPARC COHORT STUDY
Authors: Botelho Bruna Gopp , Barbalho Daniella Gomes , Louzada Vinicius Leiria Teixeira , Azevedo Rafael Bellotti , Sampaio Fernando Bizzo , Antequera Lucas Alves , Diniz Pedro Henrique Pimenta , Marinho Beatriz Deberaldini , Rocha Débora De Castro , Ferreira Leonardo Villa Leão , Velasco Pedro Julio Pacheco , Araujo Humberto Montilho , Monteiro Daniela Fiuza Gomes , Mallet Ana Luisa Da Rocha , Muxfeldt Elizabeth Silaid
Published: April 2021

Objective:

To evaluate concordance between diagnosis of hypertension by Office Blood Pressure (OBP) and Home Blood Pressure Monitoring (HBPM) in a young adult population.

Design and method:

A cross-sectional population study enrolled adults between 20 and 50 years registered in a primary healthcare unit in the city of Rio de Janeiro, Brazil. Socio-demographic and anthropometric characteristics were registered at the entrance of the study. Also, the presence of CV risk factors was evaluated. OBP was determined by calculating the mean value of 2 consecutive measurements (Omron-705CP) while the HBPM followed a 7-day protocol with 2 measurements in the morning and 2 in the evening (28 measurements). Measurements of the first day were discarded and the average of the other 6 days was calculated. It was considered normal a Home BP < 135 x 85 mmHg and OBP < 140 x 90 mmHg. Patients were classified into 4 groups: normotension (controlled OBP and HBPM); white coat hypertension (uncontrolled OBP and controlled HBPM); masked hypertension (controlled OBP and uncontrolled HBPM) and sustained hypertension (uncontrolled OBP and HBPM).

Results:

A total of 462 individuals were evaluated [37.7% males with mean age 37.4 ± 8.8 years]. Sedentary lifestyle (43%), dyslipidemia (38%) and obesity (28%) were the main CV risk factors. By OBP, the prevalence of hypertension was 13.4% while by HBPM was 18.6%. Kappa coefficient demonstrated a low concordance between the two diagnostic methods (kappa = 0.472). After HBPM, 68 individuals (16.9%) changed the diagnosis, being 21 (5.6%) with white coat hypertension and 45 (11.3%) with masked hypertension. The variables that were independently associated with hypertension diagnosed by OBP were male gender (OR 1.83, CI95%, 1.01–3.33, p = 0.04) and increased neck circumference (OR 3.77, CI95%:1.59–8.93, p = 0.003). Hypertension diagnosed by HBPM was associated with obesity (OR 2.18, CI95%, 1.27–3.76, p = 0.005) and increased neck circumference (OR 2.37, CI95%, 1.05–5.33, p = 0.04).

Conclusions:

Concordance between office BP and HBPM was low in this young adult population. Thus, If the diagnosis was based only in the office BP values, 17.5% of the subjects would have an erroneous diagnosis of hypertension.
BLOOD PRESSURE RESPONSE TO THE PRESENCE OF A PHYSICIAN DURING BLOOD PRESSURE MEASUREMENT
Authors: Filipovsky Jan , Seidlerova Jitka , Kordikova Veronika
Published: April 2021

Objective:

Automated blood pressure (BP) measurement has attracted attention since the SPRINT study had been published. It can be measured either with (attended) or without the presence of the staff (unattended). Although it is well known that attended measurements are higher, studies that quantify the effect in well defined conditions are scarce.

Design and method:

We performed a study on 38 stable treated hypertensive subjects, mean age 66.5 ± 8.1 years, 45% males. Two sets of BP measurement, attended and unattended, were done with the Omron 907 device in a random order; each set consisted of three measurements separated by a one-minute interval. During attended BP measurements, a physician unknown to the patient was present. The physician was either in close (n = 22) or loose (n = 16) contact with the subject. During the close contact, the physician placed the stethoscope to the cubita as if he measured BP with auscultatory method so that the distance from the patient was standardized but all the measurements were oscillometric. With the loose contact, the physician was sitting in the room at a two-meter distance from the patient.

Results:

Means of three BP attended and unattended measurements were 129.3/73.5 mm Hg and 123.7/70.3 mm Hg, respectively, difference: 6.1 ± 7.6/3.2 ± 5.1 mm Hg, p < 0.0004. The difference was higher with close contact (8.2/4.3 mm Hg, p = 0.0023) than with loose contact (3.2/1.7, p = 0.16). Predictors of BP increase during attended measurements were studied in a multivariate linear regression. While no factor was associated with systolic BP increase, diastolic BP increase was positively related to smoking (p = 0,028) and negatively to the room temperature (p = 0,018).

Conclusions:

Our study shows that circumstances under which BP is measured are crucial even in the subjects treated for hypertension for a long time. The BP reaction is higher when the physician is close to the patient, imitating auscultatory measurement.
ASSESSMENT OF CENTRAL AORTIC BLOOD PRESSURE IN PATIENTS WITH HYPERTENSION: RESULTS FROM A PAN-INDIA ASSESS CABP REGISTRY
Authors: Bhasin Neeraj , Potdar Anil
Published: April 2021

Objective:

Although central aortic blood pressure (CABP) has shown to be better predictor of cardiovascular events than brachial BP in randomized trials, the real-world clinical practice data are scarce. Our study aimed to assess brachial and CABP and illustrate the correlation between them in patients with hypertension. It also aimed to assess the therapeutic drug classes prescribed in hypertensive patients.

Design and method:

This was a single-visit, prospective, non-interventional, observational study of hypertensive outpatients. Data collection included clinical and demographic characteristics, brachial (sphygmomanometer) and CABP (Agedio B900 device (IEM, Stolberg, Germany) and antihypertensive treatment.

Results:

A total of 3989 patients were enrolled with the mean age of 56.6 ± 12.2 years. About 58.6% were male and 66.4% were obese. Mean systolic (SBP) and diastolic blood pressure (DBP) was 156 ± 15.2/ 95.6 ± 12.9 mm Hg. Mean arterial pressure was 119.4 ± 21.8 mm Hg and heart rate was 83.1 ± 14.6 bpm. The central blood pressure parameters were: central systolic blood pressure (CSBP), 139.8 ± 16.3 mm Hg; central diastolic blood pressure (CDBP), 96.1 ± 13.2 mm Hg; central pulse pressure (CPP), 43.4 ± 15.3 mm Hg; augmentation index (%), 29.1 ± 16.6; pulse wave velocity, 8.8 ± 3.8 m/s. A positive correlation was observed between SBP and CSBP (r = 0.6809, p < 0.0001); DBP and CDBP (r = 0.7413, p < 0.0001); and PP and CPP (r = 0.638, p < 0.0001). About 83.1% patients were taking antihypertensive medications and 76.94% (n = 3163) patients were receiving monotherapy: ACE inhibitors, 6.96%, angiotensin receptor blockers, 30.92%, beta-Blockers, 12.6%, calcium channel blockers, 17.93%, diuretics, 8.54%, and alpha/central blockers, 0.17%. Combinations of two and three drugs were received by 21.6% and 1.46%, respectively

Conclusions:

Brachial BP was positively correlated to CABP in hypertensive patients. Majority of patients were receiving angiotensin receptor blockers as antihypertensive monotherapy.
SMARTPHONE-BASED BLOOD PRESSURE MEASUREMENTS VALIDATION USING THE AAMI/ESH/ISO UNIVERSAL PROTOCOL: RESULTS FROM THE FIRST FORTY PATIENTS
Authors: Wuerzner Gregoire , Degott Jean , Hofmann Gregory , Proença Martin , Bonnier Guillaume , Lemkaddem Alia , Lemay Mathieu , Schorer Raoul , Christen Urvan , Knebel Jean -Francois , Brenet Fanny , Eliott Jones , Wuerzner Arlène , Burnier Michel , Schoettker Patrick
Published: April 2021

Objective:

Hypertension is a preventable disease but only half of the affected population is aware of it. Digital health approaches, in particular mobile health diagnostics, have been shown to be effective and scalable for chronic disease detection and management. Smartphones are widely available and have the potential to be used as a “cuffless” blood pressure (BP) measuring devices. Using a smartphone-based pulse wave analysis algorithm (oBPMâ) trained with invasive blood pressure measurements, the objective was to assess the performance and accuracy of the oBPMâ in an outpatient setting.

Design and method:

We collected optical signals from patient's fingertip via a smartphone in an outpatient setting. After an initial calibration, smartphone optical BP were generated and compared to simultaneous acquired auscultatory systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure in an initial set of participants in accordance with the AAMI/ESH/ISO universal consensus for the validation of BP measuring devices.

Results:

Signals acquired from 40 patients (range of age 21–78 years) generated 140 smartphone BP measurements. The prevalence of low, normal or elevated systolic blood pressure (SBP) was respectively 12.9%, 70.00% and 17.1 %. The prevalence of low, normal or elevated diastolic blood pressure (DBP) was respectively 25.0%, 61.4% and 13.6%. The mean difference in BP and its standard deviation between the optical vs. reference value were -0.7 ± 7·7 mmHg for the SBP, -0·4 ± 4·5 mm Hg for DBP and -0·6 ± 5·2 mmHg for mean blood pressure. These results were within the range of the ISO standards.

Conclusions:

These results demonstrate that BP can be measured with accuracy after an initial calibration using a smartphone and newly developed algorithm. If the accuracy of these smartphone-based measurements can be confirmed in various subtypes of population, it may become an important tool to detect and manage hypertension in various settings, in particular low income countries, where the availability of smartphones is high but access to health care is scarce.
ASSESSMENT OF BLOOD PRESSURE MEASUREMENT AT VARIOUS WORK PLACE IN HYDERABAD, PAKISTAN
Authors: Shaheen Sumera
Published: April 2021

Objective:

According to JNC guidelines, Blood Pressure measurement is one the mandatory part for hypertension management. By knowing the values, a patient can better his/her blood pressure. The current study was conducted to know the KAP values at different work places in Hyderabad, Pakistan

Design and method:

The cross-sectional descriptive study was conducted in 3 different work places including Hospital, universities and bank. The total number of participants are 200. The sampling technique was purposive who had confirmed diagnosis of Hypertension. The duration of study was one years during 2019. The data were transferred in excel sheet and then compared with standard references

Results:

200 samples from each work place were enrolled. The age range was from 20 to 58 years. The mean age of the participants were 46 years. The male was more than female. The systolic and diastolic work are not known by the majority of the samples. The normal values of blood pressure are known by 53% of the participants. The KAP values are low in female as compared to male. While KAP values are good in university samples.

Conclusions:

Conclusion: The study was revealed that Blood pressure measurement values are not known by the majority of samples. Proper CMEs will be conducted to aware them.
COMPARISON OF OFFICE BP MEASUREMENTS BY VARIOUS BP MONITORS IN DIFFERENT CONDITIONS
Authors: Muzik Jan , Peleska Jan , Holubova Anna , Canek Rene , Navratil Vojtech , Fiala Dominik , Doksansky Marek , Kaspar Jan , Vranka Jakub , Hronova Julie , Chrolenko Anna , Jiravova Maria , Dolezil David , Jozifova Marie , Jedlickova Petra
Published: April 2021

Objective:

Comparison of various types of BP measurement (BPM) is controversial. It also depends on a study design used.

Design and method:

Dabl validated BP monitors Nissei DM-3000 (both auscultatory and oscillometric), SunTech-CT40 (mean of 5 successive automated unattended BPMs - quiet room) and Fora P30Plus in both conditions were used for office BPM in triplets by one physician at the entry and exit of the 3 monthś home BP telemonitoring study. 93 treated essential hypertensives aged 26–85 years, 57% males, were referred by their physicians as well controlled. Their therapy was not changed during this study. Those starting BPMs in the office at the entry started BPMs in the quiet room at the exit and vice versa, approximately at the same time.

The effect of methods of BPM at the entry and exit of the study on the systolic BP was evaluated using a linear mixed model adjusted for gender, age and BMI.

Results:

The interaction of BPM method vs. study phase (entry/exit) showed a significant effect on systolic BP (SBP) values (p < 0.001). Significantly higher SBP values were measured using Fora in the quiet room in comparison with all the other methods of BPM and/or settings only at the entry (Table 1), whereas those measured at the exit did not differ significantly. There were no significant differences among other methods either.

SBP measured by Fora was not dependent on the measurement order (physician/quiet room) significantly (p = 0.279). The first self-measurement SBP values of the study in the quiet room were higher probably due to a stress from the first contact with a telemonitoring equipment.

Conclusions:

In this pilot study we found significant differences between BPM methods used in systolic BP measurement, Fora showed higher SBP values in the quiet room only at the entry. We did not prove any influence of measurement order when Fora was used in both attended and unattended conditions. Contrary to others, our results suggest that different BPM methods/conditions could give comparable SBP values, if performed correctly.
PREVALENCE OF HYPERTENSION IN THE FRENCH GENERAL POPULATION BY AUTOSCREENING OR HOME BLOOD PRESSURE MONITORING: FLAHS 2020 SURVEY
Authors: Girerd Xavier , Pathak Atul , Silhol François , Wimart Marie Catherine , Hanon Olivier
Published: April 2021

Objective:

To assess the prevalence of hypertension in the general population based on the completion of an autoscreening or self-measurement protocol using an automatic home blood pressure monitor.

Design and method:

The FLAHS 2020 survey questioned individuals aged 35 and over from the Kantar Health Metascope permanent sample base (a representative panel of the population living in metropolitan France) with the question: Do you have a blood pressure monitor at home? The respondents assessed their blood pressure according to the protocol suiviHTA (6 sessions of 3 measurements, 3 sessions in the morning, 3 sessions in the evening, 3 consecutive days, 1 minute interval between each measurement, sitting position, without getting up between each measurement). The analysis calculated for each subject the average of the 18 measurements (protocol suiviHTA) and the average of the last 2 measurements of the first session (protocol depistHTA). High blood pressure was determined with thresholds >135/85 and >140/90 based on data from both protocols (mmHg).

Results:

Of the 4069 participants in FLAHS 2020, 827 had a blood pressure monitor of which 488 (59%) were on at least one antihypertensive therapy. With the protocol suiviHTA, the mean BP in treated subjects was 129.0/75.5, compared to 119.5/72.7 in untreated subjects. The table details the % prevalence [IC95] of high blood pressure by blood pressure threshold and protocol:

Conclusions:

Significant differences in the prevalence of high blood pressure according to the protocol performed are observed, particularly in the population of subjects treated with antihypertensive drugs.

With the protocol suiviHTA, which is the one recommended by the French Health Authority, the prevalence of high blood pressure in France is 28% in the population of subjects aged 35 years and over.
USING A NOVEL NON-INVASIVE, CUFF-LESS, WIRELESS DEVICE FOR 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING
Authors: Gepner Yftach , Nachman Dean , Gilan Adi , Goldstein Nir , Constantini Keren , Littman Romi , Eisenkraft Arik , Grossman Ehud
Published: April 2021

Objective:

Ambulatory blood pressure monitoring (ABPM) using cuff-based devices is used for diagnosis and treatment of hypertension. Technical limitations, low compliance and complex procedure limit their use. The aim of the present study was to compare a new technique of 24H ABPM using a photoplethysmography (PPG)-based, wearable device to the standard cuff-based device.

Design and method:

In this prospective study, 24H ABPM was performed using a standard cuff-based device and the PPG-based device (Wrist-monitor) in parallel on volunteers aged 18–65 years, while documenting their daily activities. Level of comfort and activity disturbance of both devices were recorded. Linear regression and Bland-Altman were used to evaluate the agreement between the Wrist-monitor and Holter. Receiver Operating Characteristic (ROC) curve analysis was used to assess the ability of the Wrist-monitor to identify abnormal BP values.

Results:

The study included 28 subjects (18 men) mean age 41.5 ± 16.2 years. Bland-Altman analysis results in 24H bias of -1.1 mmHg for both diastolic blood pressure (DBP) and systolic blood pressure (SBP). Mean daytime bias was -1.9 mmHg for DBP and SBP, while nighttime bias was smaller (0.7 and 0.4 mmHg for DBP and SBP respectively). ROC curve analysis on all BP readings (n = 2381) yielded a mean area under the curve (AUC) for 24 hours of 0.965 for both SBP and DBP. 24H ABPM with the Wrist-monitor caused significantly less inconvenience compared to the Holter (p < 0.001).

Conclusions:

The cuff-less device provides comparable measurements to those obtained with the currently used ABPM device, with significantly less inconvenience to the subject.
PREVALENCE OF ARTERIAL HYPERTENSION AND CHARACTERISTICS OF NOCTURNAL BLOOD PRESSURE PROFILE OF ASTHMA PATIENTS ACCORDING TO THERAPY AND SEVERITY OF THE DISEASE: THE BADA STUDY
Authors: Musiari Gaia , Di Raimondo Domenico , Benfante Alida , Battaglia Salvatore , Rizzo Giuliana , Tuttolomondo Antonino , Scichilone Nicola , Pinto Antonio
Published: April 2021

Objective:

Several studies report an increased risk for asthmatic subjects to develop arterial hypertension and the relationship between these two diseases, frequently co-existing, still has some unclear aspects. Available data reports that asthmatics were 36 to 43 % more likely to have high blood pressure than non-asthmatics. None of these studies evaluated the event of an unrecognized hypertension and/or the 24-hours blood pressure profile of asthmatic patients through an Ambulatory Blood Pressure Monitoring (ABPM).

Design and method:

The BADA (Blood pressure levels, clinical features and markers of subclinical cArdiovascular Damage of Asthma patients) Study is aimed to evaluate the prevalence of the cardiovascular comorbidities of asthma and their impact on the clinical outcome. In this pilot study forty patients affected by asthma were consecutively recruited. Forty consecutive individuals referring for ambulatory examination due to medical reasons different from respiratory diseases served as the control group. Main exclusion criteria were the presence of other respiratory diseases, current smoking, any contraindication to ABPM.

Results:

The overall percentage of asthmatics having also hypertension was 75 % (30 patients) vs 45 % (18 patients) of the control group (p: 0,012). Reduced level of FEV1 (but neither inhaled steroid therapy or other asthma-related factors) was associated to newly-diagnosed hypertension (p: 0.0002), higher day SBP levels (p: 0.003), higher day DBP levels (p: 0.03), higher 24h-SBP levels (p: 0.005) and higher 24h-DBP levels (p: 0.03). A comparison of nocturnal dipping patterns between asthmatics and controls, do not found any statistically significant differences between the two groups.

The regression analysis performed taking into account sex, age, diabetes, fasting glucose, Body Mass Index confirms the independent role played by asthma towards the overall hypertension (both already note adn newly diagnosed): Odds Ratio (OR): 3.66 (CI: 1.29–11.1).

Conclusions:

Arterial hypertension in asthma is more prevalent than how supposed before, emphasizing the need for a deeper cardiovascular screening for asthma patients. In particular, our data highlights the need for a more extensive use of ABPM.
DOES OFFICE BLOOD PRESSURE STILL RELIABLE IN TYPE 2 DIABETES MELLITUS TO ASSESS BLOOD PRESSURE CONTROL?
Authors: Allouche Emna , Ahmed Habib Ben , Abid Omar , Boudiche Faten , Beji Mohamed , Ouechtati Wejdene , Bezdah Leila
Published: April 2021

Objective:

Ambulatory blood pressure (ABP) monitoring in type 2 diabetes (T2DM) is not yet routine in clinical practice.

We aimed to quantify abnormal ABP patterns and their associations with diabetic complications and to assess the reliability of office blood pressure (OBP) for assessing BP control in T2DM.

Design and method:

In a cross-sectional study, eligible patients with T2DM underwent OBP and 24- hour ABP measurements under standardized conditions and screening for diabetic complications.

Results:

Eighty patients (mean age 58 + 10 years, males 30%) completed assessment. All patients had a known history of hypertension. Non-dipping and nocturnal systolic hypertension (SHT) were prevalent in 54 (67,5%) and 30(37,5%) patients, respectively. Non-dipping had a significant association with microvascular complications (p = 0,001). There was no association between other abnormal ABP patterns and diabetic complications. The sensitivity and specificity of OBP for assessing BP control were 52% and 63% respectively. The positive and negative predictive values were 31% and 81% respectively.

Conclusions:

Non-dipping, reverse dipping and nocturnal SHT are highly prevalent in patients with T2DM with a known history of hypertension. Compared with nocturnal SHT, non-dipping may be a stronger predictor of end-organ damage. The reliability of OBP for assessing BP in T2DM is only modest. Patients with T2DM are likely to benefit from routine ABP monitoring.
CORONARY ARTERY CALCIUM SCORE AND HOME BLOOD PRESSURE VARIABILITY IN A MIDDLE-AGED SAMPLE OF THE SWEDISH POPULATION
Authors: Wijkman Magnus , Engvall Jan , Östgren Carl Johan , Nystrom Fredrik H.
Published: April 2021

Objective:

The aim of this study was to explore associations between coronary artery calcium (CAC) score and home blood pressure variability (HBPV) in a Swedish population sample.

Design and method:

In this cross-sectional study, we analysed data from a Swedish population-based cohort (n = 5057). We included all participants (n = 4262) who as part of the baseline examination had undergone a CAC scoring, and who also during a seven-day period had performed systolic home blood pressure measurements thirteen times (each in triplicate). Mean home systolic blood pressure (HSBP) was calculated, and its standard deviation (SD) and coefficient of variation (CV = 100 X SD / HSBP) were used as measures of HBPV. Participants were divided in four groups: group 1 had CAC score zero (n = 2578), group 2 had CAC score 1–99 (n = 1180), group 3 had CAC score 100–399 (n = 352) and group 4 had CAC score > = 400 (n = 152). One-way analysis of variance was used to test for statistically significant between-group differences. Post-hoc pairwise comparisons were adjusted for multiple comparisons as described by Bonferroni.

Results:

Overall, there were significant associations between CAC score groups and SD, CV and HSBP, (P < 0.001 for all comparisons). Average SD in group 1 (7.0 ± 2.4 mmHg) was significantly lower than in group 2 (7.3 ± 2.6 mmHg), group 3 (8.1 ± 3.0 mmHg) and group 4 (8.4 ± 3.3 mmHg), P for pairwise comparisons: 0.006, <0.001 and <0.001, respectively. Average CV in group 1 (5.9 ± 1.9) was not significantly different from group 2 (6.0 ± 2.0, P = 1.00) but was significantly lower than in group 3 (6.3 ± 2.1, P = 0.005) and group 4 (6.5 ± 2.4, P = 0.003). Average HSBP in group 1 (117.9 ± 13.6 mmHg) was significantly lower than in group 2 (122.6 ± 13.0 mmHg), group 3 (127.3 ± 12.5) and group 4 (129.1 ± 12.2 mmHg), P for all pairwise comparisons <0.001.

Conclusions:

In this middle-aged sample of the Swedish population, CAC score was modestly but significantly associated with HBPV. The prognostic performance of HBPV remains to be determined in this cohort.
VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH RISK OF HOSPITALIZATION IN A COMMUNITY ELDERLY COHORT OF 1095 PARTICIPANTS IN HONG KONG
Authors: Yiu Karen , Tsoi Kelvin , Yu Ruby , Woo Jean , Lee Eric , Wong Samuel
Published: April 2021

Objective:

Hospitalization rate is significantly higher among the elderly compared to those aged below 65. This study aimed to identify the risk factors to predict the hospitalization based on the visit-to-visit BPV.

Design and method:

e-Health project is an ongoing multi-centered programme targets to monitor BP in the elderly community by using cloud system for real-time analysis. Participants had regular BP measurement weekly and those with at least 30 BP records in the first year of follow-up were included in this analysis. Visit-to-visit BPV is defined by the mean absolute residuals of individual linear regression trend of BP readings. Machine learning approach has been used to stratify the levels of BPV for K-means clustering algorithm on both systolic and diastolic BP. All subjects were classified into low, medium and high levels of BPV groups. The hospitalization was used as the study outcome. Age, gender, mean BP, BPV, number of medications used, frailty, sarcopenia, and memory function were considered to investigate the associations. Multivariate logistic regression was used to measure the odds ratio (OR) with 95% confidence interval (CI).

Results:

A total of 1,095 subjects were follow-up for 1 year with average of 163 BP readings per each participant (SD = 74). Age, BPV, use of medications, frailty, sarcopenia, and memory function were shown to be associated with the risk of hospitalization (Table 1). In the multivariate analyses, there were significantly increased risk of hospitalization in the medium and high BPV groups (OR = 1.67; 95% CI = 1.23–2.28 and OR = 2.07; 95% CI = 1.36–3.13, respectively), in patients prescribed 1–4 medications and 5 or above medications (OR = 2.39; 95% CI = 1.29–4.86 and OR = 4.05; 95% CI = 2.09–8.51, respectively); in the pre-frail and frail groups (OR = 1.47; 95% CI = 1.04–2.09 and OR = 3.15; 95% CI = 2.11–4.74, respectively).

Conclusions:

Visit-to-visit BPV, other than comorbid conditions with complex medication used and personal frailty, is shown to be a risk factor for hospitalization. Regular measurement of blood pressure is recommended to better understand BPV levels.
RESTING HEART RATE AS A PROGNOSTIC MARKER OF HYPERTENSION AMONG SUDANESE ADULTS
Authors: Hassan Dina , Behairy Hind , Ali Ibtisam , Abdalla Asma , Abdalla Naema , Madani Safa , Elamin Maha
Published: April 2021

Objective:

Hypertension remains one of the major health problems worldwide. Elevated HR increases the risk of cardiovascular disease and contributes to the total mortality in hypertensive patients. The current survey aims to estimate the correlation of increased resting HR level to hypertension and to evaluate its use as a predicting and prognostic marker of hypertension in Sudan

Design and method:

This is a cross-sectional study based on a survey conducted by Sudanese society of hypertension during the MMM, 2018 campaign. A total of 23981 participants were recruited through opportunistic sampling from six Sudanese states, all being more thant 18 years of age (F/M ratio 1:1). Average of three measurements of heart rate, systolic and diastolic blood pressure was calculated. Hypertensive patients were defined as those having systolic blood pressure (SBP) more than or equal 130 mmHg or diastolic blood pressure (DBP) more than or equal 80 mmHg, or being on antihypertensive medication.

Results:

The crude prevalence of hypertension in our study sample was 37.4 percent. Among hypertensive patients, only 10.9 percent were aware of having high blood pressure, among whom, 65.5 percent were already on treatment for hypertension and 40.3% have their BP controlled. Normal resting HR was observed among 90.0 percent while tachycardia (HR more than100 bpm) and bradycardia (HR less than 60 bpm) were observed among 8.5 percent and 1.5 percent respectively of all hypertensive patients. Hypertensive patients unaware of having high blood pressure constituted 74.6 percent. Among unaware hypertensives, resting HR was correlated with systolic, diastolic BP, age and gender and is significantly higher among known hypertensive not receiving medication. Among known hypertensive patients, a significant correlation was observed between HR was correlated to smoking, age, gender, BMI, SBP and DBP. The age group (18–39) showed the highest percentage of elevated HR and hypertension compared to other age groups.

Conclusions:

The prevalence of hypertension is alarming and the situation is aggravated by the poor control and lack of awareness. Based on the above results, resting heart rate can be used as a predicting and prognostic marker of hypertension specially among young adults.
INFLUENCE OF AGE, SEX AND AN OCCURRENCE OF CARDIOVASCULAR EVENT ON SEASONAL VARIATIONS IN BLOOD PRESSURES IN HYPERTENSIVE PATIENTS: INSIGHTS FROM THE ASCOT COHORT
Authors: Gupta Ajay , Godec Thomas , Mackay Judith , Whitehouse Andrew , Rostamian Somayeh , Collier Timothy , Poulter Neil , Sever Peter
Published: April 2021

Objective:

In hypertensive patients, the extent to which patient-related characteristics influence seasonal blood pressure (BP) variations is unclear. We used repeated BP-measurements in the ASCOT trial to investigate the influence of age, sex, geographical residence and cardiovascular (CV) event occurrence, on the association between month-of-year and BP-level.

Design and method:

18,746 hypertensive patients, with 5-year median follow-up and a median (IQR) of 14 [12–17] visits, contributed to these analyses. We developed mixed effects models to estimate mean systolic-BP (SBP) for each month of the year. Models were adjusted for a priori confounders (age, sex, BMI, total cholesterol, presence of diabetes, smoking status, ethnicity, socio-economic status, randomized treatment-allocation) and in-trial period. Subgroup analyses were conducted by age-groups, sex, geographical residence, and occurrence of CV-event or not. Age was appropriately categorised (see figure) and geographical region was split into two-groups: Scandinavian countries and Scotland and England and Ireland. We estimated mean SBP-difference between the coldest pair of months (January/February) and warmest (July/August): overall; and separately by subgroups; evaluating for presence of interactions.

Results:

Mean SBP differs significantly across months of year, with higher BPs during winter and lower BPs during summer (mean SBP-difference between coldest and warmest pairs: 3.07 [95% CI 2.87, 3.27] mm Hg, p < 0.001). The trend was similar in each age-group, but with a significantly higher mean SBP-difference amongst older (= >75 years) patients (4.59 [3.87, 5.30] mm Hg) vs younger (<55 years) (1.97 [1.47, 2.46]) (interaction p-value < 0.001). The magnitude of mean SBP-difference differs substantially by geographical region with a mean SBP-difference of 1.99 [1.70, 2.27] mm Hg amongst those in Scandinavia and Scotland vs. 4.10 [3.82, 4.39] amongst those in England and Ireland (interaction p-value < 0.001). Those who had a CV-event had significantly higher seasonal BP-variability vs. those who didn’t, and amongst those with a CV-event: the seasonal BP-variability was higher after the event vs before (p-value = 0.034). No interaction with gender was apparent.

Conclusions:

The magnitude of seasonal BP-variability is influenced by age, residence, and an occurrence of CV-event in hypertensive patients. These findings may have important clinical implications for BP-control strategies.