bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPARISON OF ATTENDED AND UNATTENDED CENTRAL AND PERIPHERAL OFFICE BLOOD PRESSURE MEASUREMENTS IN HYPERTENSIVE PATIENTS IN GENERAL PRACTICE
Authors: Fuentes Linda Elizabeth Villagomez , Höller Julia , Riemer Thomas Günther , Matthias Klaus , Kreutz Reinhold
Published: April 2021

Objective:

Central hemodynamic indices have been established as parameters of arterial health, but the prognostic value of central vs. conventional office blood pressure (OBP) measurements remains unclear. Furthermore, the use of attended vs. unattended automated OBP measurements is a current topic of controversy.

Design and method:

We conducted a prospective cohort study in general practice in Germany and included 42 consecutive patients with hypertension. The Mobil-O-Graph oscillometric device was used for the automated OBP recordings in all patients. Measurements were performed in a separate quiet room after five minutes rest in seated position. We compared in random order in each patient the attended vs. unattended automated central and peripheral systolic OBP (SOBP), diastolic OBP (DOBP), and pulse velocity wave (PVW).

Results:

The mean age of patients was 71 years (range 34–89 years, 54.8% females). Patients were treated on average with 1.95 antihypertensive drugs. The mean attended and unattended automated peripheral SOBP (131.7 and 131.6 mmHg, respectively) and DOBP (83.4 and 82.4 mmHg, respectively) values recorded by the device were not significantly different. In addition, there was no difference between the mean attended and unattended central aortic SOBP (120.1 and 120.2 mmHg, respectively) and DOBP (84.7 and 83.7 mmHg, respectively) values. Bland-Altman analysis revealed the small inter-individual differences between attended und unattended peripheral and central SOBP and DOBP values. There was no asymmetry and narrow limits of agreement between the two methods. Finally, no significant difference for PVW was found between attended and unattended measurements (10.1 and 10.2 m/sec, respectively).

Conclusions:

The attended versus unattended status of automated OBP measurements had no impact on derived peripheral OBP, central OBP and PVW values in general practice when using the Mobil-O-Graph oscillometric device.
HOW MANY BLOOD PRESSURE VALUES WE SHOULD USE TO PREDICT OUT-OF-OFFICE BLOOD PRESSURE ON PROOF-BP ALGORITHM. IS THE MORE BETTER THAN THE LESS ?
Authors: Silva Marco Antonio Vieira Da , Resende Luiz Antonio Pertili R. De , Resende Elizabeth Mantovani R. De , Filho Dalmo Correia , Neto Otavio Barbosa , Silva Luiz Otavio Da , Jajah Camila Blanco Ferreira , Vieira Mateus Marchiori , Ferreira Pedro Paulo G. Dos Reis , Achkar João Lucas Carvalho , Vieira Livia Marchiori , Rambourg Nicole Cristine , Moreira Guilherme Marchiori , Resende Ana Luísa Mantovani , Ganem Fernando
Published: April 2021

Objective:

Compare the performance of 3 or 6 sequential blood pressure (BP) measurements to predict awake BP (ABP) values by Predicting Out of Office Blood Pressure in the clinic (PROOF BP).

Design and method:

This study is a secondary analysis of published research. A nursey collected clinical characteristics, in all participants, taking six sequential observed BP measurements, with a 1-minute interval (Microlife-BP3BTOA). Also, it was recorded ABPM (DynaMAPA). We selected 426 suspected people having hypertension. We estimated out-of-office BP on an algorithm from first to third BP (PROOF BP 1–3) and fourth to sixth (PROOF BP 4–6). We classified the patients in four BP categories, such as true hypertension (HT), true normotension (NT), masked hypertension (MH), and white coat hypertension (WCT). The office standard average considered the first three measurements as office BP (cut off – 140/90) and ABP as a reference standard, and for ABP and tested BP, the cut off was 135/85. We correctly compared the proportion of classified patients, coefficient of correlation (r), receiver operating characteristic curve (AUC), and Bland–Altman plot. The differences of proportions were evaluated using the chi-square test for media analysis of covariance.

Results:

Among 446 patients, 40.1% were classified as HT, 17.4% (MH), 11.7% (WCH) and 30.8% (NT), age 43.3 ± 13.3, women (44.6%), white people (67.8%), diabetes (2.6%), dyslipidemia (19.2%), obese (39.9%), body mass index 28. 9 ± 5.3, smokers (8.6%). The algorithm recommended AMBP in 41.07%. The proportion of HT was 40.1% MH 17.4%, WCH 11.7%, and NT 30.8%. The main clinical characteristics were age 43.3 ± 13.3, women (44.6%), white people (67.8%), diabetic (2.6%), dyslipidemia (19.2%), obese (39.9%), body mass index 28. 9 ± 5.3, smokers (8.6%). The mains results are in Table 1. Figure 1 shows a Bland and Altman plot of PROOF BP 1–3 and 4–6 against ABP.

Conclusions:

In conclusion, this secondary analysis data reinforce that the algorithm correctly classifies the vast majority of hypertensive patients and recommends ABPM in less than half of patients. It also adds that six sequential measurements no longer add accuracy to the ambulatory BP prediction tool.
24-HR AMBULATORY BLOOD PRESSURE MONITORING & ACTIGRAPHY-MEASURED SLEEP DISTURBANCES
Authors: Veerabhadrappa Praveen , Mcdonnell Evan , Rhudy Matthew , Schade Serena , Phillips Jenna
Published: April 2021

Objective:

Non-dippers tend to have a high risk for cardiovascular disease. Actigraphy has been validated for objective measures of sleep in clinical-based and population-based studies. PURPOSE: The purpose of this study was to assess Actigraphy measured sleep disturbances among dippers and non-dippers.

Design and method:

Thirteen (6F/7 M) relatively healthy and clinically free of any sleep-related disorder were recruited. 24-hr Ambulatory blood pressure (BP) monitor applied to the non-dominant arm was used to profile dipping and nondipping status (awake value - sleep value)/awake value < 0.1. 24-hr wrist (dominant arm) Actigraphy data were collected in 1 min epochs, and the ‘Cole-Kripke’ sleep algorithm for adults was used to assess sleep. Sleep disturbance metrics including sleep efficiency, total min in bed, total sleep time, number of awakenings, long wake after sleep onset (WASO: number of min awake between sleep onset and time of final waking) were assessed.

Results:

Awake SBP (Mean ± SD) for non-dippers (N = 7) 120.2 ± 8.1 vs. dippers 129.1 ± 8.1mmHg; sleep SBP for non-dippers 117.2 ± 8.4 vs. dippers 114.3 ± 5.5mmHg. Non-dippers vs. dippers sleep efficiency (85 vs. 89%); total min in bed (408 vs. 450 min); total sleep time (352 vs. 398 min); number of awakenings (21.1 ± 10.2 vs. 21.1 ± 3.1) were not statistically different. WASO for non-dippers 55.5 ± 32.5 vs. dippers 49.5 ± 18.2 min (p < 0.05).

Conclusions:

In our preliminary study with a very small N, WASO was 10% higher in non-dippers compared to dippers despite having similar number of awakenings. This indicates that participants with a non-dipper blood pressure profile have disturbed sleep with being awake for a greater amount of time between sleep onset and time of final waking when compared to dippers. Thus, sleep assessment among non-dippers might be reasonable.
GEOGRAPHIC VARIATION IN VASCULAR STIFFNESS VALUES IN CROATIAN AND INDIAN PATIENTS WITH HYPERTENSIVE URGENCY
Authors: Varahabhatla Sai Krishna Ragh , Achappa Basavaprabhu , Kamath Padmanabh , Prkacin Ingrid
Published: April 2021

Objective:

The food habits, life style and genetic constitution are different for every country and contribute to a significant raise in blood pressure. Objective was to estimate the values of pulse wave velocity (PWV) and central blood pressure (CBP) in hypertensive urgency (raise in systolic and diastolic blood pressure with no end target organ damage) in patients from two different geographical areas Croatia (C) and India (I) for the first time non-invasively.

Design and method:

We identified 17 patients from Croatia and 20 patients from India with a clinical diagnosis of hypertensive crisis with no end target organ damage, who entered the emergency outpatient clinics in respective countries. The PWV, pulse pressure (PP), CBP, brachial pressure (BP) were evaluated using the noninvasive Agedio B900 device (Germany). Statistical data was processed in SPSS software, significant differences were considered at p < 0,05.

Results:

Average age of patients in C (64,18 ± 10,87 years, 58,82% were females and 41,18% were males); I (63.35 ± 9.74 years, 30% were females and 70% males). Average brachial systolic BP in C and I was found to be 191,17 ± 10,98 mmHg and 191,42 ± 9,88 mmHg respectively. Average central systolic blood pressure in C and I was 149.23 ± 18.93 mmHg, 178.35 ± 28.61 and average central diastolic blood pressure was 99.23 ± 17.22 mmHg; 115.64 ± 8.01 respectively. PWV for each patient was higher than the reference range for age with average values of 10,5 ± 2,01 m/s in C and 11.74 ± 1.74 in I population. Student's t-test showed statistically significant difference between PWV measured in patients from Croatia and India (C- 10.54 ± 2.15, I- 11.17 ± 1.74; p = 0.008). Values of PWV showed a positive correlation with age in both patient groups C (r = 0.9471, p < 0.00001); I (r = 0.838, p < 0.00001). Central systolic blood pressure shows a weak positive correlation with PWV, C (r = 0.5225, p = 0.03);I (r = 0.1294, p = 0.05).

Conclusions:

It is clear from the results that the PWV, CBP and vascular age were higher in Indian population than the Croatian data. This is explained by the irregular lifestyle, high risk of diabetes, obesity and high salt diet corresponds to increased vascular stiffness.
PRESCRIPTION PATTERN AND FACTORS ASSOCIATED WITH THE CONTROL OF BLOOD PRESSURE AMONG HYPERTENSIVE PATIENTS RECEIVING CARE IN A NIGERIAN TERTIARY HOSPITAL
Authors: Ukoha-Kalu Blessing Onyinye , Adibe Maxwell , Ukwe Chinwe
Published: April 2021

Objective:

Despite the numerous Pharmacological and non-Pharmacological modalities available for the management of Hypertension, majority of the patients. The study aimed to identify the factors associated with the control of blood pressure among hypertensive patients receiving care in a Nigerian Tertiary Hospital.

Design and method:

The study was a retrospective cross sectional study carried out at the University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu State Nigeria. A well Structured Pro-forma was used to extract variables from patient folders. These variables include Age, gender, marital status, religion, state of origin, educational level, occupation, age at first dose of antihypertensive, co-morbidities (diabetes, CKD), antihypertensive(s) used, duration of therapy, reasons for stopping (if stopped). Quantitative data was managed using Microsoft office excel and statistical product and services solution (SPSS) for windows.

Continuous variables were expressed as mean ± SD and categorical variables as percentages with 95% confidence intervals. The students’t-test and the paired sample t-test were used to compare continuous variables while the pearson chi square test and fishers exact test will be used to compare categorical variables. All statistical test will be considered significant when the 2- sided p-value is <0.05.

Results:

Three hundred and Ninety patient Folders were used for the study. About 174 (42.4%) of the patients were male while 216 (52.7%) were female with a mean age of 62 years. Amlodipine with a frequency of 182 (64%) was the most prescribed antihypertensive in this study followed by losartan 182 (46.43%) and the least being atenolol and nebivolol with frequency of 4 (1.03%) each. 302 (94.4%) patients had hypertension and an existing comorbidity while 88(22.6%) had no comorbidities. The most common comorbidities were diabetes mellitus and chronic kidney disease.

About 197 (50.3%) of the patients had their blood pressure under control while 193(49.7%) had uncontrolled blood pressure. Age, Monthly income, educational status and presence of comorbidity were the major predictors of uncontrolled blood pressure.

Conclusions:

Amlodipine was the most frequently prescribed antihypertensive. About half of the patient had their blood pressure uncontrolled. Age and monthly income were associated with uncontrolled blood pressure.
COMPARISON OF THE EUROPEAN SOCIETY OF HYPERTENSION STRATIFICATION AND EUROPEAN SOCIETY OF CARDIOLOGY HEARTSCORE FOR PREDICTION OF CORONARY ARTERY DISEASE AND STROKE IN ESSENTIAL HYPERTENSION
Authors: Leontsinis I. , Tsioufis K. , Dimitriadis K. , Kasiakogias A. , Liatakis I. , Koutra E. , Konstantinidis D. , Laina A. , Kouremeti M. , Andrikou I. , Iliakis P. , Tsioufis P. , Thomopoulos K. , Tzorovili E. , Tousoulis D.
Published: April 2021

Objective:

For estimation of overall cardiovascular risk ESH proposes stratification according to BP, prevalence of risk factors, asymptomatic TOD, diabetes, kidney and symptomatic cardiovascular disease, while the ESC HeartScore constitutes another potent predictive tool of adverse outcome. The purpose is to compare the predictive role of ESH stratification and ESC HeartScore for the incidence of the composite end-point of coronary artery disease (CAD) and stroke in a cohort of essential hypertensive patients.

Design and method:

We followed up 2150 essential hypertensives (mean age 55.7 years, 1085 males, office BP = 145/91 mmHg) for a mean period of 8 years. All subjects had at least one annual visit. CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure. Stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by imaging findings.

Results:

The incidence of CAD, stroke and their composite over the follow-up period were 2.8% 1.11% and 3.9% respectively. By using the ESH stratification, 15.3% was of low and moderate risk, 54.4% was of moderate to high and high risk and 30.3% was high to very high and very high risk. According to the ESC HeartScore 89.2% was of low to moderate risk, 10% of high risk and 0.8% of very high risk. Cox-regression analyses revealed that high to very high and very high ESH risk category was related to increased risk for the composite end-point of CAD and stroke (hazard ratio = 4.5, p < 0.0001), while focusing on the ESC Heart Score the composite end-point was predicted by the high risk category (hazard ratio = 3.43, p < 0.0001). The ESH risk model had better fit than the ESC HeartScore due to the lowest Akaike's values (1442.66 vs 1498.31, respectively).

Conclusions:

The ESH risk stratification constitutes a better prediction model for CAD and stroke than the ESC HeartScore in essential hypertension and its estimation is essential in order to improve overall risk assessment in this setting.
ASSOCIATION OF SLEEP-DISORDERED BREATHING AND SLEEP-RELATED FACTORS WITH DIFFERENT TYPES OF NOCTURNAL–MORNING HYPERTENSION AND OFFICE HYPERTENSION: THE NAGAHAMA STUDY
Authors: Tabara Yasuharu
Published: April 2021

Objective:

High morning blood pressure and an increase in the nocturnal blood pressure are well-documented risk factors for poor cardiovascular outcomes. A possible shared risk factor for the morning and nocturnal hypertension (HT) is sleep-disordered breathing (SDB). This study aimed to clarify the association of SDB with nocturnal and morning HT, as well as office HT, to better understand the pathophysiological significance of SDB in HT.

Design and method:

Study participants in this cross-sectional study were 5,866 general population (mean age: 57.9 years). Sleep characteristics including sleep duration and sleep efficiency were evaluated using a wrist activity monitor for one week. SDB was assessed using the 3% oxygen desaturation index corrected for actigraphy-determined sleep duration. A timer-equipped cuff-oscillometric device was used for home and sleep blood pressure monitoring. The BP monitor was programmed to automatically measure the BP at 0.00, 2.00, and 4.00 a.m. Sleep BP was determined using actigraphy and BP values measured within 1 h after waking up and within 1 h before sleeping were considered as morning and evening BPs, respectively.

Results:

Isolated nocturnal, isolated morning, and sustained nocturnal-to-morning HT occurred in 13.5%, 9.1%, and 25.9% of participants, respectively. Participants with HT generally were older, more frequently were men, and obese compared with normotensive individuals (all P < 0.001). Other clinical factors that were significantly different depending on the HT types were carotid hypertrophy, nocturnal voiding frequency, sleep efficiency, and SDB (all P < 0.001). Multinomial logistic regression analysis identified SDB as a significant determinant for sustained HT (coefficient = 0.026, P < 0.001) and morning HT (coefficient = 0.024, P < 0.001) but not isolated nocturnal HT (P = 0.907). SDB was also associated with office HT (Coefficient = 0.027, P < 0.001). In contrast, low sleep efficiency was associated with isolated nocturnal HT, while the frequency of nocturnal urination showed a positive association with isolated nocturnal HT and sustained HT.

Conclusions:

SDB had a stronger influence on morning than nocturnal BP, while low sleep efficiency and nocturnal urination had greater influences on sleep BP
UNATTENDED VERSUS ATTENDED BP MEASUREMENT: RELATIONSHIP WITH 24 HOURS BLOOD PRESSURE VALUES
Authors: Salvetti Massimo , Paini Anna , Bertacchini Fabio , Aggiusti Carlo , Stassaldi Debora , Capellini Sara , Saccà Giovanni , Arnoldi Chiara , De Ciuceis Carolina , Rizzoni Damiano , Bertini M. , Gatta Roberto , Muiesan Maria Lorenza
Published: April 2021

Objective:

It has been suggested that measurement of “unattended” or “automated oscillatory” blood pressure(BP) values (AOBP) may provide advantages over conventional BP measurement. More data are needed on the relationship between BP values measured by the conventional approach, by AOBP and values obtained by 24 hours BP monitoring (ABPM).

Design and method:

In 607 consecutive patients attending the outpatient clinic at an ESH Excellence Centre, BP values were measured by the physician with an automated oscillometric device (Omron HEM 9000Ai, mean of 3 measurements), after 5 minutes of rest. After the measurement of BP by the physician, the patient was left alone in the room, and the device was programmed to automatically perform 3 BP measurements after 5 minutes. ABPM was performed in all subjects.

Results:

Mean age was 60 ± 13 yrs, 53% females, BMI 26 ± 4, 77 % with a previous diagnosis of hypertension (58 % treated). Unattended systolic BP (SBP) (126.4 ± 14.5) was lower as compared to attended SBP (132.7 ± 15.9mmHg) and to 24 hours daytime BP (129.4 ± 14.5 mmHg). Attended and unattended SBP were similarly correlated to daytime BP (r = 0.649, R = 0.669, P < 0.000, p for the comparison between r ns). The differences (d) between SBP values obtained using the three techniques were 6.3 ± 7.7 mmHg (attended-unattended), 3.5 ± 12.2 mmHg (attended-daytime BP) and – 2.8 ± 11.0 (unattended-daytime).

Conclusions:

Our findings indicate that “unattended BP” measurement provides values significantly lower as compared to measurements obtained in the presence of the physician and also to 24 hours daytime BP. In our population BP values obtained by the unattended approach are similar to 24 hours daytime BP values. However 24 hours daytime BP was similarly correlated to both attended and unattended BP
DISTRIBUTION OF SPOT URINARY ELECTROLYTES AND THEIR PREDICTED 24 HOUR LEVELS BY ETHNICITY ASSOCIATIONS WITH MORTALITY IN A LONGITUDNAL COHORT
Authors: Saluja Sushant , Powell Leo -Paul , Jiang Xiao , Heald Adrian , Cruickshank Kennedy , Anderson Simon
Published: April 2021

Objective:

Hypertension is a modifiable risk factor for development of cardiovascular disease. Increased urinary sodium excretion, representing high dietary sodium intake is associated with hypertension. Observational cohort studies consistently demonstrate a low sodium intake is also associated with increased mortality. It is not known what the optimal amount of salt intake is good for cardiovascular health. Hypertension is a modifiable risk factor for development of cardiovascular disease. Increased urinary sodium excretion, representing high dietary sodium intake is associated with hypertension. Observational cohort studies consistently demonstrate a low sodium intake is also associated with increased mortality. It is not known what the optimal amount of salt intake is good for cardiovascular health.

Design and method:

Urine samples were obtained from 331 people [100 Afro-Caribbean (AC), 118 European and 113 Gujarati Indians] to estimate 24-hour sodium and potassium excretion. Association between estimated urinary sodium, potassium and creatinine excretion to composite outcome of major cardiovascular event and death were examined. We also aimed to study if ethnicity influenced this relationship.

Results:

We noted heterogeneity in association between sodium, potassium, creatinine excretion and mortality. Significantly higher, age-sex adjusted, spot urinary sodium (OR- 2.7; CI – 1.9–3.2) and creatinine (OR- 1.7; CI – 1.2–2.2) levels were seen in AC men who also had higher mean diastolic blood pressure (84 ± 5.5 vs 78 ± 3.3; p < 0.05). Overall, 42.9% (n = 142) of the cohort were hypertensive. Of the 331 eligible participants at baseline, a total 69 cardiovascular deaths were recorded. Spot sodium levels were higher in those who died from cardiovascular causes [(125.3; CI- 116.9, 133.7) mmol/l] vs [(108.7; CI - 99.4 – 118.0); p = 0.02]. Survival was associated with a urinary sodium below and urinary potassium above the median. There was no survival advantage associated with differences in creatinine output.

Conclusions:

This study estimates a sodium intake of between 2.0 g/day and 2.5 g/day as being associated with a lower risk of death and cardiovascular events. A higher potassium excretion was associated with a lower risk of death and cardiovascular events. Creatinine output made no difference to survival advantage.
ASSESSING THE USEFULNESS OF SELF-MEASUREMENT OF BLOOD PRESSURE IN PATIENTS IN CONTROLLING BLOOD PRESSURE IN HYPERTENSIVES
Authors: Patil Vishal , Patil Mansi
Published: April 2021

Objective:

To evaluate the efficiency of self-measurement of blood pressure (SMBP) in controlling blood pressure levels in known hypertensives

Design and method:

The study was conducted on 1700 known adult hypertensives attending the outpatient department of a charitable hospital. The patients were on anti-hypertensive treatment but had poorly controlled hypertension (Systolic Blood pressure more than equal to 140 mmHg, Diastolic Blood Pressure more than equal to 90 mmHg). The patients were divided into Group 1(Non-Intervention group) and Group 2 (Intervention group). The patients were given an Omronâ HEM-7200-AP3 automatic blood pressure monitor to record their blood pressure daily at home. Blood pressure was recorded at each visit to the clinic. There were 820 participants in the intervention group, 880 in the control group. Baseline characteristics were similar in both groups. Training was given to the participants to measure their blood pressure. The patients recorded 3 blood pressure readings at home daily in the morning at an interval of 1 minute between each reading.

Results:

Blood pressure was measured after 6 weeks of the self-monitoring of blood pressure and the proportion of patients whose blood pressure was well controlled was 13.4% higher in the intervention group than in the control group (P = .01). After 12 weeks of SMBP the difference between groups was 14.1% (P = .02).

Most participants(n = 1340/1700, 78.8%) did not take 5 minutes rest before recording their first blood pressure and 91.7% participants (n = 1560/1700) did not wait for 1 minute between two blood pressure readings.

Conclusions:

Self-measurement of blood pressure was effective in controlling blood pressure in the short term, but its effects need to be studied over a long term.

The patients did not wait for 1 minute between each blood pressure reading or took complete 5 minutes rest before the first reading.

Regular training and guidance for the patients is needed for protocols to be followed.
ACCURACY OF THE WATCHBP O3 DEVICE FOR AMBULATORY BLOOD PRESSURE MONITORING ACCORDING TO THE NEW CRITERIA OF THE ISO81060–2 2018 PROTOCOL
Authors: Fania Claudio , Lazzaretto Ilaria , Fontana Umberto , Palatini Paolo
Published: April 2021

Objective:

To determine the accuracy of the Microlife WatchBP O3 monitor for ambulatory blood pressure measurement according to the new ISO81060–2 2018 protocol.

Design and method:

The WatchBP O3 model is an oscillometric fully automatic device for blood pressure measurement at the upper arm. The device accuracy was first tested in 97 subjects from the general population (mean age, 71.3 years; 48 men) over a wide range of arm circumferences using four cuffs of different size suitable for arm circumferences ranging from 14.0 to 52.0 cm. In a second study, 36 subjects (mean age, 72.9 years; 18 men) underwent stress testing on a cycle ergometer in order to increase their heart rate by 15% or more. The new recommendations of the ISO81060–2 2018 protocol were followed. Blood pressure measurement was performed by two observers with binaural stethoscope using the same arm sequential method.

Results:

In the general population, the mean device–observer difference in the 291 separate blood pressure data pairs was 1.33 ± 3.18 mmHg for systolic blood pressure and was 0.73 ± 3.17 mmHg for diastolic blood pressure. These data were in agreement with criterion 1 of the protocol standard requirements (mean, less than or equal to 5 mmHg; SD, ± 8 mmHg). Also criterion 2 was satisfied being the Standard Deviations of the 97 participants well below the maximum values required by the protocol. During the ambulatory monitoring study, the minimum heart rate increase during exercise stress testing was obtained in all subjects. The average heart rate increase was 20.3% (range 15.4% to 28.9%). The mean device–observer difference in the 108 separate blood pressure data pairs was 1.51 ± 2.79 mmHg for systolic blood pressure and was 1.72 ± 2.58 mmHg for diastolic blood pressure. Also these data were in agreement with criterion 1 of the protocol standard requirements.

Conclusions:

These data show that the Microlife WatchBP O3 monitor satisfied the ISO 81060–2:2018 standard requirements for a general population across a wide range of arm sizes and that also the protocol criteria for validation of devices intended for ambulatory blood pressure monitoring were fulfilled.
SLEEP APNEA, HYPERTENSION AND DIABETES: RISK FACTORS FOR CARDIOVASCULAR DISEASE
Authors: Filho Silvio Paffer , Paffer Matheus Toscano , Paffer Pedro Toscano
Published: April 2021

Objective:

Obstructive sleep apnea (OSA) is an emerging risk factor for cardiovascular disease and its coexistence with high blood pressure (HBP) and Diabetes mellitus (DM) is very common among patients, especially in obese patients, when its presence play a major role for the development of such co-morbidities.

To evaluate a cohort of 177 patients with diagnosis of OSA and observe the coexistence of HBP and/or DM at a private hypertension clinic.

Design and method:

177 patients with diagnosis of OSA (apnea/hypopnea index >= 5) had their medical records analyzed over the period of January to November of 2019, in order to identify the presence of HBP and/or DM at a private hypertension clinic. All the patients were submitted to a home polysomnography with a Resmed Apnealink Air device over a period of one night.

Results:

The sample consisted of 177 patients, 107 male (60.45%). 19% had mild OSA (apnea/hypopnea index – AHI >=5), 45% moderate OSA (AHI>=15) and 36% severe OSA (AHI>=30). 79 % of the patients with OSA diagnosis also were hypertensive (Blood pressure >=140x90mmHg), 44.6% had type 2 DM and 34,4% had both DM and HBP diagnosis. The AHI in the whole sample ranged from 6 to 234, average of 28.97 +−22.8, and the mean minimum Oxygen saturation was 78.17 +−7.36 %.

Conclusions:

It is well known the contribution of OSA for the development of HBP, especially in those patients with resistant hypertension. The presence of OSA is also a key factor for the development of type 2 DM, with the latest guidelines suggesting the screening for this condition at the diabetic population, especially with the epidemic data of obesity, condition extremely common both on DM and OSA. In this study, it was very evident the association of these co-morbidities, with 79 % of the group of patients with sleep apnea being hypertensive. More than 1/3 of the sample with the diagnosis were both hypertensive and diabetic, reassuring the relationship of both conditions and OSA.
HOME BLOOD PRESSURE MONITORING: REPORT OF A DATABASE OF 1474 PATIENTS
Authors: Filho Silvio Paffer , Paffer Matheus Toscano , Paffer Pedro Toscano , Figeuiredo Matheus Cabral , Veras Carmen Oliveira , Fonsêca Francyelle Barbosa
Published: April 2021

Objective:

Hypertension is a highly prevalent disease, considered one of the main risk factors for major cardiovascular events. Out of office blood pressure (BP) evaluation has been encouraged in the most recent hypertension guidelines, once validated devices become more available with reasonable costs and good quality. White coat hypertension phenomenon is defined as a clinical condition when the patient has elevated office BP values and normal values at home readings through home blood pressure monitoring(HBPM) or 24 hour BP monitoring. The aim of this study is to review a databank of 1,474 patients who performed HBPM assisted at a private cardiology clinic, highlighting the cases of white coat hypertension.

Design and method:

We evaluated the HBPM results of 1474 patients from a private cardiology clinic, in Recife/PE, Brazil. The device model used on all patients was the Omron 705 CP BP Monitor during 5 days after explanation of the correct usage and protocol (3 readings in the morning and 3 at night, before meals), excluding the first day of the readings.

Results:

1474 patients were studied, 57.8% woman, with average age of 53.4 years (+− 16.17). The average office measurement of systolic BP was 130.68 mmHg (+−18.54) and diastolic of 81.83 mmHg (+− 11.55). The mean systolic pressure of the HBPM tests was 123.99 mmHg (+−14.3) and the diastolic was 76.5 mmHg (+−8.99). 196 patients (13.3% of the group) had the diagnosis of white coat hypertension. 50.5% were male and the average age was 56 years old (+− 15.15). The mean office systolic BP was 148.5 mmHg (+−11.79) and diastolic was 90 mmHg (+−8.78). The overall average of the HBPM for the systolic BP was 125 mmHg (+−6.78) and diastolic of 76.4 mmHg (+−6.44).

Conclusions:

White coat hypertension had significant high prevalence among evaluated patients, highlighting the importance of the HBPM for arterial hypertension diagnosis. Therefore, it is important to follow the most recent guidelines from all over the world, as the latest European one, which suggests the importance of HBPM in order to avoid the misdiagnosis of hypertension and unnecessary medication.
OPTIMAL DURATION OF UNATTENDED AUTOMATIC BLOOD PRESSURE MEASUREMENTS IN SUBJECTS WITH NEWLY DIAGNOSED TYPE 2 DIABETES
Authors: Olesen Thomas , Jøhnk Frederik , Nielsen Jens Steen , Højlund Kurt , Olsen Hecht
Published: April 2021

Objective:

Unobserved automated office blood pressure (AOBP) measurement is better correlated to daytime ambulatory blood pressure (Day-ABPM) than traditional office blood pressure (BP) measurements. However, prolonged AOBP duration may underestimate BP-levels especially in subjects with increased risk of cardiovascular disease. The aim of this study was to determine optimal duration of AOBP in subjects with newly diagnosed type 2 diabetes (DM2).

Design and method:

A subsample of participants from the “Specialist supervised individualized multifactorial treatment of new clinically diagnosed type 2 diabetes in general practice” (IDA) study underwent 24 hour ABPM as well as unattended AOBP. AOBP recordings were taken in the sitting position and started without prior rest for 25 minutes at 3 minute intervals (with a minimum of 7 valid recordings). Multiple intervals/protocols were compared with Day-ABPM by mean difference and Pearsons correlation coefficients. Logistic regression for each time-interval was used to evaluate the area under the curve (AUC) for prediction of uncontrolled hypertension defined as Day-ABPM>135mmHg. The same type of BP device (Mobil-O-Graph, IEM) was used for both AOBP and Day-ABPM.

Results:

We evaluated 159 subjects (39% female) with a mean age of 58 ± 11 years. 93 (58%) subjects were treated for hypertension. Average Day-ABPM was 129 ± 12/79 ± 9 mmHg. The optimal AOBP protocol was found when taking the average of 15 minute recordings after discarding the initial 10 minute recordings with a mean difference between systolic AOBP and Day-ABPM of 1.4mmHg with 95% limits of agreement between -16.5 and 19.4mmHg (Pearson correlation coefficient = 0.74). In comparison, duration of AOBP of 10 minutes without prior rest yielded a mean difference to Day-ABPM of 4.5mmHg with 95% limits of agreement between -16.12 and 25.3mmHg (Pearson correlation coefficient = 0.69).

The prediction of uncontrolled hypertension was superior in the optimal protocol AUC = 0.853 (0.795–0.910) compared to all protocols derived from measurement duration up to 10 minutes, P = 0.029 (highest AUC = 0.812, from 10 minute duration, discarding the first recording).

Similar observations were made for diastolic BP measurements.

Conclusions:

In patients with newly diagnosed DM2 extending AOBP duration beyond 10 minutes improved correlation to Day-ABPM and improved predictive capability of detecting uncontrolled hypertension.
POSSIBLE ROLE OF THE INVASIVE ARTERIAL BLOOD PRESSURE MEASUREMENT IN SEVERE RESISTANT HYPERTENSION AND GENERALISED ATHEROSCLEROSIS
Authors: Vujanic Aleksandra , Babnik Nina Filipic , Oblak Teja , Dolenc Primoz , Salobir Barbara , Hitij Jana Brguljan
Published: April 2021

Objective:

In severe resistant hypertension, a generalised atherosclerosis with high arterial stiffness present significant challenge for clinicians to obtain the realistic non-invasive blood pressure measurements and adjust antihypertensive treatment successfully.

Design and method:

Several patients with generalised atherosclerosis and severe resistant hypertension of the renovascular and renoparenchymal aetiology were referred to our Excellence centre. After performing ambulatory blood pressure monitoring (ABPM) and testing for non-compliance, often we still don’t reach target blood pressure. Due to generally expressed atherosclerosis, daily oscillometer technique could not be reliable in these set of patients.

Invasive arterial blood pressure measurements via intra-arterial radial line were recorded for 24-hours and the consecutive non-invasive blood pressure was measured on the ipsilateral arm by oscillatory method.

Results:

In 3 patients, hypertension was renovascular and renoparenchymal (serum creatinine 134–219 micromol/l, oGF CDK-EPI 47 ml/min). The blood pressure values obtained by oscillatory method ranged from 170/100 mmHg to 230/120 mmHg. Generalised atherosclerosis with obstructive coronary and carotid artery disease, stenosis of iliac arteries, a hemodynamically important renal artery stenosis and subclavian artery stenosis was present in all 3 patients; one had comorbid periaortitis. Two patients were treated with six and one with five antihypertensives in maximum doses, at least one being a diuretic, and with at least one antihypertensive drug exceeding maximum dose. The difference in blood pressure measurements by the invasive vs. non-invasive method ranged from -20/10 mmHg to -50/30 mmHg. In 2 patients, marked blood pressure elevations (+40/20 mmHg) were triggered by elevated sympathycotonus. At discharge, doses of antihypertensive drugs could be lowered or stayed in the same range and a short-acting anxiolytic was added.

Conclusions:

In patients with severe resistant hypertension and generalised atherosclerosis, after excluding non-adherence, invasive blood pressure technique could be helpful in determining the relative difference to non-invasive measurements and safely adjusting antihypertensive therapy.
DIFFERENCE IN BLOOD PRESSURE VALUES FROM OBSERVED AND NO OBSERVED BLOOD PRESSURE MEASUREMENTS WITH AWAKE BLOOD PRESSURE
Authors: Moreira Guilherme Marchiori , De Martino Fernando , Resende Luiz Antonio Pertili R. De , Resende Elizabeth Mantovani R. De , Filho Dalmo Correia , Neto Otavio Barbosa , Dias Valdo Jose , Resende Jose Augusto Mantovani , Vieira Mateus Marchiori , Vieira Livia Marchiori , Resende Ana Luisa Mantovani , Marra Danilo , Capuci Hebert Henrique , Silva Marco Antonio Vieira Da
Published: April 2021

Objective:

Evaluate the correlation and agreement of blood pressure (BP) values from observed and non-observed measurements with awake blood pressure (ABP).

Translate the results of the difference between observed and awake BP into SPRINTb Ambulatory Blood Pressure Study.

Design and method:

Two hundred seventy-eight patients over eighteen years old were eligible. After 5 minutes on rest, a nurse collected clinical characteristics, took three sequential observed (OBP) and non-observed (N-OBP) BP measurements (Microlife- BP 3AC1–1PC), in an alternate order, every fifteen seconds. Also, was recorded twenty-four hours of ABPM (DynaMAPA). BP measurements and ABPM recording followed recommendations of European Guidelines.

We calculated Cardiovascular (CV) risk using the SCORE system. aa well as, the average of OBP, N-OBP, awake BP (ABP), and the difference OBP-ABP. We assessed the relationship of observed or non-observed BP values with ABP by calculating the Pearson coefficient (r), and the agreement using a Bland–Altman plot. The significance of differences between average BP values was evaluated using analysis of covariance and Student's T-Test into variance in OBP-ABP.

Results:

Among 278 patients, 48.6% performed non-observed BP measurements firstly. Demographic and main clinical characteristics were demonstrated in table 1, as well as, all BP media and the differences between OBP-ABP in four subgroups of the studied population. The table below shows p values p values to compared of BP average and differences on BP. Figure 1 shows a Bland Altman plot of the agreement between tested BP against ABP. Figure 2 shows the results of the correlation between the tested BP and ABP. The red marks on X-axis are the ABP values on standard (S - 138.8/78.6) and intensive (I - 126.5/72.0) groups at the end of 27 months of the ABP SPRINT Study, and those on Y-axis the corresponding values of OBP and N-OBP, according to the differences with ABP found in this study.

Conclusions:

In conclusion, the findings of this study showed a strong correlation and a significant difference to both observed, no observed BP values with awake BP. Our results could be useful in interpreting the ABP SPRINT Study.
MAY MEASUREMENT MONTH 2019: AN ANALYSIS OF BLOOD PRESSURE SCREENING RESULTS IN NEPAL
Authors: Khanal Pratik , Bhattarai Hari Krishna , Ranabhat Kamal , Adhikari Tara Ballav , Koirala Sweta , Parajuli Surya , Pokharel Yashashwi , Mishra Shiva Raj , Shrestha Aamod Dhoj , Paudel Santosh , Soti Pabitra Babu , Mahato Sweta , Pandey Ghanashyam , Gyawali Pawan , Pandey Sadhana , Devkota Surya , Koirala Bhagawan , Neupane Dinesh
Published: April 2021

Objective:

Hypertension is a leading risk factor of global deaths. May Measurement Month (MMM) is an initiative of the International Society of Hypertension (ISH) to raise awareness on the importance of measuring blood pressure. Nepal has been participating in the MMM campaign since 2017. This study presents the initial results of 2019 MMM in Nepal.

Design and method:

An opportunistic cross-sectional survey of volunteers aged at least 18 years was carried out in May 2019. Data were collected from 30 out of 77 districts using structured questionnaire developed by ISH; adapted in the local language and context. Screenings were conducted in health facilities and public places using either the digital or manual sphygmomanometers. Trained volunteers were mobilized to take part in the screening. Ethical approval for the study was obtained from the Nepal Health Research Council.

Results:

The mean age of the participants was 39.4 ± 15.2 years and 58% of them were female. A total of 72,320 individuals were screened, out of which the mean of the 2nd and 3rd readings was available for 66,955 {93%} individuals. The proportions of self-reported diabetes, current tobacco user and current alcohol drinkers were 6%, 24% and 22% respectively. Likewise, 27% of the participants were overweight and 12% were obese. The mean systolic blood pressure was 119 ± 14 mm Hg and mean diastolic blood pressure were 80 ± 11 mm Hg. A third of the participants {32%} were screened for blood pressure for the first time in the last one year. The proportion of hypertension was 24% {n = 15,872} with more hypertensive male {28%} than female {18%}. Among individuals with hypertension, 47% {7,507} were receiving treatment and among those under treatment, 19% {1,226} had uncontrolled blood pressure.

Conclusions:

These blood pressure screening results suggest higher proportion of hypertensive patients were not on treatment and only a fifth of those under treatment achieved blood pressure control in Nepal. Screening campaign such as MMM with mobilization of volunteers can be an important approach for identifying undetected or uncontrolled cases of hypertension in low resource settings like Nepal.
ESTIMATION OF MEAN ARTERIAL PRESSURE BY THE ANALYSIS OF BRACHIAL PULSE WAVEFORM RECORDED BY APPLANATION TONOMETRY AND COMPARISON WITH CURRENTLY USED ALGORITHMS
Authors: Grillo Andrea , Colapietro Nina , Salvi Paolo , Furlanis Giulia , Baldi Corrado , Rovina Matteo , Salvi Lucia , Faini Andrea , Bilo Grzegorz , Fabris Bruno , Carretta Renzo , Benetos Athanase , Parati Gianfranco
Published: April 2021

Objective:

Mean arterial pressure (MAP) is usually calculated by adding one third of pulse pressure (PP) to diastolic blood pressure (DBP). This formula assumes that the average waveform of pulse pressure (PP) is constant in all individuals and 33.3% of PP is needed to obtain MAP (MAP = DBP + PPx0.333). Other empirical formulas were proposed to calculate MAP, by adding to DBP a different established percentage of PP: MAP = DBP + PPx0.40; MAP = DBP + PPx0.412; MAP = DBP + PPx0.333 + 5mmHg. The estimation of MAP by considering a fixed relationship between SBP and DBP may not be appropriate in the single patient, if significant inter-individual and intra-individual variations occur in the pressure waveform.

Design and method:

We evaluated the inter-individual variations in MAP calculated from the integral of brachial pressure waveform recorded by applanation tonometry in 1526 patients belonging to 3 distinct cohorts: elderly, hypertensive, and normotensive adults, and the intra-individual variations in 19 healthy controls after a mental stress test.

Results:

The percentage of PP required to be added to DBP to obtain MAP was extremely variable among individuals, ranging from 23% to 58% (mean: 42.2 ± 5.5%), was higher in females (42.9 ± 5.6%) compared to males (41.2 ± 5.1%, p < 0.001), lower in the elderly cohort (40.9 ± 5.3%) than in the general population cohort (42.8 ± 6.0%, p < 0.001) and in the hypertensives (42.4 ± 4.8%, p < 0.001). This percentage was significantly associated with DBP (b = 0.357, p < 0.001) and gender (b = 0.203, p < 0.001). A significant increase in this percentage (from 39.9 ± 3.2 to 43.0 ± 4.0, p < 0.0001) was found in 19 volunteers, after mental stress test, and was significantly correlated to the increase in blood pressure and heart rate (p = 0.001). MAP value assessed on the brachial tonometric curve was compared with the MAP estimated by formulas proposed in the literature: the average bias from tonometric MAP (mean ± 1.96xSD) was: -5.0 ± 6.7 mmHg when MAP = DBP + PPx0,333; -1.2 ± 6.1 mmHg when MAP = DBP + PPx0.40; -0.6 ± 6.1 mmHg when MAP = DBP + PPx0.412; -0.4 ± 6.7 mmHg when MAP = DBP + PPx0.333 + 5.

Conclusions:

Due to high interpersonal variability, the estimation of MAP based on fixed formulas is unreliable and inadequate. An improvement in the evaluation of MAP is advisable in daily clinical practice and may be based on the analysis of brachial pulse waveform.
A BEFORE AND AFTER STUDY ON THE PROFICIENCY IN BLOOD PRESSURE MEASUREMENT OF POST-GRADUATE INTERNS
Authors: Gonzales-Rome Karen , Guison-Bautista Ma Teresa Tricia
Published: April 2021

Objective:

This research determines if there is an improvement in the blood pressure skills of post-graduate interns after watching a video presentation on how to take the blood pressure

Design and method:

Descriptive study Forty post-graduate interns rotating in the Family Medicine department were randomly observed prior and subsequently after watching the video on blood pressure measurement. They were assessed using the American Heart Association 11-element skill set.

Results:

Sadly, even after the video presentation, the subjects were still prone to errors in taking the blood pressure.

Conclusions:

Competency in blood pressure measurement should be started early during medical school, emphasizing the guidelines and its practical aspects. Regular reevaluation and reinforcement of this skill during medical school, training and throughout the clinician's practice are vital for optimal blood pressure measurement.
’HYPERTENSION PREVALENCE, AWARENESS, TREATMENT AND CONTROL STATUS AMONG THE HEALTHCARE PROVIDERS OF BANGLADESH WORKING AT PRIMARY HEALTH CARE LEVEL
Authors: Faruque Mithila , Barua Lingkan , Banik Palash Chandra
Published: April 2021

Objective:

This study aimed to determine the prevalence of hypertension and awareness, treatment and control status of hypertension among the primary healthcare providers of Bangladesh.

Design and method:

This was a cross-sectional study conducted among 1912 senior stuff nurses (SSN) and para-health professionals who came to attend a 3-day training in Bangladesh University of Health Sciences (BUHS) during November 2017 to April 2018. The study population was selected by the Government from all districts of Bangladesh. Data were collected using STEPS questionnaire of World Health Organization. Two blood pressure measurements were obtained by trained observers by use of a mercury sphygmomanometer. Information on history of hypertension and use of antihypertensive medications was obtained by use of a standard questionnaire. Hypertension was defined as systolic and/or diastolic blood pressure equal or more than 140/90 mmHg or a self-reported diagnosis of hypertension and/or use of antihypertensive medications according to JNC 7 guidelines.

Results:

The mean age of the population was 37.63 ± 9.5 years and their average duration of employment was 13.8 ± 9.5. Among the total, 29.7% (95% CI, 2 7.7–31.7) of the healthcare providers had hypertension, 67.4% were aware of their hypertension and 88.7% of them were taking antihypertensive medication. But only 40.8% attained blood pressure control. The overall prevalence of hypertension was slightly higher among men than among women. The prevalence of hypertension was found increased with age. The age specific prevalence of hypertension was 16.3% (95% CI, 14.6–18.0), 22.9% (95% CI, 21.0–24.8), 42.1% (95% CI, 39.9–44.3) and 49.8% (95% CI, 47.6–52.0) among 20–29, 30–39. 40 49 and equal or more than 50 years age groups respectively. Added salt intake, diabetes mellitus, central obesity and generalized obesity were significantly associated with hypertension (p < 0.05). Age and diabetes mellitus was two significant predictors of hypertension.

Conclusions:

Hypertension is highly prevalent among the healthcare providers of Bangladesh working at primary healthcare level. More than two-third are aware that they have hypertension but controlled rate by anti-hypertensive is low. These results underscore the urgent need to develop national strategies for detection and treatment of hypertension among these service providers.