bluuebunny/crossref_metadata_2025 huggingface dataset:
VASCULAR AGE AS A KEY FOR A TEAM-BASED APPROACH TO MANAGE BLOOD PRESSURE AND CARDIOVASCULAR RISK BETWEEN COMMUNITY PHARMACISTS AND PRIMARY HEALTH CARE CENTERS (TOGETHER)
Authors: Rodilla Enrique , Aichberger Monika , Ardelt Florian , Baixauli Vicente , Cinza Sergio , Fernandez Marisol , Garcia Luis , Mayer Christopher , Pereira Telmo , Santschi Valérie , Weber Thomas
Published: May 2024

Objective:

Hypertension (HTN) is the main cause of premature death worldide. Previous studies in Portugal, Austria and Spain have shown that estimating arterial stiffness in Community Farmacies (CPh) improves its management. The main objective is to evaluate whether empowering hypertensive subjects by determining arterial stiffness in CPh increases the rate of HTN control. Secondary objective is to establish paths of lasting cooperation between Primary Care (PC) doctors and CPh.

Design and method:

TOGETHER is a randomized study in Portugal, Austria and Spain. All consecutive expected 1260 subjects entering CPh will be offered blood pressure measurement and ambulatory blood pressure monitoring (ABPM) for those cases with high values. 140 CPh will be randomly grouped into a usual care arm (health education associated with HTN and communication of the results to PC). In the experimental care group, early vascular aging (EVA) will additionally be assessed estimating oscillometric pulse wave velocity. The concept and therapeutic options of EVA will be explained to patients and PC. HTN will be treated by PC according to usual clinical practice. After 6 months a second evaluation with ABPM will be performed and HTN control will be compared between the two arms. The degree of patient-doctor interaction and economic implications will be determined through validated surveys.

Results:

TOGETHER will address five fundamental unmet needs: 1) lack of HTN screening programs; 2) the concept of cardiovascular risk is difficult to understand. The EVA concept (“Your arteries are 10 years older than you”) is simple and more informative; 3) understanding CV risk on an individual basis (individual EVA) should improve patient adherence and reduce physician inertia; 4) TOGETHER will implement health educational programs, combined with the concept of EVA; 5) there is an objective need to improve collaboration and develop a team-based approach to HTN care between CPh and PC.

Conclusions:

The complementary strengths and organizational settings of CPh and PC will allow TOGETHER to create new strategies for early identification and intervention in HTN, ranging from lifestyle to medical treatment, taking social, economic, and behavioral aspects into account.
OFFICE, HOME AND AMBULATORY BLOOD PRESSURE CONTROL IN PATIENTS WITH HIGH AND VERY HIGH CARDIOVASCULAR RISK – RESULTS FROM BP-PROACTION BG
Authors: Postadzhiyan Arman , Yotov Yoto , Ticheva-gospodinova Snesanka , Nikolov Fedya , Ramchev Konstantin , Gruev Ivan
Published: May 2024

Objective:

Current ESH guidelines emphasize out-of-office blood pressure monitoring in patients requiring antihypertensive therapy. Achieving control within the 24-hour period and during home monitoring is of key importance in patients at high (HR) and very high cardiovascular risk (VHR).

Design and method:

220 treated with antihypertensive agents’ patients at high or very high risk were included in BP-proAction BG study. All individuals underwent office BP measurements and 24-hour ambulatory blood pressure monitoring consequently followed by 7-day home BP monitoring. Therapy was modified according to office blood pressure values based on methodical standards and treating physicians’ preferences. The protocol was repeated after 3 month of therapy intensification

Results:

19% of enrolled patients experienced a cardiovascular event prior to study enrollment, with a mean SCORE 2/SCORE 2 OP of 17.2% among individuals in the primary prevention setting. Despite treatment with an average of 2.7 medications, the majority of patients had uncontrolled blood pressure at the baseline visit - office 93%, home 72%, 24h ABPM 70%, daytime ABPM 63%, nighttime ABPM 69%. After therapy intensification to average 3.4 medications the frequency of uncontrolled hypertension was reduced to 21%, 38%, 34%, 33% and 37% respectively at month 3. The prevalence of masked uncontrolled hypertension among patients with control of office blood pressure was 17% for home masked hypertension, 15% for ambulatory masked hypertension and 10% for dual MH. The rate of uncontrolled hypertension was significantly lower in patients being treated with fix dose combination alone vs free drugs combination. (Table 1)

Conclusions:

Among patients with high and very high cardiovascular risk, lack of control of out-of-office blood pressure is a common phenomenon, requiring adequate detection and therapeutic management.
METHODOLOGICAL AND DIAGNOSTIC RELIABILITY OF 24-H ABPM: A PARADIGM SHIFT IN DAILY CLINICAL PRACTICE?
Authors: Neumann Claas Lennart , Witoska Torsten , Schulz Egbert G.
Published: May 2024

Objective:

Blood pressure measurementst form the cornerstone of diagnosing, treating, and researching arterial hypertension. The 24-hour ambulatory blood pressure monitoring (24-h ABPM) is widely considered best practice, but challenges such as availability and cost persist. This study evaluates the validity, accuracy, and practicality of ABPM in clinical settings.

Design and method:

Retrospectively analyzing 450 24-h ABPM measurements from the Nephrology Center Göttingen, using validated devices from I.E.M. and BOSO, this study assesses adherence to European Society of Hypertension (ESH) and German Hypertension Society (DHL) guidelines. Criteria include a minimum 24-hour recording, at least 20 valid day and 7 valid night measurements, and a minimum of 70% overall validity. Patient cancellations are considered if measurements end before 7:30 a.m. or last less than 22 hours without technical faults.

Results:

Only 23% (n=106) of ABPMs met all guideline criteria; 77% failed at least one criterion. In 27% (n=120) of cases, duration was below 24 hours, and in 22% (n=98), it was below 22 hours. Motion artifacts caused validity failures in 50%, daytime pressurization issues in 17%, and nighttime issues in 27%. Patient cancellations constituted 20.6% (n=93), with adipose patients 40% more likely to cancel. Diabetes and severe hypertension correlated with a 40% reduction in guideline-conforming measurements. Sixteen percent (n=72) were canceled without recording early morning blood pressure, correlating strongly with cardiovascular risk.

Conclusions:

The study emphasizes the importance of correct ABPM execution, urging explicit discussions with patients. Acknowledging ABPM limitations, the paper recommends additional methods like telemetrically transferred blood pressure measurements at home (idTM) for intervention options. Given the variability in ABPM data quality, its validity must be scrutinized case by case. The findings advocate for increased use of home blood pressure measurements, aligning with current guidelines for diagnostics and therapy.
EXPLORING BLOOD PRESSURE ASSOCIATIONS: HOME AND OFFICE MEASUREMENTS IN STROKE, MYOCARDIAL INFARCTION, AND DIABETES OUTCOMES
Authors: Costa Matheus , Sousa Ana Luiza , Morangoni Barbara , Correia Mikaelle , Barbosa Letícia , Vitorino Priscila , Inuzuka Sayuri , Frigieri Gustavo , Barroso Weimar
Published: May 2024

Objective:

Evaluate the association of blood pressure (BP) with home and office measurements and the outcomes of stroke, acute myocardial infarction, and diabetes

Design and method:

Cross-sectional study, utilizing variables such as age, gender, office systolic blood pressure (OSBP), office diastolic blood pressure (ODBP), and home blood pressure measurements (HBPM). Other variables include time since the diagnosis of arterial hypertension, and outcomes: stroke (AVC), acute myocardial infarction (AMI), and diabetes. The criteria for hypertension are office BP 140/90mmHg and HBPM 130/80mmHg. Data collected from participants and medical records. Data analysis conducted using the chi-square test and Student's t-test. Blood pressure (BP) values were adjusted based on the time since the diagnosis of arterial hypertension (HA), with a significance level of p<0.05.

Results:

240 patients were evaluated, with average age of 63.4 years (±11.8), and 73.3% were female, 62.5% had diabetes, and 76.7% had dyslipidemia. The incidence of MI was 7.9%, and AVC was 11.7%. The average time of arterial hypertension was 19.1 years (±11.9). Uncontrolled BP, according HBPM criteria, was observed in 54.2% (n=130); according to the casual measurement criteria (office), it was 42.1% (n=101). Men exhibited higher rates of uncontrolled BP by HBPM (65.6% - 42) compared to women (50.0% - 88; p-value = 0.032). Average ODBP were significantly higher (138.1 (22.9) /81.6(±12.2) than home values (129.0 (±15.2) /79.4(±10.0). Average diastolic BP (DBP) values were lower among women, both in office (80.6 ±11.8 and 86.0 ±12.8; p=0.001) and home measurements (78.7 ±9.4 and 83.6 ±10.7; p=0.001). The average systolic/diastolic BP values, by HBPM, were significantly higher (132.1 ±14.0/84.2 ±12.8 mmHg) among those with a history of stroke (124.2 ±14.5/79.5±9.5 mmHg); average HBPM systolic BP values (132.4 ±17.0 and 124.5 ±14.3) were significantly higher among those with a history of myocardial infarction. Office measurements did not show the same association.

Conclusions:

The average BP values were lower at home, as were the control rates. The association of blood pressure (HBPM) with outcomes such as acute myocardial infarction (AMI) and stroke (AVC) demonstrated higher values when assessed at home, with no association observed with office measurements.
HOME BLOOD PRESSURE MONITORING VALIDATION SURVEY
Authors: Martínez Fernando , Solaz Elena , Sanz Mªnieves , Costa José Antonio , Escudero Veronica , Serna Lucas , De Castro Andrea , Redon Josep
Published: May 2024

Objective:

To evaluate home blood pressure monitoring (HBPM) habits and the validation of blood pressure (BP) devices in patients with chronic hypertension.

Design and method:

An anonymous electronic survey was conducted targeting chronic hypertensives who engage in HBPM to identify deficiencies in usage and device validation, referencing StrideBP.org for device validation status. Multivariable logistic regression, adjusted for confounding variables, was used to pinpoint factors tied to inadequate BP control.

Results:

The study included 90 participants with a mean age of 59.2 years, 70% male, and an average BMI of 28.2 kg/m2. These individuals had been managing hypertension for an average of 13.1 years and were on 1.8 antihypertensive medications; 26.6% had complications related to hypertension. The survey's response rate was 42.7%. Device validation showed 64.6% were validated, 35.4% were not, and 8 lacked sufficient information for determination. Arm devices, comprising 85.6% of the total, were validated more often (74.3%) compared to wrist devices (8.3%, p<0.001). Omron/Beurer were the leading brands among validated devices, while Vitalcontrol/Medisana were prominent among non-validated ones. Only 31% of patients were aware of their device's validation status. The frequency of BP measurements varied, with an average of nearly 9 per week, and some measuring 1-2 times biweekly or monthly. The average number of consecutive readings was 2.5, predominantly using the left arm (83.3%). While 75.6% documented their BP, mainly on paper (60.7%), only 20% adhered to pre-consultation measurement guidelines. Forty percent regularly shared their HBPM data with their physician. Despite 84.4% knowing their BP levels, only 37% were controlled (BP<135/85 mmHg). In the adjusted multivariable logistic regression model, the use of validated devices was a significant risk factor for the lack of BP control (OR 3.7, p=0.010).

Conclusions:

The findings, albeit limited by sample size and potential biases, underscore the need for improvements in HBPM utilization and device validation awareness.
DIAGNOSTIC PERFORMANCE OF COMMUNITY HEALTH WORKER-LED ATTENDED AND UNATTENDED OFFICE BLOOD PRESSURE MEASUREMENTS IN RURAL SUB-SAHARAN AFRICA
Authors: Lucinde Ruth Khadembu , Jobe Modou , Awori Juliet Otieno , Perkins Alexander D , Oyando Robinson , Leon David A , Herrett Emily , Prentice Andrew M , Tsofa Benjamin , Shah Anoop Sv , Perel Pablo , Etyang Anthony O
Published: May 2024

Objective:

The burden of hypertension in rural sub-Saharan Africa (SSA) has been on the rise. In rural SSA, screening, diagnosis and treatment monitoring for hypertension is typically through attended office blood pressure (OBP) conducted by a trained health worker. A community-centered approach where community health workers (CHWs) conduct out-of-office blood pressure (BP) measurements at the homes of community members may increase the proportion of patients diagnosed early and improve monitoring during treatment. However, the diagnostic performance of these BP measurements when conducted by CHWs remains unclear.

Design and method:

We are conducting a cross-sectional study to determine the diagnostic performance of OBP performed by CHWs in identifying individuals with hypertension in rural Kenya and The Gambia. A random age-stratified random sample of 1250 participants aged 30 years and above from the Kilifi Health and Demographic Surveillance System and the Kiang West Demographic Surveillance System are being enrolled into the study. Participants undergo randomly assigned attended and unattended OBP measurement and 24-hour ambulatory BP monitoring (reference standard) conducted by trained CHWs at their homes.

Results:

Recruitment is ongoing. We have enrolled and completed BP measurements for 166 participants, all from the Kenya study site (13% of the total sample). Of these, 114 (69%) are female with an average age of 57 years (standard deviation 15 years). Based on ambulatory BP, 71 (43%) of included participants are hypertensive. The preliminary sensitivity of attended and unattended OBP is 0.50 (0.38, 0.62) and 0.47 (0.35, 0.59) respectively with both measurement methods having a high specificity of 0.93 (0.85, 0.97). The diagnostic odds ratio (DOR) for attended OBP (DOR 13.6; likelihood ratio (LR) positive 7.33 (3.26, 16.47)) is higher than that of unattended OBP (DOR 12.1; LR positive 6.89 (3.05, 15.54)). Diagnostic performance does not appear to differ by age or sex. Further analyses will be conducted when recruitment is complete.

Conclusions:

Attended OBP appears to have better diagnostic performance than unattended OBP when conducted at participants’ homes by CHWs, but the sensitivity of both methods for detecting hypertension is low.
WHICH BLOOD PRESSURE MEASUREMENT PERFORMS BEST FOR THE DIAGNOSIS OF HYPERTENSION IN A YOUNG POPULATION? THE B.P.R.I.G.H.T PROJECT
Authors: Khalid Rija , Aslam Aiman , Zehra Wila-e , Mahmud Azra
Published: May 2024

Objective:

Averaging multiple blood pressure (BP) measurements is recommended for hypertension (HTN) screening, but can be impractical, especially in low resource settings. We aimed to explore the implications of the number of BP measurements on BP classification in a healthy, young Pakistani population.

Design and method:

We evaluated the performance of three standardized BP readings obtained during HTN screening in young Pakistani population (n=400, mean age, 21±3 SD) at a single visit at Fatima Jinnah Medical University, Lahore. HTN was classified as >130/80, mm Hg, per American (ACC/AHA) and >140/90, mm Hg per European (ESC/ESH) guidelines. Results were expressed as mean±SD for continuous and percentages for categorical variables. Differences between means was analysed using chi-square test for categorical and Wilcoxan rank Sums test for continuous variables, p,0.05 considered significant.

Results:

The mean difference of systolic BP between the 1st and 2nd measurement was, -2.9 mm Hg (- 1.95 to -3.8, 95% CI), between the 2nd and 3rd measurement, -1.7, mm Hg (-1 to -2.7, 95% CI) and -4.7, mm Hg (-3.75 to -5.7, 95%, CI) between the 1st and 3rd BP measurements. For diastolic BP, the mean difference between the 1st and 2nd measurement was, -2 mm Hg (- 1.2 to -2.8, 95% CI), between the 2nd and 3rd measurement, -2.1, mm Hg (-1.6 to -3.7, 95% CI) and -2.0, mm Hg (-1.2 to -2.9, 95%, CI) between the 1st and 3rd measurements. The prevalence of systolic/diastolic HTN was 5.9%, 4.6% and 3.9% according to the American guidelines, for the 1st, 2nd and 3rd measurement respectively. Using the European guidelines, 2% were hypertensive at the 1st, and 1% on subsequent readings. Averaging the 2nd and 3rd BP measurements, 2.7% and 0.8% of the participants were hypertensive using the American and European guidelines respectively.

Conclusions:

The prevalence of HTN is significantly higher using the American versus. European guidelines in a young healthy Pakistani population. Obtaining two BP readings may be sufficient for initial HTN screening in this population. A universal office BP measurement procedure is necessary for detection and control of HTN, especially in low resource settings.
NON-LINEAR RELATIONSHIPS BETWEEN WITHIN-VISIT BLOOD PRESSURE VARIABILITY, MEAN BLOOD PRESSURE, SEX, AND AGE IN UNTREATED MAY MEASURMENT MONTH 2019 PARTICIPANTS
Authors: Kerr Gabriele , Beaney Thomas , Schlaich Markus , Schutte Aletta , Stergiou George , Poulter Neil
Published: May 2024

Objective:

This study aimed to explore change in four commonly used measures of blood pressure variability (BPV) by mean blood pressure (BP), age, and sex in May Measurement Month (MMM) 2019 global survey participants.

Design and method:

We performed an observational analysis of BP readings from MMM 2019 participants. Adults (18 years and older) were surveyed via convenience sampling from 92 countries in May 2019. Each participant had three seated BP readings. Participants who reported taking antihypertensive medication or who lacked all three readings were excluded. Four indices of BPV were calculated: the standard deviation (SD), coefficient of variation (CV), absolute difference between the second and first BP readings (AR), and variation independent of the mean (VIM). A regression model was created for each index. Each model was adjusted for mean BP, age, sex, and an interaction between age and sex. Age and mean BP were each included as natural cubic splines with five knots.

Results:

Data from 922,259 participants were included. The mean age was 42.6 (SD 15.9) and 50.8% were female. Systolic SD and AR increased with higher mean BP up to 150 mmHg, while systolic CV and VIM decreased with higher BP across the BP range (Figure 1). Up to 90 mmHg, diastolic CV and VIM decreased with increased mean BP. All diastolic indices increased with higher mean BP above 90 mmHg.

Systolic BPV was higher in females between 35 and 70 years (Figure 2), with little difference between sexes within diastolic BPV. Diastolic BPV was lowest between 40 and 50 years of age and highest in the youngest and oldest age groups. Systolic BPV was lowest between 25 and 30 years for females, and at around 45 years for males.

Conclusions:

All within-visit BPV indices examined showed non-linear variation with mean BP levels and age, particularly for diastolic BPV. Studies should consider non-linear effects when investigating and modelling BPV.
MINIMUM NUMBER OF READINGS NEEDED TO DETERMINE LONG-TERM VISIT-TO-VISIT SYSTOLIC BLOOD PRESSURE VARIABILITY FOR PREDICTING CARDIOVASCULAR OUTCOMES IN DIABETIC PATIENTS
Authors: Kim Ju Hyeon , Oh Seungmi , Hong Soon Jun , Yu Cheol Woong , Kim Yong Hyun , Kim Eung Ju , Joo Hyung Joon
Published: May 2024

Objective:

In clinical practice, office blood pressure (BP) measurements are used for assessing long-term, visit-to-visit variability (VVV) of BP and the consistency of BP control in patients treated for hypertension. We aimed to determine the reproducibility of VVV and the minimum number of BP measurements required to estimate VVV for predicting cardiovascular outcomes.

Design and method:

This multicenter, retrospective study used data from the Korea University Medical Center database built on electronic health records. A total of 10,475 diabetic patients with >9 readings of BP during a minimum of two years were identified. Patients were followed up for 3 years after determining the coefficient of variation (CV), and the primary outcome was major adverse cardiovascular events (MACE), including cardiovascular mortality, myocardial infarction, stroke, and hospitalization for heart failure.

Results:

In diabetic patients, the average age of the patients was 65.2 years; 53.2% were men; and 87.4% had hypertension. The mean CV of systolic BP (SBP) was 9.0 ± 3.6. The mean CV of multiple readings that best predicted 3-year MACE were 8.4 for the 3 SBP readings (area under the curve [AUC], 0.57), 9.5 for the 5 readings (AUC, 0.61), 9.0 for the 7 readings (AUC, 0.63), 9.0 for the 9 readings (AUC, 0.64), and 9.7 for all readings (AUC, 0.66). In univariable analysis, 3-year MACE was significantly associated with high VVV from all SBP readings (HR 2.44, p<0.001) and 5 SBP readings (HR 2.03, p<0.001). Hence, a minimum of 5 SBP readings (median time 252 days) is needed for determining intraindividual VVV.

Conclusions:

In clinical practice, long-term VVV is reliably reproducible in diabetic patients. We recommend a minimum of five BP measurements for the estimation of intraindividual VVV. It is important to consider the number and duration of BP measurements used to calculate VVV when predicting cardiovascular outcomes.
HOME BLOOD PRESSURE MONITORING SHOULD BE IMPROVED IN CROATIA
Authors: Ivankovic Iva , Alagic Marieta , Andelic Ana Marija , Horvat Petra , Abramovic Inga , Zdilar Ana Marija , Domislovic Marija , Glavic Mihaela Marinovic , Jelakovic Bojan
Published: May 2024

Objective:

Home blood pressure monitoring (HBPM) serves as a self-monitoring tool recommended by ESH guidelines for long-term follow-up of treated hypertension. This study aimed to evaluate standpoints on the usage of HBPM monitors in the general adult population.

Design and method:

This study comprised 1779 individuals (a random sample of the general adult population in Croatia included in the ’Epidemiology of Hypertension in Croatia -2’ project). Participants were administered a questionnaire about the possession of BP monitors for home BP measurement and various socioeconomic factors.

Results:

Out of 1779 participants, 1173 (65.9%) have a device for HBPM. The prevalence of those who possess a BP monitor within different categories of the average monthly income is: 354 (30.2%) earn less than €326; 234 (19.9%) earn between €326–€465; 253 (21.6%) earn €465–€649 and 332 (28.3%) earn more than €649. The majority of subjects have not shown devices to physicians or nurses (70.5%). Only 65.1% used a device validated according to an established protocol; 231 (27.2%) used a non-validated device; 55 (6.5%) did not know and 10 (1.2%) used mercury sphygmomanometers. A total of 713 individuals answered the question covering the reasons for choosing a specific BP monitor; 63 (8.8%) of them bought a device on physician or nurse's suggestion; 180 (25,2%) on pharmacists’ suggestion while 333 (46.7%) independently selected the device.

Conclusions:

A high proportion of the general population in Croatia have their own devices for HBPM. However, not validated devices are still used too frequently, and patients very seldom discuss devices with physicians. Our results confirmed earlier observations that there is an urgent need for increased awareness and education. Physicians, nurses, and pharmacists could exert a more substantial influence on this crucial method for BP measurement.
NOCTURNAL BLOOD PRESSURE FLUCTUATIONS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA
Authors: Hofmann Elisabeth , Küchler Gert
Published: May 2024

Objective:

Reverse dipping of nocturnal blood pressure (BP) is a sensitive predictor of cardiovascular morbidity and mortality. Nocturnal blood pressure fluctuations (NBPF) related to obstructive sleep apnea may be causative. Studies based on ambulatory blood pressure measurements (ABPM) can only provide mean BP values and long-term BP variability due to low frequent variability during the night. This limits the explanatory power of the method. Here, we apply non-invasive, continuously measuring methods to investigate NBPF in patients with obstructive sleep apnea syndrome (OSAS).

Design and method:

In a first study, we included 34 patients with suspected diagnosis of sleep apnea undergoing polysomnography. BP was estimated using pulse transit time (PTT, SOMNOscreenTM) as well as measured by Portapres®. In a second study, we included 97 patients with an apnea/hypopnea index greater than 30 (severe OSA). The systolic BP (SBP) was continuously determined using PTT (SOMNOscreenTM) during polysomnography.

Results:

In the first study, 11 patients with OSA were analyzed. Sleep apnea related SBP fluctuations >8mmHg measured by Portapres™ were included. Both, the PTT-based method and Portapres® detected the same apnea related SBP fluctuations during night. Bland Altman plot showed a mean difference <1mmHg between both methods, with limits of agreement of ±13.4 mmHg. Mean apnea related SBP fluctuations were between 28 and 29 mmHg for both methods. In the second study, we found, in addition to normal NBPFs, BP fluctuations arranged like steps in 48 patients. Thereby, the SBP decrease after the event did not reach the level before the apnea. This led to a continuous increase of the SBP baseline called “superposition” of BP. Further, this phenomenon resulted in extremely high SBP values in some of the patients.

Conclusions:

BP fluctuations induced by OSA may contribute to the non-dipping/reverse dipping phenomena in OSA patients. The continuously measuring methods used here offer detailed insight into patterns of BP fluctuations. This improves our understanding of BP control during night time and helps to identify patients with increased risk for cardiovascular events.
PREFERENCE IN USING HOME VERSUS AMBULATORY BP MONITORING FOR THE ASSESSMENT OF NOCTURNAL HYPERTENSION IN HEMODIALYSIS PATIENTS
Authors: Leonidou K , Georgianos P , Kollias A , Vaios V , Divanis D , Georgianou E , Chrapis P , Anastasiou S , Stergiou G , Zebekakis P , Liakopoulos V
Published: May 2024

Objective:

Although ambulatory blood pressure (ABP) monitoring is for long considered as the unique method for the diagnosis of nocturnal hypertension, novel home BP (HBP) monitors have been developed to facilitate the assessment of BP during the period of sleep. This study aimed to investigate the preference in using HBP versus ABP monitoring for the assessment of nighttime BP in hemodialysis patients.

Design and method:

A total of 70 stable hemodialysis patients underwent assessment of BP with 2 methods: (i) 44-hour interdialytic ABP monitoring (20-min intervals; Microlife WatchBP O3 device) and (ii) HBP monitoring for 7 days (duplicate morning and evening BP measurements) and 3 nights (3 BP measurements per night over the 3-day interdialytic interval; Microlife WatchBP Home N). After the completion of these measurements, patients were asked to complete a questionnaire on their preference in using HBP vs. ABP monitoring for the assessment of nighttime BP.

Results:

The mean age of study participants was 65.3±13.3 years, 45 patients (64.0%) were males, and 62 patients (88.7%) were receiving antihypertensive treatment. Moderate-to-severe anxiety with respect to the diagnostic procedure was reported by 10.0% vs. 24.3% of patients for HBP and ABP monitoring (P<0.001), respectively. Moderate-to-severe discomfort (15.7% vs. 44.3%, P<0.001) and disturbance of the quality of sleep (30.0% vs. 48.6%, P<0.001) was reported less commonly with the use of HBP than with the use of ABP monitoring. Furthermore, severe restriction of daily activities occurred in 4.3% of patients during the period of HBP monitoring versus 12.9% of patients during the period of ABP monitoring (P=0.343). HBP monitoring was the preferred method for the assessment of nighttime BP in 67.1% of study participants.

Conclusions:

The present study shows that relative to interdialytic ABP monitoring, nocturnal HBP recordings are preferred by a higher proportion of hemodialysis patients for the diagnosis of nocturnal hypertension.
INCREMENTAL VALUE OF A CUFF-LESS BLOOD MEASUREMENT DEVICE COMPARED TO CLINIC BLOOD PRESSURE MEASUREMENT
Authors: Vischer Annina , Hotz Leana , Derendinger Felicia , Krisai Philipp , Socrates Thenral , Schumacher Christina , Mayr Michael , Burkard Thilo
Published: May 2024

Objective:

Cuffless, pulse-transit-time based 24-hour blood pressure measurement (BPM) lacks clinical validation based on recent protocols. It tends to higher values than cuff-based BPM, making standard hypertension cut-off values inapplicable. Additionally, the cuffless device exhibits a lower ability to track 24-hour blood pressure changes than standard devices. Due to these limitations, this study aims to evaluate if there is an advantage of cuffless BPM over clinic BPM (CBP).

Design and method:

166 participants were prospectively enrolled for simultaneously performed cuffless (TestBP, Somnotouch NIBP) and cuff-based (RefBP, Spacelabs or Mobil-o-graph) 24h-BPM. CBP was defined as the mean of 3 cuff-based BPM: after 5 min of rest, BP was measured sequentially at both upper arms. Then, first, RefBPM was used as calibration for cuffless TestBP. We compared the TestBP and CBP to mean awake RefBP including calculation of test characteristics for the diagnosis of elevated BP using ROC curve analysis to identify ideal cut-off values for the TestBP. Gold standard for the detection of elevated BP was mean awake RefBP (>134/84 mmHg).

Results:

Median age was 51 years (IQR 40-63). Mean awake systolic and diastolic RefBP was 134±15 mmHg and 83±10 mmHg, respectively. Mean differences between TestBP and RefBP were 6±13/5±8 mmHg and mean absolute differences 11±9/7±6 mmHg, for systolic/diastolic values, respectively, whereas for CBP 7±13/5±7 mmHg and 12±10/7±5 mmHg. There was a linear relationship between TestBP/CBP and RefBP (Figure, panels A-D). In ROC analysis CBP and TestBP showed an AUC for the diagnosis of hypertension on awake RefBP of 0.845/0.873 and 0.862/0.877 for systolic/diastolic values, respectively. Best cut-off for hypertension was at 133/88 mmHg for mean 24h, 137/88 mmHg for awake and 136/80 mmHg for asleep cuffless TestBP values. Misclassifications compared to RefBP with these (ASV) and previously published (TS) cut-offs for TestBP and usual cut-offs for CBP are shown in the figure (panels E-F).

Conclusions:

We found a low incremental value of the TestBP device in relation to CBP, with comparable AUCs and correlation coefficients. With the application of the adapted awake BP cut-off of 137/88 mmHg, masked hypertension misclassification may be reduced
VALIDATION OF THE SMARTPHONE BLOOD PRESSURE MEASUREMENT SOLUTION OPTIBP™ TO TRACK BLOOD PRESSURE CHANGES IN PREGNANT WOMEN
Authors: Almeida Pedro , Cuènoud Alexia , Othenin-girard Alexandra , Hoang Harry , Christen Urvan , Schoettker Patrick
Published: May 2024

Objective:

Hypertensive disorders present significant morbidity and mortality during pregnancy. While ambulatory blood pressure measurement remains the standard of care for normotensive women, self-monitoring at home is increasingly prevalent. The widespread use of smartphones worldwide has sparked interest in mobile applications that leverage the built-in hardware for blood pressure estimation, yet few trials have assessed their accuracy.

Design and method:

This prospective, longitudinal and monocentric study evaluated the accuracy of the OptiBP algorithm against standard oscillometric blood pressure measurements in a sample of pregnant women. Patients scheduled for elective caesarean sections were enrolled during the preoperative anesthesia consultations. Paired blood pressure measurements using OptiBP and the reference method were obtained at multiple time-points in late pregnancy and the post-partum period. Agreement between methods was assessed using the AAMI/ESH/ISO 81060-2:2018 standard thresholds of 5±8 mmHg for mean ± standard deviation of the error (criterion 1) and patient-specific standard deviation of the mean error (criterion 2) and represented graphically by Bland-Altman scatterplots.

Results:

Twenty-four women were enrolled of which 15 completed the protocol, yielding 166 total valid measurement pairs. Mean and standard deviation of the error were -0.74 ± 8.38 and 0.99±6.88, and the patient-specific standard deviation of the mean error was 5.84 and 3.36, for SBP and DBP respectively.

Conclusions:

Compared with blood pressure measure with an oscillometric device, OptiBP's blood pressure estimates meet the AAMI/ESH/ISO 81060-2:2018 criteria for DBP.
POOR TOLERABILITY OF THE STANDARD, EXTENDED, 48H AMBULATORY BLOOD PRESSURE MONITORING IN HEMODIALYSIS PATIENTS
Authors: Torino Claudia , Mallamaci Francesca , Sarafidis Pantelis , Papagianni Aikaterini , Ekart Robert , Hojs Radovan , Balafa Olga , Giudice Antonio Del , Aucella Filippo , Morosetti Massimo , Tripepi Rocco , Marino Carmela , Tripepi Giovanni , Zoccali Carmine
Published: May 2024

Objective:

44h or 48h Ambulatory blood pressure monitoring (ABPM) is recommended for diagnosing hypertension in dialysis patients. Because the longer recording period, the notorious sleeping disturbances and the symptom burden of the ESKD population, the feasibility of the technique may be limited in this population. However, its large-scale tolerability of ABPM in hemodialysis patients has never been investigated.

Design and method:

We performed a survey of the feasibility and tolerability of 48h ABPM in 6 European centres, led by motivated nephrologists members of the EURECA-m working group. 48h ABPM recording was proposed to a representative sample of the dialysis population of these centres. Recordings were made at 15-minute (day) or 30-minute (night) intervals. Reasons for refusal to undergo the test, for not completing the monitoring, and symptoms developed during the ABPM study were systematically recorded.

Results:

In the whole hemodialysis population of participating centers including 735 patients, 440 (60%) were invited to participate in the study. Among these patients 119 patients (27%) refused to undergo ABPM recording. Reasons for refusal are detailed in the table. Among the 321 patients who performed the 48h ABPM recording, 29 patients (9%) did not complete it and the main reason for interrupting the recording were discomfort (41%) and device failure (34%). Frequent interruption of sleeping because of noise or discomfort was a symptom reported by 32% of patients, followed by itching (24%) and pain during the measurements (20%). The detailed list of symptoms is reported in the table.

Conclusions:

About 25% of hemodialysis patients consider 48h ABPM a laborious and discomforting test and prejudicially refuse to undergo it. Among patients who undergo 48h ABPM, itching and interruption of sleeping are complained by about 1/3 of patients. These figures are substantially higher than those reported in studies in the general population and in hypertensive patients and point to peculiar barriers at applying extended ABPM recordings in the hemodialysis population. Studies applying more tolerable instruments and a minimum set of measurements over a shorter time are clinical research priority for extending the use of ABPM in the hemodialysis population.
AUTOMATED ATRIAL FIBRILLATION DETECTION DURING ROUTINE BLOOD PRESSURE MEASUREMENT: DIAGNOSTIC ACCURACY OF THE OSCILLOMETRIC BLOOD PRESSURE MONITOR MICROLIFE BP B3 AFIB ADVANCED
Authors: Ntousopoulos Vasileios , Menti Ariadni , Kyriakoulis Konstantinos , Tsiachris Dimitrios , Kollias Anastasios , Stergiou George
Published: May 2024

Objective:

To evaluate the diagnostic accuracy of the oscillometric upper-arm cuff home blood pressure (BP) monitor Microlife BP B3 AFIB Advanced in detecting atrial fibrillation (AF) during automated BP measurement.

Design and method:

Participants with permanent AF aged >60 years (AF group) and others with sinus rhythm (SR) matched for age and sex (control group) were recruited. Electrocardiography (ECG) recording and blood pressure (BP) measurements were simultaneously conducted twice for each participant. Using an AF specific diagnostic algorithm of the BP monitor, the rhythmicity of heart rate was evaluated three times during each automated BP measurement. When AF is detected in at least 2 of the 3 assessments, the device reports the presence of AF detection. A single wide-range cuff of the test device was used for arm circumference 22-42 cm.

Results:

A total of 108 individuals were analyzed, (50%/50% with AF/SR, 59%/59% men, mean age [SD] 76±10.5/73±9.5 years for AF/SR, systolic BP 123.4±19.6/131.5±17.9 mmHg [p<0.01], diastolic BP 74.2±11.7/73.4±10.6 mmHg [p=NS]). False negative and false positive AF detection in AF and control group respectively are shown in Table. The sensitivity of the test device in detecting AF was 87%, specificity 100%, positive predictive value 100% and negative predictive value 88.5%.

Conclusions:

These findings indicate that the Microlife BP B3 AFIB Advanced automated BP monitor equipped with an AF detecting algorithm with triplicate assessment of the cardiac rhythm during each automated BP measurement, has an exceptional diagnostic accuracy. Thus, this novel technology can be employed as a reliable screening tool for detecting asymptomatic AF in elderly adults during routine screening or long-term monitoring of treated hypertension.
ARTERIAL STIFFNESS AND LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH WHITE COAT HYPERTENSION
Authors: Solé Ricardo Cabrera , Lucas Caridad Turpin , Luepke Erick
Published: May 2024

Objective:

White coat hypertension (WCHTA) is not a benign process as previously believed. In many cases they end up being true hypertensives. Little has been published on the index of arterial stiffness and pulse pressures, as well as central pressures in such patients.

To assess the arterial stiffness index, left ventricular hypertrophy and central pressures in patients with WCHTA and compare them with normotensive (PN) patients (P).

Design and method:

MATERIAL AND METHODS: we studied 100 P with WCHTA and compared them with another group of 100 normotensive P in whom a study was performed with ABPM, an echocardiogram to assess hypertrophy and central pressures were measured (Central sys, Central diast), as well as the augmentation index (AI). The results were compared and shown below:

Results:

Conclusions:

P with WCHTA have higher blood pressures than those considered normotensive in both peripheral and central measurements. Likewise, these P have greater arterial stiffness than normotensives, more hypertrophy of the left ventricle and there is more diastolic dysfunction measured by the E/A index of mitral flow, which we will have to take into account when we encounter this type of P, since they also entail a greater cardiovascular risk.
ASSOCIATION OF SUBCLINICAL INFLAMMATION MARKERS WITH PRIMARY HYPERTENSION IN CHILDREN - A SYSTEMATIC REVIEW WITH META-ANALYSIS
Authors: Dziedzic-jankowska Katarzyna , Kolodziej Maciej , Skrzypczyk Piotr
Published: May 2024

Objective:

Primary hypertension (PH) is a growing threat to children's health. The pathogenesis of this phenomenon is not fully known, and subclinical inflammation and activation of the immune system are potential explanations. This systematic review and meta-analysis aimed to systematically determine whether there is an association between low–grade inflammation markers and PH in children.

Design and method:

The MEDLINE, EMBASE, and Cochrane databases were searched up to March 2023, with no language restrictions, for cohort, cross-sectional, and case-control studies; additional references were obtained from reviewed articles. The included studies needed to investigate an association between any inflammation markers and PH defined by the authors. Participants of the study were children (<18 years old) with PH and healthy controls. The main outcome measured was the concentration of any subclinical inflammation markers in children with PH and in healthy controls. This meta-analysis included 12 studies published between 2005 and 2022, enrolling 1220 patients (689 with PH and 531 healthy controls). The data were analyzed using Review Manager. Pooled mean difference (MD) with 95% confidence interval (95% CI) was used to assess the differences in inflammation markers levels. All analyses were based on the random-effect model. The risk of bias was assessed using the Newcastle-Ottawa Scale.

Results:

There was a significant difference between hypertensive and control groups in high-sensitivity C-reactive protein (hsRCP) concentration (MD: 0.07 95%CI [0.04,0.09]), intercellular adhesion molecule 1 (ICAM-1) (MD: 85.28 95%CI: [50.57-119.99]), vascular cell adhesion molecule 1 (VCAM-1) (MD: 259.78 95%CI: [22.65-496.91]), neutrophil count (MD: 0.80 95%CI [0.53-1.07]), monocyte count (MD: 0.07 95%CI: [0.02-0.12]), and neutrophil-to-lymphocyte ratio (NLR) (MD: 0.49 95%CI: [0.32-0.65]). There was no difference in terms of interleukin 6 (IL-6), lymphocyte count, platelet count, mean platelet volume (MPV), as well as in platelet-to-lymphocyte (PLR) and monocyte-to-lymphocyte (MLR) ratios.

Conclusions:

Some easily accessible markers of low-grade inflammation might be used as an additional tool for diagnosis and screening for hypertension in pediatric patients. These promising results should be validated in large and well-conducted studies.
ASSOCIATION BETWEEN TRAJECTORIES OF SYSTOLIC BLOOD PRESSURE AND FRAILTY OUTCOME IN MIDDLE-AGED AND OLDER ADULTS
Authors: Yu Bingyan , Ou Yanqiu , Dong Haojian
Published: May 2024

Objective:

The association between blood pressure and frailty outcome in the middle-aged and older population remains controversial. This study aimed to examine the relationship between trajectories of systolic blood pressure (SBP) and new-onset frailty.

Design and method:

From the China Health and Retirement Longitudinal Study, 6168 subjects were recruited in 2011 with follow ups in 2013, 2015 and 2018. The frailty index (FI) was constructed based on 40 scored items, with FI more than or equal to 0.25 defined as frailty. We identified the 5-year trajectory of SBP by latent class trajectory modeling. The association between SBP trajectories and frailty was explored based on hazard ratios (HR) by four Cox proportional hazards models. Restricted cubic splines were used to clarify the relationship between SBP and systolic blood pressure variability (SBPV) and frailty.

Results:

6168 participants were included in this study with a mean age of 59 years. We identified five trajectories based on SBP, which are maintained low-stable SBP (T0), moderate-stable SBP (T1), remitting then increasing SBP (T2), increasing then remitting SBP (T3), and remaining stable at high SBP levels (T4). During the 7-year follow-up period, frailty outcome occurred in 1415 participants. After adjusting for other confounders, the two trajectories labeled “T2” and “T4” were associated with a higher risk of frailty compared with T0. In addition, elevated SBP and increased SBPV were associated with risk of frailty.

Conclusions:

Higher risk of frailty occurred in two trajectories, remitting then increasing and remaining stable at high SBP levels, were associated with a relatively higher risk of frailty.
HIGH-SODIUM DIET INCREASE THE LIKELIHOOD OF BEING NON-DIPPING: ROLE OF 24H PRESSURE MONITORING IN THE DIAGNOSIS OF SALT SENSIVITY
Authors: Tunesi Francesca , Simonini Marco , Citterio Lorena , Zagato Laura , Manunta Paolo , Lanzani Chiara Livia
Published: May 2024

Objective:

Sodium sensitivity is a change in blood pressure (BP) depending on Na+ intake. Either a salt load test or a sodium dietary protocol can be used to stratify the population into 3 groups based on BP variation: sodium sensitive (SS), sodium resistant (SR), inverse sodium sensitivity (ISS), based on an increase, a non-significant variation or a decrease in BP following the administration of Na+. SS and ISS subject have increase Cardiovascular (CV) risk. BP has a circadian rhythm, detectable with ABPM, characterized by a blood pressure drops by 10% to 20% while sleeping at night (normal dipping), the loss of this phenomenon is associated with increased CV. We evaluate the relationship between sodium sensitivity and ABPM, in particular dipping in untreated hypertensive subjects.

Design and method:

We recruited 844 patients stratified as SS, SR or ISS through acute salt load test carried out at the San Raffaele Hospital in Milan. 600 patients of our cohort also performed ABPM in order to evaluate their dipping pattern.

Results:

The proportion of SR patients is 33.6%, SS is 34.1%, and ISS is 32.2%. 25.8% were dippers while 74.2% were non-dippers. The non-dipper condition is significantly more frequent (p=0,049) in the SS (31.8%). By evaluating the natriuresis during the test, we found that non-dipping subjects excreted more sodium than the others.

The assessment of 24 hours pre-test natriuresis, which reflects the patient's diet, showed that high salt diet is correlated with the non-dipping condition (p= 0,007). The risk of non-dipping in hypertensive patients is increased 1.417 times by a natriuresis greater than 150, which is the upper recommended values for patients with hypertension. Moreover no differences in 24-hour urine sodium were found between the three groups of salt sensitivity.

Conclusions:

A high-salt diet does not determine sodium sensitivity, but increases the likelihood of non-dipping. The data suggests that sodium sensitivity and non-dipping are associated, and a high-salt diet also predisposes to the non-dipping condition.
RIGHT VENTRICLE IN PATIENTS WITH ARTERIAL HYPERTENSION AND B STAGE HEART FAILURE
Authors: Tsverava Mikheil , Tsverava Dimitri , Ungiadze Sophio
Published: May 2024

Objective:

According to ACC/AHA Heart failure (HF) classification the A stage of HF is a high risk for HF but without structural heart disease or symptoms; B stage is a structural heart disease but without signs or symptoms of HF. One of the most important risk factors of HF is Arterial Hypertension (AH). There is no information about Right Ventricular (RV) structure and function, in patients with stage A and B of HF.

The aim of our research was to study RV structure and function in patients with AH and stage A or B HF.

Design and method:

We studied 163 patients with AH (female-76, male 87). 45 in stage A and 118 in stage B HF. All patients undergone standard EchoCG examination. RV outflow tract (RVout) was examined by M-mode from parasternal short axis and PW TDI from subcostal position (RVoutTDI). The shape of RWoutTDI was different from the Tricuspid anulus TDI. It consists from positive isometric contraction (ICTs), isotonic contraction (s), negative early diastolic (e) late (a) diastolic waves velocities, two negative (e1) positive (e2) isometric relaxation waves. We measured the pick velocities of these waves in cm/sec and isometric contraction (ICT), ejection (RVET) and isometric relaxation time (IRT) intervals in msec.

On M-mode EcoCG of RVoutRV we measured Diastolic Diameter (Dd) systolic diameter (Ds), fractional shortening (RWoutFS) and RW wall systolic excursion (RWexc).

Results:

We did not find any significant differences between in RV EcoCG, RVout, RVoutTRI and Tricuspid annulus TDI parameters between the A and B Heart Failure groups in patients wit Arterial Hypertension.

Conclusions:

There is no difference in EchoCG parameters between A and B Heart Failure groups in patients with Arterial Hypertension.