bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.