bluuebunny/crossref_metadata_2025_split huggingface dataset:
IN SEARCH OF THE OPTIMAL CUFF FOR BLOOD PRESSURE MEASUREMENT IN THE VERY OBESE
Authors: Palatini Paolo , Benetti Elisabetta , Fania Claudio , Ermolao Andrea , Spinella Paolo , Battista Francesca , Gasperetti Andrea , Saladini Francesca 
Published: April 2021

Objective:
Rectangular (cylindrical) cuffs and bladders are currently used for blood pressure (BP) measurement at the upper arm. However, large arms have a conical shape which make cylindrical cuffs potentially unsuitable. Aim of this study was to study the shape of the arm in people with severe obesity and to investigate the effect of the shape of the cuff on BP measurement in these subjects.

Design and method:
In 79 obese subjects with upper arm mid-circumference >40 cm and 79 subjects of control, cylindrical and tronco-conical cuffs of appropriate size were compared. We considered the upper arm either as a single truncated cone (model 1) or as the sum of two tronco-conical shapes, with bases at the proximal and middle arm circumference, respectively (model 2). The frustum slant angle of the proximal (upper angle) and distal (middle angle) truncated cones were measured. If the difference between upper and middle angles is equal to zero, the upper arm can be assimilated to a single truncated cone as in model 1. If the difference is positive (model 2), it means that the distal half of the arm is more conical than the proximal half.

Results:
In the Obese, upper angle was greater than middle angle, whereas in the Nonobese the two angles were similar (p < 0.0001 versus Obese for both angles). In the Obese, the cylindrical cuff overestimated BP measured with the tronco-conical cuff by 4.3 ± 5.4/3.1 ± 4.7 mmHg, whereas in the Nonobese slight discrepancies were found between the two cuffs (p < 0.0001/<0.0001versus Obese). In the whole study sample, the difference between the upper and middle angles was correlated with systolic BP (p = 0.0008) and diastolic (p < 0.0001) BP discrepancies. In a multivariable linear regression, the difference between the two angles was an independent predictor of the between-cuff BP differences in obese men (p = 0.004/0.0007) but not in obese women.

Conclusions:
In very obese people, the tronco-conical shape of the upper-arm is more pronounced on the distal than the proximal half, a feature that amplifies the BP measurement error when cylindrical cuffs are used.
ARM BASED ON LEG BLOOD PRESSURES (ABLE-BP): CAN LEG BLOOD PRESSURE MEASUREMENTS PREDICT BRACHIAL BLOOD PRESSURE? INDIVIDUAL PARTICIPANT DATA META-ANALYSIS FROM THE INTERPRESS-IPD
Authors: Mcdonagh Sinead , Sheppard James , Warren Fiona , Boddy Kate , Fordham Jayne , Farmer Leon , Lewis Philip , Baumber Rachel , Martin Una , Clark Christopher 
Published: April 2021

Objective:
Hypertension, a key modifiable risk factor for prevention of stroke, is diagnosed and managed using upper arm blood pressure (BP) measurement. Amputations, altered muscle tone or limb deformities can prevent accurate brachial BP measurement and cardiovascular risk estimation, thus placing a cohort with known vascular risks at a disadvantage. Leg BP measurement is often used as a practical alternative, but limited data exist to guide clinicians’ interpretation of leg BP values for the diagnosis and treatment of hypertension.
Using data from the INTERPRESS-IPD Collaboration, which holds 34,543 individual records from 15 international studies, we will examine the relationship between arm and leg BP, develop and validate a multivariable model predicting arm BP from leg BP and investigate the prognostic role of leg BP in cardiovascular event and mortality risk prediction.

Design and method:
In an observational cohort design, individual participant data meta-analyses will be undertaken to explore cross-sectional relationships between arm and leg BP in multivariable models. Using hierarchical linear regression models, we will investigate the association between arm and leg BP and participant characteristics. Planned predictor variables will include age, sex, cardiovascular disease risk and past medical history. Prognostic models will be derived for all-cause and cardiovascular mortality and cardiovascular events. Heterogeneity will be assessed using I2 2 and tau2. Study quality will be assessed using a modified Quality In Prognostic Studies tool.

Results:
Arm and leg BP records exist for 34,543 individuals. The median follow-up period is 8.5 years, with 3,870 participants experiencing cardiovascular events and 3,096 dying within 10 years. Further analyses are underway and arm-leg BP models will be presented at the conference.

Conclusions:
We will provide the first evidence-based method for estimating individual brachial systolic BP, and cardiovascular risk, from leg BP measurements. Our findings will support clinicians and patients in detecting and managing hypertension more effectively where leg measurements are required.
ARTERIAL STIFFNESS AND MALNUTRITION BUT NOT ABPM ARE ASSOCIATED WITH ALL-CAUSE MORTALITY IN PATIENTS UNDERGOING CHRONIC HEMODIALYSIS
Authors: Matasin Marija , Premuzic Vedran , Katalinic Lea , Barisic Ivan , Gallineo Lana , Jelakovic Bojan 
Published: April 2021

Objective:
Our aim was to analyze association of diurnal variations of blood pressure with all-cause and cardiovascular (CV) mortality in patients undergoing chronic hemodialysis during a follow-up of 48 months.

Design and method:
A total of 126 HD patients (74m 52w; average age 61.5 ± 15.8) were enrolled. All patients were dialysed by European and KDIGO guidelines. ABPM (24-hours) was performed with SpaceLab 90207 after mid-week dialysis; pulse wave velocity (PWV) and aortic augmentation index (AIx) were measured using Arteriograph after mid-week dialysis. Malnutrition-inflammation score (MIS) and protein energy wasting (PEW) score were calculated in all enrolled patients. There were 67.6% of patients without prior CV disease, and prior coronary heart disease, valvular disease, atrial fibrillation, stroke, and peripheral arterial disease were diagnosed in 7.1%, 5,6%, 4.7%, 8.7%, 3.9% patients, respectively. Prior diabetes and prior hypertension were diagnosed in 26.2% and 92.4%, respectively.

Results:
There were 74.6% of non-dippers, while white coat hypertension and masked hypertension were diagnosed in 25.4% and 7.9%, respectively. During the follow up period of 48 months 69 patients died from all-cause and 53 from CV mortality. Diurnal variations of blood pressure were not associated with all-cause mortality. Neither white-coat nor masked hypertension were associated with all-cause mortality. Patients with arterio-venous fistula showed significantly better survival when compared to patients with permanent dialysis catheters and in the linear regression model MIS/PEW and PWV were the only predictors of longer survival (b = −0.371, p = 0.001; b = −0.249, p = 0.009).

Conclusions:
Blood pressure characteristics (ABPM) were not predictors of all-cause mortality in patients undergoing chronic hemodialysis. On contrary, arterial stiffness and malnutrition were associated with shorter survival. Observed better survival of patients with A-V fistula compared to patients with permanent catheter is very probably reverse epidemiology. Due to small number of CV deaths we were not able to perform analyzes of CV deaths.
POTENTIAL OF AROMATHERAPY AS A LIFESTYLE MEASURE IN BLOOD PRESSURE REDUCTION: AN ANCIENT PRACTICE INCORPORATED IN MODERN MEDICINE: PILOT PROJECT
Authors: Cuti Edina Catic , Kovacevic Idriz , Cuti Tomislav 
Published: April 2021

Objective:
Aromatherapy is ancient practice of using natural oils to enhance psychological and physical well-being. Despite its long history there is paucity of scientific evidence regarding autonomic response to aromatherapy.
Purpose of this prospective study is to evaluate potential beneficial effects of aromatherapy using essential oils Ylang Ylang and Citrus on blood pressure and heart rate in real life practice.

Design and method:
In this prospective study 52 subjects were involved (mean age 59,2; 71% men) with verified and treated hypertension.
The subjects were divided into two groups. Treatment group (N = 21) received aromatherapy and a control group (N = 31) did not receive aromatherapy prior to seeing a nephrologist.
Blood pressure measurements were taken before and after aromatherapy.
Blood pressure was measured using Omron M6 device as defined by ESH/ESC guidelines and central blood pressure and Pulse Wave Velocity were measured using MobiloGraph.
Due to statistical requirements blood pressure was analyzed separately by systolic and diastolic component through paired samples t-test. Statistical differences were tested on significance level of 5%.

Results:
Statistically significant reduction in systolic (t(20) = 6.338, p = 0.000)) and diastolic blood pressure (t(20) = 4.557, p = 0.000) was found in the treatment group.
There was statistically significant improvement in heart rate within treatment group (t(20) = 5.206, p = 0.000)). Heart rate was lowered from 79 ± 12 bpm to 72 ± 11 bpm.
Control group had significantly higher systolic (135 ± 18 mmHg) and diastolic (92 ± 13 mmHg) central blood pressure compared to the treatment group (119 ± 10 mmHg and 77 ± 10 mmHg respectively). T-test (students’ t-test) was used for statistical analysis.

Conclusions:
This pilot study suggests there may be a beneficial effect of short term aromatherapy on blood pressure and heart rate reduction. This practice could be utilized in variety of clinical scenarios such as lessening the white coat effect. Additional studies with larger patient population and longer follow up are needed to gain better insights into the effect of aromatherapy on autonomic system.
EFFECTS OF SKIN TONE AND AMBIENT LIGHTING ON ACCURACY OF CONTACTLESS MEASUREMENT OF HEART RATE AND PULSE TRANSIT TIME: AN INVESTIGATION TOWARD IMAGE-BASED BLOOD PRESSURE ESTIMATION
Authors: Shirbani Fatemeh , Hui Tsz Him , Tan Isabella , Butlin Mark , Avolio Alberto 
Published: April 2021

Abstract

Objective:
Image-based photoplethysmography (iPPG) using video of the skin offers potential for contactless blood pressure (BP) estimation from the pulse transit time (PTT). Optical properties of human skin and ambient lighting are likely to affect accuracy of image-based PTT (iPPT) and are investigated here.

Design and method:
Twelve healthy volunteers (6 female, 27 ± 6 years) with a range of skin tones (Fitzpatrick skin scores of 5 to 27) were recruited. For each subject, the experiment was performed in standard fluorescent room lighting (100 lux) and repeated at five other levels of light intensity (40–310 lux). Two-minute videos were acquired from each subject's face and palm of the left hand; simultaneous electrocardiogram (ECG) and non-invasive finger BP were also measured. In each frame, two regions of interest (ROIs) were selected from the subject's face and hand, and the average of green colour intensity for each ROI were calculated as iPPG. The iPPG signal was band-pass filtered between 0.66–3 Hz, (corresponding to a 40–180 bpm heart rate (HR) range). HR was calculated as the dominant peak in the Fourier spectrum of filtered iPPG. Beat-to-beat values of iPTT were calculated between the corresponding feet of the iPPG pulsations.

Results:
The absolute error between average HR (errHR) determined from ECG and that calculated from iPPG in both ROIs was significantly correlated with room lumen (RL) and skin score (SC) (errHR = – 0.08 × RL + 0.67 × SC + 12, p < 0.05). The minimum HR error was in standard room lighting (errHR = 3.9 ± 8.9 bpm). Using average iPTT in room lighting as the reference, the percentage error (iPTT%err) between reference iPTT and iPTT in other lighting conditions significantly decreased with lower lighting conditions but was not significantly changed with skin tone score (iPTT%err = -0.09 × RL + 55, p < 0.05).

Conclusions:
Skin tone and ambient lighting intensity affects accuracy of contactless HR measurement. Only light intensity affects accuracy of iPTT measurement. It is likely that errors in contactless BP estimation are minimised in standard room lighting conditions but increase in dimmer conditions.
IS AUSCULTATION ADEQUATE TO ESTIMATE BLOOD PRESSURE RESPONSES RELATED TO BODY POSITION CHANGES?
Authors: Wuerzner Gregoire , Vybornova Anna , Wurzner Arlène , Polychronopoulou Erietta , Fallet Sibylle , Sola Josep , Alpert Bruce 
Published: April 2021

Abstract

Objective:
The auscultatory blood pressure (BP) measurement technique, relying on the K1 and K5 Korotkoff sounds, is the current reference to validate new devices in the standard sitting position. There are few data to tell whether it should also be used for device validation in other body positions, since the K1 and K5 sounds can be affected by changes in vascular tone. In this study, we recorded the BP responses to body position changes by the auscultatory method, and we compared them to data from simultaneous recordings by a volume-clamp method.

Design and method:
Systolic (SBP) and diastolic (DBP) were estimated on the left upper arm by two independent blinded observers, and on the ipsilateral middle finger by a volume-clamp device (Nexfin, BMEYE, The Netherlands) in the supine followed by the standing position, and in the standing followed by the supine position. The auscultatory readings were repeated if readings differed more than 4mmHg between the two observers. A first auscultation was performed before the position change, and a second one 150 s after the position change. Because volume-clamp measurements were not available during upper-arm cuff inflation, the mean of volume-clamp values in a 30 s window prior to auscultation onset were used for the analyses.

Results:
Sixty-seven participants, between 21 and 65 years old, participated in this study. As illustrated in the figure, volume-clamp reported a consistent mean DBP increase of 9.3 mmHg when moving from supine to sitting, and a consistent mean DBP decrease of 10.4 mmHg when moving from sitting to supine. These results agree with those previously reported using simultaneous invasive and volume-clamp measurements. On the contrary, auscultation detected no consistent body position-related change in the DBP readings. Neither auscultation nor volume-clamp detected consistent body position-related changes in SBP readings.

Conclusions:
Compared to volume-clamp, auscultation was not able to detect any consistent changes in BP during orthostatic challenge. Our study suggests that the use of Korotkoff sounds to estimate BP in body positions other than sitting and relaxed may not be appropriate.
OUTCOME-DRIVEN THRESHOLDS OF CENTRAL SYSTOLIC BLOOD PRESSURE AND CROSS-CLASSIFICATION OF SYSTOLIC HYPERTENSION AT CENTRAL AND BRACHIAL ARTERIES
Authors: Cheng Yi-Bang , Aparicio Lucas S. , Thijs Lutgarde , Melgarejo Jesus D. , Huang Qi-Fang , Sheng Chang -Sheng , Gilis-Malinowska Natasza , Wei Fang -Fei , Niiranen Teemu J. , Yang Wen -Yi , Boggia José , Stolarz-Skrzypek Katarzyna , Barochiner Jessica , Wojciechowska Wiktoria , Tikhonoff Valérie , Casiglia Edoardo , Narkiewicz Krzysztof , Filipovský Jan , Czarnecka Danuta , Kawecka-Jaszcz Kalina , Jula Antti M. , Struijker-Boudier Harry A.J. , Wang Ji-Guang , Zhang Zhen-Yu , Li Yan , Staessen Jan A. 
Published: April 2021

Objective:
We aimed to determine the outcome-driven thresholds for central systolic blood pressure (cSBP) based on the new ACC/AHA hypertension classification and to explore the characteristics and prognosis associated with central systolic hypertension (cSHT).

Design and method:
In 5580 participants enrolled from 9 populations (mean age 54.2 years; 54.1% women), cSBP was estimated tonometrically from the radial waveform (SphygmoCor, Atcor, Australia). We determined the thresholds for cSBP, resulting in 5-year cardiovascular risks similar to those associated with the 2017 ACC/AHA classification of brachial systolic blood pressure (bSBP). Statistical methods included analysis of covariance, the log-rank test and proportional hazards regression.

Results:
Over 4.1 years (median), 203 persons died (6.4 per 1000 person years) and 252 experienced a composite cardiovascular endpoint (8.2 per 1000 person-years). After rounding to the nearest 5 mm Hg, approximate thresholds for elevated cSBP and stages 1 and 2 and severe cSHT were 110, 120, 130 and 150 mm Hg, respectively. In 3659 untreated subjects, those with isolated cSHT (cSBP > = 120 mmHg, n = 137, 3.7%), compared to the participants with central (cSBP < 120 mmHg) and brachial (bSBP <130 mmHg) normotension (n = 1953, 53.4%), were older, more likely being female, had smaller height, slower heart rate and higher augmentation index. The opposite was true for isolated brachial hypertension (bSHT; bSBP > = 130 mmHg, n = 192, 5.3%). Among 1921 treated patients, the use of b-blockers was more frequent (50% vs. 36.2%, P = 0.027), whereas in isolated cSHT (n = 72, 3.8%) compared with controlled cSBP, RAAS inhibitors less often used (50% vs. 65.3%, P = 0.013). Among all participants, with brachial and central normotension as reference, the multivariable-adjusted hazard ratios (95% confidence interval) of the composite cardiovascular events were 1.29 (0.57–2.90; P = 0.54) for isolated bSHT, 2.30 (1.22–4.33; P = 0.01) for isolated cSHT, and 2.00 (1.39–2.88; P = 0.002) for concordant cSHT and bSHT.

Conclusions:
Outcome-driven thresholds of central systolic BP were approximately 10 mm Hg lower than their brachial counterparts. cSHT, either isolated (4%) or combined bSHT (90%), was characterised by greater systolic augmentation and was associated with higher cardiovascular risk.
USE OF DOUBLE FIXED-DOSE COMBINATION OF OLMESARTAN AND AMLODOPINE VERSUS FIXED-DOSE COMBINATION OF LISINIPRIL AND AMLODOPINE IN UNCONTROLLED HYPERTENSIVE PATIENTS
Authors: Koval Sergey , Penkova Marina , Starcenko Tatiyana , Rieznik Larisa 
Published: April 2021

Objective:
To check the efficacy of double fixed-dose combination of Olmesartan (O) and Amlodopine (A) versus the fixed-dose combination of Lisinopril (L) and amlodipine (A) in obese patients with uncontrolled moderate-to-severe arterial hypertension (AH).

Design and method:
Design and method: 60 hypertensive patients with abdominal obesity. The first subgroup of patients (n = 30) received fixed-dose combination: O and A (20 mg/5 mg; 40 mg/10 mg), the second subgroup (n = 30) - L and A (10 mg/5 mg; 20 mg/5 mg; 20 mg/10 mg). The examinations were carried out at baseline and in 6 months.

Results:
Results: The frequencies of BP target levels after treatment were higher in the first subgroup than in the second (75% versus 53%, p < 0.05). According to 24-hour BP monitoring, the fixed - doses combination of O/A lowered such parameters as 24-hour systolic BP and diastolic BP, systolic BP (night) and diastolic BP (night) more significantly than fixed-doses combination L/A. The adherence to double fixed-dose combination O/A was also higher in comparison with fixed combination L/A (85% versus 61%, p < 0.05). It has been established that lower fixed-doses combination of O/A (20 mg / 5 mg) were more often used compared to L/A (20% versus 10%, P < 0.05) in this patients. At the same time, the maximum doses of these drugs were necessary to achieve target BP levels in a significantly lower number of patients receiving a fixed dose combination of O/A compared to patients on L/A (60% against 81%, p < 0.05).

Conclusions:
The study demonstrated superior efficacy of O/A in reducing office BP, as well as 24-h ambulatory BP versus L/A in obese patients with uncontrolled moderate-to-severe AH. Achievement of target BP levels in patients with AH and abdominal obesity was possible at lower fixed-dose combination of O/A than L/A.
EFFECT OF ACCESSORY RENAL ARTERY ON ESSENTIAL HYPERTENSION
Authors: Song Wei , Wu Fengyuan , Guo Ran , Lu Yan , Zhang Ying , Jian Yinong 
Published: April 2021

Objective:
Whether the accessory renal arteries (ARAs) are involved in hypertension has been disputed for decades. Our study was designed to determine whether there were differences between primary hypertensive patients with or without ARAs.

Design and method:
Patients who has been diagnosed with essential hypertension in our hospital between June 2017 and October 2019 were collected. They were divided into two groups according to the presence or absence of ARAs confirmed by computed tomography angiography of renal arteries. Control group comprised 126 patients whose kidneys were supplied by single arteries while ARAs group comprised 118 patients with accessory renal arteries. The background and clinical data of these patients were collected.

Results:
There were no significant differences in age, hypertension duration, diabetes, smoking, BMI and drug history of antihypertensive treatment between the two groups (all P > 0.05). In our study, 45.8% of accessory renal arteries were on the left, 29.7% on the right and 24.5% on both sides. Male patients had a higher incidences of ARAs (72.9%).Mean blood pressure in 24 hours was 143/93 ± 15/11 mmHg in ARAs group while 151/99 ± 14/10 mmHg in control group. The blood pressure was significantly high in patients with ARAs than patients without ARAs (P < 0.01). Renin concentration was higher in ARAs group than control (P = 0.037). Target organ damage was compared. The thickness of left ventricular posterior wall and interventricular septum was dramatically increased in ARAs group compared with that of control (all P < 0.01).Left atrial dimension of ARAs group was greatly larger than control (P < 0.01). Creatinine and cystatin C was increased in ARAs group compared with that of control (P = 0.032 and 0.01 respectively). Flow-mediated dilation (FMD) was remarkably low in ARAs group compared with control (P = 0.017). Left carotid intima-media thickness (IMT), right femoral IMT and bilateral popliteal IMT of ARAs were significant thicker than control group (all P < 0.05).

Conclusions:
We concluded that patients with accessory renal arteries may have higher blood pressure. The mechanism involved maybe the increased renin concentration. Hypertensive patients with accessory renal artery may lead to more serious damage in target organs.