bluuebunny/crossref_metadata_2025_split huggingface dataset:
PRESENT RECOMMENDED REGIMEN FOR HOME BLOOD PRESSURE MONITORING MAY NEED REVISION FOR ACCURATE MONITORING AND DIAGNOSIS OF HYPERTENSION
Authors: Carlsson Martin , Brudin Lars , Darwiche Gassan 
Published: April 2021

Objective:
Recent NICE guidelines for management of hypertension stress the importance of home blood pressure management (HBPM) to confirm a diagnosis of hypertension. The objectives were to investigate the difference in two subsequent blood pressure (BP) measurements, evaluate diurnal variation using home blood pressure measurement and assess change in BP levels during a standard measurement period in home environment.

Design and method:
A total of 758 (male 372/female 386, mean age 57.9 ± 8.2 years) treated for primary hypertension were investigated. No intervention was given during the trial period. BP values were obtained by self-measurement at home using a Bluetooth-equipped oscillometric BP monitor connected to a smartphone application (Accumbo AB). For the first two weeks of the trial, participants were asked to measure HBPM on at least seven days in the morning (before breakfast) and at least seven days in the evening. Each measurement consisted of two BP measurements at 1-minute intervals.

Results:
The second/subsequent BP measurement showed lower values for both systolic BP (mean SBP 135 ± 12 mmHg vs. 134 ± 12 mmHg) and diastolic blood pressure (mean DBP 88 ± 9 mmHg vs. 87 ± 9 mmHg) compared with the first measurement (p < 0.001). Difference was more pronounced for SBP in males (-0.65 mmHg) than females (-0.52 mmHg), (p < 0.05). Diurnal BP variation was non-significant for SBP (p = 0.18) while DBP showed higher values in the morning (89 ± 9 mmHg) compared with evening values (86 ± 9 mmHg), (p < 0.001). The BP morning surge was more pronounced for males vs. females (p < 0.001). Mean BP was lower during the second week (134/87 ± 12/9 mmHg) compared with the first week (135/88 ± 12/9 mmHg, p < 0.001). This difference was driven by a reduction in BP significant for women (p < 0.001), but not for men (p = 0.37).

Conclusions:
The results indicate significant gender related differences in subsequent blood pressure values over time which might affect decision for treatment. The guidelines for home blood pressure monitoring may need to be revised to include more measurements over a longer period considering gender affiliation.
HYPERTENSION IN THE UNITED ARAB EMIRATES: A REGISTRY OF EMIRATI REPRESENTATIVE POPULATION
Authors: Shehab A. , Bhagavathula A.S. 
Published: April 2021

Objective:
We aimed to present the characteristics of Emirati patients, newly diagnosed with hypertension and registered for treatment in the 52 ambulatory clinics across Abu Dhabi, United Arab Emirates.

Design and method:
A retrospective assessment of the clinical data of Emirati patients who are newly diagnosed with hypertension and initiated treatment in ambulatory settings, January to December, 2017. Data was collected including socio-demographic and clinical characteristics, blood pressure, cardiovascular risk factors, and comorbidities were collected.

Results:
A total of 5308 patients were identified. The mean age was 54.8 (95% confidence interval (CI): 54.5, 55.1 years), and more than half (53.7%) are women. Overall, 1375 subjects (25.9%) were overweight, and 2343 (44.1%) are obese. Around 35.5% are smokers, a quarter (26.6%) of hypertension patients had diabetes, and dyslipidemia (24.5%). The mean systolic blood pressure (SBP) was 133.9 ± 17.1 mmHg and diastolic blood pressure (DBP) 72.9 ± 12.7 mmHg and around 40% of the patients are on two or more antihypertensive medications

Conclusions:
Most of the hypertension patients are middle-aged females, obese (44.1%), smokers (44.1%), and using at least two antihypertensive medications.
AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENTS RECORDED WITH AND WITHOUT PRECEDING REST AND ITS ASSOCIATION WITH AWAKE AMBULATORY BLOOD PRESSURE
Authors: Andreadis Emmanuel , Geladari Charalampia , Angelopoulos Epameinondas 
Published: April 2021

Abstract

Objective:
Automated office blood pressure (AOBP) measurement, attended or unattended, eliminates the white-coat effect (WCE) showing a strong association with awake ambulatory blood pressure (ABP).
This study examined the difference in AOBP readings, with and without 5 min of rest prior to 3 readings recorded at 1-min intervals and their relation to awake ABP levels.

Design and method:
This was a method comparison study performed in 100 consecutive hypertensive patients referred for suspected hypertension. Inclusion criteria: a. individuals aged > / = 18 years who had never taken or who had not received antihypertensive medication for at least the previous 6 months, b. subjects on stable antihypertensive medication for at least 4 weeks. Hypertension was obtained by an average office reading of systolic BP (SBP) > / = 140 mmHg or diastolic BP (DBP) / = 90 mmHg on three consecutive visits, based on semi-automated oscillometric technique. Exclusion criteria: secondary hypertension, atrial fibrillation, gross proteinuria, renal failure with estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 or heart failure (HF) with ejection fraction < 30%. Written informed consent was obtained from all patients and the study was approved by the scientific board of the hospital.

Results:
Cross-sectional data from 100 randomized selected hypertensives, 61 men and 39 women, with a mean age of 52.2+/-10.8 years, 82% treated, were analyzed. The mean systolic AOBP values without preceding rest was 127.0+/-18.2 mmHg and the mean systolic AOBP values with 5 minutes of preceding rest was 125.7+/-17.9 mmHg, (p = 0.05). A significant order effect was observed for the mean systolic BP values when AOBP without 5 min of preceding rest was performed as the first measurement (130.0+/-17.7 versus 126.5+/-16.2, p = 0.008). When we used a target systolic AOBP > / = 130 mmHg awake ABP yielded lower readings while at a target systolic AOBP value of < 130 mmHg higher awake ABP values were obtained.

Conclusions:
Our findings indicate that systolic AOBP can be initially checked without any preceding rest and if readings are normal can be accepted. Otherwise when AOBP is > / = 130 mmHg, measurements should be rechecked with 5 min of rest.
ALBUMINURIA IN PATIENTS WITH WHITE COAT EFFECT IS ASSOCIATED WITH OFFICE BLOOD PRESSURE
Authors: Andreadis Emmanuel , Geladari Charalampia , Angelopoulos Epameinondas 
Published: April 2021

Abstract

Objective:
The aim of this study is to investigate whether microalbuminuria observed in subjects with white coat effect (WCE) is a result of higher office blood pressure (BP).

Design and method:
We analyzed data in untreated and treated subjects assessed by office and ambulatory BP (ABP). Individuals aged > / = 18 years were included. Office BP measurements were taken using a digital oscillometric BP electronic device. ABP was monitored on a routine working day using validated oscillometric arm device. WCE was defined as OBP > / = 140/90 mmHg and 24 h mean ABP < 130/80 mmHg (daytime < 135/85 mmHg and nighttime < 120/70 mmHg). Urine albumin excretion (UAE) was measured in one 24-h urine collection.

Results:
A total of 151 subjects with WCE and 100 normotensives (mean age 58+/-12 years, 47.8% males) were analyzed. Their characteristics are shown in the Table.
Patients with WCE were significantly younger than normotensives (p = 0.035). Subjects with WCE had increased incidence of albuminuria compared to normotensives. Among patients with WCE 7.9% with albuminuria had both higher mean systolic OBP and systolic daytime ABP values compared to those without albuminuria (171+/-24mmHg vs 152+/-13mmHg, p = 0.019 and 127+/-6mmHg vs 123+/-8mmHg, p = 0.038, for the systolic OBP and systolic daytime ABP values, respectively). This association was not present in normotensive individuals.

Conclusions:
Microalbuminuria observed in subjects with WCE resulted from higher office and ambulatory BP values, underlining that the WCE phenotype is not innocent.
IMPACT OF USING INAPPROPRIATE CUFF SIZE IN BLOOD PRESSURE CLASSIFICATION: ANALYSIS FOR AUSCULTATORY AND OSCILLOMETRIC METHODS
Authors: Albuquerque Nila , Sheppard James , Araujo Thelma 
Published: April 2021

Abstract

Objective:
This study aims to identify how using an inappropriate cuff size in auscultatory and oscillometric methods changes blood pressure (BP) classification according American hypertension guidelines.

Design and method:
In this diagnostic accuracy study, 60 adult subjects were recruited. After ten-minutes of rest, six sequential BP measurements were performed. First measurement was considered the reference measurement as it was performed using a calibrated aneroid sphygmomanomether and a cuff size appropriate to participant's arm circumference. Second measurement was also performed with an appropriate cuff size, but using a HBP-1100 atuomatic monitor. The next four measurement were test measurements so they were taken using a standard adult cuff size (16 × 30 cm). Participants with upper arm circumference between 27 and 34 cm were excluded as the standard adult cuff size was the appropriate size for them. Third and fifth measurements were auscultatory and fourth and sixth were oscillometric measurements. Hypertension was considered present when BP readings were classified as stage 1 or 2. Stata/SE 15.0 was used to calculated performance measurements of diagnostic tests.

Results:
360 complete measurements were performed. Mean upper arm circumference was 30.01 (±6.74). According to ACC/AHA classification, the automatic monitor with an appropriate cuff size had a sensitivity of 0.9, a specificity of 0.82 and a diagnostic accuracy of 83%, compared to the aneroid with the same cuff size. When a smaller or larger cuff was used instead of an appropriate cuff, the automatic monitor had a sensitivity of 0.9, a specificity of 0.8 and a diagnostic accuracy of 81,66% and the aneroid had a sensitivity of 0.9, a specificity of 0.92 and a diagnostic accuracy of 91,66%.

Conclusions:
According to ACC/AHA hypertension guidelines, the automatic monitor was not as sensitive, specific and accurate as the aneroid to classify hypertension when BP is measured with an appropriate cuff size. In addition, when an inappropriate cuff size is used, the automatic monitor was also relatively less accurate than aneroid for classifying BP according to the ACC/AHA guidelines. Based on the findings, auscultatory measurements are most appropriate when only the standard adult cuff size is available.
EFFECT OF UNDERCUFFING ON AUSCULTATORY AND OSCILLOMETRIC BLOOD PRESSURE MEASUREMENT
Authors: Albuquerque Nila , Padwal Raj , Araujo Thelma 
Published: April 2021

Abstract

Objective:
The objective of the present investigation was to identify the effect of using a blood pressure (BP) cuff size smaller than that appropriate for patient's arm circumference (undercuffing) on auscultatory and oscillometric measurements.

Design and method:
It was a single-centre equivalence trial that recruited 47 adult subjects with upper arm circumferences between 35 and 44 cm. After ten minutes rest, six sequential BP measurements were performed 30 and, at most, 60 seconds apart while seated. First, third and fifth measurements were performed using blinded, simultaneous, two-observer auscultation using a calibrated anaeroid sphygmomanometer and requiring a between-observer agreement equal to or less than 4 mmHg. Second, fourth and sixth were performed with the Omron HBP-1100 oscillometric monitor. The first two measurements (one auscultatory and one oscillometric) were performed using a large adult cuff (16 x 36 cm), which represented appropriate cuffing for the study subjects. Third, fourth, fifth and sixth measurements were performed with a standard adult cuff size (16 × 30 cm). BP differences were calculated using device – observer measurement. A paired t-test was used to identify statistically significant differences between BP readings in each method.

Results:
282 complete measurements were available. Mean upper arm circumference size was 38.38 (±2.85) cm. Mean SBP and DBP when the appropriate cuff was used was 115.08 ± 18.32/70.25 ± 12.3 mmHg using the auscultatory method vs. 120.91 ± 17.15/72.57 ± 11.74 mmHg using the oscillometric method (p-value < 0.005). When smaller cuff size was used, mean SBP and DBP was 119.97 ± 15.88/76.78 ± 12.03 mmHg in the auscultatory method vs. 126.95 ± 16.17/74.56 ± 10.97 mmHg in the oscillometric method (p-value < 0.005). The mean device-observer disagreement for SBP (Fig 1) was 5.82 (±9.12) when appropriate cuff size was used and 6.98 (±8.06) with a smaller cuff size (p-value = 0.79). For DBP (Fig 2), the disagreement was 2.31 (±6.28) vs. -2.22 (±5.88) (p-value < 0.005).

Conclusions:
Using a smaller cuff size overestimates SBP and DBP, in both auscultatory and oscillometric methods and also results in a greater systolic disagreement between these two measurement methods.
CUFFLESS DEVICES CAN OPEN A NEW CHAPTER IN AMBULATORY BLOOD PRESSURE MONITORING ONLY IF VALIDATED RIGOROUSLY: DESIGN OF A CHALLENGING PROTOCOL FOR AKTIIA BRACELET
Authors: Vybornova Anna , Sola Josep , Fallet Sibylle , Olivero Elisa , De Marco Bastien , Grossenbacher Olivier , Ignatovic Natalia , Ignatovic Blagoje , Favre-Bulle Matthieu , Levinson Nora , Siutryk Nadège , Chapuis Valentin , Bertschi Mattia , Alpert Bruce 
Published: April 2021

Objective:
Cuffless wrist-based blood pressure (BP) monitors have a great potential to make ambulatory monitoring more appealing to patients and provide clinicians with better BP profiling. Investigators must be vigilant to validate these devices properly, as little guidance has been published.
We propose a protocol that addresses ambulatory environment challenges, such as body posture changes and variable arm position. In addition to reporting the accuracy, we suggest reporting the number of successful automated measurements – the acceptance rate.

Design and method:
We tested the Aktiia Bracelet, a cuffless automated device that records optical signals at the wrist and requires an initial calibration, with the proposed protocol on 10 healthy volunteers. We simultaneously recorded the signals from the Aktiia Bracelet and a reference volume-clamp device positioned on the contralateral arm during the following interventions: sitting, lying supine, standing with both arms positioned at heart level; sitting with the Aktiia bracelet wrist positioned 30 cm lower than heart level; isometric leg extension inducing large BP changes. We calculated the mean and standard deviations of the error between Aktiia bracelet and the reference, as well as the acceptance rates in different measurement scenarios.

Results:
The figure illustrates the mean and standard deviation (STD) of the error between Aktiia bracelet and the reference, as well as the acceptance rate (Acc) for the diastolic BP (DBP). The dashed area illustrates the expected hydrostatic bias. The mean and the standard deviation of the error fell within ISO81060-2 limits. Aktiia bracelet readings were not affected by the hydrostatic bias intervention, even though one could expect an error of more than 20 mmHg.
The maximum of the accepted measurements was achieved when patients were lying supine (67%) and sitting (52%). Thus, the user can expect a high density of measurements during night-time. However, when standing, the acceptance dropped (27%).

Conclusions:
This protocol provides more realistic testing of cuffless wrist-based BP monitors and suggests a way to improve the validation of this new family of devices.
AMBULATORY CENTRAL BLOOD PRESSURE OBTAINED BY BPLAB IS QUESTIONABLE
Authors: Posokhov Igor 
Published: April 2021

Objective:
Reference intervals of ambulatory (24-h) central blood pressure (ACBP) obtained from large healthy population are lacking in Russia. ACBP and 24-h BP amplification percentile for each age would be potentially useful for medical practice. This was an attempt to obtain reference values.

Design and method:
Database consisted of 8987 ABPM files was received by the BPLab device (Russia) during a survey of few districts in Russia. 1st, ABPM-files that corresponded to the normal ambulatory BP according to 2018 ESC/ESH Guidelines for the management of arterial hypertension were selected from database. 2nd, files that indicate antihypertensive treatment, elevated BMI and any disease in extended BPLab-diary were excluded. 3rd, age-specific percentiles ACBP-curves were generated with Vasotens (Russia) and LMS Chartmaker Pro (UK) software.

Results:
As a result, a selection of 2510 records was suitable for analysis. 24-h BP amplification is shown schematically in the figure below.
In the figure: A: Well-known data that are combined from the Framingham Study, from the US National report on high BP in children and adolescents, from the Sydney Group study (2010) and from the Anglo-Cardiff Collaborative Trial II. B: Data from the present study (amplification adapted to a similar systolic pressure).
The 24-h BP amplification obtained by the test method is too high, especially in people over the age of 40.

Conclusions:
The obtained values cannot be recommended for routine medical practice as a reference. The method for calculating central BP used in the device-under-test is likely questionable.
PULSE ARRIVAL TIME CAN TRACK CHANGES IN SYSTOLIC BLOOD PRESSURE
Authors: Heimark Sondre , Rindal Ole Marius Hoel , Seeberg Trine , Stepanov Alexey , Boysen Elin Sundby , Søraas Camilla Lund , Stenehjem Aud -Eldrid , Elmula Fadl Elmula Mohamed Fadl , Waldum-Grevbo Bård 
Published: April 2021

Objective:
Automated cuff-based blood pressure (BP) monitoring is limited to intermittent measurements vulnerable to movement. Pulse arrival time (PAT), calculated using electrocardiography (ECG) and photo plethysmography (PPG), has shown promise for non-invasive, continuous BP monitoring. The precise relationship between BP parameters and PAT under varying conditions remains to be fully understood. This study aimed to investigate the correlation between PAT and BP under different exercise modalities.

Design and method:
Data was analyzed on 33 volunteers aged 18 years or older with and without hypertension. The test protocol consisted of isometric leg exercise, an incremental ergometer bicycle test and seated periods of rest before, in-between and after. PAT was measured with an easy-to-use chest belt consisting of a 1-channel ECG and PPG sensor. PAT was calculated and averaged using a gliding average over 200 cycles from the R-wave in the ECG signal to the foot of the PPG waveform. Reference BP was measured every minute manually with an aneroid sphygmomanometer. Systolic- and diastolic BP was recorded to the nearest second for optimal synchronicity.

Results:
Subjects were aged 42.3 ± 13.3 years, ranging from 18–70. 48.5% were males, 18.2% had a prior diagnosis of hypertension and 15.2 % used antihypertensive medication. Systolic- and diastolic BP at inclusion were 123.6 ± 16.1 and 76.4 ± 8.4 mmHg with ranges from 98–168 and 66–100 mmHg respectively. Pearson's correlation between systolic BP and PAT was -0.86 ± 0.08, -0.84 ± 0.14 and -0.81 ± 0.14 for the full protocol, isometric exercise and dynamic exercise respectively. Corresponding correlation for diastolic BP was 0.43 ± 0.31, -0.75 ± 0.20 and 0.39 ± 0.35. For diastolic BP, correlation with PAT was positive in most subjects for the full protocol (94%) and dynamic exercise (79%), and negative in all subjects for isometric exercise. Systolic BP showed negative correlation inn all subjects for all analyses. Figure 1 shows test protocol and results for one subject.

Conclusions:
The results suggest that pulse arrival time can track changes in systolic blood pressure. The relationships between diastolic blood pressure and pulse arrival time varied between exercise modalities and remains to be further elucidated.
HYPERTENSION AND BLOOD PRESSURE CONTROL AMONG RESPONDENTS LIVING IN DHAKA DIVISION, BANGLADESH
Authors: Hasan Mehedi , Khan Md Showkat Ali , Sutradhar Ipsita , Hossaine Moyazzam , Yoshimura Yukie , Choudhury Sohel Reza , Sarker Malabika , Mridha Malay Kanti 
Published: April 2021

Objective:
In Bangladesh, 67% of all deaths are due to non-communicable diseases (NCDs), of which17% are attributable to cardiovascular diseases (CVD). Hypertension is a major risk factor for CVD. We conducted a baseline survey titled SHASTO (Strengthening Health Systems through Organizing Communities) to estimate the prevalence of hypertension, their risk factors, health care seeking behaviour among residents living in Dhaka division of Bangladesh.

Design and method:
This cross-sectional study was conducted among residents aged >30 years living in Dhaka north, Dhaka south, Narsinghdi and Gazipur district of Dhaka division. The respondents were interviewed using a modified version of STEPS questionnaire and physical measurements were taken following a standard operating procedure. Hypertension was defined as systolic blood pressure (BP) > = 140 mm of Hg and/or diastolic BP > = 90 mm of Hg and/or persons with already diagnosed hypertension.

Results:
A total of 4930 respondents participated in the study and mean age of male and female respondents was 48 and 45 years respectively. Overall, 31% of the respondents were hypertensive and the prevalence was higher among urban (37%) and female (38%) respondents than their rural (31%) and male (24%) counterparts. A higher prevalence of hypertension was also observed among respondents currently not working (not working: 47% vs working: 30%), consumed inadequate fruits and vegetables (inadequate: 32% vs adequate: 28%), performed inadequate physical activities (inadequate: 43% vs adequate: 28%) and overweight or obese (overweight/obese: 39% vs not overweight/obese: 24%). About 75% of hypertensive patients were aware of their status and 64% of them sought care. More than half (54%) of them were taking medication, however, 44% of them had uncontrolled BP. The prevalence of uncontrolled BP was found higher among female (63%), rural (89%), overweight or obese (60%), and nuclear family (63%) respondents.

Conclusions:
The prevalence of hypertension and uncontrolled BP was high among respondents living in Dhaka division of Bangladesh. The government should implement hypertension control and prevention programmes to tackle the burden and its associated complications.