bluuebunny/crossref_metadata_2025_split huggingface dataset:
A SCOPING REVIEW ON BLOOD PRESSURE TIME AT TARGET AND ITS PROGNOSTIC VALUE FOR CARDIOVASCULAR OUTCOMES
Authors: Li Wansha , Gnanenthiran Sonali , Schutte Aletta E , Tan Isabella 
Published: May 2024

Objective:
The amount of time blood pressure (BP) is at target levels, commonly referred to as time at target (TTR), has been shown to be a useful measure for evaluating hypertension management effectiveness and assessing longitudinal BP control. This scoping review was conducted to identify and describe measurement methodologies used for determining BP-TTR and the association between BP-TTR and cardiovascular outcomes.

Design and method:
We followed the PRISMA extension for scoping review protocol. Literature was systematically searched from five databases (Embase, PubMed, Scopus, Web of Science and CINAHL). Search terms included “hypertension”, “blood pressure”, “time at target”, “time in therapeutic range”, “cardiovascular outcome∗”, “cardiovascular event∗”, and “clinical outcome∗”. Clinical trials, observational studies, cohort studies, cross-sectional studies, and systematic reviews related to TTR and cardiovascular outcomes were included, excluding conference proceeding and abstracts. Only English language articles were included.

Results:
Of the 369 articles identified, 17 articles were included in this scoping review. Majority of the studies (n=11, 65%) adopted the linear interpolation method for BP-TTR calculation, whereby a linear increase/decrease is assumed between two consecutive BP readings and TTR is determined as the proportion of time (in days) BP was in range. Four studies reported TTR determined as the proportion of BP readings in target range. Office BP readings was the dominant BP measurement method (n=15) in the selected studies, while 24-hour ambulatory BP monitoring (n=1) and home BP monitoring (n=1) were used in two studies. Studies differed in the time range over which BP-TTR was determined (range 13 days to 15 years) as well as frequency and total number of BP measurements (range 2 to 28). All studies demonstrated that a higher BP-TTR was associated with a reduced risk of cardiovascular outcomes, reflecting better BP control.

Conclusions:
This scoping review identified two main categories of BP-TTR calculation methods, the linear interpolation method and the proportion of BP readings method. All studies demonstrated the value of BP-TTR as a measure of BP control regardless of the calculation method, with lower TTR being associated with higher risk of poorer cardiovascular outcomes.
COMPARISON OF CALIBRATION METHODS IN THE PRECISION OF A RING-TYPE CUFFLESS BLOOD PRESSURE MEASUREMENT DEVICE
Authors: Lee Huijin , Lee Hae-YOUNG 
Published: May 2024

Objective:
This study aimed to compare the efficacy of two calibration methods for a ring-type cuffless blood pressure (BP) measurement device, CART-I Plus, to assess if regular calibration with a traditional brachial arm cuff device enhances its precision.

Design and method:
The study involved 40 patients, with 28 completing the study. Participants underwent calibration in three different positions (sitting, standing, supine). Prior to the initial calibration, they were seated quietly for 3–5 minutes. Calibration was executed using a conventional brachial arm cuff device on the same arm. In each position, calibration was performed twice, separated by a minimum interval of one minute. A rest period exceeding two minutes was allowed between position changes for stabilization. BP estimates from the CART-I Plus, derived from photoplethysmography signals, were then compared with corresponding conventional 24-hour ambulatory BP monitoring (ABPM) measurements.

Results:
The mean differences between the CART-I Plus and ABPM, when calibrated using the sitting position alone (twice), were -2.12±8.53/2.36±7.82 mmHg (awake/sleep SBP) and -4.11±7.73/0.27±7.99 mmHg (awake/sleep DBP), respectively. When calibration included all three positions (six total calibrations), the mean differences remained similar; -2.14±8.95/2.17±8.53 mmHg (awake/sleep SBP) and -4.10±7.91/0.25±7.73 mmHg (awake/sleep DBP) (p > 0.5). Neither the standing nor the supine position, nor a combination of sitting and supine positions, significantly improved precision. In both standing and supine positions, the devices demonstrated a strong correlation for systolic blood pressure (SBP) (r=0.86 and r=0.90, respectively) and diastolic blood pressure (DBP) (r=0.90 for both), with all correlations being statistically significant (p < 0.001).

Conclusions:
Provided that patient stabilization is adequately ensured, and precise brachial BP measurements are taken by medical personnel, a single sitting position calibration appears to be sufficient. The addition of dynamic three-point calibration involving standing and supine positions did not significantly enhance precision.
FEASIBILITY AND EFFECTIVENESS OF A RING-TYPE BLOOD PRESSURE MEASUREMENT DEVICE COMPARED WITH 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING DEVICE
Authors: Lee Huijin , Lee Hae-YOUNG 
Published: May 2024

Objective:
This investigation aimed to assess the feasibility and accuracy of the CART-I Plus, a novel ring-type cuffless blood pressure (BP) measuring device and compare its performance with standard 24-hour ambulatory BP monitoring (ABPM).

Design and method:
The study recruited 40 patients, of which 33 were included in the final analysis. Participants were instructed to wear both the CART-I Plus and the ABPM devices on the same arm for a duration of approximately 24 hours. The BP readings obtained from the CART-I Plus, which utilizes photoplethysmography (PPG) signals for measurement, were compared against those from the ABPM.

Results:
In terms of systolic/diastolic blood pressure (SBP/DBP) readings, the CART-I Plus recorded values of 131.4±14.1 / 81.1±12.0 mmHg, 132.7±13.9 / 81.9±11.9 mmHg, and 128.7±14.6 / 79.3±12.2 mmHg for the 24-hour, daytime, and nighttime periods, respectively. In comparison, the ABPM showed readings of 129.7±11.7 / 84.4±11.2 mmHg, 131.9±11.6 / 86.3±11.1 mmHg, and 124.5±13.6 / 80.0±12.2 mmHg for the same intervals. The mean variances in SBP/DBP between the CART-I Plus and ABPM were 1.74±6.69 / -3.24±6.51 mmHg, 0.75±7.44 / -4.41±7.42 mmHg, and 4.15±6.15 / -0.67±5.23 mmHg for the 24-hour, daytime, and nighttime measurements, respectively. Furthermore, a significant correlation was observed between the devices, with correlation coefficients of r=0.725 for SBP and r=0.750 for DBP during the transition from daytime to nighttime (both p <0.001).

Conclusions:
The CART-I Plus device, with its innovative ring-type design, demonstrates considerable accuracy in BP measurement, aligning closely with the established ABPM method. These findings indicate that the CART-I Plus could be an effective tool for continuous BP monitoring in clinical settings. Its ability to provide consistent and reliable measurements, along with the convenience of its cuffless design, highlights its potential as a valuable addition to current BP monitoring practices.
NUMBER OF HOME BLOOD PRESSURE MEASUREMENT AND COGNITIVE IMPAIRMENT
Authors: Hoshide Satoshi , Nishizawa Masafumi , Kanegae Hiroshi , Kario Kazuomi 
Published: May 2024

Objective:
The advantage of home blood pressure (BP) measurement compared to office BP measurement can only be achieved if the patients remember to take the measurements as instructed. Cognitive function tends to decline with age, and individuals with mild cognitive impairment (MCI) often have difficulty completing established self-management tasks.

Design and method:
The aim of this study was to investigate the association between the number of days within a 5-and-a-half-day period that patients took their home BP as instructed and MCI assessed by the Japanese version of the Montreal Cognitive Assessment (MoCA-J) in an elderly clinical population.

Results:
We analyzed 303 ambulatory patients (mean age 77.3±8.2 years) in whom MoCA-J had been assessed, who were instructed to take home BP for 1 evening and twice a day for the next five days, and who had at least one morning home BP measurement. The average total MoCA-J score was 18.5±6.0 points. After accounting for patient characteristics including age, sex, body mass index, drinking, smoking, prevalent cardiovascular disease, morning systolic BP and diastolic BP, and the use of antihypertensive drugs, the number of days home BP was measured was independently associated with both total MoCA-J score (estimate, 0.82; 95% confidence interval [CI], 0.43–1.21; P<0.001) and the lowest quartile of MoCA-J score (13 or below) (odds ratio [OR], 0.72; 95%CI, 0.59–0.87; P=0.001). Home BP measurement noncompliance (< 5 days’ measurement) was also independently associated with the total MoCA-J score (estimate, -2.56; 95%CI, -4.09 to -1.03; P=0.001) and the lowest quartile of MoCA-J score (OR, 3.32; 95%CI, 1.59–6.96; P=0.001).

Conclusions:
Poor compliance with home BP monitoring was associated with cognitive impairment in elderly cases who had been specifically instructed to perform home BP monitoring during a designated period.
DIPPING STATUS OF BLOOD PRESSURE AND PROGNOSIS
Authors: Gaspar Ludovit , Kmetova Iveta , Filipova Slavomira 
Published: May 2024

Objective:
Ambulatory blood pressure monitoring (ABPM) plays an important role in monitoring the effectiveness of antihypertensive treatment. It enables to obtain clear information about absolute values and variability of blood pressure in time-defined periods. The aim of our work was to evaluate the clinical benefit not only from the point of view of BP control, but also from the prognostic aspect by determining the diurnal index.

Design and method:
To control the effectiveness of antihypertensive treatment, we used ABPM - Cardiosoft-Tonoport V, General Electric (USA) with oscillometric blood pressure measurement. We analyzed 206 ABPM records in hospitalized patients. There were 93 men (45%) and 113 women (55%). The monitored group of patients was divided into 4 groups according to age. There were 31 persons in the age group of 18-44 years, 78 persons in the age group of 45-64 years, 52 persons in the age group of 65-74 years and 45 persons in the oldest age group (75 years and over). In 15 patients (7.3%), we did not determine the diurnal sign for night waking.

Results:
The group of dippers consisted of 79 people (38.3%), there were also 79 people (38.3%) in the group of non-dippers, there were 30 risers (14.6%) and 3 extreme dippers (1.5%). Following the further fate of the investigated persons, we found that 19 persons (9.2%) died within 2 years, of which 14 were from groups with a disturbed diurnal index (9 non-dippers and 5 risers).

Conclusions:
Our results point to the fact that in addition to the basic parameters of BP used as an indicator of blood pressure control, the analyses of diurnal character disturbances has a importance in prognostic aspect. Identifying these patients may therefore be helpful in the management of hypertension and comorbidities.
BLOOD PRESSURE SURGE DURING THE EARTHQUAKE IN CITY OF PETRINJA, BANIJA REGION IN CROATIA
Authors: Crnojevic Ivana , Josipovic Josipa , Mirosevic Gordana , Gabric Ivo Darko , Jelakovic Bojan 
Published: May 2024

Objective:
Stress is known to contribute to other well-known environmental risk factors to hypertension leading to sympathetic overactivity. While usual environmental factors can be easily measured, exposure to stress is difficult to objectivize, especially during catastrophic events which are recognized as main stressors. There are several reports about earthquakes, blood pressure (BP) and cardiovascular events.

Design and method:
We are reporting a case on ambulatory blood pressure monitoring (ABPM) in 42-year-old women during Croatian earthquake.

Results:
A 42-year-old women with multiple genetic and environmental risk factors for hypertension was evaluated for secondary hypertension, and adult autosomal polycystic kidney disease was diagnosed. Kidney function was normal and there were no signs of target organ damage. She was treated with a fixed dose combination perindopril/amlodipine 4/5 mg (morning). ABPM revealed mildly uncontrolled systolic-diastolic hypertension with extreme nocturnal dip. Average 24-hour, daytime and nighttime BP values were 130±20,4/79±19,9 mmHg, 137±16,2 /85±17,9 mmHg, 100±11,8 /55±11,7 mmHg, respectively. White coat effect was present, and masked hypertension was ruled out. Average 24-hour, daytime and nighttime heart rate were: 88b/min, 93b/min, and 79b/min. A significant surge in BP and heart rate (200/130 mmHg,140 b/min) was recorded at 12:30 p.m. exactly at the time when earthquake occurred in city Petrinja, also felt in Zagreb city. The earthquake was clearly stated in the blood pressure diary (Figure 1).

Conclusions:
Although chronic stress is emphasized to affect human health more than acute, catastrophic events such as earthquakes can have deleterious effect such as enormous elevation of BP. It is necessary to have strategies for BP management in disaster-related diseases to prevent organ damage.
MAY MEASUREMENT MONTH 2017-2023 IN CHINA
Authors: Chen Xin 
Published: May 2024

Objective:
We investigated status of hypertension in a large opportunistic screening study in China from 2017 to 2023.

Design and method:
Data was derived from May Measurement Month (MMM). MMM China project strictly followed the international MMM protocol. Study participants had to be >= 18 years of age and had ideally not taken blood pressure for >= 1 year. Blood pressure was measured three times consecutively in the sitting position with a 1-minute interval, using a validated electronic BP monitor or mercury sphygmomanometer. Trained volunteer investigators administered a questionnaire to collect information on medical history, lifestyle, and use of medications.

Results:
Since 2017, more than 1600 measurement sites have been set up, and 1.7 million adult blood pressure measurements have been completed. Mean systolic blood pressure and diastolic blood pressure over the years is around 119-124mmHg, and 74-81 mmHg, respectively. From the results of MMM program, about 30% (24.7% to 29.2%) had hypertension. Through 3 years of efforts, the awareness (46.9% in 2017 to 51.5% in 2019), treatment (40.7% in 2017 to 48.4% in 2019), and control (15.3% in 2017 to 29.1% in 2019) rates of hypertension in China have improved. However, after COVID-19, the awareness (45.3% in 2020 to 16.0% in 2023), treatment (39.7% in 2020 to 14.3% in 2023) and control (24.2% in 2020 to 7.1% in 2023) rate of hypertension have declined. The main barriers to blood pressure awareness in China included age, gender, and body mass. The awareness of hypertension was higher in patients with comorbid diseases, such as diabetes mellitus, coronary heart disease, stroke or TIA, or the use of statins, than those without. The main barriers affecting hypertension control in China included age, gender, smoking and low proportion of combination therapy.

Conclusions:
The situation of low control rate of hypertension needs to be changed as soon as possible. Several modifiable factors as barriers to blood pressure control in China, such as current smoking, and the under-use of combination therapy warrants attention.
TRANSIENT HYPOTENSION IN AN ELDERLY HYPERTENSIVE PATIENT
Authors: Alibhai Alyzeh , Kumar Nikhil 
Published: May 2024

Objective:
A 60 year old hypertensive female presented to the office with fatigue and pre syncope lasting for 6 hours after a home blood pressure reading showed her systolic was 60. This happened several times a week. A 24 hr ABP was done & the patient woke up early hours feeling terrible & her SBP was below 70 mm Hg & the 24 hr ABP which showed 2 hypotensive readings between 6 and 7am. The BP came up slowly in a few hours & she recovered several hours later.

Design and method:
The patient was originally on Ramipril for hypertension prescribed by a local cardiologist, and then Nifedipine was added. Both short acting agents. She got these attacks weekly. She was switched over to long acting Perindopril & Amlodipine taken 12 hours apart. The frequency of the attacks reduced considerably to less than one per month. There was no orthostatic drop in pressure or any relationship to meals or exercise.

Results:
Systolic blood pressure below 70mmHg can lead to reduced perfusion to the brain. Low SBP can present as symptoms or manifestations of decreased cardiac or cerebrovascular circulation. It is important to differentiate orthostatic and postprandial hypotension from this transient cause. It is still unclear if the probability of organ damage is the same in symptomatic vs asymptomatic patients. Some patients have short term, or transient, symptomatic hypotension that has an poor prognosis.

Conclusions:
Managing hypertension in elderly is a challenge & must take into consideration to avoid orthostatic hypotension. It is important to do ambulatory monitoring on them to be able to register symptomatic episode. In this situation the drop in pressure was not Orthostatic or Post prandial. The mechanism is not easily explained but cases have been documented and in patients complaining of fatigue & Presyncope or Syncope, ambulatory monitoring is the key. When treating hypertension in elderly patients, the goal of treatment should not be to meet target but treating to lowest level tolerated without causing hypotension. A med review should be done to optimize on the class of drugs being taken.
CARDIOVASCULAR RISK FACTORS HAVE DIFFERENT EFFECTS ON TOTAL BRAIN VOLUME AND CEREBRAL WHITE MATTER LESIONS OVER TIME: THE HELIUS STUDY
Authors: Vriend Esther M.C. , De Sitter Alexandra , Bouwmeester Thomas A. , Franco Oscar H. , Galenkamp Henrike , Van Charante Eric P. Moll , Collard Didier , Nederveen Aart , Van Den Born Bert-jan H. 
Published: May 2024

Objective:
Cardiovascular risk factors have been associated with brain volume reduction and the development of cerebral white matter lesions (WML), both early markers of cognitive decline and cerebrovascular disease. Most studies, however, are cross-sectional in design and involve older populations. We examined the prognostic value of cardiovascular risk factors on brain and WML volumes in a middle-aged, multi-ethnic population.

Design and method:
We use baseline data and 3T brain magnetic resonance imaging (MRI) scans in 562 participants of Moroccan, South-Asian Surinamese, and Dutch descent from the HELIUS study. Brain volume and WML volumes were determined using automated segmentation pipelines based on MP-RAGE and 3D-FLAIR scans. Linear regression analyses, adjusted for age, sex, and ethnicity, were performed to assess the association between (change in) cardiovascular risk factors and brain and WML volumes.

Results:
Mean age was 58.5 (standard deviation 7.7) years, 45% was female. Median follow-up time was 8.4 [interquartile range 7.4; 9.5] years. Both elevated BMI and presence of diabetes at baseline as well as increases in BMI and HbA1C levels over time were significantly associated with reduced brain volume at follow-up. Hypertension, systolic and diastolic blood pressure levels, the use of antihypertensive medication, new-onset hypertension and history of cerebrovascular disease were all independently and positively associated with WML volume.

Conclusions:
Elevated body weight and diabetes mellitus significantly contribute to decreased brain volumes, whereas hypertension and cerebrovascular disease are key risk factors for the development of WML. The present findings underscore the importance of obesity and hypertension in mid-life as predictors of future risk of cerebrovascular disease.
IMPAIRED BETA-ADRENERGIC VASODILATOR FUNCTION IN HYPERTENSIVE PATIENTS WITH SYMPTOMS OF DEPRESSION
Authors: Farukh Bushra , Faconti Luca , Mcnally Ryan , Chowienczyk Phil 
Published: May 2024

Objective:
Hypertension and depression are amongst the most common chronic physical and mental conditions worldwide. The two conditions cluster, however the mechanisms underlying the association are not well understood. Hypertension complicated by affective disorders may be characterised by high sympathetic activity. We investigated whether symptoms of depression may be associated with impaired endothelium-dependent beta2-adrenergic vasodilator responses.

Design and method:
Hypertensive subjects with no previous history of diabetes or cardiovascular disease were recruited from the hypertension outpatient service at St. Thomas’ Hospital, London. Detailed medical history and baseline characteristics including blood pressure (BP), heart rate (HR), routine biochemistry including C-reactive protein (CRP) and low-density lipoprotein (LDL) were obtained during a single study visit. Plasma concentrations of normetadrenaline were measured as a marker of resting sympathetic activity. Depression symptom severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). The pulse wave response to the beta2-adrenergic vasodilator salbutamol (PWRS) was assessed using radial tonometry to measure the change in augmentation index after inhalation of 200μg salbutamol from a metered dose inhaler with spacer device.

Results:
100 subjects (62% male, mean ± SD age 41.0±11.6 years) were recruited. 79% were on pharmacological treatment for hypertension. Mean PHQ-9 depression score was 8.8±6.2, consistent with a high prevalence of depression. After adjusting for confounders (age, sex, smoking status, body mass index, BP, HR, CRP, LDL, treatment for hypertension), PWRS was significantly related to depression score (Beta= 0.447, P=0.002). Depression score was also significantly associated with plasma concentrations of normetadrenaline (Beta= 0.605, P<0.001) and after adjusting for plasma normetadrenaline level, the association between PWRS and depression score was no longer significant (Beta= 0.343, P=0.102).

Conclusions:
These results suggest that in hypertensive subjects with depression, an impaired endothelium-dependent beta2-adrenergic vasodilator response is mediated by a high level of sympathetic activity which could contribute to cardiovascular complications.