bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.