bluuebunny/crossref_metadata_2025_split huggingface dataset:
TIME OF DAY, WEEKDAY, AND SEASON ARE ASSOCIATED WITH BLOOD PRESSURE MEASURED IN THE EMERGENCY DEPARTMENT
Authors: Oras Pontus , Olbers Joakim , Svensson Per 
Published: June 2023

Objective:
Elevated blood pressure is often observed in the emergency department. Although it sometimes is explained by factors such as pain, anxiety, or white coat syndrome, it is nevertheless associated with incident atherosclerotic CVD and should not be disregarded. However, the impact of other factors on blood pressure in this setting is largely unknown. Therefore, we aimed to investigate whether season, weekday, or time of day is associated with patients’ systolic blood pressure in the emergency department.

Design and method:
In this electronic health record study, we selected all visits by adult patients with at least one measured blood pressure from a university hospital emergency department between 2010 to 2016. Systolic and diastolic blood pressure, age, sex, time of day, weekday, and month of the visit were derived from the hospital's electronic health records. Linear regression was used to estimate the relationship between time factors and blood pressure. Sex, age with restricted cubic splines, inclusion year, and emergency desk were included as covariates in the analysis.

Results:
A total of 604,091 ED-visits were included in the study. The systolic blood pressure was higher in visits during winter; 2.3 mm Hg (95% CI: 2.1-2.4), spring; 1.6 mmHg (95% CI: 1.4–1.7) and autumn; 1.7 mmHg (95% CI 1.5–1.9) compared to visits in the summer. When accounting for confounders, the systolic blood pressure was higher in visits during evening; 2.8 mm Hg (95% CI: 2.7–3.0) and night; 2.2 mmHg (95% CI: 2.0–2.5) compared to visits in the morning. Minor differences were observed in the afternoon (+0.3 mm Hg, 95% CI 0.1-0.4) and on the weekend (+0.3 mmHg, 95% CI 0.2–0.5).

Conclusions:
The time and season of the visit are associated with blood pressure measured in the emergency department. The systolic blood pressure on a winter evening was 5 mm Hg higher on average compared to a summertime morning visit. Our findings suggest that these factors should be considered while assessing the patient's future risk associated with a high blood pressure reading in the emergency department.
COMPARISON OF BLOOD PRESSURE MEASUREMENTS ON THE BARE ARM AND THE SLEEVED ARM - WHAT DOES IT COVER?
Authors: Leiba Adi , Ishay Rotem Tal-Ben , Rapoport Vladimir , Katzir Zeev 
Published: June 2023

Objective:
The question of blood pressure measuring on the bare arm was debated for many years. The updated guidelines recommend measuring on the bare arm, although former studies found no significant differences between measurements taken over a rolled-down or up sleeve compared to the bare arm. We aim to compare blood pressure measurements on the same patients over a bare and a sleeved arm.

Design and method:
We collected blood pressure measurements of 100 patients visiting the nephrology clinic between January 2019 and December 2022. Measurements were performed with and without sleeves on each arm for each patient (total of 400 arms) and taken simultaneously on both arms (exchanging the bare and the sleeved arm in the second measurement). Since most variables were not normally distributed, we proceeded to a non-parametric Wilcoxon test to compare each patient's measurements on each arm.

Results:
No statistically significant differences were found between the sleeved and the bare arm measurements, with one exception of systolic blood pressure measured on the left arm (p = 0.041).
Although the actual values demonstrated no statistically significant difference, the absolute values of the differences demonstrated clinically significant higher median values on the sleeved arms, both in systolic blood pressure (7 mmHg on the right arm and 8 mmHg on the left arm) and diastolic blood pressure (5.5 mmHg for both arms).
As demonstrated by the wide interquartile ranges in table 1 and seen in figure 1 for all variables, the values of all variables had high variance.

Conclusions:
We found no statistically significant difference in blood pressure measurements between sleeved and bare arms. However, measurement of blood pressure over sleeved arms provided unpredictable results, with up to 40-50 mmHg differences in some individuals. As clinicians, we believe that in order to standardize blood pressure measurements we should measure blood pressure on the bare arms.
FEASIBILITY AND MEASUREMENT STABILITY OF SMARTWATCH-BASED CUFFLESS BLOOD PRESSURE MONITORING
Authors: Lee Hae-Young , Cho Myeong-Chan 
Published: June 2023

Objective:
Cuffless wearable devices are currently being developed for long-term monitoring of blood pressure (BP) in patients with hypertension and in apparently healthy people. This study evaluated the feasibility and measurement stability of smartwatch-based cuffless BP monitoring in real-world conditions.

Design and method:
Users of the first smartwatch-based cuffless BP monitor approved in Korea (Samsung Galaxy Watch) were invited to upload their data from using the device for 4 weeks post calibration.

Results:
A total of 760 participants (mean age 43.7±11.9, 80.3% men) provided 35,797 BP readings (average monitoring 22±4 days [SD]; average readings 47±42 per participant [median 36]). Each participant obtained 1.5±1.3 readings/day and 19.7% of the participants obtained measurements every day. BP showed considerable variability, mainly depending on the day and time of the measurement. There was a trend towards higher BP levels on Mondays than on other days of the week and on workdays than in weekends. BP readings taken between 00:00 and 04:00 tended to be the lowest, whereas those between 12:00 and 16:00 the highest. The average pre-post calibration error for systolic BP (difference in 7-day BP before and after calibration), was 6.8±5.6 mmHg, and was increased with higher systolic BP levels before calibration.

Conclusions:
Smartwatch-based cuffless BP monitoring is feasible for out-of-office monitoring in the real-world setting. The stability of BP measurement post calibration and the standardization and optimal time interval for recalibration need further investigation.
COMPARISONS OF THE PREDICTIVE VALUE OF MORNING AND EVENING BLOOD PRESSURE FOR NOCTURNAL HYPERTENSION AND MORNING BLOOD PRESSURE SURGE
Authors: Lee Chun-Wei , Chang Wei-Lun , Lee Yu-Hsuan , Chuang Shao-Yuan , Chiang Chern-En , Chen Chen-Huan , Cheng Hao-Min 
Published: June 2023

Objective:
Evidences showed that morning blood pressure (BP) surge (MS) and nocturnal hypertension (NH) may increase the risk of cardiovascular events. The purpose of this study is to determine whether morning and evening hypertension can be used to predict NH and MS in hypertensive patients.

Design and method:
Participants with BP over 140/90 mmHg from 11 medical centers in Taiwan were included in the cohort. Every participant had ambulatory BP monitoring (ABPM) and home blood pressure values that were taken twice daily (morning and evening). According to the ABPM data, MS and NH were characterized as overnight BP 120 and/or 70 mmHg and sleep-trough morning (6AM-8AM) BP rise larger than 43.67 mmHg, respectively. The cut point of both morning home BP hypertension (MHBP) and evening home BP hypertension (EHBP) were 135/85 mmHg. We used MHBP and EHBP separately and together in logistic regression models to analyze the predictive value for NH and MS, adjusting for potential confounders, such as age, sex, alcohol usage, and smoking.

Results:
A total of 1621 individuals were included, with a median age of 58.9 years. MHBP and EHBP were present in 17.93% and 15.8% respectively. NH was present in 76.25% (n = 1361) and MS was present in 9.69% (n = 173) of the cohort. The accuracy of MHBP to predict NH, MS and NH or MS were 0.843, 0.889 and 0.865 respectively. The accuracy of EHBP to predict NH, MS and NH or MS were 0.837, 0.887 and 0.862 respectively. After adjusting for potential confounders, both MHBP and EHBP can significantly predict NH, MS and the combination of both. EHBP outperformed MHBP of predicting NH (OR 5.57 vs 1.65). The relationship between EHBP and NH or MS was also stronger for EHBP than for MHBP (OR 10.44 vs 2.37). Nevertheless, MHBP had a marginally higher predictive value for MS than EHBP (OR 2.40 vs 1.88).

Conclusions:
EHBP showed more predictive of NH and MHBP has a better predictive value of MS in hypertensive subjects. Both MHBP and EHBP are useful for detecting NH or MS and should not be overlooked for overall BP control.
PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION IN TREATED HYPERTENSIVE PATIENTS
Authors: Hamdani Achref , Ajra Zaineb , Bayar Mohamed Fehmi , Gheni Refaat , Rashikou Lamia , Hmida Riadh Ben , Ounissi Taha , Elhadj Zied Ibn 
Published: June 2023

Objective:
There are limited data in Tunisia on the quality of treated blood pressure (BP) control, and in particular, masked uncontrolled hypertension (MUCH) in treated hypertensive patients defined as controlled office BP but uncontrolled out-of-clinic BP. The objective of the study is to define the prevalence of MUCH in treated hypertensive patients.

Design and method:
An analytical cross-sectional study including 84 treated hypertensive patients aged > 18 years, followed at the outpatient cardiology clinic of the Mohamed Taher Maamouri university hospital in Nabeul over a six months period (July-December 2021). The BP measurement in the office was performed on the day of inclusion.
Patients were asked to measure BP at home as instructed by the physician using validated blood pressure self-measurement devices ( MICROLIFE BP A3 PLUS, MICROLIFE BP A2 Basic and Beurer BM 40 ). These devices were loaned to the patient who had to return them on the day of the ABPM installation. Laying of ABPM was performed immediately after the HBPM using a Bravo Mini validated device from Sun Tech Medical.
The comparisons of percentages were carried out by the Chi-square test.

Results:
The mean age of our population was 59.37±13.10 years (range 21-92 years), composed of 43 women and 41 men. The prevalence of MUCH was 6% in HBPM and 8.3% in ABPM. The difference between these two methods was not statistically significant for the detection of masked uncontrolled hypertension (p = 0.320). The prevalence of MUCH was higher in women detected by HBPM (11.6% versus 0%; p = 0.055) and by ABPM (14% versus 2.4%; p = 0.110), the difference according to gender was not statistically significant. ABPM detected also masked uncontrolled nocturnal hypertension in 14.3% of cases.

Conclusions:
Office BP monitoring alone is thus inadequate to ascertain optimal BP control because of BP variation. HBPM and mainly ABPM which can detect elevated nocturnal BP were needed to confirm proper BP control especially in patients with high cardiovascular risk in whom the prevalence of MUCH is higher.
IMPACT OF OUTDOOR TEMPERATURE ON BLOOD PRESSURE PHENOTYPES: A LARGE MULTICENTER HOME BLOOD PRESSURE MONITORING STUDY
Authors: Duarte Barbosa Costa , Feitosa Audes Diogenes. M. , Sentalin Monizze V. R. , Mota-Gomes Marco Antonio , Barroso Weimar Sebba , Miranda Roberto Dischinger , Brandão Andrea Araújo , Farina Giovani , Filho José Lima , Albuquerque Jones , Nascimento Maria L. S. , Paula Isabel C.G. , Barros Beatriz , Freitas Maria C.V. , Silva Hernade P. , Sposito Andrei , Babkowski Miguel C. , Coca Antonio , Nadruz Wilson 
Published: June 2023

Objective:
Blood pressure (BP) increases in colder seasons, but the impact of outdoor temperature on BP phenotypes derived from office BP (OBP) and home BP monitoring (HBPM) is not is not completely established due to the scarcity of data. This study evaluated the relationship of outdoor temperature with normotension (NT), white-coat hypertension (WCH), masked hypertension (MH) and sustained hypertension (SH) in a large multicenter Brazilian sample.

Design and method:
This cross-sectional study evaluated 57,606 individuals [39% men, mean age = 57.4±15.6 years, OBP = 131.4±19.8/83.9±11.8 mmHg, HBPM = 125.0±15.8/79.4±9.6 mmHg, 51% using antihypertensive medications (AH)] from 13 cities/metropolitan regions of the 5 Brazilian regions (North, Northeast, Central-West, Southeast and South) who underwent OBP and HBPM measurements from 2018 to 2022. Data on daily outdoor mean temperature (OMT), wind velocity and atmospheric pressure, and outdoor monthly humidity were collected from meteorological stations located in the studied cities. BP phenotypes were defined as: NT (OBP<140/90mmHg and HBPM<135/85mmHg), WCH (OBP > = 140/90mmHg and HBPM<135/85mmHg), MH (OBP<140/90mmHg and HBPM> = 135/85mmHg) and SH (OBP> = 140/90mmHg and HBPM> = 135/85mmHg). All regression analyses were adjusted for age, sex, BMI, calendar time, region, AH use and city altitude, wind velocity, atmospheric pressure and humidity.

Results:
Adjusted linear regression analysis showed a direct relationship of OMT with the difference in systolic OBP minus systolic HBPM (beta = 0.153±0.025; p<0.001) and the difference in diastolic OBP minus diastolic HBPM (beta = 0.066±0.015; p<0.001). Adjusted logistic regression analysis showed that each 1oC OMT increase was associated with a higher risk of WCH (OR [95%CI] = 1.011 [1.001–1.021]; p = 0.025) and NT (OR [95%CI] = 1.059 [1.051–1.066; p<0.001], and lower risk of MH (OR [95%CI] = 0.965 [0.950–0.975]; p<0.001) and SH (OR [95%CI] = 0.945 [0.937–0.952]; p<0.001).

Conclusions:
Higher OMT is associated with greater difference in OBP levels relative to HBPM levels and is related to greater risk of WCH and NT and lower risk of MH and SH. These findings suggest that outdoor temperature should be considered in the evaluation and management of hypertension and BP phenotypes.
COMPARISON OF BLOOD PRESSURE MEASUREMENT WITH A CUFFLESS TONOMETRIC WRIST-WORN DEVICE AND CONVENTIONAL BRACHIAL CUFF SPHYGMOMANOMETRY FOR AMBULATORY BLOOD PRESSURE MONITORING
Authors: Butlin Mark , Cox James , Tan Isabella , Avolio Alberto 
Published: June 2023

Objective:
Ambulatory blood pressure monitoring (ABPM) is used for confirmation of diagnosis of hypertension. However, conventional cuff-based blood pressure (BP) measurement involves the obtrusive procedure of cuff inflation, making multiple measurements over extended periods uncomfortable. This study aims to compare BP measurement using the unobtrusive procedure of radial applanation tonometry with that of the conventional brachial cuff sphygmomanometer for ABPM.

Design and method:
ABPM (24 hour) was conducted in 16 participants (53±14 years, 4 female) using validated brachial cuff devices (Microlife WatchBPO3, n = 6; BPLab, n = 10) with BP measurements every 15 minutes during daytime and every 30 minutes during nighttime. BP measurements were obtained with a wrist-worn tonometric device (BPro, Healthstats) every 15 minutes, using an initial calibration obtained with the ABPM device.

Results:
Averaged over 24 hours, tonometric BP estimates correlated with brachial cuff systolic BP (SBP, r = 0.89, p<0.001) but not with diastolic BP (DBP, r = 0.48, p = 0.059) with mean differences (bias) of -4±14 mmHg (SBP) and 16±17 mmHg (DBP). Daytime and night-time correlations and mean difference were, day: SBP (r = 0.92, p<0.001), -1±13 mmHg; DBP (r = 0.44, p = 0.089), 18±21 mmHg; night: SBP (r = 0.66, p = 0.007), 6±22 mmHg; DBP (r = 0.64, p = 0.010); 15±13 mmHg. Over 24 hours, the total number of successful readings from the tonometric device was 52% less than that from the brachial cuff devices. The average correlation between SBP and DBP using only cuff readings was 0.29±0.40 (range -0.47 to 0.86). The average correlation between SBP and DBP for the tonometric device was 0.99±0.01 (range 0.97 to 1.00).

Conclusions:
The cuffless tonometric method employed in the BPro device enables unobtrusive monitoring of BP. In comparison to conventional cuff ABPM devices, the BPro device showed low mean differences for SBP but large differences in DBP in both day and night measurements with consistently low precision. The large differences for DBP may be due to the high correlation between tonometric DBP and SBP, suggesting that waveform features are used for SBP estimation only, from which DBP is directly calculated.
THE RELATIONSHIP BETWEEN LEFT VENTRICULAR HYPERTROPHY AND HYPERTENSION PHENOTYPES IN UNTREATED HYPERTENSIVE POPULATION
Authors: Antza Christina , Chovarda Eleni , Anagnostis Panagiotis , Kitsios Konstantinos , Trakatelli Christina , Stabouli Stella , Kotsis Vasilios 
Published: June 2023

Objective:
The aim of this study was to investigate which hypertension phenotype can be better correlated with left ventricular hypertrophy in the untreated hypertensive population.

Design and method:
175 consecutive subjects (42% male) aged 57.9±14.9 years were included in the study. Subjects were never treated before for hypertension. All subjects underwent 24h-ABPM on a usual working day, while office BP was measured in the clinic using a mercury sphygmomanometer. Left ventricular hypertrophy was evaluated by a cardiologist with the use of a 3D echocardiography.

Results:
Regarding patients with left ventricular hypertrophy, 45% of the population were confirmed hypertensives and 36, 7% were masked hypertensives. Only 10% presented a white coat phenotype and 8.3% normal values of blood pressure. Of those presenting a non-dipping status, 55.3% found to have left ventricular hypertrophy, while of those presenting a dipping status, only 33.3% found to have left ventricular hypertrophy.

Conclusions:
These results indicate that the confirmed and masked hypertensive population as well as the non-dipping population present higher percentages of left ventricular hypertrophy. This population have to be monitored and followed up more often to prevent heart failure.
HOME BLOOD PRESSURE MONITORING IN SLOVAKIA IN 2022. WHO MANAGES THE PATIENTS WITH ARTERIAL HYPERTENSION THE BEST?
Authors: Vachulova Anna , Filipova Slavomira , Goncalvesova Eva , Simkova Adriana , Hatala Robert 
Published: June 2023

Objective:
Home blood pressure monitoring (HBPM) is a reliable, convenient method for the diagnosis and management of arterial hypertension (AH). Moreover, HBPM can help improve the control of blood pressure in patients (pts).

Design and method:
To evaluate HBPM and office blood pressure (BP) measurements. To compare the efficacy of the AH treatment according to doctors‘ and patients‘ age and gender.

Results:
4375 pts with AH were enrolled (2089 women, 51,8%), mean age 61,1 ± 19,1 years. The mean office BP was higher in male pts 136,7 ± 10,9/ 81,9 ± 7,2 mmHg, vs in female pts 135±7,2/ 80,2 ± 6,2 mmHg. Mean HBPM was also higher in male pts 134,1± 7,2/ 81,1± 6,3 mmHg. In our program participated 129 female doctors (72%), mean age of 49,6 ± 10,1 years, and the mean age of male doctors was 44,9 ± 7,2 years. The reduction in BP for 7 days of HBPM was documented. A greater reduction of HBPM was achieved when the female doctor treated female patients 132,01/78 mmHg p = 0,0081, contrary to a smaller reduction of BP when the female doctor treated male pts 134,18/81,32 mmHg p = 0,026. The highest office BP was measured in male pts treated by male doctors 136,59/81,59 mmHg, beyond the lowest office BP was measured when the female doctor treated female pts 132,01/78,74 mmHg p = 0,0081. Male doctors treated more frequently with a higher number of AH drugs. The proportion of use of fixed-dose AH drugs combination was highest when the male doctor treated male pts (70,7%), and the lowest use of fixed-dose combination was when the female doctor treated female patients 52,1%.

Conclusions:
In our project with HBPM and office BP measurement in 2022 in Slovakia we found that the most precise BP control both in the office and in HBPM was reached when female patients were treated by female doctors. On the other hand, male doctors have preferred to use fixed-dose AH combinations. These data show that better involvement and engagement of doctors, and patients could lead to better implementation of guidelines and better BP control.
ACCURACY OF THE AUTOMATED OSCILLOMETRIC HOME BLOOD PRESSURE MONITOR BRAUN BUA4000 WITH WIDE RANGE CUFF: VALIDATION ACCORDING TO THE AAMI/ESH/ISO UNIVERSAL STANDARD
Authors: Menti Ariadni , Ntineri Angeliki , Ntousopoulos Vasileios , Theodosiadi Aikaterini , Stathopoulou Panagiota , Kyriakoulis Konstantinos , Kollias Anastasios , Stergiou George S. 
Published: June 2023

Objective:
To evaluate the blood pressure (BP) measurement accuracy of the Braun BUA4000 automated oscillometric upper-arm cuff device for self-home use in a general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018) and its Amendment 1.2020-01.

Design and method:
Participants were recruited to fulfil the age, sex, BP, and limb distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. A single wide-range cuff of the test device was used for arm circumference range 22-42 cm.

Results:
A total of 98 individuals were recruited and 85 were analyzed (mean age 60.3±16.1 [SD] years, 44 men, arm circumference 31.5±5.1 cm, range 22-41.5 cm). For validation Criterion 1, the mean difference ±SD between the test device and reference BP readings (N = 255) was 0.9±6.4/-0.3±6.4 mmHg (systolic/diastolic; threshold < = 5±8 mmHg). For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per individual (N = 85) was 5.15/5.81 mmHg (systolic/diastolic; threshold < = 6.88/6.95 mmHg).

Conclusions:
The Braun BUA4000 automated oscillometric home BP monitor fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in a general population and can be recommended for clinical use.
ASSOCIATION OF PRESSURE CONTROL RATE AND USE OF ANTI-HYPERTENSIVE DRUGS AMONG BRAZILIAN HYPERTENSIVE PATIENTS
Authors: Magalhaes Fabricio Galdino , Sousa Andrea Cristina , Inuzuka Sayuri , Amorim Kécia Cristina Faria Oliveira , Batista Sandro Rodrigues , Barroso Weimar Kunz Sebba , Sousa Ana Luiza Lima 
Published: June 2023

Objective:
To analyze the association between the rate of blood pressure (BP) control and the use of antihypertensive drugs among hypertensive patients.

Design and method:
Analytical cross-sectional study, using data from the TeleMRPA platform, which records data from Residential Blood Pressure Measurements (MRPA). Variables used: age, sex, systolic BP (SBP) and diastolic BP (DBP) at office and residential, amount of medication in use, categorized into monotherapy, dual therapy, triple combination and four or more; BP variability. Comparison between categories was performed using the chi-square test and ANOVA test for comparison of means, considering a 95% confidence interval and significance level p<0.05.

Results:
Participants were 25,543 hypertensive patients, with a mean age of 60.6 (±14.4) years, minimum age 18 and maximum age 114 years. 63.1% were women and were older (mean 61.9 (±14.3) than men (58.5 (±14.2). The BP control rate was 42.3% in total sample, being proportionally higher among women (67.6%). The BP control rate was higher among young adults (<60 years) than among the elderly; 60 to 70 years. The amount of antihypertensive drugs was distributed in 42.6% in monotherapy, 37.4% double, 15.7% triple, and 4.4% four or more. Women used proportionally more triple combination (16.2%) than men (14.7%; p = 0.014) and in the other combinations there was no difference in the distribution of therapies and gender. than among the elderly (38.2%); drug combinations had higher proportions among the elderly. BP control rates were higher among those on monotherapy (42.7%) and dual combination (43.4%) than among the elderly what a triple combination (41.4%) and four or more (32.5%).

Conclusions:
The BP control rate was higher among women and among young adults. Monotherapy was more present among young adults and as the amount of drug combination increased, the rate of BP control decreased.