bluuebunny/crossref_metadata_2025_split huggingface dataset:
CAN IMPARED SYSTOLIC FUNCTION BE DETECTED FROM PRESSURE WAVEFORMS?
Authors: Orter Stefan , Hametner Bernhard , Wassertheurer Siegfried , Danninger Kathrin , Argyris Antonis , Protogerou Athanase , Kaniusas Eugenijus , Binder Ronald , Weber Thomas 
Published: June 2022

Objective:
Heart failure with reduced ejection fraction (HFrEF) is a significant health problem. Early diagnosis, using widely available, cheap methods, remains an important goal. Therefore, we investigated whether individuals with normal left ventricular ejection fraction (EF) can be discriminated from patients with reduced EF with contemporary, automated analysis of pressure pulse waveforms.

Design and method:
Left ventricular EF was measured prospectively in 78 patients with HFrEF (15 females) with echocardiography (apical 4 chamber view, Simpson`s method, on a Philips EPIQ system). The control group was matched for age, sex, height, weight, and brachial blood pressure. Pressure waveforms were acquired from the radial artery (SphygmoCor system, AtCor medical) and processed with ARCSolver algorithms to derive Wave Intensity Analysis (WIA) parameters S and D and their ratio (SDR). Additionally, left ventricular ejection time index (iLVET) was calculated using a method based on numerical derivatives. Clinical characteristics between patients and controls were compared, using t-tests or Mann Whitney U test, as appropriate. Receiver-operating-curves (ROC) analysis was performed to investigate the discriminative ability of the pulse waveform parameters.

Results:
Patients with HFrEF (mean EF░=░28%) and controls (mean EF░=░66%) were well matched, according to age (56 vs. 56░years, p░=░0.597), sex, height (1.74 vs. 1.73 m, p░=░0.576), weight (86 vs. 83░kg, p░=░0.590), brachial systolic (127 vs. 129░mmHg, p░=░0.359) and diastolic (79 vs.79░mmHg, p░=░0.763) blood pressure, and the presence of hypertension (51 vs. 51%) respectively. Mean heart rate of patients and controls differed slightly (65 vs. 61 BPM, p░=░0.040). Diabetes, coronary artery disease, and the use of ACE-inhibitors/Angiotensin Receptor Blockers/Angiotensin Receptor Neprilysin Inhibitors were more prevalent in patients, as compared to controls. SDR (2.4 vs. 5.7 %, p░<░0.001) and iLVET (0.39 vs. 0.42, p░<░0.001) were significantly lower in HFrEF patients, as compared to controls. Moreover, SDR (AUC░=░0.93, 95% CI░=░[0.96, 0.88]) and iLVET (AUC░=░0.90, 95% CI░=░[0.94, 0.83]) were highly discriminative between HFrEF patients and controls – fx30.

Conclusions:
Parameters derived from pressure pulse waveforms, obtained non-invasively and processed automatically, may be suitable for early diagnosis of severely impaired EF.
VALIDATION OF THE OPTICAL AKTIIA BRACELET IN DIFFERENT BODY POSITIONS FOR THE PERSISTENT MONITORING OF BLOOD PRESSURE
Authors: Sola Josep , Vybornova Anna , Fallet Sibylle , Polychronopoulou Erietta , Wurzner-Ghajarzadeh Arlene , Wuerzne Gregoire 
Published: June 2022

Objective:
The diagnosis of hypertension and the adjustment of antihypertensive drugs are evolving from repeated isolated measurements performed at the physician offices to the full phenotyping of patients in real-life conditions. Indeed, epidemiologic data show that prediction of risk is largely improved when blood pressure (BP) is measured out of the doctor’s office. Today, out-of-office measurements of BP are mostly performed by a series of self-measurements done at home over several days (HBPM monitoring), or automatically for 24 hours (ABPM monitoring). None of these approaches allow assessing and tracking the 24 hour hypertensive phenotype of patients in the long term. The aim of this study was to demonstrate that a wearable BP monitor (the CE-marked Aktiia Bracelet) can accurately estimate BP in the most common body positions of daily life and thus become a candidate solution for the long-term BP phenotyping of patients.

Design and method:
We recruited 91 patients with BP ranging from low to hypertensive levels and compared BP values from the Aktiia Bracelet against auscultatory reference values for four weeks at different body positions according to an extended and adapted ISO 81060-2 protocol.

Results:
The observed means and standard deviations of differences for systolic BP were of 0.46 ± 7.75 mmHg in the sitting position, -2.44 ± 10.15 mmHg in the lying, -3.02 ± 6.10 mmHg in the sitting with the device on the lap, and -0.62 ± 12.51 mmHg in the standing position. Differences for diastolic BP readings were respectively of 0.39 ± 6.86 mmHg, -1.93 ± 7.65 mmHg, 4.22 ± 6.56 mmHg and -4.85 ± 9.11 mmHg. For the sitting and relax position (for which the ISO 81060–2 performance criteria are applicable) the Aktiia Bracelet met criterion 1 and criterion 2.

Conclusions:
This study demonstrates that the optical Aktiia Bracelet can accurately estimate BP in the most common body positions compared to auscultation, although precision varies across positions. These findings pave the way to the use of this wearable device for the persistent monitoring of BP, and the further identification of individual BP phenotypes at scale.
ASSOCIATION BETWEEN NON-DIPPER OR NIGHT-TIME BLOOD PRESSURE PATTERN AND ALCOHOL DRINKING OR QUALITY OF SLEEP IN KOREAN REGISTRY OF AMBULATORY BLOOD PRESSURE MONITORING STUDY
Authors: Shin Jinho , Kim Ju-Han , Kim Woo-Shik , Lee Sang-Jae , Kim Jang-Young , Park Sungha , Lee Eun-Mi , Ihm Sang-Hyun , Pyun Wook Bum 
Published: June 2022

Objective:
Non-dipper or reverse dipper is known to be associated with adverse cardiovascular prognosis in general population and clinical cohort. There are few large sized to explore the factor related to non-dipper or nighttime blood pressure pattern in terms of sleep quality and lifestyle factors.

Design and method:
With the database of Korean multicenter nationwide prospective Registry of Ambulatory Blood Pressure monitoring (KORABP) study, 3745 patients referred for blood pressure evaluation was nalysed for clinical profiles including current smoking and alcohol drinking habits, sleep quality in 4 Likert scale as hardly sleep, poor sleep, not so bad, and very good with 1 to 4 points, and medical history.

Results:
Age was 55.5+/-14.3 years and female was 45%. BMI was 24.7+/-3.4 kg/m2. 33.6% of the study population. Smoking and drinking habits 14.6% and 37.2%, respectively. Prevalence of diabetes mellitus, hypercholesterolemia, and cardiovascular diseases were 19.0%, 27.9% and 22.1%, respectively. Normotensive, untreated hypertension, and treated hypertension were 29.1%, 37.2% and 33.6%, respectively. Sleep qualities in hardly sleep, poor sleep, not so bad, and very good were 14.7%, 32.6%, 32.1% and 20.6%, respectively. In multivariable regression analyses for non-dipper or reverse dipper, age > 56 years, cardiovascular disease history, hypertension by ABPM, and poor sleep are positively associated factors whereas drinking and hypertension by clinic BP were negatively associated factors. Antihypertensive medication has no association. Sleep quality was negatively and positively associated with extreme dipper and reverse dipper, respectively.

Conclusions:
Age, cardiovascular diseases, and hypertension by ABPM were associated with non-dipper. Drinking was associated with dipper. Good and poor sleep qualities were significant factors for extreme dipper and reverse dipper or non-dipper, respectively.
EFFECT OF DIFFERENT TREATMENT OF HYPERTENSIVE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA ON BLOOD PRESSURE: A NETWORK META-ANALYSIS
Authors: Kou Chengkun , Zhao Xu , Fan Xin , Wang Qiongying , Yu Jing 
Published: June 2022

Objective:
OSA is one of the common causes of secondary hypertension. The antihypertensive treatment include pharmacotherapy and non-pharmacotherapy. However, the effect of different treatment on blood pressure is still unclear. Theaim of this study was to compare the effect of pharmacotherapy and non-pharmacotherapy for obstructive sleep apnea on blood pressure.

Design and method:
We searched PubMed, EMBASE, Web of Science, Cochrane Library database, China Biology Medicine disc (up to June 1, 2021) to identify the studies that met the inclusion criteria. Two reviewers independently screened literature, extracted data, and assessed the risk of bias. R software was used to perform the meta-analysis.

Results:
A total of 30 clinical trials involving 3483 patients were included. Angiotensin-Converting Enzyme Inhibitors(ACEI) /Angiotensin receptor blockers(ARB) showed the most significant antihypertensive effects on office systolic blood pressure as compared with placebo (MD = -4.56, 95%CI: -27.53~-1.69). Mineralocorticoid receptor antagonist (MRA) showed the most significant antihypertensive effects on office diastolic blood pressure as compared with placebo (MD = -15.02, 95%CI: -24.35~-5.72). Rankogram also shows the ACEI/ ARB is the best treatment on office systolic blood pressure and MRA is the best treatment on office diastolic blood pressure.

Conclusions:
For hypertensive patients with obstructive sleep apnea, Renin-angiotensin-aldosterone System inhibitor (RAS-I) may be the optimal antihypertensive treatment.
AMBULATORY BLOOD PRESSURE MONITORING IN HUNGARY: THE FIRST CROSS-SECTIONAL RESULTS OF AN OPEN LABEL, PROSPECTIVE, OBSERVATIONAL STUDY
Authors: Járai Zoltán , Nemcsik János , Páll Dénes 
Published: June 2022

Objective:
Background: Ambulatory blood pressure monitoring (ABPM) is gold standard method in the diagnosis and follow-up of hypertensive patients. There is no systematic assessment on the daily practice of the utilization of ABPM in Hungary.
Aim: The goal of the project is to assess the indication and the number of monitoring, and to analyze the blood pressure results.

Design and method:
This is a multicenter, open-label, observational non-interventional study. Data collection is performed in GPs’ practices and in outpatient clinics of cardiology and internal medicine. Meditech ABPM-06 monitors are used for ABPM measurements. Basic patients’ data are documented in an eCRF and all ABPM data are transferred through a closed online surface into the database for further analysis.

Results:
7498 ABPM were performed between 21st of February and 21st of December, 2021. The monitoring was performed mainly by GPs (62%). The average age of the patients was 54.4 years (12–96 years). More than half of the patients (54%) were female. The indication of ABPM was elevated blood pressure (BP) at home (59.7%), labile BP (41.5%), therapy control (17.0%), suspicion of white coat hypertension (13.5%), suspicion of masked hypertension (2.5%), suspicion of nocturnal hypertension (3.2%) and suspicion of secondary hypertension (1.3%). The average duration of hypertension among hypertensive patients was 9.8 years (1–73 years). 32.6% of the patients were newly diagnosed as hypertensive. The average 24-hour systolic blood pressure was 133.9 mmHg, the average diastolic blood pressure was 79.3 mmHg, while the average pulse rate was 73.2 beats/min. The 24-hour average percent time elevation of systolic and diastolic blood pressure was 53.0% and 38.8%, respectively. The average systolic diurnal index was 9.6%, the average diastolic diurnal index was 13.3%.

Conclusions:
The two most frequent indication for ABPM in the routine practice are elevated home BP and labile BP values. One third of the patients was newly diagnosed as hypertensive subject. ABPM was performed mainly in patients with uncontrolled hypertension. The routine use of ABPM may increase the awareness of hypertension.
IMPACT OF ARTERIAL SITE AND PULSE WAVE ANALYSIS METHOD ON ARTERIAL FORM FACTOR AND MEAN ARTERIAL PRESSURE ESTIMATION
Authors: Izzo Joseph , Mukhopadhyay Debduti , Nagpal Sagar , Osmond Peter 
Published: June 2022

Objective:
Mean arterial pressure (MAP) is often estimated from systolic (S) and diastolic (D) blood pressure (BP) using a constant “form factor’’ (FF), usually MAP = DBP + 0.33*pulse pressure (PP), yet accurate measurement requires pulse wave analysis (PWA) and waveform integration. MAP is constant across all conduit arteries but PP increases distally [peripheral (p)PP > central ©PP]. Thus, cFF should be higher than pFF; results should also be similar between PWA methods.

Design and method:
We tested these principles in 2 cohorts using 2 transfer function-dependent PWA devices: SphygmoCor (SPG, radial tonometric PWA with integrated MAP) and Mobil-O-Graph (MOB, 24-hour ambulatory brachial oscillometric PWA with proprietary MAP). SPG data (signal-average of 10 PWA) were obtained after 5–10 minutes of rest and MOB values at 20-minute intervals. For direct MAP comparisons, 101 pairs from the SPG and MOB cohorts were matched precisely for pSBP and pDBP (130.9/78.7 mmHg for each, p>.999).

Results:
For SPG, n = 376, [mean(SD)]: pBP 140(28)/80(15) and cBP 126(28)/81(15) mmHg, age 48(20) yr, BMI 28(6.6), 54% men, 20% black. SPG-cFF was higher than SPG-pFF [0.44(.049) vs 0.34(.056), p < 0.000] and cFF and pFF were correlated (r2 = 0.23, p < 0.000). On stepwise multiple regression, SPG-pFF was related to MAP > gender > age (multiple-r2 = 0.37, p < 0.000; BMI and race were excluded). For MOB: n = 157, pBP 135(18)/81(12) and cBP 123(16)/83(12) mmHg, age 59(16) yr, BMI 30(6), 52% men, 24% black. MOB-pFF was almost invariate, lower than MOB-cFF [0.46(0.00098) vs 0.57(0.048), p < 0.000], and not correlated with MOB-cFF or any other characteristic. MOB-cFF was higher than SPG-cFF (p < 0.000) with similar variability. In the paired cohorts, mean FF’s were similar to the full cohorts but SPG-MAP was much lower than MOB-MAP [96.3 vs 102.6 mmHg (p < 0.000)].

Conclusions:
1) FF varies within-subjects by arterial location, with cFF > pFF; 2) SPG-pFF varies between-subjects and is affected by MAP, gender, and age; 3) proprietary MOB-pFF is invariate and higher than integrated SPG-pFF; and 4) MOB-MAP is 6% higher than SPG-MAP. These findings may impact studies requiring FF or MAP estimates, especially from proprietary oscillometric devices.
HOW MANY DAYS TO CONFIRM HYPERTENSION USING HOME BOOD PRESSURE MONITORING
Authors: Girerd Xavier , De Buyer Paul , Boualit Robert , Hanon Olivier , Pathak Atul , Asmar Roland 
Published: June 2022

Objective:
To confirm the diagnosis of hypertension with a probability of 99% according to the blood pressure obtained by Home Blood Pressure Monitoring (HBPM) at home after one or two days.

Design and method:
In 3910 subjects followed in a specialist hospital department, 72% of whom were treated with at least one antihypertensive drug, HBPM was performed with 18 measurements over 3 days (3 measurements in the morning and evening). The mean of the 18 measurements was used as the reference value to define ‘hypertension’ status with the thresholds SBP> = 135 or DBP > = 85. Univariate statistical analysis determined the mean SBP/DBP value obtained after day 1 and day 2 to affirm or deny the diagnosis of hypertension at the 99% threshold

Results:
The population, aged 60 ± 13 years, had a mean SBP/DBP of 134 ± 14/81 ± 10 mmHg. With the average of the 3 days of self-measurement to define blood pressure status, the diagnosis of hypertension or normotension was obtained for 44% of the population after the first day and for 73% after the second day.
The values of mean SBP and/or DBP that allowed the diagnosis to be confirmed after 1 or 2 days of self-measurement with the probability of 99% are given in the table:

Conclusions:
It is possible to shorten the HBPM protocol to 1 day in 42% of patients followed for hypertension while maintaining a very high probability of diagnosis of blood pressure status. To allow patients to follow a HBPM protocol adapted to their blood pressure level Applications dedicated to self-measurement should use these results.
IMPROVED OFFICE BLOOD PRESSURE CONTROL BY AUTOMATIC DELAYED-READING OSCILLOMETRIC DEVICE
Authors: Fernandez-Llama Patricia , Coll-Brito Veronica , Calero Francesca , Arias Piedad , Ayasreh Nadia , Ochoa Jackson , Ramos Alejandra , Guirado Luis 
Published: June 2022

Objective:
Office blood pressure measurement is a recommended procedure by clinical guidelines. We designed the study to know the degree of blood pressure control by clinical measurement using an automatic delayed-reading oscillometric device.

Design and method:
During one month we collect demographic and clinical data, office attended systolic blood pressure and diastolic blood pressure measured with an automatic device with a delayed start of the measurement and, if performed, data from ambulatory blood pressure monitoring.

Results:
We included 102 patients (67 men), with a mean age of 64.9 years, 30% diabetic and 34% with cardiovascular complications. 70% had a controlled hypertesion (<140/90 mmHg) by office blood pressure, the mean systolic blood pressure was 131 ± 16.5 mmHg and the diastolic blood pressure was 73 ± 9.5 mmHg which is a high percentage compared with other studies. Old age and diabetes were associated with uncontrolled hypertension. Thirty three patients had ambulatory blood pressure monitoring data, which allowed them to be classified according to the 24-hour blood pressure into: 30% true normotension, 9% white-coat hypertension, 15% sustained hypertension, and 45% masked hypertension. Therefore, ambulatory measurements did not confirm the good blood pressure control.

Conclusions:
The use of automatic delayed-reading device reduces the white-coat phenomenon, improving the percentage of patients with office blood pressure controlled. However, this control is not confirmed outside the clinic, showing the importance of ambulatory blood pressure monitoring in the global evaluation of hypertension control. Aspects such as the presence or not of an observer, the number of blood pressure readings and the use of validated automatic devices with or without delayed start of the measurement should be the subject of clinical studies to determine the optimal technique for measuring office blood pressure.
BLOOD PRESSURE MEASUREMENT AMONG PATIENTS WITH PERIPARTUM CARDIOMYOPATHY; CONTROL AND BARRIERS DURING FOLLOW UP
Authors: Farhan Hasan Ali , Yaseen Israa Fadhil 
Published: June 2022

Objective:
To identify the frequency of blood pressure (BP) control among patients with peripartum cardiomyopathy (PPCM), barriers for follow up, and causes for elevation of BP.

Design and method:
Data about BP values, control, follow up, and treatment were prospectively documented for patients with PPCM who were presented to the cardio-maternal unit between 2015 - 2020. Baseline BP values were compared with the second readings between six months to one year postpartum. Adherence to medication and identifying the causes of elevated BP were reported.

Results:
Among 64 patients with PPCM presented to the unit, loss of follow up reported in 59.4% of patients; 60.5% for unknown cause, 21.1% due to COVID-19 pandemic, and 18.4 due to death. For 26 (40.6%) patients who adhered to follow up, the mean age was (32.5 ± 7), 61.5% patients had normal BP at baseline and during follow up, while 38.5% of them had elevated BP at baseline or during follow up (cutoff 140/90); 30% showed reduced BP to normal values comparing to their baseline measurements, and 70% developed increased in BP values during follow up (Table 1). All patients with increased BP measurements during follow up had hypertension associated with pregnancy, however, only 28.6% of them had known history of hypertension before pregnancy. Most common anti-hypertensive drug used post delivery was angiotensin-converting enzyme inhibitors 77%. Causes for increased BP measurements during follow up were obesity 57.1%, stress 28.6%, and use of oral contraceptive pills 14.3%.

Conclusions:
Among patients with PPCM with elevated BP at baseline, control of BP was reported in less than one-third of the patients. However, data for more than half of the patients was missing due to loss of follow up which is related to COVID-19 pandemic or mortality, but for the majority of patients the cause was unknown. Factors associated with elevated BP were obesity, stress, and use of oral contraceptive pills. Therefore, future enhancement in patient education regarding the importance of follow up and life style modifications is essential for better BP control among patients with PPCM.
NOCTURNAL BLOOD PRESSURE, NOCTURNAL DIPPING, AND MORTALITY
Authors: de La Sierra Alejandro , Williams Bryan , Gorostidi Manuel , Vinyoles Ernest , Segura Julian , Ruilope Luis 
Published: June 2022

Objective:
A blunted nocturnal BP decline is associated with an increased cardiovascular risk. Nevertheless, patients with a reduced BP dip usually have higher levels of nighttime BP, being both parameters clearly related. The aim of the study was to assess the prognostic value of nocturnal BP decline, independently of the presence or not of nocturnal BP elevation.

Design and method:
Vital status and death due to cardiovascular causes were obtained from death certificates in 59110 adults, mostly hypertensives, enrolled in the Spanish ABPM Registry between 2004 and 2014, and having a valid 24-h ABPM at entry. On the basis of BP data, patients were classified in 4 groups: Normal (<120 mmHg) night systolic BP (SBP) and normal (<0.9) systolic night-to-day ratio (NDR). Normal night SBP with elevated (> = 0.9) NDR. Elevated (> = 120 mmHg) SBP with normal NDR and both elevated SBP and NDR. Association between NDR, dipping status and groups combining night SBP and NDR with total and cardiovascular mortality were assessed by Cox models, adjusted for clinical confounders.

Results:
The total number of deaths were 2866 (978 of cardiovascular causes) during a median follow-up of 5 years. NDR predicted total mortality (HR for 1 SD change: 1.19; 95%CI: 1.15–1.23). Both patients with reduced dipping (HR: 1.28; 1.17–1.41) and risers (HR: 1.59; 1.42–1.77) had increased risk of total mortality, whereas extreme dippers (NDR < 0.8) did not. With respect to patients with both normal night SBP and NDR, those with elevated NDR in the absence of elevated night SBP had increased risk of death (HR: 1.36; 1.19–1.55), as well as those with elevated night SBP and normal NDR (HR; 1.40; 1.21–1.62). Those combining both abnormalities had the highest risk (HR: 1.78; 1.60–1.98). Similar results were obtained for cardiovascular mortality.

Conclusions:
Abnormalities in the circadian dipping pattern are responsible for an increased risk of mortality, both total and cardiovascular. Increased mortality rates are observed in patients with a reduced nocturnal dip and, even more intensively, in those with a riser pattern. This abnormal dipping increases the risk of mortality even in the absence of BP elevation.