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Background The aim of this study was to quantify hypertension control and evaluate concordance between all commonly available blood pressure (BP) modalities in kidney transplant recipients (KTRs). Methods For this prospective cross-sectional study, 89 stable KTRs were recruited at the Charité Transplant Outpatient Clinic. For each study participant office [manual office BP (MOBP) and automated office BP (AOBP)], 7-day home (HBPM) and 24-hour ambulatory BP (24h-ABPM) measurements were performed. Results 80 of the 89 patients recruited had sufficient BP recordings. The mean BP for MOBP, AOBP, HBPM and 24h-ABPM was 129/73, 126/71, 131/85 and 130/81 mmHg, respectively. Uncontrolled hypertension, as defined by 24h-ABPM (mean ≥130/80 mmHg), was present in 53 (66%) patients. MOBP, AOBP and HBPM classified 19 (24%), 22 (28%) and 41 (51%) patients, respectively, as 'uncontrolled hypertensive'. The Bland–Altman plot showed good agreement between systolic MOBP, AOBP, HBPM and daytime-ABPM (mean bias: −1 ± 13 mmHg, −4 ± 13 mmHg, 1 ± 10 mmHg, respectively). Uncontrolled night-time hypertension was present in 74 (93%) KTRs, with 71 (89%) patients showing a non-physiological dipping pattern. Moderate positive correlation between daytime-ABPM/HBPM and night-time-ABPM (Pearson correlation coefficients: 0.62–0.73), followed by MOBP/AOBP (Pearson correlation coefficients: 0.49–0.59) was noted. Estimated eGFR and proteinuria displayed weak correlation with 24h-, daytime- and night-time-ABPM (absolute values of Pearson correlation coefficients: 0.04–0.41). No robust association with either 24h-, daytime- or night-time-ABPM was observed for volume status exams. Conclusions Masked hypertension is highly prevalent in KTRs, especially due to high rates of uncontrolled night-time hypertension. HBPM shows the narrowest limits of agreement with daytime-ABPM. Daytime-ABPM and HBPM show the highest, albeit clinically insufficient, correlation with night-time-ABPM. Systematic integration of 24h-ABPM into clinical practice, as proposed by the 2023 ESH guidelines for the management of arterial hypertension, should not be withheld for the KTR population. Clinical trials evaluating the treatment of hypertension in KTRs are urgently needed. [ABSTRACT FROM AUTHOR]

The document titled "2024 ESC Guidelines for the management of elevated blood pressure and hypertension" provides comprehensive guidelines for the management of high blood pressure and hypertension. It covers various topics such as the pathophysiology and clinical consequences of elevated blood pressure, methods for measuring blood pressure, risk assessment for cardiovascular disease, diagnosing hypertension and investigating underlying causes, prevention and treatment strategies, managing specific patient groups or circumstances, acute and short-term blood pressure management, and patient-centered care. The guidelines aim to provide evidence-based recommendations for healthcare professionals in order to improve the management and prevention of hypertension and its associated complications. [Extracted from the article]

BACKGROUND International standards used for device validation protocols require that the reference cuff conforms to a width and length that is 37 to 50% and 75 to 100% of the arm circumference, respectively. However, there is no published chart of appropriate width and length dimensions across the range of arm circumferences. The objective of this report was to create a chart that could be used to guide reference cuff selection and compare recommended dimensions with two common cuff systems. METHODS Arm circumferences, ranging from 22 to 52 cm were used to create a reference table for width and length requirements. Arm circumferences were grouped following the American Heart Association (AHA) recommendation for cuff sizes. Cuff dimension data was extracted from the website of a cuff system commonly used for validations (the Baum Corporation). Both the AHA recommendations and Baum sizes were compared with the recommended reference dimensions RESULTS There were discrepancies in size naming conventions between the Baum Corporation and the AHA cuff systems. Moreover, there were gaps in both systems where the cuff would not be recommended for validation (31–32 cm for Baum and 30–31 cm for the AHA). Neither system had cuffs that could be used for the largest arm circumferences. CONCLUSIONS This chart highlights the need for more than one cuff system in validation studies and the critical need for cuffs that could be used for validation among larger arm circumferences. [ABSTRACT FROM AUTHOR]

Background and Objectives Two exploratory 6-month pilots of triadic walking with culturally celebratory social reminiscence in gentrifying neighborhoods tested feasibility and health impact among normal and mildly cognitively impaired (MCI) older Black adults. Research Design and Methods Fourteen triads walked 1-mile 3×/week, using a navigational application with image-based reminiscence prompts. Focus groups evaluated perceived health impact and experience. Primary outcome measures were program evaluations (feasibility), pre–post self-report health, Montreal Cognitive Assessment, blood pressure, and weight. Analysis used mean rank scores for program evaluations, pre–post paired t -tests for health outcomes, and thematic coding for 30 focus groups. Results Feasibility: Retention was 74% and 86% for pilots, and 100% and 92%, respectively, were "extremely likely" to recommend to friends/family. Mean rank scores indicated appropriate pace and dose, effective conversational prompts, and program readiness with minor changes. Health impact: Self-rated health, mood, activity levels, and energy improved, days feeling downhearted decreased, and days feeling calm/peaceful were maintained or improved. Among Cohort 2, cognitive assessment scores were maintained or improved for 67%; for MCI, 76% had mean improvement of 2.4 (p  = .045). Blood pressure and weight decreased for 78% and 44%, respectively. Focus groups: Perceived impact of triadic walking included increased physical and social activity outside the program, increased awareness of cognitive decline risk and personal agency, and deep-seated sense of community connection. Discussion and Implications Triadic walking provides structure, accountability, connection, and purpose, motivating sustained engagement. Walking programs that center socialization, particularly within culturally meaningful contexts, may be more effective among older Black adults. Clinical Trial Registration Number NCT05906654 ; NCT05906667 [ABSTRACT FROM AUTHOR]

Aims Hypertensive patients of African ancestry (Afr-a) have higher incidences of heart failure and worse clinical outcomes than hypertensive patients of European ancestry (Eu-a), yet the underlying mechanisms remain misunderstood. This study investigated right (RV) and left (LV) ventricular remodelling alongside myocardial tissue derangements between Afr-a and Eu-a hypertensives. Methods and results 63 Afr-a and 47 Eu-a hypertensives underwent multi-parametric cardiovascular magnetic resonance. Biventricular volumes, mass, function, mass/end-diastolic volume (M / V) ratios, T2 and pre-/post-contrast T1 relaxation times, synthetic extracellular volume, and myocardial fibrosis (MF) were measured. 3D shape modelling was implemented to delineate ventricular geometry. LV and RV mass (indexed to body-surface-area) and M/V ratio were significantly greater in Afr-a than Eu-a hypertensives (67.1 ± 21.7 vs. 58.3 ± 16.7 g/m2, 12.6 ± 3.48 vs. 10.7 ± 2.71 g/m2, 0.79 ± 0.21 vs. 0.70 ± 0.14 g/mL, and 0.16 ± 0.04 vs. 0.13 ± 0.03 g/mL, respectively; P < 0.03). Afr-a patients showed greater basal interventricular septum thickness than Eu-a patients, influencing LV hypertrophy and RV cavity changes. This biventricular remodelling was associated with prolonged T2 relaxation time (47.0 ± 2.2 vs. 45.7 ± 2.2 ms, P = 0.005) and higher prevalence (23% vs. 4%, P = 0.001) and extent of MF [2.3 (0.6–14.3) vs. 1.6 (0.9–2.5) % LV mass, P = 0.008] in Afr-a patients. Multivariable linear regression showed that modifiable cardiovascular risk factors and greater end-diastolic volume, but not ethnicity, were independently associated with greater LV mass. Conclusion Afr-a hypertensives had distinctive biventricular remodelling, including increased RV mass, septal thickening and myocardial tissue abnormalities compared with Eu-a hypertensives. From this study, modifiable cardiovascular risk factors and ventricular geometry, but not ethnicity, were independently associated with greater LV myocardial mass. [ABSTRACT FROM AUTHOR]

BACKGROUND Self-measured blood pressure (SMBP) is an effective strategy for managing and controlling hypertension. However, uncertainty regarding patients' ability to accurately measure their blood pressure (BP) contributes to treatment inertia. Therefore, we compared BP measurements with the Omron HEM-9210T device obtained by nurses and community-dwelling adults after training. METHODS This cross-sectional study was conducted in a simulated home environment at an academic institution. After a 5-min rest, a trained nurse measured a participant's BP twice at a 1-min interval. The participants then ambulated at their usual pace for 2 min. Next, they were asked to rest for 5 min, during which each individual watched a 3-min video on SMBP. Following the rest, the participants obtained two readings at a 1-min interval. RESULTS We recruited 102 community-dwelling adults with a mean age of 54 (±14) years; 59% female, 88% Black race, and 63% with a hypertension diagnosis. Half (n  = 51) had a home BP monitor. Overall, there were no significant differences between nurse- and participant-obtained systolic BP (mean difference [MD]: −1.1; standard deviation [SD]: 8.0; P  = 0.178) or diastolic BP (MD: −0.9; SD: 5.5; P  = 0.111). Participants who used an extra-large cuff had higher self-measured diastolic BP (MD: −2.9; SD: 4.5; P  = 0.010). All participants demonstrated satisfactory SMBP skills after the training. CONCLUSIONS Community-dwelling adults can accurately measure BP after a 3-min video training. Integrating SMBP training into patient encounters may result in reliable home BP measurements, improving hypertension management and clinical decision making. [ABSTRACT FROM AUTHOR]

Maternal poor sleep quality may increase blood pressure during pregnancy, but sound evidence is still limited and inconsistent. To evaluate whether sleep disturbances in early gestation are risk factors for the development of hypertensive disorders of pregnancy, we conducted the Early Life Plan Project from June 2016 to December 2019. Maternal sleep patterns were assessed at 12–16 weeks of gestation by using the Pittsburgh Sleep Quality Index questionnaire. For gestational hypertension and preeclampsia, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using multinomial logistic regression models adjusting for potential confounders. Among 5,532 eligible women, we observed that maternal blood pressure in early gestation was significantly higher in women with low sleep efficiency (≤85%), long sleep duration (≥9 hours/night), and snoring. Compared with nonsnorers, snoring in early gestation was independently associated with preeclampsia (OR = 1.72 (95% CI: 1.09, 2.73) for snoring once or twice per week; OR = 2.06 (95% CI: 1.01, 4.31) for snoring 3 or more times per week), particularly for term preeclampsia (OR = 1.79 (95% CI: 1.08, 2.95) and 2.26 (95% CI: 1.03, 4.95), respectively). Results suggest that snoring in early gestation may be a significant risk factor for preeclampsia, with a dose-response pattern. [ABSTRACT FROM AUTHOR]

Aims The non-invasive myocardial work index (MWI) has been validated in patients without aortic stenosis (AS). A thorough assessment of methodological limitations is warranted before this index can be applied to patients with AS. Methods and results We simultaneously measured left ventricular pressure (LVP) by using a micromanometer-tipped catheter and obtained echocardiograms in 20 patients with severe AS. We estimated LVP curves and calculated pressure–strain loops using three different models: (i) the model validated in patients without AS; (ii) the same model, but with pressure at the aortic valve opening (AVO) adjusted to diastolic cuff pressure; and (iii) a new model based on the invasive measurements from patients with AS. Valvular events were determined by echocardiography. Peak LVP was estimated as the sum of the mean aortic transvalvular gradient and systolic cuff pressure. In same-beat comparisons between invasive and estimated LVP curves, Model 1 significantly overestimated early systolic pressure by 61 ± 5 mmHg at AVO compared with Models 2 and 3. However, the average correlation coefficients between estimated and invasive LVP traces were excellent for all models, and the overestimation had limited influence on MWI, with excellent correlation (r = 0.98, P < 0.001) and good agreement between the MWI calculated with estimated (all models) and invasive LVP. Conclusion This study confirms the validity of the non-invasive MWI in patients with AS. The accuracy of estimated LVP curves improved when matching AVO to the diastolic pressure in the original model, mirroring that of the AS-specific model. This may sequentially enhance the accuracy of regional MWI assessment. [ABSTRACT FROM AUTHOR]

Racial inequities in blood pressure levels have been extensively documented. Experiences of racial discrimination could explain some of this disparity, although findings from previous studies have been inconsistent. To address limitations of prior literature, including measurement error, we implemented instrumental variable analysis to assess the relationship between racial discrimination in institutional settings and blood pressure. Using data from 3,876 Black and White adults with an average age of 32 years from examination 4 (1992–1993) of the Coronary Artery Risk Development in Young Adults Study, our primary analysis examined the relationship between self-reported experiences of racial discrimination in institutional settings and blood pressure using reflectance meter measurement of skin color as an instrument. Findings suggested that an increase in experiences of racial discrimination was associated with higher systolic and diastolic blood pressure (β = 2.23 mm Hg (95% confidence interval: 1.85, 2.61) and β = 1.31 (95% confidence interval: 1.00, 1.62), respectively). Our instrumental variable estimates suggest that experiences of racial discrimination within institutional settings contribute to racial inequities in elevated blood pressure and cardiovascular disease outcomes in a relatively young cohort of adults and may yield clinically relevant differences in cardiovascular health over the life course. [ABSTRACT FROM AUTHOR]

In this study, novel methods were developed, which allowed continuous (24/7) measurement of arterial blood pressure and renal blood flow in freely moving rats and the intermittent collection of arterial and renal venous blood to estimate kidney metabolic fluxes of O2 and metabolites. Specifically, the study determined the effects of a high salt (HS; 4.0% NaCl) diet upon whole kidney O2 consumption and arterial and renal venous plasma metabolomic profiles of normal Sprague–Dawley rats. A separate group of rats was studied to determine changes in the cortex and outer medulla tissue metabolomic and mRNAseq profiles before and following the switch from a 0.4% to 4.0% NaCl diet. In addition, targeted mRNA expression analysis of cortical segments was performed. Significant changes in the metabolomic and transcriptomic profiles occurred with feeding of the HS diet. A progressive increase of kidney O2 consumption was found despite a reduction in expression of most of the mRNA encoding enzymes of TCA cycle. A novel finding was the increased expression of glycolysis-related genes in Cx and isolated proximal tubular segments in response to an HS diet, consistent with increased release of pyruvate and lactate from the kidney to the renal venous blood. Data suggests that aerobic glycolysis (eg, Warburg effect) may contribute to energy production under these circumstances. The study provides evidence that kidney metabolism responds to an HS diet enabling enhanced energy production while protecting from oxidative stress and injury. Metabolomic and transcriptomic analysis of kidneys of Sprague-Dawley rats fed a high salt diet. Graphical Abstract [ABSTRACT FROM AUTHOR]

Hypertension is the most common finding in chronic kidney disease patients, with prevalence ranging from 60% to 90% depending on the stage and etiology of the disease. It is also a significant independent risk factor for cardiovascular disease, progression to end-stage kidney disease and mortality. According to the current guidelines, resistant hypertension is defined in the general population as uncontrolled blood pressure on three or more antihypertensive drugs in adequate doses or when patients are on four or more antihypertensive drug categories irrespective of the blood pressure control, providing that antihypertensive treatment included diuretics. The currently established definitions of resistant hypertension are not directly applicable to the end-stage kidney disease setting. The diagnosis of true resistant hypertension requires confirmation of adherence to therapy and confirmation of uncontrolled blood pressure values by ambulatory blood pressure measurement or home blood pressure measurement. In addition, the term "apparent treatment-resistant hypertension," defined as an uncontrolled blood pressure on three or more antihypertensive medication classes, or use of four or more medications regardless of blood pressure level was introduced. In this comprehensive review we focused on the definitions of hypertension, and therapeutic targets in patients on renal replacement therapy, including the limitations and biases. We discussed the issue of pathophysiology and assessment of blood pressure in the dialyzed population, management of resistant hypertension as well as available data on prevalence of apparent treatment-resistant hypertension in end-stage kidney disease. To conclude, larger sample-size and even higher quality studies about drug adherence should be conducted in the population of patients with the end-stage kidney disease who are on dialysis. It also should be determined how and when blood pressure should be measured in the group of dialysis patients. Additionally, it should be stated what the target blood pressure values in this group of patients really are. The definition of resistant hypertension in this group should be revisited, and its relationship to both subclinical and clinical endpoints should be established. [ABSTRACT FROM AUTHOR]

Statistical approaches to adaptive treatment strategies (ATS) can be used to mimic the sequential decision-making inherently found in clinical practice. To illustrate the use of a statistical ATS approach, we emulated a target trial of different blood pressure (BP) control plans for the prevention of cardiovascular events among individuals with hypertension at high cardiovascular risk, inspired by the Systolic Blood Pressure Intervention Trial (SPRINT). We included 103,708 patients with hypertension and a "QRISK3" estimated 10-year risk of cardiovascular disease of ≥20% who initiated an antihypertensive drug between 1998 and 2018. Dynamic marginal structural models estimated the comparative effects of treating patients with intensive (target BP: 130/80 mm Hg), standard (140/90 mm Hg), and conservative (150/90 mm Hg) BP control strategies. The adjusted hazard ratios (HRs) for the intensive versus standard strategy were 0.96 (95% confidence interval (CI): 0.92, 1.00) for major adverse cardiovascular events and 0.93 (95% CI: 0.88, 0.97) for death from cardiovascular causes. For the conservative versus standard strategy, they were 1.06 (95% CI: 1.02, 1.10) and 1.08 (95% CI: 1.03, 1.13), respectively. These results are largely compatible with SPRINT. ATS can be used to emulate randomized controlled trials of complex treatment strategies in an observational setting and represents an alternative approach for situations where randomized controlled trials are not feasible. [ABSTRACT FROM AUTHOR]

Background Healthcare reform in the United States has focused on improving the value of health care, but there are some concerns about the inequitable delivery of value-based care. Objective We examine whether the receipt of high- and low-value care differs by education levels. Methods We employed a repeated cross-sectional study design using data from the 2010–2019 Medical Expenditure Panel Survey. Our outcomes included 8 high-value services across 3 categories and 9 low-value services across 3 categories. Our primary independent variable was education level: (i) no degree, (ii) high school diploma, and (iii) college graduate. We conducted a linear probability model while adjusting for individual-level characteristics and estimated the adjusted values of the outcomes for each education group. Results In almost all services, the use of high-value care was greater among more educated adults than less educated adults. Compared to those with no degree, those with a college degree were significantly more likely to receive all high-value services except for HbA1c measurement, ranging from blood pressure measurement (4.5 percentage points [95% CI: 3.9–5.1]) to colorectal cancer screening (15.6 percentage points [95% CI: 13.9–17.3]). However, there were no consistent patterns of the use of low-value care by education levels. Conclusion Our findings suggest that more educated adults were more likely to receive high-value cancer screening, high-value diagnostic and preventive testing, and high-value diabetes care than less educated adults. These findings highlight the importance of implementing tailored policies to address education-based inequities in the delivery of high-value services in the United States. [ABSTRACT FROM AUTHOR]

Background Air pollution has recently been linked to a number of cardiovascular diseases, particularly hypertension (HT). In our study, we aimed to evaluate the association between air pollution and blood pressure (BP) and compare the relationship of BP measurement results obtained using different methods (office, home, and 24-hour ambulatory BP monitoring [ABPM]). Methods This retrospective nested panel study performed with prospective Cappadocia cohort data investigated the relationships between particulate matter (PM) 10 and sulfur dioxide (SO2) and concurrent home, office, and 24-hour ABPM data at each control performed over a 2-year period. Results A total of 327 patients in the Cappadocia cohort were included in this study. On the day of office blood pressure measurement, there was an increase of 1.36 mm Hg in systolic BP and 1.18 mm Hg in diastolic BP for every 10 µm/m3 rise in SO2 values. A mean 3-day 10 µm/m3 increase in SO2 was linked to an increase of 1.60 mm Hg in systolic BP and 1.33 mm Hg in diastolic BP. A 10 µm/m3 rise in mean SO2 on the day of 24-hour ABPM measurement was found to be associated with an increase of 1.3 mm Hg in systolic BP and 0.8 mm Hg in diastolic BP. SO2 and PM 10 had no effect on home measurements. Conclusion In conclusion, increased SO2 levels, during winter months in particular, can be associated with an elevation in office BP values. Our study findings show that air pollution in the setting in which BP is measured may be associated with the results. [ABSTRACT FROM AUTHOR]

Background Accurate blood pressure (BP) measurement is essential to identify and manage hypertension. Prior studies have reported a difference between BP measured in routine patient care and in research studies. We aimed to investigate the agreement between BP measured in routine care and research-grade BP in Kaiser Permanente Southern California, a large, integrated healthcare system with initiatives to standardize BP measurements during routine patient care visits. Methods We included adults ≥65 years old with hypertension, taking antihypertensive medication, and participating in the Ambulatory Blood Pressure in Older Adults (AMBROSIA) study in 2019–2021. Clinic BP from routine care visits was extracted from the electronic health record. Research-grade BP was obtained by trained AMBROSIA study staff via an automatic oscillometric device. The mean difference between routine care and research-grade BP, limits of agreement, and correlation were assessed. Results We included 309 participants (mean age 75 years; 54% female; 49% non-Hispanic white). Compared with measurements from routine care, mean research-grade systolic BP (SBP) was 0.1 mm Hg higher (95% CI: −1.5 to 1.8) and diastolic BP (DBP) was 0.4 mm Hg lower (95% CI: −1.6 to 0.7). Limits of agreement were −29 to 30 mm Hg for SBP and −21 to 20 mm Hg for DBP. The intraclass correlation coefficient was 0.42 (95% CI: 0.33 to 0.51) for SBP and 0.43 (95% CI: 0.34 to 0.52) for DBP. Conclusions High within-person variation and moderate correlation were present between BP measured in routine care and following a research protocol suggesting the importance of standardized measurements. [ABSTRACT FROM AUTHOR]

Background it is not known if clinical practice reflects guideline recommendations for the management of hypertension in older people and whether guideline adherence varies according to overall health status. Aims to describe the proportion of older people attaining National Institute for Health and Care Excellence (NICE) guideline blood pressure targets within 1 year of hypertension diagnosis and determine predictors of target attainment. Methods a nationwide cohort study of Welsh primary care data from the Secure Anonymised Information Linkage databank including patients aged ≥65 years newly diagnosed with hypertension between 1st June 2011 and 1st June 2016. The primary outcome was attainment of NICE guideline blood pressure targets as measured by the latest blood pressure recording up to 1 year after diagnosis. Predictors of target attainment were investigated using logistic regression. Results there were 26,392 patients (55% women, median age 71 [IQR 68–77] years) included, of which 13,939 (52.8%) attained a target blood pressure within a median follow-up of 9 months. Success in attaining target blood pressure was associated with a history of atrial fibrillation (OR 1.26, 95% CI 1.11, 1.43), heart failure (OR 1.25, 95% CI 1.06, 1.49) and myocardial infarction (OR 1.20, 95% CI 1.10, 1.32), all compared to no history of each, respectively. Care home residence, the severity of frailty, and increasing co-morbidity were not associated with target attainment following adjustment for confounder variables. Conclusions blood pressure remains insufficiently controlled 1 year after diagnosis in nearly half of older people with newly diagnosed hypertension, but target attainment appears unrelated to baseline frailty, multi-morbidity or care home residence. [ABSTRACT FROM AUTHOR]

Aims: To examine the secular trends in blood pressure measurements and normal or high blood pressure classification among Spanish schoolchildren from 2010 to 2017, to analyze the persistence in the blood pressure category reported in 2017 compared with 2013 in those children born in 2007–08 and to compare in this cohort the prevalence of high blood pressure using both definitions, the 2004 and 2017 guidelines. Methods and results: The data for the prevalence/trend analysis were obtained from cross-sectional analyses conducted in 2010, 2013, and 2017 of 2709 schoolchildren aged 4–6 and 8–11 years from 22 schools in the province of Cuenca, Spain. The data for the longitudinal analysis were obtained from cross-sectional analyses of measurements gathered in 2013 and 2017 in the same cohort of children (n = 275). The prevalence of normal blood pressure increased by 5.4% in children aged 4–6 years from 2013 to 2017 and by 2.2% in children aged 8–11 from 2010 to 2017. This increase was mainly driven by a decrease in the children classified in any stage of hypertension by 4.2% and 2.3% in each age range, respectively. In the same birth cohort, there was an increase of 7.6% in normal blood pressure prevalence. Conclusion: The high blood pressure prevalence in Spanish children has clearly decreased over the last decade, but is still important to detect this condition to design specific school-based interventions and the evaluation of children classified as hypertensive who might need medical supervision and treatment. Graphical Abstract [ABSTRACT FROM AUTHOR]

Purpose Blood pressure (BP) is measured at almost every general practitioner (GP) consultation in the region of Auvergne, France. A 2018 qualitative study shows that GPs measure BP to satisfy patients, whereas patients declare themselves indifferent to the absence of the measurement. The objective was to validate the results of a qualitative study, to quantitatively assess patient satisfaction when BP is not measured, and to study the factors associated with the degree of patient satisfaction. Methods This was a quantitative observational study conducted using self-questionnaires among patients in medical practices in Auvergne. Results Four hundred and ninety-two questionnaires were evaluated in 20 medical practices. Sixty percent of patients had indifferent or favorable feelings in the absence of BP measurement. In bivariate analysis, young age, male sex, absence of pathology, and low frequency of visits were associated with indifferent or favorable feelings in the absence of BP measurement. In multivariable analysis, a history of hypertension and psychiatric history were associated with unfavorable feelings. The intraclass correlation coefficient for practice-related variability was 5.6%. Patients' susceptibility to having particularly favorable or unfavorable feelings could be related to their GP (physician effect). Conclusion The hypothesis put forward in the qualitative study is confirmed: the majority of patients are in favor of or indifferent to the absence of BP measurement in general practice. General practice could be more efficient by measuring BP less frequently and better. [ABSTRACT FROM AUTHOR]

Background A postural blood pressure assessment is required to diagnose Orthostatic Hypotension. With increasing remote consultations, alternative methods of performing postural blood pressure assessment are required. Objective Determine whether postural blood pressure measurement at home, without a clinician, is reliable, feasible and safe. Design Service improvement project within a falls and syncope service in Northeast England. Subjects Eligibility criteria : aged ≥60 years; postural blood pressure measurement is indicated and is physically and cognitively able to perform. Exclusion criteria : nursing home residents, attending clinic in person. Methods Postural blood pressure measurements were performed in patients' homes under clinical observation. Patient-led assessments were performed independent of the clinician, following written guidance. This was followed by a clinical-led assessment after 10-minute supine rest. Outcomes Agreement between patient and clinician derived postural blood pressure values and diagnosis of Orthostatic Hypotension; intervention safety, feasibility and acceptability. Results Twenty-eight patients were eligible and 25 participated (mean age 75, median Clinical Frailty Score five). There was 95% agreement (Cohen's kappa 0.90 (0.70, 1.00)) between patient and clinician derived readings to diagnose orthostatic hypotension. Postural systolic blood pressure drop correlated strongly (r  = 0.80), with patient derived readings overestimating by 1 (−6, 3) mmHg. Limits of agreement, determined via Bland Altman analysis, were +17 and −20 mmHg, greater than pre-determined maximum clinically important difference (±5 mmHg). Twenty participants performed valid postural blood pressure assessments without clinical assistance. Conclusions Patient-led postural blood pressure assessment at home is a reliable, safe and acceptable method for diagnosing Orthostatic Hypotension. [ABSTRACT FROM AUTHOR]

Background Automated office blood pressure (AOBP) using 3–5 measurements taken with an oscillometric device with or without an attendant in the room may decrease "white coat" effect. We evaluated the impact of the presence or absence of the attendant and rest on BP and diagnosis of hypertension. Methods We randomly assigned 133 adults aged 18–85 with high BP at baseline (≥140/90 mm Hg), no hypertensive diagnosis and no antihypertensive medications to either attended AOBP first, unattended second, or unattended AOBP first, attended second. Outcomes included within-person BP difference for attended vs. unattended measurements; 5 vs. 15 minutes of rest; and the diagnostic performance of AOBP compared with daytime automated blood pressure measurement (ABPM). Results We found no significant differences between attended and unattended AOBP (mean difference attended − unattended [95% confidence interval, CI], systolic 0.14 mm Hg [−0.78, 1.06]; diastolic 0.16 mm Hg [−0.45, 0.78]) or by rest time (mean difference 15 − 5 minutes [95% CI], systolic −0.45 mm Hg [−1.36, 0.47]; diastolic 0.61 mm Hg [−1.23, 0.003]). AOBP was lower than mean daytime ABPM, regardless of attendance or rest (after 5 minutes rest systolic −3.6 and diastolic −2.55 mm Hg, P = 0.001 for both comparisons). Using daytime ABPM of ≥135/85 mm Hg as the diagnostic threshold, AOBP sensitivity and specificity after 5 minutes of rest were 71.0% and 54.1%, respectively. Conclusions The presence or absence of a clinic attendant during AOBP measurement and the amount of rest time before AOBP measurements had no effects on BP. AOBP measurements have low sensitivity and specificity for making a new diagnosis of hypertension. [ABSTRACT FROM AUTHOR]

The article describes an innovative model of blood pressure (BP) drive-through created by clinical pharmacists designed to meet patient needs during the COVID-19 pandemic. Topics covered include the BP processes and workflows that had to be developed to ensure the success of the service, the challenges of developing the hypertension (HTN) intervention in a pandemic setting, and the keys to success of the program.

BACKGROUND The PRedicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm accurately predicted out-of-office blood pressure (BP) among adults with suspected high BP in the United Kingdom and Canada. We tested the accuracy of PROOF-BP in a diverse US population and evaluated a newly developed US-specific algorithm (PROOF-BP-US). METHODS Adults with ≥2 office BP readings and ≥10 awake BP readings on 24-hour ambulatory BP monitoring from 4 pooled US studies were included. We compared mean awake BP with predicted out-of-office BP using PROOF-BP and PROOF-BP-US. Our primary outcomes were hypertensive out-of-office systolic BP (SBP) ≥130 mm Hg and diastolic BP (DBP) ≥80 mm Hg. RESULTS We included 3,058 adults, mean (SD) age was 52.0 (11.9) years, 38% were male, and 54% were Black. The area under the receiver-operator characteristic (AUROC) curve (95% confidence interval) for hypertensive out-of-office SBP was 0.81 (0.79–0.82) and DBP was 0.76 (0.74–0.78) for PROOF-BP. For PROOF-BP-US, the AUROC curve for hypertensive out-of-office SBP was 0.82 (0.81–0.83) and for DBP was 0.81 (0.79–0.83). The optimal predicted out-of-office BP ranges for out-of-office BP measurement referral were 120–134/75–84 mm Hg for PROOF-BP and 125–134/75–84 mm Hg for PROOF-BP-US. The 2017 American College of Cardiology/American Heart Association BP guideline (referral range 130–159/80–99 mm Hg) would refer 93.1% of adults not taking antihypertensive medications with office BP ≥130/80 mm Hg in the National Health and Nutrition Examination Survey for out-of-office BP measurement, compared with 53.1% using PROOF-BP and 46.8% using PROOF-BP-US. CONCLUSIONS PROOF-BP and PROOF-BP-US accurately predicted out-of-office hypertension in a diverse sample of US adults. [ABSTRACT FROM AUTHOR]

Background Published evidence has shown that troncoconical cuffs improve blood pressure measurement accuracy in subjects with obesity. However, the exact shape of these cuffs according to arm size is unknown. The aim of the present study was to investigate the anthropometric characteristics of the arm in a large population in order to identify the appropriate shape of the cuff for each arm. Methods The anthropometric characteristics were assessed in 729 adults with middle arm circumference ranging from 16 to 55 cm. Subjects were divided into classes of arm size and the upper-arm slant angle of the truncated cone was calculated. Results In the whole sample, the conical shape of the arm progressively increased with increasing arm circumference (r = 0.61, P < 0.0001). Independent predictors of the conical shape were arm circumference (P < 0.0001) and length (negative relationship, P < 0.0001), and female sex (P = 0.048). Women had a slightly more pronounced conical shape of the arm (P = 0.007) than men. However, the decrease in the slant angle across the arm-size classes showed a similar trend in men and women, and in a 2-way analysis of variance there was no interactive effect between arm size and sex on the conical shape of the arm (P = 0.11). On the basis of the slant angle calculated in each arm-size class, we provide dimensions for bladders that would appropriately fit the arm within a given circumference range. Conclusions To properly fit the upper arm in patients with obesity cuffs should have a troncoconical shape. This study provides reference data according to arm size. [ABSTRACT FROM AUTHOR]

Managing hypertension is not only concerned with lowering blood pressure (BP) by using antihypertensive medications but also aims at minimizing its consequences through adopting self-care. The aim of this study was to assess the effectiveness of mobile application on self-care, BP control, self-efficacy and hypertension-related knowledge among adult patients with hypertension. A randomized design, two groups, pretest–posttest, between subjects with a 1:1 allocation ratio was used. The sample was selected from cardiology clinics has completed the study. Using a block randomization method, 57 of the participants were assigned to the intervention group receiving the educational application intervention, and 59 of them were assigned to the control group receiving usual care. The study's findings showed that participants in the intervention group reported statistically significant higher self-care and knowledge scores than the participants in the control group after 8 weeks of receiving the study intervention. Additionally, compared with the control group participants, more participants in the intervention group demonstrated BP control. The educational application is effective in improving knowledge, self-care and BP control. The positive results indicate the value of integrating mobile applications in the care of patients with hypertension. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia is a multisystem disorder of pregnancy which is a major cause of maternal and fetal morbidity and mortality worldwide. The cardinal clinical features of the condition are hypertension and proteinuria occurring after 20 weeks gestation in women who were not previously known to be hypertensive. Aim of the Work: The aim of the work was to evaluate the role of uterine artery Doppler in the second trimester as a predictor of preeclampsia in high risk pregnancy. Patients and Methods: We included 80 pregnant females in the second trimester at high risk pregnancy in our study, uterine artery Doppler ultrasound was done in the second trimester and the patients were followed up in the third trimester for blood pressure measurement and diagnosis of PE. Results: Our results revealed correlation between high indices of uterine arteries and development of PE. Conclusion: Our study revealed that we can use uterine artery Doppler as a reliable method to predict preeclampsia. [ABSTRACT FROM AUTHOR]

Background: An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. An estimated 46% of adults with hypertension are unaware that they have the condition. Less than half of adults (42%) with hypertension are diagnosed and treated. Aim of the work: To determine the value of 24 hour ambulatory blood pressure monitoring vs in office /home BP measurement in predicting left ventricular mass index in Egyptian hypertensive adults receiving anti hypertensives medications. Patients and Methods: The present study included 100 known hypertensive patients. All were on either one or two anti-hypertensive drugs, and were coming in for follow up in the period between January 2021 and July 2022. The study setting was Ain Shams University hospitals and national heart institute. Results: Conclusion: Ambulatory blood pressure monitoring was superior to office and home blood pressure measurement in assessing left ventricular mass index in hypertensive Egyptian medicated patients. There was a discordance between ambulatory blood pressure monitoring and home / office-BP measurement in detecting controlled hypertension status of patients. [ABSTRACT FROM AUTHOR]

Background: Hemorrhage is a major cause of preventable death worldwide, and early identification can be lifesaving. Pulse wave contour analysis has previously been used to infer hemodynamic variables in a variety of settings. We hypothesized that pulse arrival time (PAT), a form of pulse wave contour analysis which is assessed via electrocardiography (ECG) and photoplethysmography (PPG), is associated with hemorrhage volume.Methods: Yorkshire-Cross swine were randomized to hemorrhage (30 mL/kg over 20 minutes) vs. control. Continuous ECG and PPG waveforms were recorded with a novel monitoring device, and algorithms were developed to calculate PAT and PAT variability throughout the respiratory cycle, termed "PAT index" or "PAT_I." Mixed effects models were used to determine associations between blood loss and PAT and between blood loss and PAT_I to account for clustering within subjects and investigate inter-subject variability in these relationships.Results: PAT and PAT_I data were determined for ∼150 distinct intervals from five subjects. PAT and PAT_I were strongly associated with blood loss. Mixed effects modeling with PAT alone was substantially better than PAT_I alone (R2 0.93 vs. 0.57 and Akaike information criterion (AIC) 421.1 vs. 475.5, respectively). Modeling blood loss with PAT and PAT_I together resulted in slightly improved fit compared to PAT alone (R2 0.96, AIC 419.1). Mixed effects models demonstrated significant inter-subject variability in the relationships between blood loss and PAT.Conclusions: Findings from this pilot study suggest that PAT and PAT_I may be used to detect blood loss. Because of the simple design of a single-lead ECG and PPG, the technology could be packaged into a very small form factor device for use in austere or resource-constrained environments. Significant inter-subject variability in the relationship between blood loss and PAT highlights the importance of individualized hemodynamic monitoring. [ABSTRACT FROM AUTHOR]

Objectives Screening for hypertension in children is recommended by pediatric consensus guidelines. However, current practice is unknown. We evaluated rates of blood pressure assessment and hypertension recognition in primary care. Methods This retrospective cohort study evaluated electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network between 2011 and 2017. Children aged 3 to <18 years with at least one clinical encounter were included. Screening, follow-up, and hypertension recognition rates were evaluated. Descriptive statistics and multivariate logistical regression were used to determine patient and provider characteristics associated with increased screening and recognition of pediatric hypertension. Results Among 378,002 children, blood pressure was documented in 33.3% of all encounters, increasing from 26.7% in 2011 to 36.2% in 2017; P=0.007. Blood pressure was documented in 76.0% of well child visits. Follow-up visits occurred within 6 months for 26.4% of children with elevated blood pressure, 57.1% of children with hypertension, and within 1 month for 7.2% of children with hypertension. Patient factors associated with increased blood pressure screening include being overweight (OR 2.15, CI 2.09 to 2.22), having diabetes (OR 1.69, CI 1.37 to 2.08), chronic kidney disease (OR 7.51, CI 6.54 to 8.62), increased social deprivation (OR 1.10, CI 1.09 to 1.11), and urban residence (OR 1.27, CI 1.15 to 1.4). Overall prevalence of hypertension was 1.9% (n=715) and of those, 5.6% (n=40) had recognized hypertension. Factors associated with increased recognition include male sex, overweight, and hyperlipidemia. Conclusions Rates of hypertension screening and recognition are low in primary care settings in Canada, suggesting pediatric hypertension should be a priority for implementation and dissemination of interventions. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate blood pressure (BP) in Indian children who had similar demographic characteristics but hailed from different altitudes.Methods: BP of school going children, aged 5 to 12 years, at five different locations varying in altitude (near sea level: n = 425; 2000 feet: n = 244; 4000 feet: n = 248; 6000 feet: n = 242 and 8000 feet: n = 250) was measured in a mountainous district in Himalaya. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded by aneroid sphygmomanometer in the sitting posture using a calibrated instrument and four trained resident doctors. The average of three readings was taken.Results: Of the 1229 children whose data were analyzed, 50.4% were boys. SBP showed a progressive rise from 99.5 (4.00) mmHg [mean (standard deviation)] at near sea level to 106.7 (4.17) mmHg at 8000 feet. Similarly, DBP showed a rise from 60.1 (3.67) mmHg to 66.8 (4.58) mmHg over the same altitude range. Analysis of covariance for BP variation with altitude, with age as covariate, indicated a modest but statistically significant rise in both SBP and DBP with altitude. Higher BP values was noted among children residing at higher than at lower altitude (0.8% at sea level to 18.8% at 8000 feet). Correlations between SBP and DBP values and height and weight, though positive and significant at p < 0.01 level, were weak.Conclusions: These data will help in correct interpretation of BP readings in children residing at high altitude. [ABSTRACT FROM AUTHOR]

Objectives Fire departments have employed far-infrared sauna (FIRS) use as part of post-fire call protocols to address concerns related to carcinogens. The inability of the autonomic nervous system (ANS) to fully recover following an emergency call, as demonstrated by heightened sympathetic nervous system activity and delayed parasympathetic nervous system reactivation, has been implicated as a potential factor related to sudden cardiac death. The use of a sauna post-fire call, which has been demonstrated to elevate body temperature, may interfere with the ability of the ANS to fully recover. The purpose of this study was to examine ANS responses to FIRS exposure in firefighters (FFs) with (EX) and without (NONEX) prior maximal exercise. Methods Sixteen career FFs participated in this study. Body temperature (TEMP), heart rate (HR), heart rate variability (HRV), blood pressure (BP), and blood lactate (La─) were measured at the start of each testing session, following a maximal exercise test (EX only), and immediately after a 15-min FIRS exposure for NONEX and EX. Results In NONEX, TEMP increased (P < 0.001); however, there was no change in HR, HRV, BP, or La─. In EX, BP remained unchanged while TEMP, HR, and La─ were significantly (P < 0.001) greater than baseline following FIRS exposure and HRV was significantly (P = 0.018) lower than baseline. Conclusions These findings indicate that FIRS following maximal exercise did support some ANS recovery, but may interfere with restoration of body temperature and parasympathetic nervous system reactivation, potentially influencing post-call cardiovascular risk in FFs. [ABSTRACT FROM AUTHOR]

Background Plasma copeptin, a surrogate marker for vasopressin levels, is increased in neonates born preterm, particularly in those with a more severe neonatal course, as reflected by bronchopulmonary dysplasia. Copeptin levels in adulthood are unknown. Methods In this case–control study of 101 adults born very preterm (<30 weeks of gestation) and 105 control adults born full-term, a comprehensive clinical and biological assessment was performed, including blood pressure measurements, kidney ultrasound and determination of plasma copeptin, renin activity, angiotensin II, aldosterone, apelin, sodium and potassium, serum and morning urine osmolality. Results The median age in the study was 23.1 years [interquartile range (IQR) 21.2–24.8] and 57% were females. In males, the median copeptin levels were 8.2 pmol/L (IQR 6.3–12.4) and 6.1 pmol/L (IQR 4.3–9.0) in the preterm and term groups, respectively (P = 0.022). In females, the median copeptin levels were 5.2 pmol/L (IQR 3.9–7.6) and 4.0 pmol/L (IQR 2.8–5.7) in the preterm and term groups, respectively (P = 0.005). Adults born preterm with a history of bronchopulmonary dysplasia had further increased copeptin levels. The kidney volume, adjusted for height, was smaller and albuminuria was higher in the preterm group, and both were associated with higher plasma copeptin levels. Conclusions Plasma copeptin is higher in young adults born preterm and is related to a more severe neonatal course and smaller kidney volume. [ABSTRACT FROM AUTHOR]

Objective Digital ulcers related to digital occlusive arterial disease (DOAD) are frequent in patients with SSc. Finger systolic blood pressure (FSBP) and digital-brachial pressure index (DBI) using laser Doppler flowmetry constitute a non-invasive means of detecting DOAD in SSc, although thresholds have yet to be established for defining DOAD. The purpose of this study was to ascertain FSBP and DBI thresholds to detect DOAD in SSc patients. The intra/interday reproducibility of curve reading by four vascular physicians in relation to finger pressure measurement was also investigated. Methods SSc patients were followed in this single-centre study (Rennes University Hospital, France) between November 2017 and October 2019.These patients underwent tests before and after heating at two visits spaced 10 days apart. DOAD was diagnosed on the basis of post-warming skin blood flow of ≤206 arbitrary units measured by laser Doppler flowmetry, contingent on previous results validated by arteriography as a gold standard. An interday kappa coefficient with a 95% confidence interval was used to assess reproducibility. Results Sixteen [10 females; mean age: 63 (9) years] SSc patients were included. Mean time interval between visits was 9 (5) days. The best FSBP threshold for DOAD diagnosis was 76 mmHg and DBI was 0.74 after warming. FSBP and DBI sensitivity/specificity were 59.1% (95% CI: 49.6, 68.5%)/92.5% (95% CI: 85.3, 99.6%) and 73.3% (95% CI: 64.9, 81.8%)/83.0% (95% CI: 72.9, 93.1%), respectively. Intra/interday reproducibility ranged from fair to good. Conclusion The conclusions drawn from this study suggest that FSBP ≤ 76 mmHg and DBI ≤ 0.74 thresholds are potentially reliable indicators of DOAD and demonstrate fair to good intra- and interday reproducibility. Trial registration ClinicalTrials.gov, www.clinicaltrials.gov , NCT03264820. [ABSTRACT FROM AUTHOR]

Aim To determine the effects of slow breathing exercise (SBE) on heart rate (HR) and blood pressure (BP) in patients after percutaneous coronary intervention (PCI). Methods and results The study is a single-blind, randomized controlled trial. Seventy-eight eligible patients after primary PCI were divided randomly into either the control group or the trial group. The control group only received routine post-PCI care. In addition to routine care, participants in the trial group performed SBE at home, two to three times for a total of 30 min every day for 12 weeks. The main outcomes were HR and BP measured in the office and at home. The secondary outcome was compliance with the breathing exercise. Patients allocated to the trial group, on average, performed 5.21 days/week for 26.00 min/day. The trial group showed a significant reduction in HR of 3.95 b.p.m. (P =  0.004) measured in the office. The reduction in HR measured in the office was greater for the trial group, with a significant difference between the two groups (P =  0.005). There was no significant difference between the two groups in HR measured at home. There was also no significant difference in BP measured in the office or at home between the two groups. Conclusion Slow breathing exercise is an effective non-pharmacological method to reduce HR in patients undergoing PCI. Further study is needed to confirm whether the intervention is effective on BP. Registration The trial was registered at the Chinese Clinical Trial Registry: ChiCTR-IOR-17012525 [ABSTRACT FROM AUTHOR]

Objectives High blood pressure (BP) or hypertension, a major risk factor for death and disease, is pervasive among older adults. While reducing BP to targeted levels can prevent adverse outcomes, rates of successful BP control remain suboptimal, and it is unclear whether older adults recognize its proven benefits. The current study sheds light on older adults' beliefs about the consequences of hypertension and benefits of BP control by examining how their self-reports of hypertension diagnosis and BP control, as well as measured BP, contribute to subjective life expectancy (SLE), their perceived probability of surviving to a target age. Methods In a representative sample of U.S. adults aged 50–89 from the 2006–2014 Health and Retirement Study (n = 18,979 respondents), we analyze SLE using generalized linear regression. Results Diagnosed hypertension is associated with lower SLE, regardless of measured BP. Among diagnosed hypertensives, those who self-report controlled BP expect to live longer than those who do not. Finally, about 1 in 10 older adults have high measured BP but have never been diagnosed with hypertension, and most diagnosed hypertensives with uncontrolled measured BP self-report their BP as controlled. Discussion Older adults appear to recognize the harmful effects of hypertension and the benefits of BP control, but often lack knowledge of their own hypertension and BP control statuses. Health communications should continue to stress the value of BP control, although improvements may require increased hypertension awareness and BP monitoring. [ABSTRACT FROM AUTHOR]

Background: Accurate measurement of blood pressure (BP) is extremely important in the management of sick preterm newborns. The primary objective of this study was to compare non-invasive blood pressure measurement (NIBP) with invasive blood pressure measurement (IBP) using peripheral arterial cannulation (PAC) in preterm neonates < 37 weeks in the neonatal intensive care unit.Methods: Preterm neonates needing PAC were prospectively enrolled in the study. NIBP measurements were taken in the same limb as that of peripheral arterial line. Initially IBP was recorded followed by NIBP within 1 min using the same monitor. These were called as paired measurements since they are taken within 1 min of each other.Results: Seventy-three preterm infants with 1703 paired measurements were included in the final analysis (median gestational age 32 weeks, IQR 30-34 weeks, median birth weight 1540 g, IQR 1160-2100 g). In preterm infants not receiving vasoactive agents (n = 51, 1428 paired measurements, Bland-Altman analysis for agreement between invasive mean blood pressure (MBP) and non-invasive mean BP revealed a bias of -2.9123 mmHg (SD 7.8074). The 95% limits of agreement were from -18.2157 to 12.3893 mmHg. In preterm infants with hypotension, we detected a bias of -3.9176 mmHg (SD 5.1135) between invasive MBP and non-invasive MBP. The 95% limits of agreement were from -13.9401 to 6.1048 mmHg. In normotensive preterm infants receiving vasoactive agents, we detected a bias of -0.7629 mmHg (SD 8.0539) between invasive MBP and non-invasive MBP. The 95% limits of agreement were from -16.5485 to 15.02274 mmHg.Conclusions: There is poor level of agreement between IBP and NIBP measurements in sick preterm neonates, leading to overestimation or underestimation of blood pressure. The bias was less for mean BP measurements as compared with systolic BP measurements and also for normotensive neonates as compared with hypotensive neonates. Hence, NIBP may be used as a screening method in haemodynamically stable preterm infants, but infants who are haemodynamically unstable and need to be commenced on vasoactive agents should have IBP monitoring. [ABSTRACT FROM AUTHOR]

Objectives To determine whether exposure to an epidemic is associated with better health behaviors. Methods Using nationally representative survey data collected in 2011 and 2014, we identified middle-aged and older Chinese adults whose communities experienced an outbreak of the 2002–2004 severe acute respiratory syndrome (SARS). We estimated logistic models of health behaviors in the years after the SARS epidemic. Results Compared to those who lived in communities not hit by the epidemic, respondents who lived in communities with a SARS outbreak in 2002–2004 were more likely to get a physical examination in 2010–2011 and have their blood pressure checked and participate in regular physical exercise in the years following the SARS epidemic. These associations varied by gender and rural–urban residence. Discussion Exposure to the SARS epidemic could be positively associated with health behavior among middle-aged and older Chinese adults. [ABSTRACT FROM AUTHOR]

Background We aimed to assess the postnatal pattern of cardiovascular remodeling associated with intrauterine exposure to maternal HIV and antiretroviral treatment (ART). Methods Prospective cohort including 34 HIV-exposed uninfected (HEU) infants and 53 non-HIV-exposed infants were evaluated from fetal life up to 6 months postnatally. A cardiovascular evaluation was performed including echocardiography, blood pressure, and carotid intima media thickness (cIMT) measurement. Results ART regimens during pregnancy included 2 nucleoside reverse transcriptase inhibitors (Abacavir + Lamivudine (32.4%), Emtricitabine + Tenofovir (41.2%), and Zidovudine + Lamivudine (20.6%)). At 6 months of age, HIV-exposed uninfected infants showed thicker myocardial walls (septal wall thickness mean 5.02 mm (SD 0.85) vs 3.98 mm (0.86); P <.001), relative systolic dysfunction with decreased mitral ring displacement (8.57 mm (2.03) vs 10.34 mm (1.84); P =.002), and decreased tricuspid S' (9.71 cm/s (1.94) vs 11.54 cm/s (2.07); P =.003) together with relative diastolic dysfunction showed by prolonged left isovolumic relaxation time (58.57 ms (13.79) vs 47.94 (7.39); P <.001). Vascular assessment showed significantly higher systolic and diastolic blood pressure (102 mmHg (16.1) vs 80 mmHg (13.9); P <.001 and 64 mmHg (14.4) vs 55 mmHg (10.2); P =.045 respectively), with 50% of HIV-exposed children meeting criteria for hypertension vs 3.77% of the non-HIV-exposed group (P <.001) and thicker mean cIMT in the HIV-exposed group (0.62 µm (0.09) vs 0.51 µm (0.09); P =.015). Conclusions Subclinical cardiac impairment together with higher blood pressure and thicker cIMT were observed in HIV-exposed infants at 6 months of age. Half of them presented hypertension. Our findings support a possible increased cardiovascular risk in HIV uninfected infants exposed in utero to ART. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether visit-to-visit blood pressure (BP) variability (BPV) is associated with incident frailty. We included 1 394 nonfrail community-dwelling participants aged ≥70 years from the Multidomain Alzheimer Preventive Trial (MAPT) who underwent repeated clinical examinations, including BP and frailty, over a 5-year follow-up period. Systolic BPV (SBPV), diastolic BPV (DBPV), mean arterial pressure variability (MAPV), and pulse pressure variability (PPV) were evaluated using standard deviation (SD), coefficient of variation (CV), average real variability, successive variation, variation independent of mean, and residual SD. Incident frailty was assessed using the Fried phenotype. Cox proportional hazards models were used for the analyses. Higher SBPV was significantly associated with greater risk of frailty (1-SD increase of CV: hazard ratio [HR] = 1.18, 95% confidence interval [CI]: 1.02-1.36) after adjustment for demographics, systolic BP, antihypertensive drugs, body mass index, diabetes, ischemic heart disease, congestive heart failure, stroke, atrial fibrillation, MAPT randomization group, and frailty status. Similar results were observed with all indicators of variability. Higher PPV was associated with a greater risk of developing frailty over time (1-SD increase of CV: HR = 1.17, 95% CI: 1.01-1.35). DBPV and MAPV were not significantly associated with incident frailty. Higher SBPV and PPV were associated with greater risk of incident frailty. Our findings support the concept of BP physiological dysregulation underlying the frail state and suggest that BP instability could be an early marker of frailty. [ABSTRACT FROM AUTHOR]

Objective assess how many patients with low ambulatory diastolic blood pressure (DBP) are not identified when relying on office DBP alone, and thus have 'masked diastolic hypotension'. Design cross-sectional, retrospective cohort study. Setting academic hospital. Subjects 848 patients treated for hypertension who received ambulatory blood pressure monitoring (ABPM). Methods cut-off value between on- and off-target systolic blood pressure (SBP): 140 mmHg. Cut-off for low office and/or ambulatory DBP: DBP ≤ 70 mmHg. 'Masked diastolic hypotension' was defined as office DBP > 70 mmHg and mean ambulatory DBP ≤ 70 mmHg. Results mean age of the sample was 60 ± 13 years, 50% was female, 37% had diabetes, 42% preexisting cardiovascular disease (CVD), mean office blood pressure (BP) was 134/79 mmHg. In all patients (n  = 848), low office DBP was present in n  = 84(10%), while n  = 183(22%) had low ambulatory DBP. In all patients with normal-to-high office DBP (n  = 764), n  = 122(16%) had 'masked diastolic hypotension'. In this group, ambulatory DBP was 14–19 mmHg lower than office DBP. Patients with low ambulatory DBP were older, had more (cardiovascular) comorbidities, and used more (antihypertensive) drugs. Antihypertensive drugs were lowered or discontinued in 30% of all patients with 'masked diastolic hypotension' due to side effects. Conclusions 'masked diastolic hypotension' is common among patients treated for hypertension, particularly in older patients with CVD (e.g. coronary artery disease, diabetes), patient groups in which the European Society of Cardiology/Hypertension guideline advises to prevent low DBP. Although it remains to be examined at which BP levels the harms of low DBP outweigh the benefits of lowering SBP, our observations are aimed to increase awareness among physicians. [ABSTRACT FROM AUTHOR]

Background Conventional measures for assessing arterial stiffness are inherently pressure dependent. Whereas statistical pressure adjustment is feasible in (larger) populations, it is unsuited for the evaluation of an individual patient. Moreover, statistical "correction" for blood pressure may actually correct for: (i) the acute dependence of arterial stiffness on blood pressure at the time of measurement; and/or (ii) the remodeling effect that blood pressure (hypertension) may have on arterial stiffness, but it cannot distinguish between these processes. METHODS We derived—assuming a single-exponential pressure–diameter relationship—3 theoretically pressure-independent carotid stiffness measures suited for individual patient evaluation: (i) stiffness index β 0, (ii) pressure-corrected carotid pulse wave velocity (cPWVcorr), and (iii) pressure-corrected Young's modulus (E corr). Using linear regression analysis, we evaluated in a sample of the CATOD study cohort changes in mean arterial pressure (ΔMAP) and comparatively the changes in the novel (Δ β 0, ΔcPWVcorr, and Δ E corr) as well as conventional (ΔcPWV and Δ E) stiffness measures after a 2.9 ± 1.0-year follow-up. RESULTS We found no association between ΔMAP and Δ β 0, ΔcPWVcorr, or Δ E corr. In contrast, we did find a significant association between ΔMAP and conventional measures ΔcPWV and Δ E. Additional adjustments for biomechanical confounders and traditional risk factors did neither materially change these associations nor the lack thereof. Conclusions Our newly proposed pressure-independent carotid stiffness measures avoid the need for statistical correction. Hence, these measures (β 0, cPWVcorr, and E corr) can be used in a clinical setting for (i) patient-specific risk assessment and (ii) investigation of potential remodeling effects of (changes in) blood pressure on intrinsic arterial stiffness. [ABSTRACT FROM AUTHOR]

Background Studies have considered the validity of self-reported hypertension relative to hypertension detected by examination; no study has explored trends in the difference between these two measures. Our objective was to calculate these differences overtime within subpopulations of the USA. Methods We included non-Hispanic white, non-Hispanic black and Hispanic adults who participated in the National Health and Nutrition Examination Surveys from 1999 to 2016, in the analysis (N  = 44 333). We subtracted self-reported hypertension from hypertension detected by examination to calculate blood pressure difference (BPD). We fit weighted linear regression models that included important covariates along with all combination of two- and three-way interactions to predict the BPD. We used the fitted lines of the models to depict the patterns of differences in the different subpopulations. Results Age ≥ 45 years, lack of annual clinical visit, body mass index (BMI) < 25 and time were important factors associated with increased BPD. Conclusions People who are ≥ 45 years, have normal BMI, or do not have annual medical visits are more likely to have a bigger BPD. We can use the calculated BPD, to adjust estimates of the prevalence of self-reported hypertension. [ABSTRACT FROM AUTHOR]

BACKGROUND Obesity and hypertension are public health priorities, with obesity considered to be a potential cause of hypertension. Accurate blood pressure (BP) determination is required and often obtained by automated oscillometric cuff devices. We sought to determine the correlation of oscillometric measurement in children, and if obesity was associated with worse correlation between methods than nonobese children. METHODS Retrospective matched case-controlled study of 100 obese (97–99th percentile) and 100 nonobese (25–70th percentile) children after cardiac surgery with simultaneous systolic, diastolic, and mean invasive and oscillometric measurements. Matching was 1:1 for age, sex, race, and Risk Adjustment for Congenital Heart Surgery-1 score. Intraclass correlation coefficients and Bland–Altman plots were used to determine agreement with 0.75 as threshold. RESULTS Median age was 13 years (10–15). Agreement was low for systolic (0.65 and 0.61), diastolic (0.68 and 0.61), and mean measurements (0.73 and 0.69) (obese/nonobese). Bland–Altman plots demonstrated oscillometric BP measurements underestimated systolic hypertension (oscillometric readings lower than intra-arterial). Oscillometric measurements underestimated hypotension (systolic oscillometric measurements were higher than intra-arterial). This occurred in obese and nonobese patients. Correlation of oscillometric measurements was similar for nonobese and obese patients. CONCLUSIONS In this first ever study of simultaneous BP measurement by oscillometric vs. intra-arterial in obese and nonobese children, correlation is below accepted norms. The correlation of oscillometric cuff measurements is not affected by habitus in children. There is less correlation between oscillometric measurements and intra-arterial measurements during hypertension or hypotension. Healthcare providers should be aware of the limitations of oscillometric measurements. [ABSTRACT FROM AUTHOR]

The use of quality antenatal care (ANC) improves maternal and newborn health outcomes. Ensuring equity in access to quality maternal health services is a priority agenda in low- and middle-income countries. This study aimed to assess inequalities in the use of quality ANC in nine East African countries using the most recent Demographic and Health Surveys. We used two outcome variables to examine ANC service adequacy: four or more ANC contacts and quality ANC. We defined quality ANC as having six of the recommended ANC components during follow-up: blood pressure measurement, urine sample test, blood sample test, provision of iron supplements, drug for intestinal parasite and tetanus toxoid injections. We used the concentration index (CCI) to examine inequalities within and across countries. We fitted a multilevel regression model to assess the predictors of inequalities in the contact and content of ANC. This study included 87 068 women; among those 54.4% (n = 47 387) had four or more ANC contacts, but only 21% (n = 15 759) reported receiving all six services. The coverage of four or more ANC and receipt of all six services was pro-rich within and across all countries. The highest inequality in four or more ANC contacts was in Ethiopia with a CCI of 0.209, while women in Burundi had the highest inequality in coverage of all six services (CCI: 0.318). Higher education levels and media exposure were predictors of service uptake, while women who had unintended pregnancies were less likely to make four or more ANC contacts and receive six services. Interventions to improve access to quality ANC require rethinking the service delivery mechanisms in all countries. Moreover, ensuring equity in access to quality ANC requires tailoring service delivery modalities to address the social determinants of service uptake. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the difference of blood pressure criteria and the difference in blood pressure measurement among children and adolescents. METHODS The latest blood pressure criteria for children and adolescents in China, the normal blood pressure standard the United States, and Europe have been used to calculate blood pressure differences for the same age, gender, and height. Based on 3 blood pressure measurements of 45,314 Chinese and 15,279 American children and adolescents, the differences in blood pressure measurements were calculated through repeated measurement analysis of variance and compared with criteria differences. RESULTS More than 60% of the difference in blood pressure standard is distributed between −3 and 3 mm Hg. But the difference between Chinese standards and American standards can be 5–10 mm Hg in children aged 13. The difference between Chinese standards and European standards can be 6–9 mm Hg at the age of 16. The analysis of repeated blood pressure data shows that the maximum difference in systolic blood pressure measurement for Chinese boys and girls is 3.7 and 4.1 mm Hg, respectively, and the maximum difference in diastolic blood pressure measurement is 2.0 and 2.1 mm Hg. The difference between the 3 measurements of boys and girls in the United States is nearly 1 mm Hg. CONCLUSIONS The difference between blood pressure standards is smaller than the measurement difference, and accurate measurement and repeated measurement of blood pressure may be more important for evaluating blood pressure status than the selection of blood pressure standards. [ABSTRACT FROM AUTHOR]

Objective Hyperbilirubinemia is associated with protection against various oxidative stress-mediated diseases. We aimed to investigate the association between bilirubin and novel electrocardiography (ECG)-based ventricular repolarization parameters. Methods We enrolled 201 healthy men with mild hyperbilirubinemia (group 1) and 219 healthy men with normal bilirubin levels (group 2). The Tpeak-Tend (Tp-e) interval (defined as the interval from the peak of the T wave to the end of the T wave), corrected (c) Tp-e interval, QT interval, cQT interval, and Tp-e interval/QT interval ratio were measured from leads V5 and V6 with 20 mm/mV amplitude and 50 mm/second rate. Results The Tp-e interval, cTp-e interval, and Tp-e interval/QT interval ratio were significantly lower in group 1 compared with group 2. The cTp-e interval showed a significant negative correlation with total bilirubin, conjugated bilirubin, and unconjugated bilirubin. The cTp-e interval (odds ratio [OR], 0.900; P  =.002) and Tp-e interval/QT interval ratio (OR, 0.922; P  =.04) were significantly associated with mild hyperbilirubinemia. Conclusion We showed the association of mild hyperbilirubinemia with decreased novel ECG-based ventricular repolarization parameters. [ABSTRACT FROM AUTHOR]

BACKGROUND Blood pressure (BP) measurement error may lead to under- or overtreatment of hypertension. One common source of error is terminal digit preference, most often a terminal digit of "0." The objective was to evaluate national trends in terminal digit preference in office BP measurements among adults with treated hypertension. METHODS Data were from IQVIA's National Disease and Therapeutic Index, a nationally representative, serial cross-sectional survey of office-based physicians. The analysis included office visits from 2015 to 2019 among adults aged ≥18 years receiving antihypertensive treatment. Annual trends were examined in the percent of systolic and diastolic BP measurements ending in zero by patient sex, age, and race/ethnicity, physician specialty, and first or subsequent hypertension treatment visit. RESULTS From 2015 to 2019, there were ~60 million hypertension treatment visits annually (unweighted N : 5,585–9,085). There was a decrease in the percent of visits with systolic (41.7%–37.7%) or diastolic (42.7%–37.8%) BP recordings ending in zero. Trends were similar by patient characteristics. However, a greater proportion of measurements ended in zero among patients aged ≥80 (vs. 15–59 or 60–79) years, first (vs. subsequent) treatment visits, visits to cardiologists (vs. primary care physicians), and visits with systolic BP ≥140 or diastolic BP ≥90 (vs. <140/90) mm Hg. CONCLUSIONS Despite modest improvement, terminal digit preference remains a common problem in office BP measurement in the United States. Without bias, 10%–20% of measurements are expected to end in zero. Reducing digit preference is a priority for improving BP measurement accuracy and hypertension management. [ABSTRACT FROM AUTHOR]

Burn surgery can cause extensive bleeding, which lead to perioperative blood transfusions. The purpose of this study was to investigate whether blood transfusions during burn surgery, guided by standard monitoring with inspection of the operative field, measurements of blood pressure, heart rate, hourly diuresis, and concentrations of hemoglobin and lactate could sustain the preoperative cardiac output (CO) till end of surgery. We investigated 15 patients ≥18 years of age scheduled for burn surgery, where the perioperative monitoring included an arterial line. After induction of anesthesia and before start of surgery, we measured baseline values of CO with the minimally invasive LiDCOrapid, mean arterial pressure, and concentrations of hemoglobin and lactate in arterial blood. We measured these values every 30 minutes through surgery. The primary outcome was change in CO from baseline till end of surgery. Secondary outcomes included the change in concentrations of hemoglobin and lactate from baseline till end of surgery. We found no statistically significant change in CO from baseline till end of surgery (6.6 [±2.4] liters/min; 7.2 [±3.2] liters/min; P = .26). We found a statistically significant decrease in concentration of hemoglobin (7.2 [±0.8] mmol/liter; 6.2 [±0.9] mmol/liter; P = .0002), and a statistically significant increase in concentration of lactate (1.3 [±0.5] mmol/liter; 1.7 [±1] mmol/liter; P = .02). The perioperative blood transfusion guided by standard monitoring seemed to sustain CO from baseline till end of surgery; however, further research is needed to confirm this. [ABSTRACT FROM AUTHOR]