Blood Pressure Assessment Research Articles

Hypertension and Lifestyle Determinants in Public Transport Drivers: A Sector-specific Study in Coimbatore, Tamil Nadu

Introduction: Cardiovascular diseases are a leading cause of death worldwide, prompting this investigation into hypertension – a key risk factor – among a vulnerable group, bus drivers, who may be affected by job-related stress and health behaviors. Materials and Methods: This cross-sectional analysis evaluated 800 male TNSTC bus drivers from Coimbatore using a multistage sampling method. Interviews, physical measurements, and blood pressure assessments provided the data, which were subjected to comprehensive statistical analysis. Results: A concerning 49.9% of drivers were hypertensive, and 27.75% did not have their condition under control. Increased risk was linked with advancing age (those above 51 were 3.28 times more at risk than those under 30), lower educational attainment, familial hypertension history, and lifestyle choices, including sedentary habits, excessive salt consumption, and substance use. A striking correlation was observed between obesity and hypertension (odds ratio: 1.36; 95% confidence interval: 1.09–1.69). Conclusion: This research highlights an alarming rate of hypertension within the bus driver cohort, influenced by both modifiable and non modifiable risk factors. It underscores the urgent need for targeted health programs, proactive screenings, and educational initiatives. Expanding the study to other centers will provide a broader context for these findings.

Revising blood pressure classification guidelines: A call for normal lower limits in the “American college of cardiology/American heart association task force on clinical practice guidelines for hypertension”

The existing blood pressure classification guidelines established by the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology/European Society of Hypertension (ESC/ESH) lack specified lower limits for the “Normal” category. This paper underscores the imperative need for revisiting these guidelines to incorporate defined lower limits for the “Normal” classification. The absence of such lower limits hinders the precision of clinical practice and undermines the comprehensive assessment of blood pressure in individuals. By advocating for the inclusion of lower limits, this paper aims to enhance the accuracy of blood pressure categorization, thereby providing clinicians with more nuanced guidance and fostering improved cardiovascular health outcomes.

High Amino Acid Intake in Early Life Is Associated With Systolic but Not Diastolic Arterial Hypertension at 5 Years of Age in Children Born Very Preterm.

The life course of individuals born very premature is a topic of increasing concern. The association between high early amino acid intake and later high blood pressure (HBP) in preterm neonates is debated. In a national, prospective, population-based birth cohort, EPIPAGE-2 (Etude Epidémiologique sur Petits Ages Gestationnels), we assessed blood pressure at 5 years. Eligible infants were those born between 24 and 29 weeks of gestation. Infants were distributed in 2 groups of 717 infants matched on propensity score on whether or not they were exposed to high amino acid intake (>3.5 g/kg per day at day 7); 455 control term infants were also enrolled. A value ≥95th percentile of reference values for age and height defined systolic or diastolic HBP. Blood pressure at 5 years of age was assessed for 389 and 385 children in the exposed and nonexposed groups, respectively. Rates (in percent) of systolic and diastolic HBP were 18.0% (95% CI, 14.5%-22.2%), 13.3% (95% CI, 10.3%-17.0%), 8.5% (95% CI, 6.5%-11.1%), and 9.0% (95% CI, 6.6%-12.3%), 10.2% (95% CI, 7.5%-13.6%), and 5.4% (95% CI, 3.8%-7.6%) in exposed, nonexposed, and term-born groups, respectively. Exposure to high early amino acid intake and maximal serum creatinine (by 50 μmol/L) between day 3 and day 7 were 2 independent risk factors for systolic HBP (adjusted odds ratio [aOR], 1.60 [95% CI, 1.05-2.43] and aOR, 1.59 [95% CI, 1.12-2.26], respectively) but not for diastolic HBP (aOR, 0.84 [95% CI, 0.50-1.39] and aOR, 1.09 [95% CI, 0.71-1.67], respectively). After adjustment for 5-year weight Z score, the aOR between high early amino acid intake and systolic HBP was 1.50 [95% CI, 0.98-2.30]. These results suggest that mechanisms of childhood systolic HBP involve neonatal renal challenge by high amino acid intake or dysfunction.

Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians.

The early period of the COVID-19 pandemic necessitated a rapid increase in out-of-office care. To capture the impact from COVID-19 on care for patients with hypertension, a questionnaire was disseminated to community health center clinicians. The extent, types, and causes of care delays and disruptions were assessed along with adaptations and innovations used to address them. Clinician attitudinal changes and perspectives on future hypertension care were also assessed. Of the 65 respondents, most (90.8%) reported their patients with hypertension experienced care delays or disruptions, including lack of follow-up, lack of blood pressure assessment, and missed medication refills or orders. To address care delays and disruptions for patients with hypertension, respondents indicated that their health center increased the use of telehealth or other technology, made home blood pressure devices available to patients, expanded outreach and care coordination, provided medication refills for longer periods of time, and used new care delivery options. The use of self-measured blood pressure monitoring (58.5%) and telehealth (43.1%) was identified as the top adaptations that should be sustained to increase access to and patient engagement with hypertension care; however, barriers to both remain. Policy and system level changes are needed to support value-based care models that include self-measured blood pressure and telehealth.

Graphene-based Two-Stage Enhancement Pressure Sensor for Subtle Mechanical Force Monitoring.

The development of pressure sensors with high sensitivity and a low detection limit for subtle mechanical force monitoring and the understanding of the sensing mechanism behind subtle mechanical force monitoring are of great significance for intelligent technology. Here, we proposed a graphene-based two-stage enhancement pressure sensor (GTEPS), and we analyzed the difference between subtle mechanical force monitoring and conventional mechanical force monitoring. The GTEPS exhibited a high sensitivity of 62.2 kPa-1 and a low detection limit of 0.1 Pa. Leveraging its excellent performance, the GTEPS was successfully applied in various subtle mechanical force monitoring applications, including acoustic wave detection, voice-print recognition, and pulse wave monitoring. In acoustic wave detection, the GTEPS achieved a 100% recognition accuracy for six words. In voiceprint recognition, the sensor exhibited accurate identification of distinct voiceprints among individuals. Furthermore, in pulse wave monitoring, GTEPS demonstrated effective detection of pulse waves. By combination of the pulse wave signals with electrocardiogram (ECG) signals, it enabled the assessment of blood pressure. These results demonstrate the excellent performance of GTEPS and highlight its great potential for subtle mechanical force monitoring and its various applications. The current results indicate that GTEPS shows great potential for applications in subtle mechanical force monitoring.

Performance of wearable watch-type home blood pressure measurement devices in a real-world clinical sample.

Independent testing of home blood pressure (BP) measurement (HBPM) devices is often lacking, particularly among older and multi-morbid patients. We studied the Bpro G2 (using tonometry), Omron HeartGuide (using occlusive oscillometric technology), and Heartisans (using photoplethysmography) wrist watch HBPM devicesagainst a gold standard brachial sphygmomanometer. To test device performance, we used the ISO81060-2 protocol (though this protocol cannot formally validate cuffless devices). We also used linear mixed models to compare adjusted longitudinal BP measurements between devices. Finally, as a surrogate for usability, we recorded instances of device failure where no BP measurement was returned. We enrolled 128 participants (median [Q1-Q3] age 53 [40-65] years, 51% male, 46% on antihypertensive drugs), of whom 100 were suitable for the primaryanalysis. All three devices had mean BP values within 5mmHg of sphygmomanometry. However, due to insufficient reliability (e.g., wider than accepted standard deviations of mean BP), none of the three devices passed all criteria required by the ISO81060-2 protocol. In adjusted longitudinal analyses, the Omron device also systematically underestimated systolic and diastolic BP (-8.46mmHg; 95% CI 6.07, 10.86; p < 0.001; and -2.53mmHg; 95% CI -4.03, -1.03; p = 0.001; respectively). Nevertheless, compared to the Omron device, BPro and Heartisans devices had increased odds of failure (BPro: odds ratio [OR] 5.24; p < 0.0001; Heartisans: OR 5.61; p < 0.001). While we could not formally validate the cuffless devices, our results show that wearable technologies will require improvements to offer reliable BP assessment. This study also highlights the need for validation protocols specifically designed for cuffless BP measurement technologies.

Management of hypertensive disorders in pregnancy: An updated review

Hypertensive disorders in pregnancy (HDP) pose substantial risks to maternal and fetal health. Pre-eclampsia, a globally significant pregnancy complication associated with maternal mortality and adverse outcomes, is on the rise, driven by factors such as obesity, advanced maternal age, and the increasing prevalence of underlying medical conditions. This review explores recent advancements in managing these conditions, extending the scope to encompass cases of hypertension during pregnancy and up to 12 weeks postpartum. Notably, chronic hypertension is now incorporated within the HDP definition, with blood pressure (BP) assessment as a cornerstone in diagnosis. Emphasizing the importance of out-of-office BP measurements, including ambulatory and home-based monitoring, is underscored for pregnant and non-pregnant women. Recent insights into preeclampsia and other HDP have paved the way for enhanced preventive measures, screening protocols, and management strategies. With emerging early detection and intervention tools, there is significant potential for reshaping clinical practices.

Cardiovascular Risk Assessment of Elevated Blood Pressure for Screening and Early Detection in Children 6 to 9 Years of Age in the Valencian Community: ANIVA Study.

Elevated blood pressure (EBP), hypertension (HT), and prehypertension (PHT), along with the rising prevalence of overweight/obesity in children, correlate with a heightened risk of cardiovascular complications. This study focuses on assessing the prevalence of overweight/obesity and EBP and identifying potential indicators for effective early screening and detection of EBP in children aged 6 to 9 years old. This cross-sectional study was conducted with 1142 students from different schools across the Valencian Community in Spain. Data collection involved administering a questionnaire alongside direct anthropometric measurements of each student. The collected data underwent comprehensive statistical analysis, including frequencies, percentages, means, and chi-square automatic interaction detector (CHAID) analysis. In the sample, 7.5% of the children had HT and 6.8% had PHT, meaning 14.3% presented with EBP. Additionally, 17.0% of the children were classified as overweight and 3.9% as obese. Body mass index >23.1, body fat percentage >20.79%, and Kidmed scores <8 were identified as potential markers for early detection of EBP. The study reveals a significant incidence of EBP and overweight/obesity. Implementing screening protocols for early detection of EBP is imperative to forestall future cardiovascular events. Moreover, lifestyle modifications emerge as the most crucial approach for managing these risk factors.

Invasively measured and estimated central blood pressure using the oscillometric algorithm Antares in patients with and without obesity.

Obesity is a global health concern and risk factor for cardiovascular disease. The assessment of central blood pressure (cBP) has been shown to improve prediction of cardiovascular events. However, few studies have investigated the impact of obesity on cBP in adults, and invasive data on this issue are lacking. This study aimed to evaluate cBP differences between patients with and without obesity, identify cBP determinants, and evaluate the accuracy of the algorithm Antares for non-invasive cBP estimation. A total of 190 patients (25% female; 39% with BMI ≥30kg/m2; age: 67±12 years) undergoing elective cardiac catheterization were included. cBP was measured invasively and simultaneously estimated non-invasively using the custo screen 400 device with integrated Antares algorithm. No significant cBP differences were found between obese and non-obese patients. However, females, especially those with obesity, had higher systolic cBP compared to males (P<0.05). Multiple regression analysis showed that brachial mean arterial pressure, pulse pressure, BMI, and heart rate predicted cBP significantly (adjusted R2 = 0.82, P<0.001). Estimated cBP correlated strongly with invasive cBP for systolic, mean arterial, and diastolic cBP (r = 0.74-0.93, P<0.001) and demonstrated excellent accuracy (mean difference <5 and SD <8 mmHg). This study discovered no significant difference in cBP between obese and non-obese patients. However, it revealed higher cBP values in women, especially those with obesity, which requires further investigation. Additionally, the study highlights Antares' effectiveness in non-invasively determining cBP in obese individuals. This could improve the diagnosis and treatment of hypertension in this special patient population.

Assessment of Blood Pressure, Pulse, and Body Weight of Selected Staff and Students of Federal University Wukari, Nigeria

This research study assessed the body weight, pulse and blood pressure of some staff and students of Federal University Wukari, Taraba State, Nigeria. A total of eighty-six people were used for the purpose of this research. They comprised of forty-three members of staff and forty-three students of Federal University Wukari, Nigeria. The members of staff and students’ blood pressures, pulse and body weights were checked and recorded. The equipment used for this research are Wrist Digital cs70 Sphygmomanometer and a digital personal weighing scale (PH-2015A). The results showed there is a significant difference (p&lt;0.05) between the mean body weight, systolic and diastolic readings of the staff and students. There is no significant difference (p&gt;0.05) between the mean pulse of the staff and students. The mean body weight, systolic, diastolic and average blood pressure of the staff are higher than that of the students, while the average pulse of the students is higher than the average pulse of the staff. The blood pressure of thirty-two (32) staff is within the normal range. The blood pressure of seven (7) staff is slightly high, while the blood pressure of four (4) staff is high. The blood pressure of forty (40) students is within the normal range. The blood pressure of two (2) students is slightly high, while the blood pressure of one (1) student is slightly low. The findings of this study showed that the mean body weight of the members of staff is significantly higher than that of the students. More body mass and/or bone mass may be building up as age progresses during adulthood. The pulse of most of the staff and students are normal, showing that the hearts of the staff and students are functioning properly. The average blood pressure of both the staff and students are within the normal range, showing that most of the staff and students may not be facing any cardiovascular disease challenge which may arise as a result of hypertension or hypotension.

HIF1α Elevations at Tissue and Serum Levels and Their Association With Metabolic Disorders in Children With Obesity.

We aimed to examine the expression profile and circulating level of hypoxia-inducible factor 1 alpha (HIF1α) in children and the relationships with metabolic disorders. A total of 519 children were recruited, with paired subcutaneous and omental adipose tissues collected from 17 children and serum samples from the remaining children. All children underwent anthropometric and biochemical analyses. The mRNA, protein, and serum levels of HIF1α were determined by real-time PCR, immunohistochemistry, and enzyme-linked immunosorbent assay, respectively. Both HIF1α mRNA and protein levels, especially in omental adipose tissue, were increased in overweight or obese (OV/OB) children (P < .05). Likewise, serum HIF1α level was remarkably higher in OV/OB children than in normal-weight children (P < .05). Serum HIF1α level was positively correlated with BMI z-score, fat mass percentage, waist to height ratio, systolic blood pressure, alanine aminotransferase, total triglycerides, uric acid, and homeostasis model assessment of insulin resistance (IR). Furthermore, a binary logistic regression analysis of serum HIF1α level indicated that the risks for IR, nonalcoholic fatty liver disease (NAFLD), and metabolic syndrome remained significant in the presence of all potential confounding variables. Finally, the area under the receiver operating characteristic curves for serum HIF1α level in children who were diagnosed with IR, NAFLD, and metabolic syndrome were 0.698 (95% CI, 0.646-0.750; P < .001), 0.679 (95% CI, 0.628-0.731; P < .001), and 0.900 (95% CI, 0.856-0.945; P < .001). HIF1α expression is higher in the adipose tissue, especially omental, of children with obesity than in children with normal weight. Elevated serum HIF1α level is associated with adiposity and metabolic disorder, which may predict a higher risk of obesity complications.

"Paediatricians brace thyself" - Healthcare provider perspectives on childhood and adolescent hypertension: A qualitative study.

Paediatric and adolescent hypertension is becoming a public health concern as it contributes to the development of cardiovascular diseases. However, the problem largely remains undiagnosed. This makes early detection and institution of appropriate preventive measures difficult. The existing diagnostic guidelines and management policies for paediatric hypertension are complex. They have individual specific cut-offs (based on age, gender and height), making their interpretation difficult. The present study aims to gain insights into paediatrician's perspectives on childhood hypertension. Qualitative Studies using Key Informant Interviews (KIIs) were conducted with paediatricians to know about their perspectives on blood pressure assessment in children and adolescents, its barriers, their experience, practices and expectations for main streaming hypertensive screening in national health programmes. The interviews were audio recorded after taking their consent. Grounded theory was used to analyse transcripts. A total of 40 providers within the public and private health sector were invited to participate; 36 consented and completed the interviews. There was a perception of increased prevalence of paediatric hypertension. Several system, provider and patient-level barriers, like unavailability of paediatric-sized cuffs, and complicated guidelines for interpreting blood pressure, prevented screening and accurate diagnosis. Despite the lack of guidelines for screening, paediatricians still recommended lifestyle interventions. They expressed concerns about implementing standard guidelines for screening. They also expressed the need for a clinical assessment tool to assist in accurate diagnosis. They were willing to contribute to the development and implementation of training programme for health providers to overcome barriers to blood pressure measurement in children.

Exercise-Induced Blood Pressure Dynamics: Insights from the General Population and the Athletic Cohort.

Blood pressure (BP) dynamics during graded exercise testing provide important insights into cardiovascular health, particularly in athletes. These measurements, taken during intense physical exertion, complement and often enhance our understanding beyond traditional resting BP measurements. Historically, the challenge has been to distinguish 'normal' from 'exaggerated' BP responses in the athletic environment. While basic guidelines have served their purpose, they may not fully account for the complex nature of BP responses in today's athletes, as illuminated by contemporary research. This review critically evaluates existing guidelines in the context of athletic performance and cardiovascular health. Through a rigorous analysis of the current literature, we highlight the multifaceted nature of exercise-induced BP fluctuations in athletes, emphasising the myriad determinants that influence these responses, from specific training regimens to inherent physiological nuances. Our aim is to advocate a tailored, athlete-centred approach to BP assessment during exercise. Such a paradigm shift is intended to set the stage for evidence-based guidelines to improve athletic training, performance and overall cardiovascular well-being.

Temporal relationship between triglyceride-glucose index and blood pressure and their joint cumulative effect on cardiovascular disease risk: a longitudinal cohort study

BackgroundConcurrent insulin resistance and elevated blood pressure are commonly observed in cardiovascular disease (CVD) and have long been proposed to contribute to CVD. However, the temporal relationship between them and the effect of their cumulative co-exposure on future incident CVD remains unclear.MethodsLongitudinal analysis of data on 57,192 participants from a real-world, prospective cohort study (Kailuan Study) was performed to address the temporal relationship between Triglyceride-Glucose Index (TyG, calculated as ln [TG (mg/dL) × FBG (mg/dL)/2]) and blood pressure (BP) assessed by cross-lagged analyses in an approximately 4-year exposure period (2006/2007 to 2010/2011). After excluding 879 participants with known diabetes, 56,313 nonCVD participants were included for further analysis of the CVD outcome. Cox regression models were used to examine the hazard ratios (HRs) upon the cumulative TyG (CumTyG) and BP(CumBP) in the exposure period.ResultsThe standard regression coefficient from baseline TyG to follow-up systolic BP was 0.0142 (95% CI 0.0059–0.0226), which was greater than the standard regression coefficient from baseline systolic BP to follow-up TyG (− 0.0390; 95% CI − 0.0469 to − 0.0311). The same results were observed in the cross-lag between TyG and diastolic blood pressure [0.0271 (0.0185 to 0.0356) vs. − 0.0372 (− 0.0451 to − 0.0293)]. During a median follow-up of 9.98 years, 3981 CVD cases occurred. Significant interactions were observed between the median CumTyG (8.61) and CumSBP thresholds (130, 140 mmHg) (P = 0.0149), the median CumTyG (8.61) and CumDBP thresholds (80, 90 mmHg) (P = 0.0441). Compared to CumTyG < 8.61 and CumSBP < 130 mmHg, after adjusting for potential confounding factors, the HR gradually increased in the high co-exposure groups. The hazard ratios (HRs) and 95% confidence intervals (CIs) for Q2–Q6 were 1.39 (1.24, 1.57), 1.94 (1.69, 2.22), 2.40 (2.12, 2.71), 2.74 (2.43, 3.10), and 3.07 (2.74, 3.45). Additionally, the CVD risks in the co-exposure were more prominent in younger participants.ConclusionsThese findings suggest that elevated TyG has a greater impact on future blood pressure changes than vice versa. Dual assessment and management of insulin resistance and blood pressure contribute to the prevention of CVD, especially in younger individuals.

Integration of point-of-care screening for type 2 diabetes mellitus and hypertension into the COVID-19 vaccine programme in Johannesburg, South Africa

BackgroundSouth Africa grapples with a substantial burden of non-communicable diseases (NCDs), particularly type 2 diabetes (diabetes) and hypertension. However, these conditions are often underdiagnosed and poorly managed, further exacerbated by the strained primary healthcare (PHC) system and the disruptive impact of the COVID-19 pandemic. Integrating NCD screening with large-scale healthcare initiatives, such as COVID-19 vaccination campaigns, offers a potential solution, especially in low- and middle-income countries (LMICs). We investigated the feasibility and effectiveness of this integration.MethodsA prospective cohort study was conducted at four government health facilities in Johannesburg, South Africa. NCD screening was incorporated into the COVID-19 vaccination campaign. Participants underwent COVID-19 rapid tests, blood glucose checks, blood pressure assessments, and anthropometric measurements. Those with elevated blood glucose or blood pressure values received referrals for diagnostic confirmation at local PHC centers.ResultsAmong 1,376 participants screened, the overall diabetes prevalence was 4.1%, combining previously diagnosed cases and newly identified elevated blood glucose levels. Similarly, the hypertension prevalence was 19.4%, comprising pre-existing diagnoses and newly detected elevated blood pressure cases. Notably, 46.1% of participants displayed waist circumferences indicative of metabolic syndrome, more prevalent among females. Impressively, 7.8% of all participants screened were potentially newly diagnosed with diabetes or hypertension. Approximately 50% of individuals with elevated blood glucose or blood pressure successfully linked to follow-up care within four weeks.ConclusionOur study underscores the value of utilizing even brief healthcare interactions as opportunities for screening additional health conditions, thereby aiding the identification of previously undiagnosed cases. Integrating NCD screenings into routine healthcare visits holds promise, especially in resource-constrained settings. Nonetheless, concerted efforts to strengthen care linkage are crucial for holistic NCD management and control. These findings provide actionable insights for addressing the NCD challenge and improving healthcare delivery in LMICs.

Dual nature of ferritin for hematologic, liver functional, and metabolic parameters in older diabetic patients

This study explored the association between ferritin with hematologic, liver functional, and metabolic parameters in older diabetic patients. A total of 210 diabetic patients aged 65 or older were classified into four groups according to the reference range of serum ferritin. Demographic variables and health-related lifestyle factors were obtained through the utilization of a standardized questionnaire. Anthropometric measures, blood pressure, hematology test, and biochemical assessment were also performed. Among all patients, 29.5% had anemia. The percentage of anemia in groups low ferritin (< 40 μg/L), lower side within the reference range (40–120 μg/L), higher side within the reference range (121–200 μg/L), and high ferritin levels (> 200 μg/L) were 50.0, 27.7, 20.5, and 24.2% (P = 0.025), respectively. Low ferritin levels had a higher risk of anemia and a high red blood cell distribution width (RDW). High ferritin levels were associated with a higher risk of high glutamate pyruvate transaminase, obesity, high fasting blood glucose (FBG), and high postprandial blood glucose. The higher side within the reference range of ferritin also showed a higher risk of high FBG and high glycated hemoglobin. Nevertheless, there was no significant association between ferritin and inflammation marker, serum lipids or blood pressure. Overall, ferritin demonstrates a dual nature in older diabetic patients: low ferritin levels are linked to anemia or elevated RDW, while high levels are linked to obesity, increased liver enzymes, and worse glycemia control.

A Novel Convolutional Neural Network Deep Learning Implementation for Cuffless Heart Rate and Blood Pressure Estimation

Cardiovascular diseases (CVDs) affect components of the circulatory system responsible for transporting blood through blood vessels. The measurement of the mechanical force acting on the walls of blood vessels, as well as the blood flow between heartbeats and when the heart is at rest, is known as blood pressure (BP). Regular assessment of BP can aid in the prevention and early detection of CVDs. In the present research, a deep learning algorithm was developed to accurately calculate both blood pressure (BP) and heart rate (HR) by extracting relevant features from photoplethysmogram (PPG), electrocardiogram (ECG), and ABP signals. This algorithm was implemented using the Medical Information Mart for Intensive Care (MIMIC-II) dataset. It captures vital blood pressure-related features extracted from the PPG signal and accounts for the time relationship with the ECG. The algorithm also determines the values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) based on the ABP waveform through a convolutional neural network and stepwise multivariate linear regression. In comparison with other established BP measurement methods, our proposed approach achieved better results, with a mean absolute error (MAE) of approximately 4.7 mmHg for SBP and 2.1 mmHg for DBP, respectively. The standard deviation (STD) for SBP and DBP was approximately 7.6 mmHg and 3.9 mmHg, respectively. This study makes a valuable contribution to the healthcare field by introducing a novel, cost-effective continuous BP measurement method with improved accuracy while also minimizing the data dimension without losing any important information.

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment in CKD

IntroductionCentral aortic blood pressure (BP) could be a better risk predictor than brachial BP. This study examined whether invasively measured aortic systolic BP improved outcome prediction beyond risk prediction by conventional cuff-based office systolic BP in patients with and without chronic kidney disease (CKD). MethodsIn a prospective, longitudinal cohort study aortic and office systolic BPs were registered in patients undergoing elective coronary angiography. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2. Multivariable Cox models were used for the association with incident myocardial infarction (MI), stroke, and death. ResultsAortic and office systolic BPs were available in 39,866 patients (mean age: 64 years; 58% males; 64% with hypertension) out of which 6,605 (17%) had CKD. During a median follow-up of 7.2 years (interquartile range: 4.6-10.1 years), 1,367 strokes (CKD: 353), 1,858 MIs (CKD: 446) and 7,551 deaths (CKD: 2,515) occurred. CKD increased the risk of stroke, MI and death significantly. Office and aortic systolic BP were both associated with stroke in non-CKD patients (adjusted hazard ratios with 95% confidence interval per 10 mmHg: 1.08 (1.05–1.12) and 1.06 (1.03–1.09), respectively) and with MI in CKD patients (adjusted hazard ratios: 1.08 (1.03–1.13) and 1.08 (1.04–1.12), respectively). There was no significant difference between prediction of outcome with office or aortic systolic BP when adjusted models were compared with C-statistics. ConclusionRegardless of CKD status, invasively measured central aortic systolic BP does not improve the ability to predict outcome compared with brachial office BP measurement.

Abstract 16270: Pulse Pressure Amplification Contributes to the Exaggerated Peripheral Blood Pressure Response to Exercise in Patients With HFpEF

Background: Patients with suspected heart failure and preserved ejection fraction (HFpEF) undergo invasive (right heart catheterization) cardiopulmonary exercise testing (iCPET) to confirm diagnosis. During iCPET peripheral arterial blood pressure (BP) is measured using a brachial cuff or radial arterial catheter. Notably, peripheral BP is typically higher than central BP and this difference is assessed by measuring pulse pressure amplification (PPA; peripheral - central PP; PP = systolic BP [SBP] - diastolic BP). The effect of PPA on the assessment of (exaggerated) exercise BP in HFpEF is unknown. Methods: 20 patients with HFpEF (75% Female; age: 69±7 years, BMI: 38±7 kg/m 2 ) were studied at rest and during submaximal and maximal cycling exercise. We measured radial BP (arterial catheterization) and derived ascending aortic BP using a transfer function applied to radial arterial waveforms (SphygmoCor). Pulse pressure amplification was assessed as radial-aortic pulse pressure. Data were compared with one-way and two-way (Site*Exercise Stage) ANOVA. Results: The increase in radial PP with exercise was greater than aortic PP (Site*Stage P&lt;0.001; Figure A); thus, PPA increased with exercise (ANOVA, P =0.001; Figure B). The increase in PPA was due to a greater increase in radial compared to aortic SBP (Site*Stage P=0.002; Figure C). The change in diastolic pressure was not different between sites (Figure D). Increases in PPA accounted for ~30% of the increase in radial SBP. The incidence of exaggerated exercise SBP (Male: &gt;210 mmHg; Female: &gt;190 mmHg) was higher in the radial artery compared to aorta (95 vs 40 %, χ2&lt;0.001). Conclusion: Peak exercise SBP was ~50 mmHg greater in the radial artery compared to aorta. The marked overestimation of central BP during exercise when measuring peripheral BP leads to misguided interpretation of BP responses to exercise, the magnitude of afterload and has implications for the assessment of ventricular-arterial coupling.

White coat effect in patients with hypertension

The article is devoted to various aspects of white coat effect (WCE) in patients with hypertension (HTN). WCE is due to the patient’s anxious response to office blood pressure (BP) measurement and is characterized by a BP increase. In patients with HTN, WCE is detected with a high frequency. Pronounced WCE in hypertensive patients is associated with worsening the HTN course and the prognosis of all-cause and cardiovascular mortality. In addition, BP increase in these patients during a doctor’s visit may lead to additional prescription of antihypertensive drugs, increasing costs and side effects. To identify WCE, a large number of methods are used, which can be divided into following groups: I – data from clinical and daytime ambulatory blood pressure measurement, II – clinical and home BP assessment, III – only ambulatory BP measurement, IV – clinical and laboratory BP data, and V – only clinical BP measurement. There are following WCE in patients with HTN: female sex, age, never smoking, as well as anxiety, introversion, etc. WCE is due to the patient’s anxiety state during office BP measurement and a conditioned reflex BP increase associated both with the physician presence and medical background. Severe WCE in some groups of patients with HTN may be associated with a worse prognosis compared with other hypertensive patients as follows: in individuals with a significant difference between clinical and ambulatory blood pressure levels or between the first and third BP office data, with a combination of resistant HTN and WCE, with WCE increasing from visit to visit, etc.