Clinic Blood Pressure Research Articles

Elevated blood pressure accelerates white matter brain aging among late middle-aged women: a Mendelian Randomization study in the UK Biobank.

Elevated blood pressure (BP) is a modifiable risk factor associated with cognitive impairment and cerebrovascular diseases. However, the causal effect of BP on white matter brain aging remains unclear. In this study, we focused on N = 228 473 individuals of European ancestry who had genotype data and clinical BP measurements available (103 929 men and 124 544 women, mean age = 56.49, including 16 901 participants with neuroimaging data available) collected from UK Biobank (UKB). We first established a machine learning model to compute the outcome variable brain age gap (BAG) based on white matter microstructure integrity measured by fractional anisotropy derived from diffusion tensor imaging data. We then performed a two-sample Mendelian randomization analysis to estimate the causal effect of BP on white matter BAG in the whole population and subgroups stratified by sex and age brackets using two nonoverlapping data sets. The hypertension group is on average 0.31 years (95% CI = 0.13-0.49; P < 0.0001) older in white matter brain age than the nonhypertension group. Women are on average 0.81 years (95% CI = 0.68-0.95; P < 0.0001) younger in white matter brain age than men. The Mendelian randomization analyses showed an overall significant positive causal effect of DBP on white matter BAG (0.37 years/10 mmHg, 95% CI 0.034-0.71, P = 0.0311). In stratified analysis, the causal effect was found most prominent among women aged 50-59 and aged 60-69. High BP can accelerate white matter brain aging among late middle-aged women, providing insights on planning effective control of BP for women in this age group.

Abstract P327: “The More Data, The Better”: Patient Experiences With Blood Pressure Measurement For Hypertension Diagnosis

Background: Out-of-office blood pressure (BP) measurement is recommended when making new hypertension diagnoses. However, in current practice, hypertension is primarily diagnosed using clinic BP measurements. Objective: To understand patient attitudes about the accuracy and patient-centeredness of different BP measurement and hypertension diagnostic methods. Design: Qualitative study within a randomized controlled diagnostic study comparing the accuracy and acceptability of clinic BP, home BP monitoring (HBPM), and kiosk BP (in a waiting room or pharmacy) for diagnosing hypertension among patients in an integrated delivery system. All participants also completed 24-hour ambulatory blood pressure monitoring regimen (ABPM). Participants: Qualitative interview participants (aged 31-76 years) were recruited from the main study with a goal of balancing by study arms, measurement result (high vs normal ABPM), hypertension diagnosis status at 6 months, gender, and age. Approach: We conducted semi-structured interviews at two time points—shortly after completion of diagnostic testing and 6 months later—to explore attitudes and behaviors related to the different BP measurement diagnostic methods. Key results: Interview participants (n=35) found HBPM to be comfortable, convenient, and low burden, and believed it produced accurate results. Participants reported higher confidence in high BP measurements from HBPM or ABPM compared to measurement in clinics. Clinic measurements were reported as less convenient than HBPM. Participants overall did not favor kiosks due to concerns about accuracy and privacy. ABPM was described by participants as the most accurate method, partly due to repeated measurements over the 24-hour period in real-world contexts, but many found it uncomfortable and disruptive. Participants also noted that methods that involved repeated measures such as HBPM and ABPM were especially influential in making their own personal decision as to whether or not they had hypertension. Conclusions: Our findings suggest that strategies to enhance HBPM implementation for hypertension diagnosis in primary care may improve diagnosis and patient understanding of hypertension.

B3X: a novel efficient algorithm for accurate automated auscultatory blood pressure estimation

Objective. The auscultatory technique is still considered the most accurate method for non-invasive blood pressure (NIBP) measurement, although its reliability depends on operator’s skills. Various methods for automated Korotkoff sounds analysis have been proposed for reliable estimation of systolic (SBP) and diastolic (DBP) blood pressures. To this aim, very complex methodologies have been presented, including some based on artificial intelligence (AI). This study proposes a relatively simple methodology, named B3X, to estimate SBP and DBP by processing Korotkoff sounds recordings acquired during an auscultatory NIBP measurement. Approach. The beat-by-beat change in morphology of adjacent Korotkoff sounds is evaluated via their cross-correlation. The time series of the beat-by-beat cross-correlation and its first derivative are analyzed to locate the timings of SBP and DBP values. Extensive tests were performed on a public database of 350 annotated measurements, and the performance was evaluated according to the BHS, AAMI/ANSI, and International Organization for Standardization (ISO) quality standards. Main results. The proposed approach achieved ‘A’ scores for SBP and DBP in the BHS grading system, and passed the quality tests of AAMI/ANSI and ISO standards. The B3X algorithm outperformed two well-established algorithms for oscillometric NIBP measurement in both SBP and DBP estimation. It also outperformed four AI-based algorithms in DBP estimation, while providing comparable performance for SBP, at the cost of a much lower computational burden. The full code of the B3X algorithm is provided in a public repository. Significance. The very good performances ensured by the proposed B3X algorithm, at a low computational cost and without the need for parameter training, support its direct implementation into clinical blood pressure (BP) monitoring devices. The results of this study pave the way for solving/overcoming the trade-off between the accuracy of the auscultatory technique and the objectivity of oscillatory measurements, by bringing an automated auscultatory BP measurement method in clinical practice.

Abstract 109: Geriatric Unhoused Patients Presenting To A Free Clinic In Miami- Dade Had Significantly Higher Rates Of Stage 1 And 2 Hypertension And Are At Significantly Increased Risk For Untreated Hypertension Compared To Age- Matched General Population

Introduction: People over age 50 comprise 30% of people experiencing homelessness (PEH) in the United States and are predicted to increase exponentially in the next ten years. Few studies have documented PEH hypertension (HTN) prevalence, and treatment protocols rarely test their efficacy specifically when treating older PEH. The few geriatric PEH HTN studies that have been conducted are based out of homeless shelters, with even less known about the HTN rates of people experiencing unsheltered homelessness (PEUH) who constitute one-third of PEH nationally. Our objective is to assess prevalence of elevated blood pressure (BP) and HTN treatment rates among geriatric PEUH presenting at a free clinic in Miami-Dade County. Methods: Clinical information and BP measurements of 105 PEUH over 50 were documented as part of care by a street outreach medical team. Clinical information was recorded in a REDCap electronic database. De-identified data was compared to the Centers for Disease Control National Health and Nutrition Examination Survey 2017-2019 pre-pandemic cohort (CDC NHANES) and analyzed in R studio version 4.3.2. Results: PEUH were at significantly increased relative risk (RR) for Stage 1 HTN (RR 3.97, Confidence Interval (CI) 2.68-5.89, p&lt;0.0001) when compared to age- matched NHANES dataset. After 10-year age cohort stratification the small PEH sample size (N=11) lacked enough power to reach significance. PEUH were also found to be at significantly increased risk of Stage 2 HTN (RR 6.17, CI 4.93-7.73, p&lt;0.0001). Here findings remained significant after 10-year age cohort stratification (N=41). NHANES reports medication use by 20-year age groups: 50.8% of people aged 40-59, and 49.4% of people over 60 with diagnosed HTN were on BP control medication. PEUH were at significantly increased risk of untreated HTN (RR 1.67, CI 1.50-1.87, p&lt;0.0001). Only 15.9% were prescribed medication. Conclusion: Increased risk of elevated BP and untreated HTN among geriatric PEUH likely reflect barriers of access to chronic disease management. There are likely also unidentified confounding factors preventing proper care for this vulnerable population. Further investigation should critically assess gaps in the care to devise protocols for improving treatment outcomes.

Abstract P328: A Retro And Prospective Review Of Within Session Clinic Bp Assessment In Hypertenison Clinical Trials

There has been an increased interest and discussion around oscillometric blood pressure variability across the use of different BP measurement modalities and technology. Recent publications have referenced the BP variability as Very short term, short term, mid term and long term variability with each variability associated with a specific BP modality. The scientific and medical working groups have referenced the importance of capturing replicate readings during a standard clinic assessment. An area which has not received as much focus is on the assessment of BP variability within a standard clinic assessment with replicate readings. This becomes of specific interest during the conduct of a clinical trial where BP assessment can be a primary efficacy endpoint (hypertension drug development) or safety (Draft FDA Pressor guidance). This abstract will approach this specific area by providing examples and analysis from recent clinical trials which incorporated standardized clinic BP technology and automated sequence of BP readings across the study population. Each of the studies implemented a different sequence of readings and visit averaging function which will also be expanded upon in the presentation as to developing industry and scientific guidelines. Through this abstract and presentation the attendee will be provided present approaches to clinic/office based assessment in clinical trials and decisions around implementation strategies to address observed variability.

224 Surgical Repair of Mitral Valve Prolapse: Hypertension and Other Determinants of Failure

Abstract Aim It has been postulated that hypertension is associated with an increased likelihood of repair failure in patients with mitral valve prolapse. This study aims to assess whether there is a significant association between hypertension and disease recurrence and need for reoperation. Method A retrospective observational cohort study was conducted at a single centre in the United Kingdom. Patients who underwent surgical repair for mitral valve prolapse were identified between January 2011 and December 2020, with follow-up data collected to December 2021. Patients were classified as hypertensive if they had a pre- operative clinic blood pressure of 140/90 mm Hg or above. Treatment failure was confirmed by the presence of moderate or worse regurgitation on post-operative echocardiography and/or need for reoperation. Multivariate logistic regression and Cox regression were used for statistical analysis. Results A total of 278 patients were identified who had pre-operative blood pressure data available, of those 144 were hypertensive. By the conclusion of the study period, treatment failure occurred in 11.5% of the study sample. No significant association was identified between the presence of hypertension and treatment failure, or time to treatment failure. Concomitant atrial ablation was, however, found to be protective against treatment failure (odds ratio, 6.1; 95% confidence interval, 1.2 to 32.8) and associated with longer time to treatment failure (hazard ratio, 6.3; 95% confidence interval, 1.6 to 25.1). Conclusions There is insufficient evidence to demonstrate that hypertension is associated with treatment failure or time to treatment failure for patients undergoing surgical repair for mitral valve prolapse.

Challenges Associated with the use of Smartwatches for out of Clinic Blood Pressure Monitoring Among Expectant Mothers in a Developing Country: A Case study of Nakuru County Kenya

Pre-eclampsia is a leading cause of maternal mortality globally and more so in developing countries. The condition, if detected early, can be prevented to avert death and suffering. This early detection has become easier with the development of devices such as smartwatches with BP sensors which have enhanced the practice of Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM). However, most of these devices and monitoring practices have not been widely adopted in developing countries due to the high cost of devices and the lack of institutionalization of the ABPM and HBPM in healthcare systems. This study sought to examine the use of low-cost smartwatches, a mobile application, and a support system for the implementation of ABPM and HBPM among expectant mothers in Nakuru county, Kenya. A total of 34 expectant mothers were involved in the study over 8 months. A total of 967 readings were collected with only 3 out of the 34 mothers managing to take at least 71 readings during the period of the study. The study established that the use of low-specification phones that were incompatible with the mobile application, failure of the smartwatches to work appropriately, difficulties in getting mothers who met the inclusion criteria under 20 weeks gestation, poor adherence to the data collection, and loss of the devices negatively impacted the quality and consistency of BP monitoring among the expectant mothers. The study therefore recommends the use of more robust devices such as cuff BP readers and the inclusion of community health volunteers in the early identification of pregnant mothers from the community and subsequent follow-up for ABPM and HBPM.

Can blood pressure decrease after maximal exercise test predict the blood pressure lowering effect of aerobic training in treated hypertensive men?

The acute decrease in blood pressure (BP) observed after a session of exercise (called post-exercise hypotension) has been proposed as a tool to predict the chronic reduction in BP induced by aerobic training. Therefore, this study investigated whether post-exercise hypotension observed after a maximal exercise test is associated to the BP-lowering effect of aerobic training in treated hypertensives. Thirty hypertensive men (50 ± 8 years) who were under consistent anti-hypertensive treatment underwent a maximal exercise test (15 watts/min until exhaustion), and post-exercise hypotension was determined by the difference between BP measured before and at 30 min after the test. Subsequently, the patients underwent 10 weeks of aerobic training (3 times/week, 45 min/session at moderate intensity), and the BP-lowering effect of training was assessed by the difference in BP measured before and after the training period. Pearson correlations were employed to evaluate the associations. Post-maximal exercise test hypotension was observed for systolic and mean BPs (-8 ± 6 and -2 ± 4 mmHg, all P < 0.05). Aerobic training reduced clinic systolic/diastolic BPs (-5 ± 6/-2 ± 3 mmHg, both P < 0.05) as well as awake and 24 h mean BPs (-2 ± 6 and -2 ± 5 mmHg, all P < 0.05). No significant correlation was detected between post-exercise hypotension and the BP-lowering effect of training either for clinic or ambulatory BPs (r values ranging from 0.00 to 0.32, all p > 0.05). Post-exercise hypotension assessed 30 min after a maximal exercise test cannot be used to predict the BP-lowering effect of aerobic training in treated hypertensive men.

A Rare Case of Focal Renal Fibromuscular Dysplasia Treated With Angioplasty: A Case Report.

Fibromuscular dysplasia is an idiopathic, segmental, nonatherosclerotic, noninflammatory vascular disease that can lead to arterial stenosis, tortuosity, occlusion, aneurysms, and dissection. Fibromuscular dysplasia is a rare cause of hypertension that can easily be missed. To date, there has been no definitive treatment for fibromuscular dysplasia. In this report, we present an uncommon case of renovascular hypertension in a 21-year-old non-white female with a 3-year history of hypertension secondary to fibromuscular dysplasia involving bilateral renal arteries. Computed tomography angiography during the arterial phase revealed distal focal narrowing of the right main renal artery, distal focal narrowing of the left main renal artery, and proximal focal narrowing of the left accessory lower renal artery. Percutaneous balloon dilatation of the stenotic lesion was performed successfully up to 1year After the procedure, the arterial blood pressure was within the normal range (110/70 to 125/75mmHg) without medication. After 1year of follow-up, CTA revealed re-stenosis in left main renal artery without clinical symptoms and normal blood pressure. Repeated procedure was done successfully. This case report highlights the difficulty in the diagnosis and treatment of focal fibromuscular dysplasia in young non-white female patients. Computerized tomographic angiography is a useful tool for identifying the cause and showing the benefit of percutaneous transluminal renal angioplasty treatment for this rare entity, as an early percutaneous angioplasty intervention may have a clinical cure for hypertension.

Home versus Clinic Blood Pressure Monitoring: Evaluating Applicability in Hypertension Management via Telemedicine.

Hypertension is a significant public health concern in Saudi Arabia, affecting 28.6% of the population. Despite the availability of effective treatments, optimal blood pressure control is not always achieved, highlighting the need for effective management strategies. This study aimed to evaluate the applicability of home, compared to clinic, blood pressure measurements for managing hypertension in the Qassim region of Saudi Arabia. The study included 85 adults undergoing antihypertensive treatment. Home blood pressure measurements were obtained during the day and the evening using automated oscillometric sphygmomanometers, whereas clinic measurements were taken during clinic hours. Home blood pressure readings were significantly lower than clinic blood pressure readings, with mean differences of 20.4 mmHg and 4.1 mmHg for systolic and diastolic blood pressures, respectively. There was a positive correlation between the clinic systolic and diastolic blood pressures (r = 0.549, p < 0.001) and a weak correlation between the daytime home and clinic systolic blood pressures (r = 0.218, p < 0.05). This study provides insight into the applicability of home blood pressure monitoring, which may aid in the development of more effective hypertension management strategies, particularly the use of morning home blood pressure monitoring to aid treatment decisions through telehealth medicine.

Prognostic Impact of On-Treatment Cumulative Ambulatory Blood Pressures for Adverse Macro- and Microvascular Outcomes in Individuals With Type 2 Diabetes: The Rio de Janeiro Type 2 Diabetes Cohort.

The prognostic value of on-treatment mean cumulative ambulatory blood pressures (BPs) in type 2 diabetes has never been investigated. We aimed to assess it in a prospective cohort of 647 individuals with type 2 diabetes. Clinic-office and ambulatory BPs were measured at baseline and serially during follow-up. Multivariable Cox analyses assessed the associations between baseline and mean cumulative BPs with the occurrence of cardiovascular events, major adverse cardiovascular events, all-cause and cardiovascular mortality, and microvascular outcomes (microalbuminuria, renal failure, retinopathy, and peripheral neuropathy). C statistics and the integrated discrimination improvement (IDI) index evaluated the improvement in risk discrimination by using cumulative ambulatory BPs instead of baseline BPs. Over a median follow-up of 10.6 years, there were 202 cardiovascular events (163 major adverse cardiovascular events), 254 all-cause deaths (118 cardiovascular); 125 individuals had microalbuminuria development/progression, 104 developed advanced renal failure, 159 had retinopathy, and 174 individuals had peripheral neuropathy development/progression. The risks associated with mean cumulative ambulatory BPs were in general higher than those associated with baseline BPs, particularly for cardiovascular (HR, 1.42 versus 1.25 for increments of 1 SD in 24-hour systolic blood pressure) and mortality outcomes (1.56 versus 1.26). Compared with cumulative clinic BPs, mean cumulative ambulatory BPs improved risk discrimination for most outcomes, with IDIs from 11% to 14% for major adverse cardiovascular events and mortality up to 24% to 26% for microalbuminuria and neuropathy. Compared with clinic-office BPs, mean cumulative ambulatory BPs during follow-up improve risk discrimination for most complications and mortality in individuals with type 2 diabetes. Serial ambulatory BP monitoring shall be more widely used in clinical management.

Efficacy of beetroot juice on reducing blood pressure in hypertensive adults with autosomal dominant polycystic kidney disease (BEET-PKD): study protocol for a double-blind, randomised, placebo-controlled trial

BackgroundIn autosomal dominant polycystic kidney disease (ADPKD) impaired nitric oxide (NO) synthesis, in part, contributes to early-onset hypertension. Beetroot juice (BRJ) reduces blood pressure (BP) by increasing NO-mediated vasodilation. The aim of this double-blind, randomised, placebo-controlled study is to test the hypothesis that BRJ reduces systolic and diastolic clinic BP in hypertensive adults with ADPKD.MethodsParticipants with ADPKD and treated hypertension (n = 60) will be randomly allocated (1:1) to receive a daily dose of either nitrate-replete (400 mg nitrate/day) or nitrate-deplete BRJ for 4 weeks. The co-primary outcomes are change in mean systolic and diastolic clinic BP before and after 4 weeks of treatment with daily BRJ. Secondary outcomes are changes in daily home BP, urinary albumin to creatinine ratio, serum and salivary nitrate/nitrite levels and serum asymmetric dimethylarginine levels before and after 4 weeks of BRJ.DiscussionThe effect of BRJ in ADPKD has not been previously tested. BRJ is an accessible, natural dietary supplement that, if effective, will provide a novel adjunctive approach for treating hypertension in ADPKD.Trial registrationClinicalTrials.gov NCT05401409. Retrospectively registered on 27th May 2022.

Is Education Enough to Change the Practice of Monitoring of Blood Pressure in Outpatient Clinics? Case Report

Purpose: Hypertension (HTN) is a prevalent and preventable risk factor for several medical conditions that can lead to death. The purpose of this study was to investigate the frequency of physical and occupational therapists taking blood pressure (BP) in outpatient clinics before and after education focused on the clinical importance of monitoring BP. Methods: This pre/posttest model consists of 2 phases. In phase 1, physical and occupational therapists were surveyed regarding attitudes, behaviors, and barriers toward monitoring BP; and electronic medical records (EMR) were audited to determine frequency of BP documentation. For phase 2, educational webinars were developed highlighting the importance of BP monitoring and followed by another EMR audit. Results: Nine clinicians participated in our survey. Survey results indicated that one-third agreed that BP should be monitored during evaluations, but 100% responded that they rarely take BP. An audit of 488 EMR charts pre-education showed there was no BP documented. Three months after education, another 237 EMR charts were audited, with a 12.7% improvement in the frequency of BP documented. A chi-square analysis showed that this improvement was statistically significant (P &lt; .001). Conclusions: Therapists did not monitor and document BP. After the webinar series, there was a significant increase, however still below recommendations for monitoring BP.

Lifestyle Medicine as a Treatment for Resistant Hypertension.

Approximately 10% of the adults with hypertension fail to achieve the recommended blood pressure treatment targets on 3 antihypertensive medications or require ≥ 4 medications to achieve goal. These patients with 'resistant hypertension' have an increased risk of target organ damage, adverse clinical events, and all-cause mortality. Although lifestyle modification is widely recommended as a first-line approach for the management of high blood pressure, the effects of lifestyle modifications in patients with resistant hypertension has not been widely studied. This review aims to provide an overview of the emerging evidence on the benefits of lifestyle modifications in patients with resistant hypertension, reviews potential mechanisms by which lifestyles may reduce blood pressure, and discusses the clinical implications of the recent findings in this field. Evidence from single-component randomized clinical trials demonstrated that aerobic exercise, weight loss and dietary modification can reduce clinic and ambulatory blood pressure in patients with resistant hypertension. Moreover, evidence from multi-component trials involving exercise and dietary modification and weight management can facilitate lifestyle change, reduce clinic and ambulatory blood pressure, and improve biomarkers of cardiovascular risk. This new evidence supports the efficacy of lifestyle modifications added to optimized medical therapy in reducing blood pressure and improving cardiovascular risk biomarkers in patients with resistant hypertension. These findings need to be confirmed in larger studies, and the persistence of benefit over extended follow-up needs further study.

Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol

Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions. The NEXTGEN-BP open-label, multicenter, randomized controlled trial will investigate the efficacy, safety, acceptability and cost-effectiveness of a wearable blood pressure monitor-based care strategy for the treatment of hypertension, compared to usual care, in lowering clinic blood pressure over 12 months. NEXTGEN-BP will enroll 600 adults with high blood pressure, treated with 0 to 2 antihypertensive medications. Participants attending primary care practices in Australia will be randomized 1:1 to the intervention of a wearable-based remote care strategy or to usual care. Participants in the intervention arm will undergo continuous blood pressure monitoring using a wrist-wearable cuffless device (Aktiia, Switzerland) and participate in 2 telehealth consultations with their primary care practitioner (general practitioner [GP]) at months 1 and 2. Antihypertensive medication will be up-titrated by the primary care practitioner at the time of telehealth consults should the percentage of daytime blood pressure at target over the past week be <90%, if clinically tolerated. Participants in the usual care arm will have primary care consultations according to usual practice. The primary outcome is the difference between intervention and control in change in clinic systolic blood pressure from baseline to 12 months. Secondary outcomes will be assessed at month 3 and month 12, and include acceptability to patients and practitioners, cost-effectiveness, safety, medication adherence and patient engagement. NEXTGEN-BP will provide evidence for the effectiveness and safety of a new paradigm of wearable cuffless monitoring in the management of high blood pressure in primary care. ACTRN12622001583730.

Early Pregnancy Systolic Blood Pressure Patterns Predict Early- and Later-Onset Preeclampsia and Gestational Hypertension Among Ostensibly Low-to-Moderate Risk Groups.

Background Clinical risk factors, a single blood pressure (BP) measurement, current biomarkers, and biophysical parameters can effectively identify risk of early-onset preeclampsia but have limited ability to predict later-onset preeclampsia and gestational hypertension. Clinical BP patterns hold promise to improve early risk stratification for hypertensive disorders of pregnancy. Methods and Results After excluding preexisting hypertension, heart, kidney, or liver disease, or prior preeclampsia, the retrospective cohort (n=249 892) all had systolic BP <140 mm Hg and diastolic BP <90 mm Hg or a single BP elevation ≤20 weeks' gestation, prenatal care at <14 weeks' gestation, and a still or live birth delivery at Kaiser Permanente Northern California hospitals (2009-2019). The sample was randomly split into development (N=174 925; 70%) and validation (n=74 967; 30%) data sets. Predictive performance of multinomial logistic regression models for early-onset (<34 weeks) preeclampsia, later-onset (≥34 weeks) preeclampsia, and gestational hypertension was evaluated in the validation data set. There were 1008 (0.4%), 10 766 (4.3%), and 11 514 (4.6%) patients with early-onset preeclampsia, later-onset preeclampsia, and gestation hypertension, respectively. Models with 6 systolic BP trajectory groups (0-20 weeks' gestation) plus standard clinical risk factors performed substantially better than risk factors alone to predict early- and later-onset preeclampsia and gestational hypertension, with C-statistics (95% CIs) of 0.747 (0.720-0.775), 0.730 (0.722-0.739), and 0.768 (0.761-0.776) versus 0.688 (0.659-0.717), 0.695 (0.686-0.704) and 0.692 (0.683-0.701), respectively, with excellent calibration (Hosmer-Lemeshow P=0.99, 0.99, and 0.74, respectively). Conclusions Early pregnancy BP patterns up to 20 weeks' gestation plus clinical, social, and behavioral factors more accurately discriminate hypertensive disorders of pregnancy risk among low-to-moderate risk pregnancies. Early pregnancy BP trajectories improve risk stratification to reveal higher-risk individuals hidden within ostensibly low-to-moderate risk groups and lower-risk individuals considered at higher risk by US Preventive Services Task Force criteria.

Multimorbidity clusters and associated health care cost among patients attending psychiatric clinics in Odisha, India.

There is a dearth of data on common multimorbidity clusters and the healthcare costs for individuals with mental health disorders. This study aimed to identify clinically meaningful physical-mental multimorbidity clusters, frequently occurring clusters of conditions, and healthcare utilization patterns and expenditure among patients attending a psychiatric outpatient clinic. Data were collected in the psychiatric outpatient department among patients aged 18 years and above in February-July 2019 (n = 500); follow-up data on non-communicable disease incidence were collected after 18 months. For analysis, morbidity clusters were defined using two approaches: 1) agglomerative hierarchical clustering method to identify clusters of diseases; and 2) non-hierarchical cluster k mean analysis to identify clusters of patients. Self-reported healthcare costs in these clusters were also calculated. Two disease clusters were identified: using the 1st approach were; 1) hypertension, diabetes, and mood disorder; 2) Neurotic, stress-related, and somatoform disorders, and acid peptic disease. Three clusters of patients identified using the 2nd approach were identified: 1) those with mood disorders and cardiometabolic, musculoskeletal, and thyroid diseases; 2) those with neurotic, substance use, and organic mental disorders, cancer, and epilepsy; and 3) those with Schizophrenia. Patients in Cluster 1 were taking more than six medicines and had more hospital visits. Within 18 months, 41 participants developed either one or two chronic conditions, most commonly diabetes, hypertension, or thyroid disease. Cardiometabolic diseases are most commonly clustered with mood disorders. There is a need for blood pressure and sugar measurement in psychiatric clinics and mood disorder screening in cardiac, endocrinology, and primary care clinics.

Validation of the YuWell YE660D oscillometric upper-arm blood pressure monitor for clinic and home in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard (International Organization for Standardization 81060-2:2018) and the International Organization for Standardization Amendment 1. 2020.

To evaluate the accuracy of the YuWell YE660D oscillometric upper-arm blood pressure (BP) monitor in general population (for clinic and home BP measurements in adults) according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2 : 2018) and its Amendment 1. 2020. Subjects were recruited to fulfill the age, sex, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumferences 22-32 cm (standard) and 22-45 cm (wide range). Ninety-two subjects were recruited and 85 subjects were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.3 ± 7.2/2.2 ± 5.5 mmHg (systolic/diastolic). For validation criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 6.1/4.8 mmHg (systolic/diastolic). The YuWell YE660D oscillometric upper-arm electronic BP monitor has passed the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2 : 2018) and its Amendment 1. 2020 in adults and hence can be recommended for home and clinical use.

Blood pressure measurement and blood pressure control in Veterans Affairs medical centers.

The Veterans Affairs (VA) medical centers provide care for millions of Veterans at high risk of cardiovascular disease and accurate BP measurement in this population is vital for optimal BP control. Few studies have examined terminal digit preference (TDP), a marker of BP measurement bias, clinician perceptions of BP measurement, and BP control in VA medical centers. This mixed methods study examined BP measurements from Veterans aged 18 to 85 years with hypertension and a primary care visit within 8 VA medical centers. TDP for all clinic BP measurements was examined using a goodness of fit test assuming 10% frequency for each digit. Interviews were also conducted with clinicians from 3 VA medical centers to assess perceptions of BP measurement. The mean age of the 98,433 Veterans (93% male) was 68.5 years (SD 12.7). BP was controlled(<140/90mmHg) in 76.5% and control rates ranged from 72.2% to 81.0% across the 8 VA medical centers. Frequency of terminal digits 0 through 9 differed significantly from 10% for both SBP and DBP within each center (P<.001) but level of TDP differed by center. The highest BP control rates were noted in centers with highest TDP for digits 0 and 8 for both SBP and DBP. Clinicians reported use of semi-automated oscillometric devices for clinic BP measurement, but elevated BP readings were often confirmed by auscultatory methods. Significant TDP exists for BP measurement in VA medical centers, which reflects continued use of auscultatory methods.

24 Hour blood pressure monitoring is a better predictor of mortality than clinic blood pressure in a large cohort of primary care patients: what is the impact on clinical practice?

24 Hour blood pressure monitoring is a better predictor of mortality than clinic blood pressure in a large cohort of primary care patients: what is the impact on clinical practice?