Blood Pressure Monitoring Device Research Articles

Delivering remote monitoring, through primary care, to patients with chronic heart failure

Abstract It is estimated that over 90,000 patients in Ireland have a diagnosis of Heart Failure. The HeartCare at Home study was commenced in 2021 as a collaboration between Centric Health and Roche Diagnostic. The study aimed to examine the feasibility of implementing a remote monitoring programme for patients with heart failure, through primary care, and the impact on hospitalisations, A&E attendances, and GP visits. Patients were referred to the study by their GP. Patients were provided with a blood pressure monitor, weighing scales and smart device in line with the study protocol. The remote monitoring app, a CE-certified Medical Device Class IIa, was provided by Luscii Healthtech. Patients were requested to input their weight, blood pressure, heart rate and symptoms for two weeks after a undergoing a clinical onboard to establish a baseline. Thereafter, readings were entered by patients twice weekly. Patients participated for a minimum of 12 months. If measurements fell outside pre-determined parameters or a deterioration was noted, the team was alerted through the Luscii app dashboard. Where clinically appropriate and in line with cardiologist approved protocols, the team supported the patient to titrate their diuretic medication at home for a maximum of 3 days, with continuous daily monitoring. The patient’s GP was informed of all deteriorations and changes in the patient’s condition and of all recommendations made by the HeartCare at Home team. One hundred and sixty-two patients were onboarded to the programme while 120 patients completed one year follow up (42% female; median age 76 years, range 31-100 years). Thirty five percent of patients had a diagnosis of HFrEF, 13% HFpEF, and 6% HFmrEF while 43% were undifferentiated. Seventy five percent of patients had a NYHA I or II classification. Over 95,000 clinical measurements were recorded through the Luscii app over the course of the study. Of the decompensations managed directly by the HeartCare at Home team with medication titration and daily monitoring, 70% were clinically resolved following the HeartCare at Home protocol. Adherence to inputting monitoring data remained strong throughout the intervention period with over 89% of participating patients continuing to upload readings as scheduled at 12 months. Using established and secure communication pathways, such as HealthLink and Healthmail, the clinical team were able to interact with each patients GP to ensure continuity of care and optimised patient treatment. The HeartCare at Home study demonstrates the feasibility of implementing a remote monitoring programme through primary care. Remote monitoring with direct access to clinical support has potential benefits for patients, clinicians, and the health service at large. Further research, in a larger cohort, and examination of the cost of implementation of remote monitoring in primary care, is warranted.

RU-Net, Multi-Scale Feature Fusion and Transfer Learning: Unlocking the Potential of Cuffless Blood Pressure Monitoring with PPG and ECG.

This study introduces an innovative deep-learning model for cuffless blood pressure estimation using PPG and ECG signals, demonstrating state-of-the-art performance on the largest clean dataset, PulseDB. The rU-Net architecture, a fusion of U-Net and ResNet, enhances both generalization and feature extraction accuracy. Accurate multi-scale feature capture is facilitated by short-time Fourier transform (STFT) time-frequency distributions and multi-head attention mechanisms, allowing data-driven feature selection. The inclusion of demographic parameters as supervisory information further elevates performance. On the calibration-based dataset, our model excels, achieving outstanding accuracy (SBP MAE ± std: 4.49 ± 4.86 mmHg, DBP MAE ± std: 2.69 ± 3.10 mmHg), surpassing AAMI standards and earning a BHS Grade A rating. Addressing the challenge of calibration-free data, we propose a fine-tuning-based transfer learning approach. Remarkably, with only 10% data transfer, our model attains exceptional accuracy (SBP MAE ± std: 4.14 ± 5.01 mmHg, DBP MAE ± std: 2.48 ± 2.93 mmHg). This study sets the stage for the development of highly accurate and reliable wearable cuffless blood pressure monitoring devices.

Concept, study design, and baseline nighttime blood pressure control status of the WISDOM-Night Study using a wrist-type oscillometric home blood pressure monitoring device.

There is growing evidence that nocturnal hypertension is an independent risk factor for cardiovascular diseases, including heart failure. However, brachial blood pressure (BP) measurements during sleep might themselves disturb sleep quality. We initiated a nationwide, multicenter observational prospective study using a wrist-type oscillometric nighttime BP monitoring device with new algorithms to measure supine BP accurately without sleep disturbance. This study, named the Wrist ICT-based Sleep and Circadian Blood Pressure Monitoring Program-Night BP Study (WISDOM-Night Study), was designed to clarify the impact of wrist-measured daily nighttime BPs on cardiovascular prognosis (stroke, coronary artery disease, heart failure, etc.) using 7 days of BP measurements at 2:00 a.m., 3:00 a.m., 4:00 a.m., and 4 h after bedtime. A total of 2751 patients with one or more cardiovascular risk factors were recruited between March 2021 and March 2024 and are currently being followed up for 7 years. Additionally, 1416 of the WISDOM-Night Study-enrolled patients who also agreed to participate in the WISDOM-Hypertension-Mediated Organ Damage (HMOD) Study underwent echocardiography to evaluate the association between wrist-measured BP and left ventricular structure. Data from this WISDOM-Night Study should provide the prospective association between nighttime BP and cardiovascular disease and reveal the indexes of nighttime BP with clinical pathological relevance. This first report of the WISDOM-Night Study describes the study design, baseline characteristics, and BP control status.

Wearable cuffless blood pressure monitoring devices: a commentary.

Hypertension is a growing public challenge as a leading risk factor for cardiovascular disease and all-cause mortality. Reducing overall cardiovascular risk through early screening, initiation of treatment and ongoing monitoring remains a priority in the comprehensive management of hypertension and its complications. Community nurses are ideally positioned to play a crucial role in the early detection of hypertension and providing support for its management. Wearable cuffless devices have the potential for continuous remote blood pressure monitoring. However, there is not enough literature on the validity and usability of wearable cuffless blood pressure devices to justify their use in clinical practice. This commentary critically appraises a systematic review designed to assess the validity, features and clinical usability of wearable cuffless devices, and expands on its findings and their relevance to community nursing and future research.

Innovations in blood pressure measurement and reporting technology: International Society of Hypertension position paper endorsed by the World Hypertension League, European Society of Hypertension, Asian Pacific Society of Hypertension, and Latin American Society of Hypertension.

Blood pressure (BP) is a key contributor to the lifetime risk of preclinical organ damage and cardiovascular disease. Traditional clinic-based BP readings are typically measured infrequently and under standardized/resting conditions and therefore do not capture BP values during normal everyday activity. Therefore, current hypertension guidelines emphasize the importance of incorporating out-of-office BP measurement into strategies for hypertension diagnosis and management. However, conventional home and ambulatory BP monitoring devices use the upper-arm cuff oscillometric method and only provide intermittent BP readings under static conditions or in a limited number of situations. New innovations include technologies for BP estimation based on processing of sensor signals supported by artificial intelligence tools, technologies for remote monitoring, reporting and storage of BP data, and technologies for BP data interpretation and patient interaction designed to improve hypertension management ("digital therapeutics"). The number and volume of data relating to new devices/technologies is increasing rapidly and will continue to grow. This International Society of Hypertension position paper describes the new devices/technologies, presents evidence relating to new BP measurement techniques and related indices, highlights standard for the validation of new devices/technologies, discusses the reliability and utility of novel BP monitoring devices, the association of these metrics with clinical outcomes, and the use of digital therapeutics. It also highlights the challenges and evidence gaps that need to be overcome before these new technologies can be considered as a user-friendly and accurate source of novel BP data to inform clinical hypertension management strategies.

Penetration of M-Health Apps and Devices among Undergraduate Medical Students in Puducherry: A Cross-Sectional Study

Background: With advance in technologies, there is a notable shift in healthcare industry towards integrating mobile health solutions. Medical students are at the forefront to be proficient in the use of cutting-edge medical technologies. This study gives insight about the penetration of m-health among the budding young doctors of Puducherry. Materials and Methods: A facility based analytical cross-sectional study was conducted among 390 undergraduate medical students over a period of two months (Aug-September 2023). Pre-tested semi-structured questionnaire was used to estimate the m-health app/device user, usage pattern and attitude towards m-health apps/devices. Data collected in google form and descriptive statistics was done using MS Excel 2019. Chi square test was applied to find the association between study participant characteristic and m-health app/device user. Results: Proportion of the participants using m-health app was 31.8%. The M-health devices used by the participants were smartphone (100.0%), smartwatch (54%), wrist band (32.2%), blood pressure monitoring device (13.7%). They were using for physical fitness (85.5%), clinical training (32.3%) and disease monitoring (26.6%). Around half 46% of the participants were using it for at least once in a day. Majority (91.1%) were highly confident and confident on the results provided by m-health apps/devices. Proportion of male participants using were higher compared to the female participants. Conclusion: Around one-third of the participants are using mhealth. Almost majority for physical fitness. Male gender was associated with m-health app use. Though there are few downsides with the advancing technology it will be addressed with its evolution.

Assessment of blood pressure variability: characteristics and comparison of blood pressure measurement methods.

Previous studies have reported that blood pressure variability (BPV) is associated with the risk of cardiovascular events independent of blood pressure (BP) levels. While there is little evidence from intervention trials examining whether suppressing BPV is useful in preventing cardiovascular disease, it is suggested that detection of abnormally elevated BPV may be useful in reducing cardiovascular events adding by complementing management of appropriate BP levels. Cuffless BP devices can assess beat-to-beat BPV. Although cuffless BP monitoring devices have measurement accuracy issues that need to be resolved, this is an area of research where the evidence is accumulating rapidly, with many publications on beat-to-beat BPV over several decades. Ambulatory BP monitoring (ABPM) can assess 24-hour BPV and nocturnal dipping patterns. Day-to-day BPV and visit-to-visit BPV are assessed by self-measured BP monitoring at home and office BP measurement, respectively. 24 h, day-to-day, and visit-to-visit BPV have been reported to be associated with cardiovascular prognosis. Although there have been several studies comparing whether ABPM and self-measured BP monitoring at home is the superior measurement method of BPV, no strong evidence has been accumulated that indicates whether ABPM or self-measured home BP is superior. ABPM and self-measured BP monitoring have their own advantages and complement each other in the assessment of BPV.

A novel cuffless blood pressure monitoring device in hypertension care

Background: Hypertension management is challenged by the dynamic nature of blood pressure (BP) fluctuations. These fluctuations are influenced by factors such as physical activity, emotional changes, and sleep patterns. Traditional guidelines focus on static measurements taken in clinical settings. However, these readings may not accurately represent an individual’s typical BP levels. This approach can lead to misdiagnoses, such as white coat or masked hypertension, resulting in either unnecessary treatment or missed diagnoses.Current Concepts: Recent global hypertension guidelines emphasize the importance of home BP monitoring and 24-hour ambulatory BP measurements for more accurate diagnoses and treatment plans. However, several barriers exist, such as the high cost of ambulatory BP devices and practical challenges associated with home BP monitoring, which limit their widespread utilization. Despite these challenges, integrating BP measurements into mobile devices offers a promising approach to monitoring BP outside the clinical setting. Various innovative approaches have been developed, including smartwatches utilizing photoplethysmography sensors and machine learning algorithms. However, their accuracy and the need for periodic calibration are areas of concern.Discussion and Conclusion: Mobile device BP monitoring represents a significant advancement in hypertension management, offering the potential for continuous, convenient, and less intrusive monitoring. Despite these potential benefits, challenges such as device accuracy verification, large-scale data interpretation, and calibration must be addressed. The future of hypertension management will likely rely on these technologies, along with traditional methods, to provide better insight into individual BP profiles. This integration promises to improve hypertension diagnosis, management, and ultimately patient outcomes, although further research and development are necessary to overcome the current limitations.

Real-time monitoring system for blood pressure monitoring based on internet of things

Real-time monitoring system for blood pressure monitoring based on internet of things

A comparative study of ProRithm and standard monitoring techniques for non-invasive blood pressure measurement using photoplethysmography and electrocardiography signals through artificial intelligence/machine learning methods

Background: Multi-parameter monitoring devices are essential for providing real-time patient data, which is crucial for effective healthcare interventions. This clinical trial evaluated the accuracy of the ProRithm beat-to-beat cuffless device for arterial blood pressure monitoring, comparing it with a standard sphygmomanometer. Methods: This observational study included 30 subjects aged 18 and above. Systolic and diastolic blood pressure measurements from both the ProRithm device and the Philips Monitor were compared using statistical analysis. Results: The analysis revealed no statistically significant differences between the ProRithm device and the manual method. In comparison with manual measurements using a sphygmomanometer, the mean systolic blood pressure was 131.2 mmHg with ProRithm it was 129.3 mmHg. Similarly, with the manual method, while the mean diastolic blood pressure was 76.2 mmHg and with ProRithm it was 75.9 mmHg. Conclusions: This study indicates that portable, small-sized devices like ProRithm, which facilitate remote monitoring, are effective for real-time blood pressure assessment in clinical settings.

FEASIBILITY OF WATCH-TYPE CUFF-LESS BLOOD PRESSURE MEASUREMENT DEVICE IN DAILY BLOOD PRESSURE MONITORING

Objective: Cuff-less blood pressure (BP) measurement devices integrated into smartwatches have gained prominence for daily monitoring, yet limited studies provide the analysis of real-world BP data collected by such devices. In this study, we evaluated the feasibility of photoplethysmographic BP measuring smartwatch by analyzing data collected in real-world. Design and method: The campaign, “Smartwatch Blood Pressure Monitoring Challenge with Korean Hypertension Society”, was held in June 1-14, 2023 and 896 participants reported 35592 BP values measured by smartwatch (Samsung Galaxy Watch 6, approved in Korean Ministry of Food and Drug Safety). Participants were instructed to measure BP daily, in the morning (5AM-8AM) and evening (6PM-9PM) for two weeks, with initial calibration and re-calibration after the first week. We evaluated 1) BP difference between before and after re-calibration, and 2) difference in morning and evening BP. We also evaluated the determining factors of the BP differences. Results: Morning and evening BP values showed significant difference, higher in the evening by 1.42±5.25 mmHg (p<0.05). However, the diurnal variation was much smaller than reported in other studies using conventional BP monitoring devices. ANOVA identified significant variables for evening-morning differences, including basal metabolic rate, skeletal muscle mass, total body water, average systolic BP (SBP), diastolic BP (DBP), and heart rate in the morning (p < 0.01 in both ITT and PP). Participants who have evening-morning difference higher than the third quartile, where evening SBP was significantly higher than morning SBP, exhibited smaller variable sizes. Turkey’s Honest Significant Difference showed that this relationship is statistically significant between Q1-Q4 and Q2-Q4 in all variables. The calibration stability was assessed by the difference in average BP before and after calibration, resulting in an SBP difference of 4.64±4.73 mmHg and DBP of 3.66±3.62 mmHg, smaller than a 2021 campaign (6.8±5.6mmHg). When the difference of average was measured between same period of time (morning versus morning and evening versus evening), SBP of 5.39±5.22 mmHg and DBP of 4.3±3.99 mmHg. Conclusions: In conclusion, watch-based devices may not detect clinical-level BP variability, but refining calibration protocols offers improvement potential.

SLEEP BLOOD PRESSURE MEASURED WITH A HOME BLOOD PRESSURE MONITOR WAS INDEPENDENTLY ASSOCIATED WITH INCIDENCE OF CARDIOVASCULAR DISEASES: THE NAGAHAMA STUDY

Objective: Nocturnal blood pressure (BP) was reported to be associated with cardiovascular diseases. However, nocturnal BP measured using ambulatory monitoring device usually includes BP without sleep. We investigated an association between sleep BP measured using a timer-equipped home BP monitor and cardiovascular diseases in a general population. Design and method: Study population was 6,037 middle-aged and older community residents (mean age: 57.8 years old, men: 30.9%). Participants were required to sleep with wrapping cuffs in the upper-arm and sleep BP was measured automatically at 0:00, 2:00, and 4:00. Actigraph was used to determine BP measured during sleep. Participants were also measured home morning BP manually using a same device. Incidence of cardiovascular diseases including stroke and myocardial infarction were assessed by reviewing personal hospital records. Results: Mean morning systolic and diastolic BP was 126 ± 18 and 77 ± 11 mmHg, respectively, while sleep systolic and diastolic BP was 112 ± 15 and 66 ± 9 mmHg. During 5.0 years mean follow-up period, we observed 80 cases of cardiovascular diseases (stroke and myocardial infarction). Morning hypertension (>135/85 mmHg) [hazard ratio (HR) = 3.22, P < 0.001] and sleep hypertension (>120/70 mmHg) [HR = 2.21, P = 0.002], but not office hypertension (>140/90 mmHg) [HR = 1.44, P = 0.127], was significantly associated with incidence of cardiovascular diseases independently of age, sex, and body mass index. Clinical characteristics including sleep efficiency (normotension: 91 ± 4%, sleep hypertension: 89 ± 5%, morning hypertension: 90 ± 4%, sleep and morning hypertension: 89 ± 5%, P< 0.001) and oxygen desaturation index (5.9 ± 4.8, 8.3 ± 6.6, 9.3 ± 7.1, 11.1 ± 9.0 times/h, P < 0.001) differed significantly by the hypertension status. However, sleep hypertension [HR = 2.94, P = 0.015], morning hypertension [HR = 4.81, P < 0.001], and sleep and morning hypertension [HR = 4.71, P < 0.001] was identified as significant factors for cardiovascular diseases after adjustment of covariates including the sleep parameters. Conclusions: High sleep BP measured home BP monitoring device was independently associated with incidence of cardiovascular disease in a general population.

NEW HOME BLOOD PRESSURE TELEMONITORING SYSTEM IN AN AGED COMMUNITY: PROTOCOL OF THE DIGITAL CARDIOVASCULAR PREVENTION FEASIBILITY STUDY

Objective: We sought to (i) determine the precise feasibility of a new telemonitoring-based healthcare system in a community of aged individuals and (ii) clarify the clinical implications of blood pressure variabilities in a time series until the end of life for the management of hypertension in elderly patients. Design and method: We have devised a simple, easy-to-use blood-pressure monitoring system and automated telemonitoring system, i.e., the DICAP (DIgital Cardiovascular Prevention) system, that obtains all of the different blood pressure values measured in a time series in different settings in community-dwelling elderly individuals in their homes and other facilities. Results: The feasibility of the DICAP system was confirmed by the successful serial transmission of the home blood pressure data of the community-dwelling hypertensive patients including those who were not familiar with digital technology and those who resided at different community locations. Among the first-recruited 221 subjects, 92.3% have been monitoring their blood pressure with the DICAP >12 times/week. Conclusions: The newly developed DICAP system using a cellular blood-pressure monitoring device suggests the possibility of being feasible and acceptable for the management of hypertension among elderly community-living individuals.

A Direct Assessment of Noninvasive Continuous Blood Pressure Monitoring in the Emergency Department and Intensive Care Unit

IntroductionNoninvasive continuous blood pressure monitoring has the potential to improve patient treatment in the hospital setting. Such noninvasive devices can be applied earlier in the treatment process to empower nurses and clinicians to react more quickly to patient deterioration with the added benefit of eliminating the risks associated with invasive monitoring. However, emerging technologies must be capable of reproducing current clinical measures for medical decision making. MethodsThis study aimed to determine the usability and willingness of nurses to implement a noninvasive continuous blood pressure monitoring device. The secondary aim directly compared the systolic blood pressure, diastolic blood pressure, and mean arterial pressure values recorded by the device (VitalStream; CareTaker Medical LLC, Charlottesville, VA) with the “gold standard” brachial cuff and arterial line measures recorded in the emergency department and intensive care unit settings. ResultsVitalStream was similarly received by nurses in the emergency department and intensive care setting, but ultimately had greater promotion from emergency nurses. Despite some statistical similarity between measurement methodologies, all direct comparisons were found to not meet the Association for the Advancement of Medical Instrumentation 2008 and Association for the Advancement of Medical Instrumentation / European Society of Hypertension / International Organization for Standardization 2019 consensus statement criteria for acceptable blood pressure measure differences between the VitalStream and “gold standard” clinical measures. In all instances, the standard deviation of the Bland-Altman bias exceeded 8 mm Hg with less than 85% of paired differences falling within 10 mm Hg of the “gold standard.” DiscussionTaken together, the tested device requires additional postprocessing for medical decision making in trauma or emergent care.

Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study.

The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio's Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non-grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). In total, 88% (103/117) of Cardi-OH grant-funded members and 8.14% (98/1204) of non-grant-funded members completed the needs assessment survey. Of these, 51.5% (53/103) of Cardi-OH grant-funded members and 47% (46/98) of non-grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5%), atypical diabetes (38/103, 36.9%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9%), and mental health and CVD (38/103, 36.9%). For non-grant-funded members, the top topics were lifestyle prescriptions (53/98, 54%), mental health and CVD (39/98, 40%), alcohol and CVD (27/98, 28%), and cardiovascular complications (27/98, 28%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7%), family-focused interventions (40/103, 38.8%), and adverse childhood events (37/103, 35.9%). Non-grant-funded members' choices were family-focused interventions (51/98, 52%), implicit bias (43/98, 44%), and adverse childhood events (39/98, 40%). Assessment of other risk factors for CVD and diabetes across grant- and non-grant-funded members revealed screening for social determinants of health in approximately 50% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80% to 90% of the patients. Access to best practice home monitoring devices was challenging, with 30% (16/53) and 41% (19/46) of clinical grant-funded and non-grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68% (36/53) and 43% (20/46) reporting challenges with continuous glucose monitors. Cardi-OH grant- and non-grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers.

Abstract P310: Preference for Home Blood Pressure Monitoring versus Ambulatory Blood Pressure Monitoring for Measuring Sleep Blood Pressure: The BetterBP Study

Background: Home blood pressure (BP) monitoring (HBPM) devices have been adapted as an alternative to ambulatory BP monitoring devices (ABPM) for measuring sleep BP. We evaluated participants' preference for using HBPM versus ABPM to monitor sleep BP in the BetterBP study. Methods: Participants in the BetterBP study (N=591) completed one night of HBPM (3 measurements total) and 24 hours of ABPM (measurements every 30 minutes) in random order. After completing both procedures, participants were asked about the side effects experienced, willingness to again perform HBPM for one night versus ABPM for 24 hours to monitor sleep BP, and overall preference for HBPM versus ABPM for monitoring BP. We used McNemar’s test to evaluate differences between devices. Results: Among all 591 participants, the mean age was 39 years old, and 63% were women. Additionally, 49% were non-Hispanic, White; 21% were non-Hispanic, Black; 15% were non-Hispanic, Asian; and 7% were Hispanic. Interference of normal sleeping pattern was less common for HBPM compared with ABPM (46% versus 57%; p<0.001). Overall, 7% and 6% of participants reported removing the HBPM and ABPM device, respectively, due to disturbance while sleeping (p=0.88). Also, 27% of participants reported pain while undergoing HBPM for one night compared to 47% for ABPM (p<0.001); 43% had irritation while undergoing HBPM for one night compared to 68% for ABPM (p<0.001); and 12% had bruising while undergoing HBPM compared to 23% for ABPM (p<0.001). For the willingness to perform one night of HBPM versus ABPM to monitor sleep BP, 80% were very or completely willing to use HBPM compared to 60% who were very or completely willing to use ABPM ( Table , p<0.001). For overall preference, 71% of participants preferred HBPM, 24% preferred ABPM, and 5% did not prefer either HPBM or ABPM. Conclusion: Participants reported fewer side effects and greater tolerability with HBPM than ABPM and preferred one night of HBPM over 24 hours of ABPM to monitor sleep BP.

Validation of the Meditech ABPM-06 24-hour blood pressure monitoring system in a pediatric population according to International Organization for Standardization Protocol 81060-2:2018.

Ambulatory blood pressure monitoring (ABPM) devices play a crucial role in diagnosing hypertension, not only in adults but also in pediatric patients. ABPM-06, the latest oscillometric device from Meditech Ltd. (Budapest, Hungary), is the focus of this study. The objective was to validate the ABPM-06 device using the International Organization for Standardization (ISO) 81060-2 : 2018 standard. A total of 86 healthy patients, consisting of 34 males and 52 females, aged between 3 and 17 years, were enrolled in this study. During the ambulatory phase, a total of 50 patients were enrolled, with 35 patients falling within the 3- to 12-year-old age range and 15 patients aged between 12 and 17 years. Additionally, for the dynamic test, 36 patients were selected, comprising of 10 individuals aged 3-12 years and 26 patients aged 12-17 years. These patients were recruited from the outpatient clinics of the Department of Pediatrics at Albert Szent-Györgyi University in Szeged, Hungary. The validation process involved utilizing the same-arm sequence protocol, both in resting positions and during stress testing. The ABPM-06 performed well in both clinical and ambulatory validations. In terms of validation criterion 1, the mean ± SD of the differences between the test device and reference blood pressure readings was -1.3 ± 3.5 mmHg for systolic and -0.1 ± 2.3 mmHg for diastolic, in children under the age of 12 years. For those over the age of 12 years, the mean ± SD of the differences was -2.8 ± 4.6 mmHg for systolic and -0.5 ± 2.7 mmHg for diastolic. Regarding the ambulatory validation, for children under 12 years old, the mean ± SD of the differences was -1.3 ± 3.5 mmHg for systolic and -0.1 ± 2.3 mmHg for diastolic. In the age group above 12 years, the mean ± SD of the differences was -2.8 ± 4.6 mmHg for systolic and -0.5 ± 2.7 mmHg for diastolic. Both tests successfully met the established criteria regarding the mean and SD values of the differences between the device readings and the observed SBP and DBP measurements. The ABPM-06 oscillometric device fully adheres to the ISO 81060-2 : 2018 standard requirements for ABPM determination in the pediatric population (ages 3-17 years). Consequently, this ABPM device proves to be suitable for effectively managing hypertension in children and adolescents.

Value and Variability of Pulse Shape Indicator for Estimating Mean Arterial Pressure in the Radial and Femoral Arteries.

The form factor (FF) is a pulse shape indicator that corresponds to the fraction of pulse pressure added to diastolic blood pressure to estimate the time-averaged mean arterial pressure (MAP). Our invasive study assessed the FF value and variability at the radial and femoral artery levels and evaluated the recommended fixed FF value of 0.33. Hemodynamically stable patients were prospectively included in 2 intensive care units. FF was documented at baseline and during dynamic maneuvers. A total of 632 patients (64±16 years of age, 66% men, MAP=81±14 mm Hg) were included. Among them, 355 (56%) had a radial catheter and 277 (44%) had a femoral catheter. The FF was 0.34±0.06. In multiple linear regression, FF was influenced by biological sex (P<0.0001) and heart rate (P=0.04) but not by height, weight, or catheter location. The radial FF was 0.35±0.06, whereas the femoral FF was 0.34±0.05 (P=0.08). Both radial and femoral FF were higher in women than in men (P<0.05). When using the 0.33 FF value to estimate MAP, the error was -0.4±4.0 mm Hg and -0.1±2.9 mm Hg at the radial and femoral level, respectively, and the MAP estimate still demonstrated high accuracy and good precision even after changes in norepinephrine dose, increase in positive end-expiratory pressure level, fluid administration, or prone positioning (n=218). Despite higher FF in women and despite interindividual variability in FF, using a fixed FF value of 0.33 yielded accurate and precise estimations of MAP. This finding has potential implications for blood pressure monitoring devices and the study of pulse wave amplification.

Photoplethysmography for Assessing Microcirculation in Hypertensive Patients After Taking Antihypertensive Drugs: A Review.

High blood pressure (BP) is a common disease and is associated with many chronic diseases. Measuring BP is essential for the treatment and management of many diseases, and therefore there is a growing need for a non-invasive, sleeveless and continuous BP monitoring device. With the development of technology, pulse waveform analysis using photoplethysmography (PPG) has become more feasible for evaluating BP. This study aimed to evaluate the changes of vascular elasticity and blood volume over time by using the characteristic parameters extracted by PPG. We reviewed the latest progress and literature on the observation of capillary network characteristics in hypertensive and non-hypertensive patients by PPG, the influence of different drugs on microcirculation characteristics in hypertensive patients with PPG, and further explored the key relationship between microcirculation and hypertension. We found that the PPG waveform produced by the fingertips of hypertensive patients is very different from that of healthy people, and the PPG waveform changes significantly during diastolic period after antihypertensive treatment. With the rapid development of medical technology, people can get more intuitive microcirculation image data, which provides beneficial help for the comprehensive understanding of hypertension.

Feasibility and Effectiveness of a Ring-Type Blood Pressure Measurement Device Compared With 24-Hour Ambulatory Blood Pressure Monitoring Device.

This study aimed to evaluate the applicability and precision of a ring-type cuffless blood pressure (BP) measurement device, CART-I Plus, compared to conventional 24-hour ambulatory BP monitoring (ABPM). Forty patients were recruited, and 33 participants were included in the final analysis. Each participant wore both CART-I Plus and ABPM devices on the same arm for approximately 24 hours. BP estimation from CART-I Plus, derived from photoplethysmography (PPG) signals, were compared with the corresponding ABPM measurements. The CART-I Plus recorded systolic blood pressure (SBP)/diastolic blood pressure (DBP) values of 131.4±14.1/81.1±12.0, 132.7±13.9/81.9±11.9, and 128.7±14.6/79.3±12.2 mmHg for 24-hour, daytime, and nighttime periods respectively, compared to ABPM values of 129.7±11.7/84.4±11.2, 131.9±11.6/86.3±11.1, and 124.5±13.6/80.0±12.2 mmHg. Mean differences in SBP/DBP between the two devices were 1.74±6.69/-3.24±6.51 mmHg, 0.75±7.44/-4.41±7.42 mmHg, and 4.15±6.15/-0.67±5.23 mmHg for 24-hour, daytime, and nighttime periods respectively. Strong correlations were also observed between the devices, with r=0.725 and r=0.750 for transitions in SBP and DBP from daytime to nighttime, respectively (both p<0.001). The CART-I Plus device, with its unique ring-type design, shows promising accuracy in BP estimation and offers a potential avenue for continuous BP monitoring in clinical practice. ClinicalTrials.gov Identifier: NCT06084065.