Blood Pressure Values Research Articles

Adolescent Blood Pressure and Early Age Stroke.

Underdiagnosis of relevant risk factors has contributed to the increasing stroke incidence in young adults. Blood pressure cut-off values for adolescents are neither sex specific nor based on cardiovascular outcomes. This nationwide, population-based, retrospective cohort study included all Israeli adolescents 16-19 years of age who were medically evaluated before compulsory military service from 1985 to 2013, including routine blood pressure measurements. The primary outcome was the first occurrence of a stroke (ischemic or hemorrhagic) at a young age (≤52 years), as documented in the Israeli National Stroke Registry. Cox proportional hazard models were stratified by sex and adjusted for birth year, sociodemographic variables, and adolescent body mass index. The cohort comprised 1,897,048 adolescents (42.4% women). During 11,355,476 person-years of follow-up, there were 1470 first stroke events at a young age. In men, an adolescent diastolic blood pressure value of ≥80 mmHg, compared with the reference group (diastolic blood pressure value of <70 mmHg), was associated with an increased risk of stroke (adjusted hazard ratio 1.28; 95% confidence interval [CI], 1.04 to 1.58), while a diastolic blood pressure value of 70-79 mmHg was not associated with an increased risk of stroke (adjusted hazard ratio 1.11; 95% CI 0.90 to 1.34). Among women, an adolescent diastolic blood pressure value of ≥80 mmHg, compared with the reference group (diastolic blood pressure value of <70 mmHg) was associated with an increased risk of stroke at a young age (adjusted hazard ratio 1.38; 95% CI 1.03 to 1.88), as was a diastolic blood pressure value of 70-79 mmHg (adjusted hazard ratio 1.41; 95% CI 1.09 to 1.81). Elevated adolescent systolic blood pressure values (≥120 mmHg) were not associated with an increased risk of stroke. Diastolic blood pressure values of ≥80 mmHg in adolescence were associated with an increased risk of stroke at a young age in both men and women. No similar association was observed for elevated systolic blood pressure.

Correlations of the Circadian Rhythmicity of Blood Pressure With Erectile Dysfunction.

Erectile dysfunction (ED) and cardiovascular diseases (CVD) share common pathophysiological mechanisms. This study aimed to assess the relationship between ED and its severity with the risk of developing CVD by analyzing changes in the circadian blood pressure (BP) rhythm. In the study, 24-h BP levels of 192 (94 with ED and 98 controls) participants with no history of CVD were evaluated using an ambulatory blood pressure monitoring (ABPM) device. The International Index of Erectile Function (IIEF) questionnaire was used to assess the ED severity in the study group. ABPM measurements revealed higher BP values among the ED group. The nondipper pattern was significantly more frequent in the ED group compared to the controls (56.2%vs. 77.1%, p<0.01). Blood pressure variability parameters, including systolic standard deviation (SD) and average real variability (ARV), were notably higher in the ED group (16.3±3.9vs. 14.6±4.3, p<0.01 and 13.39±7.24vs. 11.5±2.1, p<0.01, respectively). Furthermore, parameters reflecting arterial stiffness including pulse pressure index (PPI) and ambulatory arterial stiffness index (AASI) were higher in the ED group (0.81±0.33vs. 0.73±0.18, p = 0.03 and 0.71±0.09vs. 0.59±0.17, p = 0.014, respectively). Both AASI and ARV were significantly correlated with the severity of ED. This study suggests a significant association between ED severity and altered blood pressure patterns which in part explains the increased risk of CVD among individuals with ED.

Reproducibility and Treatment Effect on Office and Ambulatory Pressure Relation.

In the absence of outcome-based ambulatory blood pressure (BP) data hypertension guidelines provide 24-hour mean BP values corresponding to trial-validated office BP values. Data are shown for untreated and treated patients together, but whether corresponding ambulatory values are similar in untreated and treated hypertensives and reproducible at yearly measurements during treatment is undefined. In 2397 patients of the ELSA (European Lacidipine Study on Atherosclerosis) and PHYLLIS (Plaque Hypertension Lipid-Lowering Italian Study) trials, we calculated the office and 24-hour BP relationship according to the linear regression model, with office systolic BP as the independent variable, at baseline and yearly during a 3-year treatment. Twenty-four hour BP values corresponding to clinically important office BP values (hypertension grades and treatment thresholds and targets) were calculated and compared with those provided by guidelines. Office/24-hour systolic BP or diastolic BP always exhibited a significant linear relationship, with, however, limited Pearson correlation coefficients (never >0.44).The slopes of the relationship were superimposable between different years of treatment but always significantly less steep than the slope seen in untreated individuals. Compared with the guideline-provided corresponding values, 24-hour BP showed qualitative and quantitative differences; for example, it was considerably lower and higher than the guideline-corresponding values when office BP was in the high hypertension and low treatment target ranges, respectively. In treated patients with hypertension the slope of the office/24-hour BP linear regression is reproducible over time. However, the slopes are steeper in untreated individuals, indicating that information on ambulatory BP values corresponding to office BP values can be more accurate if separately estimated in these 2 conditions.

High-intensity interval training is an effective exercise mode to maintain normal blood pressure during pregnancy: a randomized control trial.

Pregnant women are more susceptible to high blood pressure (BP) than the general adult population; therefore, all means of preventing this condition should be considered. High-intensity interval training (HIIT) is effective in this regard in the general population, but there is a lack of evidence of its effectiveness during pregnancy. This study aimed to compare an 8-week HIIT program to self-performed moderate-to-vigorous physical activity among pregnant women by evaluating changes in BP after a maximal progressive cardiorespiratory exercise test (CPET) performed at pre-intervention and post-intervention time points. A total of 54 Caucasian women in uncomplicated, singleton pregnancies (age 32 ± 4 years, 22 ± 4 weeks of gestation; M ± SD) with normal BP values completed the interventions. The experimental (HIIT) group (n = 34) completed an online supervised HIIT program consisting of three sessions per week and supplemented by an educational class once per week. Participants in the education (EDU) group (n = 20) attended an educational class once per week and were encouraged to perform moderate-to-vigorous physical activity (PA) on their own. Pre- and post-intervention, all women underwent a CPET on a cycle ergometer with a respiratory gas analyzer. On the day of the CPET, maternal systolic and diastolic BP (mmHg) was measured at rest (before the CPET) and approximately 60min after the CPET using an electronic BP monitor. Identical CPET and BP measurement protocols were employed for both the HIIT and EDU groups at the pre- and post-intervention time points. Pre-intervention, the HIIT and EDU groups both showed a decrease in systolic and diastolic BP after the CPET, though only the change in systolic BP was statistically significant (HIIT group: p = 0.01; EDU group: p = 0.001). Post-intervention, there were no significant differences in either group between resting and post-CPET BP. There were significant post-intervention differences in VO2peak (p < 0.001) and HRmax (p = 0.002) between the HIIT and EDU groups. From pre- to post-intervention, the EDU and HIIT groups both showed decreases in resting systolic or diastolic BP; there was a significant difference in systolic BP in the EDU group (p = 0.005) and a significant difference in diastolic BP in the HIIT group (p = 0.03). Both groups maintained normal BP values throughout the experiment. However, HIIT, in addition to maintaining normotension, improved cardiorespiratory fitness in pregnant women. It seems that both supervised HIIT and self-performed moderate-to-vigorous PA can be recommended as strategies to prevent BP disorders during pregnancy. More studies are needed to confirm our findings.Trial registration The full study protocol was registered in ClinicalTrials.gov (NCT05009433).

Factors Influencing the Development and Severity of Cognitive Decline in Patients with Chronic Heart Failure

Background and Objectives: Considering the increasing prevalence of chronic heart failure (CHF) and cognitive decline (CD) observed in recent decades and the complex interrelation between these two pathologies often encountered in the same patient, in this study, we aimed to highlight the connection between CHF, defined as recommended by the European Society of Cardiology guidelines, and CD, evaluated by employing five neuropsychological scales. Materials and Methods: Our study was conducted on 190 patients with very high cardiovascular risk profiles admitted between 5 September 2021 and 15 November 2023 in the Municipal Emergency Hospital Timisoara. Of these, 103 had CHF (group A) and 87 did not (group B). Results: Although similar concerning age, sex distribution, and risk factors (excepting lipid profile), patients from group A had lower Mini Mental State Evaluation (MMSE) and Montreal Cognitive Assessment (MoCA levels (p = 0.003, respectively, p = 0.017) scores, more reduced daily activity (p = 0.021), and more severe depression (p = 0.015) compared to group B. We documented statistically significant correlations between left-ventricular ejection fraction (LVEF) and the levels of N-terminal pro–B-type natriuretic peptide (NT-pro-BNP), as well as with the results of MMSE (r = 0.226, p = 0.002 and r = −0.275, p = 0.005, respectively), daily activity, and depression (p ˂ 0.001). Multi-logistic regression models indicated age, blood pressure values, decreased daily activity, and depression as risk factors for CD in patients with CHF. Conclusions: In patients with CHF, there is an increased propensity of CD, with a direct relationship between MMSE and LVEF levels and an indirect one between MMSE and NT-pro-BNP levels. The concomitance of depression and reduced activity levels are aggravating CD in these patients.

Abstract 4116486: Association of assessment of clinical congestion in patients with heart failure compared with assessment using bioimpedance and microwave spectroscopy

Background: Physicians have to find a balance between decongestion therapy and the risk of dehydration so non-invasive methods assessing congestion are of great importance. Purpose: The study aimed to compare the clinical assessment of congestion to bioimpedance and microwave spectroscopy. Methods: 27 hospitalized HF patients with congestion (40% females) (Congestion Group) and 59 HF patients without fluid overload (66% females) (NON-Congestion Group) were included. Clinical examination, chest x-ray, laboratory results, echocardiography, non-invasive body mass analysis (Tanita Pro), NT-poBNP, and selected modern biomarkers concentrations [GDF-15, galectin-3, FABP, copeptin, VEGF were performed. Additionally, we assessed pulmonary congestion using a proprietary sensor with a microwave spectroscopy method based on analyzing the dielectric properties of an object (patent applications P.442466). Results: There were no differences in body mass index, blood pressure values, left ventricular ejection fraction (LVEF), and echocardiographic parameters of diastolic left ventricular function between groups. In the Congestion Group, we observed significantly more patients in NYHA Class 3 and 4 (p&lt;0.001), lower values of fT3 (median 2.4 vs 2.7; p=0.02), higher a FIB-4 index (p=0.04), lower GFR MDRD (median 52.7 vs 66.7;p=0.04), higher concentrations of: NT-proBNP (pg/ml) (median 545 vs 101; p&lt;0.001), galectin-3 (ng/ml) (median 15.01 vs 11.35; p=0.01), GDF-15 (pg/ml) (median 2069.27 vs 734.64; p=0.01), FABP (pg/ml) (median 293.6 vs 101; p=0.008) compared to NON-Congestion Group, and a larger number of detected congestion in chest x-ray (p&lt;0.01) and more patients with limb edema (p= 0.0037). The patients with congestion also needed longer hospitalizations (p=0.008). Patients with congestion had lower total body water content in kg and intracellular water (ICW) (kg) (p=0.02 and p=0.01, respectively), and the higher extracellular water/total body water index (ECW/TBW) (p=0.001) assessed in bioimpedance and significantly higher Absorption Loss evaluated with the use of microwave spectroscopy (p=0.02). In a multiple logistic regression model, the factor that was independently associated with clinically diagnosed congestion was NT-proBNP &gt;1095 pg/ml (OR 111.6, 95% CI: 2.6-50.6; p=0.001) (Figure 1). Conclusions: Absorption Loss and ECW/TBW are valuable new diagnostic tools in diagnosing lung congestion in patients with heart failure.

Abstract 4136025: Establishing normal values for central systolic blood pressure and augmentation index in healthy young people

Background: The process of cardiovascular disease (CVD), a leading cause of death worldwide, commences in childhood. Increasing evidence indicates that early exposure to CVD risk factors in childhood is associated with impaired arterial distensibility and other vascular alterations, suggesting that vascular ageing biomarkers, that capture the deterioration in vascular structure and function, can be used to identify children at risk. However, the identification of early vascular alterations in the young is hampered by the lack of a recognized, vascular biomarker that can be used in clinical practice. The Youth Vascular Consortium, an international collaborative open resource has been established to answer these gaps by analysing different biomarkers, including central systolic blood pressure (cSBP) and augmentation index (AIx). These two non-invasive measures are related to CVD and end-organ damage, however, their assessment in clinical practice is limited by the lack of established normal values. Aims: We aimed to establish cSBP and AIx normal values in a young, healthy, international population. Methods: The Consortium collected data on 36,973 participants from 24 countries. We included 14,476 and 5,047 subjects respectively for the cSBP and AIx populations. Subjects were free of any CVD or cardiovascular risk factors. Data were collected from participants aged from 1 to 40 years. Normal values of cSBP and AIx were calculated as percentiles stratified by age and sex. Percentiles curves were generated using generalised additive models. Results: The cSBP percentile curves increase with the same trend for both males and females until age 13 years. Over this age, males experience greater cSBP than females. This is in contrast to AIx, which decreases with the same trend in both sexes until 15 years of age, after which females experience increased AIx. Conclusion: Normal values of cSBP and AIx in healthy young are now available according to age and sex with a wide geographical representation. Incorporating these values into clinical practice for young could facilitate their utilization as targets for the introduction and monitoring of interventions.

The efficacy and safety of ciprofol versus propofol in patients undergoing painless hysteroscopy: a randomized, double-blind, controlled trial.

Studies have reported that ciprofol has the advantage of reducing injection pain compared to propofol during gastroscopy, colonoscopy, and fiberoptic bronchoscopy. The effect of ciprofol on the injection pain in painless hysteroscopy needs to further explore. A double-blind randomized controlled trial (RCT) was designed, and patients were recruited from the First Central Hospital of Baoding from March 2024 to June 2024. The eligible participants were allocated into ciprofol group (ciprofol combined with alfentanil) and propofol group (propofol combined with alfentanil) at 1:1 ratio. The primary outcome was injection pain. The secondary outcomes included sedation success rate, anesthesia success rate, adverse events, patient satisfaction, and comparison of vital signs before and after administration. A total of 217 participants were included for analysis, with 109 participants in the ciprofol group and 108 participants in the propofol group. The injection pain rate of ciprofol group (18.35%) was significantly lower than the propofol group (40.74%). Both the ciprofol group and propofol group had 100% of the sedation success rate. The anesthesia success rate between the two groups was comparable (P > 0.05). The rate of adverse events was lower (27.52% vs. 45.37%) and patient satisfaction was higher (9.84 ± 0.45 vs. 9.65 ± 0.85) in the ciprofol group than the propofol group. In addition, values of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) in propofol group were significantly lower than those in ciprofol group at the time of cervical dilation and consciousness recovery. Ciprofol exhibits comparable efficacy to that of propofol, and is associated with less injection pain rate, fewer adverse events, higher patient satisfaction, and more stable hemodynamics when used for general anesthesia during the painless hysteroscopy. NCT06413862.

Abstract 4138663: Peak nocturnal home blood pressure as an early and strong novel risk factor for stroke: the practitioner-based nationwide J-HOP Nocturnal BP study

Background: Clinical implications of high peak nighttime home blood pressure (BP) are currently unknown. This analysis investigated the association between peak nighttime home systolic BP (SBP) and cardiovascular events in individuals with ≥1 cardiovascular risk factor. Methods: In the Japan Morning Surge-Home Blood Pressure (J-HOP) study, nighttime home BP was automatically measured three times every night for 14 days at baseline using a nighttime home BP monitoring device (HEM-5001, Omron Healthcare). Peak nighttime home SBP was defined as average of the highest three values over the 14-night measurement period. Occurrence of cardiovascular events (stroke, coronary artery disease, heart failure, aortic dissection) was determined over a mean 7.1 years’ follow-up. Results: This analysis included 2545 individuals (mean age 63.3±10.3 years, 49% male). After adjustment for covariates (including age, sex, and average office, morning, evening, and nighttime home SBP), stroke risk was significantly higher in individuals with peak nighttime home SBP in the highest (Q5, ≥149.0 mmHg) versus lowest quintile (Q1, &lt;119.3 mmHg) (hazard ratio [HR] 4.24, 95% confidence interval [CI] 1.07–16.77; p=0.039 overall and 8.92, 1.49–53.43; p=0.017 in the subgroup with ≥6 nighttime home SBP measurements). This increased stroke risk remained significant after controlling for day-by-day average real variability of nighttime BP. The average peak nighttime home SBP cut-off value for predicting an increased risk of incident stroke was 136 mmHg. Conclusions: We propose exaggerated peak nighttime home SBP determined from ≥6 measurements as a novel risk factor for stroke, independent of conventional office and home BP values.

Clinical Validation of a Custom Wearable Patch for Accurate and Comfortable Vital Sign Monitoring in Pediatric Patients

Background/Purpose: Measuring vital signs in pediatric patients requires special consideration and adaptation due to varying anatomy and wide age range. In addition, children's anxiety, uncooperativeness, and high activity levels further complicate measurements, necessitating devices and algorithms designed to minimize the inaccuracies and discomfort. In this work, the performance of a custom wearable patch mounted on the mid-sternum was validated in uncontrolled settings on a cohort including 84 pediatric patients. Methods: Three-minute-long electrocardiogram (ECG), seismocardiogram (SCG) and photoplethysmogram (PPG) signals were acquired using the custom patch. First, pre-processing and signal smoothing algorithms were employed to suppress the out-of-band and motion noise. Two different tasks were then studied: (i) Heart rate (HR) and respiration rate were derived from the ECG, PPG and SCG signals individually. During HR derivation from the SCG, a novel Teager-energy-based HR estimation algorithm was proposed. (ii) Clinical relevance of the SCG signals was shown through mapping the SCG characteristics to body mass index (BMI) and blood pressure values. Results: While the best HR estimation was achieved through the PPG-infrared signal with an absolute error of 2.22.1 bpm, the best respiration estimation was achieved with PPG-Red signal with an error of 2.62.2 breaths/min. On the other hand, regression models resulted in a minimum of 85% confidence interval, revealing that the SCG characteristics indeed have salient correlation with the BMI and blood pressure values. Conclusion: Overall, such a system can potentially be leveraged in clinical practices to achieve more comfortable and accurate measurements.

Combination of body mass index and body fat percentage in middle and late pregnancy to predict pregnancy outcomes in patients with gestational diabetes in Wenzhou, China: a single-centre retrospective cohort study

ObjectivesThe present study aimed to evaluate whether body mass index (BMI) and body fat percentage (BFP) could be used to predict pregnancy outcomes in patients with gestational diabetes mellitus (GDM).DesignRetrospective...

Predictors of progression of arterial hypertension in patients with type 2 diabetes

Abstract Background Arterial hypertension (aHT) is a common comorbidity in patients with type 2 diabetes (T2D). The aim of the present analysis was to determine which predictors are associated with the progression of aHT in participants with T2D. Methods We analyzed data from the sleep-disordered breathing (SDB) sub-study of the DIACORE study, a prospective cohort study of participants with T2D. Blood pressure values were determined at baseline and after a mean follow-up of 2.7 years in a standardized manner with three repeated measurements at rest. Arterial hypertension was defined as blood pressure ≥140/80 mm Hg. Progression of aHT was defined as systolic blood pressure ≥140 mm Hg at follow-up with a concomitant increase of at least 10 mm Hg. Results Of 1122 participants (41% female, age 66 ± 9 years, body mass index 30.7 ± 5.3 kg/m2), 925 had pre-existing aHT at baseline. At follow-up, 280 had aHT with additional progression. Multivariate regression analysis revealed that systolic blood pressure at baseline (odds ratio [95% confidence interval]: 0.984 [0.976;0.993]; p &lt; 0.001) and age (OR [95%CI]: 1.024 [1.002;1.047]; p = 0.015) were associated with progression of aHT, independently of known modulators. Neither SDB nor its treatment were associated with progression of aHT. Conclusion In participants with T2D, lower systolic blood pressure at baseline and age but not SDB were associated with progression of aHT.

Comparative Evaluation of Dexmedetomidine and Clonidine on Propofol Consumption, Haemodynamics and Postoperative Recovery in Laparoscopic Surgeries: A Prospective, Double-Blind, Placebo-Controlled, Randomised Study

Background and Aims: Laparoscopic surgery is associated with significant haemodynamic changes due to pneumoperitoneum formation. Various studies have demonstrated that α2 adrenergic agonists, such as clonidine and dexmedetomidine, prevent the haemodynamic response due to pneumoperitoneum during laparoscopic surgery. Methods: A total of 104 female patients undergoing laparoscopic hysterectomies were divided into three groups at random. Group D patients were administered a loading dose of 1 μg/kg of dexmedetomidine prior to induction over a period of 15 minutes and a maintenance dose of 0.5 μg/kg/h during the surgical procedure. Group CL patients were given a loading dose of 2 μg/kg of clonidine before induction over a period of 15 minutes and a maintenance dose of 1 μg/kg/h during the surgery. Group C received same volume of normal saline over same duration and maintenance infusion throughout the surgery. The primary outcome was the haemodynamic changes at different time interval. The secondary outcome was the response to verbal commands, extubation time and orientation time. Results: There was no significant difference in heart rate and blood pressure values between group D and group CL during whole study period. Whereas in group C, there was a statistically significant increase in heart rate and blood pressure after intubation and during pneumoperitoneum period ( P &lt; 0.05). Extubation time and orientation time were significantly delayed in group D and group CL when compared with group C and D ( P &lt; 0.05). Conclusion: Clonidine or dexmedetomidine effectively attenuates the haemodynamic changes in patients undergoing laparoscopic hysterectomies compared to the control group.

Systemic Immune Inflammatory Index as Predictor of Blood Pressure Variability in Newly Diagnosed Hypertensive Adults Aged 18–75

Background: Accumulating evidence from clinical trials, large registries, and meta-analyses of population studies shows that increased Blood Pressure Variability (BPV) is predictive of Cardiovascular (CV) outcomes, independently of the average Blood Pressure (BP) values. One of the mechanisms explaining the relationship between BPV and target organ damage is the inflammatory response. The Systemic Immune Inflammation Index (SII), which relies on peripheral blood cell counts, including platelets, neutrophils, and lymphocytes, has emerged as a predictor of prognosis and outcomes in various diseases. The aim of this study was to investigate the association of the SII with Ambulatory Blood Pressure Variability (ABPV) in newly diagnosed hypertensive patients. Methods: This study was designed as a cross-sectional observational study. A total of 1606 consecutive newly diagnosed Hypertension (HT) patients were included in the study. The population was evaluated across 3 different categories according to HT grades (5 groups), eligibility for antihypertensive therapy (2 groups) and ABPV levels (2 groups). Results: Significant differences were observed between ABPV groups in terms of Neutrophil to Lymphocyte ratio, Platelet to Lymphocyte ratio, glucose, SII, high-sensitive CRP, HT grade, Inter-Ventricular Septum, Posterior Wall thickness, and Left Ventricular Mass (p &lt; 0.005). There was a significant relationship between SII and ABPV (r: 0.619, p &lt; 0.05). At the cutoff value of 580.49, SII had 77% sensitivity and 71% specificity for ABPV &gt; 14 (AUC: 0.788). Conclusions: SII may assist in developing an early treatment approach to minimize complications in patients with high ABPV who are at a higher risk of CV events.

Oscillatory blood pressure values in newborn infants: observational data over gestational ages.

Normative blood pressure (BP) values on preterm infants exist but are based on small cohorts of infants. Utilizing electronic medical records (EMR), we can explore earlier gestational ages (GA) and follow their progression to 40 weeks corrected gestational age (CGA). A retrospective cohort study of infants within the SSM Health System from 7/01/2013 through 6/30/2023. Infants born at >22 0/7 weeks but < 41 weeks GA were included if any BP measurements existed (n=29,323 infants, 1.4 million BPs). Data was extracted electronically from EMR using Microsoft SQL. Systolic BP (SBP), mean arterial pressures (MAP), and Diastolic BP (DBP) were determined for each week of life from birth and percentile ranges (1st to 99th) for infants alive at CGA, and BP patterns for GA determined. Percentiles for SBP, DBP and MAP are provided. There is a rapid increase in BP at all gestations during the first two weeks, thus BP values are higher at any CGA in infants born at an earlier GA than infants born at that GA. For MAP values between the 5th and 10th percentile, the GA is appropriate for first week then use CGA + 5 mmHg. After the first week, 2.8 X CGA is between 90 and 95 percentile for SBP. . . The BP is dependent on the gestational age at birth and the corrected gestational age when it is measured. SBP, MAP, and DBP all increase rapidly in the two weeks of life prior to a gradual increase over time.

Cuff-less wearable biosensor in continuous noninvasive human radial artery pulse waveform and blood pressure measurement using self-mixing interferometry

In this paper, we propose a compact, wearable biosensor for the noninvasive measurement of human radial artery pulse waveform curve (PWC) and blood pressure (BP). In this system, self-mixing interferometry (SMI) technology is employed to measure the weak arterial vascular deformation, enabling accurate PWC retrieval. Based on the reconstructed PWC features, BP values are precisely estimated by means of deep learning method. Here continuous wavelet transform (CWT), enabling visualization of the relationship between the SMI signal temporal frequency components and the PWC characteristics, is highlighted for PWC flipping points seeking and convolutional neural network (CNN) input parameter acquisition. For the first time, a novel deep learning network preprocessing method is proposed that allows direct feature extraction from the CWT scalogram of SMI signal without the complicated PWC reconstruction algorithm. The robustness and accuracy of our device are validated by a series of clinical measurements, mean absolute error (MAE) and standard deviation (STD) values are calculated and compared with the existing models. We approach minimal BP estimation results (MAE ± STD) of 1.41 ± 1.89 mmHg for systolic blood pressure (SBP) and 1.78 ± 2.01 mmHg for diastolic blood pressure (DBP), respectively. The luxuriant novelties and remarkable performance clearly demonstrate our wearable sensor’s great potential in BP monitoring, and other clinical applications.

Blood pressure variability associated with falls in nursing home residents.

High variations in serially measured blood pressures (BPs) portend a variety of adverse clinical events including dementia, cardiovascular sequelae and frailty. In this study, systolic blood pressure variability (BPV) was examined for its association with fall frequency and time to next fall among older adults living in nursing homes. BP values and falls over time were extracted from medical records of nursing home residents aged ≥65 years over a 10-month period. BPV was measured as the standard deviation of 17 to 20 systolic values, and its correlation with falls and time to next fall were evaluated according to quartile values. One hundred patient charts were analyzed with nearly 2000 BP data points. All older adults had at least one fall incident. Higher BPV was related to more falls, shorter time between the first and second fall and fewer average days between falls. Subgroups of high BP and different diagnoses affected this association between BPV and falls. People who fall often show a high variability in BP; as the number of falls increases, the BPV also increases. This study suggests that BPV may be marker for patients who might benefit from more aggressive application of fall reduction strategies. Geriatr Gerontol Int 2024; ••: ••-••.

Echocardiographic Assessment in Patients with Vascular Ehlers-Danlos Syndrome: Insights from an Unexplored Field.

Vascular Ehlers-Danlos syndrome (vEDS) is an inherited connective tissue disorder characterized by arterial fragility. Celiprolol is a β1-adrenoceptor antagonist with partial β2 agonist activity that has been shown to reduce rates of vascular events in this setting, though the underlying mechanisms are not yet fully understood. Moreover, very few echocardiographic data are available in patients with vEDS. To perform a comprehensive echocardiographic assessment of a cohort of patients with vEDS with or without celiprolol therapy compared with healthy subjects. Twenty patients with genetically confirmed diagnosis of vEDS followed at our Institution (University Hospital of Brescia, Italy) were divided into two groups according to whether or not they were on celiprolol therapy at the maximum recommended dose (400mg daily) for at least 12 months. Both groups were compared to 10 healthy individuals matched for sex, age, body mass index (BMI), and office blood pressure (BP) values. Each participant underwent transthoracic echocardiography with tissue Doppler analysis (TDI) for a comprehensive evaluation of cardiac structure and function. Mean age was 35 years and mean BMI was 21.6 kg/m2. Female sex was prevalent (60%). Left ventricular (LV) internal diameter values tended to be lower in patients with untreated vEDS than in healthy controls (4.33 vs 4.74cm, respectively), though this difference was not statistically significant. Similar data were observed for LV mass index (56.9 vs 68.6 g/m2), stroke volume (56.6 vs 71.6 mL), and E/A ratio (1.26 vs 1.66), whereas an opposite trend was observed for e' lateral (13.2 vs 12.2cm/s). No statistically significant difference was found between groups in terms of other parameters of LV mass, systolic and diastolic function. A normal LV geometry was found in all the cases. Indices of mechano-energetic efficiency and ventricular-arterial coupling were also similar between groups. No patient presented with aortic root dilation, mitral valve prolapse, valve insufficiency of more than mild degree, or valve stenosis of any degree. Our study suggests that patients with vEDS have normal cardiac mass and geometry, as well as normal systolic and diastolic function. Celiprolol therapy does not seem to significantly influence such aspects. Compared with vascular imaging, less stringent follow-up with echocardiography seems reasonable in this setting. Future studies with prospective design should confirm these aspects.

Relationship between proxy behavior in clinic attendance and disease control among persons with hypertension and diabetes at a rural primary health center: A cohort analysis in South India

ABSTRACT Aims: Among persons with hypertension and diabetes on treatment for at least 1 year at the Rural Health Centre (RHC) noncommunicable disease (NCD) clinic, 1. To determine the control status for hypertension and diabetes. 2. To assess the relationship between proxy behavior for collection of medications and the control status. Settings and Design: Rural Health Centre, Ramanathapuram, Puducherry, India; record-based retrospective observational study. Methods and Material: The study employed a universal sampling of 396 eligible persons with diabetes and hypertension who had been on medication for over a year at the RHC NCD clinic and had recorded blood pressure and glucose values within the last 4 months. Case sheets of these patients were retrieved from the Medical Registration Department, and data from the past 12 months were collected and analyzed to assess proxy behaviors and absenteeism. Statistical Analysis Used: Data were entered from the case sheets in Epicollect5 and analyzed using Stata v17. Results: Among hypertensive patients, 48.01% were aged 60 and above, with 55.63% being female. Fifty-six percent of hypertensive patients had their condition controlled. For diabetic patients, 40.88% were aged 45–59 years, with 59.75% being female. Only 18.24% of diabetic patients had their condition controlled. The multivariable analysis examined factors associated with the control status of hypertension and diabetes. Those aged 30–44 (aRR: 1.47, 95% CI: 1.01–2.15) and 45–59 (aRR: 1.37, 95% CI: 1.03–1.82) had a higher risk of uncontrolled hypertension compared to those aged 60 and above. Gender did not show significant associations with hypertension control status. Regarding attendance status, patients who had both proxy and missed visits (RR: 1.46, 95% CI: 1.02–2.07) had a higher risk of uncontrolled hypertension. There was also a significant association with patients having more than three proxies (aRR: 1.51, 95% CI: 1.10–2.17) exhibiting a higher risk of uncontrolled hypertension. Absenteeism status showed that those absent for 1–3 visits had a higher relative risk (RR: 1.37, 95% CI: 1.03–1.82) of uncontrolled hypertension compared to those with no absenteeism. Conclusion: Proxy behavior affects the control status of persons with hypertension and diabetes. A longitudinal study is warranted to assess the relationship between proxy visits and control status.

Assessment of Metabolic Syndrome in Patients with Chronic Obstructive Pulmonary Disease: A 6-Month Follow-Up Study.

The association between chronic obstructive pulmonary disease (COPD) and metabolic syndrome (MetS) is a common one, with long-term therapeutic and prognostic impact. In view of the high pulmonary and cardiovascular morbidity and mortality, self-management contributes to decreasing the risk of an acute cardiac event or pulmonary decompensation. We conducted a prospective cohort study on 100 patients admitted to Iasi Clinical Rehabilitation Hospital who were divided into two groups according to the presence (67 patients) or absence (33 patients) of MetS. All patients benefited from multidisciplinary counseling sessions on their active role in improving modifiable cardiovascular risk factors and thus increasing quality of life. The aim of this study was to examine the impact of metabolic syndrome on lung function and the role of self-management in a 6-month follow-up period. The demographic, anthropometric, cardiovascular risk factors, and respiratory function were analyzed at baseline and at 6 months. The presence of MetS was associated with higher fasting blood glucose (p = 0.004) and triglycerides (p = 0.003) but not with higher levels of interleukins or TNF-alpha. At the 6-month follow-up, abdominal circumference, forced expiratory volume in one second (FEV1), dyspnea severity, and blood pressure values improved in male patients with COPD. Systolic and diastolic blood pressure decreased in the COPD group as a whole, but especially in male patients with and without associated MetS. BMI was positively correlated with FEV1 (r = 0.389, p = 0.001) and the FEV1/forced vital capacity (FVC) ratio (r = 0.508, p < 0.001) in all COPD patients and in the MetS subgroup. In the COPD group as a whole. the six-minute walk test (6MWT) results (m) were positively correlated with FEV1 and FVC. The correlation remained significant for FVC in COPD patients with and without MetS. An increase in BMI by one unit led to an increase in TG values by 3.358 mg/dL, and the presence of metabolic syndrome led to an increase in TG values by 17.433 mg/dL. In our study, MetS is a common comorbidity in patients with COPD and is associated with higher BMI, fasting glucose, and triglycerides but not with the inflammatory parameters. A mixed pulmonary-cardiovascular rehabilitation intervention leads to improvement in various parameters in both female and male COPD patients.