Changes In Blood Pressure Research Articles

The effect of aromatherapy during urodynamic testing on patients anxiety and cortisol levels: A randomized controlled trial.

During urodynamic testing (UT), patients may experience emotions such as embarrassment, discomfort, irritability, and tension, which can cause anxiety. Aromatherapy is a complementary and alternative treatment that may be employed in clinical settings to alleviate patients' anxiety before invasive procedures. The aim of this study was to determine the effect of aromatherapy on patients' anxiety and cortisol levels during UT. The sample of this single-center, prospective, two-armed, randomized controlled clinical study consisted of 98 patients undergoing UT. Patients were randomly assigned to the intervention group (n = 49) and the control group (n = 49). The anxiety level was assessed using the state-trait anxiety inventory (STAI), and measured with physiological responses to anxiety, such as changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), peripheral oxygen saturation (SpO2), and cortisol levels, pre and post-UT. Aromatherapy was applied to the intervention group starting 5 min before UT and continuing throughout the testing. The control group received routine treatment and care. Data were analyzed using Pearson's χ2, dependent samples t-tests, and independent samples t-tests. In the study, post-UT anxiety in the intervention group was significantly lower than in the control group (p < 0.001), while SpO2 was higher (p = 0.021). In the study group, post-UT anxiety (p < 0.001), HR (p = 0.000), and cortisol levels (p = 0.005) decreased compared to pre-UT, whereas in the control group, anxiety (p < 0.001) and HR (p = 0.000) decreased, and SBP (p = 0.010) and RR (p = 0.004) increased. Aromatherapy during UT positively influenced both the psychological and physiological responses to anxiety.

Milrinone in persistent pulmonary hypertension of newborn: a scoping review.

Persistent pulmonary hypertension of the newborn (PPHN) is a common neonatal condition in newborns admitted to the neonatal intensive care units (NICUs). PPHN has still a high mortality and morbidity. Inhaled nitric oxide (iNO) is the first line vasodilator therapy for PPHN in high income countries. In low-to-middle income countries (LMICs), availability of iNO remains scarce and expensive. The purpose of this scoping review was to evaluate the current existing literature for milrinone therapy in PPHN and to identify the knowledge gaps in milrinone use in infants with PPHN. The available evidence for milrinone remains limited both as monotherapy and as an adjuvant to iNO. The studies were heterogeneous, conducted in different settings, with different populations and more importantly the endpoints of these trials were short-term outcomes such as changes in oxygenation and blood pressure. Large prospective studies investigating long-term outcomes, mortality, and the need for Extracorporeal membrane oxygenation (ECMO) are warranted. Randomized controlled trials with milrinone as monotherapy are needed in LMICs where iNO availability remains limited. IMPACT: Milrinone has a potential role in the management of PPHN both as an adjuvant to iNO as well as a monotherapy. This scoping review identified the problems existing in the published literature on milrinone and the barriers to generalization of these results. Multi-centre randomized controlled trials on milrinone, especially involving centers from low- and middle-income countries are needed, where it can be evaluated as first-line pulmonary vasodilator therapy.

Revisiting resistant hypertension in kidney disease.

As compared to controlled or uncontrolled hypertension, resistant hypertension in patients with chronic kidney disease (CKD) poses a significantly increased healthcare burden due to greater target end-organ damage including cardiovascular disease and CKD progression. Patients with CKD have two to three times higher risk of developing resistant hypertension. True resistant hypertension needs to be distinguished from apparent treatment resistant hypertension (aTRH); however, it is usually not possible in epidemiological studies. Moreover, impact of contemporary guidelines changes in the target blood pressure (BP) goal to less than 130/80 mmHg remains to be determined. Up to half of patients with CKD meet aTRH criteria using 2017 ACC/AHA target BP less than 130/80 mmHg. Excess sodium retention in extracellular and tissue compartment remains the cornerstone cause of resistance to the treatment in CKD. Maximizing and optimizing the diuretic regimen in addition to dietary sodium restriction plays a critical role in these patients. Management requires a trustworthy provider-patient relationship facilitating identification and intervention for the barriers restricting the uptake of lifestyle modifications and medications. Recently, renal denervation has been approved and many other novel agents are on the horizon for treatment of true resistant hypertension associated with CKD. This review discusses the latest in the pathophysiology, definition, identification and treatment strategies of resistant hypertension in individuals with CKD. Further investigations are required to identify the prevalence, future implication and treatment outcome data for true resistant hypertension associated with CKD.

Posterior Reversible Encephalopathy Syndrome in Children and Adolescents.

Posterior reversible encephalopathy syndrome, or PRES, is a constellation of severe, acute hypertension and specific brain imaging findings. This may be caused by failure of the cerebral autoregulatory system to manage acute or severe changes in blood pressure. The incidence in children is unknown but estimated to be more common in children with predisposing factors including renal disease, autoimmune disease, malignancy, solid organ transplantation, stem cell transplantation, hypertension, sepsis, and exposure to certain medications. Management of PRES includes addressing hypertension, removing offending agents when possible, and anti-epileptic medications. Most children with PRES recover completely, but recurrence is possible. Lack of resolution of imaging findings likely portends a worse prognosis.

Associations between antiretroviral regimen and changes in blood pressure: results from the D2EFT study.

In this randomised, controlled study in 14 low- and middle-income countries, individuals taking dolutegravir with darunavir/ritonavir for 48 weeks had a greater increase in systolic and diastolic blood pressure than individuals taking two nucleoside reverse transcriptase with darunavir/ritonavir. The difference remained significant after controlling for confounding factors including weight gain.

Analysis of local anesthetics side effects and determination of ways for their minimization

According to the World Health Organization (WHO), the development of side effects of drugs is one of the serious medical problems.The relevance of this problem is proven by numerous statistical data obtained in different countries of the world. The aim of the study was to determine the assortment of local anesthetics (LAs) on the pharmaceutical market of Ukraine, to analyze the evidence base of the effectiveness and safety of modern LAs, to monitor the side effects (SEs) of LAs in Kharkiv and Kharkiv region for the period 2018–2021, and to provide recommendations for their minimization. The methods of passive pharmacovigilance, method of spontaneous reports, method of system approach and system analysis were used in the study. To analyze the clinical effectiveness and conditions of rational use of LAs, well-known data bases were used: Cochrane Library, Trip Database, and PubMed. These databases contain systematized primary or secondary information on a specific clinical issue: the effectiveness and safety of various medical technologies. The results of the analysis of the assortment of LAs on the pharmaceutical market of Ukraine showed that in 2023, based on 9 international non-patented names of LAs, 65 trade names were presented. Bupivacaine and procaine drugs (16 trade names each) and articaine drugs in combinations (13 trade names) are market leaders. The results of the analysis of notification cards with cases of SEs for 4 years revealed that the majority of them in the form of dizziness, weakness, changes in blood pressure, heart rate, edema, itching, hyperemia at the site of application were recorded when using lidocaine drugs, which are the most in demand and popular among doctors. According to the data of systematic reviews, the main directions for reducing the side effects of LAs have been established, such as administration under ultrasound control, the use of the least toxic modern anesthetics ropivacaine and levobupivacaine (not available on the Ukrainian market), the addition of substances with vasoconstrictive properties to the anesthetic solution, the use of combinations of long-acting and short-acting anesthetics. The results obtained can be used by practicing doctors and health care organizers to optimize LAs.

Real-World Clinical Experience of Oral Semaglutide in a Secondary Diabetes Clinic in the UK: A Retrospective Observational Study.

Oral semaglutide improves cardiovascular risk factors in people with type 2 diabetes (T2D) in clinical trials, though real-world evidence is limited. We aimed to determine the real-world impact of oral semaglutide on routinely collected clinical data in our practice. People with T2D initiated on oral semaglutide in secondary care diabetes clinics at two hospital sites in Wales (United Kingdom) were included. Data were collected on reasons for oral semaglutide initiation and changes in bodyweight, blood pressure, glycemic control, and lipid profiles over follow-up at 3-6months, and at 6-12months. Data were collected to determine the safety of oral semaglutide. Seventy-six patients were included, with a median age 59.3 [51.4-67.6] years, and 38 (50.0%) patients were female. The most common reasons for oral semaglutide were need for weight loss and improved glycemia (69.8%), and improved glycemia alone (25.0%). Oral semaglutide associated with significantly reduced bodyweight (- 3.3kg), body mass index (BMI) (-0.9kg/m2), glycated hemoglobin (HbA1c) (- 11mmol/mol), and total cholesterol (- 0.4mmol/l) by 3-6months follow-up. At 6-12months, there was a significant reduction in systolic blood pressure (- 7.0mmHg), in addition to sustained reductions in other metabolic parameters. By 12months, 18 (23.6%) patients had discontinued the drug, largely resulting from gastrointestinal disturbance, but there were no serious events in this cohort. Oral semaglutide was effective in improving cardiovascular risk factors in this real-world population living with T2D, and no serious events were identified related to oral semaglutide in this patient group.

Influence of Blood Pressure Reduction on Pulse Wave Velocity in Primary Hypertension: A Meta-Analysis and Comparison With an Acute Modulation of Transmural Pressure.

Increased arterial stiffness and pulse wave velocity (PWV) of the aorta and large arteries impose adverse hemodynamic effects on the heart and other organs. Antihypertensive treatment reduces PWV, but it is unknown whether this results from an unloading of stiffer elements in the arterial wall or is due to an alternate functional or structural change that might differ according to class of antihypertensive drug. We performed a systematic review and meta-analysis of the effects of different antihypertensive drug classes and duration of treatment on PWV with and without adjustment for change in mean arterial blood pressure (BP; study 1) and compared this to the change in PWV after an acute change in transmural pressure, simulating an acute change in BP (study 2). A total of 83 studies involving 6200 subjects were identified. For all drug classes combined, the reduction of PWV was 0.65 (95% CI, 0.46-0.83) m/s per 10 mm Hg reduction in mean arterial BP, a change similar to that induced by an acute change in transmural pressure in a group of hypertensive subjects. When adjusted for change in mean arterial BP, the reduction in PWV after treatment with beta-blockers or diuretics was less than that after treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists or calcium channel antagonists. Reduction in PWV after antihypertensive treatment is largely explained by the reduction in BP, but there are some BP-independent effects. These might increase over time and contribute to better outcomes over the long term, but this remains to be demonstrated in long-term clinical trials.

Effect of pharmacist‐led interventions on hypertension‐related knowledge, medication adherence, and blood pressure control: A multi‐center, randomized, controlled trial in Vietnam

AbstractIntroductionHypertension is the single most important leading cause of morbidity and mortality in the Vietnamese population and remains poorly controlled by the current conventional care model.ObjectivesTo evaluate whether pharmacist‐led interventions can improve hypertension knowledge, medication adherence, and blood pressure (BP) control in Vietnamese patients with hypertension.MethodsA multi‐center, randomized, controlled trial was conducted in three hospitals in Vietnam from October 2021 to May 2022. The educational interventions included direct counseling, printed material, and educational videos for smartphones. The primary outcome was hypertension knowledge assessed by the Hypertension Knowledge‐Level Scale (HK–LS). Secondary outcomes were medication adherence as assessed by the Morisky Green Levine Adherence Scale (MGL) and changes in systolic (SBP) and diastolic BP (DBP) at week 12.ResultsA total of 381 patients were included in the study, with 190 and 191 patients in the intervention and control groups, respectively. At week 12, patients in the intervention group had a significantly higher mean HK–LS than the control group (18.97 ± standard deviation [SD] 2.10 vs. 14.98 ± SD 3.55, respectively; p &lt; 0.001). Significantly higher medication adherence was observed in the intervention group than in the control group (MGL score of 3.76 ± 0.52 vs. 3.20 ± 0.87, respectively; p &lt; 0.001). Patients in the intervention group had a significant reduction in mean SBP/DBP (−6.15/−2.58 mmHg) compared with the control group (−0.98/−0.92 mmHg; p &lt; 0.001).ConclusionPharmacist‐led interventions resulted in a significant improvement in disease knowledge, medication adherence, and BP control in the Vietnamese context of practice and health system.

Systolic Blood Pressure, Diastolic Blood Pressure and Pulse Pressure and the Risk of Subclinical Myocardial Injury: The HUNT Study.

Subclinical myocardial injury expressed as higher cardiac troponin concentrations may represent an important intermediary between hypertension and the risk of cardiovascular disease. The study aimed to assess the relative strength of associations between systolic blood pressure (BP), diastolic BP, and pulse pressure, and subclinical myocardial injury, and how change in BP variables over time associates with subclinical myocardial injury. cTnl (cardiac troponin I) was measured in 32 968 participants of the fourth wave of the population-based cohort HUNT4 (Trøndelag Health Study) without a history of cardiovascular disease. An additional longitudinal analysis included participants from HUNT4 with BP measurements from HUNT3 (n=18 681). Associations between BP variables and cTnI concentrations were assessed by linear and logistic regression analyses. The median cTnI concentration was 1.6 ng/L (25th-75th percentiles, 0.6-3.1 ng/L), median age was 52 years (39.1-65.6 years), and 57% were female subjects. Cross-sectionally, only systolic BP categories ≥130 mm Hg associated with higher cTnI concentrations, compared with a reference systolic BP of <110 mm Hg. All categories of diastolic BP and pulse pressure were positively associated with higher cTnI concentrations when diastolic BP 70 to 79 mm Hg and pulse pressure <40 mm Hg were used as references, respectively. When comparing systolic BP, diastolic BP, and pulse pressure as continuous variables, cross-sectionally, pulse pressure most strongly associated with cTnI concentrations (P for all comparisons <0.001), whereas longitudinally, change in diastolic BP was most strongly associated with cTnI concentrations (P for all comparisons <0.05). Subjects with high pulse pressure and longitudinal increase in diastolic BP are at higher risk for subclinical myocardial injury.

The Effectiveness of Clinician-Led Community-Based Group Exercise Interventions on Health Outcomes in Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluated the combined effects of clinician-led and community-based group exercise interventions on a range of health outcomes in adults with type 2 diabetes mellitus. Our literature search spanned Medline, Scopus, PubMed, Embase, and CINAHL databases, focusing on peer-reviewed studies published between January 2003 and January 2023. We included studies involving participants aged 18 years and older and articles published in English, resulting in a dataset of eight studies with 938 participants. Spanning eight peer-reviewed studies with 938 participants, the analysis focused on the interventions’ impact on glycemic control, physical fitness, and anthropometric and hematological measurements. Outcomes related to physical fitness, assessed through the six-minute walk test, the 30 s sit-to-stand test, and the chair sit-and-reach test, were extracted from five studies, all of which reported improvements. Anthropometric outcomes from seven studies highlighted positive changes in waist circumference and diastolic blood pressure; however, measures such as body mass index, systolic blood pressure, weight, and resting heart rate did not exhibit significant changes. Hematological outcomes, reviewed in four studies, showed significant improvements in fasting blood glucose, triglycerides, and total cholesterol, with glycemic control evidenced by reductions in HbA1c levels, yet LDL and HDL cholesterol levels remained unaffected. Ten of the fifteen outcome measures assessed showed significant enhancement, indicating that the intervention strategies implemented may offer substantial health benefits for managing key type 2 diabetes mellitus-related health parameters. These findings in combination with further research, could inform the refinement of physical activity guidelines for individuals with type 2 diabetes mellitus, advocating for supervised group exercise in community settings.

Blood pressure changes during smoking cessation on dulaglutide and placebo treatment - a secondary analysis of the randomized, double-blind, placebo-controlled SKIP trial

Blood pressure changes during smoking cessation on dulaglutide and placebo treatment - a secondary analysis of the randomized, double-blind, placebo-controlled SKIP trial

Evaluation of the correlation between cerebral hemodynamics and blood pressure by comparative analysis of variation in cerebral blood flow in hypertensive versus normotensive individuals: A systematic review and meta-analysis.

Current understanding of the cerebral vascular response to variations in blood pressure (BP) among individuals with hypertension is limited. The aim of this meta-analysis was to determine the correlation between hypertension, risk of stroke, and cerebral blood flow (CBF). We reviewed studies published between 2000 and 2023 from PubMed, Google Scholar, and Science Direct that compared mean CBF in normotensive and hypertensive patients. A random effects model was used to construct the risk ratio (RR), 95% confidence interval (CI), forest plot, and inverse variance weighting. Additionally, a mixed-effects meta-regression was employed to examine the impact of study-specific patient variables. This meta-analysis included eight prospective cross-sectional studies published from 2002 to 2023. It revealed a significant average difference in the standard mean CBF of -0.45 (95% CI -0.60 to -0.30, I2 = 69%, P < 0.00001), distinguishing normotensive from hypertensive subjects. A RR of 0.90 (95% CI 0.63 to 1.30, I2 = 89%, P = 0.04) indicated a significant decrease in CBF among individuals with hypertension. We found a statistically significant relationship between changes in diastolic and systolic BPs and the mean CBF (R = -0.81, P = 0.001 and R = -0.90, P = 0.005, respectively). Our research demonstrates a strong relationship between elevated BP and reduced CBF, with hypertension reducing CBF compared to normotensive individuals, by increasing cerebrovascular resistance.

Hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers on the day of prone positioning spinal surgery in elderly patients

IntroductionThe hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers (ARBs) before surgery in elderly patients undergoing spinal surgery in a prone position during anesthesia induction to skin incision are still unknown.MethodsIn this prospective study, 80 patients undergoing spinal surgery in a prone position with general anesthesia, aged 60–79 years, American Society of Anesthesiologists (ASA) II or III, were enrolled. Patients who had ARBs only in their preoperative medication list were randomly divided into two groups at a 1:1 ratio: In Group A, ARBs were continued on the morning of surgery, while in Group B, they were withhold. Norepinephrine was infused to maintain the blood pressure at the baseline level of ±20% during anesthesia induction in all patients. The primary outcome was the consumption of norepinephrine in each group from anesthesia induction to skin incision. The secondary outcomes include changes in invasive arterial blood pressure and heart rate, the fluid infusion volumes, the amounts of anesthetic drugs, and the total time from induction to skin incision.ResultsThere were no significant differences in the demographics, the fluid infusion volumes, the amounts of anesthetic drugs, the total time from induction to skin incision, and hemodynamics at different time points (p &amp;gt; 0.05), while significant differences were found in norepinephrine consumption between the two groups (p &amp;lt; 0.001). Compared with Group B, the consumption of norepinephrine increased significantly in Group A (93.3 ± 29.8 vs. 124.1 ± 38.7 μg, p = 0.000). In addition, the same trend was illustrated in the pumping rate of norepinephrine between Group B (0.04 ± 0.01 μg·kg−1·min−1) and Group A (0.06 ± 0.02 μg·kg−1·min−1) (p = 0.004).ConclusionOur study conducted in elderly patients with hypotension undergoing prone spinal surgery demonstrated a greater pumping rate of norepinephrine during anesthesia induction in patients with ARBs continuing before surgery than those withholding, indicating that it was more difficult to maintain hemodynamic stability.Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=141081, ChiCTR2100053583.

Postural effects on blood pressure, intraocular pressure, and ocular perfusion pressure in patients with spinal cord injury

Background Reduced ocular perfusion pressure (OPP) from hypotension and consistent OPP variability due to blood pressure (BP) fluctuations are predisposing factors for glaucoma. Low resting BP and orthostatic hypotension (OH) in spinal cord injury (SCI) patients may increase the risk of glaucoma post-injury. This study investigated BP, intraocular pressure (IOP), and OPP changes between supine and sitting positions in SCI and normal individuals. Methods Twenty SCI cases (high paraplegia, T1–T6 n = 6; low paraplegia, T7–L3 n = 14) and matched controls (1:1) were included. Systolic and diastolic BP (SBP and DBP) were measured digitally, and IOP with rebound tonometry. Measurements were taken one minute apart in both positions. Mean arterial pressure (MAP) was calculated, and OPP was determined using position-specific formulas. Results No SCI subjects exhibited OH. Both groups experienced significant BP increment (P < 0.05) from supine to sitting. SBP increased by 4.4 ± 8.4 mmHg (SCI) and 3.6 ± 6.2 mmHg (normal), while DBP increased by 4.2 ± 5.1 mmHg (SCI) and 6.7 ± 5.5 mmHg (normal). IOP and OPP decreased significantly (P < 0.05) after postural change in both groups, yet differences between them were not significant. Analysis by injury level revealed lower parameter values in high paraplegia than in low paraplegia, with the latter group showing a more significant reduction in OPP after postural change. Conclusion Postural changes differently affect BP, IOP, and OPP in SCI compared to normal individuals, with variations based on the level of SCI. While not directly assessing glaucoma, the study offers insights into ocular hemodynamics in SCI compared to normals.

Safety and Efficacy of 2.5 mg and 1.25 mg Nebulized Salbutamol Compared with Placebo on Transient Tachypnea of the Newborns: A Triple-Blind Phase II/III Parallel Randomized Controlled Trial.

Background: To evaluate the safety and efficacy of 2.5 and 1.25 mg nebulized salbutamol on Transient Tachypnea of the Newborn (TTN) compared with placebo. Methods: We conducted a triple-blind, phase II/III parallel randomized controlled trial in two university-affiliated hospitals with neonatal intensive care units. Newborns with a confirmed diagnosis of TTN, with gestational age >35 weeks and gestational weight >2 kg were included. Cases of asphyxia, meconium aspiration syndrome, and persistent pulmonary hypertension were excluded. Ninety eligible patients were randomly allocated in three intervention groups (2.5 mg salbutamol, 1.25 mg salbutamol, and placebo), and a single-dose nebulized product was prescribed 6 hours after the birth. Safety outcomes included postintervention tachycardia, hyperglycemia, hypokalemia, and changes in blood pressure. To evaluate the efficacy, the duration of postintervention tachypnea, TTN clinical score, and clinical and paraclinical respiratory indices were assessed. Parents, Outcome assessors, and data analyzer were blind to the intervention. Results: There was no adverse reaction, including tachycardia, hypokalemia, and jitteriness. Both groups of salbutamol recipients showed significant improvement regarding respiratory rate, TTN clinical score, and oxygenation indices compared with the placebo (p-values <0.001). Nonstatistically significant higher hospital stay was observed in the placebo group. Single 2.5 mg salbutamol nebulization showed a little better outcome than the dose of 1.25 mg, although we could not find statistical superiority. Conclusion: The newly applied single high dose of 2.5 mg nebulized salbutamol is safe in treating TTN and leads to notable faster improvement of respiratory status without any considerable adverse reaction. Registry code: IRCT20190328043133N1.

Cortical blindness after percutaneous vertebroplasty: a case report and comprehensive review of the literature

ABSTRACT Objective Many complications but cortical blindness after percutaneous vertebroplasty has been rarely reported. Here, we describe a case who developed cortical blindness after percutaneous vertebroplasty. We also reviewed the literature to find the possible causes of this complication and its treatment. Methods Case report and literature review. Results A 71-year-old woman experienced cortical blindness after percutaneous vertebroplast. She developed dizziness, nausea, sweating, blood pressure changes, and vision loss during the procedure. MRI confirmed bilateral cerebral infarctions. The patient recovered with conservative treatment. Conclusions Percutaneous vertebroplasty, though helpful, carries a rare risk of cortical blindness. Surgeon awareness is crucial for informing patients of this potential complication.

Impact of seasonal blood pressure changes on visit-to-visit blood pressure variability and related cardiovascular outcomes.

Visit-to-visit blood pressure (BP) variability associates with an increased risk of cardiovascular events. We investigated the role of seasonal BP modifications on the magnitude of BP variability and its impact on cardiovascular risk. In 25 390 patients included in the ONTARGET and TRANSCEND trials, the on-treatment systolic (S) BP values obtained by five visits during the first two years of the trials were grouped according to the month in which they were obtained. SBP differences between winter and summer months were calculated for BP variability quintiles (Qs), as quantified by the coefficient of variation (CV) of on-treatment mean SBP from the five visits. The relationship of BP variability with the risk of cardiovascular events and mortality was assessed by the Cox regression model. SBP was approximately 4 mmHg lower in summer than in winter regardless of confounders. Winter/summer SBP differences contributed significantly to each SBP-CV quintile. Increase of SBP-CV from Q1 to Q5 was associated with a progressive increase in the adjusted hazard ratio (HR) of the primary endpoint of the trials, i.e. morbid and fatal cardiovascular events. This association was even stronger after removal of the effect of seasonality from the calculation of SBP-CV. A similar trend was observed for secondary endpoints. Winter/summer SBP differences significantly contribute to visit-to-visit BP variability. However, this contribution does not participate in the adverse prognostic significance of visit-to-visit BP variations, which seems to be more evident after removal of the BP effects of seasonality from visit-to-visit BP variations.

CiGNN: A Causality-Informed and Graph Neural Network Based Framework for Cuffless Continuous Blood Pressure Estimation.

Causalityholds profound potentials to dissipate confusion and improve accuracy in cuffless continuous blood pressure (BP) estimation, an area often neglected in current research. In this study, we propose a two-stage framework, CiGNN, that seamlessly integrates causality and graph neural network (GNN) for cuffless continuous BP estimation. The first stage concentrates on the generation of a causal graph between BP and wearable features from the the perspective of causal inference, so as to identify features that are causally related to BP variations. This stage is pivotal for the identification of novel causal features from the causal graph beyond pulse transit time (PTT). We found these causal features empower better tracking in BP changes compared to PTT. For the second stage, a spatio-temporal GNN (STGNN) is utilized to learn from the causal graph obtained from the first stage. The STGNN can exploit both the spatial information within the causal graph and temporal information from beat-by-beat cardiac signals for refined cuffless continuous BP estimation. We evaluated the proposed method with three datasets that include 305 subjects (102 hypertensive patients) with age ranging from 20-90 and BP at different levels, with the continuous Finapres BP as references. The mean absolute difference (MAD) for estimated systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 3.77 mmHg and 2.52 mmHg, respectively, which outperformed comparison methods. In all cases including subjects with different age groups, while doing various maneuvers that induces BP changes at different levels and with or without hypertension, the proposed CiGNN method demonstrates superior performance for cuffless continuous BP estimation. These findings suggest that the proposed CiGNN is a promising approach in elucidating the causal mechanisms of cuffless BP estimation and can substantially enhance the precision of BP measurement.

Impact of Shifting From Office Work to Telework on Workers' Physical Health: A Longitudinal Study.

The aim of the study is to clarify the longitudinal association between teleworking and physical health changes of Japanese workers before and during the COVID-19 pandemic. Participants were in a certain company who received mandatory health examinations in 2019 and 2020. In June 2020, the participants were asked about frequency of teleworking, which was introduced owing to the COVID-19. Whether physical health differed by the frequency of teleworking was analyzed. The participants were 3689 workers. Frequency of teleworking were associated with more deleterious changes in diastolic blood pressure, antilipidemic drug use, low-density lipoprotein (LDL) cholesterol, Glutamic Oxaloacetic Transaminase(GOT), Glutamic Pyruvic Transaminase(GPT), metabolic syndrome, and insufficient walking time among men. In contrast, no significant changes were observed in women. Male workers who teleworked more frequently were more likely to experience a deterioration in their physical health within 1-year compared with those who worked at the office.