Classification Of Hypertension Research Articles

The Incidence of Hypertension of Posbindu PTM Participants

Non-communicable diseases cannot be transmitted to others, but their development occurs slowly over a long period of time. One of the non-communicable diseases that is a priority in global health today is hypertension. Hypertension often causes complications such as stroke, heart disease, and kidney failure. The aim is to describe the incidence of hypertension in Posbindu PTM Bumiroso participants. The quantitative descriptive method using the total sampling technique obtained 38 respondents. The data was analyzed descriptively to describe the results of the respondents' blood pressure examinations. The results of the study based on the classification of hypertension, participants who experienced pre-hypertension and hypertension level 1 were 12 (31.58%), hypertension level 2 was 9 (23.68%) and normal was 5 (12.16%). The conclusion is that more than half of Posbindu PTM participants experience hypertension, as a suggestion, they can carry out routine checks at the nearest health facility.

Clinical Impact of 3- versus 5-Minute Delay and 30- versus 60-Second Intervals on Unattended Automated Office Blood Pressure Measurements.

Guidelines advise automated office blood pressure (AOBP) with an initial 5-minute delay and multiple measurements at least 60 seconds apart. Recent studies suggest that AOBP may be accurate with shorter delays or intervals, but evidence in clinical settings is limited. Patients referred to one hypertension (HTN) center underwent 24-hour ambulatory blood pressure monitoring (ABPM) and one of four non-randomized, unattended AOBP protocols: a 3- or 5-minute delay with a 30 or 60-second interval, i.e., 3min/30sec/30sec, 3/60/60, 5/30/30 and 5/60/60 protocols. HTN was defined as systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg. We compared differences in mean blood pressure and HTN classification between average AOBP and awake-time ABPM by t-tests and Fisher's exact test. Among 212 participants (mean 58.9 years, 61% women, 25% Black), there was substantial overlap in the probability distributions of awake-time ABPM and each of the three AOBP measures. Systolic blood pressure means were similar between the 5/60/60 and 3/30/30 protocols and 5/30/30 and 3/60/60 protocols. The 5/30/30 was associated with a higher proportion of systolic HTN, while the 3/60/60 protocol was associated with a higher proportion of diastolic HTN. There were no significant differences in systolic or diastolic HTN between 5/60/60 and 3/30/30 protocols with respect to awake-time ABPM. In this quality improvement study, the shortest AOBP protocol did not differ significantly from the longest protocol. The time savings of shorter protocols may improve AOBP adoption in clinical practice without meaningfully compromising accuracy.

Development of metabolic syndrome in people with Cystic Fibrosis one year after exposure to elexacaftor-tezacaftor-ivacaftor

BackgroundThe constellation of hypertension, truncal obesity, impaired fasting glucose, low high-density lipoprotein, and hypertriglyceridemia is known as metabolic syndrome (MetSyn) and is associated with cardiovascular and other diseases. Elexacaftor-tezacaftor-ivacaftor (ETI) in people with cystic fibrosis (pwCF) is associated with weight gain but effects on cardiovascular risk are unknown. This study sought to investigate ETI exposure and risk for development of MetSyn in pwCF. MethodsA prospective cohort study including pwCF ≥ 18 years old exposed to ETI was performed. All data for calculating MetSyn was collected from the electronic medical record at initiation and 1 year ± 3 months after starting ETI. A total of 152 pwCF exposed to ETI and 34 pwCF never exposed to CF transmembrane conductance regulator modulators were included in the analysis. Changes to hypertension classification was also examined over this period. ResultsAfter 1 year of ETI there was an increase in MetSyn from 13 to 30 pwCF, p < 0.0001. No new cases of MetSyn were seen in the group not exposed to ETI. After 1 year of ETI, more people met criteria for class 1 (BP 130–139/90–99 mm Hg) or class 2 hypertension (BP ≥140/≥90 mm Hg) regardless of prior modulator exposure, p < 0.0001. ConclusionsExposure to ETI for 1 year resulted in an increased number of cases of MetSyn. There was an increased incidence of hypertension associated with ETI exposure. Additional studies are needed to further examine this trend and to determine if these changes will translate to cardiovascular complications over time.

Blood Pressure and Heart Rate Measurement for Hypertension Classification Using the K-Nearest Neighbors Method Based on IoT

This research aims to develop a hypertension classification system based on measuring blood pressure and heart rate using the K-Nearest Neighbor (KNN) method and storing data on the Thingspeak cloud server. Hypertension is a major health problem that requires regular monitoring for effective prevention and management. This research created a tool that can measure blood pressure and heart rate using the KNN method as a classification. The data was collected using a sensor device integrated with Thingspeak for real-time data storage and analysis. The KNN method is used to classify measurement data into optimal, normal, prehypertension, grade 1 hypertension, and grade 2 hypertension categories. The implementation of data storage on the Thingspeak cloud server allows easy data access and efficient analysis, and supports continuous health monitoring. In conclusion, the system developed can be an effective tool in monitoring and classifying hypertension, and has the potential to be applied on a wider scale for public health management.

To Investigate the Prevalence of White Coat Hypertension in Community Dwelling Older Adults Referred for a Falls Assessment

Abstract Background Falls and frailty are the main focus in our integrated care programme for older persons (ICPOP). Office blood pressure (OBP) measurements are commonly used in practice although out of office recordings are proven to be a better predictor of cardiovascular risk (Myers et al, 2018). The European Society of Cardiology guidelines (ESC, 2018) have proposed BP values for the classification of hypertension (HTN). Methods We retrospectively completed a chart review on older adults’ who attended ICPOP with a referral for a falls assessment from November 2021 to April 2024. OBP were obtained after the patient was in the hub for approximately one hour following their comprehensive geriatric assessment (CGA). The OBP was documented following a supine period of 5 minutes. We compared the OBP and ambulatory blood pressure monitor (ABPm) average readings to assess the prevalence of HTN based on the ESC guidelines. Results 75 charts were reviewed. 3 ABPm recordings were unsuccessful due to cognitive impairment or not tolerating the ABPm. These were excluded from the audit. No patient had hypotension on either their OBP or ABPm recordings. On their OBP recordings, 29/72 (40%) had a normal reading while 43/72 (60%) had HTN. On their ABPm 54/72 (75%) had a normal reading while 18/72 (25%) had HTN. When we looked at antihypertensive medication use in those who had a normal reading on their ABPm, 47/54 (87%) were on antihypertensive treatment. All patients with HTN on their ABPM were on antihypertensive treatment. Conclusion Our findings suggest that OBP readings greatly increase the numbers of patients diagnosed with HTN compared to ABPm (60% versus 25%). Therefore, we suggest that all patients should have an ABPm as a gold standard to falls assessment to avoid over-treating white coat HTN.

Phenotypes in pulmonary hypertension.

The clinical classification of pulmonary hypertension (PH) has guided diagnosis and treatment of patients with PH for several decades. Discoveries relating to underlying mechanisms, pathobiology and responses to treatments for PH have informed the evolution in this clinical classification to describe the heterogeneity in PH phenotypes. In more recent years, advances in imaging, computational science and multi-omic approaches have yielded new insights into potential phenotypes and sub-phenotypes within the existing clinical classification. Identification of novel phenotypes in pulmonary arterial hypertension (PAH) with unique molecular profiles, for example, could lead to new precision therapies. Recent phenotyping studies have also identified groups of patients with PAH that more closely resemble patients with left heart disease (group 2 PH) and lung disease (group 3 PH), which has important prognostic and therapeutic implications. Within group 2 and group 3 PH, novel phenotypes have emerged that reflect a persistent and severe pulmonary vasculopathy that is associated with worse prognosis but still distinct from PAH. In group 4 PH (chronic thromboembolic pulmonary disease) and sarcoidosis (group 5 PH), the current approach to patient phenotyping integrates clinical, haemodynamic and imaging characteristics to guide treatment but applications of multi-omic approaches to sub-phenotyping in these areas are sparse. The next iterations of the PH clinical classification are likely to reflect several emerging PH phenotypes and improve the next generation of prognostication tools and clinical trial design, and improve treatment selection in clinical practice.

Definition, classification and diagnosis of pulmonary hypertension.

Pulmonary hypertension (PH) is a haemodynamic condition characterised by elevation of mean pulmonary arterial pressure (mPAP) >20 mmHg, assessed by right heart catheterisation. Pulmonary arterial wedge pressure (PAWP) and pulmonary vascular resistance (PVR) distinguish pre-capillary PH (PAWP ≤15 mmHg, PVR >2 Wood Units (WU)), isolated post-capillary PH (PAWP >15 mmHg, PVR ≤2 WU) and combined post- and pre-capillary PH (PAWP >15 mmHg, PVR >2 WU). Exercise PH is a haemodynamic condition describing a normal mPAP at rest with an abnormal increase of mPAP during exercise, defined as a mPAP/cardiac output slope >3 mmHg/L/min between rest and exercise. The core structure of the clinical classification of PH has been retained, including the five major groups. However, some changes are presented herewith, such as the re-introduction of "long-term responders to calcium channel blockers" as a subgroup of idiopathic pulmonary arterial hypertension, the addition of subgroups in group 2 PH and the differentiation of group 3 PH subgroups based on pulmonary diseases instead of functional abnormalities. Mitomycin-C and carfilzomib have been added to the list of drugs with "definite association" with PAH. For diagnosis of PH, we propose a stepwise approach with the main aim of discerning those patients who need to be referred to a PH centre and who should undergo invasive haemodynamic assessment. In case of high probability of severe pulmonary vascular disease, especially if there are signs of right heart failure, a fast-track referral to a PH centre is recommended at any point during the clinical workup.

Prediction of hypertension risk based on multiple feature fusion

ObjectiveIn the application of machine learning to the prediction of hypertension, many factors have seriously affected the classification accuracy and generalization performance. We propose a pulse wave classification model based on multi-feature fusion for accuracy prediction of hypertension. Methods and MaterialsWe propose an ensemble under-sampling model with dynamic weights to decrease the influence of class imbalance on classification, further to automatically classify of hypertension on inquiry diagnosis. We also build a deep learning model based on hybrid attention mechanism, which transforms pulse waves to feature maps for extraction of in-depth features, so as to automatically classify hypertension on pulse diagnosis. We build the multi-feature fusion model based on dynamic Dempster/Shafer (DS) theory combining inquiry diagnosis and pulse diagnosis to enhance fault tolerance of prediction for multiple classifiers. In addition, this study calculates feature importance ranking of scale features on inquiry diagnosis and temporal and frequency-domain features on pulse diagnosis. ResultsThe accuracy, sensitivity, specificity, F1-score and G-mean after 5-fold cross-validation were 94.08%, 93.43%, 96.86%, 93.45% and 95.12%, respectively, based on the hypertensive samples of 409 cases from Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine and Hospital of Integrated Traditional Chinese and Western Medicine. We find the key factors influencing hypertensive classification accuracy, so as to assist in the prevention and clinical diagnosis of hypertension. ConclusionCompared with the state-of-the-art models, the multi-feature fusion model effectively utilizes the patients’ correlated multimodal features, and has higher classification accuracy and generalization performance.

Sarcoidosis-associated pulmonary hypertension due to pulmonary arteries stenosis – a case report

BackgroundSarcoidosis-associated pulmonary hypertension (SAPH) is listed in Group 5 of the clinical classification of pulmonary hypertension, due to its complex and multifactorial pathophysiology. The most common cause of SAPH development is advanced lung fibrosis with the associated destruction of the vascular bed, and/or alveolar hypoxia. However, a substantial proportion of SAPH patients (up to 30%) do not have significant fibrosis on chest imaging. In such cases, the development of pulmonary hypertension may be due to the lesions directly affecting the pulmonary vasculature, such as granulomatous angiitis, pulmonary veno-occlusive disease, chronic thromboembolism or external compression of vessels by enlarged lymph nodes. Based on the case of a 69-year-old female who developed SAPH due to pulmonary arteries stenosis, diagnostic difficulties and therapeutic management are discussed.Case presentationThe patient, non-smoking female, diagnosed with stage II sarcoidosis twelve years earlier, presented with progressive dyspnoea on exertion, dry cough, minor haemoptysis and increasing oedema of the lower limbs. Computed tomography pulmonary angiography (CTPA) showed complete occlusion of the right upper lobe artery and narrowing of the left lower lobe artery, with post-stenotic dilatation of the arteries of the basal segments. The vascular pathology was caused by adjacent, enlarged lymph nodes with calcifications and fibrotic tissue surrounding the vessels. Pulmonary artery thrombi were not found. The patient was treated with systemic corticosteroid therapy and subsequently with balloon pulmonary angioplasty. Partial improvement in clinical status and hemodynamic parameters has been achieved.ConclusionsAn appropriate screening strategy is required for early detection of pulmonary hypertension in sarcoidosis patients. Once SAPH diagnosis is confirmed, it is crucial to determine the appropriate phenotype of pulmonary hypertension and provide the most effective treatment plan. Although determining SAPH phenotype is challenging, one should remember about the possibility of pulmonary arteries occlusion.

Hyperosmolar therapy response in traumatic brain injury: Explainable artificial intelligence based long-term time series forecasting approach

In the neurological intensive care setting implementing tier-based therapy, osmotic therapy serves as an intermediate approach for reducing intracranial pressure (ICP). However, discussions regarding quantitative and specific criteria for the maintenance and transition of treatment remain limited. This study proposes an explainable neural network forecasting of physiological responses after osmotic therapy administration for the purpose of treatment guidance. Recordings of arterial blood pressure and intracranial pressure were obtained from 107 patients with traumatic brain injury. To maintain adequate intracranial pressure, arterial blood pressure, and cerebral perfusion pressure, 20 % mannitol (100 ml; no. infusion, 3,571) and 11.3 % hypertonic saline (40 ml; no. infusion, 574) were administered. The LTSF-NLinear model was used to predict the target signal response for the subsequent 1 h. Six prediction models were derived by combining two agents (mannitol or hypertonic saline) and three target signals (mean arterial blood pressure, mean intracranial pressure and cerebral perfusion pressure). To validate the model’s robustness while considering patient heterogeneity, group (5)-fold cross-validation was implemented. To assess the predictive ability of the proposed model for adverse clinical events, binary classification of hypotension, intracranial hypertension, and cerebral hypoperfusion was performed. The overall function of the model was elucidated using linear weight visualization. Additionally, the DeepSHAP application allows for a detailed investigation of the prediction process for a single case. The relationship between response to osmotic therapy and patient outcomes was statistically significant. The proposed models achieved reasonable performance, with R2 score > 0.8 for physiological signal predictions and accuracy > 0.9 for event predictions. Through global explanation, the recent values of mean arterial blood pressure, mean intracranial pressure, and cerebral perfusion pressure of input signals significantly influenced physiological responses after osmotic treatment. In the context of local explanation (a single case), it was possible to determine how physiological state influenced the response. The proposed model is expected to provide objective and quantitative information on osmotherapy in neurological intensive care environments, enabling guidance for alternative and aggressive treatments. Thus, it can potentially aid in enhancing the prognosis of patients with traumatic brain injury and improving the clinical workflow. Moreover, the global and local explanations of the proposed model can provide valuable insights for future researchers.

Analysis of Related Factors Influencing Hypertension Classification among Centenarians in Hainan, China.

As a population ages, blood pressure levels gradually increase, leading to a higher incidence of hypertension and increased cardiovascular diseases risk. This study examines factors affecting hypertension grading among centenarians in the Hainan Province. Data from 2014 to 2016 were accessed from the cross-sectional database "Hypertension Levels and Epidemiological Characteristics of the Elderly and Centenarians in Hainan province of China". This study included 690 centenarians with hypertension. Hypertension grading was the dependent variable, analyzed against independent variables including demographic information (sex, age, ethnicity, education level, marital status, cohabitation, and regional distribution), lifestyle factors (smoking, alcohol consumption, and physical activity), body mass index (BMI), and comorbid conditions (diabetes and hyperlipidemia). Logistic regression models, adjusted for these factors, were used to assess the determinants of hypertension grading among the participants. Multivariate regression analysis, after adjusting for other variables, revealed significant associations between BMI, low-density lipoprotein (LDL) levels, and hypertension grades. Individuals with BMI below 18.5 had a 0.614-fold lower risk of developing grade III hypertension (odds ratio [OR]: 0.614, 95% confidence interval [CI]: 0.390-0.966, p = 0.0350) and a 0.586-fold lower risk for grade II hypertension (OR: 0.586, 95% CI: 0.402-0.852, p = 0.0052). Furthermore, individuals with elevated LDL levels had a 6.087-fold greater risk of progressing from grade I to grade III hypertension (OR: 6.087, 95% CI: 1.635-22.660, p = 0.0071) and a 4.356-fold greater risk of progressing from grade II to grade III hypertension (OR: 4.356, 95% CI: 1.052-18.033, p = 0.0423). Additionally, individuals of Li ethnicity had 1.823-fold greater risk of progressing from grade I to grade II hypertension compared to those of Han ethnicity (OR: 1.823, 95% CI: 1.033-3.218, p = 0.0383). A BMI below 18.5 , elevated LDL, and ethnicity emerged the primary factors associated with hypertension grading in centenarians. To reduce the risk of hypertension, it is crucial for centenarians to maintain a healthy weight, normal LDL levels, and adopt dietary habits including a low-cholesterol and low-fat diet.

Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa

BackgroundHypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes.MethodsWe conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120–129 and dBP < 80), stage 1 hypertension (sBP 130–139 or dBP 80–89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group.ResultsFrom May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes.ConclusionThe ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension.

RETRACTION NOTICE: Statistical methods for the classification and risks for arterial hypertension

Retraction note: Cortez Gutiérrez, H. O., Cortez Gutiérrez, M. M., Durand Gonzales, C. A. &amp; Espinoza Flores, B. P. (2022). Statistical methods for the classification and risks for arterial hypertension. TECHNO REVIEW. International Technology, Science and Society Review Revista Internacional De Tecnología, Ciencia Y Sociedad, 12(2), 1–11. https://doi.org/10.37467/revtechno.v11.4399 The Editorial Office of Eurasia Academic Publishing Group has retracted this article. An investigation carried out by our Research Integrity Department has found a group of articles, among which this one is found, that are not within the thematic scope of the journal. We believe that the editorial process was manipulated and, furthermore, acceptance decisions were made under possibly inappropriate peer review.

#395 Gut dysbiosis in ADPKD patients: a controlled pilot study

Abstract Background and Aims Gut dysbiosis has been associated with chronic kidney disease (CKD) and nephrolithiasis and may thus be a factor explaining variability of outcome in autosomal dominant polycystic kidney disease (ADPKD). However, beside a single pilot study the gut microbiome has not been studied in ADPKD. Due to the implications of microbiota in inflammation and crystal formation, we hypothesized that gut dysbiosis could also negatively affect PKD. For this reason, we aimed to characterize the intestinal microbiome in a controlled pilot study of PKD patients and explore the potential impact of dysbiosis on PKD disease progression. Method This study was designed as an observational, cross-sectional controlled pilot study. 25 ADPKD patients were recruited from the AD(H)PKD patient cohort. 12 healthy control subjects were age- and sex matched. Patients with chronic bowel disease were excluded. Serum parameters including eGFR were analyzed around the timepoint of stool collection. The gut microbiome was analyzed by 16S rRNA gene profiling of stool samples. The sequencing data was processed using the DADA2 pipeline and QIIME version 2. Differentially abundant features were identified using linear discriminant analysis (LDA) effect size (LEfSe) analysis. Bacteria-derived serum uremic toxins (total and free Trimethylaminoxid, Indoxylsulfate, p-Cresyl-Sulfate) were measured using liquid chromatography coupled to tandem mass spectrometry (LC- MS/MS). Microbiome data was then correlated with age, kidney function, and markers of PKD disease progression like Mayo classification and early onset of arterial hypertension or urologic complications (&amp;lt;35 years of age). Results Healthy control subjects revealed a significantly higher abundance Actinobacteria (LEfSe LDA score = 3.9, p = 0.025) including probiotic Bifidobacteriaceae (LEfSe LDA score = 3.9, p = 0.021). ADPKD patients displayed a significantly increased abundance of potentially dysbiotic Enterobacteriaceae (LEfSe LDA score = 3.6, p = 0.009). Those findings were independent of kidney function. Most notably, the abundance of Streptococcaceae were significantly overrepresented in PKD patients with Mayo Classes 1D and 1E compared to 1A-1C (p = 0.011). Additionally, early onset of hypertension (&amp;lt; 35 years of age) was associated with an increased abundance of potentially dysbiotic Proteobacteria and a decreased abundance of potentially probiotic Tannerelleaceae. Furthermore, ADPKD patients revealed increased abundance of Peptococcaceae with increasing age and declining kidney function. Finally, serum uremic toxins were significantly increased in ADPKD patients and highly correlated with eGFR. Serum uremic toxins revealed a tendency of positive correlation with the abundance of Peptococcaceae which did not reach statistical significance. Conclusion This controlled pilot study confirms alterations of specific OTUs in PKD patients showing an increase of Enterobacteriaceae and decrease of probiotic Bifidobacteriaceae upon PKD. This suggests a potential shift towards gut dysbiosis. Most notably, the abundance of specific OTUs were observed to be associated with markers of rapid disease progression like Mayo classification 1D and 1E, as well as early onset of arterial hypertension. This suggests for the first time, that gut dysbiosis could affect PKD disease progression. However, it still remains unknown whether gut dysbiosis is caused by ADPKD itself or is a consequence of secondary circumstances such as antibiotic treatment which is common in ADPKD due to frequent urinary tract or cyst infections. Thus, further investigation in larger cohorts is warranted to elucidate the impact of gut microbiota on ADPKD.

Investigating the Sources of Variability in Blood Pressure Monitoring Systems

Accurate and reliable blood pressure measurement is critical for diagnosing and managing hypertension properly. Based on a consensus document announced in the Journal of Hypertension, this is so much so that a 5.0 mm Hg BP measurement error can result in incorrect hypertension classification in 84 million individuals worldwide. Understanding how BP measurement goes wrong and how to tackle them can improve the diagnosis and management of hypertension. Unfortunately, BP measurement is problematically performed in clinical practice, accumulating errors that inappropriately alter management decisions in 20% to 45% of cases. In this study, the sources of variability from the aspects of the blood pressure monitoring system were attempted to be scrutinized. The variability increases with additive properties such as pressure gauge inaccuracy, cuff tightness, and cloth over-measurement. An artificial plastic arm was created to measure the pressure with multiple monitors. The study concluded that each monitor had its inherent characteristics in increasing monitor pressures concerning the actual pressure, and further, the increases in cuff loosening distance and the cloth-over layers might cause more significant variability, as hypothesized in this study. The study could more clearly verify the reason for blood pressure measurement variability.

Using Machine Learning to Evaluate the Value of Genetic Liabilities in the Classification of Hypertension within the UK Biobank.

Background and Objective: Hypertension increases the risk of cardiovascular diseases (CVD) such as stroke, heart attack, heart failure, and kidney disease, contributing to global disease burden and premature mortality. Previous studies have utilized statistical and machine learning techniques to develop hypertension prediction models. Only a few have included genetic liabilities and evaluated their predictive values. This study aimed to develop an effective hypertension classification model and investigate the potential influence of genetic liability for multiple risk factors linked to CVD on hypertension risk using the random forest and the neural network. Materials and Methods: The study involved 244,718 European participants, who were divided into training and testing sets. Genetic liabilities were constructed using genetic variants associated with CVD risk factors obtained from genome-wide association studies (GWAS). Various combinations of machine learning models before and after feature selection were tested to develop the best classification model. The models were evaluated using area under the curve (AUC), calibration, and net reclassification improvement in the testing set. Results: The models without genetic liabilities achieved AUCs of 0.70 and 0.72 using the random forest and the neural network methods, respectively. Adding genetic liabilities improved the AUC for the random forest but not for the neural network. The best classification model was achieved when feature selection and classification were performed using random forest (AUC = 0.71, Spiegelhalter z score = 0.10, p-value = 0.92, calibration slope = 0.99). This model included genetic liabilities for total cholesterol and low-density lipoprotein (LDL). Conclusions: The study highlighted that incorporating genetic liabilities for lipids in a machine learning model may provide incremental value for hypertension classification beyond baseline characteristics.

Predicting mixed venous oxygen saturation (SvO2) impairment in COPD patients using clinical-CT radiomics data: A preliminary study.

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic airway diseases in the world. To predict the degree of mixed venous oxygen saturation (SvO2) impairment in patients with COPD by modeling using clinical-CT radiomics data and to provide reference for clinical decision-making. A total of 236 patients with COPD diagnosed by CT and clinical data at Xiangyang No. 1 People's Hospital (n= 157) and Xiangyang Central Hospital (n= 79) from June 2018 to September 2021 were retrospectively analyzed. The patients were divided into group A (SvO⩾2 62%, N= 107) and group B (SvO<2 62%, N= 129). We set up training set and test set at a ratio of 7/3 and time cutoff spot; In training set, Logistic regression was conducted to analyze the differences in general data (e.g. height, weight, systolic blood pressure), laboratory indicators (e.g. arterial oxygen saturation and pulmonary artery systolic pressure), and CT radiomics (radscore generated using chest CT texture parameters from 3D slicer software and LASSO regression) between these two groups. Further the risk factors screened by the above method were used to establish models for predicting the degree of hypoxia in COPD, conduct verification in test set and create a nomogram. Univariate analysis demonstrated that age, smoking history, drinking history, systemic systolic pressure, digestive symptoms, right ventricular diameter (RV), mean systolic pulmonary artery pressure (sPAP), cardiac index (CI), pulmonary vascular resistance (PVR), 6-min walking distance (6MWD), WHO functional classification of pulmonary hypertension (WHOPHFC), the ratio of forced expiratory volume in the first second to the forced vital capacity (FEV1%), and radscore in group B were all significantly different from those in group A (P< 0.05). Multivariate regression demonstrated that age, smoking history, digestive symptoms, 6MWD, and radscore were independent risk factors for SvO2 impairment. The combined model established based on the abovementioned indicators exhibited a good prediction effect [AUC: 0.903; 95%CI (0.858-0.937)], higher than the general clinical model [AUC: 0.760; 95%CI (0.701-0.813), P< 0.05] and laboratory examination-radiomics model [AUC: 0.868; 95%CI (0.818-0.908), P= 0.012]. The newly created nomogram may be helpful for clinical decision-making and benefit COPD patients. SvO2 is an important indicator of hypoxia in COPD, and it is highly related to age, 6MWD, and radscore. The combined model is helpful for early identification of SvO2 impairment and adjustment of COPD treatment strategies.

The echocardiographic pulmonary to left atrial ratio: A noninvasive variable for the hemodynamic classification of pulmonary hypertension in dogs.

Hemodynamic classification of pulmonary hypertension (PH) has important clinical implications. However, only a few echocardiographic variables have been used to hemodynamically classify PH in dogs. To evaluate the echocardiographic pulmonary to left atrial ratio index (ePLAR) in dogs with PH. Forty-six dogs with intermediate to high probability of PH. Cross-sectional study. Variables were compared between dogs with precapillary PH [PrePH (n = 24)] vs postcapillary PH [PostPH (n = 22)], and with combined PH [CombPH (n = 14)] vs isolated PH [IsoPH (n = 8)] using the t-, Mann-Whitney, Pearson's Chi, or Fisher's exact test. The receiver operating characteristic curve and Youden index were used to identify the optimal ePLAR cutoff value to differentiate among the groups, intraclass correlation coefficients (ICC) were used to determine the reliability of measurements. The mean (SD) ePLAR of the PrePH was higher than that of the PostPH group [0.36 (0.13) vs 0.26 (0.09), respectively; P = .005]. The median (interquartile range) ePLAR of the CombPH was higher than that of the IsoPH subgroup [0.29 (0.24-0.38), vs 0.20 (0.16-0.23), respectively; P = .001]. The best cutoff value of ePLAR for identifying IsoPH was <0.245 [AUC at cutoff point = 0.86; sensitivity (95% confidence interval [CI]) = 0.71 (0.47-0.95); specificity (95% CI) = 1 (0.76-1)]. The ICC analysis indicated a high degree of reliability. ePLAR can be considered a valid noninvasive variable to hemodynamically classify PH in dogs with an intermediate to high probability of PH. Assessment of ePLAR can be useful in the therapeutic management of PH in dogs.

SURVEY OF ELEVATED BLOOD PRESSURE IN CHILDREN

Background: Hypertension is one of the leading risk factors for death, one of the main risks of cardiovascular disease. Clinical characteristics of hypertension are diverse, the early detection of symptoms of hypertension contributes significantly to early diagnosis and treatment. In Can Tho, there is little research on hypertension in children. Objectives: Describe the clinical and subclinical characteristics of hypertensive children being treated at the Cardiology Department, Can Tho Children’s Hospital. Materials and methods: Analytical descriptive cross-sectional study on 96 pediatric patients diagnosed with hypertension at Can Tho Pediatrics Hospital. Research subjects: Pediatric patients (&lt;16 years old) being treated at the department who are expected to have hypertension over a period of time. Sample selection criteria: Pediatric patients are expected to have hypertension determined according to the standards of the new Guidelines in Clinical Practice of the American Academy of Pediatrics (AAP) 2017. Exclusion criteria: Family members do not agree to allow the patient to participate in the study. Children are not appropriate for measuring BP due tocongenital anomalies: Ventricular septal defect, Atrial septal defect, Patent ductus arteriosus, Tetralogy of Fallot. Results: The common age group is under 13 years old (60.4%). The male and female gender ratio is approximately 2.1/1. The stage 2 hypertension classification is the most common (49.8%). The rate of neurological, gastrointestinal and cardiovascular symptoms was 59.4%, respectively; 19.8%; 24%. And there is no association between gastrointestinal, cardiovascular clinical symptoms and the grade of hypertension (p&gt;0.05). Hyperlipidemia, HbA1C in children with hypertension accounted for a high rate of 47.1% and 50%. While in BUN disorder, proteinuria accounted for a low rate of 5.3% and 26.3%. No abnormalities were noted on renal Doppler ultrasound. The rate of abnormal results on echocardiography, chest X-ray and ECG was 53.3%; 23.3%;13.7% respectively.

HIGHER FATTY LIVER INDEX VALUES AT SIMILAR BLOOD PRESSURE CLASSIFICATION INDICATE HIGH INSULIN RESISTANCE AND POTENTIAL INFLAMMATION

Objective: The relationship between fatty liver, which is visceral fat accumulation, and insulin resistance and inflammation as seen in hypertension classification is not clear. The Fatty Liver Index (FLI) is an established score for metabolic dysfunction-associated fatty liver disease (MASLD), which is associated with a risk of diabetes and cardiovascular disease. FLI is derived from a formula based on body mass index, waist circumference, and triglyceride and gamma-glutamyltransferase values. Design and method: A cross-sectional study enrolling consecutive individuals was conducted at a health checkup center in Japan from January 2022 to November 2022. A total of 3553 men (mean Age 50.6), excluding those with diabetes mellitus and those undergoing treatment for inflammatory diseases, were included in the study, and divided according to the Classification of hypertension in the ESH guideline. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and C-reactive protein (CRP) levels were divided into two groups by FLI (&lt;26 (group L) and &gt; or = 26 (group H)) and compared by Mann-Whitney U test. The cutoff value for fatty liver by FLI was determined by prior abdominal ultrasonography, and was set at 26(sensitivity 0.82, specificity 0.72). Results: Results of single regression analysis with FLI showed significant correlations in systolic blood pressure(r=0.31, p &lt; 0.0001), diastolic blood pressure(r=0.36, p &lt; 0.0001), HOMA-IR(r=0.36, p &lt; 0.0001), and CRP(r=0.08, p &lt; 0.0001). Optimal blood pressure(n=1783, mean FLI; 23.1, mean HOMA-IR; 1.28, mean CRP; 0.098mg/dL), Normal blood pressure(n=807, 33.9, 1.61, 0.14), High-normal blood pressure(n=535, 37.8, 1.90, 0.12), Grade 1 hypertension(n=124, 44.8, 2.0, 0.14), Grade 2 hypertension(n=53, 49.0, 1.71, 0.09), Grade 3 hypertension(n=18, 54.6, 2.89, 0.22), Isolated systolic hypertension(n=118, 36.2, 1.59, 0.09), Isolated diastolic hypertension(n=115, 44.1, 1.94, 0.12). HOMA-IR and CRP of H group were significantly higher than L group (all p &lt; 0.001). Conclusions: Higher FLI values at similar blood pressure levels may indicate high insulin resistance and potential inflammation, suggesting the need for strict management.