Classification Of Hypertension Research Articles

Automated recognition of hypertension through overnight continuous HRV monitoring

Hypertension is a common and chronic disease, caused by high blood pressure. Since hypertension often has no warning signs or symptoms, many cases remain undiagnosed. Untreated or sub-optimally controlled hypertension may lead to cardiovascular, cerebrovascular and renal morbidity and mortality, along with dysfunction of the autonomic nervous system. Therefore, it could be quite valuable to predict or provide early warnings about hypertension. Heart rate variability (HRV) analysis has emerged as the most valuable non-invasive test to assess autonomic nervous system function, and has great potential for detecting hypertension. However, HRV indicators may be subtle and present at random, resulting in two challenges: how to support continuous monitoring for hours at a time while being unobtrusive, and how to efficiently analyze the collected data to minimize data collection and user burden. In this paper, we present a machine learning-based approach for detecting hypertension, using a waist belt continuous sensing system that is worn overnight. Using 24 hypertension patients and 24 healthy controls, we demonstrate that our approach can differentiate hypertension patients from healthy controls with 93.33% accuracy. This represents a promising approach for performing hypertension classification in the field, and also we would improve its performance based on a large number of hypertensive subjects monitored by the proposed pervasive sensors.

GAGAL JANTUNG KIRI DAN HIPERTENSI PULMONAL

In patients with left heart failure, pulmonary hypertension and right ventricular dysfunction is a common condition and has important implications in the development of disease, disability and death, so it required special attention. Pulmonary hypertension is the most common form with approximately 65-80% of cases. Although today is already highly developed understanding of the pathophysiology and clinical assessment, as well as setting the hemodynamic definition and classification of pulmonary hypertension in left heart failure, but the interrelation hemodynamics in pulmonary hypertension combination of pre- and post-capillary is still very complex, and there is no evidence-based recommendations the handling of pulmonary hypertension is left heart failure. Here, we will discuss the prevalence and significance of pulmonary hypertension and cardiac dysfunction Right in patients with both heart failure with ejection fraction decreased, as well as heart failure with ejection fraction, as well as provides an overview of the pathophysiology of the complex due to the interaction of cardiopulmonary left heart failure, which can supports the evolution of the phenotype of the left ventricle into the right ventricle phenotype through the travel history of heart failure. Next, we will discuss fenoitp pulmonary hypertension by combining the clinical context, the assessment of non-invasive and invasive hemodynamic variables in a structured diagnostic assessment.

Phenomapping for the Identification of Hypertensive Patients with the Myocardial Substrate for Heart Failure with Preserved Ejection Fraction.

We sought to evaluate whether unbiased machine learning of dense phenotypic data ("phenomapping") could identify distinct hypertension subgroups that are associated with the myocardial substrate (i.e., abnormal cardiac mechanics) for heart failure with preserved ejection fraction (HFpEF). In the HyperGEN study, a population- and family-based study of hypertension, we studied 1273 hypertensive patients utilizing clinical, laboratory, and conventional echocardiographic phenotyping of the study participants. We used machine learning analysis of 47 continuous phenotypic variables to identify mutually exclusive groups constituting a novel classification of hypertension. The phenomapping analysis classified study participants into 2 distinct groups that differed markedly in clinical characteristics, cardiac structure/function, and indices of cardiac mechanics (e.g., phenogroup #2 had a decreased absolute longitudinal strain [12.8 ± 4.1 vs. 14.6 ± 3.5%] even after adjustment for traditional comorbidities [p < 0.001]). The 2 hypertension phenogroups may represent distinct subtypes that may benefit from targeted therapies for the prevention of HFpEF.

Hypertension in the Neonatal Period: An Update.

There has been a growing interest among neonatologists and paediatricians regarding identification and evaluation of hypertension in the neonatal period. Despite the emergent normative data on blood pressure values in term and preterm neonates over the last two decades, there is still controversy regarding correct definition and classification of hypertension. This article will discuss the current definitions, available normative data and etiology of neonatal hypertension. There is paucity of records in terms of efficacy of antihypertensive drugs in this specific population and management is usually experience based, causing considerable heterogeneity amongst different units. This review article will also cover the evaluation, management, outcomes and follow up of neonatal hypertension with latest advances in this field.

Современная классификация и диагностика легочной гипертензии

Современная классификация и диагностика легочной гипертензии

Surgically Curable Pulmonary Hypertension

ABSTRACT Chronic thromboembolic pulmonary hypertension is 1 of 5 classifications of pulmonary hypertension. A patient with progressive dyspnea on exertion for the past 2 years underwent diagnostic ...

Clinical classification and initial diagnosis of pulmonary hypertension: recommendations of the Cologne Consensus Conference 2016

The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed information about the clinical classification and diagnosis of pulmonary hypertension, and furthermore provide novel recommendations for risk stratification and follow-up assessments. However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the clinical classification and initial diagnosis of PH. This article summarizes the results and recommendations of this working group.

Contemporary diagnosis and management of pulmonary hypertension

Pulmonary hypertension (PH) encompasses a group of diseases associated with an elevated mean pulmonary artery pressure (mPAP) ≥25 mm Hg at rest. The symptoms of PH are non-specific, and it...

Hypertensive Disorders in Pregnancy

In pregnancy, both mother and fetus benefit from blood pressure in normal ranges. There is discrepancy in the normenclature and thresholds for classification of hypertension in pregnancy and for initiation of antihypertensive treatment in different international guidelines. Systolic and diastolic blood pressure values that are associated with normal outcome are notably lower than any recommended treatment threshold in pregnancy. Tight blood pressure control under 85 mmHg diastolic is save and significantly prevents severe maternal hypertension as could be demonstrated in CHIPS. Close blood pressure monitoring comprising modern methods and devices including telemonitoring allows early recognition of risk developments and optimal guidance of antihypertensive therapy starting early in pregnancy. Only a few pharmacological substances are suitable for antihypertensive treatment in pregnancy.

OS 26-01 CLASSIFICATION OF ARTERIAL HYPERTENSION USING A COMPUTATIONAL MODEL BASED ON ARTIFICIAL MODULAR NEURAL NETWORKS

Objective: The development of an artificial modular neural network (MNN) method for diagnosing and classification of arterial Hypertension based on the level of the blood pressure (BP) of a patient is presented. The main goal is to diagnose the degree of hypertension based on the BP values using MNN applying response integration via a gating network approach. Design and Method: This study was performed with 28 patients to classify the BP levels, based on the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) Guidelines of Hypertension. We collected patient data with the Ambulatory blood pressure monitoring (ABPM), which is a tool that can help diagnose hypertension. The main goal is to model the 24-hr ABPM patterns in patients with the MNN and classify the BP of the patient using the Levenberg-Marquardt algorithm. The proposed computational method using Artificial MNN consists on designing the best system architecture of the MNN based on previous data. Results: Based on ABPM data of the 28 patients, we implemented a computational system based on three different MNN architectures. The first one achieved a classification rate of 93.3%, the second one of 91.7% and the third one of 89.7% respectively, and with this we can note that excellent classifications results are obtained. The best architecture of the MNN for achieving these results is the following: 25 neurons in the first layer and 30 neurons for the second layer for each of the modules, and the Target Error for learning is 0.002 and 500 epochs are used during learning. Conclusions: We can conclude that with the proposed method using a MNN and the European Guidelines of Hypertension, good results are obtained for diagnosis and classification of hypertension. We can note that MNNs have proven to be a reliable and accurate technique when compared to conventional classification methods.

PS 09-02 BURDEN &amp; CORRELATES OF DIAGNOSED &amp; UNDIAGNOSED HYPERTENSION

Objective: Hypertension is a silent major risk factor for cardiovascular and cerebro-vascular disease (CVD) related morbidity & mortality. The objectives of the study were to measure the prevalence of doctor diagnosed hypertension (DDH), undiagnosed hypertension and assessment of the associations of socio-demographic and behavioral factors. Design and Method: WHO classification of hypertension and gradations were used in the cross sectional study of 5347 adults of an established urban longitudinal population cohort of West Bengal, India. Information gathered from pre-tested questionnaire, anthropometry and brachial arterial blood pressure obtained with electronic sphygmomanometer. Results: Among the participants, 2083 (38.96%) were male and 3264 (61.04%) were female. 1712 (32.05%) were hypertensive, 1039 (19.48%) had DDH out of which 963 (92.69%) were on medications. Among DDH, 512 (49.28%) were uncontrolled hypertensives while majority on treatment .Undiagnosed hypertensives were 664 (12.42%). Increasing age is associated with DDH [AOR = 1.08, 95% CI: (1.08–1.09), p < .0001] and overall hypertension [AOR = 1.09, 95% CI: (1.08–1.10), p < .0001]. Ex-smokers and ex-drinkers were associated with DDH [AOR = 1.60, 95% CI: (1.15–2.22), p = 0.0055] and [AOR = 1.74, 95% CI: (1.14–2.63), p = 0.0096] respectively. Always snorers were associated with DDH [AOR = 2.05, 95% CI: (1.71–2.47), p < .0001] and overall hypertension [AOR = 1.71, 95% CI: (1.44–2.02), p < .0001]. Obese persons were associated with DDH [AOR = 3.21, 95% CI: (2.48–4.16), p < .0001] and overall hypertension [AOR = 2.85, 95% CI: (2.44–3.63), p < .0001]. Participants consuming additional salt always [AOR = 1.85, 95% CI: (1.45–2.36), p < .0001] or sometimes [AOR = 1.66, 95% CI: (1.25–2.20), p = 0.0005] with food were associated with undiagnosed hypertension. Conclusions: Nearly one third of the adult cohort was hypertensive and one fifth was doctor diagnosed. Half of DDH remained uncontrolled while 93% being on treatment. Majority of risk factors noted were reversible therefore targeted evidence based intervention is expected to reduce the burden of hypertension and related complications.

Evaluating electronic health record data sources and algorithmic approaches to identify hypertensive individuals.

Phenotyping algorithms applied to electronic health record (EHR) data enable investigators to identify large cohorts for clinical and genomic research. Algorithm development is often iterative, depends on fallible investigator intuition, and is time- and labor-intensive. We developed and evaluated 4 types of phenotyping algorithms and categories of EHR information to identify hypertensive individuals and controls and provide a portable module for implementation at other sites. We reviewed the EHRs of 631 individuals followed at Vanderbilt for hypertension status. We developed features and phenotyping algorithms of increasing complexity. Input categories included International Classification of Diseases, Ninth Revision (ICD9) codes, medications, vital signs, narrative-text search results, and Unified Medical Language System (UMLS) concepts extracted using natural language processing (NLP). We developed a module and tested portability by replicating 10 of the best-performing algorithms at the Marshfield Clinic. Random forests using billing codes, medications, vitals, and concepts had the best performance with a median area under the receiver operator characteristic curve (AUC) of 0.976. Normalized sums of all 4 categories also performed well (0.959 AUC). The best non-NLP algorithm combined normalized ICD9 codes, medications, and blood pressure readings with a median AUC of 0.948. Blood pressure cutoffs or ICD9 code counts alone had AUCs of 0.854 and 0.908, respectively. Marshfield Clinic results were similar. This work shows that billing codes or blood pressure readings alone yield good hypertension classification performance. However, even simple combinations of input categories improve performance. The most complex algorithms classified hypertension with excellent recall and precision.

Pulmonary Hypertension.

To review the clinical classification, diagnosis, and pathophysiology of pulmonary hypertension in children, emphasizing the role of right ventricular function, ventricular interaction, and congenital heart disease in the evolution and progression of disease, as well as management strategies and therapeutic options. MEDLINE, PubMed. Critically ill children with pulmonary hypertension associated with congenital heart disease are a high-risk population. Congenital cardiac defects resulting in either increased pulmonary blood flow or impaired pulmonary venous drainage predispose patients to developing structural and functional aberrations of the pulmonary vasculature. Mortality from pulmonary hypertension is most directly related to right ventricular failure.

Pulmonary Veno-Occlusive Disease in a Patient with History of Major Depressive Disorder

Introduction: Pulmonary veno-occlusive disease (PVOD) represents a specific subgroup of the group 1 of the clinical classification of pulmonary hypertension. Case presentation: We introduce a young male patient with history of major depressive disorder who was on psychiatric medications and presented with gradually progressive dyspnea and syncope. The preliminary diagnostic tools showed the presence of pulmonary hypertension; further imaging studies and right heart catheterization showed findings consistent with PVOD. Conclusion: To best of our knowledge, this is the first report of PVOD in a patient taking psychiatric medications.

Drug-induced Pulmonary Hypertension - a Current Review

The current classification of pulmonary Hypertension (PH) consists of five clinical groups, and drug-induced pulmonary arterial hypertension (PAH) is classified under Group 1 as a distinct entity. Our present work encompasses the available data concerning the association between the intake of a wide range of drugs and development of PAH. A selective literature search was performed in Pubmed to include published work between the years 1960 - 2015. For this search, the terms pulmonary hypertension, pulmonary arterial hypertension, pulmonary veno-occlusive disease, drug induced pulmonary hypertension and chemotherapy induced PVOD were used. Mainly German, English and French publications regarding this topic were considered. An association between drug intake and PH development was described for different medications, among them appetite-suppressant drugs, interferon alpha and beta, but also several chemotherapeutic drugs. The present literature regarding drug-induced PH mainly comprises case reports and small patient cohorts. Drug-induced PH has become increasingly discussed in recent years and needs further elucidation. A close cooperation between clinicians, PH expert centers and regulatory agencies is mandatory to identify other potential drugs at an early stage that may be linked to PH development. For the clinician, a thorough patient interview including drug history is necessary in the evaluation of a patient with PH.

The Evolving Classification of Pulmonary Hypertension.

- An explosion of information on pulmonary hypertension has occurred during the past few decades. The perception of this disease has shifted from purely clinical to incorporate new knowledge of the underlying pathology. This transfer has occurred in light of advancements in pathophysiology, histology, and molecular medical diagnostics. - To update readers about the evolving understanding of the etiology and pathogenesis of pulmonary hypertension and to demonstrate how pathology has shaped the current classification. - Information presented at the 5 World Symposia on pulmonary hypertension held since 1973, with the last meeting occurring in 2013, was used in this review. - Pulmonary hypertension represents a heterogeneous group of disorders that are differentiated based on differences in clinical, hemodynamic, and histopathologic features. Early concepts of pulmonary hypertension were largely influenced by pharmacotherapy, hemodynamic function, and clinical presentation of the disease. The initial nomenclature for pulmonary hypertension segregated the clinical classifications from pathologic subtypes. Major restructuring of this disease classification occurred between the first and second symposia, which was the first to unite clinical and pathologic information in the categorization scheme. Additional changes were introduced in subsequent meetings, particularly between the third and fourth World Symposia meetings, when additional pathophysiologic information was gained. Discoveries in molecular diagnostics significantly progressed the understanding of idiopathic pulmonary arterial hypertension. Continued advancements in imaging modalities, mechanistic pathogenicity, and molecular biomarkers will enable physicians to define pulmonary hypertension phenotypes based on the pathobiology and allow for treatment customization.

Abstract 239: Receipt of Routine Health Care Among African American Adults With Diabetes and Hypertension: Results from The Jackson Heart Study

Objectives: African Americans (AA) have a high prevalence of chronic diseases including hypertension (HTN) and diabetes (DM). Routine care is necessary to prevent adverse affects of chronic diseases. Few studies have examined patterns of routine care among AA with chronic diseases. This study uses Jackson Heart Study (JHS), a large prospective cohort of AA adults, to understand patterns of routine healthcare among AA adults with HTN and DM. Methods: Using data collected at 1st (2000-2004) and 3rd visit (2009-2012), adults with HTN (n=2,668) and those with DM (n=949) were analyzed. Routine healthcare at visits 1 and 3 by participants self reports of whether or not they have seen a doctor or other health professional for a routine physical exam or general check-up when not sick or pregnant within the past year. Independent variables were self-reported insurance status (private/ public/private and public/none), income status (Poor/Lower-Middle/Upper-Middle/Affluent based on self-reported annual income, family size, year, and poverty levels for 2000-2004), gender (male/female), age (years), healthcare trust (yes/no), difficulty obtaining healthcare (yes/no), and health status (excellent/good/fair/poor). HTN classification (normal/pre-HTN/stage 1/stage 2), DM classification (normal/at risk/diabetic) was based on directly assessed clinic, lab values, and included those on anti medications, regardless of blood pressure and triglyceride control. Logistic regression was used to determine crude and adjusted odds ratios and adjusted cross-sectional odds ratios of having routine care at visits 1 and 3 for those with DM and those with HTN. Findings: Routine care was high for both those with HTN and those with DM at both visits 1 and 3 (78% and 86% for HTN and 80% 87% DM, respectively). For both groups of patients, poor trust in the health care system decreased odds of routine care at visit 1 (DM adjusted Odds Ratio (aOR) 0.53 (95% Confidence Interval (CI) 0.33, 0.86), HTN aOR 0.59 (95% CI 0.45, 0.77) and at visit 3 (DM aOR 0.31 (95% CI 0.14, 0.71), HTN aOR 0.56 (95% CI 0.38, 0.83). Among the HTN sample, those with stages 1 or 2 HTN at visit 1 decreased odds of routine care at both visit 1 (aOR 0.51 (95% CI 0.31, 0.83) and visit 3 (aOR 0.48 (95% CI 0.28, 0.84) and increased severity of HTN at visit 3 decreased odds of routine care at visit 3. For both groups of patients, men had statically significant lower odds of routine care than women at visit 1 and visit 3 and increased age was associated with increased routine care. Insurance status and income status were not significantly associated with routine care in any of the adjusted models. Conclusions: AA with HTN and DM have high rates of routine care regardless of insurance or socioeconomic status. Rates of routine care were associated with trust in the health care system and self-reported difficulty obtaining health care independent of insurance status or income.

Hypertension pulmonaire : définition, classification et traitements

Pulmonary hypertension (PH) is a cardio-pulmonary disorder that may involve multiple clinical conditions and can complicate the majority of cardiovascular and respiratory diseases. Its definition is an increase in mean pulmonary artery pressure (mPAP) \hbox{$\geqslant $} ⩾ 25 mmHg at rest, leading to right heart failure and ultimately death. The clinical classification of pulmonary hypertension (PH) categorizes PH into groups which share similar pathophysiological and hemodynamic characteristics and treatments. Five groups of disorders that cause PH are identified: pulmonary arterial hypertension (Group 1) which is a pre-capillary PH, defined by a normal pulmonary artery wedge pressure (PAWP) \hbox{$\leqslant $} ⩽ 15 mmH, due to remodelling of the small pulmonary arteries (<500 μm); pulmonary hypertension due to left heart disease (Group 2) which is a post-capillary PH, defined by an increased pulmonary artery wedge pressure (PAWP) >15 mmHg; pulmonary hypertension due to chronic lung disease and/or hypoxia (Group 3); chronic thrombo-embolic pulmonary hypertension (Group 4); and pulmonary hypertension due to unclear and/or multifactorial mechanisms (Group 5). PAH (PH group 1) can be treated with agents targeting three dysfunctional endothelial pathways of PAH: nitric oxide (NO) pathway, endothelin-1 pathway and prostacyclin pathway. Patients at low or intermediate risk can be treated with either initial monotherapy or initial oral combination therapy. In patients at high risk initial combination therapy including intravenous prostacyclin analogues should be considered. Patients with inadequate clinical response to maximum treatment (triple therapy with an intravenous prostacyclin) should be assessed for lung transplantation. Despite progresses, PAH remains a fatal disease with a 3-year survival rate of 58%. Treatment of group 2, group 3 and group 5 PH is the treatment of the causal disease and PAH therapeutics are not recommended. Treatment of group 4 PH is pulmonary endarteriectomy if patients are eligible, otherwise balloon pulmonary angioplasty and/or medical therapy can be considered.

Pediatric pulmonary hypertension: diagnosis and management.

The article is intended to provide an overview of the most current modalities for the diagnosis and management of pulmonary hypertension in the pediatric population. The WHO has recently updated the classification for pulmonary hypertension to include an expanded range of pediatric disease cohorts. We continue to gain knowledge of traditional pulmonary hypertension therapies (phosphodiesterase inhibitors, endothelin-receptor antagonists, and prostanoids) and remain optimistic that new therapeutic modalities [cyclic guanosine monophosphate (cGMP) stimulators, oral prostacyclins, and gene therapy] will lead to improved outcomes in pediatric patients. Pediatric pulmonary hypertension is a heterogeneous disorder that has the potential to improve in some cases as children grow throughout childhood. Utilization of dedicated multidisciplinary teams of medical providers is necessary to deliver the highest level of medical care to this complex patient population. Ongoing development of enhanced screening protocols, novel disease-specific therapeutic targets, and comprehensive registries will hopefully lead to improved morbidity and mortality in the future.

Pulmonary Hypertension, Cor Pulmonale, and other Pulmonary Vascular Conditions

This review covers the diseases that affect the pulmonary vasculature directly. These conditions include pulmonary hypertension; pulmonary arterial hypertension; chronic thromboembolic pulmonary hypertension; pulmonary hypertension attributed to left heart disease, lung disease and/or hypoxemia, and other disorders; cor pulmonale; pulmonary atriovenous malformations; and pulmonary aneurysms. Figures show changes in the pulmonary vasculature in pulmonary hypertension, pathways involved in the development of pulmonary hypertension, general guidelines for the evaluation of suspected pulmonary hypertension, enlarged proximal pulmonary arteries with pruning of distal pulmonary vasculature (typical of advanced pulmonary arterial hypertension), the remodeling of the heart and continuous-wave Doppler study results observed with chronic pulmonary hypertension, ventilation and perfusion scans of the lungs with results typical of chronic thromboembolic pulmonary hypertension, and a general approach to the treatment of patients with pulmonary arterial hypertension. Tables list the revised nomenclature and classification of pulmonary hypertension, the World Health Organization classification of functional capacity in patients with pulmonary hypertension, advanced vascular medications for pulmonary artery hypertension, and perioperative management of pulmonary arterial hypertension. This review contains 8 highly rendered figures, 4 tables, and 118 references.