Classification Of Hypertension Research Articles

CONTENT, STRUCTURE AND DELIVERY CHARACTERISTICS OF YOGA INTERVENTIONS FOR MANAGING HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

Objective: The objective of the systematic review was to synthesise the content, structure and delivery characteristics of yoga interventions used for managing hypertension. Design and method: The Joanna Briggs Institute guidelines were followed in conducting the systematic review. This systematic review included randomised controlled trials (RCTs) conducted among adults (18 years and older) with hypertension. Studies in line with the classification of hypertension by the International Society of Hypertension/American Society of Hypertension were eligible. RCTs reporting at least one of the major components of yoga (i.e., asana (yogic poses), pranayama (breathing practices), and dhyana (meditation) and relaxation practices) and comparing them with no intervention or any intervention (e.g., lifestyle modification and pharmacotherapy) were eligible. Nineteen databases were searched for published and unpublished studies without any date and language restrictions. Results: The literature search yielded 11,629 records. Thirty-one RCTs (evaluating 35 yoga interventions) met the inclusion criteria, and 2837 participants were included. Overall, the methodological quality of these studies was found to be low. Yoga interventions improved systolic and diastolic blood pressure (SBP, DBP) compared to control group (mean difference -6.69 and -2.68; 95% CI -9.32 to -4.07 and -4.11 to -1.24, respectively). Sixteen, 13 and 18 interventions were effective in improving SBP, DBP or either, respectively. Twelve out of 18 interventions incorporated all the three major components of yoga and allocated similar durations to each component. The most common duration and frequency of effective interventions was 45 min/session (in 5 interventions), 3 or 6 or 7 days/week (in 12 interventions) and 12 weeks (in 10 interventions). Eleven were centre-based, seven were both centre- and home-based, and 15 were supervised. Conclusions: Yoga interventions seem to be effective in managing hypertension. High-quality RCTs, utilising the synthesised content, structure and delivery characteristics of effective yoga interventions, should be conducted.

OUTCOME-DRIVEN THRESHOLDS OF CENTRAL SYSTOLIC BLOOD PRESSURE AND CROSS-CLASSIFICATION OF SYSTOLIC HYPERTENSION AT CENTRAL AND BRACHIAL ARTERIES

Objective: We aimed to determine the outcome-driven thresholds for central systolic blood pressure (cSBP) based on the new ACC/AHA hypertension classification and to explore the characteristics and prognosis associated with central systolic hypertension (cSHT). Design and method: In 5580 participants enrolled from 9 populations (mean age 54.2 years; 54.1% women), cSBP was estimated tonometrically from the radial waveform (SphygmoCor, Atcor, Australia). We determined the thresholds for cSBP, resulting in 5-year cardiovascular risks similar to those associated with the 2017 ACC/AHA classification of brachial systolic blood pressure (bSBP). Statistical methods included analysis of covariance, the log-rank test and proportional hazards regression. Results: Over 4.1 years (median), 203 persons died (6.4 per 1000 person years) and 252 experienced a composite cardiovascular endpoint (8.2 per 1000 person-years). After rounding to the nearest 5 mm Hg, approximate thresholds for elevated cSBP and stages 1 and 2 and severe cSHT were 110, 120, 130 and 150 mm Hg, respectively. In 3659 untreated subjects, those with isolated cSHT (cSBP > = 120 mmHg, n = 137, 3.7%), compared to the participants with central (cSBP < 120 mmHg) and brachial (bSBP <130 mmHg) normotension (n = 1953, 53.4%), were older, more likely being female, had smaller height, slower heart rate and higher augmentation index. The opposite was true for isolated brachial hypertension (bSHT; bSBP > = 130 mmHg, n = 192, 5.3%). Among 1921 treated patients, the use of b-blockers was more frequent (50% vs. 36.2%, P = 0.027), whereas in isolated cSHT (n = 72, 3.8%) compared with controlled cSBP, RAAS inhibitors less often used (50% vs. 65.3%, P = 0.013). Among all participants, with brachial and central normotension as reference, the multivariable-adjusted hazard ratios (95% confidence interval) of the composite cardiovascular events were 1.29 (0.57–2.90; P = 0.54) for isolated bSHT, 2.30 (1.22–4.33; P = 0.01) for isolated cSHT, and 2.00 (1.39–2.88; P = 0.002) for concordant cSHT and bSHT. Conclusions: Outcome-driven thresholds of central systolic BP were approximately 10 mm Hg lower than their brachial counterparts. cSHT, either isolated (4%) or combined bSHT (90%), was characterised by greater systolic augmentation and was associated with higher cardiovascular risk.

Participation in pulmonary hypertension support group improves patient-reported health quality outcomes: a patient and caregiver survey.

Support group participation has been shown to be effective in many chronic medical conditions. The evidence for integrating support group into pulmonary hypertension care and its effect on quality of life, physical and psychological well-being is limited. We sought to assess the effect of support group participation on quality of life in patients diagnosed with pulmonary hypertension and their caregivers. The emPHasis-10 questionnaire (a tool validated for quality of life assessment in pulmonary hypertension) was used to evaluate the effect of support group participation. Additional demographic and health-related quality measures were examined. Results showed that 165 subjects were enrolled in the study; 122 (74.4%) were patients with pulmonary hypertension, 41 (25.0%) were their caregivers, and 2 (0.02%) did not respond. The cohort was predominantly female (n = 128, 78%), Caucasian (n = 10, 61%), and the principal self-reported classification of pulmonary hypertension was World Health Organization Group 1 (n = 85, 51.8%) and the self-reported New York Heart Association Functional Class was II and III (n = 43, 57.3%). Most participants (n = 118, 71.5%) attended support groups and of them, a majority (n = 107, 90.6%) stated it helped them. There was no difference in quality of life as assessed by emPHasis-10 scores with support group participation (median score 30 vs 32, p = 0.387). There was self-reported improvement in understanding condition better including procedures such as right heart catheterization, medication compliance, and confidence in self-care (p < 0.05). Using multivariate logistic regression, baseline variables that were independently associated with emPHasis-10 scores for the entire cohort included knowledge of New York Heart Association Functional Class (odds ratio: 1.919, 95% CI: 1.004–3.67, p = 0.04) and greater distance traveled to visit pulmonary hypertension physician (odds ratio: 1.391, 95% CI: 0.998--1.94, p = 0.05). In conclusion, support group participation does not improve quality of life as assessed by emPHasis-10 scores but improves other meaningful health-related quality outcomes.

UNSUPERVISED CLUSTER ANALYSIS OF HYPERTENSIVE INDIVIDUALS IDENTIFIES A ROBUST HIGH-RISK SUBGROUP

Abstract Objective: Despite hypertension being a crucial risk factor for cardiovascular disease, the current classification of hypertension does not reflect the heterogeneity or the wide variation in cardiovascular outcomes of hypertensive individuals. Our objective was therefore to identify subgroups of hypertensive individuals with distinct cardiovascular outcomes using data-driven cluster analysis. Design and method: To identify phenotypically distinct subgroups of hypertensive individuals, we performed unsupervised hierarchical clustering in participants with grade 2 hypertension from two population cohorts (FINRISK 2002 and 2012; n = 1971, mean age 59.8 years, 49% women) with up to 16 years of follow-up for incident cardiovascular events (n = 260). We defined hypertension as either systolic blood pressure (SBP) over 160 mmHg, diastolic blood pressure (DBP) over 100 mmHg, or use of antihypertensive medication. We computed the clusters separately for men and women based on eight factors related to hypertension and cardiovascular outcomes: mean arterial pressure (MAP; steady state pressure), pulse pressure (PP; pulsatile pressure), non-high-density lipoprotein cholesterol (non-HDLc), glycated hemoglobin (HbA1c), body-mass index (BMI), C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), and alcohol consumption (rAlcohol). In analyses with men and women combined, we used Cox regression models adjusted for age and sex to assess the risk of cardiovascular outcomes between the resulting clusters. Results: We observed two comparable clusters for both sexes (Figure). These clusters had significantly different patient characteristics. Notably, mean HbA1c (5.5 ± 0.4 vs. 7.6 ± 0.9 in men; 5.5 ± 0.3 vs. 7.7 ± 0.8 in women) and BMI (29.0 ± 4.5 vs. 31.1 ± 4.3 in men; 29.4 ± 5.4 vs. 33.3 ± 5.5 in women) were higher in Cluster 2 than in Cluster 1. Individuals in Cluster 2 had 2.1-fold greater risk (95% CI 1.4–3.1, p &lt; 0.001) of cardiovascular disease than individuals in Cluster 1. Conclusions: Using unsupervised hierarchical clustering, we stratified patients into two subgroups with differing disease progression and risk of complications. Substratification of hypertensive patients by low vs. high blood glucose and BMI could help to tailor and target early treatment to patients who would benefit most from it.

MEDICATION-FREE BLOOD PRESSURE (B.P.) MANAGEMENT IN INDIVIDUALS WITH PRE-HYPERTENSION OR STAGE 1 HYPERTENSION

Objective: Hypertension is defined as systolic blood pressure (S.B.P.) &gt; 140 mm Hg and/or diastolic blood pressure (D.B.P.).) &gt; 90 mm Hg at rest. Further classification of hypertension generates 4 groups of patients. Those with normal high blood pressure (S.B.P. &gt; 130–139 mm Hg and /or D.B.P. &gt; 85–89 mm Hg) and with stage 1 hypertension (SAP &gt; 140–159 mm Hg and / or D.A.P. &gt; 90–99 mm Hg), form a special category in which, the implement of medication creates debatable and controversial opinions among health care professionals, due to borderline values and patients’ low compliance. We aim to evaluate the management of B.P. without medication in patients with high normal blood pressure or stage 1 hypertension. Design and method: 180 individuals, 77 men (43%) and 103 women (57%), aged 40–70 years, without comorbidities except of dyslipidemia, were classified as pre-hypertensive or stage 1 hypertensive patients after measuring their B.P. three times a day for a week. Subsequently, they were weighed and recommended to follow hygienic-dietary measures such as Mediterranean diet, reduced sodium intake, weight loss and exercise with a daily walk of about 4 kilometers. After a period of 6 months, they were reevaluated with a new record of body weight and a special questionnaire regarding the observance of doctor's recommendations. Of the total sample, 122 (67%) were considered suitable for the study, 55 of which were men (45%). Results: 122 (67%) were considered suitable for the study, 55 of which were men (45%). 83 of these patients (69%), 36 men and 47 women, presented regulation of their B.P. at normal levels. In addition, there was a significant reduction of LDL levels in half of the patients (35/68). Medication for hypertension was given to the remaining 39, approximately 1/3 of the initial patients. Conclusions: The adoption of hygienic-dietary measures contributes to regulation of B.P. and improvement of lipid status in a major proportion of patients with marginally high B.P or with stage 1 hypertension, avoiding the need for medication at least for some years, justifying the guidelines that insist in taking such measures.

HIGH BLOOD PRESSURE SCREENING DURING MAY MEASUREMENT MONTH (MMM) 2019: TIME FOR ADOLESCENTS?

Abstract Objective: Every year, may 17th is dedicated to the World Hypertension Day (WHD). This is an initiative of the World Hypertension League, an affiliate of the International Society of Hypertension. These united forces have expanded to make May Measurement Month (MMM), a month of campaigning to raise awareness against hypertension. The objective of this study was to introduce the data obtained from a sample of adults and adolescents during the 2019 WHD. Design and method: Screening was conducted at a French hospital (Hôpital Avicenne) with the voluntary and volunteer assistance of physicians, interns, pharmacy and nursing students of our service, while following the standard MMM protocol. The support of the French Society of Hypertension (in partnership with Omron France) has been proposed to provide our centre with blood pressure (BP) monitors (Omron HEM-FL31/M3 Comfortâ). Results: Anonymous general data for this population of 140 subjects, including 66 adolescents, are summarized in the table. The majority of adult participants reported that their last BP measurement was more than a year ago, or was never even taken. All adolescents had measured their BP for the first time during this campaign. The number of known hypertensive adults 15 (20,3%). No adolescents were known to have high BP. In this population, 10 (13,5%) adults and 3 (4,5 %) adolescents have an unknown high normal BP. As for new hypertensive patients, there are 6 adults (8,1%) and 4 adolescents (6,1%) broken down as follows: Grade 1 hypertension: 4 adults and 4 adolescents, Grade II: only 2 adults, and Grade III: no one. Conclusions: Hypertension in children and adolescents is underestimated and under-diagnosed in clinical practice. European and American guidelines tend to simplify adult hypertension classifications to apply it in adolescents, but data from intervention and screening trials are not yet available. Although our screening approach remains modest in France (or at the European level), it aims to place young people at the centre of screening actions. A sustainable and methodical model for hypertension screening campaigns must make it possible to involvement the future generations in the fight against cardiovascular risk.

Pulmonary Hypertension in Rural Minnesota

<h3>Purpose</h3> Pulmonary arterial hypertension (PAH) is a progressive disease characterized by pulmonary vascular remodeling and right ventricular (RV) dysfunction. Pulmonary hypertension (PH) classification and prevalence at major urban centers is well described while natural history of rural patients (population < 20,000) with pulmonary hypertension evolves. <h3>Methods</h3> All consecutive patients at a rural outreach cardiology practice with mean pulmonary artery pressure (mPAP) ≥ 20 mmHg on right heart catheterization (RHC) were included. All patients had echocardiogram and RHC. Patients were grouped into PAH (group 1), combined pre- and post-capillary PH (group 1*), and non-group 1 PH (groups 2-5) using standard definitions. <h3>Results</h3> Of 229 patients, 56 patients had PAH, 41 patients had group 1* PH, and 132 patients had non-group 1 PH. Patients with PAH were younger compared to non-group 1 PH (69±14 vs. 73±11 years; p=0.02). Patients ≥80 at diagnosis had increased mortality at 2 years compared to patients < 80 (<b>Figure 1,</b> p=0.003). PAH patients had similar 2-year mortality to other PH groups (p=0.276). Moderate or severe left atrial enlargement on echo (OR 0.377; 95% CI: 0.195, 0.727), coronary artery disease (OR 0.52; 95% CI: 0.275, 0.982), and atrial fibrillation/flutter (OR 0.29; 95% CI: 0.149, 0.562) were predictive of non-group 1 PH. Male sex (OR 2.186, 95% CI: 1.158, 4.125) was predictive of PAH. <h3>Conclusion</h3> Group 1 and group 1* patients appear different at baseline. Age at diagnosis remains a critical factor in patient prognosis. PAH patients may have similar mortality to other PH groups. Contrary to prior literature, males were more likely to be diagnosed with PAH in this rural subset. Rural patients face different barriers to diagnosis than urban patients, and continued vigilant screening may impact patient morbidity and mortality.

Association of Stage 1 Hypertension Defined by the ACC/AHA 2017 Guideline With Asymptomatic Coronary Atherosclerosis.

This study sought to assess the relationship between stage 1 hypertension and subclinical coronary atherosclerosis. A total of 4,666 individuals with available coronary computed tomography angiography (CCTA) results from a health checkup were enrolled. The classification of hypertension was adapted from the American College of Cardiology/American Heart Association (ACC/AHA) 2017 guideline. The presence of coronary plaques and its characteristics, and other CCTA findings were assessed. There was a linear relationship between blood pressure (BP), both systolic BP (SBP) and diastolic BP (DBP), and the presence of coronary plaque. Patients were classified into 4 groups according to the BP category: normal BP (SBP <120 mm Hg and DBP <80 mm Hg; n = 2,395; 51.3%), elevated BP (SBP 120-129 mm Hg and DBP <80 mm Hg; n = 467; 10.0%), stage 1 hypertension (SBP 130-139 mm Hg or DBP 80-89 mm Hg; n = 1,139; 24.4%), and stage 2 hypertension (SBP ≥140 mm Hg or DBP ≥90 mm Hg; n = 665; 14.2%). Compared with the normal BP group after multivariate adjustment, the stage 1 hypertension group was significantly associated with the presence of atherosclerotic plaque (adjusted odds ratio [95% confidential interval], 1.37 [1.17-1.62]; P < 0.001), especially in noncalcified and mixed plaques. The relationship between stage 1 hypertension and stenosis >50% was not statistically significant. Isolated diastolic and isolated systolic stage 1 hypertensions were significantly related to the presence of coronary plaque. The elevated BP group was not associated with any positive CCTA findings. Stage 1 hypertension was independently associated with subclinical coronary atherosclerosis.

Endostatin and Vascular Endothelial Growth Factor-A165b May Contribute to Classification of Pulmonary Hypertension.

Background: Pulmonary hypertension (PH) is characterized by dysregulation of small pulmonary arteries. In addition to endostatin (ES), placenta growth factor (PlGF), vascular endothelial growth factor-A (VEGF-A), and the anti-angiogenesis isoform of VEGF-A (VEGF-A165b) are associated with PH. However, the usefulness of these biomarkers in PH in unknown. We investigated whether these 4 biomarkers are related to PH classification.Methods and Results: Between July 2015 and August 2017, 33 control patients and 107 PH patients were enrolled in the study. Among the PH patients, 48 had pulmonary arterial hypertension (PAH), 5 had left heart disease-associated PH (LHD-PH), 4 had lung disease-associated PH (LD-PH), and 50 had chronic thromboembolic PH (CTEPH). Among the PAH patients, 16 had idiopathic PAH (IPAH) and 17 had connective tissue disease-associated PAH (CTD-PAH). PlGF, total VEGF-A, and VEGF-A165b levels were measured in the control and PH groups. ES was only measured in the PH group. VEGF-A165b levels were significantly higher in the LD-PH group than in the PAH, LHD-PH, and CTEPH groups (all P<0.001). PlGF levels were significantly higher in the CTD-PAH group than in the IPAH and control groups. ES levels were significantly correlated with the 6-min walk distance (P<0.001), B-type natriuretic peptide (P<0.001), and pulmonary vascular resistance (P=0.008).Conclusions: ES could detect CTD-PAH in PAH and may be an indicator of PH severity. VEGF-A165b was useful in detecting LD-PH.

Association of microalbuminuria and adverse outcomes in hypertensive patients: a meta-analysis.

Studies on the association of microalbuminuria with adverse outcomes in patients with hypertension remain controversial. This meta-analysis aimed to assess the predictive value of microalbuminuria in hypertensive patients. PubMed and Embase databases were comprehensively searched for studies that published from their inceptions to July 10, 2020. Observational studies reporting the association of microalbuminuria (defined as urinary albumin excretion 30 and 300mg/24h urine or albumin/creatinine ratio 30-300mg/g from a spot urine or equivalent value) with all-cause mortality or major adverse cardiovascular events (MACEs) in hypertensive patients were selected. Nine studies with a total of 19,893 hypertensive patients were included. When compared with those without microalbuminuria, hypertensive patients with microalbuminuria had an increased risk of all-cause mortality (risk ratio [RR] 1.68; 95% confidence interval [CI] 1.46-1.93) and MACEs (RR 1.40; 95% CI 1.22-1.62), respectively. Gender-specific analysis indicated that microalbuminuria was significantly associated with an increased risk of all-cause mortality (RR 1.61; 95% CI 1.17-2.21) in men but not in women (RR 1.18; 95% CI 0.78-1.80). This meta-analysis suggests that microalbuminuria is independently associated with higher risk of MACEs and all-cause mortality in hypertensive patients. Determination of microalbuminuria has potential to improve the risk classification of hypertension.

Starting Antihypertensive Drug Treatment With Combination Therapy

Starting Antihypertensive Drug Treatment With Combination Therapy

High CD200 Expression on T CD4+ and T CD8+ Lymphocytes as a Non-Invasive Marker of Idiopathic Pulmonary Hypertension–Preliminary Study

Pulmonary arterial hypertension (PAH) can develop subsequently to disorganized endothelial cell proliferation within the pulmonary arteriolar layers that provide mechanical limits to the pulmonary vascular bed. Although the actual factor triggering vascular endothelial proliferation remains unknown to date, genetic susceptibility, hypoxia, inflammation, as well as response to drugs and toxins have been proposed as possible contributors. Since inflammation contributes to vascular remodeling, the changed immune response is increasingly considered a plausible cause of this cardiovascular disease. The interaction of a membrane glycoprotein cluster of differentiation 200 (CD200) and its structurally similar receptor (CD200R) plays a crucial role in the modulation of the inflammatory response. Our previous studies have shown that the overexpression of the other negative co-stimulatory molecule (programmed death cell-PD-1) and its ligand-1 (PD-L1) is closely related to iPAH and the presence of Epstein-Barr virus (EBV) reactivation markers. Therefore, we considered it necessary to analyze the different types of PAH in terms of CD200 and CD200R expression and to correlate CD200/CD200R pathway expression with important clinical and laboratory parameters. The CD200/C200R-signaling pathway has not been subject to much research. We included 70 treatment-naïve, newly diagnosed patients with PAH in our study. They were further divided into subsets according to the pulmonary hypertension classification: chronic thromboembolic pulmonary hypertension (CTEPH) subset, pulmonary arterial hypertension associated with congenital heart disease (CHD-PAH), pulmonary arterial hypertension associated with connective tissue disease (CTD-PAH), and idiopathic pulmonary arterial hypertension (iPAH). The control group consisted of 20 healthy volunteers matched for sex and age. The highest percentages of T CD200+CD4+ and T CD200+CD8+ lymphocytes were observed in the group of patients with iPAH and this finding was associated with the presence of EBV DNA in the peripheral blood. Our assessment of the peripheral blood lymphocytes expression of CD200 and CD200R indicates that these molecules act as negative co-stimulators in the induction and persistence of PAH-associated inflammation, especially that of iPAH. Similar results imply that the dysregulation of the CD200/CD200R axis may be involved in the pathogenesis of several immune diseases. Our work suggests that CD200 and CD200R expression may serve to distinguish between PAH cases. Thus, CD200 and CD200R might be useful as markers in managing PAH and should be further investigated.

Deep learning algorithm evaluation of hypertension classification in less photoplethysmography signals conditions

This study used photoplethysmography signals to classify hypertensive into no hypertension, prehypertension, stage I hypertension, and stage II hypertension. There are four deep learning models are compared in the study. The difficulties in the study are how to find the optimal parameters such as kernel, kernel size, and layers in less photoplethysmographyt (PPG) training data condition. PPG signals were used to train deep residual network convolutional neural network (ResNetCNN) and bidirectional long short-term memory (BILSTM) to determine the optimal operating parameters when each dataset consisted of 2100 data points. During the experiment, the proportion of training and testing datasets was 8:2. The model demonstrated an optimal classification accuracy of 76% when the testing dataset was used.

High blood pressure in children and adolescents: lights and shadows in the American Academy of Pediatrics clinical practice guidelines

High blood pressure in pediatric age is meeting a growing interest owing to the possible aftermaths in adult age in terms of public health. In fact, children and adolescents with high blood pressure values are likely to become hypertensive adults, thus developing cardiovascular diseases. Over the last decade, numerous studies have been conducted in this field. That is the reason why the American Academy of Pediatrics in 2017 published un update on the previous recommendations of the United States Fourth Working Group on pediatric blood pressure. This update includes a new classification of hypertension, the endorsement of the 24-hour ambulatory blood pressure monitoring and the reduction in the blood pressure target for both chronic kidney disease and non-chronic kidney disease hypertensive children. This review discusses strengths and weaknesses of the recent practical guidelines of the American Academy of Pediatrics.

Attended Automated Office Blood Pressure Measurement Versus Ambulatory Blood Pressure Monitoring in a Primary Healthcare Setting in Chile.

As part of the HEARTS in the Americas initiative, Chilean primary healthcare centers have implemented novel hypertension management strategies, including new diagnostic approaches. This study evaluated the concordance between attended automated office blood pressure (AOBP) measurements with an oscillometric device and ambulatory blood pressure monitoring (ABPM). This was an observational cohort study to evaluate and compare attended AOBP and ABPM for the diagnosis of hypertension in adults in a primary healthcare setting. The study evaluated 309 participants (54.2 ± 15.7 years; 50.5% male) from four primary healthcare centers in Santiago, Chile. Attended AOBP measurements were obtained at the clinic on two separate days, followed by ABPM. AOBP values indicated that 69.6% of patients had a systolic blood pressure (SBP) of ≥140 mm Hg and 34.6% had a diastolic blood pressure (DBP) of ≥90 mm Hg. A total of 83.5% had hypertension, 45.3% had high SBP, and 56.0% had high DBP. ABPM values indicated that 65.0% of patients had hypertension. The combined AOBP and ABPM analysis showed that 57.0% of patients had sustained hypertension, 26.5% had white coat hypertension, 8.1% had masked hypertension, and 8.4% were normotensive. The concordance between AOBP and ABPM (κ coefficient) was low (κ = 0.133; 95% confidence interval 0.028-0.237). The comparison of AOBP and ABPM measurements (Bland-Altman plots and bias calculations) showed an important bias in BP as measured using the AOBP method, especially for SBP (13.7 ± 11.6, 95% confidence interval -9.1 to 36.5). Attended AOBP alone may not be sufficient for adequate classification, diagnosis, and management of hypertension in Chile or other countries with similar demographics.

Restricted Boltzmann Machines for Fundus Image Reconstruction and Classification of Hypertension Retinopathy

Conventionally classification of hypertensive retinopathy through analysis of fundus images by experts, but this method the results are highly dependent on the accuracy of observations and expert experience. In this study, we propose a fundus image reconstruction and Hypertensive retinopathy classification model using Restricted Boltzmann Machines (RBM), as well as the Messidor database that has been labeled as a dataset. The experimental results show that the performance of the model produces an accuracy level of 99.05% where the model can generalize image input into one of the nine classes of the severity of hypertension retinopathy.

Progress in the study of the pathogenesis and diagnosis of hypertension

In recent years, there has been a tendency to “tighten” the criteria for the diagnosis of hypertension. So, experts from the unifying national committee (ONC) for the identification, assessment and treatment of high blood pressure (USA, 1993) recommended diagnosing hypertension with a high blood pressure of more than 140/90 mm Hg. and highlight 4 stages. In 1999, recommendations of the World Health Organization (WHO) and the International Society of Hypertension (SAG) for the treatment of hypertension were published, which provide a new classification of hypertension. According to this classification, it is necessary to determine the degree of arterial hypertension, as well as stratify the risk of developing cardiovascular complications to assess the prognosis.

Cytokines, Chemokines, and Inflammation in Pulmonary Arterial Hypertension.

According to the World Symposium Pulmonary Hypertension (WSPH) classification, pulmonary hypertension (PH) is classified into five categories based on etiology. Among them, Group 1 pulmonary arterial hypertension (PAH) disorders are rare but progressive and often, fatal despite multiple approved treatments. Elevated pulmonary arterial pressure in patients with WSPH Group 1 PAH is mainly caused by increased pulmonary vascular resistance (PVR), due primarily to sustained pulmonary vasoconstriction and excessive obliterative pulmonary vascular remodeling. Growing evidence indicates that inflammation plays a critical role in the development of pulmonary vascular remodeling associated with PAH. While the role of auto-immunity is unclear, infiltration of inflammatory cells in and around vascular lesions, including T- and B-cells, dendritic cells, macrophages, and mast cells have been observed in PAH patients. Serum and plasma levels of chemokines, cytokines, and autoantibodies are also increased in PAH patients; some of these circulating molecules are correlated with disease severity and survival. Preclinical experiments have reported a key role of the inflammation in PAH pathophysiology in vivo. Importantly, anti-inflammatory and immunosuppressive agents have further exhibited therapeutic effects. The present chapter reviews published experimental and clinical evidence highlighting the canonical role of inflammation in the pathogenesis of PAH and as a major target for the development of anti-inflammatory therapies in patients with PAH.

ANALYSE THE RISK FACTORS OF CORONARY HEART DISEASE IN YOUNG AND MIDDLE – AGED MALE PATIENTS USING MULTIVARIATE STATISTICAL

Objective: To study the correlation between various risk factors and coronary CTA calcification score ( CACS ) in young and middle-aged male patients with coronary heart disease by multiple linear regression, and to predict plaque properties by Mahalanobis distance discrimination method. This study provides evidence for early clinical evaluation of the extent of coronary artery calcification and the property of plaque in patients having suffered coronary heart disease. Methods: choose 98 male patients under 55 years old with coronary heart disease randomly and collecte relevant medical history data and test results while in hospital.Utilizing the theory of multiple linear regression and Mahalanobis distance discriminant to analyse these dates. Results: Factors including hypertension classification×years, number of cigarettes smoked(packs / week )×years,and time of diabetes(years) have a positive correlation between CACS respectively. Comparing calcified plaque and vulnerable plaque, mixed plaque and vulnerable plaque,there is a significant differences ( p &lt; 0.01) while hs-CRP and IL-6 are as the indicator. Mahalanobis distance discrimination method has a discrimination accuracy of 91.83 % for the group wrih susceptible factors only. Conclusion: The model of predicting the extent of coronary artery calcification by multiple linear regression has high reliability. Vulnerable plaques can be distinguished from plaques of other properties efficiently using Mahalanobis distance discrimination method.

Characteristics of calcium homeostasis in patients with different degrees of arterial hypertension

Background: Calcium is the most common cation in the human body. An abnormal distribution of intracellular and extracellular ionized Ca plays a significant role in the formation of arterial hypertension. The purpose of the study is to analyze the fractional composition of calcium in blood serum and urinary calcium excretion in patients with hypertension, as well as to identify the features of the distribution of these. Material and methods: The study included 80 patients. The population of the study consisted of 60 patients with various degrees of hypertension (38 women and 22 men) aged from 65 to 74 years old and the control group composed of 20 patients (12 men and 8 women) in the same age group without signs of hypertension. The patients with clinically expressed coronary heart disease requiring specific therapy, heart defects, impaired liver function and impaired kidney function were excluded from this study. Patients were divided into three groups, according to the World Health Organization (WHO) classification of arterial hypertension. Indicators of calcium concentration in blood and urine were determined using test kits for determining calcium with glyoxal bis-2 hydroxyanil from LACHEMA. To determine the ionized calcium, a standard technique of ion-selective electrode was used. Results and conclusion: In patients with arterial hypertension, a redistribution of the calcium pool in the blood is noted due to a decrease in the concentration of ionized calcium and an increase in the bound calcium, depending on the severity of the disease. An increase in urinary calcium excretion in patients with arterial hypertension is characteristic of moderate and severe forms of arterial hypertension, which given the age of patients, may be one of the causes of osteoporosis. The increase in the level of intracellular calcium with the progression of arterial hypertension is an example of pathophysiological reactions that occur at the body level, the result of which can be not only banal muscle constriction but also a violation of the synthesis and production of biologically active substances that regulate blood pressure.