Clinic Blood Pressure Measurements Research Articles

White coat effect in patients with hypertension

The article is devoted to various aspects of white coat effect (WCE) in patients with hypertension (HTN). WCE is due to the patient’s anxious response to office blood pressure (BP) measurement and is characterized by a BP increase. In patients with HTN, WCE is detected with a high frequency. Pronounced WCE in hypertensive patients is associated with worsening the HTN course and the prognosis of all-cause and cardiovascular mortality. In addition, BP increase in these patients during a doctor’s visit may lead to additional prescription of antihypertensive drugs, increasing costs and side effects. To identify WCE, a large number of methods are used, which can be divided into following groups: I – data from clinical and daytime ambulatory blood pressure measurement, II – clinical and home BP assessment, III – only ambulatory BP measurement, IV – clinical and laboratory BP data, and V – only clinical BP measurement. There are following WCE in patients with HTN: female sex, age, never smoking, as well as anxiety, introversion, etc. WCE is due to the patient’s anxiety state during office BP measurement and a conditioned reflex BP increase associated both with the physician presence and medical background. Severe WCE in some groups of patients with HTN may be associated with a worse prognosis compared with other hypertensive patients as follows: in individuals with a significant difference between clinical and ambulatory blood pressure levels or between the first and third BP office data, with a combination of resistant HTN and WCE, with WCE increasing from visit to visit, etc.

GeogRaphic and socioecoNomic Distribution of real-world Indian data of home blood pressure monitoring (GRAND Study): Study protocol for an observational study in 18 medical centers across India.

One-fourth of death in India is attributed to cardiovascular disease (CVD) and more than 80% is related to ischemic heart disease and stroke. The main risk factor for CVD is hypertension. Every third person in India suffers from hypertension and the prevalence increased drastically in the past 20 years, especially among the youngest age group of 20 and 44 years. Regardless of being under anti-hypertension medication, the blood pressure (BP) control rate in the country is still low ranging between 6% and 28% only. Assessing the "true BP control rate" should be performed using both clinic BP measurement and out-of-office BP measurement as the latter shows better prognosis for patients' hypertension and CVD outcomes. Home blood pressure monitoring (HBPM) shows superiority over ambulatory BP measurement as multiple measurements can be collected at the patient's convenience. Only limited evidence on HBPM in India is available and it's either lacking in hypertension participants or of a small sample size. This study will investigate the real BP control status among 2000 hypertensive patients from 18 centers in 12 states across Pan-India. The outcome of this study will emphasize the value of establishing BP control management practice guidelines suitable for physicians and help policymakers in building proper strategies for hypertension management to reduce the CVD burden on the health situation in India.

Impact of Nonsurgical Periodontal Treatment on Blood Pressure: A Prospective Cohort Study.

Arterial hypertension and periodontitis are two of the most common diseases worldwide and recent evidence supports a causal relationship between them. Despite all antihypertensive strategies, an important number of patients are undiagnosed and a large number of the diagnosed fail to achieve optimal blood pressure (BP) measurements. Some studies point out that periodontal treatment could have positive effects on BP levels. The aim of this study is to determine if nonsurgical periodontal treatment can help BP level control in prehypertensive patients with periodontitis. Thirty-five patients were included in the study and received nonsurgical periodontal treatment according to necessity. Clinical data, periodontal data, and BP measurements were taken at baseline, periodontal re-evaluation visit (4-6 weeks after treatment), and 6-month follow-up. Periodontal treatment caused a statistically significant reduction (p < 0.05) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at re-evaluation visit of 4.7 (p = 0.016) and 3.4 mm Hg (p = 0.015), respectively. The effect was maintained at 6-month follow-up visit with a reduction in SBP and DBP of 5.2 (p = 0.007) and 3.7 (p = 0.003) mm Hg, respectively. Despite the limitations of this study, it suggests that nonsurgical periodontal treatment can be effective in lowering BP levels in patients with prehypertension and periodontitis. Moreover, it highlights the importance of dentists in prevention, detection, and control of this important cardiovascular risk factor.

СПИРОНОЛАКТОН В СОСТАВЕ АНТИГИПЕРТЕНЗИВНОЙ ТЕРАПИИ ПЕРВОЙ ЛИНИИ: ВЛИЯНИЕ НА СОСУДИСТОЕ РЕМОДЕЛИРОВАНИЕ

Introduction. Previously, clinical studies have proven a pronounced antihypertensive effect of spironolactone in patients with true resistant hypertension. The effectiveness of spironolactone as part of first-line therapy, as well as the effect on vascular wall remodeling, has not been studied. Target. To study the effect of spiroconolactone as part of the first line of therapy when added to telmisartan on indicators of vascular wall stiffness in patients with hypertension at high/very high cardiovascular risk. Materials and methods 32 patients (54 (45; 59) years old) were randomly divided into two groups: in the main group receiving spironolactone at a dose of 25 mg in addition to telmisartan (ARB/spironolactone) and in the group receiving hydrochlorothiazide/ARB combination (control). group). Inclusion criteria: age of patients (30-65 years), hypertension at high/very high cardiovascular risk without antihypertensive therapy, no contraindications to prescribed drugs. At baseline and 6 months later, all patients underwent clinical (office) blood pressure (BP) measurements, ABPM, endothelium-dependent vasodilation (EDVD), vascular remodeling indicators: central blood pressure (CAP), augmentation index, pulse wave velocity (PWV). In patients in the ARB/spironolactone group, serum potassium levels were assessed at baseline and after 4 weeks of treatment. Results. In both groups, a significant decrease in clinical and average daily blood pressure was revealed, as well as a decrease in the augmentation index and CAP. PWV in the carotid-radial segment (CWCR) did not significantly decrease in both groups, while PWV in the carotid-femoral area (CWCF) decreased in the ARB/spironolactone group from 9.8 (9.0; 10.6) m/s to 8.6 (8.0; 10.2) m/s (p = 0.0007). The dynamics of SPWcr was 0.9 (1.3;-0.5) m/s in the ARB/HCT group. In all patients, blood potassium was within reference values. Conclusions. Spironolactone as part of first-line therapy, when added to ARBs in patients with hypertension at high/very high cardiovascular risk, led to a significant decrease in clinical and mean daily blood pressure, as well as a decrease in PWCF.

Elevated blood pressure accelerates white matter brain aging among late middle-aged women: a Mendelian Randomization study in the UK Biobank.

Elevated blood pressure (BP) is a modifiable risk factor associated with cognitive impairment and cerebrovascular diseases. However, the causal effect of BP on white matter brain aging remains unclear. In this study, we focused on N = 228 473 individuals of European ancestry who had genotype data and clinical BP measurements available (103 929 men and 124 544 women, mean age = 56.49, including 16 901 participants with neuroimaging data available) collected from UK Biobank (UKB). We first established a machine learning model to compute the outcome variable brain age gap (BAG) based on white matter microstructure integrity measured by fractional anisotropy derived from diffusion tensor imaging data. We then performed a two-sample Mendelian randomization analysis to estimate the causal effect of BP on white matter BAG in the whole population and subgroups stratified by sex and age brackets using two nonoverlapping data sets. The hypertension group is on average 0.31 years (95% CI = 0.13-0.49; P < 0.0001) older in white matter brain age than the nonhypertension group. Women are on average 0.81 years (95% CI = 0.68-0.95; P < 0.0001) younger in white matter brain age than men. The Mendelian randomization analyses showed an overall significant positive causal effect of DBP on white matter BAG (0.37 years/10 mmHg, 95% CI 0.034-0.71, P = 0.0311). In stratified analysis, the causal effect was found most prominent among women aged 50-59 and aged 60-69. High BP can accelerate white matter brain aging among late middle-aged women, providing insights on planning effective control of BP for women in this age group.

Evaluation of office and ambulatory blood pressure in the practice of a primary care physician. Guidelines

The guidelines contain data on modern approaches to blood pressure assessment, the basic rules for its measurement, data interpretation, making conclusion, including with combined evaluation of clinical and ambulatory measurement data. Information on the diagnosis of hypertension, evaluation of the effectiveness of antihypertensive therapy using clinical and ambulatory blood pressure measurement, both with their separate and combined use, is reflected. Aspects related to the measurement of blood pressure when standing and the diagnosis of hypotension are briefly covered. The guidelines are intended for primary care physicians (internists, general practitioners, cardiologists, neurologists and other specialists), students of medical universities and postgraduate education institutions.

Abstract P327: “The More Data, The Better”: Patient Experiences With Blood Pressure Measurement For Hypertension Diagnosis

Background: Out-of-office blood pressure (BP) measurement is recommended when making new hypertension diagnoses. However, in current practice, hypertension is primarily diagnosed using clinic BP measurements. Objective: To understand patient attitudes about the accuracy and patient-centeredness of different BP measurement and hypertension diagnostic methods. Design: Qualitative study within a randomized controlled diagnostic study comparing the accuracy and acceptability of clinic BP, home BP monitoring (HBPM), and kiosk BP (in a waiting room or pharmacy) for diagnosing hypertension among patients in an integrated delivery system. All participants also completed 24-hour ambulatory blood pressure monitoring regimen (ABPM). Participants: Qualitative interview participants (aged 31-76 years) were recruited from the main study with a goal of balancing by study arms, measurement result (high vs normal ABPM), hypertension diagnosis status at 6 months, gender, and age. Approach: We conducted semi-structured interviews at two time points—shortly after completion of diagnostic testing and 6 months later—to explore attitudes and behaviors related to the different BP measurement diagnostic methods. Key results: Interview participants (n=35) found HBPM to be comfortable, convenient, and low burden, and believed it produced accurate results. Participants reported higher confidence in high BP measurements from HBPM or ABPM compared to measurement in clinics. Clinic measurements were reported as less convenient than HBPM. Participants overall did not favor kiosks due to concerns about accuracy and privacy. ABPM was described by participants as the most accurate method, partly due to repeated measurements over the 24-hour period in real-world contexts, but many found it uncomfortable and disruptive. Participants also noted that methods that involved repeated measures such as HBPM and ABPM were especially influential in making their own personal decision as to whether or not they had hypertension. Conclusions: Our findings suggest that strategies to enhance HBPM implementation for hypertension diagnosis in primary care may improve diagnosis and patient understanding of hypertension.

Abstract 109: Geriatric Unhoused Patients Presenting To A Free Clinic In Miami- Dade Had Significantly Higher Rates Of Stage 1 And 2 Hypertension And Are At Significantly Increased Risk For Untreated Hypertension Compared To Age- Matched General Population

Introduction: People over age 50 comprise 30% of people experiencing homelessness (PEH) in the United States and are predicted to increase exponentially in the next ten years. Few studies have documented PEH hypertension (HTN) prevalence, and treatment protocols rarely test their efficacy specifically when treating older PEH. The few geriatric PEH HTN studies that have been conducted are based out of homeless shelters, with even less known about the HTN rates of people experiencing unsheltered homelessness (PEUH) who constitute one-third of PEH nationally. Our objective is to assess prevalence of elevated blood pressure (BP) and HTN treatment rates among geriatric PEUH presenting at a free clinic in Miami-Dade County. Methods: Clinical information and BP measurements of 105 PEUH over 50 were documented as part of care by a street outreach medical team. Clinical information was recorded in a REDCap electronic database. De-identified data was compared to the Centers for Disease Control National Health and Nutrition Examination Survey 2017-2019 pre-pandemic cohort (CDC NHANES) and analyzed in R studio version 4.3.2. Results: PEUH were at significantly increased relative risk (RR) for Stage 1 HTN (RR 3.97, Confidence Interval (CI) 2.68-5.89, p&lt;0.0001) when compared to age- matched NHANES dataset. After 10-year age cohort stratification the small PEH sample size (N=11) lacked enough power to reach significance. PEUH were also found to be at significantly increased risk of Stage 2 HTN (RR 6.17, CI 4.93-7.73, p&lt;0.0001). Here findings remained significant after 10-year age cohort stratification (N=41). NHANES reports medication use by 20-year age groups: 50.8% of people aged 40-59, and 49.4% of people over 60 with diagnosed HTN were on BP control medication. PEUH were at significantly increased risk of untreated HTN (RR 1.67, CI 1.50-1.87, p&lt;0.0001). Only 15.9% were prescribed medication. Conclusion: Increased risk of elevated BP and untreated HTN among geriatric PEUH likely reflect barriers of access to chronic disease management. There are likely also unidentified confounding factors preventing proper care for this vulnerable population. Further investigation should critically assess gaps in the care to devise protocols for improving treatment outcomes.

Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol

Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions. The NEXTGEN-BP open-label, multicenter, randomized controlled trial will investigate the efficacy, safety, acceptability and cost-effectiveness of a wearable blood pressure monitor-based care strategy for the treatment of hypertension, compared to usual care, in lowering clinic blood pressure over 12 months. NEXTGEN-BP will enroll 600 adults with high blood pressure, treated with 0 to 2 antihypertensive medications. Participants attending primary care practices in Australia will be randomized 1:1 to the intervention of a wearable-based remote care strategy or to usual care. Participants in the intervention arm will undergo continuous blood pressure monitoring using a wrist-wearable cuffless device (Aktiia, Switzerland) and participate in 2 telehealth consultations with their primary care practitioner (general practitioner [GP]) at months 1 and 2. Antihypertensive medication will be up-titrated by the primary care practitioner at the time of telehealth consults should the percentage of daytime blood pressure at target over the past week be <90%, if clinically tolerated. Participants in the usual care arm will have primary care consultations according to usual practice. The primary outcome is the difference between intervention and control in change in clinic systolic blood pressure from baseline to 12 months. Secondary outcomes will be assessed at month 3 and month 12, and include acceptability to patients and practitioners, cost-effectiveness, safety, medication adherence and patient engagement. NEXTGEN-BP will provide evidence for the effectiveness and safety of a new paradigm of wearable cuffless monitoring in the management of high blood pressure in primary care. ACTRN12622001583730.

Validation of the YuWell YE660D oscillometric upper-arm blood pressure monitor for clinic and home in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard (International Organization for Standardization 81060-2:2018) and the International Organization for Standardization Amendment 1. 2020.

To evaluate the accuracy of the YuWell YE660D oscillometric upper-arm blood pressure (BP) monitor in general population (for clinic and home BP measurements in adults) according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2 : 2018) and its Amendment 1. 2020. Subjects were recruited to fulfill the age, sex, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumferences 22-32 cm (standard) and 22-45 cm (wide range). Ninety-two subjects were recruited and 85 subjects were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.3 ± 7.2/2.2 ± 5.5 mmHg (systolic/diastolic). For validation criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 6.1/4.8 mmHg (systolic/diastolic). The YuWell YE660D oscillometric upper-arm electronic BP monitor has passed the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2 : 2018) and its Amendment 1. 2020 in adults and hence can be recommended for home and clinical use.

Blood pressure measurement and blood pressure control in Veterans Affairs medical centers.

The Veterans Affairs (VA) medical centers provide care for millions of Veterans at high risk of cardiovascular disease and accurate BP measurement in this population is vital for optimal BP control. Few studies have examined terminal digit preference (TDP), a marker of BP measurement bias, clinician perceptions of BP measurement, and BP control in VA medical centers. This mixed methods study examined BP measurements from Veterans aged 18 to 85 years with hypertension and a primary care visit within 8 VA medical centers. TDP for all clinic BP measurements was examined using a goodness of fit test assuming 10% frequency for each digit. Interviews were also conducted with clinicians from 3 VA medical centers to assess perceptions of BP measurement. The mean age of the 98,433 Veterans (93% male) was 68.5 years (SD 12.7). BP was controlled(<140/90mmHg) in 76.5% and control rates ranged from 72.2% to 81.0% across the 8 VA medical centers. Frequency of terminal digits 0 through 9 differed significantly from 10% for both SBP and DBP within each center (P<.001) but level of TDP differed by center. The highest BP control rates were noted in centers with highest TDP for digits 0 and 8 for both SBP and DBP. Clinicians reported use of semi-automated oscillometric devices for clinic BP measurement, but elevated BP readings were often confirmed by auscultatory methods. Significant TDP exists for BP measurement in VA medical centers, which reflects continued use of auscultatory methods.

Classification of blood pressure during sleep impacts designation of nocturnal nondipping.

The identification of nocturnal nondipping blood pressure (< 10% drop in mean systolic blood pressure from awake to sleep periods), as captured by ambulatory blood pressure monitoring, is a valuable element of risk prediction for cardiovascular disease, independent of daytime or clinic blood pressure measurements. However, capturing measurements, including determination of wake/sleep periods, is challenging. Accordingly, we sought to evaluate the impact of different definitions and algorithms for defining sleep onset on the classification of nocturnal nondipping. Using approaches based upon participant self-reports, applied definition of a common sleep period (12 am -6 am), manual actigraphy, and automated actigraphy we identified changes to the classification of nocturnal nondipping, and conducted a secondary analysis on the potential impact of an ambulatory blood pressure monitor on sleep. Among 61 participants in the Eastern Caribbean Health Outcomes Research Network hypertension study with complete ambulatory blood pressure monitor and sleep data, the concordance for nocturnal nondipping across methods was 0.54 by Fleiss' Kappa (depending on the method, 36 to 51 participants classified as having nocturnal nondipping). Sleep quality for participants with dipping versus nondipping was significantly different for total sleep length when wearing the ambulatory blood pressure monitor (shorter sleep duration) versus not (longer sleep duration), although there were no differences in sleep efficiency or disturbances. These findings indicate that consideration of sleep time measurements is critical for interpreting ambulatory blood pressure. As technology advances to detect blood pressure and sleep patterns, further investigation is needed to determine which method should be used for diagnosis, treatment, and future cardiovascular risk.

CORRELATION BETWEEN CLINIC AND AMBULATORY BLOOD PRESSURE MEASUREMENT

Objective: Blood pressure (BP) measurements taken in the clinic provide limited information about the BP load. Ambulatory blood pressure monitoring (ABPM) provide a more comprehensive assessment of blood pressure over the course of a day. This study examined the correlation between clinic and ambulatory BP measurements. Design and method: We collated clinic and 24 hour ambulatory BP data of 100 patients aged &gt; 18 years from the outpatient cardiology clinic of Mohamed Taher Maamouri University hospital in Nabeul (n = 100) over a six months period (July-December 2021). Laying of ABPM was performed using a Bravo Mini validated device from Sun Tech Medical. We used the Pearson correlation coefficient (r) to measure the strength of the relationship between these two measurements methods. Results: The mean age of our population was 59.14±13.12 years (range 21-92 years), composed of 47 women and 53 men. The most frequent reason for carrying out ABPM was the monitoring of hypertensive patients in 84% of cases, 16% were done to confirm the diagnosis of hypertension. ABPM confirmed the diagnosis of hypertension in 62.5% and detected 18.75% isolated nocturnal hypertension in patients with suspected hypertension and 14.3% masked uncontrolled nocturnal hypertension in hypertensive patients. Concordance was found in 66% of cases between clinic measurement and the 24-hour ABPM data. There was a weak correlation between clinic systolic BP and 24-hour ambulatory systolic BP (P &lt;0.001; r = 0.349; Curve A) and moderate correlation between clinic diastolic BP and 24-hour ambulatory diastolic BP (P &lt;0.001; r = 0.566; Curve B). Conclusions: The correlation between these two methods isn’t important mainly explained by variation of BP especially at night detected by ABPM which remains the reference method for diagnosing and monitoring hypertension

PROGRESSION OF HYPERTENSION-MEDIATED ORGAN DAMAGE IN PATIENTS WITH AND WITHOUT NONALCOHOLIC FATTY LIVER DISEASE

Objective: Nonalcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease and is associated with an increased risk of cardiovascular death. Fatty liver index (FLI) is a validated marker of NAFLD and can be used as a screening measure of hepatic steatosis. The purpose of the study was to compare the progression of hypertension-mediated organ damage (HMOD) in hypertensive patients with and without NAFLD. Design and method: Hypertensive patients (n = 60) without a history of cardiovascular disease participated in the study (mean age, 52 years; males, 55%; baseline clinic BP, 145/92 mmHg) and were followed for one year. In the baseline visit, FLI was calculated, and patients were divided into two groups by FLI below 60 or 60 or above (i.e., high-risk of NAFLD). All patients underwent clinic and 24-hour ambulatory BP measurements, echocardiographic examination, nailfold capillaroscopy, pulse wave velocity, and urinary albumin excretion assessment (albumin to creatinine ratio, [ACR]). Left ventricular mass index (LVMI) was also calculated using the Devereux formula. Results: In baseline visit, patients with FLI &gt; or = 60 (n = 32) compared to the control group had higher values of ACR (26.5±57mg/g vs. 9.6±6.3 mg/g, p = 0.02) and lower values of capillary densities (75±18cap/mm2 vs. 86±12cap/mm2, p = 0.002), whereas there was no relative difference in PWV and LVMI. At the end of follow-up, patients with FLI &gt; or = 60 had higher values of ACR (12.6±11.9 mg/g vs. 6.8±5.3 mg/g p = 0.025), PWV (9.9±2m/sec vs. 8.8±1.3 m/sec, p = 0.02), LVMI (81.4±13.2 g/m2 vs. 72.5±13.2 g/m2, p = 0.02) but lower number of capillaries (65.1±8.8 cap/mm2 vs. 79.6±7.5 cap/mm2, p&lt;0.001). Linear regression analysis revealed that FLI &gt; or = 60 was an independent determinant of follow-up ACR, PWV, LVMI, and the number of capillaries. Conclusions: Increased FLI may adversely modify the progression of HMOD in hypertension.

Nocturnal Blood Pressure Assessment, an Entity of High Prognostic Value, Not Utilized to Its Potential in Clinical Practice

Hypertension, a disease of epidemic proportion, is assessed by measuring blood pressure (BP). Various methods are employed, the most common being “clinic blood pressure measurement (CBPM).” However, environment and technical errors can confound it. Other methods include home blood pressure measurement (HBPM), which shows readings of awake time only, and 24-hour ambulatory blood pressure monitoring (ABPM). A recent technique that causes less sleep disturbance is “timed HBPM.” Blood pressure is a 24-hour phenomenon, and prognostically night time blood pressure, being more important, must be assessed properly. Besides providing the precise mean of 24-hour blood pressure, it extends knowledge regarding many other parameters of clinical importance like dipping pattern and morning surge etc. For nocturnal BP assessment, 24-hour ABPM and time-triggered HBPM are utilized. The importance of nocturnal blood pressure assessment for diagnostic and prognostic evaluation of various cardiovascular and non-cardiovascular conditions would be highlighted in this review article.

A Machine Learning Approach to the Non-Invasive Estimation of Continuous Blood Pressure Using Photoplethysmography

Blood pressure is an important vital sign that sometimes requires continuous measurement. The current methods include cuff measurements (manual auscultation and oscillometric techniques) for non-continuous measurement and invasive arterial cannulation for continuous measurement. The use of photoplethysmography as a cuffless, non-invasive, and continuous blood pressure measurement system is investigated through the use of four neural networks. These predict the systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and waveform shape. The models are trained on 890 h of data from 1669 patients in the MIMIC-III database. Feature-trained artificial neural networks predict the systolic blood pressure to 5.26 ± 6.53 mmHg (mean error ± standard deviation), the diastolic blood pressure to 2.96 ± 3.31 mmHg, and the mean arterial pressure to 3.27 ± 3.55 mmHg. These are used to shift and scale the predicted waveform, allowing the waveform prediction neural network to optimise for the wave shape rather than the amplitude. The waveform prediction has 86.4% correlation with the actual arterial blood pressure waveform. All results meet international clinical blood pressure measurement standards and could potentially change how blood pressure is measured in both clinical and research settings. However, more data from healthy individuals and analysis of the models’ biases based on clinical features is required.

Hypertension care during the COVID-19 pandemic in an integrated health care system.

Retention in hypertension care, medication adherence, and blood pressure (BP) may have been affected by the COVID-19 pandemic. In a retrospective cohort study of 64766 individuals with treated hypertension from an integrated health care system, we compared hypertension care during the year pre-COVID-19 (March 2019-February 2020) and the first year of COVID-19 (March 2020-February 2021). Retention in hypertension care was defined as receiving clinical BP measurements during COVID-19. Medication adherence was measured using prescription refills. Clinical care was assessed by in-person and virtual visits and changes in systolic and diastolic BP. The cohort had a mean age of 67.8 (12.2) years, 51.2% were women, and 73.5% were White. In 60757 individuals with BP measurements pre-COVID-19, 16618 (27.4%) had no BP measurements during COVID-19. Medication adherence declined from 86.0% to 80.8% (p< .001). In-person primary care visits decreased from 2.7 (2.7) to 1.4 (1.9) per year, while virtual contacts increased from 9.5 (12.2) to 11.2 (14.2) per year (both p < .001). Among individuals with BP measurements, mean (SD) systolic BP was 126.5 mm Hg (11.8) pre-COVID-19 and 127.3 mm Hg (12.6) during COVID-19 (p= .14). Mean diastolic BP was 73.5 mm Hg (8.5) pre-COVID-19 and 73.5 mm Hg (8.7) during COVID-19 (p= .77). Even in this integrated health care system, many individuals did not receive clinical BP monitoring during COVID-19. Most individuals who remained in care maintained pre-COVID BP. Targeted outreach may be necessary to restore care continuity and hypertension control at the population level.

Abstract 57: Distinct Gestational Blood Pressure Trajectories Predict Pregnancy, Birth, and Postpartum Health in a Low-Income Hispanic Population

Objective: Blood pressure (BP) typically drops to a nadir around 20 to 24 gestation weeks in a normal pregnancy. Distinct BP trajectories over pregnancy could reveal underlying cardiovascular function and predict future cardiovascular risk, but little is known about BP trajectories in Hispanic women. We aim to identify BP trajectories during pregnancy among low-income, Hispanic women. Methods: In the prospective Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) pregnancy cohort, we abstracted clinic BP measures of 732 participants who had an average of 12 BP measures over pregnancy, ranging from 4 to 41 weeks. We used latent class mixture modeling to identify BP trajectories. We examined associations of population characteristics, pregnancy and birth outcomes, and 1-year postpartum BP with the identified trajectories. Results: We identified three distinct BP trajectories ( Figure ). Compared to the majority (class 1, n=569), the consistently high class 2 (14.8%, 108) was characterized by a higher pre-pregnancy BMI (ppBMI, 32.3±7.6 vs. 27.6 ±6.1 Kg/m 2 ) and a higher proportion of having college or above education (21.3% vs. 14.9%), while the high-low-high U-shape class 3 (7.5%, 55) had a higher ppBMI (32.0±7.9 Kg/m 2 ) but lower proportion of having college or above education (9.1%). Risk of preeclampsia was the highest in class 3 (43.6%), followed by class 2 (10.2%) and class 1 (6.0%), while the risk of gestational diabetes was the highest in class 2 (14.8%), followed by class 1 (7.9%) and class 3 (7.3%). Birthweight and gestational duration were both significantly lower in class 3 than classes 1 and 2. One-year postpartum systolic BP was significantly higher in class 2 (120.2±16.0 mmHg) and class 3 (122.4±16.0 mmHg) than class 1 (111.7±26.2 mmHg) after adjusting for maternal age, pre-pregnancy BMI, parity, and education. Conclusion: Elevated blood pressure may develop into district trajectories in pregnancy that further predict pregnancy and birth outcomes, as well as postpartum blood pressure.

Abstract P307: Elevated Blood Pressure Accelerates White Matter Brain Aging in Late Middle-Aged Women: A Mendelian Randomization Study in UK Biobank

Background: Elevated blood pressure (BP) is a modifiable risk factor associated with cognitive impairment and cerebrovascular diseases. However, the causal effect of BP on white matter (WM) brain aging remains unclear. In this study, we hypothesize that increasing BP will accelerate WM brain aging. Methods: In our study, we focused on N=219,968 non-pregnant, family-unrelated individuals of European ancestry who had genotype data and two non-null clinical BP measurements available (99,532 male and 120,436 female, age range: 40-69, 16,901 have neuroimaging data available) collected from UK Biobank (UKBB). In the current study, we adopted a chronological age-adjusted brain age metric, Brain Age Gap (BAG), as the outcome variable to measure the brain aging status. As a first step, we applied machine learning method to establish the model to compute BAG based on fractional anisotropy (FA) measurements derived from structural neuroimaging data among a group of subjects without hypertension (N=7,728). The established model will be applied to calculate WM BAG in other subjects with or without hypertension. We then performed association analysis as well as a two-sample Mendelian Randomization (MR) analysis to estimate the causal effect of BP on WM BAG in the whole population and subgroups stratified by gender and age brackets . In the first sample with genotype and BP data but no WM FA data (N=20,3067), we tested the genetic-exposure association and identified relevant genetic variants as instrumental variables. In the second non-overlapping sample with genotype, BP, and WM FA data, we tested the genetic-outcome association (N=8,822). The causal effect of BP on WM BAG is estimated by using a generalized version of the inverse-variance weighted (IVW) approach. Results: The non-hypertension group and females had younger brains (WM BAG) across all the year cycles than the hypertension group by 0.3098 year and males by 1.2666 years, respectively, both p &lt;0.0001. The association analysis revealed that both Diastolic Blood Pressure (DBP) and Systolic Blood Pressure (SBP) had a stronger significant relationship with WM BAG among females (&amp;#946;SBP=0.0149; &amp;#946;DBP=0.0233), 50-59 aged group (&amp;#946;SBP=0.0163; &amp;#946;DBP=0.0259), and 60-69 aged group (&amp;#946;SBP=0.0086; &amp;#946;DBP=0.0147), all p &lt; 0.0001. The MR analyses showed that DBP had a significant causal effect on WM BAG among females aged 50-59 (&amp;#946;=0.0720, p=0.0243) and females aged 60-69 (&amp;#946;=0.1000, p=0.0085). We only observed SBP had a marginal causal effect (0.05&lt;p&lt;0.1) among males aged 50-59 (&amp;#946;= -0.0458), females aged 40-49 (&amp;#946;= -0.0446) and aged 50-59 (&amp;#946;=0.0326). Conclusion: Hypertension and genetic predisposition to higher BP can accelerate WM brain aging specifically targeting at late middle-aged women, providing insights on planning effective control of BP for women in this age group.

Validation of the Hingmed DBP-01P clinical automatic blood pressure monitor provided with wide-range cuff, evaluated in a general population according to the ISO 81060-2:2018 protocol.

To determine the accuracy of the Hingmed DBP-01P monitor for clinical automatic blood pressure (BP) measurement according to the International Organization for Standardization (ISO) 81060-2 2018 protocol. The DBP-01P was tested in 85 subjects from the general population (mean age, 69.9 years; 43 men) using a wide-range cuff for arm circumferences from 17 to 42 cm. The mean device-observer difference was 1.32 ± 3.18 mmHg for SBP and 0.78 ± 3.15 mmHg for DBP. These data were in agreement with criterion 1 of the protocol standard requirements (≤5 ± 8 mmHg). Also, criterion 2 was satisfied with the SDs of the 85 participants being well below the maximum values required by the protocol (6.80 and 6.89 mmHg for SBP and DBP pressure, respectively). These data show that the Hingmed BP monitor DBP-01P satisfied the ISO 81060-2:2018 standard requirements for a general population across a wide range of arm sizes using a single wide-range cuff.