Sphygmomanometer Research Articles

Visual assessment of Korotkoff sounds improves the accuracy of a validated professional automated auscultatory blood pressure monitor KOROT P3 Accurate.

A novel automated auscultatory upper-arm cuff blood pressure (BP) monitor for office use (KOROT P3 Accurate, previously InBody BPBIO480KV), which displays Korotkoff sound curves for each BP reading was recently developed. This study investigated whether the review of Korotkoff sound curves by healthcare professionals further improves the accuracy of the device by identifying unreliable BP readings. Three observers assessed independently the morphology of Korotkoff sound curves of BP measurements obtained during an ISO 81060-2:2018 validation study, and classified them as of good, fair, or poor quality (low amplitude or sound intensity, aberrant morphology, background noise, signal artifact, auscultatory gap, irregular rhythm). The observers were blinded to the study BP measurements. Korotkoff sound curves of 255 BP readings obtained in 85 individuals were analyzed (mean age 57.3 ± 15.0 years, 53 men). Of the SBP readings 80.4/12.2/7.4% were classified as good/fair/poor, and DBP 76.9/12.2/10.9%. Inter-observer agreement in detecting poor-quality curves was 84.7/83.1% (systolic/diastolic). Of poor-quality curves, 10.5/60.7% (systolic/diastolic) clustered in the same individuals. The validation criterion 1 [mean test-reference BP difference ≤5 ± 8 (SD) mmHg] was satisfied for readings with good (0.1 ± 4.9/0.3 ± 3.8 mmHg, systolic/diastolic) and fair-quality curves (-0.4 ± 6.4/0.2 ± 5.0), but not for poor-quality ones (2.7 ± 8.8/3.6 ± 8.1). By excluding poor-quality readings (40 of 255), criterion 1 of the validation study was improved (0.2 ± 4.9/0.2 ± 3.9 versus 0.3 ± 5.5/0.6 ± 4.7 mmHg). The visual assessment of Korotkoff sounds generated during automated auscultatory BP measurement by the KOROT P3 Accurate professional monitor identifies unreliable readings and further improves the device accuracy.

Paradox pain sensitivity using cuff pressure or algometer testing in patients with hemophilia.

Pain is a common comorbidity in patients with hemophilia (PwH) due to hemophilic arthropathy. This study aims to explore pain sensitivity in PwH methodologically investigating in cuff pressure testing compared to algometer testing. 37 PwH and 35 healthy control subjects (Con) enrolled in this study. Joint health status was assessed. Subjective pain was evaluated using numeric rating scales. Pain sensitivity was measured with pressure algometry and cuff pressure algometry. Pressure pain thresholds of the algometer (PPTa) were measured at knee, ankle joints, and forehead. Subsequently, thresholds of cuff pressure were measured at the left and right lower legs (PPTcuff). In both, lower values represent higher pain sensitivity. PwH exerted a worse joint health status than Con. Pain sensitivity was higher in PwH compared to Con as PPTa of the knee and ankle joints were lower in PwH. No difference was observed in PPTa at the forehead. Contrastingly, lower pain sensitivity was detected in PwH by higher PPTcuff values compared to Con in both legs. While PPTa of the knee and ankle joints are lower in PwH, PPTcuff are higher in PwH compared to Con. This reveals a paradox situation, highlighting that PwH experience local, joint- and hemophilic arthropathy-related pain, whereas pain sensitivity of non-affected soft tissue structures is lower. The reasons explaining the PPTcuff results remain elusive but might be explained by coping strategies counteracting chronic joint pain, resulting in lower sensitivity at non-affected structures.

Validation of a Suprasystolic Cuff System for Static and Dynamic Representation of the Central Pressure Waveform.

Noninvasive pulse waveform analysis is valuable for central cardiovascular assessment, yet controversies persist over its validity in peripheral measurements. Our objective was to compare waveform features from a cuff system with suprasystolic blood pressure hold with an invasive aortic measurement. This study analyzed data from 88 subjects undergoing concurrent aortic catheterization and brachial pulse waveform acquisition using a suprasystolic blood pressure cuff system. Oscillometric blood pressure (BP) was compared with invasive aortic systolic BP and diastolic BP. Association between cuff and catheter waveform features was performed on a set of 15 parameters inclusive of magnitudes, time intervals, pressure-time integrals, and slopes of the pulsations. The evaluation covered both static (subject-averaged values) and dynamic (breathing-induced fluctuations) behaviors. Peripheral BP values from the cuff device were higher than catheter values (systolic BP-residual, 6.5 mm Hg; diastolic BP-residual, 12.4 mm Hg). Physiological correction for pressure amplification in the arterial system improved systolic BP prediction (r2=0.83). Dynamic calibration generated noninvasive BP fluctuations that reflect those invasively measured (systolic BP Pearson R=0.73, P<0.001; diastolic BP Pearson R=0.53, P<0.001). Static and dynamic analyses revealed a set of parameters with strong associations between catheter and cuff (Pearson R>0.5, P<0.001), encompassing magnitudes, timings, and pressure-time integrals but not slope-based parameters. This study demonstrated that the device and methods for peripheral waveform measurements presented here can be used for noninvasive estimation of central BP and a subset of aortic waveform features. These results serve as a benchmark for central cardiovascular assessment using suprasystolic BP cuff-based devices and contribute to preserving system dynamics in noninvasive measurements.

Association of Arterial Stiffness With Mid- to Long-Term Home Blood Pressure Variability in the Electronic Framingham Heart Study: Cohort Study.

Short-term blood pressure variability (BPV) is associated with arterial stiffness in patients with hypertension. Few studies have examined associations between arterial stiffness and digital home BPV over a mid- to long-term time span, irrespective of underlying hypertension. This study aims to investigate if arterial stiffness traits were associated with subsequent mid- to long-term home BPV in the electronic Framingham Heart Study (eFHS). We hypothesized that higher arterial stiffness was associated with higher home BPV over up to 1-year follow-up. At a Framingham Heart Study research examination (2016-2019), participants underwent arterial tonometry to acquire measures of arterial stiffness (carotid-femoral pulse wave velocity [CFPWV]; forward pressure wave amplitude [FWA]) and wave reflection (reflection coefficient [RC]). Participants who agreed to enroll in eFHS were provided with a digital blood pressure (BP) cuff to measure home BP weekly over up to 1-year follow-up. Participants with less than 3 weeks of BP readings were excluded. Linear regression models were used to examine associations of arterial measures with average real variability (ARV) of week-to-week home systolic (SBP) and diastolic (DBP) BP adjusting for important covariates. We obtained ARV as an average of the absolute differences of consecutive home BP measurements. ARV considers not only the dispersion of the BP readings around the mean but also the order of BP readings. In addition, ARV is more sensitive to measurement-to-measurement BPV compared with traditional BPV measures. Among 857 eFHS participants (mean age 54, SD 9 years; 508/857, 59% women; mean SBP/DBP 119/76 mm Hg; 405/857, 47% hypertension), 1 SD increment in FWA was associated with 0.16 (95% CI 0.09-0.23) SD increments in ARV of home SBP and 0.08 (95% CI 0.01-0.15) SD increments in ARV of home DBP; 1 SD increment in RC was associated with 0.14 (95% CI 0.07-0.22) SD increments in ARV of home SBP and 0.11 (95% CI 0.04-0.19) SD increments in ARV of home DBP. After adjusting for important covariates, there was no significant association between CFPWV and ARV of home SBP, and similarly, no significant association existed between CFPWV and ARV of home DBP (P>.05). In eFHS, higher FWA and RC were associated with higher mid- to long-term ARV of week-to-week home SBP and DBP over 1-year follow-up in individuals across the BP spectrum. Our findings suggest that higher aortic stiffness and wave reflection are associated with higher week-to-week variation of BP in a home-based setting over a mid- to long-term time span.

Timing and Patient Position During Cuff Blood Pressure Measurement Affect Myocardial Work Parameters Measured by Echocardiography

Although cuff blood pressure measurement is a critical parameter to calculate myocardial work noninvasively, there is no recommendation about when and how to measure it. Accordingly, we sought to evaluate the effects of the timing during the echo study and the patient's position on the scanning bed during the cuff blood pressure measurement on myocardial work parameter calculations. One hundred one consecutive patients (44 women, 66±14years) undergoing clinically indicated echocardiography were prospectively enrolled. During the echocardiographic study, we measured the cuff blood pressure 4 times, using a fully automatic digital blood pressure monitor applied to the right and left arm in the same position throughout the study: BP1, before the start of the echo study, with the patient lying in the supine position; BP2, after positioning the patients on their left side to start the echo study; BP3, at the time of the acquisition of the 3 apical views (4- and 2-chamber and long-axis) used to measured left ventricular global longitudinal strain; and BP4, at the end of the echo study with the patient again in the supine position. Systolic blood pressureat BP1 was 147±21mm Hg. Between BP1 and BP2, it dropped by 17±9mm Hg (P<.05). Systolic blood pressure at BP3 was significantly lower than BP2 (130±20mm Hg vs 122±18mm Hg, P<.05), and at BP4 was significantly lower than at BP1 (-9 ± 13mm Hg, P<.05). The average global longitudinal strain was -16%±3%. Accordingly, the global work index was 1,929±441mm Hg% at BP1, dropped to 1,717±421 at BP2, decreased to 1,602±351mm Hg% at BP3, and increased to 1,815±386mm Hg% at BP4 (P<.001). The timing during the echocardiography study and the patient's position on the scanning bed are critical determinants of the measured cuff systolic blood pressure and the resulting values of myocardial work parameters.

Telephone-Based Guideline-Directed Medical Therapy Optimization in Navajo Nation

Underutilization of guideline-directed medical therapy for heart failure with reduced ejection fraction is a major cause of poor outcomes. For many American Indian patients receiving care through the Indian Health Service, access to care, especially cardiology care, is limited, contributing to poor uptake of recommended therapy. To examine whether a telehealth model in which guideline-directed medical therapy is initiated and titrated over the phone with remote telemonitoring using a home blood pressure cuff improves guideline-directed medical therapy use (eg, drug classes and dosage) in patients with heart failure with reduced ejection fraction in Navajo Nation. The Heart Failure Optimization at Home to Improve Outcomes (Hózhó) randomized clinical trial was a stepped-wedge, pragmatic comparative effectiveness trial conducted from February to August 2023. Patients 18 years and older with a diagnosis of heart failure with reduced ejection fraction receiving care at 2 Indian Health Service facilities in rural Navajo Nation (defined as having primary care physician with 1 clinical visit and 1 prescription filled in the last 12 months) were enrolled. Patients were randomized to the telehealth care model or usual care in a stepped-wedge fashion, with 5 time points (30-day intervals) until all patients crossed over into the intervention. Data analyses were completed in January 2024. A phone-based telehealth model in which guideline-directed medical therapy is initiated and titrated at home, using remote telemonitoring with a home blood pressure cuff. The primary outcome was an increase in the number of guideline-directed classes of drugs filled from the pharmacy at 30 days postrandomization. Of 103 enrolled American Indian patients, 42 (40.8%) were female, and the median (IQR) age was 65 (53-77) years. The median (IQR) left ventricular ejection fraction was 32% (24%-36%). The primary outcome occurred significantly more in the intervention group (66.2% vs 13.1%), thus increasing uptake of guideline-directed classes of drugs by 53% (odds ratio, 12.99; 95% CI, 6.87-24.53; P < .001). The number of patients needed to receive the telehealth intervention to result in an increase of guideline-directed drug classes was 1.88. In this heart failure trial in Navajo Nation, a telephone-based strategy of remote initiation and titration for outpatients with heart failure with reduced ejection fraction led to improved rates of guideline-directed medical therapy at 30 days compared with usual care. This low-cost strategy could be expanded to other rural settings where access to care is limited. ClinicalTrials.gov Identifier: NCT05792085.

Blood Pressure Lowering in Patients With Central Hypertension: A Randomized Clinical Trial.

Cuff blood pressure (BP) is recommended for guiding hypertension management. However, central BP has been proposed as a superior clinical measurement. This study aimed to determine whether controlling hypertension as measured by central BP was beneficial in reducing left ventricular mass index beyond control of standard cuff hypertension. This multicenter, open-label, blinded-end point trial was conducted in individuals treated for uncomplicated hypertension with controlled cuff BP (<140/90 mm Hg) but elevated central BP (≥0.5 SD above age- and sex-specific normal values). Participants were randomized to 24-months intervention with spironolactone 25 mg/day (n=148) or usual care control (n=153). The primary outcome was change in left ventricular mass index measured by cardiac MRI. Cuff and central BPs were measured by clinic, 7-day home and 24-hour ambulatory BPs. At 24-months, there was a greater reduction in left ventricular mass index (-3.2 [95% CI, -5.0 to -1.3] g/m2; P=0.001) with intervention compared with control. Cuff and central BPs were lowered by a similar magnitude across all BP measurement modes (eg, clinic cuff systolic BP, -6.16 [-9.60 to -2.72] mm Hg and clinic central systolic BP, -4.96 [-8.06 to -1.86] mm Hg; P≥0.48 all). Secondary analyses found that changes in left ventricular mass index correlated to changes in BP, with the magnitude of effect nearly identical for BP measured by cuff (eg, 24-hour systolic BP, β, 0.17 [0.02-0.31] g/m2) or centrally (24-hour systolic BP, β, 0.16 [0.01-0.32] g/m2). Among individuals with central hypertension, spironolactone had beneficial effects in reducing LV mass. Secondary analyses showed that changes in LV mass were equally well associated with lower measured standard cuff BP and central BP. URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12613000053729.

Conditioned pain modulation (CPM) paradigm type affects its sensitivity as a biomarker of fibromyalgia

Fibromyalgia (FM) is a widespread chronic pain syndrome, possibly associated with the presence of central dysfunction in descending pain inhibition pathways. Conditioned Pain Modulation (CPM) has been proposed as a biomarker of FM. Nonetheless, the wide variety of methods used to measure CPM has hampered robust conclusions being reached. To clarify the validity of CPM as a biomarker of FM, we tested two CPM paradigms (parallel and sequential) in a sample of 23 female patients and 23 healthy women by applying test (mechanical) stimuli and conditioning (pressure cuff) stimuli. We evaluated whether CPM indices could correctly classify patients and controls, and we also determined the correlations between the indices and clinical variables such as symptomatology, disease impact, depression, quality of life, pain intensity, pain interference, fatigue and numbness. In addition, we compared the clinical status of CPM responders (efficient pain inhibitory mechanism) and non-responders. We observed that only parallel CPM testing correctly classified about 70% of patients with FM. In addition, more than 80% of healthy participants were found to be responders, while the rate was about 50% in the FM patients. The sequential CPM test was not as sensitive, with a decrease of up to 40% in the response rate for both groups. On the other hand, we did not observe any correlation between CPM measures and clinical symptoms. In summary, our findings demonstrate the influence of the CPM paradigm used and confirm that CPM may be a useful marker to complement FM diagnosis. However, the findings also cast doubts on the sensitivity of CPM as a marker of pain severity in FM.

Postpartum Remote Blood Pressure Monitoring Using a Mobile App in Women with a Hypertensive Disorder of Pregnancy.

Hypertensive disorders of pregnancy affect approximately 15% of pregnancies in the United States and are a leading cause of postpartum readmissions. Morbidity due to hypertension may be higher in the first several weeks postpartum. The ability to monitor blood pressure and intervene in the postpartum period is critical to reducing morbidity and mortality. At WellSpan Health, hypertensive disorders were increasing and a leading cause of severe maternal morbidity and readmission. A remote blood pressure monitoring app called BabyScripts™ myBloodPressure was implemented in September 2020. Prior to discharge postpartum, all patients with a diagnosis of a hypertensive disorder of pregnancy were given an automatic blood pressure cuff and instructions on how to monitor and track their blood pressure daily in the app. A total of 1,260 patients were enrolled in the BabyScripts™ myBloodPressure module between September 2020 and July 2022 across five maternity hospitals. Of those enrolled 74% ( n = 938) entered seven or more blood pressures, and of those who entered at least one blood pressure 9% ( n = 107) entered at least one critical range blood pressure ( ≥ 150 mmHg systolic and or ≥ 100 mmHg diastolic). Most women enrolled in the app were highly engaged and entered seven or more readings. Patients with critical blood pressures were identified; thus, the program has the potential to identify those at risk of severe complications. Barriers should be removed, and remote patient monitoring considered as a solution to improve postpartum assessment in patients with hypertensive disorders of pregnancy.

Concurrent validity of dynamic bedside quantitative sensory testing paradigms in breast cancer survivors with persistent pain.

Studies on the concurrent validity of clinically applicable testing protocols for conditioned pain modulation (CPM) and temporal summation of pain (TSP) in breast cancer survivors (BCS) with persistent pain are lacking. This study investigated the concurrent validity of two bedside protocols for CPM and TSP in comparison to a respective reference protocol. The participants' preferences for bedside CPM and TSP protocols were assessed. Thirty BCS experiencing persistent pain were included in this study. Each participant underwent a reference test along with two bedside alternatives for assessing both TSP and CPM. For CPM, a cold pressor test (CPT) and blood pressure cuff (BPC) were used as conditioning stimulus. The test stimulus was elicited in parallel by pressure pain threshold after 45 and 90 s of conditioning at the lower limb. The CPM reference test consisted of parallel heat stimuli at the forearms using a two-thermode system. TSP was elicited using a von Frey monofilament (256 mN) and an algometer (98 kPa) at the affected site and opposite lower limb. The TSP reference test consisted of heat stimuli at the affected site and opposite lower limb. Participants' testing preference was examined using a purpose-designed questionnaire. Spearman's rank test examined the correlation between protocols. The two bedside CPM protocols were strongly correlated (r = 0.787-0.939, p < 0.005). A strong correlation was found between the BPC protocol and reference test using the relative effect magnitude (r = 0.541-0.555, p < 0.005). The bedside TSP protocols were moderately correlated with each other only at the lower limb using absolute change scores (r = 0.455, p = 0.012). No significant correlation was found between the bedside and reference TSP protocols. The significantly moderate to very strong correlations between the bedside protocols validate their interchangeability. Researchers and clinicians should be able to choose which bedside protocol they utilize; however, participants favored the use of a BPC and algometer for the evaluation of CPM and TSP, respectively.

Cellular-Enabled Remote Patient Monitoring for Pregnancies Complicated by Hypertension

Unmanaged hypertension in pregnancy is the second most common cause of direct maternal death and disproportionately affects women in rural areas. While telehealth technologies have worked to reduce barriers to healthcare, lack of internet access has created new challenges. Cellular-enabled remote patient monitoring devices provide an alternative option for those without access to internet. This study aimed to assess maternal and neonatal clinical outcomes and patient acceptability of an integrated model of cellular-enabled remote patient monitoring devices for blood pressure supported by a 24/7 nurse call center. In a mixed-methods study, 20 women with hypertension during pregnancy were given a cellular-enabled BodyTrace blood pressure cuff. Participants' blood pressures were continuously monitored by a nurse call center. Participants completed a baseline survey, post-survey, and semi-structured interview after 8 weeks of device use. Participants reported a significant decrease in perceived stress after device use (P = .0004), high satisfaction with device usability (mean = 78.38, SD = 13.68), and high intention to continue device use (mean = 9.05, SD = 1.96). Relatively low hospitalization and emergency department rates was observed (mean = 0.35, SD =0.59; mean = 0.75, SD = 0.91). Participant-perceived benefits of device use included convenience, perceived better care owing to increased monitoring, and patient empowerment. Perceived disadvantages included higher blood pressure readings compared to clinical readings and excessive calls from call center. Remote patient monitoring for women whose pregnancies are complicated by hypertension can reduce barriers and improve health outcomes for women living in rural and low-health-resource areas.

Correlation between Left Ventricular Pressure–Strain Loop and Severity in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome and Its Application Value in Short-Term Prognosis Evaluation

Purpose To investigate the diagnostic value of nonintrusive left ventricular pressure–strain loop (LV-PSL) for assessing overall myocardial function in sufferers with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with or without coronary stenosis. The results of this research might provide insights into the diagnosis and management of NSTE-ACS. Methods All 268 sufferers with NSTE-ACS who were received by the First Affiliated Hospital of Nanchang University between June 2019 and June 2021 were enrolled. Sufferers with single or multiple extramural coronary diameter stenosis ≥70% on coronary angiography were defined as the stenosis group. All sufferers underwent noninvasive LV-PSL construction by using cuff blood pressure as the left ventricular pressure before coronary angiography, and the resulting images were imported and analysed with offline analysis software to obtain global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The correlation between severity Gensini score and myocardial work (MW) parameters was identified through Spearman analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off values for predicting coronary stenosis, and logistic regression analysis was used to identify independent factors affecting left ventricular myocardial function in sufferers of NSTE-ACS. The occurrence of adverse cardiac events during the follow-up period was recorded. Results Through the comparative analysis of general clinical data, significant differences were found between the stenosis and nonstenosis groups in terms of gender, hyperlipidaemia, hypertension and smoking. However, statistical difference was observed only for hypertension (stenosis group 54.2%; p &lt; 0.05) and hypercholesterolaemia (stenosis group 53.5%; p &lt; 0.05). GLS (tz value 3.063), GCW (tz value 11.494), GWI (tz value 9.627) and GWE (tz value 12.780) reduced and GWW (tz value 11.504) increased in the stenosis group compared with those in the nonstenosis group. All differences were statistically significant (all p &lt; 0.05). Severity Gensini scores were negatively correlated with GLS, GCW, GWI and GWE but positively correlated with GWW (p &lt; 0.001). The ROC curve and univariate and multivariate logistic regression analyses revealed that GWE (odds ratio (OR) 2.881; 95% confidence internal (95% CI) 2.176–3.816; p &lt; 0.001) had the largest area under the curve and greatest sensitivity for coronary stenosis diagnosis. GWE was (OR 2.875; 95% CI 2.217–3.727; p &lt; 0.001) and (OR 2.881; 95% CI 2.176–3.816; p &lt; 0.001). During an average follow-up period of 26.7 months, 19 sufferers experienced adverse cardiac events. GWE exhibited high predictive ability for identifying such events. Conclusions Noninvasive LV-PSL can identify whether sufferers of NSTE-ACS have acute coronary stenosis regardless of the location or size of the stenosis and can detect varying degrees of left ventricular dysfunction in such sufferers. Amongst indices, GWE had the highest diagnostic efficiency for diagnosing sufferers of NSTE-ACS with coronary stenosis and highest predictive ability for adverse cardiac events.

Assessing heart rate and blood pressure estimation from image photoplethysmography using a digital blood pressure meter

This study presents a non-contact approach to measuring heart rate and blood pressure using an image photoplethysmography (iPPG) signal, and compares the results to those from an oscillometric blood pressure meter. Facial videos of 100 subjects were recorded via a webcam under ambient lighting conditions to extract iPPG signals. The results revealed a strong correlation between the heart rate derived from iPPG and that obtained from an oscillometric blood pressure meter. In addition, a continuous wavelet transform images with a 6-s duration were used as input for a custom convolutional neural network model, providing the most accurate blood pressure estimation. The proposed method received a grade A for diastolic and grade B for systolic blood pressure based on the British Hypertension Society's criteria. It also met the standards set by the Association for the Advancement of Medical Instrumentation. This non-contact framework shows promising potential for efficient screening purposes.

A pilot study exploring novel contexts for out-of-office blood pressure measurement.

Out-of-office blood pressure (BP) monitoring is increasingly valuable in the diagnosis and management of hypertension. With advances in wearable BP technologies, the ability to gain insight into BP outside of traditional centers of care has expanded greatly. Here we explore the usability of a novel, wrist-worn BP cuff monitor for out-of-office data collection with participants following digital cues rather than in-person instruction. Transmitted measurements were used to evaluate BP variation with the time of day and day of week, BP variation with mood, and orthostatic measurements. Fifty participants, with a mean age of 44.5 years, were enrolled and received the BP monitor. 82% of the participants transmitted data via the smartphone application, and the median wear time of the device during the 4-week study was 11 days (IQR 8-17). This prospective digital pilot study illustrates the usability of wearable oscillometric BP technology combined with digital cues via a smartphone application to obtain complex out-of-office BP measurements, including orthostatic vital signs and BP associated with emotion. 25 out of 32 participants who attempted orthostatic vital signs based on in-app instruction were able to do so correctly, while 24 participants transmitted BP readings associated with emotion, with a significant difference in BP noted between calm and stressed emotional states.

Continuous Versus Intermittent Control Cuff Pressure for Preventing Ventilator-Associated Pneumonia: An Updated Meta-Analysis.

This study aimed to evaluate the effect of continuous control cuff pressure (CCCP) versus intermittent control cuff pressure (ICCP) for the prevention of ventilator-associated pneumonia (VAP) in critically ill patients. Relevant literature was searched in several databases, including PubMed, Embase, Web of Science, ProQuest, the Cochrane Library, Wanfang Database and China National Knowledge Infrastructure between inception and September 2022. Randomized controlled trials were considered eligible if they compared CCCP with ICCP for the prevention of VAP in critically ill patients. This meta-analysis was performed using the RevMan 5.3 and Trial Sequential Analysis 0.9 software packages. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the level of evidence. We identified 14 randomized control trials with a total of 2080 patients. Meta-analysis revealed that CCCP was associated with a significantly lower incidence of VAP compared with ICCP (relative risk [RR] = 0.52; 95% confidence interval [CI]: 0.37-0.74; P < 0.001), although considerable heterogeneity was observed (I2 = 71%). Conducting trial sequential analysis confirmed the finding, and the GRADE level was moderate. Subgroup analysis demonstrated that CCCP combined with subglottic secretion drainage (SSD) had a more significant effect on reducing VAP (RR = 0.39; 95% CI = 0.29-0.52; P < 0.001). The effect of CCCP on ventilator-associated respiratory infection (VARI) incidence was uncertain (RR = 0.81; 95% CI = 0.53-1.24; P = 0.34; I2 = 61%). Additionally, CCCP significantly reduced the duration of mechanical ventilation (MV) (mean difference [MD] = -2.42 days; 95% CI = -4.71-0.12; P = 0.04; I2 = 87%). Descriptive analysis showed that CCCP improved the qualified rate of cuff pressure. However, no significant differences were found in the length of intensive care unit (ICU) stay (MD = 2.42 days; 95% CI = -1.84-6.68; P = 0.27) and ICU mortality (RR = 0.86; 95% CI = 0.74-1.00; P = 0.05). Our findings suggest that the combination of CCCP and SSD can reduce the incidence of VAP and the duration of MV and maintain the stability of cuff pressure. A combination of CCCP and SSD applications is suggested for preventing VAP.

Regular snoring is associated with uncontrolled hypertension

Snoring may be a risk factor for cardiovascular disease independent of other co-morbidities. However, most prior studies have relied on subjective, self-report, snoring evaluation. This study assessed snoring prevalence objectively over multiple months using in-home monitoring technology, and its association with hypertension prevalence. In this study, 12,287 participants were monitored nightly for approximately six months using under-the-mattress sensor technology to estimate the average percentage of sleep time spent snoring per night and the estimated apnea-hypopnea index (eAHI). Blood pressure cuff measurements from multiple daytime assessments were averaged to define uncontrolled hypertension based on mean systolic blood pressure≥140 mmHg and/or a mean diastolic blood pressure ≥90 mmHg. Associations between snoring and uncontrolled hypertension were examined using logistic regressions controlled for age, body mass index, sex, and eAHI. Participants were middle-aged (mean ± SD; 50 ± 12 y) and most were male (88%). There were 2467 cases (20%) with uncontrolled hypertension. Approximately 29, 14 and 7% of the study population snored for an average of >10, 20, and 30% per night, respectively. A higher proportion of time spent snoring (75th vs. 5th; 12% vs. 0.04%) was associated with a ~1.9-fold increase (OR [95%CI]; 1.87 [1.63, 2.15]) in uncontrolled hypertension independent of sleep apnea. Multi-night objective snoring assessments and repeat daytime blood pressure recordings in a large global consumer sample, indicate that snoring is common and positively associated with hypertension. These findings highlight the potential clinical utility of simple, objective, and noninvasive methods to detect snoring and its potential adverse health consequences.

Feasibility of Leveraging Consumer Wearable Devices with Data Platform Integration for Patient Vital Monitoring in Low-Resource Settings.

Manual monitoring of vital signs, which often fails to capture the onset of deterioration, is the main monitoring modality in most Ghanaian hospitals due to the high cost and inadequate supply of patient bedside monitors. Consumer wearable devices (CWDs) are emerging, relatively low-cost technologies for continuous monitoring of physiological status; however, their validity has not been established in low-resource clinical settings. We aimed to (1) investigate the validity of the heart rate (HR) and oxygen saturation (SpO2) data from two widely used CWDs, the Fitbit Versa 2 and Xiaomi Mi Smart Band 6, against gold standard bedside monitors in one Ghanaian hospital and (2) develop a web application to capture and display CWD data in a clinician-friendly way. A healthy volunteer simultaneously wore both CWDs and blood pressure cuffs to measure HR and SpO2. To test for concordance, we conducted the Bland-Altman and mean absolute percentage error analyses. We also developed a web application that retrieves and displays CWD data in near real time as text and graphical trends. Compared to gold standards (patient monitor and manual), the Fitbit Versa 2 had 96.87% and 96.67% measurement accuracies for HR, and the Xiaomi Mi Smart Band 6 had 94.24% and 93.21% measurement accuracies for HR. The Xiaomi Mi Smart Band 6 had 98.79% measurement accuracy for SpO2. The strong concordance between CWD and gold standards supports the potential implementation of these devices as a novel method of vital sign monitoring to replace manual monitoring, thus saving costs and improving patient outcomes. Further studies are needed for confirmation.

Improving Hypertension Control in the Black Patient Population: A Quality Improvement Study of Workflow Redesign Using the Electronic Health Record to Integrate Self-Monitoring, Education, and Reporting.

Nearly half of American adults have hypertension (HTN), and non-Hispanic Black patients are diagnosed at a higher rate than others. Our local clinic population reflected disproportionate rates of uncontrolled HTN among Black patients. A quality improvement pre-/postintervention design was used to evaluate an educational intervention to reduce blood pressure (BP) and improve self-monitoring of BP in Black patients using the Chronic Care Model. A team-based approach was used to redesign clinic workflows and patient education, prescribe self-paced videos from an electronic health record (EHR) patient portal, and provide home BP cuffs. Black participants (n = 79) improved viewing of prescribed videos (7.9% to 68.5%), knowledge scores (67.9 to 75.2), and mean systolic BP (-20.3 mm Hg; P > .001). This team-based approach enhanced patient engagement, self-monitoring skills, EHR-reported BP, and overall BP control for a cohort of Black patients with uncontrolled BP.

Depressive symptoms are not associated with clinically important levels of digital home blood pressure in the electronic Framingham Heart Study

BACKGROUNDDepressive symptoms are common and share many biopsychosocial mechanisms with hypertension. Association studies between depressive symptoms and blood pressure (BP) have been inconsistent. Home BP monitoring may provide insight. OBJECTIVETo investigate the association between depressive symptoms and digital home BP METHODSElectronic Framingham Heart Study (eFHS) participants were invited to obtain a smartphone app and digital BP cuff at research exam 3 (2016-2019). Participants with ≥3 weeks of home BP measurements within one year were included. Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CES-D). Multivariable linear mixed models were used to test the associations of continuous CES-D score and dichotomous depressive symptoms (CES-D ≥16) (independent) with home BP (dependent), adjusting for age, sex, cohort, number of weeks since baseline, lifestyle factors, diabetes, and CVD. RESULTSAmong 883 participants (mean age 54 years, 59% women, 91% White), the median CES-D score was 4. Depressive symptoms prevalence was 7.6%. Mean SBP and DBP at exam 3 were 119 and 76 mmHg; hypertension prevalence was 48%. A 1 SD higher CES-D score was associated with 0.9 (95% CI: 0.18 to 1.56, p=0.01) and 0.6 (95% CI: 0.06 to 1.07, p=0.03) mmHg higher home SBP and DBP respectively. Dichotomous depressive symptoms were not significantly associated with home BP(p>0.2). CONCLUSIONDepressive symptoms were not associated with clinically substantive levels of home BP. The association between depression and CVD risk factors warrants more data, which may be supported by mobile health measures.

Butorphanol-Azaperone-Medetomidine Is as Safe and Effective as Nalbuphine-Azaperone-Medetomidine for Immobilization of Juvenile American Black Bears (Ursus americanus).

Immobilization kits including butorphanol-azaperone-medetomidine (BAM) and nalbuphine-azaperone-medetomidine can provide effective, safe, and easy-to-use protocols in bears. Nalbuphine-azaperone-medetomidine is not commercially available but may be useful for wildlife agencies because it does not contain controlled substances. This study directly compared BAM to nalbuphine-azaperone-medetomidine immobilization in 10 juvenile healthy black bears (10 mo old; four females, six males) undergoing prerelease examinations after rehabilitation. Bears were immobilized via remote delivery of 1 mL of BAM (n=5) or nalbuphine-azaperone-medetomidine (n=5) intramuscularly in the shoulder during December (randomized, blinded trial). Bears were intubated, monitored with an electrocardiogram, pulse oximeter, capnograph, noninvasive blood pressure cuff, and rectal thermometer, and underwent physical examination, sample collection, morphometrics, and ear-tag placement. Induction, physiologic, and recovery parameters were recorded, including arterial blood gas analysis. The anesthetic agents were antagonized with atipamezole and naltrexone. There were no differences between protocols in induction or recovery times. There were no differences between protocols in heart rate, respiratory rate, temperature, oxygen saturation, end-tidal CO2, mean arterial pressure, or blood gas analysis or any differences between male and female bears in any parameters. Bears were hypertensive and normoxemic with low oxygen saturation via pulse oximeter, but all recovered smoothly and were released within 2 h of recovery. This study supports that nalbuphine-azaperone-medetomidine is clini-cally as safe and effective as BAM in American black bears.