Diastolic Blood Pressure Measurements Research Articles

Exposure to organophosphate ester flame retardants and plasticizers and associations with preeclampsia and blood pressure in pregnancy

BackgroundOrganophosphate esters (OPEs), flame retardants and plasticizers found widely in consumer products, may impact vascularization processes in pregnancy. Yet, the association between maternal exposure to OPEs and both preeclampsia and blood pressure during pregnancy remains understudied. MethodsWithin the LIFECODES Fetal Growth Study (N = 900), we quantified 8 OPE metabolites from maternal urine collected at up to 3 time points during pregnancy and created within-subject geometric means. Outcomes included diagnosis of preeclampsia and longitudinal systolic (SBP) and diastolic (DBP) blood pressure measurements (mean = 14 per participant). Cox proportional hazards models were used to estimate associations between OPE metabolites and preeclampsia. Associations between average OPE metabolite concentrations and repeated blood pressure measurements were estimated using generalized estimating equations. ResultsFive OPE metabolites were detected in at least 60% of samples; 3 metabolites detected less frequently (5–39%) were examined in an exploratory analysis as ever vs. never detectable in pregnancy. There were 46 cases of preeclampsia in our study population. Associations between OPE metabolites and preeclampsia were null. We noted several divergent associations between OPE metabolites and longitudinal blood pressure measurements. An interquartile range (IQR) difference in average bis(2-chloroethyl) phosphate concentrations was associated with a decrease in SBP (−0.81 mmHg, 95% confidence interval [CI]: −1.62, 0.00), and, conversely, bis(1-chloro-2-propyl) phosphate was associated with a slight increase in SBP (0.94 mmHg, 95% CI: 0.28, 1.61). We also noted a decrease in SBP in association with several metabolites with low detection frequency. ConclusionsWe observed null associations between OPE metabolites and preeclampsia, but some positive and some inverse associations with blood pressure in pregnancy. While our study was well-designed to assess associations with blood pressure, future studies with a larger number of preeclampsia cases may be better poised to investigate the association between OPE metabolites and phenotypes of this heterogenous hypertensive disorder of pregnancy.

Non-Contact Blood Pressure Estimation From Radar Signals by a Stacked Deformable Convolution Network.

This study introduces a contactless blood pressure monitoring approach that combines conventional radar signal processing with novel deep learning architectures. During the preprocessing phase, datasets suitable for synchronization are created by integrating Kalman filtering, multiscale bandpass filters, and a periodic extraction method in the time domain. These data comprise data on chest micro variations, encapsulating a complex array of physiological and biomedical information reflective of cardiac micromotions. The Radar-based Stacked Deformable convolution Network (RSD-Net) integrates channel and spatial self attention mechanisms within a deformable convolutional framework to enhance feature extraction from radar signals. The network architecture systematically employs deformable convolutions for initial deep feature extraction from individual signals. Subsequently, continuous blood pressure estimation is conducted using self attention mechanisms on feature map from single source coupled with multi-feature map channel attention. The performance of model is corroborated via the open-source dataset procured using a non-invasive 24 GHz six-port continuous wave radar system. The dataset, encompassing readings from 30 healthy individuals subjected to diverse conditions including rest, the Valsalva maneuver, apnea, and tilt-table examinations. It serves to substantiate the validity and resilience of the proposed method in the non-contact assessment of continuous blood pressure. Evaluation metrics reveal Pearson correlation coefficients of 0.838 for systolic and 0.797 for diastolic blood pressure predictions. The Mean Error (ME) and Standard Deviation (SD) for systolic and diastolic blood pressure measurements are -0.32 ±6.14 mmHg and -0.20 ±5.50 mmHg, respectively. The ablation study assesses the contribution of different structural components of the RSD-Net, validating their significance in the overall of model performance.

First-trimester screening identifies maternal cardiac maladaptation in midgestation.

We have previously established that a logistic regression model, based on maternal demographic characteristics and blood pressure measured at 11-13 weeks' gestation, can identify about 70% of women who develop future chronic hypertension (CH) in the 3 years following pregnancy, at a screen-positive rate of 10%. Furthermore, in midgestation, women who subsequently develop hypertensive disorders of pregnancy (HDP) have increased peripheral vascular resistance and mild cardiac functional and morphological alterations and these cardiovascular abnormalities persist for at least 2 years after delivery. In this study, we set out to examine whether use of the first-trimester risk model for subsequent development of CH can help to identify women at high risk for cardiovascular maladaptation in midgestation. This was a prospective observational study of 3812 women with singleton pregnancy attending for a routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation and again at 19 + 1 to 23 + 3 weeks at King's College Hospital, London, UK, between December 2019 and August 2020. The first-trimester visit included recording of maternal demographic characteristics and medical history and measurement of systolic and diastolic blood pressure. In midgestation, detailed maternal cardiovascular assessment was carried out. The association between risk for development of CH, determined from first-trimester assessment, and cardiovascular indices in midgestation was examined. Women who were at high risk for development of future CH, compared to those at low risk, had a higher incidence of HDP. In addition, high-risk women had reduced systolic and diastolic function in midgestation. Among women with HDP, those who were at high risk for future CH, compared to those at low risk, had worse cardiac function in midgestation. Use of a model for first-trimester prediction of subsequent development of CH can identify women who show evidence of cardiac maladaptation in midgestation. Further studies are needed to clarify whether women who screen as high risk for future CH, compared to those at low risk, have reduced cardiac function beyond pregnancy. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Accuracy of community pharmacy blood pressure measurement: a cross-sectional study

Background: Recently, community pharmacy blood pressure measurement has gained popularity as it is easily accessible and cost-effective out-of-office method especially for blood pressure monitoring. However, it’s practical applicability and clinical value has not been fully studied. This study aimed to evaluate the accuracy of community pharmacy blood pressure measurement. Methods: Study participants were adults (390) who measured their blood pressure at different community pharmacies and came to the emergency departments (for confirmation of their blood pressure reading on the same day) of eight major hospitals in Baghdad, Iraq 2024. Participants were directly interviewed and blood pressure measured according to guidelines. Results: The mean age was (44.8±14.2) years of whom (58.7%) were males. The sensitivity was (85.1%), specificity (9.1%), positive and negative predictive values (22.9%, 65.9%), respectively. Paired t test showed significant difference between both systolic and diastolic blood pressure measurements in pharmacies (156.4±21.7 and 91.9±14.2, respectively) and hospital (122.7±15.4 and 77.4±9.50, respectively) (p<0.001). Pearson’s correlation test showed that there was mild positive correlation between measurements in hospital with body mass index (BMI) (r=0.20, p=0.005 and r=0.22, p<0.005, respectively). Conclusions: Community pharmacy blood pressure measurement lack accuracy. Further detailed studies are needed.

Systemic immune-inflammation index and its relation to blood pressure and dyslipidemia in adults: A retrospective study.

High blood pressure (BP) and dyslipidemia are major risk factors for cardiovascular disease mortality. The systemic immune-inflammation index (SII) has been suggested as a predictive tool to identify those at risk for chronic diseases, however, its use for predicting high BP and dyslipidemia has not been thoroughly investigated. This study aimed to examine the association between SII and high BP as well as lipid markers. Retrospective hospital data from a large cohort (n = 3895) of Saudi adults aged ≥18 years were analyzed. Lipid markers (cholesterol, high-density lipoprotein, low-density lipoprotein [LDL]), systolic BP, and diastolic BP measures were extracted. When the sample was divided into quartiles of SII, cholesterol, triglycerides, and LDL were higher in those with a higher SII than in those with a lower SII (P < .01). After adjusting for potential confounders, higher SII was significantly associated with higher odds of hypertension (odds ratio: 1.12, 95% confidence interval: 1.04-1.21) and elevated LDL (odds ratio: 1.07, 95% CI: 1.02-1.14), but not with elevated cholesterol. Across quartiles of SII, there was a significant trend between higher SII and the odds of hypertension in people with diabetes and those aged ≥65 years. The SII could be an economical predictive measure for identifying individuals at risk of hypertension and some aspects of dyslipidemia. Longitudinal studies are needed to confirm this relationship.

A comparative study of ProRithm and standard monitoring techniques for non-invasive blood pressure measurement using photoplethysmography and electrocardiography signals through artificial intelligence/machine learning methods

Background: Multi-parameter monitoring devices are essential for providing real-time patient data, which is crucial for effective healthcare interventions. This clinical trial evaluated the accuracy of the ProRithm beat-to-beat cuffless device for arterial blood pressure monitoring, comparing it with a standard sphygmomanometer. Methods: This observational study included 30 subjects aged 18 and above. Systolic and diastolic blood pressure measurements from both the ProRithm device and the Philips Monitor were compared using statistical analysis. Results: The analysis revealed no statistically significant differences between the ProRithm device and the manual method. In comparison with manual measurements using a sphygmomanometer, the mean systolic blood pressure was 131.2 mmHg with ProRithm it was 129.3 mmHg. Similarly, with the manual method, while the mean diastolic blood pressure was 76.2 mmHg and with ProRithm it was 75.9 mmHg. Conclusions: This study indicates that portable, small-sized devices like ProRithm, which facilitate remote monitoring, are effective for real-time blood pressure assessment in clinical settings.

Health Impact of a Mobile-Delivered Diabetes Intervention to Control Blood Pressure in Older Adults

IntroductionPatient education is an effective modality to reinforce self-care practices for chronic disease management. The purpose of this study was two-fold: (1) to assess the health impact of a phone delivered diabetes intervention and (2) to identify predictors of telehealth message use among adults, aged 18-65 with diabetes in a primary care setting using the TAM theoretical framework. MethodsA pretest-posttest experimental study design was employed. Participants were randomized to received seven-weeks of telehealth self-care messages or to the routine care group. Outcome measures included a) telehealth use among patients who received weekly telehealth messages, b) self-care behavior management derived from the Behavior Score Instrument (BSI) and c) clinical outcomes measures. ResultsWe enrolled 150 patients, and of these, 138 (18-65 years) completed the study. Participants, aged 53 ± 9.6 (mean ± SD) years were mainly females (n = 93; 76%), and the majority received government sponsored health insurance (n=75; 54%). Age was a strong predictor of telehealth use, p<.001. Among patients who received telehealth messages, systolic and diastolic blood pressure measures (140/78 mmHg vs. 134/74 mmHg) were statistically significant at follow-up, p=.001 and p=.007, respectively. ConclusionsDigital support tools can play a valuable role in supporting lifestyle modification changes and reinforcing good diabetes self-care practices in older adults. Providing accessible tools and resources empowers adults to take an active role in their own health.

Safety and efficacy of adaptive atrial pacing regulated by blood pressure during low-level exercise: a proof-of-concept study.

Despite half of all heart failure patients suffering from heart failure with preserved ejection fraction (HFpEF), treatment options are limited. This study aims to compare safety and efficacy of standard pacemaker programming (DDD or DDDR) and a novel pacing algorithm PressurePace™ (BaroPace Inc, Issaquah, WA, USA) which modulates atrial pacing rate based on blood pressure (BPAP). This prospective, randomized, double-blind, non-significant risk proof of concept study was conducted at two large cardiology clinics in Los Angeles, California, USA. Subjects underwent two modified Bruce protocol graded treadmill exercise tests in which pacemaker programming was randomized to either standard programming (DDD or DDDR), or BPAP at least 1week apart. Physiological measurements of heart rate (HR), and systolic and diastolic blood pressure (BP) were collected at 2min intervals. During the BPAP treadmill test, the pacemaker activity sensor was disabled. The PressurePace algorithm instructed the pacemaker technician to modify or leave unchanged the atrial pacing rate based on these BP measurements. Subjects and clinical staff were blinded to pacemaker programming, only the pacemaker technician was unblinded. Ten subjects with HFpEF associated with hypertension who also had permanent dual-chamber pacemakers, previously implanted for standard clinical indications, participated in the study. Mean age was 70.1±6.8 years, left ventricular ejection fraction of 54.8±1.9%. Exercise duration increased in all 10 subjects, when paced in the BPAP mode compared with standard pacemaker programming, showing a mean increase of 117s (26%, P=0.0016). The algorithm could adjust HR at each 2min interval. The majority of subjects (60%) had their atrial pacing rate increased an average of 20% at t=2min. In the remaining 40% of subjects, the algorithm instructed HR to be unchanged. In two subjects, the pacing rate was not increased until t=6min. In contrast, subjects programmed to DDDR experienced an average of 45% increase in atrial pacing rate at t=2min. In the post-treadmill recovery period, SBP was higher for subjects who underwent BPAP. This difference in SBP was most pronounced immediately post-treadmill and diminished as subjects progressed through the 30min recovery period. Statistical significance was achieved at t=0, 20, and 30min post-treadmill. An increase in exercise duration was reported in HFpEF subjects using a pacing algorithm that modulated HR based on BP compared with standard programming. These encouraging results form the basis for a larger, randomized cross-over trial to confirm these initial observations, further characterize the safety, efficacy, and possible mechanisms of action in both acute and longer-term treatment.

Impact of Ultrafiltration Profiling Compared to Conventional Methods on Blood Pressure Regulation Among Hemodialysis Patients

Background: Standard hemodialysis sessions pose challenges for patients due to fluctuations in blood pressure. Alternative strategies, such as ultrafiltration profiling, have been proposed as potentially more effective treatments. Objectives: This study aimed to evaluate the effects of ultrafiltration profiling compared to the conventional method on blood pressure regulation among hemodialysis patients. Methods: This study employed a pre-test and post-test design, involving a single group of 30 hemodialysis patients undergoing treatment at Shahid Beheshti Hospital in Hamadan in 2022. The sampling method used was simple random sampling. The intervention consisted of three sessions using the routine method, followed by three sessions utilizing the ultrafiltration profile method, which employed an interval with a negative slope. Demographic and clinical information about the patients was recorded on a checklist. Systolic and diastolic blood pressure measurements were taken before the commencement of hemodialysis, at 1-, 2-, and 3-hour intervals post-treatment initiation, and again 15 minutes after completing hemodialysis. Results: The mean blood pressure changes observed during dialysis stages increased with both methods; however, there was a significant difference between the methods (P &lt; 0.001). Specifically, patients receiving the ultrafiltration profile method experienced significantly lower increases in blood pressure compared to those receiving the routine method. Conclusions: Based on the research results, integrating ultrafiltration profiling into hemodialysis can be regarded as an effective and viable strategy for enhancing blood pressure regulation in patients undergoing hemodialysis treatment. Therefore, it is recommended that this approach be considered in hemodialysis programs as well.

Examining the Pre- and Post-percutaneous Coronary Intervention Blood Pressure Variability Using Ambulatory Blood Pressure Monitoring in Patients With Stable and Unstable Coronary Artery Disease.

Introduction The World Health Organization has drawn attention to the fact that coronary artery disease (CAD) is our modern "epidemic." Nowadays, sudden death during sleep has become prevalent due to a lack of oxygen supply to the heart. CAD causes more deaths and disabilities and incurs greater economic costs than any other illness in the developed world. The prevalence of cardiovascular disorders and heart disease is on the rise in India. Hypertension is one of the leading risk factors for all cardiovascular diseases. This study aims to compare blood pressure variability before and after percutaneous coronary intervention (PCI), using ambulatory blood pressure monitoring (ABPM) in patients with stable and unstable CAD. Materials and methods This prospective observational study was conducted among 52 patients with stable and unstable CAD, admitted to the medicine department, who required PCIat a tertiary care hospital. Before and after PCI, the same antihypertensive drugs were orally administered. ABPM was performed before PCI and one day after PCI. ABPM was conducted every 30 minutes during the day and every 60 minutes during the night over a 24-hour period using a mobil-o-graph (IEM, Germany). The results of the observed parameters were analyzed using the HMS Client-Server 4.0 system (Informer Technologies, Inc., Los Angeles, USA). The collected data were analyzed using SPSS Statistics version 21.0 software (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). Results Out of 52 patients, 28 (53.8%) had stable CAD and 24 (46.2%) had unstable CAD. The mean age of patients with stable and unstable CAD was 56.64±9.44 and 57.04±12.36 years, respectively. The majority of patients with stable (67.9%) and unstable CAD (62.5%) were males. Various other variables were considered, such as lipid profile, blood sugar, cardiac troponin-I, and medical history, including hypertension and type 2 diabetes mellitus. Among stable CAD patients, a comparison between pre- and post-PCI systolic blood pressure (SBP) did not show a significant difference in all SBP measurements (p>0.05). However, the mean diurnal index was significantly lower following PCI compared to before PCI (p=0.019). Among unstable CAD patients, a comparison between pre- and post-PCI SBP showed a significant change in peak daytime, average daytime, and diurnal index (p<0.05). For all other SBP measurements, the difference between pre- and post-PCI measurements was not statistically significant (p>0.05). In patients with stable CAD, a statistically significant change in diastolic blood pressure (DBP) following PCI was observed for peak daytime, peak nighttime, and average nighttime values. In contrast, for patients with unstable CAD, a statistically significant change in DBP following PCI was observed for peak daytime, peak nighttime, and minimum daytime values (p<0.05). Statistically, post-PCI, there was no significant difference between the two groups for SBP and DBP measurements (p>0.05). Additionally, there was no significant difference between the two groups pre- and post-PCI in the pattern of dipping. Conclusion A comparison of the ABPM before and after PCI showed that, within 48 hours post-PCI, the ambulatory blood pressure indicators did not differ statistically from those before PCI.

Associations between anxiety, sleep, and blood pressure parameters in pregnancy: a prospective pilot cohort study

BackgroundThe potential effect modification of sleep on the relationship between anxiety and elevated blood pressure (BP) in pregnancy is understudied. We evaluated the relationship between anxiety, insomnia, and short sleep duration, as well as any interaction effects between these variables, on BP during pregnancy.MethodsThis was a prospective pilot cohort of pregnant people between 23 to 36 weeks’ gestation at a single institution between 2021 and 2022. Standardized questionnaires were used to measure clinical insomnia and anxiety. Objective sleep duration was measured using a wrist-worn actigraphy device. Primary outcomes were systolic (SBP), diastolic (DBP), and mean (MAP) non-invasive BP measurements. Separate sequential multivariable linear regression models fit with generalized estimating equations (GEE) were used to separately assess associations between anxiety (independent variable) and each BP parameter (dependent variables), after adjusting for potential confounders (Model 1). Additional analyses were conducted adding insomnia and the interaction between anxiety and insomnia as independent variables (Model 2), and adding short sleep duration and the interaction between anxiety and short sleep duration as independent variables (Model 3), to evaluate any moderating effects on BP parameters.ResultsAmong the 60 participants who completed the study, 15 (25%) screened positive for anxiety, 11 (18%) had subjective insomnia, and 34 (59%) had objective short sleep duration. In Model 1, increased anxiety was not associated with increases in any BP parameters. When subjective insomnia was included in Model 2, increased DBP and MAP was significantly associated with anxiety (DBP: β 6.1, p = 0.01, MAP: β 6.2 p < 0.01). When short sleep was included in Model 3, all BP parameters were significantly associated with anxiety (SBP: β 9.6, p = 0.01, DBP: β 8.1, p < 0.001, and MAP: β 8.8, p < 0.001). No moderating effects were detected between insomnia and anxiety (p interactions: SBP 0.80, DBP 0.60, MAP 0.32) or between short sleep duration and anxiety (p interactions: SBP 0.12, DBP 0.24, MAP 0.13) on BP.ConclusionsWhen including either subjective insomnia or objective short sleep duration, pregnant people with anxiety had 5.1–9.6 mmHg higher SBP, 6.1–8.1 mmHg higher DBP, and 6.2–8.8 mmHg higher MAP than people without anxiety.

Exploring machine learning strategies for predicting cardiovascular disease risk factors from multi-omic data

BackgroundMachine learning (ML) classifiers are increasingly used for predicting cardiovascular disease (CVD) and related risk factors using omics data, although these outcomes often exhibit categorical nature and class imbalances. However, little is known about which ML classifier, omics data, or upstream dimension reduction strategy has the strongest influence on prediction quality in such settings. Our study aimed to illustrate and compare different machine learning strategies to predict CVD risk factors under different scenarios.MethodsWe compared the use of six ML classifiers in predicting CVD risk factors using blood-derived metabolomics, epigenetics and transcriptomics data. Upstream omic dimension reduction was performed using either unsupervised or semi-supervised autoencoders, whose downstream ML classifier performance we compared. CVD risk factors included systolic and diastolic blood pressure measurements and ultrasound-based biomarkers of left ventricular diastolic dysfunction (LVDD; E/e' ratio, E/A ratio, LAVI) collected from 1,249 Finnish participants, of which 80% were used for model fitting. We predicted individuals with low, high or average levels of CVD risk factors, the latter class being the most common. We constructed multi-omic predictions using a meta-learner that weighted single-omic predictions. Model performance comparisons were based on the F1 score. Finally, we investigated whether learned omic representations from pre-trained semi-supervised autoencoders could improve outcome prediction in an external cohort using transfer learning.ResultsDepending on the ML classifier or omic used, the quality of single-omic predictions varied. Multi-omics predictions outperformed single-omics predictions in most cases, particularly in the prediction of individuals with high or low CVD risk factor levels. Semi-supervised autoencoders improved downstream predictions compared to the use of unsupervised autoencoders. In addition, median gains in Area Under the Curve by transfer learning compared to modelling from scratch ranged from 0.09 to 0.14 and 0.07 to 0.11 units for transcriptomic and metabolomic data, respectively.ConclusionsBy illustrating the use of different machine learning strategies in different scenarios, our study provides a platform for researchers to evaluate how the choice of omics, ML classifiers, and dimension reduction can influence the quality of CVD risk factor predictions.

Differential Role for the Clock Gene, BMAL1, on Kidney Function in Male versus Female Rats

Many activities of modern life, such as social visits with friends at night, long working hours, jet lag, and shift work cause circadian rhythm disturbances, which increase the risk of renal decline and eventual disease. Chronic kidney disease (CKD) is defined by decreases in glomerular filtration rate (GFR) which is higher during the daytime and lower at night in healthy individuals. Prior studies indicate that processes critical for maintaining blood pressure ( e.g. autoregulation) contribute to this time-of-day-dependence mediated by a molecular timekeeping mechanism known as the molecular circadian clock that resides in all tissues including the kidney. We hypothesized that loss of the molecular clock would impair normal kidney physiology through misalignment of functional rhythms with normal environmental patterns associated with day and night. We used a rat model of circadian disruption to interrogate our hypothesis. Male and female brain and muscle ARNT-like protein 1 knockout (BMAL1 KO) and littermate control (CON) rats aged 12-14 weeks underwent GFR measurements using FITC-labeled sinistrin clearance at two times of the day corresponding to the dark (active) and light (inactive) periods. Following GFR measurements, rats were placed in metabolic cages with food to record water intake and urine excretion over 12h active and inactive periods. Implantable telemeters were used for 24h measurement of systolic and diastolic blood pressure, locomotor activity and body temperature. Autoregulatory behavior was assessed using the isolated juxtamedullary nephron preparation to determine afferent arteriole diameter responses to changes in perfusion pressure. Diurnal measurements of GFR revealed that male BMAL1 KO rats had a significantly lower GFR in the active period as compared to CON males (1.87±0.37 vs 2.55±0.47 ml/min/100g; 2-way ANOVA, p&lt;0.05; n=8-9). As a result, there was no diurnal variation in the KO males as seen in the CON males (Δ GFR 0.63±0.24 vs 0.04±0.21 ml/min/100g/12h CON vs KO respectively) (Sidak post-hoc, p&lt;0.05; n=8-9) in parallel with a lack of diurnal variation in urine volume and Na excretion. Both male (n=8) and female (n=6-9) BMAL1 KO rats also displayed a significantly lower 24h mean arterial pressure (Males; 103±1 vs 107±1 mmHg, p&lt;0.05; Females; 110±1 vs 100±2 mmHg, p&lt;0.05) compared to CON with diurnal variation and autoregulatory reactivity preserved. Male BMAL1 KO rats consumed significantly more water compared to CON (n=5-9, 22.5±5.4 vs 14.7±4.0 mL/12h, p&lt;0.05) concomitant with increased urine excretion (n=5-9, 13.3±6 vs 4.2±0.8 mL/12h, p&lt;0.05) and reduced urine osmolality (n=5-7, 967±398 vs 2140±811 mmol/kg, p&lt;0.05) regardless of time of day. Taken together these data suggest that BMAL1 is necessary for maintaining renal functional rhythms and urine concentrating ability in a sex-dependent manner. R01 DK134562 P01 HL158500. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

SYSTEMIC DISEASES ARE A GROUP OF INFLAMMATORY ILLNESSES THAT CAN DAMAGE THE ARTERIAL WALL ASSESSED ACCORDING TO NON-INVASIVE ARTERIAL TONOMETRY

Objective: Objective: Hypertensive Cardiovascular Disease is a complex, multifactorial, and chronic illness, frequently beginning during childhood or adolescence, could develop functional and/or structural organ damage by the increase of arterial stiffness and the curve volume/pressure that in turn can raise the stress into the ventricular-arterial coupling and the appearance of arrhythmias. The aim of this study was to assess systemic inflammatory diseases according to non-invasive arterial tonometry and their possible complications. Design and method: Design &amp; Method: This cross-sectional study registered 339 patients, women 77%, both sexes, presented various systemic inflammatory diseases such as Psoriasis (123), Rheumatoid Arthritis (26), Celiac disease (13), Sjögren's disease (9), Crohn's disease (7), Ulcerative colitis (10), Endometriosis (10), Polycystic Ovary Syndrome (141). Anthropological data, Systolic/Diastolic Blood Pressure, and Heart Rate were measured. Central Hemodynamic Parameters (Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure, Pulse Pressure, Augmentation Pressure) and the difference between the maximum normal level and the observed value of the Augmentation Index (Diff-AIx), the surrogated value of arterial stiffness, were assessed with the SphygmoCor System-PVX, according to established protocols by sex and age. Results: Results: The mean age of women and men was 45-51 years. The mean of Systolic/Diastolic Blood Pressure among women and men was 132.5/81.6-135.2/85.9 mmHg, respectively. The Diff-AIx among women was 4.8 and among men was 5.4. The most important finding of the assessment of the systemic inflammatory diseases was the presence of hypertensive cardiovascular disease, considering the measurements of high systolic and diastolic blood pressure, and the abnormal Central hemodynamic parameters. The most important complication observed was the brief phases of atrial fibrillation during the 24-hour Holter monitoring (7.4%), the mean age of patients was 64.2 years, range of 44-88 years, and the highest percentage of each group were Ulcerative colitis (20.0%), Rheumatoid Arthritis (15.4%), and Crohn's disease (14.3%), Psoriasis (10.6%), Endometriosis (10.0%). Conclusions: Conclusions: The systemic diseases can damage the arterial wall and contribute to the development of Hypertensive Cardiovascular Disease. Cardiologists and clinical physicians, in the anamnesis, should include the search for inflammatory systemic diseases for a more complete clinical evaluation and therapeutic guidance.

A Practical Approach for Ischemic Preconditioning Intervention in Sports: A Pilot Study for Cuff Thigh Occlusion Pressure Estimation Based on Systolic Blood Pressure.

For the ischemic preconditioning (IPC) intervention, the accuracy of the protocol is paramount for mediating its possible ergogenic effects. However, the lack of standardization and widespread use of arbitrary cuff pressures (ranging from 130 to >300 mmHg) have been predominantly observed, potentially affecting the results and compromising the reproducibility of findings. Thus, the purpose of this study was to determine an appropriate cuff pressure during IPC. Seventeen healthy male participants were enrolled in the study. Anthropometric measurements were initially conducted, followed by systolic and diastolic blood pressure measurements. Subsequently, we determined the individual thigh occlusion pressure (TOP) for the right leg using a hand-held Doppler device. Based on these findings, we developed an estimation equation for TOP, considering the current brachial systolic blood pressure (SBP) values. We then conducted a retrospective analysis of its capacity to mediate occlusion. We observed the ability to estimate TOP using the equation (p = 0.01; ES: 0.86), presenting ~6% superiority in absolute values for occlusion compared to direct measurement (TOP equation: 169.9 ± 9.1; TOP direct measured: 161.2 ± 11.1). However, TOP estimation was insufficient to produce complete occlusion in two out of 17 subjects (11.8%). In conclusion, the estimation of TOP incorporating SBP values may offer a valid and practical means for cuff administration during IPC protocols with potential to minimize adverse effects and maximize its positive effects.

First trimester plasma per- and Polyfluoroalkyl Substances (PFAS) and blood pressure trajectories across the second and third trimesters of pregnancy

BackgroundEvidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) increases risk of high blood pressure (BP) during pregnancy. Prior studies did not examine associations with BP trajectory parameters (i.e., overall magnitude and velocity) during pregnancy, which is linked to adverse pregnancy outcomes. ObjectivesTo estimate associations of multiple plasma PFAS in early pregnancy with BP trajectory parameters across the second and third trimesters. To assess potential effect modification by maternal age and parity. MethodsIn 1297 individuals, we quantified six PFAS in plasma collected during early pregnancy (median gestational age: 9.4 weeks). We abstracted from medical records systolic BP (SBP) and diastolic BP (DBP) measurements, recorded from 12 weeks gestation until delivery. BP trajectory parameters were estimated via Super Imposition by Translation and Rotation modeling. Subsequently, Bayesian Kernel Machine Regression (BKMR) was employed to estimate individual and joint associations of PFAS concentrations with trajectory parameters – adjusting for maternal age, race/ethnicity, pre-pregnancy body mass index, income, parity, smoking status, and seafood intake. We evaluated effect modification by age at enrollment and parity. ResultsWe collected a median of 13 BP measurements per participant. In BKMR, higher concentration of perfluorooctane sulfonate (PFOS) was independently associated with higher magnitude of overall SBP and DBP trajectories (i.e., upward shift of trajectories) and faster SBP trajectory velocity, holding all other PFAS at their medians. In stratified BKMR analyses, participants with ≥ 1 live birth had more pronounced positive associations between PFOS and SBP velocity, DBP magnitude, and DBP velocity – compared to nulliparous participants. We did not observe significant associations between concentrations of the overall PFAS mixture and either magnitude or velocity of the BP trajectories. ConclusionEarly pregnancy plasma PFOS concentrations were associated with altered BP trajectory in pregnancy, which may impact future cardiovascular health of the mother.

Prevalence of Undiagnosed Hypertension and its Associated Factors Among Adult Peoples Living in Enemor Woreda, South Ethiopia, 2021. Community Based Cross Sectional Study

Background: Hypertension is defined as two or more readings of systolic blood pressure measurement of 130 mm Hg or higher or diastolic blood pressure measurement of 80 mm Hg or higher. In the early stages, symptoms of HTN are often not detectable and thus many people with the disease are left undiagnosed. Undiagnosed HTN increases the risk of complications such as renal failure, myocardial infarction, heart failure, stroke and premature death. There was a high prevalence of undiagnosed HTN among adolescents. Objective: To assess the prevalence of undiagnosed hypertension and its associated factors among adult peoples living in Enemor Woreda, Ethiopia, 2021. Method: A community based cross-sectional study design was conducted from April to May, 2021. Data were collected using a structured self-administered English version questionnaire; which translated to the national Amharic language. The data were collected from 630 households using systematic random sampling technique at K=7. The data were entered to epi data version 3.4 and analyzed by SPSS version 26. Bivariate and multivariable logistic regression with 95% CI was hold to determine the significance of variables. Result: In this finding 260 (45.3%) of respondents were identified as having undiagnosed hypertension. Respondents having sedentary life style (AOR=2.24, 95%CI (1.37, 3.67)], BMI ≥25 (AOR=2.42, 95%CI (1.43, 4.09)], smokers [AOR: 0.45, 95%CI(0.28, 0.73)], health seeking behavior [AOR: 0.41, 95%CI(0.25, 0.66)], monthly income &lt;2000 ETB [AOR: 0.68, 95%CI(0.48,0.97)] and respondents dietary habit Enjera with Wot [AOR: 0.57, 95%CI(0.40, 0.83)] were significantly associated with undiagnosed hypertension. Conclusion: The overall prevalence of undiagnosed hypertension was 45.3%. respondents with BMI kg/m2 &gt;25, having sedentary life style, cigarette smoking, health seeking behavior, dietary habit and monthly income were significance predictors of undiagnosed HTN; therefore, people should follow Life style modification and have health seeking behavior to early detect and manage undiagnosed HTN with in the community.

Blood pressure in preterm infants with bronchopulmonary dysplasia in the first three months of life

BackgroundNeonatal hypertension is common in preterm infants with bronchopulmonary dysplasia (BPD). Our study aimed to examine blood pressure variation in the first three months of life in preterm BPD patients.MethodsWe conducted a retrospective, single-centre study at the Neonatal Intensive Care Unit of the University of Szeged, Hungary. We collected blood pressure data from 26 preterm infants (born at < 30 weeks gestation) with moderate or severe BPD over three years (2019–2021). We calculated the BPD group's daily average blood pressure values and used previously defined normal blood pressure values from a preterm patient group born at < 30 weeks gestation as a reference. We used 19,481 systolic, diastolic and mean blood pressure measurement data separately to calculate daily average blood pressures.ResultsWe found a statistically significant correlation between the blood pressure values of the BPD patient group and the reference data. The difference between the blood pressure curve of the group with BPD and that of the reference group was also statistically significant. We also analysed individual patients' daily average blood pressure values and found that 11 patients (42%) had hypertensive blood pressure values for three or more days within the first 90 days of life. Within this group, our statistical analysis showed a 25% chance of acute kidney injury.ConclusionThe blood pressure of the BPD group not only correlated with but also significantly differed from the reference data. Hypertension lasting three or more days occurred more frequently in patients with acute kidney injury accompanied by BPD.Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information

A Comparative Study on the Difference of Blood Pressure Criteria and the Difference in Blood Pressure Measurement Among Children and Adolescents in China, the United States, and Europe

Abstract OBJECTIVE To compare the difference of blood pressure criteria and the difference in blood pressure measurement among children and adolescents. METHODS The latest blood pressure criteria for children and adolescents in China, the normal blood pressure standard the United States, and Europe have been used to calculate blood pressure differences for the same age, gender, and height. Based on 3 blood pressure measurements of 45,314 Chinese and 15,279 American children and adolescents, the differences in blood pressure measurements were calculated through repeated measurement analysis of variance and compared with criteria differences. RESULTS More than 60% of the difference in blood pressure standard is distributed between −3 and 3 mm Hg. But the difference between Chinese standards and American standards can be 5–10 mm Hg in children aged 13. The difference between Chinese standards and European standards can be 6–9 mm Hg at the age of 16. The analysis of repeated blood pressure data shows that the maximum difference in systolic blood pressure measurement for Chinese boys and girls is 3.7 and 4.1 mm Hg, respectively, and the maximum difference in diastolic blood pressure measurement is 2.0 and 2.1 mm Hg. The difference between the 3 measurements of boys and girls in the United States is nearly 1 mm Hg. CONCLUSIONS The difference between blood pressure standards is smaller than the measurement difference, and accurate measurement and repeated measurement of blood pressure may be more important for evaluating blood pressure status than the selection of blood pressure standards.

Incidence and prevalence of hypertension among HIV-TB co-infected participants accessing treatment: A five-year prospective cohort analysis.

Hypertension is a leading risk factor for cardiovascular disease among people living with human immunodeficiency virus (PLWH). This study determined incidence and prevalence of hypertension among PLWH receiving antiretroviral therapy (ART). We prospectively followed-up 642 HIV and tuberculosis (TB) co-infected study participants from 2005-2013. We defined hypertension as two consecutive elevated systolic and/or diastolic blood pressure measurements above 139/89 mmHg or current use of antihypertensive therapy. Of 507 participants analyzed, 53% were women. Median [interquartile range (IQR)] age, body mass index (BMI), and CD4 count was 34 (28.0-40.0) years, 22.7 (20.5-25.4) kg/m2, and 145 (69.0-252.0) cells/mm3, respectively. Incidence [95% confidence interval (CI)] of both systolic and diastolic hypertension overall, in men, and in women over 40 years was 1.9 (1.4-2.6), 5.9 (3.6-9.6), and 5.0 (2.7-9.3) per 100 person-years (PY), respectively. Risk of developing hypertension was higher in men [(adjusted hazard ratio (aHR) 12.04, 95% CI: 4.35-33.32)] and women over 40 years (aHR 8.19, 95% CI 2.96-22.64), and in men below 40 years (aHR 2.79, 95% CI 0.95-8.23). Higher incidence rates of hypertension among older men and women accessing ART highlight opportunities to expand current integrated HIV-TB care models, to include cardiovascular disease risk screening and care to prevent premature death.