Differences In Blood Pressure Research Articles

Ionized hypocalcemia as a prognostic factor of early mortality in traumatic brain injury

ABSTRACT Traumatic brain injury (TBI) is a common neurological condition. It can affect mental, physical, and cognitive functions and is a common cause of mortality. Electrolytes imbalance is common in those patients. Effective therapy of electrolytes abnormalities improves neurological outcome and reduces mortality. Therefore, we studied the predictive significance of ionized hypocalcemia for early mortality in TBI patients. Patients and method This observational study in the intensive care units of the Ain Shams University hospitals was done on sixty adult patients with TBI of both sexes, divided into two groups: group A (ionized hypocalcemic patients), and group B (normocalcemic patients). On admission, medical history, physical examination including neurological evaluation, and appropriate investigations were performed. Ionized calcium was measured at the start of the 28-day study and then every five days after that. Results There was no statistically significant difference between the two groups for demographic data, brain injury type, or the number of intubated patients (p > 0.05). There was a statistically significant difference for diffuse axonal damage, subdural hemorrhage, cerebral edema, GCS, and mean blood pressure (p < 0.001). Serum ionized calcium in group A was significantly lower than in group B on the day of admission and day five (p < 0.001). On the day of admission, there was a significant difference in serum sodium (p < 0.05). In both groups, there was a significant difference in the ICU stay as regards survivors (p < 0.001). There was a statistically significant difference in 28-day mortality between the two groups (p = 0.001). Conclusion In TBI patients, ionized hypocalcemia on admission and on day five, hypernatremia and disturbed conscious level are strongly linked to greater fatality rates.

Renal functional reserve assessment in patients with coronary microvascular dysfuntion and preserved renal function

Abstract Funding Acknowledgements None. Introduction Renal Functional Reserve (RFR) is a field of scientific debate and may be a valuable diagnostic tool for the early detection of subclinical renal disease. According to literature, chronic kidney disease is related to cardiovascular disease (CVD), however the available data on the association of early renal dysfunction and CVD are sparse. Aim The aim of the present study is to evaluate RFR in patients with coronary microvascular dysfunction (CMD) and preserved renal function [eGFR≥ 60 ml/min/1.73m2 (CKD-EPI) and proteinuria&amp;lt; 400mg/24h]. Methods This is a single-center, prospective study enrolling patients with CMD. We are presenting preliminary resuts. In the absence of significant coronary artery stenosis, functional coronary circulation assessment was performed for all patients. Coronary flow reserve (CFR) and index of microvascular resistance (IMR) were measured invasively. In all participants, RFR was estimated by endogenous creatinine clearance after oral protein load (cooked meal, 1.2gr/kg). Normal RFR was defined as ≥30 ml/min/1.73m2. Also, patients with CMD were offered 24-hour Ambulatory Blood Pressure Monitoring (ABPM). Results A total of 25 participants have been enrolled so far in study: 11 without CMD - non-CMD group [7 female, 64%, mean age: 52.9±8.8 years) and 14 with INOCA – CMD group (11 female, 79%, mean age : 53.5±10.3 years). CMD patients were classified into 2 groups, structural and functional endotype (CFR&amp;lt;2.5 and IMR≥25 were considered abnormal). The RFR value for CMD group is 7.4±6.3 ml/min/1.73m2, while for control group 36.3±5.8 ml/min/1.73m2 (p&amp;lt;0.005), This difference between groups was found to be statistically significant after controlling for confounding factors. It was found that RFR value for functional CMD endotype was 3.8±2.6 ml/min/1.73m2, while for patients with structural endotype 9.6±7,2 ml/min/1.73m2 (p=0.06). Furthermore, no statistical significance was found between RFR and IMR, CFR indices (p =0.35, p =0.23 respectively). According to data from 24hr ABPM , there were no significant differences in ambulatory blood pressure (systolic and diastolic) between the two endotypes of CMD (p=NS for all), as well as no relationship with RFR (p=0.6, p=0.6 respectively) was observed. However, the proportion of non-dippers (for both SBP and DBP) was significantly higher in functional CMD endotype (p&amp;lt;0.05). It was not found correlation between RFR and non-dipping phenotype, for both SBP and DBP (p=NS). Conclusion Abnormal RFR has been observed in all patients with microvascular dysfunction. In addition, patients with functional CMD show a lower RFR value compared to those with structural. RFR is not related to levels of BP or the non-dipping pattern. Given the hypothesis that the assessment of renal functional reserve is an early diagnostic tool for subclinical renal disease, the early identification of patients with specific phenotypes could contribute to the individualization of therapeutic interventions.

Vasodilators for acute heart failure. A systematic review of randomized clinical trials with meta-analysis and trial sequential analysis

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Danish Cardiovascular Academy Novo Nordisk Foundation. Background Acute heart failure (AHF) is an increasing public health concern with limited evidence for current treatments, such as vasodilators. Recent studies have shown mixed results regarding the efficacy of vasodilation in AHF, leading to downgraded recommendations in European Society of Cardiology (ESC) 2021 guidelines. Method We conducted a systematic review of randomized clinical trials (RCTs) to assess vasodilator therapy's effectiveness in managing AHF. The search for relevant studies was conducted without restrictions across the major databases: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACS), Web of Science, and the Cochrane Central Register of Controlled Trials. The study protocol was published and registered at PROSPERO, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. We included RCTs that compared vasodilators to standard care, placebo, no-intervention, or co-interventions. Our primary outcome was all-cause mortality, while secondary outcomes included serious adverse events (SAEs), tracheal intubation and length of hospital stay. Systolic blood pressure difference was an exploratory outcome. We assessed the risks of bias in individual trials using the Cochrane Collaboration risk of bias tool. Results We included 46 RCTs comprising 28,374 patients with AHF. Meta-analysis and Trial Sequential Analysis showed that vasodilators did not reduce the risk of all-cause mortality (risk ratio (RR) = 0.96, 95% CI: 0.90 to 1.03; I2 = 0%; P = 0.26). However, meta-analysis showed evidence of a beneficial effect of vasodilators in reducing the need for tracheal intubation (RR = 0.82, 95% CI: 0.68 to 0.99; I2 = 55.05%; P = 0.04). No evidence of a difference was seen in the risk of SAEs (RR = 1.01, 95% CI: 0.97 to 1.06; I2 = 0%; P = 0.50) or length of hospital stay (Mean difference (MD) = -0.28, 95% CI: -0.73 to 0.16; I2 = 69.84%; P = 0.28). Finally, a significant decrease in systolic blood pressure (MD = -6.26, 95% CI: -8.06 to -4.46; I2 = 90.51%; P &amp;lt; 0.01) was demonstrated. Conclusion In patients hospitalised with AHF, vasodilator therapy did not result in a reduction of all-cause mortality, SAEs or length of hospital stay. However, the need for tracheal intubations was significantly decreased.Forest plot of all-cause mortalityForest plot of Tracheal intubation

Racial Disparities in Blood Pressure at Time of Acute Ischemic Stroke Presentation: APopulation Study.

Hypertension is a stroke risk factor with known disparities in prevalence and management between Black and White patients. We sought to identify if racial differences in presenting blood pressure (BP) during acute ischemic stroke exist. Adults with acute ischemic stroke presenting to an emergency department within 24 hours of last known normal during study epochs 2005, 2010, and 2015 within the Greater Cincinnati/Northern Kentucky Stroke Study were included. Demographics, histories, arrival BP, National Institutes of Health Stroke Scale score, and time from last known normal were collected. Multivariable linear regression was used to determine differences in mean BP between Black and White patients, adjusting for age, sex, National Institutes of Health Stroke Scale score, history of hypertension, hyperlipidemia, smoking, stroke, body mass index, and study epoch. Of 4048 patients, 853 Black and 3195 White patients were included. In adjusted analysis, Black patients had higher presenting systolic BP (161 mm Hg [95% CI, 159-164] versus 158 mm Hg [95% CI, 157-159], P<0.01), diastolic BP (86 mm Hg [95% CI, 85-88] versus 83 mm Hg [95% CI, 82-84], P<0.01), and mean arterial pressure (111 mm Hg [95% CI, 110-113] versus 108 mm Hg [95% CI, 107-109], P<0.01) compared with White patients. In adjusted subanalysis of patients <4.5 hours from last known normal, diastolic BP (88 mm Hg [95% CI, 86-90] versus 83 mm Hg [95% CI, 82-84], P<0.01) and mean arterial pressure (112 mm Hg [95% CI, 110-114] versus 108 mm Hg [95% CI, 107-109], P<0.01) were also higher in Black patients. This population-based study suggests differences in presenting BP between Black and White patients during acute ischemic stroke. Further study is needed to determine whether these differences influence clinical decision-making, outcome, or clinical trial eligibility.

A Intervention of the DASH (Dietary Approach to Stop Hypertention) Diet on Blood Pressure Reduction in the Elderly at BSLU Mandalika

Background: Physical changes in the elderly include changes in the aorta and systemic blood vessels that affect blood pressure. Increased blood pressure in the elderly is a health problem that must be handled properly. The management of hypertension can be done by giving the DASH diet, in this case this study provides an interlude to the DASH diet. Research Methods: This type of research uses a quasi-experimental research design with a randomized pre-test-post-test control group design. Subjects were divided into two groups, namely the treatment group and the control group.Research Results: Most of the subjects in this study were elderly aged 70-74 years (33.3%) in the treatment and 75-80 years (50%) in the control. The research subjects were mostly female, namely 27 elderly (75%). The average body weight for the treatment group was 54.24 kg and the control group was 48.48 kg. The mean blood pressure in both groups before the intervention was higher than the mean blood pressure after the intervention. The results of the paired-t test statistic showed that there was a difference in the mean of systolic (0.000) and diastolic (0.000) blood pressure before and after the intervention. Meanwhile, the two-group difference test showed that there was no difference in systolic and diastolic blood pressure before the intervention. However, after the intervention, there was a difference in systolic and diastolic blood pressure. Furthermore, there was an effect of the DASH diet interlude on Systolic blood pressure (p = 0.000) and Diastolic blood pressure (p = 0.034) after the DASH diet snack was given.Conclusion: there is an effect of giving a DASH diet interlude on systolic blood pressure (p=0.000) and diastolic blood pressure (p=0.034) after giving the DASH diet snack.

The impact of yoga in pregnancy on placental growth factor levels and mean arterial pressure in pre-eclampsia: A randomized controlled trial

Context: Pre-eclampsia is a pregnancy-related condition characterized by hypertension, proteinuria, and edema occurring after 20 weeks of pregnancy or during the postpartum period. Several markers are often assessed to determine the suitable option for confirming pre-eclampsia diagnosis, one of which is the examination of placental growth factor (PlGF) as a placental ischemia indicator. Aims: To evaluate the impact of prenatal yoga on PlGF and mean arterial pressure (MAP) levels in pre-eclampsia within the Madura region. Methods: A randomized controlled trial was conducted on fifty subjects that were randomly allocated to the experimental group with pre-post control groups consisting of 50 participants, namely 25 pregnant women with pre-eclampsia and 25 healthy individuals. The selection was conducted based on the following inclusion criteria: belonging to Madura ethnicity spanning three generations, exhibiting pregnancy duration &gt;20 weeks, maternal ages ranging from 20–35 years, pre-pregnancy body mass index (BMI) &gt;25, a history of hypertension, diabetes mellitus (DM), kidney disorders, pre-eclampsia, chronic hypertension, or family history of chronic high blood pressure and pre-eclampsia among those at risk. PlGF levels were estimated using an ELISA kit, while blood pressure was measured with an Omron brand sphygmomanometer. Results: Statistical analysis performed with the Wilcoxon sign test and T-test indicated significant differences (p&lt;0.005) in systolic blood pressure, diastolic blood pressure, and MAP between the groups. Furthermore, a significant difference was observed in PlGF levels before and after engaging in prenatal yoga practice (p&lt;0.05). Conclusions: The results showed that prenatal yoga contributed to the elevation of PlGF levels in women with pre-eclampsia, compared to their healthy counterparts.

Analysis of the Effect of Family-Centered Empowerment Model (FCEM) Health Education Through WeChat on Medication Compliance and Blood Pressure of Elderly Hypertensive Patients in Rural Areas

Objective: To validate the effectiveness of a Family-Centered Empowerment Model (FCEM) health education through WeChat on medication compliance and blood pressure among elderly hypertensive patients in rural areas. Methods: One hundred and two rural elderly hypertensive patients aged 65–80 years were selected and randomly divided into an experimental and control group of 51 each. The control group implemented conventional health education, and the experimental group implemented FCEM health education through WeChat platform for 4 consecutive weeks. The Therapeutic Adherence Scale for Hypertensive Patients (TASHP) scores and blood pressure measurements were compared between and within the two groups. Results: After the intervention, there were significant differences in medication compliance and blood pressure between the two groups (P &lt; 0.001). In the control group, before and after the intervention, there was a significant difference in medication compliance (P &lt; 0.001), but no significant difference in blood pressure (P &gt; 0.05). In the experimental group, there were significant differences in medication compliance and blood pressure before and after the intervention (P &lt; 0.001). Conclusion: The FCEM health education through an online social platform significantly improved medication compliance and led to effective blood pressure control in rural elderly hypertensive patients. Therefore, as an effective, safe, and economical model, it is also necessary to explore its effectiveness in improving health problems in other chronic diseases and other age groups.

Genome-wide analysis in over 1 million individuals of European ancestry yields improved polygenic risk scores for blood pressure traits.

Hypertension affects more than one billion people worldwide. Here we identify 113 novel loci, reporting a total of 2,103 independent genetic signals (P < 5 × 10-8) from the largest single-stage blood pressure (BP) genome-wide association study to date (n = 1,028,980 European individuals). These associations explain more than 60% of single nucleotide polymorphism-based BP heritability. Comparing top versus bottom deciles of polygenic risk scores (PRSs) reveals clinically meaningful differences in BP (16.9 mmHg systolic BP, 95% CI, 15.5-18.2 mmHg, P = 2.22 × 10-126) and more than a sevenfold higher odds of hypertension risk (odds ratio, 7.33; 95% CI, 5.54-9.70; P = 4.13 × 10-44) in an independent dataset. Adding PRS into hypertension-prediction models increased the area under the receiver operating characteristic curve (AUROC) from 0.791 (95% CI, 0.781-0.801) to 0.826 (95% CI, 0.817-0.836, ∆AUROC, 0.035, P = 1.98 × 10-34). We compare the 2,103 loci results in non-European ancestries and show significant PRS associations in a large African-American sample. Secondary analyses implicate 500 genes previously unreported for BP. Our study highlights the role of increasingly large genomic studies for precision health research.

The Reduction of Blood Pressure in Elderly People with Hypertension Through Morning Walk Therapy

Background: Hypertension in the elderly is a very dangerous disease because without early indications it can cause sudden death. The prevalence of people with hypertension in the Burneh Health Center in 2021 is 15.935 people (11.29%). The proportion of elderly with hypertension is 1,820 elderly men (0.10%) and 1,670 elderly women (0.09%). Purpose: This study aims to analyze the effect of morning walking physical activity on reducing systolic blood pressure in elderly people with hypertension. Method: This study was conducted in the village of Burneh, Bangkalan, East Java, Indonesia from May to June 2022. The research design used a Quasy Experiment with a Pre-test and Post-test approach, the independent variable in this study was physical activity therapy for morning walks and the dependent variable systolic blood pressure in elderly with hypertension. The sample size is 14 elderly with purposive sampling technique. Data analysis used the Paired t-test. Results: The results of the statistical test obtained p-value = 0.041 &lt;0.05 indicating that there was a difference in systolic blood pressure before and after being given physical activity therapy for the morning walk. Most of the respondents (57.14%) experienced a decrease in systolic blood pressure with an average decrease of 8.72 mmHg. Conclusion: Therapeutic physical activity walking in the morning has a significant effect on systolic blood pressure in elderly people with hypertension. Health workers need to provide correct information about the benefits of morning walks for elderly people with hypertension and monitor the consistency of sufferers.

Co-Loading Versus Pre-Loading for Preventing Post-Spinal Hypotension in Caesarean Section

Co-Loading Versus Pre-Loading for Preventing Post-Spinal Hypotension in Caesarean Section

Blood pressure and cerebral oxygenation with physiologically-based cord clamping: sub-study of the BabyDUCC trial.

Cord-clamping strategies may modify blood pressure (BP) and cerebral tissue oxygen saturation (rStO2) immediately after birth. We conducted a sub-study nested within the Baby-Directed Umbilical Cord-Clamping trial. Infants ≥32+0 weeks' gestation assessed as requiring resuscitation were randomly allocated to either physiologically-based cord clamping (PBCC), where resuscitation commenced prior to umbilical cord clamping, or standard care where cord clamping occurred early (ECC). In this single-site sub-study, we obtained additional measurements of pre-ductal BP and rStO2. In a separate observational arm, non-randomised vigorous infants received 2 min of deferred cord clamping (DCC) and contributed data for reference percentiles. Among 161 included infants, n = 55 were randomly allocated to PBCC (n = 30) or ECC (n = 25). The mean (SD) BP at 3-4 min after birth (primary outcome) in the PBCC group was 64 (10) mmHg compared to 62 (10) mmHg in the ECC group, mean difference 2 mmHg (95% confidence interval -3-8 mmHg, p = 0.42). BP and rStO2 were similar across both randomised arms and the observational arm (n = 106). We found no difference in BP or rStO2 with the different cord clamping strategies. We report reference ranges for BP and rStO2 for late-preterm and full-term infants receiving DCC. Among late-preterm and full-term infants receiving varying levels of resuscitation, blood pressure (BP, at 3-4 minutes and 6 min) and cerebral tissue oxygen saturation (rStO2) are not influenced by timing of cord clamping in relation to establishment of ventilation. Infants in this study did not require advanced resuscitation, where cord clamping strategies may yet influence BP and rStO2. The reference ranges for BP and rStO2 represent the first, to our knowledge, for vigorous late-preterm and full-term infants receiving deferred cord clamping. rStO2 > 90% (~90th percentile) may be used to define cerebral hyperoxia, for instance when studying oxygen supplementation after birth.

Sex-specific associations between the environmental exposures and low-grade inflammation and increased blood pressure in young, healthy subjects

Long-term exposures to environmental factors including airborne as well as noise pollutants, are associated with cardiovascular risk. However, the influence of environmental pollution on the young population is controversial. Accordingly, we aimed to investigate the relationships between long-term exposures to different environmental factors and major cardiovascular and inflammatory parameters and biomarkers in young, healthy subjects. Representative sample of permanent residents of two cities differing in air and noise pollution levels, aged 15–21 years, were recruited. Krakow and Lublin, both located in southern Poland, were chosen in relation to their similarities in demographic and geopolitical characteristics, but differences in air pollution (higher in Krakow) and noise parameters (higher in Lublin). A total of 576 subjects were studied: 292 in Krakow and 284 in Lublin. All subjects underwent health questionnaire, blood pressure measurements and biomarker determinations. Inflammatory biomarkers, such as CRP, hs-CRP, fibrinogen as well as homocysteine were all significantly higher in subjects living in Krakow as opposed to subjects living in Lublin (for hsCRP: 0.52 (0.32–0.98) mg/l vs. 0.35 (0.22–0.67) mg/l; p < 0.001). Increased inflammatory biomarker levels were observed in Krakow in both male and female young adults. Interestingly, significant differences were observed in blood pressure between male and female subjects. Males from Krakow had significantly higher mean systolic blood pressure (127.7 ± 10.4 mm/Hg vs. 122.4 ± 13.0 mm/Hg; p = 0.001), pulse pressure (58.7 ± 8.9 mm/Hg vs. 51.4 ± 12.3 mm/Hg; p < 0.001) and lower heart rate (p < 0.001) as compared to males living in Lublin. This was not observed in young adult females. Long-term exposure to environmental factors related to the place of residence can significantly influence inflammatory and cardiovascular parameters, even in young individuals. Interestingly, among otherwise healthy young adults, blood pressure differences exhibited significant variations based on biological sex.

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.

Spironolactone versus Eplerenone in Patients with Resistant Hypertension: A Systematic Review and Indirect Meta-analysis

Background: Spironolactone and eplerenone, both mineralocorticoid receptor antagonists (MRAs), have been shown to be effective in the management of resistant hypertension (RH), although there is a lack of randomised controlled trials (RCTs) that directly comparing the two. This systematic review and indirect meta-analysis compares the two MRAs and their effectiveness in lowering blood pressure (BP) in patients with RH. Methods: RCTs comparing eplerenone or spironolactone with a placebo in RH patients were included in the review. The primary outcome was the mean difference (MD) of systolic blood pressure (SBP) and diastolic blood pressure (DBP). The secondary outcome was the MD of serum potassium levels. The pooled estimates of mean BP and mean potassium level difference were then analysed to attain the adjusted indirect comparisons. Results: Six RCTs involving 665 patients were included in the systematic review. The pooled MD of systolic and diastolic BP between eplerenone and placebo showed a reduction of −0.38 (p=0.0007) and −4.45 (p&lt;0.0001), respectively. The pooled MD of systolic and diastolic BP between spironolactone and placebo showed a reduction of −4.82 (p=0.01) and −2.31 (p=0.006), respectively. The pooled MD of serum potassium levels between eplerenone and placebo as well as spironolactone and placebo was 0.16 (p=0.39) and −0.08 (p=0.59), respectively. An indirect comparison meta-analyses of the MD in systolic and diastolic BP (systolic MD 1.66; 95% CI [−3.46–6.78]; p=0.5250 and diastolic MD 2.14; 95% Cl [−0.63–4.91]; p=0.1293) as well as mean serum potassium levels (MD 0.24; 95% Cl, [−0.23–0.71]; p=0.313) between spironolactone and eplerenone, showed no significant difference. Conclusion: Spironolactone and eplerenone showed an equal reduction in systolic and diastolic BP, as well as serum potassium levels in patients with RH.

The effect of clothes on blood pressure measurement in normotensive and hypertensive subjects in a real-life setting.

The effect of clothing on the recording of blood pressure in a normotensive and hypertensive population remains essential remains to diagnosing and managing. This is a cross-sectional study to measure blood pressure using a validated oscillometric sphygmomanometer in two populations. The records were made over the thicker sleeve arm and non-sleeved arm (either on bare arm or indicating the removal of the outermost garment). Clothing was categorized according to how patients attended the outpatient clinic based on the real world. A total of 75 patients were included with a diagnosis of hypertension whose mean age was 67.1 years (SD ± 16.3). The group of normotension included 63 patients whose mean age was 21.1 years (DS ± 2.2). There was not variability related to technique or inherent to the condition of the subject on the first and second measurements of blood pressure. In the comparative analysis, the group with normotension did not report a significant difference in systolic or diastolic blood pressure due to the effect of clothing during the first or second measurement (p> 0.05). In the group with hypertension, a significant difference was observed in the first measurement, between the group over the sleeve and non-sleeved arm (systolic blood pressure, p: 0.021, and diastolic, p: 0.001). However, when the variable order of measurement was analyzed by randomizing the initial registry with or without clothing was not found a statistical difference. Clothing does not a significant difference in the measure of blood pressure in a normotensive or hypertensive population.

Correlation between risk factors of cognitive dysfunction and blood pressure variability after acute ischemic stroke in northwest Shanghai

： Objective: To explore the relationship between risk factors of cognitive dysfunction and blood pressure variability after acute ischemic stroke in northwest Shanghai to establish a model for early identification of high-risk groups of cognitive dysfunction and formulation of more targeted prevention and treatment measures. Methods: Spearman test was used to evaluate the correlation between blood pressure variability and Montreal Cognitive Assessment (MoCA) score in patients with acute ischemic stroke and the partial regression coefficient model was constructed based on the above independent risk factors, and the receiver operating characteristic (ROC) curve was described to analyze the relevant independent risk factors. Results: ROC curve analysis results showed that the clinical prediction model was significantly more effective than a single factor in predicting the risk of cognitive impairment after acute ischemic stroke in northwest Shanghai（P < 0.05）. Conclusion: Cognitive dysfunction after acute ischemic stroke was closely related to high Homocysteine (Hcy) levels, high standard deviation of systolic blood pressure, previous infarction history and infarction of cognitive function area in northwest Shanghai. The prediction model based on the above factors showed satisfactory value in predicting of cognitive dysfunction risk after acute ischemic stroke and there was also the correlation between cognitive function and blood pressure variability.

Validation of the RBP-9801 oscillometric blood pressure monitor in the general population according to the association for the Advancement of Medical Instrumentation/European Society of Hypertension/ International Organization for Standardization Universal Standard.

The aim of this study was to evaluate the accuracy of the single upper-arm cuff oscillometric blood pressure (BP) monitor RBP-9801 developed for office and home BP measurement in the general population 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). Subjects were recruited to fulfil the age, gender, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. A total of 105 subjects were recruited and 85 were analyzed. For validation criterion 1, the mean±SD of the differences between the test device and reference BP readings was 2.3±6.4/3.1±5.8mmHg (systolic/diastolic). For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 5.24/5.03mmHg (systolic/diastolic). The conclusion is that the RBP-9801 oscillometric device for office and home BP measurement fulfilled all the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in the general population and can be recommended for clinic and self-use at home.

Analysis of acupoint massage combined with touch on relieving anxiety and pain in patients with oral implant surgery.

Oral implant surgery is an effective procedure for artificial implants in missing tooth areas under local anesthesia. Because patients under local anesthesia are conscious during this procedure, compared with general anesthesia-related operations, they are more likely to experience negative emotions, such as anxiety and tension. These emotional reactions result in shivering and chills in the limbs, leading to poor doctor-patient cooperation and even avoidance of treatment. In traditional Chinese medicine, it is believed that acupoint massage regulates blood and Qi, dredge menstruation, and relieve pain, which is beneficial for patients' emotional adjustment; however, there are few related clinical studies. To observe the changes in anxiety and pain in patients with oral implant after acupoint massage combined with touch therapy. One hundred patients undergoing oral implantation in our hospital between May 2020 and May 2023 were randomly divided into control and study groups, according to a random number table, with 50 patients in each group. The control group received routine intervention, and the study group received acupoint massage combined with touch on the basis of the control group. Anxiety [assessed using the Modified Dental Anxiety Scale (MDAS)], pain severity, blood pressure, heart rate, and satisfaction were compared between the two groups. Before intervention, the difference in MDAS score between the two groups was not significant (P > 0.05), while after the intervention, the MDAS scores decreased in both groups compared with those before the intervention (P < 0.05); the MDAS score of the study group was lower than that of the control group, with a statistically significant difference (P < 0.05). The degree of pain in the intervention group was significantly lower than that in the control group (P < 0.05). Before the intervention, there were no significant differences in systolic and diastolic blood pressures or heart rate between the two groups (P > 0.05). The systolic and diastolic blood pressures and heart rate in the intervention group, during and after the intervention, were significantly lower than those in the control group (P < 0.05). The total degree of satisfaction in the study group was significantly higher than that in the control group (P < 0.05). Acupoint massage combined with touch better relieves anxiety and pain in patients undergoing dental implant surgery, improving the perioperative comfort of these patients and ensuring safety and a smooth operation.

Non-Invasive Assessment of Micro- and Macrovascular Function after Initiation of JAK Inhibitors in Patients with Rheumatoid Arthritis.

Janus kinase (JAK) inhibitors constitute a novel class of oral biologic disease-modifying antirheumatic drugs for patients with rheumatoid arthritis (RA). However, their use has been associated with increased risk of major cardiovascular events. We investigated whether treatment with JAK inhibitors exerts significant alterations in the micro- and microvasculature in RA patients. Thirteen patients with RA initiating treatment with JAK inhibitors were prospectively studied. Eventually, data from 11 patients who completed the study were analyzed. Procedures were performed at baseline and 3 months after treatment. Nailfold videocapillaroscopy was applied to detect alterations of the dermal capillary network. Participants underwent 24 h ambulatory blood pressure monitoring (Mobil-O-Graph device) for the assessment of blood pressure (both brachial and aortic) and markers of large artery stiffening [pulse wave velocity (PWV), augmentation index] throughout the whole 24 h and the respective day- and nighttime periods. Carotid intima-media thickness was assessed with ultrasound. Three-month treatment with JAK inhibitors was not associated with any differences in brachial and aortic blood pressure, arterial stiffness, and carotid atherosclerosis, with the only exception of nighttime PWV, which was significantly elevated at follow-up. However, three-month treatment with JAK inhibitors induced significant microvascular alterations and increased the total number of capillaroscopic abnormalities. Three-month treatment with JAK inhibitors may exert significant effects on microcirculation as assessed with nailfold videocapillaroscopy, whereas macrovascular structure and function appears largely unaffected. Further research toward this direction may add substantial information to the available literature regarding cardiovascular aspects of JAK inhibitors in RA.

Inter-leg systolic blood pressure difference has been associated with all-cause and cardiovascular mortality: analysis of NHANES 1999–2004

BackgroundInter-leg systolic blood pressure difference (ILSBPD) has emerged as a novel cardiovascular risk factor. This study aims to investigate the predictive value of ILSBPD on all-cause and cardiovascular mortality in general population.MethodsWe combined three cycles (1999–2004) of the National Health and Nutrition Examination Survey (NHANES) data. Levels of ILSBPD were calculated and divided into four groups based on three cut-off values of 5, 10 and 15mmHg. Time-to-event curves were estimated with the use of the Kaplan-Meier method, and two multivariable Cox proportional hazards regression models were conducted to assess the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and cardiovascular mortality associated with ILSBPD.ResultsA total of 6 842 subjects were included, with the mean (SD) age of 59.5 (12.8) years. By December 31, 2019, 2 544 and 648 participants were identified all-cause and cardiovascular mortality respectively during a median follow-up of 16.6 years. Time-to-event analyses suggested that higher ILSBPD was associated with increased all-cause and cardiovascular mortality (logrank, p < 0.001). Every 5mmHg increment of ILSBPD brings about 5% and 7% increased risk of all-cause and cardiovascular mortality, and individuals with an ILSBPD ≥ 15mmHg were significantly associated with higher incidence of all-cause mortality (HR 1.43, 95%CI 1.18–1.52, p < 0.001) and cardiovascular mortality (HR 1.73, 95%CI 1.36–2.20, p < 0.001) when multiple confounding factors were adjusted. Subgroup and sensitivity analysis confirmed the relationship.ConclusionsOur findings suggest that the increment of ILSBPD was significantly associated with higher risk of all-cause and cardiovascular mortality in general population.