Home Blood Pressure Monitoring Research Articles

#1112 A simplified lung ultrasound guided management protocol of pulmonary congestion in hemodialysis

Abstract Background and Aims Pulmonary congestion PC is frequent in Hemodialysis HD and holds a negative prognostic value. Lung ultrasound LUS is accurate in detecting and quantification PC, however, there are many methods to use LUS to evaluate PC. Here we validate a simplified LUS guided pulmonary congestion management protocol in HD patients that can be easily integrated in clinical practice, while studying at the same time the impact of such method on blood pressure control. Methods A prospective randomized multi-centric trial including stable HD patients in 3 countries. Patients were randomized into two groups: active and control group. All patients had a bedside LUS at the end of their mid-week session every two weeks according to the following time-line: Day 1, 15, 30, 45, 60. Lung ultrasound was performed according to the 8-zone method, and a B line score BLS was obtained. A global BLS of more than 6 was considered reflecting a significant PC level. The dry weight was adapted according to the standard of care in the control group. In the active group, in addition to the standard of care, if BLS was more than 6 at day 1 then the dry weight was reduced by 500 g. The same procedure was repeated at Day 15. (The maximum global dry weight modification per patient was 1 kg) (Fig. 1). Home blood pressure monitoring HBPM was also obtained weekly all through the study period. Results 28 stable HD patients (21 males) were enrolled in the study up until now. Mean age was 66.4 years, 14 were diabetics, 4 with stable ischemic heart disease, 1 heart failure and 27 were suffering from hypertension. Mean dialysis vintage was 35.8 months, and mean residual urine volume was 548 ml/24H. Mean session time was 4 hours. Main study population characteristics are described in Table 1. In the active group, mean BLS at day 1 (13.5) was significantly reduced, and reached (7.57) at day 60. (P < 0.001, ES:1.55) (Fig. 2). This was in parallel with a little but significant reduction in the dry weight (P: 0.03, ES: 0.6) but without a statistically greater UF values (P: 0.23) (Table 2). A significant reduction in home blood pressure was also observed by the HBPM readings, especially in the diastolic BP (P: 0.004). In the control group, the mean BLS at day 1 was (12.1). This level did not change all through the study time line, as it was (12.1) at day 60. No significant difference was observed in the dry weight, or ultrafiltration rate UF or home blood pressure values (Table 3). Conclusion Our simplified LUS guided management protocol was able to safely reduce the pulmonary congestion in HD patients in addition to better controlling their blood pressure. This protocol can be applied easily in every HD unit, and may be added to the standard of care to better estimate the dry weight in HD patients.

Association of Knowledge and Practice of Home Blood Pressure Monitoring (HBPM) Among Second-Year Medical Students

Objective: Hypertension is a global public health challenge, often exhibiting suboptimal management resulting in numerous health complications. Home blood pressure monitoring (HBPM) is a valuable tool for aiding healthcare providers in the diagnosis and treatment of hypertension in patients. Approximately 15% of individuals with hypertension fall within the young adult demographic, ranging from 18 to 39 years old. The early onset of hypertension exposes them to a heightened risk of cardiovascular events occurring prematurely. Consequently, the objective of this research is to assess the association of knowledge of HBPM with practice among medical students. Methods: This was part of a larger study entitled: “Effect of Video Intervention on Knowledge of Proper Home Blood Pressure Monitoring Among Second Year Medical Students, UPM”. It was a cross sectional study done among all second-year medical students in the Universiti Putra Malaysia from April 2022 to 2023 (JKEUPM-2022-143). The students were given online questionnaires on HBPM. The questionnaire underwent content validation by a panel of experts. It consisted of 20 questions on knowledge, with one point for each correct answer. A higher score indicates better knowledge. There were two questions on practice which asked if they did HBPM on themselves or their family members/friends. Results: We report (n=21, 24.1%) of participants do their blood pressure at home, while (n=45,51.7%) do BP monitoring at home to their family members/friends. The mean (+sd) knowledge scores out of a possible 20 for these groups are 10.81 (+ 3.0) and 11.29 (+2.5) respectively. Those who assisted family members/friends with their BP at home had significantly more knowledge scores that those who didn’t (mean difference= 2.7, p=0.000). No significant associations with the group with self BP monitoring. Conclusion: Therefore, we conclude that those who assist others in HBPM have significantly higher knowledge scores compared to those who did not.International Journal of Human and Health Sciences Supplementary Issue 01: 2024 Page: S50

Design and rationale of the cardiometabolic health program linked with community health workers and mobile health telemonitoring to reduce health disparities (LINKED-HEARTS) program

Hypertension and diabetes are major risk factors for cardiovascular diseases, stroke, and chronic kidney disease (CKD). Disparities in hypertension control persist among Black and Hispanic adults and persons living in poverty in the United States. The "LINKED-HEARTS Program" (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS"), is a multi-level intervention that includes home blood pressure (BP) monitoring (HBPM), blood glucose telemonitoring, and team-based care. This study aims to examine the effect of the LINKED-HEARTS Program intervention in improving BP control compared to enhanced usual care (EUC) and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the program. Using a hybrid type I effectiveness-implementation design, 428 adults with uncontrolled hypertension (systolic BP ≥ 140 mm Hg) and diabetes or CKD will be recruited from 18 primary care practices, including community health centers, in Maryland. Using a cluster-randomized trial design, practices are randomly assigned to the LINKED-HEARTS intervention arm or EUC arm. Participants in the LINKED-HEARTS intervention arm receive training on HBPM, BP and glucose telemonitoring, and community health worker and pharmacist telehealth visits on lifestyle modification and medication management over 12 months. The primary outcome is the proportion of participants with controlled BP (<140/90 mm Hg) at 12 months. The study tests a multi-level intervention to control multiple chronic diseases. Findings from the study may be leveraged to reduce disparities in the management and control of chronic diseases and make primary care more responsive to the needs of underserved populations. ClinicalTrials.gov. Identifier: NCT05321368.

The association of home blood pressure with all-cause mortality in hemodialysis patients: A prospective observational study.

Prior observational studies conducted in the hemodialysis population have suggested a reverse association between dialysis-unit blood pressure (BP) and mortality. The present study aimed to investigate the prognostic association of home versus dialysis-unit BP with all-cause mortality in hemodialysis patients. At baseline, 146 patients receiving maintenance hemodialysis underwent assessment of their BP with the following methods: (i) 2-week averaged routine predialysis and postdialysis BP measurements; (ii) home BP monitoring for 1 week that included duplicate morning and evening BP measurements with the use of validated devices. Over a median follow-up period of 38 months (interquartile range [IQR]: 22-54), 44 patients (31.1%) died. In Kaplan-Meier curves, predialysis and postdialysis systolic BP (SBP) was not associated with all-cause mortality, while home SBP appeared to be of prognostic significance (log rank p = 0.029). After stratifying patients into quartiles, all-cause mortality was lowest when home SBP was ranging from 128.1 to 136.8 mmHg (quartile 2). In univariate Cox regression analysis, using quartile 2 as a referent category, the risk of all-cause mortality was 3.32-fold higher in quartile 1, 1.53-fold higher in quartile 3 and 3.25-fold higher in quartile 4. The risk-association remained unchanged after adjustment for several confounding factors (adjusted hazard ratio: 4.79, 1.79, 3.63 for quartiles 1, 3, and 4 of home systolic BP, respectively). Our findings suggest that among hemodialysis patients, 1-week averaged home SBP is independently associated with all-cause mortality. In sharp contrast, SBP recorded either before or after dialysis over 2 weeks is not prognostically informative.

Report from a text-based blood pressure monitoring prospective cohort trial among postpartum women with hypertensive disorders of pregnancy

BackgroundHypertensive disorders of pregnancy are a main cause of maternal morbidity and mortality in the United States and worldwide, and it is estimated that approximately 60% of maternal deaths in the United States occur during the postpartum period. The utilization of telehealth modalities such as home blood pressure monitoring has shown improvement in blood pressure control and adherence with follow up visits. Our study sought to determine if standardized education improved patient hypertension knowledge and if this when combined with home blood pressure telemonitoring increased participants’ postpartum self-blood pressure monitoring and postpartum visit attendance.MethodsThis is an Institutional Review Board approved prospective cohort study conducted at the University of Mississippi Medical Center. Women with a hypertensive disorder of pregnancy who met the inclusion criteria and provided written informed consent to participate were enrolled. Participants received a baseline pre-education questionnaire designed to assess their knowledge of their hypertensive diagnosis, hypertension management, and postpartum preeclampsia (PreE). Participants then received standard education, a blood pressure monitor, and were scheduled a follow-up visit during the first 10 days following discharge. Remote home blood pressure monitoring was performed via text messages and voice calls for 6-weeks postpartum. At the conclusion of the study, participants repeated their original questionnaire.Results250 women provided informed consent to participate in the study and were included in this analysis. Relative to the baseline survey, there was a significant increase (p = 0.0001) in the percentage of correct responses. There was not an association between study engagement and percentage of correct responses on end of study questionnaire (p = 0.33) or postpartum visit attendance (p = 0.69). Maternal age was found to drive study engagement, even when adjusted for community-level distress (p = 0.03) and maternal race (p = 0.0002).ConclusionImplementing a standardized postpartum education session was associated with improvement in patient’s knowledge. Further studies are needed with more longitudinal follow up to assess if this program would also result in improved long-term outcomes and decreased hospital readmission rates.Trial registrationNCT04570124.

CURRENT STATUS OF USE OF VALIDATED DEVICES FOR HOME BLOOD PRESSURE MONITORING AMONG PATIENTS WITH HYPERTENSION

Objective: Hypertension is the most important modifiable risk factor for cardiovascular diseases. Nevertheless, the control rate (&lt;140/90 mmHg) in hypertensive patients is lower than 50% in Korea. The implementation of Home Blood Pressure Monitoring (HBPM) improves the diagnosis and treatment of hypertension. Current clinical guidelines advocate the use of validated HBPM devices. However, there are few studies about the current use of validated devices for HBPM. We aimed to investigate the present status of use of validated HBPM devices in real-world hypertensive patients. Design and method: This study was conducted on Korean hypertensive patients using CareforMe®, a smartphone healthcare application which allows the patients to record their HBPM data. HBPM devices included upper-arm and wrist devices. According to the STRIDE BP, validated devices included 3 categories: Preferred devices (published within the last 10 years and used a recently established protocol of device validation), Validated devices (have passed established validation procedures that have been checked and approved by the STRIDE BP Scientific Advisory Board), and Equivalent devices (equivalent to a device that has fulfilled the criteria for validated devices). Results: From May 2021 through December 2023, a total of 2,539 patients inputted model numbers of their HBPM devices. 112 devices and 32 different manufacturers were identified. 96.9% (n=2,461) of patients used upper-arm devices and 3.1% (n=78) used wrist devices. Out of 112 devices, 12 Preferred upper-arm devices, 5 Validated upper-arm devices, 5 Equivalent devices and 2 Validated wrist devices were identified. Only 17.8% (n=453) our of 2,539 patients were using Preferred HBPM devices, 2.3% (n=58) used Validated upper-arm devices, and 25.7% (n=652) were using Equivalent devices. Among patients using wrist devices, 17.9% (n=14) used validated devices. Conclusions: To the best of our knowledge, this is the first study to analyze the current status of use of validated HBPM devices among hypertensive patients in Korea. 96.9% patients used upper-arm devices, and among them, only 47.3% patients were using validated devices. Our results proposed the urgent need of patient education on accurate HBPM and public accessibility on validated devices to better management of patients with hypertension.

WHITE-COAT EFFECT AND MASKED HYPERTENSION IN HIGH-NORMAL OFFICE BLOOD PRESSURE: RESULTS OF THE HUNGARIAN ABPM REGISTRY

Objective: White-coat hypertension refers to the untreated condition in which BP is elevated in the office but is normal when measured by ambulatory blood pressure monitoring (ABPM), home blood pressure monitoring (HBPM) or both. However, white-coat effect can be present in high-normal blood pressure (BP) category as well. The aims of this study were to evaluate the presence of white-coat effect and masked hypertension in high-normal office BP (OBP) and also to explore the prevalence of untreated very high CV risk (CVD) patients with high-normal OBP. Design and method: Data of the Hungarian ABPM Registry were used in our analysis. Results: From 14 817 uploaded ABPM curves with clinical data 1 255 subjects were categorized as having high-normal OBP. 999 (79.6%) were on antihypertensive treatment. Based on the ABPM recordings apparent high-normal BP was found in 35.9% (n=450), white-coat effect was present in 28.5% (n=358) and masked hypertension was diagnosed in 35.6% (n=447). Similar results were found in treated and untreated subjects as well. Independent predictors of white-coat effect were age (OR: 1.014 (95%CI:1.006-1.023), p=0.001), male sex (OR: 0.565 (0.432-0.739), p&lt;0.001), and obesity (OR: 1.994 (1.480-2.687), p&lt;0.001). Independent predictors of masked hypertension were age (OR: 1.014 (95%CI:1.005-1.023), p=0.003), heart rate (OR: 1.028 (1.011-1.044), p=0.01) and obesity (OR:1.679 (1.262-2.234), p&lt;0.001). 142 subjects had very high CV risk with high-normal OBP and only 7 of them were untreated. With ABPM only one of them had apparent high-normal BP. Conclusions: In high-normal OBP ABPM is a useful tool to diagnose white-coat effect and masked hypertension. Untreated high-normal OBP with very high CV risk is a very rare condition in the general practitioner practice when ABPM is also recommended to evaluate the true blood pressure phenotype before therapeutic decisions.

SLEEP BLOOD PRESSURE MEASURED WITH A HOME BLOOD PRESSURE MONITOR WAS INDEPENDENTLY ASSOCIATED WITH INCIDENCE OF CARDIOVASCULAR DISEASES: THE NAGAHAMA STUDY

Objective: Nocturnal blood pressure (BP) was reported to be associated with cardiovascular diseases. However, nocturnal BP measured using ambulatory monitoring device usually includes BP without sleep. We investigated an association between sleep BP measured using a timer-equipped home BP monitor and cardiovascular diseases in a general population. Design and method: Study population was 6,037 middle-aged and older community residents (mean age: 57.8 years old, men: 30.9%). Participants were required to sleep with wrapping cuffs in the upper-arm and sleep BP was measured automatically at 0:00, 2:00, and 4:00. Actigraph was used to determine BP measured during sleep. Participants were also measured home morning BP manually using a same device. Incidence of cardiovascular diseases including stroke and myocardial infarction were assessed by reviewing personal hospital records. Results: Mean morning systolic and diastolic BP was 126 ± 18 and 77 ± 11 mmHg, respectively, while sleep systolic and diastolic BP was 112 ± 15 and 66 ± 9 mmHg. During 5.0 years mean follow-up period, we observed 80 cases of cardiovascular diseases (stroke and myocardial infarction). Morning hypertension (&gt;135/85 mmHg) [hazard ratio (HR) = 3.22, P &lt; 0.001] and sleep hypertension (&gt;120/70 mmHg) [HR = 2.21, P = 0.002], but not office hypertension (&gt;140/90 mmHg) [HR = 1.44, P = 0.127], was significantly associated with incidence of cardiovascular diseases independently of age, sex, and body mass index. Clinical characteristics including sleep efficiency (normotension: 91 ± 4%, sleep hypertension: 89 ± 5%, morning hypertension: 90 ± 4%, sleep and morning hypertension: 89 ± 5%, P&lt; 0.001) and oxygen desaturation index (5.9 ± 4.8, 8.3 ± 6.6, 9.3 ± 7.1, 11.1 ± 9.0 times/h, P &lt; 0.001) differed significantly by the hypertension status. However, sleep hypertension [HR = 2.94, P = 0.015], morning hypertension [HR = 4.81, P &lt; 0.001], and sleep and morning hypertension [HR = 4.71, P &lt; 0.001] was identified as significant factors for cardiovascular diseases after adjustment of covariates including the sleep parameters. Conclusions: High sleep BP measured home BP monitoring device was independently associated with incidence of cardiovascular disease in a general population.

CONTROL RATE OF THE OFFICE BLOOD PRESSURE AND ECHOCARDIOGRAPHIC DATA FOR TARGET ORGAN DAMAGE IN ONE AMBULATORY CARDIOLOGICAL PRACTICE IN BULGARIA

Objective: After the COVID 19 pandemic, the regular examinations of the patients with arterial hypertension were restarted in the ambulatory cardiological practice. 297 visits were done in one such outpatient clinic in the city center of Sofia, Bulgaria during the first 9 month of 2023. The aim of or study was to estimate the control rate of the office blood pressure and the hypertension mediated target organ damage, evaluated with echocardiography. Design and method: The patients were with mean age 62 years/18-87/.193 were women and 106 men. They were examined by cardiologist, an ECG was performed, and their office blood pressure was measured according to the ESH recommendations.Only 25 patients underwent 24 hours ABPM. According to the regulations of the National Health Care Fund, the patients with arterial hypertension should be referred for echocardiography every 2 years, so we analyzed the results, entered in their medical records. Results: 52% of the subjects were with good control of the office blood pressure/below 140/90 mm Hg/ and this percentage is comparable with the results from the recent real world data trails in Bulgaria. 71% of them fulfill the criteria for grade 1 diastolic dysfunction with E/A less than 1. 64% of the patients were with left ventricular hypertrophy, defined as left ventricular wall thickness greater than 11 mm. And 64% of them had LA diameter greater than 40 mm. Conclusions: Despite of the decent control of the office blood pressure almost 2/3 of the patients had data for hypertension mediated target organ damage from their routine echocardiography. This may be a result of the delay of the initiation of the therapy or more probably of the insufficient time under control That is why we must strongly encourage wider implementation of ABPM and home BP monitoring in ambulatory cardiology practice in Bulgaria.

AUTOMATED ATRIAL FIBRILLATION DETECTION DURING ROUTINE BLOOD PRESSURE MEASUREMENT: DIAGNOSTIC ACCURACY OF THE OSCILLOMETRIC BLOOD PRESSURE MONITOR MICROLIFE BP B3 AFIB ADVANCED

Objective: To evaluate the diagnostic accuracy of the oscillometric upper-arm cuff home blood pressure (BP) monitor Microlife BP B3 AFIB Advanced in detecting atrial fibrillation (AF) during automated BP measurement. Design and method: Participants with permanent AF aged &gt;60 years (AF group) and others with sinus rhythm (SR) matched for age and sex (control group) were recruited. Electrocardiography (ECG) recording and blood pressure (BP) measurements were simultaneously conducted twice for each participant. Using an AF specific diagnostic algorithm of the BP monitor, the rhythmicity of heart rate was evaluated three times during each automated BP measurement. When AF is detected in at least 2 of the 3 assessments, the device reports the presence of AF detection. A single wide-range cuff of the test device was used for arm circumference 22-42 cm. Results: A total of 108 individuals were analyzed, (50%/50% with AF/SR, 59%/59% men, mean age [SD] 76±10.5/73±9.5 years for AF/SR, systolic BP 123.4±19.6/131.5±17.9 mmHg [p&lt;0.01], diastolic BP 74.2±11.7/73.4±10.6 mmHg [p=NS]). False negative and false positive AF detection in AF and control group respectively are shown in Table. The sensitivity of the test device in detecting AF was 87%, specificity 100%, positive predictive value 100% and negative predictive value 88.5%. Conclusions: These findings indicate that the Microlife BP B3 AFIB Advanced automated BP monitor equipped with an AF detecting algorithm with triplicate assessment of the cardiac rhythm during each automated BP measurement, has an exceptional diagnostic accuracy. Thus, this novel technology can be employed as a reliable screening tool for detecting asymptomatic AF in elderly adults during routine screening or long-term monitoring of treated hypertension.

FUTURE BLOOD PRESSURE PREDICTION ARTIFICIAL INTELLIGENCE PROGRAM: THE DR. ANSWER MEDICAL SOFTWARE

Objective: Current guidelines recommend home blood pressure (HBP) monitoring in patients diagnosis with hypertension and those with white coat hypertension or masked hypertension. Delicate classification of these patients are important because the intensification of antihypertensive drug therapy for patients with white coat uncontrolled hypertension or white coat hypertension may not be needed because cardiovascular risk seems not to be greater. Therefore, its detection is important to avoid overtreatment. Meanwhile patients with masked hypertension or masked uncontrolled hypertension and uncontrolled hypertension need further intensification of antihypertensive treatment. Dr. Answer project consists of 21 artificial intelligence (AI) medical software that cover eight major diseases including hypertension. The main object of Dr. Answer hypertension project is to predict the patients next visit office BP according to the home BP data and provide effective and precise treatment plan. Design and method: 2,057 patients and 156,117 pure HBP data were collected in the Dr. Answer hypertension project. Patients were enrolled in 1 tertiary center (Chonnam National University Hospital) and other 21 non-tertiary centers from January 2022 to September 2022. 1,447 patients and 153,712 were excluded due to insufficient HBP data and follow up loss. Finally 610 patients and 2,405 HBP data were evaluated in the AI program model. Results: Patients were 66.7 ± 14.4 years and proportion of women was 24.1%. and patients enrolled in tertiary center was 73.4%. Mean HBP 8weeks of systolic blood pressure and 4 weeks of diastolic blood pressure data were evaluated in the AI program model. Recurrent Neural Network, Long Short-term Memory, Attention algorism were selected in AI model program. Mean Absolute Error (MAE) and Root Mean Square Error (RMSE) and Accuracy data were used as the AI model parameter. MAE of systolic BP was 3.96 and MAE of diastolic BP was 2.1. Meanwhile, RMSE of systolic BP was 5.81 and RSME of diastolic BP was 2.88. Accuracy data showed 74.1% and 91.4% respectively. Conclusions: Dr. Answer hypertension AI medical software showed promising results for predicting future blood pressure data in hypertension patients. Further advancement in the AI program model would be needed.

BLOOD PRESSURE EFFECTS OF TRAZODONE IN HYPERTENSIVE OLDER ADULTS

Objective: Trazodone is commonly prescribed in older adults and may have hypotensive effects due to the inhibition of alpha-adrenergic receptors. The present study aimed to investigate the effects of trazodone on blood pressure (BP) and its related risk of syncope and falls in hypertensive older adults. Design and method: A longitudinal observational study involving patients aged 75 or older was conducted at the Hypertension Clinic and Memory Clinic of the Division of Geriatric and Intensive Care Medicine, Careggi Hospital, Florence. Participants underwent multidimensional geriatric assessment including office BP measurement, 3-minute active stand test (BP measurement immediately after standing [T0] and at 1 [T1] and 3 minutes [T3]), home and ambulatory BP monitoring. The composite outcome of syncope and falls was assessed at 12 months and its association with trazodone was analysed using multivariate Cox regression analysis. Results: Among 123 participants (mean age 81 years, 59% female), 12 (10%) reported regular trazodone use. Participants receiving trazodone showed lower office diastolic BP (71.8 mmHg vs. 80.1 mmHg, p=0.042) and a greater systolic and diastolic BP reduction immediately after standing (δsystolicT0 16.2 mmHg vs. 9.7 mmHg, p=0.038; δdiastolicT0 11 mmHg vs. 1.7 mmHg, p=0.003). No differences were reported as regards home and ambulatory BP. Incidence of syncope and falls at 12 months was 25%, with a significantly higher rate in patients receiving trazodone (58.3% vs. 21.2%, p=0.005). Trazodone was associated with an increased risk of syncope or falls independently of physical performance (HR 2.654, 95% CI 1.104 - 6.378). This association was not confirmed when multivariate Cox analysis was adjusted for dementia diagnosis (HR for trazodone 1.874, 95% CI 0.736 – 4.773; HR for dementia 2.556, 95% CI 1.018 – 6.419). Conclusions: In older adults with hypertension, trazodone is associated with a greater orthostatic BP drop and might increase the risk of syncope and falls.

DAY-TO-DAY REPRODUCIBILITY OF NOCTURNAL BLOOD PRESSURE FALL (DIPPING) EVALUATED WITH WEARABLE AND HOME DEVICES IN HYPERTENSIVE PATIENTS

Objective: Non-dipping status has been associated with increased risk of heart failure and cardiovascular events. However, its reproducibility when evaluated by means of ambulatory blood pressure monitoring (BPM) is often suboptimal. Wearable devices (WD) and home BPM devices equipped with nocturnal measurement function (HBPMN) offer the opportunity of estimating dipping status over different days thus potentially increasing precision owing to statistical averaging. We aimed to determine the reproducibility of nocturnal BP dipping estimated through a combined use of WD and HBPMN devices for daytime and night-time BP estimation within one week. Design and method: We recruited treated and untreated adult patients with hypertension. Patients underwent one week of home BP monitoring through a HBPMN device (NightView, OMRON Healthcare, HEM9601T-E3) and with an oscillometric WD (HeartGuide, OMRON Healthcare, HEM-6411T-MAE). Patients were asked to measure BP over one week with WD according to ESH-HBPM guidelines for daytime measurements and with HBPMN according to standard device settings for night-time measurements. Interclass correlation coefficient (ICC) was calculated to evaluate reproducibility. Results: 76 patients were included in the study. The main characteristics are summarised as follows: age (61±11.84 years), 32 (42%) females, BMI (28.12±4.90 Kg/m2). Most of them (98%) were treated hypertensives. Office systolic and diastolic BP were 134±4.43 mmHg and 80±4.84 mmHg, respectively. The average one-week systolic BP dipping was 16.14±9.44%. When we considered patients who had dipping assessment over at least the first 5 days (37 patients), intra-individual variability in the categorical definition of dipping status was observed (Figure 1) with a suboptimal reproducibility of average nocturnal BP fall (ICC 0.60). Conclusions: Nocturnal BP dipping estimated as continuous variable through the combined use of WD and HBPMN exhibits suboptimal reproducibility resulting in a variable day-by-day classification of patients according to their dipping status. Whether this reflects technical issues, or rather depends on the physiological variability of BP and sleeping patterns needs to be determined by future studies.

OFFICE, HOME AND AMBULATORY BLOOD PRESSURE CONTROL IN PATIENTS WITH HIGH AND VERY HIGH CARDIOVASCULAR RISK – RESULTS FROM BP-PROACTION BG

Objective: Current ESH guidelines emphasize out-of-office blood pressure monitoring in patients requiring antihypertensive therapy. Achieving control within the 24-hour period and during home monitoring is of key importance in patients at high (HR) and very high cardiovascular risk (VHR). Design and method: 220 treated with antihypertensive agents’ patients at high or very high risk were included in BP-proAction BG study. All individuals underwent office BP measurements and 24-hour ambulatory blood pressure monitoring consequently followed by 7-day home BP monitoring. Therapy was modified according to office blood pressure values based on methodical standards and treating physicians’ preferences. The protocol was repeated after 3 month of therapy intensification Results: 19% of enrolled patients experienced a cardiovascular event prior to study enrollment, with a mean SCORE 2/SCORE 2 OP of 17.2% among individuals in the primary prevention setting. Despite treatment with an average of 2.7 medications, the majority of patients had uncontrolled blood pressure at the baseline visit - office 93%, home 72%, 24h ABPM 70%, daytime ABPM 63%, nighttime ABPM 69%. After therapy intensification to average 3.4 medications the frequency of uncontrolled hypertension was reduced to 21%, 38%, 34%, 33% and 37% respectively at month 3. The prevalence of masked uncontrolled hypertension among patients with control of office blood pressure was 17% for home masked hypertension, 15% for ambulatory masked hypertension and 10% for dual MH. The rate of uncontrolled hypertension was significantly lower in patients being treated with fix dose combination alone vs free drugs combination. (Table 1) Conclusions: Among patients with high and very high cardiovascular risk, lack of control of out-of-office blood pressure is a common phenomenon, requiring adequate detection and therapeutic management.

PEAK NOCTURNAL HOME BLOOD PRESSURE AS AN EARLY AND STRONG NOVEL RISK FACTOR FOR STROKE: THE PRACTITIONER-BASED NATIONWIDE J-HOP NOCTURNAL BP STUDY

Objective: Recent evidence suggests a correlation between nighttime blood pressure BP) measured through ambulatory BP monitoring (ABPM), the nocturnal BP dipping phenotype, and cardiovascular risk. However, the clinical implications of elevated peak nighttime home BP are currently unknown. This analysis investigated the association between peak nighttime home systolic BP (SBP) and cardiovascular events in outpatients with one or more cardiovascular risk factors. Design and method: In the Japan Morning Surge-Home Blood Pressure (J-HOP) study, nighttime home BP was automatically measured three times every night for 14 days using a nighttime home BP monitoring device (HEM-5001, Omron Healthcare) at baseline. Peak nighttime home SBP was defined as average of the highest three values recoded during the 14-night measurement period. Cardiovascular events (stroke, coronary artery disease, heart failure, aortic dissection) were tracked over a mean 7.1 years’ follow-up period. Results: This analysis included 2545 individuals (mean age 63.3±10.3 years, 49% male) with their nighttime home BPs. After adjustment for covariates (including age, sex, and average office, morning, evening, and nighttime home SBP), individuals with peak nighttime home systolic blood pressure (SBP) in the highest quintile (Q5, &gt;=149.0 mmHg) demonstrated a significantly elevated risk of stroke compared to those in the lowest quintile (Q1, &lt;119.3 mmHg) (hazard ratio [HR] 4.24, 95% confidence interval [CI] 1.07–16.77; p=0.039 overall and 8.92, 1.49–53.43; p=0.017 in the subgroup with &gt;=6 nighttime home SBP measurements). Even when controlling for average real variability of nighttime BP, peak nighttime home SBP remained an independent predictor of stroke risk. On spline regression analysis, the average peak nighttime home SBP cut-off value for predicting an increased risk of incident stroke was 136 mmHg. Conclusions: We propose exaggerated peak nighttime home SBP determined from &gt;=6 measurements as a novel risk factor for stroke, independent of conventional office and home BP values.

Performance of Home-Based and Ambulatory Blood Pressure Monitoring in Obese Children and Their Correlation With End Organ Damage.

The increasing prevalence of childhood obesity has led to a corresponding increase in hypertension among children, necessitating early identification of subclinical target organ damage for accurate cardiovascular risk assessment. However, in the pediatric population, there is a paucity of literature comparing ambulatory and home blood pressure monitoring, and this knowledge gap is exacerbated by limited access to ambulatory blood pressure monitoring (ABPM) facilities, particularly in developing countries, where pediatricians often resort to home blood BP monitoring as the preferred option. In this cross-sectional study with 60 obese children (aged 5-18 years) at tertiary health care in central India, we aimed to comprehensively characterize blood pressure profiles, including office, ambulatory, and home, and investigated their correlations with indicators of end-organ damage. Among 60 children, 26 (43.3%) participants were found to be hypertensive based on 24-hour-ABPM evaluation. Masked hypertension (MH) and white coat hypertension (WCH) were observed in 21.6% and 13.3%, respectively. Surprisingly, 20% of participants were identified as hypertensive through 7-day home BP monitoring (HBPM). A notable discordance of 36.6% was between HBPM and ABPM results. Moreover, 26.7% of the children had end-organ damage, with higher odds associated with night-time systolic ambulatory hypertension in the adjusted regression model (OR = 1.06, 95% CI: 1.03-1.10, P < 0.001). The study highlights 24-hour ABPM's vital role in classifying hypertensive status, especially in high-risk children. The diagnostic performance of HBPM shows poor sensitivity in detecting MH and lower specificity in identifying WCH compared to ABPM. This limitation translates to missed opportunities for early preventive interventions.

Assessing Priorities in a Statewide Cardiovascular and Diabetes Health Collaborative Based on the Results of a Needs Assessment: Cross-Sectional Survey Study.

The Ohio Cardiovascular and Diabetes Health Collaborative (Cardi-OH) unites general and subspecialty medical staff at the 7 medical schools in Ohio with community and public health partnerships to improve cardiovascular and diabetes health outcomes and eliminate disparities in Ohio's Medicaid population. Although statewide collaboratives exist to address health improvements, few deploy needs assessments to inform their work. Cardi-OH conducts an annual needs assessment to identify high-priority clinical topics, screening practices, policy changes for home monitoring devices and referrals, and preferences for the dissemination and implementation of evidence-based best practices. The results of the statewide needs assessment could also be used by others interested in disseminating best practices to primary care teams. A cross-sectional survey was distributed electronically via REDCap (Research Electronic Data Capture; Vanderbilt University) to both Cardi-OH grant-funded and non-grant-funded members (ie, people who have engaged with Cardi-OH but are not funded by the grant). In total, 88% (103/117) of Cardi-OH grant-funded members and 8.14% (98/1204) of non-grant-funded members completed the needs assessment survey. Of these, 51.5% (53/103) of Cardi-OH grant-funded members and 47% (46/98) of non-grant-funded members provided direct clinical care. The top cardiovascular medicine and diabetes clinical topics for Cardi-OH grant-funded members (clinical and nonclinical) were lifestyle prescriptions (50/103, 48.5%), atypical diabetes (38/103, 36.9%), COVID-19 and cardiovascular disease (CVD; 38/103, 36.9%), and mental health and CVD (38/103, 36.9%). For non-grant-funded members, the top topics were lifestyle prescriptions (53/98, 54%), mental health and CVD (39/98, 40%), alcohol and CVD (27/98, 28%), and cardiovascular complications (27/98, 28%). Regarding social determinants of health, Cardi-OH grant-funded members prioritized 3 topics: weight bias and stigma (44/103, 42.7%), family-focused interventions (40/103, 38.8%), and adverse childhood events (37/103, 35.9%). Non-grant-funded members' choices were family-focused interventions (51/98, 52%), implicit bias (43/98, 44%), and adverse childhood events (39/98, 40%). Assessment of other risk factors for CVD and diabetes across grant- and non-grant-funded members revealed screening for social determinants of health in approximately 50% of patients in each practice, whereas some frequency of depression and substance abuse screening occurred in 80% to 90% of the patients. Access to best practice home monitoring devices was challenging, with 30% (16/53) and 41% (19/46) of clinical grant-funded and non-grant-funded members reporting challenges in obtaining home blood pressure monitoring devices and 68% (36/53) and 43% (20/46) reporting challenges with continuous glucose monitors. Cardi-OH grant- and non-grant-funded members shared the following high-priority topics: lifestyle prescriptions, CVD and mental health, family-focused interventions, alcohol and CVD, and adverse childhood experiences. Identifying high-priority educational topics and preferred delivery modalities for evidence-based materials is essential for ensuring that the dissemination of resources is practical and useful for providers.

Frequency of office blood pressure measurements and the seasonal variability of blood pressure: results of the Hungarian Hypertension Registry

Purpose Hypertension is a major public health problem, thus, its timely and appropriate diagnosis and management are crucial for reducing cardiovascular morbidity and mortality. The aim of the new Hungarian Hypertension Registry is to evaluate the blood pressure measurement practices of general practitioners (GPs), internists and cardiologists in outpatient clinics, as well as to assess the seasonal variability of blood pressure. Materials and methods Omron M3 IT devices were used during four-month periods between October 2018 and April 2023 in GP practices and in hypertension clinics. The blood pressure data were then transmitted online from the monitors’ cuffs to a central database using the Medistance system of Omron. Results Family physicians (n = 2491), and internists/cardiologists (n = 477) participated in the study. A total of 4804 821 blood pressure measurements were taken during 10 four-month evaluation periods. In the ten periods, the daily average number of measurements was between 3.0 and 5.6. Following ESH diagnostic criteria, the proportion of subjects in optimal, normal and high-normal blood pressure categories were 14, 13.4 and 16.7%, respectively. Altogether 56% of the measurements belonged to stage 1, stage 2 or stage 3 hypertension categories (31.6, 17.1 and 7.4%, respectively). On average, a difference of 5/2 mmHg was observed between winter and summer data in systolic and diastolic blood pressures, respectively. The average systolic blood pressure values were higher in GP practices with more than 2000 patients than in the ones with less than 1500 patients (141.86 mmHg versus 140.02 mmHg, p < 0.05). Conclusion In conclusion, the low daily average number of blood pressure measurements indicates a limited blood pressure screening awareness/capacity in the case of Hungarian family physicians. In GP practices with more patients, blood pressure is usually less well-controlled. These results suggest that the further promotion of home blood pressure monitoring is necessary.

Ambulatory blood pressure monitoring profiles in Asia.

High blood pressure (BP) remains a major health problem globally, with a proportion of hypertension-mediated organ damage (HMOD) increasing worldwide including in Asia region. Cardiovascular (CV), cerebral and kidney diseases related to hypertension were reported to be closely associated with morning surge and nocturnal hypertension-a subset of BP variability-which can be detected by out-of-office BP measurement. Ambulatory BP monitoring (ABPM) and Home BP monitoring (HBPM) have been recommended by major guidelines to be used in the evaluation of BP variability and outcomes' prediction of hypertension patients. However, an interesting profile of ABPM in Asia has been reported and hypothesized to correlate with different outcomes. This review will focus on the current recommendation of ABPM use by the guidelines, the major different profiles of ABPM in Asia as compared to Western countries according to clinical indications, and the challenges in implementing optimal use of ABPM in Asian countries based on available evidence.

Design and rationale of the Comprehensive intelligent Hypertension managEment SyStem (CHESS) evaluation study: A cluster randomized controlled trial for hypertension management in primary care

BackgroundHypertension management in China is suboptimal with high prevalence and low control rate due to various barriers, including lack of self-management awareness of patients and inadequate capacity of physicians. Digital therapeutic interventions including mobile health and computational device algorithms such as clinical decision support systems (CDSS) are scalable with the potential to improve blood pressure (BP) management and strengthen the healthcare system in resource-constrained areas, yet their effectiveness remains to be tested. The aim of this report is to describe the protocol of the Comprehensive intelligent Hypertension managEment SyStem (CHESS) evaluation study assessing the effect of a multi-faceted hypertension management system for supporting patients and physicians on BP lowering in primary care settings. Materials and MethodsThe CHESS evaluation study is a parallel-group, cluster-randomized controlled trial conducted in primary care settings in China. 41 primary care sites from 3 counties of China are randomly assigned to either the usual care or the intervention group with the implementation of the CHESS system, more than 1600 patients aged 35-80 years with uncontrolled hypertension and access to a smartphone by themselves or relatives are recruited into the study and followed up for 12 months. In the intervention group, participants receive patient-tailored reminders and alerts via messages or intelligent voice calls triggered by uploaded home blood pressure monitoring data and participants’ characteristics, while physicians receive guideline-based prescription instructions according to updated individual data from each visit, and administrators receive auto-renewed feedback of hypertension management performance from the data analysis platform. The multiple components of the CHESS system can work synergistically and have undergone rigorous development and pilot evaluation using a theory-informed approach. The primary outcome is the mean change in 24-hour ambulatory systolic BP from baseline to 12-month. DiscussionThe CHESS trial will provide evidence and novel insight into the effectiveness and feasibility of an implementation strategy using a comprehensive digital BP management system for reducing hypertension burden in primary care settings. Trial registrationhttps://www.clinicaltrials.gov, NCT05605418