Korotkoff Method Research Articles

COMPARATIVE EFFECTIVENESS OF FREE AND FIXED COMBINED ANTIHYPERTENSIVE THERAPY IN ACHIEVING TARGET BLOOD PRESSURE VALUES IN UNCONTROLLED ARTERIAL HYPERTENSION

Objective: Aim of our study was to assess the achievement of target blood pressure in uncontrolled hypertensive patients with high and very high-risk, resistant to double AHT, depending on the treatment regimen - free and fixed combinations of three antihypertensive drugs. Design and method: The study included 143 patients II-III AH stage, who were on double AHT, who are not reached the target blood pressure level. The average age of patients was 55.8±9.35 years, including men n=70 (49%), women n=73 (51%). All patients underwent a physical examination with three measurements of office blood pressure using the Korotkoff method. Patients were randomized into 2 groups: group 1- triple antihypertensive therapy with a free combination of indapamide, amlodipine, and perindopril (n=71), and 2 nd group- a fixed combination therapy (n=72). Statistics were carried out between the stages before treatment and 6 months. Results: Research results. Against the background of triple AHT, target blood pressure levels were achieved in both groups: in group 1, initial SBP/DBP before treatment was 171.29±16.6 mmHg/99.64±9.03 mmHg, in dynamics 128.38±8.5 mmHg/80.89±6.38 mmHg. (p=0.0001); in group 2: initially SBP/DBP before treatment 170.76±17.75 mmHg/100.63±8.39 mmHg, 6 months of therapy 121.95±6.7 mmHg st./77.23±5.59 mmHg (p=0.0001). The results showed a significant decrease in SBP (p=0.0001) and DBP (p=0.0001) in group 2 compared to group 1. At the same time, the primary target level in group 1 was achieved in 83.3%, in group 2 in 94.4% of patients (χ2 = 7.471; p = 0.006). The target blood pressure level <130/80 according to SBP was achieved by 42% and 67% of patients, respectively, for groups 1 and 2 (χ2=11.61; p=0.0001); for DBP – 10% and 33.3%, respectively, for groups 1 and 2 (χ2=9.011; p=0.003). Conclusions: Obtained results showed the high antihypertensive effectiveness of 6-month AHT with a triple fixed combination therapy compared to free, achieving the primary target blood pressure level and the main target blood pressure level in a significantly larger number of patients with hypertension on a triple fixed combination of antihypertensive drugs.

Relationship between sleep quality and blood pressure level in nurses performing shift work

Abstract Objective The aim of the study was to evaluate the quality of sleep in nurses performing shift work in therapeutic and surgical departments and to establish possible relationships between level of blood pressure (BP) and quality of sleep. Methods A total of 20 nurses of the therapeutic departments and 20 nurses of the surgical departments were enrolled in the study. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). BP was measured according to the standard protocol using the Korotkoff method; a sphygmomanometer was used for this twice with an interval of 2 min between 10:00 a.m. and 10:30 a.m. The average value for the 2 indicators was calculated. The diagnosis of essential arterial hypertension (AH) was established according to the recommendations of the European Association of Cardiology and the European Association of Hypertension (2018). Results The overall assessment of the sleep quality of the nurses involved in shift work indicates poor sleep quality; this was true in respondents of both the surgical and therapeutic profiles. However, it was observed that the quality of sleep was significantly lower in nurses of the therapeutic departments. Moreover, poor sleep quality was associated with AH, which was diagnosed in 65% of the nurses of the therapeutic departments and 45% of the nurses of the surgical departments, that is, in almost all of the subjects. Herewith, in the nurses of the therapeutic departments, the level of systolic BP exceeded that of the nurses of the surgical departments. Conclusions Poor sleep quality is a significant risk factor for AH development and is relevant to nurses performing shift work. Additional clinical studies should be conducted to better understand the mechanisms underlying such adverse cardiometabolic outcomes associated with sleep disorders in the health-sector shift workers.

Occurrence of dystonic-type response to physical stress in soccer players

Purpose: to investigate the occurrence of dystonic type response to physical activity in the form of submaximal PWC170 test in soccer players. Material & Methods: 741 soccer players divided into 3 groups according to their sports qualification were examined. The data of 68 high-class soccer players with "infinite tone" and 69 high-class soccer players without "infinite tone" were compared, 251 advanced soccer players with "infinite tone" with 179 advanced soccer players without "infinite tone", and 69 intermediate soccer players with "infinite tone" with 105 similarly qualified soccer players without "infinite tone". Blood pressure was measured by the Korotkoff method using an aneroid sphygmomanometer (Romed, Netherlands) on the right arm. Three measurements were taken 5 minutes apart, and the lowest reading was used. Physical working capacity was assessed on a bicycle ergometer (Corival, Netherlands). Results: it was found that physical working capacity didn't differ significantly between athletes with and without "infinite tone", and in the group of advanced athletes was significantly higher in players with "infinite tone". The same number of soccer players with signs of metabolic cardiomyopathy was found with and without “infinite tone” (p=0.916). Conclusions: dystonic type of reaction of cardiovascular system to physical load in the form of submaximal PWC170 test with "infinite tone" is found in 52,4% of examined soccer players, more often in advanced athletes aged 19 (18; 22) years – 64,7%, in comparison with intermediate players aged 16 (15; 17) years – 17,8%, p<0,001, which doesn’t confirm the opinion about occurrence of "infinite tone" in adolescents during puberty. The absence of significant differences in most of the studied indicators, in particular, the relative value of physical working capacity and blood pressure at 5 minutes of recovery period, indicates the unrelated appearance of "infinite tone" in soccer players of different sports qualification. The opinion of scientists that the dystonic type of reaction to physical load with "infinite tone" is physiological and the reaction is atypical is confirmed with the recommendation to make corrections in the section "Functional tests" of the national textbook "Physical Rehabilitation. Sports Medicine".

КЛИНИЧЕСКИЕ АСПЕКТЫ И ФАКТОРЫ РИСКА АРТЕРИАЛЬНЫХ ГИПО- И ГИПЕРТОНИЙ У ОБУЧАЮЩИХСЯ ПЕРВОГО КУРСА МЕДИЦИНСКОГО ВУЗА

Aim. This study aims to analyze objective examination results (blood pressure, heart rate, body weight, height), medical history, and hereditary data to identify risk factors for arterial hypo- and hypertension development among first-year medical students. Additionally, the study seeks to determine indications for health improvement and maintenance. Materials and Methods. A prospective study of 105 first-year students at the Institute of Pediatrics of Altai State Medical University, conducted in September-October 2023, was analyzed. The average age of the students was 17.4±0.5 years. Parameters studied included blood pressure measured by the Korotkoff method, heart rate, systolic and diastolic blood pressure, and the Kettle index. The results of a voluntary questionnaire survey were also analyzed, considering gender, body weight, height, hereditary cardiovascular diseases, habits, sleep duration, associated diseases, and specific complaints. Results. In the total group of surveyed students, female students predominated at 78%. Approximately 33.3% of students exhibited either increased or decreased blood pressure, with every fourth female student experiencing decreased blood pressure. Risk factors for arterial hypo- and hypertension included aggravated heredity for arterial hypertension in over 50% of the examined students, excessive body weight in 16.2% of students, sleep and rest disorders in one-third of the examined, and concomitant somatic diseases in some students. Conclusion. The study identified blood pressure changes in 33.3% of the 105 first-year students, with 14.3% exhibiting elevated blood pressure and every fourth female student experiencing low blood pressure. The findings highlight the relevance of arterial hypertension among students and support the need for preventive methods to address cardiovascular pathology. Additionally, a high percentage of aggravated heredity for arterial hypertension was observed, emphasizing the significance of this risk factor. Arterial hypertension was statistically more prevalent in students with aggravated heredity and/or excessive body weight, particularly obesity of degree I or II (16.2% and 8.6%, respectively).

Gender peculiarities of blood pressure changes in patients with arterial hypertension and different biorhythms

Background. It is known that the risk of cardiovascular diseases, especially in conditions of increased rhythm of life, psycho-emotional stress, social cataclysms, is associated with various biorhythms, therefore, the study of the influence of various factors on the course of hypertension, taking into account the patient's chronotype, remains relevant. Aim of the study was to analyze the level of blood pressure in patients with arterial hypertension with different chronotypes of the female and male genders. Materials & Methods. The study included 42 patients with diagnosed essential arterial hypertension who were receiving inpatient treatment. The inclusion criterion was patients with arterial hypertension of the 2nd degree. Measurements of Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) (mmHg) were performed using the Korotkoff method. To study the chronotype, we used the validated questionnaire "Composite Scale of Morningness" and scales from official available sources. Results & Conclusions. Arterial hypertension was diagnosed in 33.33% of patients with the evening chronotype, 7.17% with the morning chronotype, and 59.53% with the intermediate chronotype. Taking into account gender, female patients with evening and morning chronotypes and male patients with an intermediate chronotype predominated. Patients with evening chronotype compared to patients with intermediate and morning chronotypes had significantly higher Body Mass Index (BMI) (by 62.69% and 40.33%), disease duration (by 42.68% and 6.23%) and SBP (by 8.21% and 12.21%), respectively. At the same time, BMI in patients with arterial hypertension with an evening chronotype was as close as possible to obesity. The obtained results can be used in the practical work of nurses for the prevention of arterial hypertension by adjusting the duration of sleep and wakefulness and the diet. Keywords: chronotype, gender, age, body mass index, relationships.

Outlook for ergometer testing with beat to beat blood pressure measurement

Objective. The article discusses the advantages of performing stress tests with pressure control at each heartbeat. The question of increasing accuracy, informativeness and safety of the test is considered. Materials and methods. We performed 30 bicycle ergometric tests with ECG measurement, beat to beat blood pressure measurement and periodic blood pressure measurement by the Korotkoff method in the shoulder. Results. It was shown that arterial pressure registered by Korotkoff sounds in the shoulder corresponded with continuous pressure at the registration moment. Because of the impossibility to measure the dynamics, the underestimation of maximum systolic arterial pressure by the Korotkoff method exceeds 20 mm Hg in every 3 tests, and exceeds 30 mm Hg in every 5 tests. Therefore, the beat to beat measurement of BP significantly improves the accuracy and informativeness value of stress tests. Conclusions. Continuous BP signal in the finger increases reliability of noisy Korotkoff sounds extraction and the results of BP measurement in the shoulder by the classical method. The increased accuracy and reliability of the measurement provides greater patient safety. Continuous pressure corrected by Korotkoff sounds during reference measurements in the shoulder gives a detailed and accurate picture of BP variations, which allows to investigate in detail features of the patient’s cardiovascular system regulation, both during and after the load, which is not available with classical BP measurement.

ASSOCIATIONS BETWEEN EPICARDIAL FAT AND LEFT VENTRICULAR GEOMETRY IN YOUNG NON-OBESE HYPERTENSIVES

Objective: Epicardial adipose tissue (EAT) has been considered as a marker of cardiovascular risk. Previously association between the EAT volume with the insulin resistance index, metabolic parameters and emodelling parameters of the left heart was observed in young obese people with abdominal obesity. Aim: to evaluate the relations between epicardial adipose tissue thickness (EAT) with metabolic parameters and left ventricular geometry in young non-obese individuals with hypertension comparing to normotensive subjects. Design and method: 30 young non-obese subjects with untreated essential hypertension (HTN) diagnosed by office blood pressure (BP) measurements by Korotkoff method and/or ambulatory BP monitoring (ESH, 2018) were included as study group (mean age - 23 ± 3 yrs, 100% were male, mean BMI 26 ± 6 kg/m2, office SBP/DBP 138 [130; 171] / 74 [64; 97] mm Hg). The control group consisted of 20 healthy volunteers without HTN (mean age - 33 ± 6 yrs, 100% were male, mean BMI 26 ± 4 kg/m2, office SBP/DBP 126 [124; 128] / 70 [65; 75] mm Hg). The thickness and area of the epicardial fat were measured by CT-scan images with parasternal short axis view at basal, mid-ventricular and apical levels and horizontal long axis view directly surrounding the main coronary arteries Results: EAT thickness was higher in AH group comparing to healthy volunteers (7,42 [5,22; 11,01] vs 7,17 [4,67; 9,67] mm, p < 0.05) and EAT square was larger in study group comparing to control group (93,5 [60,3; 267.0] vs 88,7 [50,7; 126,6] mm2, p < 0.05). Correlations between EAT square and LDL-cholesterol (r = 0.53, p < 0,05), HDL-cholesterol (r = -0,51, p < 0,05), interventricular septum thickness of the left ventricle (r = 0.47, p < 0,05), left ventricular posterior wall thickness (r = 0.56, p < 0,05), relative wall thickness (r = 0.45, p < 0,05) were found in AH group. No significant correlations were found in the control group. Conclusions: The accumulation of EAT among patients with AH is larger than among people with normal blood pressure. Epicardial adipose tissue thickness as early marker of visceral obesity associated with left ventricular emodelling in young non-obese patients with essential hypertension.

Comparison of two non-invasive arterial blood pressure monitoring techniques in brown bears (Ursus arctos)

Monitoring arterial blood pressure (BP), represents a more accurate evaluation of hemodynamics than heart rate alone and is essential for preventing and treating intra- and post-operative complications in wildlife chemical immobilization.The objectives of the study were to test the correlation between standard oscillometry and Korotkoff's technique in anesthetized free-ranging brown bears in Croatia and Scandinavia and to assess the blood pressure in both locations.Five bears were snared and darted with xylazine and ketamine in Croatia, and 20 bears were darted from a helicopter with medetomidine and tiletamine-zolazepam in Scandinavia. Blood pressure was simultaneously measured with both techniques every 5 minutes. Correlation between techniques, trends of BP variation, and the factors of the capture which likely influenced BP were assessed.Successful measurements of BP were achieved in 93% of all attempts with the Korotkoff's technique but in only 29% of all attempts with oscillometry. The latter method mostly provided lower values of BP compared to Korotkoff's technique in yearlings. Most bears showed a decreasing trend in systolic and mean BP over time, consistent between the two techniques. All bears were hypertensive: the auscultatory technique detected moderate to severe systolic hypertension in 25% and 84% of bears in Croatia and in Scandinavia, respectively, with significantly higher BP in subadults and adults compared to yearlings. Only Korotkoff's method resulted in a reliable and effective tool for BP assessment in brown bears. The anesthetic protocols used in the present study in association with the capture methods produced hypertension in all animals.

A11477 Volume-compressive oscillometry as new blood pressure-measuring device

Objectives: to compare values of BP, obtained by the volume-compression oscillometry (VCO) with BP levels measured on the brachial artery by the Korotkoff method, and with central BP assessed by applanation tonometry. Methods: 95 volunteers were included in the study - 41 young adults (<35 years) and 54 patients with arterial hypertension (AH) aged >60 years. BP was measured using a mercury sphygmomanometer by the Korotkoff method, as well as by the VCO method using the tachooscillometric device EDTV-Hemodin (Innovative Medical Technologies, Russia). Central systolic and diastolic BP, was measured using a SphygmoCor device (AtCorMedical, WestRyde, NSW, Australia). 62% were male. Results: the mean systolic BP by Korotkoff method was 129.0 ± 10.1 mm Hg, diastolic - 73.0 ± 8.9 mm Hg, by VCO - 114.0 ± 9.9 mm Hg and 53.8 ± 10.0 mm Hg, respectively. The mean central systolic BP, measured by applanation tonometry, was 111.2 ± 9.8 mm Hg; mean diastolic BP was 74.7 ± 8.6 mm Hg. No significant correlation between BP, measured by the auscultatory method and VCO, was found. Spearman's correlation between the systolic BP and the central systolic BP was r = 0.48 (p < 0.05), and the bias between the methods, measured with Bland-Altman statistics, was minimal (−2.01 [6.01, 1.7] mm Hg). The positive correlation between BP measured by the method of the VCO and central systolic BP was noted: for the group of healthy volunteers (104.2 ± 5.8 mm Hg and 117.5 ± 9.0 mm Hg, respectively), the Bland-Altman's bias was 4.55 [−9.76; 1.33] mm Hg, and for the group of patients with AH (109.5 ± 10.8 mm Hg and 116.9 ± 11.0 mm Hg, respectively) - 1.02 [−4.98; 5.89] mm Hg. Conclusion: the comparability of systolic BP values calculated in the aorta by applanation tonometry and measured with VCO was demonstrated by the Bland-Altman method.

Efficiency of perindopril arginine and indapamide retard in patients with nocturnal hypertension: The results of the study “Chronos”

Objective. To assess the antihypertensive efficiency of perindopril arginine and indapamide retard in patients with nocturnal hypertension (HTN). Design and methods. In the regional program “Chronos” of the open, multicenter, observational, non-controlled study, we included 196 patients with nocturnal hypertension (2nd degree — 59,4%; 3rd degree — 40,6%). Upon inclusion, instead of the previous therapy the patients received 10 mg perindopril arginine at night and 1,5 mg indapamide retard in the morning. The follow-up was 3 months, the efficiency and tolerability were assessed in 2 weeks, 1 and 3 months of therapy. Blood pressure (BP) was measured by Korotkoff method. Statistical analysis was performed with the use of the programs Microsoft Excel 2012, Statsoft Statistica 10.0. Results. At baseline, daytime median systolic BP was 165,5 (160; 180) mmHg, diastolic BP was 100 (90; 100) mmHg. After 2 weeks of treatment by perindopril arginine and indapamide retard, both daytime and nocturnal BP decreased (p &lt; 0,05). The positive changes maintained for the whole follow-up period. Seven patients did not achieve target BP 1 month later. In these cases, additional therapy (other drug class medications) was prescribed. Conclusion. All patients demonstrated both daytime and nighttime BP decrease. In 73% patients there was no morning BP rise anymore. In 60% BP was normalized in patients who had been considered resistant. The combination therapy was well-tolerated.

Relationships between injury years and thermoregulatory responses during heat stress in spinal cord injury persons.

Thermoregulatory responses via sympathetic nerve activity during heat stress are absent or impaired in persons with spinal cord injury. However, relationships between their injury years and responses of sweating and cutaneous vasodilation to increased core temperature remained unknown. Six of cervical (CSCI; N=6; level of C5‐7; injury years of 1–22 yrs) and 8 thoraciolumbal (SCI; N=8; Th4‐L1; 1–24 yrs) spinal cord injury persons and 10 healthy subjects (AB; able‐body) were recruited. They wore water‐perfused suits with taking a supine position and 33‐degree C water was perfused into the suits to make a whole body thermoneutral condition, while all devices were applied. After 10‐min measurements during thermoneutral condition, heat stress was performed with infusion of 47‐degree C water until esophageal temperature (thermocouples) increased by 1 degree C. Mean arterial pressure (MAP; the brachial artery; Korotkoff's method), mean skin (Tsk) and local chest temperatures (Tchest; thermocouples), sweat rate (SR; capacitance hygrometry) and skin blood flow (SkBF; laser‐Doppler velocimetry) on the chest. Cutaneous vascular conductance (CVC) were calculated as SkBF divided by MAP. Tsk was about 35 degree C in all groups and increased by 3 degree C. Tchest increased by 1.4 degree C during heat stress. CVC increased by 4 times as baseline in AB, 3 times in SCI during heat stress, but no increase was observed in CSCI. Patterns of SR in all groups were similar to CVC. Maximal response of CVC [control/degrees] was tended to be negatively correlated, but that of SR [mg/cm2/min] was positively correlated with injury years. In conclusion, thermoregulatory responses to increased core temperature were absent in CSCI and impaired in SCI. In SCI, sweating response on the chest, where sympathetic nerve activity is intact, is possibly enhanced to compensate for reduced cutaneous vasodilation with increased injury year.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

PP.06.21] VOLUME-COMPRESSIVE OSCILLOMETRY IN NONINVASIVE ASSESSMENT OF HEMODYNAMIC PARAMETERS IN HYPERTENSIVE PATIENTS

Objective: To evaluate hemodynamic parameters in patients with arterial hypertension (AH) before and during antihypertensive treatment using volume-compressive oscillometry (VCO) - new cuff-based device. The main advantages of VCO comparing to other oscillometry technic of BP registration is formation and recording the curve automatically in synchronism with the cuff inflation and recording the artery response by changing the cuff volume throughout the all period of cuff compression. VCO diagram could considered as indicator of aortic stiffness. Design and method: 45 untreated patients hospitalized with AH without acute coronary syndrome, severe valve problems, secondary hypertension, advanced chronic heart failure were enrolled. Mean age 55 ± 11.8 yrs, 51% male, mean BMI - 28.9 ± 6.7 kg/m2. Antihypertensive treatment included combination of amlodipine 5 mg/fosinopril 10 mg per day. The pulse wave velocity (PWV), brachial blood pressure (BP), cardiac index, stroke index and systemic vascular resistance were measured twice (at admission and discharging) by VCO (EDTV, Russia). Results: The mean systolic BP by VCO at admission was 147.7 ± 14.8 mmHg (by Korotkoff method 161 ± 9.8 mm Hg), diastolic 83.1 ± 14.1 mmHg (by Korotkoff method 99 ± 11.3 mmHg) and mean pulse pressure 64 ± 9.5 mmHg. Mean heart rate was 70.4 ± 14.5 bpm. Mean cardiac index was 3.08 ± 0.44 l/(min*m2), stroke index - 45.7 ± 11.7 ml/m2 and systemic vascular resistance (SVR) was 1373 ± 236 dyn*s/cm5. Mean PWV in these population was 7.6 ± 1.1 m/sec. After treatment with mean duration of hospitalization 6.3 ± 2.5 days, systolic and diastolic BP by VCO were reduced to 123.3 ± 10.8 mmHg and 57.5 ± 13.3 mmHg respectively (p < 0.05). Mean pulse pressure increased to 65.9 ± 11.8 mm Hg nonsignificantly. Mean stroke index increased to 49.7 ± 16.7 ml/m2 and SVR decreased to 1169 ± 374 dyn*s/cm5. We found no significant changes in cardiac index, heart rate and PWV. Conclusions: Systolic and diastolic BP by VCO is significantly lower comparing to Korotkoff method. Next studies are needed to determine the feasibility of VCO in noninvasive assessment of central hemodynamics.

The effect of antihypertensive therapy and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea syndrome in association with arterial hypertension

Objective. To evaluate the effect of antihypertensive therapy (AHT) and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea (OSA) syndrome in association with arterial hypertension (AH). Materials and methods. The study included 43 male patients with severe OSA syndrome (Apnea-Hypopnea Index 52.4 [46.1; 58.6]) and AH (systolic blood pressure 144.0 [142.0; 156.0] mm Hg, diastolic blood pressure 90.9 [88.3; 93.5] mm Hg). Treatment with angiotensin-converting enzyme inhibitors, calcium antagonists, and thiazide-like diuretics was performed till target BP level measured with Korotkoff method was achieved. The patients who had reached target BP level (BP≤140/90 mm Hg) were randomized into two groups: group 1 included 23 patients who continued taking the AHT, group 2 included 22 patients who continued taking the AHT to which CPAP therapy was added. Peripheral blood lymphocyte immunophenotyping, cytokine panel test (IL-1β, IL-6, tumor necrosis factor a, IL-2Ra, sCD40L), adhesion molecule analysis (ICAM-1, VCAM-1), thromboxane B2, 6-keto-prostaglandin F1 alpha (6-keto-PGF1a), and endothelin-1 levels in blood serum were evaluated at admission, after target BP level achievement (2nd visit) and after 3 months of AHT or AHT+CPAP therapy (3rd visit). Flow-mediated dilation of brachial artery was assessed using reactive hyperemia test by D.Celermajer. Results. Against the background of combined AHT the target BP level was achieved by 95% of patients. After target BP level achievement a significant decrease of IL-1β -0.16 [-0.5; 0], p=0.000 level and number of CD50+ cells (lymphocytes with inter-cellular adhesion molecule ICAM-3) from 2158.5 [1884.7; 2432.3] to 1949.6 [1740.9; 2158.3], p=0.050 were observed in patients with severe OSA associated with AH. There were no significant changes in vascular endothelial function observed in patients taking only AHT. Significant decrease of fibrinogen (-0.3 [-0.4; -0.1], p=0.002) and homocystein (-2.03 [-3.8; -0.2], p=0.03) levels was observed in patients taking both AHT and CPAP therapy. Conclusion. The combination of AHT and CPAP therapy in patients with severe OSA and AH not only allows reaching the target BP level but also leads to inflammatory and endothelial dysfunction markers levels decrease.

Влияние антигипертензивной и СИПАП-терапии на маркеры воспалительного ответа и эндотелиальной функции у пациентов с синдромом обструктивного апноэ сна тяжелой степени в сочетании с артериальной гипертонией

Objective. To evaluate the effect of antihypertensive therapy (AHT) and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea (OSA) syndrome in association with arterial hypertension (AH). Materials and methods. The study included 43 male patients with severe OSA syndrome (Apnea-Hypopnea Index 52.4 [46.1; 58.6]) and AH (systolic blood pressure 144.0 [142.0; 156.0] mm Hg, diastolic blood pressure 90.9 [88.3; 93.5] mm Hg). Treatment with angiotensin-converting enzyme inhibitors, calcium antagonists, and thiazide-like diuretics was performed till target BP level measured with Korotkoff method was achieved. The patients who had reached target BP level (BP≤140/90 mm Hg) were randomized into two groups: group 1 included 23 patients who continued taking the AHT, group 2 included 22 patients who continued taking the AHT to which CPAP therapy was added. Peripheral blood lymphocyte immunophenotyping, cytokine panel test (IL-1β, IL-6, tumor necrosis factor a, IL-2Ra, sCD40L), adhesion molecule analysis (ICAM-1, VCAM-1), thromboxane B2, 6-keto-prostaglandin F1 alpha (6-keto-PGF1a), and endothelin-1 levels in blood serum were evaluated at admission, after target BP level achievement (2nd visit) and after 3 months of AHT or AHT+CPAP therapy (3rd visit). Flow-mediated dilation of brachial artery was assessed using reactive hyperemia test by D.Celermajer. Results. Against the background of combined AHT the target BP level was achieved by 95% of patients. After target BP level achievement a significant decrease of IL-1β -0.16 [-0.5; 0], p=0.000 level and number of CD50+ cells (lymphocytes with inter-cellular adhesion molecule ICAM-3) from 2158.5 [1884.7; 2432.3] to 1949.6 [1740.9; 2158.3], p=0.050 were observed in patients with severe OSA associated with AH. There were no significant changes in vascular endothelial function observed in patients taking only AHT. Significant decrease of fibrinogen (-0.3 [-0.4; -0.1], p=0.002) and homocystein (-2.03 [-3.8; -0.2], p=0.03) levels was observed in patients taking both AHT and CPAP therapy. Conclusion. The combination of AHT and CPAP therapy in patients with severe OSA and AH not only allows reaching the target BP level but also leads to inflammatory and endothelial dysfunction markers levels decrease.

Logistic ordinal regression for the calibration of oscillometric blood pressure monitors

Oscillometric blood pressure (BP) monitors are omnipresent and used on a daily basis for personalized healthcare. Nevertheless, physicians generally approach these devices cautiously since the mercury Korotkoff sphygmomanometer remains the golden standard. Various reasons explain the hesitating attitude of the medical world towards automated BP monitors: (i) its principle is based on the pressure pulsations arriving at the cuff by the cardiac cycle instead of an audio wave used by physicians triggered by the turbulences in the artery, (ii) the actual computation of the systolic and diastolic BP from the measured oscillometry is manufacturer dependent and not based on general scientific principles, (iii) the quality of the oscillometric monitors is labeled by a trial such that the devices correspond well to the Korotkoff method for the average healthy patient but deviates for patients suffering from hypo- or hypertension. In this paper, we develop a statistical learning technique to calibrate and correct an oscillometric monitor such that the device better corresponds to the Korotkoff method regardless of the health status of the patient. The technique is based on logistic regression which allows correcting and eliminating systematic errors caused by patients suffering from hyper -or hypotension. No user interaction is required since the technique is able to train and validate the calibration procedure in an unsupervised way. In our case study, the systematic error is reduced by nearly 50% corresponding to the performance specifications of the device.

EFFICACY OF CAPTOPRIL, MOXONIDINE AND THEIR COMBINATIONS WITH NIFEDIPINE IN THE NON-THREATENING HYPERTENSION

Objective. To study several medications and their combinations in non-threatened hypertension worsening captopril, and moxonidine, captopril + nifedipine, captopril + moxonidine.Design and methods. We include326 patients (253 females) aged 45–89 years who referred for the urgent health care due to the non-threatene hypertension worsening. Mean duration of hypertension was 20,6 ± 0,6 years. Special questionnaires were fille in, heart rate, blood pressure by Korotkoff method, and electrocardiogram were registered.Results. Moxonidinwas shown to be more effective in patients with the sympathetic hyperactivity, captopril — in patients withouincreased sympathetic activity. The combination of captopril and nifedipine was associated with the reductioof therapy effi ciency, and the combination of moxonidine and nifedipine — with its increase. Moreover, administration of captopril and nifedipine led to the higher rate of side effects, compared to the combination moxonidine and nifedipin.

Automatic blood pressure measurement device using oscillometric method and Korotkoff sounds

The oscillometric method and Korotkoff sound method are the most common ways to measure the blood pressure. A new automatic blood pressure measurement device, which uses both oscillometric method and Korotkoff method, was developed. A pressure sensor was used to obtain cuff pressure and oscillation signal, and a microphone was used to detect Korotkoff sounds. Forty-five measurements from fifteen subjects were used for analysis. Correlation coefficients between the traditional auscultatory method and Korotkoff sound method were 0.9820 and 0.9721 for the systolic and diastolic blood pressure values, respectively. Standard deviations of differences for the systolic and diastolic blood pressure values were 1.3019 and 1.4495, respectively. Correspondingly, correlation coefficients between the traditional auscultatory method and oscillometric method using newly developed algorithm were 0.9651 and 0.9136 for the systolic and diastolic blood pressure values, with the standard deviations of 1.42 and 1.73, respectively. The results showed that the newly developed algorithm for oscillometirc method provide accurate blood pressure values, moreover, Korotkoff sound method using microphone provides even higher accuracy. Therefore, a new automatic device which utilizes both oscillometric method and Korotkoff sound method would provide the accurate and reliable blood pressure values.

Mother-off spring aggregation in home versus conventional blood pressure in the Tohoku Study of Child Development (TSCD)

Objective Few studies described the home blood pressure (HBP) in young children. Using intrafamilial correlations of blood pressure as research focus, we assessed the feasibility of HBP monitoring in this age group.Methods We enrolled 382 mothers (mean age 38.8 years) and singletons (7.0 years) in the Tohoku Study of Child Development. We measured their conventional blood pressure (CBP; single reading) at an examination centre. Participants monitored HBP in the morning. We used the OMRON HEM-7080IC for CBP and HBP measurement. In a separate group of 84 children (mean age 7.7 years), we compared blood pressure readings obtained by the OMRON monitor and the Dinamap Pro 100, a device approved by FDA for use in children. We used correlation coeffi cients as measure of intrafamilial aggregation, while accounting for the mothers’ age, body mass index, heart rate and smoking and drinking habits and the children’s age, height, and heart rate.Results Mother-off spring correlations were closer (P ≤ 0.003) for HBP than CBP for systolic pressure [0.28 (P < 0.0001) vs 0.06 (P = 0.26)] and diastolic pressure [0.28 (P < 0.0001) vs 0.02 (P = 0.65)]. The between-device diff erences (OMRON minus Dinamap) averaged 7.8 ± 6.0 mmHg systolic and 5.8 ± 5.5 mmHg diastolic.Conclusions HBP monitoring is an easily applicable method to assess intrafamilial blood pressure aggregation in young children and outperforms CBP. Validation protocols for HBP devices in young children need revision, because the Korotkoff method is not practicable at this age and there is no agreed alternative reference method.

Analyzing the Windkessel Model as a Potential Candidate for Correcting Oscillometric Blood-Pressure Measurements

Developing a good model for oscillometric blood-pressure measurements is a hard task. This is mainly due to the fact that the systolic and diastolic pressures cannot be directly measured by noninvasive automatic oscillometric blood-pressure meters (NIBP) but need to be computed based on some kind of algorithm. This is in strong contrast with the classical Korotkoff method, where the diastolic and systolic blood pressures can be directly measured by a sphygmomanometer. Although an NIBP returns results similar to the Korotkoff method for patients with normal blood pressures, a big discrepancy exist between both methods for severe hyper- and hypotension. For these severe cases, a statistical model is needed to compensate or calibrate the oscillometric blood-pressure meters. Although different statistical models have been already studied, no immediate calibration method has been proposed. The reason is that the step from a model, describing the measurements, to a calibration, correcting the blood-pressure meters, is a rather large leap. In this paper, we study a “databased” Fourier series approach to model the oscillometric waveform and use the Windkessel model for the blood flow to correct the oscillometric blood-pressure meters. The method is validated on a measurement campaign consisting of healthy patients and patients suffering from either hyper- or hypotension.

Phenomenon of declining blood pressure in elderly - high systolic levels are undervalued with Korotkoff method

BackgroundSystolic blood pressure (SBP) decline has been reported in octogenarians. The aim was to study if it could be observed while measuring SBP with two methods: Korotkoff (K-BP) and Strain-Gauge-Finger-Pletysmography (SG-BP), and which of them were more reliable in expressing vascular burden.MethodsA cohort of 703 men from a population of Malmö, Sweden, were included in "Men born in 1914-study" and followed-up at ages: 68 and 81 years. 176 survivors were examined with K-BP and SG-BP at both ages, and 104 of them with Ambulatory Blood Pressure at age 81/82. Ankle Brachial Index (ABI) was measured on both occasions, and Carotid Ultrasound at age 81.ResultsFrom age 68 to 81, mean K-BP decreased in the cohort with mean 8.3 mmHg, while SG-BP increased with 13.4 mmHg. K-BP decreased in 55% and SG-BP in 31% of the subjects. At age 81, K-BP was lower than SG-BP in 72% of subjects, and correlated to high K-BP at age 68 (r = --.22; p < .05). SG-BP at age 81 was correlated with mean ambulatory 24-h SBP (r = .480; p < .0001), daytime SBP (r = .416; p < .0001), nighttime SBP (r = .395; p < .0001), and daytime and nighttime Pulse Pressure (r = .452; p < .0001 and r = .386; p < .0001). KB-BP correlated moderately only with nighttime SBP (r = .198; p = .044), and daytime and nightime pulse pressure (r = .225; p = .021 and r = .264; p = .007). Increasing SG-BP from age 68 to 81, but not K-BP, correlated with: 24-h, daytime and nighttime SBP, and mean daytime and nighttime Pulse Pressure. Increasing SG-BP was also predicted by high B-glucose and low ABI at age 68, and correlated with carotid stenosis and low ABI age 81, and the grade of ABI decrease over 13 years.ConclusionIn contrast to K-BP, values of SG-BP in octogenarians strongly correlated with Ambulatory Blood Pressure. The SG-BP decline in the last decade was rare, and increasing SG-BP better than K-BP reflected advanced atherosclerosis. It should be aware, that K-BP underdetected 46% of subjects with SG-BP equal/higher than 140 mmHg at age 81, which may lead to biased associations with risk factors due to differential misclassification by age.