Mean Difference In Blood Pressure Research Articles

Clinical Impact of 3- versus 5-Minute Delay and 30- versus 60-Second Intervals on Unattended Automated Office Blood Pressure Measurements.

Guidelines advise automated office blood pressure (AOBP) with an initial 5-minute delay and multiple measurements at least 60 seconds apart. Recent studies suggest that AOBP may be accurate with shorter delays or intervals, but evidence in clinical settings is limited. Patients referred to one hypertension (HTN) center underwent 24-hour ambulatory blood pressure monitoring (ABPM) and one of four non-randomized, unattended AOBP protocols: a 3- or 5-minute delay with a 30 or 60-second interval, i.e., 3min/30sec/30sec, 3/60/60, 5/30/30 and 5/60/60 protocols. HTN was defined as systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg. We compared differences in mean blood pressure and HTN classification between average AOBP and awake-time ABPM by t-tests and Fisher's exact test. Among 212 participants (mean 58.9 years, 61% women, 25% Black), there was substantial overlap in the probability distributions of awake-time ABPM and each of the three AOBP measures. Systolic blood pressure means were similar between the 5/60/60 and 3/30/30 protocols and 5/30/30 and 3/60/60 protocols. The 5/30/30 was associated with a higher proportion of systolic HTN, while the 3/60/60 protocol was associated with a higher proportion of diastolic HTN. There were no significant differences in systolic or diastolic HTN between 5/60/60 and 3/30/30 protocols with respect to awake-time ABPM. In this quality improvement study, the shortest AOBP protocol did not differ significantly from the longest protocol. The time savings of shorter protocols may improve AOBP adoption in clinical practice without meaningfully compromising accuracy.

Evaluation of Virtual Care in Kidney Transplant Recipients in the Early Posttransplant Period.

Though virtual care was widely adopted during the COVID-19 pandemic, evidence to support its use in kidney transplant recipients early after transplantation is limited. We conducted a retrospective cohort study comparing post kidney transplant outcomes in patients who received in-person transplant care before the COVID-19 pandemic with those who received mainly virtual transplant care during the COVID-19 pandemic. The usual-care group included 69 patients who received a kidney transplant from March 1, 2019 to September 1, 2019, and the virtual-care group included 64 patients who received a kidney transplant from September 1, 2020 to March 1, 2021. At 6 months, five patients in the usual-care group and three patients in the virtual-care group died. There was one graft loss and one episode of acute rejection in the usual-care group, and two episodes of acute rejection in the virtual-care group (p = 0.60). Estimated glomerular filtration rate was higher for patients in the virtual-care group (59mL/min/1.73m2 vs. 52mL/min/1.73m2, p = 0.046) and serum creatinine was not different (138 µmol/L vs. 127µmol/L, p = 0.27). There was no difference in mean blood pressure or hospitalizations. Outcomes were similar among recipients of a kidney transplant prior to the COVID-19 pandemic when care was mainly in person and during the pandemic when care was mainly virtual, without a signal of harm. Patient and donor selection may have led to unmeasured differences between groups.

Validation of combiomed hipermax-BF model A7101 automatic oscillometric upper-arm sphygmomanometer in general population: AAMI/ESH/ISO universal standard (ISO 81060-2:2018/Amd 1:2020).

This study evaluates the accuracy of the Hipermax-BF model A7101 (Combiomed, Havana, Cuba) automatic oscillometric upper-arm sphygmomanometer for office and home use in general population as part of the HEARTS in the Americas initiative. The research was developed according to the Universal Standard AAMI/ESH/ISO ISO 81060-2:2018/Amd 1:2020. The subjects were recruited according to the requirements of age, gender, blood pressure values and upper-arm circumference. The same upper-arm sequential blood pressure measurement method was used. For measurements with the device under test, the 2-piece cuff from 22-44 cm limb circumference range was used. 92 subjects were recruited and 85 were analyzed. Mean age was 44.8 ± 14.7 years, mean upper-arm circumference was 32.3 ± 6.2, and 56.5% were female. For Validation Criterion 1, the mean value ± standard deviation of the differences in readings between the device under test and the reference device was 1.2 ± 4.9/0.8 ± 4.9 mmHg (systolic/diastolic). For both pressures, in criterion 1 the standard requires a mean value of the differences ≤ ± 5 mmHg and a standard deviation ≤ ± 8 mmHg. For Validation Criterion 2, the standard deviation of the mean blood pressure differences per subject was 4.2/4.2 mmHg (systolic/diastolic). According to Table 1 of criterion 2, for the mean values of 1.2/0.8 mmHg (systolic/diastolic), the maximum allowable standard deviation had to be < 6.84 for systolic and < 6.89 for diastolic pressure. The Combiomed Hipermax-BF A7101 automatic sphygmomanometer meets the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018/Amd 1:2020) in the general population.

Healthcare Utilization and Chronic Disease Management for Non-Medicaid-Eligible Patients in a City-Wide Safety-Net Healthcare Access Program.

In 2019, New York City (NYC) launched NYC Care (NYCC), a healthcare access program through NYC Health + Hospitals (H + H) for individuals who are ineligible for federally funded health insurance programs or cannot purchase insurance through the State Marketplace, predominantly undocumented individuals. To examine the sociodemographic characteristics, healthcare use patterns, and chronic disease quality measures for diabetes mellitus (DM) and hypertension among NYCC patients compared with Medicaid patients seen at NYC H + H. Observational study. Adults aged 18years and older enrolled in NYCC (N = 83,003) or Medicaid (N = 512,012) as of January 1, 2022. Patients were included if they had at least one visit between January 1, 2021, and December 31, 2021. Sociodemographic characteristics, healthcare use patterns, and quality measures for DM and hypertension. NYCC patients (n = 83,003) were, on average, older, more likely to be Hispanic with Spanish as their preferred language, had more comorbidities, and had more primary care (adjusted incidence rate ratio 2.75 [95% confidence interval 2.71, 2.80]) and specialty care (2.22 [2.17, 2.26]) visits compared to Medicaid patients (n = 512,012). Rates of emergency department visits were similar between the two groups (1.02 [1.00, 1.04]), but NYCC patients had relatively fewer hospitalizations (0.64 [0.62, 0.67]). NYCC patients with DM or hypertension had higher rates of having a documented hemoglobin A1c or blood pressure in 2022, respectively, and clinically similar rates of chronic disease control (mean difference in hemoglobin A1c - 0.05 [- 0.09, - 0.01] in patients with DM and mean difference in blood pressure - 0.38 [- 0.67, - 0.10]/ - 0.64 [- 0.82, - 0.46]) compared with Medicaid patients. NYCC effectively enrolled a large number of uninsured participants and provided them with healthcare access similar to that of Medicaid patients. Future studies should evaluate the impact of NYCC enrollment on healthcare utilization and disease outcomes.

Improvement of non-adherence and reduction of BP values in patients with difficult-to-treat hypertension: the ATHAN clinical trial.

Hypertension treatment and blood pressure (BP) control reduce cardiovascular disease burden. However, prevalence of controlled BP is overall insufficient and lack of adherence to treatment is a suggested major contributor. This prospective, randomized clinical trial was designed to evaluate whether a specific 3-month (m) action plan to improve therapeutic adherence results in a decrease in BP. Patients with ambulatory 24 h-BP ≥ 130/80 mmHg despite receiving ≥2 antihypertensive drugs and with therapeutic non-compliance confirmed by antihypertensive drugs analyzed in urine were randomized (1:1) to receive a specific 3 m program to improve adherence (INT = intervention) or routine follow-up (C = control). Antihypertensive treatment was not modified and knowledge of non-adherence was only notified to patients randomized to the intervention group. Before randomization and at 3 m all patients underwent urinary screening for antihypertensive drugs and 24 h-ambulatory-BP monitoring. Forty-five patients (36% women, mean age: 58 ± 13 yr) were randomized. At 3 m, mean (95% CI) BP differences (INT vs. C) were 12.2 mmHg (4.3-20.8), adjusted-p = 0.032 and 8.7 mmHg (2.5-14.8), adjusted-p = 0.018 for 24 h-systolic and 24 h-diastolic BP, respectively. Differences (INT vs. C) for office SBP and DBP were 18.4 mmHg (6.8-30.1), adjusted-p = 0.005 and 15.7 mmHg (7.2-24.2), adjusted-p < 0.001. Non-detected antihypertensive drugs were median [IQR]: 40% [25-100] and 0% [0-20] at baseline and 3 m, respectively, in the INT group, and 33.3% [25-63.7] and 33.3% [23.8-57.9], in the C group (p < 0.001 for the 3-month between-group comparison). A combined action plan of notifying knowledge of non-adherence plus a 3-month specific nursing intervention to improve therapeutic adherence results in BP reduction in patients with inadequate therapeutic compliance.

Urinary Volatile Organic Compound Metabolites are Associated with High Blood Pressure Among Non-smoking Participants in the National Health and Nutrition Examination Survey (2011-2018).

Volatile organic compounds (VOCs) are ubiquitous environmental pollutants. Exposure to VOCs is associated with cardiovascular disease (CVD) risk factors, including elevated blood pressure (BP) in susceptible populations. However, research in the general population, particularly among non-smoking adults, is limited. We hypothesized that higher VOC exposure is associated with higher BP and hypertension, among non-smokers. We included four cycles of data (2011-2018) of non-smoking adults (n=4,430) from the National Health and Nutrition Examination Survey (NHANES). Urinary VOC metabolites were measured by ultra-performance liquid chromatography-mass spectrometry, adjusted for urine dilution, and log-transformed. We estimated mean differences in BP using linear models and prevalence ratio of stage 2 hypertension using modified Poisson models with robust standard errors. Models were adjusted for age, sex, race and ethnicity, education, body mass index, estimated glomerular filtration rate and NHANES cycle. Participants were 54% female, with a median age of 48 years, 32.3% had hypertension, and 7.9% had diabetes. The mean differences (95% CI) in systolic BP were 1.61 (0.07, 3.15) and 2.46 (1.01, 3.92) mmHg when comparing the highest to lowest quartile of urinary acrolein (CEMA) and 1,3-butadiene (DHBMA) metabolites. The prevalence ratios (PR) for hypertension were 1.06 (1.02, 1.09) and 1.05 (1.01, 1.09) when comparing the highest to lowest quartiles of urinary acrolein (CEMA) and 1,3-butadiene (DHBMA), respectively. Exposure to VOCs may be relevant yet understudied environmental contributors to CVD risk in the non-smoking, US population.

The effect of light massage and Spiritual Emotional Freedom Technique interventions on blood pressure among hypertension patients in Indonesia

Hypertension remains a significant global public health concern. Non-pharmacological interventions such as light massage and the Spiritual Emotional Freedom Technique (SEFT) offer potential avenues to mitigate sustained increases in blood pressure among patients with hypertension. However, research exploring these methods as alternative therapies, particularly in Indonesia, is limited. This study aimed to investigate the effects of light massage and SEFT on the blood pressure of hypertensive individuals. Employing a quasi-experimental design with a time series approach, the study utilized purposive sampling to select 27 participants. Light massage and SEFT were considered independent variables, while blood pressure served as the dependent variable. Data analysis involved repeated measures ANOVA and one-way ANOVA tests. The results revealed significant differences in mean blood pressure before and after the light massage intervention (p-values: 0.002, &lt;0.001, &lt;0.001). The intervention sessions yielded the most significant results (p-values: &lt;0.001, 0.002, &lt;0.001), whereas no differences were observed in the control group (systolic and Mean Arterial Pressure, MAP, p-values: 0.012 and 0.017, respectively). Notably, there were discrepancies in mean blood pressure before and after interventions in both the light massage and SEFT groups, indicating a potential benefit of these interventions. Conversely, no such differences were noted in the control group. These results highlight the potential benefits of integrating light massage and SEFT into holistic approaches for managing hypertension, potentially improving outcomes and quality of life for affected individuals.

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.

THE EFFECTS OF OLMESARTAN/AMLODIPINE ADMINISTERED IN THE MORNING OR AT NIGHT ON NOCTURNAL BLOOD PRESSURE IN CHINESE PATIENTS WITH MILD-MODERATE ESSENTIAL HYPERTENSION (OMAN TRIAL)

Objective: The clinical evidence of antihypertensive chronotherapy remains controversial. This study aimed to compare the effects of morning and bedtime antihypertensive administration on the nocturnal blood pressure (BP) reduction and the circadian rhythm of hypertensives. Design and method: A randomized, multicenter, open-label clinical trial was conducted in China from March, 2022. Patients aged 18-75, not taking or stopped using antihypertensive drugs for 2 weeks, were recruited. At baseline, all patients received 24-h ambulatory BP measurement (ABPM) and office BP measurement (OBPM), and were randomized to the morning (06:00-10:00 AM, group 1) or the bedtime dosing group (6:00-10:00 PM, group 2). Each patient received one tablet of olmesartan/amlodipine (OA) (20/5 mg) daily for 4 weeks, and then followed up every 4 weeks for 12 weeks. The OA dosage was adjusted based on the ABPM and OBPM. Patients with uncontrolled BP at the first follow-up received an increased dosage to 1.5 tablets, and increased to 2 tablets if BP was uncontrolled after 4 weeks of dosage increase. Results: 700 patients were recruited (mean age 56.54±10.52 years; 45.5% female), with 382 finished the 12-week follow-up and were included in the analysis (follow-ups are continuing). At week 4, the mean BP differences of ABPM and OBPM did not differ significantly between groups. At week 12, compared with group 1, patients in group 2 showed significantly greater reductions from baseline in nighttime systolic BP (SBP) (between-group difference -5.04mmHg, 95% confidence interval (CI): -8.38 to -1.70), and diastolic BP (DBP) (-3.03mmHg, 95% CI -5.08 to -0.97); with better nocturnal SBP control (67.4% vs. 76.7%, P=0.04), and decrease in nocturnal BP load. The proportion of non-dipper or reverse dipper increased from 52.3% to 54.4% in group 1 (P=0.64), and dropped from 57.9% to 45.5% in group 2 (P&lt;0.01). The incidence of nocturnal hypotension (SBP/DBP&lt;100/90mmHg) did not differ. Conclusions: Compared with morning dosing, bedtime dosing can better control nocturnal BP, and improve the circadian rhythm without increasing the risk of nocturnal hypotension. It represents a reasonable strategy to optimize BP control, especially nocturnal BP control.

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.

Abstract P101: The Association Between Residing in a Food Desert and Hypertension in Victims of Sudden Death

Introduction: Sudden deaths, defined as unexpected deaths not attributable to suicide, trauma or cancer account for over 10% of deaths in adults aged 18-64 years. More evidence is needed to understand how socioeconomic factors interplay with physiological processes such as hypertension to contribute to sudden death. We hypothesized that residing in a food desert would be associated with hypertension and poor blood pressure (BP) control in people who died of sudden death. Methods: We screened Emergency Medical Services (EMS) records from 2013 to 2015 in Wake County, NC, which includes the capital city of Raleigh and &gt;1 million residents, and adjudicated 399 sudden death victims using a standardized protocol. We collected medical history and BP measures from health records and linked geocoded patient addresses to census-tract data from the USDA’s Food Access Research Atlas. Of these, 350 victims had address data available, and of these 196 had blood pressures available. Residing in a food desert was defined as living in a low income and low access area, which is defined as no access to grocery stores within 1 mile in urban areas and 10 miles in rural areas. The ten most recent systolic BP measures prior to death were used to calculate average BP. We calculated unadjusted differences in mean BP by residence in a food desert. We also calculated unadjusted odds ratios (ORs) comparing the probability of having a hypertension diagnosis and of having controlled BP (systolic BP &lt;130 mmHg) by residence in a food desert. Results: We examined 350 sudden decedents who were 33% Black (116 of 350), 64% White (224 of 350), 31% women (109 of 350), and a median age of 55. Of these, seventy-nine (23%) resided in a food desert, and these were more likely to have diabetes mellitus (38.0% vs. 26.6%), (30 of 79 and 72 of 271 respectively). Sudden decedents who resided in a food desert had higher systolic BP with a mean of 140 mmHg compared with 134 mmHg for those who did not reside in a food desert (mean difference 6.15, CI 6.012-6.298). Of those residing in a food desert, 60.8% (48 of 79) had a medical diagnosis of hypertension, and 33.3% (14 of 48) had controlled BP. There was no association between residing in a food desert and a diagnosis of hypertension (OR 1.04, 95% CI 0.62-1.74) or controlled BP (OR 1.73, 95% CI 0.85-3.54). Conclusion: Almost a quarter of sudden decedents resided in a food desert at the time of death. In this case group, residing in a food desert was associated with a small BP increase but not with diagnosed hypertension or controlled BP. Large population studies are necessary to investigate the risk of sudden death and poor blood pressure control associated with residing in a food desert.

Validation of the Raycome model M2 ambulatory 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 (ISO 81060-2:2018).

The aim of this study was to evaluate the accuracy of the Raycome model M2 oscillometric upper-arm blood pressure (BP) monitor developed for ambulatory 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) at rest and during dynamic exercise. Subjects were recruited to fulfill the age, gender, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in the general population using the same arm sequential BP measurement method. Three cuffs of the test device were used for arm circumference 18-22 cm (small), 22-32 cm (medium) and 32-42 cm (large). For the general validation study, 106 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 0.5 ± 6.2/-0.2 ± 5.1 mmHg (systolic/diastolic). For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 5.23/4.50 mmHg (systolic/diastolic). In the ambulatory validation study ( N = 35), the mean difference was 0.4 ± 5.9/-1.1 ± 5.8 mmHg. The Raycome model M2 performed well against the standard in both the general and ambulatory validations and the Bland-Altman plots did not show any systematic variation in the error. These data show that the Raycome model M2 monitor meets the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) and in the ambulatory setting, indicating its suitability for measuring BP in the general population.

Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities

Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.

Effect of Crataegus Extract on the Relief of Heart Palpitation and Anxiety in Teenagers: An Interventional Quasi-Experimental Study

Background: Heart palpitation is a common complaint defined as an unpleasant or abnormal heartbeat feeling. This study aimed to investigate the effectiveness of Crataegus extract on the relief of heart palpitations and anxiety in adolescents. Methods: This is an interventional quasi-experimental study performed from February 19, 2016 to February 19, 2017 on 120 adolescents aged 13 to 19 years with a complaint of heart palpitations, referring to heart clinic in Afshar Hospital of Yazd. The participants' demographic information, heartbeat feeling, Hamilton anxiety scaling, blood pressure, heartbeat rate, and electrocardiogram (ECG) were recorded. Patients were first treated with 20 drops every 8 hours for three days and then 25 drops every 8 hours for one month with Crataegus edible drops. They were then re-evaluated for heart palpations and anxiety. Results: Of 120 adolescents referring to Afshar Hospital with heart palpitations, 98 of participants (81.7%) experienced improvement. Mean differences in systolic blood pressure, heart rate, and anxiety scores before and after treatment with Crataegus extract decreased significantly by 1.71, 8.52, 6.55, respectively, but the mean difference in diastolic blood pressure increased by 1.46 (P&lt;0.05). Conclusion: According to the results, Crataegus extract might be effective in reducing palpitation and anxiety in adolescents. Further studies are suggested to approve the results of the study.

Abstract 12950: A Nationwide Remote Patient Intervention Hypertension Program: Can Remote Patient Monitoring and a Multi-Disciplinary Team of Clinicians Improve Blood Pressure Control?

Introduction: Traditional methods for diagnosing and treating HTN, which is the most common modifiable risk factor accounting for ASCVD in the US, have been ineffective. Innovative solutions, like remote patient monitoring (RPM), can transform how we provide longitudinal care for patients with HTN. Hypothesis: An advanced practice provider led HTN program, which leverages RPM and technology-enabled treatment protocols, can provide a scalable solution for optimizing HTN management nationwide. Methods: Cadence is a healthcare technology organization that enrolled patients into a virtual HTN program in PCP clinics in 11 states across the US from February 2022 to April 2023. Eligible patients were Medicare enrollees who had a diagnosis of HTN based on ICD-10 codes, mean blood pressure (BP) &gt;140/90 (using last 3 EMR-based vitals) and were enrolled for at least 30 days. Using daily vitals from a cellular enabled BP cuff and scheduled visits, a team of multidisciplinary clinicians leveraged technology-enabled clinical protocols to facilitate optimization of HTN control. A two-sample t-test was used to detect a difference in mean BP. Results: A total of 4006 patients were enrolled (mean age 73 +/- 9, 70% White) with a baseline BP of 144/83 mmHg. The total reduction in systolic BP (SBP)/diastolic BP (DBP) was 9/6 (p&lt;0.001) in the last week compared to the first week (mean follow-up of 136 +/- 92 days). The total number of vitals recorded, clinical visits and phone calls completed, and high acuity clinical alerts resolved is depicted in Figure 1A. The SBP/DBP reductions by different BP strata are depicted in Figure 1B. There was a ~2x increase in the number patients at goal (BP&lt;130/80) in the last week compared to the first week (31% vs. 15%; p&lt;0.001). Conclusions: A remote patient monitoring HTN program not only can improve the diagnosis of hypertension, but also can significantly reduce blood pressure, and in doing so help more patients achieve guideline recommended BP goals.

Abstract 13683: Deciphering the Effects of Quercetin on Blood Pressure: A Systematic Review and Meta-Analysis

Introduction: Hypertension, a key driver of global cardiovascular diseases, has prompted interest in nutritional solutions like dietary supplements for managing blood pressure. The flavonoid quercetin, found in fruits and vegetables, has garnered attention for potential antihypertensive effects, although research on quercetin supplementation's impact on blood pressure has yielded varied outcomes. Hypothesis: This study aims to assess Quercetin supplementation's effects on blood pressure to comprehend its potential role in hypertension management. Methods: A systematic search was conducted across PubMed, Cochrane Library, Embase, and Scopus databases until December 2022 to include studies on the effects of Quercetin supplementation on blood pressure. The Mean Difference in Blood Pressure was used as the pooled effect size to compare the impact of Quercetin on patients, calculated with a random-effects model in R (version 4.0.3) using the metafor and meta packages. The I2 statistic was employed to evaluate heterogeneity. Results: The meta-analysis included ten studies with 743 participants, with 372 and 371 in the Quercetin and placebo/control groups, respectively. Quercetin supplementation in patients diagnosed with hypertension led to a statistically significant reduction in systolic blood pressure (MD: -3.19 mmHg; 95% CI: -4.41 to -1.99, P&lt;0.01, I2=73%). However, the reduction in diastolic blood pressure was not statistically significant (MD: -2.65 mmHg; 95% CI: -6.79 to 1.51, P=0.21, I2=98%). In individuals with normal blood pressure, quercetin supplementation resulted in a significant reduction in systolic blood pressure (MD: -2.97 mmHg; 95% CI: -4.72 to -1.22, P&lt;0.01, I2=74%), while its effect on diastolic blood pressure was not significant (MD: -2.99 mmHg; 95% CI: -10.18 to 4.21, P=0.42, I2=99%). Conclusions: The results indicate that quercetin supplementation notably lowers systolic blood pressure in hypertensive and normotensive individuals, but its impact on diastolic blood pressure is insignificant. These findings hint at Quercetin's potential as an auxiliary treatment for systolic hypertension, with a need for more high-quality, randomized controlled trials to determine its optimal dosage and duration.

Role of erector spinae plane block in transjugular intrahepatic portosystemic shunt procedure: A randomized controlled trial

ABSTRACT Background Anesthesia for transjugular intrahepatic portosystemic shunt (TIPS) for lowering raised portal pressure is clinically challenging. As patients, candidates for TIPS are medically complex due to chronic liver disease, adding to remote area anesthesia’s complexities. Multimodal analgesia, including erector spinae plane block (ESPB), can improve anesthesia quality with patient satisfaction. Methods Fifty-six patients scheduled for TIPS, aged 18–60 years and with Child classification A or B, were randomly allocated into two groups. The ESPB group experienced ESPB (n = 24), while the control group was introduced with sedation spontaneously breathing (n = 24). Primarily, we investigated the records of the hemodynamic profile and analgesia nociceptive index (ANI). As a secondary aim, we recorded the opioid consumption, complication incidence, and patient and interventional radiologist satisfaction scores. Results Heart rate was significantly lower in the ESPB group at the beginning of the procedure, liver puncture, and balloon dilatation events, while there were no significant differences in mean blood pressure. Analgesia assessment by ANI was significantly higher in the ESPB group indicating adequate analgesia. Opioid consumption was significantly lower in the ESPB group than in the control group. Statistical analysis for patient satisfaction showed better results in the ESPB group, while the surgeon satisfaction score showed no significant statistical differences. Conclusion ESPB could be recommended as an alternative to analgesia in TIPS and its vulnerable patients to improve safety by reducing sedation-related morbidity and complications with improving the patient’s degree of satisfaction.

Effects of Cuff Size on the Accuracy of Blood Pressure Readings

Clinical practice guidelines recommend selecting an appropriately sized cuff based on mid-arm circumference prior to measuring blood pressure (BP). To our knowledge, the effect of miscuffing on BP measurement when using an automated BP device has not been quantified. To determine the effect of using a regular BP cuff vs an appropriately sized BP cuff on automated BP readings. This randomized crossover trial of community-dwelling adults with a wide range of mid-arm circumferences took place between March 16 and October 25, 2021, in Baltimore, Maryland. Participants were recruited via BP screening events at a public food market and a senior housing facility, targeted mailings to prior research participants, placement of study brochures in hypertension clinics at Johns Hopkins University, and referrals from physicians providing hypertension care to adults. Participants underwent 4 sets of triplicate BP measurements, with the initial 3 sets using an appropriate, too-small, or too-large BP cuff in random order; the fourth set of triplicate measurements was always completed with an appropriate BP cuff. The primary outcome was the difference in mean BP when measured with a regular BP cuff compared with an appropriate BP cuff. The secondary outcome was the difference in BP when using too-small or too-large BP cuffs vs an appropriate BP cuff across all cuff sizes. Results were also stratified by systolic BP (≥130 mm Hg vs <130 mm Hg) and body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30 vs <30). A total of 195 adults (mean [SD] age, 54 [16] years; 67 [34%] male; 132 [68%] Black; 100 [51%] with hypertension) were randomized for inclusion. Among individuals requiring a small BP cuff, use of a regular BP cuff resulted in a statistically significant lower BP reading (mean systolic BP difference, -3.6 [95% CI, -5.6 to -1.7] mm Hg). In contrast, among individuals requiring a large or extra-large BP cuff, use of a regular BP cuff resulted in a statistically significant higher BP reading (mean systolic BP difference, 4.8 [95% CI, 3.0-6.6] mm Hg and 19.5 [95% CI, 16.1-22.9] mm Hg, respectively). For the secondary outcome, BP differences with overcuffing and undercuffing by 1 and 2 cuff sizes were greater among those requiring larger BP cuffs. The results were consistent in stratified analyses by systolic BP and body mass index. In this randomized crossover trial, miscuffing resulted in strikingly inaccurate BP measurements. This is particularly concerning for settings where 1 regular BP cuff size is routinely used in all individuals, regardless of arm size. A renewed emphasis on individualized BP cuff selection is warranted. ClinicalTrials.gov Identifier: NCT04610775.

Validation of the Withings BPM Core Device for Self-Blood Pressure Measurements in General Population According to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard.

Most of the scientific societies recommend assessing the accuracy of electronic devices for blood pressure (BP) measurements using established validation protocol. To determine the accuracy of the BP measurements using the Withings BPM Core device in the general population according to the "Universal Standard (ISO 81060-2:2018/AMD 1:2020)". The Withings BPM Core is an oscillometric device measuring BP at the brachial level. The study was performed according to the "Universal Standard (ISO 81060-2:2018/AMD 1:2020) protocol" using the same-arm sequential BP measurement method. Subjects (n ≥ 85) fulfilling the age, gender, BP, and cuff distribution criteria of the protocol were included. Analysis was performed as required by the Universal protocol using Criterion 1 - differences between observers' mercury sphygmomanometer reference measurements and test device BP values (test versus reference) and their standard deviation (SD); and Criterion 2 - The SD of the mean BP differences between the test device and reference BP per subject. Eighty-six subjects were selected, 85 of whom were included. The mean BP differences between the simultaneous two observers' measurements were -0.2 ± 2.1 mmHg for systolic BP (SBP) and 0.3 ± 2.1 mmHg for diastolic BP (DBP). For validation criterion 1, the mean difference ± SD between the reference and device BP values was -0.6 ± 4.8 mmHg for SBP and 0.1 ± 3.7 mmHg for DBP (≤5 ± 8 mmHg for both SBP and DBP). For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 3.2/2.6 mmHg for SBP and DBP (≤6.91/6.95 mmHg). The results of this study showed that the Withings BPM Core oscillometric device for home BP measurement fulfilled the accuracy requirements of the (ISO 81060-2:2018/AMD 1:2020) Universal protocol in the general population.

#4470 THE IMPACT OF RESIDUAL NATRIURESIS ON INTRADIALYTIC HYPERTENSION IN PATIENTS ON ISONATRIC DIALYSIS: A MONOCENTRIC STUDY AT THE FRANCK JOLY HOSPITAL CENTER

Abstract Background and Aims Intradialytic hypertension (IDH) is an elevation of blood pressure recorded during dialysis monitoring and at the end of the session relative to the values recorded at the connection. Hypervolemia and positive sodium balance are the main mechanisms. Isonatric dialysis allows a restoration of natremia corresponding to an optimal state of cellular hydration at the end of the session, and residual natriuresis is related to the state of extracellular hydration. Hence, their potential role in the appearance of IDH. The objective of this study is to measure the impact of residual natriuresis on IDH in patients on chronic isonatric hemodialysis. Method Transversal, descriptive and analytical study, having examined 12 last dialysis sessions of December 2023 of 65 patients in chronic hemodialysis (780 dialysis sessions) at the FRANCK JOLY Hospital Center in French Guiana. The primary outcome was the presence of intradialytic hypertension (IDH), defined as a difference in mean blood pressure ≥ 15 mmHg at disconnection from branching, or the need for antihypertensive treatment during the session with as main explanatory variables: residual natriuresis and sodium perdialytic concentration. Welche, Mann Whitney, Fisher and chi2 tests were used in univariate analysis and logistic regression in multivariate analysis to determine factors associated with IDH. The significance threshold was set at: p &amp;lt; 0.005. Results The 65 files analyzed had a predominance of women at 55%. 780 dialysis sessions were reviewed, including 206 with IDH, or nearly 1/4 of the sessions. 37% of patients were affected by IDH with a sex ratio of 1. 94% of patients had a history of hypertension and 22% were diabetic. 57% of patients had zero residual diuresis. The average interdialytic weight gain was 2.3 kg. 48% had at least triple antihypertensive therapy. The average duration of a dialysis session was 4 hours, the mean KT/V was 1.2; The mean natremia was 138 mEq/L and the mean perdialytic sodium concentration was 140 mEq/L. The median residual natriuresis was 8.55[0; 26.2] mEq/L. The mean NT-proBNP level was 2407 pg/ml. In univariate analysis, residual natriuresis and perdialytic natremia were not statistically associated with HID. Factors significantly associated with IDH were a number of antihypertensive treatments, NT-proBNP level and duration of dialysis session. In multivariate analysis: the high number of antihypertensive treatments and the increased duration of the dialysis session emerged as risk factors for IDH. Indeed, when the number of antihypertensives increased by 1 unit, the IDH score was multiplied on average by 2.74 (p&amp;lt;0.001), and when the session duration (h) increased by 0.1 units, the IDH score was multiplied by an average of 1.39 (p = 0.019). Residual natriuresis appeared as a protective factor against interdialytic weight gain, because when urinary sodium (mEq/l) increased by 10 units, mean interdialytic weight gain (kg) decreased by an average of -0.116 (p = 0.043). Conclusion Intradialytic hypertension is common and multifactorial. Antihypertensive combination therapy, usually reflecting resistant high blood pressure, is a major risk factor. The present study, at the expense of the definition criteria used, did not find significant associations with perdialytic natremia and residual natriuresis. However, the latter remains protective against interdialytic hypervolemia. Hence, the need for its preservation.