Mean Difference In Blood Pressure Research Articles

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.

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.

Accuracy of the KOROT P3 Accurate automated auscultatory blood pressure measuring device for professional use in people with extra-large arms.

To determine the accuracy of the KOROT P3 Accurate (previously InBody BPBIO480KV) monitor, an automated auscultatory blood pressure (BP) measuring device developed for professional use, in people with extra-large arms according to the ISO81060-2 2018 protocol. The KOROT P3 Accurate was tested in 37 subjects with upper-arm circumference ranging from >42 to 53 cm using a mercury sphygmomanometer coupled to a 20 × 40 cm tronco-conical cuff as the reference standard. The mean BP difference between the device and the observers' reference measurements was 1.2 ± 2.0 mmHg for systolic BP and 1.0 ± 2.0 mmHg for diastolic BP. These data were in agreement with criterion 1 of the protocol standard requirements (≤5 ± 8 mmHg). Also criterion 2 was satisfied being the standard deviations ± 1.7 mmHg for systolic BP and ± 1.6 for diastolic BP, well below the maximum values required by the protocol (±6.84/6.87 mmHg). Scatterplots of device-reference systolic and diastolic BP differences showed similar accuracy across the range of participants' BP, arm circumference and upper-arm slant angle. These data show that the KOROT P3 Accurate monitor satisfied the ISO 81060-2:2018 standard requirements in a special population of people with extra-large arms ranging from >42 to 53 cm.

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.

VISUAL ASSESSMENT OF KOROTKOFF SOUNDS FURTHER IMPROVES THE ACCURACY OF A VALIDATED PROFESSIONAL AUTOMATED AUSCULTATORY BLOOD PRESSURE MONITOR – INBODY BPBIO480KV

Objective: A novel automated auscultatory upper-arm cuff blood pressure (BP) monitor for office use (InBody BPBIO480KV, Seoul, S Korea) has been recently validated, which allows healthcare professionals to visually review the Korotkoff sounds curves generated for each BP reading. This study investigated whether this feature could further improve the accuracy of the device by identifying unreliable BP readings. Design and method: Three observers assessed independently the morphology of Korotkoff sound curves generated during a validation study according to the ISO 81060-2:2018 standard, and classified them as having good, fair, or poor signal quality (low signal amplitude or sound intensity, aberrant signal morphology, interference of background noise or other signal artifact, presence of auscultatory gap, or irregular rhythm), separately for the systolic and diastolic BP area. The observers were blinded to the automated and the reference BP measurement results. Disagreement among observers was resolved by a supervisor. Factors associated with poor quality signal were also investigated. Results: A total of 255 Korotkoff sound curves (test BP readings) by 85 participants (mean age 57.3±15.0 years, 53 men) were analyzed. For systolic BP, 82.0/12.2/7.5% were classified as good/fair/poor quality and for diastolic 76.9/12.2/11.0%. Inter-observer agreement in detecting poor quality curves was 84.7/83.1% (systolic/diastolic). Of poor quality curves 10.5/60.7% (systolic/diastolic) clustered in the same individuals. Young age and female sex increased the odds for poor quality signal. ISO validation Criterion 1 (mean BP difference ±SD) was satisfied for readings with good (0.1±4.9/0.3±3.8 mmHg, systolic/diastolic) and fair (-0.4±6.4/0.2±5.0) quality curves, good/fair quality curves (0.1±5.1/0.2±4.0 mmHg, systolic/diastolic), but not for those with poor quality signal (2.7±8.8/3.6±8.1 mmHg). In the ISO validation study, excluding readings with poor quality signal (systolic and/or diastolic area; 40 of 255) Criterion 1 was improved (0.2±4.9/0.2±3.9 mmHg versus 0.3±5.5/0.6±4.7 mmHg). Conclusions: The visual assessment of Korotkoff sounds generated by automated auscultatory BP measurement using the InBody BPBIO480KV professional office BP monitor is useful in identifying unreliable readings and further improves the device accuracy.

Sex differences in autonomic and cardiovascular responses during lower-body negative pressure

Female adults have a lower tolerance to central hypovolemia, simulated by tilt testing and lower body negative pressure (LBNP; PMID: 26109186). However, the mechanisms responsible for this observation remain unknown. Previous studies investigated sex differences at baseline and presyncope, but the intermediate responses are not fully understood, particularly when expressed as a percentage of tolerance. Therefore, the purpose of this study was to compare autonomic and cardiovascular responses to a simulated hemorrhage between female and male adults at the same relative percentage of their tolerance. We tested the hypothesis that females would have lower blood pressure (BP) and muscle sympathetic nerve activity (MSNA) at the same relative percentage of their tolerance. Eight female (28±8 years old, 171±8 cm, 77±6 kg, BMI: 27±3 kg/m 2 ) and eight male (age: 32±7 years old, height: 178±9 cm, mass: 86±10 kg, BMI: 27±2 kg/m 2 ) adults completed a progressive LBNP protocol that started at -40 mmHg and was further reduced by 10 mmHg every 3 minutes until the participant reached pre-syncope. Presyncope was based on the following criteria: continued reports by the subject of feeling faint and/or nauseous; a rapid decline in blood pressure resulting in systolic blood pressure &lt; 80 mmHg; and/or a relative bradycardia accompanied by narrowing of pulse pressure. LBNP tolerance was quantified as a cumulative stress index (CSI) (mmHg·min) and was compared between sexes using an unpaired t-test. MSNA (microneurography - radial nerve), beat-to-beat blood pressure (BP; Finometer), and heart rate (HR) were obtained at baseline, at 33% and 66% of maximum CSI (60-second averages for both), and the last 30 seconds before 100% CSI (i.e., presyncope). Data were statistically analyzed between the sexes using mixed effects analysis and are presented as mean ± SD. Consistent with prior findings, tolerance to LBNP was lower in females (female: 607±369 vs. male: 960±339 mmHg·min, p = 0.067). There were no differences in systolic, mean, or diastolic BP or HR between the sexes (e.g., main effect of sex, p &gt; 0.199 for all indices) throughout the protocol. MSNA burst frequency (bursts/min) (baseline: 18±8 vs. 25±11; 33% CSI: 30±13 vs. 50±5; 66% CSI: 38±11 vs. 56±4; 100% CSI: 28±10 vs. 40±12; sex: p = 0.004, stage: p &lt; 0.0001, interaction: p = 0.704) and burst incidence (bursts/100 cardiac cycles) (baseline: 29±9 vs. 41±20; 33% CSI: 38±21 vs. 58±10; 66% CSI: 35±18 vs. 52±10; 100% CSI: 32±18 vs. 37±12; sex: p = 0.047, stage: p = 0.022, interaction: p = 0.952) were lower in females than males throughout the protocol, respectively. However, there was no interaction between sexes and relative LBNP stages for MSNA burst frequency or burst incidence. These findings suggest a lack of sex differences in the magnitude of the increase of MSNA throughout LBNP and that lower basal sympathetic activity may be related to reduced tolerance to central hypovolemia. Department of Defense - US Army W81XWH1820012 (CGC) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Noninvasive Monitoring of Blood Pressure and Heart Rate during Estrous Cycle Phases in Normotensive Wistar-Kyoto and Spontaneously Hypertensive Female Rats.

Since 2015, the National Institutes of Health has called for its funded preclinical research to include both male and female subjects. However, much of the basic animal research that has studied heart rate and blood pressure in the past has used male rats. Male rats have been preferred for these studies to avoid the possible complicating effects of the female estrous cycle. The aim of the current study was to determine whether blood pressure and heart rates vary as a function of the estrous cycle phase of young normotensive Wistar-Kyoto (WKY) and Spontaneously Hypertensive (SHR) female rats. Blood pressure and heart rate were measured at the same time of day throughout the estrous cycle by using a noninvasive tail cuff sphygmomanometric technique. As expected, 16-wk-old female SHR rats had higher blood pressure and heart rates than did age-matched female WKY rats. However, no significant differences in mean, systolic, or diastolic arterial blood pressure or heart rate were detected across the different stages of the estrous cycle in either strain of female rats. Consistent with previous reports, heart rates were higher and showed less variation in the hypertensive SHR female rats as compared with the normotensive WKY female rats. These results indicate that studies measuring blood pressure and heart rate can include young female SHR and WKY rats with no effect of estrous cycle stage.

Association of blood manganese concentrations with 24-h based brachial and central blood pressure, and pulse-wave velocity.

Potential environmental determinants of BP and hypertension in older adults are far less known than their lifestyle risk factors. Manganese (Mn) is an essential element for life that may induce changes in blood pressure (BP), but the direction of the association is unclear. We aimed to examine the association of blood manganese (bMn) with 24-h-based brachial, central BP (cBP), and pulse-wave velocity (PWV). With this purpose, we analyzed data from 1009 community-living adults aged >65 years without BP medication. bMn was measured using inductively-coupled plasma-mass spectrometry and 24-h BP with validated devices. The association of bMn (median: 6.77 μg/L; IQR: 5.59–8.27) with daytime brachial and central systolic (SBP) and with diastolic BP (DBP) was non-linear, with BP increases up to around the median of Mn and then stabilization or slight rightward decrease. Mean BP differences (95% confidence interval) comparing Mn Q2 to Q5 (vs Q1 quintile) for brachial daytime SBP were 2.56 (0.22; 4.90), 3.59 (1.22; 5.96), 3.14 (0.77; 5.51) and 1.72 (−0.68; 4.11) mmHg, respectively; and 2.22 (0.70, 3.73), 2.55 (1.01, 4.08), 2.45 (0.91; 3.98), and 1.68 (0.13; 3.24), respectively, for DBP. Daytime central-pressures showed a similar dose-response relationship with bMn as daytime brachial-pressures. The association with nighttime BP was linearly positive for brachial BPs, and only increasing for Q5 for cBP. Regarding PWV, a tendency to significant linear increase along bMn levels was observed (p-trend = 0.042). The present findings extend the scarce evidence on the association between Mn and brachial BP to 2 other vascular parameters, suggesting Mn levels as a candidate risk factor for increasing levels of both brachial and cBPs in older adults, yet further research is needed with larger cohort studies in adults at all age ranges.

Assessment of a Calibration-Free Method of Cuffless Blood Pressure Measurement: A Pilot Study.

We design an adaptive algorithm to detect the feature of the pulse wave, making it possible for two sensors to measure the local PWV in the radial artery at a short distance. Unlike the cuffless BPM that needs to use a regression model for calibration. We encapsulate the piezoelectric sensor material in a cavity and design an analog front-end circuit. This study used color ultrasound imaging equipment to measure radial arterial parameters, including the diameter and wall thickness, to aid the estimation of blood pressure (BP) using the Moens-Korteweg (MK) equation of hemodynamics. We compared the blood pressure estimated by the MK equation with the reference BP measured using an aneroid sphygmomanometer in a test group of 32 people, resulting in a mean difference of systolic BP of -0.63 mmHg, and a standard deviation of ±5.14 mmHg, a mean difference of mean arterial pressure (MAP) of 0.97 mmHg, with a standard deviation of ±3.54 mmHg, and a mean difference of diastolic BP of -1.14 mmHg, with a standard deviation of ±4.08 mmHg. This study has verified its compliance with ISO 81060-2. A new type of wearable continuous calibration-free BPM can replace the situation that requires the use of traditional ambulatory BPM and reduce patient discomfort. In this study can provide long-term continuous blood pressure monitoring in the hospital.

EFFECT OF CALCIUM AND VITAMIN D SUPPLEMENTATION IN PREGNANT WOMAN WITH HYPERTENSION AT SENTANI COMMUNITY HEALTH CENTER

Low calcium intake causes an increase in high blood pressure by stimulating the release of parathyroid hormone and renin, which causes an increase in intracellular calcium concentration in the smooth muscle cells of blood vessels and results in vasoconstriction. This study aims to determine the effect of giving calcium and vitamin D supplements to pregnant hypertension women on the anthropometric outcomes of newborns. The research design was quasi-experimental with two groups of post-test-only design. A respondent of 30 hypertension pregnant women at 28-32 weeks of gestation was selected by purposive sampling—data analysis using Mann Whitney. Calcium supplements (2 x 500 mg/day) and vitamin D3 (400 IU/day) were administered and monitored for eight weeks to 15 pregnant women as the intervention group and 15 pregnant women as the control group who were assumed to receive calcium supplements from the Health Service Program. Data on blood pressure and calcium levels were taken before and after eight weeks of intervention. The results showed that there was a significant difference in mean blood pressure between the control and intervention groups, with a p-value of systolic blood pressure (0.002) and a p-value of diastolic blood pressure (0.014), and the average decrease in blood pressure was more significant in the intervention group. There were differences in anthropometric results between the intervention group and the control group, with p-value s ​​for body weight (0.000), body length (0.000), and head circumference (0.000). The intervention group's average weight, length, and head girth were higher than the control group's. Thus, for eight weeks, calcium and vitamin D supplementation in hypertensive pregnant women can reduce blood pressure and result in better baby weight, body length, and head circumference. Keywords: Anthropometry, Calcium, Hypertension, Vitamin D

Effect of Crystalloid or Colloid Fluid Loading and Vasopressor Pre-Treatment on the Timing of Hypotension in Cesarean Section with Subarachnoid Block

BACKGROUND: Cesarean section (C-section) is the most frequently performed surgery in obstetrics, generally using subarachnoid block (SAB) or epidural block for anesthesia. The previous studies have shown the effectiveness of fluid loading and vasopressor pretreatment in preventing maternal hypotension (decreased blood pressure), the most common side effect of SAB. However, the timing of hypotension in response to these treatments has not been analyzed. AIM: This study therefore aimed to compare the effects of crystalloid or colloid fluid loading and vasopressor pre-treatment on the timing of hypotension in cases of C-section under SAB anesthesia. METHODS: The study was a single-blind randomized controlled clinical trial with three treatment groups: Group I, 10 mL/kgBW crystalloid solution (Ringer’s lactate) loading 10 min before SAB; Group II, 5 mL/kgBW colloid fluid (gelatin) loading 10 min before SAB; and Group III, pretreatment with 0.1 mg/kgBW vasopressor (ephedrine) intravenous bolus just before SAB. RESULTS: Significant differences in mean blood pressure between groups were observed between the second and 8th min (p &lt; 0.05). Hypotension was observed in the crystalloid group within the first 5 min, while average blood pressure was relatively stable all groups after the first 10 min. In addition, hypotension occurred more frequently in the crystalloid group (nine subjects, 45%), compared with the colloid and vasopressor groups (two subjects per group, 10%; p &lt; 0.05). CONCLUSION: Hypotension occurred more rapidly and more frequently when crystalloid loading was utilized, compared with colloid loading or vasopressor pretreatment. Administration of colloid fluid loading and vasopressor pretreatment has been shown to prevent hypotension in SAB anesthesia.