SBP Measurements Research Articles

Systolic blood pressure variability in late-life predicts cognitive trajectory and risk of Alzheimer's disease.

The relationship of systolic blood pressure variability (SBPV) with Alzheimer's disease (AD) remains controversial. We aimed to explore the roles of SBPV in predicting AD incidence and to test the pathways that mediated the relationship of SBPV with cognitive functions. Longitudinal data across 96 months (T0 to T4) were derived from the Alzheimer's disease Neuroimaging Initiative cohort. SBPV for each participant was calculated based on the four measurements of SBP across 24 months (T0 to T3). At T3, logistic regression models were used to test the SBPV difference between 86 new-onset AD and 743 controls. Linear regression models were used to test the associations of SBPV with cognition and AD imaging endophenotypes for 743 non-demented participants (median age = 77.0, female = 42%). Causal mediation analyses were conducted to explore the effects of imaging endophenotypes in mediating the relationships of SBPV with cognitive function. Finally, Cox proportional hazard model was utilized to explore the association of SBPV with incident risk of AD (T3 to T4, mean follow-up = 3.5 years). Participants with new-onset AD at T3 had significantly higher SBPV compared to their controls (p = 0.018). Higher SBPV was associated with lower scores of cognitive function (p = 0.005 for general cognition, p = 0.029 for memory, and p = 0.016 for executive function), higher cerebral burden of amyloid deposition by AV45 PET (p = 0.044), lower brain metabolism by FDG PET (p = 0.052), and higher burden of white matter hyperintensities (WMH) (p = 0.012). Amyloid pathology, brain metabolism, and WMH partially (ranging from 17.44% to 36.10%) mediated the associations of SBPV with cognition. Higher SBPV was significantly associated with elevated risk of developing AD (hazard ratio = 1.29, 95% confidence interval = 1.07 to 1.57, p = 0.008). These findings supported that maintaining stable SBP in late life helped lower the risk of AD, partially by modulating amyloid pathology, cerebral metabolism, and cerebrovascular health.

Abstract P327: Comparing the Blood Pressure Response to Antihypertensive Treatment Intensification and Dose Increase to No Action for Uncontrolled Hypertension

Background: The addition of a new antihypertension medication class (CA) or dose increase (DI) in patients with hypertension (HTN) is relatively infrequent when HTN is uncontrolled (blood pressure [BP, mmHg] ≥ 140/90) during outpatient visits. We compared systolic (S)BP changes following CA, DI, or no medication changes for uncontrolled BP. Methods: A patient cohort from 6 diverse healthcare organizations, engaged in a quality improvement program, was identified with previously diagnosed HTN. Uncontrolled outpatient SBP measurements observed at participating program sites were compared to follow-up measurements within 7 to 120 days for evaluating SBP change. ANCOVA and linear regression analyses were used to control clinical and demographic covariates and assess differences in SBP change following treatment decision. Results: A prospective cohort of 124,068 patients with HTN spanning 280,937 events was identified, mean age 63.3 ± 13.9. Class addition reduced SBP 2.0 mmHg (95% CI, 1.81 – 2.24), whereas dose increase did not lower SBP [-0.07 (95% CI, -0.31, 0.16)]. Conclusion: In this study, CA lowered BP modestly, whereas DI appeared ineffective. Since patients were not randomized, our results may under-estimate the effects of CA and DI on BP, i.e., clinicians may have expected a greater decline of SBP than simply regression to the mean for patients with uncontrolled hypertension in the absence of DI or TI. Our data are consistent with reports that CA has a greater effect to lower BP than DI. Our findings also highlight some challenges of interpreting real world data compared to randomized clinical trials.

Finger SBP measurement as a way to manage hypertension in patients with markedly calcified arteries: a case report.

Overestimation of blood pressure (BP) resulting from medial artery calcification (MAC) is a cause of pseudoresistant hypertension. In this condition, there is no noninvasive way to reliably assess the BP. We report the case of a 62-year-old man who had a four-limb MAC, hypertension despite five antihypertensive molecules, and significant orthostatic hypotension following the addition of the fifth drug. Hypotension symptoms resolved after discontinuation of two treatments. Subsequently, measurement of finger SBP (FSBP) by laser Doppler flowmeter (LDF) was used to estimate upper-limb SBP. While the brachial SBP was greater than 170 mmHg, the FSBP was always less than 140 mmHg. In the absence of upper-limb artery disease, by evidencing the discrepancy between FSBP and brachial SBP, LDF-obtained FSBP could be a reliable tool to ascertain pseudohypertension and monitor the antihypertensive treatment.

Cumulative Blood Pressure Load and Incident CKD

The association of long-term cumulative blood pressure (BP) loads with the risk of incident chronic kidney disease (CKD) remains a matter of debate. This study investigated this association among healthy Korean adults with normal kidney function. Prospective cohort study. We analyzed 5,221 participants without CKD in the Korean Genome and Epidemiology Study. Cumulative systolic and diastolic BP (SBP and DBP) loads were calculated as the ratios of the areas under the curve (AUC) for SBP≥120mm Hg or≥80mm Hg for DBP divided by the AUC for all SBP or DBP measurements during the exposure period. These AUCs were categorized into 4 groups: group 0 (reference), cumulative BP load of 0 and groups 1-3, tertiles of cumulative BP loads. Primary end point was incident CKD defined as a composite of an estimated glomerular filtration rate (eGFR) below 60mL/min/1.73m2 or proteinuria greater than 1+on dipstick examination for at least 2 consecutive measurements≥90 days apart. Multivariable Cox proportional hazards regression to estimate the independent association of cumulative BP loads with incident CKD. Higher cumulative SBP and DBP loads were associated with an increased risk of incident CKD (HR, 1.23 [95% CI, 1.12-1.35] for SBP; and HR, 1.14 [95% CI, 1.04-1.26] for DBP loads for each 1.0-unit greater load). Compared with SBP group 0, groups 2 and 3 were associated with 1.94- and 1.89-fold greater risk of incident CKD. Compared with DBP group 0, groups 2 and 3 were associated with 1.42- and 1.54-fold greater risks. These associations of high cumulative BP loads with an increased risk of incident CKD remained consistent even in the subgroups not taking antihypertensive agents or without prior hypertension diagnosis. The assessment of CKD outcomes relied on eGFR and spot urine tests. These findings highlight the association between high cumulative SBP and DBP loads and the occurrence of CKD, even in individuals with normal BP levels. Although hypertension is a major risk factor for chronic kidney disease (CKD), most studies have focused on single-point blood pressure (BP) measurements. To explore the association between long-term cumulative BP load and the development of CKD, 5,221 Korean adults with normal kidney function were included in this study. Cumulative systolic BP and diastolic BP load both exhibited a significant association with an increased risk of incident CKD. Notably, the association of cumulative BP loads with elevated risk of incident CKD was evident also in individuals who were not taking antihypertensive agents or who had no previous history of hypertension. These findings underscore the importance of managing long-term exposure to high BP, even in individuals with normal BP levels.

Rapid Intravenous Glyceryl Trinitrate in Ischemic Damage (RIGID): A potential neuroprotection strategy for acute ischemic stroke (AIS) patients

Despite advances in intravenous thrombolysis and endovascular thrombectomy, numerous acute ischemic stroke survivors continue to experience various disability levels. The nitric oxide (NO) donor, Glyceryl Trinitrate (GTN), has been identified as a potential neuroprotective agent against ischemic damage. We evaluated the safety and feasibility of intravenous GTN in AIS patients. Subsequently, we conducted a secondary analysis to assess for possible efficacy of GTN as a neuroprotectant. We conducted a prospective, double-blind, randomized controlled trial in the Stroke Intervention & Translational Center (SITC) in Beijing Luhe Hospital, Capital Medical University (ChiCTR2100046271). AIS patients within 24 h of stroke onset were evenly divided into GTN or control groups (n = 20 each). The GTN group received intravenous GTN (5 mg in 50 ml saline at a rate of 0.4 mg/h for 12.5 h/day over 2 days), while controls were administered an equivalent volume of 0.9% saline. Both groups followed standard Stroke Guidelines for treatment. Safety measures focused on SBP<110 mmHg and headache occurrence. Efficacy was assessed via the 90-day modified rankin score (mRS) and the national institutes of health stroke score (NIHSS). Of the 40 AIS patients, baseline characteristics such as age, gender, risk factors, and pre-mRS scores showed no significant difference between the groups. Safety measures of SBP<110 mmHg and headache occurrence were comparable. Overall, 90-day mRS (1 vs. 1) and NIHSS (1 vs. 1) did not significantly differ between groups. However, the GTN-treated group had a benefit in enhancing NIHSS recovery (△NIHSS 4.5 vs. 3, p = 0.028), indicating that GTN may augment recovery. Subgroup analyses revealed a benefit in the GTN group at the 90-day NIHSS score and △NIHSS follow up for non-thrombolysis patients (1 vs. 2, p = 0.016; 5 vs. 2, p = 0.001). Moreover, the GTN group may benefit mild stroke patients in NIHSS score at 90 day and △NIHSS observed at 90 days (1 vs. 1, p = 0.025; 3 vs. 2 p = 0.002). Overall, while preliminary data suggest GTN might aid recovery in NIHSS improvement, the evidence is tempered due to sample size limitations. The RIGID study confirms the safety and feasibility of intravenous GTN administration for AIS patients. Preliminary data also suggest that the GTN group may provide improvement in NIHSS recovery compared to the control group. Furthermore, a potential benefit for non-thrombolysis patients and those with mild stroke symptoms was identified, suggesting a possible potential role as a tailored intervention in specific AIS subgroups. Due to the limited sample size, further larger RCT will be necessary to replicate these results. Trial Registrationwww.chictr.org.cn, identifier: ChiCTR2100046271.

Association between Preoperative Blood Pressures and Postoperative Adverse Events.

The relationship between postoperative adverse events and blood pressures in the preoperative period remains poorly understood. This study tested the hypothesis that day-of-surgery preoperative blood pressures are associated with postoperative adverse events. The authors conducted a retrospective, observational study of adult patients having elective procedures requiring an inpatient stay between November 2017 and July 2021 at Vanderbilt University Medical Center to examine the independent associations between preoperative systolic and diastolic blood pressures (SBP, DBP) recorded immediately before anesthesia care and number of postoperative adverse events-myocardial injury, stroke, acute kidney injury, and mortality-while adjusting for potential confounders. The study used multivariable ordinal logistic regression to model the relationship. The analysis included 57,389 cases. The overall incidence of myocardial injury, stroke, acute kidney injury, and mortality within 30 days of surgery was 3.4% (1,967 events), 0.4% (223), 10.2% (5,871), and 2.1% (1,223), respectively. The independent associations between both SBP and DBP measurements and number of postoperative adverse events were found to be U-shaped, with greater risk both above and less than SBP 143 mmHg and DBP 86 mmHg-the troughs of the curves. The associations were strongest at SBP 173 mmHg (adjusted odds ratio, 1.212 vs. 143 mmHg; 95% CI, 1.021 to 1.439; P = 0.028), SBP 93 mmHg (adjusted odds ratio, 1.339 vs. 143 mmHg; 95% CI, 1.211 to 1.479; P < 0.001), DBP 106 mmHg (adjusted odds ratio, 1.294 vs. 86 mmHg; 95% CI, 1.003 to 1.17671; P = 0.048), and DBP 46 mmHg (adjusted odds ratio, 1.399 vs. 86 mmHg; 95% CI, 1.244 to 1.558; P < 0.001). Preoperative blood pressures both less than and above a specific threshold were independently associated with a higher number of postoperative adverse events, but the data do not support specific strategies for managing patients with low or high blood pressure on the day of surgery.

Validation of the Meditech ABPM-06 24-hour blood pressure monitoring system in a pediatric population according to International Organization for Standardization Protocol 81060-2:2018.

Ambulatory blood pressure monitoring (ABPM) devices play a crucial role in diagnosing hypertension, not only in adults but also in pediatric patients. ABPM-06, the latest oscillometric device from Meditech Ltd. (Budapest, Hungary), is the focus of this study. The objective was to validate the ABPM-06 device using the International Organization for Standardization (ISO) 81060-2 : 2018 standard. A total of 86 healthy patients, consisting of 34 males and 52 females, aged between 3 and 17 years, were enrolled in this study. During the ambulatory phase, a total of 50 patients were enrolled, with 35 patients falling within the 3- to 12-year-old age range and 15 patients aged between 12 and 17 years. Additionally, for the dynamic test, 36 patients were selected, comprising of 10 individuals aged 3-12 years and 26 patients aged 12-17 years. These patients were recruited from the outpatient clinics of the Department of Pediatrics at Albert Szent-Györgyi University in Szeged, Hungary. The validation process involved utilizing the same-arm sequence protocol, both in resting positions and during stress testing. The ABPM-06 performed well in both clinical and ambulatory validations. In terms of validation criterion 1, the mean ± SD of the differences between the test device and reference blood pressure readings was -1.3 ± 3.5 mmHg for systolic and -0.1 ± 2.3 mmHg for diastolic, in children under the age of 12 years. For those over the age of 12 years, the mean ± SD of the differences was -2.8 ± 4.6 mmHg for systolic and -0.5 ± 2.7 mmHg for diastolic. Regarding the ambulatory validation, for children under 12 years old, the mean ± SD of the differences was -1.3 ± 3.5 mmHg for systolic and -0.1 ± 2.3 mmHg for diastolic. In the age group above 12 years, the mean ± SD of the differences was -2.8 ± 4.6 mmHg for systolic and -0.5 ± 2.7 mmHg for diastolic. Both tests successfully met the established criteria regarding the mean and SD values of the differences between the device readings and the observed SBP and DBP measurements. The ABPM-06 oscillometric device fully adheres to the ISO 81060-2 : 2018 standard requirements for ABPM determination in the pediatric population (ages 3-17 years). Consequently, this ABPM device proves to be suitable for effectively managing hypertension in children and adolescents.

Microvascular abnormalities induced by hand-transmitted vibration reflects in finger systolic blood pressure: a cross-sectional study in China.

Local vibration can cause microcirculatory abnormalities such as blood stasis and symmetrical intermittent digital artery vasospasm. Finger SBP (FSBP) measurement is a potential way of assessing vascular components. This study aims to comprehensively investigate the relationship between the occurrence of the vibration-induced white finger (VWF) and changes in FSBP and then set the application value of FSBP measurements in the early diagnosis of VWF. All samples were judgmental sampling from one factory. Totally 50 patients with VWF were the case group, while 50 without occupational hand-transmitted vibration exposure were the control group. FSBP measurements and epidemiological feature investigations were taken. There were significant reductions in FSBP level and %FSBP index at both 10 °C and 30 °C in fingers reported VWF ( P < 0.05). The %FSBP abnormal rate of the index, ring and little finger in the VWF group was higher than the control (44.00% vs. 18.00%, 78.00% vs. 26.00%, 64.00% vs. 8.00%). The %FSBP of the ring and little finger had a relatively high application value (area under curve = 0.902, 0.737), while their standard regression coefficients were -0.23 and -0.412. The diagnostic cutoff value of the ring finger was 77.60%, while the sensitivity and specificity were 86.67%. FSBP measurements were proven helpful in monitoring and diagnosing VWF prospectively and proved to have great application value in our study. %FSBP of the ring finger was the appropriate diagnostic index in FSBP measurements, while its abnormal value could be set as 80.00%.

Arterial blood gas measurements are different for brachycephalic and nonbrachycephalic dogs acclimatized to an altitude of 1,535 meters.

To define reference intervals (RIs) for arterial blood gas (aBG) measurements in healthy, nonsedated, dolichocephalic, and mesocephalic (nonbrachycephalic) dogs at approximately 1,535 m above sea level and compare these findings with healthy, nonsedated, brachycephalic dogs living at the same altitude. 120 adult nonbrachycephalic dogs and 20 adult brachycephalic dogs. Cases were prospectively enrolled from October 2021 to June 2022. Dogs were enrolled from the community or after presentation for wellness examinations or minor injuries including lacerations, nail injuries, and lameness. Physical examinations and systolic blood pressure (sBP) measurements were obtained before blood sample collection. Arterial blood was collected from the dorsal pedal artery or femoral artery. After data collection, brachycephalic dogs underwent pre- and postexercise tolerance assessments. The mean and RI values for arterial pH (7.442; 7.375 to 7.515), partial pressure of oxygen in arterial blood (Pao2; 78.3; 59.2 to 92.7 mm Hg), partial pressure of carbon dioxide in arterial blood (Paco2; 28.0; 21.5 to 34.4 mm Hg), saturation of arterial oxygen (Sao2; 98.4; 84.3% to 101.4%), HCO3 (18.9; 14.9 to 22.4 mmol/L), concentration of total hemoglobin (ctHb; 17.5; 13.4 to 21.1 g/dL), and sBP (133; 94 to 180 mm Hg) were established for healthy nonbrachycephalic dogs at 1,535-m altitude. All aBG measurements were statistically and clinically different from those previously reported for dogs at sea level. Brachycephalic dogs had significantly lower Pao2 and Sao2 (P = .0150 and P = .0237, respectively) and significantly higher ctHb (P = .0396) compared to nonbrachycephalic dogs acclimatized to the same altitude; the nonbrachycephalic RIs were not transferable to the brachycephalic dogs for Pao2. This study represents the first collation of aBG measurements for healthy nonbrachycephalic dogs acclimatized to an altitude of 1,535 m. Additionally, this study identified differences in arterial oxygenation measurements between brachycephalic and nonbrachycephalic dogs. RIs in brachycephalic dogs need to be established.

Abstract TMP31: Rapid Intravenous Glyceryl Trinitrate in Ischemic Damage (RIGID): A Potential Neuroprotection Strategy for Acute Ischemic Stroke (AIS) Patients

Background: Despite advances in intravenous thrombolysis and endovascular thrombectomy, numerous acute ischemic stroke survivors continue to experience various disability levels. The nitric oxide (NO) donor, Glyceryl Trinitrate (GTN), has been identified as a potential neuroprotective agent against ischemic damage. This study evaluates the safety and preliminary efficacy of intravenous GTN administration in AIS patients. Methods: We conducted a prospective, double-blind, randomized controlled trial at Beijing Luhe Stroke Center (ChiCTR2100046271). AIS patients within 24 hours of onset were evenly divided into GTN or control groups (n=20 each). The GTN group received intravenous GTN (5 mg in 50 ml saline at a rate of 0.4 mg/h for 12.5 h/day over 2 days), while controls were administered an equivalent volume of 0.9% saline. Both groups followed standard Stroke Guidelines for treatment. Safety measures focused on SBP&lt;110mmHg and headache occurrence. Efficacy was assessed via the 90-day modified rankin scale (mRS) and the national institutes of health stroke scale (NIHSS) scores. Results: Of the 40 AIS patients, baseline characteristics such as age, gender, risk factors, and mRS scores showed no significant difference between the groups. Safety measures of SBP&lt;110mmHg and headache occurrence were also comparable. Overall, 90-day mRS(1 vs 1) and NIHSS (1 vs1 )did not significantly differ between groups. However, the GTN-treated group showed a superior NIHSS recovery (ΔNIHSS 4.5 Vs 3, p=0.028), indicating that GTN can well-allow patients to recover within the same time frame. Subgroup analyses revealed a noteworthy benefit of GTN in the 90-day NIHSS score for non-thrombolysis patients (1 vs 2, p=0.016). Moreover, GTN benefited mild stroke patients (NIHSS score &lt;6) at 90 days (p=0.025). Conclusion: The RIGID study confirms the safety of intravenous GTN for AIS patients. Notably, while overall 90-day mRS and NIHSS scores between the GTN and control groups did not significantly vary, the GTN group displayed a pronounced improvement in NIHSS recovery. Additionally, GTN demonstrated particular efficacy for non-thrombolysis patients and those with mild stroke symptoms, suggesting its potential as a tailored intervention in specific AIS subgroups.

COMPARISON EFECTIVENESS OF DEXMEDETOMIDINE VERSUS DEXMEDETOMIDINE WITH KETAMINE FOR TYMPANOPLASTY SURGERY DONE UNDER MONITOREDANAESTHESIA CARE

Background: Monitored Anaesthesia Care (MAC) has been widely used for patients undergoing middle ear surgeries. The use of dexmedetomidine in middle ear surgeries as a sole anaesthetic agent had many disadvantages owing to its insufficient sedative effect, increased recovery time and haemodynamic instability. Aims and objectives: To evaluate the effectiveness of dexmedetomidine and ketamine combination in comparison with dexmedetomidine alone for tympanoplasty surgery under MAC. Materials and Methods: In this cross sectional observational study, a total of 100 patients were included. Before the surgery, group D received 1 μg/kg dexmedetomidine followed by infusion of 0.2μg/kg/h to maintain 2 or 3 of modified observers assessment of analgesia and sedation score. The patients in group DK received 1 μg/kg dexmedetomidine followed by infusion of 0.2μg/kg/h plus ketamine 0.5mg/kg 10 minutes before the start of the procedure. Results: In the present study total of 100 patients were included, among which 66.0% were females and 34.0% were males. The mean age of 100 patients was 38.3±11.34 years. There were no differences in baseline measurements of HR, SBP and DBP between the two groups, but Group DK had significant fall in heart rate (5-10%) (P &lt; 0.001). Average patients and surgeons satisfaction with sedation and analgesia was higher in Group DK than Group D (P = 0.001). Conclusion: Dexmedetomidine and ketamine combination provides good haemodynamic stability, higher sedation score with safe and effective method of anaesthesia that provides good MAC for patients undergoing tympanoplasty surgery.

Association between anxiety and elevated blood pressure in adolescent patients: a single-center cross-sectional study.

Although anxiety is known to be associated with elevated blood pressure and hypertension in adults, this has not been studied in children. The aim of this study was to determine the association between anxiety and elevated blood pressures in adolescents. Adolescents, aged 12-18 years old, referred to the nephrology clinic were eligible to participate. Elevated blood pressure was defined as either SBP or DBP measurement above the 95th percentile for age, height, and sex. Participants were evaluated for anxiety using the validated Screen for Child Anxiety Related Disorders questionnaire filled independently by the child (SCARED-C) and parent (SCARED-P) evaluating the child. Two hundred adolescents participated in this study. Thirty-one (53%) of SCARED-P-positive participants were found to have elevated blood pressure compared with 27 (19%) of SCARED-P negative, P 0.03. Twenty-five (43%) of SCARED-P positive had elevated DBP compared with 31 (28%) of SCARED-P negative ( P 0.003). In SCARED-P positive, mean DBP (78.4 ± 9.9) was higher compared with SCARED-P negative (74.9 ± 9.2) ( P 0.03). In a subgroup of adolescents (№ 130) not treated with blood pressure medications mean DBP was higher in both SCARED-P (79.0 ± 10.1) and SCARED-C (77.1 ± 10.4) positive groups compared with SCARED-P (73.6 ± 9.3) and SCARED-C (73 ± 8.9) negative, respectively. Our study demonstrates an association between anxiety and elevated DBP in adolescent children. Screening adolescents for anxiety should be a part of the routine evaluation of adolescent children.

Abstract 12210: Repeated Systolic Blood Pressure Measures During Intensive Treatment Show a Loss Of Protective Effect Over Time. A Secondary Analysis of the SPRINT Trial

Introduction: The SPRINT trial showed a 25% reduction in the primary outcome with SBP intensive treatment using Cox proportional risk analysis. A recent secondary analysis by the SPRINT group assessed the post-trial maintenance of this protection by considering repeated SBP measurements and using a mixed linear regression model. They found that the intervention lost its protective effect post-trial, possibly due to the loss of intensive blood pressure control. Could this loss of protective effect also be found during the clinical trial, when considering repeated measurements of systolic blood pressure in the analysis? Methods: Secondary analysis of the SPRINT study database included 9,068 patients with repeated measures of SBP and complete baseline information. Cox proportional hazards and mixed linear models were used to analyze the primary endpoint and repeated SBP measures, respectively. A Cumulative Joint Model Analysis was conducted to combine the direct and indirect effects of the intervention on the primary outcome. R Studio V12.0 software was used for the analyses. Results: The protective effect is lost during the trial, both in the total population (3.4 years) as well as in subgroups such as women (1.1 years), patients with CVD (1.3 years), CKD (1.3 years), black patients (1.8 years), younger than 75 years (2.1 years) and in patients who present serious adverse events (3.4 years) compared to those who do not present SAEs (4.2 years). Beyond the loss of blood pressure control, other factors such as cumulative BP, adverse events, and the increase in SBP variability could be considered. Conclusions: Including repeated measures of SBP revealed a loss of protective effect in the intervention during the trial and generated Simpson's paradox. This highlights the need to consider alternative statistical methods in clinical trial analysis beyond Cox proportional hazard analysis for a comprehensive perspective on intervention efficacy.

Reliability of systolic blood pressure measured by parents in young children at home using a hand held doppler device and aneroid sphygmomanometer.

We report data regarding systolic BP monitoring in children aged <5 years performed over a 2-week period by parents at home using a hand-held doppler device and aneroid sphygmomanometer for SBP measurements (HDBPM). Our objectives were to compare health professional measured office systolic BP by doppler device (Office-SBP Doppler ) with parent measured home systolic BP using the same doppler device (Home-SBP Doppler ). We also report data evaluating reliability and optimal number of days of measurement required. We taught parents to measure systolic BP and assessed their technique using a hand-held doppler device and aneroid sphygmomanometer. We requested parents to perform three consecutive BP measurements twice daily (ideally morning and evening around similar times) when the child was awake, settled and cooperative. Over a 3-year period, data from 48 of 62 children who underwent HDBPM measurements were evaluated with median (IQR) age of 1.9 (0.9, 3.6) years, 27 (56%) boys and 14 (29%) on antihypertensive medication. Office-SBP Doppler was 2.9 ± 8.9 mmHg [95% confidence interval (CI), -14.4 to 20.4, P = 0.026] higher than Home-SBP Doppler . Mean Home-SBP Doppler between Week-1 and Week-2 monitoring was similar -0.45 ± 3.5 mmHg (95% CI, -7.35 to 6.45, P = 0.41). Morning HDBPM measurements were lower than evening with a mean difference of -2.77 ± 3.92 mmHg, P < 0.001). Over Week-1, mean Home-SBP Doppler was closer to mean Office-SBP Doppler with increasing cumulative days of monitoring and with smaller standard deviations suggesting that readings become more reliable from day 4 onwards. HDBPM is a reliable method for measuring systolic BP in young children with BP levels measured by parents comparable to those performed by health professional in clinic. HDBPM technique described here and performed by parents over a 7-day period with a minimum of 4-days, offers a reliable and reproducible technique to measure blood pressure at home.

Race differences in ambulatory blood pressure monitoring parameters.

Mean systolic and diastolic blood pressure (SBP and DBP) on ambulatory blood pressure (BP) monitoring (ABPM) are higher among Black compared with White adults. With 48 to 72 BP measurements obtained over 24 h, ABPM can generate parameters other than mean BP that are associated with increased risk for cardiovascular events. There are few data on race differences in ABPM parameters other than mean BP. To estimate differences between White and Black participants in ABPM parameters, we used pooled data from five US-based studies in which participants completed ABPM (n = 2580). We calculated measures of SBP and DBP level, including mean, load, peak, and measures of SBP and DBP variability, including average real variability (ARV) and peak increase. There were 1513 (58.6%) Black and 1067 (41.4%) White participants with mean ages of 56.1 and 49.0 years, respectively. After multivariable adjustment, asleep SBP and DBP load were 5.7% (95% CI: 3.5-7.9%) and 2.7% (95% CI: 1.1-4.3%) higher, respectively, among Black compared with White participants. Black compared with White participants also had higher awake DBP ARV (0.3 [95%CI: 0.0-0.6] mmHg) and peak increase in DBP (0.4 [95% CI: 0.0-0.8] mmHg). There was no evidence of Black:White differences in awake measures of SBP level, asleep peak SBP or DBP, awake and asleep measures of SBP variability or asleep measures of DBP variability after multivariable adjustment. Asleep SBP load, awake DBP ARV and peak increase in awake DBP were higher in Black compared to White participants, independent of mean BP on ABPM.

DIFFERENT METHODS OF ADHERENCE TO THERAPY IN PATIENTS WITH RESISTANT HYPERTENSION (PILOT STUDY)

Poor adherence to treatment is one of the reasons for not reaching the target levelof blood pressure and the consequences in the form of the development of cardiovascularcomplications.Aim – to analysis adherence to treatment of patients with resistant arterial hypertensionby various methods and to determine ways to overcome non-adherence to treatment.Material and methods. 12 patients with resistant hypertension were included into the study.Men and women over the age of 18 were included, provided that the average level of officeblood pressure was greater than 140/90 mm Hg when taking 3 or more antihypertensivedrugs included with fixed combination of valsartan, amlodipine, hydrochlorotiazide. Todetermine adherence to treatment, questionnaires and determination of drugs in urinewere performed in the central laboratory using the chromatography method. All patientsunderwent the following studies at the beginning: measurement of office SBP, DBP, andheart rate. The duration of observation was 12 months.Results. The average age of the patients was 58,67±13,68 years. Men and women –50 %/50 % (n=6/6). The degree of decrease in office blood pressure after 12 monthsof treatment was for SBP/DBP – 35.5/16.7 mm Hg, (p &lt;0.001 for both values) againsta background of a fixed triple combination of valsartan/amlodipine/hydrochlorothiazide.According to the determination of drugs in the urine, we found that 25 % of patients(n=3) did not take drugs at all. The result of the survey showed the need to increase the awareness of patients about the symptoms of the disease. Survey data indicate the needto clarify the necessity to ensure continuous, long-term self-monitoring of blood pressureand taking antihypertensive drugs by keeping a diary in order to improve adherence andeffectiveness of treatment.Conclusion. In 25 % of patients with resistant arterial hypertension, drugs were notdetected in the urine at all, that is, they were nonadherence to therapy.

Systolic blood pressure measurements with Doppler ultrasonic flow detector and high-definition oscillometry are comparable on population level but show large intra-individual differences in apparently healthy elderly dogs.

Agreement of systolic blood pressure measurements (SBP) between noninvasive blood pressure devices in conscious dogs is poorly studied. Situational hypertension is expected in clinics, but studies are lacking. This study aimed to compare SBP measurements obtained with Doppler ultrasonic flow detector (Doppler) versus high-definition oscillometry (HDO) in clinics and at home and to estimate the prevalence of situational hypertension in conscious, apparently healthy elderly dogs. 122 apparently healthy elderly or geriatric dogs were prospectively recruited. Systolic blood pressure was obtained consecutively with Doppler and HDO techniques in a randomized order per dog, following a standardized protocol. An at-home measurement was advised for in-clinic hypertensive dogs (SBP ≥ 160 mmHg), also using both devices. Dual measurements were available in 102 dogs. Median SBP was 147.3 mmHg (range, 105 to 239 mmHg) for Doppler and 152.3 mmHg (range, 113 to 221 mmHg) for HDO. Forty-six percent (56/122) were hypertensive, of which 9% (11/122) were hypertensive with both methods. No significant difference was found between the 2 devices in the global study population or within the group of hypertensive dogs. Repeated at-home measurements were performed in 20/56 (35.7%) hypertensive dogs, resulting in a 10 and 26 mmHg lower median SBP value for Doppler and HDO, respectively (P > .05). In-clinic situational hypertension was presumed in 8/20 (40%) dogs. The choice of the noninvasive blood pressure device did not significantly impact SBP results, but large interindividual differences in SBP between techniques occurred. Situational hypertension was frequently observed in clinic.

Different time points, different blood pressures: complexity of blood pressure measurement in hemodialysis patients.

We used our established database to investigate predialysis blood pressure (BP) measurements at different time points. Our study period spanned from 1 January 2019 to 31 December 2019. The different time points included: the long interdialytic interval versus the short interdialytic interval; different hemodialysis shifts. Multiple linear regression was used to explore the association between BP measurements and different time points. A total of 37 081 cases of hemodialysis therapies were included. After a long interdialytic interval, predialysis SBP and DBP were significantly elevated. Predialysis BP was 147.72/86.73 mmHg on Monday and 148.26/86.52 mmHg on Tuesday, respectively. Both predialysis SBP and DBP were higher in the a.m. shift. The mean BP in the a.m. and p.m. shifts were 147.56/87 mmHg and 144.83/84.64 mmHg, respectively. In both diabetic nephropathy and non-diabetic nephropathy patients, higher SBP measurements after a long interdialytic interval were observed; however, in diabetic nephropathy patients, we did not find significant differences in DBP among different dates. In diabetic nephropathy and non-diabetic nephropathy patients, we observed that the effect of different shifts on BP was similar. In Monday, Wednesday and Friday subgroups, the long interdialytic interval was also associated with BP; however, in Tuesday, Thursday and Saturday subgroups, different shifts but not the long interdialytic interval was associated with BP. The long interdialytic interval and different hemodialysis shifts have a significant effect on predialysis BP in patients with hemodialysis. When interpreting BP in patients with hemodialysis, different time points is a confounder.

THE FEASIBILITY OF CUFFLESS, NON-OCCLUSIVE BLOOD PRESSURE ASSESSMENTS USING THE NOVEL LIFELEAF WRISTWATCH AND PLATFORM

Objective: Hypertension affects 1.3 billion people worldwide and is the leading cause of myocardial infarction and stroke. Successful treatment of hypertension continues to be a global challenge, likely given that the most common tool for assessment is the sphygmomanometer, which can be time-consuming and cumbersome to utilize on a consistently compliant basis. More straightforward means of blood pressure (BP) measurement may facilitate earlier detection and closer monitoring of hypertension, thereby helping to alleviate potential comorbidities. The ability to seamlessly collect longitudinal BP data could also enhance ambulatory blood pressure monitoring, which is preferred over in-office BPs for tracking hypertension and decisions regarding pharmacotherapy. BP measurements in the ambulatory setting may also be more representative of true BPs by eliminating white coat syndrome. We therefore investigated the reliability of performing BP measurements via a novel cuffless, non-occlusive photoplethysmography (PPG)-based wristwatch compared to a standard automatic BP cuff reference. Design and method: The LIFELEAF® wristwatch (LifePlus, Inc., San Jose, CA) utilizes novel signal processing and machine learning (ML) algorithms to predict real-time systolic and diastolic blood pressures (SBP and DBP) using features extracted from PPG signal at the wrist. 274 total subjects from 3 centers (Cleveland Clinic Abu Dhabi, UAE; Hospital Sebarang Jaya, Malaysia; and iKure Clinic, India) were enrolled. Subjects were outpatients 18 years of age or older; females who were gravid or actively trying to conceive were excluded. Automatic BP cuff reference measurement on the left arm was immediately followed by 1 minute of wristwatch PPG signal acquisition on that arm. An average of 10.77 paired data acquisitions per subject were collected. Datasets were randomly split for model training (60%) and prediction (40%). Results: There were no significant differences in mean SBP or mean DBP between cuff reference measurements and wristwatch predictions. The wristwatch-predicted SBPs and DBPs also demonstrated significant linear correlation with cuff reference values. Conclusions: Longitudinal SBP and DBP measurements are feasible via non-occlusive methods incorporating sophisticated signal processing and machine learning (ML) applied to wrist PPG. Further algorithmic improvements to accuracy may improve BP/hypertension tracking by facilitating assessments compared to conventional sphygmomanometers.

OFFICE BLOOD PRESSURE VARIABILITY: WITHIN SESSION STABILITY ACROSS CONSECUTIVE MEASUREMENTS USING OSCILLOMETRIC DEVICES

Objective: Blood pressure (BP) is routinely monitored by healthcare providers and during drug development. For improvement in accuracy, several oscillometric devices perform multiple sequential inflations, rather than relying on a single inflation, to determine a mean systolic and diastolic blood pressure (SBP, DBP). Blood pressure is known to vary physiologically throughout a day, and over the course of days and weeks, due to intrinsic and extrinsic factors. Little data has been published describing the variability of SBP and DBP recorded minutes apart using oscillometric methods (i.e. within session variability). Design and method: We investigated the stability of within session SBP and DBP across 4 datasets by evaluating differences between 3 consecutive inflations recorded 1-2 minutes apart using a clinically validated oscillometric BP monitor that passed the ANSI/AAMI/ISO 2013, ESH-IP 2002 and BHS 1993 protocols (Table 1). These datasets included patients with controlled or uncontrolled hypertension. Results: Data were available from over 10.000 measurement pairs. The differences between inflation 1 and 2 were within ±10, 20 and 30 mmHg for 78.1, 94.4 and 97.9% of the SBP measurements, respectively. For the DBP, 90.7, 95.5 and 97.3 % of the differences between inflation 1 and 2 were within ±10, 15 and 20 mmHg, respectively. A similar trend was seen between inflation 2 and 3. Table 1: Categorical Analysis of BP changes between consecutive inflations. Conclusions: Our data demonstrate substantial variability between consecutive oscillometric BP measurements performed a few minutes apart. Over 20% of the time, consecutive inflations show an absolute change in SBP of at least 10 mmHg. It is unclear whether this represents true physiologic changes in BP or is partly artefactual due to failure of a device's algorithm to determine BP accurately from the oscillometric waveform. These data suggest that criteria for within session variability for automated oscillometric blood pressure devices should be established, including a threshold for repeating the session after 10 minutes of rest.