Systolic Blood Pressure Measurements Research Articles

Clinical Performance Measures for Emergency Department Care for Adults With Intracranial Hemorrhage

Though select inpatient-based performance measures exist for the care of patients with nontraumatic intracranial hemorrhage, emergency departments lack measurement instruments designed to support and improve care processes in the hyperacute phase. To address this, we propose a set of measures applying a syndromic (rather than diagnosis-based) approach informed by performance data from a national sample of community EDs participating in the Emergency Quality Network Stroke Initiative. To develop the measure set, we convened a workgroup of experts in acute neurologic emergencies. The group considered the appropriate use case for each proposed measure: internal quality improvement, benchmarking, or accountability, and examined data from Emergency Quality Network Stroke Initiative-participating EDs to consider the validity and feasibility of proposed measures for quality measurement and improvement applications. The initially conceived set included 14 measure concepts, of which 7 were selected for inclusion in the measure set after a review of data and further deliberation. Proposed measures include 2 for quality improvement, benchmarking, and accountability (Last 2 Recorded Systolic Blood Pressure Measurements Under 150 and Platelet Avoidance), 3 for quality improvement and benchmarking (Proportion of Patients on Oral Anticoagulants Receiving Hemostatic Medications, Median ED Length of Stay for admitted patients, and Median Length of Stay for transferred patients), and 2 for quality improvement only (Severity Assessment in the ED and Computed Tomography Angiography Performance). The proposed measure set warrants further development and validation to support broader implementation and advance national health care quality goals. Ultimately, applying these measures may help identify opportunities for improvement and focus quality improvement resources on evidence-based targets.

Real-time prediction of intradialytic hypotension using machine learning and cloud computing infrastructure.

In maintenance hemodialysis patients, intradialytic hypotension (IDH) is a frequent complication that has been associated with poor clinical outcomes. Prediction of IDH may facilitate timely interventions and eventually reduce IDH rates. We developed a machine learning model to predict IDH in in-center hemodialysis patients 15-75min in advance. IDH was defined as systolic blood pressure (SBP) <90mmHg. Demographic, clinical, treatment-related and laboratory data were retrieved from electronic health records and merged with intradialytic machine data that were sent in real-time to the cloud. For model development, dialysis sessions were randomly split into training (80%) and testing (20%) sets. The area under the receiver operating characteristic curve (AUROC) was used as a measure of the model's predictive performance. We utilized data from 693 patients who contributed 42 656 hemodialysis sessions and 355 693 intradialytic SBP measurements. IDH occurred in 16.2% of hemodialysis treatments. Our model predicted IDH 15-75min in advance with an AUROC of 0.89. Top IDH predictors were the most recent intradialytic SBP and IDH rate, as well as mean nadir SBP of the previous 10 dialysis sessions. Real-time prediction of IDH during an ongoing hemodialysis session is feasible and has a clinically actionable predictive performance. If and to what degree this predictive information facilitates the timely deployment of preventive interventions and translates into lower IDH rates and improved patient outcomes warrants prospective studies.

Blood pressure in healthy term and late preterm newborns in Mexico City.

Describe the measurements of systolic, diastolic and mean blood pressure in healthy term and late preterm newborns to establish normal values. Cross-sectional study carried out in the nursery of the Hospital Español, located in Mexico City. A sample of 551 healthy newborns were included in the study. Blood pressure (BP) measurements were taken within the first 48 hours of life with the oscillometric method. After the evaluation of normality, a descriptive analysis of the population and calculation of percentiles (25, 50 and 75) specific for each week of gestation was performed. All analyzes were performed in STATA v14.2. Male newborns had a mean SBP value of 64.6 mmHg at week 35 of gestation, this value increased to 69.8 mmHg at week 40; the systolic blood pressure (SBP) value was 42.6 mmHg at week 35 of gestation, which decreased to 40.8 mmHg at week 40. The mean SBP values in female newborns were 65.5 mmHg at week 35, increasing to 73.5 mmHg at week 40; the diastolic blood pressure (DBP) value at week 35 of gestation was 38 mmHg, increasing to 41.3 mmHg at week 40. The BP values in healthy newborns are modified by the gestational age and sex of the patients. These results can serve as a reference for other physicians located in countries or cities with a similar altitude than the one in Mexico City.

Perioperative hypertension

The effects of hypertension on the outcomes during the perioperative period are still unclear. No specific systolic or diastolic blood pressure measurement has been determined as the cutoff point to continue with the surgical plan or adjourn.This study is designed as a narrative review of the available scientific evidence on the perioperative management of hypertension. A non-systematic review was conducted in Pubmed considering the title and abstract; 120 articles were pre-selected of which 55 papers were selected for full-text eligibility and 16 were excluded for a total of 39 articles including ACCF/AHA 2009 and ACC/AHA 2014 on perioperative cardiovascular care; 2013 ESH/ESC, 8 JNC, and the 2017 ACC/AHA/AAPA/ABC Guideline for the Prevention, detection, and management of hypertension in adults. Blood pressure values, target organ damage, and type of surgery should be considered for decision-making in the perioperative period. If surgery is an option, blood pressure fluctuations should be avoided and actively treat any potential causes. A patient with mild hypertension with values below SBP 160 and DBP 110 mmHg may be managed in the ambulatory setting during the postoperative period, as long as the clinical conditions are favorable.

Sex differences in impact of cumulative systolic blood pressure from childhood to adulthood on albuminuria in midlife: a 30-year prospective cohort study

Background and objectivesAlbuminuria is recognized as being a predictor of cardiovascular and renal disease. We aimed to identify the impact of the long-term burden and trends of systolic blood pressure on albuminuria in midlife, as well as to explore sex differences concerning this relationship.MethodsThis longitudinal study consisted of 1,683 adults who had been examined 4 or more times for blood pressure starting in childhood, with a follow-up time period of 30 years. The cumulative effect and longitudinal trend of blood pressure were identified by using the area under the curve (AUC) of individual systolic blood pressure measurement with a growth curve random effects model.ResultsOver 30 years of follow-up, 190 people developed albuminuria, including 53.2% males and 46.8% females (aged 43.39 ± 3.13 years in the latest follow-up). The urine albumin-to-creatinine ratio (uACR) values increased as the total and incremental AUC values increased. Additionally, women had a higher albuminuria incidence in the higher SBP AUC groups than men do (13.3% for men vs. 33.7% for women). Logistic regression showed that the ORs of albuminuria for males and females in the high total AUC group were 1.34 (0.70–2.60) and 2.94 (1.50–5.74), respectively. Similar associations were found in the incremental AUC groups.ConclusionsHigher cumulative SBP was correlated with higher uACR levels and a risk of albuminuria in middle age, especially in women. The identification and control of cumulative SBP levels from an early age may assist in reducing the incidences of renal and cardiovascular disease for individuals in later life.

Effects of High-Intensity Interval Training on Central Blood Pressure: A Systematic Review and Meta-Analysis.

Central blood pressure (cBP) is considered an independent predictor of organ damage, cardiovascular events and all-cause mortality. Evidence has shown that high intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness and vascular function. However, the effects of these aerobic training modalities on cBP have not yet been properly reviewed.This meta-analysis aims to investigate to effects of HIIT versus MICT on cBP.We conducted a meta-analysis of randomized controlled trials that compared HIIT versus MICT on cBP. Primary outcomes were measures of central systolic blood pressure (cSBP) and central diastolic blood pressure (cDBP). Peripheral systolic blood pressure (pSBP) and diastolic blood pressure (pDBP), pulse wave velocity (PWV) and maximal oxygen uptake (VO2max) were analyzed as second outcomes. Meta-analysis of mean differences (MD) was conducted using the random effects model.Our study included 163 patients enrolled in six trials. We found that HIIT was superior to MICT in reducing the cSBP (MD = -3.12 mmHg, 95% CI: -4.75 to -1.50, p = 0.0002) and SBP (MD = -2.67 mmHg, 95% CI: -5.18 to -0.16, p = 0.04), and increasing VO2max(MD = 2.49 mL/kg/min, 95% CI: 1.25 to 3.73, p = 0.001). However, no significant differences were reported for cDBP, DBP and PWV.HIIT was superior to MICT in reducing the cSBP, which suggests its potential role as a non-pharmacological therapy for high blood pressure.

Does Isometric Handgrip Exercise Really Has Effect on Blood Pressure Changes and Life Quality in People with Hypertension?

In 2020, around 1.56 billion people worldwide were estimated to suffer from hypertension, making it one of the leading causes of death across the globe. The purpose of this research was to examine the impact that isometric handgrip training has on changes in blood pressure as well as the quality of life of people who have hypertension. This research used a quasi-experimental approach with a control group that had different characteristics before and after the tests. The hypothesis test carried out by the intervention group produced p-values that were less than 0.05 for the measures of systolic and diastolic blood pressure as well as quality of life. At the time of the pre-test, the independent statistical analysis of systolic blood pressure, diastolic blood pressure, and quality of life scores for both the intervention group and the control group produced p-values that were greater than 0.05. The p-values for systolic, diastolic, and quality of life scores between the intervention group and the control group at the time of the post-test were 0.013, 0.003, and 0.051, respectively. There were significant differences in the average blood pressure and quality of life scores before and after the intervention of isometric handgrip exercises in the intervention group, whereas there was no difference in the control group. The intervention group consisted of people who did the exercises.

The quality of vital signs measurements and value preferences in electronic medical records varies by hospital, specialty, and patient demographics

We aimed to assess the frequency of value preferences in recording of vital signs in electronic healthcare records (EHRs) and associated patient and hospital factors. We used EHR data from Oxford University Hospitals, UK, between 01-January-2016 and 30-June-2019 and a maximum likelihood estimator to determine the prevalence of value preferences in measurements of systolic and diastolic blood pressure (SBP/DBP), heart rate (HR) (readings ending in zero), respiratory rate (multiples of 2 or 4), and temperature (readings of 36.0 °C). We used multivariable logistic regression to investigate associations between value preferences and patient age, sex, ethnicity, deprivation, comorbidities, calendar time, hour of day, days into admission, hospital, day of week and speciality. In 4,375,654 records from 135,173 patients, there was an excess of temperature readings of 36.0 °C above that expected from the underlying distribution that affected 11.3% (95% CI 10.6–12.1%) of measurements, i.e. these observations were likely inappropriately recorded as 36.0 °C instead of the true value. SBP, DBP and HR were rounded to the nearest 10 in 2.2% (1.4–2.8%) and 2.0% (1.3–5.1%) and 2.4% (1.7–3.1%) of measurements. RR was also more commonly recorded as multiples of 2. BP digit preference and an excess of temperature recordings of 36.0 °C were more common in older and male patients, as length of stay increased, following a previous normal set of vital signs and typically more common in medical vs. surgical specialities. Differences were seen between hospitals, however, digit preference reduced over calendar time. Vital signs may not always be accurately documented, and this may vary by patient groups and hospital settings. Allowances and adjustments may be needed in delivering care to patients and in observational analyses and predictive tools using these factors as outcomes or exposures.

Quantifying Blood Pressure Visit-to-Visit Variability in the Real-World Setting: A Retrospective Cohort Study.

Visit-to-visit variability (VVV) in blood pressure values has been reported in clinical studies. However, little is known about VVV in clinical practice and whether it is associated with patient characteristics in real-world setting. We conducted a retrospective cohort study to quantify VVV in systolic blood pressure (SBP) values in a real-world setting. We included adults (age ≥18 years) with at least 2 outpatient visits between January 1, 2014 and October 31, 2018 from Yale New Haven Health System. Patient-level measures of VVV included SD and coefficient of variation of a given patient's SBP across visits. We calculated patient-level VVV overall and by patient subgroups. We further developed a multilevel regression model to assess the extent to which VVV in SBP was explained by patient characteristics. The study population included 537 218 adults, with a total of 7 721 864 SBP measurements. The mean age was 53.4 (SD 19.0) years, 60.4% were women, 69.4% were non-Hispanic White, and 18.1% were on antihypertensive medications. Patients had a mean body mass index of 28.4 (5.9) kg/m2 and 22.6%, 8.0%, 9.7%, and 5.6% had a history of hypertension, diabetes, hyperlipidemia, and coronary artery disease, respectively. The mean number of visits per patient was 13.3, over an average period of 2.4 years. The mean (SD) intraindividual SD and coefficient of variation of SBP across visits were 10.6 (5.1) mm Hg and 0.08 (0.04). These measures of blood pressure variation were consistent across patient subgroups defined by demographic characteristics and medical history. In the multivariable linear regression model, only 4% of the variance in absolute standardized difference was attributable to patient characteristics. The VVV in real-world practice poses challenges for management of patients with hypertension based on blood pressure readings in outpatient settings and suggest the need to go beyond episodic clinic evaluation.

Temporal relationship between hyperuricemia and hypertension and its impact on future risk of cardiovascular disease

BackgroundAlthough hyperuricemia and hypertension are significantly correlated, their temporal relationship and whether this relationship is associated with risk of cardiovascular disease (CVD) are largely unknown. This study aimed to examine temporal relationship between hyperuricemia and hypertension, and its association with future risk of CVD. MethodsThis study included 60,285 participants from the Kailuan study. Measurement of serum uric acid (SUA), systolic and diastolic blood pressure (SBP and DBP) were obtained twice at 2006 (baseline) and 2010. Cross-lagged and mediation analysis were used to examine the temporal relationship between hyperuricemia and hypertension, and the association of this temporal relationship with CVD events risk after 2010. ResultsAfter adjusting for covariates, the cross-lagged path coefficients (β1) from baseline SUA to follow-up SBP and DBP were significantly greatly than path coefficients (β2) from baseline SBP and DBP to follow-up SUA (β1=0.041 versus β2=0.003; Pdifference<0.0001 for SBP; β1=0.040 versus β2=0.000; Pdifference<0.0001 for DBP). The path coefficients from baseline SUA to follow-up SBP and DBP in group with incident CVD were significantly greatly than that in group without incident CVD (Pdifference of β1 in the two groups was 0.0018 for SBP and 0.0340 for DBP). Furthermore, SBP and DBP partially mediated the effect of SUA on incident CVD, the mediation effect was 57.64% for SBP and 46.27% for DBP. Similar mediated results were observed for stroke and myocardial infarction. ConclusionIncreased SUA levels probably precede elevated BP, and BP partially mediates the pathway from SUA to incident CVD.

Elevated late-life blood pressure may maintain brain oxygenation and slow amyloid-β accumulation at the expense of cerebral vascular damage.

Hypertension in midlife contributes to cognitive decline and is a modifiable risk factor for dementia. The relationship between late-life hypertension and dementia is less clear. We have investigated the relationship of blood pressure and hypertensive status during late life (after 65 years) to post-mortem markers of Alzheimer's disease (amyloid-β and tau loads); arteriolosclerosis and cerebral amyloid angiopathy; and to biochemical measures of ante-mortem cerebral oxygenation (the myelin-associated glycoprotein:proteolipid protein-1 ratio, which is reduced in chronically hypoperfused brain tissue, and the level of vascular endothelial growth factor-A, which is upregulated by tissue hypoxia); blood-brain barrier damage (indicated by an increase in parenchymal fibrinogen); and pericyte content (platelet-derived growth factor receptor β, which declines with pericyte loss), in Alzheimer's disease (n = 75), vascular (n = 20) and mixed dementia (n = 31) cohorts. Systolic and diastolic blood pressure measurements were obtained retrospectively from clinical records. Non-amyloid small vessel disease and cerebral amyloid angiopathy were scored semiquantitatively. Amyloid-β and tau loads were assessed by field fraction measurement in immunolabelled sections of frontal and parietal lobes. Homogenates of frozen tissue from the contralateral frontal and parietal lobes (cortex and white matter) were used to measure markers of vascular function by enzyme-linked immunosorbent assay. Diastolic (but not systolic) blood pressure was associated with the preservation of cerebral oxygenation, correlating positively with the ratio of myelin-associated glycoprotein to proteolipid protein-1 and negatively with vascular endothelial growth factor-A in both the frontal and parietal cortices. Diastolic blood pressure correlated negatively with parenchymal amyloid-β in the parietal cortex. In dementia cases, elevated late-life diastolic blood pressure was associated with more severe arteriolosclerosis and cerebral amyloid angiopathy, and diastolic blood pressure correlated positively with parenchymal fibrinogen, indicating blood-brain barrier breakdown in both regions of the cortex. Systolic blood pressure was related to lower platelet-derived growth factor receptor β in controls in the frontal cortex and in dementia cases in the superficial white matter. We found no association between blood pressure and tau. Our findings demonstrate a complex relationship between late-life blood pressure, disease pathology and vascular function in dementia. We suggest that hypertension helps to reduce cerebral ischaemia (and may slow amyloid-β accumulation) in the face of increasing cerebral vascular resistance, but exacerbates vascular pathology.

Lifespan psychosocial stressors, optimism, and hemodynamic acute stress response in a national sample.

To understand the association between psychosocial stressors and cardiovascular health by evaluating: (a) lifespan patterns of childhood and adulthood stressors in relation to hemodynamic acute stress reactivity and recovery and (b) the role of optimism in these associations. Participants (n = 1,092, 56% women, 21% racial/ethnic minority, Mage = 56.2) were from the Midlife in the United States Study II Biomarker Project. Lifespan profiles of psychosocial stressor exposure (low lifespan exposure, high childhood only, high adulthood only, persistent exposure) were constructed from responses to the Childhood Trauma Questionnaire and a life events inventory. Optimism was measured with the Life Orientation Test-Revised. Hemodynamic acute stress reactivity to and recovery from cognitive stressors were assessed using a standardized laboratory protocol involving continuous measurements of systolic and diastolic blood pressure (BP) and baroreflex sensitivity (BRS). Compared with the low lifespan exposure group, the high childhood- and persistent-exposure groups showed lower BP reactivity, and to a lesser extent, slower BP recovery. Persistent exposure was also associated with slower BRS recovery. Optimism did not modify the association between stressor exposure and any hemodynamic acute stress responses. However, in exploratory analyses, greater stressor exposure across all developmental periods was indirectly associated with reduced BP acute stress reactivity and slower recovery via lower optimism levels. Findings support childhood as a unique developmental period wherein high adversity exposure may exert an enduring influence on adulthood cardiovascular health by limiting individuals' capacity to cultivate psychosocial resources and altering hemodynamic responses to acute stressors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Systolic Blood Pressure and Cardiovascular Risk in Normotensive Adults

ObjectiveTo examine the association of systolic blood pressure (SBP) and cardiovascular risk in normotensive adults. Patients and MethodsThis study analyzed data from 7 prospective cohorts between September 29, 1948, and December 31, 2018. Complete information on history of hypertension and baseline blood pressure measurements were required for inclusion. We excluded individuals younger than 18 years old, those with a history of hypertension, and patients with baseline SBP measurements of less than 90 mm Hg or 140 mm Hg or higher. Cox proportional hazards regression and restricted cubic spline models were used to evaluate the hazards of cardiovascular outcomes. ResultsA total of 31,033 participants were included. The mean ± SD age was 45.3±14.8 years, 16,693 of the participants (53.8%) were female, and the mean ± SD SBP was 115.8±11.7. Over a median follow-up of 23.5 years, 7005 cardiovascular events occurred. Compared with those who had SBP levels of 90 to 99 mm Hg, participants with SBP levels of 100 to 109, 110 to 119, 120 to 129, and 130 to 139 mm Hg experienced 23% (hazard ratio [HR], 1.23; 95% CI, 1.07 to 1.42), 53% (HR, 1.53; 95% CI, 1.33 to 1.76), 87% (HR, 1.87; 95% CI, 1.62 to 2.16), and 117% (HR, 2.17; 95% CI, 1.87 to 2.52) increased risks of cardiovascular events, respectively. Compared with follow-up SBP of 90 to 99 mm Hg, the HRs for cardiovascular events were 1.25 (95% CI, 1.02 to 1.54), 1.93 (95% CI, 1.58 to 2.34), 2.55 (95% CI, 2.09 to 3.10), and 3.39 (95% CI, 2.78 to 4.14), respectively, for follow-up SBP levels of 100 to 109, 110 to 119, 120 to 129, and 130 to 139 mm Hg. ConclusionIn adults without hypertension, there is a stepwise increase in risk of cardiovascular events, with increasing SBP starting at levels as low as 90 mm Hg.

Elabela levels in pregnancies with intrauterine growth retardation.

The aim of our study is to examine maternal serum Elabela levels in pregnancy with intrauterine growth retardation (IUGR). IUGR is one of the most important causes of perinatal mortality and morbidity. IUGR is also related future comorobidities such as diabetes mellitus, hyperlipidemia, hypertension and coronary artery disease. Fifty pregnancies diagnosed as IUGR (Group 1) and fifty healthy pregnancies (Group 2) enrolled into the study. Obstetric and demographic characteristics of the patients, serum elabela levels, ultrasound parameters, cord pH value and APGAR scores of the newborns were recorded. In the study, which was planned as a prospective case-control study, an independent t test was used for the evaluation of continuous data and the Mann Whitney U test was used for the statistical evaluation of ordinal data. p < 0.05 was considered significant. The mean gestational age of the cases at delivery was 36.35 ± 1.29 in Group 1 and 38.16 ± 0.94 weeks in Group 2 (p < 0.05). Mean serum Elabela levels were 15.05 ± 9.03 in Group 1 and 8.96 ± 4.33 ng/mL in Group 2 (p < 0.0001). Mean newborn weights were 2498.20 ± 465.92 in Group 1 and 3179.44 ± 387.99 gr. in Group 2 (p < 0.0001). Systolic and diastolic blood pressure measurements taken on the day of delivery were higher in Group 1, and diastolic blood pressure was 77.0 ± 9.53 in Group 1 and 72.60 ± 13.37 mmHg in Group 2 (p < 0.05). Bilateral uterine artery Pulsatile Index (PI) and umbilical artery PI value were significantly higher in Group 1 (p < 0.05), and middle cerebral artery PI and cerebroplacental ratio were significantly lower in Group 1 compared to Group 2 (p < 0.05). Although the cord pH value, 1st and 5th minute APGAR scores were lower in Group 1 compared to Group 2, no statistically significant difference was found (p > 0.05). In our study, it was found that serum Elabela levels increased significantly in pregnancies complicated by IUGR compared to the control group.

Abstract P166: First Trimester Plasma Per- and Polyfluoroalkyl Substance (PFAS) Concentrations and Blood Pressure Trajectories Throughout the Second and Third Trimesters of Pregnancy

Introduction: Evidence suggests that PFAS exposures increase risk of hypertensive disorders of pregnancy. Prior studies did not examine blood pressure (BP) trajectories during pregnancy – an important outcome to consider since adverse health outcomes can occur without diagnosis of a hypertensive disorder. Hypothesis: We hypothesized that higher PFAS exposures in the 1 st trimester would be associated with higher BP trajectory and faster BP velocity in later stages of pregnancy. Methods: We collected plasma from 1,308 individuals to measure six circulating PFAS in early pregnancy (median: 9.4 weeks gestation). Systolic BP (SBP) and diastolic BP (DBP) measurements, recorded from 12 weeks gestation until delivery, were abstracted from outpatient medical records. We estimated the mean BP trajectory via growth curve analysis, then employed BKMR to examine PFAS exposures with parameters of the trajectory – adjusting for age, race/ethnicity, pre-pregnancy BMI, income, parity, alcohol intake, and physical activity. We evaluated effect modification by age and BMI. Results: We collected a median of 13 BP measurements (IQR: 11 – 14) per participant. BKMR single PFAS analyses showed higher concentrations of PFOS were associated with higher SBP and DBP trajectory from 12 weeks gestation to delivery (Figure 1A) as well as faster SBP velocity. Stratified analyses showed evidence of effect modification. PFOS was associated with higher SBP trajectory in those with a BMI &lt; 25 kg/m 2 and higher DBP trajectory in those with a BMI ≥ 25 kg/m 2 (Figure 1B). In contrast, PFNA and PFHxS were associated with lower DBP trajectory for those with low BMI (Figure 1C). Lastly, exposure to lower quantiles of the PFAS mixture was associated with slower SBP velocity for those with low BMI. No associations were observed between PFAS and DBP velocity. Conclusions: Our findings suggest that select prenatal PFAS exposures may impact BP trajectories during pregnancy. Higher concentrations of PFOS are associated with higher BP trajectory and faster BP velocity. 1

Racial differences in time to blood pressure control of aneurysmal subarachnoid hemorrhage patients: A single-institution study.

Aneurysmal subarachnoid hemorrhage occurs in approximately 30,000 patients annually in the United States. Uncontrolled blood pressure is a major risk factor for aneurysmal subarachnoid hemorrhage. Clinical guidelines recommend maintaining blood pressure control until definitive aneurysm securement occurs. It is unknown whether racial differences exist regarding blood pressure control and outcomes (HLOS, discharge disposition) in aneurysmal subarachnoid hemorrhage. Here, we aim to assess whether racial differences exist in 1) presentation, 2) clinical course, and 3) outcomes, including time to blood pressure stabilization, for aSAH patients at a large tertiary care medical center. We conducted a retrospective review of adult aneurysmal subarachnoid hemorrhage cases from 2013 to 2019 at a single large tertiary medical center. Data extracted from the medical record included sex, age, race, insurance status, aneurysm location, aneurysm treatment, initial systolic and diastolic blood pressure, Hunt Hess grade, modified Fisher score, time to blood pressure control (defined as time in minutes from first blood pressure measurement to the first of three consecutive systolic blood pressure measurements under 140mmHg), hospital length of stay, and final discharge disposition. 194 patients met inclusion criteria; 140 (72%) White and 54 (28%) Black. While White patients were more likely than Black patients to be privately insured (62.1% versus 33.3%, p < 0.001), Black patients were more likely than White patients to have Medicaid (55.6% versus 15.0%, p < 0.001). Compared to White patients, Black patients presented with a higher median systolic (165 mmHg versus 148 mmHg, p = 0.004) and diastolic (93 mmHg versus 84 mmHg, p = 0.02) blood pressure. Black patients had a longer median time to blood pressure control than White patients (200 minutes versus 90 minutes, p = 0.001). Black patients had a shorter median hospital length of stay than White patients (15 days versus 18 days, p < 0.031). There was a small but statistically significant difference in modified Fisher score between black and white patients (3.48 versus 3.17, p = 0.04).There were no significant racial differences present in sex, Hunt Hess grade, discharge disposition, complications, or need for further interventions. Black race was associated with higher blood pressure at presentation, longer time to blood pressure control, but shorter hospital length of stay. No racial differences were present in aneurysmal subarachnoid hemorrhage associated complications or interventions.

Factors Related to Hypertension in Pregnancy

Background: Hypertension in pregnancy is a measurement of systolic blood pressure ≥ 140 mmHg and diastolic ≥ 90 mmHg during pregnancy. According to the Indonesian Health Profile (2015), the five biggest causes of maternal death are bleeding (28%), hypertension in pregnancy (25%), infections (11%), prolong labor (5%), and abortion (5%).&#x0D; Objective: This study aims to determine the factors associated with the incidence of hypertension in pregnancy in Harapan Jayakarta Hospital.&#x0D; Methodology: This research is an analytical method with a cross sectional study. The sample in this study was 190 pregnant women. The sampling technique is simple random sampling. The instrument is medical record data. Data were analyzed using chi square statistical test.&#x0D; Results: The results showed that there was a significant relationship between age (p = 0.001), employment status (p = 0.003), parity (p = 0.009), pregnancy interval (p = 0.003), history of diabetes mellitus (p = 0.038), obesity (p = 0.017), history of hormonal contraception (p = 0.044) with incidence hypertension in pregnancy.&#x0D; Conclusions and Recommendations: There was a significant relationship between age, occupational status, gravida status, pregnancy interval, history of diabetes mellitus, obesity and history of hormonal contraception with the incidence of hypertension in pregnancy. It is expected that health workers provide health education to anticipate complications in pregnancy and women are expected to carry out the health education provided.&#x0D; Keywords: hypertension in pregnancy; age; occupational status; gravida; pregnancy interval; history of diabetes mellitus; obesity; history of hormonal contraception.

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.

Validation of a Remote Monitoring Blood Pressure Device in Pregnancy.

The Ideal Life Blood Pressure Manager measures blood pressure (BP) and automatically transmits results to the patient's medical record independent of internet access, but has not been validated. Our objective was to conduct a validation study of the Ideal Life BP Manager in pregnant women using a validation protocol. Pregnant participants were enrolled into three subgroups per the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization protocol: normotensive (systolic blood pressure (SBP) < 140 and diastolic blood pressure (DBP) < 90), hypertensive without proteinuria (SBP ≥ 140 or DBP ≥ 90), and preeclampsia (SBP ≥ 140 or DBP ≥ 90 with proteinuria). Two trained research staff used a mercury sphygmomanometer to validate the device, alternating sphygmomanometer, and device readings for a total of 9 measurements. Among 51 participants, the mean SBP and DBP differences and standard deviations between the device and the mean staff measurements for all participants were 1.7 ± 7.1 and 1.5 ± 7.0 mm Hg, respectively. The standard deviations of the individual participant's paired device and mean staff SBP and DBP measurements were 6.0 and 6.4 mm Hg, respectively. The device was more likely to overestimate rather than underestimate BP (SBP: mean difference = 1.67, 95% CI [-12.15 to 15.49]; DBP: mean difference = 1.51, 95% CI [-12.26 to 15.28]). Most paired readings had a difference of less than 10 mm Hg across averaged paired readings. The Ideal Life BP Manager met internationally recognized validity criteria in this sample of pregnant women.

Prevalence and incidence of hypertension in a heavily treatment-experienced cohort of people living with HIV in Uganda.

The effect of long-term exposure to antiretroviral therapy (ART) on hypertension in sub-Saharan Africa remains unclear. We aimed to determine the prevalence and incidence of hypertension in people living with HIV (PLWH) with more than 10 years of ART in Uganda. The analysis was performed within a cohort of adult PLWH with more than 10 years of ART at an HIV clinic in Kampala, Uganda. Participants were eligible for this analysis if they had ≥2 follow-up visits. Hypertension was defined as two consecutive systolic blood pressure (SBP) measures greater than 140 mmHg and/or diastolic blood pressure (DBP) greater than 90 mmHg, and/or documented diagnosis and/or the initiation of antihypertensives. We determined the proportion of PLWH with hypertension at baseline and used multivariable logistic regression to determine the factors associated with prevalent hypertension. To determine the incidence of hypertension, follow-up began from the cohort baseline date and was censored at the last clinic visit or date of the event, whichever occurred earlier. Multivariable Poisson regression was used to determine the adjusted incidence rate ratios (aIRR) of hypertension according to demographic, ART, and clinical characteristics. Of the 1000 ALT participants, 970 (97%) had ≥2 follow-up visits, and 237 (24.4%) had hypertension at baseline. The odds of prevalent hypertension were 1.18 for every 5-year increase in age (adjusted odds ratio (aOR) 1.18, 95% CI 1.10-1.34) and were higher among males (aOR 1.70, 95% CI 1.20-2.34), participants with diabetes mellitus (aOR 2.37, 95% CI 1.10-4.01), obesity (aOR 1.99, 95% CI 1.08-3.60), high cholesterol (aOR 1.47, 95% CI 1.16-2.01), and those with prior exposure to stavudine (aOR 2.10, 95% CI 1.35-3.52), or nevirapine (aOR 1.90, 95% CI 1.25-3.01). Of the 733 participants without hypertension at baseline, 116 (15.83%) developed hypertension during 4671.3 person-years of follow-up (incidence rate 24.8 per 1000 person-years; 95% CI 20.7-29.8). The factors associated with incident hypertension were obesity (adjusted incidence rate ratio (aIRR) 1.80, 95% CI 1.40-2.81), older age (aIRR 1.12 per 5-year increase in age, 95% CI 1.10,1.25), and renal insufficiency (aIRR1.80, 95% CI 1.40-2.81). The prevalence and incidence of hypertension were high in this heavily treated PLWH cohort. Therefore, with increasing ART coverage, HIV programs in SSA should strengthen the screening for hypertension in heavily treated PLWH.