Blood Pressure Measurements Research Articles

Determinants of/ factors affecting glycaemic control among type 2 diabetic patient attending a health insurance clinic in Benue, Nigeria.

Background: Diabetes mellitus is a multisystem disease that requires multifaceted management approach with the aim of maintaining good glycaemic control. Proper knowledge of factors affecting glycaemic control will provide standard operational protocols in the management of patients with resultant good glycaemic control, better quality of life, and overall reduced morbidity and mortality. Objectives: This study aimed to assess the determinants of good glycaemic control among adult patients with type 2 diabetes. Methodology: This study was a hospital based cross-sectional study conducted between December 2021 and March 2022 involving 381 adult patients with T2DM attending the National Health Insurance Authority clinic. The participants were selected by systematic random sampling. Data was collected by an interviewer administered questionnaire. Anthropometry and blood pressure measurements were also taken. Data was analyzed with the Statistical Package for Social Sciences (SPSS). Version 24 with level of confidence at 5% (p=0.005) Result: There were 194 male (50.9%). The mean age of patients was 54.94±7.21 years. The proportion of T2DM patients with good glycaemic control was 106 (27.8%). Duration of diabetes diagnosis, co-morbidities, smoking or tobacco use, frequency of vigorous intensity sports, current complementary and alternative medicine use and blood pressure had statistically significant association with good glycaemic control following bivariate analysis. Conclusion: Level of glycaemic control was por. Primary care physicians should increase efforts in identifying, educating and counselling of patients with T2DM on measures to attain optimal good glycaemic control.

The effect of anxiety on metabolic parameters in patients with primary hypertension

Aims: Although the role of anxiety in the pathogenesis of hypertension is known, the effect of anxiety on metabolic parameters in hypertension has not been demonstrated. This study aimed to evaluate the effect of anxiety on metabolic parameters and blood pressure regulation in patients with primary hypertension. Methods: The study was designed as a single-center, descriptive cross-sectional study. A total of 150 patients receiving antihypertensive therapy for primary hypertension were included in the study. Patients were divided into minimal, mild, moderate, and severe anxiety groups according to the Beck Anxiety Inventory. Anthropometric measurements, metabolic parameters, and blood pressure measurements were compared between groups. Results: Significant positive correlations were found between anxiety severity and total cholesterol, LDL cholesterol, body mass index, and waist circumference (p<0.05). Subgroup analyses showed that total cholesterol, LDL cholesterol, body mass index, and waist circumference were higher in the severe anxiety group than in the minimal anxiety group (p<0.05). Conclusion: Anxiety in patients with primary hypertension appears to have negative consequences on total cholesterol, LDL cholesterol, body mass index, and waist circumference. In hypertension, female gender and obesity are associated with increased anxiety levels.

In silico data-based comparison of the accuracy and error source of various methods for noninvasively estimating central aortic blood pressure

Background and objectivesThe higher clinical significance of central aortic blood pressure (CABP) compared to peripheral blood pressures has been extensively demonstrated. Accordingly, many methods for noninvasively estimating CABP have been proposed. However, there still lacks a systematic comparison of existing methods, especially in terms of how they differ in the ability to tolerate individual differences or measurement errors. The present study was designed to address this gap. MethodsA large-scale ‘virtual subject’ dataset (n = 600) was created using a computational model of the cardiovascular system, and applied to examine several classical CABP estimation methods, including the direct method, generalized transfer function (GTF) method, n-point moving average (NPMA) method, second systolic pressure of periphery (SBP2) method, physical model-based wave analysis (MBWA) method, and suprasystolic cuff-based waveform reconstruction (SCWR) method. The errors of CABP estimation were analyzed and compared among methods with respect to the magnitude/distribution, correlations with physiological/hemodynamic factors, and sensitivities to noninvasive measurement errors. ResultsThe errors of CABP estimation exhibited evident inter-method differences in terms of the mean and standard deviation (SD). Relatively, the estimation errors of the methods adopting pre-trained algorithms (i.e., the GTF and SCWR methods) were overall smaller and less sensitive to variations in physiological/hemodynamic conditions and random errors in noninvasive measurement of brachial arterial blood pressure (used for calibrating peripheral pulse wave). The performances of all the methods worsened following the introduction of random errors to peripheral pulse wave (used for deriving CABP), as characterized by the enlarged SD and/or increased mean of the estimation errors. Notably, the GTF and SCWR methods did not exhibit a better capability of tolerating pulse wave errors in comparison with other methods. ConclusionsClassical noninvasive methods for estimating CABP were found to differ considerably in both the accuracy and error source, which provided theoretical evidence for understanding the specific advantages and disadvantages of each method. Knowledge about the method-specific error source and sensitivities of errors to different physiological/hemodynamic factors may contribute as theoretical references for interpreting clinical observations and exploring factors underlying large estimation errors, or provide guidance for optimizing existing methods or developing new methods.

Assessment Outcomes Effect of Apolipoprotein E4 Allele on Cardiovascular Diseases

The apolipoprotein E4 allele is a genetic risk factor that has a negative impact on the quality of life of people with cardiovascular disease. Our current study aimed to evaluate the effect of apolipoprotein E4 allele in cardiovascular patients (n=85). A total of 85 elderly patients with cardiovascular disease were enrolled in the study, which was conducted at hospitals in Baghdad, Iraq, between 18 January 2022 and 27 October 2023. Comprehensive cardiovascular examinations were performed on each patient, including blood pressure, heart rate, and other vital sign measurements. APOE genotype analysis was conducted to evaluate the impact on the patients. Additionally, questionnaires were administered to assess the quality of life of patients with cardiovascular disease. In terms of clinical outcomes, chest pain was identified as the most prevalent symptom among patients, with a total of 38 cases. Additionally, the E3/E4 genotype of the APOE gene was observed in 41.18% of patients, which was associated with an increase in serum lipid-lipoprotein levels in terms of SBP (145.39 ± 27.46) mmHg and DBP (87.89 ± The mean values for the variables were as follows: glucose (3.11 ± 1.12) mg/dL, triglycerides (224 ± 46.25) mg/dL, LDL-C (167.29 ± 12.92) mg/dL, and HDL-C (14.82 ± 3.82) mg/dL. The adverse findings revealed that 23 cases involved heart attacks, and 30 cases involved strokes. Patients with CVD who carried the apolipoprotein E4 allele exhibited negative impacts on their quality of life, as evidenced by the following scores: physical functioning (46.38 ± 14.26), energy/fatigue (53.25 ± 12.29), and emotional problems (62.10 ± 10.29). In general, patients with the apolipoprotein E4 allele exhibit elevated levels of lipid profiles, which signify an elevated risk of severe complications in patients with cardiovascular disease.

Prevalence of peripheral artery disease in young coronary artery disease patients

Background and objectives. Peripheral artery disease (PAD) and coronary artery disease (CAD) are progressive inflammatory conditions caused by arteriosclerosis, typically presenting after the age of 50. However, assessing peripheral vascular disease (PVD) in younger populations may offer early indications of coronary heart disease (CHD) risk. This study investigates the prevalence of abnormal ankle brachial index (ABI) values among young myocardial infarction (MI) patients and examines the correlation of ABI with other cardiovascular risk factors. Material and methods. This cross-sectional study was conducted at Saveetha Medical College and Hospital, involving 147 patients aged 40 years or younger who were admitted with MI symptoms. The study focused on the incidence and severity of MI in relation to age, sex, and the presence of risk factors such as smoking, alcohol use, dyslipidemia, hypertension (HTN), and diabetes mellitus (DM). Results. The study analyzed the incidence of myocardial infarction (MI) in a population under 40 years old. It was found that the incidence rate increased with age within this group. Specifically, males were more frequently affected than females, with 70% of cases occurring in males. Among female participants, all were over 30 years old. In terms of ankle-brachial index (ABI) values, 40% of females exhibited abnormal ABI, compared to 25% of males. Significant risk factors identified included smoking, with 60% of participants reporting tobacco use, alcohol consumption at 50%, and dyslipidemia present in 45% of cases. Hypertension (HTN) and diabetes mellitus (DM) were less prevalent, affecting 20% and 15% of participants, respectively. There was a significant correlation between low ABI values and the use of tobacco (p<0.01) and alcohol (p<0.05). However, the analysis showed no significant relationship between the number of vascular involvements indicated by ABI and the length of hospital stay. The length of hospital stay did increase with patient age, with an average increase of 2 days for every decade of age, but this was not significantly associated with ABI values. Conclusion. ABI is a valuable diagnostic tool in young populations for detecting early signs of CHD, offering advantages over routine blood pressure measurements. This study supports the broader use of ABI in both young and older populations to improve early detection and management of cardiovascular risks. Further research is needed to explore the implications of ABI in routine clinical practice and its correlation with other cardiovascular risk factors.

Community-engaged implementation of a safety bundle for pregnancy-related severe hypertension in the outpatient setting: protocol for a type 3 hybrid study with a multiple baseline design

BackgroundHypertensive disorders of pregnancy are among the leading causes of maternal mortality and morbidity in the U.S., with rates highest among birthing people who are Black, rural residents, and/or have low-income. Severe hypertension, in particular, increases risk of stroke and other serious pregnancy complications. To promote early detection and treatment of severe hypertension, the Alliance for Innovation on Maternal Health developed the Severe Hypertension During Pregnancy and Postpartum Period Safety Bundle (HTN Bundle). Multiple studies have demonstrated the HTN Bundle’s effectiveness in the inpatient setting. With funding from the National Heart, Lung, and Blood Institute, we engaged community partners to adapt the HTN Bundle for the outpatient setting (i.e., O-HTN Bundle) and planned for its implementation. In this paper, we describe the protocol for a study evaluating O-HTN Bundle implementation in 20 outpatient clinics serving Black, rural, and/or low-income populations.MethodsThis study is a hybrid type 3 effectiveness-implementation trial with a multiple baseline design. We will implement the O-HTN Bundle in three successive cohorts of clinics using a multicomponent implementation strategy to engage community partners (coalition, patient workgroup) and support clinics (training, facilitation, education materials, and simulations of severe hypertension events). To test the strategy, we will compare clinic fidelity to evidence-based guidelines for (a) patient education on hypertension and (b) blood pressure measurement technique, with repeated measures occurring before and after strategy receipt. We will also observe strategy effects on community- and clinic-level intermediate outcomes (community engagement, organizational readiness), implementation outcomes (reach, adoption, fidelity, maintenance), and effectiveness outcomes (receipt of guideline concordant care). Analyses will address whether outcomes are equitable across Black, rural, and/or low-income subgroups. Guided by the Consolidated Framework for Implementation Research 2.0, we will use mixed methods to identify adaptations and other determinants of implementation success.DiscussionThis study integrates community engagement and implementation science to promote equitable and timely response to severe HTN in the outpatient setting during pregnancy and postpartum. This is one of the first studies to implement an outpatient HTN Bundle and to use simulation as a strategy to reinforce team-based delivery of guideline concordant care.Trial registrationThis study was registered with ClinicalTrials.gov as “Testing Implementation Strategies to Support Clinic Fidelity to an Outpatient Hypertension Bundle (AC3HIEVE).” Registration number NCT06002165, August 21, 2023: https://clinicaltrials.gov/study/NCT06002165.

Survival status and its predictors among adult victims of road traffic accident admitted to public hospitals of Bahir Bar City, Amhara regional state, Northwest, Ethiopia, 2023: multi center retrospective follow-up study

IntroductionRoad traffic accident is the most common cause of death in adults worldwide. Road traffic accident-related deaths increased from time to time in low- and middle-income countries including Ethiopia; however, there is limited evidence about Survival status and its predictors among adult victims of road traffic accidents admitted to Hospitals in Ethiopia specifically in the study area. Thus, this study aimed to assess Survival status and its predictors among adult victims of road traffic accident admitted to Hospitals.MethodsAn institutional-based retrospective follow-up study was conducted from July 01/2019 to June 30/2022. A total of 402 samples were chosen using simple random sampling. Data was collected by a prepared checklist from the victims’ chart and entered into Epi-Data version 4.6 software and then exported to STATA version 14.1 for analysis. Kaplan-Meier failure function and log-rank test were computed. The assumption was checked by Schoenfeld residual test. All variables in bivariable analysis, p-value < 0.25 were entered into multivariable cox-regression model. Adjusted Hazard Ratio with 95% Confidence Interval was reported to declare the strength of association and statistical significance p-value of < 0.05. Model fitness was checked by using Cox-Snell residual. Data was presented by text, table, and graph.ResultThe median survival time was 504 h. From all, 63(15.6%) deaths, 57% of deaths occurred between 24 and 168 h of follow-up with an overall incidence of 15.34deaths per10, 000 victims-hours observation. According to the Kaplan-Meier failure curve together with the log-rank test, the incidence density rate of death among victims who had a complication during admission was71.86per10,000victims-hour observation (95%, CI:53.66–96.25), which is different from those who did not have complication 5.17per10,000person-hour observation (95%, CI:3.26–8.21). The incidence density rate of death among victims who had low level of arterial oxygen saturation (SPO2 < 95%) during admission was 82.87per10, 000 victims-hour observation (95%, CI: 63.15-108.75), which is different from those who had arterial oxygen saturation ≥ 95% 3.16per10, 000victims -hour observation (95%, CI: 1.75–5.71) Develop complication (AHR = 3.1,95% CI:1.44–6.70), systolic blood pressure measurement value ≤ 89 mmHg (AHR = 2.4,95% CI:1.10–5.19), not admitted intensive care unit (AHR = 0.46,95% CI:0.022–0.97), Glasgow Coma Scale score ≤ 8 (AHR = 2.9,95% CI:1.07–7.75), Glasgow Coma Scale score 9–12(AHR = 3.8,95% CI:1.61–8.97) and, level of arterial oxygen saturation ≤ 95% (AHR = 6.5,95% CI:2.38–17.64) were predictors of outcome variable.Conclusion and recommendationsThe median survival time was short. Complication, low systolic blood pressure measurement value, low Glasgow Coma Scale score, not admit to intensive care unit and low level of arterial oxygen saturation were significant predictors of the outcome variable. So that healthcare providers better give special attention and care to those victims admitted to Hospitals. A further prospective study is recommended.

Ulcerative colitis and concomitant arterial hypertension (literature review)

ulcerative colitis is a complex disease that results from a complex interaction of genetic predisposition, environmental factors, which leads to dysregulation of the immune system, chronic intestinal inflammation with damage to the mucous membrane. Systemic chronic inflammation can cause the development of arterial hypertension, thereby complicating the course of the primary disease. However, the cause-and-effect relationship between these diseases is not fully understood. Early detection of high blood pressure in patients with ulcerative colitis, a multidisciplinary approach to diagnosis makes it possible to achieve optimal treatment results in a timely manner and prevent the occurrence of intestinal complications. The aim of this study was to provide a comprehensive review of diagnostic procedures such as colonoscopy, inflammatory biomarkers (faecal calprotectin, faecal lactoferrin, serum zonulin), and to study the features of the colon structure in ultrasound diagnostics in patients with ulcerative colitis and concomitant hypertension. The data from PubMed and Ukrainian scientific sources on the comorbidity of these diseases, the possibility of using non-invasive diagnostic methods to assess the condition of the intestine in patients with ulcerative colitis and arterial hypertension were analysed. The literature review includes 50 scientific sources. The main focus is on the pathophysiological relationships of diseases, peculiarities of non-invasive diagnosis of ulcerative colitis during follow-up and early detection of arterial hypertension, which makes it possible to prevent complications in ulcerative colitis. Given the literature review, it can be concluded that the problem of timely diagnosis of hypertension in patients with ulcerative colitis is relevant today. For a rational approach to the management of patients with ulcerative colitis and concomitant hypertension, it is necessary to carry out a set of diagnostic procedures, including outpatient blood pressure measurement, ultrasound examination of the intestinal wall, and the use of non-invasive inflammatory biomarkers.

Impact of Systolic and Diastolic Blood Pressure on Cardiovascular Health Outcomes

Background: One well-known risk factor for cardiovascular (CV) disease that significantly raises morbidity and mortality rates globally is hypertension. Optimising treatment options requires an understanding of the distinct effects of diastolic and systolic blood pressure on CV outcomes. The study aims to examine into how the effects of both systolic hypertension (SH) and diastolic hypertension (DH) affected the frequency of major CV events, such as hemorrhagic, ischemic, and myocardial infarction (MI). Methods: A retrospective cohort research comprising 180 patients was carried out, with automated oscillometric cuffs being used to measure blood pressure. The burdens of SH and DH, which were determined as continuous variables from weighted average blood pressure, were the main predictors. A composite of ischemic stroke, MI, or hemorrhagic stroke was the main result. Logistic regression and bivariate and multivariable Cox survival analyses were included in the statistical studies. Results: The study population had average age of 65.4 years, with 52% males and 48% females. During the observation period, 45 composite outcome events occurred (25% incidence rate). Bivariate Cox analysis showed significant associations between SH burden (HR: 1.45, p&lt;0.001) and diastolic hypertension burden (HR: 1.30, p=0.015) with the composite outcome. Multivariable analysis confirmed these associations, with consistent findings in logistic regression models. Conclusion: Both SH and DH burdens are significant predictors of adverse CV outcomes. Effective management of both blood pressure components is essential for reducing the risk of ischemic stroke, MI, and hemorrhagic stroke. Recommendations: To lower the risk of significant CV events, clinicians should monitor and treat both systolic and diastolic blood pressure in individuals with hypertension. Subsequent studies ought to investigate the underlying mechanisms of these correlations and assess the effectiveness of focused interventions. Keywords: Hypertension, Cardiovascular Outcomes, Diastolic Blood Pressure, Systolic Blood Pressure.

Applying the 2023 ESH Hypertension Guidelines to the Irish Population- findings from the Irish Longitudinal Study on Ageing (TILDA)

Abstract Background Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD), the leading cause of mortality worldwide. The aim of this study was to apply the latest European Society of Hypertension (ESH) Guidelines 2023 to the Irish general population. Methods This study used data from Wave 1 (2009-2010) and Wave 3 (2014-2015) of the Irish Longitudinal Study on Ageing (TILDA). TILDA is a prospective cohort study based on stratified random sampling, which is representative of the community living older population in Ireland (Aged 50 years and over). Using this data, the prevalence of HTN in the general population by grade and stage, as set out in the ESH 2023 guidelines, was calculated. Population awareness of diagnosis, treatment status, control on treatment and adherence to recommended anti-hypertensive medication classes were assessed. Subgroup analyses were explored in alignment with specified groups highlighted in the Guidelines including those over 80 years old with and without frailty, those with chronic kidney disease and those with home blood pressure (BP) measurements. Inverse probability weighting was applied to account for the complex survey design used in TILDA and data analysis was conducted using Stata 15.1. Results Results from Wave 3 (N=5,329): The prevalence of hypertension was 64.0% (95% confidence interval (CI) 62.4-65.6%). Of those with HTN, 55.5% (95% CI 53.3-57.7) were aware of their HTN diagnosis and 70.4% (95% CI 68.3-72.2%) were on antihypertensive treatment. Of those on treatment, 53.2% were controlled (BP &amp;lt; 140/90), and only 20.0% (95% CI 18.3-21.8) were on a recommended dual therapy. 55.2% were on at least one agent recommended by the ESH guidelines. Conclusion This study indicates a high prevalence of HTN in the general population in Ireland aged 50+ years with low levels of awareness, control, and poor adherence to the most recent ESH HTN guidelines.

To Investigate the Prevalence of White Coat Hypertension in Community Dwelling Older Adults Referred for a Falls Assessment

Abstract Background Falls and frailty are the main focus in our integrated care programme for older persons (ICPOP). Office blood pressure (OBP) measurements are commonly used in practice although out of office recordings are proven to be a better predictor of cardiovascular risk (Myers et al, 2018). The European Society of Cardiology guidelines (ESC, 2018) have proposed BP values for the classification of hypertension (HTN). Methods We retrospectively completed a chart review on older adults’ who attended ICPOP with a referral for a falls assessment from November 2021 to April 2024. OBP were obtained after the patient was in the hub for approximately one hour following their comprehensive geriatric assessment (CGA). The OBP was documented following a supine period of 5 minutes. We compared the OBP and ambulatory blood pressure monitor (ABPm) average readings to assess the prevalence of HTN based on the ESC guidelines. Results 75 charts were reviewed. 3 ABPm recordings were unsuccessful due to cognitive impairment or not tolerating the ABPm. These were excluded from the audit. No patient had hypotension on either their OBP or ABPm recordings. On their OBP recordings, 29/72 (40%) had a normal reading while 43/72 (60%) had HTN. On their ABPm 54/72 (75%) had a normal reading while 18/72 (25%) had HTN. When we looked at antihypertensive medication use in those who had a normal reading on their ABPm, 47/54 (87%) were on antihypertensive treatment. All patients with HTN on their ABPM were on antihypertensive treatment. Conclusion Our findings suggest that OBP readings greatly increase the numbers of patients diagnosed with HTN compared to ABPm (60% versus 25%). Therefore, we suggest that all patients should have an ABPm as a gold standard to falls assessment to avoid over-treating white coat HTN.

From Concept to Cure: The Life and Legacy of Scipione Riva-Rocci.

The evolution of cardiovascular diagnostics has been profoundly influenced by the invention of the sphygmomanometer, a groundbreaking tool that transformed the measurement of blood pressure from an imprecise and invasive process into a routine and reliable clinical practice. Scipione Riva-Rocci, an Italian physician, developed the mercury sphygmomanometer in 1896, revolutionizing the way blood pressure was measured and managed. This simple yet innovative device, comprising an inflatable cuff, a mercury column manometer, and a stethoscope, provided the first accurate, noninvasive method for measuring blood pressure. The introduction of the Riva-Rocci sphygmomanometer not only enhanced the ability to diagnose and treat hypertension but also laid the foundation for modern cardiovascular medicine. The widespread adoption of this device has had a lasting impact on patient care, enabling early detection and management of cardiovascular diseases, thus significantly reducing morbidity and mortality. This review examines the design, development, and enduring legacy of Riva-Rocci's sphygmomanometer, highlighting its pivotal role in the history of medical innovation and its continued relevance in contemporary clinical practice.

Efektivitas Konsumsi Ubi Jalar Rebus dan Jus Pisang dalam Mengontrol Hipertensi pada Ibu Hamil di Puskesmas Bojonggede Tahun 2024

Hypertension in pregnant women is a health issue that needs to be properly addressed to prevent complications. This study aims to compare the effectiveness of consuming boiled sweet potatoes and banana juice in controlling hypertension in pregnant women at Bojonggede Health Center in 2024. The method used was a case study. Respondent 1 was given 300 grams of boiled sweet potatoes and 10 mg of nifedipine for seven days, while Respondent 2 was given 200 ml of banana juice and 10 mg of nifedipine with the same procedure. Blood pressure measurements were taken on the first and seventh days. The results showed that in the boiled sweet potato respondent, blood pressure decreased from 150/100 mmHg to 140/100 mmHg, while in the banana juice respondent, the reduction was more significant, from 150/100 mmHg to 130/90 mmHg. These findings indicate that banana juice is more effective in reducing blood pressure in hypertensive pregnant women compared to boiled sweet potatoes, making it a potential alternative in hypertension management.

Influence of body fat on heart rate variability in healthy females.

To evaluate the effect of central obesity indices in healthy females on cardiac autonomic activity, using heart rate variability as an index reflecting the cardiac autonomic balance. The cross-sectional study was conducted at the Department of Physiology, College of Medicine, Mustansiriyah University, Baghdad, Iraq, from September 2020 to April 2021, and comprised adult healthy women having a regular menstrual cycle who were not consumers of tobacco, alcohol or any medication. Waist circumference, waist-hip ratio, waist-height ratio and lipid accumulation product measurements were noted for each subject. Repeated blood pressure and heart rate measurements were taken on the brachial artery of the right arm until stable values were achieved. Heart rate variability was based on electrocardiogram data related to R-R interval. Data was analysed using GraphPad InStat version 3.06. There were 53 women with mean age 37.4±10.5 years. Low-frequency power normalised units at the highest two quintiles of waist circumference was significantly higher than the lowest two quintiles (p<0.03), and significantly and positively correlated with waist-hip ratio (p<0.02) and waist-height ratio (p<0.05). At the highest two quintiles of lipid accumulation product, low-frequency power normalised units value was significantly higher than at the lowest two quintiles (p<0.02). Increased waist circumference, waist-height ratio, waist-hip ratio and lipid accumulation product values were significantly associated with high sympathetic tone.

Intraoperative hypotension in children-Measurement and treatment

Intraoperative hypotension is acommon perioperative complication in pediatric anesthesia. Oscillometric blood pressure measurement is therefore an essential part of standard perioperative monitoring in pediatric anesthesia. The optimum measurement site is the upper arm. Attention must be paid to the correct cuff size. Blood pressure should be measured before induction. In children undergoing major surgery or in critically ill children, invasive blood pressure measurement is still the gold standard. Continuous noninvasive measurement methods could be an alternative in the future.Threshold values to define hypotension remain unknown, even in awake children. There are also little data on hypotension thresholds in the perioperative setting. The most reliable measurement parameter for estimating hypotension is the mean arterial pressure. The threshold values for intraoperative hypotension are 40 mm Hg in newborns, 45 mm Hg in infants, 50 mm Hg in young children and 65 mm Hg in adolescents. Treatment should be initiated at adeviation of 10% and intensified at adeviation of 20%.Bolus administration of isotonic balanced crystalloid solutions, vasopressors and/or catecholamines are used as treatment options. Consistent and rapid intervention in the event of hypotension appears to be crucial. So far there is no evidence as to whether this leads to an improvement in outcome parameters.

Correlates and Predictors of Symptom Severity Over Time in People Under Investigation for Postural Orthostatic Tachycardia Syndrome.

Postural orthostatic tachycardia syndrome (POTS) is a poorly understood chronic disorder characterized by an unexplained excessive increase in heartbeat upon standing. The aim of this study was to investigate psychosocial and physiological correlates and predictors of symptom severity over time in patients presenting with POTS-like symptoms. Longitudinal cohort study of patients under investigation for POTS ( n = 149). Patients completed questionnaires at 1 month preclinic appointment and 6 months later. Diagnosis, blood pressure (BP), and heart rate (HR) measures were collected from medical records. Data were analyzed using hierarchical linear multiple regression. Orthostatic and small fiber neuropathy (SFN) symptoms remained stable over time and were significantly correlated with distress, cardiac anxiety, threatening views of the illness, and cognitive-behavioral responses to symptoms, but not with emotional reactivity or social support. Baseline psychosocial factors collectively explained 48% ( F = 5.37, p < .001) of the variance in orthostatic symptoms, and 35% ( F = 3.49, p < .001) of the variance of SFN symptoms at baseline, but a nonsignificant amount of variance in symptoms at 6 months when controlling for baseline symptoms. Hemodynamic measures explained a significant 4% ( F = 3.37, p = .026) of variance of orthostatic symptoms at 6 months. Symptom burden in patients with suspected POTS remained high over 6 months. Psychosocial factors explained a large amount of the variance in symptoms at baseline. As symptoms did not change/improve over time, baseline symptoms accounted for most of the variance in symptoms at 6 months. An integrated approach addressing psychosocial factors alongside medical treatments may promote adjustment to the condition and lessen symptom burden for this group.

Fiber Bragg Grating Pulse and Systolic Blood Pressure Measurement System Based on Mach-Zehnder Interferometer.

A fiber Bragg grating (FBG) pulse and systolic blood pressure (SBP) measurement system based on the edge-filtering method is proposed. The edge filter is the Mach-Zehnder interferometer (MZI) fabricated by two fiber couplers with a linear slope of 52.45 dBm/nm. The developed system consists of a broadband light source, an edge filter, fiber Bragg gratings (FBGs), a coarse wavelength-division multiplexer (CWDM), and signal-processing circuits based on a field-programmable gate array (FPGA). It can simultaneously measure pulse pulsations of the radial artery in the wrist at three positions: Cun, Guan and Chi. The SBP can be calculated based on the pulse transit time (PTT) principle. The measurement results compared to a standard blood pressure monitor showed the mean absolute error (MAE) and standard deviation (STD) of the SBP were 0.93 ± 3.13 mmHg. The system meets the requirements of the Association for the Advancement of Medical Instrumentation (AAMI) equipment standards. The proposed system can achieve continuous real-time measurement of pulse and SBP and has the advantages of fast detection speed, stable performance, and no compression sensation for subjects. The system has important application value in the fields of human health monitoring and medical device development.

Associations between Changes in Body Weight Status and High Blood Pressure among Lithuanian Children and Adolescents during the COVID-19 Pandemic: A Retrospective Cohort Study.

(1) Background: High blood pressure (HBP), overweight, and obesity are common, growing public health problems worldwide. The aim of this study was to evaluate associations between changes in body weight status and HBP among Lithuanian children and adolescents during the COVID-19 pandemic. (2) Methods: In this study, we analysed data on blood pressure and anthropometric measurements of 2430 children and adolescents aged 8-18 years, who participated in both the baseline study conducted before the COVID-19 pandemic (from November 2019 to March 2020) and the follow-up study during the COVID-19 pandemic (from November 2021 to April 2022). Multivariate logistic regression analysis was used to estimate the associations between changes in weight status categories and HBP. (3) Results: At baseline, 17.1% of the subjects had overweight, 5.9% had obesity, 5.6% had abdominal obesity, and 23.7% had HBP, whereas at the follow-up, these percentages increased to 20.1%, 8.2%, 6.8%, and 27.4%, respectively. Compared to schoolchildren who maintained normal weight from baseline to the follow-up period, subjects who newly developed overweight/obesity and those who remained with persistent overweight/obesity had increased odds of HBP, with adjusted odds ratios (aORs) of 1.95 (p < 0.001) and 2.58 (p < 0.001), respectively. In subjects who transitioned from overweight/obesity to normal weight, the odds of HBP were slightly increased, with an aOR of 1.14 (p = 0.598), but the change was not statistically significant (p > 0.05). (4) Conclusions: This study observed an increase in the prevalence of overweight, obesity, and HBP among schoolchildren during the COVID-19 pandemic. The study also suggested that changes from normal body weight status at baseline to overweight/obesity during follow-up, especially persistent overweight/obesity, were associated with higher odds of HBP in Lithuanian children and adolescents during the COVID-19 pandemic.

Factors beyond Body Mass Index Associated with Cardiometabolic Risk among Children with Severe Obesity.

Background: The increasing prevalence of severe obesity among children and adolescents poses a significant challenge for pediatricians and general practitioners. This study aimed to investigate the relationships between biochemical results, anthropometry, blood pressure measurements, and bioimpedance analysis (BIA)-derived parameters to identify potential cardiometabolic complications associated with severe obesity. Methods: This study included 347 children (162 boys, 185 girls) aged 0-19 years, meeting the criteria for severe obesity based on BMI thresholds for different age groups. The patients were recruited in four pediatric endocrinology centers in Poland (Zabrze, Cracow, Rzeszow, Szczecin). Each participant underwent anthropometric measurements, pubertal stage assessment, blood pressure measurement, biochemical and hormonal tests, and BIA. Results: BMI showed significant associations with fat mass percentage (FM%) and waist-to-height ratio (WHtR) but not waist-to-hip ratio (WHR). The relationship between BMI and FM% was stronger in girls and prepubertal children. The metabolic syndrome (MetS) Z-score showed a strong positive correlation with BMI in the pubertal children. A negative correlation between HDL and triglycerides was observed only in the boys. The prepubertal children exhibited more significant correlations, despite a smaller sample size and shorter duration of obesity. Conclusions: Considering multiple parameters beyond BMI alone provides a better understanding of cardiometabolic risks associated with severe obesity in children. MetS Z-score was not a reliable indicator of increased cardiometabolic risk in younger children. Early-onset severe obesity was associated with a higher risk of metabolic complications. Early intervention is crucial to mitigate metabolic complications in this population.

BP-Diff: a conditional diffusion model for cuffless continuous BP waveform estimation using U-Net.

Continuous monitoring of blood pressure (BP) is crucial for daily healthcare. Although invasive methods provide accurate continuous BP measurements, they are not suitable for routine use. Photoplethysmography (PPG), a non-invasive technique that detects changes in blood volume within the microcirculation using light, shows promise for BP measurement. The primary goal of this study is to develop a novel cuffless method based on PPG for accurately estimating continuous BP.&#xD;Approach. We introduce BP-Diff, an end-to-end method for cuffless continuous BP waveform estimation utilizing a conditional diffusion probability model combined with a U-Net architecture. This approach takes advantage of the stochastic properties of diffusion models and the strong feature representation capabilities of U-Net. It integrates the continuous BP waveform as the initial status and uses the PPG signal and its derivatives as conditions to guide the training and sampling process.&#xD;Main results. BP-Diff was evaluated using both uncalibrated and calibrated schemes. The results indicate that, when uncalibrated, BP-Diff can accurately track BP dynamics, including peak and valley positions, as well as timing. After calibration, BP-Diff achieved highly accurate BP estimations. The mean absolute error (MAE) of the estimated BP waveforms, along with the systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) from the calibrated BP-Diff model, were 2.99 mmHg, 2.6 mmHg, 1.4 mmHg, and 1.44 mmHg, respectively. Consistency tests, including Bland-Altman analysis and Pearson correlation, confirmed its high reliability compared to reference BP. BP-Diff meets the American Association for Medical Instrumentation (AAMI) standards and has achieved a Grade A from the British Hypertension Society (BHS).&#xD;Significance. This study utilizes PPG signals to develop a novel cuffless continuous BP measurement method, demonstrating superiority over existing approaches. The method is suitable for integration into wearable devices, providing a practical solution for continuous BP monitoring in everyday healthcare.