mmHg For Systolic Blood Pressure Research Articles

Diagnostic criteria for initial orthostatic hypotension: a narrative review.

Abnormalities in orthostatic blood pressure changes upon active standing are associated with morbidity, mortality, and reduced quality of life. However, over the last decade, several population-based cohort studies have reported a remarkably high prevalence (between 25 and 70%) of initial orthostatic hypotension (IOH) among elderly individuals. This has raised the question as to whether the orthostatic blood pressure patterns in these community-dwelling elderly should truly be considered as pathological. If not, redefining of the systolic cutoff values for IOH (i.e., a value ≥ 40mmHg in systolic blood pressure in the first 15s after standing up) might be necessary to differ between normal aging and true pathology. Therefore, in this narrative review, we provide a critical analysis of the current reference values for the changes in systolic BP in the first 60s after standing up and discuss how these values should be applied to large population studies. We will address factors that influence the magnitude of the systolic blood pressure changes following active standing and the importance of standardization of the stand-up test, which is a prerequisite for quantitative, between-subject comparisons of the postural hemodynamic response.

Cuff-less blood pressure measurement based on hybrid feature selection algorithm and multi-penalty regularized regression technique

One of the prominent reasons behind the deterioration of cardiovascular conditions is hypertension. Due to lack of specific symptoms, sometimes existing hypertension goes unnoticed until significant damage happens to the heart or any other body organ. Monitoring of BP at a higher frequency is necessary so that we can take early preventive measures to control and keep it within the normal range. The cuff-based method of measuring BP is inconvenient for frequent daily measurements. The cuffless BP measurement method proposed in this paper uses features extracted from the electrocardiogram (ECG) and photoplethysmography (PPG). ECG and PPG both have distinct characteristics, which change with the change of blood pressure levels. Feature extraction and hybrid feature selection algorithms are followed by a generalized penalty-based regression technique led to a new BP measurement process that uses the minimum number of features. The performance of the proposed technique to measure blood pressure was compared to an approach using an ordinary linear regression method with no feature selection and to other contemporary techniques. MIMIC-II database was used to train and test our proposed method. The root mean square error (RMSE) for systolic blood pressure (SBP) improved from 11.2 mmHg to 5.6 mmHg when the proposed technique was implemented and for diastolic blood pressure (DBP) improved from 12.7 mmHg to 6.69 mmHg. The mean absolute error (MAE) was found to be 4.91 mmHg for SBP and 5.77 mmHg for DBP, which have shown improvement over other existing cuffless techniques where the substantial number of patients, as well as feature selection algorithm, were implemented. In addition, according to the British Hypertension Society standard (BHS) standard for cuff-based BP measurement, the criteria for acceptable measurement are to achieve at least grade B; our proposed method also satisfies this criterion.

Levels of hypersensitive troponin T in the emergency department as a predictive factor of mortality for hospitalized COVID-19 patients

Abstract Background Coronavirus disease 2019 (COVI-19) has resulted in considerable morbidity ans mortality worldwide since December 2019. Cardiac complications are a common condition among patients with COVID-19. The association between elevated hypersensitivity troponin T in COVID-19 disease and risk of mortality remains unclear but data suggest it could be associated with higher risk of in-hospital mortality. Purpose The present study examine the potential association between the level of hypersensitive troponin T (Hs TnT) in emergency department (ED) and mortality among patients hospitalized with COVID-19. Methods Consecutive patients admitted in two hospitals from ED with confirmed PCR COVID-19 were included in this retrospective study. The data were collected from October 1, 2020 to December 31, 2020. The demographic characteristics (age and sex), clinical data (symptoms, comorbidities, laboratory findings, treatments, complications, and outcomes), and results of cardiac examinations (cardiac biomarkers and electrocardiogram) were collected in an electronic database. There data were analyzed and the mortality at 1 month was compared for patients with normal or elevated Hs TnT (>14 ng/L). Results The study population included 413 hospitalized patients with a confirmed PCR COVID-19. The median age was 82. The comorbidities like cardiovascular diseases, cerebrovascular diseases, pulmonary diseases and renal insufficiency are associated with a significant higher mortality (P<0.05). Clinicals findings like tachypnea (respiratory rate >20/minute) or hypotension (<90 mmHg systolic blood pressure) also result an increased mortality (P<0.05). In this cohort, 90 patients had an analysis of Hs TnT in the ED. The mortality at 1 month was higher in patients with elevated Hs TnT (>14 ng/L) compared to the patients with normal levels of Hs TnT and the correlation was significant (P<0.05). The relative risk of fatal outcome is 3.86 when the troponin level is >14ng/L. Conclusion Elevated Hs TnT levels in the emergency department appear to be a predictive factor of mortality at one month for patients with COVID-19 infection requiring admission. Funding Acknowledgement Type of funding sources: None.

Orthostatic Hypotension in Male Hypertensive Patients: A Cross-Sectional Study at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.

BackgroundOrthostatic hypotension (OH) is defined as a fall in systolic blood pressure (SBP) ≥20 mmHg or diastolic BP (DBP) ≥10 mmHg within 3 minutes of standing. OH incidence is increased with hypertension, and management of these patients may pose challenges, as treatment of one can worsen the other.ObjectiveThis study aimed to determine the prevalence of OH and its associated factors among male hypertensive patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.MethodsA hospital-based cross-sectional design was employed. Seated BP was measured twice and the average of the two taken. After BP had been stabilized for 5 minutes, SBP within 3 minutes of standing was measured twice and the minimum of the two taken. A drop of ≥20 mmHg in SBP within 3 minutes of standing was taken as OH. All male hypertensive patients who were able to attain a standing position were included. Sociodemographic, anthropometric, and clinical status of the patients were taken using structured interviewer-administered questionnaires. Data were entered and analyzed using SPSS 21. Both bivariate and multivariate logistic regression analysis were done. P≤0.05 was considered statistically significant.ResultsThe median age of study participants was 57 (25–96) years. The prevalence of OH was 17.6%. Uncontrolled hypertension (adjusted OR 2.08, 95% CI 1.125–3.872) and duration of hypertension ≥5 years (adjusted OR 2.04, 95% CI 1.069–3.895) were significantly associated with OH in hypertensive patients.ConclusionThe prevalence of OH among male hypertensive patients was high. Hypertensive patients whose BP was uncontrolled and having had hypertension ≥5 years were risk factors of OH.

Unattended automated office blood pressure measurement in children

Purpose We studied the performance of unattended automated office blood pressure (uAOBP) measurement in children, in relation to oscillometric office BP (OBP) and ambulatory blood pressure monitoring (ABPM). Materials and Methods One hundred and eleven stable treated and untreated outpatients investigated for hypertension underwent uAOBP measurements (seated unattended in a quiet room separate from the renal clinic room, six times after a 5 min rest with the BpTRU device), and immediately before using the oscillometric device. Ambulatory 24 h blood pressure monitoring (ABPM) was performed on the same day in a subgroup of 42 children. Results UAOBP measurements were successful in 106 children (95%), 5 pre-school children did not tolerate to be alone in the room. The mean ± SD systolic/diastolic uAOBP, OBP and daytime ABP were 109.1 ± 14.0/70.8 ± 10.7 mmHg, 121.6 ± 16.5/77.6 ± 10.5 mmHg and 123.5 ± 11.3/73.7 ± 6.8 mmHg, respectively. Systolic/diastolic uAOBP was significantly lower than OBP by 13.6/7.6 mmHg (p < 0.0001) and lower than daytime ABP by 14.4 ± 0.5/2.9 ± 0.3 mmHg (p < 0.0001). The heart rate was not significantly different during uAOBP than during OBP measurements. On Bland Altman analysis the uAOBP underestimated OBP by a mean of 15.6 mmHg for systolic BP and by 8.6 mmHg for diastolic BP. In all 9 children with white-coat systolic hypertension uAOBP was within the normal range (<95th pc for OBP), in six of nine children with white-coat diastolic hypertension uAOBP was within the normal range however, in three of them it was elevated despite normal ABP. Conclusion uAOBP measurement is feasible in school-aged children, its values are considerably lower than OBP as well as daytime ABP and it could help with detection of white-coat systolic hypertension. The clinical applicability of uAOBP in children should be confirmed in further studies.

Abstract P479: Pathogenesis And Altered Cardiac Transcriptomic Landscape In Western Diet Treated Aged Mice Overexpressing Human Angiotensin Type 1 Receptor

Overexpression of human angiotensin II type 1 receptor (hAT1R) may lead to pathophysiological outcomes due to overactivation of the renin angiotensin system. We have shown that transgenic (TG) mice containing Hap-I (hypertensive genotype) of human AT1R gene are more prone to develop metabolic syndrome (MetS) as compared to TG mice with Hap-II (normotensive genotype). The increased risk of MetS, especially in hypertension, compounded by the effects of aging and Western diet (WD), which may lead to cardiac complications. However, the underlying mechanisms are not well examined. For this purpose, we studied the pathophysiological changes and gene expression profile alterations in the heart of aged Hap-I and Hap-II TG mice following exposure to WD. Aged mice (20-24 months of age) were maintained on a regular diet or high fat diet with 2% NaCl (WD) for 16 weeks. On regular diet, aged Hap-I mice presented higher (~9 mmHg) systolic blood pressure with respect to age-matched Hap-II animals. Following administration of WD, blood pressure increased in both groups of mice, but to a larger extent in Hap-I animals (~15 mmHg), in comparison to Hap-II (~7 mmHg). With respect to Hap-II, aged Hap-I mice on regular diet tended to have larger heart weight-to-body weight ratio and higher levels of fibrosis. Western Diet treatment exacerbated these differences. RNA sequencing data from cardiac tissue of WD treated Hap-I aged mice (compared to control diet treated age-matched mice) revealed that WD significantly altered the expression of &gt;500 genes (p-adj. &lt;0.05). Bioinformatics analysis, using Qiagen IPA software, identified major alterations in main canonical pathways involved in cardiac function, inflammation, and oxidative damage. Top hits in the disease and biological function category included arrhythmia, chamber enlargement, and cell death. Importantly, IRF3, IRF7, IFNG and STAT1 were among the top upstream regulators significantly affected by WD. Overall, these results indicate that Western diet promotes hypertension, hypertrophy, and fibrosis in the heart of aged mice. Results from these studies will assist in the identification of novel molecules and mechanisms involved in hypertension and associated cardiac pathophysiology.

Abstract P128: Direct Observed Therapy In Suspected Resistant Hypertension Is Safe

Introduction: Direct observed therapy (DOT) has emerged as a method for assessment of adherence, particularly in patients with apparent treatment-resistant hypertension (ATRH), in clinical care as well as research. We have previously demonstrated that direct observed therapy resulted in controlled hypertension in 30% of patients with ATRH. In this study we report on the safety of DOT in terms of change in blood pressure (BP) and hypotensive symptoms. Methods: Patients with ATRH were enrolled in a prospective study of DOT, which was followed by ambulatory blood pressure monitoring on the same day and at one month. DOT was performed by administering all prescribed BP lowering drugs, supervised by a nurse in an outpatient clinic setting. BP and vitals were measured at baseline and every 30 minutes until BP plateau based on two consecutive BP readings. All BP measurements during DOT were performed using an automated oscillometric BP device. In this study, we report the change in BP during DOT, with incidence of orthostatic symptoms, and decrease in systolic BP &gt; 20 mm Hg as outcomes of interest. Results: 50 patients underwent DOT, 32 men, mean age 62 years on median 4 BP lowering drugs (range 3 to 7). The mean baseline BP was 146/77 mm Hg , and the lowest BP during DOT was 129/68 mm Hg. The median decrease in systolic BP was 14 mm Hg (range 0 to 60) and diastolic BP was 8 mm Hg (range 0 to 37). 5 patients (10%) developed orthostatic symptoms during DOT, none of which required any interventions, and resolved with continued observation. A decrease of &gt; 20 mm Hg in systolic BP was seen in 19 patients (38%), and a systolic BP of &lt; 110 mm Hg was seen in only 6 patients (12%). Conclusions: DOT caused decrease in BP by &gt;20 mmHg in about 40% of patients. While these large acute decreases in BP were largely asymptomatic, close observation of BP is required until peak BP lowering effect wanes. As decrease in BP is driven by the degree of non-adherence and number of prescribed BP lowering drugs, our safety record has limitation dictated by the number of subjects enrolled, and relatively small number of patients with more than 5 BP lowering drugs.

Abstract MP09: Effect Of Western Diet On Renal Transcriptome Of Hypertensive Mice Overexpressing Human Angiotensin Receptor Type 1

Over-expression of human angiotensin-II receptor type1 (hAT1R) may cause pathological outcomes due to overactivation of renin-angiotensin system. Transgenic (TG) mice containing Hap-I (hypertensive genotype) of human hAT1R gene are more prone to develop metabolic syndrome disorders as compared to TG mice with Hap-II (normotensive genotype). This gene variant associated risk of hypertension together with Western diet and aging may lead to renal disorders. However, mechanisms underlying this process are not well examined. For this purpose, we studied the renal gene expression alterations in aged TG mice containing either Hap-I or Hap-II of hAT1R gene. Aged mice (20-24 months of age) were maintained on a regular diet or high fat diet with 2% NaCl (Western diet, WD) for 16 weeks. On a regular diet, aged Hap-I mice presented higher (~9 mmHg) systolic blood pressure with respect to age-matched Hap-II animals. Following administration of Western diet, blood pressure increased in both groups of mice, but to a larger extent in Hap-I animals (~15 mmHg in comparison to ~7 mmHg in Hap-II). Aged Hap-I mice on Western diet showed increased renal fibrosis. RNA-seq data from renal tissue of Hap-I aged mice revealed that WD significantly altered the expression of &gt;400 genes (p-adj. &lt;0.05). Bioinformatics analysis (Qiagen IPA software) identified major alterations in main canonical pathways involved in renal function and oxidative damage. These changes in turn resulted in kidney failure, renal tubular injury, and renal proliferation. In addition, post WD treatment, RNA seq. analysis from Hap-I and Hap-II kidneys also reveals haplotype specific regulation of genes associated with blood pressure regulation and kidney disorders. Overall, these results indicate that Western diet promotes hypertension and fibrosis in the kidneys of aged mice. These alterations are paralleled by perturbation of renal transcriptional profile. Overall, these studies will assist in the identification of novel mechanisms and molecules involved in hypertension and associated kidney pathophysiology.

The association of actigraphy-assessed sleep duration with sleep blood pressure, nocturnal hypertension, and nondipping blood pressure: the coronary artery risk development in young adults (CARDIA) study.

Nocturnal hypertension and nondipping systolic blood pressure (SBP) are associated with increased cardiovascular disease (CVD) risk. Short and long sleep duration (SSD and LSD) are also associated with increased CVD risk and may be risk factors for nocturnal hypertension and nondipping SBP. We examined the association between SSD and LSD with sleep BP, nocturnal hypertension, and nondipping SBP among 647 white and African American Coronary Artery Risk Development in Young Adults (CARDIA) study participants who completed 24-h ambulatory BP monitoring, wrist actigraphy, and sleep diaries in 2015-2016. The times when participants were asleep and awake were determined from actigraphy complemented by sleep diaries. Nocturnal hypertension was defined as sleep BP ≥120/70 mmHg and nondipping SBP as mean sleep-to-awake SBP ratio >0.90. Sleep duration was categorized as SSD (<6 h), normal sleep duration (NSD: 6-8.9 h), and LSD (≥9 h). The prevalence of SSD and LSD were 13.9 and 21.1%, respectively. Compared to participants with NSD, participants with LSD had higher mean sleep SBP (2.1 mmHg, 95% confidence interval [CI] 0.2, 4.1 mmHg) and diastolic BP (1.7 mmHg, 95% CI 0.5, 3.0 mmHg). Participants with LSD had a higher prevalence of nocturnal hypertension (prevalence ratio [PR]: 1.26, 95% CI 1.03-1.54) and nondipping SBP (PR 1.33, 95% CI 1.03-1.72) compared to participants with NSD. There was no evidence of an association between SSD and sleep SBP or DBP, nocturnal hypertension, or nondipping SBP. These findings suggest that LSD may be associated with nocturnal hypertension and nondipping SBP.

Health Care Delivery Interventions for Hypertension Management in Underserved Populations in the United States: A Systematic Review.

[Figure: see text].

Cuffless blood pressure estimation from PPG signals and its derivatives using deep learning models

Blood pressure (BP) is a direct indicator for hypertension, therefore, continuous and non-invasive BP monitoring is essential for reducing future health complications. Most non-invasive blood pressure monitors use the oscillometric technique, which can be cumbersome and impractical. To address this problem, we explore several features extracted from the Photoplethysmogram (PPG) waveform and its first and second derivatives and employ deep learning recurrent models for non-invasive cuffless estimation for systolic and diastolic BP. In this research, three techniques have been considered including statistical and machine learning techniques for reducing the collinearity and redundancy in the input feature vector. The estimation models consist of a one bidirectional recurrent layer, followed by a series of stacked conventional recurrent layers and an attention layer. All models were evaluated on 942 subjects collected from the MIMIC II dataset. The best performing model (consists of one bidirectional layer followed by several Long Short-Term Memory layers and an attention layer) achieved a mean absolute error, and standard deviation of 4.51 ± 7.81 mmHg for systolic BP (SBP), and 2.6 ± 4.41 mmHg for diastolic BP (DBP). The results show that the deep learning model trained on features extracted from one PPG sensor yield good performance for continuous and cuffless BP monitoring. Additionally, the results fulfil the international standard for cuffless BP estimation.

Associations Between Trajectory of Different Blood Pressure Components in Pregnancy and Risk of Adverse Birth Outcomes - A Real World Study.

BackgroundHigh blood pressure during pregnancy has been suggested to be associated with adverse birth outcomes (ABO), but it is unclear how different blood pressure changes and the extent of the effect. Therefore, we aimed to investigate the association between blood pressure trajectories (systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP)) of pregnant women and ABO in a real-world study.Material and MethodsLeveraging 28,679 pregnant women and their fetuses from a register-based cohort from January 1, 2010, to December 31, 2019. Blood pressure trajectories were estimated by package “traj” in R software using real-world blood pressure data of routine antenatal care examinations. Logistic regression models were applied to examine the association between trajectories of different blood pressure components (SBP, DBP, MAP, and PP) during pregnancy and the risk of ABO.ResultsTrajectories of all blood pressure components were identically labeled as low-stable, moderate-increasing, moderate-decreasing and high-stable. After adjusting for confounding factors, compared with pregnant women with the low-stable pattern, pregnant women with a high-stable or moderate-increasing pattern had a significantly increased risk of developing adverse birth outcomes. Pregnant women with a moderate-decreasing pattern had no significant increased risk of ABO but had a lower risk of adverse birth outcomes than those with a moderate-increasing pattern. The trajectories crossed at 17–20 weeks of gestation for all blood pressure components.ConclusionOur study results indicated that reduction and maintenance of blood pressure to a low level of less than 110 mmHg for SBP and 65 mmHg for DBP after 20 weeks of gestation would benefit prevention of adverse birth outcomes, regardless of the level of blood pressure at early pregnancy.

Randomized Trial on the Effects of Dietary Potassium on Blood Pressure and Serum Potassium Levels in Adults with Chronic Kidney Disease.

In the general population, an increased potassium (K) intake lowers blood pressure (BP). The effects of K have not been well-studied in individuals with chronic kidney disease (CKD). This randomized feeding trial with a 2-period crossover design compared the effects of diets containing 100 and 40 mmol K/day on BP in 29 adults with stage 3 CKD and treated or untreated systolic BP (SBP) 120–159 mmHg and diastolic BP (DBP) <100 mmHg. The primary outcome was 24 h ambulatory systolic BP. The higher-versus lower-K diet had no significant effect on 24 h SBP (−2.12 mm Hg; p = 0.16) and DBP (−0.70 mm Hg; p = 0.44). Corresponding differences in clinic BP were −4.21 mm Hg for SBP (p = 0.054) and −0.08 mm Hg for DBP (p = 0.94). On the higher-K diet, mean serum K increased by 0.21 mmol/L (p = 0.003) compared to the lower-K diet; two participants had confirmed hyperkalemia (serum K ≥ 5.5 mmol/L). In conclusion, a higher dietary intake of K did not lower 24 h SBP, while clinic SBP reduction was of borderline statistical significance. Additional trials are warranted to understand the health effects of increased K intake in individuals with CKD.

Deep generative model with domain adversarial training for predicting arterial blood pressure waveform from photoplethysmogram signal

Background and Motivations:Continuous blood pressure (BP) monitoring is of critical importance to health state tracking and disease prevention. However, current mainstream BP measurement approaches are cuff-based, which is inconvenient and limit its usage scenarios. Predicting arterial blood pressure (ABP) could provide richer information than isolated BP values. The individual differences among data may hinder training. Methods:A novel continuous, non-invasive and cuff-less approach is presented for generating ABP waveform using only raw photoplethysmogram (PPG) signal, from a signal conversion perspective, where a convolution-based deep autoencoder (DAE) model is developed. To overcome individual differences, Multi-domain adversarial training is merged with DAE (abbr. RDAE) to learn cross-domain features, and partial data is further used to calibrate (optional) the general model. Results:The mean absolute error (MAE) of uncalibrated RDAE reached 7.945, 4.114 and 3.834 mmHg in systolic BP (SBP), diastolic BP (DBP) and mean BP (MBP) prediction. After using 80 s data for calibration, the MAE of RDAE reduced to 5.424, 3.144 and 2.885 mmHg accordingly. Conclusion:Owning to the high-quality converted ABP segments, the resulting estimated BP is accurate. According to the BHS standard, RDAE achieved Grade C, Grade A and Grade A for SBP, DBP and MBP prediction, and the calibrated RDAE achieved Grade B, Grade A, Grade A accordingly. Significance:Both domain adversarial training and calibration improve the performance in varying degrees. RDAE is competitive to other mainstream regression-based deep learning methods, while with fewer model parameters, and to other representative machine learning methods, while no need of complicated feature engineering.

Validation of the wrist blood pressure measuring device Omron RS6 (HEM-6221-E) among obese Sudanese patients according to the European Society of Hypertension International Protocol Revision 2010

Background: Electronic devices for measuring blood pressure (BP) need to go through independent clinical validation as recommended by different authorities, both in general and specific populations. The aim of this study was to assess the validity of the Omron RS6 (HEM-6221-E) wrist oscillometric devices in obese Sudanese patients. Methods: Of 90 obese individuals invited for recruitment, 33 were included in the study, and had their BP at the level of the wrist measured using Omron RS6 and standard mercury sphygmomanometer. Two observations were made and the mean was taken. BP differences between the two methods for the 33 participants were classified into three categories (≤5, ≤10, and ≤15 mmHg), according to the European Society of Hypertension-International Protocol revision 2010 (ESH-IP2) criteria. This was then used to assess the validity of the tested Omron RS6 device. Results: Participants had a mean age of 56.97 years (standard deviation (SD), 8.75; range, 36-79). Average systolic blood pressure (SBP) was 146.21 mmHg (SD, 23.07; range, 107-182), and average diastolic blood pressure (DBP) was 93.82 mmHg (SD, 16.06; range, 67-128). There was a good agreement between the two observations using the OMRON RS6 and the standard sphygmomanometer: −4 to + 3 mmHg for SBP and −4 to +4 mmHg for DBP, with the mean difference of 1.73±1.11 mmHg for SBP and 1.49±1.02 mmHg for DBP. Conclusion: Thus, the Omron RS6 (HEM-6221-E) is a valid and suitable measure of BP according to ESH-IP2.

Hypertension genetics past, present and future applications.

Essential hypertension is a complex trait where the underlying aetiology is not completely understood. Left untreated it increases the risk of severe health complications including cardiovascular and renal disease. It is almost 15 years since the first genome-wide association study for hypertension, and after a slow start there are now over 1000 blood pressure (BP) loci explaining ∼6% of the single nucleotide polymorphism-based heritability. Success in discovery of hypertension genes has provided new pathological insights and drug discovery opportunities and translated to the development of BP genetic risk scores (GRSs), facilitating population disease risk stratification. Comparing highest and lowest risk groups shows differences of 12.9 mm Hg in systolic-BP with significant differences in risk of hypertension, stroke, cardiovascular disease and myocardial infarction. GRSs are also being trialled in antihypertensive drug responses. Drug targets identified include NPR1, for which an agonist drug is currently in clinical trials. Identification of variants at the PHACTR1 locus provided insights into regulation of EDN1 in the endothelin pathway, which is aiding the development of endothelin receptor EDNRA antagonists. Drug re-purposing opportunities, including SLC5A1 and canagliflozin (a type-2 diabetes drug), are also being identified. In this review, we present key studies from the past, highlight current avenues of research and look to the future focusing on gene discovery, epigenetics, gene-environment interactions, GRSs and drug discovery. We evaluate limitations affecting BP genetics, including ancestry bias and discuss streamlining of drug target discovery and applications for treating and preventing hypertension, which will contribute to tailored precision medicine for patients.

Revisiting blood pressure thresholds to define hypertension during pregnancy: is 140/90 mmHg too high?

While definitions for pre-eclampsia and hypertensive disorders of pregnancy have drifted over several decades—from a triad of signs in the 1950s to hypertension and multi-organ involvement in 2018—one constant has been the cutoff to define hypertension: 140 mmHg systolic blood pressure (sBP) and 90 mmHg diastolic blood pressure (dBP). Long used as a reliable border separating normal from abnormal, this simple cutoff has been called into question.

PENGARUH PEMBERIAN PUDING PISANG MELON DAN AIR KELAPA MUDA TERHADAP PENURUNAN TEKANAN DARAH PENDERITA HIPERTENSI

Background : Hypertension is a condition when systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg blood. One of herbal therapies to help lowering blood pressure is by utilizing foods which contain high potassium, such as bananas, melons, and young coconut water.Objective : To analyze the effect of banana melon and young coconut water pudding on lowering blood pressure levels of hypertensive patients at the Palembang Public Health Center.Method : A quasi-experimental study with pre and pos test control group design. The subjects were 60 hypertensive patients at Palembah PHC who were eagerly fulfilled inclusion and exclusion criteria. Data analysis were used t-dependent and t-independent tests to analyze the effect of melon banana pudding and young coconut water with blood pressure.Results : The results showed there was an average decrease in systolic and diastolic blood pressure in the treatment group of 13.07 mmHg (p= 0.000) and 6.93 mmHg (p= 0,000). Consumption of banana melon pudding and young coconut water showed a significant effect on reducing 6.1 mmHg systolic blood pressure (p=0.003) and 4.56 mmHg diastolic blood pressure (p=0,000). T-independent test showed that systolic blood pressure in the treatment and control groups obtained p-0.005 and diastolic blood pressure obtained p-value 0.048.Conclusion : Consumption of banana melon pudding and young coconut water could lower blood pressure levels f hypertensive patients

CNN-Based LCD Transcription of Blood Pressure From a Mobile Phone Camera.

Routine blood pressure (BP) measurement in pregnancy is commonly performed using automated oscillometric devices. Since no wireless oscillometric BP device has been validated in preeclamptic populations, a simple approach for capturing readings from such devices is needed, especially in low-resource settings where transmission of BP data from the field to central locations is an important mechanism for triage. To this end, a total of 8192 BP readings were captured from the Liquid Crystal Display (LCD) screen of a standard Omron M7 self-inflating BP cuff using a cellphone camera. A cohort of 49 lay midwives captured these data from 1697 pregnant women carrying singletons between 6 weeks and 40 weeks gestational age in rural Guatemala during routine screening. Images exhibited a wide variability in their appearance due to variations in orientation and parallax; environmental factors such as lighting, shadows; and image acquisition factors such as motion blur and problems with focus. Images were independently labeled for readability and quality by three annotators (BP range: 34–203 mm Hg) and disagreements were resolved. Methods to preprocess and automatically segment the LCD images into diastolic BP, systolic BP and heart rate using a contour-based technique were developed. A deep convolutional neural network was then trained to convert the LCD images into numerical values using a multi-digit recognition approach. On readable low- and high-quality images, this proposed approach achieved a 91% classification accuracy and mean absolute error of 3.19 mm Hg for systolic BP and 91% accuracy and mean absolute error of 0.94 mm Hg for diastolic BP. These error values are within the FDA guidelines for BP monitoring when poor quality images are excluded. The performance of the proposed approach was shown to be greatly superior to state-of-the-art open-source tools (Tesseract and the Google Vision API). The algorithm was developed such that it could be deployed on a phone and work without connectivity to a network.

What Types of Exercise Are More Effective in Reducing Obesity and Blood Pressure for Middle-Aged Women? A Systematic Review With Meta-Analysis.

A systematic review was performed to identify the types of physical activities effective as interventions in preventing metabolic syndrome in middle-aged women. Electronic databases (MEDLINE, EMBASE, the Cochrane Library, and CINAHL) served as the data sources. Cochrane's Risk of Bias 2 was applied to assess the risk of bias of the randomized controlled trials. Meta-analyses were performed on selected studies using Review Manager 5.3. Thirty-one trials enrolling 2,202 participants were included. Compared to controls, the effects of physical activity were indicated by pooled mean differences, which were -0.57 kg for body weight, -0.43 kg/m2 for body mass index, -1.63 cm for waist circumference, -4.89 mmHg for systolic blood pressure (BP), and -2.71 mmHg for diastolic BP. The effects were greater on the measurements of waist circumference and BP than on body weight and BMI. The types of physical activities were further analyzed according to sub-groups. Only aerobic exercise did not affect body weight and resistance exercise did not significantly change any results. Contrarily, combined exercises significantly reduced measurements of waist circumference and BP. This review can provide valuable information for research and implementation of measures to prevent metabolic syndrome in middle-aged women.