mmHg For Systolic Blood Pressure Research Articles

Cuffless Blood Pressure Measurement Using Linear and Nonlinear Optimized Feature Selection.

The cuffless blood pressure (BP) measurement allows for frequent measurement without discomfort to the patient compared to the cuff inflation measurement. With the availability of a large dataset containing physiological waveforms, now it is possible to use them through different learning algorithms to produce a relationship with changes in BP. In this paper, a novel cuffless noninvasive blood pressure measurement technique has been proposed using optimized features from electrocardiogram and photoplethysmography based on multivariate symmetric uncertainty (MSU). The technique is an improvement over other contemporary methods due to the inclusion of feature optimization depending on both linear and nonlinear relationships with the change of blood pressure. MSU has been used as a selection criterion with algorithms such as the fast correlation and ReliefF algorithms followed by the penalty-based regression technique to make sure the features have maximum relevance as well as minimum redundancy. The result from the technique was compared with the performance of similar techniques using the MIMIC-II dataset. After training and testing, the root mean square error (RMSE) comes as 5.28 mmHg for systolic BP and 5.98 mmHg for diastolic BP. In addition, in terms of mean absolute error, the result improved to 4.27 mmHg for SBP and 5.01 for DBP compared to recent cuffless BP measurement techniques which have used substantially large datasets and feature optimization. According to the British Hypertension Society Standard (BHS), our proposed technique achieved at least grade B in all cumulative criteria for cuffless BP measurement.

The association of liver enzymes with systolic and diastolic blood pressure in young adults

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Science and Technology Department, Brazilian Ministry of Health. Introduction Nonalcoholic fatty liver (NAFLD) disease has been associated with metabolic syndrome and cardiovascular risk factors including cholesterol, type 2 diabetes, obesity, and hypertension. Patients with NAFLD also have increased risk of coronary artery disease and major adverse cardiovascular events. Purpose The aim of this study was to assess the associations of liver enzymes with systolic and diastolic blood pressure in 22-year-old individuals from a 1993 birth cohort in Brazil. Methods During 1993, all live born babies in the city were invited to take part in a prospective study and sub-samples of this cohort were followed-up since then. At the 22-year follow-up, the liver enzymes evaluated were aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyl transferase (GGT). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were obtained calculating the mean of two measurements (at the beginning and the end of the interview) using a blood pressure monitoring device. The co-variables taken into consideration were sex, fasting period, body mass index (BMI), waist circumference (WC), triglycerides, cholesterol, excessive alcohol consumption (>8 points in the Alcohol Use Disorders Identification Test), and physical inactivity. Adjusted linear regressions have been performed and p < 0.05 was considered statistically significant. Results The sample was composed of 2603 (49.6%) men and 2645 (50.4%) women of approximately 22 years old. Median (IQR) AST (U/L) was 21 (18-26), and GGT (U/L) 24 (18-33). Mean (±SD) ALT (U/L) was 19 ± 16.5, SBP (mmHg) 123.9 ± 13.8, and DBP (mmHg) 73 ± 8.7. An increase of 1 U/L in ALT concentrations corresponded to a predicted increase of 0.87 mmHg in SBP and 0.62 mmHg in DBP (Table). This was stronger for GGT, as an increase of 1 U/L in GGT concentrations corresponded to a predicted increase of 1.41 mmHg in SBP and 1.14 mmHg in DBP (Table). AST was not associated with SBP (p = 0.094) or DBP (p = 0.093) (Table). Conclusions ALT and GGT are positively associated with SBP and DBP independent of potential confounders since early adult age. As causal roles remain unclear, prospective large-scale studies are necessary to better understand this association. Abstract Figure.

Cuffless Blood Pressure Estimation Based on Monte Carlo Simulation Using Photoplethysmography Signals.

Blood pressure measurements are one of the most routinely performed medical tests globally. Blood pressure is an important metric since it provides information that can be used to diagnose several vascular diseases. Conventional blood pressure measurement systems use cuff-based devices to measure the blood pressure, which may be uncomfortable and sometimes burdensome to the subjects. Therefore, in this study, we propose a cuffless blood pressure estimation model based on Monte Carlo simulation (MCS). We propose a heterogeneous finger model for the MCS at wavelengths of 905 nm and 940 nm. After recording the photon intensities from the MCS over a certain range of blood pressure values, the actual photoplethysmography (PPG) signals were used to estimate blood pressure. We used both publicly available and self-made datasets to evaluate the performance of the proposed model. In case of the publicly available dataset for transmission-type MCS, the mean absolute errors are 3.32 ± 6.03 mmHg for systolic blood pressure (SBP), 2.02 ± 2.64 mmHg for diastolic blood pressure (DBP), and 1.76 ± 2.8 mmHg for mean arterial pressure (MAP). The self-made dataset is used for both transmission- and reflection-type MCSs; its mean absolute errors are 2.54 ± 4.24 mmHg for SBP, 1.49 ± 2.82 mmHg for DBP, and 1.51 ± 2.41 mmHg for MAP in the transmission-type case as well as 3.35 ± 5.06 mmHg for SBP, 2.07 ± 2.83 mmHg for DBP, and 2.12 ± 2.83 mmHg for MAP in the reflection-type case. The estimated results of the SBP and DBP satisfy the requirements of the Association for the Advancement of Medical Instrumentation (AAMI) standards and are within Grade A according to the British Hypertension Society (BHS) standards. These results show that the proposed model is efficient for estimating blood pressures using fingertip PPG signals.

Validation of Continuous Noninvasive Blood Pressure Monitoring Using Error Grid Analysis.

Error grid analysis was recently proposed to compare blood pressure obtained by 2 measurement methods. This study aimed to compare continuous noninvasive blood pressure (CNBP) with invasive blood pressure (IBP) using the error grid analysis and investigate the confounding risk factors attributable to the differences between CNBP and IBP. Sixty adult patients undergoing general anesthesia were prospectively enrolled. Simultaneous comparative data regarding CNBP and IBP were collected. The Bland-Altman analysis was conducted to compare CNBP and IBP for systolic blood pressure (SBP) and mean blood pressure (MBP; acceptable accuracy: mean bias <5 mm Hg; standard deviation <8 mm Hg). The clinical relevance of the discrepancies between CNBP and IBP was evaluated by the error grid analysis, which classifies the differences into 5 zones from "no risk" (A) to "dangerous risk" (E). Additionally, an ordinal logistic regression analysis was performed to evaluate the relationship between the risk zones for MBP, classified by the error grid analysis and covariates of interest. A total of 10,663 pairs of CNBP/IBP were finally analyzed. The Bland-Altman analysis showed an acceptable accuracy with a bias of -3.3 ± 5.6 mm Hg for MBP but a poor accuracy with a bias of 5.4 ± 10.5 mm Hg for SBP. The error grid analysis showed the proportions of zones A to E as 96.7%, 3.2%, 0.1%, 0%, and 0% for SBP, respectively, and 72.0%, 27.9%, 0.1%, 0%, and 0% for MBP, respectively. The finger cuff missed 23.9% of epochs when SBP <90 mm Hg and 55.3% of epochs when MBP <65 mm Hg. The ordinal logistic regression analysis revealed that older age (adjusted odds ratio for decade: 1.54, 95% confidence interval [CI], 1.15-2.08; P = .004) and length of time from the initiation of finger cuff inflation (adjusted odds ratio for 60 minutes: 1.40, 95% CI, 1.13-1.73; P = .002) were significant factors of being in a more dangerous zone of the error grid. The error grid analysis revealed the larger clinical discrepancy between CNBP and IBP in MBP compared with that in SBP. Old age and longer finger cuff inflation time were significant factors of being in a more dangerous zone of the error grid, which could affect the hemodynamic management during surgery.

Influence of hemoglobin on blood pressure among people with GP.Mur blood type☆

GP.Mur is a clinically important red blood cell (RBC) type. GP.Mur and band 3 interact on the RBCs. We previously observed that healthy adults with GP.Mur type present slightly higher blood pressure (BP). Because band 3 and Hb comodulate nitric oxide (NO)-dependent vasodilation and hemoglobin (Hb) is positively associated with BP, we aimed to test whether these could contribute to higher BP in GP.Mur+people. We recruited 989 non-elderly adults (21% GP.Mur) free of catastrophic illness and not on cardiovascular or anti-hypertensive medication. Their body indices, blood lab data and lifestyle data were collected for analyses of potential BP-related factors (BMI, age, smoking, Hb, and GP.Mur). BMI and age remained the most significant contributors to BP. GP.Mur slightly increased systolic BP (SBP). The direct correlation between Hb and BP was only found in Taiwanese non-anemic men, not women. After age and BMI adjusted, we estimated an increase of 1.8mmHg and 2.6mmHg of SBP by 1g/dL Hb among men without and with GP.Mur type, respectively. Hb was generally lower among people expressing GP.Mur, which likely limited their larger impact on BP. GP.Mur contributed to BP in both Hb-dependent and Hb-independent fashion. A pronounced impact of hemoglobin on BP likely requires sufficient Hb, as GP.Mur increased the sensitivity of SBP to Hb only in non-anemic Taiwanese men, and not in Taiwanese women or anemic men. The mechanism through which GP.Mur affected BP independent of Hb is unknown.

Assessment of the Uncertainty Associated With Two Consecutive Blood Pressure Measurements Using the Auscultatory Method

Accurate non-invasive blood pressure measurements are vital in preventing and treating many cardiovascular diseases. The “gold standard” for non-invasive procedures is the auscultatory method, which is based on detecting Korotkoff sounds while deflating an arm cuff. Using this method as a “gold standard” requires highly-trained technicians and has an intrinsic uncertainty in its blood pressure predictions. In this paper, we analyze and characterize the origins of this uncertainty. This paper defines an uncertainty model for two consecutive blood pressure measurements. Our research group developed a computer-based simulation of auscultatory blood pressure measurement uncertainty, and these results were compared to a human-subject experiment with a group of 20 diverse-conditioned individuals. Uncertainties were categorized and quantified. The total computer-simulated uncertainty ranged between -8.4 mmHg to 8.4 mmHg in systolic blood pressure and -8.4 mmHg to 8.3 mmHg in diastolic blood pressure at a 95% confidence interval, while the limits in the human-based study ranged from -8.3 mmHg to 8.3 mmHg in systolic blood pressure and -16.7 mmHg to 4.2 mmHg in diastolic blood pressure.

Blood Pressure and Heart Rate Measurements Using Photoplethysmography with Modified LRCN

In this study, single-channel photoplethysmography (PPG) signals were used to estimate the heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP). A deep learning model was proposed using a long-term recurrent convolutional network (LRCN) modified from a deep learning algorithm, the convolutional neural network model of the modified inception deep learning module, and a long short-term memory network (LSTM) to improve the model's accuracy of BP and HR measurements. The PPG data of 1,551 patients were obtained from the University of California Irvine Machine Learning Repository. How to design a filter of PPG signals and how to choose the loss functions for deep learning model were also discussed in the study. Finally, the stability of the proposed model was tested using a 10-fold cross-validation, with an MAE ± SD of 2.942 ± 5.076 mmHg for SBP, 1.747 ± 3.042 mmHg for DBP, and 1.137 ± 2.463 bpm for the HR. Compared with its existing counterparts, the model entailed less computational load and was more accurate in estimating SBP, DBP, and HR. These results established the validity of the model.

ReViSe: Remote Vital Signs Measurement Using Smartphone Camera

Remote Photoplethysmography (rPPG) is a fast, effective, inexpensive and convenient method for collecting biometric data as it enables vital signs estimation using face videos. Remote contactless medical service provisioning has proven to be a dire necessity during the COVID-19 pandemic. We propose an end-to-end framework to measure people’s vital signs including Heart Rate (HR), Heart Rate Variability (HRV), Oxygen Saturation (SpO2) and Blood Pressure (BP) based on the rPPG methodology from the video of a user’s face captured with a smartphone camera. We extract face landmarks with a deep learning-based neural network model in real-time. Multiple face patches also called Regions-of-Interest (RoIs) are extracted by using the predicted face landmarks. Several filters are applied to reduce the noise from the RoIs in the extracted cardiac signals called Blood Volume Pulse (BVP) signal. The measurements of HR, HRV and SpO2 are validated on two public rPPG datasets namely the TokyoTech rPPG and the Pulse Rate Detection (PURE) datasets, on which our models achieved the following Mean Absolute Errors (MAE): a) for HR, 1.73Beats-Per-Minute (bpm) and 3.95bpm respectively; b) for HRV, 18.55ms and 25.03ms respectively, and c) for SpO2, an MAE of 1.64% on the PURE dataset. We validated our end-to-end rPPG framework, ReViSe, in daily living environment, and thereby created the Video-HR dataset. Our HR estimation model achieved an MAE of 2.49bpm on this dataset. Since no publicly available rPPG datasets existed for BP measurement with face videos, we used a dataset with signals from fingertip sensor to train our deep learning-based BP estimation model and also created our own video dataset, Video-BP. On our Video-BP dataset, our BP estimation model achieved an MAE of 6.7mmHg for Systolic Blood Pressure (SBP), and an MAE of 9.6mmHg for Diastolic Blood Pressure (DBP). ReViSe framework has been validated on datasets with videos recorded in daily living environment as opposed to less noisy laboratory environment as reported by most state-of-the-art techniques.

Effectiveness of a Workplace-Based, Multicomponent Hypertension Management Program in Real-World Practice: A Propensity-Matched Analysis.

Limited studies had investigated the potential benefits of workplace-based hypertension management programs on long-term blood pressure (BP) control and health outcomes. This study used the propensity score matching to examine the effectiveness of a workplace-based hypertension management program on BP control and risks of major adverse cardiovascular events and all-cause mortality. Within the Kailuan study, a workplace-based hypertension management program was initiated in 2009 among men with hypertension, which included regular BP measuring (twice a month), free antihypertensive medications, and individualized health consultation. Participants were followed until loss to follow-up, death, or December 31, 2019. Among 17 724 male hypertensives aged 18 to 60 years, 6400 participated in the program. The propensity score matching yielded 6120 participants in the management group and 6120 participants in the control group. Both systolic and diastolic BPs were significantly lower in the management group than in the control group over follow-up, and the mean between-group difference at the 10th year was -7.83 (95% CI, -9.06 to -6.62) mm Hg for systolic BP and -4.72 (95% CI, -5.46 to -3.97) mm Hg for diastolic BP. Participants in the program were more likely to achieve BP control (odds ratio, 1.70 [95% CI, 1.41-2.06]) and had significantly lower risks of major adverse cardiovascular events (hazard ratio, 0.83 [95% CI, 0.72-0.94]) and all-cause mortality (hazard ratio, 0.71 [95% CI, 0.58-0.86]), compared with those who were not in the program. A workplace-based hypertension management program was related to reduced BP levels and lower risks of major adverse cardiovascular events and mortality in Chinese men with hypertension.

Serum aldosterone and urine electrolytes dynamics in response to DASH diet intervention - An inpatient mechanistic study.

Dietary approach to stop hypertension (DASH) diet reduces blood pressure (BP) as effectively as one antihypertensive drug, yet its mechanism of action was never fully characterized. We designed a translational inpatient trial to elucidate the biological pathway leading from nutritional change, through hormonal response, reversal of urine electrolytes ratio, to BP reduction. A single-center open-label interventional trial. Volunteers were admitted for 14 days, transitioning from an American-style diet to DASH diet. Vital signs, blood, and urine samples were collected daily. Participants completed two 24-hour ambulatory BP measurements (ABPM) and two 24-hour urine collections on days 1 and 10. Nine volunteers completed the protocol. During inpatient stay, serum aldosterone increased from day 0 (mean 8.3 ± 5.0) to day 5 (mean 17.8 ± 5.8) after intervention and decreased on day 11 (mean 11.5 ± 4.7) despite continuous exposure to the same diet (p-value = 0.002). Urine electrolyte ratio ([Na]/[K]) decreased significantly from a mean of 3.5 to 1.16 on day 4 (p < 0.001). BP by 24-hour ABPM decreased by a mean of 3.7 mmHg systolic BP and 2.3 mmHg diastolic BP from day 1 to 10. Shifting from a high-sodium/low-potassium diet to the opposite composition leads to aldosterone increase and paradoxical BP reduction. Urine electrolyte ratio reflects nutritional changes and should guide clinicians in assessing adherence to lifestyle modification.

Intravenous Labetalol vs Intravenous Clonidine for Attenuation of Haemodynamic Responses during Laryngoscopy and Intubation in Controlled Hypertensive Patients Undergoing General AnaesthesiaA Randomised Clinical Trial

Introduction: Laryngoscopy and endotracheal intubation during general anaesthesia are associated with haemodynamic surges which can be detrimental, particularly if there is preexisting hypertension or cardiovascular disease. Intravenous (i.v.) labetalol, a β-adrenergic blocker with additional α1- adrenoceptor blocking activity, and clonidine, a centrally acting α2 agonist, are known to attenuate this haemodynamic response. Aim: To compare the effects of i.v. labetalol and clonidine in attenuating haemodynamic changes during laryngoscopy and intubation in controlled hypertensive patients. Materials and Methods: This single centre, parallel-group, double-blind, randomised clinical trial was conducted in the Surgery Operation Theater (OT) of Midnapore Medical College, District Paschim Medinipur, West Bengal, India, from February 2018 to August 2019. The study included 90 adult patients of either sex, who were randomly allocated to receive either clonidine 1 mcg/kg or labetalol 0.15 mg/kg by intravenous route. After recording baseline parameters, patients were preoxygenated with 100% oxygen for 3 min and the study drug was given 5 min prior to induction. Heart Rate (HR), Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) and the rate pressure product were recorded prior to induction, at the time of intubation and 1, 3, 5, and 10 min after intubation. General anaesthesia maintenance was done in a similar manner in both groups. Two-sample t-test was used to assess significance of difference in means between independent samples. Fisher’s exact test was employed for comparing categorical data. Analysis was two-tailed and p-value&lt;0.05 was considered statistically significant. Results: Both the groups were evenly matched at baseline with respect to age and sex as well as standard anthropometric parameters (p-value&gt;0.05). Both drugs were able to attenuate the expected rise in HR following intubation but labetalol was more effective than clonidine throughout the postintubation period. SBP and DBP were comparable between the two groups at baseline but underwent greater attenuation in the labetalol group at intubation and subsequent measurements. The differences were around 10 bpm for HR, 20-30 mmHg for SBP and 10 mmHg for DBP, in favour of labetalol. Adverse events like bradycardia, hypotension, sedation or undesirable ECG changes were not encountered. Conclusion: Intravenous labetalol is more effective than i.v. clonidine in controlling haemodynamic changes during laryngoscopy and intubation in controlled hypertensive patients undergoing general anaesthesia without any complications

Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic

Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic

The acute effects of particulate matter air pollution on ambulatory blood pressure: A multicenter analysis at the hourly level.

Epidemiological evidence from ambulatory blood pressure monitoring is needed to clarify the associations of particulate air pollution with blood pressure and potential lag patterns. We examined the associations of fine and coarse particulate matter (PM2.5, PM2.5-10) with ambulatory blood pressure among 7108 non-hypertensive participants from 7 Chinese cities between April 2016 and November 2020. Hourly concentrations of PM2.5 and PM2.5-10 were obtained from the nearest monitoring stations. We measured four blood pressure indicators, including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and pulse pressure (PP). Linear mixed-effect models combined with distributed lag models were applied to analyze the data. Generally, very short-term exposure to PM2.5 was significantly associated with elevated blood pressure. These effects occurred on the same hour of blood pressure measurement, attenuated gradually, and became insignificant approximately at lag 12h. An interquartile range (IQR, 33μg/m3) increase of PM2.5 was significantly associated with cumulative increments of 0.58mmHg for SBP, 0.31mmHg for DBP, 0.38mmHg for MAP, and 0.33mmHg for PP over lag 0 to 12h. The exposure-response relationship curves were almost linear without thresholds, but tended to be flat at very high concentrations. No significant associations were observed for PM2.5-10. Our study provides independent and robust associations between transient PM2.5 exposure and elevated blood pressure within the first 12h, and reinforces the evidence for a linear and non-threshold exposure-response relationship, which may have implications for blood pressure management and hypertension prevention in susceptible population.

Orthostatic hypertension is associated with lower plasma Aβ42/Aβ40 ratio: The Multidomain Alzheimer Preventive Trial (MAPT)

AbstractBackgroundOrthostatic hypertension (OHYPER), an emerging hemodynamic cardiovascular risk factor, is associated with cardiovascular events and mortality. Recent findings indicated that it could be an important risk factor for cognitive decline and dementia, including Alzheimer’s disease (AD). We aimed to assess the association between OHYPER and low plasma Aβ42/Aβ40 ratio, a surrogate biomarker for brain amyloidosis, associated with greater risk of mild cognitive impairment (MCI) and AD.MethodWe included 483 non‐demented community‐dwelling participants aged ≥ 70 years from the Multidomain Alzheimer Preventive Trial (MAPT). OHYPER was assessed at baseline and defined as an increase of at least 20 mmHg in systolic blood pressure (BP) and/or 10 mmHg in diastolic BP after standing. Plasma Aβ42 and Aβ40 were measured at 12 months, using an immunoprecipitation and liquid chromatography‐mass spectrometry assay. Low plasma Aβ42/Aβ40 ratio was defined as ≤ 0.107. Logistic regression models were used to assess the association between OHYPER and low plasma Aβ42/Aβ40 ratio.ResultOf 483 participants (mean age 76 years, 59% female), 113 (23.6%) had OHYPER and 161 (33.3%) low plasma Aβ42/Aβ40 ratio. OHYPER was associated with low plasma Aβ42/Aβ40 ratio (OR = 1.58, 95% CI [1.02‐2.44]) in unadjusted models. Adjustment for age, sex, education, MAPT randomization group, lying BP, antihypertensive drug use, MCI, and presence of 1 or 2 ApoE ε4 alleles did not change the results (OR = 1.67, 95% CI [1.02‐2.72]). Sensitivity analyses using the 25th percentile of plasma Aβ42/Aβ40 ratio (≤ 0.103) as an alternative cutoff and long‐term OHYPER (at least two‐thirds of visits over 12 months) reported consistent findings.ConclusionOHYPER was associated with lower plasma Aβ42/Aβ40 ratio in community‐dwelling older adults, even after accounting for potential confounders. Monitoring OHYPER may have clinical utility for identifying patients who are at risk for cognitive decline, AD or in the preclinical stages of the disease.

Abstract 10181: The Effect of Immune Checkpoint Inhibitors for Cancer on Blood Pressure

Introduction: Immune checkpoint inhibitors (ICIs) treat an expanding range of cancers and the use of ICIs has been associated with an increase in atherosclerotic cardiovascular disease (ASCVD) events. The mechanisms involved in the increase in ASCVD with ICIs are incompletely understood. These same immune checkpoints targeted for cancer also regulate vascular function, yet there are no data testing the effect of ICIs on blood pressure. Hypothesis: Based on basic data on the role of these immune checkpoints in vascular function, we hypothesize that the use of ICIs would increase systolic and diastolic blood pressure. Methods: This was a single academic medical center study of 8,724 patients treated with an ICI. The primary analysis evaluated whether exposure to ICIs was associated with changes in blood pressure using repeated measures multivariate mixed linear regression models. The secondary analysis evaluated the effect of changes in blood pressure on all cause mortality using Cox proportional hazard models. Results: Of the 8,724 patients, 4,812 (55.2%) had a diagnosis of hypertension at ICI start. The average blood pressure at ICI start was 128.3±18.1/72.5±10.1mmHg. Among the entire cohort, there was a decrease of 2.9 mmHg in systolic blood pressure (95% CI: 2.70-3.02) after starting an ICI, and a drop of 1.6 mmHg (95% CI: 1.52-1.70) in diastolic blood pressure (adjusted, p&lt;0.001 for both) (Figure 1). The effect of an ICI on blood pressure was independent of the development of any toxicity associated with an ICI. Patients who had an increase of ≥20 mmHg in systolic blood pressure after starting ICI had a lower risk of all-cause death (HR 0.74, 95% CI: 0.63-0.86) compared to patients with no or less than ≥20 mmHg increase. Conclusions: Among a large cohort of patients, ICI therapy is associated with a drop in systolic and diastolic blood pressure. However, patients who had an increase of at least ≥20 mmHg in systolic blood pressure had lower risk of all-cause death.

Abstract 12049: Orthostatic Hypertension is Associated With Lower Plasma aβ 42 /aβ 40 Ratio: The Multidomain Alzheimer Preventive Trial (MAPT)

Introduction: Orthostatic hypertension (OHYPER), an emerging hemodynamic cardiovascular risk factor, is associated with cardiovascular events and mortality. Recent findings indicated that it could be an important risk factor for cognitive decline and dementia, including Alzheimer’s disease (AD). Hypothesis: We aimed to assess the association between OHYPER and low plasma Aβ 42 /Aβ 40 ratio, a surrogate biomarker for brain amyloidosis. Methods: We included 483 non-demented community-dwelling participants aged ≥ 70 years from the Multidomain Alzheimer Preventive Trial (MAPT). OHYPER was assessed at baseline and defined as an increase of at least 20 mmHg in systolic blood pressure (BP) and/or 10 mmHg in diastolic BP after standing. Plasma Aβ 42 and Aβ 40 were measured at 12 months, using an immunoprecipitation and liquid chromatography-mass spectrometry assay. Low plasma Aβ 42 /Aβ 40 ratio was defined as ≤ 0.107. Logistic regression models were used to assess the association between OHYPER and low plasma Aβ 42 /Aβ 40 ratio. Results: Of 483 participants (mean age 76 years, 59% female), 113 (23.6%) had OHYPER and 161 (33.3%) low plasma Aβ 42 /Aβ 40 ratio. OHYPER was associated with low plasma Aβ 42 /Aβ 40 ratio (OR = 1.58, 95% CI [1.02-2.44]) in unadjusted models. Adjustment for age, sex, education, MAPT randomization group, lying BP, antihypertensive drug use, MCI, and presence of 1 or 2 ApoE ε4 alleles did not change the results (OR = 1.67, 95% CI [1.02-2.72]). Sensitivity analyses using the 25 th percentile of plasma Aβ 42 /Aβ 40 ratio (≤ 0.103) as an alternative cutoff and long-term OHYPER (at least two-thirds of visits over 12 months) reported consistent findings. Conclusions: OHYPER was associated with lower plasma Aβ 42 /Aβ 40 ratio in community-dwelling older adults, even after accounting for potential confounders. Monitoring OHYPER may have clinical utility for identifying patients who are at risk for cognitive decline, AD or in the preclinical stages of the disease.

Effective Access to Care in a Crisis Period: Hypertension Control During the COVID-19 Pandemic by Telemedicine.

ObjectiveTo assess the effectiveness of telemedicine video visits in the management of hypertensive patients at home during the first year of the COVID-19 pandemic.MethodsA quantitative analysis was performed of all home video visits coded with a diagnosis of essential hypertension during the first 12 months of the COVID-19 pandemic (March 2020 through February 2021). A total of 10,634 patients with 16,194 hypertension visits were present in our national telemedicine practice database during this time. Among this population, a total of 569 patients who had 1785 hypertension visits met the criteria of having 2 or more blood pressure (BP) readings, with the last BP reading occurring in the report period. We analyzed baseline characteristics and BP trends of these 569 patients during the study period. Voluntarily submitted patient satisfaction ratings, which were systematically requested at the end of each visit, were also analyzed.ResultsThe mean age of the patients in this study cohort of 569 patients was 43.9 years, and 48.3% (275) were women. More than 62% (355) of the patients had an initial systolic BP (SBP) above 140 mm Hg, and 25.3% (144) had an initial SBP of greater than 160 mm Hg. The average number of visits during the study period was 3.1 visits per patient; an average of 6.4 BP measurements per patient were available. During the study period, 77% (438) of the patients experienced an improvement in either SBP or diastolic BP (DBP), with mean reductions of −9.7 mm Hg and −6.8 mm Hg in SBP and DBP, respectively. A total of 416 patients in the cohort started with a BP above 140/90 mm Hg. For this subset of patients, 55.7% (232) achieved a BP of 140/90 mm Hg or lower by the end of the study period, and the average reductions in SBP and DBP were −17.9 mm Hg and −12.8 mm Hg, respectively, which corresponded to improvements of 11.2% and 12.4%. These improvements did not vary significantly when patients were stratified by age, sex, or geographic region of residence (rural vs urban/suburban). Voluntarily submitted patient surveys indicated a high degree of patient satisfaction, with a mean satisfaction score of 4.94 (5-point scale).ConclusionClinician-patient relationships established in a video-first telemedicine model were broadly effective for addressing suboptimally controlled hypertension. Patient satisfaction with these visits was high.

APPLICATION OF THERAPY BRISK WALKING EXERCISE ELDERLY BLOOD PRESSURE WITH HYPERTENSION IN THE PUSKESMAS AMBARAWA

The elderly are the largest contributor to hypertension worldwide. Hypertension or an increased blood pressure &gt; 140/90 mmHg. Brisk Walking Exercise therapy is a non-pharmacological therapy to control blood pressure. This case study aims to describe the application of Brisk Walking Exercise to reduce blood pressure in the elderly with hypertension. This research method uses a descriptive method involving 2 respondents with the criteria of elderly aged &gt;6O years.category 1 hypertension.the results of this case study show a decrease in blood pressure between before and after brisk walking exercise therapy. Subject I experienced an average decrease of 3.71 mmHg in systolic and diastolic an average decrease of 1.71 mmHg.subject II experienced an average decrease of 4.41 mmHg in systolic blood pressure while in diastolic blood pressure there was an average decrease of 1.71 mmHg. Subject II experienced an average decrease of 4.14 mmHg in systolic and diastolic an average decrease of 3.14 mmHg.the conclusion of this case study is that brisk walking exercise therapy is effective in reducing blood pressure in both subjects.brisk walking exercise therapy is recommended as a nursing intervention in hypertension management in the elderly with hypertension.

A Continuous Blood Pressure Estimation Method Using Photoplethysmography by GRNN-Based Model.

Compared with diastolic blood pressure (DBP) and systolic blood pressure (SBP), the blood pressure (BP) waveform contains richer physiological information that can be used for disease diagnosis. However, most models based on photoplethysmogram (PPG) signals can only estimate SBP and DBP and are susceptible to noise signals. We focus on estimating the BP waveform rather than discrete BP values. We propose a model based on a generalized regression neural network to estimate the BP waveform, SBP and DBP. This model takes the raw PPG signal as input and BP waveform as output. The SBP and DBP are extracted from the estimated BP waveform. In addition, the model contains encoders and decoders, and their role is to be responsible for the conversion between the time domain and frequency domain of the waveform. The prediction results of our model show that the mean absolute error is 3.96 ± 5.36 mmHg for SBP and 2.39 ± 3.28 mmHg for DBP, the root mean square error is 5.54 for SBP and 3.45 for DBP. These results fulfill the Association for the Advancement of Medical Instrumentation (AAMI) standard and obtain grade A according to the British Hypertension Society (BHS) standard. The results show that the proposed model can effectively estimate the BP waveform only using the raw PPG signal.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.