mmHg For SBP Research Articles

Evaluation of the relationship between pseudo-hypertension and the parameters of subclinical atherosclerosis.

Methods using for determining the subclinical atherosclerosis have gained growing interest in the recent years. However, the effects of pseudo-hypertension on the parameters of subclinical atherosclerosis are uncertain. We aimed to evaluate the relationship between pseudo-hypertension and subclinical atherosclerosis in individuals diagnosed with pseudo-hypertension. A total of 122 patients who underwent radial elective coronary angiography were included in the present study. These patients were divided into two groups based on the difference between invasive and noninvasive blood pressure (BP) measurements: pseudo-hypertension group who had a difference ≥15 mmHg in SBP or ≥10 mmHg in DBP levels between invasive and noninvasive measurements (n = 28), and the other group who did not have any difference as described on these levels (n = 94). In order to evaluate the subclinical atherosclerosis; flow-mediated dilatation (FMD), carotid intima-media thickness (IMT), pulse wave velocity (PWV), and augmentation index were recorded in all patients. Two groups were compared with respect to these parameters. The median age of the pseudo-hypertension group was 76 years, while the median age of the other group was 63.5 years (P < 0.0001). The incidence of concomitant hypertension was higher in the pseudo-hypertension group as compared to the other group (P < 0.001). There was a significant difference in augmentation index, cardiac output, PWV, FMD, and IMT values between two groups (P = 0.016, P = 0.023, P <0.001, P < 0.001, P < 0.001, respectively). The present results demonstrated that there was a strong correlation between pseudo-hypertension and the parameters of subclinical atherosclerosis; augmentation index, PWV, FMD, and carotids IMT.

Banxia Baizhu Tianma decoction attenuates obesity-related hypertension

Ethnopharmacological relevanceBanxia Baizhu Tianma decoction (BBTD) is a classical representative prescription for expelling phlegm, extinguishing wind, strengthening the spleen and dissipating excessive fluid in traditional Chinese medicine (TCM). According to both TCM theory and about 300 years of clinical practice, BBTD is especially suitable for hypertensive patients of abdominal obesity and lacking physical activity. Aim of the studyThe present study tried to interpret the pharmacology of the ancient formula of BBTD. Herein, we focused on the plasma metabonomics of BBTD and evaluated the effect and targets of BBTD on endothelial protective effect. MethodsObesity-related hypertensive mice were induced by high-fat diet for 20 weeks. BBTD (17.8 g/kg) was administered intragastrically for 8 weeks, and telmisartan group (12.5 mg/kg) was used as positive drug. Body weight, blood pressure, triglyceride and cholesterol were recorded to evaluate the efficacy of BBTD in vivo. Lipid deposition in aortic roots was assessed by oil red O staining, while morphology of aortas was observed by HE staining. Ultra performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) was performed to study the plasma non-targeted metabonomics. According to the data of metabonomics, human aortic endothelial cells (HAECs) were treated by oxidized low-density lipoprotein (ox-LDL, 50 μg/mL) with/without BBTD (2, 1 or 0.5 mg/mL). Apoptosis rate (Annexin V-FITC/PI), migration (Transwell), cytoskeleton (Phalloidin) and density of VE-cadherin (Immunofluorescence staining) were used to investigate the effect of BBTD in vitro. Transcriptome sequencing was performed (2 mg/mL BBTD vs ox-LDL) to screen the possible targets of BBTD in endothelial protection against ox-LDL. ResultsBBTD effectively reduced the body weight and total cholesterol, and decreased 12.1 mmHg in SBP and 10.5 mmHg in DBP of obesity-related hypertensive mice (P < 0.05). BBTD attenuated lipid deposition in arterial roots and improved the morphology of aortas in vivo. Plasma metabolite profiles identified 94 differential metabolites and suggested BBTD mainly affected glycerophospholipids and fatty acyls. Bioinformatics analysis indicated sphingolipid metabolism and fluid shear stress and atherosclerosis were main pathways. Therefore, we focused on endothelial protective effect of BBTD against ox-LDL. In vitro, BBTD demonstrated endothelial protective effects, decreasing apoptosis rate, improving cell migration in dose-dependent manner and maintaining cell morphology. Transcriptome sequencing identified 251 downregulated and 603 upregulated mRNAs after 24h-BBTD treatment, which reversed 51.8% change in mRNAs (393 DE mRNAs) induced by ox-LDL. Bioinformatics analysis supported the potential of BBTD in hypertension and suggested that BBTD improved endothelial cells by targeting mainly on p53 and PPAR signaling pathways. ConclusionsBBTD attenuates obesity-related hypertension by regulating metabolism of glycerophospholipids and endothelial protection.

Ambulatory blood pressure adaptations to high-intensity interval training: a randomized controlled study.

Hypertension remains the leading cause of cardiovascular disease and premature mortality globally. Although high-intensity interval training (HIIT) is an effective nonpharmacological intervention for the reduction of clinic blood pressure (BP), very little research exists regarding its effects on ambulatory BP. The aim of this study was to measure alterations in ambulatory and clinic BP following HIIT in physically inactive adults. Forty-one participants (22.8 ± 2.7 years) were randomly assigned to a 4-week HIIT intervention or control group. The HIIT protocol was performed on a cycle ergometer set against a resistance of 7.5% bodyweight and consisted of 3 × 30-s maximal sprints separated with 2-min active recovery. Clinic and ambulatory BP was recorded pre and post the control period and HIIT intervention. Following the HIIT intervention, 24-h ambulatory BP significantly decreased by 5.1 mmHg in sBP and 2.3 mmHg in dBP (P = 0.011 and 0.012, respectively), compared with the control group. In addition, clinic sBP significantly decreased by 6.6 mmHg compared with the control group (P = 0.021), with no significant changes in dBP and mean BP (mBP). Finally, 24-h ambulatory diastolic, daytime sBP, mBP and dBP, and night-time sBP and mBP variability significantly decreased post-HIIT compared with the control group. HIIT remains an effective intervention for the management of BP. Our findings support enduring BP reduction and improved BP variability, which are important independent risk factors for cardiovascular disease.

First results of Russian multicenter prospective clinical study VICTORY II: Vamloset® and Co-Vamloset effectiveness and safety in patients with stage 2 and 3 arterial hypertension

Abstract&#x0D; VICTORY II study objective. Evaluation of Vamloset and Co-Vamloset safety and effectiveness in reaching target blood pressure (BP) level in patients with stages 23 arterial hypertension (AH).&#x0D; Materials and methods. Russian multicenter prospective clinical study conducted in 8 clinical centers in6 cities in Russian Federation included 103 patients over 18 years of age with diagnosed essential hypertension of stages 23 (in accordance with 2013 European guidelines) who previously did not receive treatment (with office systolic BP sBP160 mm Hg and/or office diastolic BP dBP100 mmHg) or did not achieve target BP levels after receiving mono- or dual therapy. Office BP target levels comprised 139 mmHg for sBP and 89 mm Hg for dBP for patients without diabetes mellitus (DM), and 139 mm Hg for sBP and 84 mm Hg for dBP for patients with DM. All patients with stage 2 AH (group 1) were prescribed Vamloset (amlodipine/valsartan, 5/80 mg), patients with stage 3 AH Vamloset (amlodipine/valsartan, 5/160 mg). Therapy correction Vamloset (amlodipine/valsartan) in doses 5/160 mg, 10/160 mg and Co-Vamloset (amlodipine/valsartan/hydrochlorothiazide) in doses 10/160/12,5 mg, 10/160/25 mg (КРКА-RUS) was performed every 4 weeks according to provided schemes. At follow-up every 4 weeks the decision on necessity of antihypertensive treatment (AHT) correction were made by medical researcher in accordance with analysis of patients complaints, general condition and physical examination, results of office BP measurement, diary of BP self-control. In 40 patients in subgroup with additional assessment 24-hour BP monitoring, pulse wave velocity measurement, central BP evaluation, augmentation index calculation, and endothelium damage markers determination were performed.&#x0D; Results. Active phase of the study included 100 patients aged 59.510.9 years (59% female) suffering from AH for 83.48.4 months. The patients received treatment with study medication (safety population). The protocol population (sampling Per Protocol) included 80 patients who completed the study without severe protocol violation. At the moment of study entrance 83% of patients received AHT. In all patients treatment duration comprised 15.9 weeks. In Per Protocol population target office BP level was achieved by 90.0% (95% confidence interval 81.295.6%) of the patients. Overall clinical effectiveness (extremely high, very high, high, and sufficient) was achieved in 98.8% [95% confidence interval 93.2100%] of the patients. In group of patients with stage 2 AH target office BP level was achieved by 93.8% of patients, in group with stage 3 AH by 84.4% of patients. Mean BP change in study group was -32.2 mm Hg for SBP and -16.0 mm Hg for DBP. Among patients with stage 2 AH target office BP level was achieved by 93.8% of patients, with mean BP change -30,7 mm Hg for SBP and -15.5 mm Hg for DBP. In patients with stage 3 AH target BP levels were achieved in 84.4% of patients with mean BP change -34,6 mm Hg for SBP and -16.7 mm Hg for DBP. After 16 weeks of treatment in Full Analysis Set population with recovery of missed measures using Last Observation Carried Forward 40.2% of patients reached target BP levels according to BP self-control results. Considering the limitations of results evaluation this practice requires further assessment, standardization, and improvement. According to 24-hour BP monitoring reaults after 16 weeks of treatment 26.5% of patients achieved target BP daily profile (for patients from subgroup with additional assessment in Full Analysis Set population with recovery of missed measures using Last Observation Carried Forward), that indicates additional influence of studied AHT on the prognosis of patients with stages 23 AH.&#x0D; Conclusion. In clinical study VICTORY II Vamloset and Co-Vamloset optimal effectiveness and safety in patients with stage 2 and 3 arterial hypertension were shown.

Motivational Interviewing for the control of type 2 diabetes mellitus and arterial hypertension

Abstract Background Motivational Interviewing (MI) has been effective in promoting positive changes in various health-related behaviors, including chronic disease management. The main goal of this study was evaluating the effectiveness of this care technology in individual nursing consultations for the control of type 2 Diabetes Mellitus (2DM) and Arterial Hypertension (AH) in primary healthcare. Methods Double-blind, controlled, parallel randomized clinical trial conducted in Porto Alegre, Rio Grande do Sul - Brazil, from June 2018 to July 2019. The study subjects suffered from 2DM with associated diagnosis of AH and were randomized individually to the Test/MI Group and Control Group. The Test Group was subjected to an MI-based nursing consultation intervention with a professional who had been trained for 20 hours, while the Control Group received conventional nursing consultation. The variables were collected in order to measure the main glycated hemoglobin and blood pressure outcomes, and for the secondary adherence outcome. Results After an average follow-up of 6 months, 175 patients completed the study. There was a significant difference between the groups with improvement in the Test/MI group for the outcomes Systolic Blood Pressure - SBP (p &amp;lt; 0.01), Diastolic Blood Pressure - DBP (p &amp;lt; 0.01), Total Adherence Score in Martín-Bayarre-Grau Questionnaire (p = 0.011) and their dimensions 'Treatment compliance' and 'Personal implication' (p = 0.033; p = 0.031). The blood pressure levels of the patients who received the Motivational Interviewing Intervention showed a significant mean reduction of 15.2 mmHg in SBP and 6.4 mmHg in DBP, compared to the control group. The Test group also showed a significant average intragroup reduction of 0.5% in HbA1c at the completion of the study (p &amp;lt; 0.01). Conclusions It is concluded that the MI-based nursing consultation was effective in improving clinical control and adherence in diabetic and hypertensive patients in primary healthcare. Key messages MI-based nursing consultation is effective in reducing pressure and glycemic levels in primary healthcare. The MI improves adherence levels in diabetic and hypertensive patients.

Antidepressant use and orthostatic hypotension in older adults living with mild-to-moderate Alzheimer disease.

Antidepressant use is often reported as a risk factor for Orthostatic Hypotension (OH), however this relationship has never been explored in those with mild/moderate Alzheimer Disease (AD), who may represent a particularly vulnerable cohort. We performed a cross-sectional analysis of baseline data from the NILVAD study. Participants with mild-moderate AD were recruited from 23 centres in nine countries. Systolic and Diastolic Blood Pressure (SBP/DBP) was recorded in the seated position and after both 1 and 5 minutes of standing. OH was defined as a drop of ≥20 mmHg SBP/≥10 mmHg DBP. We examined the relationship between antidepressant use, orthostatic BP drop and the presence of OH, controlling for important covariates. Of 509 participants (72.9 ± 8.3 years, 61.9% female), two-fifths (39.1%; 199/509) were prescribed a regular antidepressant. Antidepressant use was associated with a significantly greater SBP and DBP drop at 5 minutes (β: 1.83, 0.16-3.50, P = .03 for SBP; β: 1.13, 0.02-2.25, P < .05 for DBP). Selective Serotonin Reuptake Inhibitor (SSRI) use was associated with a significantly greater likelihood of OH (OR 2.0, 1.1-3.6, P = .02). Both findings persisted following robust covariate adjustment. In older adults with AD, antidepressants were associated with a significantly greater SBP/DBP drop at 5 minutes. SSRI use in particular may be a risk factor for OH. This emphasises the need to screen older antidepressant users, and particularly those with AD, for ongoing orthostatic symptoms in order to reduce the risk of falls in this vulnerable cohort.

Birth weight is inversely correlated with blood pressure: population-based study.

The current representative national cross-sectional study examines the association of birth weight and blood pressure (BP) among the adult Australian population.Questions about birth weight were added to the second round of AusDiab study. Hypertension was defined based on WHO (≥140/90), and NCEP-ATPIII (≥130/85). Both definitions were examined against the continuous birth weight and dichotomous variable of low birth weight (LBW); less than 2.5 kg, adjusting for age, BMI, physical activity, smoking, alcohol intake and socioeconomic factors. A total of 4502 respondents reported their birth weights with a mean (SD) of 3.37 (0.7) kg. Females with LBW had significantly higher mean SBP and DBP than those with normal birth weight. This relationship persisted with adjustments for various confounding factors. Males with LBW showed a trend towards a higher SBP and DBP, though NS, than normal birth weight more than 2.5 kg. LBW individuals, less than 2.5 kg were at higher risk for having high SBP hypertension at least 140/90 mmHg and at least 130/85 mmHg compared with those with normal birth weight. Among females, for each kilogramme of birth weight, there was a predicted decrease of 1.59 (0.7, 2.5) mmHg in SBP, P = 0.001 and 0.85 (0.2, 1.5) mmHg in DBP, P = 0.001; after adjustments for age, body size, physical activity, smoking status, alcohol intake and socioeconomic factors. Among males, for each kilogramme of birth weight, there was a decrease of 1.74 (0.7, 2.8) mmHg in SBP, P = 0.002 and 1.06 (0.3, 1.9) mmHg in DBP, P = 0.008 after adjustments for all confounding factor. This study has examined the association of birth weight and BP in a representative adult population. LBW was significantly associated with the risk of developing high BP.

Unobtrusive Blood Pressure Estimation using Personalized Autoregressive Models.

Cuffless and continuous blood pressure (BP) measurement using wearable devices is of great clinical value and health monitoring importance. Pulse arrival time (PAT) based technique was considered as one of the most promising methods for this purpose. Considering the dynamic and nonlinear relationship between BP, PAT and other cardiovascular variables, this paper proposes for the first time to use nonlinear autoregressive models with extra inputs (ARX) for BP estimation. The models were first trained by the baseline data of all 25 subjects to determine the model structure and then trained by individual data to obtain the personalized model parameters. To assess the effects of the dynamic and nonlinear factors, the data during water drinking and the first 5 minutes of recovery after drinking were used to validate the four models: linear regression, linear ARX, nonlinear regression and nonlinear ARX. The reference BP, which were measured by Finometer, were increased by 36.7±10.5 mmHg for SBP and 28.4 ±7.7 mmHg for DBP. This BP changes were best modelled by the nonlinear ARX, with Mean ± SD differences of 5.6 ± 8.8 mmHg for SBP and 3.8 ±5.8 mmHg for DBP. The study also showed that nonlinear factor significantly reduced the root mean square error (RSME) by about 50%, i.e., from 20.4 to 10.7 mmHg for SBP and 13.3 to 7.3 mmHg for DBP during drinking. While the effects of dynamic factors were not as significant as nonlinear factors, especially after introducing nonlinear factors.

CHANGES OF COGNITIVE FUNCTION IN PATIENTS WITH HYPERTENSION WITH CONCOMITANT DIABETES MELLITUS TYPE 2

Relevance. Till now there is no clear clinical trial understanding of the relationship between hypertension (AH) and the patient's cognitive function.&#x0D; Objective: the investigation of changes in cognitive function in patients with hypertension with concomitant type 2 diabetes mellitus (DM2).&#x0D; Materials and methods. 215 people were examined: Group I (n = 131) – stage II hypertensive disease (HD); Group II (n = 46) – HD, combined with diabetes mellitus2; Group III, control (n = 38) – without a diagnosis of HD and diabetes mellitus2. All examined blood pressure (BP), echocardiogram. Clinical complaints, anamnestic data, and neuropsychiatric testing data were used to diagnose moderate cognitive impairment (MCI). Used modified diagnostic criteria J. Touchon, R. Petersen. To assess cognitive function used: Short scale of assessment of mental state (Mini-Mental State Examination - MMSE); Frontal Assessment Battery (FAB); clock drawing test; test for literal and categorical associations; Schulte tables; the Global Deterioration Scale (GDS) and the Clinical Dementia Rating (CDR).&#x0D; Result. In patients with HD, the most significant risk factors for moderate cognitive impairment are hypercholesterolemia and overweight (with OR 1.8), obesity (OR 1.6), the presence of concomitant diabetes mellitus2, which, especially in overweight, significantly impairs cognitive function ( OR 2.56). Deterioration of cognitive function correlates with the duration of HD, cholesterol levels. Concomitant diabetes mellitus2 in patients with HD creates a statistically significant additional negative effect on the results of cognitive function. In patients with HD with a distorted daily blood pressure profile, the neurodynamic component of cognitive function is first of all affected - conceptualization, repetition, the reaction of choice. The relationship between cognitive function and daily monitoring of blood pressure often have a U-shaped relationship, where the maximum indicators of cognitive function are at the level of the optimal recommended blood pressure figures (130-139 mm Hg for SBP, and 75-85 mm Hg for DBP, and the daily index within 10%).&#x0D; Conclusions. There is a dependence on changes in cognitive function on the presence of risk factors and signs of subclinical damage to target organs. The nonlinear U-shaped character of the relationship between the average daily, average night, and average daily blood pressure and the results of screening tests and scales for assessing cognitive function are shown.

Active gingival inflammation is linked to hypertension.

Cardiovascular diseases (CVD) including hypertension, are characterized by underlying systemic inflammation. Periodontitis, which can impact the systemic inflammatory burden has recently been linked to high blood pressure (BP). However, the relationship of gingival bleeding, as an easily accessible marker of periodontal disorder, with hypertension, remains unclear. Survey-based propensity score matching (PSM) incorporating major confounders shared between hypertension and periodontal diseases was applied to cross-sectional NHANES III data from 5396 adults at least 30 years old who underwent BP measurement and periodontal examination, identifying two matched groups with and without gingival bleeding. The association of bleeding gums with SBP (mmHg) and high/uncontrolled BP was then assessed with generalized additive models incorporating inflammatory markers. Stratification by periodontal status (healthy; gingivitis; stable periodontitis; unstable periodontitis) was performed. Variables importance was estimated using machine learning. Gingival bleeding (gingivitis; unstable periodontitis) was independently associated with +2.6 mmHg (P < 0.001) SBP compared with no bleeding (healthy periodontium; stable periodontitis), and with greater odds (OR = 1.42; 95% CI = 1.19-1.68; P < 0.001) of high/uncontrolled BP. Participants with unstable periodontitis had higher SBP than those with stable periodontitis (+2.1 mmHg; P < 0.001) or gingivitis (+5.3 mmHg; P < 0.001). Unstable periodontitis and gingivitis were consistently associated with increased risk of high/uncontrolled BP (OR = 1.65, 95% CI = 2.14-1.82; OR = 1.49, 95% CI = 1.22-1.82, respectively). Inflammatory markers allowed a maximum of 12% gain in the models' predictive power. Gingival bleeding contributes to shaping the relationship between periodontal diseases and BP, but the burden represented by periodontitis is also crucial. Periodontal evaluation might be of importance in difficult to control hypertension.

Use of fixed double and triple combinations in achievement of target level of ambulatory blood pressure in patients with arterial hypertension

The objective of the research - to evaluate the therapeutic efficacy of the generic combination (a fixed triple combination of valsartan / amlodipine / hydrochlorothiazide compared with a double fixed combination of valsartan / amlodipine) in the treatment of patients with arterial hypertension II-III degree. The objectives of the study were: to study the therapeutic efficacy on ambulatory BP of a fixed triple and double combination in the treatment of arterial hypertension.Material and methods. The study included 50 patients with 2-3 grade hypertension. The office measurement of BP, ABMP, biochemical blood tests before and after 3 months fixed combination therapy val/aml or val/aml/HTZ. The study included patients with moderate and severe arterial hypertension without diabetes. Patients were divided into 2 groups. The first group (n = 25) received fixed triple combination of 160 mg valsartan / 5 mg amlodipine / 12.5 mg hydrochlorothiazide once daily, in the morning for 1 month. Patients in the second group (n = 25) received a double fixed combination of 160 mg valsartan / 5 mg amlodipine once a day, in the morning for 1 month. When necessary, if there was no achievement of the target level of office blood pressure &lt;140/90 mm Hg, the dose was titrated to a daily dose of 320/10 / 12.5 mg (valsartan / amlodipine / hydrochlorothiazide) on a fixed triple combination and up to 320/10 mg (valsartan / amlodipine) on a fixed double combination. After three months of treatment, therapy was monitored.Results. The average age of patients was 54.9 ± 1.8 (25-75) years. The average BMI was 31.2 ± 0.7 kg / m2. The average of office SBP and DBP at the beginning of the study were 161.7 ± 1.8 mm Hg and 98.5 ± 1.4 mmHg. The average office heart rate was 70.7 ± 1.4 beats / min. The mean 24 blood pressure monitoring was 143.8 ± 1.1 mm Hg for SBP and 92.4 ± 1.2 mm Hg for DBP. The average daily heart rate was 71.5 ± 1.5 beats / min. The decrease in average 24BP was 18.0 / 16.1 mm Hg (p &lt; 0,05) on double combination (val/aml) and 23,8 / 20,7 mm Hg (p &lt; 0,05) on the triple combination (val/aml/HTZ). The decrease mean day time blood pressure was 19.4 / 17.8 mm Hg (p &lt; 0,05) on double (val/aml) and 17,8 / 22,6 mm Hg (p &lt; 0,05) on the triple combination (val/aml/HTZ). Decrease mean nocturnal blood pressure were 17.0 / 12.1 mm Hg. (p &lt; 0,05) on double (val/aml) and 20,5 / 18,2 mm Hg (p &lt; 0,05) on the triple (val/aml/ HTZ) combination. Achievement of target BP at ABPM was 77.3% - in the double (val/aml) combination and 95.2% in the triple (val/aml/HTZ) combination.Conclusions. The triple fixed combination (val/aml/HTZ) was more effective in reducing blood pressure with daily monitoring compared to a double fixed (val/ aml) combination which was not accompanied by an increase in side effects.

Validation of the Rossmax AC1000f upper-arm blood pressure monitor in adults according to the British Hypertension Society Protocol.

To evaluate the accuracy of the Rossmax AC1000f oscillometric upper-arm blood pressure monitor in adults according to the British Hypertension Society Protocol. Eighty-five subjects (male 42 and female 43) with a mean age of 48.1 years were recruited to fulfill the blood pressure distribution criteria of the British Hypertension Society Protocol in general population using the same arm sequential blood pressure measurement method. For each subject, we sequentially measured blood pressure using a mercury sphygmomanometer (two observers) and the AC1000f device (one supervisor). Data analysis was carried out according to the British Hypertension Society Protocol. A total of 255 comparison pairs were obtained for analysis. The device achieved grade A. The percentage of blood pressure differences within 5, 10 and 15 mmHg was 66.7, 92.2 and 98.0%, respectively, for SBP, and 64.7, 90.2 and 98.4%, respectively, for DBP. The average (±SD) of the device-observer differences was -0.5 ± 6.0 mmHg for SBP and -1.4 ± 5.9 mmHg for DBP, respectively. The automated upper-arm blood pressure monitor Rossmax AC1000f has passed the requirements of the British Hypertension Society Protocol, and hence can be recommended for blood pressure measurement in adults.

Investigation on the effect of Womersley number, ECG and PPG features for cuff less blood pressure estimation using machine learning

ObjectiveRegulation and inhibition of high blood pressure, known as hypertension are intricate, and it demands a continuous, accurate blood pressure measurement system. All the existing continuous non-invasive techniques own challenges such as exact placement of the sensor, reconstruction of arterial pressure from finger cuff, frequent and subject based calibration. This paper presents an algorithm based on new time-domain features for continuous blood pressure monitoring which is crucial in intensive care units and can be used to predict cardiovascular ailments. MethodsHere, we propose the method to estimate BP that extracts informative features like Womersley number (α), QRS, QTc interval, SDI from ECG and PPG signals and regression techniques which are employed to estimate blood pressure continuously. Performance metrics like MAE, RMSE, r, bias & 95% CI are considered to validate the proposed method. To explore the relevance of proposed physiological features with the blood pressure, genetic algorithm(GA) with the random forest model is employed. ResultsSignificant features like alpha, QRS complex, QT interval, SDI, heart rate are acquired. The best optimal feature set from GA reduced the MAE from 13.20 to 9.54 mmHg, 9.91 to 5.48 mmHg, 7.71 to 3.37 mmHg for SBP, DBP and MBP respectively. ConclusionModel build with ECG and PPG time-domain features outperform the model trained with PPG features alone. Results obtained from GA validates the significance of ECG features correlation with BP. SignificanceIdentifying the associations of ECG features with BP helps in selecting relevant features which minimize the computational cost as well as errors in the assessment of BP.

Functional health and white matter hyperintensities as effect modifiers of blood pressure-lowering on cognitive function and vascular events in older Secondary Prevention of Small Subcortical Strokes trial participants.

To determine whether cerebral small vessel disease or disability modify the effect of SBP treatment on cognitive and vascular outcomes in older patients with recent lacunar stroke. Participants aged at least 65 years of the Secondary Prevention of Small Subcortical Strokes Trial were randomized to a higher (130-149 mmHg) or lower (<130 mmHg) SBP target. The primary outcome was change in cognitive function (Cognitive Abilities Screening Instrument); secondary outcomes were incident mild cognitive impairment, stroke, major vascular events (all-stroke, myocardial infarction), and all-cause death. Results were stratified by severity of white matter hyperintensities (WMH; none/mild, moderate, severe) on baseline MRI, and by disability (no vs. at least one limitation in activities of daily living). One thousand, two hundred and sixty-three participants (mean age 73.8 ± 5.9 years, 40% women) were included. Participants with severe WMH or disability had worse cognitive function at baseline and after a mean follow-up of 3.9 years. No significant interactions existed between treatment group and effect modifiers (WMH, disability) for change in cognitive function (P for interaction 0.42 and 0.66, respectively). A lower SBP target appeared more beneficial among those with worse WMH burden for vascular outcomes (P for interaction = 0.01 for stroke and 0.03 for major vascular events). There was no difference in the effect of lowering SBP to less than 130 mmHg on cognitive function by cerebral small vessel disease or disability among older adults with a history of lacunar stroke. Those with evidence of small vessel disease may derive greater benefit from lower SBP on prevention of subsequent vascular events. Clinicaltrials.gov Identifier: NCT00059306.

The association of outdoor temperature with blood pressure, and its influence on future cardio-cerebrovascular disease risk in cold areas.

To explore whether lower outdoor temperature increases cardio-cerebrovascular disease risk through regulating blood pressure and whether indoor heating in winter is beneficial to prevent cardio-cerebrovascular disease in cold areas. We analyzed the data of 38 589 participants in Harbin from the China Kadoorie Biobank (CKB) during 2004-2008, with an average of 7.14-year follow-up. Linear regression analysis was performed to estimate the relationship between outdoor temperature and blood pressure. Cox regression analysis and logistic regression analysis were used to analyze the association of blood pressure with cardio-cerebrovascular event risk. Mediation analysis was performed to explore the role of blood pressure in the association between outdoor temperature and cardio-cerebrovascular events risk. There was an increase of 6.7 mmHg in SBP and 2.1 mmHg in DBP for each 10 °C decrease in outdoor temperature when outdoor temperature was higher than 5 °C. There was an inverse association between outdoor temperature and cardio-cerebrovascular event morbidity. The increases in blood pressure and cardio-cerebrovascular event morbidity were attenuated in months when central heating was fully provided. Participants with hypertension have higher risks of cardio-cerebrovascular disease (hazard ratio 1.347; 95% CI 1.281--1.415), CVD (hazard ratio 1.347; 95% CI 1.282--1.416), MACE (hazard ratio 1.670; 95% CI 1.560--1.788) and stroke (hazard ratio 1.683; 95% CI 1.571--1.803). Mediation analysis demonstrated that the association between outdoor temperature and cardio-cerebrovascular events risk was potentially mediated by blood pressure. Temperature-driven blood pressure potentially mediates the association between outdoor temperature and cardio-cerebrovascular events risk. Indoor heating in winter is probably beneficial to cardio-cerebrovascular disease prevention by inhibition of blood pressure increase.

Association of fried food intake with prehypertension and hypertension: the Filipino women's diet and health study.

BACKGROUND/OBJECTIVESFew epidemiological studies examined the association between fried food intake and hypertension. This study examined whether fried food intake was associated with higher prevalence of prehypertension and hypertension combined in a cross-sectional study of the Filipino Women's Diet and Health Study (FiLWHEL).SUBJECTS/METHODSThis study included a total of 428 women aged 20–57 years who have ever been married to Korean men. Prehypertension was defined as 120 - < 140 mmHg of SBP or 80 - < 90 mmHg of DBP and hypertension as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. Fried food intake was assessed using one-day 24-hour recall. Fried foods were categorized into total, deep/shallow and pan/stir fried foods. The odds ratio (OR)s and 95% confidence interval (CI)s were calculated using multivariate logistic regression.RESULTSThe prevalence of prehypertension and hypertension combined was 41.36% in this population. High fried food intake was associated with high prevalence of prehypertension and hypertension combined. The odds of having prehypertension and hypertension was higher in the 3rd tertile of fried food intake among fried food consumers compared to non-fried food consumers (OR = 2.46, 95% CI = 1.24, 4.87; P for trend = 0.004). Separate analysis for types of frying showed that deep and shallow fried food intake was associated with prevalence of prehypertension and hypertension combined for comparing the 3rd tertile vs. non-fried food consumers (OR = 2.93; 95% CI = 1.57-5.47; P for trend = < 0.001).CONCLUSIONSThis study showed the evidence that high fried food intake was significantly associated with high prevalence of prehypertension and hypertension combined among Filipino women married to Korean men.

Clinical and molecular evidence of accelerated ageing following very preterm birth.

The mechanisms responsible for the associations between very preterm birth and a higher risk of poor cardiovascular and metabolic health in adult life are unknown. Here, we compare the clinical and molecular phenotypes of healthy, normal-weight young adults (18-27 years), born very preterm (<33 weeks gestational age (GA)) and at full-term (37-42 weeks GA). Outcomes included whole-body MRI, hepatic and muscle 1H MRS, blood pressure measurements and telomere length. We recruited 156 volunteers, 69 preterm (45 women; 24 men) and 87 born at full-term (45 women; 42 men). Preterm individuals had a significantly altered blood pressure profile, including higher systolic blood pressure (SBP mmHg: preterm men 133.4 ± 10.1, term men 23.0 ± 6.9; preterm women 124.3 ± 7.1, term women 118.4 ± 8.0, p < 0.01 for all). Furthermore, preterm men had fewer long telomeres (145-48.5 kb: preterm men 14.1 ± 0.9%, term men 17.8 ± 1.1%, p < 0.05; 48.5-8.6 kb: preterm men 28.2 ± 2.6, term men 37.0 ± 2.4%, p < 0.001) and a higher proportion of shorter telomeres (4.2-1.3 kb: preterm men 40.4 ± 3.5%, term men 29.9 ± 3.2%, p < 0.01). Our data indicate that healthy young adults born very preterm manifest clinical and molecular evidence of accelerated ageing.

Optimal Design of a New Strain-Type Sensor for Cuff-Less Blood Pressure Measurement via Finite Element Modeling and Taguchi Method

A new cuff-less blood pressure (BP) sensor is designed and optimized in this paper. This BP sensor is in a shape of a circular disc of polymer enclosing an electrode. As the sensor is attached to the wrist artery, the dynamic bending of the sensor due to small artery pulsation induces variation in the electrode strain, and then, its resistance varies. With adequate amplification to sense resistance variation, the pulsation signals can be successfully obtained. With the measured pulsation representing well the blood volume pulsation (BVP), BP can be estimated next via the pulse wave velocity (PWV) theory. Effort is dedicated by this paper to optimize the sizes and geometry of the proposed sensor to maximize the electrode curvature change for largest measured signal-to-noise ratio (SNR) possible, which maximizes the accuracy of BP estimation. To this end, the optimization via the finite element modeling and the Taguchi method is carried out. In results, the optimal sizes in height/radius, fillet, hardness, and the electrode position of the polymer disc are successfully derived, which are in the height of 2 mm, the radius of 6mm, the distance between the planar electrode and the bottom surface of sensor being 1 mm, the hardness of the encapsulating polymer being 25 in shore A hardness, and the fillets at the bottom of the polymer disc being 1 mm in radii. BP is measured for 59 subjects. The resulted errors are 3.60 ± 5.40 mmHg (mean difference ± standard deviation) and 1.15 ± 1.63 mmHg for SBP and DBP, respectively. The correlations are 0.8787 and 0.9648, demonstrating well the favorable performance of the developed sensor.

Nimodipine-Induced Blood Pressure Changes Can Predict Delayed Cerebral Ischemia.

Background: Early diagnosis of delayed cerebral ischemia (DCI) in patients after aneurysmal subarachnoid hemorrhage (aSAH) still poses a leading problem in neurointensive care. The aim of this study was to analyze the effect of oral Nimodipine administration on systemic blood pressure in patients with evolving DCI compared to patients without DCI.Methods: Systolic (SBP), mean (MAP), and diastolic (DBP) blood pressures were analyzed at the time of Nimodipine administration and additionally 30, 60, and 120 min thereafter on days 1, 3, and 5 after aSAH. Additionally, the 24 h period preceding DCI and in patients without DCI day 10 after aSAH were analyzed. Statistical analysis was performed for SBP, MAP and DBP at time of Nimodipine administration and for the maximal drop in blood pressure after Nimodipine administration.Results: Thirty patients with aSAH were retrospectively analyzed with 17 patients developing DCI (“DCI”) and 13 patients who did not (“Non-DCI”). DCI patients showed a more pronounced rise in MAP and DBP over the examined time period as well as a higher decrease in SBP following Nimodipine administration. A fall of 18 mmHg in SBP after Nimodipine administration showed a sensitivity of 82.4% and specificity of 92.3% for occurrence of DCI.Conclusion: An increase of MAP and DBP after aSAH and a heightened sensitivity to Nimodipine administrations may serve as additional biomarkers for early detection of evolving DCI.

P2622Use of intravenous vasodilators in patients hospitalized with acute heart failure: insights from Tokyo cardiovascular care unit network database

Abstract Background Despite recommendations from clinical practice guidelines, there is scant evidence confirming the effects of vasodilators on clinical outcomes in patients with acute heart failure (AHF). Purpose We sought to investigate the effects of intravenous vasodilators on clinical outcomes and to identify the potential patient populations that would benefit from its use. Methods Data of 26 212 consecutive patients urgently hospitalized for AHF between 2009 and 2015 were extracted from a multicenter data registration system (Tokyo Cardiovascular Care Unit Network Database, including 72 institutions within the Tokyo metropolitan area in Japan). Patients who did not present with typical AHF episodes, including those without pulmonary congestion on physical and/or chest X-ray and serum B-type natriuretic peptide level &lt;500 pg/ml, as well as those who had hypotension and/or hypoperfusion (systolic blood pressure [SBP] &lt;100 mmHg) as dominant presentation, were excluded. Propensity scores were calculated with multiple imputation and 1:1 matching performed between patients with and without vasodilators. The primary endpoint was in-hospital mortality and the secondary endpoints were length of intensive/cardiovascular care unit (ICU/CCU) stay and hospital stay. Results Overall, 8 863 patients were included in the present analysis; they were predominantly male (57%) with a median age of 79 (interquartile range: 70–86) years. Compared with the group without vasodilator use, the vasodilator group had higher SBPs and heart rates and higher frequency of assisted ventilation use, but lower frequency of intravenous diuretics use. After propensity score matching, there were no significant differences in in-hospital mortality rates (7.8% vs. 8.9% in patients without vasodilators, p=0.16) or in length of ICU/CCU stay (5.8 days vs. 5.4 days, p=0.44) and hospital stay (22.7 days vs. 23.8 days, p=0.22) between the groups. However, in subgroup analyses, favorable impacts of vasodilator use on in-hospital mortality were observed among patients who had higher SBPs and among those who had no atrial fibrillation upon admission (Figure). In addition, vasodilators were likely to be more effective in AHF patients with SBP increasing; while levels below 140 mmHg of SBP appeared to be associated with an increased risk for mortality among patients treated with vasodilators compared with those without vasodilators. Figure 1 Conclusions In patients with AHF, vasodilator use was not universally associated with improved in-hospital outcomes; however, its effect was dependent of individual clinical presentation. Detailed phenotyping might aid tailoring of treatment strategies for patients with AHF. Acknowledgement/Funding the Tokyo Metropolitan Government