mmHg For SBP Research Articles

Periodontitis is associated with hypertension: a systematic review and meta-analysis.

Recent evidence suggests a link between periodontitis (PD) and hypertension, but the nature of this association remains unclear. The overall aim of this review was to critically appraise the evidence linking these two common disorders. Systematic search was conducted for studies published up to December 2018. Prevalence of hypertension in patients with PD (moderate/severe groups) vs. those without PD (non-PD) was the primary outcome. Additional outcomes included adjusted mean difference in systolic (SBP) and diastolic (DBP) blood pressure (BP) levels in PD vs. non-PD, assessment of biomarkers in PD and hypertension, and BP changes after periodontal therapy. From 81 studies selected, 40 were included in quantitative meta-analyses. Diagnoses of moderate-severe PD [odds ratio (OR) = 1.22; 95% confidence interval (CI): 1.10-1.35] and severe PD (OR = 1.49; 95% CI: 1.09-2.05) were associated with hypertension. Prospective studies confirmed PD diagnosis increased likelihood of hypertension occurrence (OR = 1.68; 95% CI: 0.85-3.35). Patients with PD exhibited higher mean SBP [weighted mean difference (WMD) of 4.49 mmHg; 95% CI: 2.88-6.11] and DBP (2.03 mmHg; 95% CI: 1.25-2.81) when compared with non-PD. Lastly, only 5 out of 12 interventional studies confirmed a reduction in BP following periodontal therapy, ranging from 3 to 12.5 mmHg of SBP and from 0 to 10 mmHg of DBP. PD is associated with increased odds of hypertension (SORT C) and higher SBP/DBP levels. The evidence suggesting that PD therapy could reduce BP is inconclusive. Although additional research is warranted on this association, these results suggest that oral health assessment and management of PD could not only improve oral/overall health and quality of life but also be of relevance in the management of patients with hypertension.

Reproducibility of the European Society of Hypertension - International Protocol for validation of blood pressure measuring devices in obese patients.

Electronic devices for blood pressure (BP) measurements need to go through independent clinical validation as recommended by different authorities, both in general and special populations. Reproducibility of such validation protocols is unknown. The aim of this study was to assess the inter-centre reproducibility of the European Society of Hypertension-International protocol (ESH-IP) in patients with large arm circumference at least 32 cm or obesity. Two independent validation studies were performed in parallel according to the ESH-IP protocol in two centres (Serbia and Armenia). The two studies were performed blindly and independently. The ESH-IP criteria were applied for the analysis. The OMRON RS7 wrist oscillometric devices were used in both studies. The distribution of the mean differences values of 5 or less, 10 or less and 15 mmHg or less between the observers and the device were for the Serbia team: 74, 95 and 98 for SBP and 78, 95 and 99 for DBP; and for the Armenia team: 86, 95 and 99 for SBP and 90, 99 and 99 for DBP. The mean differences (SD) of BP values between the observers and the device were for the Serbia team of 1.7 ± 4.8 mmHg for SBP and 1.2 ± 4.6 mmHg for DBP and for the Armenia team of -1.1 ± 4.2 mmHg for SBP and -0.3 ± 3.5 mmHg for DBP. This study showed that the ESH-IP validation protocol presents a good inter-centre reproducibility. The OMRON RS7 device showed similar results, fulfilling the validation criteria in two independent studies in patients with arm circumference at least 32 cm.

Interrelationships between pulse arrival time and arterial blood pressure during postural transitions before and after spaceflight.

We tested the hypothesis that acute changes in arterial blood pressure (BP) when astronauts moved between supine and standing posture before and after spaceflight can be tracked by beat-to-beat changes in pulse arrival time (PAT). Nine male crewmembers (45 ± 7 yr of age; mean mission length: 165 ± 13 days) participated in a standardized supine-to-sit-to-stand test (5 min-30 s-3 min) before flight and 1 day following return to Earth with continuous monitoring of ECG and finger arterial BP. PAT was determined from the R-wave of the ECG to the foot of the BP waveform. On average, modest cardiovascular deconditioning was detected by ~10 beats/min increase in heart rate in supine and standing posture after spaceflight (P < 0.05). When looking across the full data collection period, the r2 values between inverse of PAT (1/PAT) and systolic (SBP) and diastolic BP (DBP) varied considerably between individuals (SBP preflight 0.142 ± 0.186, postflight 0.262 ± 0.243). Individual variability was consistent during periods of transition (SBP preflight 0.284 ± 0.324, postflight 0.297 ± 0.269); however, when SBP dropped >20 mmHg, r2 was significant in 5 of 5 preflight tests and 5 of 7 postflight tests. The standard error of the estimate based on a simple linear model during both pre- and postflight testing was 9-11 mmHg for SBP and 6-7 mmHg for DBP. Overall, the results support the hypothesis that PAT tracked dynamic changes in BP. PAT as a noninvasive, nonintrusive surrogate for changes in BP could be developed as an indicator of risk for syncope on return from spaceflight or other Earth-based applications.NEW & NOTEWORTHY Astronauts returning to Earth's gravity are at increased risk of low blood pressure on standing. Arterial pulse arrival time tracked the decrease in arterial blood pressure on moving from supine to upright posture. Nonintrusive technology providing indicators sensitive to acute changes in blood pressure could act as an early warning system to identify risk for hypotension that place astronauts, or people on Earth, at risk of impaired cognitive performance, fainting, and falls.

The accuracy of blood pressure measurement by a smartwatch and a portable health device

ABSTRACTObjectives: Handheld medical devices and smartwatches that measure BP without a cuff have recently become available. Since these measurements are relatively more user-friendly than conventional cuff-based measurements they may aid in more frequent BP monitoring. We investigated the accuracy and precision of two popular cuff-less devices: the Everlast smartwatch and the BodiMetrics Performance Monitor.Methods: We enrolled 127 patients from the Thomas Jefferson University Hospital Preadmission Testing Center. Research staff were trained to measure BP according to manufacturer guidelines for the investigational devices. The Everlast smartwatch provides measurements of systolic (SBP) and diastolic (DBP) BP, whereas the Bodimetrics only provides SBP. Reference BP measurements were obtained using a hospital-grade automated sphygmomanometer. After 5 minutes of quiet sitting, four standard and three investigational BP measurements were taken with sixty seconds in between each measurement. The reference BP value was calculated by determining the average of the 2 standard BP measurements that bounded the investigational measurements. We thus determined 3 comparison pairs for each investigational device in each subject. We calculated the mean (SD) of the absolute difference between the respective investigational devices and the reference for SBP and DBP.Results: Data from 42 individuals was excluded because of variation in standard BP measurements per prespecified rules. Of 85 participants used for analysis, 36 (42%) were women, the mean (SD) age was 53 (21) years, 32 (38%) self-reported hypertension, and 97% of these (n = 31) reported taking antihypertensive medications. The average differences between the Everlast watch and reference were 16.9 (13.5) mm Hg for SBP and 8.3 (6.1) mm Hg for DBP. The average difference between the Bodimetrics performance monitor and the reference was 5.3 (4.7) mm Hg for SBP.Conclusions: The Everlast smartwatch and the BodiMetrics Performance Monitor we tested are not accurate enough to be used as BP measurement devices.

M-HEALTH IN PATIENTS WITH UNCONTROLLED HYPERTENSION

Objective: Hypertension (HTN) has multiple combinations of stages and risk profiles affecting treatment efficacy. Handy m-Health tools are to be a valuable adjunct to conventional care. The aim was to determine the effect of m-Health intervention in patients with essential uncontrolled HTN with response to its stage and related cardiovascular (CVD) risk profile. Design and method: Study enlisted 64 patients (44 males, mean age 50 ± 16 y.o.) with essential HTN, office and home blood pressure (BP) above target for 3 previous months. A non-blind design was expected and all patients consecutively underwent teleBP monitoring and distant counseling using safe and simple m-Health app integrated into local medical information system. Follow-up for 6 months with treatment effect calculation respectively to HTN stage and CVD risk profile according to the latest practice Guidelines (Group 1: stage 1 HTN and low-to-moderate risk; Group 2: stages 2–3 HTN and high-to-very high risk). Results: Total of 60 patients has completed follow-up (42 males, 48 ± 14 y.o., 5 with Grade 3, 22 - Grade 2 and 33 - Grade 1 HTN; mean office BP 156 ± 15.4 mmHg). Of all individuals 8 were with stage 3 HTN (mostly due to HFpEF and AFib, very-high risk), 22 patients with stage 2 HTN (mostly due to hypertensive LVH, high risk) and 30 - uncomplicated stage 1 HTN (low-to-moderate risk), therefore Group 1 and 2 consisted of 30 patients each. Patients in Group 2 were older (56 ± 15.6 vs 42.2 ± 12.7 y.o., p < 0.001), with longer history of HTN (10.3 ± 5.1 vs 3.5 ± 1.4 years, p < 0.0001). The overall effect of m-Health was –22 ± 12,4 mmHg for SBP and –13,6 ± 10,8 mmHg for DBP) and 63% (n = 38) of patients were in target range at 6 months. Patients in Group 1 were more likely to have their BP controlled at the end of the study (n = 24 in Group 1 and n = 14 in Group 2, OR 4.57, [95%CI, 1.45 - 14.4]). Conclusions: m-Health intervention is associated with remarkable improvement in blood pressure at 6 months. The effect is more pronounced in younger patients with uncomplicated short-term HTN and of low-to-moderate CVD risk.

Relationship between Nutrition and Alcohol Consumption with Blood Pressure: The ESTEBAN Survey.

Background: Dietary interventions are recommended for the prevention of hypertension. The aim of this study was to evaluate and quantify the relationship between alcohol consumption and the DASH (Dietary Approaches to Stop Hypertension) score with blood pressure (BP) stratified by gender. Methods: Cross-sectional analyses were performed using data from 2105 adults from the ESTEBAN survey, a representative sample of the French population. Pearson correlation analyses were used to assess the correlation between the DASH score and alcohol with BP. Regressions were adjusted by age, treatment, socio-economic level, tobacco, exercise, Body mass index (BMI), and cardiovascular risk factors and diseases. Results: The DASH score was negatively correlated with systolic (SBP) and diastolic BP (DBP) (p < 0.0001). Alcohol was positively associated with increased BP only in men. The worst quintile of the DASH score was associated with an 1.8 mmHg increase in SBP and an 0.6 mmHg increase in SBP compared to the greatest quintile in men and with a 1.5 mmHg increase in SBP and an 0.4 mmHg increase in SBP in women. Male participants in the worst quintile of alcohol consumption showed an increase of 3.0 mmHg in SBP and 0.8 mmHg in DBP compared to those in the greatest quintile. Conclusion: A high DASH score and a reduction in alcohol consumption could be effective nutritional strategies for the prevention of hypertension.

An Unobtrusive and Calibration-free Blood Pressure Estimation Method using Photoplethysmography and Biometrics

We introduce a novel paradigm to unobtrusively and optically measure blood pressure (BP) without calibration. The algorithm combines photoplethysmography (PPG) waveform analysis and biometrics to estimate BP, and was evaluated in subjects with various age, height, weight and BP levels (n = 1249). In the young population (<50 years old) with low, medium and high systolic blood pressures (SBP, <120 mmHg; 120–139 mmHg; ≥140 mmHg), the fitting errors are 6.3 ± 7.2, −3.9 ± 7.2 and −20.2 ± 14.2 mmHg for SBP respectively; In the older population (>50 years old) with the same categories, the fitting errors are 12.8 ± 9.0, 0.5 ± 8.2 and −14.6 ± 11.5 mmHg for SBP respectively. A simple personalized calibration reduces fitting errors significantly (n = 147), and good peripheral perfusion helps to improve the fitting accuracy. In conclusion, PPG may be used to calculate BP without calibration in certain populations. When calibrated, it shows great potential to serially monitor BP fluctuation, which can bring tremendous economic and health benefits.

A novel deep learning based automatic auscultatory method to measure blood pressure

BackgroundIt is clinically important to develop innovative techniques that can accurately measure blood pressures (BP) automatically. ObjectivesThis study aimed to present and evaluate a novel automatic BP measurement method based on deep learning method, and to confirm the effects on measured BPs of the position and contact pressure of stethoscope. Methods30 healthy subjects were recruited. 9 BP measurements (from three different stethoscope contact pressures and three repeats) were performed on each subject. The convolutional neural network (CNN) was designed and trained to identify the Korotkoff sounds at a beat-by-beat level. Next, a mapping algorithm was developed to relate the identified Korotkoff beats to the corresponding cuff pressures for systolic and diastolic BP (SBP and DBP) determinations. Its performance was evaluated by investigating the effects of the position and contact pressure of stethoscope on measured BPs in comparison with reference manual auscultatory method. ResultsThe overall measurement errors of the proposed method were 1.4 ± 2.4 mmHg for SBP and 3.3 ± 2.9 mmHg for DBP from all the measurements. In addition, the method demonstrated that there were small SBP differences between the 2 stethoscope positions, respectively at the 3 stethoscope contact pressures, and that DBP from the stethoscope under the cuff was significantly lower than that from outside the cuff by 2.0 mmHg (P < 0.01). ConclusionOur findings suggested that the deep learning based method was an effective technique to measure BP, and could be developed further to replace the current oscillometric based automatic blood pressure measurement method.

Effect of one‐time successive immersion of the right hand into ice‐cold and warm water on blood pressure in prehypertensives

An early diagnostic and awareness of hypertension are crucial for controlling and prevention from further its development. The dysfunction of the autonomic nervous system (ANS) is a cornerstone of hypertension pathophysiology which underlies the initiation and development of hypertension. The HRV is commonly used for the evaluation of ANS activity. Though physiological/therapeutic effects of hydrotherapy for maintaining health, preventing, and treating the diseases, were well documented, the scientific base of these effects till now remains unclear.The 79 normotensive and 76 prehypertensive men, 102 normotensive and 50 prehypertensive women (117.4±0.6 mm Hg and 135.0±1.0 mm Hg, 111.1±0.6 mm Hg and 126.3±0.8 mm Hg for SBP, respectively) were enrolled from V.N. Karazin Kharkiv National University student population. All of them gave written informed consents.The ECG was continually recorded during the 5‐minutes resting stage and cold‐warm test (CWT): 5‐minutes immersion of the right hand into warm water (37°C) following by 1‐minute immersion of the hand into the ice‐cold water. HR, LnLF and HF HRV power were obtained by digital 2‐channel ECG amplifier (CardioLab 2010, Ukraine). HRV was assessed in the frequency‐domain analysis during the resting and warm‐water stages. SBP and DBP were recorded at the end of the resting and warm‐water stages by means the automatic digital sphygmomanometer (Nissei WS‐1011, Ltd, Japan) and MBP was calculated. Three‐way repeated measure MANOVA was used to compare HR, MBP, LnLF, LnHF HRV power by sex, the presence of prehypertension, and CWT. Two‐way MANOVA was used to analyze the possible effect of sex and prehypertension on cardiovascular and HRV responses to cold‐warm test. Statistical analysis was performed with the SPSS statistical program, version 22.During CWT the HR decreased significantly compared with the resting stage in normotensive and prehypertensive groups (P&lt;0.001 for both), MBP increased in normotensive subjects (P=0.032) while decreased in the prehypertensive group (P&lt;0.001). The LnHF power widely used as an index of cardiovagal activity tended to be increased in normotensive subjects (P=0.054) while the LnLF power indicating, according to our hypothesis, an index of sympathoinhibition, increased only in the normotensive group at high significant level (P=0.003).Sex differences were found between normotensive subjects in ΔHR, ΔLnLF, and ΔLnHF HRV power, such that LnLF and LnHF increased more and HR decreased more in normotensive women than in men (P=0.034, P=0.010, and P=0.015, respectively) indicating that reduction of HR due to activation of cardiovagal activity and sympathoinhibition was higher in normotensive women.So, during CWT the increase in parasympathetic activity and sympathoinhibition led to the reduction of HR in normotensive subjects, while prehypertensive subjects demonstrated the decrease of both HR and MBP without change of HRV indices possibly due to the reduction of tonic activity of the sympathetic nervous system. This cold‐warm test may be used for early diagnostic of hypertension since the MBP in normotensives significantly increased and in prehypertensives decreased at high significant level.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

P118 A novel technique for repair of the vertebral artery during cranial surgery

ObjectivesTo demonstrate a novel/alternative technique for repair of the vertebral artery intraoperatively.DesignLeft-sided retromastoid craniotomy in one patient.SubjectsA 61-year-old male patient with meningioma in the foramen magnum encasing the vertebral artery on the left side.MethodsStandard retrosigmoid craniotomy performed with preservation of transverse and sigmoid sinuses. The dura was opened and the cerebellum was retracted with CSF release. The tumour was debulked gradually. The attempt to peel the tumour from the vertebral artery resulted in arterial bleeding. The hole in the artery was sealed using an N-hydroxysuccinimide functionalised polyethylene glycol-coated collagen patch (Hemopatch®, Baxter Healthcare Ltd) as an onlay, applying pressure for 2 minutes. Another patch was applied for further support and the artery checked for haemostasis. The dura was closed with 3–0 vicryl and Hemopatch® onlay after further tumour debulking.ResultsHaemostasis of the vertebral artery was achieved at 140 mmHg SBP and a catheter angiogram found no dissection or false lumen. The patient did not suffer postoperative haemorrhage and after three months of inpatient rehabilitation was discharged with significantly improved cranial nerve function. There was no CSF leak.ConclusionsHaemostasis was successfully achieved in the vertebral artery with this novel technique. It can prove to be important in such scenarios where direct cross-clamping and arterial repair is technically challenging and can lead to brainstem ischemia.

The prevalence, awareness, treatment, and control of hypertension among adults: the first cross-sectional national population-based survey in Laos.

AimThe aim of this study was to determine the national prevalence of hypertension and its awareness, treatment, and control in Laos.MethodsA national cross-sectional study was conducted in 2013. Using stratified cluster random sampling, 2,543 individuals aged 18–64 years were included from Laos. According to WHO STEPS methodology, questionnaire interview, anthropometric and blood pressure measurements, and biochemistry tests were conducted. Logistic regressions were used to estimate the determinants of hypertension (SBP [and/or DBP] ≥140 [90] mmHg or use of antihypertensive medications).ResultsOverall, 20.0% of the population had hypertension, 18.5% among men and 21.1% among women. Among hypertensives, 29.4% were aware, 18.2% were currently using antihypertensive medication, and 16.7% had controlled their blood pressure (<140 mmHg SBP and DBP <90 mmHg). In fully adjusted models in both men and women, older age and general obesity were positively associated with hypertension. In addition, among men having raised cholesterol and completed primary education, and among women central obesity and hazardous or harmful alcohol users were positively associated with hypertension.ConclusionThe study found a significant prevalence of hypertension and low awareness, treatment, and control rates of hypertension among adults in Laos.

Blood Pressure Estimation From Beat-by-Beat Time-Domain Features of Oscillometric Waveforms Using Deep-Neural-Network Classification Models

In general, existing machine learning based approaches, developed for systolic and diastolic blood pressure (SBP and DBP) estimation from oscillometric waveforms (OWs), employ features extracted from the OW envelope (OWE) alone and ignore important beat-by-beat (BBB) features which represent fundamental physical properties of the entire non-invasive blood pressure (NIBP) measurement system. Unlike the existing literature, this paper proposes a novel deep-learning based method for BP estimation trained with BBB time-domain features extracted from OWs. First, we extract six time-domain features from each beat of the OW, relative to the preceding beat. Second, using the extracted BBB features along with the corresponding cuff pressures, we form a feature vector for each OW beat and locate it in one of three different classes, namely pre-systolic (PS), between systolic and diastolic (BSD) and after diastolic (AD). We then devise a deep-belief network (DBN)-deep neural network (DNN) classification model as well as a novel artificial feature extraction method for estimating SBP and DBP from feature vectors extracted from OWs and their corresponding deflation curves. The proposed DBN-DNN classification approach can effectively learn the complex nonlinear relationship between the artificial feature vectors and target classes. The SBP and DBP points are then obtained by mapping the beats at which the network output sequence switches from PS phase to BSD phase and from BSD phase to AD phase, respectively, to the deflation curve. Adopting a 5-fold cross-validation scheme and using a data base of 350 NIBP recordings gave an average mean absolute error of 1.1±2.9 mmHg for SBP and 3.0±5.6 mmHg for DBP relative to reference values. We experimentally show that the proposed DBN-DNN-based classification algorithm trained with BBB time-domain features can outperform traditional deep-learning based methods for BP estimation trained with features extracted only from OWEs.

Acute and Chronic Antihypertensive Effect of Fractions, Tiliroside and Scopoletin from Malva parviflora.

Hypertension is a disease of high prevalence and morbidity where vascular inflammation and associated oxidative stress (endothelial dysfunction) is the underlying cause of this pathology. We are reporting the antihypertensive activity of extracts and fractions of Malva parviflora in mice with chronic and acute hypertension. Also, the treatments of this plant were able to counteract the kidney inflammation and associated oxidative stress. The chronic hypertension model consisted of administration of angiotensin II (AGII) during 12 weeks, causing a sustained increase in systolic (SBP) or diastolic (DBP) pressure, with values of pharmacological constants of: ED50 = 0.038 mg/kg y Emax = 135 mmHg for SBP and ED50 = 0.046 mg/kg y Emax = 98 mmHg for DBP. The chronic hypertension caused the inflammation and lipid peroxidation in kidneys, measured by of tissue level of cytokines such as interleukin-1β (IL-1β), IL-6, Tumor Necrosis Factor-α (TNF-α), IL-10 and malondialdehyde, and treatments for M. parviflora were able to modulate these parameters. The chemical fractionation allowed to identify three compounds: oleanolic acid, tiliroside and scopoletin, which were tested in a model of acute hypertension. The pharmacodynamic parameters for SBP were ED50 = 0.01 and 0.12 mg/kg while Emax = 33.22 and 37.74 mmHg for scopoletin and tiliroside, respectively; whereas that for DBP data were ED50 = 0.01 and 0.02 mg/kg; with an Emax = 7.00 and 6.24 mmHg, in the same order. M. parviflora, is able to counteract the effect of chronic and acute administration of AGII, on hypertension, but also the inflammatory and oxidative damage in the kidney. The oleanolic acid, scopoletin and tiliroside are the compounds responsible for such activities.

Cuff-less continuous measurement of blood pressure using wrist and fingertip photo-plethysmograms: Evaluation and feature analysis

Continuous monitoring of blood pressure improves prevention and control of cardiovascular diseases. Currently, cuff-based oscillometric sphygmomanometers are commonly used to monitor the systolic and diastolic blood pressure. However, this technique is discontinuous in nature and inconvenient for repeated measurements. Here we have proposed indirect measurement of blood pressure from photo-plethysmograms (PPG) simultaneously recorded from wrist and fingertip. The signals were recorded from 111 participants and different morphological features were obtained from PPG and its second derivative, acceleration plethysmograms (APG). Moreover, different measures of pulse transit time (PTT) and pulse wave velocity (PWV) were obtained from the recorded PPGs. Multi-layer Neural Networks were used to estimate the non-linear relationship between these features and systolic and diastolic blood pressures (SBP and DBP). Mean absolute errors of 6.77 and 4.82 mmHg were achieved in comparison with measurements from a validated commercial oscillometric sphygmomanometer. Feature analysis provided insight about the importance of features for estimating BP, and demonstrated that these features are not the same for SBP and DBP. Using the highest-ranked 15 and 13 features obtained from moving-backward algorithm the mean absolute errors were reduced to 5.31 and 4.62 mmHg for SBP and DBP. However, the optimum optimal feature sets provided by a genetic algorithm for estimating SBP/DBP led to the lowest mean absolute errors of 4.94/4.03. These results compared to previous studies and the available standards suggest that the method is a promising substitute for oscillometric sphygmomanometers which can be used conveniently for continuous monitoring of blood pressure.

Total, insoluble, and soluble dietary fiber intake and insulin resistance and blood pressure in adolescents.

Background/Objectives:To evaluate sex and race differences in fiber intakes, which are understudied in adolescents, and to investigate whether low insoluble and soluble fiber intakes would be associated with higher risk for insulin resistance and blood pressure (BP).Subjects/Methods:A total of 754 black and white adolescents, 14 to 18 years old (49.2% blacks; 50.3% female) were previously recruited in Augusta, Georgia, the US between 2001 to 2005. Diet was assessed with four to seven independent 24-hour dietary recalls.Results:The average daily consumption of total, insoluble, and soluble fiber were 10.9, 6.7, and 4.0g, respectively. Only two adolescents met their daily fiber intake recommendation. Adjusted multiple linear regressions revealed that increasing dietary fiber intake from current averages to recommendation levels (12g to 38g in the male and 9.9g to 25g in the female), were associated with predicted decreases of 5.4 and 3.0 mg/dL fasting glucose, 7.0 and 5.0 mg/dL fasting insulin, 1.6 and 1.1 HOMA-IR, 6.3 and 3.7 mmHg SBP, and 5.2 and 3.0 mmHg DBP in the males and females, respectively (all p < 0.05). Furthermore, both insoluble and soluble fiber intakes were inversely associated with fasting insulin and HOMA-IR (p <0.05); whereas only soluble fiber intake was found to be associated with BP (p <0.05).Conclusions:Fiber consumption in adolescents is far below daily-recommended levels across all sex and race groups. Lower fiber intake of all types is associated with higher insulin level. Fiber Intake at recommendation levels may be associated with significant cardiometabolic benefits.

Lifestyle characteristics as moderators of the effectiveness of weight control interventions among semiconductor workers

BackgroundWorkers in high technology industry are experiencing stressful environment and have been ranked as a high risk group for adverse health effects. The effectiveness of worksite health promotion is important for occupational health. This study is to investigate the effect of health interventions on body measurement changes while examining the role of their lifestyle factors. MethodsA total of 904 participants aged over 30 years were recruited from 14 semiconductor worksites in Taiwan from 2011 to 2015. A multi-settings, quasi-experimental study was conducted that assigned participants into two intervention programs, including exercise program and diet-plus-exercise program. The outcomes include the changes of body weight, waist circumference, body mass index (BMI), and biophysiological indicators. Lifestyle variables include alcohol consumption, cigarette smoking, and regular exercise. Multiple linear regression analyses were performed to test the association. ResultsThe findings have demonstrated that one kilogram body weight reduction is associated with a decrease of 0.58 mmHg SBP (p < 0.001), 0.29 mmHg DBP (p < 0.001), 3.33 mg/dL triglyceride (p < 0.001), 0.96 mg/dL total cholesterol (p < 0.001), and 0.68 mg/dL LDL (p < 0.001). The diet-plus-exercise group had more significant effect on both weight changes and biophysiological changes than exercise-only group (p < 0.001). Lifestyle factors, including cigarette smoking, alcohol consumption, and regular exercise, were significant moderators of the effectiveness of health interventions. ConclusionsBoth exercise and diet interventions are important to the effectiveness of health promotion in occupational sectors. Lifestyle modifications are vital for weight control programs in improving body shape changes and biophysiological indicators.

A13979 Efficacy and safety of compound-reserpine-triamterene tabletsin treatment to non-dipper hypertension in elderly

Objectives: To observe the Efficacy and safety of compound-reserpine-triamterene tablets in treatment to non-dipper hypertension in elderly. Methods: This is a multi-center, open, random and controlled study. Patients older than 60 years old with mild to moderate hypertension were enrolled in. All of patients were divided into two groups, one group taken Compound-reserpine-triamterene tablet in the morning (morning group) and the other at night (night group). Results: Total 155 patients were enrolled in, their mean age were (68.2 ± 6.0) years. Baseline BP was (158.7 ± 11.3)/(90.0 ± 9.8)mmHg. Eighty-one patients were in morning group and the other 74 patients were in night group. Clinic blood pressure decreased significantly in both groups after treatment. The mean decrease were (33.1 ± 14.0) /(31.9 ± 11.4)mmHg in SBP and (11.3 ± 11.2) /(11.8 ± 9.9)mmHg in DBP in the two groups respectively, the difference haven’t statistical significance (P = 0.583 and P = 0.760). The results of ABPM showed that after six months treatment, the mean decrease of blood pressure was 24.7/14.8mmHg in the whole day, 23.6/12.1mmHg mmHg in daytime and 28.5/15.mmHg in nighttime respectively, the difference between the two groups haven’t reach the statistical significance. The blood pressure curve of total 37 patients changed into dipper type, 23 (28.4%) in the morning group and the other 14 (18.9%) in night group, the difference hasn’t statistical significance (P = 0.168).The changes of laboratory examination didn’t reach the statistical significance also. There haven’t serious side effects. Conclusion: It is effective and safe of Compound reserpine-triamterene tablets in the treatment of hypertension in aged patients. Patients with non-dipper hypertension can take Compound reserpine-triamterene tablets either in the morning or at night.

A11591 Ambulatory Blood Pressure Monitoring (ABPM) and Holter Monitoring Simultaneously as a Standard Care Approach to Evaluate the Risk Correlates in Hypertensives

Objectives: We evaluated 3230 (Males = 2228, Females = 1002) hypertensives, hospitalised for 24 hours to analyse association of hypertension and arrhythmia simultaneously for three years Methods: We used holter recorder and ABPM. ST depression was defined as an ST segment depression (1 mm limb or chest recordings V1 to V6) Results: Mean age was 51.2 ± 7.9 years (range 41 - 82 yrs). The tertile in triad of age > 60 years, duration of diabetes > 20 years and HbA1c > 11% had highest incidence of arrhythmias, statistically significant as compared with the other tertiles (p < 0.0001). Socioeconomic status were high, middle income and low income in 43% (n = 1388), 36 % (n = 1163) and 21 % (n = 679), respectively. Awake and asleep BP mean were 147 ± 11 mmHg and 137 ± 13.7 mmHg for SBP, 89.5 ± 10.2 and 83.1 ± 8.9 mmHg for DBP, respectively. Arterial pressure variability and bradyarrhythmia were significantly associated with sleep apnea (p < 0.0001). Patients with ST-T wave depression > 1 mm (26%) and tachycardia (31%) were significantly associated with both the reverse dippers and non-dippers. (p < 0.0001) Conclusion: The combined-simultaneous approach of holter and ABPM is a suitable approach for optimising the standard care in hypertensives. Association of various arrhythmia and BP patterns are important to triage high-risk patients and customise therapeutic approach. We could not draw out association between white coat hypertension and BP variability as ABPM was done under controlled environment in hospital setting only. Chronotherapy in concurrence with circadian rhythm to reduce side effects, optimise the dosage, reduce pill burden would be a suitable option to achieve a better BP control. Nocturnal anti-hypertensive dosing to target nocturnal hypertension would be an appropriate management approach

A17293 Relationship between amount of salt intake and long-term blood pressure variability

Objectives: Existing data indicate that blood pressure (BP) variability is a strong predictor of cardiovascular events in patients with arterial hypertension (AH). In spite of known influence of salt intake amount on BP level, relationship between amount of salt intake and BP variability (BPV) still needs investigation. Methods: 50 men with AH (mean age 55.94 ± 9.8 years) underwent to three different 10 day salt intake diets: regular (9–12 g/day), low (2.5–4 g/day) and high (>20 g/day). Home BP measurement three times a day (9am; 3pm; 9pm) according to the standard protocol during the whole study period was used. Standard deviation (SD) of measured BPs was used to calculate BPV. Coefficient of variation was calculated in all the groups according to the salt intake amount. Results: Average SBPs, DBPs and SDs during regular, low and high salt intake were as follows: 152.4 mmHg vs 148.2 mmHg and 154.8 mmHg for SBP, 91.4 mmHg, 90.2 mmHg and 93.8 mmHg for DBP, respectively; SDs of SBP were 12.2 ± 4.2 vs 9.4 ± 3.8 vs 13.2 ± 3.5 for systolic and 6.4 ± 3.7 vs 6.3 ± 3 and 6.8 ± 3.3 for diastolic, respectively. Coefficient of variation of SBP for regular, low and high salt diets were 8 ± 2.7%, 6.3 ± 2.5% and 8.6 ± 2.3% and for DBP - 6.9 ± 4%, 7 ± 3.3% and 7.3 ± 3.5%, respectively. High salt diet significantly increased average SBP, DBP and SDs. Conclusion: Study data show, that high sodium diet leads to the higher average BP and BPV. Differences of SBP and DBP between the groups were higher than 2 mmHg. Framingham Heart Study showed that population wide reduction of DBP in 2 mmHg is associated with a 6% reduction in CHD risk and Lewington et al, in 2002 showed that SBP reduction in only 2 mmHg would lead to 7% reduction in the incidence of death secondary to stroke and 10% reduction in IHD. High BPV is considered as a strong indicator for CV events per

A15778 A multicenter randomized controlled study of the effects of remote management of hypertension based on the Yijiayi Intelligent Hypertension Management System

Objectives: To investigate the effects of remote management of hypertension based on the Yijiayi Intelligent Hypertension Management System (IHMS). Methods: In 2017, 1,230 patients with essential hypertension in 6 cities in China were recruited. They were randomized into 3 groups: a conventionally-managed group, a non-remotely-managed group and a remotely-managed group. The follow-up time was 180 days. At days 30, 90 and 180 after inclusion, the patients returned to hospitals for follow-up visits. Intergroup comparisons were conducted with regard to the measurements before and after intervention, which involved the percentage of patients achieving the target blood pressure, blood pressure level, hypertension knowledge score and the compliance with home blood pressure measurement in the remotely-managed group. Results: 1,102 patients completed follow-up visits. At 180 days of follow-up, the percentage of patients achieving the target blood pressure in the remotely-managed group was 72.7% higher than that in the conventionally-managed group and that in the non-remotely-managed group (P < 0.05). The systolic pressure (SBP) in the remotely-managed group was 132.0 ± 12.9 mmHg lower than that in the conventionally-managed group and that in the non-remotely-managed group (P < 0.05); and compared with the conventionally-managed group, the remotely-managed group achieved a greater decrease by 5.1 mmHg in SBP. The diastolic pressure in the remotely-managed group was 79.0 ± 9.7 mmHg lower than that in the conventionally-managed group. The hypertension knowledge score at 180 days in the remotely-managed group was improved by 4.66 ± 2.932 points. Conclusion: Remote management of hypertension based on the Yijiayi Intelligent Hypertension Management System is an effective method on the management of hypertension.