Oscillometric Method Research Articles

OBSTRUCTIVE SLEEP APNEA AND TARGET BP VALUE IN NON-OBESE HYPERTENSIVE PATIENTS

Objective: To assess obstructive sleep apnea impact on the target blood pressure (BP) value achievement in non-obese hypertensive patients. Design and method: In this prospective cross-sectional study were included 305 patients (mean age 60.0 years old [48.0; 67.0], 203 men) with different stages and grades of arterial hypertension (AH). All patients have been receiving antihypertension therapy, prescribed by their cardiologist, for at least 3 weeks before inclusion in the study. During the study, office systolic and dyastolic blood pressure (SBP and DBP resp.) were assessed (oscillometric method, Omron, Japan) and home sleep respiratory monitoring (SomnoChek, Weinmann, Germany) was done in all patients. Results: Two groups were formed: non-target BP group (BP>140/90 mm Hg, n=164) and target BP group (BP<140/90 mm Hg, n=141). Comparative data analysis included such indicators as: age, body mass index (BMI), apnea/hypopnea index (AHI), desaturation index (DI) and minimum oxygen saturation (min SaO2), revealed only differences between age (61.0 years old [50.0; 68.0] versus 57.0 years old [47.0; 66.0] resp., p=0.03) and BMI (32.5 kg/m2 [29.7; 38.1] vs. 31.6 kg/m2 [27.8; 35.5] resp., p=0.02). The analysis of non-obese patients’ data (BMI <30 kg/m2, n=100) didn’t reveal differences by age, but a higher value of AHI and DI were determined in patients with non-target BP, as well as higher BMI; similar differences were not found in obese patients (BMI>30 kg/m2, n=205) (Table 1). In two-factor logistic regression analysis (included AHI and BMI) AHI was the only predictor of non-target BP in patients without obesity, while BMI had no predictive value (Table 2). Conclusions: Even mild or moderate obstructive sleep apnea may be an important negative factor in achieving BP targets in non-obese patients, unlike the other clinical cases with AH.

Comparative study between cuff sizes in the determination of systolic blood pressure, by non-invasive methods in anesthetized dogs

The measurement of systolic blood pressure (SBP) is a variable of paramount importance in clinical routine, obtained and measured according to published guidelines for dogs. The study evaluated the influence of cuff size on the determination of systolic blood pressure (SBP) values in dogs, comparing two non-invasive methods. Eighteen healthy dogs of different breeds and ages were used, clinically evaluated and undergoing elective surgeries. SBP was measured using vascular Doppler and high-definition oscillometric methods during the anesthetic period, using both ideal-sized cuffs and smaller cuffs. The dogs were divided into groups, Group 1 composed of dogs with ideal cuff no. 2, Group 2 dogs with ideal cuff no. 3 and Group 3 ideal cuff no The results showed that smaller cuffs significantly overestimated the mean SBP values compared to the ideal cuff values, regardless of the method used. It was concluded that cuffs with a lower than ideal number overestimate SBP values in anesthetized dogs, regardless of the non-invasive method used.

Effects of Vitamin D Supplementation on Central Hemodynamic Parameters and Autonomic Nervous System in Obese or Overweight Individuals.

Previous studies have been inconsistent in demonstrating beneficial cardiovascular effects of vitamin D supplementation. To evaluate the effects of vitamin D3 supplementation on central hemodynamic parameters and autonomic activity in obese/overweight individuals with low vitamin D levels (<30ng/dl). Adults 40-65 years old with body mass index ≥25<40 kg/m2 were enrolled in this prospective, randomized, double-blind clinical trial (NCT05689632). Central hemodynamics was assessed using the oscillometric method (Mobil-O-Graph®), and heart rate variability using a Polar heart rate monitor (Kubios® software). Patients (n=53) received a placebo in the control group (CO, n=25) or vitamin D3 (VD, n=28) 7000 IU/day, and were evaluated before (W0) and after 8 weeks (W8) with a significance level of 0.05. The groups were homogeneous regarding age (51±6 vs 52±6 years, p=0.509) and vitamin D levels (22.8±4.9 vs 21.7±4.5ng/ml, p=0.590). At W8, the VD group had significantly higher levels of vitamin D (22.5 vs 35.6ng/ml, p<0.001). Only the VD group showed a significant reduction in systolic blood pressure (SBP; 123±15 vs 119±14mmHg, p=0.019) and alkaline phosphatase (213±55 vs 202±55mg/dl, p=0.012). The CO group showed an increase in augmentation pressure (AP: 9 vs 12 mmHg, p=0.028) and augmentation index (AIx: 26 vs 35%, p=0.020), which was not observed in the VD group (AP: 8 vs 8 mmHg, AIx: 26 vs 25%, p>0.05). VD group showed an increase in the parasympathetic nervous system index (PNSi) (-0.64±0.94 vs -0.16±1.10, p=0.028) and the R-R interval (866±138 vs 924±161 ms, p= 0.026). In this sample, eight weeks of daily vitamin D supplementation resulted in an improvement in blood pressure levels and autonomic balance.

Evaluation of the oscillometric method for noninvasive blood pressure measurement during cuff deflation and cuff inflation with reference to intra-arterial blood pressure.

There is little quantitative clinical data available to support blood pressure measurement accuracy during cuff inflation. In this study of 35 male and 5 female lightly anaesthetized subjects aged 64.1 ± 9.6 years, we evaluate and compare the performance of both the oscillometric ratio and gradient methods during cuff deflation and cuff inflation with reference to intra-arterial measurements. We show that the oscillometric waveform envelopes (OWE), which are key to both methods, exhibit significant variability in both shape and smoothness leading to at least 15% error in the determination of mean pressure (MP). We confirm the observation from our previous studies that K1 Korotkoff sounds underestimate systolic blood pressure (SBP) and note that this underestimation is increased during cuff inflation. The estimation of diastolic blood pressure (DBP) is generally accurate for both the ratio and the gradient method, with the latter showing a significant increase during inflation. Since the gradient method estimates SBP and DBP from points of maximum gradient on each OWE recorded, it may offer significant benefits over the ratio method. However, we have shown that the ratio method can be optimized for any data set to achieve either a minimum mean error (ME) of close to 0 mmHg or minimum root mean square error (RMSE) with standard deviation (SD) of <5.0 mmHg. We conclude that whilst cuff inflation may offer some advantages, these are neither significant nor substantial, leaving as the only benefit, the potential for more rapid measurement and less patient discomfort.

Assessment of the significance of dilated perivascular spaces and nocture arterial hypertension in the development of Alzheimer's disease

To study the severity and localization of dilated perivascular spaces (DPVS), the levels of protein markers of amyloidosis and neurodegeneration in the cerebrospinal fluid (CSF) at different daily blood pressure (BP) profiles in patients with Alzheimer's disease (AD) and other types of cognitive impairment. A total of 119 people, aged 53 to 92 years, including 55 patients with AD, 27 patients with vascular cognitive disorders (VCD), 19 patients with frontotemporal degeneration (FTD). All patients underwent BP monitoring for 24 hours using a standard oscillometric measurement method, lumbar puncture to assess Aβ-42 and Aβ-40 amyloid protein, total and phosphorylated tau protein in the CSF, magnetic resonance imaging tomography of the brain with subsequent assessment of the severity of expansion and localization of DPVS according to the G.M. Potter scale. In 58.3% of patients with AD, there is no adequate reduction in BP at night in comparison with patients with VCD (p<0.05). A significant degree of expansion of the DPVS turned out to be most typical for patients with AD: grade 3 was detected in 45.7% of patients, and the maximum, grade 4, was detected in 13.4%. At the same time, DPVSs were significantly more often detected in the group of subjects with insufficient reduction in diastolic BP (DBP) at night. A strong inverse correlation was established between the level of Aβ-42 in the CSF and the variability of DBP at night (r= -0.92; p<0.05). The decrease in the level of Aβ-42 in AD, especially at the prodromal stage, is directly related to the low variability of DBP at night, which is more characteristic of an insufficient decrease or increase in BP during night sleep. Patients with AD were characterized by an insufficient decrease in BP at night, which is associated with the severity and degree of maximum expansion of the DPVS. A decrease in the level of Aβ-42 amyloid protein in the CSF strongly correlates with the variability of DBP at night.

Physical Anthropometry Influences Arterial Stiffness in Hypertensive Patients of North Karnataka

Background: Very less is known about the influence of Physical Anthropometry on arterial stiffness in hypertensive patients. Objectives: The study aimed to find out influences of physical anthropometry on arterial stiffness in hypertensive patients. Materials and Methods: Age matched participants were divided into 2 groups (group 1, control, n = 36; group 2, hypertensive patients, n = 73). Waist Circumference (WC), Body Mass Index (BMI), Waist Hip ratio (WHR) which is the markers of obesity was measured. Blood pressure (BP) was recorded manually in resting posture using sphygmomanometer. Arterial Stiffness Index (ASI) which is linked with hypertension was recorded by Periscope which work based on oscillometric method. The results were expressed as mean + SD. We did correlation between our variables using Spearman’s correlation considering p&lt;0.05 as statistically significant. Result: Obesity indexes and arterial stiffness index were found to be higher in hypertensive patients as compared to its respective controls. There were significant positive correlation between the obesity indexes and arterial stiffness index in group 1 and group 2. Conclusion: These observations are indicative of influences of physical anthropometry in hypertension.

Hypotension in Preterm Newborns and Its Short-Term Outcome: Experience of a Tertiary Care Hospital in Bangladesh

Background: Blood pressure values of too low or too high can be related with serious morbidity and mortality. Neonatal hypotension has been found to be related with serious short term as well as significant long-term health complications. Thus, identifying this low blood pressure in preterm neonates with its impacts on neonatal health is crucial. Objectives: To evaluate blood pressure values in preterm newborn and short-term impacts of hypotension on neonatal health. Methods: This prospective observational study was conducted in Neonatal Intensive Care Unit (NICU) of Bangabandhu Sheikh Mujib Medical University a tertiary care hospital of Dhaka city after approval from Institutional Review Board for a period of one years. Neonates having gestation&lt; 37 completed weeks admitted in NICU of BSMMU were enrolled in the study after getting informed consent from the parents. Proper antenatal and postnatal history were recorded in data collection form. Blood pressure was measured by non-invasive oscillometric method in all neonates within 24 hours after birth by ideal procedure. Blood pressure was monitored at an interval of 12 hours or more frequently when required till discharge or death. Information on neonatal mortality and morbidity were recorded in data collection form. Results: A total of 114 preterm neonates were studied during the study period, among them 61 (53.5%) had normal blood pressure and 53 (46.5%) had hypotension. Among the enrolled patients, 15 (13.2%) patients died, 3 (2.6%) left against medical advice, 11 (9.6%) 96 (84.2%) were discharged with advice. Short time outcomes like culture proven sepsis, use of ionotrops, need for oxygen support and assisted ventilation, feeding intolerance, Necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity and duration of hospital stay were significantly higher in hypotensive group. Mortality was also higher in hypotensive group than normotensive group (26.4% vs 3.3%, p &lt;0.001). Conclusion: Hypotension in preterm neonates was associated with significant mortality and morbidity in early post-natal period.

Diagnostic Accuracy of Office Blood Pressure Measurement and Home Blood Pressure Monitoring for Hypertension Screening Among Adults: Results From the IDH Study.

Using high awake blood pressure (BP; ≥130/80 mm Hg) on ambulatory BP monitoring (ABPM) as a reference, the purpose of this study was to determine the accuracy of high office BP (≥130/80 mm Hg) at an initial visit and high confirmatory office BP (≥130/80 mm Hg), and separately, high home BP (≥130/80 mm Hg) among participants with high office BP (≥130/80 mm Hg) at an initial office visit. The accuracy of office BP measurements using the oscillometric method for detecting high BP on ABPM was determined among 379 participants with complete office BP and ABPM data in the IDH (Improving the Detection of Hypertension) study. For detecting high BP on ABPM, the accuracy of high confirmatory office BP using the oscillometric method and, separately, high home BP was also determined among the subgroup of 122 participants with high office BP at an initial visit and complete home BP monitoring data. High office BP had moderate sensitivity (0.61 [95% CI, 0.53-0.68]) and high specificity (0.85 [95% CI, 0.80-0.90]) for high awake BP. High confirmatory office BP and high home BP had moderate sensitivity (0.69 [95% CI, 0.59-0.79] and 0.79 [95% CI, 0.71-0.87], respectively) and low and moderate specificity (0.44 [95% CI, 0.27-0.61] and 0.72 [95% CI, 0.56-0.88], respectively). Many individuals with high BP on ABPM do not have high office BP. Confirmatory office BP and home blood pressure monitoring also had limited ability to identify individuals with high BP on ABPM.

Pengaruh pemberian bubuk susu kacang hijau terhadap tekanan darah dan denyut nadi pasca pemulihan atlet sepakbola

Background: Resistance exercise can cause microdamage to muscle tissue, leading to more severe damage over time. In particular, athletes who tend to exercise with moderate to heavy intensity are at a high risk of injury and have a longer recovery due to excessive fatigue during exercise. A proper nutritional strategy is needed to reduce the effects of exercise and accelerate recovery by supplementation with amino acids (BCAA). BCAAs are a branch-chain amino acid series of leucine, lysine, and isoleucine. Green beans are foods high in amino acids, such as lysine, valine, isoleucine, cysteine, methionine, and tryptophan.Objectives: This study aimed to investigate the effect of green bean milk powder on post-recovery blood pressure and pulse rate in football athletes.Method: The research used a quasi-experimental approach with a one-group pre-posttest control group design. The subjects in this study were 22 football athletes at BPPLOP Central Java, conducted in May 2023. The markers used in this study were post-recovery blood pressure and pulse rate. Blood pressure and pulse measurements were performed using the oscillometric method by placing the cuff on the upper arm, and the measurement results were observed on the monitor connected to the cuff on the Omron® digital tensimeter. Data were analyzed using an Independent Sample T-Test and Mann-Whitney U test at 95% CI.Results: Both groups of subjects in this study consisted of ages ranging from 15-19 years, body weight between 52-72 kg, height between 165-178 cm, nutritional status between normal-fat, percent body fat in the normal category, energy intake, carbohydrates, protein, and fat. At the same time, the energy and nutrient intake analysis results in each group showed that the subjects’ energy intake was still in the deficit or deficient group. In contrast, fat intake in each group was classified as excess. There was no significant difference in the provision of mung bean milk powder intervention before and after stages 1 and 2 of the study on the results of systolic blood pressure measurements (p= 0,844), diastolic blood pressure (p= 0,115) and post-recovery pulse rate (p= 0,972).Summary: Giving green bean milk powder at 25 g/day after exercising for eight days did not significantly affect blood pressure or post-recovery pulse rate.

History of blood pressure measurement in newborns and infants.

The development of methods for measuring blood pressure (BP) in newborns and small children has a rich history. Methods for BP measuring in adults had to be adapted to this age group. For measuring BP in direct invasive way, a suitable approach had to be found to access the arterial circulation through the umbilical and later radialis artery. Currently, results obtained from direct invasive BP measurement are considered the "gold standard". The development of non-invasive methods for BP measuring in newborns and children began with the use of von Basch's sphygmomanometer (1880). In 1899, Gustav Gärtner constructed the device, which was the basis for the flush method. After the discovery of the palpation and auscultation methods, these methods were also used for BP measurement in newborns and children, however, the BP values obtained in these ways were typically underestimated using excessively wide cuffs. From the auscultation method, methods utilizing ultrasound and infrasound to detect arterial wall movement and blood flow were later developed. The oscillometric method for BP measurement was introduced by E. J. Marey so early as in 1876. In 1912, P. Balard used the oscillometric technique to measure blood pressure in a large group of newborns. Through different types of oscillometers using various methods for detecting vascular oscillations (such as xylol method, impedance and volume plethysmography, etc.), the development has continued to assessment of vascular oscillations by modern sensor technology and software. For continuous non-invasive blood pressure measurement, the volume-clamp method, first described by Jan Peňáz in 1968, was developed. After modification for use in newborns, application of the cuff to the wrist instead of the finger, it is primarily used in clinical physiological studies to evaluate beat-to-beat BP and heart rate pressure variability, such as in the determination of the baroreflex sensitivity.

Assessment of sympathovagal balance by HRV analysis in alcoholic and nonalcoholic fatty liver disease patients

BACKGROUND: Heart rate variability (HRV) is the variation in the time intervals between continuous heartbeats also called interbeat intervals to give information related to the heart, blood pressure, gaseous exchange, and sympathetic and parasympathetic balance. Abnormalities in the conduction of the cardiac system alter the measurements of heart rate variability and lead to alteration in autonomic function with a higher risk of mortality. So, our objective includes the assessment of sympathovagal balance in AFLD and NAFLD patients. MATERIALS AND METHODS: The study included 78 alcoholic and 54 nonalcoholic fatty liver patients. A room temperature of 23°C with 25–35% humidity will be maintained in a recording room. Basal supine heart rate and BP will be recorded by the oscillometric method using an automated blood pressure monitor Omron MX3, India. Lead II ECG will be recorded for the next 5 minutes in total resting condition for short-term HRV analysis. Short-term HRV indices including time domain and frequency domain were recorded from each patient. Under time domain, SDNN, RMSSD, and average RR were noted. Under frequency domain, LF, HF, VLF, LF (nu), HF (nu), and LF/HF were calculated. The data were collected by using a 16-bit, power lab 8/30 data acquisition system (New South Wales, Australia) with acknowledge 3.8.2 software. Inferential analyses such as independent t-tests and Mann–Whitney tests were used to compare NAFLD and AFLD patient groups. Carl Pearson correlation analysis was performed to obtain a relationship between variables. RESULTS: SDNN in (ms) which represents the overall HRV found to be decreased in both alcoholic (32.84 ± 79.08) and nonalcoholic fatty liver disease (22.04 ± 13.85) compared to the normal range (50 ± 16)) from 27 studies. The value of RMSSD in (ms) was decreased in both alcoholic (17.00 ± 12.48) and nonalcoholic fatty liver disease patients (14.00 ± 9.44) with the normal range of (42 ± 15) from 15 studies. Pearson correlation analysis showed the age of AFLD patients significantly and positively correlated with average RR. Pearson correlation analysis for the age of NAFLD patients was significantly and positively correlated with the average RR, HF, SDNN, RMSSD, and LF. CONCLUSION: Altered autonomic activity was noted in both alcoholic and nonalcoholic fatty liver disease patients. An early prognosis of fatty liver is very necessary to prevent the disease progress into later fatal life-threatening stages.

The Accuracy and Reliability of Automated Oscillometric Measurement of Ankle-Brachial Index in the Diagnosis of Peripheral Artery Disease

Comparing the accuracy and reliability of ankle-brachial index (ABI) measured by an oscillometric device with the Doppler method in peripheral arterial disease (PAD). 122 patients admitted to the department of interventional radiology with PAD were studied. ABI was measured with the 2 methods in random order. After excluding the inconclusive results, Doppler ABIs were compared with the oscillometric ABIs in each limb, the reliability was evaluated by intraclass correlation coefficient (ICC), and the accuracy and consistency were assessed by receiver operating characteristic curves and Bland-Altman method. In 122 patients (244 legs), 27 legs got inconclusive oscillometric results, 4 legs got inconclusive oscillometric and inconclusive dorsalis pedis artery Doppler results, 2 legs had oscillometric cuff pressure intolerance. Using Doppler ABI <0.9 as a diagnostic threshold, compared with the high Doppler ABI, oscillometric method had a sensitivity of 57.81%, a specificity of 95.18%, the ICC was 0.626 (95% confidence interval [CI]: 0.536-0.701), Bland-Altman method showed 11/211 (5.21%) difference points outside the 95% limits of agreement. Compared with the low Doppler ABI, oscillometric method had a sensitivity of 50.66%, a specificity of 98.31%, the ICC was 0.541(95% CI: 0.483-0.630), Bland-Altman method showed 11/211 (5.21%) difference points outside the 95% limits of agreement. Using 1.00 as the diagnostic threshold and considering error oscillometric results as abnormal ABIs, the sensitivity improved to 88.05% with high Doppler ABI and 81.42% with the low. The accuracy and reliability of oscillometric ABI in patients with PAD is unsatisfied, which makes it not suitable as an alternative method in clinic disease assessment. Using 1.0 as the ABI oscillometric threshold for PAD diagnosis can improve the diagnostic value.

Development and clinical validation of a miniaturized finger probe for bedside hemodynamic monitoring

Our aim is to develop a blood pressure (BP) measurement technology that could be integrated into a finger-worn pulse oximeter, eliminating the need for a brachial cuff. We present a miniature cuffless tonometric finger probe system that uses the oscillometric method to measure BP. Our approach uses a motorized press that is used to apply pressure to the fingertip to measure BP. We verified the functionality of the device in a clinical trial (n= 43) resulting in systolic and diastolic pressures ((mean± SD) mmHg) of (-3.5± 8.4) mmHg and (-4.0± 4.4) mmHg, respectively. Comparison was made with manual auscultation (n= 26) and automated cuff oscillometry (n= 18). In addition to BP, we demonstrated the ability of the device to assess arterial stiffness (n= 18) and detect atrial fibrillation (n= 6). We were able to introduce a sufficiently small device that could be used for convenient ambulatory measurements with minimal discomfort.

One Step Back from Bedside to the Bench-How Do Different Arterial Stiffness Parameters Behave in Relation to Peripheral Resistance?

The investigation of arterial stiffening is a promising approach to estimating cardiovascular risk. Despite the widespread use of different methods, the dynamic nature of measured and calculated stiffness parameters is marginally investigated. We aimed to determine the stability of large artery elasticity parameters assessed via commonly used, ultrasound-based and oscillometric methods in relation to peripheral resistance modulation. A human experimental environment was composed, and fifteen young males were investigated at rest after extremity heating and external compression. Functional vascular parameters were monitored in each session, and several arterial stiffness parameters were analysed. The distensibility coefficient (DC) did not show significant changes during heat provocation and extremity compression, while DC's stability seemed to be acceptable. The same stability of carotid-femoral pulse wave velocity (PWV) was detected with ultrasound measurement (5.43 ± 0.79, 5.32 ± 0.86 and 5.28 ± 0.77, with p = 0.38, p = 0.27 and p = 0.76, respectively) with excellent intersession variability (intraclass correlation coefficient of 0.90, 0.88 and 0.91, respectively). However, the oscillometric PWV (oPWV) did change significantly between the heating and outer compression phase of the study (7.46 ± 1.37, 7.10 ± 1.18 and 7.60 ± 1.21, with p = 0.05, p = 0.68 and p < 0.001, respectively), the alteration of which is closely related to wave reflection, represented by the changes in reflection time. Our results indicate the good stability of directly measured elastic parameters such as DC and PWV, despite the extreme modulation of peripheral resistance. However, the oscillometric, indirectly detected PWV might be altered by physical interventions, which depend on wave reflection. The effective modulation of wave reflection was characterized by changes in the augmentation index, detected using both oscillometry and applanation tonometry. Thus, the environment during oscillometric measurement should be rigorously standardized. Furthermore, our results suggest the dynamic nature of the reflection point, rather than being a fixed anatomical point, proposed previously as aortic bifurcation.

Relationship between arterial stiffness, left ventricular diastolic function, and renal function in chronic kidney disease

AimIn chronic kidney disease, IgA nephropathy, and left ventricular diastolic dysfunction have prognostic significance as well. However, the relationship between diastolic dysfunction, arterial stiffness, and renal function has not been fully elucidated.Methods79 IgA nephropathy patients (aged 46 ± 11 years) and 50 controls were investigated. Tissue Doppler imaging was used to measure early (Ea) and late (Aa) diastolic velocities. Arterial stiffness was measured by a photoplethysmographic (stiffness index (SI)) and an oscillometric method (aortic pulse wave velocity (PWVao)).ResultsWe compared the IgAN patients to a similar cardiovascular risk group with a preserved eGFR. A strong correlation was found between Ea/Aa and SI (p < 0.001), also with PWVao (p < 0.001), just in IgAN, and with eGFR (p < 0.001) in both groups. IgAN patients were divided into groups CKD1-2 vs. CKD3-5. In the CKD 3–5 group, the incidence of diastolic dysfunction increased significantly: 39% vs. 72% (p = 0.003). Left ventricle rigidity (LVR) was calculated, which showed a close correlation with SI (p = 0.009) and eGFR (p = 0.038). By linear regression analysis, the independent predictors of SI were age, E/A, and E/Ea; SI was the predictor of LVR; and E/A and hypertension were the predictors of eGFR.ConclusionIn chronic kidney disease, increased cardiac rigidity and vascular stiffness coexist with decreased renal function, which is directly connected to diastolic dysfunction and vascular stiffness. On the basis of comparing the CKD group to the control group, vascular alterations in very early CKD can be identified.

Comparison of Doppler and Oscillometric Methods of Assessing Ankle-Brachial Index in Non-diabetic Premenopausal Women in Ghana for CME Credit September 2023

Comparison of Doppler and Oscillometric Methods of Assessing Ankle-Brachial Index in Non-diabetic Premenopausal Women in Ghana for CME Credit September 2023

Brachial-ankle pulse wave velocity is associated with intracranial artery calcification in acute stroke patients

BackgroundIntracranial artery calcification (IAC) is closely associated with cerebrovascular disease. Brachial-ankle pulse wave velocity (baPWV) is a noninvasive method for estimating arterial stiffness, which reflects the stiffness of peripheral arteries. This study aimed to examine the association of baPWV with the presence and degree of IAC in patients with acute ischemic stroke. MethodsA total of 143 ischemic stroke subjects were recruited. A head computed tomography (CT) scan was used to assess the presence and severity of IAC. The oscillometric method was used to simultaneously measure bilateral brachial and posterior tibial arterial pulse waveforms and arterial BP. Multiple logistic regression analysis was used to identify the independent relationship between baPWV and IAC. Results143 subjects were included in this study. The demographic and clinical characteristics of the study population were classified according to the baPWV quartile. A higher prevalence of IAC was noted across increasing baPWV quartiles (Q1: 53 %, Q2: 69 %, Q3: 86 %, Q4: 94 %, P < 0.001). IAC scores were also increased with elevated ccPWV values (1.60 ± 1.71; 2.56 ± 1.99; 3.44 ± 1.91; 4.64 ± 1.58. P < 0.001). After an additional adjustment for age and hypertension, the odds ratio (95 % confidence interval) for the IAC scores was 1.61 (1.06–2.45; P = 0.025) in the top quartile of baPWV compared with those in the lowest quartile. ConclusionsArterial stiffness as defined by baPWV was positively associated with the degree of IAC in patients with acute ischemic stroke, suggesting the severity of IAC may also be a marker of peripheral or systemic arterial stiffness.

New approaches for rapid setpoint determination and uninterrupted tracking in non-invasive continuous blood pressure monitoring based on volume-clamp method

The volume-clamp method (VCM) is a widely used non-invasive continuous blood pressure (BP) monitoring technique, but determining the volume setpoint (V0) in the open-loop phase can be time-consuming and may cause finger tissue displacement. Additionally, frequent interruptions in BP measurement are required during the closed-loop phase to reset V0. We proposed two new approaches: the proportional value method (PVM) for rapid V0 determination in the open-loop phase and the uninterrupted V0 tracking method (UVTM) in the closed-loop phase. PVM adaptively searches for V0 by analyzing the shape index (Prop) of the plethysmographic (PG) signal under constant cuff pressure, while UVTM introduces a new vascular compliance calculation method in closed-loop phase to track changes in V0 without interrupting BP measurement. We describe the non-invasive continuous BP monitor (NC-BPM) based on these methods. Experimental results show that PVM can accurately determine V0, with a mean arterial pressure error of −1.72 ± 2.80 mmHg when compared to oscillometric method (OSCM). UVTM in NC-BPM produced a mean absolute error (MAE) of 2.44 ± 2.91 mmHg for mean arterial pressure (MAP) in induced BP fluctuation test compared to the Nexfin monitor. In the clinical study with invasive reference, the MAE in measuring MAP by NC-BPM was 4.69 ± 5.39 mmHg. Our results show that PVM and UVTM are highly accurate and reliable, with the potential to integrate effectively into VCM-based BP monitoring devices that could benefit patients, healthcare providers, and researchers.

MASSAGE EFFECT ON PSYCHOEMOTIONAL STATE AND BLOOD GLUCOSE IN TYPE 1 DIABETES ADOLESCENTS

In 2021, there were approximately 1.5 million people under age 20 with type 1 diabetes mellitus (T1D) worldwide. Massage affects both physiological processes and also improves the psycho-emotional state. There have been studies on diabetes and the effects of massage on blood glucose levels, but the topic is under-researched. The purpose of the study: to find out the effect of classical massage on the psycho-emotional state and blood glucose level (BGL) in adolescents with T1D. Fifteen adolescents aged 12 to 16, diagnosed with T1D for at least six months, participated in the study. During the study, teenagers were given five classic back massages (once a week, 30 minutes). BGL was measured with glucometer before and after each massage. Participants completed the Positive and Negative Affect Schedule before each massage and the Depression Anxiety Stress Scales at the beginning and end of all massage sessions. Oscillometric method was used to determine the heart rate. The study results show that classical massage positively affects BGL and emotional states in adolescents with T1D. The overall results show a reduced BGL as well as heart rate. Although the differences are not statistically significant, and the effect is not large due to the sample size, the change direction is clinically relevant. When evaluating the results, it is necessary to consider the adolescents' specific age.

Comparison of Doppler and Oscillometric Methods of Assessing Ankle-Brachial Index in Non-diabetic Premenopausal Women in Ghana

Introduction: Peripheral arterial disease (PAD) is a common cardiovascular disorder less commonly diagnosed in female patients. Peripheral arterial disease is objectively diagnosed using the ankle-brachial index (ABI), which can be measured using the “gold standard” Doppler method or the oscillometric method. The agreement between these 2 methods is less investigated in the sub-Saharan African population. Therefore, we compared the diagnostic characteristics of the oscillometric method of measuring ABI with the Doppler method in premenopausal female patients in Ghana. Methods: The ABI was measured in non-diabetic premenopausal women suspected of having PAD using the Doppler method with an 8 MHz handheld Doppler (LifeDop 250, Summit Doppler) and an oscillometric device (Vasera 1500N, Fukuda Denshi) in 160 patients (320 legs). Peripheral arterial disease was defined as an ABI &lt;0.90 in at least one leg. Leg symptoms were assessed using the Edinburgh claudication questionnaire. Results: Leg pain on exertion was present in 101 patients screened with similar mean ABIs in the right and left legs. The prevalence of PAD as screened by the Doppler method was 25.7% (18.9%-33.4%) and that of the oscillometric method was 32.2% (24.9%-40.3%). In comparison with the Doppler method, the accuracy of the oscillometric method was 88.2%, and the sensitivity, specificity, positive predictive value, and negative predictive value were 89.7%, 87.6%, 71.4%, and 96.1%, respectively. The overall agreement between the Doppler and oscillometric methods was high, = 0.78 (0.62-0.91), P &lt; .001, with an intraclass correlation of 0.89 (0.87-0.92, P &lt; .001). In receiver-operating characteristic (ROC) curve analysis, the oscillometric method showed an area under the curve of 0.925 compared with the Doppler method in the diagnosis of PAD. Conclusion: In non-diabetic premenopausal women in our study, oscillometric ABI performed acceptably in the diagnosis of PAD when compared with Doppler ABI.