Sphygmomanometer Research Articles

Effect of pocket compression device on pocket hematoma after cardiac implantable electronic device implantation

Pocket hematoma is a common and serious complication following cardiac implantable electronic device (CIED) implantation, contributing to significant morbidity and mortality. This study aimed to evaluate the efficacy of a novel pocket compression device in reducing pocket hematoma occurrence. We enrolled 242 patients undergoing CIED implantation, randomly assigning them to receive either the novel compression vest with a pressure cuff or conventional sandbag compression. Pocket hematomas were categorized as grade 1 (mild), grade 2 (moderate), or grade 3 (severe, requiring intervention or prolonged hospitalization). The primary endpoint, incidence of pocket hematoma 24 h post-procedure, did not significantly differ between the two groups (26.7% vs. 19.7%, p = 0.224). Rates of grade 2 hematoma were similarly low and comparable (2.5% vs. 0.8%, p = 0.368), with no grade 3 hematomas observed. Skin reactions and patient comfort were similar between groups. The sole predictor for hematoma occurrence was current oral anticoagulation use. In conclusion, our study found a low incidence of clinically significant pocket hematomas. The novel pocket compression device showed comparable efficacy to conventional methods, suggesting it as a viable alternative for reducing post-procedural complications without additional adverse effects.Trial registration number: The study was registered in the Thai Clinical Trials Registry (TCTR) at https://www.thaiclinicaltrials.org/ , with the identification number TCTR20230913005, date of first trial registration 13/09/2023.

Comparative analysis of computer-programmed versus artificial right arm blood pressure measurement in detecting hypertension among elderly individuals

Objective: To compare the impact of manual right arm blood pressure measurement with computer-controlled blood pressure meter (CCBPM) on the detection rate of hypertension among elderly individuals. Method: This was a cross-sectional study. Elderly residents undergoing routine health check-up in a village in Jiangxi Province from April to June 2024 were enrolled. Manual blood pressure measurements were performed on the right arm using an electronic sphygmomanometer, while standardized dual-arm synchronized blood pressure assessments were conducted using the CCBPM. Blood pressure data were recorded from three sources: manual measurement on the right arm; the first CCBPM measurement on the arm with higher systolic blood pressure (CCBPM single); and the mean blood pressure of the arm with higher systolic blood pressure from two (if the difference between the first two measurements was less than 5 mmHg, 1 mmHg=0.133 kPa) or three (if the difference exceeded 5 mmHg) CCBPM measurements (CCBPM mean). Hypertension detection rates from these three datasets were compared. Subgroup analysis was performed according to age (60-74 years old as the elderly group,≥75 years old as the senior group) and gender. Intra-group correlation coefficient (ICC) was analyzed to evaluate the consistency of blood pressure data of different blood pressure measurement methods, and Kappa value was analyzed to evaluate the consistency of hypertension classification determined by different blood pressure measurement methods. Results: A total of 1 498 participants were enrolled, aged (71.30±6.83) years old, including 678 males (45.26%). The blood pressure and heart rate measured by the artificial right arm blood pressure measurement were higher than those measured by CCBPM single (blood pressure: (140.09±17.19)/(82.40±10.93) mmHg vs. (135.31±18.98)/(81.23±10.51) mmHg; heart rate: (75.76±11.72) beats/min vs.(72.94±11.21) beats/min) and CCBPM mean (blood pressure: (140.09±17.19)/(82.40±10.93) mmHg vs. (134.64±18.39)/(80.28±9.78) mmHg; heart rate: (75.76±11.72) beats/min vs. (72.87±10.70) beats/min, all P<0.05). The detection rate of hypertension determined by CCBPM mean was significantly lower than that of artificial right arm (40.25% (603/1 498) vs.54.34% (814/1 498)) and CCBPM single (40.25% (603/1 498) vs. 44.79% (671/1 498), all P<0.05). Subgroup analysis showed that that the detection rate of hypertension determined by CCBPM mean was lower than that measured by artificial right arm regardless of gender and age (all P<0.05). The consistency of blood pressure data between artificial right arm and the CCBPM mean was moderate (systolic blood pressure: ICC=0.70; diastolic blood pressure: ICC=0.62), with less consistent classification (Kappa=0.37). The consistency of blood pressure data between CCBPM single and CCBPM mean is extremely high (systolic blood pressure: ICC=0.94; diastolic blood pressure: ICC=0.91), with highly consistent classification (Kappa=0.74). Conclusions: Artificial right arm blood pressure measurement in physical examinations may overestimate the hypertension detection rate, and the standardized dual-arm synchronized blood pressure measurement using CCBPM can reduce irregular blood pressure measurement.

School Nurse Practices Related to Blood Pressure Screening, and Identification and Monitoring of High Blood Pressures in Youth.

Despite rising prevalence of high blood pressure among youth, literature on school nurses' practices related to youth blood pressure is limited. We aimed to describe school nurses' current practices related to blood pressure screening and identification and monitoring of high blood pressures. We conducted a web-based national survey of currently practicing school nurses and received 195 responses across 37 states. All participants reported having a blood pressure cuff, nearly all (98%) reported confidence measuring children's blood pressure, and 82% reported interest in doing more to support children's cardiovascular health. Blood pressure measurement by school nurses was common (73% reported "sometimes" or "often" and 25% reported "seldomly"). However, only 32% stated hypertension impacts their students and only 19% endorsed having enough time to complete all their necessary tasks. In describing school nurse's current practices related to youth blood pressure, we highlight opportunities for expanding this role and considerations for doing so.

Appropriate tourniquet pressure for peripherally inserted central catheter placement in the upper arm.

A peripherally inserted central catheter (PICC) placement often requires ultrasound guidance. Previous studies using an adult blood pressure cuff have suggested that veins do not easily collapse at the tourniquet pressure from diastolic to systolic blood pressure. When inserting a PICC into the basilic vein of the upper arm, a narrow blood pressure cuff should be used as a tourniquet to avoid concealing the puncture site. The aim of this study was to determine the appropriate tourniquet pressure using a narrow cuff when inserting a PICC into the upper arm. We measured the upper arm's blood pressure of seven healthy participants using a pediatric cuff and applied pressure to the upper arm with the pediatric cuff at six levels: 0mmHg (0), half of the diastolic pressure (D/2), diastolic pressure (D), pressure obtained by combining the systolic and diastolic pressures and dividing by two (DS), systolic pressure (S), and blood pressure as the pulse wave disappears (S + α). An ultrasound probe compressed the basilic vein through the skin. The pressure at which the vein collapsed at each tourniquet pressure was examined. The venous collapse pressure was higher when the tourniquet pressure was D, DS, or S. D to S is appropriate for PICC placement in the basilic vein of the upper arm in terms of venous collapse.

Secondary fastener (tape) placement on a blood pressure cuff causes interindividual Doppler blood pressure measurement variability in healthy large-breed dogs.

The objective of this study was to compare Doppler blood pressure (DBP) measurements between blood pressure cuffs (BPCs) with and without a secondary fastener (tape) in healthy nonanesthetized large-breed dogs. 28 healthy dogs. Superficial palmar venous arch DBP measurements with and without tape on the BPC were performed in lateral recumbency with Doppler ultrasound. Each method was performed 6 consecutive times, with the final 5 values averaged. Bland-Altman plots were made and limits of agreement calculated. The limits of agreement were -40.8 (95% CI, -55.6 to -26.0) to 45.6 (95% CI, 30.8 to 60.4), indicating that the DBP measured with tape would be expected to be between 40.8 mm Hg below and 45.6 mm Hg above that measured without tape 95% of the time. The mean bias estimate was 2.4 mm Hg (SD, 22.0; 95% CI, -6.1 to 11.0; P = .724), indicating that DBP measurements with tape averaged 2.4 mm Hg higher than without tape. Doppler blood pressure measurements obtained with secondary fasteners on the BPCs differed by > 10 mm Hg compared to the BPCs' standard hook-and-loop fasteners 54% (30 of 56) of the time. Blood pressure cuffs with dysfunctional hook-and-loop fasteners should be replaced due to poor clinical reliability of DBP measurements. However, it is unclear whether Doppler sphygmomanometry is more accurate with the use of traditional Velcro BPC fasteners or with tape BPC fasteners.

Immediate Effect of Compression Contrast Therapy on Quadriceps Femoris Muscles' Regeneration in MMA Fighters.

Objectives: This study aimed to evaluate the immediate effect of Game Ready (GR) heat-cold compression contrast therapy (HCCT) on changes in the biomechanical parameters of the quadriceps femoris muscles and tissue perfusion. Methods: Fifteen male MMA fighters were subjected to HCCT on the dominant leg's thigh and control sham therapy on the other. The experimental intervention used a pressure cuff with the following parameters: time-20 min; pressure-25-75 mmHg; and temp.-3-45°C, changing every 2 min. For the control group, the temp. of sham therapy was 15-36 °C, and pressure was 15-25 mmHg, changing every 2 min. Measurements were taken on the head of the rectus femoris muscle (RF) 5 min before therapy, 5 min after, and 1 h after therapy in the same order in all participants: microcirculatory response (PU), muscle tension (MT), stiffness (S), flexibility (E), tissue temperature (°C), and pressure pain threshold (PPT). Results: The analysis revealed significant differences between the HCCT and sham therapy groups and the measurement time (rest vs. post 5 min and post 1 h) for PU, MT, E, and °C (p < 0.00001) (a significant effect of time was found) in response to GR therapy. No significant differences were found for the PPT. Conclusions: The results of this study prove that GR HCCT evokes changes in the biomechanical parameters of the RF muscles and perfusion in professional MMA fighters.

Impact of equine interactions on human acute pain perception: Two cross sectional studies.

Research has demonstrated the effectiveness of Animal-Assisted Therapy, usually involving dogs, as a way to reduce pain in inpatient and outpatient populations. Here two studies investigate the effectiveness of interacting with horses for reducing human acute pain perception. In Study 1, a blood-pressure cuff was used to administer acute ischaemic pain to 70 adult participants, who were allocated to one of three groups: Equine Assisted Psychotherapy (EAP), Horse Interaction without EAP (HI), and a Control (no horses present). All participants engaged in an activity (finding a horse treat) in a large, enclosed arena. The dependent variable was the subjective pain rating (scale 0-10) of the participant in response to moderate pain induced pre- and post-activity. In Study 2, 53 adult participants were recruited and allocated to either an Equine Assisted Learning (EAL) Group or a Control Group. The same paradigm was used. Following the activity sessions, qualitative data was elicited from the participants regarding their insights and feelings. It was hypothesized that any interaction with horses would significantly reduce an individual's perception of pain. In both studies, planned paired-samples t-tests showed significant reductions in pain ratings from pre-activity to post-activity in the EAL, EAP and HI groups (large and medium effect sizes) but not the Control groups. Thematic analysis of the qualitative responses showed an overwhelmingly positive array of responses from those who interacted with the horses, for example, feeling relaxed and happy during the activity. Interactions with horses can reduce acute pain perception. Distraction, physiological changes, and positive emotions are discussed as possible underlying mechanisms. It remains to be seen how this could be more widely applied, for example, in relation to chronic pain.

A non-invasive heart rate prediction method using a convolutional approach.

The research focuses on leveraging convolutional neural networks (CNNs) to enhance the analysis of physiological signals, specifically photoplethysmogram (PPG) data which is a valuable tool for non-invasive heart rate prediction. Recognizing the global challenge of heart failure, the study seeks to provide a rapid, accurate, and non-invasive alternative to traditional, uncomfortable blood pressure cuffs. To achieve more accurate and efficient heart rate estimates, a k-fold CNN model with an optimal number of convolutional layers is employed. While the findings show promising results, the study addresses potential sources of error in cuffless PPG-based heart rate measurement, including motion artifacts and skin color variations, emphasizing the need for validation against gold standard methods. The research optimizes a CNN model with optimal layers, operating on 1D arrays of 8-s data slices and employing k-fold cross-validation to mitigate probabilistic uncertainties. Finally, the model yields a remarkable minimum absolute error (MAE) rate of 6.98 beats per minute (bpm), marking a significant 10% improvement over recent studies. The study also advances medical diagnostics and data analysis, then lays a strong foundation for developing cost-effective, reliable devices that offer a more comfortable and efficient way of predicting heart rate.

Abstract 4124531: Digital Health Intervention to Enhance Optimization of Heart Failure Care: From Reciprocal Innovation using Human-Centered Design to Pilot Study

Introduction: Guideline-directed medical therapy (GDMT) for Heart Failure with reduced ejection fraction (HFrEF) reduces adverse events by 70%, but is underutilized. The Human Centered Design (HCD) methodology can be useful to build a strategy to optimize GDMT centered on patients’ demands and perspectives. We aimed to reciprocally innovate a telephone-based digital health intervention (DHI) from a Brazilian trial to an app co-developed for a US trial and iterate it again to the Brazilian context using HCD. We will evaluate the app’s usability and utility to facilitate HF GDMT optimization, considering barriers of the Brazilian public health system users, such as low literacy and socioeconomic status. Methods: Mixed methods study. Steps were carried out according to HCD method: (1) empathizing and identifying challenges, (2) suggesting solutions, (3) prototype development, (4) ranking features for feasibility and utility (5) engineering work and (6) prototype testing. In stages 1-3, semi-structured interviews were held with 10 HF patients and 2 health professionals. Steps 4 and 5 were done by the research team. In stage 6, we conducted a pilot study with 10 HFrEF patients, with at least one GDMT drug with an optimization gap. The primary outcome was the app’s usability assessed by an engagement score, and the app’s utility at 4 weeks. Secondary outcomes included change in self-care score using the European Self-Care Behavior Scale. After step 6, new interviews were carried out to capture the user experience and identify new iterations. Interviews were recorded and transcribed for content analysis. Results: The average engagement score was 80% (SD 16) and the app’s utility score was 82% (SD 8). The average self-care score increased by 32% (SD 25) at the end of the pilot. The main challenges were lack of knowledge about HF and self-care. Technical difficulties and lack of trust in the app to handle health data were mentioned. In the pilot, patients reported the app was easy to use and contributed to self-care and understanding of HF. Among the DHI components, teleconsultation was best evaluated, followed by the educational videos. The greatest challenge was connecting the blood pressure cuff and scale via Bluetooth. Conclusion: The app was well accepted and considered useful by patients. User contributions were fundamental to create tools that facilitate engagement and utility. The final product will be evaluated in a randomized, multicenter, clinical trial.

Abstract 4115642: Resonance Sonomanometry in an Early Prototype Device Effectively Measures Continuous, Noninvasive Blood Pressure

Background: Nearly half of American adults have hypertension; however, reliable, continuous, noninvasive blood pressure (BP) measurement (cNIBP) for inpatient and outpatient use is not currently available. This study evaluated a new method for cNIBP measurement called resonance sonomanometry (RSM). RSM derives blood pressure using first-principles physics, is applicable to any artery, and requires no calibration, blood vessel deformation, or dependence on demographic inputs. Methods: A prospective, observational feasibility study was undertaken to compare carotid artery BP measurements with a prototype ultrasound-based cNIBP device incorporating RSM, to arterial catheter BP measurements in the radial arteries of 60 test subjects. Catheter measurements were obtained from a distal peripheral artery (radial), oscillometric cuff from the brachial artery, and RSM was obtained from a central artery (carotid). This study was the first-in-human study for the RSM method in comparison to arterial catheters. Results: RSM-induced arterial resonance was observed in all tested subjects. For each of the subjects, the arterial resonant frequency increased with increasing BP during systole, and decreased with diastole (consistent with the cardiac cycle), as predicted by the physical model. RSM-derived BP traces were qualitatively similar to catheter data, exhibiting features such as the dicrotic notch. The RSM method yielded similar diastolic BP (DBP), but lower systolic BP (SBP) compared to the arterial catheter, likely due to expected peripheral pulse amplification. RSM DBP was not significantly different from the catheter (+1.5mmHg, p = 0.187), while BP cuff DBP was significantly different from the catheter (−4.3mmHg, p=0.002). There were significant differences in the catheter to RSM SBP (34.1 mmHg, p &lt; 0.01), consistent with the aforementioned expectations from a central-versus-peripheral continuous pressure measurement. Conclusions: RSM is a novel BP measurement technique that could enable cNIBP measurements with accuracy required in hospitals. While the data are promising, significant future work remains. The study was meant to test the RSM method, not the device or form factor. Consequently, the form factor will need to be improved prior to clinical use. The prototype was designed for manual operation; thus, future work will also be needed to enhance the ability of the device to autonomously locate and track the artery for ease of use.

TO-LAB model: Real time Touchless Lung Abnormality detection model using USRP based machine learning algorithm.

Due to the increasing prevalence of respiratory diseases and the importance of early diagnosis. The need for non-invasive and touchless medical diagnostic solutions has become increasingly crucial in modern healthcare to detect lung abnormalities. Existing methods for lung abnormality detection often rely on invasive and time-consuming procedures limiting their effectiveness in real-time diagnosis. This work introduces a novel Touchless Lung Abnormality (TO-LAB) detection model utilizing universal software radio peripherals (USRP) and machine learning algorithms. The TO-LAB model integrates a blood pressure meter and an RGB-D depth-sensing camera to gather individual data without physical contact. Heart rate (HR) is analyzed through image conversion to IPPG signals, while blood pressure (BP) is obtained via analog conversion from the blood pressure meter. This touchless imaging setup facilitates the extraction of essential signal features crucial for respiratory pattern analysis. Advanced computer vision algorithms like Mel-frequency cepstral coefficients (MFCC) and Principal Component Analysis (PCA) process the acquired data to focus on breathing abnormalities. These features are then combined and inputted into a machine learning-based Multi-class SVM for breathing activity analysis. The Multi-class SVM categorizes breathing abnormalities as normal, shallow, or elevated based on the fused features. The efficiency of this TO-LAB model is evaluated with the simulated and real-time data. According to the findings, the proposed TO-LAB model attains the maximum accuracy of 96.15% for real time data; however, the accuracy increases to 99.54% for simulated data for the efficient classification of breathing abnormalities. From this analysis, our model attains better results in simulated data but it declines the accuracy while processing with real-time data. Moreover, this work has a significant medical impact since it presents a solution to the problem of gathering enough data during the epidemic to create a realistic model with a large dataset.

Oscillometric blood pressure measurements on smartphones using vibrometric force estimation

This paper proposes a smartphone-based method for measuring Blood Pressure (BP) using the oscillometric method. For oscillometry, it is necessary to measure (1) the pressure applied to the artery and (2) the local blood volume change. This is accomplished by performing an oscillometric measurement at the finger’s digital artery, whereby a user presses down on the phone’s camera with steadily increasing force. The camera is used to capture the blood volume change using photoplethysmography. We devised a novel method for measuring the force applied of the finger without the use of specialized smartphone hardware with a technique called Vibrometric Force Estimation (VFE). The fundamental concept of VFE relies on a phenomenon where a vibrating object is dampened when an external force is applied on to it. This phenomenon can be recreated using the phone’s own vibration motor and measured using the phone’s Inertial Measurement Unit (IMU). A cross device reliability study with three smartphones of different manufacturers, shape, and prices results in similar force estimation performance across all smartphone models. In an N = 24 proof of concept study of the BP measurement, the smartphone technique achieves a mean absolute error of 9.21 mmHg and 7.77 mmHg of systolic and diastolic BP, respectively, compared to an FDA approved BP cuff. The vision for this technology is not necessarily to replace existing BP monitoring solutions, but rather to introduce a downloadable smartphone software application that could serve as a low-barrier hypertension screening measurement fit for widespread adoption.

Mechanism of action of exercise regulating intestinal microflora to improve spontaneous hypertension in rats.

Hypertension is a prevalent cardiovascular disease. Exercise is widely recognized as an effective treatment for hypertension, and it may also influence the composition of the intestinal microflora. However, it remains unclear whether exercise can specifically regulate the intestinal microflora in the context of hypertension treatment. In this study, tail blood pressure in spontaneously hypertensive rats (SHR) was measured using a blood pressure meter after exercise intervention and fecal bacteria transplantation following exercise. Blood lipid levels were assessed using an automatic biochemical analyzer, and 16S rRNA sequencing was employed to analyze the intestinal microflora. Histological examinations of ileal tissue were conducted using HE and Masson staining. Intestinal permeability, inflammatory status, and sympathetic activity were evaluated by measuring the levels of diamine oxidase, D-lactic acid, C-reactive protein, interleukin-6, tumor necrosis factor-α, lipopolysaccharide, norepinephrine, angiotensin II, cyclic adenosine monophosphate, and cyclic guanosine monophosphate. Exercise was found to reduce blood pressure and blood lipid levels in SHR. It also improved the composition of the intestinal microflora, as evidenced by a reduced Firmicutes/Bacteroidetes ratio, an increase in bacteria that produce acetic and butyric acid, and higher Chao 1 and Shannon diversity indices. Furthermore, exercise reduced the thickness of the fibrotic and muscular layers in the ileum, increased the goblet cell/villus ratio and villus length, and decreased intestinal permeability, inflammatory markers, and sympathetic nerve activity. The intestinal microbial flora regulated by exercise demonstrated similar effects on hypertension. In conclusion, exercise appears to regulate the intestinal microflora, and this exercise-induced change in flora may contribute to improvements in hypertension in rats.

Automated cardiac arrest DETECTion incorporated into a wristband: validation of a photoplethysmography algorithm in patients with spontaneous and induced cardiac arrest

Abstract Background Although survival from out-of-hospital cardiac arrest (OHCA) has improved, this does not apply to unwitnessed cases, as the arrest is often recognized too late. Automated cardiac arrest detection and alarming using a wristband is a promising technology to facilitate early assistance after cardiac arrest in a home setting. In the DETECT-1 study, a photoplethysmography(PPG) algorithm for circulatory arrest detection has been developed in patients with induced circulatory arrest. Purpose To assess the performance of the developed PPG algorithm for circulatory arrest detection in: 1) patients with spontaneous cardiac arrest; 2) subjects with induced circulatory arrest using blood pressure cuff inflation. Methods We selected patients with episodes of spontaneous cardiac arrest who participated in the DETECT-1 study and patients/healthy subjects with short-lasting induced circulatory arrest using blood pressure cuff inflations from the DETECT-1 and DETECT-2 studies. The DETECT-1 study included patients who underwent transcatheter aortic valve implantation (TAVI), subcutaneous ICD implantation, or ventricular tachycardia ablation. Included patients wore the PPG-wristband during the procedure. Continuous ECG and invasive blood pressure data were collected as reference standard. The DETECT-2 study included healthy volunteers who wore the PPG-wristband during physical exercise. Sensitivity for spontaneous and induced circulatory arrest and false positive alarms were assessed using the previously developed algorithm for circulatory arrest detection. All episodes were analyzed as individual events. Results A total of 39 individuals were included; nine patients with spontaneous cardiac arrests during TAVI and 20 subjects with 116 induced circulatory arrests. Of the patients with spontaneous cardiac arrest, two had ventricular fibrillation, five had pulseless electrical activity (figure), and two had asystole. Eight out of nine cardiac arrest events were detected by the circulatory arrest detection algorithm (sensitivity 89% [95% CI 51-99%]). Of the subjects with induced circulatory arrests, the PPG algorithm detected 114 induced circulatory arrests, yielding a sensitivity of 98% (95% CI 93-100%). In the entire group, there were no false positive alarms during 60 recording hours. Conclusions Automated cardiac arrest detection using a PPG-wristband is feasible with excellent sensitivity for both spontaneous and induced circulatory arrest. False positive alarms were absent in this controlled setting. Further study is warranted to assess algorithm performance in a larger sample of spontaneous cardiac arrests, and false positive alarms during daily life use. If available, automated cardiac arrest detection and alarming has the potential to markedly increase survival from OHCA in a home setting.Episode of spontaneous cardiac arrest

Postpartum Management of Hypertensive Disorders of Pregnancy in Six Large U.S. Hospital Systems: Descriptive Review and Identification of Clinical and Research Gaps.

Hypertensive disorders of pregnancy (HDPs) are a key contributor to maternal morbidity and mortality. Several gaps in knowledge remain regarding best practices in the postpartum management of HDPs. In this review, we describe postpartum HDPs management among six large academic U.S. hospital systems: Medical College of Wisconsin, University of Pittsburgh, University of Wisconsin-Madison, Northwestern University, University of Minnesota, and Boston Medical Center. We identified that all six health systems discharge patients with HDPs diagnosed with a blood pressure (BP) cuff and use the same two antihypertensive medications, nifedipine and labetalol, as first- and second-line treatment of HDPs. Northwestern University routinely adds oral furosemide for 5 days for patients with BP that exceeds 150/100 mm Hg. Most hospital systems administer magnesium sulfate routinely when readmission for HDPs occurs. In contrast, there was variation in BP threshold for antihypertensive treatment initiation, use of remote BP monitoring program, use of a transition clinic, delivery or lack of education on long-term cardiovascular disease risk, and BP management through the first 6 weeks postpartum and beyond. Based on the clinical review, we identified clinical gaps and formulated considerations for research priorities in the field of postpartum HDPs management. KEY POINTS: · Several gaps in knowledge remain regarding best practices in postpartum management of HDPs.. · There is a variation in the BP threshold for antihypertensive treatment initiation.. · Data are lacking on the reduction in severe maternal morbidity (SMM) and racial disparities in SMM with remote monitoring..

Blood Pressure Cuff Sizes for Pregnant Women in the United States: Findings From the National Health and Nutrition Examination Survey.

The use of correctly sized blood pressure (BP) cuffs is important to ensure accurate measurement and effective management of hypertension. The goals of this study were to determine the proportions of pregnant women that would require small, adult, large, and extra-large (XL) cuff sizes, and to examine the demographic characteristics associated with need for a large or XL cuff. This cross-sectional study analyzed 1,176 pregnant women (≥18 years) included in the National Health and Nutrition Examination Survey (NHANES) 1999-2006 cycles. Recommended BP cuff sizes, based on American Heart Association recommendations, were categorized by mid-arm circumference: small adult (≤26 cm), adult (>26 to ≤34 cm), large (>34 to ≤44 cm), and extra-large (XL) (>44 cm). Among US pregnant women, recommended cuff sizes were: 17.9% small adult, 57.0% adult, and 25.1% for large or XL. About 38.5% of non-Hispanic Black, 21.6% of Mexican American and 21.0% of non-Hispanic White pregnant women required a large or XL cuff. About 81.8% of women in the highest quartile for BMI required large or XL cuffs, which was significantly higher than women in other quartiles. Roughly one out of every four pregnant women required large or XL BP cuffs. The requirement for large or XL cuffs was highest among non-Hispanic Black women and women with the highest BMI. For pregnant women, measuring the arm circumference and selecting an appropriately sized cuff is important to facilitate accurate blood pressure monitoring and hypertension management.

Recommendations for Updates to Emergency Medical Kits for Commercial Aviation

INTRODUCTION: Emergency medical kits (EMK) are provided to clinicians who volunteer on commercial aircraft during a medical emergency. The contents of the EMKs are mandated by the Federal Aviation Administration in the United States and, internationally, by the International Civil Aviation Organization and the country of airline origin. The mandatory contents of the kits have not been updated by the Federal Aviation Administration since 2006, and the EMKs continue to lack key equipment such as automated blood pressure cuffs, glucometers, pulse oximeters, and epinephrine autoinjectors. Of further concern is a lack of standardized and centralized reporting for in-flight medical events that, if it existed, could better inform the contents of the kits. This commentary is intended to advocate for an update to the EMKs in the United States given the authors’ experiences with in-flight medical events. Rajagopal AB, Pissaris A, Clark K, Merrill A, Glatter R, Ho A, Towle DC, Yanuck J, Lahham S, Ulin L, Fischetti C, Apisa L. Recommendations for updates to emergency medical kits for commercial aviation. Aerosp Med Hum Perform. 2024; 95(10):794–796.

Low-intensity blood flow restriction (LI-BFR) and moderate-intensity improves quadriceps strength and thigh circumference in older women

Background and objectives. Weakness and atrophy in the quadriceps femoris lead to decreased functional capacity, heightened fall risk, and increased mortality among older women. While moderate-intensity strength training is generally recommended for the elderly, higher-intensity exercises carry a greater risk of injury. Low-intensity exercises with blood flow restriction offer an alternative, providing comparable benefits to high-intensity training. This study aims to evaluate the effects of moderate-intensity and low-intensity blood flow restriction exercises on quadriceps femoris strength and thigh circumference in healthy elderly women. Materials and methods. The sample size was of 88 subjects equally randomized into a moderate-intensity group and a blood-flow restriction group. The moderate-intensity group performed strengthening exercises with a load of ≥40–60% of 1RM, 3 sets, 36 repetitions. The blood-flow restriction group conducted exercises at 20–30% of 1RM, completing 75 repetitions across 4 sets, using a pressure cuff applied to the upper thigh at 50 mmHg or 40% of the Arterial Occlusion Pressure (AOP). Both groups exercised twice a week over a 6-week period. Muscle strength (assessed via dynamometer and 1RM) and thigh circumference were recorded before and after the intervention. Results. After six weeks of intervention, both groups showed a significant increase in muscle strength and thigh circumference (p &lt;0.001). However, no notable differences were observed between the moderate intensity group and the blood flow restriction group regarding quadriceps strength (dynamometer), quadriceps 1RM strength, or thigh circumference (p &gt;0.05). Muscle soreness was reported in 18% of participants in the moderate intensity group. Conclusion. Low-intensity resistance exercises with blood flow restriction in older women can promote strength gains and muscle hypertrophy comparable to moderate-intensity training, while offering a safer alternative.

Effect of wearing N95 masks for 10 hours on ambulatory blood pressure in healthy adults.

The impact of wearing a face mask for an extended duration is unknown. This study aimed to determine if wearing a face mask for 10 h impacts blood pressure (BP) and arterial stiffness. Subjects received an ambulatory blood pressure cuff and were asked to wear it for 10 h while readings were taken every 15 min. During the face mask trial, subjects wore an N95 mask for 10 h. During the control, subjects did not wear a mask. Subjects were randomized to start their trial. An accelerometer was given to ensure no physical activity differences. Linear mixed models were used to determine group differences, and McNemar test was used to assess frequency differences when determining BP load. Twelve college-aged (20.5 ± 1.5 years) male (n = 5) and female (n = 7) individuals with normal BP participated in this study. There were no differences in time spent in any physical activity domain (all P > 0.05). There was no difference in brachial SBP (P = 0.688), brachial DBP (P = 0.063), central SBP (P = 0.875), central DBP (P = 0.246), heart rate (P = 0.125), and augmentation pressure (P = 0.158) between conditions. During mask condition, augmentation pressure was reduced by 5.2 ± 3.1% compared to control (P < 0.001). There were no frequency differences in the number of BP readings above 140 mmHg for SBP (P = 0.479) and >90 mmHg for DBP (P = 0.212). The current study found that wearing an N95 mask for 10 h did not affect brachial or central BP but significantly decreased augmentation pressure.

Arterial hypertension-clinical trials update 2024.

Arterial hypertension remains the most important modifiable cardiovascular risk factor for morbidity and mortality worldwide. This review summarizes and discusses major clinical trials published in 2023 and early 2024 in hypertension research. These trials include new epidemiological data, studies investigating the impact of blood pressure cuff size on blood pressure measurements, benefits of salt substitutes, and novel antihypertensive treatment options, including pharmacotherapy and bariatric surgery in patients with obesity. This summary reviews the major clinical trials published in 2023 and early 2024. AHT arterial hypertension, BP blood pressure, HR hazard ratio, OBP office blood pressure, PRA plasma renin activity, SBP systolic blood pressure.