Blood Pressure Range Research Articles

Getting to the heart of anatomical diversity and phenotypic plasticity: fish hearts are an optimal organ model in need of greater mechanistic study.

Natural selection has produced many vertebrate 'solutions' for the cardiac life-support system, especially among the approximately 30,000 species of fishes. For example, across species, fish have the greatest range for central arterial blood pressure and relative ventricular mass of any vertebrate group. This enormous cardiac diversity is excellent ground material for mechanistic explorations. Added to this species diversity is the emerging field of population-specific diversity, which is revealing that cardiac design and function can be tailored to a fish population's local environmental conditions. Such information is important to conservation biologists and ecologists, as well as physiologists. Furthermore, the cardiac structure and function of an individual adult fish are extremely pliable (through phenotypic plasticity), which is typically beneficial to the heart's function when environmental conditions are variable. Consequently, exploring factors that trigger cardiac remodelling with acclimation to new environments represents a marvellous opportunity for performing mechanistic studies that minimize the genetic differences that accompany cross-species comparisons. What makes the heart an especially good system for the investigation of phenotypic plasticity and species diversity is that its function can be readily evaluated at the organ level using established methodologies, unlike most other organ systems. Although the fish heart has many merits as an organ-level model to provide a mechanistic understanding of phenotypic plasticity and species diversity, bringing this potential to fruition will require productive research collaborations among physiologists, geneticists, developmental biologists and ecologists.

Diastolic and systolic blood pressure time in target range as a cardiovascular risk marker in patients with type 2 diabetes: A post hoc analysis of ACCORD BP trial

AimsWe investigated the associations between time in target range (TTR) of blood pressure (BP) and cardiovascular outcomes in patients with diabetes. Methods4651 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) BP trial were included in the present study. The diastolic BP target range was defined as 70 to 80 mm Hg, and the systolic as 120 to 140 mm Hg and 110 to 130 mm Hg for the standard and intensive therapy, respectively. ResultsAfter adjusting for covariates, 1-SD increase of diastolic TTR was significantly associated with lower risks of primary outcome (HR 0.82, 95% CI: 0.74–0.91, P < 0.001; HR 0.86, 95% CI: 0.77–0.95, P = 0.0044, as well as nonfatal myocardial infarction (HR 0.79, 95% CI: 0.69–0.91, P < 0.001). Meanwhile, systolic TTR was significantly associated with various cardiovascular outcomes (P ≤ 0.016) in fully-adjusted models. The diastolic TTR sustained significance in myocardial infarction when systolic blood pressure average was higher than 120 mm Hg. ConclusionsIn patients with diabetes, TTR of diastolic and systolic BP was independently associated with lower risks of major outcomes. The diastolic BP within the optimal target range was considerably important for reducing the risk of myocardial infarction, even when systolic BP was under stable control.

Hypertension Control in Patients Attending Outpatient Department: A Hospital Based Study from Lumbini Province Nepal

Background: Systemic hypertension is major public health problem. It is easy to diagnose and initiate treatment. But still it remains under detected, undertreated and less well controlled throughout the world. We wanted to know control of hypertension in patients attending outpatient department in a cardiac center. Methods: This is a cross-sectional observational study conducted at Gautam Buddha Community Heart Hospital. One hundred newly detected hypertensive patients attending outpatient department were evaluated in this study. Results: Distribution of patients was males 56% and females 44%. Most patients (55%) were in the age group 45 to 65 years. Headache (42%) and dizziness (39%) were common symptoms at presentation. Majority of hypertensive pa-tients had blood pressure range 140 to 160 SBP (49%) and 90 to 100 DBP (56%). Hypertension control target reached in 69% for SBP and 90% for DBP at one month. Target blood pressure was present in 82% for SBP and 84% for DBP at three months follow up. Conclusion: Hypertension management in short term appears promising but long term control is more important to prevent complications. So long term fol-low up study or national registry database is important.

FEWER ANTIHYPERTENSIVE DRUGS ACHIEVE STRICTER BLOOD PRESSURE TARGET IN LESS SEVERE HYPERTENSIVE PATIENTS: A RETROSPECTIVE STUDY IN A COMMUNITY IN BEIJING

Objective: Nowadays, it is not clear how many antihypertensive drugs should be used to achieve treatment goals from real-world studies. This study aims to analyze the BP control situation and the burden of anti-hypertensive drugs in a big community in Beijing. Design and method: We conducted a retrospective study of 4991 residents living in the Majiapu community and collected the baseline and the follow-up data including blood pressure (BP) and drug prescription. BP was analyzed by the mean average value. Hypertension is defined as office systolic BP &gt; = 140mmHg and/or diastolic BP &gt; = 90mmHg. We divided the patient with antihypertensive treatment into a strict control group (BP&lt;130/80mmHg) and a standard control group (BP range from 130-139/80-89mmHg). The comparison of baseline and follow-up data were used to recognize the burden of anti-hypertensive drugs for residents with hypertension and estimate the BP control rate in this population. Results: Of 4991 residents, the prevalence of hypertension was 54%, 34.80% (939) of the patients were under 140/90mmHg and 14.46% (390) were under 130/80mmHg. The control rate of standards of 140/90mmHg and 130/80mmHg among the whole population was 64.7% and 35.3%. And the treatment rate in the whole group of hypertension was 62.5%. In the standard control group, the average number of antihypertensive drugs was 1.66 keeping their BP range from 130-139/80-89mmHg, and the mean BP was 132.1±5.39/79.6±6.71mmHg. However, in the strict control group, the average number of antihypertensive drugs was 1.55, and the mean BP was controlled at 118.8±8.45/71.6±5.79mmHg (P&lt;0.05). There were no differences between the two subgroups by age and smoking status. BMI in the strict group (24.6±3.3 kg/m2) was lower than the mild group (25.5±3.3kg/m2, p&lt;0.01). About 49.2% in the strict control group and 47.0% in the standard control group were combined with lipid-lowing drugs. The LDL levels in the standard control group (2.8±0.8mmol/l) tended to be higher than that in the strict control group (2.7±0.9mmol/l, p = 0.06). Conclusions: In the Majiapu community where BP controls were insufficient, patients had fewer antihypertensive drugs to achieve stricter targets may be due to the lower risk profile of the patients.

DESIGNING A CLINICAL TRIAL PROTOCOL INCLUDING PHYSICAL AND MENTAL ACTIVITIES TO EXPLORE BLOOD PRESSURE DYNAMICS FOR MEDICAL DEVICE DEVELOPMENT

Objective: Cuff blood pressure monitoring is uncomfortable, limited for daily-routine and it provides sparse measurements in time. To enable continuous non-invasive monitoring, a new cuffless blood pressure (BP) meter based on photoplethysmography (PPG) is assessed in a first clinical trial. It aims at exploring the relationship between BP variations and optical features, including a wide range of intra-individual BP variations. Design and method: The initial cohort of the clinical trial (NCT05393401, approved by Human Research Review Board (CPP SM I) and Health French Ministry) includes five healthy subjects (1F/4M, age [37-60] years). Each subject is monitored with a medical-grade continuous BP meter, and a multi-sensing homemade platform integrating gold standard cuff measurements. The latter gathers PPG sensors, an ECG, a nasal cannula. The subject undertakes the following exercises: rest, static and dynamic strength exercises with a Pilates fitness ring, mental calculation, guided relaxation, and wall sit exercise. Each phase lasts 3 minutes, except the relaxation (10 minutes) and is followed by a 3-minute recovery. Results: The impact of each activity is quantified by the range of mean arterial pressure (MAP), i.e. the difference between the initial value and the extremum during the interval. As the table shows, the highest median impact is achieved with the dynamic ring (+39 mmHg) and the wall sit (+33mmHg). The static ring and the stress occurred by the calculation exercise have a lower impact with an increase of 21mmHg and 19mmHg. Finally, the effect of the relaxation is verified with a median decrease of 13 mmHg. Conclusions: These preliminary results (trial still running) show that building an accurate BP meter requires exploring the full range of BP in response to various physiological mechanisms. Therefore, it is necessary to combine relaxing and physical activities. Their impact vary among subjects and activities and illustrate that special care should be taken using real-time monitoring.

PREVALENCE OF WHITE-COAT AND MASKED HYPERTENSION AT DIFFERENT OFFICE BLOOD PRESSURE LEVELS IN UNTREATED SUBJECTS

Objective: The European Guidelines for the management of arterial hypertension support the use of out-of-office blood pressure (BP) measurements for confirming the diagnosis of hypertension and detecting BP phenotypes such as white-coat hypertension (WCH) and masked hypertension (MH), especially in patients with grade 1 hypertension and subjects with high normal BP. However, it is not clear enough, whether out-of-office blood pressure measurements should be performed in patients with higher grades of hypertension as well as in subjects with normal or optimal BP. The aim of our study was to investigate the prevalence of WCH in untreated patients with grade 1, grade 2 and grade 3 hypertension as well as the prevalence of MH in never treated subjects with high normal, normal and optimal BP values. Design and method: A total of 2357 untreated subjects referred to our Hypertension Unit for evaluation underwent 24-h ambulatory BP monitoring. According to their office BP levels were divided into 6 categories: optimal (&lt;120/80mmHg), normal (120/80 – 129/84mmHg), high normal (130/85 – 139/89mmHg), grade 1(140/90 – 159/99mmHg), grade 2 (160/100 – 179/109mmHg) and grade 3 (&gt; = 180/110mmHg). Subjects with office BP&gt; = 140/90mmHg and 24-h BP&lt;130/80mmHg were defined as WCHs and patients with office BP&lt;140/90mmHg and 24-h BP&gt; = 130/80mmHg as MHs. Statistical analysis was performed by means of chi-square test and one-way ANOVA. Results: The percentages of WCH were 53%, 31% and 24% for patients with grade 1, grade 2 and grade 3 hypertension, respectively. The percentages of MH were 34%, 29% and 17% for patients with high normal, normal and optimal BP, respectively. Conclusions: The prevalence of WCH is significantly higher in grade 1 hypertension, however patients with grade 2 and 3 hypertension present also high rates of WCH. Similarly, MH is more common in subjects with high normal BP, however high percentages are observed in subjects with normal and optimal BP. Our results support that out-of-office BP measurements should be performed across all office BP range for the optimal detection of WCH and MH.

Beat-to-beat resting blood pressure variability in patients with type 2 diabetes: effect of statin therapy

Type 2 diabetes (T2D) is a major health concern affecting more than 30 million people in the United States alone. Approximately two-thirds of patients with T2D develop hypertension, a major risk factor for cardiovascular disease. In addition to higher resting absolute blood pressure (BP), increased variability in BP has also been related to greater cardiovascular disease risk. However, whether patients with T2D display greater beat-to-beat BP variability remains unknown. Herein, we hypothesized that patients with T2D would exhibit greater beat-to-beat BP variability than age and body-weight-matched control subjects. In addition, since previous literature has shown that statins lower cardiovascular disease risk through favorable pleiotropic mechanisms, we further hypothesized that patients with T2D taking statins (T2D+statin) would have a lower beat-to-beat BP variability compared to patients with T2D not taking statins (T2D-statin). Beat-to-beat BP (finger photoplethysmography) and heart rate (ECG) were continuously measured, and absolute BP (automated sphygmomanometer) was measured periodically in patients with T2D (N=23; T2D+statin: N=10, T2D-statin: N=13) and age and body weight-matched control subjects (N=17). Measurements were made over the course of a quiet resting baseline period (9.5±1.3 minutes) with subjects in a supine position. Beat-to-beat BP variability was quantified as standard deviation (SD), range, and average real variability (average change in BP from one heartbeat to the next). Data are presented as mean ± standard deviation. Resting absolute systolic BP, diastolic BP, and mean arterial pressure (MAP) were not different between control subjects and T2D patients (P&gt;0.05 for all). There was also no difference in beat-to-beat systolic BP, diastolic BP, or MAP variability between the groups (e.g., MAP SD: control: 4.5±1.3 mmHg, T2D: 4.7±1.1 mmHg, P=0.763). When comparing T2D patients taking statins and those not taking statins, no difference was observed in absolute resting BP (P&gt;0.05). Likewise, systolic BP variability was not different between groups (SD: T2D-statin: 7.0±2.2 mmHg, T2D+statin: 6.3±1.4 mmHg, P=0.369). However, diastolic BP variability was significantly higher in T2D-statin patients (SD: T2D-statin: 4.1±1.1 mmHg, T2D+statin: 3.1±0.6 mmHg, P=0.013) and MAP variability tended to be higher (SD: T2D-statin: 5.2±1.4 mmHg, T2D+statin: 4.3±0.7 mmHg, P=0.061). Similar results were found for BP range and average real variability. These preliminary findings suggest that statin therapy may have a beneficial effect in lowering BP variability in patients with T2D. Supported by American Heart Association (AHA) - Institutional Award for Undergraduate Student Training - #915555. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Toward Real-Time Blood Pressure Monitoring via High-Fidelity Iontronic Tonometric Sensors with High Sensitivity and Large Dynamic Ranges.

Continuous, noninvasive blood pressure (CNIBP) monitoring provides valuable hemodynamic information that renders detection of the early onset of cardiovascular diseases. Wearable mechano-electric pressure sensors that mount on the skin are promising candidates for monitoring continuous blood pressure (BP) pulse waveforms due to their excellent conformability, simple sensing mechanisms, and convenient signal acquisition. However, it is challenging to acquire high-fidelity BP pulse waveforms since it requires highly sensitive sensors (sensitivity larger than 4 × 10-5 kPa-1 ) that respond linearly with pressure change over a large dynamic range, covering the typical BP range (5-25kPa). Herein, this work introduces a high-fidelity, iontronic-based tonometric sensor (ITS) with high sensitivity (4.82 kPa-1 ), good linearity (R2 > 0.995), and a large dynamic range (up to 180% output change) over a broad working range (0 to 38kPa). Additionally, the ITS demonstrates a low limit of detection at 40Pa, a fast load response time (35ms) and release time (35ms), as well as a stable response over 5000 load per release cycles, paving ways for potential applications in human-interface interaction, electronic skins, and robotic haptics. This work further explores the application of the ITS in monitoring real-time, beat-to-beat BP by measuring the brachial and radial pulse waveforms. This work provides a rational design of a wearable pressure sensor with high sensitivity, good linearity, and a large dynamic range for real-time CNIBP monitoring.

41. Stage Of Hypertension And The Incident Of Atrial Fibrillation Among PROLANIS Community In Bandung, West Java

Background: The most important risk of atrial fibrillation (AF) is hypertension. The 2017 AHA/ACC blood pressure classification system can identify adults risk for AF events. Little is known whether the newest hypertension classification by ISHG (International Society of Hypertension Global) 2020 is associated with incident of AF. Objective: PROLANIS (Program Pengelolaan Penyakit Kronis) had been a program that held by Ministry of Health in Indonesia to manage hypertension. This analytical study is aimed to identify association between stage of hypertension by ISHG 2020 and incidents of AF among PROLANIS community in Bandung. Method: A cross-sectional study was carried out among PROLANIS community in Bandung. We performed blood pressure examination and recorded AF using six-leads FDA approved ECG mobile in twenty-one primary care during march-october 2022. There are 692 data were collected. Data was categorized as having grade 1 HT (n = 229) and grade 2 HT (n = 88). Result: We found that 4.4% population (n = 14) with hypertension had recorded ECG of AF. Proportion of grade 2 HT was 4.5% (n = 4) which higher than AF in grade 1 HT (4.4%, n = 10). Two variables had been analyzed using Somers’D analysis and the result was there is no association between stage of hypertension and AF (Sig &gt;0.05). Conclusion: Stage of hypertension is not associated with the incident of AF among PROLANIS community in Bandung. Several studies have found that risk of developing AF persists even into the upper normal range of blood pressure. Further investigation is needed to describe characteristic of the population.

Variability of blood pressure and risk of postoperative acute kidney injury in patients undergoing surgery for acute aortic dissection: A 11-year single-center study.

In patients receiving surgery, increased blood pressure variability may contribute to the onset of acute kidney injury (AKI). However, the extent and significance of blood pressure variability in patients undergoing aortic dissection surgery have yet to be determined. The authors analyzed all patients operated for aortic dissection at Peking University Shenzhen Hospital from January 1, 2011 to December 31, 2021. Preoperative blood pressure variability was expressed as standard deviation, coefficient of variation (CV), and range. The primary outcome was postoperative AKI. After multivariate analysis, systolic blood pressure variability was found to be independently associated with AKI after aortic dissection surgery. The odds ratios and 95% confidence intervals for standard deviation, CV, and systolic blood pressure range were 1.232 (1.011-1.500), 1.451 (1.058-1.991), and 1.138 (0.986-1.288) for postoperative AKI, respectively. However, there was no significant relationship between diastolic blood pressure variability and AKI after aortic dissection surgery. Finally, in patients undergoing surgery for aortic dissection, the variability of systolic blood pressure is actually an important factor in the development of AKI.

Association of long-term time in target range for systolic blood pressure with cardiovascular risk in the elderly: a Chinese veteran cohort study.

Short-term blood pressure (BP) time in target range (TTR) independently predicts cardiovascular (CV) outcomes in adults. However, there are limited data regarding long-term TTR for BP among elderly participants. We aimed to determine whether future CV risk varies for those who can maintain a long-term systolic BP (SBP) target range by assessing TTR in elderly individuals with hypertension. The Chinese veteran cohort study included 943 elderly participants with hypertension aged over 75 years. The primary outcome was the first occurrence of CV events during annual visits. Time in target range was estimated over 15 years of follow-up using linear interpolation. The target range was defined as 120-140 mmHg according to guidelines. The association between SBP TTR and CV outcomes was estimated using multivariable Cox proportional hazards models. During the 15 year follow-up, the probability of CV events gradually decreased with increasing TTR for SBP. After multivariable adjustment for traditional CV risk factors and mean BP, comparing the highest vs. lowest quartiles of TTR for SBP, the hazard ratios (HRs) [95% confidence intervals (CIs)] were 0.424 (0.289-0.624) for the primary outcome. For each 1 SD increase in TTR, the risk of the primary outcome decreased by 25.4% (HR: 0.746; 95% CI: 0.666-0.834). Consistent findings were observed in sensitivity analyses. Greater long-term TTR for SBP was associated with a decreased risk of CV events in elderly individuals independent of mean BP, suggesting that SBP TTR might serve as a modifiable risk factor for future CV health in elderly patients with hypertension. This ongoing Chinese veteran cohort study adds to the understanding of the relationship between higher long-term systolic blood pressure (SBP) time in target range (TTR) and cardiovascular benefits among elderly individuals with hypertension.

Remote Blood Pressure Estimation via the Spatiotemporal Mapping of Facial Videos

Blood pressure (BP) monitoring is vital in daily healthcare, especially for cardiovascular diseases. However, BP values are mainly acquired through a contact-sensing method, which is inconvenient and unfriendly for BP monitoring. This paper proposes an efficient end-to-end network for estimating BP values from a facial video to achieve remote BP estimation in daily life. The network first derives a spatiotemporal map of a facial video. Then, it regresses the BP ranges with a designed blood pressure classifier and simultaneously calculates the specific value with a blood pressure calculator in each BP range based on the spatiotemporal map. In addition, an innovative oversampling training strategy was developed to handle the problem of unbalanced data distribution. Finally, we trained the proposed blood pressure estimation network on a private dataset, MPM-BP, and tested it on a popular public dataset, MMSE-HR. As a result, the proposed network achieved a mean absolute error (MAE) and root mean square error (RMSE) of 12.35 mmHg and 16.55 mmHg on systolic BP estimations, and those for diastolic BP were 9.54 mmHg and 12.22 mmHg, which were better than the values obtained in recent works. It can be concluded that the proposed method has excellent potential for camera-based BP monitoring in the indoor scenarios in the real world.

Abstract 9: Autoregulation-based Blood Pressure Targets After Endovascular Thrombectomy

Background: Optimal level blood pressure (BP) targets in acute stroke remain elusive. Tailored hemodynamic management after endovascular thrombectomy (EVT) may reduce the risk of reperfusion injury and promote penumbral recovery. Our study aimed to evaluate the relationship between personalized autoregulation-based BP targets, secondary brain injury, and functional outcomes. Methods: We prospectively enrolled 200 patients with acute ischemic stroke who underwent EVT. Autoregulatory function was continuously measured for &gt;=24 hours using simultaneous recordings of near-infrared spectroscopy and mean arterial pressure (MAP). The resulting autoregulatory index was used to calculate and trend the BP range at which autoregulation was most preserved. Percent time and “dose” that MAP exceeded the upper limit or dropped below the lower limit of autoregulation (ULA, LLA) were calculated for each patient. Hemodynamic parameters were correlated with short-term clinical endpoints (symptomatic ICH), biomarkers of secondary brain injury (net water uptake, hemorrhagic transformation (HT), infarct progression), and 90-day functional outcomes. Results: Personalized BP targets were successfully computed in 195 patients (mean age 70 ± 16, 45% female, mean NIHSS 14, mean monitoring time 31 ± 28 hours). Time above the ULA was associated with worse functional outcomes at 90-days after adjusting for age, sex, NIHSS, ASPECTS and TICI (adjusted OR per 10% increase 1.4, 95% CI 1.1-1.6, P=0.004). The burden of hyperperfusion was significantly greater among patients with HT (median 2.7 vs. 3.2 mmHg*min, p=0.01) and sICH (median 2.8 vs. 4.8 mmHg*min, p=0.05) than in those without it. Furthermore, time spent above the ULA was significantly correlated with net water uptake at 72 hours (r=0.37, p=0.03). Among patients with unsuccessful reperfusion, there was a non-significant correlation between time below the LLA and infarct progression (r=0.35, p=0.064). Conclusions: In the largest study conducted to date, deviations from personalized BP targets were associated with an increased risk of secondary brain injury and worse functional outcomes. Autoregulation-oriented BP management represents a promising strategy for maximizing recovery after ischemic stroke.

High spatial and temporal resolution cerebrovascular reactivity for humans and large mammals: A technological description of integrated fNIRS and niABP mapping system.

Introduction: The process of cerebral vessels maintaining cerebral blood flow (CBF) fairly constant over a wide range of arterial blood pressure is referred to as cerebral autoregulation (CA). Cerebrovascular reactivity is the mechanism behind this process, which maintains CBF through constriction and dilation of cerebral vessels. Traditionally CA has been assessed statistically, limited by large, immobile, and costly neuroimaging platforms. However, with recent technology advancement, dynamic autoregulation assessment is able to provide more detailed information on the evolution of CA over long periods of time with continuous assessment. Yet, to date, such continuous assessments have been hampered by low temporal and spatial resolution systems, that are typically reliant on invasive point estimations of pulsatile CBF or cerebral blood volume using commercially available technology. Methods: Using a combination of multi-channel functional near-infrared spectroscopy and non-invasive arterial blood pressure devices, we were able to create a system that visualizes CA metrics by converting them to heat maps drawn on a template of human brain. Results: The custom Python heat map module works in "offline" mode to visually portray the CA index per channel with the use of colourmap. The module was tested on two different mapping grids, 8 channel and 24 channel, using data from two separate recordings and the Python heat map module was able read the CA indices file and represent the data visually at a preselected rate of 10 s. Conclusion: The generation of the heat maps are entirely non-invasive, with high temporal and spatial resolution by leveraging the recent advances in NIRS technology along with niABP. The CA mapping system is in its initial stage and development plans are ready to transform it from "offline" to real-time heat map generation.

Selection Bias in the Hypotension Prediction Index: Comment.

Selection Bias in the Hypotension Prediction Index: Comment.

Postoperative hemorrhage after biomedical glue sling technique in microvascular decompression for vertebrobasilar artery-associated cranial nerve diseases: A retrospective study of 14 cases.

The biomedical glue sling technique is a convenient and effective method for vertebrobasilar artery-associated cranial nerve diseases but postoperative hemorrhage is poorly understood. We retrospectively reviewed 14 of 1157 patients associated with cranial nerve diseases who were subjected to the biomedical glue sling technique in microvascular decompression at our hospital from January 2015 to January 2020. There were 14 patients with cranial nerve diseases included in this study. A clinical diagnosis of postoperative hemorrhage was made after an average of 41.75 h (ranging between 0.5 and 95 h). A cerebellopontine angle hemorrhage was presented in 5 patients, while basal ganglia hemorrhage was observed in 2 patients. Both a cerebellopontine angle and brainstem hemorrhage was seen in 1 patient. Distal supratentorial subdural hemorrhage was recorded in 6 patients. The correlation coefficient was -0.1601 (p = 0.7094) between the standard deviation of systolic blood pressure and the Hemphill Score, -0.2422 (p = 0.5633) between the coefficient of variation of systolic blood pressure and the Hemphill Score, and -0.0272 (p = 0.9489) between the range of systolic blood pressure and the Hemphill Score. The incidence of postoperative hemorrhage after MVD with the biomedical glue sling technique is higher than with traditional MVD and most cases have a favorable prognosis. Postoperative symptoms are the main area of concern and changes in symptoms usually suggest the occurrence of hemorrhage. Several factors, including surgical procedures, the release of CSF, and blood pressure might be associated with hemorrhaging. We still believe such a technique is an efficient approach to treating complicated cranial nerve diseases.

PS-BPC03-4: DIAGNOSTIC AGREEMENT OF MASKED UNCONTROLLED HYPERTENSION DETECTED BY AMBULATORY BP AND HOME BP MEASURED BY AN ALL-IN-ONE BP MONITORING DEVICE

Objectives: Masked hypertension is a phenomenon in which office blood pressure (BP) is in the controlled BP range while out-of-office BP measured by ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) is in the uncontrolled BP range. Out-of-office BP control status may differ if defined by different BP indexes or measured under different conditions (resting or ambulatory), over different time-windows, or with different devices. This study aims to investigate the diagnostic agreement of masked uncontrolled hypertension (MUHT) detected by ABPM indexes (ABPM-MUHT) and HBPM indexes (HBPM-MUHT) using the same all-in-one device. Methods: Medicated hypertension patients enrolled in the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective (HI-JAMP) Study between 2017 and 2020 consecutively underwent office BP monitoring, 24-h ABPM (with 30-min intervals), and 5-day HBPM (twice each morning and evening) using the same device (TM-2441; A&amp;D Company, Tokyo). Controlled BP ranges for each BP index were as follows: office systolic BP [SBP] &lt; 140 mmHg; morning home, evening home, or morning-evening (ME) average SBP &lt; 135 mmHg; 24-h average SBP &lt; 130 mmHg; daytime SBP &lt; 135 mmHg; and nighttime SBP &lt; 120 mmHg. Results: Of 2322 patients (males 53.2%, average age 69.2 ± 11.5 years, average office SBP 132.8 ± 18.8 mmHg), the prevalences of ABPM-MUHT and HBPM-MUHT were 11.0% and 13.9%, respectively, when MUHT was defined only by 24-h average SBP or ME average SBP. Among the 445 patients with any MUHT according to this definition, the diagnostic agreement of MUHT detected by ABPM and HBPM was 29.7%. The prevalences of HBPM-MUHT defined by morning SBP and evening SBP were 22.4% and 11.6%, respectively, and those of ABPM-MUHT defined by daytime SBP and nighttime SBP were 11.8% and 13.8%. When MUHT was defined by any time-window index (ABPM: daytime, nighttime, and 24-h average SBP; HBPM: morning, evening, ME average SBP), the prevalences of ABPM-MUHT and HBPM-MUHT were 19.8% and 25.0%, respectively, and the diagnostic agreement of MUHT detected by ABPM and HBPM in patients with any MUHT (n = 743) increased to 40.1%. Conclusion: Even in treated patients with well-controlled office BP, the prevalence of MUHT in the morning and nighttime was high. Assessment of BP control status only by ME average or 24-h average SBP, without considering specific time-windows, might underestimate cardiovascular risk.

PS-C08-11: RELATIONSHIP OF AMBULATORY WAKE SYSTOLIC BLOOD PRESSURE AND COGNITIVE FUNCTIONING IN CHILDREN AND ADOLESCENTS: THE SHIP-AHOY STUDY

Objective: 24-Hour Ambulatory blood pressure monitoring (ABPM) has been shown to be associated with cognitive functioning in both adults and children with hypertension. Few studies have examined this relationship in youth with normal to mildly elevated blood pressure (BP). We aimed to address this gap in the literature by examining the relationship between average wake systolic BP and targeted cognitive abilities in children and adolescents with normal to mildly elevated BP. Design: Cross-sectional cohort study across six academic centers in the United States. Methods: Participants were part of the SHIP AHOY Project examining target organ damage in children and adolescents with normal to mildly elevated BP. Patients were recruited from pediatric nephrology and/or cardiology clinics and had BP levels &gt; 75th percentile to &gt; 95th percentile). Ascertainment was designed to balance BMI across this BP range by actively recruiting normotensive subjects with obesity. Exclusion criteria included stage 2 hypertension, use of antihypertensive or lipid-lowering medication in the past 6 months, diabetes mellitus (type 1 or 2), kidney disease, or other chronic medical conditions. The primary exposure for this study was average wake Systolic BP. Cognitive variables included the Test of Nonverbal Intelligence, Woodcock-Johnson-V Verbal Attention, and Conners Continuous Performance Test-3 Errors of Omission and Errors of Commission. Preliminary analyses comprised the use of unadjusted linear regressions for the entire sample, with follow-up analyses planned to include key covariates for any significant findings. Results: We recruited 397 adolescents, ages 11–19 years (M∼15.5 yrs.), who comprised approximately 60% males and 53% white. About 25% of the participants had caregivers with a high school degree or less. About 40% of the sample had elevated BP (&gt; 90th percentile). There was a significant relationship between wake average systolic BP and Verbal Attention (p &lt; .009); and wake average systolic BP and Errors of Commission (p &lt; .026). All findings were in the expected direction with higher average wake BP being related to lower performance on the attention-related variables. SBP and Errors of Omission approached significance (p &lt; .07), while Nonverbal IQ was nonsignificant (p &lt; .34). Conclusions: Higher average wake BP, even in adolescents with BP below the hypertensive range, is associated with lower performance on tests of attention regulation and response inhibition. These findings suggest that efforts to minimize associated neurocognitive dysfunction in the late adolescence and young adult years should begin before the presence of hypertension.

Efficacy of Yoga therapy as Non-pharmacological management in Women with High-risk Pregnancy: A Single Case Report

This present case study is about a High-risk Pregnancy that includes Pregnancy-induced Hypertension and an abnormal range of Uterine artery pressure, 22 years old female consulted to Gynaecologist for a complaint of missing menstrual cycle. They were diagnosed with Pregnancy positive with the help of a urinary pregnancy test (UPT). In the 13th week, as per a routine follow-up gone for an antenatal ultrasound scan report shows a There is a single live intrauterine gestation with an abnormal range of Right uterine artery PI and left uterine artery PI and diagnosed as a high-risk pregnancy. After a week, time patient has given a blood sample for a thyroid profile. Reports revealed that TRI IODO THYRONINE (T3)-2.13H and THYROXINE (T4) 21.9 H are in the higher range and noticed blood pressure range in higher side diagnosed as Pregnancy induced Hypertension (PIH) High-risk pregnancy will affect both mother and fetus in its way, on mother side, it increases blood pressure called preeclampsia and affects fetal growth result in Intrauterine growth restriction, premature birth, Stillbirth (1). After the 13th week of Pregnancy diagnosed with high-risk Pregnancy, patients are introduced to yoga therapy, including Asana, Pranayama, Meditation, etc., for three days a week regularly till the date of delivery and followed case till delivery. Yoga helps normalize blood pressure and impacts pregnancy outcomes as a standard range of APGAR score in babies and healthy birth weight. Does not show any complications of High-risk Pregnancy on the maternal and fetal side.

Rehabilitation of Lower limb balance For Post-Stroke Patients using Augmented Reality

Applications that use augmented or virtual reality can create an immersive and engaging virtual environment for motor rehabilitation using the cooperative stimulation of several sensory channels, including sight, hearing, and movement. These applications can also improve the effectiveness of rehabilitation through repetition, feedback, and encouragement. In this study, we suggest an integrated application for teaching and assessing individuals with lower limb balance disorders. The Oculus Quest VR headset-based AR-based rehabilitation programme for post-stroke patients shows potential in improving patient outcomes. It provides more fun and successful approach to rehabilitation than traditional methods. Utilizing the headset to assess temperature and blood pressure could save time and resources, but accuracy must be verified. Virtual encounters with doctors using the VR app are convenient and allow for distant progress tracking. Workout videos tailored to a patient blood pressure range can assist assure safety, but they must be suited for the patient specific needs. Overall, the programme improves access to rehabilitation services, but it requires dependable and specialized technology to achieve the best results.