Repeated Blood Pressure Measurements Research Articles

Evaluating the Effectiveness of a Training on Ergonomic Risks of Measuring Blood Pressure.

Background: Musculoskeletal disorders (MSDs) occur as a result of long-term exposure to inappropriate working postures and repetitive use of body postures, leading to harmful consequences for patients, employees, and employers. Evaluating distinct working postures can contribute to effective interventions. Purpose: The aim of this study was to determine ergonomic risks of MSDs during repeated blood pressure measurement processes and to evaluate the effectiveness of a training on this topic. Methods: A pretest/posttest quasi-experimental design studied 64 nurses in a training and research hospital in Turkey. Participants were evaluated for the prevalence and risk of MSDs using the Nordic Musculoskeletal Questionnaire Extended Version and the Rapid Entire Body Assessment (REBA) Checklist, and by photographing them performing the procedure. Nurses with high risk for MSDs received an ergonomics training program and were followed up twice in 3 months. Results: Reduction in prevalence of MSDs in neck, shoulder, and hip/thigh areas, and in mean REBA scores after the training were statistically significant. Conclusion: Nurses should be trained about correct posture for specific high-risk activities that may cause MSDs, and offered exercise programs that support the musculoskeletal system.

Blood Pressure Variability and Plasma Alzheimer's Disease Biomarkers in the SPRINT Trial.

Recent observational studies suggest higher blood pressure (BP) variability (BPV) is associated with Alzheimer's disease (AD) biomarkers amyloid-beta (Aβ) and tau. Less is known about relationships in interventional cohorts with strictly controlled mean BP levels. Investigate the longitudinal relationship between BPV and change in plasma AD biomarkers under standard versus intensive BP treatment. In this post hoc analysis of the SPRINT trial, 457 participants (n = 206 in standard group, n = 251 in intensive group) underwent repeated BP measurement between baseline and 12-months follow-up, and venipuncture at baseline and median (IQR) 3.5 (3.0-4.0) years later to determine plasma AD biomarkers total tau and Aβ1-42:Aβ1-40 ratio. BPV was calculated as tertiles of variability independent of mean. Linear mixed models investigated the effect of BPV×time on AD biomarker levels. Higher BPV was associated with increased levels of total tau in the standard group (β [95% CI] 1st versus 3rd tertiles of BPV: 0.21 [0.02, 0.41], p = 0.035), but not in the intensive group (β [95% CI] 1st versus 3rd tertiles of BPV: -0.02 [-0.19, 0.16], p = 0.843). BPV was not associated with Aβ 1-42:Aβ 1-40 ratio in either group. Mean BP was not associated with biomarkers. Higher BPV was associated with increased plasma total tau under standard BP treatment. Findings add new evidence to prior observational work linking BPV to AD pathophysiology and suggest that, despite strict control of mean BP, BPV remains a risk for pathophysiological change underlying risk for AD.

Blood pressure levels and adverse cardiovascular outcomes in heart failure: A systematic review and meta-analysis.

Existing data on the association between blood pressure levels and adverse cardiovascular outcomes in patients with heart failure (HF) are inconsistent. The optimal blood pressure targets for patients with HF remain uncertain. This study sought to assess the associations between blood pressure (systolic and diastolic blood pressure, SBP and DBP) levels and adverse cardiovascular disease (CVD) outcomes in patients with HF. A systematic review and meta-analysis were conducted using MEDLINE, Embase, the Cochrane Library, and Web of Science databases up to 5 May 2023. The outcomes of interest included adverse cardiovascular events and all-cause mortality. Pooled relative risks (RRs) with corresponding 95% confidence intervals (CIs) were calculated. Forty-three unique observational cohort studies, comprising 120 643 participants with HF, were included. The pooled RRs (95% CIs) for SBP thresholds of ≥140 mmHg vs <140 mmHg were 0.92 (0.83-1.01) for all-cause mortality, 0.83 (0.67-1.04) for CVD death, and 0.98 (0.80-1.21) for HF hospitalization. The pooled RR (95% CI) for SBP thresholds of ≥160 mmHg vs <160 mmHg and all-cause mortality was 0.67 (0.62-0.74). SBP levels below <130, <120, and < 110 mmHg were each associated with an increased risk of various cardiovascular endpoints and all-cause mortality. The pooled RR (95% CI) for DBP thresholds of ≥80 mmHg vs <80 mmHg and all-cause mortality was 0.86 (0.67-1.10). A 10 mmHg increase in SBP or DBP was associated with a reduction in all-cause mortality and other cardiovascular endpoints. The findings suggest that lower and normal baseline SBP levels (<130, <120, and < 110 mmHg) may be associated with future risk of worse outcomes in patients with HF. Optimal baseline blood pressure levels for these patients may lie within the range of ≥140 mmHg for SBP. In the absence of observational studies with repeated blood pressure measurements or definitive trials evaluating optimal blood pressure targets, individualized blood pressure targets based on patients' unique circumstances are warranted in HF management.

Blood Pressure Trajectories Through the First Year Postpartum in Overweight or Obese Individuals Following a Hypertensive Disorder of Pregnancy.

Hypertensive disorders of pregnancy are associated with cardiovascular disease; however, patterns of blood pressure (BP) recovery are understudied. We compared pregnancy and postpartum BP trajectories among individuals with hypertensive disorders of pregnancy who developed persistent hypertension at 1-year postpartum compared with individuals with normalization of BP. We used data from a randomized clinical trial of individuals with overweight, obesity, and hypertensive disorders of pregnancy conducted in the first year after delivery. Pregnancy BPs were obtained during prenatal visits; postpartum BPs were prospectively obtained through home monitoring. Demographic characteristics and trajectories were compared by hypertensive status (systolic BP ≥130 mm Hg, diastolic BP ≥80 mm Hg, or use of antihypertensive medications) at 1 year. We used repeated BP measures to fit separate mixed-effects linear regression models for pregnancy and postpartum using restricted cubic splines. We included 129 individuals; 75 (58%) individuals progressed to hypertension by 1-year postpartum. Individuals with hypertension were older, delivered at earlier gestational ages, and had higher body mass index at 1-year postpartum compared with those with normalization. Individuals with hypertension had similar BP trajectories during pregnancy to those with BP normalization but a significantly different BP trajectory (P<0.01 for systolic and diastolic BPs) in the first year postpartum. These differences persisted in multivariable models after adjustment for early pregnancy body mass index, age, and severity of hypertensive disorder of pregnancy (P<0.01 for systolic and diastolic BPs). BP trajectories in the first year postpartum, but not during pregnancy, may provide important information for risk stratification after a hypertensive disorder of pregnancy. URL: https://clinicaltrials.gov; Unique identifier: NCT03749746.

The effect of lower limb strengthening exercise on orthostatic blood pressure and the skeletal muscle pump in older people with orthostatic hypotension.

Activation of muscles during standing is recommended to activate the skeletal muscle pump, increasing venous return and increasing blood pressure (BP) in people with orthostatic hypotension (OH). The aim of this study is to determine if increasing the strength of the lower limb muscles can improve the effectiveness of the venous pump and postural BP in older people with OH. Ten older people with OH underwent an 8-week lower limb strengthening intervention. Repeated measurements of orthostatic BP, calf venous ejection fraction (EF) and muscle strength took place before, during and after intervention. The intervention increased calf muscle strength by 21% (interquartile range: 18-28), p = 0.018, from a median baseline of 38 (34-45) kg. Participants had normal levels of venous EF 64% (51-75) at baseline, with little to no venous reflux. The median ejection volume at baseline was 44 (36-58) mL per calf. Despite increasing muscle strength, venous EF did not increase (percentage change -10% (-16 to 24), p = 0.8) and systolic BP drop did not improve (percentage change 0% (-17 to 16), p = 1.0). Similarly, visual analysis of individual case-series trends revealed increasing muscle strength with no clinically meaningful change in EF or orthostatic BP. Muscle strengthening exercise does not increase the effectiveness of the skeletal muscle pump and is not an efficacious intervention for OH. As there is little to no venous pooling in the calf during standing in older people with OH, below knee compression is unlikely to be clinically effective.

Evaluation and application of treadmill Cardiopulmonary Exercise Testing and field measurement results of female national team water polo players

Abstract Introduction Due to intensive sport adaptation, examinations of elite athletes are a special entity of cardiology. Cardiovascular follow-up of elite athletes is a significant method of supporting safe and successful sport. In many sports like water polo, training work takes place in different environments and with different forms of movement, then the tests applied in laboratory circumstances. Although treadmill cardiopulmonary exercise testing (CPET) is widely used in cardiology screening, we have little information of its usefulness in physical fitness follow-up in non-running sports. Purpose We aimed to analyze and to compare the data of elite youth team (YT) and adult water polo players collected from maximal intensity cardio-pulmonary exercise testing (CPET) and field examinations in definition of current fitness status of the different age groups. Methods During the age- and sport specific field measurements (swimming tests) and CPET examinations, we collected resting and exercise heart rate data and lactate levels at defined time points. During CPET, continuous 12-lead ECG, gas analysis and repeated blood pressure measurements were also carried out. Results 46 female water polo players were examined (age: 18.5±5.9y, adults: 19, training: 18.0±7.9h/w). Comparing CPET and field measurements, no differences were found between resting heart rate (75.7±13.4vs73.1±13.0 BPM, p=0.22) and resting lactate levels (1.5±0.4vs1.6±0.6 mM, p=0.29). Achieved maximal heart rates were higher during CPET examinations, than during field tests (196.3±9.7 vs 191.0±12.5 BPM, p=0.001) On the contrary, maximal lactate levels were lower during CPET in comparison to field measurements (8.4±2.4 vs 9.6±2.7 mM, p=0.01). Lactate levels stayed high after routine cool-down swimming ordered by the trainers, but decreased after suggested further training (6.6±2.7 vs 3.7±1.6 mM, p=10-16). When comparing the age groups, CPET examinations showed similar relative maximal aerobic capacity (44.4±4.8vs44.9±5.5 ml/kg/min, p=0.72) and peak lactate values (8.2±2.7vs8.7±1.9 mM, p=0.48), while maximal heart rates were higher in YT groups (200.7±7.2 vs 190.1±9.6 BPM, p&amp;lt;0.001) as compared to adults. Similarly, maximal lactate levels showed no differences (9.1±2.6 vs 10.4±2,7 mM, p=0.13), while maximal heart rates were higher in YT groups (197.7±10.0 vs 181.4±8.9 BPM, p&amp;lt;0.001) as compared to adults during field examinations. Conclusions Although field measurements and laboratory CPET results differ from several points of view, differences between age groups and the kinetics of the data are similar. Maximal heart rates are easier to achieve during CPET, while more intensive lactate increase could be observed during field measurements. Combining the above examinations helps defining maximal physiological values, fitness status, differences between different age groups, and optimizing training plans, as well as differentiating between physiological and pathological sport adaptation.

Abstract 15182: Evaluation of an Electronic Clinical Decision Support Tool for Incident Elevated Blood Pressure in Adolescents

Introduction: The PedsBP Clinical Decision Support (CDS) is an electronic health record-linked tool developed in an urban health system that aims to improve the quality of blood pressure (BP) measurement and recognition of hypertension in children. Aims: To describe the feasibility of implementing the PedsBP tool for use in a rural health system, and to describe repeat BP measurement among patients 6-17 years with an incident hypertensive BP at high-intensity clinics using the PedsBP CDS. Methods: This is a 3-arm, parallel group, cluster randomized controlled pragmatic trial in 40 community-based primary care clinics in a rural Midwestern health system (Essentia Health). Clinics were randomized 1:1:1 to usual care, low-intensity implementation (PedsBP CDS only), or high-intensity implementation (Peds BP CDS plus in-person training, monitoring CDS use, and feedback). The PedsBP CDS includes an alert to re-measure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1-3 weeks, and patient-specific order sets. Study outcomes include repeat BP measurement at an index visit and diagnosis of hypertension within 6 months of meeting clinical criteria. Safety outcomes include stroke, transient ischemic attack, acute renal failure, uncontrolled hypertension within 6 months of index visit. Results: Among 22,238 (50.9% female, mean age 11.7 years, SD=3.5 years) patients with visits between 8/1/22-1/31/23 at participating clinics, 4008 (18.0%) had an incident hypertensive BP and 239 (1.1%) met clinical criteria for hypertension. Among those who met clinical criteria for hypertension, there were no cases of uncontrolled hypertension or other safety outcomes. Of 7974 patients with encounters at 13 high-intensity clinics and with a BP measured, the initial BP was elevated for 1307 (16.4%) and remeasured in 628 (48.1%). Among 1265 patients at high-intensity clinics with a BP elevated and with body mass index (BMI) information, 482 (38.1%) were obese (BMI percentile ≥95%), 209 (16.5%) were overweight (BMI percentile 85% to &lt;95%), and 574 (45.4%) were not overweight or obese (BMI percentile &lt;85%). Conclusions: The PedsBP CDS is feasible to implement in a new health system and has the potential to improve the quality of pediatric BP care.

Abstract 18592: Association of Lactation Duration With Blood Pressure Recovery at One Year Postpartum in Overweight and Obese Individuals With a Hypertensive Disorder of Pregnancy

Introduction: Hypertensive disorders of pregnancy (HDP) are associated with an increased risk of maternal cardiovascular (CV) disease. Lactation is associated with favorable metabolic and CV profiles, but its impact on blood pressure (BP) recovery following a HDP is less clear. Hypothesis: Longer lactation duration is associated with lower systolic and diastolic BP throughout the first year postpartum (PP). Methods: We utilized data from a randomized clinical trial of overweight and obese individuals with a HDP diagnosis and no pre-pregnancy hypertension. BP was assessed in triplicate along with self-reported lactation status at enrollment (6 weeks to 6 months PP) and follow up (8-12 months PP). Hypertension was defined as ≥130/80 mmHg or the use of anti-hypertensive medications. PP BPs were also obtained daily using home BP monitoring for the first six weeks, then one week per month for the remainder of the first year PP. We compared demographic and cardiometabolic outcomes by lactation status at both study visits using two-sample t-tests and chi-squared tests. We utilized multivariable logistic regression models to assess the relationship of lactation with hypertension and repeated BP measurements were fit to mixed-effects linear regression models by lactation status to assess BP recovery. Results: Data from 129 individuals included 14,177 home BPs. Overall, 81% of participants initiated lactation and mean lactation duration was 5.8 ± 4.0 months PP. At follow up (10.9 ± 2.1 months PP), both systolic (p=0.004) and diastolic (p=0.008) BP were lower in individuals who lactated compared to those who did not. Each month of lactation was associated with a 12% (aOR 0.88; 95% CI 0.78-0.98) decreased odds of hypertension at one year PP with adjustment for age, race, education, BMI. Lactating individuals had a healthier BP recovery profile (p&lt;0.01 for systolic and diastolic BP) in the first year PP. Conclusions: In overweight and obese individuals with a HDP, lactation is associated with a statistically and clinically significant reduction in systolic and diastolic BP at one-year PP. This study emphasizes the need to address barriers to lactation to improve long-term CV health.

Abstract 12210: Repeated Systolic Blood Pressure Measures During Intensive Treatment Show a Loss Of Protective Effect Over Time. A Secondary Analysis of the SPRINT Trial

Introduction: The SPRINT trial showed a 25% reduction in the primary outcome with SBP intensive treatment using Cox proportional risk analysis. A recent secondary analysis by the SPRINT group assessed the post-trial maintenance of this protection by considering repeated SBP measurements and using a mixed linear regression model. They found that the intervention lost its protective effect post-trial, possibly due to the loss of intensive blood pressure control. Could this loss of protective effect also be found during the clinical trial, when considering repeated measurements of systolic blood pressure in the analysis? Methods: Secondary analysis of the SPRINT study database included 9,068 patients with repeated measures of SBP and complete baseline information. Cox proportional hazards and mixed linear models were used to analyze the primary endpoint and repeated SBP measures, respectively. A Cumulative Joint Model Analysis was conducted to combine the direct and indirect effects of the intervention on the primary outcome. R Studio V12.0 software was used for the analyses. Results: The protective effect is lost during the trial, both in the total population (3.4 years) as well as in subgroups such as women (1.1 years), patients with CVD (1.3 years), CKD (1.3 years), black patients (1.8 years), younger than 75 years (2.1 years) and in patients who present serious adverse events (3.4 years) compared to those who do not present SAEs (4.2 years). Beyond the loss of blood pressure control, other factors such as cumulative BP, adverse events, and the increase in SBP variability could be considered. Conclusions: Including repeated measures of SBP revealed a loss of protective effect in the intervention during the trial and generated Simpson's paradox. This highlights the need to consider alternative statistical methods in clinical trial analysis beyond Cox proportional hazard analysis for a comprehensive perspective on intervention efficacy.

Ambient air temperature and temperature variability affecting blood pressure—a repeated-measures study in Augsburg, Germany

Ambient air temperature and temperature variability are supposed to influence blood pressure (BP); however, findings are inconsistent. We examined the effects of short-term changes in ambient temperature and temperature variability on systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) in a repeated-measures study. Repeated BP measurements were available for 3184 participants from the German population-based Cooperative Health Research in the Region of Augsburg (KORA) S4 survey (1999–2001) and two follow-up examinations (2006–08 and 2013–14). Daily meteorological data were obtained from fixed measurement stations including air temperature and diurnal temperature range (DTR). We used confounder-adjusted additive mixed models to examine immediate (same-day, lag 0), delayed (lag 1 to lag 4), and cumulative (up to lag 0–13) exposure effects. Decreases in air temperature were associated with increases in SBP, DBP, and MAP, while we observed no effects for PP at all. For example, a 1 °C decrease in the 14-day moving average (lag 0–13) mean air temperature was associated with a 0.54% [95% confidence interval [95%CI]: 0.41%;0.68%] increase in SBP. Furthermore, decreasing DTR was linked to increasing SBP, DBP, and MAP measures. In the sensitivity analyses, results were found to be robust. Examination of exposure–response functions according to season revealed, that associations for summer and winter can be considered linear, while we detected non-linear functions in spring and autumn. Furthermore, exposure–response functions also differed in the three different surveys. As BP levels influence the risk of cardiovascular mortality, our results show the importance of considering temperature and its variation as potential risk factors. As ongoing climate change affects temperature variability, it is important to understand how the body adapts to changing ambient temperatures.

PREDICTING PREECLAMPSIA DURING PREGNANCY: THE VALUE OF BLOOD PRESSURE MEASUREMENT TRENDS TO IDENTIFY WOMEN AT HIGHEST RISK

Objective: Hypertensive disorders of pregnancy, including preeclampsia are serious complications increasing the risk of morbidity and mortality for both mother and baby. We hypothesise that blood pressure (BP) trends during pregnancy are a useful, accessible and practical predictor of preeclampsia onset. In this study we aimed to determine: (i) the association between mean arterial pressure (MAP), Systolic BP (SBP) and Diastolic BP (DBP) at time of pregnancy booking with subsequent preeclampsia development, and (ii) whether repeated measures of BP thought pregnancy can improve prediction of preeclampsia. Design and method: Data were from 11,008 women with a singleton pregnancy who received antenatal care and gave birth across three metropolitan Sydney hospitals 2017-2020. BP measurements were represented as MAP, SBP and DBP. Three sets of logistic regression models were used to yield odds ratios (ORs) with 95% confidence intervals (CIs) for the association of preeclampsia with: (1) booking BP, (2) summary BP measurements (mean, maximum, standard deviation (SD)) and (3) growth curve parameters (mean BP, slope and standard error of slope) derived from mixed effects models, representing each women's BP trajectory. Akaike's information criterion was used to determine the ‘best fitting’ model. Results: Booking BP was taken between 5 and 15 weeks of pregnancy (median 14 weeks). There were 80,624 BP measurements taken throughout pregnancy, the number and timing varied between women: median (min, max): 8(3,17) measurements. There were 191 cases of preeclampsia. Booking MAP before 16 weeks’ gestation (OR (95%CI) (per SD higher) (1.78 (1.53, 2.06) yielded a better model fit than SBP (1.67 (1.44, 1.94) or DBP (1.66 1.43, 1.96)) for preeclampsia. Of the summary measures, maximum MAP yielded the best fitting model (OR (95%CI) (per SD higher): 4.37 (3.76, 5.11). Growth curve parameters were significant predictors of preeclampsia, and substantially improved model fit in comparison to booking BP alone. Conclusions: Booking visit MAP was more strongly associated with preeclampsia than SBP or DBP. Using repeated BP measures, in the form of summary MAP measures and BP trajectories, improved the prediction of preeclampsia.

HEARTS in the Americas clinical pathway. Strengthening the decision support system to improve hypertension and cardiovascular disease risk management in primary care settings.

HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative. It is implemented in 24 countries and over 2,000 primary healthcare facilities. This paper describes the results of a multicomponent, stepwise, quality improvement intervention designed by the HEARTS in the Americas to support advances in hypertension treatment protocols and evolution towards the Clinical Pathway. The quality improvement intervention comprised: 1) the use of the appraisal checklist to evaluate the current hypertension treatment protocols, 2) a peer-to-peer review and consensus process to resolve discrepancies, 3) a proposal of a clinical pathway to be considered by the countries, and 4) a process of review, adopt/adapt, consensus and approval of the clinical pathway by the national HEARTS protocol committee. A year later, 16 participants countries (10 and 6 from each cohort, respectively) were included in a second evaluation using the HEARTS appraisal checklist. We used the median and interquartile scores range and the percentages of the maximum possible total score for each domain as a performance measure to compare the results pre and post-intervention. Among the eleven protocols from the ten countries in the first cohort, the baseline assessment achieved a median overall score of 22 points (ICR 18 -23.5; 65% yield). After the intervention, the overall score reached a median of 31.5 (ICR 28.5 -31.5; 93% yield). The second cohort of countries developed seven new clinical pathways with a median score of 31.5 (ICR 31.5 -32.5; 93% yield). The intervention was effective in three domains: 1. implementation (clinical follow-up intervals, frequency of drug refills, routine repeat blood pressure measurement when the first reading is off-target, and a straightforward course of action). 2. treatment (grouping all medications in a single daily intake and using a combination of two antihypertensive medications for all patients in the first treatment step upon the initial diagnosis of hypertension) and 3. management of cardiovascular risk (lower BP thresholds and targets based on CVD risk level, and the use of aspirin and statins in high-risk patients). This study confirms that this intervention was feasible, acceptable, and instrumental in achieving progress in all countries and all three domains of improvement: implementation, blood pressure treatment, and cardiovascular risk management. It also highlights the challenges that prevent a more rapid expansion of HEARTS in the Americas and confirms that the main barriers are in the organization of health services: drug titration by non-physician health workers, the lack of long-acting antihypertensive medications, lack of availability of fixed-doses combination in a single pill and cannot use high-intensity statins in patients with established cardiovascular diseases. Adopting and implementing the HEARTS Clinical Pathway can improve the efficiency and effectiveness of hypertension and cardiovascular disease risk management programs.

Abstract P169: Prenatal Per- and Polyfluoroalkyl Substance (PFAS) Exposures and Offspring Blood Pressure From Birth to Late Adolescence: A Prospective Study in Project Viva

Introduction: Mice studies showed that prenatal PFAS exposures increase offspring blood pressure (BP), but findings in human studies are inconsistent. Prior studies did not have repeated BP measurements from birth to late adolescence or use a mixture approach to investigate the interactions or overall effects of prenatal PFAS exposures. Methods: Participants are from the prospective pre-birth cohort Project Viva. We measured PFAS in maternal plasma samples collected in the 1 st -trimester (median: 9.6w) and child systolic (SBP) and diastolic BP (DBP) at six follow-up visits: 1) birth; 2) infancy (median: 6m); 3) early childhood (median: 3.2y); 4) mid-childhood (median: 7.7y); 5) early adolescent (median: 13.0y), 6) mid-adolescent (median: 17.5y). At each study visit, BP was measured 4-5 times, and the average value was taken. We used linear regression to examine associations of each individual PFAS, and Bayesian kernel machine regression (BKMR) to examine PFAS mixtures, with BP at each visit, adjusting for maternal age, race/ethnicity, education, pre-pregnancy body mass index, parity, smoking status, and chronic hypertension before pregnancy. Results: Sample sizes at each visit ranged from 549-919 ( Legend ). Prenatal PFAS was not consistently associated with offspring SBP or DBP across all visits. PFOS was associated with higher SBP in mid-childhood ( Panel A1 ), EtFOSAA was associated with higher SBP in infancy and in mid-childhood ( Panel A5 ), and MeFOSAA was associated with higher SBP in infancy ( Panel A6 ). PFOS, PFNA, EtFOSAA, and MeFOSAA were associated with lower DBP only in early childhood but not at other visits ( Panels B1, B4, B5, B6 ). BKMR did not suggest prenatal PFAS interactions or the overall effects of exposure to multiple PFAS on offspring SBP or DBP. Conclusions: There are no consistent associations between prenatal PFAS exposures and BP from birth to late adolescence. Future studies should examine whether there are other critical windows (e.g., mid- or late pregnancy) of susceptibility for PFAS on offspring BP.

Variability Independent of Mean Blood Pressure as an Electronic health record‐based Measure of Dementia Risk

AbstractBackgroundThe risk of developing Alzheimer’s Disease and Related Dementias (ADRD) is associated with visit‐to‐visit blood pressure (BP) variability, including variability independent of the mean (VIM).1,2 The association between ADRD and VIM has primarily been evaluated using standardized BP measurements from clinical trials and cohorts, rather than utilizing measurements from clinical practice, potentially limiting generalizability to the real‐world context. As such, we sought to evaluate the relationship between ADRD and BP VIM utilizing real‐world data collected from the electronic health record (EHR).MethodWe studied all patients with repeated BP measurements and without a prior diagnosis of ADRD across ambulatory visits within a high‐volume academic healthcare system from 2013 to 2016. Using EHR data, we calculated BP VIM for all patients during the first 4 years of the study period and followed all patients through the end of 2019 or most recent office visit, whichever came first. The primary outcome of interest was incident ADRD, defined by presence of ICD‐10 codes for ADRD or prescription for dementia medication. We used multivariable adjusted Cox proportional hazards models to examine risk of incident ADRD associated with increasing BP VIM.ResultWe identified 46,703 patients with repeated BP measurements over 730,721 ambulatory visits between 2013 and 2016. In multivariable analyses, higher levels of both systolic (HR, 95% CI: 1.26, 1.15‐1.38) and diastolic (1.15, 1.04‐1.27) BP VIM were positively associated with risk of incident dementia (Figure A). In subgroup analyses, results were similar when stratified by age, diabetes, prior stroke, renal disease, and hypertension (Figures B‐D). For both systolic (p = 0.036) and diastolic (p = 0.043) BP VIM, risk of incident dementia was higher among patients below the age of 60 compared to those 60 and older.ConclusionVisit‐to‐visit variability in BP, a measure readily ascertainable from the EHR, is associated with increased risk for incident dementia independent of mean BP in the context of a high‐volume, real‐world patient care setting. These findings indicate the EHR derived VIM may serve as an additional tool in risk assessment for incident ADRD. Future research is needed to determine efficacy of targeted interventions aimed at lowering BP variability in clinical practice.

Abstract 10335: Implementation of a Population Health Infrastructure for Hypertension in a Primary Care Clinic Setting

Introduction: In 2021, 48% of patients in the Hartford Hospital Adult Primary Care (APC) Clinic with a diagnosis of hypertension had controlled blood pressures of &lt;140/90 compared to 63% in Hartford Healthcare (HHC) as a whole. This demonstrates potential healthcare disparities within the APC clinic, whose patient panel consists primarily of an underserved Hispanic population with Medicare, Medicaid or are uninsured and lack overall health literacy. The aim of this project is to have 75% of APC patients with hypertension to have blood pressures of &lt;140/90 by 2023. Methods: The team implemented standardized staff and resident training regarding blood pressure measurement and ACC/AHA Hypertension Guidelines with pre- and post- training surveys. Residents reviewed their patient roster to schedule appointments for those with uncontrolled hypertension. The team created an Epic SmartPhrase to incorporate standard work by all providers for initial and follow-up hypertension visits. This included blood pressure-lowering medications, environmental risk factors, evaluation for obstructive sleep apnea, and recommendations for nonpharmacological interventions. Staff implemented standardized workflow which included: repeat blood pressure measurement after 5 minutes of rest for blood pressures &gt;140/90, ensuring proper documentation of repeat blood pressure in correct field in Epic, and scheduling 3-week follow-up appointments for blood pressure management. The clinic has been approved for a grant for BP monitors for those without health insurance. Results: In May 2022, 52% (727/1409) of patients at APC had blood pressures of &lt;140/90 compared to 38% (104453/272615) at HHC. Conclusion: Implementation of standardized staff and resident training, Epic SmartPhrases, and clinic workflow may lead to improved blood pressure control in an academic primary care clinic. Future direction includes assessing if optimizing BP control leads to improved patient outcomes.

Design and analysis of a continuous optoelectronic pulse wave velocity blood pressure sensor with multiple-subject controlled experiments

The main purpose of this study is to perform the pulse wave velocity (PWV) measurements with a new noninvasive optoelectronic continuous-time wearable sensor design and to analyze the quantitative relation between the reference blood pressure (BP) measurement. PWV was measured at baseline 32 normotensive volunteers, including 15 females and 17 males aged between 23 and 41 years old. The day before the measurements, the volunteers were not allowed to drink alcohol, stay up late or use any medicine that would affect BP. Repeated BP measurements were performed with an average follow-up system at certain times of the day. Results: Equivalent constituents were established after questioning age, height, weight, physical activity levels in daily life, genetic predisposition for blood pressure and diabetic from all volunteers participating in the measurements. Systolic BP (SBP), diastolic BP (DBP), heart rate (HR), pulse pressure (PP), mean arterial pressure (MAP), distance between brachial to radial artery (D), pulse transit time between brachial to radial artery (brPTT) and PWV measurements were all collected to correlate results with the introduced sensor’s readings. Following the experimental results, a linear link was found between SBP and PWV when the two groups separated by gender related were examined and the correlation coefficients between them were r: 0.9915 in females and r: 0.9845 in males Measurements taken with the new non-invasive low-power continuous-time sensor design show that the PWV may in the near future be used as a screening tool to identify continuous SBP values in clinical practice. The new non-invasive design suggests that SBP has the strongest correlation with PWV among a variety of BP parameters. • Non-invasive continuous monitoring of blood pressure may improve the quality of life for patients. • Pulse wave velocity measurement (PWV) is one of the promising methods to measure blood pressure. • A simple wearable sensor has proven a distinguishable correlation between PWV readings and corresponding blood pressure. • A multi-subject human experiments from a variety of groups have suggested that PWV can be a candidate for blood pressure sensors.

Gestational PM2.5 exposure may increase the risk of small for gestational age through maternal blood pressure and hemoglobin: A mediation analysis based on a prospective cohort in China, 2014–2018

BackgroundMaternal gestational PM2.5 exposure was associated with small for gestational age (SGA). Identifying potential mediating factors may help design preventive strategies to reduce this risk. ObjectiveThis study aimed to explore the roles of maternal blood pressure and hemoglobin may play in the PM2.5 exposure and SGA relationship among 117,162 births in 16 counties across China during 2014–2018. MethodsDaily PM2.5 concentration was collected from China National Environmental Monitoring Center. According to maternal residency during pregnancy, the PM2.5 exposure for each trimester and the whole pregnancy was assessed using an inverse-distance weighting approach. Repeated measurements of maternal blood pressure and hemoglobin during pregnancy were collected for each woman. We estimated the total effect of gestational PM2.5 exposure on SGA, and further tested the mediation effects of maternal blood pressure and hemoglobin concentration during pregnancy. ResultsOf 117,162 included mother-infant pairs, 11,361 (9.7 %) were SGA. The odds ratios of SGA associated with PM2.5 exposure (per 10 μg/m3 increase) in the second trimester and the whole pregnancy were 1.023 (95 % CI: 1.009, 1.037) and 1.024 (1.001, 1.048), respectively. We identified the independent mediating effect of blood pressure and hemoglobin in the second and third trimesters, with the proportion of mediation ranging from 1.64 % to 5.78 % and 2.40 % to 8.70 %, respectively. When considering the mediators jointly, we found a stronger mediating effect with a proportion of mediation ranging from 3.93 % to 13.69 %. DiscussionIncreases in maternal blood pressure and hemoglobin in the second and third trimesters can independently and jointly mediate the effects of gestational PM2.5 exposure on SGA. Monitoring and managing maternal blood pressure and hemoglobin during prenatal care may constitute a promising avenue to reducing SGA risk associated with gestational PM2.5 exposure.

Coaching quality improvement in primary care to improve hypertension control.

Effective management of hypertension (HTN) is a priority in primary care, necessary to decrease the costs, morbidity, and mortality associated with cardiovascular disease. Strategies to support quality improvement (QI) efforts in primary care are needed to make significant improvements in population health, especially for patients who experience socioeconomic inequalities. To address the high rate (>50%) of uncontrolled HTN in the state of Ohio, a statewide QI project was implemented in high-volume Medicaid practices, aimed at improving blood pressure control and addressing racial disparities. The initiative expanded to include coaching QI to support efforts in primary care practices. The Model for Improvement guided development of Plan-Do-Study-Act (PDSA) cycles facilitated by QI coaching and APRN collaboration to implement key components of HTN guidelines: accurate blood pressure measurement, effective treatment, and timely follow-up. Interventions were implemented after PDSA cycles over 18 months in two practice sites to address HTN control. Linking multiple PDSA test cycles and review of data bimonthly allowed for reflection on the impact of interventions for non-Hispanic Black patients and the overall patient population. The percentage of patients with controlled HTN, repeat blood pressure measurement, and timely follow-up improved in an urban primary care practice associated with an academic medical center and in a rural federally qualified health center. Primary care practices can benefit from the external support of coaching when implementing QI processes to make meaningful change. APRNs are key collaborators for expanding QI efforts in primary care.

Case report: G1P0A0 33 weeks pregnant with Eclampsia

Eclampsia is the onset of convulsions in women with preeclampsia. Pre-eclampsia is a pregnancy disorder with high blood pressure and large amounts of protein in the urine or other organ dysfunction. Onset may be before, during, or after delivery. Most often occurs during the second half of pregnancy. Seizures manifest as a tonic-clonic type and usually last about a minute. Pre-eclampsia is diagnosed when repeated blood pressure measurements are greater than or equal to 140/90mmHg, and signs of organ dysfunction, including proteinuria, thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral symptoms, or abdominal pain. Usually, pregnant women have hypertension and proteinuria before the onset of seizures (convulsions). Long-lasting (persistent) headache, blurred vision Photophobia (i.e., the bright light causes discomfort), Abdominal pain Either in the epigastric region (the middle part of the abdomen above the umbilicus or at the umbilicus) and the right upper quadrant of the stomach (below the right side) rib cage), mental status changes (confusion) is one of these symptoms may appear before or after the seizure occurs. This case report reports the patient Mrs. T G1P0A0 33 weeks pregnant, not yet inpartu with Eclampsia.

Bidirectional Longitudinal Relationships Between Arterial Stiffness and Hypertension Are Independent of Those Between Arterial Stiffness and Diabetes: A Large-Scale Prospective Observational Study in Employees of a Japanese Company.

BackgroundHypertension and diabetes frequently coexist; however, it has not yet been clarified if the bidirectional longitudinal relationships between arterial stiffness and hypertension are independent of those between arterial stiffness and diabetes.Methods and ResultsIn this 16‐year prospective observational study, 3960 middle‐aged employees of a Japanese company without hypertension/diabetes at the study baseline underwent annual repeated measurements of blood pressure, serum glycosylated hemoglobin A1c levels, and brachial‐ankle pulse wave velocity. By the end of the study period, 664, 779, 154, and 406 subjects developed hypertension, prehypertension, diabetes, and prediabetes, respectively. Increased brachial‐ankle pulse wave velocity at the baseline was associated with a significant odds ratio (per 1 SD increase) for new onset of prehypertension/hypertension with (2.45/3.28; P<0.001) or without (2.49/2.76; P<0.001) coexisting prediabetes/diabetes, but not for new onset of prediabetes/diabetes without coexisting hypertension. Analyses using the latent growth curve model confirmed the bidirectional relationships between brachial‐ankle pulse wave velocity and hypertension, but no such relationship was observed between brachial‐ankle pulse wave velocity and abnormal glucose metabolism.ConclusionsIn middle‐aged employees of a Japanese company, while bidirectional relationships were found to exist between increased arterial stiffness and hypertension, such a relationship was not found between increased arterial stiffness and diabetes. Therefore, it appears that increased arterial stiffness may be associated with the development of hypertension but not with that of diabetes.