Standardized Blood Pressure Measurements Research Articles

Improving Pediatric Hypertension Screening in an Academic Primary Care Setting.

Adherence to the American Academy of Pediatrics clinical practice guidelines for screening and managing high blood pressure (BP) is low. This team sought to improve recognition and documentation of relevant diagnoses in patients aged 13-20 years who presented to general pediatric clinics. The primary outcome measure was the proportion of office visits for patients ages 13-20 with a BP ≥ 120/80 with a visit or problem list diagnosis of hypertension or elevated BP. Secondary measures included (1) the proportion of patients who had their BP measured in the right arm, (2) the proportion of patients who had a mid-arm circumference measurement recorded, and (3) the proportion of patients who had a second BP reading measured at the visit. Interventions addressed key drivers for evidence-based high BP screening: standard BP measurement, electronic health record clinical decision support, and clinical pathway adoption. Data were collected over a twenty-seven-month period and plotted using the Laney p' chart. Provider documentation of elevated BP or hypertension improved from a baseline mean of 24% in April 2020 through January 2022 to 41% in February 2021 through June 2022. All secondary outcome measures also demonstrated significant improvement. This project demonstrates the feasibility of improving adherence to best practices of BP measurement in primary care clinics through education, acquisition of resources, and implementation of electronic health record flags for abnormal values.

The impact of sphygmomanometer placement and cuff placement on blood pressure measurements.

Hypertension is the most significant global risk factor for mortality and morbidity, making standardized blood pressure measurement crucial. To investigate whether the location of blood pressure monitors and the positioning of cuffs yield differing results in blood pressure measurements. Patients admitted to the Affiliated Hospital of Jiujiang College between 1 January 2022 and 30 June 2023 were enrolled in this study and randomly allocated into four groups. These groups were defined based on the positioning of monitoring equipment as follows: varied placements of cuffs on automatic blood pressure monitors, different heights for mercury column blood pressure monitors, varied heights for automatic blood pressure monitors, and different orientations for the cuff airbag tubes on electrocardiogram monitors. Blood pressure was measured and recorded for each group, followed by an analysis of the variations in readings across the different setups. In the first cohort of 763 individuals, mean systolic blood pressure measured at the standard upper arm site was 128.8 ± 10.5 mmHg, compared to 125.3 ± 10.4 mmHg at the elbow fossa. The corresponding diastolic pressures were 79.2 ± 10.7 and 75.0 ± 10.6 mmHg, respectively. The difference in systolic pressure between these positions was significant at 3.48 ± 3.22 mmHg (t₁ = 29.91, p₁ < 0.001) and for diastolic pressure at 4.23 ± 1.31 mmHg (t₂ = 88.98, p₂ < 0.001). For the subsequent groups, involving 253, 312, and 225 individuals, respectively, blood pressure measurements were analyzed and compared across different methods within each group. All p-values exceeded 0.05, indicating no statistically significant differences. Blood pressure values measured at the elbow fossa position using an upper arm-type automatic sphygmomanometer were found to be lower than those measured at the upper arm position, with a difference of 3.48 mmHg for systolic and 4.23 mmHg for diastolic pressures. It is therefore essential to position the cuff correctly, specifically 2-3 cm above the elbow fossa, when utilizing an upper arm-type automatic sphygmomanometer for blood pressure monitoring. Conversely, the placement of the mercury column sphygmomanometer and the automated sphygmomanometer at varying heights had no significant effect on blood pressure readings. Similarly, the orientation of the electrocardiogram's cuffed balloon tube, whether facing upward or downward, did not influence blood pressure measurement outcomes.

ACCURACY AND BLOOD PRESSURE THRESHOLD CONTROL ANALYSIS OF UNATTENDED AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENT: A CROSS-SECTIONAL STUDY BASED ON MULTICENTER POPULATIONS

Objective: The emergence of unattended automated office blood pressure (u-AOBP) measurement, facilitated by the flourishing development of electronic blood pressure monitors, has been proposed as a potential alternative or complementary approach for assessing patients’ blood pressure status within clinical settings. However, robust evidence is lacking to determine its application in diagnosing hypertension within the clinical practice in China. This study aims to compare u-AOBP values with standard office blood pressure data, assess the correlation between u-AOBP and diagnostic thresholds. Design and method: The study involved participants recruited from October 2023 to February 2024 in three hospitals: People's Hospital of Gongyi City in Henan Province, Nangong City Hospital in Hebei Province, and Fuwai Hospital of the Chinese Academy of Medical Sciences. Standardized validated upper arm blood pressure monitors were used to measure blood pressure. Baseline demographic data, anthropometric measurements, u-AOBP, and standard office blood pressure data were collected, along with additional examination results, including echocardiograms and 24-hour ambulatory blood pressure monitoring. Results: 1. The difference between u-AOBP and awake dynamic average blood pressure was 1.34 mmHg (95% confidence interval: 0.88-3.55 mmHg), and the difference was not statistically significant (P = 0.236). 2. The optimal cutoff values for diagnosing elevated blood pressure using u-AOBP, determined by ROC curve analysis based on awake dynamic blood pressure measurements, were 130.75/83.75 mmHg (sensitivity 89.73%, specificity 27.27%). 3. In participants with a dipper blood pressure diurnal rhythm, there was no statistically significant difference between standard office blood pressure and u-AOBP measurements (P &gt; 0.05). However, in the group including non-dipper rhythm participants, standard office blood pressure was higher than u-AOBP by 5.84/4.98 mmHg (P &lt; 0.05). Conclusions: 1. Unattended automated blood pressure measurements can reduce, but not eliminate, the white coat effect, with an optimal cutoff value for diagnosing elevated blood pressure determined as 130.75/83.75 mmHg. 2. In individuals with a normal dipper blood pressure diurnal rhythm, standardized u-AOBP values are equivalent to standard office blood pressure.

Intelligent Assist Office Blood Pressures (IOBP) versus awake ambulatory monitoring and conventional auscultatory office readings in Chinese primary medical institutions.

To practice standardized office blood pressure (OBP) measurement guidelines pragmatically, we developed an intelligent assisted OBP (IOBP) measurement system in the Chinese community, which can automatically obtain two or three BP values after a 5-min rest before the patients visit the doctor and transfer values to the community medical network in real time. We conducted a comparative study to investigate the agreement among IOBP, awake ambulatory BP (ABP), and conventional auscultatory OBP at different BP levels. Participants were divided into three groups according to BP, with 120/80 mmHg and 160/100 mmHg as the cut-off points. Attended IOBP, unattended IOBP, and auscultatory OBP were randomly measured before ABP monitoring. In total, 245 participants were included in the analysis. The mean systolic attended/unattended IOBP, auscultatory OBP, and awake ABP were 135.0, 136.7, 135.6, and 136.2 mmHg, respectively. Bland-Altman analysis revealed a bias of -1.1 and 0.5 mmHg for systolic attended/unattended IOBP compared with awake ABP in the overall sample. For auscultatory OBP, the bias was -0.4 (attended) and 1.2 mmHg (unattended). The discrepancy between the systolic attended/unattended IOBP and awake ABP was inconsistent at different BP levels. In Group 1 the values were -8.4 and -6.9 mmHg, whereas in Group 3, the values were 9.4 and 10.0 mmHg. BP measured using the IOBP measurement system was in accordance with awake ABP and conventional OBP, and can be a good choice in the Chinese community.

Accuracy and Performance of Triage Blood Pressure Measurements in A Real-World Clinic Setting

ObjectivesTo investigate the agreement and accuracy of triage blood pressure (BP) in a real-world clinic setting, compared with the reference standard. Study designPaired triage and standardized BP measurements from patients 4 through 21 years old evaluated in an obesity-related hypertension clinic were obtained via chart-review. Triage BPs were measured by a medical assistant or nurse, often by automated device. Triplicate manual BPs were obtained by the clinic physician. Bland-Altman analyses determined mean differences between paired triage and mean standardized BPs. GEE-based multivariable relative risk (RR) regression determined the RR of triage BP overestimation by ≥5mmHg. Overall agreement, sensitivity, specificity, positive predictive value, and negative predictive value of triage BP measurements identifying hypertensive BP were determined. Results130 participants with 347 clinic encounters were included. Mean age was 13.3 years (standard deviation 3.94), 76% were Black, and 58% were male. Overall mean systolic and diastolic BP difference was 8.7 mmHg (95% limits on agreement: -16.66, 34.07) and 4.1 mmHg (95% limits on agreement: -18.56, 26.68), respectively. Triage systolic BP was more likely overestimated by ≥5 mmHg when a large adult (RR=1.49; 95%CI: 1.00, 2.21) or thigh cuff (RR=1.94; 95%CI: 1.08, 3.51) was required compared with when a child/adult cuff was required. Overall agreement in identifying hypertensive BP was 57.6%. Sensitivity (52.6%), specificity (63.4%), positive predictive value (60.8%), and negative predictive value (55.3%) were low across all cuffs. ConclusionsThere was poor agreement between usual triage and standardized BP measurements, with potential for significant clinical implications.

Atherosclerosis and Hippocampal Volumes in Older Adults: The Role of Age and Blood Pressure.

Lower hippocampal volume is associated with late-life cognitive decline and is an important, but nonspecific marker for clinical Alzheimer's dementia. Cerebrovascular disease may also be associated with hippocampal volume. Here we study the role of intracranial large vessel disease (atherosclerosis) in association with hippocampal volume and the potential role of age, average late-life blood pressure across all visits, and other factors (sex, apolipoprotein ε4 [APOE ε4], and diabetes). Data came from 765 community-based older people (91 years old on average at death; 72% women), from 2 ongoing clinical-pathologic cohort studies. Participants completed baseline assessment, annual standardized blood pressure measurements, vascular risk assessment for diabetes, and blood draws to determine APOE genotype, and at death, brains were removed and underwent exvivo magnetic resonance imaging and neuropathologic evaluation for atherosclerosis pathology and other cerebrovascular and neurodegenerative pathologies. Linear regression models examined the association of atherosclerosis and hippocampal to hemisphere volume ratio and whether age at death, blood pressure, and other factors modified associations. In linear regression models adjusted for demographics and neurodegenerative and other cerebrovascular pathologies, atherosclerosis severity was associated with a lower hippocampal to hemisphere volume ratio. In separate models, we found the effect of atherosclerosis on the ratio of hippocampal to hemisphere volume was attenuated among advanced age at death or having higher systolic blood pressure (interaction terms P≤0.03). We did not find confounding or interactions with sex, diabetes, or APOE ε4. Atherosclerosis severity is associated with lower hippocampal volume, independent of neurodegenerative and other cerebrovascular pathologies. Higher systolic blood pressures and advanced age attenuate associations.

Exploring flexible methods for national health examination surveys in Germany

Abstract Background National health examination surveys (HES) are rarely carried out due to high costs and high complexity. We piloted more flexible methods such as self-sampling, self-measurements and household visits conducted by a study-nurse replacing physician examinations in study centers. Methods Feasibility of several new methods for the German HES was tested, e.g.: large-scale implementation of unattended self-sampled dried blood spots (DBS) and oral-nasal swabs (ONS) in a countrywide general population panel including a large subsample with migration background (Study 1, n = 15,122); household visits with brief biosampling &amp; examinations (Study 2, n = 470); and unattended blood pressure (BP) self-measurements with mailed devices and video instructions (Study 3, n = 202). Results Among participants consenting to participate, Study 1 showed successful postal self-sampling of DBS for SARS-CoV-2 antibody tests in 98% of participants and 97% valid ONS for SARS-CoV-2 PCR tests. Study 2 showed successful standardized measurements of BP (97%), weight/height (99%) and DBS and venous blood sampling with onsite whole blood centrifugation (97%). Temperature requirements for centrifugation, cooled transport and ATC-coded medication assessment (Anatomical Chemical Classification) proved challenging and needed revised methods to avoid data loss. Nested validation studies confirmed use of a multiplex assay for various antibodies with DBS and of HbA1c analysis with uncooled specimen. The strict and time-consuming BP self-measurement-protocol with 12 measurements in Study 3 was followed only by 54% of participants. Conclusions Self-sampling and biosampling &amp; examinations in households are feasible options for HES but protocols with high complexity may result in low data completeness.

Head-to-head comparison of the WHO STEPwise approach with immediate unattended and delayed unattended automated blood pressure measurements during household-based screening: a diagnostic accuracy study in Lesotho

WHO introduced the STEPwise approach to surveillance (STEPS) to monitor trends in non-communicable diseases. For arterial hypertension, the STEPS protocol takes the average of the last two out of three standard blood pressure measurements (SBPM). This study assesses the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24 h ambulatory measurement (24h-ABPM) as reference. This diagnostic accuracy study was done within a population-based household survey on cardiovascular risk factors in two districts in Northern Lesotho. Adults (aged ≥ 18 years) with elevated SBPM (defined as ≥140/90mmHg), and 2:1 age- and sex-matched participants with normal SBPM during the survey were recruited. Following SBPM, first uABP readings were obtained on survey day. Afterwards, participants received a 24h-ABPM device. Second uABP readings were taken 24h later, after retrieval of the 24h-ABPM. The main outcome was overall diagnostic accuracy of all screening measurements (SBPM, first uABP, and second uABP), determined using area under the receiver operating characteristic curve (AUROC), with 24h-ABPM as a reference. Between November 2, 2021 and August 31, 2022, 275 participants (mean age 58 years (SD: 16 years), 163 (59%) female) were enrolled, 183 of whom had elevated and 92 had normal SBPM. Mean difference between systolic daytime 24h-ABPM and screening measurements was highest for SBPM (mean difference:-13mmHg; 95% CI:-14 to-11). Mean difference between diastolic daytime 24h-ABPM and diastolic SBPM was-2mmHg (95% CI:-4 to-1), whereas no difference was found for mean diastolic first uABP (mean difference:-1mmHg; 95% CI:-2.0 to 0.3); and mean diastolic second uABP (mean difference: 1.0mmHg; 95% CI:-0.4 to 2.3). White coat hypertension was highest with SBPM (55 [20%]), followed by first uABP (27 [9.8%]), and second uABP (18 [6.5%]). Using systolic daytime 24h-ABPM as a reference, the uABPs had higher AUROC (first uABP: 87% [95% CI: 83-91]; second uABP: 88% [95% CI: 84-92]); SBPM: (79% [95% CI: 74-85]). This difference was significant between first uABP and SBPM (P=0.0024), and between second uABP and SBPM (P=0.0017). uABP had better diagnostic performance than SBPM. Integration of uABP into STEPS protocol should be considered. Swiss Agency for Development and Cooperation under the ComBaCaL project, and the World Diabetes Foundation.

Prenatal and Childhood Per- and Polyfluoroalkyl Substance (PFAS) Exposures and Blood Pressure Trajectories From Birth to Late Adolescence in a Prospective US Prebirth Cohort.

Background Evidence is limited regarding the associations of prenatal and childhood per- and polyfluoroalkyl substance (PFAS) exposures with blood pressure (BP) trajectories in children. Methods and Results Participants are from Project Viva, a prospective prebirth cohort in eastern Massachusetts. We measured PFAS in early-pregnancy maternal (median, 9.6 weeks) and midchildhood (median, 7.7 years) plasma samples. We conducted standardized BP measurements at 6 research visits: birth, infancy (median, 6.3 months), early childhood (median, 3.2 years), midchildhood (median, 7.7 years), early adolescence (median, 12.9 years), and late adolescence (median, 17.5 years). We used linear regression to examine associations of individual PFASs with BP at each visit, linear spline mixed-effects regression to model BP trajectories, and a mixture approach to estimate PFAS exposure burden. We included 9036 BP measures from 1506 participants. We observed associations between particular individual prenatal PFASs and child BP at specific time points, for example, prenatal 2-(N-ethyl-perfluorooctane sulfonamido) acetate (EtFOSAA) and 2-(N-methyl-perfluorooctane sulfonamido) acetate (MeFOSAA) with higher systolic BP at birth; prenatal perfluorooctane sulfonate (PFOS) and EtFOSAAwith lower diastolic BP in infancy; and prenatal PFOS, perfluorooctanoate (PFOA), and EtFOSAAwith higher systolic BP at midchildhood. No prenatal or childhood PFAS was consistently associated with BP across all visits. Diastolic BP trajectories from 0 to 20 years differed slightly by prenatal PFOA, perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA)(P values 0.01-0.09). Diastolic BP trajectories from 6 to 20 years differed slightly by midchildhood PFHxS and MeFOSAA(P-values 0.03-0.08). Prenatal or childhood PFAS mixture burden scoreswere not associated with BP. Conclusions We found associations of prenatal and childhood PFAS exposures with BP at specific time points between birth and late adolescence but no consistent associations across all time points or PFAS types.

Continuous Noninvasive Blood Pressure Measurement With “ClearSight” Compared to Standard Intermittent Blood Pressure Measurement in Patients With Peripheral Arterial Disease. Are Potential Differences Influenced by Phenylephrine or Dobutamine?

To investigate the agreement between continuous noninvasive blood pressure measurement with the ClearSight system (cNIBP-CS) and standard intermittent noninvasive blood pressure measurement (iNIBP) in patients with peripheral arterial disease (PAD). Additionally, the influence of vasoactive medication on potential measurement differences was assessed. A secondary analysis of a randomized controlled trial. At a university hospital. Thirty-four patients with PAD undergoing percutaneous transluminal angioplasty of the lower limbs. None. Continuous noninvasive blood pressures were measured with the "ClearSight" system and compared to standard iNIBPs. Bland-Altman analysis revealed a mean bias of 13 mmHg (±15) between cNIBP-CS and iNIBP, with 95% limits of agreement (LOA) ranging from -17 to 42 mmHg. When comparing both medication groups, a similar mean bias was found for phenylephrine and dobutamine (12 mmHg [±13] and 13 mmHg [±13], respectively). In this study, in patients with PAD, cNIBP-CS showed an underestimation of blood pressure compared to iNIBP in phenylephrine- and dobutamine-treated patients. Compared to previous studies, a larger bias and wider 95% LOA were found.

The effect of a ketogenic diet on weight loss in CKD: a randomized controlled trial in obese stage G1-3a CKD patients.

This study describes a multicentre randomized controlled trial comparing the effects of a ketogenic diet with a low-energy standard diet containing 0.8g/kg/day on weight loss and metabolic alterations in adult patients with mild-to-moderate non-diabetic chronic kidney disease (CKD) and mild-to-severe obesity. The study is being conducted to understand the impact of the ketogenic diet on weight loss in these patients, as the existing evidence on the ketogenic diet's effect in CKD patients is limited and inconclusive. The study will enrol mild-to moderate adult CKD patients (Stages G1-3a) with albumin to creatinine ratio ≥200mg/g, without diabetes, with obesity (body mass index ≥30kg/m2), and stable body weight and estimated glomerular filtration rate from at least 3months. The primary outcome will be weight loss at 6months, and secondary outcomes will include adherence to prescribed dietary regimens, body composition changes, changes in standardized blood pressure measurements, metabolic parameters, lipid profile, liver profile, mineral bone disease biomarkers, and changes in renal function and albuminuria. The findings of this study will contribute to a better understanding of the potential benefits and risks of the ketogenic diet in CKD patients with obesity. The results will help guide future research on the ketogenic diet and renal health.

1249-P: Lack of Concordance of Blood Pressure Control among Heterosexual Couples with Diabetes—An Analysis of Aging Cohorts from USA, China, and India

Background: Previous studies observed high concordance of diabetes and hypertension among married or partnered couples globally due to assortative mating and cohabitation. However, whether there is concordance in controlled blood pressure (BP) among couples with diabetes, an important risk factor for micro/macrovascular complications, is unknown. Methods: Using cross-sectional data from Health and Retirement Study (HRS 2016-17, n = 1749) and its international partner studies from China (CHARLS 2015-16, n = 923) and India (LASI 2017-19, n = 4582), we identified couples (aged 21-97 years) among whom at least one partner had diabetes and both partners had standardized BP measurements. We defined controlled BP as systolic BP &amp;lt; 140 mmHg and diastolic BP &amp;lt; 90 mmHg. We used multiple imputation and survey-weighted modified Poisson regression to study the association of controlled BP between couples for wives and husbands respectively. We adjusted for current medication use, individual and household characteristics. We additionally examined between-country differences in the association. Results: Our analytic sample consisted of 3802 wives and 4504 husbands with diabetes. The proportion of wives with controlled blood pressure were 76.6% [73.2, 80.1] in the USA, 67.5% [63.3, 71.8] in China and 65.1% [62.6, 67.6] in India. The proportion of husbands with controlled blood pressure were 70.8% [67.4, 74.1] in the USA, 63.6% [58.5, 68.6] in China and 60.0% [57.8, 62.3] in India. Partner’s control of BP was not associated with own controlled BP for wives (prevalence ratio, PR: 1.05 [0.97, 1.14]) and husbands (PR: 1.07 [0.94, 1.21]) with diabetes. Estimates of association were null across all countries. Estimates were similar when restricted to couples (n = 1076) when both partners had diabetes. Conclusions: Lack of concordance in BP control among couples with diabetes suggest continuation of strategies for individualized management of high blood pressure. Disclosure J.Varghese: None. C.Li: None. P.Lu: None.

Development and characterization of canine-specific computational models to predict pulsatile arterial hemodynamics and ventricular-arterial coupling.

Pulsatile hemodynamics analyses provide important information about the ventricular-arterial system which cannot be inferred by standard blood pressure measurements. Pulse wave analysis (PWA), wave separation analysis (WSA), and wave power analysis (WPA) characterize arterial hemodynamics with limited preclinical applications. Integrating these tools into preclinical testing may enhance understanding of disease or therapeutic effects on cardiovascular function. We used a canine rapid ventricular pacing (RVP) heart failure model to: (1) Characterize hemodynamics in response to RVP and (2) assess analyses from flow waveforms synthesized from pressure compared to those derived from measured flow. Female canines (n = 7) were instrumented with thoracic aortic pressure transducers, ventricular pacing leads, and an ascending aortic flow probe. Data were collected at baseline, 1 week, and 1 month after RVP onset. RVP progressively reduced stroke volume (SV), the PWA SV estimator, and WSA and WPA pulsatility and wave reflection indices. Indices derived from synthesized flow exhibited similar directional changes and high concordance with measured flow calculations. Our data demonstrate the value of analytical hemodynamic methods to gain deeper insight into cardiovascular function in preclinical models. These approaches can provide complementary value to standard endpoints in evaluating potential effects of pharmaceutical agents intended for human use.

Remote ischemic conditioning in necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a devastating intestinal inflammatory disorder, most prevalent in premature infants, and associated with a high mortality rate that has remained unchanged in the past two decades. NEC is characterized by inflammation, ischemia, and impaired microcirculation in the intestine. Preclinical studies by our group have led to the discovery of remote ischemic conditioning (RIC) as a promising non-invasive intervention in protecting the intestine against ischemia-induced damage during early-stage NEC. RIC involves the administration of brief reversible cycles of ischemia and reperfusion in a limb (similar to taking standard blood pressure measurement) which activate endogenous protective signaling pathways that are conveyed to distant organs such as the intestine. RIC targets the intestinal microcirculation and by improving blood flow to the intestine, reduces the intestinal damage of experimental NEC and prolongs survival. A recent Phase I safety study by our group demonstrated that RIC was safe in preterm infants with NEC. A phase II feasibility randomized controlled trial involving 12 centers in 6 countries is currently underway, to investigate the feasibility of RIC as a treatment for early-stage NEC in preterm neonates. This review provides a brief background on RIC as a therapeutic strategy and summarizes the progression of RIC as a treatment for NEC from preclinical investigation to clinical evaluation.

PERFORMANCE OF STANDARD, IMMEDIATE AND DELAYED UNATTENDED AUTOMATED BLOOD PRESSURE MEASUREMENTS DURING HOUSEHOLD-BASED SCREENING IN RURAL AFRICA: A DIAGNOSTIC ACCURACY STUDY

Objective: The World Health Organization's STEPwise approach to surveillance (STEPS) recommends three standard blood pressure measurements over five minutes (SBPM) to monitor trends of hypertension in low-income countries. The objective of this study was to assess the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24hr ambulatory measurement (24h-ABPM) as reference during a population-based prevalence survey in Lesotho. Design and method: Participants with elevated SBPM (&gt; = 140/90 mmHg) and age- and sex-matched participants with normal SBPM during a household-based survey were recruited. For SBPM and uABP, participants sat and rested for 5 minutes before three measurements were taken each 2 min apart. For both, the mean of second and third measurements was taken as final blood pressure. 1st uABP readings were obtained on survey day. Afterwards participants received a 24h-ABPM device. 2nd uABP readings were taken 24h later after retrieval of the 24h-ABPM. Discrimination was determined for all screening measurements (SBPM, 1st, 2nd uABP) using area under the receiver operating characteristic curve (AUROC), and 24h-ABPM as reference. Results: We enrolled 275 participants [mean age 58 years, 163 (59%) female], 183 with elevated and 92 with normal SBPM. Mean difference between systolic daytime 24h-ABPM and screening measurements was highest for SBPM (mean difference: -12 mmHg; 95%CI: -14 to -9). Mean difference between diastolic daytime ABPM and diastolic SBPM was -2 mmHg (95%CI: -3 to -0.7), whereas no difference was found for mean diastolic 1st uABP (mean difference: -0.6 mmHg; 95%CI: -1.9 to 0.6); and mean diastolic 2nd uABP (mean difference: 1.0 mmHg; 95%CI: -0.4 to 2.4). Misclassification as having hypertension (Figure 1) was highest with SBPM (55 [20%]), followed by 1st uABP (27 [9.8%]) and 2nd uABP (18 [6.5%]). Using systolic daytime 24h-ABPM as reference, the uABPs had higher AUROC (1st uABP: 87% [95%CI: 83-91]; 2nd uABP: 88% [95%CI: 84-92]); SBPM: (79% [95%CI: 74-85]). This difference was significant between 1st uABP and SBPM (p = 0.002), and between 2nd uABP and SBPM (p&lt;0.001). Conclusions: uABP measurements had better diagnostic performance compared to SBPM. Integration of uABP into the STEPS protocol should be considered.

0198 Effects of a 1-hour nightly weeklong sleep extension pilot study in undergraduates on health

Abstract Introduction Sleep restriction impairs health, but less is known about the potential health benefits of extending sleep in undergraduate students with habitual short sleep. This study examined the effects of a 1-week, 1-hour per night sleep extension on cardiometabolic health, hydration status, sedentary behavior, and physical activity in undergraduate students. Methods Twelve healthy undergraduate students (83% female; mean±SD age 20.2±1.5; range 18-23 years) obtaining fewer than 7 hours of average nightly sleep completed a two-week study. The first week consisted of sleeping typically ("Habitual"), followed by a peer-delivered intervention to extend time in bed by ≥1 hour/night during the second week ("Extension"). Sleep and physical activity actigraphy were collected throughout. Following each week, participants completed in-person cardiometabolic assessments, including a standardized meal response procedure and blood pressure measurement. Blood samples for measurement of glucose and insulin were collected before, during, and following a standardized breakfast. Urine samples yielded markers of hydration (specific gravity and osmolality). Mixed-effects regression models with random intercepts for individuals compared outcomes after the Extension week to Habitual outcomes. Results Compared to Habitual sleep, average sleep duration across the Extension week increased (b±SEM, +42.6±.3 minutes; p=.005). After the breakfast meal, glucose area under the curve (AUC; −26.5±10.2 mg/dL*h; p=.025) and time to return to baseline levels (−83.0±46.4 minutes; p=.031) decreased following Extension. There was no change in insulin AUC. Systolic blood pressure decreased (−6.6±2.8 mmHg; p=.037) after Extension. Average time spent in sedentary behavior (−44.3±15.7 minutes; p=.018) and percentage of wake spent in moderate-to-vigorous physical activity (−1%±.4%; p=.030) decreased across the Extension week. Participants who increased average sleep duration ≥15 minutes (n=9) were better hydrated according to urine osmolality (−187.0±68.4 mOsm/kg; p=.026) and specific gravity (−.01±.002 g/mL; p=.012) and had lowered odds of dehydration according to urine osmolality (≥800 mOsm/kg; −67%; OR=.03; p=.035). Conclusion This pilot study provided evidence that sleep extension may improve cardiometabolic health and hydration and reduce both sedentary behavior and moderate-to-vigorous physical activity. Future research in randomized controlled trials should examine if such findings extrapolate to larger samples and older populations. Support (if any) CRC/CTSI: UL1-TR002014; pilot grant to AMC from the Department of Biobehavioral Health, Pennsylvania State University

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

Is a unified blood pressure threshold feasible in the current scenario?: Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure": Commentary on the article"130/80mmHg as a unifying hypertension threshold for office brachial, office central and ambulatory daytime brachial blood pressure".

Blood pressure goals in chronic kidney disease : What is the optimal blood pressure for inhibition of progression and risk reduction?

Well-controlled blood pressure is an essential factor in inhibiting the progression of renal failure and also in controlling cardiovascular mortality and morbidity. For decades there has been an intensive search for the optimal blood pressure target values in order to reduce the progression of renal insufficiency to aphysiological level as far as possible. In the last few decades, very different target blood pressure values have been defined, which time and again contribute more to confusion than clarity in everyday clinical practice. The present work considers the relevant guidelines; it analyzes the basis on which the sometimes widely varying guidelines were created. All guidelines agree that blood pressure control with atarget of less than 140 mm Hg systolic should be achieved in patients with impaired renal function. The European guidelines recommend aiming for atarget of 130-140 mm Hg systolic. The American guidelines go one step further and specify asystolic blood pressure target of less than 130 mm Hg. The Kidney Disease: Improving Global Outcomes (KDIGO) organization is even more ambitious. It recommends ablood pressure target of less than 120 mm Hg, whereby in contrast to the European and American guidelines, the level of evidence required in the guidelines is considered to be very weak and the goals should also be achieved if automated, standardized blood pressure measurement is carried out, which is rarely available in everyday practice and may not be feasible. The present overview discusses the arguments for lowering blood pressure with different goals and presents the evidence. Of course, the blood pressure goals in the presence or absence of albuminuria should also be considered.

Stagnating rates of blood pressure control in Australia: insights from opportunistic screening of 10 046 participants of the May Measurement Month campaigns.

Raised blood pressure (BP) remains the single most important modifiable risk factor contributing to cardiovascular and all-cause mortality in Australia and worldwide. May Measurement Month , a global BP measurement and screening campaign initiated by the International Society of Hypertension and carried out in Australia since its inception in 2017, aimed at obtaining standardized BP measurements from members of the community to increase awareness of high BP and its associated risks. Adults participants (≥18 years) were recruited through opportunistic sampling across Australia during the month of May in 2017, 2018 and 2019. Trained volunteers recorded BP readings in a standardized manner and collected data on demographic, lifestyle factors and comorbidities. Hypertension was defined as SBP of at least 140 mmHg, or DBP of at least 90 mmHg, or taking antihypertensive medication. Data were collated centrally and analysis was carried out using regression models to evaluate the associations between BP and participant characteristics. A total of 10 046 participants were screened, of whom 3097 (31.0%) had hypertension, only 48.5% were aware of their condition and 44.4% were taking antihypertensive medication. Of those taking antihypertensive medication, 53.2% were controlled to less than 140/90 mmHg, whereas the remaining 46.8% of participants had BP of at least 140/90 mmHg suggestive of inadequately treated hypertension. Consecutive data obtained over a 3-year period in Australia demonstrated stagnating awareness, treatment and control rates with the latter two being substantially lower than global rates and those in other high-income countries. Concerted efforts from all stakeholders will be required to help overcome the unacceptably poor rates of BP treatment and control in Australia.

International Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action

High blood pressure (BP) is the single leading risk factor for cardiovascular disease worldwide,1-4 and BP lowering substantially reduces that risk.5-7 Effective BP management relies on accurate measurement. This joint statement from 13 scientific health organizations around the globe has the focused goal of emphasizing the importance of, and introducing a pragmatic approach to, standardized clinic BP measurement implemented in clinical practice.