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Addison ML, Ranasinghe P, Webb DJ. Novel Pharmacological Approaches in the Treatment of Hypertension: A Focus on RNA-Based Therapeutics. Hypertension 2023; 80:2243-2254. [PMID: 37706295 DOI: 10.1161/hypertensionaha.122.19430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Hypertension remains the leading cause of cardiovascular disease and premature death globally, affecting half of US adults. A high proportion of hypertensive patients exhibit uncontrolled blood pressure (BP), associated with poor adherence, linked to pill burden and adverse effects. Novel pharmacological strategies are urgently needed to improve BP control. Dysregulation of the renin-angiotensin system increases BP through its primary effector, Ang II (angiotensin II), which results in tissue remodeling and end-organ damage. Silencing liver angiotensinogen (the sole source of Ang II) has been achieved using novel RNA therapeutics, including the antisense oligonucleotide, IONIS-AGT (angiotensinogen)-LRX, and the small-interfering RNA, zilebesiran. Conjugation to N-acetylgalactosamine enables targeted delivery to hepatocytes, where endosomal storage, slow leakage, and small-interfering RNA recycling (for zilebesiran) result in knockdown over several months. Indeed, zilebesiran has an impressive and durable effect on systolic BP, reduced by up to 20 mm Hg and sustained for 6 months after a single administration, likely due to its very effective knockdown of angiotensinogen, without causing acute kidney injury or hyperkalemia. By contrast, IONIS-AGT-LRX caused less knockdown and marginal effects on BP. Future studies should evaluate any loss of efficacy relating to antidrug antibodies, safety issues associated with long-term angiotensinogen suppression, and broader benefits, especially in the context of common comorbidities such as type 2 diabetes and chronic kidney disease.
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Affiliation(s)
- Melisande L Addison
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, College of Medicine & Veterinary Medicine, The University of Edinburgh, Scotland, United Kingdom (M.L.A., P.R., D.J.W.)
| | - Priyanga Ranasinghe
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, College of Medicine & Veterinary Medicine, The University of Edinburgh, Scotland, United Kingdom (M.L.A., P.R., D.J.W.)
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka (P.R.)
| | - David J Webb
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, College of Medicine & Veterinary Medicine, The University of Edinburgh, Scotland, United Kingdom (M.L.A., P.R., D.J.W.)
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Wang J, Jiang C, Li S, Wang Z, Wang Y, Lai Y, Wang Z, Lv W, Bai Y, Yang Z, Guo Q, Huang L, He L, Guo X, Li S, Liu N, Jiang C, Tang R, Long D, Du X, Sang C, Dong J, Ma C. Systolic Blood Pressure Time in Target Range and Incident Atrial Fibrillation in Patients With Hypertension: Insights From the SPRINT Trial. Hypertension 2023; 80:2306-2314. [PMID: 37589154 DOI: 10.1161/hypertensionaha.123.21651] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Systolic blood pressure (SBP) time in target range (TTR) indicates the mean value, exposure time, and variability in blood pressure over time. The prognostic value of SBP TTR for incident atrial fibrillation (AF) in patients with hypertension is unclear. METHODS We performed a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a randomized controlled trial comparing intensive (<120 mm Hg) and standard (<140 mm Hg) SBP interventions in participants with hypertension. SBP target ranges for intensive and standard arms were defined as 110 to 130 and 120 to 140 mm Hg, respectively. TTR was calculated by linear interpolation method using SBP from months 0 to 3. We used Cox proportional regression models to assess the association of SBP TTR with incident AF. RESULTS Among 7939 participants included in this analysis, 187 incident AF cases occurred during follow-up. After multivariable adjustment, a 10% increase in SBP TTR was independently associated with a 7% lower risk of incident AF (hazard ratio, 0.93 [95% CI, 0.88-0.97]; P=0.003). The restricted spline curve depicted a linear and inverse relationship between SBP TTR and incident AF. Sensitivity analyses generated consistent results when calculating TTR over a longer period or setting target range as 110 to 140 mm Hg for the whole population. CONCLUSIONS Higher SBP TTR independently predicts a lower risk of incident AF. Efforts to attain SBP within 110 to 140 mm Hg over time may be an effective strategy to prevent AF. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01206062.
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Affiliation(s)
- Jue Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Sitong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Zhiyan Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Yufeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Zhen Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Wenhe Lv
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Yu Bai
- School of Clinical Medicine, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (Y.B.)
| | - Zejun Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Qi Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Lihong Huang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
- Heart Health Research Center, Beijing, China (X.D.)
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China (J.D.)
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (J.W., Chao Jiang, Sitong Li, Zhiyan Wang, Y.W., Y.L., Zhen Wang, W.L., Z.Y., Q.G., L. Huang, L. He, X.G., Songnan Li, N.L., Chenxi Jiang, R.T., D.L., X.D., C.S., J.D., C.M.)
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Zhao N, Chung TD, Guo Z, Jamieson JJ, Liang L, Linville RM, Pessell AF, Wang L, Searson PC. The influence of physiological and pathological perturbations on blood-brain barrier function. Front Neurosci 2023; 17:1289894. [PMID: 37937070 PMCID: PMC10626523 DOI: 10.3389/fnins.2023.1289894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
The blood-brain barrier (BBB) is located at the interface between the vascular system and the brain parenchyma, and is responsible for communication with systemic circulation and peripheral tissues. During life, the BBB can be subjected to a wide range of perturbations or stresses that may be endogenous or exogenous, pathological or therapeutic, or intended or unintended. The risk factors for many diseases of the brain are multifactorial and involve perturbations that may occur simultaneously (e.g., two-hit model for Alzheimer's disease) and result in different outcomes. Therefore, it is important to understand the influence of individual perturbations on BBB function in isolation. Here we review the effects of eight perturbations: mechanical forces, temperature, electromagnetic radiation, hypoxia, endogenous factors, exogenous factors, chemical factors, and pathogens. While some perturbations may result in acute or chronic BBB disruption, many are also exploited for diagnostic or therapeutic purposes. The resultant outcome on BBB function depends on the dose (or magnitude) and duration of the perturbation. Homeostasis may be restored by self-repair, for example, via processes such as proliferation of affected cells or angiogenesis to create new vasculature. Transient or sustained BBB dysfunction may result in acute or pathological symptoms, for example, microhemorrhages or hypoperfusion. In more extreme cases, perturbations may lead to cytotoxicity and cell death, for example, through exposure to cytotoxic plaques.
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Affiliation(s)
- Nan Zhao
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
| | - Tracy D. Chung
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Zhaobin Guo
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
| | - John J. Jamieson
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Lily Liang
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Raleigh M. Linville
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Alex F. Pessell
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Linus Wang
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Peter C. Searson
- Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD, United States
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54
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Lin M, Lin Y, Li Y, Lin X. Effect of exercise training on blood pressure variability in adults: A systematic review and meta-analysis. PLoS One 2023; 18:e0292020. [PMID: 37851627 PMCID: PMC10584136 DOI: 10.1371/journal.pone.0292020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND AND AIMS Targeting blood pressure variability (BPV) can potentially reduce cardiovascular events and incidence of mortality, but whether exercise reduces BPV remains controversial. This systematic review and meta-analysis were designed to study the impact of an exercise intervention on BPV in adults. METHODS A systematic search of PubMed, Web of Science, Scopus, EBSCO host, Cochrane, Embase, Science direct databases was done to retrieve controlled trials published from inception to January 10, 2023 that investigated the effects of exercise on BPV. The main characteristics of each study were synthesized, re-evaluated, and used in this meta-analysis. RESULTS Eleven studies with 514 adults with exercise training were eligible for single-arm meta-analysis and six randomized controlled trials (RCTs) were selected for further meta-analysis. After exercise training, systolic blood pressure variability (SBPV) (effect size = -0.76, 95%CI: -1.21 to -0.30, I2 60%), especially the average real variability SBP (-0.85, -1.44 to -0.27, I2 59%), was significantly improved. SBPV (-0.68, -1.18 to -0.18, I2 64%) significantly improved in hypertension patients. Aerobic exercise improved SBPV (-0.66, -1.32 to -0.00, I2 45%), and combined training improved both SBPV (-0.74, -1.35 to -0.14, I2 65%) and diastolic blood pressure variability (DBPV) (-0.36, -0.65 to -0.02, I2 33%). The SBPV of daytime (-0.90, -1.39 to -0.40, I2 57%) and DBPV of daytime (-0.31, -0.53 to -0.08, I2 0%) values demonstrated significant improvement compared to the night-time values. Moreover, six RCTs demonstrated a decrease in SBPV (-1.03, -1.77 to -0.28, I2 45%). CONCLUSION This study provides quantitative evidence that exercise training can improve BPV, especially SBPV, in adults. This meta-analysis suggests that aerobic exercise and combined training should be recommended for hypertension patients.
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Affiliation(s)
- Min Lin
- Department of Electro-Cardiographic Information, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen, China
- The Shengli Clinical College, Fujian Medical University, Fuzhou, China
| | - Yipin Lin
- Department of Electro-Cardiographic Information, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen, China
| | - Yuhua Li
- Department of Electro-Cardiographic Information, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen, China
| | - Xiongbiao Lin
- Department of Electro-Cardiographic Information, The First Affiliated Hospital of Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Cardiac Electrophysiology, Xiamen, China
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Franklin D, Tzavelis A, Lee JY, Chung HU, Trueb J, Arafa H, Kwak SS, Huang I, Liu Y, Rathod M, Wu J, Liu H, Wu C, Pandit JA, Ahmad FS, McCarthy PM, Rogers JA. Synchronized wearables for the detection of haemodynamic states via electrocardiography and multispectral photoplethysmography. Nat Biomed Eng 2023; 7:1229-1241. [PMID: 37783757 PMCID: PMC10653655 DOI: 10.1038/s41551-023-01098-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/18/2023] [Indexed: 10/04/2023]
Abstract
Cardiovascular health is typically monitored by measuring blood pressure. Here we describe a wireless on-skin system consisting of synchronized sensors for chest electrocardiography and peripheral multispectral photoplethysmography for the continuous monitoring of metrics related to vascular resistance, cardiac output and blood-pressure regulation. We used data from the sensors to train a support-vector-machine model for the classification of haemodynamic states (resulting from exposure to heat or cold, physical exercise, breath holding, performing the Valsalva manoeuvre or from vasopressor administration during post-operative hypotension) that independently affect blood pressure, cardiac output and vascular resistance. The model classified the haemodynamic states on the basis of an unseen subset of sensor data for 10 healthy individuals, 20 patients with hypertension undergoing haemodynamic stimuli and 15 patients recovering from cardiac surgery, with an average precision of 0.878 and an overall area under the receiver operating characteristic curve of 0.958. The multinodal sensor system may provide clinically actionable insights into haemodynamic states for use in the management of cardiovascular disease.
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Affiliation(s)
- Daniel Franklin
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Onatrio, Canada.
| | - Andreas Tzavelis
- Medical Scientist Training Program, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | | | | | - Jacob Trueb
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Hany Arafa
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Sung Soo Kwak
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Ivy Huang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Yiming Liu
- Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Megh Rathod
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Onatrio, Canada
| | - Jonathan Wu
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Onatrio, Canada
| | - Haolin Liu
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Onatrio, Canada
| | - Changsheng Wu
- Department of Materials Science and Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Jay A Pandit
- Scripps Research Translational Institute, San Diego, CA, USA
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - John A Rogers
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA.
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.
- Department of Materials Science and Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA.
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Lennon MJ, Lam BCP, Lipnicki DM, Crawford JD, Peters R, Schutte AE, Brodaty H, Thalamuthu A, Rydberg-Sterner T, Najar J, Skoog I, Riedel-Heller SG, Röhr S, Pabst A, Lobo A, De-la-Cámara C, Lobo E, Bello T, Gureje O, Ojagbemi A, Lipton RB, Katz MJ, Derby CA, Kim KW, Han JW, Oh DJ, Rolandi E, Davin A, Rossi M, Scarmeas N, Yannakoulia M, Dardiotis T, Hendrie HC, Gao S, Carrière I, Ritchie K, Anstey KJ, Cherbuin N, Xiao S, Yue L, Li W, Guerchet MM, Preux PM, Aboyans V, Haan MN, Aiello AE, Ng TP, Nyunt MSZ, Gao Q, Scazufca M, Sachdev PSS. Use of Antihypertensives, Blood Pressure, and Estimated Risk of Dementia in Late Life: An Individual Participant Data Meta-Analysis. JAMA Netw Open 2023; 6:e2333353. [PMID: 37698858 PMCID: PMC10498335 DOI: 10.1001/jamanetworkopen.2023.33353] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023] Open
Abstract
Importance The utility of antihypertensives and ideal blood pressure (BP) for dementia prevention in late life remains unclear and highly contested. Objectives To assess the associations of hypertension history, antihypertensive use, and baseline measured BP in late life (age >60 years) with dementia and the moderating factors of age, sex, and racial group. Data Source and Study Selection Longitudinal, population-based studies of aging participating in the Cohort Studies of Memory in an International Consortium (COSMIC) group were included. Participants were individuals without dementia at baseline aged 60 to 110 years and were based in 15 different countries (US, Brazil, Australia, China, Korea, Singapore, Central African Republic, Republic of Congo, Nigeria, Germany, Spain, Italy, France, Sweden, and Greece). Data Extraction and Synthesis Participants were grouped in 3 categories based on previous diagnosis of hypertension and baseline antihypertensive use: healthy controls, treated hypertension, and untreated hypertension. Baseline systolic BP (SBP) and diastolic BP (DBP) were treated as continuous variables. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of Individual Participant Data reporting guidelines. Main Outcomes and Measures The key outcome was all-cause dementia. Mixed-effects Cox proportional hazards models were used to assess the associations between the exposures and the key outcome variable. The association between dementia and baseline BP was modeled using nonlinear natural splines. The main analysis was a partially adjusted Cox proportional hazards model controlling for age, age squared, sex, education, racial group, and a random effect for study. Sensitivity analyses included a fully adjusted analysis, a restricted analysis of those individuals with more than 5 years of follow-up data, and models examining the moderating factors of age, sex, and racial group. Results The analysis included 17 studies with 34 519 community dwelling older adults (20 160 [58.4%] female) with a mean (SD) age of 72.5 (7.5) years and a mean (SD) follow-up of 4.3 (4.3) years. In the main, partially adjusted analysis including 14 studies, individuals with untreated hypertension had a 42% increased risk of dementia compared with healthy controls (hazard ratio [HR], 1.42; 95% CI 1.15-1.76; P = .001) and 26% increased risk compared with individuals with treated hypertension (HR, 1.26; 95% CI, 1.03-1.53; P = .02). Individuals with treated hypertension had no significant increased dementia risk compared with healthy controls (HR, 1.13; 95% CI, 0.99-1.28; P = .07). The association of antihypertensive use or hypertension status with dementia did not vary with baseline BP. There was no significant association of baseline SBP or DBP with dementia risk in any of the analyses. There were no significant interactions with age, sex, or racial group for any of the analyses. Conclusions and Relevance This individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive use was associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.
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Affiliation(s)
- Matthew J. Lennon
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Aging, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Ben Chun Pan Lam
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Aging, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Darren M. Lipnicki
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Aging, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - John D. Crawford
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Aging, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Ruth Peters
- The George Institute for Global Health, Sydney, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Aletta E. Schutte
- The George Institute for Global Health, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Aging, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Eastern Suburbs Older Persons’ Mental Health Service, Sydney, Australia
| | - Anbupalam Thalamuthu
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Aging, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Therese Rydberg-Sterner
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg, Gothenburg, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Jenna Najar
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg, Gothenburg, Sweden
- Psychiatry, Cognition and Old Age Psychiatry Clinic, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Centre for Ageing and Health at the University of Gothenburg, Gothenburg, Sweden
- Psychiatry, Cognition and Old Age Psychiatry Clinic, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
- School of Psychology, Manawatu Campus, Massey University, Palmerston North, New Zealand
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Antonio Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Concepción De-la-Cámara
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Elena Lobo
- Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Toyin Bello
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oye Gureje
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Akin Ojagbemi
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Mindy J. Katz
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Carol A. Derby
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Jong Oh
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Elena Rolandi
- Golgi Cenci Foundation, Abbiategrasso, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | | | - Nikolaos Scarmeas
- First Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, Columbia University, New York, New York
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Themis Dardiotis
- Department of Neurology, University Hospital of Larissa, Larissa, Greece
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Hugh C. Hendrie
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
- Indiana Alzheimer Disease Research Center, Indiana Alzheimer Disease Research Center, Indianapolis
| | - Sujuan Gao
- Indiana Alzheimer Disease Research Center, Indiana Alzheimer Disease Research Center, Indianapolis
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | - Isabelle Carrière
- Institut for Neurosciences of Montpellier, University Montpellier, National Institute for Health and Medical Research, Montpellier, France
| | - Karen Ritchie
- Institut for Neurosciences of Montpellier, University Montpellier, National Institute for Health and Medical Research, Montpellier, France
- Institut du Cerveau Trocadéro, Paris, France
| | - Kaarin J. Anstey
- University of New South Wales, School of Psychology, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Nicolas Cherbuin
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Shifu Xiao
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer’s Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Ling Yue
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer’s Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Li
- Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Alzheimer’s Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China
| | - Maëlenn M. Guerchet
- National Institute for Health and Medical Research U1094, Institut de Recherche pour le Developpement UMR270, Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, University Limoges, Centre Hospitalier et Universitaire Limoges, Limoges, France
| | - Pierre-Marie Preux
- National Institute for Health and Medical Research U1094, Institut de Recherche pour le Developpement UMR270, Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, University Limoges, Centre Hospitalier et Universitaire Limoges, Limoges, France
| | - Victor Aboyans
- National Institute for Health and Medical Research U1094, Institut de Recherche pour le Developpement UMR270, Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, University Limoges, Centre Hospitalier et Universitaire Limoges, Limoges, France
- Department of Cardiology, Dupuytren 2 University Hospital, Limoges, France
| | - Mary N. Haan
- School of Medicine, University of California, San Francisco
| | - Allison E. Aiello
- Robert N. Butler Columbia Aging Center, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Tze Pin Ng
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Geriatric Education and Research Institute, Ministry of Health, Singapore, Singapore
| | - Ma Shwe Zin Nyunt
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Qi Gao
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marcia Scazufca
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Perminder S. S. Sachdev
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Aging, Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia
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Tsioufis PA, Iliakis P, Konstantinidis D, Dimitriadis K, Tsioufis K. 7-day Aktiia bracelet vs 24 h ABPM study: more questions than answers? Hypertens Res 2023; 46:2251-2253. [PMID: 37443260 DOI: 10.1038/s41440-023-01344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 07/15/2023]
Affiliation(s)
| | - Panagiotis Iliakis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Kyriakos Dimitriadis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
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58
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Vu CC, Kim J, Nguyen TH. Health Monitoring System from Pyralux Copper-Clad Laminate Film and Random Forest Algorithm. MICROMACHINES 2023; 14:1726. [PMID: 37763889 PMCID: PMC10537244 DOI: 10.3390/mi14091726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023]
Abstract
Sensor technologies have been core features for various wearable electronic products for decades. Their functions are expected to continue to play an essential role in future generations of wearable products. For example, trends in industrial, military, and security applications include smartwatches used for monitoring medical indicators, hearing devices with integrated sensor options, and electronic skins. However, many studies have focused on a specific area of the system, such as manufacturing processes, data analysis, or actual testing. This has led to challenges regarding the reliability, accuracy, or connectivity of components in the same wearable system. There is an urgent need for studies that consider the whole system to maximize the efficiency of soft sensors. This study proposes a method to fabricate a resistive pressure sensor with high sensitivity, resilience, and good strain tolerance for recognizing human motion or body signals. Herein, the sensor electrodes are shaped on a thin Pyralux film. A layer of microfiber polyesters, coated with carbon nanotubes, is used as the bearing and pressure sensing layer. Our sensor shows superior capabilities in respiratory monitoring. More specifically, the sensor can work in high-humidity environments, even when immersed in water-this is always a big challenge for conventional sensors. In addition, the embedded random forest model, built for the application to recognize restoration signals with high accuracy (up to 92%), helps to provide a better overview when placing flexible sensors in a practical system.
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Affiliation(s)
- Chi Cuong Vu
- Faculty of Electrical and Electronics Engineering, Ho Chi Minh City University of Technology and Education, 01 Vo Van Ngan Street, Linh Chieu Ward, Ho Chi Minh City 700000, Vietnam;
| | - Jooyong Kim
- Department of Materials Science and Engineering, Soongsil University, Seoul 156-743, Republic of Korea;
| | - Thanh-Hai Nguyen
- Faculty of Electrical and Electronics Engineering, Ho Chi Minh City University of Technology and Education, 01 Vo Van Ngan Street, Linh Chieu Ward, Ho Chi Minh City 700000, Vietnam;
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Ko YE, Jhee JH. Short-term blood pressure variability as a potential therapeutic target for kidney disease. Clin Hypertens 2023; 29:23. [PMID: 37580839 PMCID: PMC10426225 DOI: 10.1186/s40885-023-00248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/11/2023] [Indexed: 08/16/2023] Open
Abstract
Short-term blood pressure variability (BPV) measured with ambulatory blood pressure (BP) monitoring has been demonstrated to be significant in predicting various clinical outcomes. Short-term BPV is distinguished from long-term BPV based on the time interval in which BP fluctuations are measured. Increased short-term BPV has been linked to detrimental effects on the microvascular structure and contributes to subclinical organ damage in the heart, blood vessels, and kidneys, regardless of the average 24-h BP levels. Short-term BPV can be defined by various measures, including calculated metrics (standard deviation, coefficient of variation, average real variability, weighted standard deviation, variability independent of the mean) or dipping patterns. Nevertheless, the additional role of short-term BPV beyond the predictive value of average 24-h BPs or established risk factors for cardiovascular disease and kidney disease remains unclear. In particular, longitudinal studies that evaluate the association between short-term BPV and kidney function impairment are limited and no conclusive data exist regarding which short-term BPV indicators most accurately reflect the prognosis of kidney disease. The issue of how to treat BPV in clinical practice is another concern that is frequently raised. This paper presents a review of the evidence for the prognostic role of short-term BPV in kidney outcomes. Additionally, this review discusses the remaining concerns about short-term BPV that need to be further investigated as an independent risk modifier.
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Affiliation(s)
- Ye Eun Ko
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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60
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Sigawi T, Ilan Y. Using Constrained-Disorder Principle-Based Systems to Improve the Performance of Digital Twins in Biological Systems. Biomimetics (Basel) 2023; 8:359. [PMID: 37622964 PMCID: PMC10452845 DOI: 10.3390/biomimetics8040359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Digital twins are computer programs that use real-world data to create simulations that predict the performance of processes, products, and systems. Digital twins may integrate artificial intelligence to improve their outputs. Models for dealing with uncertainties and noise are used to improve the accuracy of digital twins. Most currently used systems aim to reduce noise to improve their outputs. Nevertheless, biological systems are characterized by inherent variability, which is necessary for their proper function. The constrained-disorder principle defines living systems as having a disorder as part of their existence and proper operation while kept within dynamic boundaries. In the present paper, we review the role of noise in complex systems and its use in bioengineering. We describe the use of digital twins for medical applications and current methods for dealing with noise and uncertainties in modeling. The paper presents methods to improve the accuracy and effectiveness of digital twin systems by continuously implementing variability signatures while simultaneously reducing unwanted noise in their inputs and outputs. Accounting for the noisy internal and external environments of complex biological systems is necessary for the future design of improved, more accurate digital twins.
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Affiliation(s)
| | - Yaron Ilan
- Department of Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem P.O. Box 12000, Israel;
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Al Haddad N, Costanian C, Zibara V, Bilen Y, Kilani H, Tohme F, Bahous SA. The association between sleep disturbances and blood pressure variability: a review of the literature. J Clin Sleep Med 2023; 19:1533-1544. [PMID: 37078190 PMCID: PMC10394351 DOI: 10.5664/jcsm.10566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/21/2023]
Abstract
STUDY OBJECTIVES Sleep disturbances are an underrecognized public health issue that results in various adverse outcomes and disturbed quality of life. Blood pressure variability (BPV) is an emerging entity in assessing cardiovascular disease risk and accumulating evidence suggests that BPV is closely associated with end-organ damage. This review aims to explore the association between sleep disturbances and BPV. METHODS A comprehensive systematic literature search was conducted electronically using Web of Science, Ovid MEDLINE, , and SCOPUS. The electronic search was restricted to relevant English-language studies published between 1985 and August 2020. Most studies were prospective cohorts in design. After applying eligibility criteria, 29 articles were included for synthesis. RESULTS This review shows that sleep disturbances are linked to short-term, midterm, and long-term BPV. Restless legs syndrome, shift work, insomnia, short sleep, long sleep, obstructive sleep apnea, and sleep deprivation were all positively associated with systolic blood pressure or diastolic blood pressure fluctuations. CONCLUSIONS Given the prognostic implications of BPV and sleep disturbances on cardiovascular mortality, recognizing and treating both disorders is essential. More research is needed to examine the impact of sleep disorder treatment on BPV and cardiovascular mortality. CITATION Al Haddad N, Costanian C, Zibara V, et al. The association between sleep disturbances and blood pressure variability: a review of the literature. J Clin Sleep Med. 2023;19(8):1533-1544.
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Affiliation(s)
- Nadia Al Haddad
- Lebanese American University School of Medicine, Byblos, Lebanon
| | | | - Victor Zibara
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
| | - Yara Bilen
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
| | - Hala Kilani
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
| | - Fadi Tohme
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
| | - Sola Aoun Bahous
- Lebanese American University School of Medicine, Byblos, Lebanon
- Department of Internal Medicine, Lebanese American University Medical Center—Rizk Hospital, Beirut, Lebanon
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Gu S, Wang S, Wang Y, Zhang J, Cai H, Zou R, Wang C. Changes in Blood Pressure Variability in Children with Postural Tachycardia Syndrome. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1244. [PMID: 37508741 PMCID: PMC10378093 DOI: 10.3390/children10071244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
(1) Objective: In this research, we explored the difference in blood pressure variability (BPV) between children with postural tachycardia syndrome (POTS) and healthy children. Furthermore, we tried to investigate the effect of BPV on POTS and its relationship with prognosis of POTS. (2) Methods: 47 children with POTS (11.2 ± 1.8 years, 23 males) were enrolled in the POTS group and 30 healthy children (10.9 ± 1.9 years, 15 males) were matched for the control group. All participants completed 24 h ambulatory blood pressure monitoring (24hABPM). Thirty-three children with POTS were followed up for 52.0 (30.5, 90.5) days and were divided into a response group and a non-response group after evaluation. (3) Results: The 24 h diastolic blood pressure standard deviation (24hDSD), daytime diastolic blood pressure standard deviation (DDSD), nighttime systolic blood pressure standard deviation (NSSD), daytime diastolic blood pressure variation coefficient (DDCV) and nighttime systolic blood pressure variation coefficient (NSCV) in the control group were lower than those in the POTS group (p < 0.05). Percentage of females, age and height were lower in the response group than in the non-response group in children with POTS (p < 0.05). Univariate analysis showed that 24hDSD, DDSD, NSSD, DDCV and NSCV were potential risk factors for POTS, and sex and height were potential risk factors for poor prognosis of POTS. After adjusting for covariates, the risk of POTS increased by 48%, 53% and 49% when DDSD, NSSD and NSCV increased by 1 mmHg, 1 mmHg and 1%, respectively. The risk of poor prognosis in females was 12.99 times higher than that in males. (4) Conclusions: The results suggest that children with POTS may have an abnormal circadian rhythm in blood pressure and increased BPV. DDSD, NSSD and NSCV are independent risk factors for POTS, and being female is an independent risk factor for poor prognosis of POTS.
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Affiliation(s)
- Shuangshuang Gu
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Shuo Wang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuwen Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Juan Zhang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Hong Cai
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Runmei Zou
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Cheng Wang
- Department of Pediatric Cardiovasology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha 410011, China
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Xu C, Fu Z, Wu W, Zhang J, Liu M, Gao L. Association between High-Sensitivity C-Reactive Protein and Blood Pressure Variability in Subacute Stage of Ischemic Stroke. Brain Sci 2023; 13:998. [PMID: 37508930 PMCID: PMC10377720 DOI: 10.3390/brainsci13070998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
The determinants of blood pressure variability (BPV) are complex. We aimed to evaluate whether circulating high-sensitivity C-reactive protein (hsCRP) is associated with short-term BPV during the subacute stage of ischemic stroke. In this observational study, a consecutive series of acute ischemic stroke patients who underwent 24 h ambulator blood pressure monitoring (ABPM) during day 4 to 10 after onset were enrolled. Multivariable linear regression models were constructed to assess relationships between hsCRP and BPV. Among a total of 325 patients analyzed, the mean age was 60 years old and 72% were male. The SD, CV, ARV of 24 h SBP and DBP were more likely to be higher in patients with hsCRP ≥ 2 mg/L, and these predispositions remained unchanged in linear regression analyses after adjusting for possible confounding factors, with a dose-response relationship when patients were additionally categorized into quartiles according to hsCRP levels using the lowest quartile as a reference category. In contrast, similar results were observed for the mean of SBP but not the mean of DBP. These results indicate that hsCRP is dose-dependently associated with short-term BPV during the subacute stage of ischemic stroke. These findings suggested that patients with a higher level of hsCRP tended to have larger blood pressure fluctuations.
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Affiliation(s)
- Chuanli Xu
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Zhiyong Fu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Wei Wu
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang 110122, China
| | - Jin Zhang
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Meitong Liu
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Lianbo Gao
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
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Tan I, Gnanenthiran SR, Chan J, Kyriakoulis KG, Schlaich MP, Rodgers A, Stergiou GS, Schutte AE. Evaluation of the ability of a commercially available cuffless wearable device to track blood pressure changes. J Hypertens 2023; 41:1003-1010. [PMID: 37016925 PMCID: PMC10158604 DOI: 10.1097/hjh.0000000000003428] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/13/2023] [Accepted: 03/01/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES Cuffless wearable blood pressure (BP) devices may allow detailed evaluation of BP for prolonged periods, but their ability to accurately track BP changes is uncertain. We investigated whether a commercially available cuffless wearable device tracks: 24-h systolic (SBP) and diastolic BP (DBP) compared to conventional ambulatory monitoring (ABPM); and antihypertensive medication-induced BP changes compared to cuff-based home BP monitoring (HBPM). METHODS We fitted 41 participants (32% females, 58 ± 14 years, 80% hypertensive) with a wrist-wearable cuffless BP device (Aktiia) continuously for 6-12 days. At the beginning and the end of this period, 24-h ABPM was performed. Three participants with hypertension (one female; 60 ± 8 years) wore the Aktiia device and performed HBPM continuously one week before and 2 weeks after antihypertensive medication uptitration. RESULTS Compared to ABPM, Aktiia reported higher average SBP for 24-h (difference 4.9 mmHg, 95% CI [1.9, 7.9]) and night-time (15.5[11.8, 19.1] mmHg; all P ≤ 0.01), but similar daytime (1.0 [-1.8, 3.8] mmHg; P = 0.48). Similarly, average cuffless DBP was higher for 24-h (4.2 [2.3, 6.0] mmHg) and night-time (11.8 [9.5, 14.1] mmHg; both P < 0.001), but similar during daytime (1.4 [-0.4, 3.23] mmHg; P = 0.13). Aktiia also reported reduced night-time dip for SBP (difference 14.2 [12.1, 16.3] mmHg) and DBP (10.2 [8.5, 11.9] mmHg; both P < 0.001). The average medication-induced SBP/DBP decline after 2 weeks of uptitration was -1.0/-0.8 mmHg with Aktiia vs. -19.7/-11.5 mmHg with HBPM ( P = 0.03 for difference). CONCLUSION This cuffless wearable device did not accurately track night-time BP decline and results suggested it was unable to track medication-induced BP changes.
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Affiliation(s)
- Isabella Tan
- The George Institute for Global Health
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University
| | - Sonali R. Gnanenthiran
- The George Institute for Global Health
- Concord Repatriation General Hospital, Concord West, Sydney
| | - Justine Chan
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, and Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
| | - Konstantinos G. Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Markus P. Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, and Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
| | | | - George S. Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Aletta E. Schutte
- The George Institute for Global Health
- School of Population Health, University of New South Wales, Sydney, Australia
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Kario K, Hoshide S, Mogi M. Topics 2023 in Hypertension Research leading to guidelines in Asia. Hypertens Res 2023; 46:1357-1362. [PMID: 37271784 DOI: 10.1038/s41440-023-01285-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Masaki Mogi
- Department of Pharmacology, Ehime University Graduate School of Medicine, Ehime, Japan
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Jamal NE, Brooks TG, Cohen J, Townsend RR, de Sosa GR, Shah V, Nelson RG, Drawz PE, Rao P, Bhat Z, Chang A, Yang W, FitzGerald GA, Skarke C. Prognostic utility of rhythmic components in 24-hour ambulatory blood pressure monitoring for the risk stratification of chronic kidney disease patients with cardiovascular co-morbidity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.02.23289413. [PMID: 37205602 PMCID: PMC10187452 DOI: 10.1101/2023.05.02.23289413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Chronic kidney disease (CKD) represents a significant global burden. Hypertension is a modifiable risk factor for rapid progression of CKD. Methods We extend the risk stratification by introducing the non-parametric determination of rhythmic components in 24-hour profiles of ambulatory blood pressure monitoring (ABPM) in the African American Study for Kidney Disease and Hypertension (AASK) cohort and the Chronic Renal Insufficiency Cohort (CRIC) using Cox proportional hazards models. Results We find that rhythmic profiling of BP through JTK_Cycle analysis identifies subgroups of CRIC participants at advanced risk of cardiovascular death. CRIC participants with a history of cardiovascular disease (CVD) and absent cyclic components in their BP profile had at any time a 3.4-times higher risk of cardiovascular death than CVD patients with cyclic components present in their BP profile (HR: 3.38, 95% CI: 1.45-7.88, p=0.005). This substantially increased risk was independent of whether ABPM followed a dipping or non-dipping pattern whereby non-dipping or reverse dipping were not significantly associated with cardiovascular death in patients with prior CVD (p>0.1). In the AASK cohort, unadjusted models demonstrate a higher risk in reaching end stage renal disease among participants without rhythmic ABPM components (HR:1.80, 95% CI: 1.10-2.96); however, full adjustment abolished this association. Conclusions This study proposes rhythmic blood pressure components as a novel biomarker to unmask excess risk among CKD patients with prior cardiovascular disease.
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Affiliation(s)
- Nadim E1 Jamal
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas G. Brooks
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jordana Cohen
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Raymond R. Townsend
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Vallabh Shah
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA
- Department of Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Robert G. Nelson
- The Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Paul E. Drawz
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN, USA
| | - Panduranga Rao
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Zeenat Bhat
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Alexander Chang
- Kidney Health Research Institute, Department of Population Health Sciences, Geisinger, Danville, PA, USA
| | - Wei Yang
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Garret A. FitzGerald
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carsten Skarke
- Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Zhao W, Liu L, Chen L. Comparison of antihypertensive drugs amlodipine and perindopril on blood pressure variability after long-term treatment of hypertension induced by apatinib and bevacizumab. CHINESE J PHYSIOL 2023; 66:137-143. [PMID: 37322624 DOI: 10.4103/cjop.cjop-d-22-00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
The purpose of this study was to elucidate the therapeutic effect of different antihypertensive drugs (amlodipine and perindopril) on hypertension induced by apatinib and bevacizumab. Sixty patients with hypertension treated with apatinib or bevacizumab were selected and divided into two groups: one group was treated with amlodipine and the other group was treated with perindopril. Before and after treatment, the dynamic blood pressure (BP) measurement (systolic BP [SBP] and diastolic BP [DBP]), echocardiography (left ventricular end-diastolic diameter, interventricular septal thickness [IVST], left ventricular posterior wall thickness [LVPWT], and left atrial diameter [LAD]), and detection of nitric oxide (NO) content in venous blood were performed. In the amlodipine group, the 24hSBP, 24hSSD, 24hSCV, daytime mean SBP (dSBP), daytime mean SSD (dSSD), daytime mean SBP CV, night mean SBP (nSBP), night mean SSD, 24hDBP, 24hDSD, 24 h DBP CV, daytime mean DBP (dDBP), daytime mean DSD (dDSD), daytime mean DBP CV, night mean DBP (nDBP), LAD, and LAD index (LADi) after treatment were all lower than before treatment, while NO was higher than before treatment (all P < 0.05). In the perindopril group, the 24hSBP, dSBP, nSBP, 24hDBP, dDBP, nDBP, LAD, LADi, IVST, LVPWT, and left ventricular mass index (LVMI) after treatment were lower than before treatment, and NO level after treatment was higher than before treatment (all P < 0.05). After treatment, the 24hSBP, 24hSSD, dSBP, dSSD, nSBP, 24hDBP, 24hDSD, dDBP, dDSD, nDBP, night mean DSD, and NO were all lower while the LAD, LADi, IVST, LVPWT, and LVMI were higher in the amlodipine group than those in the perindopril group (all P < 0.05). Our study suggests that the SBP and DBP variability of amlodipine in the treatment of hypertension induced by apatinib and bevacizumab is slightly better than that of perindopril, but the effect of perindopril in improving endothelial function indices NO and echocardiographic data is better than that of amlodipine.
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Affiliation(s)
- Weichao Zhao
- Department of Cardiovascular Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lanbo Liu
- Department of Cardiovascular Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liqiang Chen
- Department of Cardiovascular Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Rickard S, Ashton C, Shimwell C, Walker T, Worswick L, Lewis P. Community stroke team use of home blood pressure monitoring improves blood pressure control after stroke: a quality improvement report. BMJ Open Qual 2023; 12:bmjoq-2022-002067. [PMID: 37257914 DOI: 10.1136/bmjoq-2022-002067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 05/08/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Sarah Rickard
- Greater Manchester Neurorehabilitation & Integrated Stroke Delivery Network, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Christopher Ashton
- Greater Manchester Neurorehabilitation & Integrated Stroke Delivery Network, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Carolyn Shimwell
- HMR Community Stroke Team, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Tracy Walker
- North Manchester Community Services, Manchester University NHS Foundation Trust, Manchester, UK
| | - Louise Worswick
- Salford Community Stroke Team, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Philip Lewis
- Cardiology Consultant, Stockport NHS Foundation Trust, Stockport, UK
- Hypertension Associate, Greater Manchester and Eastern Cheshire Strategic Clinical Networks, Manchester, UK
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69
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Avolio A. The reality and serendipity of cuffless blood pressure monitoring. Hypertens Res 2023:10.1038/s41440-023-01269-z. [PMID: 37016027 DOI: 10.1038/s41440-023-01269-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/12/2023] [Indexed: 04/06/2023]
Affiliation(s)
- Alberto Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
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70
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Nour M, Polat K, Şentürk Ü, Arıcan M. A Novel Cuffless Blood Pressure Prediction: Uncovering New Features and New Hybrid ML Models. Diagnostics (Basel) 2023; 13:diagnostics13071278. [PMID: 37046499 PMCID: PMC10093721 DOI: 10.3390/diagnostics13071278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
This paper investigates new feature extraction and regression methods for predicting cuffless blood pressure from PPG signals. Cuffless blood pressure is a technology that measures blood pressure without needing a cuff. This technology can be used in various medical applications, including home health monitoring, clinical uses, and portable devices. The new feature extraction method involves extracting meaningful features (time and chaotic features) from the PPG signals in the prediction of systolic blood pressure (SBP) and diastolic blood pressure (DBP) values. These extracted features are then used as inputs to regression models, which are used to predict cuffless blood pressure. The regression model performances were evaluated using root mean squared error (RMSE), R2, mean square error (MSE), and the mean absolute error (MAE). The obtained RMSE was 4.277 for systolic blood pressure (SBP) values using the Matérn 5/2 Gaussian process regression model. The obtained RMSE was 2.303 for diastolic blood pressure (DBP) values using the rational quadratic Gaussian process regression model. The results of this study have shown that the proposed feature extraction and regression models can predict cuffless blood pressure with reasonable accuracy. This study provides a novel approach for predicting cuffless blood pressure and can be used to develop more accurate models in the future.
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Affiliation(s)
- Majid Nour
- Department of Electrical and Computer Engineering, Faculty of Engineering, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Kemal Polat
- Department of Electrical and Electronics Engineering, Faculty of Engineering, Bolu Abant Izzet Baysal University, 14280 Bolu, Turkey
- Correspondence:
| | - Ümit Şentürk
- Department of Computer Engineering, Faculty of Engineering, Bolu Abant Izzet Baysal University, 14280 Bolu, Turkey
| | - Murat Arıcan
- Department of Electrical and Electronics Engineering, Faculty of Engineering, Bolu Abant Izzet Baysal University, 14280 Bolu, Turkey
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71
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Barbato E, Azizi M, Schmieder RE, Lauder L, Böhm M, Brouwers S, Bruno RM, Dudek D, Kahan T, Kandzari DE, Lüscher TF, Parati G, Pathak A, Ribichini FL, Schlaich MP, Sharp ASP, Sudano I, Volpe M, Tsioufis C, Wijns W, Mahfoud F. Renal denervation in the management of hypertension in adults. A clinical consensus statement of the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EUROINTERVENTION 2023; 18:1227-1243. [PMID: 36789560 PMCID: PMC10020821 DOI: 10.4244/eij-d-22-00723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/19/2022] [Indexed: 02/16/2023]
Abstract
Since the publication of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) Guidelines for the Management of Arterial Hypertension, several high-quality studies, including randomised, sham-controlled trials on catheter-based renal denervation (RDN) were published, confirming both the blood pressure (BP)-lowering efficacy and safety of radiofrequency and ultrasound RDN in a broad range of patients with hypertension, including resistant hypertension. A clinical consensus document by the ESC Council on Hypertension and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on RDN in the management of hypertension was considered necessary to inform clinical practice. This expert group proposes that RDN is an adjunct treatment option in uncontrolled resistant hypertension, confirmed by ambulatory BP measurements, despite best efforts at lifestyle and pharmacological interventions. RDN may also be used in patients who are unable to tolerate antihypertensive medications in the long term. A shared decision-making process is a key feature and preferably includes a patient who is well informed on the benefits and limitations of the procedure. The decision-making process should take (i) the patient's global cardiovascular (CV) risk and/or (ii) the presence of hypertension-mediated organ damage or CV complications into account. Multidisciplinary hypertension teams involving hypertension experts and interventionalists evaluate the indication and facilitate the RDN procedure. Interventionalists require expertise in renal interventions and specific training in RDN procedures. Centres performing these procedures require the skills and resources to deal with potential complications. Future research is needed to address open questions and investigate the impact of BP-lowering with RDN on clinical outcomes and potential clinical indications beyond hypertension.
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Affiliation(s)
- Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michel Azizi
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France
- Hypertension Department, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France and FCRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany and Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Hospital Aalst, Aalst, Belgium and Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rosa Maria Bruno
- Paris Centre de Recherche Cardiovasculaire, INSERM, Université Paris Cité, Paris, France
- Pharmacology Unit, AP-HP, Hôpital Européen Georges-Pompidou, Paris, France
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland and GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Thomas Kahan
- Department of Clinical Sciences, Karolinska Institute, Solna, Sweden and Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden and Department of Cardiology, Danderyd University Hospital Corporation, Stockholm, Sweden
| | | | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals, London, UK, and National Heart and Lung Institute, Imperial College, London, UK, and School of Cardiovascular Medicine and Sciences, Kings College London, London, UK, and Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy and Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Atul Pathak
- Department of Cardiovascular Medicine, Centre Hospitalier Princesse Grace, Monte Carlo, Monaco
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, Perth, WA, Australia, and Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia and Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia
| | - Andrew S P Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Isabella Sudano
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Massimo Volpe
- Department of Cardiology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Costas Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece and Hippocratio Hospital, Athens, Greece
| | - William Wijns
- The Lambe Institute for Translational Medicine, Galway, Ireland and University of Galway, Galway, Ireland
- The Smart Sensors Lab, London, UK and CURAM, London, UK
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
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Vakali E, Rigopoulos D, Dinas PC, Drosatos IA, Theodosiadi AG, Vazeou A, Stergiou G, Kollias A. Relationship between Short- and Mid-Term Glucose Variability and Blood Pressure Profile Parameters: A Scoping Review. J Clin Med 2023; 12:jcm12062362. [PMID: 36983362 PMCID: PMC10053380 DOI: 10.3390/jcm12062362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Background. Increased variability of glucose (GV) and blood pressure (BPV) is linked to a higher risk of macro- and microvascular complications and other hard endpoints. This scoping review aims to summarize the existing evidence regarding the association between the parameters of the blood pressure (BP) profile, especially BPV, with indices of short- and mid-term GV. Methods. A literature search was conducted in the MEDLINE/PubMed, Cochrane, Embase, Web of Science, and Wiley Online Library databases. Results. The main findings of this review are as follows: (i) 13 studies were included, mainly with small sample sizes; (ii) there was a considerable degree of heterogeneity in the characteristics of the study participants (age range, individuals with normoglycemia, type 1 or 2 diabetes, normal BP, or hypertension), as well as in the methodologies (mainly in terms of the duration of the data collection period) and variability indices examined (mean amplitude of glycemic excursions and coefficient of glucose variation most frequently reported); and (iii) the results were heterogeneous regarding the association between GV and the parameters of the BP profile. Conclusions. There is a significant lack of evidence on the association between GV and BPV. Future research implementing a standardized methodology should focus on the determinants, association, and clinical relevance of GV and BPV.
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Affiliation(s)
- Elena Vakali
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
- Endocrinology-Growth and Development Department, P&A Kyriakou Children's Hospital, 11527 Athens, Greece
| | | | - Petros C Dinas
- FAME Laboratory, Department of Physical Education and Sports Science, University of Thessaly, 42100 Trikala, Greece
| | | | - Aikaterini G Theodosiadi
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Andriani Vazeou
- Diabetes Center, A' Department of Pediatrics, P&A Kyriakou Children's Hospital, 11527 Athens, Greece
| | - George Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, 11527 Athens, Greece
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73
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Implementing Carotid Ultrasonography in Optimizing Primary Cardiovascular Prevention Strategy: Has the Time Come? J Clin Med 2023; 12:jcm12062193. [PMID: 36983195 PMCID: PMC10053698 DOI: 10.3390/jcm12062193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
The cardiovascular (CV) disease continuum begins from a cluster of CV risk factors, proceeds with the development of asymptomatic atherosclerotic lesions and ends with the occurrence of CV events [...]
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74
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Short- to long-term blood pressure variability: Current evidence and new evaluations. Hypertens Res 2023; 46:950-958. [PMID: 36759660 DOI: 10.1038/s41440-023-01199-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 02/11/2023]
Abstract
Increased blood pressure (BP) variability and the BP surge have been reported to be associated with increased cardiovascular risk independently of BP levels and can also be a trigger of cardiovascular events. There are multiple types of BP variation: beat-to-beat variations related to breathing and the autonomic nervous system, diurnal BP variation and nocturnal dipping related to sleep and physical activity over a 24-hr period, day-to-day BP variability with anomalous readings within a several-day period, visit-to-visit BP variability between outpatient visits, and seasonal variations. BP variability is also associated with the progression to hypertension from prehypertension and the progression of chronic kidney disease and cognitive impairments. Our research group proposed the "resonance hypothesis of blood pressure surge" as a new etiological hypothesis of BP variability and surges; i.e., the concept that when the time phases of surges and hypertension-inducing environmental influences coincide, resonance occurs and is amplified into a larger "dynamic surge" that triggers the onset of cardiovascular disease. New devices to assess BP variability as well as new therapeutic interventions to reduce BP variability are being developed. Although there are still issues to be addressed (including measurement accuracy), cuffless devices and information and communication technology (ICT)-based BP monitoring devices have been developed and validated. These new devices will be useful for the individualized optimal management of BP. However, evidence regarding the usefulness of therapeutic interventions to control BP variability is still lacking.
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75
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Brignole M, Rivasi G, Fedorowski A, Ståhlberg M, Groppelli A, Ungar A. Tests for the identification of reflex syncope mechanism. Expert Rev Med Devices 2023; 20:109-119. [PMID: 36814102 DOI: 10.1080/17434440.2023.2174428] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Treatment efficacy of reflex syncope is mainly related to the mechanism underlying syncope rather than its etiology or clinical presentation. The predominant mechanism underlying reflex syncope can be assigned to hypotensive or to bradycardic phenotypes. AREAS COVERED Methodology and diagnostic criteria of the most useful tests for the identification of hypotensive and bradycardic phenotypes are discussed. Diagnostic tests for the hypotensive phenotype include office blood pressure measurement with active standing test, home, and wearable blood pressure monitoring, 24-h ambulatory blood pressure monitoring and tilt table test. Diagnostic tests for the bradycardic phenotype include carotid sinus massage, tilt table test and prolonged ECG monitoring. EXPERT OPINION In reflex syncope, the documentation of bradycardia/asystole during a syncopal episode does not rule out the possibility that a preceding or parallel hypotensive reflex plays an important role. Similarly, even when a hypotensive mechanism is established, the possibility of an associated cardioinhibitory reflex should be investigated. Investigating the mechanism of reflex syncope is mandatory in patients with severe recurrent episodes, with the final aim to develop a personalized treatment strategy. Recent trials have demonstrated the benefits of personalized mechanism-based therapy, thus highlighting the importance of a comprehensive assessment of the mechanisms underlying syncope.
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Affiliation(s)
- Michele Brignole
- Department of Cardiology, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, Sweden
| | - Marcus Ståhlberg
- Department of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, Sweden
| | - Antonella Groppelli
- Department of Cardiology, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Dai J, Wu HY, Jiang XD, Tang YJ, Tang HK, Meng L, Huang N, Gao JY, Li J, Baker JS, Zheng CJ, Yang YD. Association between napping and 24-hour blood pressure variability among university students: A pilot study. Front Pediatr 2023; 11:1062300. [PMID: 36937964 PMCID: PMC10018217 DOI: 10.3389/fped.2023.1062300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
Background Blood pressure variability (BPV) has been reported to be a predictor of cardiovascular and some cognitive diseases. However, the association between napping and BPV remains unknown. This study aimed to explore the association between napping and BPV. Materials and methods A cross-sectional study including 105 university students was conducted. Participants' 24 h ambulatory blood pressure monitoring (24 h ABPM) were measured, and napping behaviors were investigated. BPV were measured by the 24 h ABPM, included standard deviation (SD), coefficient of variation (CV), and average real variability (ARV). Results Among the participants, 61.9% reported daytime napping. We found that nap duration was significantly associated with daytime CV of diastolic blood pressure (DBP) (r = 0.250, P = 0.010), nighttime CV of systolic blood pressure (SBP) (r = 0.217, P = 0.026), 24 h WCV of DBP (r = 0.238, P = 0.014), 24 h ARV of SBP (r = 0.246, P = 0.011) and 24 h ARV of DBP (r = 0.291, P = 0.003). Compared with the no napping group, 24 h WCV of DBP, daytime CV of DBP, and daytime SD of DBP were significantly higher in participants with napping duration >60 min. With multiple regression analysis we found that nap duration was an independent predictor for 24 h ARV of SBP (β = 0.859, 95% CI, 0.101-1.616, P = 0.027) and 24 h ARV of DBP (β = 0.674, 95% CI, 0.173-1.175, P = 0.009). Conclusions Napping durations are associated with BPV among university students. Especially those with napping durations >60 min had a significantly higher BPV than those non-nappers.
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Affiliation(s)
- Jie Dai
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Hua-ying Wu
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Xiao-dong Jiang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Yong-jie Tang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Hao-Kai Tang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Li Meng
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Na Huang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Jing-yu Gao
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Jian Li
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Julien S. Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Chan-Juan Zheng
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
- Correspondence: Yi-De Yang Chan-Juan Zheng
| | - Yi-De Yang
- Department of Child and Adolescent Health, School of Medicine, Hunan Normal University, Changsha, China
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
- Correspondence: Yi-De Yang Chan-Juan Zheng
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77
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Auer J, Weber T. Blood pressure measurement for prediction of chronic pressure overload and cardiovascular events. Eur J Clin Invest 2023; 53:e13902. [PMID: 36349443 DOI: 10.1111/eci.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Johann Auer
- Department of Cardiology and Intensive Care, St Josef Hospital, Braunau, Austria.,Department of Cardiology and Intensive Care, Kepler University Hospital Linz, Linz, Austria.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas Weber
- Department of Cardiology and Intensive Care, Klinikum Wels-Grieskirchen, Wels, Austria
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Kumar R, Zafer A, Dubey PK, Kumar A, Singh M, Sharma ND, Jaiswal SK, Prakash O, Kumar H, Gupta VK, Aggarwal A, Yadav S. Design and development of mechanical test bench for testing and calibration of multiple blood pressure measuring devices. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:014102. [PMID: 36725551 DOI: 10.1063/5.0100958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/04/2022] [Indexed: 06/18/2023]
Abstract
Blood pressure (BP) measurement is an important physiological parameter for human health monitoring, which plays a significant role in the diagnosis of many incurable diseases. However, due to inaccuracies in the different types of BP measuring devices, the calibration of these BP measuring instruments is a major concern for a medical practitioner. Currently, these devices' calibration, testing, and validation are performed using rigorous methods with complex clinical trials and following the available documentary standards. This article describes the design and development of an indigenous mechanical test bench (MTB) system for the testing and calibration of multiple BP devices, as per International Organization of Legal Metrology (OIML) recommended documents e.g., OIML R 16-1 and OIML R 16-2. The developed system can test and calibrate 20 BP devices, simultaneously. The traceability of the developed MTB is established by performing its calibration against the Air Piston Gauge, a national primary vacuum standard. The estimated expanded measurement uncertainty evaluated is found to be ±0.11 mmHg, which is almost one order better than the measurement uncertainty required for the test and calibration of BP measuring instruments as per standard. The MTB has successfully been used to test and calibrate several BP measuring instruments. The data of one such device is reported herein as an indicator of the performance process. The calibration of these BP measuring instruments was performed in the static mode, and the estimated expanded measurement uncertainty was found to be ±1.25 mmHg. The developed MTB system would prove to be an excellent instrument for calibration laboratories, hospitals, regulatory agencies, and other users to test and calibrate 20 BP measuring devices simultaneously and cost-effectively.
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Affiliation(s)
- Rahul Kumar
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | - Afaqul Zafer
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | - P K Dubey
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | - Ashok Kumar
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | - Megha Singh
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | - Nita Dilawar Sharma
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | - S K Jaiswal
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | - Om Prakash
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | - Harish Kumar
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | - V K Gupta
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
| | | | - Sanjay Yadav
- CSIR-National Physical Laboratory, Dr. K. S. Krishnan Marg, New Delhi 110012, India
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79
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Ilan Y. Department of Medicine 2040: Implementing a Constrained Disorder Principle-Based Second-Generation Artificial Intelligence System for Improved Patient Outcomes in the Department of Internal Medicine. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231221285. [PMID: 38142419 PMCID: PMC10749528 DOI: 10.1177/00469580231221285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/10/2023] [Accepted: 11/30/2023] [Indexed: 12/26/2023]
Abstract
Internal medicine departments must adapt their structures and methods of operation to accommodate changing healthcare systems. The present paper discusses some challenges departments of medicine face as healthcare providers and consumers continue to change. A co-pilot model is described in this article for augmenting physicians rather than replacing them. The paper presents the co-pilot models to improve diagnoses, treatments, and monitoring. Personalized variability patterns based on the constrained-disorder principle (CDP) are described to assess chronic therapies' effectiveness in improving patient outcomes. Based on CDP-based enhanced digital twins, this paper presents personalized treatments and follow-ups that improve diagnosis accuracy and therapy outcomes. While maintaining their professional values, departments of internal medicine must respond proactively to the needs of patients and healthcare systems. To meet the needs of patients and healthcare systems, they must strive for medical professionalism and adapt to the dynamic environment.
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Affiliation(s)
- Yaron Ilan
- Hebrew University and Hadassah Medical Center, Jerusalem, Israel
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80
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Ahlenius M, Koek W, Yamaguchi I. Ambulatory blood pressure monitoring in children: A retrospective single-center study. Front Pediatr 2023; 11:1088857. [PMID: 36776905 PMCID: PMC9911535 DOI: 10.3389/fped.2023.1088857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/06/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES (1) Compare 24-hour ambulatory blood pressure monitoring (ABPM) diagnoses in a pediatric population with the new 2022 guidelines to the original diagnoses with the 2014 guidelines. (2) Determine whether findings of hypertension from ABPM could be predicted from prior patient data. (3) Determine whether ABPM readings could predict left ventricular mass index (LVMI) in patients who obtained an echocardiogram (ECHO). STUDY DESIGN Single-center retrospective study on patients referred to Pediatric Nephrology Clinic for evaluation of elevated blood pressure who underwent ABPM from 2015 to 2018. Predictions of hypertension were obtained using a logistic regression model, and predictions of LVMI were performed using regression models including (a) the wake systolic and diastolic BP indices, or (b) additionally including the standard deviation (SD) of wake SBP and DBP. RESULTS With the change in 2022 to new ABPM guidelines from the AHA, comparing the old and new guidelines led to 70% of previous pre-hypertensive diagnoses now meeting criteria for diagnosis of hypertension, and a rise from 21% of the ABPMs meeting criteria for hypertension to 51% now meeting criteria. In a logistic regression model, prior patient data were not predictive of a diagnosis of hypertension from ABPM (Nagelkerke's R 2 = 0.04). Among the individual variables studied, none were statistically significant. For prediction of LVMI, the SD of wake SBP and DBP were significantly associated with increased LVMI, but the wake SBP and DBP indices were not. CONCLUSIONS In our patient population, the new ABPM guidelines led to a significant increase in diagnoses of hypertension. Prior patient data was not sufficient to predict a diagnosis of hypertension by ABPM, supporting the need for evaluation by ABPM as the gold standard. Our analysis of the relationship between ABPM readings and LVMI supports the hypothesis that BP variability contributes to increased LVMI. These data are consistent with growing evidence in the adult literature that BP variability detected by ABPM is associated with left-ventricular hypertrophy.
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Affiliation(s)
- Mark Ahlenius
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX, United States
| | - Wouter Koek
- Department of Cell Systems and Anatomy, The University of Texas Health Sciences Center at San Antonio, San Antonio, TX, United States
| | - Ikuyo Yamaguchi
- Division of Pediatric Nephrology, Department of Pediatrics, The University of Texas Health Sciences Center at San Antonio, San Antonio, TX, United States.,Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, The University of Oklahoma Health Sciences Center, and Oklahoma Children's Hospital, OU Health, Oklahoma, OK, United States
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81
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Baeg SI, Jeon J, Kang D, Na SJ, Cho J, Kim K, Yang JH, Chung CR, Lee JE, Huh W, Suh GY, Kim YG, Kim DJ, Jang HR. Impact of protocolized fluid management on electrolyte stability in patients undergoing continuous renal replacement therapy. Front Med (Lausanne) 2022; 9:915072. [PMID: 36117982 PMCID: PMC9471083 DOI: 10.3389/fmed.2022.915072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveContinuous renal replacement therapy (CRRT) is the standard treatment for critically ill patients with acute kidney injury (AKI). Electrolyte disturbance such as hypokalemia or hypophosphatemia occurs paradoxically in patients undergoing CRRT due to high clearance. We developed a fluid management protocol for dialysate and replacement fluid that depends on serum electrolytes and focuses on potassium and phosphate levels to prevent electrolyte disturbance during CRRT. The impact of our new fluid protocol on electrolyte stability was evaluated.MethodsAdult patients who received CRRT between 2013 and 2017 were included. Patients treated 2 years before (2013–2014; pre-protocol group) and 2 years following development of the fluid protocol (2016–2017; protocol group) were compared. The primary outcomes were individual coefficient of variation (CV) and abnormal event rates of serum phosphate and potassium. Secondary outcomes were frequency of electrolyte replacement and incidence of cardiac arrhythmias. Individual CV and abnormal event rates for each electrolyte were analyzed using the Wilcoxon rank-sum test and Chi-square test with Yates’ continuity correction.ResultsA total of 1,448 patients was included. Both serum phosphate and potassium were higher in the protocol group. The CVs of serum phosphate (pre-protocol vs. protocol, 0.275 [0.207–0.358] vs. 0.229 [0.169–0.304], p < 0.01) and potassium (0.104 [0.081–0.135] vs. 0.085 [0.064–0.110], p < 0.01) were significantly lower in the protocol group. The abnormal event rates of serum phosphate (rate [95% CI], 0.410 [0.400–0.415] vs. 0.280 [0.273–0.286], p < 0.01) and potassium (0.205 [0.199–0.211] vs. 0.083 [0.079–0.087], p < 0.01) were also significantly lower in the protocol group.ConclusionThe protocolized management of fluid in CRRT effectively prevented hypophosphatemia and hypokalemia by inducing excellent stability of serum phosphate and potassium levels.
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Affiliation(s)
- Song In Baeg
- Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Hanyang University Medical Center, Goyang, South Korea
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Junseok Jeon
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
- Center of Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
- Center of Clinical Epidemiology, Samsung Medical Center, Seoul, South Korea
| | - Kyunga Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, South Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung Eun Lee
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wooseong Huh
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoon-Goo Kim
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae Joong Kim
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hye Ryoun Jang
- Division of Nephrology, Department of Medicine, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Hye Ryoun Jang,
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82
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Kario K, Hoshide S, Mogi M. Digital Hypertension 2023: Concept, hypothesis, and new technology. Hypertens Res 2022; 45:1529-1530. [PMID: 35995860 PMCID: PMC9395854 DOI: 10.1038/s41440-022-00997-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Masaki Mogi
- Department of Pharmacology, Ehime University Graduate School of Medicine, Ehime, Japan
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Petmezas G, Stefanopoulos L, Kilintzis V, Tzavelis A, Rogers JA, Katsaggelos AK, Maglaveras N. State-of-the-art Deep Learning Methods on Electrocardiogram Data: A Systematic Review (Preprint). JMIR Med Inform 2022; 10:e38454. [PMID: 35969441 PMCID: PMC9425174 DOI: 10.2196/38454] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/03/2022] [Accepted: 07/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Electrocardiogram (ECG) is one of the most common noninvasive diagnostic tools that can provide useful information regarding a patient’s health status. Deep learning (DL) is an area of intense exploration that leads the way in most attempts to create powerful diagnostic models based on physiological signals. Objective This study aimed to provide a systematic review of DL methods applied to ECG data for various clinical applications. Methods The PubMed search engine was systematically searched by combining “deep learning” and keywords such as “ecg,” “ekg,” “electrocardiogram,” “electrocardiography,” and “electrocardiology.” Irrelevant articles were excluded from the study after screening titles and abstracts, and the remaining articles were further reviewed. The reasons for article exclusion were manuscripts written in any language other than English, absence of ECG data or DL methods involved in the study, and absence of a quantitative evaluation of the proposed approaches. Results We identified 230 relevant articles published between January 2020 and December 2021 and grouped them into 6 distinct medical applications, namely, blood pressure estimation, cardiovascular disease diagnosis, ECG analysis, biometric recognition, sleep analysis, and other clinical analyses. We provide a complete account of the state-of-the-art DL strategies per the field of application, as well as major ECG data sources. We also present open research problems, such as the lack of attempts to address the issue of blood pressure variability in training data sets, and point out potential gaps in the design and implementation of DL models. Conclusions We expect that this review will provide insights into state-of-the-art DL methods applied to ECG data and point to future directions for research on DL to create robust models that can assist medical experts in clinical decision-making.
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Affiliation(s)
- Georgios Petmezas
- Lab of Computing, Medical Informatics and Biomedical-Imaging Technologies, The Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leandros Stefanopoulos
- Lab of Computing, Medical Informatics and Biomedical-Imaging Technologies, The Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilis Kilintzis
- Lab of Computing, Medical Informatics and Biomedical-Imaging Technologies, The Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Tzavelis
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - John A Rogers
- Department of Material Science, Northwestern University, Evanston, IL, United States
| | - Aggelos K Katsaggelos
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, United States
| | - Nicos Maglaveras
- Lab of Computing, Medical Informatics and Biomedical-Imaging Technologies, The Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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