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Kario K, Kai H, Rakugi H, Hoshide S, Node K, Maekawa Y, Tsutsui H, Sakata Y, Aoki J, Nanto S, Yokoi H. Consensus statement on renal denervation by the Joint Committee of Japanese Society of Hypertension (JSH), Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), and the Japanese Circulation Society (JCS). Cardiovasc Interv Ther 2024; 39:376-385. [PMID: 39080214 DOI: 10.1007/s12928-024-01017-1] [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: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 09/28/2024]
Abstract
This is the first consensus statement of the Joint Committee on Renal Denervation of the Japanese Society of Hypertension (JSH)/Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT)/Japanese Circulation Society (JCS). The consensus is that the indication for renal denervation (RDN) is resistant hypertension or "conditioned" uncontrolled hypertension, with high office and out-of-office blood pressure (BP) readings despite appropriate lifestyle modification and antihypertensive drug therapy. "Conditioned" uncontrolled hypertension is defined as having one of the following: 1) inability to up-titrate antihypertensive medication due to side effects, the presence of complications, or reduced quality of life. This includes patients who are intolerant of antihypertensive drugs; or 2) comorbidity at high cardiovascular risk due to increased sympathetic nerve activity, such as orthostatic hypertension, morning hypertension, nocturnal hypertension, or sleep apnea (unable to use continuous positive airway pressure), atrial fibrillation, ventricular arrythmia, or heart failure. RDN should be performed by the multidisciplinary Hypertension Renal Denervation Treatment (HRT) team, led by specialists in hypertension, cardiovascular intervention and cardiology, in specialized centers validated by JSH, CVIT, and JCS. The HRT team reviews lifestyle modifications and medication, and the patient profile, then determines the presence of an indication of RDN based on shared decision making with each patient. Once approval for real-world clinical use in Japan, however, the joint RDN committee will update the indication and treatment implementation guidance as appropriate (annually if necessary) based on future real-world evidence.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Hisashi Kai
- Department of Cardiology, Kurume University Medical Center, Fukuoka, Japan
| | - Hiromi Rakugi
- Osaka Rosai Hospital, Sakai, Japan
- Osaka University, Suita, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Jiro Aoki
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Shinsuke Nanto
- Department of Cardiovascular Medicine, Nishinomiya Municipal Central Hospital, Hyogo, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
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Kario K, Kai H, Rakugi H, Hoshide S, Node K, Maekawa Y, Tsutsui H, Sakata Y, Aoki J, Nanto S, Yokoi H. Consensus Statement on Renal Denervation by the Joint Committee of Japanese Society of Hypertension (JSH), Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), and the Japanese Circulation Society (JCS). Circ J 2024; 88:1718-1725. [PMID: 39069493 DOI: 10.1253/circj.cj-66-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
This is the first consensus statement of the Joint Committee on Renal Denervation of the Japanese Society of Hypertension (JSH)/Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT)/Japanese Circulation Society (JCS). The consensus is that the indication for renal denervation (RDN) is resistant hypertension or "conditioned" uncontrolled hypertension, with high office and out-of-office blood pressure (BP) readings despite appropriate lifestyle modification and antihypertensive drug therapy. "Conditioned" uncontrolled hypertension is defined as having one of the following: 1) inability to up-titrate antihypertensive medication due to side effects, the presence of complications, or reduced quality of life. This includes patients who are intolerant of antihypertensive drugs; or 2) comorbidity at high cardiovascular risk due to increased sympathetic nerve activity, such as orthostatic hypertension, morning hypertension, nocturnal hypertension, or sleep apnea (unable to use continuous positive airway pressure), atrial fibrillation, ventricular arrythmia, or heart failure. RDN should be performed by the multidisciplinary Hypertension Renal Denervation Treatment (HRT) team, led by specialists in hypertension, cardiovascular intervention and cardiology, in specialized centers validated by JSH, CVIT, and JCS. The HRT team reviews lifestyle modifications and medication, and the patient profile, then determines the presence of an indication of RDN based on shared decision making with each patient. Once approval for real-world clinical use in Japan, however, the joint RDN committee will update the indication and treatment implementation guidance as appropriate (annually if necessary) based on future real-world evidence.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine
| | - Hisashi Kai
- Department of Cardiology, Kurume University Medical Center
| | | | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Jiro Aoki
- Department of Cardiovascular Medicine, St. Luke's International Hospital
| | - Shinsuke Nanto
- Department of Cardiovascular Medicine, Nishinomiya Municipal Central Hospital
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Yan Q, Cheng M, Xu W, Cheng Y, Wu F, Wang Y, Yang Q, Shi Y, Wang J. The control rate of hypertension across months of year and hours of day in a large real-world database. Hypertens Res 2024:10.1038/s41440-024-01817-1. [PMID: 39169148 DOI: 10.1038/s41440-024-01817-1] [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: 03/11/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 08/23/2024]
Abstract
We investigated the control rate of hypertension across months of year and hours of day in a real-world database. The study participants were hypertensive patients from 142 community health centers across 16 districts in Shanghai, China, who measured their blood pressure with an automatic office blood pressure measurement platform between 2018 and 2023. The 343,400 hypertensive patients included 53.7% of women, and had average age of 70.2 (±8.1) years (range 50-90 years). For months of year, the control rate of hypertension was lowest in February and highest in August (51.9% vs 71.8%). For hours of day, the control rate of hypertension was lowest at 7:00 AM and highest at 12:00 PM (52.1% vs 76.0%). When the months of year and hour of day were considered together, the control rate was lowest at 7 AM in February (42.1%), and highest at 12 PM in July (86.8%). In 8516 patients who had uncontrolled blood pressure in the early morning and had their blood pressure also measured around noon, 45.7% had masked uncontrolled morning hypertension, with higher rates in spring and summer, and in women, those aged 50-69 years, and non-diabetic patients. The control rate of hypertension varies greatly across months of year and hours of day, suggesting that the evaluation of blood pressure control has to take into full consideration the measurement time in terms of months and hours.
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Affiliation(s)
- Qinghua Yan
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Minna Cheng
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Wenli Xu
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yibang Cheng
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, the Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fei Wu
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yuheng Wang
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qinping Yang
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yan Shi
- Division of Chronic Non-Communicable Disease and Injury, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
| | - Jiguang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, the Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Kario K, Kai H, Rakugi H, Hoshide S, Node K, Maekawa Y, Tsutsui H, Sakata Y, Aoki J, Nanto S, Yokoi H. Consensus statement on renal denervation by the Joint Committee of Japanese Society of Hypertension (JSH), Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT), and the Japanese Circulation Society (JCS). Hypertens Res 2024:10.1038/s41440-024-01700-z. [PMID: 39054340 DOI: 10.1038/s41440-024-01700-z] [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: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 07/27/2024]
Abstract
This is the first consensus statement of the Joint Committee on Renal Denervation of the Japanese Society of Hypertension (JSH)/Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT)/Japanese Circulation Society (JCS). The consensus is that the indication for renal denervation (RDN) is resistant hypertension or "conditioned" uncontrolled hypertension, with high office and out-of-office blood pressure (BP) readings despite appropriate lifestyle modification and antihypertensive drug therapy. "Conditioned" uncontrolled hypertension is defined as having one of the following: (1) inability to up-titrate antihypertensive medication due to side effects, the presence of complications, or reduced quality of life. This includes patients who are intolerant of antihypertensive drugs; or (2) comorbidity at high cardiovascular risk due to increased sympathetic nerve activity, such as orthostatic hypertension, morning hypertension, nocturnal hypertension, or sleep apnea (unable to use continuous positive airway pressure), atrial fibrillation, ventricular arrythmia, or heart failure. RDN should be performed by the multidisciplinary Hypertension Renal Denervation Treatment (HRT) team, led by specialists in hypertension, cardiovascular intervention and cardiology, in specialized centers validated by JSH, CVIT, and JCS. The HRT team reviews lifestyle modifications and medication, and the patient profile, then determines the presence of an indication of RDN based on shared decision making with each patient. Once approval for real-world clinical use in Japan, however, the joint RDN committee will update the indication and treatment implementation guidance as appropriate (annually if necessary) based on future real-world evidence.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
| | - Hisashi Kai
- Department of Cardiology, Kurume University Medical Center, Fukuoka, Japan
| | - Hiromi Rakugi
- Osaka Rosai Hospital, Sakai, Japan; Osaka University, Suita, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Jiro Aoki
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Shinsuke Nanto
- Department of Cardiovascular Medicine, Nishinomiya Municipal Central Hospital, Hyogo, Japan
| | - Hiroyoshi Yokoi
- Cardiovascular Center, Fukuoka Sanno Hospital, Fukuoka, Japan
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Ramalivhana FW, Veldsman T, Moss SJ. Assessment of non-communicable disease risk factors, functional performance, and health-related quality of life in adults: a comparative analysis in low-resourced urban and rural areas of South Africa. BMC Public Health 2024; 24:1580. [PMID: 38867182 PMCID: PMC11170915 DOI: 10.1186/s12889-024-18964-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Globally, disparities between non-communicable disease (NCD) risk factors, functional performance, and health-related quality of life (HRQoL) exist in people living in rural and low-resourced urban settings. Evidence of these health differences determined with objective NCD risk factors and functional performance measurements in South Africa, is scarce. Therefore, the study aimed to determine the differences in NCD risk factors, functional performance and HRQoL between rural and low-resourced urban areas. METHODS The study recruited 311 adults (35-80 years) presenting with at least one NCD risk factor from low-resourced urban- (n = 183) and rural (n = 128) communities. Objective measurements of physical activity (PA) by means of combined heart rate and accelerometery, body composition employing skinfolds, peripheral lipid and glucose concentrations, blood pressure, functional performance indicators (handgrip, single leg stand, sit-to-stand, timed-up-and-go speed, predicted peak VO2 max); and HRQoL were measured according to standard procedures. Independent t-tests, Mann-Whitney U, and chi-square tests were performed to determine differences between the variables of low-resourced urban and rural settings. RESULTS The participants from the low-resourced urban setting were significantly older than the rural residents (59.1 ± 10.7 years vs. 52.8 ± 11.3 years; p = 0.001). NCD risk factors were significantly more prevalent in the low-resourced urban participants compared to rural participants, in particular for elevated systolic (85.8% vs. 62.5%; p = 0.001), and diastolic blood pressure (88.5% vs. 65.6%; p = 0.001), physical inactivity (95.9% vs. 87.7%; p = 0.026), increased cholesterol concentrations (22.1% vs. 8.7%; p = 0.002), and increased waist circumference (61.9% vs. 49.2%; p = 0.027). Low-resourced urban residents presented with a higher average body fat percentage (27.69% ± 7.65% vs. 12.23% ± 4.67%; p < 0.001), and lower moderate to vigorous PA levels (37.19 ± 49.55 [95% CI = 29.12-45.27] vs. 62.92 ± 60.43 min/week [95% CI = 47.95-77.90]; p = 0.003) compared to rural residents. Rural residents showed significantly better functional performance, including peak VO2 (23.99 ± 9.89 vs. 16.95 ± 7.64 ml/min/kg; p = 0.001) and single leg stand (right leg: 44.96 ± 18.47 vs. 20.87 ± 19.18 s; p = 0.001) as well as higher HRQoL for the physical (51.06 ± 8.14% vs. 45.62 ± 11.13%; p < 0.001) and mental (54.75 ± 8.24% vs. 48.91 ± 12.27%; p < 0.001) component scores compared to participants from the low-resourced urban areas. CONCLUSION NCD risk factors, functional performance, and HRQoL significantly differ in rural communities compared to low-resourced urban communities in South Africa. Urban areas' most prevalent risk factors were elevated blood pressure, physical inactivity, and increased waist circumference. Participants from rural areas demonstrated significantly better functional performance, such as fitness and balance. HRQoL was better in rural settings than in urban settings. Future intervention programmes should be tailored for specific settings.
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Affiliation(s)
- Fhatuwani W Ramalivhana
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Tamrin Veldsman
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, Australia
| | - Sarah J Moss
- Physical Activity, Sport, and Recreation Research Focus Area (PhASRec), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
- North-West University, Private Bag X6001, Potchefstroom, 2531, South Africa.
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Bhattacharya S, Grover A, Garg S, Saleem SM, Boratne A, Lal V. Inclusion of mobile phone usage guidelines in universal hypertension management protocol: an opinion. Front Cardiovasc Med 2024; 11:1367167. [PMID: 38873264 PMCID: PMC11169832 DOI: 10.3389/fcvm.2024.1367167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar (AIIMS Deoghar), Deoghar, India
| | - Ashoo Grover
- Implementation Research Division, Indian Council of Medical Research (ICMR), New Delhi, India
| | - Suneela Garg
- Chair Program Advisory Committee, National Institute of Health and Family Welfare, University of Delhi, New Delhi, India
| | | | - Abhijit Boratne
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar (AIIMS Deoghar), Deoghar, India
| | - Vanita Lal
- Department of Biochemistry, All India Institute of Medical Sciences, Deoghar (AIIMS Deoghar), Deoghar, India
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Amrutha AM, Sidenur B, P S B, S V S, M R NG, Rajagopal H. Estimation of haemoglobin using non-invasive portable device with spectroscopic signal application. Sci Rep 2024; 14:8697. [PMID: 38622231 PMCID: PMC11018793 DOI: 10.1038/s41598-024-58990-z] [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: 02/08/2024] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
An estimated 52% of non-pregnant women of reproductive age in India are estimated to be affected by anaemia, which is categorised as a chronic condition. In 2019-2021, the National Family Health Survey-5 (NFHS-5) which was undertaken revealed the following statistics about the prevalence of anaemia in the state of Karnataka. To estimate haemoglobin levels using non-invasive portable device among nursing students. A cross sectional study was done among students of Nursing college in central Karnataka for a period of 3 months. Total of 140 students were included in the study. EzeCheck haemoglobin estimation was done twice and was recorded in the same Google form. The frequency and percentage of variation of results between Haematology Analyzer and EzeCheck devices was presented with a range of difference such as 0, less than 1, 1.0 to 1.9, 2.0 to 2.9, 3.0 to 3.9, and 4.0 and above. The total prevalence of anaemia among nursing students was 57.8% and most of the students had moderate degree of anaemia (28.6%). Two readings of haemoglobin were taken and difference of readings were calculated and majority of the students had difference of < 0.5 gm/dl (61.4%) and only 1.4% of the students had difference of > 2 gm/dl. The mean difference of haemoglobin of two readings was 0.5 ± 0.5 gm/dl. The technology employed in this study bridges the gap between patients and anaemia diagnosis by providing screening services. The device provides the diagnosis via a non-invasive, IoT-enabled service at a low cost.
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Affiliation(s)
- A M Amrutha
- Department of Community Medicine, Basaveshwara Medical College and Hospital, Chitradurga, India
| | - Bhagyalaxmi Sidenur
- Department of Community Medicine, Basaveshwara Medical College and Hospital, Chitradurga, India.
| | - Balu P S
- C-DART, Basaveshwara Medical College and Hospital, Chitradurga, India
| | - Savitha S V
- SJM Institute of Nursing, Chitradurga, India
| | - Nagendra Gowda M R
- Department of Community Medicine, Basaveshwara Medical College and Hospital, Chitradurga, India
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Silva-Filho E, Bikson M, Gebodh N, Khadka N, da Cruz Santos A, Pegado R, do Socorro Brasileiro-Santos M. A pilot randomized controlled trial of transcranial direct current stimulation adjunct to moderate-intensity aerobic exercise in hypertensive individuals. FRONTIERS IN NEUROERGONOMICS 2024; 5:1236486. [PMID: 38660589 PMCID: PMC11040684 DOI: 10.3389/fnrgo.2024.1236486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
Background Hypertension is a global issue that is projected to worsen with increasingly obese populations. The central nervous system including the parts of the cortex plays a key role in hemodynamic stability and homeostatic control of blood pressure (BP), making them critical components in understanding and investigating the neural control of BP. This study investigated the effects of anodal transcranial direct current stimulation (tDCS) associated with aerobic physical exercise on BP and heart rate variability in hypertensive patients. Methods Twenty hypertensive patients were randomized into two groups: active tDCS associated with aerobic exercise or sham tDCS associated with aerobic exercise. BP and heart rate variability were analyzed before (baseline) and after twelve non-consecutive sessions. After each tDCS session (2 mA for 20 min), moderate-intensity aerobic exercise was carried out on a treadmill for 40 min. Results A total of 20 patients were enrolled (53.9 ± 10.6 years, 30.1 ± 3.7 Kg/m2). There were no significant interactions between time and groups on diastolic BP during wake, sleep, over 24 and 3 h after the last intervention. Heart rate variability variables showed no significant difference for time, groups and interaction analysis, except for HF (ms2) between groups (p < 0.05). Conclusion Anodal tDCS over the temporal cortex associated with aerobic exercise did not induce improvements in BP and heart rate variability. Clinical trial registration https://ensaiosclinicos.gov.br/rg/RBR-56jg3n/1, identifier: RBR-56jg3n.
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Affiliation(s)
- Edson Silva-Filho
- Associated Postgraduate Program in Physical Education, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
- Postgraduate Program in Physiotherapy and Postgraduate Program in Health Science, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, United States
| | - Nigel Gebodh
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, United States
| | - Niranjan Khadka
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, United States
| | - Amilton da Cruz Santos
- Associated Postgraduate Program in Physical Education, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Rodrigo Pegado
- Postgraduate Program in Physiotherapy and Postgraduate Program in Health Science, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
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Theodorakopoulou M, Georgiou A, Iatridi F, Karkamani E, Stamatiou A, Devrikis N, Karagiannidis A, Baroutidou A, Sarafidis P. Accuracy of 24 h ambulatory blood pressure recordings for diagnosing high 44 h blood pressure in hemodialysis: a diagnostic test study. Hypertens Res 2024; 47:1042-1050. [PMID: 38291259 DOI: 10.1038/s41440-024-01584-z] [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: 10/01/2023] [Revised: 12/04/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024]
Abstract
Hypertension is highly prevalent in hemodialysis patients. Ambulatory-BP-monitoring(ABPM) during the 44 h interdialytic interval is recommended for hypertension diagnosis and management in these subjects. This study assessed the diagnostic accuracy of fixed 24 h ABPM recordings with 44 h BP in hemodialysis patients. 242 Greek hemodialysis patients that underwent valid 48 h ABPM(Mobil-O-Graph NG device) were included in the analysis. We used 44 h BP as reference method and tested the accuracy of the following BP metrics: 1st 24 h without HD period (20 h-1st), 1st 24 h including HD period (24 h-1st) and 2nd 24 h(24 h-2nd). All studied metrics showed strong correlations with 44 h SBP/DBP (20 h-1st: r = 0.973/0.978, 24 h-1st: r = 0.964/0.972 and 24 h-2nd: r = 0.978/0.977, respectively). In Bland-Altman analysis, small between-method differences (-1.70, -1.19 and +1.45 mmHg) with good 95% limits-of agreement([-10.83 to 7.43], [-11.12 to 8.74] and [-6.33 to 9.23] mmHg, respectively) for 20 h-1st, 24 h-1st and 24 h-2nd SBP were observed. The sensitivity/specificity and κ-statistic for diagnosing 44 h SBP ≥ 130 mmHg were high for 20 h-1st SBP(87.2%/96.0%, κ-statistic = 0.817), 24 h-1st SBP(88.7%/96.0%, κ-statistic = 0.833) and 24 h-2nd SBP (95.0%/88.1%, κ-statistic = 0.837). Similar observations were made for DBP. In ROC-analyses, all studied BP metrics showed excellent performance with high Area-Under-the- Curve values (20 h-1st: 0.983/0.992; 24 h-1st: 0.984/0.987 and 24 h-2nd: 0.982/0.989 for SBP/DBP respectively). Fixed 24 h ABPM recordings during either the first or the second day of interdialytic interval have high accuracy and strong agreement with 44 h BP in hemodialysis patients. Thus, ABPM recordings of either the first or the second interdialytic day could be used for hypertension diagnosis and management in these subjects.
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Affiliation(s)
- Marieta Theodorakopoulou
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Areti Georgiou
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Iatridi
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Karkamani
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Stamatiou
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Devrikis
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Artemios Karagiannidis
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Amalia Baroutidou
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Meador M, Sachdev N, Anderson E, Roy D, Bay RC, Becker LH, Lewis JH. Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians. J Healthc Qual 2024; 46:109-118. [PMID: 38150376 PMCID: PMC10901219 DOI: 10.1097/jhq.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
ABSTRACT The early period of the COVID-19 pandemic necessitated a rapid increase in out-of-office care. To capture the impact from COVID-19 on care for patients with hypertension, a questionnaire was disseminated to community health center clinicians. The extent, types, and causes of care delays and disruptions were assessed along with adaptations and innovations used to address them. Clinician attitudinal changes and perspectives on future hypertension care were also assessed. Of the 65 respondents, most (90.8%) reported their patients with hypertension experienced care delays or disruptions, including lack of follow-up, lack of blood pressure assessment, and missed medication refills or orders. To address care delays and disruptions for patients with hypertension, respondents indicated that their health center increased the use of telehealth or other technology, made home blood pressure devices available to patients, expanded outreach and care coordination, provided medication refills for longer periods of time, and used new care delivery options. The use of self-measured blood pressure monitoring (58.5%) and telehealth (43.1%) was identified as the top adaptations that should be sustained to increase access to and patient engagement with hypertension care; however, barriers to both remain. Policy and system level changes are needed to support value-based care models that include self-measured blood pressure and telehealth.
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Li J, Tian A, Liu J, Ge J, Peng Y, Su X, Li J. Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China. CARDIOLOGY DISCOVERY 2024; 4:15-22. [PMID: 38505635 PMCID: PMC10947596 DOI: 10.1097/cd9.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 01/04/2024] [Indexed: 03/21/2024]
Abstract
Objective Home blood pressure monitoring (HBPM) is viewed as a facilitating factor in the initial diagnosis and long-term management of treated hypertension. However, evidence remains scarce about the effectiveness of HBPM use in the real world. This study aimed to examine the associations of HBPM use with blood pressure (BP) control and medication adherence. Methods This prospective cohort study included hypertensive patients with high cardiovascular risk who were aged ≥50 years. At baseline, information about types of BP monitor, frequency of HBPM, perception of anti-hypertensive treatment, and measured office BP were collected. During the 1-year follow-up (visits at 1, 2, 3, 6, and 12 months), information on medication adherence was collected at each visit. The 2 major outcomes were BP control at baseline and medication adherence during the 1-year follow-up. A log-binomial regression model was used to examine the association between frequency of HBPM and outcomes, stratified by the perceptions of anti-hypertensive treatment. Results A total of 5,363 hypertensive patients were included in the analysis. The age was (64.6 ± 7.2) years, and 41.2% (2,208) were female. Of the total patients, 85.9% (4,606) had a home BP monitor and 47.8% (2,564) had an incorrect perception of anti-hypertensive treatment. Overall, 24.2% (1,299) of patients monitored their BP daily, 37.6% (2,015) weekly, 17.3% (926) monthly, and 20.9% (1,123) less than monthly. At baseline, the systolic BP and diastolic BP were (146.6 ± 10.8) mmHg and (81.9 ± 10.6) mmHg, respectively, and 28.5% (1,527) of patients had their BP controlled. Regardless of whether the patients had correct or incorrect perceptions of anti-hypertensive treatment, there is no significant association between HBPM frequency and BP control at baseline. During the 1-year follow-up, 23.9% (1,280) of patients had non-adherence to medications at least once. In patients with an incorrect perception of anti-hypertensive treatment, those monitoring BP most frequently (daily) had the highest non-adherence rate (29.9%, 175/585). Compared with those monitoring their BP less than monthly, patients who monitored their BP daily were more likely not to adhere to anti-hypertensive medications (adjusted relative risk = 1.38, 95% confidence interval: 1.11-1.72, P = 0.004). Conclusions HBPM performance among hypertensive patients in China is, in general, sub-optimal. No association was observed between using HBPM alone and hypertension control, indicating that the effects of HBPM could be conditional. Patients' misconceptions about anti-hypertensive treatment may impair the role of BP monitoring in achieving medication adherence. Fully incorporating the correct perception of hypertension into the management of hypertensive patients is needed.
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Affiliation(s)
- Jiaying Li
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jiamin Liu
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jinzhuo Ge
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Yue Peng
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Xiaoming Su
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, National Health Commission Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing 100037, China
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Karelius S, Pentti J, Juhanoja E, Jula A, Koskinen S, Niiranen TJ, Stenholm S. Association of work-related psychosocial factors and day-to-day home blood pressure variation: the Finn-Home study. J Hypertens 2024; 42:337-343. [PMID: 37965725 PMCID: PMC10763707 DOI: 10.1097/hjh.0000000000003619] [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: 03/29/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Stress, and particularly job strain, has been found to associate with ambulatory blood pressure (BP). Moreover, BP is known to vary between days. One potential over-looked factor underlying this day-to-day BP variation could be work-related psychosocial factors. Thus, we aimed to study the association between job strain, job demands, job control and day-to-day BP variation. METHODS The home BP of 754 regularly working participants (mean age 50.9 ± 4.8, women 51%) of the Finn-Home Study was measured twice in the morning and twice in the evening over seven days. Average SBP and DBP were calculated for each day. Work-related psychosocial factors were measured with survey. Multivariable-adjusted generalized linear models were used for statistical analysis. RESULTS We found a greater SBP/DBP decrease between weekdays and weekend among participants with high job strain (-1.8 [95% confidence interval, 95% CI, -2.7 to -0.8]/-1.7 [95% CI, -2.3 to -1.1] mmHg) compared to participants with low job strain (-0.7 [95% CI, -1.1 to -0.2]/-0.7 [95% CI, -1.0 to -0.4] mmHg). The participants with high job demands showed a higher BP decrease between weekdays and weekend (-1.4 [95% CI, -2.0 to -0.8]/-1.3 [95% CI, -1.6 to -0.9] mmHg) than the participants with low job demands (-0.5 [95% CI, -1.1 to 0.0]/-0.6 [95% CI, -1.0 to -0.3] mmHg). We did not find BP differences regarding job control. CONCLUSION High job strain and high job demands were associated with a greater BP reduction from weekdays to the weekend. Work-related psychosocial factors should be considered when assessing day-to-day BP variation.
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Affiliation(s)
- Saana Karelius
- Department of Internal Medicine, University of Turku
- Division of Medicine, Turku University Hospital
| | - Jaana Pentti
- Department of Public Health, University of Turku and Turku University Hospital
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eeva Juhanoja
- Department of Internal Medicine, University of Turku
- Oncology Ward, Operational Division of Surgery and Cancer Diseases, Turku University Hospital, Turku
| | - Antti Jula
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki
| | - Teemu J. Niiranen
- Department of Internal Medicine, University of Turku
- Division of Medicine, Turku University Hospital
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku
- Research Services, Turku University Hospital and University of Turku, Turku, Finland
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Tamrat T, Setiyawati YD, Barreix M, Gayatri M, Rinjani SO, Pasaribu MP, Geissbuhler A, Shankar AH, Tunçalp Ö. Exploring perceptions and operational considerations for use of a smartphone application to self-monitor blood pressure in pregnancy in Lombok, Indonesia: protocol for a qualitative study. BMJ Open 2023; 13:e073875. [PMID: 38110387 DOI: 10.1136/bmjopen-2023-073875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal deaths globally and require close monitoring of blood pressure (BP) to mitigate potential adverse effects. Despite the recognised need for research on self-monitoring of blood pressure (SMBP) among pregnant populations, there are very few studies focused on low and middle income contexts, which carry the greatest burden of HDPs. The study aims to understand the perceptions, barriers, and operational considerations for using a smartphone software application to perform SMBP by pregnant women in Lombok, Indonesia. METHODS AND ANALYSIS This study includes a combination of focus group discussions, in-depth interviews and workshop observations. Pregnant women will also be provided with a research version of the smartphone BP application to use in their home and subsequently provide feedback on their experiences. The study will include pregnant women with current or past HDP, their partners and the healthcare workers involved in the provision of antenatal care services within the catchment area of six primary healthcare centres. Data obtained from the interviews and observations will undergo thematic analyses using a combination of both inductive and deductive approaches. ETHICS AND DISSEMINATION The study was approved by the World Health Organization (WHO) and Human Reproduction Programme (HRP) Research Project Review Panel and WHO Ethical Review Committee (A65932) as well as the Health Research Ethics Committee, Faculty of Medicine, Universitas Mataram in Indonesia (004/UN18/F7/ETIK/2023).Findings will be disseminated through research publications and communicated to the Lombok district health offices. The analyses from this study will also inform the design of a subsequent impact evaluation.
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Affiliation(s)
- Tigest Tamrat
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- University of Geneva, Geneva, Switzerland
| | | | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mergy Gayatri
- Summit Institute for Development, Mataram, Indonesia
- Brawijaya University, Malang, Indonesia
| | | | | | | | - Anuraj H Shankar
- Summit Institute for Development, Mataram, Indonesia
- Oxford University Clinical Research Unit-Indonesia, Jakarta, Indonesia
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Abstract
PURPOSE The current review is to describe the definition and prevalence of resistant arterial hypertension (RAH), the difference between refractory hypertension, patient characteristics and major risk factors for RAH, how RAH is diagnosed, prognosis and outcomes for patients. MATERIALS AND METHODS According to the WHO, approximately 1.28 billion adults aged 30-79 worldwide have arterial hypertension, and over 80% of them do not have blood pressure (BP) under control. RAH is defined as above-goal elevated BP despite the concurrent use of 3 or more classes of antihypertensive drugs, commonly including a long-acting calcium channel blocker, an inhibitor of the renin-angiotensin system (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a thiazide diuretic administered at maximum or maximally tolerated doses and at appropriate dosing frequency. RAH occurs in nearly 1 of 6 hypertensive patients. It often remains unrecognised mainly because patients are not prescribed ≥3 drugs at maximal doses despite uncontrolled BP. CONCLUSION RAH distinctly increases the risk of developing coronary artery disease, heart failure, stroke and chronic kidney disease and confers higher rates of major adverse cardiovascular events as well as increased all-cause mortality. Timely diagnosis and treatment of RAH may mitigate the associated risks and improve short and long-term prognosis.
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Kario K, Tomitani N, Hoshide S, Nishizawa M, Yoshida T, Kabutoya T, Fujiwara T, Mizuno H, Okawara Y, Kanegae H. Different Home Blood Pressure Thresholds to Predict Perfect 24-Hour Ambulatory Blood Pressure Control in Treated Hypertension Based on an "All-in-One" Device. Hypertension 2023; 80:2464-2472. [PMID: 37671575 DOI: 10.1161/hypertensionaha.123.21578] [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: 05/30/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Home blood pressure (BP) is an important component of digital strategies for hypertension management. However, no studies have used the same device to investigate 24-hour BP control status in relation to different home BP control thresholds. METHODS Participants in the general practitioner-based, multicenter HI-JAMP study (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) underwent office BP measurement, then 24-hour ambulatory BP monitoring, then home BP monitoring for 5 days. A validated all-in-one BP monitoring device was used to measure office, home, and ambulatory BP. Baseline data were used to investigate ambulatory BP control status in individuals with well-controlled home BP based on the different guideline thresholds (125/75 mm Hg, 130/80 mm Hg, and 135/85 mm Hg). RESULTS Data from 2269 patients were analyzed. For individuals with well-controlled home BP <135/85 mm Hg (59.5% of the total population), the prevalence of uncontrolled 24-hour (≥130/80 mm Hg), daytime (≥135/85 mm Hg), and nighttime ambulatory BP (≥120/70 mm Hg) was 19.9%, 18.5%, and 33.6%, respectively. Corresponding prevalence rates in the 42.7% of participants with well-controlled home BP <130/80 mm Hg were 13.4%, 12.9%, and 26.0%, and when well-controlled home BP was strictly defined as <125/75 mm Hg (23.9% of the population), prevalence of rates of uncontrolled 24-hour, daytime, and nighttime ambulatory BP were 7.0%, 9.0%, and 15.3%, respectively. CONCLUSIONS Home BP control status defined using different thresholds could predict 24-hour ambulatory BP control status in treated hypertension. One-third of individuals still had uncontrolled nocturnal hypertension when home BP was controlled to <135/85 mm Hg, but ambulatory BP was quite well controlled when home BP was <125/75 mm Hg.
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Affiliation(s)
- Kazuomi Kario
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Naoko Tomitani
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Satoshi Hoshide
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | | | - Tetsuro Yoshida
- Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.)
| | - Tomoyuki Kabutoya
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Takeshi Fujiwara
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Hiroyuki Mizuno
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Yukie Okawara
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Hiroshi Kanegae
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
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Vaseekaran M, Kaese S, Görlich D, Wiemer M, Samol A. WATCH-BPM-Comparison of a WATCH-Type Blood Pressure Monitor with a Conventional Ambulatory Blood Pressure Monitor and Auscultatory Sphygmomanometry. SENSORS (BASEL, SWITZERLAND) 2023; 23:8877. [PMID: 37960576 PMCID: PMC10650650 DOI: 10.3390/s23218877] [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: 08/15/2023] [Revised: 09/18/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Smart devices that are able to measure blood pressure (BP) are valuable for hypertension or heart failure management using digital technology. Data regarding their diagnostic accuracy in comparison to standard noninvasive measurement in accordance to Riva-Rocci are sparse. This study compared a wearable watch-type oscillometric BP monitor (Omron HeartGuide), a wearable watch-type infrared BP monitor (Smart Wear), a conventional ambulatory BP monitor, and auscultatory sphygmomanometry. METHODS Therefore, 159 consecutive patients (84 male, 75 female, mean age 64.33 ± 16.14 years) performed observed single measurements with the smart device compared to auscultatory sphygmomanometry (n = 109) or multiple measurements during 24 h compared to a conventional ambulatory BP monitor on the upper arm (n = 50). The two BP monitoring devices were simultaneously worn on the same arm throughout the monitoring period. In a subgroup of 50 patients, single measurements were also performed with an additional infrared smart device. RESULTS The intraclass correlation coefficient (ICC) between the difference and the mean of the oscillometric Omron HeartGuide and the conventional method for the single measurement was calculated for both systole (0.765) and diastole (0.732). This is exactly how the ICC was calculated for the individual mean values calculated over the 24 h long-term measurement of the individual patients for both systole (0.880) and diastole (0.829). The ICC between the infrared device and the conventional method was "bad" for SBP (0.329) and DBP (0.025). Therefore, no further long-term measurements were performed with the infrared device. CONCLUSION The Omron HeartGuide device provided comparable BP values to the standard devices for single and long-term measurements. The infrared smart device failed to acquire valid measurement data.
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Affiliation(s)
- Mathini Vaseekaran
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
| | - Sven Kaese
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University Münster, 48149 Muenster, Germany;
| | - Marcus Wiemer
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
| | - Alexander Samol
- Department of Cardiology and Critical Care Medicine, Johannes Wesling University Hospital, 32429 Minden, Germany; (M.V.); (S.K.); (M.W.)
- Department of Cardiology and Angiology, St. Antonius-Hospital Gronau GmbH, Möllenweg 22, 48599 Gronau, Germany
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Al-Anazi AF, Gul R, Al-Harbi FT, Al-Radhi SA, Al-Harbi H, Altaher A, Al-Harbi MM, Al-Rashidi FO, Al-Haweeri OS, Al-Mutairi FM, Al-Riyaee AA, Al-Hotan FM, Al-Radhi AA, Al Shehri HM, Alharbi MS, ALGhasab NS. Home versus Clinic Blood Pressure Monitoring: Evaluating Applicability in Hypertension Management via Telemedicine. Diagnostics (Basel) 2023; 13:2686. [PMID: 37627945 PMCID: PMC10453092 DOI: 10.3390/diagnostics13162686] [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: 07/17/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Hypertension is a significant public health concern in Saudi Arabia, affecting 28.6% of the population. Despite the availability of effective treatments, optimal blood pressure control is not always achieved, highlighting the need for effective management strategies. This study aimed to evaluate the applicability of home, compared to clinic, blood pressure measurements for managing hypertension in the Qassim region of Saudi Arabia. The study included 85 adults undergoing antihypertensive treatment. Home blood pressure measurements were obtained during the day and the evening using automated oscillometric sphygmomanometers, whereas clinic measurements were taken during clinic hours. Home blood pressure readings were significantly lower than clinic blood pressure readings, with mean differences of 20.4 mmHg and 4.1 mmHg for systolic and diastolic blood pressures, respectively. There was a positive correlation between the clinic systolic and diastolic blood pressures (r = 0.549, p < 0.001) and a weak correlation between the daytime home and clinic systolic blood pressures (r = 0.218, p < 0.05). This study provides insight into the applicability of home blood pressure monitoring, which may aid in the development of more effective hypertension management strategies, particularly the use of morning home blood pressure monitoring to aid treatment decisions through telehealth medicine.
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Affiliation(s)
- Ali F. Al-Anazi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Rahim Gul
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Fahad T. Al-Harbi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Sulaiman A. Al-Radhi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Hamood Al-Harbi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Altigani Altaher
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Mohammed M. Al-Harbi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Fahad O. Al-Rashidi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Omer S. Al-Haweeri
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Fakhri M. Al-Mutairi
- Department of Internal Medicine, Al-Rass General Hospital, Al-Rass 58883, Qassim, Saudi Arabia
| | - Afyaa A. Al-Riyaee
- College of Medicine, Qassim University, Buraydah 51482, Qassim, Saudi Arabia
| | - Fai M. Al-Hotan
- College of Medicine, Qassim University, Buraydah 51482, Qassim, Saudi Arabia
| | - Alulu A. Al-Radhi
- Department of Pharmacy, Qassim University Medical City, Buraidah 52571, Qassim, Saudi Arabia
| | - Hamdan M. Al Shehri
- Department of Internal Medicine, Medical College, Najarn University, Najran 55461, Najran, Saudi Arabia
| | - Mohammed S. Alharbi
- Department of Internal Medicine, Medical College, Ha’il University, Ha’il 55476, Hail, Saudi Arabia
| | - Naif Saad ALGhasab
- Department of Internal Medicine, Medical College, Ha’il University, Ha’il 55476, Hail, Saudi Arabia
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Nakayama M, Goto S, Sakano T, Goto S. Detection of the Relationship between the Multi-Dimensional Data Sets of Serially Measured Blood Pressure and the Future Risk of Death in Healthy Elderly Japanese Population. J Atheroscler Thromb 2023; 30:1002-1009. [PMID: 36273901 PMCID: PMC10406660 DOI: 10.5551/jat.63798] [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: 06/29/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023] Open
Abstract
AIMS Whether the multi-dimensional data of serially measured blood pressure contains information for predicting the future risk of death in elderly individuals in nursing homes is unclear. METHODS Of the elderly individuals staying in a nursing home, 19,740 and 40,055 individuals with serially measured blood pressure from day 1 to 365 (for AI-long) and 1 to 90 (for AI-short) along with the death information at day 366 to 730 and 91-365 were included. The neural network-based artificial intelligence (AI) was applied to find the relationship between BP time-series and the future risks of death in both populations. RESULTS AI-long found a significant relationship between the serially measured BP from day 1 to day 365 days and the risk of death occurring 366-730 days with c-statistics of 0.57 (95% CI: 0.51-0.63). AI-short also found a significant relationship between the serially measured BP from day 1 to day 90 and the rate of death occurring 91-365 days with c-statistics of 0.58 (95%CI: 0.52-0.63). CONCLUSION Our results suggest that neural network-based AI could find the hidden subtle relationship between multi-dimensional data of serially measured BP and the future risk of death in apparently healthy elderly Japanese individuals under nursing care.
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Affiliation(s)
- Masamitsu Nakayama
- Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan
| | - Shinichi Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan
| | | | - Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Kanagawa, Japan
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Baumann B, Lipka T, Jänner M, Kujovic M. The neurocognitive disorder cohort RIFADE: Aims, methods, first results showing cognitive improvement in a subgroup. Eur Arch Psychiatry Clin Neurosci 2023; 273:941-952. [PMID: 36416960 PMCID: PMC10238319 DOI: 10.1007/s00406-022-01516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The NCD cohort study RIFADE (RIsk FActors of DEmentia) investigates the interaction of risk factors and neurocognitive disorders (NCDs) due to Alzheimer's disease (NCD-AD) and NCD of vascular type (NCD-vascular). Retrospective recruitment referred to a period from 2007 to 2018 in a single centre. In addition to the baseline visit, follow-up visits took place at 3, 6, 12 months followed by yearly visits. Visit times varied in part depending on adherence. The study also comprises an EEG bank and a bank with cerebral MRI (c-MRI). METHODS Inclusion criteria were broad in order to cover a wide range of patterns of NCD. At baseline, patients underwent a large panel of assessments, e.g. including clinical history, diagnostic evaluation for NCD according to DSM-IV and NINDS AIREN criteria, a cognitive test battery including the DemTect, the clock drawing test and the Instrumental-Activities-of-Daily-Living-scale of Lawton and Brodie, EEG and c-MRI. At each follow-up visit, cognitive tests were repeated, in most cases also EEGs and in some cases c-MRIs. Numerous risk factors (RF) including vascular RF, atrial fibrillation, heart failure, sleep apnoea and lifestyle factors such as sedentary lifestyle, low cognitive style and smoking were evaluated for presence and for correction status at each visit, and modulation of uncorrected RF was initiated. RESULTS Overall, 126 subjects with a clinical diagnosis of NCD were included (52% female, mean age 71 ± 10.6 years (range 35e86)), number of follow-up visits per subject 2.9 ± 2.4, observation time per subject 3.4 ± 2.8 years). Of these, 55/28/17% presented with the clinical stages subjective cognitive decline (SCD)/mild cognitive impairment (MCI)/dementia (major NCD). Clinical diagnoses, retrospectively re-evaluated according to DSM-5, were 5/21/68/6% Alzheimer´s disease (NCD-AD)/vascular NCD (NCD-vascular) / mixed NCD (NCD-AD + NCD-vascular)/unspecified NCD. First longitudinal results revealed a mean DemTect score at baseline 12.6 ± 4.2 vs last visit 12.0 ± 4.8 (p = 0.08) and a clock drawing test score at baseline 1.9 ± 1.3 vs last visit 2.3 ± 1.5 (p < 0.0001). Of all subjects with MCI or major NCD (n = 57), 19 improved in the clinical stage from baseline to last visit (33.3%). Sixteen subjects progressed from SCD or MCI (n = 104) to major NCD (15.4%). CONCLUSION The German NCD cohort RIFADE comprises patients with all clinical stages of NCD. A considerable subgroup improved in clinical stage. Further analysis is needed to answer the question of whether modulation of multiple risk factors provides a favourable effect on cognitive outcome in NCD.
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Affiliation(s)
- Bruno Baumann
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany.
| | - Tim Lipka
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Michaela Jänner
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Milenko Kujovic
- Department of Psychiatry and Psychotherapy, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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20
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Kopczak A, Stringer MS, van den Brink H, Kerkhofs D, Blair GW, van Dinther M, Onkenhout L, Wartolowska KA, Thrippleton MJ, Duering M, Staals J, Middeke M, André E, Norrving B, Bousser MG, Mansmann U, Rothwell PM, Doubal FN, van Oostenbrugge R, Biessels GJ, Webb AJS, Wardlaw JM, Dichgans M. The EffecTs of Amlodipine and other Blood PREssure Lowering Agents on Microvascular FuncTion in Small Vessel Diseases (TREAT-SVDs) trial: Study protocol for a randomised crossover trial. Eur Stroke J 2023; 8:387-397. [PMID: 37021189 PMCID: PMC10069218 DOI: 10.1177/23969873221143570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background Hypertension is the leading modifiable risk factor for cerebral small vessel diseases (SVDs). Yet, it is unknown whether antihypertensive drug classes differentially affect microvascular function in SVDs. Aims To test whether amlodipine has a beneficial effect on microvascular function when compared to either losartan or atenolol, and whether losartan has a beneficial effect when compared to atenolol in patients with symptomatic SVDs. Design TREAT-SVDs is an investigator-led, prospective, open-label, randomised crossover trial with blinded endpoint assessment (PROBE design) conducted at five study sites across Europe. Patients aged 18 years or older with symptomatic SVD who have an indication for antihypertensive treatment and are suffering from either sporadic SVD and a history of lacunar stroke or vascular cognitive impairment (group A) or CADASIL (group B) are randomly allocated 1:1:1 to one of three sequences of antihypertensive treatment. Patients stop their regular antihypertensive medication for a 2-week run-in period followed by 4-week periods of monotherapy with amlodipine, losartan and atenolol in random order as open-label medication in standard dose. Outcomes The primary outcome measure is cerebrovascular reactivity (CVR) as determined by blood oxygen level dependent brain MRI signal response to hypercapnic challenge with change in CVR in normal appearing white matter as primary endpoint. Secondary outcome measures are mean systolic blood pressure (BP) and BP variability (BPv). Discussion TREAT-SVDs will provide insights into the effects of different antihypertensive drugs on CVR, BP, and BPv in patients with symptomatic sporadic and hereditary SVDs. Funding European Union's Horizon 2020 programme. Trial registration NCT03082014.
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Affiliation(s)
- Anna Kopczak
- Institute for Stroke and Dementia
Research, University Hospital, LMU Munich, Munich, Germany
| | - Michael S Stringer
- Centre for Clinical Brain Sciences,
University of Edinburgh, Edinburgh, UK
| | - Hilde van den Brink
- Department of Neurology, UMC Utrecht
Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Danielle Kerkhofs
- Department of Neurology and School for
cardiovascular diseases (CARIM), Maastricht University Medical Center+, Maastricht,
The Netherlands
| | - Gordon W Blair
- Centre for Clinical Brain Sciences,
University of Edinburgh, Edinburgh, UK
| | - Maud van Dinther
- Department of Neurology and School for
cardiovascular diseases (CARIM), Maastricht University Medical Center+, Maastricht,
The Netherlands
| | - Laurien Onkenhout
- Department of Neurology, UMC Utrecht
Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karolina A Wartolowska
- Wolfson Centre for Prevention of Stroke
and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford,
Oxford, UK
| | | | - Marco Duering
- Institute for Stroke and Dementia
Research, University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC AG)
and Department of Biomedical Engineering, University of Basel, Basel,
Switzerland
| | - Julie Staals
- Department of Neurology and School for
cardiovascular diseases (CARIM), Maastricht University Medical Center+, Maastricht,
The Netherlands
| | - Martin Middeke
- Hypertoniezentrum München, Excellence
Centre of the European Society of Hypertension (ESH), Munich, Germany
| | - Elisabeth André
- Münchner Studienzentrum, Faculty of
Medicine, Technical University Munich (TUM), Munich, Germany
| | - Bo Norrving
- Neurology, Department of Clinical
Sciences Lund, Lund University, and Neurology, Skåne University Hospital Lund/Malmö,
Sweden
| | | | - Ulrich Mansmann
- Institute for Medical Information
Processing, Biometry, and Epidemiology, LMU Munich, Munich, Germany
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke
and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford,
Oxford, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences,
University of Edinburgh, Edinburgh, UK
| | - Robert van Oostenbrugge
- Department of Neurology and School for
cardiovascular diseases (CARIM), Maastricht University Medical Center+, Maastricht,
The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht
Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alastair JS Webb
- Wolfson Centre for Prevention of Stroke
and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford,
Oxford, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences,
University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute,
University of Edinburgh, Edinburgh, UK
| | - Martin Dichgans
- Institute for Stroke and Dementia
Research, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology
(SyNergy), Munich, Germany
- German Center for Neurodegenerative
Diseases (DZNE), Munich, Germany
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21
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Theodorakopoulou MP, Alexandrou ME, Iatridi F, Karpetas A, Geladari V, Pella E, Alexiou S, Sidiropoulou M, Ziaka S, Papagianni A, Sarafidis P. Peridialytic and intradialytic blood pressure metrics are not valid estimates of 44-h ambulatory blood pressure in patients with intradialytic hypertension. Int Urol Nephrol 2023; 55:729-740. [PMID: 36153412 PMCID: PMC9958170 DOI: 10.1007/s11255-022-03369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE In contrast to peridialytic blood pressure (BP), intradialytic and home BP measurements are accurate metrics of ambulatory BP load in hemodialysis patients. This study assessed the agreement of peridialytic, intradialytic, and scheduled interdialytic recordings with 44-h BP in a distinct hemodialysis population, patients with intradialytic hypertension (IDH). METHODS This study included 45 IDH patients with valid 48-h ABPM and 197 without IDH. With 44-h BP used as reference method, we tested the accuracy of the following BP metrics: Pre- and post-dialysis, mean and median intradialytic, mean intradialytic plus pre/post-dialysis, and scheduled interdialytic BP (out-of-dialysis day: mean of 8:00am/8:00 pm readings). RESULTS In IDH patients, peridialytic and intradialytic BP metrics showed at best moderate correlations, while averaged interdialytic SBP/DBP exhibited strong correlation (r = 0.882/r = 0.855) with 44-h SBP/DBP. Bland-Altman plots showed large between-method-difference for peri- and intradialytic-BP, but only + 0.7 mmHg between-method difference and good 95% limits of agreement for averaged interdialytic SBP. The sensitivity/specificity and κ-statistic for diagnosing 44-h SBP ≥ 130 mmHg were low for pre-dialysis (72.5/40.0%, κ-statistic = 0.074) and post-dialysis (90.0/0.0%, κ-statistic = - 0.110), mean intradialytic (85.0/40.0%, κ-statistic = 0.198), median intradialytic (85.0/60.0%, κ-statistic = 0.333), and intradialytic plus pre/post-dialysis SBP (85.0/20.0%, κ-statistic = 0.043). Averaged interdialytic SBP showed high sensitivity/specificity (97.5/80.0%) and strong agreement (κ-statistic = 0.775). In ROC analyses, scheduled interdialytic SBP/DBP had the highest AUC (0.967/0.951), sensitivity (90.0/88.0%), and specificity (100.0/90.0%). CONCLUSION In IDH patients, only averaged scheduled interdialytic but not pre- and post-dialysis, nor intradialytic BP recordings show reasonable agreement with ABPM. Interdialytic BP recordings only could be used for hypertension diagnosis and management in these subjects.
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Affiliation(s)
- Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Iatridi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Virginia Geladari
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sophia Alexiou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Stavroula Ziaka
- Department of Nephrology, General Hospital "Korgialeneio-Benakeio", Athens, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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22
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Maisons V, Le Jeune S, Barber-Chamoux N, Boudghene-Stambouli F, Brucker M, Delsart P, Lopez-Sublet M, Perez L, Radhouani I, Sosner P, Sautenet B. Relationship between accessory renal arteries and resistant hypertension: A cohort study. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:18-23. [PMID: 37120265 DOI: 10.1016/j.jdmv.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/20/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Resistant hypertension (RHT) is a major health care concern affecting 20 to 30% of hypertensive patients and increasing cardiovascular risk. Recent renal denervation trials have suggested a high prevalence of accessory renal arteries (ARA) in RHT. Our objective was to compare the prevalence of ARA in RHT vs. non-resistant hypertension (NRHT). METHODS Eighty-six patients with essential hypertension who benefited from an abdominal CT-scan or MRI during their initial workup were retrospectively recruited in 6 French ESH (European Society of Hypertension) centers. At the end of a follow-up period of at least 6 months, patients were classified between RHT or NRHT. RHT was defined as uncontrolled blood pressure despite the optimal doses of three antihypertensive agents of which one is a diuretic or similar, or controlled by ≥ 4 medications. Blinded independent central review of all radiologic renal artery charts was performed. RESULTS Baseline characteristics were: age 50±15 years, 62% males, BP 145±22/87±13mmHg. Fifty-three (62%) patients had RHT and 25 (29%) had at least one ARA. Prevalence of ARA was comparable between RHT (25%) and NRHT patients (33%, P=0.62), but there were more ARA per patient in NRHT (2±0.9) vs. RHT (1.3±0.5, P=0.05), and renin levels were higher in ARA group (51.6±41.7 mUI/L vs. 20.4±25.4 mUI/L, P=0.001). ARA were similar in diameter or length between the 2 groups. CONCLUSIONS In this retrospective series of 86 essential hypertension patients, we found no difference in the prevalence of ARA in RHT and NRHT. More comprehensive studies are needed to answer this question.
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Affiliation(s)
- Valentin Maisons
- Club des jeunes hypertensiologues, France; Service de néphrologie, CHU de Tours, Tours, France; Inserm U1246 SPHERE, université de Nantes, université de Tours, Tours, France.
| | - Sylvain Le Jeune
- Club des jeunes hypertensiologues, France; Service de médecine interne et vasculaire, CHU d'Avicenne, AP-HP, Bobigny, France.
| | - Nicolas Barber-Chamoux
- Club des jeunes hypertensiologues, France; Service de cardiologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Fanny Boudghene-Stambouli
- Club des jeunes hypertensiologues, France; Service de cardiologie, polyclinique Saint-Laurent, Rennes, France.
| | - Marie Brucker
- Club des jeunes hypertensiologues, France; Service de néphrologie, centre hospitalier de Valence, Valence, France.
| | - Pascal Delsart
- Club des jeunes hypertensiologues, France; Service de médecine vasculaire et HTA, CHU de Lille, Lille, France.
| | - Marilucy Lopez-Sublet
- Club des jeunes hypertensiologues, France; Service de médecine interne et vasculaire, CHU d'Avicenne, AP-HP, Bobigny, France; Inserm U942 MASCOT, université Paris Nord, Paris 13, France; FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
| | - Laurence Perez
- Club des jeunes hypertensiologues, France; Service de cardiologie, clinique d'Occitanie, Muret, France.
| | | | - Philippe Sosner
- Club des jeunes hypertensiologues, France; Mon Stade, maison sport-santé, Paris, France.
| | - Bénédicte Sautenet
- Club des jeunes hypertensiologues, France; Service de néphrologie, CHU de Tours, Tours, France; Inserm U1246 SPHERE, université de Nantes, université de Tours, Tours, France; FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.
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23
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Li Y, Jiang Y, Tang Y. Is remote blood pressure monitoring and management a better approach for patients with hypertension? A narrative review. J Clin Hypertens (Greenwich) 2023; 25:121-126. [PMID: 36602447 PMCID: PMC9903197 DOI: 10.1111/jch.14624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
Hypertension is a global public health problem which affects the physical and mental health of individuals. The management of hypertension is a long-term process that requires the cooperation of both doctors and patients, and the blood pressure variability is closely related to the clinical prognosis. In recent years, the development of telemedicine has promoted better blood pressure monitoring and management for patients, as well as better medical intervention and health education for patients by medical staff. This article provides a review of remote blood pressure monitoring and management.
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Affiliation(s)
- Yan Li
- Department of General MedicineChongqing University Central HospitalChongqing Emergency Medical CenterChongqingChina
| | - Yi Jiang
- Department of General MedicineChongqing University Central HospitalChongqing Emergency Medical CenterChongqingChina
| | - Yuping Tang
- Department of General MedicineChongqing University Central HospitalChongqing Emergency Medical CenterChongqingChina
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24
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Nessler K, Krztoń-Królewiecka A, Suska A, Mann MR, Nessler MB, Windak A. The reliability of patient blood pressure self-assessments - a cross-sectional study. BMC PRIMARY CARE 2023; 24:2. [PMID: 36597022 PMCID: PMC9811785 DOI: 10.1186/s12875-022-01962-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Home blood pressure monitoring (HBPM) is an increasingly important tool in managing hypertension (HTN); however, its efficacy depends on its accuracy. This study aimed to explore the differences between blood pressure (BP) measurements conducted by patients and medical professionals and the patient demographic factors correlating with inaccurate self-measured BP levels. METHODS One hundred hypertensive patients completed a questionnaire inquiring about their health status and HBPM procedures and were filmed while measuring their BP using their own devices. A researcher then measured the patients' BP using a calibrated sphygmomanometer to assess the accuracy of patient-performed readings. This cross-sectional study was conducted in five primary healthcare centers in Kraków, Poland. RESULTS The mean differences in systolic and diastolic BP readings by patients and researchers were 8.36 mmHg (SD = 10.90 mmHg) and 2.16 mmHg (SD = 9.12 mmHg), respectively. Inaccuracies in patient BP measurements were associated with a less than high school education level, patients' age, and a family history of HTN. CONCLUSION Patient self-measured BP levels were higher than researcher values, likely due to a higher patient error rate. Healthcare providers must increase training regarding correct HBPM techniques offered to patients; such efforts should be directed at all hypertensive patients, emphasizing the most error-prone demographics.
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Affiliation(s)
- Katarzyna Nessler
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Jagiellonian University Medical College, Bocheńska 4, 31-061 Kraków, Poland
| | - Anna Krztoń-Królewiecka
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Jagiellonian University Medical College, Bocheńska 4, 31-061 Kraków, Poland
| | - Anna Suska
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Students’ Family Medicine Interest Group, Jagiellonian University Medical College, Kraków, Poland
| | - Mitchell R. Mann
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Students’ Family Medicine Interest Group, Jagiellonian University Medical College, Kraków, Poland
| | - Michał B. Nessler
- Burns and Plastic Surgery Centre of Malopolska, Rydygier Memorial Hospital, Os. Zlotej Jesieni 1, 31-826 Kraków, PL Poland
| | - Adam Windak
- grid.5522.00000 0001 2162 9631Department of Family Medicine, Jagiellonian University Medical College, Bocheńska 4, 31-061 Kraków, Poland
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25
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Ihm SH, Park JH, Kim JY, Kim JH, Kim KI, Lee EM, Lee HY, Park S, Shin J, Kim CH. Home blood pressure monitoring: a position statement from the Korean Society of Hypertension Home Blood Pressure Forum. Clin Hypertens 2022; 28:38. [PMID: 36180964 PMCID: PMC9526300 DOI: 10.1186/s40885-022-00218-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Home blood pressure measurement (HBPM) has the advantage of measuring blood pressure (BP) multiple times over a long period. HBPM effectively diagnoses stress-induced transient BP elevations (i.e., white coat hypertension), insufficient BP control throughout the day (i.e., masked hypertension), and even BP variability. In most cases, HBPM may increase self-awareness of BP, increasing the compliance of treatment. Cumulative evidence has reported better improved predictive values of HBPM in cardiovascular morbidity and mortality than office BP monitoring. In this position paper, the Korean Society of Hypertension Home Blood Pressure Forum provides comprehensive information and clinical importance on HBPM.
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Affiliation(s)
- Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine and Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jang Young Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ju-Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kwang-Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital and Integrated Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Cheol-Ho Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Xia JH, Zhang DY, Kang YY, Guo QH, Cheng YB, Huang JF, Huang QF, Zhang W, Zhang LJ, Dou Y, Su YL, Liu HL, Zheng MS, Xu XJ, Mu JJ, Li Y, Wang JG. The prevalence of masked hypertension and masked uncontrolled hypertension in relation to overweight and obesity in a nationwide registry in China. Hypertens Res 2022; 45:1690-1700. [DOI: 10.1038/s41440-022-01005-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
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27
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Cansino S, Torres-Trejo F, Estrada-Manilla C, Mercado-Canales A, Medina-Velázquez D, Esquivel-García R, Ruiz-Velasco S. Effects of hypotension and hypertension on source memory and working memory. Aging Ment Health 2022; 26:1738-1746. [PMID: 34225518 DOI: 10.1080/13607863.2021.1942435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The effects of chronic low and high blood pressure on memory are unclear due to divergent results, originating in part due to participant misclassifications. The aim of this study was to compare source memory and working memory performance in individuals diagnosed with hypotension or hypertension with the performance of normotensive participants. Hypertensive and hypotensive individuals were receiving medical treatment. METHOD From a sample of 1656 participants, 219 were identified as hypertensive, and 37 were identified as hypotensive. Each of these two groups was compared with normotensive individuals matched by age, education and sex. Source memory performance and working memory performance were assessed through computerized tasks. RESULTS Source memory accuracy was poorer in hypotensive and hypertensive individuals than in normotensive individuals, and spatial working memory discrimination was inferior in hypertensive participants compared to normotensive individuals. CONCLUSION Blood pressure impairment should be considered a major concern because it has been linked to severe cardiovascular and cerebrovascular diseases. Furthermore, here we show that it has negative effects on the two types of memory that are most essential for preserving a self-sufficient lifestyle.
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Affiliation(s)
- Selene Cansino
- Laboratory of NeuroCognition, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Frine Torres-Trejo
- Laboratory of NeuroCognition, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Cinthya Estrada-Manilla
- Laboratory of NeuroCognition, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Andrés Mercado-Canales
- Laboratory of NeuroCognition, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Daniela Medina-Velázquez
- Laboratory of NeuroCognition, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ricardo Esquivel-García
- Laboratory of NeuroCognition, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Silvia Ruiz-Velasco
- Department of Probability and Statistics, Applied Mathematics and Systems Research Institute, National Autonomous University of Mexico, Mexico City, Mexico
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28
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Lin H, Pan H, Chen C, Cheng H, Chia Y, Sogunuru GP, Tay JC, Turana Y, Verma N, Kario K, Wang T. Standardized home blood pressure monitoring: Rationale behind the 722 protocol. J Clin Hypertens (Greenwich) 2022; 24:1161-1173. [PMID: 36196472 PMCID: PMC9532917 DOI: 10.1111/jch.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/07/2022]
Abstract
Home blood pressure (HBP) has been recognized as a prognostic predictor for cardiovascular events, and integrated into the diagnosis and management of hypertension. With increasing accessibility of oscillometric blood pressure devices, HBP monitoring is easy to perform, more likely to obtain reliable estimation of blood pressures, and feasible to document long-term blood pressure variations, compared to office and ambulatory blood pressures. To obtain reliable HBP estimates, a standardized HBP monitoring protocol is essential. A consensus regarding the optimal duration and frequency of HBP monitoring is yet to be established. Based on the current evidence, the "722" protocol, which stands for two measurements on one occasion, two occasions a day (morning and evening), and over a consecutive of 7 days, is most commonly used in clinical studies and recommended in relevant guidelines and consensus documents. HBP monitoring based on the "722" protocol fulfills the minimal requirement of blood pressure measurements to achieve agreement of blood pressure classifications defined by office blood pressures and to predict cardiovascular risks. In the Taiwan HBP consensus, the frequency of repeating the "722" protocol of HBP monitoring according to different scenarios of hypertension management, from every 2 weeks to 3 months, is recommended. It is reasonable to conclude that the "722" protocol for HBP monitoring is clinically justified and can serve as a basis for standardized HBP monitoring.
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Affiliation(s)
- Hung‐Ju Lin
- CardiovascularCenter and Division of Cardiology, Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Heng‐Yu Pan
- Department of Internal MedicineNational Taiwan University Hospital Yun‐Lin BranchYun‐Lin CountyTaiwan
| | - Chen‐Huan Chen
- Department of MedicineNational Yang Ming Chiao Tung University College of MedicineTaipeiTaiwan
- Department of Medical EducationTaipei Veterans General HospitalTaipeiTaiwan
| | - Hao‐Min Cheng
- Institute of Public Health and Community Medicine Research CenterNational Yang‐Ming University School of MedicineTaipeiTaiwan
- Department of MedicineDivision of CardiologyTaipei Veterans General HospitalTaipeiTaiwan
- Faculty of MedicineNational Yang‐Ming University School of MedicineTaipeiTaiwan
- Department of Medical EducationCenter for Evidence‐based MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Yook‐Chin Chia
- Department of Medical SciencesSchool of Medical and Life SciencesSunway UniversitySelangor Darul EhsanBandar SunwayMalaysia
- Department of Primary Care MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Guru Prasad Sogunuru
- Fortis HospitalsChennaiTamil NaduIndia
- College of Medical SciencesKathmandu UniversityBharatpurNepal
| | - Jam Chin Tay
- Department of General MedicineTan Tock Seng HospitalSingapore CitySingapore
| | - Yuda Turana
- Department of NeurologySchool of Medicine and Health SciencesAtma Jaya Catholic University of IndonesiaJakartaIndonesia
| | - Narsingh Verma
- Asia Pacific Society of HypertensionDepartment of PhysiologyKing George's Medical UniversityLucknowIndia
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineTochigiJapan
| | - Tzung‐Dau Wang
- Cardiovascular Center and Divisions of Cardiology and Hospital Medicine, Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipeiTaiwan
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Martens DS, Sleurs H, Dockx Y, Rasking L, Plusquin M, Nawrot TS. Association of Newborn Telomere Length With Blood Pressure in Childhood. JAMA Netw Open 2022; 5:e2225521. [PMID: 35930283 PMCID: PMC9356312 DOI: 10.1001/jamanetworkopen.2022.25521] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Adult telomere length (TL) is a biological marker of aging associated with vascular health. TL at birth is associated with later life TL and may contain early biological information of later life cardiovascular health and disease. OBJECTIVE To evaluate whether newborn TL is associated with early life blood pressure differences in childhood. DESIGN, SETTING, AND PARTICIPANTS This cohort study was part of the ENVIRONAGE (Environmental Influence on Aging in Early Life) study, a birth cohort of Belgian mother-child pairs with recruitment at birth and a median follow-up of 4.5 years conducted between October 2014 and July 2021. Participants included for analysis provided full data for evaluation at follow-up visit. Data analysis was conducted between August and September 2021. MAIN OUTCOMES AND MEASURES Cord blood and placental average relative TL were measured at birth using quantitative polymerase chain reaction (qPCR). Systolic, diastolic, and mean arterial pressure (MAP) were evaluated at follow-up. High childhood blood pressure (standardized for child age, sex, and height) was defined following the 2017 American Academy of Pediatrics guidelines. Multivariable adjusted linear and logistic regression models were used to associate newborn TL and blood pressure indicators in childhood. RESULTS This study included 485 newborn children (52.8% girls) with a mean (SD) age of 4.6 (0.4) years at the follow-up visit. Newborn TL was associated with lower blood pressure in childhood. A 1-IQR increase in cord blood TL was associated with a -1.54 mm Hg (95% CI, -2.36 to -0.72 mm Hg) lower diastolic blood pressure and -1.18 mm Hg (95% CI, -1.89 to -0.46 mm Hg) lower MAP. No association was observed with systolic blood pressure. Furthermore, a 1-IQR increase in cord blood TL was associated with lower odds of having high blood pressure at the age of 4 to 6 years (adjusted OR, 0.72; 95% CI, 0.53 to 0.98). In placenta, a 1-IQR increase in TL was associated with a -0.96 mm Hg (95% CI, -1.72 to -0.21 mm Hg) lower diastolic, -0.88 mm Hg (95% CI, -1.54 to -0.22 mm Hg) lower MAP, and a lower adjusted OR of 0.69 (95% CI, 0.52 to 0.92) for having a high blood pressure in childhood. CONCLUSIONS AND RELEVANCE In this prospective birth cohort study, variation in early life blood pressure at school-age was associated with TL at birth. Cardiovascular health may to some extent be programmed at birth, and these results suggest that TL entails a biological mechanism in this programming.
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Affiliation(s)
- Dries S. Martens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Hanne Sleurs
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Yinthe Dockx
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Leen Rasking
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tim S. Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Research Unit Environment and Health, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
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Hassanein M, Akbar MAJ, Al-Shamiri M, Amir A, Amod A, Chudleigh R, Elhadd T, Heshmat H, Jibani M, Al Saleh YM. Management of Diabetes and Hypertension within the Gulf Region: Updates on Treatment Practices and Therapies. Diabetes Ther 2022; 13:1253-1280. [PMID: 35679010 PMCID: PMC9178531 DOI: 10.1007/s13300-022-01282-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular disease (CVD) is a leading cause of death globally, driven by the high rates of risk factors, such as diabetes and hypertension. As the prevalence of these risk factors is particularly high in the Gulf region, better diagnosis and management of type 2 diabetes (T2D) and hypertension has the potential to dramatically reduce adverse cardiovascular outcomes for individuals in that part of the world. This article provides a summary of presentations made during the EVIDENT summit, a virtual symposium on Evidence in Diabetes and Hypertension, held in September 2021, including a review of the various guidelines for both T2D and hypertension, as well as recent findings relevant to the safety and efficacy for therapies relating to these conditions. Of relevance to the Gulf region, the risk of hypoglycaemia with sulfonylureas during Ramadan was reviewed. For the management of T2D, sulfonylureas have been a long-standing medication used to achieve glycaemic control; however, differences have emerged between early and later generations, with recent studies suggesting improvements in the safety profiles of late-generation sulfonylureas. For patients with hypertension, incremental therapy changes are recommended to reduce the risk of cardiovascular complications that are associated with increasing blood pressure. For first-line therapy, angiotensin-converting enzyme inhibitors (ACEi), such as perindopril, have been demonstrated to reduce the risk of cardiovascular and all-cause mortality. The addition of calcium channel blockers and diuretics to ACEi has been shown to be effective in patients with poorly controlled hypertension. The different renin-angiotensin-aldosterone system inhibitors are reviewed, and the benefit of combination therapies, including amlodipine and indapamide in patients with difficult-to-control hypertension, is investigated. The benefits of lifestyle modifications for these patients are also discussed, with important clinical considerations that are expected to inform patient management in daily clinical practice.
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Affiliation(s)
- Mohamed Hassanein
- Endocrine Department, Dubai Hospital/Dubai Health Authority, Alkhaleej Road, PO Box 7272, Dubai, United Arab Emirates.
- Gulf Medical University, Ajman, United Arab Emirates.
| | | | - Mostafa Al-Shamiri
- Cardiac Sciences Department, Medical College, King Saud University, Riyadh, Saudi Arabia
| | - Ashraf Amir
- International Medical Center Hospital (IMC), Jeddah, Saudi Arabia
| | - Aslam Amod
- Nelson R. Mandela School of Medicine & Life Chatsmed Garden Hospital, Durban, South Africa
| | | | | | - Hussien Heshmat
- Cardiology Department, Cairo University, Cairo, Egypt
- Fujairah Hospital Emirates Health Service, Fujairah, United Arab Emirates
| | | | - Yousef M Al Saleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 22490, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, 11481, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Ministry of National Gurad Health Affairs, Riyadh, 14611, Saudi Arabia
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Chi NF, Chung CP, Cheng HM, Liu CH, Lin CJ, Hsu LC, Tang SC, Lee JT, Po HL, Jeng JS, Wang TD, Lee IH. 2021 Taiwan Stroke Society Guidelines of blood pressure control for ischemic stroke prevention. J Chin Med Assoc 2022; 85:651-664. [PMID: 35507097 DOI: 10.1097/jcma.0000000000000738] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Since the publication of the 2015 Taiwan Stroke Society Blood Pressure for Treatment and Prevention of Stroke Guideline (2015 TSS BP Guideline), several new clinical studies have addressed whether a stricter blood pressure (BP) target would be effective for stroke prevention. METHODS TSS guideline consensus group provides recommendations on BP targets for stroke prevention based on updated evidences. RESULTS The present guideline covers five topics: (1) diagnosis of hypertension; (2) BP control and primary prevention of ischemic stroke; (3) BP control and secondary prevention of ischemic stroke; (4) BP control and secondary prevention of large artery atherosclerosis ischemic stroke; and (5) BP control and secondary prevention of small vessel occlusion ischemic stroke. CONCLUSION The BP target for most stroke patients with hypertension is <130/80 mm Hg.
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Affiliation(s)
- Nai-Fang Chi
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Chih-Ping Chung
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Hao-Ming Cheng
- Center for Evidence-based Medicine & Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
- Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Chi-Hung Liu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan, ROC
| | - Chun-Jen Lin
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Li-Chi Hsu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
| | - Sung-Chun Tang
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Helen L Po
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Jiann-Shing Jeng
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Tzung-Dau Wang
- Department of Cardiology, National Taiwan University, Taipei, Taiwan, ROC
| | - I-Hui Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Neurology in School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan, ROC
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Chaix B, Bista S, Wang L, Benmarhnia T, Dureau C, Duncan DT. MobiliSense cohort study protocol: do air pollution and noise exposure related to transport behaviour have short-term and longer-term health effects in Paris, France? BMJ Open 2022; 12:e048706. [PMID: 35361634 PMCID: PMC8971765 DOI: 10.1136/bmjopen-2021-048706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION MobiliSense explores effects of air pollution and noise related to personal transport habits on respiratory and cardiovascular health. Its objectives are to quantify the contribution of personal transport/mobility to air pollution and noise exposures of individuals; to compare exposures in different transport modes; and to investigate whether total and transport-related personal exposures are associated with short-term and longer-term changes in respiratory and cardiovascular health. METHODS AND ANALYSIS MobiliSense uses sensors of location, behaviour, environmental nuisances and health in 290 census-sampled participants followed-up after 1/2 years with an identical sensor-based strategy. It addresses knowledge gaps by: (1) assessing transport behaviour over 6 days with GPS receivers and GPS-based mobility surveys; (2) considering personal exposures to both air pollution and noise and improving their characterisation (inhaled doses, noise frequency components, etc); (3) measuring respiratory and cardiovascular outcomes (smartphone-assessed respiratory symptoms, lung function with spirometry, resting blood pressure, ambulatory brachial/central blood pressure, arterial stiffness and heart rate variability) and (4) investigating short-term and longer-term (over 1-2 years) effects of transport. ETHICS AND DISSEMINATION The sampling and data collection protocol was approved by the National Council for Statistical Information, the French Data Protection Authority and the Ethical Committee of Inserm. Our final aim is to determine, for communicating with policy-makers, how scenarios of changes in personal transport behaviour affect individual exposure and health.
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Affiliation(s)
- Basile Chaix
- Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Nemesis team, INSERM, Paris, France
| | - Sanjeev Bista
- Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Nemesis team, INSERM, Paris, France
| | - Limin Wang
- Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Nemesis team, INSERM, Paris, France
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
| | - Clélie Dureau
- Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, Nemesis team, INSERM, Paris, France
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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Nassar M, Nso N, Lakhdar S, Kondaveeti R, Buttar C, Bhangoo H, Awad M, Sheikh NS, Soliman KM, Munira MS, Radparvar F, Rizzo V, Daoud A. New onset hypertension after transplantation. World J Transplant 2022; 12:42-54. [PMID: 35433331 PMCID: PMC8968475 DOI: 10.5500/wjt.v12.i3.42] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/14/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
It has been reported that up to 90% of organ transplant recipients have suboptimal blood pressure control. Uncontrolled hypertension is a well-known culprit of cardiovascular and overall morbidity and mortality. In addition, rigorous control of hypertension after organ transplantation is a crucial factor in prolonging graft survival. Nevertheless, hypertension after organ transplantation encompasses a broader range of causes than those identified in non-organ transplant patients. Hence, specific management awareness of those factors is mandated. An in-depth understanding of hypertension after organ transplantation remains a debatable issue that necessitates further clarification. This article provides a comprehensive review of the prevalence, risk factors, etiology, complications, prevention, and management of hypertension after organ transplantation.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Sofia Lakhdar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Ravali Kondaveeti
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Chandan Buttar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Harangad Bhangoo
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Mahmoud Awad
- Department of Medicine, The Memorial Souad Kafafi University Hospital, 6th of October - Giza 0000, Egypt
| | - Naveen Siddique Sheikh
- Department of Physiology, CMH Lahore Medical College and Institute of Dentistry, Lahore - Punjab 0000, Pakistan
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Most Sirajum Munira
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Farshid Radparvar
- Division of Cardiology, Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11211, Egypt
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Association between urinary sodium-to-potassium ratio and home blood pressure and ambulatory blood pressure: the Ohasama study. J Hypertens 2022; 40:862-869. [PMID: 35165245 DOI: 10.1097/hjh.0000000000003087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE No studies have demonstrated the association between urinary sodium-to-potassium (Na/K) ratio and all out-of-office blood pressure (BP) [home morning and evening BP (self-measured at home), and 24-h, daytime, and night-time ambulatory BP] in the same cohort. We aimed to assess, which type of out-of-office BP is more strongly associated with urinary Na/K ratio in the general population. METHODS This cross-sectional study was conducted in the general population of Ohasama, Japan. Home and ambulatory BP levels were measured, and 24-h urine samples were obtained from 875 participants (men, 25.5%; mean age, 60.1 years). The urinary Na/K ratio in the 24-h urine samples was calculated. RESULTS The median (interquartile range) urinary Na/K ratio was 4.19 (3.36-5.26). Significant positive trends of home morning, home evening, 24-h, and daytime SBP were observed across quartiles of urinary Na/K ratio (trend P ≤ 0.041; adjusted mean values between Q1 and Q4 of urinary Na/K ratio: 121.0-125.5 mmHg for home morning, 120.1-123.8 mmHg for home evening, 121.6-123.4 mmHg for 24-h, 127.5-129.5 mmHg for daytime). Urinary Na/K ratio was not significantly associated with office or night-time SBP and nocturnal BP fall (trend P ≥ 0.13). In the model with both home morning or evening SBP and daytime SBP, only home SBP was significantly associated with urinary Na/K ratio (P ≤ 0.048 for home SBP). CONCLUSION These findings suggest that urinary Na/K ratio might be more strongly associated with home BP than with 24-h and daytime BP but was not associated with night-time BP.
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Peeters LEJ, van Oortmerssen JAE, Derks LH, den Hertog H, Fonville S, Verboon C, Rietdijk WJR, Boersma E, Koudstaal PJ, van den Meiracker AH, Versmissen J. Comparison of automated office blood pressure measurement with 24-hour ambulatory blood pressure measurement. Blood Press 2022; 31:9-18. [PMID: 35037533 DOI: 10.1080/08037051.2021.2013115] [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: 11/02/2022]
Abstract
PURPOSE Although 24-hour ambulatory blood pressure measurement (24-h ABPM) is the most important method to establish true hypertension, in clinical practice often repeated automated office blood pressure (AOBP) measurements are used because of convenience and lower costs. We aimed to assess the agreement rate between a 30 and 60 min AOBP and 24-h ABPM. MATERIALS AND METHODS Patients with known hypertension (cohort 1) and patients visiting the neurology outpatient clinic after minor stroke or transient ischaemic attack (cohort 2) were selected. We performed AOBP for 30-60 min at 5-min intervals followed by 24-h ABPM and calculated average values of both measurements. Agreement between the two methods was studied with McNemar and Bland-Altman plots with a clinically relevant limit of agreement of ≤10 mm Hg difference in systolic BP. RESULTS Our final cohort consisted of 135 patients from cohort 1 and 72 patients from cohort 2. We found relatively low agreement based on the clinical relevant cut-off value; 64.7% of the measurements were within the limits of agreement for 24-h systolic and 50.2% for 24-h diastolic. This was 61.4% for daytime systolic and 56.6% for daytime diastolic. In 73.5% of the patients, both methods led to the same diagnosis of either being hypertensive or non-hypertensive. This resulted in a significant difference between the methods to determine the diagnosis of hypertension (p < 0.0001). CONCLUSION We conclude that 30-60 min AOBP measurements cannot replace a 24-h ABPM and propose to perform 24-h ABPM at least on a yearly basis to confirm AOBP measurements.
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Affiliation(s)
- Laura E J Peeters
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Lieke H Derks
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Susanne Fonville
- Department of Neurology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Neurology, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Wim J R Rietdijk
- Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Peter J Koudstaal
- Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Jorie Versmissen
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Iatridi F, Theodorakopoulou MP, Karpetas A, Bikos A, Karagiannidis AG, Alexandrou ME, Tsouchnikas I, Mayer CC, Haidich AB, Papagianni A, Parati G, Sarafidis PA. Association of peridialytic, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events in hemodialysis patients. J Nephrol 2022; 35:943-954. [PMID: 34988941 DOI: 10.1007/s40620-021-01205-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ambulatory-BP-monitoring (ABPM) is recommended for hypertension diagnosis and management in hemodialysis patients due to its strong association with outcomes. Intradialytic and scheduled interdialytic BP recordings show agreement with ambulatory BP. This study assesses in parallel the association of pre-dialysis, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events. METHODS We prospectively followed 242 hemodialysis patients with valid 48-h ABPMs for a median of 45.7 months to examine the association of pre-dialysis, intradialytic, intradialytic plus pre/post-dialysis readings, scheduled interdialytic BP, and 44-h ambulatory BP with outcomes. The primary end-point was a composite one, composed of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary revascularization procedure or peripheral revascularization procedure. RESULTS Cumulative freedom from the primary end-point was significantly lower with increasing 44-h SBP (group 1, < 120 mmHg, 64.2%; group 2, ≥ 120 to < 130 mmHg 60.4%, group 3, ≥ 130 to < 140 mmHg 45.3%; group 4, ≥ 140 mmHg 45.5%; logrank-p = 0.016). Similar were the results for intradialytic (logrank-p = 0.039), intradialytic plus pre/post-dialysis (logrank-p = 0.044), and scheduled interdialytic SBP (logrank-p = 0.030), but not for pre-dialysis SBP (logrank-p = 0.570). Considering group 1 as the reference group, the hazard ratios of the primary end-point showed a gradual increase with higher BP levels with all BP metrics, except pre-dialysis SBP. This pattern was confirmed in adjusted analyses. An inverse association of DBP levels with outcomes was shown with all BP metrics, which was no longer evident in adjusted analyses. CONCLUSIONS Averaged intradialytic and scheduled home BP measurements (but not pre-dialysis readings) display similar prognostic associations with 44-h ambulatory BP in hemodialysis patients and represent valid metrics for hypertension management in these individuals.
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Affiliation(s)
- Fotini Iatridi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | | | | | - Artemios G Karagiannidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Maria-Eleni Alexandrou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Ioannis Tsouchnikas
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Christopher C Mayer
- Center for Health and Bioresources, Biomedical Systems, Austrian Institute of Technology, Vienna, Austria
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventative Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pantelis A Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
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Elsahoryi NA, Cardwell C, Gilchrist S, Woodside JV. Effect of high nitrate vegetable juice supplementation on plasma nitrate and blood pressure in adults: a pilot randomized crossover intervention in healthy volunteers. J Nutr Sci 2022; 11:e41. [PMID: 35720170 PMCID: PMC9171594 DOI: 10.1017/jns.2022.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/14/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Beetroot juice (BRJ) has been demonstrated to decrease blood pressure (BP) due to the high inorganic nitrate content. This pilot randomized crossover trial aimed to investigate the effect of two different high nitrate vegetable juices on plasma nitrate concentrations and BP in healthy adults. Eighteen healthy volunteers were randomized to receive 115 ml of BRJ or 250 ml of green leafy vegetable juice for 7 d which contained similar amounts of nitrate (340 mg) daily. Blood samples were collected, and clinic BP measured at baseline and at the end of each juice consumption. Daily home BP assessment was conducted 2 h after juice consumption. Nitrate and nitrite concentrations were analysed using a commercially available kit on a Triturus automated ELISA analyser. Hills and Armitage analysis was used for the two-period crossover design and paired sample t-tests were performed to compare within-group changes. Plasma nitrate and nitrite concentrations significantly increased and there was a significant reduction in clinic and home systolic blood pressure (SBP) mean during the BRJ period (P-values 0⋅004 and 0⋅002, respectively). Home diastolic blood pressure (DBP) reduced significantly during green leafy vegetable juice consumption week (P-value 0⋅03). The difference between groups did not reach statistical significance during the formal crossover analysis adjusted for period effects. BRJ and green leafy vegetable juice may reduce SBP or DBP, but there was no statistically significant difference between the two juices, although this was only a pilot study.
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Affiliation(s)
- Nour A. Elsahoryi
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
- Department of Nutrition, Faculty of Pharmacy & Medical Sciences, University of Petra, Amman, Jordan
- Corresponding author: Nour A. Elsahoryi, email
| | - Christopher Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Sarah Gilchrist
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Jayne V. Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
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38
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Liang C, Wang J, Feng M, Zhang N, Guo L. White matter changes, duration of hypertension, and age are associated with cerebral microbleeds in patients with different stages of hypertension. Quant Imaging Med Surg 2022; 12:119-130. [PMID: 34993065 DOI: 10.21037/qims-21-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/31/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND We aimed to investigate risk factors for the presence and number of cerebral microbleeds (CMBs) in patients with different stages of hypertension stages, with an emphasis on the relationship between white matter changes (WMCs) and CMBs. METHODS Since 2016, participants aged 40 years or more have been evaluated for the presence of CMBs using enhanced 3D multiecho GE T2*-weighted angiography (ESWAN) sequences. The Mann-Whitney U test and Pearson χ2 test were used to compare the clinical characteristics between the CMB and no-CMB patient groups. Furthermore, we used Spearman's rank correlation analysis to examine the associations between the degree of CMB severity and other important factors. RESULTS CMBs were detected in 110 (36.7%) of 300 participants. Among patients with stage 2 hypertension, the majority also had CMBs (61.8%, 68/110). CMBs were positively correlated with age, hypertension stage, duration of hypertension, WMCs, and silent cerebral infarction. Patients with grade 3 WMCs were significantly more likely to have CMBs than those without WMCs; this association was true for both patients with stage 1 and those with stage 2 hypertension. In patients with stage 1 or stage 2 hypertension lasting longer than 20 years, the majority had CMBs (69.0%, 29/42; 69.1%, 47/68). The results of binary logistic regression indicated that a more severe hypertension stage, longer duration of hypertension, aging, having silent cerebral infarction and higher values of WMC increase the likelihood of the occurrence of CMBs. CONCLUSIONS CMBs detected in hypertensive patients were more likely to occur in deep structures, and the grade of WMCs and duration of hypertension were more closely associated with the CMB degree than with age.
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Affiliation(s)
- Changhu Liang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Mengmeng Feng
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Nan Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Lingfei Guo
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Citoni B, Figliuzzi I, Presta V, Volpe M, Tocci G. Home Blood Pressure and Telemedicine: A Modern Approach for Managing Hypertension During and After COVID-19 Pandemic. High Blood Press Cardiovasc Prev 2022; 29:1-14. [PMID: 34855154 PMCID: PMC8638231 DOI: 10.1007/s40292-021-00492-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/18/2021] [Indexed: 01/08/2023] Open
Abstract
Hypertension is the most common cardiovascular risk factor for acute cardiovascular outcomes, including acute coronary disease, stroke, chronic kidney disease and congestive heart failure. Despite the fact that it represents the most prevalent risk factor in the general population, mostly in elderly individuals, its awareness is still relatively low, being about one third of patients living with undiagnosed hypertension and high risk of experiencing acute cardiovascular events. In addition, though recent improvement in pharmacological and non-pharmacological therapeutic options, hypertension is largely uncontrolled, with about 35-40% of treated hypertensive patients achieving the recommended therapeutic targets. Among different modern interventions proposed for improving blood pressure control in treated hypertensive patients, a systematic adoption of home BP monitoring has demonstrated to be one of the most effective. Indeed, it improves patients' awareness of the disease and adherence to prescribed medications and allows tailoring and personalizing BP lowering therapies. Home BP monitoring is particularly suitable for telemedicine and mobile-health solutions. Indeed, in specific conditions, when face-to-face interactions between patients and physicians are not allowed or even suspended, as in case of COVID-19 pandemic, telemedicine may ensure effective management of hypertension, as well as other cardiovascular and non-cardiovascular comorbidities. This review will summarize strengths and limitations of telemedicine in the clinical management of hypertension with a particular focus on the lessons learned during the COVID-19 pandemic.
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Affiliation(s)
- Barbara Citoni
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Ilaria Figliuzzi
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Vivianne Presta
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy.
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Anbarasan T, Rogers A, Rorie DA, Kerr Grieve JW, MacDonald TM, Mackenzie IS. Home blood pressure monitors owned by participants in a large decentralised clinical trial in hypertension: the Treatment In Morning versus Evening (TIME) study. J Hum Hypertens 2022; 36:32-39. [PMID: 33589759 PMCID: PMC8766290 DOI: 10.1038/s41371-021-00496-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 01/31/2023]
Abstract
Various home blood pressure monitors (HBPMs) are available to the public for purchase but only some are validated against standardised protocols. This study aimed to assess whether HBPMs owned by participants taking part in a clinical trial were validated models. The TIME study is a decentralised randomised trial investigating the effect of antihypertensive medication dosing time on cardiovascular outcomes in adults with hypertension. No HBPMs were provided to participants in this trial but patients were asked to report if they already owned one. We identified the model of HBPM reported by participants, then cross-referenced this against lists of validated HBPMs produced by dabl Educational Trust and the British and Irish Hypertension Society (BIHS). Of 21,104 participants, 10,464 (49.6%) reported their model of HBPM. 7464 (71.3%) of these participants owned a monitor that could be identified from the participants' entry. Of these, 6066 (81.3%) participants owned a monitor listed as validated by either dabl (n = 5903) or BIHS (n = 5491). Some were listed as validated by both. 1398 (18.7%) participants owned an identifiable HBPM that lacked clear evidence of validation. 6963 (93.3%) participants owned an upper arm HBPM and 501 (6.7%) owned a wrist HBPM. Validated HBPMs had a higher median online retail price of £45.00 compared to £20.00 for HBPMs lacking clear evidence of validation. A significant number of participants own HBPMs lacking evidence of validation.
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Affiliation(s)
| | - Amy Rogers
- grid.8241.f0000 0004 0397 2876Clinical Research Fellow, University of Dundee, Dundee, UK
| | - David A. Rorie
- grid.8241.f0000 0004 0397 2876Senior Software Developer, University of Dundee, Dundee, UK
| | - J. W. Kerr Grieve
- grid.8241.f0000 0004 0397 2876Clinical Research Fellow, University of Dundee, Dundee, UK
| | - Thomas M. MacDonald
- grid.8241.f0000 0004 0397 2876Professor of Clinical Pharmacology and Pharmacoepidemiology, University of Dundee, Dundee, UK
| | - Isla S. Mackenzie
- grid.8241.f0000 0004 0397 2876Professor of Cardiovascular Medicine, MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
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Nessler K, Krztoń-Królewiecka A, Suska A, Mann MR, Nessler MB, Windak A. The quality of patients' self-blood pressure measurements: a cross-sectional study. BMC Cardiovasc Disord 2021; 21:539. [PMID: 34772348 PMCID: PMC8588592 DOI: 10.1186/s12872-021-02351-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The accurate and independent measurement of blood pressure (BP) by patients is essential for home BP monitoring (HBPM) and determining the quality of hypertension (HTN) control. This study aimed to evaluate the BP self-measurement techniques of hypertensive patients and their accuracy in accordance with established guidelines. We sought to identify the common errors that patients make and suggest improvements that can be implemented in the primary healthcare setting to increase the reliability of HBPM conducted by hypertensive patients. METHODS One hundred patients diagnosed with HTN completed a questionnaire inquiring about their health and demographic data and BP monitoring practices. Patients were then observed and filmed while measuring their BP on their own devices in five primary healthcare centres in Kraków, Poland. The correctness of their techniques was assessed in accordance with the European Society of Hypertension guidelines on HBPM. RESULTS Only 3% of patients measured their BP without error; 60% made three or more errors. The most frequent error, made by 76% of subjects, was incorrect sphygmomanometer cuff placement (above or below heart level, or/and the indicator mark was not aligned with the brachial artery). Regarding patients' previous instruction for the correct use of their devices, 36% of patients referred to their monitor's user manual, 22% did not receive any prior assistance, and only 29% were adequately counselled by physicians on how to measure their BP correctly. CONCLUSIONS Our findings suggest that primary healthcare physicians and their personnel often do not adequately instruct patients on how to measure their BP correctly. Therefore, healthcare systems must provide patients with more adequate training and reference materials on the best practices of BP monitoring.
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Affiliation(s)
- Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, Bocheńska 4, 31-061, Kraków, Poland.
| | - Anna Krztoń-Królewiecka
- Department of Family Medicine, Jagiellonian University Medical College, Bocheńska 4, 31-061, Kraków, Poland
| | - Anna Suska
- Department of Family Medicine, Students' Family Medicine Interest Group, Jagiellonian University Medical College, Kraków, Poland
| | - Mitchell R Mann
- Department of Family Medicine, Students' Family Medicine Interest Group, Jagiellonian University Medical College, Kraków, Poland
| | - Michał B Nessler
- Burns and Plastic Surgery Centre of Malopolska, Burns and Plastic Surgery Centre of Malopolska, Rydygier Memorial Hospital, Rydygier Memorial Hospital, Os. Zlotej Jesieni 1, 31-826, Kraków, Poland
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Bocheńska 4, 31-061, Kraków, Poland
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Ernst B, Su S, Treiber F, Snieder H, Wang X. Diurnal Cortisol Slope and Nighttime Blood Pressure: A Study in European Americans and African Americans. Ethn Dis 2021; 31:481-488. [PMID: 34720551 DOI: 10.18865/ed.31.4.481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives African Americans (AAs) have higher nighttime blood pressure (BP) than European Americans (EAs). Stress has been suggested to play a role in this difference, but the mechanism is not well-understood. Flatter diurnal cortisol slope (DCS) is a well-known biological marker of stress. The objectives of this study were to: 1) examine ethnic differences in DCS; 2) evaluate the association between DCS and nighttime BP; and 3) determine the extent to which ethnic differences in nighttime BP can be explained by ethnic differences in DCS. Methods A total of 510 participants (age range: 14-35 years; 49.6% AAs, 54.5% females) provided four salivary cortisol samples at bedtime, wakeup, 30-minutes post-wakeup, and 60-minutes post-wakeup. Additionally, participants wore an ambulatory BP monitor for 24 hours. DCS was calculated as the average of the three morning samples minus the bedtime measurement. Results After adjustment for age, sex, BMI, and smoking, AAs had blunted DCS (P=.018) and higher nighttime systolic BP (SBP) and diastolic BP (DBP) (Ps<.001) compared with EAs. The DCS was inversely related to nighttime SBP and this relationship did not depend on ethnicity. The ethnic difference of nighttime SBP was significantly attenuated upon addition of DCS to the model. Mediation test showed that 9.5% of ethnic difference in nighttime SBP could be explained by DCS (P=.039). Conclusion This study confirms ethnic differences in DCS and nighttime BP and further demonstrates that the ethnic differences in DCS can, at least partially, explain the ethnic differences found in nighttime BP.
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Affiliation(s)
- Brooke Ernst
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Shaoyong Su
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Frank Treiber
- College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Harold Snieder
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Xiaoling Wang
- Georgia Prevention Institute, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
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43
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Malachias MVB. The New Paradigm of Blood Pressure Measurement. Arq Bras Cardiol 2021; 117:528-530. [PMID: 34550238 PMCID: PMC8462964 DOI: 10.36660/abc.20210592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marcus Vinicius Bolivar Malachias
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil.,Instituto de Hipertensão Arterial - Diretoria Clínica, Belo Horizonte, MG - Brasil
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Parati G, Stergiou GS, Bilo G, Kollias A, Pengo M, Ochoa JE, Agarwal R, Asayama K, Asmar R, Burnier M, De La Sierra A, Giannattasio C, Gosse P, Head G, Hoshide S, Imai Y, Kario K, Li Y, Manios E, Mant J, McManus RJ, Mengden T, Mihailidou AS, Muntner P, Myers M, Niiranen T, Ntineri A, O’Brien E, Octavio JA, Ohkubo T, Omboni S, Padfield P, Palatini P, Pellegrini D, Postel-Vinay N, Ramirez AJ, Sharman JE, Shennan A, Silva E, Topouchian J, Torlasco C, Wang JG, Weber MA, Whelton PK, White WB, Mancia G. Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension. J Hypertens 2021; 39:1742-1767. [PMID: 34269334 PMCID: PMC9904446 DOI: 10.1097/hjh.0000000000002922] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023]
Abstract
The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - George S. Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Martino Pengo
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | | | - Michel Burnier
- Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland
| | - Alejandro De La Sierra
- Hypertension Unit, Department of Internal Medicine, Hospital Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Cristina Giannattasio
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Cardiology IV, ‘A. De Gasperis” Department, ASTT GOM Niguarda Ca’ Granda
| | - Philippe Gosse
- Cardiology/Hypertension Unit Saint André Hospital. University Hospital of Borfeaux, France
| | - Geoffrey Head
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yutaka Imai
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yan Li
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Alexandra Hospital, Athens, Greece
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Thomas Mengden
- Kerckhoff Clinic, Rehabilitation, ESH Excellence Centre, Bad Nauheim, Germany
| | - Anastasia S. Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital, St Leonards Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Paul Muntner
- Hypertension Research Center, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Martin Myers
- Schulich Heart Program, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, Canada
| | - Teemu Niiranen
- Department of Medicine, Turku University Hospital and University of Turku
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - José Andres Octavio
- Experimental Cardiology, Department of Tropical Medicine Institute, Universidad Central de Venezuela, Venezuela
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Tohoku Institute for the Management of Blood Pressure, Sendai, Japan
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Paul Padfield
- Department of Medical Sciences, University of Edinburgh, Edinburgh, UK
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine. University of Padova, Padua
| | - Dario Pellegrini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Agustin J. Ramirez
- Arterial Hypertension and Metabolic Unit, University Hospital, Fundacion Favaloro, Argentina
| | - James E. Sharman
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Andrew Shennan
- Department of Women and Children's Health, School of Life Course Sciences, FoLSM, Kings College London, UK
| | - Egle Silva
- Research Institute of Cardiovascular Diseases of the University of Zulia, Venezuelan Foundation of Arterial Hypertension. Maracaibo, Venezuela
| | - Jirar Topouchian
- Diagnosis and Therapeutic Center, Paris-Descartes University, AP-HP, Hotel Dieu, Paris, France
| | - Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Department of Cardiovascular Neural and Metabolic Sciences
| | - Ji Guang Wang
- Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Michael A. Weber
- Division of Cardiovascular Medicine, Downstate College of Medicine, State University of New York, Brooklyn, New York, USA
| | - Paul K. Whelton
- Department of Epidemiology, Tulane University, School of Public Health and Tropical Medicine, New Orleans, Lousiana
| | - William B. White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Tomitani N, Kanegae H, Kario K. Reproducibility of nighttime home blood pressure measured by a wrist-type nocturnal home blood pressure monitoring device. J Clin Hypertens (Greenwich) 2021; 23:1872-1878. [PMID: 34418278 PMCID: PMC8678720 DOI: 10.1111/jch.14342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 01/05/2023]
Abstract
The authors investigated the reproducibility of nighttime home blood pressure (BP) measured by a wrist-type BP monitoring device. Forty-six hypertensive patients (mean 69.0±11.6 years, 56.5% male) self-measured their nighttime BP hourly using simultaneously worn wrist-type and upper arm-type nocturnal home BP monitoring devices at home on two consecutive nights. Using the average 7.4±1.3 measurements on the first night and the average 7.0 ± 1.8 measurements on the second night, the authors assessed the reliability and the reproducibility of nighttime BP measured on the two nights. The difference between nights in systolic BP (SBP) measured by the wrist-device was not significant (1.6±7.0 mmHg, p = .124), while the difference in diastolic BP (DBP) was marginally significant (1.4±4.9 mmHg, p = .050). The intraclass correlation coefficients (ICCs) for agreement between nights were high both in SBP and DBP average (SBP: 0.835, DBP: 0.804). Averaging only three points of SBP resulted in lower ICC values, but still indicated good correlations (ICC > 0.6). On the other hand, the correlations of the standard deviation and average real variability of SBP between nights were low, with ICCs of 0.220 and 0.436, respectively. In conclusion, the average SBP values measured on the first night were reliable even when averaging only three readings. The reproducibility of nighttime BP variability seemed inferior to that of BP average; it might be better to measure nighttime BP over multiple nights to assess BP variability. However, this hypothesis needs verification in other study population. In addition, our study population had well-controlled BP, which limits the generalizability of this findings to all hypertensive patients.
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Affiliation(s)
- Naoko Tomitani
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hiroshi Kanegae
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Genki Plaza Medical Center for Health Care, Tokyo, Japan
| | - Kazuomi Kario
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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Dalfó Pibernat A, García Millán R, Dalfó Pibernat E. Approach of pre-eclampsia: importance of home blood pressure monitoring and Ambulatory blood pressure monitoring in the early detection. Int Nurs Rev 2021; 68:138. [PMID: 33891769 DOI: 10.1111/inr.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kario K. Home Blood Pressure Monitoring: Current Status and New Developments. Am J Hypertens 2021; 34:783-794. [PMID: 34431500 PMCID: PMC8385573 DOI: 10.1093/ajh/hpab017] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/18/2020] [Accepted: 01/26/2021] [Indexed: 12/22/2022] Open
Abstract
Home blood pressure monitoring (HBPM) is a reliable, convenient, and less costly alternative to ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension. Recognition and use of HBPM have dramatically increased over the last 20 years and current guidelines make strong recommendations for the use of both HBPM and ABPM in patients with hypertension. The accuracy and reliability of home blood pressure (BP) measurements require use of a validated device and standardized procedures, and good patient information and training. Key HBPM parameters include morning BP, evening BP, and the morning-evening difference. In addition, newer semi-automatic HBPM devices can also measure nighttime BP at fixed intervals during sleep. Advances in technology mean that HBPM devices could provide additional relevant data (e.g., environmental conditions) or determine BP in response to a specific trigger (e.g., hypoxia, increased heart rate). The value of HBPM is highlighted by a growing body of evidence showing that home BP is an important predictor of target organ damage, and cardiovascular disease (CVD)- and stroke-related morbidity and mortality, and provides better prognostic information than office BP. In addition, use of HBPM to monitor antihypertensive therapy can help to optimize reductions in BP, improve BP control, and reduce target organ damage and cardiovascular risk. Overall, HBPM should play a central role in the management of patients with hypertension, with the goal of identifying increased risk and predicting the onset of CVD events, allowing proactive interventions to reduce risk and eliminate adverse outcomes.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
- The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tokyo, Japan
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Silva-Filho E, Albuquerque J, Bikson M, Pegado R, da Cruz Santos A, do Socorro Brasileiro-Santos M. Effects of transcranial direct current stimulation associated with an aerobic exercise bout on blood pressure and autonomic modulation of hypertensive patients: A pilot randomized clinical trial. Auton Neurosci 2021; 235:102866. [PMID: 34380099 DOI: 10.1016/j.autneu.2021.102866] [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: 03/20/2021] [Revised: 06/16/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
The objective of this article was to evaluate the effects of an aerobic exercise bout associated with a single session of anodal transcranial direct current stimulation (tDCS) over the left temporal lobe on blood pressure (BP) and heart rate variability (HRV) in hypertensive people. After met the inclusion criteria, twenty hypertensive people were randomized to active-tDCS or sham-tDCS group. Initially, they provided their sociodemographic data, a blood sample, and went through an evaluation of the cardiorespiratory performance. Then, a single session of tDCS with an intensity of 2 mA over the left lobe during 20 min was carried out. After tDCS, it was performed a session of moderate-intensity aerobic exercise during 40 min. BP during 24 h and HRV measurements were performed before (baseline) and after the intervention. Systolic BP during sleep time decreased in the active-tDCS group (p = 0.008). Diastolic BP showed a significant decrease 3 h after the intervention in the active-tDCS group (p = 0.01). An intragroup comparison showed a significant decrease in systolic BP 3 h after intervention only for the active-tDCS group (p = 0.04). Besides, there was a trend toward a difference in wake for diastolic BP for active-tDCS (p = 0.07). Lastly, there were no changes in the HRV for both groups. It is suggested that anodal tDCS associated with moderate-intensity aerobic exercise can decrease systolic and diastolic BP of hypertensive people during sleep time and 3 h after the intervention.
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Affiliation(s)
- Edson Silva-Filho
- Associated Postgraduate Program in Physical Education, Federal University of Paraíba, João Pessoa, Paraíba, Brazil.
| | - Jéssica Albuquerque
- Department of Social Psychology, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, New York, USA
| | - Rodrigo Pegado
- Postgraduate Program in Rehabilitation Sciences, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Amilton da Cruz Santos
- Associated graduate Program in Physical Education, Federal University of Paraíba, João Pessoa, Paraíba, Brazil
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Deutsch C, Bramlage C, Botta B, Krüger R, Forstner K, Bramlage P, Beime B. Validation of the blood pressure measurement device Beurer BM 28 according to the European Society of Hypertension International Protocol revision 2010. Blood Press Monit 2021; 26:292-298. [PMID: 33741775 DOI: 10.1097/mbp.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of the present study was to validate the blood pressure (BP) monitor Beurer BM 28 according to the International Protocol of the European Society of Hypertension (ESH-IP) revision 2010. METHODS In 33 subjects of age 27-81 years, BP measurements were performed according to the ESH-IP protocol, which alternates reference mercury sphygmomanometer and device-under-test (Beurer BM 28) measurements, resulting in a total of 99 comparisons. RESULTS As to part 1 of the protocol, an absolute difference within 5 mmHg between the Beurer BM 28 and the test device was found in 83 out of 99 comparisons for the SBP and 82 out of 99 comparisons for the DBP. In 95 out of 99 SBP comparisons and 96 out of 99 DBP comparisons, the difference was found to be within 10 mmHg, whereas only one outlier was noted with an SBP difference higher than 15 mmHg. Mean difference between the test device and the reference was 0.4 ± 4.4 mmHg for SBP, and 0.5 ± 4.3 mmHg for DBP. According to part 2 of the protocol, 30 out of 33 subjects for SBP, and 28 out of 33 for DBP had a minimum of two out of three comparisons staying within the range of 5 mmHg. In none of the subjects, all three comparisons stayed outside the 5 mmHg absolute difference, while in three subjects this was the case for the DBP. CONCLUSION The Beurer BM 28 met all requirements of the ESH-IP revision 2010 and can be recommended for BP measurements in the study population under investigation.
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Affiliation(s)
| | | | - Beate Botta
- Institute for Pharmacology and Preventive Medicine, Cloppenburg
| | - Ralf Krüger
- Institute for Pharmacology and Preventive Medicine, Cloppenburg
| | - Klaus Forstner
- Forschungsinstitut für klinische Medizintechnik (FIMT), Asperg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg
| | - Beate Beime
- Institute for Pharmacology and Preventive Medicine, Cloppenburg
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Affiliation(s)
- Teck K Khong
- Clinical Pharmacology, St George's, University of London, London, UK
| | - Henry Fok
- Clinical Pharmacology, St George's, University of London, London, UK.,Clinical Pharmacology, King's College British Heart Foundation Centre, London, UK
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