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Noh SA, Kim HS, Kang SH, Yoon CH, Youn TJ, Chae IH. History and evolution of blood pressure measurement. Clin Hypertens 2024; 30:9. [PMID: 38556854 PMCID: PMC10983645 DOI: 10.1186/s40885-024-00268-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
Hypertension is the leading cause of morbidity and mortality worldwide. Hypertension mostly accompanies no symptoms, and therefore blood pressure (BP) measurement is the only way for early recognition and timely treatment. Methods for BP measurement have a long history of development and improvement. Invasive method via arterial cannulation was first proven possible in the 1800's. Subsequent scientific progress led to the development of the auscultatory method, also known as Korotkoff' sound, and the oscillometric method, which enabled clinically available BP measurement. However, hypertension management status is still poor. Globally, less than half of adults are aware of their hypertension diagnosis, and only one-third of them being treated are under control. Novel methods are actively investigated thanks to technological advances such as sensors and machine learning in addition to the clinical needs for easier and more convenient BP measurement. Each method adopts different technologies with its own specific advantages and disadvantages. Promises of novel methods include comprehensive information on out-of-office BP capturing dynamic short-term and long-term fluctuations. However, there are still pitfalls such as the need for regular calibration since most novel methods capture relative BP changes rather than an absolute value. In addition, there is growing concern on their accuracy and precision as conventional validation protocols are inappropriate for cuffless continuous methods. In this article, we provide a comprehensive overview of the past and present of BP measurement methods. Novel and emerging technologies are also introduced with respect to their potential applications and limitations.
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Affiliation(s)
- Su A Noh
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
| | - Hwang-Soo Kim
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
| | - Si-Hyuck Kang
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea.
- Department of Internal Medicine, Seoul National University, Seoul, South Korea.
| | - Chang-Hwan Yoon
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - Tae-Jin Youn
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
| | - In-Ho Chae
- Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, South Korea
- Department of Internal Medicine, Seoul National University, Seoul, South Korea
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Hornstrup BG, Rosenbæk JB, Hoffmann-Petersen N, Bech JN. Screening for hypertension in adults - the use of tonometric blood pressure monitoring. Blood Press Monit 2024; 29:15-22. [PMID: 37678188 PMCID: PMC10766095 DOI: 10.1097/mbp.0000000000000679] [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: 05/27/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Arterial hypertension increases the risk of developing cardiovascular disease. Reliable screening tools for diagnosing hypertension are important to ensure correct risk stratification of subjects. In this study, we aimed to analyse if a wrist-worn device using a tonometric technique for measuring of 24-hour blood pressure could be used to diagnose hypertension and non-dipping. A conventional device using oscillometric measurements was used as golden standard. Secondary aim was to compare the degree of discomfort related to monitoring with the two devices. METHODS In 89 subjects with a history of normal blood pressure and naive to ambulatory BP monitoring (ABPM), 24-hour ABPM was measured simultaneously with A&D TM2430 (oscillometric technique) and BPro (tonometric technique). RESULTS When comparing measurements from the two devices, we found that the tonometric device misclassified 46% of hypertensive subjects and 69% of non-dippers. The tonometric device measured significantly lower systolic 24-hour and daytime blood pressure. The subjects reported less discomfort related to the tonometric than the oscillometric device. CONCLUSION Despite less discomfort related to usage of the tonometric device for 24-hour blood pressure monitoring compared to an oscillometric device, misclassification of hypertension and non-dipping makes the tonometric device inappropriate as a screening instrument.
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Affiliation(s)
- Bodil G. Hornstrup
- Department of Medicine, Gødstrup Hospital, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
| | - Jeppe B. Rosenbæk
- Department of Medicine, Gødstrup Hospital, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
| | - Nikolai Hoffmann-Petersen
- Department of Medicine, Gødstrup Hospital, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
| | - Jesper N. Bech
- Department of Medicine, Gødstrup Hospital, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
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Lunardi M, Muhammad F, Shahzad A, Nadeem A, Combe L, Simpkin AJ, Sharif F, Wijns W, McEvoy JW. Performance of wearable watch-type home blood pressure measurement devices in a real-world clinical sample. Clin Res Cardiol 2023:10.1007/s00392-023-02353-7. [PMID: 38112747 DOI: 10.1007/s00392-023-02353-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Independent testing of home blood pressure (BP) measurement (HBPM) devices is often lacking, particularly among older and multi-morbid patients. METHODS We studied the Bpro G2 (using tonometry), Omron HeartGuide (using occlusive oscillometric technology), and Heartisans (using photoplethysmography) wrist watch HBPM devices against a gold standard brachial sphygmomanometer. To test device performance, we used the ISO81060-2 protocol (though this protocol cannot formally validate cuffless devices). We also used linear mixed models to compare adjusted longitudinal BP measurements between devices. Finally, as a surrogate for usability, we recorded instances of device failure where no BP measurement was returned. RESULTS We enrolled 128 participants (median [Q1-Q3] age 53 [40-65] years, 51% male, 46% on antihypertensive drugs), of whom 100 were suitable for the primary analysis. All three devices had mean BP values within 5 mmHg of sphygmomanometry. However, due to insufficient reliability (e.g., wider than accepted standard deviations of mean BP), none of the three devices passed all criteria required by the ISO81060-2 protocol. In adjusted longitudinal analyses, the Omron device also systematically underestimated systolic and diastolic BP (- 8.46 mmHg; 95% CI 6.07, 10.86; p < 0.001; and - 2.53 mmHg; 95% CI - 4.03, - 1.03; p = 0.001; respectively). Nevertheless, compared to the Omron device, BPro and Heartisans devices had increased odds of failure (BPro: odds ratio [OR] 5.24; p < 0.0001; Heartisans: OR 5.61; p < 0.001). CONCLUSIONS While we could not formally validate the cuffless devices, our results show that wearable technologies will require improvements to offer reliable BP assessment. This study also highlights the need for validation protocols specifically designed for cuffless BP measurement technologies.
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Affiliation(s)
- Mattia Lunardi
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and University of Galway, Galway, H91 TK33, Ireland
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
- Division of Cardiology, University Hospital of Verona, Verona, Italy
| | - Farooq Muhammad
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - Atif Shahzad
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - Asma Nadeem
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - Lisa Combe
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - Andrew J Simpkin
- School of Mathematics, Statistics and Applied Mathematics, University of Galway, Galway, Ireland
- Insight Centre for Data Analytics, University of Galway, Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and University of Galway, Galway, H91 TK33, Ireland
| | - William Wijns
- The Smart Sensors Laboratory at the Lambe Institute for Translational Medicine and CURAM, University of Galway, Galway, Ireland
| | - John W McEvoy
- Department of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and University of Galway, Galway, H91 TK33, Ireland.
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Stergiou GS, Avolio AP, Palatini P, Kyriakoulis KG, Schutte AE, Mieke S, Kollias A, Parati G, Asmar R, Pantazis N, Stamoulopoulos A, Asayama K, Castiglioni P, De La Sierra A, Hahn JO, Kario K, McManus RJ, Myers M, Ohkubo T, Shroff SG, Tan I, Wang J, Zhang Y, Kreutz R, O'Brien E, Mukkamala R. European Society of Hypertension recommendations for the validation of cuffless blood pressure measuring devices: European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens 2023; 41:2074-2087. [PMID: 37303198 DOI: 10.1097/hjh.0000000000003483] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is intense effort to develop cuffless blood pressure (BP) measuring devices, and several are already on the market claiming that they provide accurate measurements. These devices are heterogeneous in measurement principle, intended use, functions, and calibration, and have special accuracy issues requiring different validation than classic cuff BP monitors. To date, there are no generally accepted protocols for their validation to ensure adequate accuracy for clinical use. OBJECTIVE This statement by the European Society of Hypertension (ESH) Working Group on BP Monitoring and Cardiovascular Variability recommends procedures for validating intermittent cuffless BP devices (providing measurements every >30 sec and usually 30-60 min, or upon user initiation), which are most common. VALIDATION PROCEDURES Six validation tests are defined for evaluating different aspects of intermittent cuffless devices: static test (absolute BP accuracy); device position test (hydrostatic pressure effect robustness); treatment test (BP decrease accuracy); awake/asleep test (BP change accuracy); exercise test (BP increase accuracy); and recalibration test (cuff calibration stability over time). Not all these tests are required for a given device. The necessary tests depend on whether the device requires individual user calibration, measures automatically or manually, and takes measurements in more than one position. CONCLUSION The validation of cuffless BP devices is complex and needs to be tailored according to their functions and calibration. These ESH recommendations present specific, clinically meaningful, and pragmatic validation procedures for different types of intermittent cuffless devices to ensure that only accurate devices will be used in the evaluation and management of hypertension.
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Affiliation(s)
- George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Alberto P Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Paolo Palatini
- Department of Medicine, University of Padova, Padova, Italy
| | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Stephan Mieke
- Physikalisch-Technische Bundesanstalt, Berlin, Germany
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit and Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Milan, Italy
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Achilleas Stamoulopoulos
- Department of Hygiene, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Paolo Castiglioni
- IRCCS Fondazione Don Carlo Gnocchi Onlus, Milan, Italy; Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Alejandro De La Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Catalonia, Spain
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, Maryland, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Martin Myers
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Sanjeev G Shroff
- Department of Bioengineering and Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Isabella Tan
- The George Institute for Global Health, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai
| | - Yuanting Zhang
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Department of Clinical Pharmacology & Toxicology, Charité University Medicine, Berlin, Germany
| | - Eoin O'Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - Ramakrishna Mukkamala
- Department of Bioengineering and Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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5
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Heimark S, Hove C, Stepanov A, Boysen ES, Gløersen Ø, Bøtke-Rasmussen KG, Gravdal HJ, Narayanapillai K, Fadl Elmula FEM, Seeberg TM, Larstorp ACK, Waldum-Grevbo B. Accuracy and User Acceptability of 24-hour Ambulatory Blood Pressure Monitoring by a Prototype Cuffless Multi-Sensor Device Compared to a Conventional Oscillometric Device. Blood Press 2023; 32:2274595. [PMID: 37885101 DOI: 10.1080/08037051.2023.2274595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE 24-hour ambulatory blood pressure monitoring (24ABPM) is state of the art in out-of-office blood pressure (BP) monitoring. Due to discomfort and technical limitations related to cuff-based 24ABPM devices, methods for non-invasive and continuous estimation of BP without the need for a cuff have gained interest. The main aims of the present study were to compare accuracy of a pulse arrival time (PAT) based BP-model and user acceptability of a prototype cuffless multi-sensor device (cuffless device), developed by Aidee Health AS, with a conventional cuff-based oscillometric device (ReferenceBP) during 24ABPM. METHODS Ninety-five normotensive and hypertensive adults underwent simultaneous 24ABPM with the cuffless device on the chest and a conventional cuff-based oscillometric device on the non-dominant arm. PAT was calculated using the electrocardiogram (ECG) and photoplethysmography (PPG) sensors incorporated in the chest-worn device. The cuffless device recorded continuously, while ReferenceBP measurements were taken every 20 minutes during daytime and every 30 minutes during nighttime. Two-minute PAT-based BP predictions corresponding to the ReferenceBP measurements were compared with ReferenceBP measurements using paired t-tests, bias, and limits of agreement. RESULTS Mean (SD) of ReferenceBP compared to PAT-based daytime and nighttime systolic BP (SBP) were 129.7 (13.8) mmHg versus 133.6 (20.9) mmHg and 113.1 (16.5) mmHg versus 131.9 (23.4) mmHg. Ninety-five % limits of agreements were [-26.7, 34.6 mmHg] and [-20.9, 58.4 mmHg] for daytime and nighttime SBP respectively. The cuffless device was reported to be significantly more comfortable and less disturbing than the ReferenceBP device during 24ABPM. CONCLUSIONS In the present study, we demonstrated that a general PAT-based BP model had unsatisfactory agreement with ambulatory BP during 24ABPM, especially during nighttime. If sufficient accuracy can be achieved, cuffless BP devices have promising potential for clinical assessment of BP due to the opportunities provided by continuous BP measurements during real-life conditions and high user acceptability.
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Affiliation(s)
- Sondre Heimark
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christine Hove
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Elin Sundby Boysen
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Øyvind Gløersen
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | | | | | | | | | - Trine M Seeberg
- Aidee Health AS, Oslo, Norway
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Anne Cecilie K Larstorp
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Cardiovascular and Renal Research, Oslo University Hospital, Ullevål, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Bård Waldum-Grevbo
- Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
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Panula T, Sirkiä JP, Koivisto T, Pänkäälä M, Niiranen T, Kantola I, Kaisti M. Development and clinical validation of a miniaturized finger probe for bedside hemodynamic monitoring. iScience 2023; 26:108295. [PMID: 38026187 PMCID: PMC10665806 DOI: 10.1016/j.isci.2023.108295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/14/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Our aim is to develop a blood pressure (BP) measurement technology that could be integrated into a finger-worn pulse oximeter, eliminating the need for a brachial cuff. We present a miniature cuffless tonometric finger probe system that uses the oscillometric method to measure BP. Our approach uses a motorized press that is used to apply pressure to the fingertip to measure BP. We verified the functionality of the device in a clinical trial (n = 43) resulting in systolic and diastolic pressures ((mean ± SD) mmHg) of (-3.5 ± 8.4) mmHg and (-4.0 ± 4.4) mmHg, respectively. Comparison was made with manual auscultation (n = 26) and automated cuff oscillometry (n = 18). In addition to BP, we demonstrated the ability of the device to assess arterial stiffness (n = 18) and detect atrial fibrillation (n = 6). We were able to introduce a sufficiently small device that could be used for convenient ambulatory measurements with minimal discomfort.
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Affiliation(s)
- Tuukka Panula
- Department of Computing, University of Turku, Vesilinnantie 5, 20500 Turku, Finland
| | - Jukka-Pekka Sirkiä
- Department of Computing, University of Turku, Vesilinnantie 5, 20500 Turku, Finland
| | - Tero Koivisto
- Department of Computing, University of Turku, Vesilinnantie 5, 20500 Turku, Finland
| | - Mikko Pänkäälä
- Department of Computing, University of Turku, Vesilinnantie 5, 20500 Turku, Finland
| | - Teemu Niiranen
- Department of Internal Medicine, University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland
- Division of Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Ilkka Kantola
- Division of Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Matti Kaisti
- Department of Computing, University of Turku, Vesilinnantie 5, 20500 Turku, Finland
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7
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Freithaler M, Chandrasekhar A, Dhamotharan V, Landry C, Shroff SG, Mukkamala R. Smartphone-Based Blood Pressure Monitoring via the Oscillometric Finger Pressing Method: Analysis of Oscillation Width Variations Can Improve Diastolic Pressure Computation. IEEE Trans Biomed Eng 2023; 70:3052-3063. [PMID: 37195838 PMCID: PMC10640822 DOI: 10.1109/tbme.2023.3275031] [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: 05/19/2023]
Abstract
OBJECTIVE Oscillometric finger pressing is a potential method for absolute blood pressure (BP) monitoring via a smartphone. The user presses their fingertip against a photoplethysmography-force sensor unit on a smartphone to steadily increase the external pressure on the underlying artery. Meanwhile, the phone guides the finger pressing and computes systolic BP (SP) and diastolic BP (DP) from the measured blood volume oscillations and finger pressure. The objective was to develop and evaluate reliable finger oscillometric BP computation algorithms. METHODS The collapsibility of thin finger arteries was exploited in an oscillometric model to develop simple algorithms for computing BP from the finger pressing measurements. These algorithms extract features from "width" oscillograms (oscillation width versus finger pressure functions) and the conventional "height" oscillogram for markers of DP and SP. Finger pressing measurements were obtained using a custom system along with reference arm cuff BP measurements from 22 subjects. Measurements were also obtained during BP interventions in some subjects for 34 total measurements. RESULTS An algorithm employing the average of width and height oscillogram features predicted DP with correlation of 0.86 and precision error of 8.6 mmHg with respect to the reference measurements. Analysis of arm oscillometric cuff pressure waveforms from an existing patient database provided evidence that the width oscillogram features are better suited to finger oscillometry. CONCLUSION Analysis of oscillation width variations during finger pressing can improve DP computation. SIGNIFICANCE The study findings may help in converting widely available devices into truly cuffless BP monitors for improving hypertension awareness and control.
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Hu JR, Park DY, Agarwal N, Herzig M, Ormseth G, Kaushik M, Giao DM, Turkson-Ocran RAN, Juraschek SP. The Promise and Illusion of Continuous, Cuffless Blood Pressure Monitoring. Curr Cardiol Rep 2023; 25:1139-1149. [PMID: 37688763 PMCID: PMC10842120 DOI: 10.1007/s11886-023-01932-4] [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] [Accepted: 07/31/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE OF REVIEW Blood pressure (BP) fluctuations outside of clinic are increasingly recognized for their role in the development of cardiovascular disease, syncope, and premature death and as a promising target for tailored hypertension treatment. However, current cuff-based BP devices, including home and ambulatory devices, are unable to capture the breadth of BP variability across human activities, experiences, and contexts. RECENT FINDINGS Cuffless, wearable BP devices offer the promise of beat-to-beat, continuous, noninvasive measurement of BP during both awake and sleep periods with minimal patient inconvenience. Importantly, cuffless BP devices can characterize BP variability, allowing for the identification of patient-specific triggers of BP surges in the home environment. Unfortunately, the pace of evidence, regulation, and validation testing has lagged behind the pace of innovation and direct consumer marketing. We provide an overview of the available technologies and devices for cuffless BP monitoring, considerations for the calibration and validation of these devices, and the promise and pitfalls of the cuffless BP paradigm.
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Affiliation(s)
- Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Nikita Agarwal
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew Herzig
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - George Ormseth
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Milan Kaushik
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Ruth-Alma N Turkson-Ocran
- Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stephen P Juraschek
- Section for Research, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- , 330 Brookline Avenue, CO-1309, #204, MA, 02215, USA.
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9
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Lacy PS, Jedrzejewski D, McFarlane E, Williams B. Blood pressure measurement modalities and indexed left ventricular mass in men with low-risk hypertension confirmed by ambulatory monitoring. J Hypertens 2023; 41:941-950. [PMID: 36927831 DOI: 10.1097/hjh.0000000000003415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Blood pressure (BP) measurement modalities such as ambulatory monitoring (ABPM) and noninvasive central aortic systolic pressure (CASP), have been reported to improve prediction of hypertension-mediated organ damage (HMOD) compared with conventional clinic BP. However, clinic BP is often confounded by poor measurement technique and 'white-coat hypertension' (WCH). We compared prediction of cardiac MRI (cMRI)-derived left ventricular mass index (LVMI) by differing BP measurement modalities in young men with elevated BP, confirmed by ABPM. METHODS One hundred and forty-three treatment-naive men (<55 years) with hypertension confirmed by ABPM and no clinical evidence of HMOD or cardiovascular disease (37% with masked hypertension) were enrolled. Relationships between BP modalities and cMRI-LVMI were evaluated. RESULTS Men with higher LVMI (upper quintile) had higher clinic, central and ambulatory SBP compared with men with lower LVMI. Regression coefficients for SBP with LVMI did not differ across BP modalities ( r = 0.32; 0.3; 0.31, for clinic SBP, CASP and 24-h ABPM, respectively, P < 0.01 all). Prediction for high LVMI using receiver-operated curve analyses was similar between measurement modalities. No relationship between DBP and LVMI was seen across measurement modalities. CONCLUSION In younger men with hypertension confirmed by ABPM and low cardiovascular risk, clinic SBP and CASP, measured under research conditions, that is, with strict adherence to guideline recommendations, performs as well as ABPM in predicting LVMI. Prior reports of inferiority for clinic BP in predicting HMOD and potentially, clinical outcomes, may be due to poor measurement technique and/or failure to exclude WCH.
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Affiliation(s)
- Peter S Lacy
- Institute of Cardiovascular Sciences, University College London
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, UK
| | | | - Ewan McFarlane
- Institute of Cardiovascular Sciences, University College London
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, London, UK
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10
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Mukkamala R, Shroff SG, Landry C, Kyriakoulis KG, Avolio AP, Stergiou GS. The Microsoft Research Aurora Project: Important Findings on Cuffless Blood Pressure Measurement. Hypertension 2023; 80:534-540. [PMID: 36458550 PMCID: PMC9931644 DOI: 10.1161/hypertensionaha.122.20410] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Conventional blood pressure (BP) measurement devices based on an inflatable cuff only provide a narrow view of the continuous BP profile. Cuffless BP measuring technologies could permit numerous BP readings throughout daily life and thereby considerably improve the assessment and management of hypertension. Several wearable cuffless BP devices based on pulse wave analysis (applied to a photoplethysmography or tonometry waveform) with or without use of pulse arrival time are now available on the market. The key question is: Can these devices provide accurate measurement of BP? Microsoft Research recently published a complex article describing perhaps the most important and highest resource project to date (Aurora Project) on assessing the accuracy of several pulse wave analysis and pulse wave analysis-pulse arrival time devices. The overall results from 1125 participants were clear-cut negative. The present article motivates and describes emerging cuffless BP devices and then summarizes the Aurora Project. The study methodology and findings are next discussed in the context of regulatory-cleared devices, physiology, and related studies, and the study strengths and limitations are pinpointed thereafter. Finally, the implications of the Aurora Project are briefly stated and recommendations for future work are offered to finally realize the considerable potential of cuffless BP measurement in health care.
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Affiliation(s)
- Ramakrishna Mukkamala
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sanjeev G. Shroff
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cederick Landry
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Konstantinos G. Kyriakoulis
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alberto P. Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - George S. Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
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11
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Long-term stability of over-the-counter cuffless blood pressure monitors: a proposal. HEALTH AND TECHNOLOGY 2023; 13:53-63. [PMID: 36713070 PMCID: PMC9870659 DOI: 10.1007/s12553-023-00726-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/17/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023]
Abstract
Blood pressure is an important cardiovascular parameter. Currently, the cuff-based sphygmomanometer is a popular, reliable, measurement method, but blood pressure monitors without cuffs have become popular and are now available without a prescription. Blood pressure monitors must be approved by regulatory authorities. Current cuffless blood pressure (CL-BP) monitors are not suitable for at-home management and prevention of hypertension. This paper proposes simple criteria for over-the-counter CL-BP monitoring. First, the history of the sphygmomanometer and current standard blood pressure protocol are reviewed. The main components of CL-BP monitoring are accuracy during the resting condition, accuracy during dynamic blood pressure changes, and long-term stability. In this proposal we recommend intermittent measurement to ensure that active measurement accuracy mirrors resting condition accuracy. A new experimental protocol is proposed to maintain long-term stability. A medically approved automated sphygmomanometer was used as the standard device in this study. The long-term accuracy of the test device is based on the definition of propagation error, i.e., for an oscillometric automated sphygmomanometer (5 ± 8 mmHg) ± the error for the test device static accuracy (-0.12 ± 5.49 mmHg for systolic blood pressure and - 1.17 ± 5.06 mmHg for diastolic blood pressure). Thus, the long-term stabilities were - 3.38 ± 7.1 mmHg and - 1.38 ± 5.4 mmHg, which satisfied propagation error. Further research and discussion are necessary to create standards for use by manufacturers; such standards should be readily evaluated and ensure high-quality evidence. Supplementary information The online version contains supplementary material available at 10.1007/s12553-023-00726-6.
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Konstantinidis D, Iliakis P, Tatakis F, Thomopoulos K, Dimitriadis K, Tousoulis D, Tsioufis K. Wearable blood pressure measurement devices and new approaches in hypertension management: the digital era. J Hum Hypertens 2022; 36:945-951. [PMID: 35322181 PMCID: PMC8942176 DOI: 10.1038/s41371-022-00675-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/13/2022] [Accepted: 03/09/2022] [Indexed: 11/09/2022]
Abstract
Out-of-office blood pressure (BP) measurement is considered an integral component of the diagnostic algorithm and management of hypertension. In the era of digitalization, a great deal of wearable BP measuring devices has been developed. These digital blood pressure monitors allow frequent BP measurements with minimal annoyance to the patient while they do promise radical changes regarding the diagnostic accuracy, as the importance of making an accurate diagnosis of hypertension has become evident. By increasing the number of BP measurements in different conditions, these monitors allow accurate identification of different clinical phenotypes, such as masked hypertension and pathological BP variability, that seem to have a negative impact on cardiovascular prognosis. Frequent measurements of BP and the incorporation of new features in BP variability, both enable well-rounded interpretation of BP data in the context of real-life settings. This article is a review of all different technologies and wearable BP monitoring devices.
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Affiliation(s)
- D Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
| | - P Iliakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - F Tatakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - K Thomopoulos
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
| | - K Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - K Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Hjortkjær HØ, Persson F, Theilade S, Winther SA, Tofte N, Ahluwalia TS, Rossing P. Non-dipping and higher nocturnal blood pressure are associated with risk of mortality and development of kidney disease in type 1 diabetes. J Diabetes Complications 2022; 36:108270. [PMID: 35964524 DOI: 10.1016/j.jdiacomp.2022.108270] [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] [Received: 03/30/2022] [Revised: 07/02/2022] [Accepted: 07/24/2022] [Indexed: 11/19/2022]
Abstract
AIMS People with type 1 diabetes have increased risk of cardiovascular (CV) and kidney disease. A 24-hour ambulatory blood pressure (BP) measurement (ABPM) examines diurnal variations in BP. We aimed to determine the prognostic significance of blunted decrease in nocturnal systolic BP of <10 % (non-dipping of nocturnal BP) for CV- and kidney disease and all-cause mortality in type 1 diabetes. METHODS From 2009 to 2011, at Steno Diabetes Center Copenhagen, 654 participants with type 1 diabetes had 24-hour ABPM obtained with a tonometric wrist-watch device (BPro, HealthStats, Singapore). In 2017, outcomes (composite CV endpoint; all-cause mortality; decline in estimated glomerular filtration rate (eGFR) ≥30 %; end-stage kidney disease (ESKD); and a composite kidney endpoint including decline in eGFR ≥30 %, ESKD and all-cause mortality) were registered. Hazard Ratios (HR) were calculated using Cox regressions. RESULTS Participants were mean ± SD 55 ± 13 years old and had median (IQR) 35 (24-44) years diabetes duration. Mean daytime and nocturnal systolic BP were 133 ± 16 and 121 ± 16 mmHg while 337 (52 %) participants demonstrated non-dipping. After CV risk factor adjustments, non-dipping was associated with all-cause mortality (HR 2.12 (1.09-4.11), p = 0.03) and the composite kidney endpoint (HR 1.92 (1.23-3.00), p = 0.004). CONCLUSIONS Non-dipping entailed increased risk of all-cause mortality and kidney disease in type 1 diabetes.
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Affiliation(s)
| | | | - Simone Theilade
- Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Signe A Winther
- Steno Diabetes Center Copenhagen, Herlev, Denmark; Novo Nordisk A/S, Søborg, Denmark
| | - Nete Tofte
- Steno Diabetes Center Copenhagen, Herlev, Denmark; Novo Nordisk A/S, Søborg, Denmark
| | - Tarunveer S Ahluwalia
- Steno Diabetes Center Copenhagen, Herlev, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark; University of Copenhagen, Copenhagen, Denmark
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Chrysant SG. Relatability of Blood Pressure Monitoring With Wearable Cuffless Devices. Am J Cardiol 2022; 169:145-147. [PMID: 35045932 DOI: 10.1016/j.amjcard.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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15
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Latest hypertension research to inform clinical practice in Asia. Hypertens Res 2022; 45:555-572. [DOI: 10.1038/s41440-022-00874-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
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Abstract
Cuffless blood pressure (BP) measurement has become a popular field due to clinical need and technological opportunity. However, no method has been broadly accepted hitherto. The objective of this review is to accelerate progress in the development and application of cuffless BP measurement methods. We begin by describing the principles of conventional BP measurement, outstanding hypertension/hypotension problems that could be addressed with cuffless methods, and recent technological advances, including smartphone proliferation and wearable sensing, that are driving the field. We then present all major cuffless methods under investigation, including their current evidence. Our presentation includes calibrated methods (i.e., pulse transit time, pulse wave analysis, and facial video processing) and uncalibrated methods (i.e., cuffless oscillometry, ultrasound, and volume control). The calibrated methods can offer convenience advantages, whereas the uncalibrated methods do not require periodic cuff device usage or demographic inputs. We conclude by summarizing the field and highlighting potentially useful future research directions. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 24 is June 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ramakrishna Mukkamala
- Department of Bioengineering and Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece; ,
| | - Alberto P Avolio
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia;
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Bodington R, Kassianides X, Bhandari S. Point-of-care testing technologies for the home in chronic kidney disease: a narrative review. Clin Kidney J 2021; 14:2316-2331. [PMID: 34751234 PMCID: PMC8083235 DOI: 10.1093/ckj/sfab080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Indexed: 01/09/2023] Open
Abstract
Point-of-care testing (POCT) performed by the patient at home, paired with eHealth technologies, offers a wealth of opportunities to develop individualized, empowering clinical pathways. The non-dialysis-dependent chronic kidney disease (CKD) patient who is at risk of or may already be suffering from a number of the associated complications of CKD represents an ideal patient group for the development of such initiatives. The current coronavirus disease 2019 pandemic and drive towards shielding vulnerable individuals have further highlighted the need for home testing pathways. In this narrative review we outline the evidence supporting remote patient management and the various technologies in use in the POCT setting. We then review the devices currently available for use in the home by patients in five key areas of renal medicine: anaemia, biochemical, blood pressure (BP), anticoagulation and diabetes monitoring. Currently there are few devices and little evidence to support the use of home POCT in CKD. While home testing in BP, anticoagulation and diabetes monitoring is relatively well developed, the fields of anaemia and biochemical POCT are still in their infancy. However, patients' attitudes towards eHealth and home POCT are consistently positive and physicians also find this care highly acceptable. The regulatory and translational challenges involved in the development of new home-based care pathways are significant. Pragmatic and adaptable trials of a hybrid effectiveness-implementation design, as well as continued technological POCT device advancement, are required to deliver these innovative new pathways that our patients desire and deserve.
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Affiliation(s)
- Richard Bodington
- Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK
| | | | - Sunil Bhandari
- Department of Renal Research, Hull Royal Infirmary, Hull, UK
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Panula T, Sirkia JP, Kaisti M. Miniaturization of a Finger-Worn Blood Pressure Instrument. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:7441-7444. [PMID: 34892816 DOI: 10.1109/embc46164.2021.9629790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Blood pressure monitoring using a traditional arm cuff device is often inconvenient and possibly painful. We present a miniature cuffless tonometric finger probe system, that uses the oscillometric method to measure blood pressure (BP). A small enough device could be used for convenient ambulatory measurement and be worn during sleep with minimal discomfort. In addition to BP, the device is able to collect arterial pulse wave data that can further be used to derive other cardiovascular parameters, such as heart rate (HR), heart rate variability (HRV) and central aortic systolic pressure (CASP). The device uses a motor controlled press that is used to apply pressure to the finger tip to measure the oscillometric response. We verified the functionality of the device by proof-of-concept measurements. Lastly we evaluate methods for further developing the concept and discuss the future directions.
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Ambulatory monitoring of central arterial pressure, wave reflections, and arterial stiffness in patients at cardiovascular risk. J Hum Hypertens 2021; 36:352-363. [PMID: 34518619 DOI: 10.1038/s41371-021-00606-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/09/2022]
Abstract
This paper reviews current 24 h ambulatory noninvasive technologies for pulse wave analysis (PWA) providing central arterial pressure, pulse wave velocity, and augmentation index and the scientific evidence supporting their use in the clinical management of patients with arterial hypertension or at risk for cardiovascular complications.The most outstanding value of these techniques lies in the fact that they are user-friendly, mostly operator independent, and enable the evaluation of vascular function during daily-life conditions, allowing to obtain repeated measurements in different out-of-office circumstances, less artificial than those of the laboratory or doctor's office.Studies performed so far suggest that 24 h PWA may represent a potentially promising tool for evaluating vascular function, structure, and damage in daily-life conditions and promoting early screening in subjects at risk. The current evidence in favor of such an approach in the clinical practice is still limited and does not recommend its routine use. In particular, at the moment, there is a shortage of long-term prognostic studies able to support the predictive value of 24 h PWA. Finally, the accuracy of the measures is strongly dependent on the type of technology and device employed with lack of interoperability among the devices that deeply affects comparability of results among studies using different technologies. It is thus mandatory in the near future to promote proper validation studies, for instance using the ARTERY protocol, and to plan well-designed long-term longitudinal studies that may prove the accuracy and high predictive value of PWA in ambulatory conditions.
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20
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Validation of the BPro radial pulse waveform acquisition device in pregnancy and gestational hypertensive disorders. Blood Press Monit 2021; 26:380-384. [PMID: 34128489 DOI: 10.1097/mbp.0000000000000552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To validate the BPro blood pressure (BP) wrist device for use in pregnancy and preeclampsia according to the Universal Standard protocol. PARTICIPANTS AND METHODS BP was measured sequentially in 45 pregnant women (including 15 with preeclampsia, 15 with gestational hypertension and 15 who remained normotensive) alternating between a mercury sphygmomanometer and BPro device. RESULTS The BPro is accurate in pregnancy with a mean device-observer difference of -1.7 ± 6.1 and 0.1 ± 4.6 mmHg for SBP and DBP, respectively. In women with preeclampsia, BPro also met the validation criteria for the Universal Standard protocol with a mean device-observer difference of -2.7 ± 7.1 and 0.3 ± 4.7 mmHg for SBP and DBP, respectively. However, the number of absolute BP differences within 5 mmHg was considerably fewer in those with preeclampsia when compared to the other two subgroups. CONCLUSION The BPro device can be recommended for BP measurement in pregnancy but should be used with caution in those with confirmed preeclampsia.
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21
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Patient preferences for ambulatory blood pressure monitoring devices: Wrist-type or arm-type? PLoS One 2021; 16:e0255871. [PMID: 34370782 PMCID: PMC8352047 DOI: 10.1371/journal.pone.0255871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background Ambulatory blood pressure monitoring (ABPM) is important in evaluating average 24-hour blood pressure (BP) levels, circadian rhythm, sleeping BP and BP variability but many patients are reluctant to use standard ABPM devices. Methods We compared two validated ABPM devices, the BPro tonometric wrist monitor and the A&D TM-2430 oscillometric upper arm monitor, for agreement of recordings and acceptability in 37 hypertensive patients (aged 55±9 years). Results Successful BP measurements were less frequent with the wrist-type than the arm-type device during the sleeping (66.3% vs. 92.9%, P <0.01) and awake periods (56.2% vs. 86.5%, P <0.01). Comparable paired readings showed no significant difference in systolic BP but diastolic BP (DBP) values were higher with the wrist compared to the arm monitor (24-hour 89±13 vs. 85±14 mmHg, P <0.01) with similar differences awake and sleeping. Bland-Altman analysis showed some large discrepancies between individual arm and wrist monitor measurements. More patients found the wrist monitor more comfortable to use than the arm monitor. Conclusions Despite the difference in individual BP measurements and the systematic overestimation of DBP values with the BPro device, wrist monitors with good patient acceptability may be useful to facilitate ABPM in some patients to provide additional information about cardiovascular risk and response to antihypertensive therapies.
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Miranda Hurtado M, Reyes Vasquez J, Rodriguez-Fernandez M. Comparison of a tonometric with an oscillometric blood pressure monitoring device over 24 hours of ambulatory use. Blood Press Monit 2021; 26:149-155. [PMID: 33470646 DOI: 10.1097/mbp.0000000000000511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Multiple devices capable of measuring ambulatory blood pressure without cuffs have been recently developed and it is required that they offer high-accuracy measurements. The purpose of this prospective study was to compare the performance of a tonometric blood pressure monitor with that of an oscillometric cuff-based device used as a reference in healthy and hypertensive subjects over 24 hours of ambulatory use. MATERIALS AND METHODS Conventional oscillometric cuff-based device (Oscar 2; Sun Tech Medical) was placed in the left arm of 33 subjects, and a watch-type device based on the tonometric method (Bpro; HealthSTATS International, Singapore) was positioned in the right wrist. Both devices were synchronized to measure simultaneously over 24 hours. RESULTS The difference between the means over 24 hours of the oscillometric and the tonometric devices was -0.9 mmHg for SBP and -4.5 mmHg for DBP; the standard deviations were 14.7 and 12.2 mmHg, respectively. Greater differences in bias and dispersion were observed overnight than during the daytime. The accuracy of the tonometric device for diagnosing hypertension was 75% and for detecting the non-dipper profile, 48%. CONCLUSION The test device presented a high disagreement (especially during the night) compared to the oscillometric cuff-based device against which it was initially calibrated. This disagreement resulted in limited accuracy for diagnosing patients with suspected arterial hypertension and detecting non-dipper profiles.
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Affiliation(s)
- Martin Miranda Hurtado
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Catolica de Chile, Macul, Santiago, Chile
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Kario K. Management of Hypertension in the Digital Era: Small Wearable Monitoring Devices for Remote Blood Pressure Monitoring. Hypertension 2020; 76:640-650. [PMID: 32755418 PMCID: PMC7418935 DOI: 10.1161/hypertensionaha.120.14742] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Out-of-office blood pressure measurement is an essential part of diagnosing and managing hypertension. In the era of advanced digital health information technology, the approach to achieving this is shifting from traditional methods (ambulatory and home blood pressure monitoring) to wearable devices and technology. Wearable blood pressure monitors allow frequent blood pressure measurements (ideally continuous beat-by-beat monitoring of blood pressure) with minimal stress on the patient. It is expected that wearable devices will dramatically change the quality of detection and management of hypertension by increasing the number of measurements in different situations, allowing accurate detection of phenotypes that have a negative impact on cardiovascular prognosis, such as masked hypertension and abnormal blood pressure variability. Frequent blood pressure measurements and the addition of new features such as monitoring of environmental conditions allows interpretation of blood pressure data in the context of daily stressors and different situations. This new digital approach to hypertension contributes to anticipation medicine, which refers to strategies designed to identify increasing risk and predict the onset of cardiovascular events based on a series of data collected over time, allowing proactive interventions to reduce risk. To achieve this, further research and validation is required to develop wearable blood pressure monitoring devices that provide the same accuracy as current approaches and can effectively contribute to personalized medicine.
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan; and the Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network
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E-Health in Hypertension Management: an Insight into the Current and Future Role of Blood Pressure Telemonitoring. Curr Hypertens Rep 2020; 22:42. [PMID: 32506273 DOI: 10.1007/s11906-020-01056-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Out-of-office blood pressure (BP) monitoring techniques, including home and ambulatory BP monitoring, are currently recommended by hypertension guidelines worldwide to confirm the diagnosis of hypertension and to monitor the appropriateness of treatment. However, such techniques are not always effectively implemented or timely available in the routine clinical practice. In recent years, the widespread availability of e-health solutions has stimulated the development of blood pressure telemonitoring (BPT) systems, which allow remote BP tracking and tighter and more efficient monitoring of patients' health status. RECENT FINDINGS There is currently strong evidence that BPT may be of benefit for hypertension screening and diagnosis and for improving hypertension management. The advantage is more significant when BPT is coupled with multimodal interventions involving a physician, a nurse or pharmacist, and including education on lifestyle and risk factors and drug management. Several randomized controlled studies documented enhanced hypertension management and improved BP control of hypertensive patients through BPT. Potential additional effects of BPT are represented by improved compliance to treatment, intensification, and optimization of drug use, improved quality of life, reduction in risk of developing cardiovascular complications, and cost-saving. Applications based on m-health and making use of wearables or smartwatches integrated with machine learning models are particularly promising for the future development of efficient BPT solutions, and they will provide remarkable support decision tools for doctors. BPT and telehealth will soon disrupt hypertension management. However, which approach will be the most effective and whether it will be sustainable in the long-term still need to be elucidated.
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Chan C, Sounderajah V, Acharya A, Normahani P, Bicknell C, Riga C. The Role of Wearable Technologies and Telemonitoring in Managing Vascular Disease. VASCULAR AND ENDOVASCULAR REVIEW 2020. [DOI: 10.15420/ver.2019.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Wearable devices and telemonitoring are becoming increasingly widespread in the clinical environment and have many applications in the tracking and maintenance of patient wellbeing. Interventions incorporating these technologies have been used with some success in patients with vascular disorders. Wearable fitness monitors and telemonitoring have been used in the community to mobilise patients with peripheral vascular disease with good results. Additionally, wearable monitors and telemonitoring have been studied for blood pressure monitoring in patients with hypertension. Telemonitoring interventions incorporating electronic medication trays and ingestible sensors have also been found to increase drug adherence in hypertensive patients and ultimately improve health outcomes. However, wearable and telemonitoring interventions often face problems with patient adherence, digital literacy and infrastructure. Further work needs to address these challenges and validate the technology before widespread implementation can occur.
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Affiliation(s)
- Calvin Chan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Amish Acharya
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Pasha Normahani
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Colin Bicknell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Celia Riga
- Department of Surgery and Cancer, Imperial College London, London, UK
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Hornstrup BG, Rosenbæk JB, Bech JN. Comparison of Ambulatory Tonometric and Oscillometric Blood Pressure Monitoring in Hypertensive Patients. Integr Blood Press Control 2020; 13:41-47. [PMID: 32280272 PMCID: PMC7125401 DOI: 10.2147/ibpc.s235228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/05/2020] [Indexed: 01/19/2023] Open
Abstract
Aim Correct measurement of blood pressure (BP) is important for optimal diagnosis and treatment of patients with hypertension. The aim of this study was to compare a wrist-worn device using tonometric measurements of BP to a conventional device using oscillometric measurements of 24 h BP, diagnosing of hypertension, and non-dipping. Methods One-hundred patients in the Renal Outpatient Clinic had 24 h ambulatory BP monitoring performed with a tonometric device, BPro, and an oscillometric device, A&D, simultaneously. Results Twenty-four-hour and daytime systolic BP was significantly lower using tonometric monitoring compared to oscillometric (7 and 6 mmHg, respectively, p< 0.001). In the population of patients diagnosed with hypertension, the tonometric device diagnosed 90% of patients with uncontrolled hypertension correctly (positive predictive value), whereas 49% of patients classified as normotensive were uncontrolled hypertensive (negative predictive value). The mean difference between relative nocturnal BP decrease between tonometric and oscillometric was 2±8% (p< 0.01), and 33% of patients classified as dippers were non-dippers (negative predictive value). Conclusion Using the BPro device for tonometric monitoring of BP and classification of hypertension and non-dipping in patients diagnosed with hypertension leads to misclassification of patients. Therefore, the BPro device is not suitable for clinical practice in hypertensive patients from a Renal Outpatient Clinic.
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Affiliation(s)
- Bodil Gade Hornstrup
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Holstebro, Denmark
| | - Jeppe Bakkestrøm Rosenbæk
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Holstebro, Denmark
| | - Jesper Nørgaard Bech
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Holstebro, Denmark
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Sharman JE, O’Brien E, Alpert B, Schutte AE, Delles C, Olsen MH, Asmar R, Atkins N, Barbosa E, Calhoun D, Campbell NR, Chalmers J, Benjamin I, Jennings G, Laurent S, Boutouyrie P, Lopez-Jaramillo P, McManus RJ, Mihailidou AS, Ordunez P, Padwal R, Palatini P, Parati G, Poulter N, Rakotz MK, Rosendorff C, Saladini F, Scuteri A, Barroso WS, Cho MC, Sung KC, Townsend RR, Wang JG, Hansen TW, Wozniak G, Stergiou G. [Lancet Commission on Hypertension Group position statement on the global improvement of accuracy standards for devices that measure blood pressurePosicionamento do Grupo da Lancet Commission on Hypertension sobre a melhoria global dos padrões de acurácia para aparelhos que medem a pressão arterial]. Rev Panam Salud Publica 2020; 44:e21. [PMID: 32117468 PMCID: PMC7039279 DOI: 10.26633/rpsp.2020.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/14/2019] [Indexed: 11/24/2022] Open
Abstract
The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3 000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organization for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.
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Affiliation(s)
- James E. Sharman
- Menzies Institute for Medical ResearchUniversidad de TasmaniaHobartTasmaniaAustraliaMenzies Institute for Medical Research, Universidad de Tasmania, Hobart, Tasmania, Australia.
| | - Eoin O’Brien
- The Conway InstituteUniversity College DublinDublínIrlandaThe Conway Institute, University College Dublin, Dublín, Irlanda.
| | - Bruce Alpert
- Centro de Ciencias de la SaludUniversidad de TennesseeMemphisTennesseeEstados UnidosCentro de Ciencias de la Salud, Universidad de Tennessee, Memphis, Tennessee, Estados Unidos (retirado)
| | - Aletta E. Schutte
- Equipo de investigación en hipertensión en África, Medical Research Council Unit for Hypertension and Cardiovascular DiseaseUniversidad del NoroestePotchefstroomSudáfricaEquipo de investigación en hipertensión en África, Medical Research Council Unit for Hypertension and Cardiovascular Disease, Universidad del Noroeste, Potchefstroom, Sudáfrica.
| | - Christian Delles
- Institute of Cardiovascular and Medical SciencesUniversidad de GlasgowGlasgowReino UnidoInstitute of Cardiovascular and Medical Sciences, Universidad de Glasgow, Glasgow, Reino Unido.
| | - Michael Hecht Olsen
- Departamento de Medicina Interna, Hospital Holbaek, Holbaek, Dinamarca; y Centre for Individualized Medicine in Arterial Diseases (CIMA), Hospital de la Universidad de OdenseUniversidad de Dinamarca MeridionalOdenseDinamarcaDinamarcaDepartamento de Medicina Interna, Hospital Holbaek, Holbaek, Dinamarca; y Centre for Individualized Medicine in Arterial Diseases (CIMA), Hospital de la Universidad de Odense, Universidad de Dinamarca Meridional, Odense, Dinamarca.
| | - Roland Asmar
- Institutos de la Fundación para la Investigación MédicaInstitutos de la Fundación para la Investigación MédicaGinebraSuizaInstitutos de la Fundación para la Investigación Médica, Ginebra, Suiza.
| | - Neil Atkins
- Medaval LtdaMedaval LtdaDublínIrlandaMedaval Ltda., Dublín, Irlanda.
| | - Eduardo Barbosa
- Liga para la hipertensión de Porto AlegreLiga para la hipertensión de Porto AlegrePorto AlegreBrasilLiga para la hipertensión de Porto Alegre, Porto Alegre, Brasil.
| | - David Calhoun
- Grupo de biología vascular e hipertensiónUniversidad de Alabama en BirminghamBirminghamEstados UnidosGrupo de biología vascular e hipertensión, Universidad de Alabama en Birmingham, Birmingham, Estados Unidos.
| | - Norm R.C. Campbell
- Departamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud Comunitaria, O’Brien Institute for Public Health y Libin Cardiovascular Institute of AlbertaUniversidad de CalgaryCalgaryAlbertaCanadáDepartamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud Comunitaria, O’Brien Institute for Public Health y Libin Cardiovascular Institute of Alberta, Universidad de Calgary, Calgary, Alberta, Canadá.
| | - John Chalmers
- George Institute for Global HealthUniversidad de Nueva Gales del SurSídneyNueva Gales del SurAustraliaGeorge Institute for Global Health, Universidad de Nueva Gales del Sur, Sídney, Nueva Gales del Sur, Australia.
| | - Ivor Benjamin
- American Heart AssociationAmerican Heart AssociationDallasTexasEstados UnidosAmerican Heart Association, Dallas, Texas, Estados Unidos.
| | - Garry Jennings
- Facultad de Medicina de SídneyUniversidad de Sídney y Baker Heart & Diabetes InstituteMelbourneVictoriaAustraliaFacultad de Medicina de Sídney, Universidad de Sídney y Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia.
| | - Stéphane Laurent
- Departamentos de Farmacología, Hospital Europeo Georges Pompidou, Assistance Publique Hôpitaux de ParisInserm UMR 970 y Universidad Paris DescartesParísFranciaDepartamentos de Farmacología, Hospital Europeo Georges Pompidou, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 y Universidad Paris Descartes, París, Francia.
| | - Pierre Boutouyrie
- Departamentos de Farmacología, Hospital Europeo Georges Pompidou, Assistance Publique Hôpitaux de ParisInserm UMR 970 y Universidad Paris DescartesParísFranciaDepartamentos de Farmacología, Hospital Europeo Georges Pompidou, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 y Universidad Paris Descartes, París, Francia.
| | - Patricio Lopez-Jaramillo
- FOSCAL, Instituto Masira, Facultad de Ciencias de la SaludUDESBucaramangaColombiaFOSCAL, Instituto Masira, Facultad de Ciencias de la Salud, UDES, Bucaramanga, Colombia.
| | - Richard J. McManus
- Nuffield Department of Primary Care Health SciencesUniversidad de Oxford, Radcliffe Observatory QuarterOxfordReino UnidoNuffield Department of Primary Care Health Sciences, Universidad de Oxford, Radcliffe Observatory Quarter, Oxford, Reino Unido.
| | - Anastasia S. Mihailidou
- Laboratorio de Investigación Cardiovascular y HormonalDepartamento de Cardiología del Kolling Institute, Royal North Shore Hospital y Facultad de Medicina y Ciencias de la Salud, Universidad MacquarieSídneyNueva Gales del SurAustraliaLaboratorio de Investigación Cardiovascular y Hormonal, Departamento de Cardiología del Kolling Institute, Royal North Shore Hospital y Facultad de Medicina y Ciencias de la Salud, Universidad Macquarie, Sídney, Nueva Gales del Sur, Australia.
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud MentalOrganización Panamericana de la SaludWashington, D.CEstados UnidosDepartamento de Enfermedades no Transmisibles y Salud Mental. Organización Panamericana de la Salud, Washington, D.C., Estados Unidos.
| | - Raj Padwal
- Departamento de Medicina, Universidad de AlbertaDepartamento de Medicina, Universidad de AlbertaEdmontonAlbertaCanadáDepartamento de Medicina, Universidad de Alberta, Edmonton, Alberta, Canadá.
| | - Paolo Palatini
- Studium Patavinum, Universidad de PaduaStudium Patavinum, Universidad de PaduaPaduaItaliaStudium Patavinum, Universidad de Padua, Padua, Italia.
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCSDepartamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Hospital San Luca, Milán, Italia; y Departamento de Medicina y Cirugía, Universidad de Milán-BicoccaMilánItaliaIstituto Auxologico Italiano, IRCCS, Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Hospital San Luca, Milán, Italia; y Departamento de Medicina y Cirugía, Universidad de Milán-Bicocca, Milán, Italia.
| | - Neil Poulter
- Imperial Clinical Trials UnitImperial College LondonLondresReino UnidoImperial Clinical Trials Unit, Imperial College London, Londres, Reino Unido.
| | - Michael K. Rakotz
- Asociación Médica EstadounidenseMejorar los Resultados en Materia de SaludChicagoIllinoisEstados UnidosAsociación Médica Estadounidense, Mejorar los Resultados en Materia de Salud, Chicago, Illinois, Estados Unidos.
| | - Clive Rosendorff
- Mount Sinai HeartDepartamento de Medicina (cardiología), Icahn School of Medicine en Mount Sinai, Nueva York, Estados Unidos, y The James J. Peters VA Medical CenterBronxNueva YorkEstados UnidosMount Sinai Heart, Departamento de Medicina (cardiología), Icahn School of Medicine en Mount Sinai, Nueva York, Estados Unidos, y The James J. Peters VA Medical Center, Bronx, Nueva York, Estados Unidos.
| | - Francesca Saladini
- Departamento de MedicinaUniversidad de Padua; Unidad de Cardiología, Hospital de CittadellaPaduaItaliaDepartamento de Medicina, Universidad de Padua; Unidad de Cardiología, Hospital de Cittadella, Padua, Italia.
| | - Angelo Scuteri
- Departamento de Ciencias Médicas, Quirúrgicas y ExperimentalesUniversidad de SácerSácerItaliaDepartamento de Ciencias Médicas, Quirúrgicas y Experimentales, Universidad de Sácer, Sácer, Italia.
| | - Weimar Sebba Barroso
- Liga para la hipertensiónDepartamento de Cardiología, Universidad Federal de GoiásGoiâniaBrasilLiga para la hipertensión. Departamento de Cardiología, Universidad Federal de Goiás, Goiânia, Brasil.
| | - Myeong-Chan Cho
- Departamento de Medicina Interna, Facultad de Medicina de la Universidad Nacional ChungbukDepartamento de Medicina Interna, Facultad de Medicina de la Universidad Nacional ChungbukCheongjuRepública de CoreaDepartamento de Medicina Interna, Facultad de Medicina de la Universidad Nacional Chungbuk, Cheongju, República de Corea.
| | - Ki-Chul Sung
- División de CardiologíaDepartamento de Medicina Interna, Hospital Kangbuk Samsung, Facultad de Medicina de la Universidad SungkyunkwanSeúlRepública de CoreaDivisión de Cardiología, Departamento de Medicina Interna, Hospital Kangbuk Samsung, Facultad de Medicina de la Universidad Sungkyunkwan, Seúl, República de Corea.
| | - Raymond R. Townsend
- Facultad de Medicina PerelmanUniversidad de PensilvaniaFiladelfiaEstados UnidosFacultad de Medicina Perelman, Universidad de Pensilvania, Filadelfia, Estados Unidos.
| | - Ji-Guang Wang
- Instituto de hipertensión de Shanghai, Hospital RuijinFacultad de Medicina de la Universidad Shanghai JiaotongShanghaiChinaInstituto de hipertensión de Shanghai, Hospital Ruijin, Facultad de Medicina de la Universidad Shanghai Jiaotong, Shanghai, China.
| | - Tine Willum Hansen
- Steno Diabetes Center CopenhagenSteno Diabetes Center CopenhagenGentofteDinamarcaSteno Diabetes Center Copenhagen, Gentofte, Dinamarca.
| | - Gregory Wozniak
- Asociación Médica EstadounidenseMejorar los Resultados en Materia de SaludChicagoIllinoisEstados UnidosAsociación Médica Estadounidense, Mejorar los Resultados en Materia de Salud, Chicago, Illinois, Estados Unidos.
| | - George Stergiou
- Hypertension Center STRIDE-7Universidad Nacional y Kapodistríaca de Atenas, Facultad de Medicina, Tercer Departamento de Medicina, Hospital SotiriaAtenasGreciaHypertension Center STRIDE-7, Universidad Nacional y Kapodistríaca de Atenas, Facultad de Medicina, Tercer Departamento de Medicina, Hospital Sotiria, Atenas, Grecia.
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Sharman JE, O’Brien E, Alpert B, Schutte AE, Delles C, Hecht Olsen M, Asmar R, Atkins N, Barbosa E, Calhoun D, Campbell NR, Chalmers J, Benjamin I, Jennings G, Laurent S, Boutouyrie P, Lopez-Jaramillo P, McManus RJ, Mihailidou AS, Ordunez P, Padwal R, Palatini P, Parati G, Poulter N, Rakotz MK, Rosendorff C, Saladini F, Scuteri A, Sebba Barroso W, Cho MC, Sung KC, Townsend RR, Wang JG, Willum Hansen T, Wozniak G, Stergiou G. Lancet Commission on Hypertension group position statement on the global improvement of accuracy standards for devices that measure blood pressure. J Hypertens 2020; 38:21-29. [PMID: 31790375 PMCID: PMC6919228 DOI: 10.1097/hjh.0000000000002246] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/05/2019] [Accepted: 08/14/2019] [Indexed: 02/03/2023]
Abstract
: The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3000 commercially available BP devices, but many do not have published data on accuracy testing according to established scientific standards. This problem is enabled through weak or absent regulations that allow clearance of devices for commercial use without formal validation. In addition, new BP technologies have emerged (e.g. cuffless sensors) for which there is no scientific consensus regarding BP measurement accuracy standards. Altogether, these issues contribute to the widespread availability of clinic and home BP devices with limited or uncertain accuracy, leading to inappropriate hypertension diagnosis, management and drug treatment on a global scale. The most significant problems relating to the accuracy of BP devices can be resolved by the regulatory requirement for mandatory independent validation of BP devices according to the universally-accepted International Organisation for Standardization Standard. This is a primary recommendation for which there is an urgent international need. Other key recommendations are development of validation standards specifically for new BP technologies and online lists of accurate devices that are accessible to consumers and health professionals. Recommendations are aligned with WHO policies on medical devices and universal healthcare. Adherence to recommendations would increase the global availability of accurate BP devices and result in better diagnosis and treatment of hypertension, thus decreasing the worldwide burden from high BP.
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Affiliation(s)
- James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Eoin O’Brien
- The Conway Institute, University College Dublin, Dublin, Ireland
| | - Bruce Alpert
- University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Aletta E. Schutte
- Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Michael Hecht Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbaek
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Roland Asmar
- Foundation-Medical Research Institutes, Geneva, Switzerland
| | | | - Eduardo Barbosa
- Hypertension League of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - David Calhoun
- Vascular Biology and Hypertension Group, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Norm R.C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O’Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Garry Jennings
- Sydney Medical School, University of Sydney and Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Stéphane Laurent
- Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 and University Paris Descartes, Paris, France
| | - Pierre Boutouyrie
- Department of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 and University Paris Descartes, Paris, France
| | | | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Anastasia S. Mihailidou
- Cardiovascular & Hormonal Research Laboratory, Department of Cardiology & Kolling Institute, Royal North Shore Hospital and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Pedro Ordunez
- Department of Non Communicable and Mental Health, Pan American Health Organization, Washington, District of Columbia
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Neil Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Michael K. Rakotz
- American Medical Association, Improving Health Outcomes, Chicago, Illinois
| | - Clive Rosendorff
- Department of Medicine (Cardiology), Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York
- The James J. Peters VA Medical Center, Bronx, New York, USA
| | - Francesca Saladini
- Cardiology Unit, Department of Medicine, University of Padova, Town Hospital of Cittadella, Padova
| | - Angelo Scuteri
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Weimar Sebba Barroso
- Hypertension League, Department of Cardiology, Federal University of Goiás, Goiânia, Brazil
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Raymond R. Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ji-Guang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Gregory Wozniak
- American Medical Association, Improving Health Outcomes, Chicago, Illinois
| | - George Stergiou
- Third Department of Medicine, Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
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Armstrong MK, Schultz MG, Picone DS, Black JA, Dwyer N, Roberts-Thomson P, Sharman JE. Brachial and Radial Systolic Blood Pressure Are Not the Same. Hypertension 2019; 73:1036-1041. [PMID: 30905194 DOI: 10.1161/hypertensionaha.119.12674] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radial intra-arterial blood pressure (BP) is sometimes used as the reference standard for validation of brachial cuff BP devices. Moreover, there is an emerging wearables market seeking to measure BP at the wrist. However, radial systolic BP may differ when compared with brachial; yet some authors have labeled these differences as a fictional Popeye phenomenon. Indeed, differences between brachial and radial systolic BP have never been accurately quantified, and this was the aim of this study. Intra-arterial BP was measured consecutively at the brachial and radial artery in 180 participants undergoing coronary angiography (aged 61±10 years; 69% men). On average, radial systolic BP was 5.5 mm Hg higher than brachial systolic BP. Only 43% of participants had radial systolic BP within ±5 mm Hg of brachial. Additionally, 46%, 19%, and 13% of participants had radial systolic BP >5, between 5 and 10, and between 10 and 15 mm Hg higher than brachial respectively. A further 14% of participants had radial systolic BP >15 mm Hg higher than brachial, representing the so-called Popeye phenomenon. Finally, 11% of participants had radial systolic BP >5 mm Hg lower than brachial. In conclusion, radial systolic BP is not representative of brachial systolic BP, with most participants having a radial systolic BP >5 mm Hg higher than brachial and many with differences >15 mm Hg. Therefore, validation testing of BP devices utilizing intra-arterial BP as the reference standard should use intra-arterial BP measured at the same site as the brachial cuff or wearable device.
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Affiliation(s)
- Matthew K Armstrong
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.K.A., M.G.S., D.S.P., J.E.S.)
| | - Martin G Schultz
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.K.A., M.G.S., D.S.P., J.E.S.)
| | - Dean S Picone
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.K.A., M.G.S., D.S.P., J.E.S.)
| | - J Andrew Black
- Department of Cardiology, Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D., P.R.-T.)
| | - Nathan Dwyer
- Department of Cardiology, Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D., P.R.-T.)
| | - Philip Roberts-Thomson
- Department of Cardiology, Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D., P.R.-T.)
| | - James E Sharman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.K.A., M.G.S., D.S.P., J.E.S.)
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Current Status and Prospects of Health-Related Sensing Technology in Wearable Devices. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:3924508. [PMID: 31316740 PMCID: PMC6604299 DOI: 10.1155/2019/3924508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 12/03/2022]
Abstract
The healthcare-related functions of wearable devices are very useful for continuous monitoring of biological information. Wearable devices equipped with communication function can be used for additional healthcare services. Among the wearable devices, the wristband type is most suitable for acquiring biological signals, and the wear preference of the user is high, so it is highly likely to be used more in the future. In this paper, the health-related functions of wristband were investigated and the technical limitations and prospects were also reviewed. Most current wristband-type devices are equipped with the combination of accelerometer, optical sensor, and electrodes for their health functions, and continuously measured data are expanding the possibility of discovering new medical meanings. The blood pressure measurement function without using cuff is the most useful and expected function among the health-related functions expected to be mounted on the wrist wearable device, in spite of its technical limits and difficulties.
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Bard DM, Joseph JI, van Helmond N. Cuff-Less Methods for Blood Pressure Telemonitoring. Front Cardiovasc Med 2019; 6:40. [PMID: 31157236 PMCID: PMC6502966 DOI: 10.3389/fcvm.2019.00040] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/21/2019] [Indexed: 01/11/2023] Open
Abstract
Blood pressure telemonitoring (BPT) is a telemedicine strategy that uses a patient's self-measured blood pressure (BP) and transmits this information to healthcare providers, typically over the internet. BPT has been shown to improve BP control compared to usual care without remote monitoring. Traditionally, a cuff-based monitor with data communication capabilities has been used for BPT; however, cuff-based measurements are inconvenient and cause discomfort, which has prevented the widespread use of cuff-based monitors for BPT. The development of new technologies which allow for remote BP monitoring without the use of a cuff may aid in more extensive adoption of BPT. This would enhance patient autonomy while providing physicians with a more complete picture of their patient's BP profile, potentially leading to improved BP control and better long-term clinical outcomes. This mini-review article aims to: (1) describe the fundamentals of current techniques in cuff-less BP measurement; (2) present examples of commercially available cuff-less technologies for BPT; (3) outline challenges with current methodologies; and (4) describe potential future directions in cuff-less BPT development.
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Affiliation(s)
- Dylan M Bard
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.,Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jeffrey I Joseph
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Noud van Helmond
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.,Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ, United States
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Saugel B, Flick M, Bendjelid K, Critchley LAH, Vistisen ST, Scheeren TWL. Journal of clinical monitoring and computing end of year summary 2018: hemodynamic monitoring and management. J Clin Monit Comput 2019; 33:211-222. [PMID: 30847738 PMCID: PMC6420447 DOI: 10.1007/s10877-019-00297-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 12/05/2022]
Abstract
Hemodynamic management is a mainstay of patient care in the operating room and intensive care unit (ICU). In order to optimize patient treatment, researchers investigate monitoring technologies, cardiovascular (patho-) physiology, and hemodynamic treatment strategies. The Journal of Clinical Monitoring and Computing (JCMC) is a well-established and recognized platform for publishing research in this field. In this review, we highlight recent advancements and summarize selected papers published in the JCMC in 2018 related to hemodynamic monitoring and management.
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Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg- Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Moritz Flick
- Department of Anesthesiology, Centre of Anesthesiology and Intensive Care Medicine, University Medical Centre Hamburg- Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karim Bendjelid
- Department of Anesthesiology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Lester A H Critchley
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shantin, N.T., Hong Kong.,The Belford Hospital, Fort William, The Highlands, Scotland, UK
| | - Simon T Vistisen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Affiliation(s)
- Fu Liang Ng
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
| | - Melvin David Lobo
- Barts BP Centre of Excellence, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Barts NIHR Cardiovascular Biomedical Research Unit, William Harvey Research Institute, Queen Mary University, London, UK
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34
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Objective sleep quality and night-time blood pressure in the general elderly population. J Hypertens 2018; 36:601-607. [DOI: 10.1097/hjh.0000000000001569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peeters SA, Engelen L, Buijs J, Chaturvedi N, Fuller JH, Jorsal A, Parving HH, Tarnow L, Theilade S, Rossing P, Schalkwijk CG, Stehouwer CDA. Circulating matrix metalloproteinases are associated with arterial stiffness in patients with type 1 diabetes: pooled analysis of three cohort studies. Cardiovasc Diabetol 2017; 16:139. [PMID: 29070037 PMCID: PMC5657128 DOI: 10.1186/s12933-017-0620-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/15/2017] [Indexed: 02/07/2023] Open
Abstract
Background Altered regulation of extracellular matrix (ECM) composition by matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase (TIMPs) may contribute to arterial stiffening. We investigated associations between circulating MMP-1, -2, -3, -9, -10 and TIMP-1, and carotid-femoral pulse wave velocity (cfPWV) and pulse pressure (PP), as markers of arterial stiffness in type 1 diabetic patients. Methods Individuals with type 1 diabetes from three different cohorts were included in this study: EURODIAB Prospective Complications study (n = 509), LEACE (n = 370) and PROFIL (n = 638). Linear regression analyses were used to investigate cross-sectional associations between circulating levels of MMP-1, -2, -3, -9, -10, and TIMP-1 and cfPWV (n = 614) as well as office PP (n = 1517). Data on 24-h brachial and 24-h central PP were available in 638 individuals from PROFIL. Analyses were adjusted for age, sex, duration of diabetes, HbA1c, mean arterial pressure (MAP), and eGFR, and additionally for other cardiovascular risk factors and presence of vascular complications. Results After adjustment for potential confounders and presence of vascular complications, circulating MMP-3 was associated with cfPWV [β per 1 SD higher lnMMP3 0.29 m/s (0.02; 0.55)]. In addition, brachial and central 24-h PP measurements in PROFIL were significantly associated with MMP-2 [(1.40 (0.47:2.33) and 1.43 (0.63:2.23)]. Pooled data analysis showed significant associations of circulating levels of MMP-1 and MMP-2 with office PP [β per 1 SD higher lnMMP-1 and lnMMP-2 = − 0.83 mmHg (95% CI − 1.50; − 0.16) and = 1.33 mmHg (0.55; 2.10), respectively]. Conclusions MMPs-1, -2, and -3 are independently associated with markers of arterial stiffening in patients with type 1 diabetes and may become therapeutic targets. Electronic supplementary material The online version of this article (doi:10.1186/s12933-017-0620-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stijn A Peeters
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,Department of Internal Medicine, Zuyderland hospital, Heerlen, The Netherlands
| | - Lian Engelen
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,Centraal Bureau voor de Statistiek, Heerlen, The Netherlands
| | - Jacqueline Buijs
- Department of Internal Medicine, Zuyderland hospital, Heerlen, The Netherlands
| | - Nish Chaturvedi
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - John H Fuller
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Anders Jorsal
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Hans-Henrik Parving
- Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lise Tarnow
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Faculty of Health, Aarhus University, Aarhus, Denmark
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. .,CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Twenty-Four-Hour Ambulatory Pulse Wave Analysis in Hypertension Management: Current Evidence and Perspectives. Curr Hypertens Rep 2017; 18:72. [PMID: 27659178 DOI: 10.1007/s11906-016-0681-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The predictive value of vascular biomarkers such as pulse wave velocity (PWV), central arterial pressure (CAP), and augmentation index (AIx), obtained through pulse wave analysis (PWA) in resting conditions, has been documented in a variety of patient groups and populations. This allowed to make appropriate recommendations in clinical practice guidelines of several scientific societies. Due to advances in technologies, largely operator-independent methods are currently available for estimating vascular biomarkers also in ambulatory conditions, over the 24 h. According to the acceptable accuracy and reproducibility of 24-h ambulatory PWA, it appears to be a promising tool for evaluating vascular biomarkers in daily life conditions. This approach may provide an opportunity to further improve the early cardiovascular screening in subjects at risk. However, concerning the clinical use of PWA over the 24 h in ambulatory conditions at the moment, there is no sufficient evidence to support its routine clinical use. In particular, long-term outcome studies are needed to show the predictive value of 24-h PWV, CAP, and AIx values, provided by these devices, over and beyond peripheral blood pressure, and to answer the many technical and clinical questions still open. To this regard, the VASOTENS Registry, an international observational prospective study recently started, will help providing answers on a large sample of hypertensive patients recruited worldwide.
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Rosenbaek JB, Al Therwani S, Jensen JM, Mose FH, Wandall-Frostholm C, Pedersen EB, Bech JN. Effect of sodium nitrite on renal function and sodium and water excretion and brachial and central blood pressure in healthy subjects: a dose-response study. Am J Physiol Renal Physiol 2017; 313:F378-F387. [PMID: 28490529 DOI: 10.1152/ajprenal.00400.2016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 04/21/2017] [Accepted: 05/02/2017] [Indexed: 01/12/2023] Open
Abstract
Sodium nitrite (NaNO2) is converted to nitric oxide (NO) in vivo and has vasodilatory and natriuretic effects. Our aim was to examine the effects of NaNO2 on hemodynamics, sodium excretion, and glomerular filtration rate (GFR). In a single-blinded, placebo-controlled, crossover study, we infused placebo (0.9% NaCl) or 0.58, 1.74, or 3.48 μmol NaNO2·kg-1·h-1 for 2 h in 12 healthy subjects, after 4 days of a standard diet. Subjects were supine and water loaded. We measured brachial and central blood pressure (BP), plasma concentrations of renin, angiotensin II, aldosterone, arginine vasopressin (P-AVP), and plasma nitrite (P-[Formula: see text]), GFR by Cr-EDTA clearance, fractional excretion of sodium (FENa) free water clearance (CH2O), and urinary excretion rate of guanosine 3',5'-cyclic monophosphate (U-cGMP). The highest dose reduced brachial systolic BP (5.6 mmHg, P = 0.003), central systolic BP (5.6 mmHg, P = 0.035), and CH2O (maximum change from 3.79 to 1.27 ml/min, P = 0.031) and increased P-[Formula: see text] (from 0.065 to 0.766 μmol/l, P < 0.001), while reducing U-cGMP (from 444 to 247 pmol/min, P = 0.004). GFR, FENa, P-AVP, and the components in the renin-angiotensin-aldosterone system did not change significantly. In conclusion, intravenous NaNO2 induced a dose-dependent reduction of brachial and central BP. The hemodynamic effect was not mediated by the renin-angiotensin-aldosterone system. NaNO2 infusion resulted in a vasopressin-independent decrease in CH2O and urine output but no change in urinary sodium excretion or GFR. The lack of increase in cGMP accompanying the increase in [Formula: see text] suggests a direct effect of nitrite or nitrate on the renal tubules and vascular bed with little or no systemic conversion to NO.
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Affiliation(s)
- Jeppe Bakkestroem Rosenbaek
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark; and
| | - Safa Al Therwani
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark; and
| | - Janni Majgaard Jensen
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark; and
| | - Frank Holden Mose
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark; and
| | | | - Erling Bjerregaard Pedersen
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark; and
| | - Jesper Noergaard Bech
- University Clinic in Nephrology and Hypertension, Regional Hospital West Jutland and Aarhus University, Aarhus, Denmark; and
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Post-Carotid Endarterectomy Hypertension. Part 1: Association with Pre-operative Clinical, Imaging, and Physiological Parameters. Eur J Vasc Endovasc Surg 2017; 54:551-563. [PMID: 28268070 DOI: 10.1016/j.ejvs.2017.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 01/24/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE/BACKGROUND Post-endarterectomy hypertension (PEH) is a well recognised, but poorly understood, phenomenon after carotid endarterectomy (CEA) that is associated with post-operative intracranial haemorrhage, hyperperfusion syndrome, and cardiac complications. The aim of the current study was to identify pre-operative clinical, imaging, and physiological parameters associated with PEH. METHODS In total, 106 CEA patients undergoing CEA under general anaesthesia underwent pre-operative evaluation of 24 hour ambulatory arterial blood pressure (BP), baroreceptor sensitivity, cerebral autoregulation, and transcranial Doppler measurement of cerebral blood flow velocity (CBFv) and pulsatility index. Patients who met pre-existing criteria for treating PEH after CEA (systolic BP [SBP] > 170 mmHg without symptoms or SBP > 160 mmHg with headache/seizure/neurological deficit) were treated according to a previously established protocol. RESULTS In total, 40/106 patients (38%) required treatment for PEH at some stage following CEA (26 in theatre recovery [25%], 27 while on the vascular surgical ward [25%]), while seven (7%) had SBP surges > 200 mmHg back on the ward. Patients requiring treatment for PEH had a significantly higher pre-operative SBP (144 ± 11 mmHg vs. 135 ± 13 mmHg; p < .001) and evidence of pre-existing impairment of baroreceptor sensitivity (3.4 ± 1.7 ms/mmHg vs. 5.3 ± 2.8 ms/mmHg; p = .02). However, PEH was not associated with any other pre-operative clinical features, CBFv, or impaired cerebral haemodynamics. Paradoxically, autoregulation was better preserved in patients with PEH. All four cases of hyperperfusion associated symptoms were preceded by PEH. Length of hospital stay was significantly increased in patients with PEH (p < .001). CONCLUSION In this study, where all patients underwent CEA under general anaesthesia, PEH was associated with poorly controlled pre-operative BP and impaired baroreceptor sensitivity, but not with other peripheral or central haemodynamic parameters, including impaired cerebral autoregulation.
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von Scholten BJ, Persson F, Svane MS, Hansen TW, Madsbad S, Rossing P. Effect of large weight reductions on measured and estimated kidney function. BMC Nephrol 2017; 18:52. [PMID: 28166744 PMCID: PMC5294831 DOI: 10.1186/s12882-017-0474-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/02/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND When patients experience large weight loss, muscle mass may be affected followed by changes in plasma creatinine (pCr). The MDRD and CKD-EPI equations for estimated GFR (eGFR) include pCr. We hypothesised that a large weight loss reduces muscle mass and pCr causing increase in eGFR (creatinine-based equations), whereas measured GFR (mGFR) and cystatin C-based eGFR would be unaffected if adjusted for body surface area. METHODS Prospective, intervention study including 19 patients. All attended a baseline visit before gastric bypass surgery followed by a visit six months post-surgery. mGFR was assessed during four hours plasma 51Cr-EDTA clearance. GFR was estimated by four equations (MDRD, CKD-EPI-pCr, CKD-EPI-cysC and CKD-EPI-pCr-cysC). DXA-scans were performed at baseline and six months post-surgery to measure changes in lean limb mass, as a surrogate for muscle mass. RESULTS Patients were (mean ± SD) 40.0 ± 9.3 years, 14 (74%) were female and 5 (26%) had type 2 diabetes, baseline weight was 128 ± 19 kg, body mass index 41 ± 6 kg/m2 and absolute mGFR 122 ± 24 ml/min. Six months post-surgery weight loss was 27 (95% CI: 23; 30) kg, mGFR decreased by 9 (-17; -2) from 122 ± 24 to 113 ± 21 ml/min (p = 0.024), but corrected for current body surface area (BSA) mGFR was unchanged by 2 (-5; 9) ml/min/1.73 m2 (p = 0.52). CKD-EPI-pCr increased by 12 (6; 17) and MDRD by 13 (8; 18) (p < 0.001 for both), while CKD-EPI-cysC was unchanged by 2 (-8; 4) ml/min/1.73 m2 (p = 0.51). Lean limb mass was reduced by 3.5 (-4.4;-2.6; p < 0.001) kg and change in lean limb mass correlated with change in plasma creatinine (R 2 = 0.28, p = 0.032). CONCLUSIONS Major weight reductions are associated with a reduction in absolute mGFR, which may reflect resolution of glomerular hyperfiltration, while mGFR adjusted for body surface area was unchanged. Estimates of GFR based on creatinine overestimate renal function likely due to changes in muscle mass, whereas cystatin C based estimates are unaffected. TRIAL REGISTRATION ClinicalTrials.gov, NCT02138565 . Date of registration: March 24, 2014.
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Affiliation(s)
| | - Frederik Persson
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 1, 2820, Gentofte, Denmark
| | | | - Tine W Hansen
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 1, 2820, Gentofte, Denmark
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 1, 2820, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
- Aarhus University, Aarhus, Denmark
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Harju J, Vehkaoja A, Kumpulainen P, Campadello S, Lindroos V, Yli-Hankala A, Oksala N. Comparison of non-invasive blood pressure monitoring using modified arterial applanation tonometry with intra-arterial measurement. J Clin Monit Comput 2017; 32:13-22. [PMID: 28105538 DOI: 10.1007/s10877-017-9984-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
Intermittent non-invasive blood pressure measurement with tourniquets is slow, can cause nerve and skin damage, and interferes with other measurements. Invasive measurement cannot be safely used in all conditions. Modified arterial tonometry may be an alternative for fast and continuous measurement. Our aim was to compare arterial tonometry sensor (BPro®) with invasive blood pressure measurement to clarify whether it could be utilized in the postoperative setting. 28 patients who underwent elective surgery requiring arterial cannulation were analyzed. Patients were monitored post-operatively for 2 h with standard invasive monitoring and with a study device comprising an arterial tonometry sensor (BPro®) added with a three-dimensional accelerometer to investigate the potential impact of movement. Recordings were collected electronically. The results revealed inaccurate readings in method comparison between the devices based on recommendations by Association for the Advancement of Medical Instrumentation (AAMI). On a Bland-Altman plot, the bias and precision between these two methods was 19.8 ± 16.7 (Limits of agreement - 20.1 to 59.6) mmHg, Spearman correlation coefficient r = 0.61. For diastolic pressure, the difference was 4.8 ± 7.7 (LoA - 14.1 to 23.6) mmHg (r = 0.72), and for mean arterial pressure it was 11.18 ± 11.1 (LoA - 12.1 to 34.2) mmHg (r = 0.642). Our study revealed inaccurate agreement (AAMI) between the two methods when measuring systolic and mean blood pressures during post-operative care. The readings for diastolic pressures were inside the limits recommended by AAMI. Movement increased the failure rate significantly (p < 0.001). Thus, arterial tonometry is not an appropriate replacement for invasive blood pressure measurement in these patients.
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Affiliation(s)
- Jarkko Harju
- Department of Anaesthesia, Tampere University Hospital, PL2000, 33521, Tampere, Finland.
| | | | | | | | | | - Arvi Yli-Hankala
- Department of Anaesthesia, Tampere University Hospital, PL2000, 33521, Tampere, Finland.,Medical School, University of Tampere, Tampere, Finland
| | - Niku Oksala
- Medical School, University of Tampere, Tampere, Finland.,Department of Surgery, Tampere University Hospital, Tampere, Finland
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Harju J, Vehkaoja A, Lindroos V, Kumpulainen P, Liuhanen S, Yli-Hankala A, Oksala N. Determination of saturation, heart rate, and respiratory rate at forearm using a Nellcor™ forehead SpO 2-saturation sensor. J Clin Monit Comput 2016; 31:1019-1026. [PMID: 27752932 DOI: 10.1007/s10877-016-9940-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 10/07/2016] [Indexed: 11/29/2022]
Abstract
Alterations in arterial blood oxygen saturation, heart rate (HR), and respiratory rate (RR) are strongly associated with intra-hospital cardiac arrests and resuscitations. A wireless, easy-to-use, and comfortable method for monitoring these important clinical signs would be highly useful. We investigated whether the Nellcor™ OxiMask MAX-FAST forehead sensor could provide data for vital sign measurements when located at the distal forearm instead of its intended location at the forehead to provide improved comfortability and easy placement. In a prospective setting, we recruited 30 patients undergoing surgery requiring postoperative care. At the postoperative care unit, patients were monitored for two hours using a standard patient monitor and with a study device equipped with a Nellcor™ Forehead SpO2 sensor. The readings were electronically recorded and compared in post hoc analysis using Bland-Altman plots, Spearman's correlation, and root-mean-square error (RMSE). Bland-Altman plot showed that saturation (SpO2) differed by a mean of -0.2 % points (SD, 4.6), with a patient-weighted Spearman's correlation (r) of 0.142, and an RMSE of 4.2 points. For HR measurements, the mean difference was 0.6 bpm (SD, 2.5), r = 0.997, and RMSE = 1.8. For RR, the mean difference was -0.5 1/min (4.1), r = 0.586, and RMSE = 4.0. The SpO2 readings showed a low mean difference, but also a low correlation and high RMSE, indicating that the Nellcor™ saturation sensor cannot reliably assess oxygen saturation at the forearm when compared to finger PPG measurements.
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Affiliation(s)
- Jarkko Harju
- Department of Anesthesia, Tampere University Hospital, PL2000, 33521, Tampere, Finland.
| | | | | | | | - Sasu Liuhanen
- Department of Anesthesia, Helsinki University Hospital, Helsinki, Finland
| | - Arvi Yli-Hankala
- Department of Anesthesia, Tampere University Hospital, PL2000, 33521, Tampere, Finland.,Medical School, University of Tampere, Tampere, Finland
| | - Niku Oksala
- Medical School, University of Tampere, Tampere, Finland.,Department of Surgery, Tampere University Hospital, Tampere, Finland
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Teong HH, Chin AML, Sule AA, Tay JC. Effect of angiotensin receptor blockade on central aortic systolic blood pressure in hypertensive Asians measured using radial tonometry: an open prospective cohort study. Singapore Med J 2016; 57:384-9. [PMID: 26875683 DOI: 10.11622/smedj.2016040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Central aortic systolic pressure (CASP) has been shown to be a stronger predictor of cardiovascular events than brachial blood pressure (BP). Different classes of drugs have differential effects on CASP and brachial BP. This open prospective cohort study aimed to observe changes in CASP (measured using radial tonometry) among hypertensive Asians after 12 weeks of treatment with valsartan, an angiotensin receptor blocker (ARB). METHODS Patients with treatment-naïve hypertension or uncontrolled hypertension who were on non-ARB therapy were eligible for inclusion. Patients with uncontrolled BP (i.e. ≥ 140/90 mmHg) received valsartan for 12 weeks. The patients' brachial systolic and diastolic BP (SBP and DBP), and CASP changes were monitored using the BPro® watch. RESULTS The mean age of the 44 enrolled patients was 35 years. At baseline, the mean BP and CASP were 150.2/91.4 ± 10.6/9.4 mmHg and 136.3 ± 12.2 mmHg, respectively. Valsartan reduced SBP, DBP and CASP by 14.9 ± 10.7 mmHg, 10.9 ± 8.4 mmHg and 15.3 ± 10.9 mmHg, respectively (all p < 0.001). Every 1.0-mmHg reduction in brachial SBP resulted in a 0.8-mmHg reduction in CASP (p < 0.001). A CASP cut-off of 122.5 mmHg discriminated between controlled and uncontrolled BP (sensitivity 74%, specificity 88%). CONCLUSION Using radial tonometry, we demonstrated good correlation between CASP and brachial SBP reductions after 12 weeks of treatment with valsartan in our study cohort. Correlation analysis between CASP and SBP reductions may be useful for demonstrating whether a drug is able to lower CASP beyond lowering SBP.
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Affiliation(s)
- Hui Hwang Teong
- Department of General Medicine, Tan Tock Seng Hospital, Singapore
| | | | - Ashish Anil Sule
- Department of General Medicine, Tan Tock Seng Hospital, Singapore
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore
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García-Hermoso A, Notario-Pacheco B, Recio-Rodríguez J, Martínez-Vizcaíno V, Rodrigo de Pablo E, Magdalena Belio J, Gómez-Marcos M, García-Ortiz L. Sedentary behaviour patterns and arterial stiffness in a Spanish adult population – The EVIDENT trial. Atherosclerosis 2015; 243:516-22. [DOI: 10.1016/j.atherosclerosis.2015.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
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Clustering of lifestyle characteristics and their association with cardio-metabolic health: the Lifestyles and Endothelial Dysfunction (EVIDENT) study. Br J Nutr 2015; 114:943-51. [DOI: 10.1017/s0007114515002500] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractLittle is known about the clustering patterns of lifestyle behaviours in adult populations. We explored clusters in multiple lifestyle behaviours including physical activity (PA), smoking, alcohol use and eating habits in a sample of adult population. A cross-sectional and multi-centre study was performed with six participating groups distributed throughout Spain. Participants (n 1327) were part of the Lifestyles and Endothelial Dysfunction (EVIDENT) study and were aged between 20 and 80 years. The lifestyle and cardiovascular risk (CVR) factors were analysed using a clustering method based on the HJ-biplot coordinates to understand the variables underlying these groupings. The following three clusters were identified. Cluster 1: unhealthy, 677 subjects (51 %), with a slight majority of men (58·7 %), who were more sedentary and smokers with higher consumption of whole-fat dairy products, bigger waist circumference as well as higher TAG levels, systolic blood pressure (SBP) and CVR. Cluster 2: healthy/PA, 265 subjects (20 %), including 24·0 % of males with high PA. Cluster 3: healthy/diet, including 29 % of the participants, with a higher consumption of olive oil, fish, fruits, nuts, vegetables and lower alcohol consumption. Using the unhealthy cluster as a reference, and after adjusting for age and sex, the multiple regression analysis showed that belonging to the healthy/PA cluster was associated with a lower waist circumference, body fat percentage, SBP and CVR. In summary, the three clusters were identified according to lifestyles. The ‘unhealthy’ cluster had the least favourable clinical parameters, the ‘healthy/PA’ cluster had good HDL-cholesterol levels and low SBP and the ‘healthy/diet’ cluster had lower LDL-cholesterol levels and clinical blood pressure.
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von Scholten BJ, Lajer M, Goetze JP, Persson F, Rossing P. Time course and mechanisms of the anti-hypertensive and renal effects of liraglutide treatment. Diabet Med 2015; 32:343-52. [PMID: 25251901 DOI: 10.1111/dme.12594] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/14/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023]
Abstract
AIMS Glucagon-like peptide-1 receptor agonist studies have revealed clinically significant reductions in systolic blood pressure (SBP). The aim was to investigate the time course of the anti-hypertensive effect of liraglutide treatment and potential underlying mechanisms. METHODS We used an open-label, single-centre trial; 31 participants with Type 2 diabetes and hypertension completed the study. All participants were treated with liraglutide escalated to a maximum dose of 1.8 mg/day for 7 weeks, followed by a 21-day washout period. The primary outcome was a change in 24-h SBP. RESULTS Twenty-four-h SBP increased by 10 mmHg on day 3 (P = 0.008) and 7 mmHg on day 7 (P = 0.033, 0.6 mg/day). On day 29, (1.8 mg/day), 24-h SBP was 7 mmHg lower compared with baseline (P = 0.11). Following the treatment period (day 49) and after washout (day 70), 24-h BP was equivalent to baseline. In addition, extracellular volume (ECV) was reduced by 2.0 l [95% confidence interval (CI) = 1.0-3.1 l, P < 0.001] and midregional-pro-atrial natriuretic peptide (MR-proANP) was reduced by 20% (95% CI = 12-28%, P < 0.001). Also, urinary albumin excretion declined by 30% (95% CI = 12-44%, P = 0.003), GFR by 11 ml/min/1.73 m(2) (95% CI = 7.2-14.4 ml/min/1.73 m(2) , P < 0.001) and fractional albumin excretion by 29% (95% CI = 3-48%, P = 0.032). CONCLUSIONS Liraglutide treatment was associated with an initial increase in 24-h SBP, followed by a 7 mmHg reduction after escalation to 1.8 mg/day. This effect subsided after 4 weeks of maximum dose. Reductions in ECV and MR-proANP may explain the anti-hypertensive potential. Liraglutide treatment was associated with reversible reductions in albuminuria and GFR, which has to be confirmed in randomized trials.
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Joergensen C, Tarnow L, Goetze JP, Rossing P. Vitamin D analogue therapy, cardiovascular risk and kidney function in people with Type 1 diabetes mellitus and diabetic nephropathy: a randomized trial. Diabet Med 2015; 32:374-81. [PMID: 25307511 DOI: 10.1111/dme.12606] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2014] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the effects of therapy with the vitamin D analogue paricalcitol on markers of cardiovascular risk and kidney function in people with Type 1 diabetes mellitus and diabetic nephropathy. METHODS In a double-blind, randomized placebo-controlled, crossover trial, 48 participants on stable renin angiotensin aldosterone system blockade and diuretics were assigned, in random order, to 12 weeks of paricalcitol and 12 weeks of placebo therapy, separated by a 4-week washout period. Primary and secondary endpoints were changes in plasma N-terminal probrain natriuretic peptide and urinary albumin excretion rate obtained before and after each intervention. Glomerular filtration rates were estimated and measured ((51) Cr-EDTA plasma clearance glomerular filtration rate) after each intervention. RESULTS The mean (sd) age of the participants was 57 (9) years, the baseline geometric mean (95% CI) urinary albumin excretion rate was 148 (85-259) mg/24 h, the mean (sd) HbA1c was 70 (9) mmol/mol [8.6 (3)%], the mean (sd) estimated glomerular filtration rate was 47 (15) ml/min/1.73 m(2) and the mean (sd) 24-h blood pressure was 135 (17)/74 (10) mmHg. Compared with placebo therapy, vitamin D analogue therapy had no significant effect on plasma N-terminal probrain natriuretic peptide concentration (P = 0.6), urinary albumin excretion rate was reduced by 18% (P = 0.03 for comparison), estimated glomerular filtration rate was reduced by 5 ml/min/1.73 m(2) (P < 0.001) and measured glomerular filtration rate was reduced by 1.5 ml/min/1.73 m(2) (P = 0.2). CONCLUSIONS Paricalcitol therapy did not affect plasma N-terminal probrain natriuretic peptide concentration in people with Type 1 diabetes and diabetic nephropathy; however, the urinary albumin excretion rate was significantly lowered.
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Quandt BM, Scherer LJ, Boesel LF, Wolf M, Bona GL, Rossi RM. Body-monitoring and health supervision by means of optical fiber-based sensing systems in medical textiles. Adv Healthc Mater 2015; 4:330-55. [PMID: 25358557 DOI: 10.1002/adhm.201400463] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/24/2014] [Indexed: 11/11/2022]
Abstract
Long-term monitoring with optical fibers has moved into the focus of attention due to the applicability for medical measurements. Within this Review, setups of flexible, unobtrusive body-monitoring systems based on optical fibers and the respective measured vital parameters are in focus. Optical principles are discussed as well as the interaction of light with tissue. Optical fiber-based sensors that are already used in first trials are primarily selected for the section on possible applications. These medical textiles include the supervision of respiration, cardiac output, blood pressure, blood flow and its saturation with hemoglobin as well as oxygen, pressure, shear stress, mobility, gait, temperature, and electrolyte balance. The implementation of these sensor concepts prompts the development of wearable smart textiles. Thus, current sensing techniques and possibilities within photonic textiles are reviewed leading to multiparameter designs. Evaluation of these designs should show the great potential of optical fibers for the introduction into textiles especially due to the benefit of immunity to electromagnetic radiation. Still, further improvement of the signal-to-noise ratio is often necessary to develop a commercial monitoring system.
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Affiliation(s)
- Brit M. Quandt
- Empa-Swiss Federal Laboratories for Materials Science and Technology; Laboratory for Protection and Physiology; Lerchenfeldstrasse 5, 9016 St. Gallen Switzerland
- ETH Zurich, Department of Information Technology and Electrical Engineering; Gloriastrasse 35 8092 Zurich Switzerland
| | | | - Luciano F. Boesel
- Empa-Swiss Federal Laboratories for Materials Science and Technology; Laboratory for Protection and Physiology; Lerchenfeldstrasse 5, 9016 St. Gallen Switzerland
| | - Martin Wolf
- Division of Neonatology; University Hospital Zurich; Frauenklinikstrasse 10 8091 Zurich Switzerland
| | - Gian-Luca Bona
- ETH Zurich, Department of Information Technology and Electrical Engineering; Gloriastrasse 35 8092 Zurich Switzerland
- Empa-Swiss Federal Laboratories for Materials Science and Technology; Überlandstrasse 129 8600 Dübendorf Switzerland
| | - René M. Rossi
- Empa-Swiss Federal Laboratories for Materials Science and Technology; Laboratory for Protection and Physiology; Lerchenfeldstrasse 5, 9016 St. Gallen Switzerland
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Tissue-informative mechanism for wearable non-invasive continuous blood pressure monitoring. Sci Rep 2014; 4:6618. [PMID: 25331013 PMCID: PMC4204067 DOI: 10.1038/srep06618] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 09/25/2014] [Indexed: 11/14/2022] Open
Abstract
Accurate continuous direct measurement of the blood pressure is currently available thru direct invasive methods via intravascular needles, and is mostly limited to use during surgical procedures or in the intensive care unit (ICU). Non-invasive methods that are mostly based on auscultation or cuff oscillometric principles do provide relatively accurate measurement of blood pressure. However, they mostly involve physical inconveniences such as pressure or stress on the human body. Here, we introduce a new non-invasive mechanism of tissue-informative measurement, where an experimental phenomenon called subcutaneous tissue pressure equilibrium is revealed and related for application in detection of absolute blood pressure. A prototype was experimentally verified to provide an absolute blood pressure measurement by wearing a watch-type measurement module that does not cause any discomfort. This work is supposed to contribute remarkably to the advancement of continuous non-invasive mobile devices for 24-7 daily-life ambulatory blood-pressure monitoring.
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García-Ortiz L, de Cabo-Laso A, Rodriguez-Martín C, Recio-Rodríguez J, Garcia Garcia A, Rodriguez-Sanchez E, Agudo-Conde C, Gomez-Marcos M. Monitorización ambulatoria de la presión arterial y actividad física en pacientes hipertensos. HIPERTENSION Y RIESGO VASCULAR 2014. [DOI: 10.1016/j.hipert.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gomez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Agudo-Conde C, Lasaosa-Medina L, Rodriguez-Sanchez E, Maderuelo-Fernandez JA, García-Ortiz L. Relationship between objectively measured physical activity and vascular structure and function in adults. Atherosclerosis 2014; 234:366-72. [DOI: 10.1016/j.atherosclerosis.2014.02.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
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