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Song YH. Aneroid Auscultatory Sphygmomanometers and Automated Oscillometric Devices as Mercury-Free Alternatives in Children. Korean Circ J 2024; 54:288-290. [PMID: 38767341 PMCID: PMC11109841 DOI: 10.4070/kcj.2024.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Young Hwan Song
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.
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2
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Liu Z, Zhang Y, Zhou C. BiGRU-attention for Continuous blood pressure trends estimation through single channel PPG. Comput Biol Med 2024; 168:107795. [PMID: 38056206 DOI: 10.1016/j.compbiomed.2023.107795] [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: 09/19/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Physiological parameter monitoring based on photoplethysmography (PPG) detection has the advantage of fast, portable, and non-invasive. Changes in the morphology of the PPG waveform can reflect the effect of arterial elasticity changes on blood pressure (BP). However, machine learning models and non-recurrent neural network models typically ignore the time-dependency of continuous PPG data, leading to the decrease of accuracy or the increased calibration frequency. OBJECTIVE This paper proposes a BiGRU model with attention to estimate BP trends, which uses a single-channel PPG signal combined with demographic information to estimate continuous BP trends point-by-point and to discuss the impact of calibration cycle. METHODS This paper selects 15 typical subjects from two groups with/without cardiovascular disease (CVD) and evaluates the model performance. Regarding the calibration frequency problem, we set two modes of non-calibration and calibration to validate the results of blood pressure trends estimation. RESULTS In the calibration mode, the estimation errors (ME ± STD) of SBP for CVD/non-CVD groups are 0.91 ± 10.58 mmHg/0.17 ± 10.06 mmHg respectively, and DBP are 0.34 ± 5.28 mmHg/-0.19 ± 5.36 mmHg; in the non-calibration mode, the estimation errors of SBP for CVD/non-CVD groups are 0.27 ± 9.87 mmHg/-0.82 ± 9.92 mmHg respectively, and DBP are -0.63 ± 3.28 mmHg/0.80 ± 4.93 mmHg. CONCLUSIONS The results show that the proposed model has high accuracy in estimating BP levels, which is expected to achieve real-time, long-term continuous BP trends monitoring in wearable devices.
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Affiliation(s)
- Ziyi Liu
- Guangdong Transtek Medical Electronics Co., Ltd., Zhongshan, 52843, People's Republic of China
| | - Yiming Zhang
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China
| | - Congcong Zhou
- Biosensor National Special Laboratory, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, People's Republic of China; Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, National Engineering Research Center for Innovation and Application of Minimally Invasive Devices, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, People's Republic of China.
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Dahle N, Ärnlöv J, Leppert J, Hedberg P. Nondipping blood pressure pattern predicts cardiovascular events and mortality in patients with atherosclerotic peripheral vascular disease. Vasc Med 2023; 28:274-281. [PMID: 37036102 PMCID: PMC10408241 DOI: 10.1177/1358863x231161655] [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: 04/11/2023]
Abstract
BACKGROUND Patients with peripheral vascular disease (PVD) are often underdiagnosed and undertreated. Nocturnal nondipping blood pressure (BP) pattern, as diagnosed by ambulatory BP monitoring (ABPM), is associated with increased cardiovascular risk, but has not been studied in patients with PVD. We aimed to investigate if a nondipping BP pattern predicts cardiovascular events or all-cause death in outpatients with PVD. METHODS Consecutive outpatients with carotid or lower-extremity PVD were examined with 24-hour ABPM (n = 396). Nondipping was defined as a < 10% fall in systolic BP level during night-time. We used Cox regression models adjusting for potential confounders. We also evaluated the incremental prognostic value of dipping status in the COPART risk score. Our primary composite outcome was cardiovascular events or all-cause death. RESULTS In the cohort (mean age 70; 40% women), 137 events occurred during a 5.1-year median follow-up; incident rate of 7.35 events per 100 person-years. Nondipping was significantly associated with outcome (hazard ratio 1.55, 95% CI 1.07-2.26, p = 0.021) in a fully adjusted model. When adding nondipping to the risk markers in the COPART risk score, the model fit significantly improved (χ2 7.91, p < 0.005) and the C-statistic increased from 0.65 to 0.67. CONCLUSION In a cohort of outpatients with PVD, nondipping was an independent risk factor for future cardiovascular events or mortality and seemed to be a strong predictor in patients with carotid artery disease but not in lower-extremity PVD. Additional studies are needed to evaluate the clinical utility of ABPM for improved prevention in these high-risk patients. (ClinicalTrials.gov Identifier: NCT01452165).
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Affiliation(s)
- Nina Dahle
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Primary Health Care Center Britsarvet-Grycksbo, County of Dalarna, Falun, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Division of Family Medicine and Primary Care, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Jerzy Leppert
- Center for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Pär Hedberg
- Center for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
- Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden
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Champaneria MK, Patel RS, Oroszi TL. When blood pressure refuses to budge: exploring the complexity of resistant hypertension. Front Cardiovasc Med 2023; 10:1211199. [PMID: 37416924 PMCID: PMC10322223 DOI: 10.3389/fcvm.2023.1211199] [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: 04/24/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
Resistant hypertension, defined as blood pressure that remains above goal despite using three or more antihypertensive medications, including a diuretic, affects a significant proportion of the hypertensive population and is associated with increased cardiovascular morbidity and mortality. Despite the availability of a wide range of pharmacological therapies, achieving optimal blood pressure control in patients with resistant hypertension remains a significant challenge. However, recent advances in the field have identified several promising treatment options, including spironolactone, mineralocorticoid receptor antagonists, and renal denervation. In addition, personalized management approaches based on genetic and other biomarkers may offer new opportunities to tailor therapy and improve outcomes. This review aims to provide an overview of the current state of knowledge regarding managing resistant hypertension, including the epidemiology, pathophysiology, and clinical implications of the condition, as well as the latest developments in therapeutic strategies and future prospects.
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Guo CY, Perng JW, Chen LC, Hsieh TL. A Hemodynamic Pulse Wave Simulator Designed for Calibration of Local Pulse Wave Velocities Measurement for Cuffless Techniques. MICROMACHINES 2023; 14:1218. [PMID: 37374803 DOI: 10.3390/mi14061218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/18/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE Devices for cuffless blood pressure (BP) measurement have become increasingly widespread in recent years. Non-invasive continuous BP monitor (BPM) devices can diagnose potential hypertensive patients at an early stage; however, these cuffless BPMs require more reliable pulse wave simulation equipment and verification methods. Therefore, we propose a device to simulate human pulse wave signals that can test the accuracy of cuffless BPM devices using pulse wave velocity (PWV). METHODS We design and develop a simulator capable of simulating human pulse waves comprising an electromechanical system to simulate the circulatory system and an arm model-embedded arterial phantom. These parts form a pulse wave simulator with hemodynamic characteristics. We use a cuffless device for measuring local PWV as the device under test to measure the PWV of the pulse wave simulator. We then use a hemodynamic model to fit the cuffless BPM and pulse wave simulator results; this model can rapidly calibrate the cuffless BPM's hemodynamic measurement performance. RESULTS We first used multiple linear regression (MLR) to generate a cuffless BPM calibration model and then investigated differences between the measured PWV with and without MLR model calibration. The mean absolute error of the studied cuffless BPM without the MLR model is 0.77 m/s, which improves to 0.06 m/s when using the model for calibration. The measurement error of the cuffless BPM at BPs of 100-180 mmHg is 1.7-5.99 mmHg before calibration, which decreases to 0.14-0.48 mmHg after calibration. CONCLUSION This study proposes a design of a pulse wave simulator based on hemodynamic characteristics and provides a standard performance verification method for cuffless BPMs that requires only MLR modeling on the cuffless BPM and pulse wave simulator. The pulse wave simulator proposed in this study can be used to quantitively assess the performance of cuffless BPMs. The proposed pulse wave simulator is suitable for mass production for the verification of cuffless BPMs. As cuffless BPMs become increasingly widespread, this study can provide performance testing standards for cuffless devices.
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Affiliation(s)
- Cheng-Yan Guo
- Accurate Meditech Inc., New Taipei City 241406, Taiwan
| | - Jau-Woei Perng
- Department of Mechanical and Electromechanical Engineering, National Sun Yat-sen University, 70 Lienhai Road, Kaohsiung 80424, Taiwan
| | - Li-Ching Chen
- LAICA International Corp, New Taipei City 231, Taiwan
| | - Tung-Li Hsieh
- Department of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung 80778, Taiwan
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6
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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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Dutta P, Sadria M, Layton AT. Influence of administration time and sex on natriuretic, diuretic, and kaliuretic effects of diuretics. Am J Physiol Renal Physiol 2023; 324:F274-F286. [PMID: 36701479 DOI: 10.1152/ajprenal.00296.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Sex differences in renal function and blood pressure have been widely described across many species. Blood pressure dips during sleep and peaks in the early morning. Similarly, glomerular filtration rate, filtered electrolyte loads, urine volume, and urinary excretion all exhibit notable diurnal rhythms, which reflect, in part, the regulation of renal transporter proteins by circadian clock genes. That regulation is sexually dimorphic; as such, sex and time of day are not two independent regulators of kidney function and blood pressure. The objective of the present study was to assess the effect of sex and administration time on the natriuretic and diuretic effects of loop, thiazide, and K+-sparing diuretics, which are common treatments for hypertension. Loop diuretics inhibit Na+-K+-2Cl- cotransporters on the apical membrane of the thick ascending limb, thiazide diuretics inhibit Na+-Cl- cotransporters on the distal convoluted tubule, and K+-sparing diuretics inhibit epithelial Na+ channels on the connecting tubule and collecting duct. We simulated Na+ transporter inhibition using sex- and time-of-day-specific computational models of mouse kidney function. The simulation results highlighted significant sex and time-of-day differences in the drug response. Loop diuretics induced larger natriuretic and diuretic effects during the active phase. The natriuretic and diuretic effects of thiazide diuretics exhibited sex and time-of-day differences, whereas these effects of K+-sparing diuretics exhibited a significant time-of-day difference in females only. The kaliuretic effect depended on the type of diuretics and time of administration. The present computational models can be a useful tool in chronotherapy, to tailor drug administration time to match the body's diurnal rhythms to optimize the drug effect.NEW & NOTEWORTHY Sex influences cardiovascular disease, and the timing of onset of acute cardiovascular events exhibits circadian rhythms. Kidney function also exhibits sex differences and circadian rhythms. How do the natriuretic and diuretic effects of diuretics, a common treatment for hypertension that targets the kidneys, differ between the sexes? And how do these effects vary during the day? To answer these questions, we conducted computer simulations to assess the effects of loop, thiazide, and K+-sparing diuretics.
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Affiliation(s)
- Pritha Dutta
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada
| | - Mehrshad Sadria
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada
| | - Anita T Layton
- Department of Applied Mathematics, University of Waterloo, Waterloo, Ontario, Canada.,Cheriton School of Computer Science, University of Waterloo, Waterloo, Ontario, Canada.,Department of Biology, University of Waterloo, Waterloo, Ontario, Canada.,School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
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Guo CY, Chang CC, Wang KJ, Hsieh TL. Assessment of a Calibration-Free Method of Cuffless Blood Pressure Measurement: A Pilot Study. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 11:318-329. [PMID: 38163041 PMCID: PMC10756135 DOI: 10.1109/jtehm.2022.3209754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 01/03/2024]
Abstract
This study proposes a low-cost, high-sensitivity sensor of beat-to-beat local pulse wave velocity (PWV), to be used in a cuffless blood pressure monitor (BPM). OBJECTIVE We design an adaptive algorithm to detect the feature of the pulse wave, making it possible for two sensors to measure the local PWV in the radial artery at a short distance. Unlike the cuffless BPM that needs to use a regression model for calibration. METHOD We encapsulate the piezoelectric sensor material in a cavity and design an analog front-end circuit. This study used color ultrasound imaging equipment to measure radial arterial parameters, including the diameter and wall thickness, to aid the estimation of blood pressure (BP) using the Moens-Korteweg (MK) equation of hemodynamics. RESULTS We compared the blood pressure estimated by the MK equation with the reference BP measured using an aneroid sphygmomanometer in a test group of 32 people, resulting in a mean difference of systolic BP of -0.63 mmHg, and a standard deviation of ±5.14 mmHg, a mean difference of mean arterial pressure (MAP) of 0.97 mmHg, with a standard deviation of ±3.54 mmHg, and a mean difference of diastolic BP of -1.14 mmHg, with a standard deviation of ±4.08 mmHg. This study has verified its compliance with ISO 81060-2. CONCLUSIONS A new type of wearable continuous calibration-free BPM can replace the situation that requires the use of traditional ambulatory BPM and reduce patient discomfort. CLINICAL IMPACT In this study can provide long-term continuous blood pressure monitoring in the hospital.
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Affiliation(s)
| | | | | | - Tung-Li Hsieh
- Department of Electronic EngineeringNational Kaohsiung University of Science and Technology, SanminKaohsiung City807618Taiwan
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9
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Guo CY, Chang HC, Wang KJ, Hsieh TL. An Arterial Compliance Sensor for Cuffless Blood Pressure Estimation Based on Piezoelectric and Optical Signals. MICROMACHINES 2022; 13:1327. [PMID: 36014249 PMCID: PMC9413124 DOI: 10.3390/mi13081327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Blood pressure (BP) data can influence therapeutic decisions for some patients, while non-invasive devices that continuously monitor BP can provide patients with a more comprehensive BP assessment. Therefore, this study proposes a multi-sensor-based small cuffless BP monitoring device that integrates a piezoelectric sensor array and an optical sensor, which can monitor the patient's physiological signals from the radial artery. METHOD Based on the Moens-Korteweg (MK) equation of the hemodynamic model, pulse wave velocity (PWV) can be correlated with arterial compliance and BP can be estimated. Therefore, the novel method proposed in this study involves using a piezoelectric sensor array to measure the PWV and an optical sensor to measure the photoplethysmography (PPG) intensity ratio (PIR) signal to estimate the participant's arterial parameters. The parameters measured by multiple sensors were combined to estimate BP based on the P-β model derived from the MK equation. RESULT We recruited 20 participants for the BP monitoring experiment to compare the performance of the BP estimation method with the regression model and the P-β model method with arterial compliance. We then compared the estimated BP with a reference device for validation. The results are presented as the error mean ± standard deviation (SD). Based on the regression model method, systolic blood pressure (SBP) was 0.32 ± 5.94, diastolic blood pressure (DBP) was 2.17 ± 6.22, and mean arterial pressure (MAP) was 1.55 ± 5.83. The results of the P-β model method were as follows: SBP was 0.75 ± 3.9, DBP was 1.1 ± 3.12, and MAP was 0.49 ± 2.82. CONCLUSION According to the results of our proposed small cuffless BP monitoring device, both methods of estimating BP conform to ANSI/AAMI/ISO 81060-2:20181_5.2.4.1.2 criterion 1 and 2, and using arterial parameters to calibrate the MK equation model can improve BP estimate accuracy. In the future, our proposed device can provide patients with a convenient and comfortable BP monitoring solution. Since the device is small, it can be used in a public place without attracting other people's attention, thereby effectively improving the patient's right to privacy, and increasing their willingness to use it.
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Affiliation(s)
- Cheng-Yan Guo
- Accurate Meditech Inc., New Taipei City 241406, Taiwan
| | | | - Kuan-Jen Wang
- Accurate Meditech Inc., New Taipei City 241406, Taiwan
| | - Tung-Li Hsieh
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, No. 415, Jiangong Rd., Sanmin Dist., Kaohsiung City 807618, Taiwan
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10
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A fusion approach to improve accuracy and estimate uncertainty in cuffless blood pressure monitoring. Sci Rep 2022; 12:7948. [PMID: 35562410 PMCID: PMC9106676 DOI: 10.1038/s41598-022-12087-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022] Open
Abstract
A substantial barrier to the clinical adoption of cuffless blood pressure (BP) monitoring techniques is the lack of unified error standards and methods of estimating measurement uncertainty. This study proposes a fusion approach to improve accuracy and estimate prediction interval (PI) as a proxy for uncertainty for cuffless blood BP monitoring. BP was estimated during activities of daily living using three model architectures: nonlinear autoregressive models with exogenous inputs, feedforward neural network models, and pulse arrival time models. Multiple one-class support vector machine (OCSVM) models were trained to cluster data in terms of the percentage of outliers. New BP estimates were then assigned to a cluster using the OCSVMs hyperplanes, and the PIs were estimated using the BP error standard deviation associated with different clusters. The OCSVM was used to estimate the PI for the three BP models. The three BP estimations from the models were fused using the covariance intersection fusion algorithm, which improved BP and PI estimates in comparison with individual model precision by up to 24%. The employed model fusion shows promise in estimating BP and PI for potential clinical uses. The PI indicates that about 71%, 64%, and 29% of the data collected from sitting, standing, and walking can result in high-quality BP estimates. Our PI estimator offers an effective uncertainty metric to quantify the quality of BP estimates and can minimize the risk of false diagnosis.
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Efe SC, Cicek MB, Karagöz A, Doğan C, Bayram Z, Guvendi B, Akbal OY, Tokgoz HC, Uysal S, Karabağ T, Kaymaz C, Ozdemir N. Effect of non-dipper pattern on echocardiographic myocardial work parameters in normotensive individuals. Echocardiography 2021; 38:1586-1595. [PMID: 34435388 DOI: 10.1111/echo.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/02/2021] [Accepted: 07/31/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is known that non-dipper pattern (NDP) is associated with adverse outcomes in hypertensive patients. However, there is insufficient data on the outcome of NDP in normotensive individuals. Using myocardial work (MW) analysis, as a new echocardiographic examination method, this study aimed to determine the early myocardial effects of NDP in normotensive individuals. METHODS This study included 70 normotensive individuals who were followed by ambulatory blood pressure monitoring (ABPM). The subjects were divided into two groups according to dipper pattern (DP) and NDP. Conventional, strain, and MW findings were compared between the groups by making echocardiographic evaluations. RESULTS The demographic characteristics, laboratory parameters, and measurements of cardiac chambers, and left ventricular (LV) walls were similar between the groups. There was no statistical difference between the groups in terms of LV 3-2-4 chambers strains and global longitudinal strain (GLS) values. LVMW parameters, global work index (GWI), and global constrictive work (GCW) were not statistically different between groups (2012 ± 127, 2069 ± 137, p = 0.16; 2327 ± 173, 2418 ± 296, p = 0.18, respectively). However, global waste work (GWW) and global work efficiency (GWE) parameters were different between the groups (144 ± 63.9, 104 ± 24.8, p < 0.001; 93.2 ± 3.17, 95.4 ± 1.28, p < 0.001, respectively). In regression analysis, GWW was independently associated with NDP. GWW model showed better results with higher likelihood chi-square and R2 values than GLS model in discriminating the predictable capability for NDP status. CONCLUSION The results of MW analysis in this study showed that GWW values were higher and the GWE values were lower in normotensive individuals with NDP.
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Affiliation(s)
- Süleyman Cagan Efe
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Mahmut Buğrahan Cicek
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ali Karagöz
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Cem Doğan
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Zübeyde Bayram
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Busra Guvendi
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Ozgur Yasar Akbal
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Hacer Ceren Tokgoz
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Samet Uysal
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Turgut Karabağ
- Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Kaymaz
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
| | - Nihal Ozdemir
- Department of cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey
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12
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Landry C, Hedge ET, Hughson RL, Peterson SD, Arami A. Accurate Blood Pressure Estimation During Activities of Daily Living: A Wearable Cuffless Solution. IEEE J Biomed Health Inform 2021; 25:2510-2520. [PMID: 33497346 DOI: 10.1109/jbhi.2021.3054597] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The objective is to develop a cuffless method that accurately estimates blood pressure (BP) during activities of daily living. User-specific nonlinear autoregressive models with exogenous inputs (NARX) are implemented using artificial neural networks to estimate the BP waveforms from electrocardiography and photoplethysmography signals. To broaden the range of BP in the training data, subjects followed a short procedure consisting of sitting, standing, walking, Valsalva maneuvers, and static handgrip exercises. The procedure was performed before and after a six-hour testing phase wherein five participants went about their normal daily living activities. Data were further collected at a four-month time point for two participants and again at six months for one of the two. The performance of three different NARX models was compared with three pulse arrival time (PAT) models. The NARX models demonstrate superior accuracy and correlation with "ground truth" systolic and diastolic BP measures compared to the PAT models and a clear advantage in estimating the large range of BP. Preliminary results show that the NARX models can accurately estimate BP even months apart from the training. Preliminary testing suggests that it is robust against variabilities due to sensor placement. This establishes a method for cuffless BP estimation during activities of daily living that can be used for continuous monitoring and acute hypotension and hypertension detection.
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Bakogiannis C, Stavropoulos K, Papadopoulos C, Papademetriou V. The Impact of Various Blood Pressure Measurements on Cardiovascular Outcomes. Curr Vasc Pharmacol 2021; 19:313-322. [PMID: 32223734 DOI: 10.2174/1570161118666200330155905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/22/2022]
Abstract
Hypertension is a potent risk factor for cardiovascular morbidity and mortality. High blood pressure (BP) correlates closely with all-cause and cardiovascular mortality. Although the gold standard remains office BP (auscultatory or automated), other methods (central or out-of-office) are gaining popularity as better predictors of CV events. In this review, we investigated the prognostic value of each method of BP measurement and explored their advantages and pitfalls. Unattended automated office BP is a novel technique of BP measurement with promising data. Ambulatory BP monitoring, and to a lesser extent, home BP measurements, seem to predict cardiovascular events and mortality outcomes better, while at the same time, they can help distinguish hypertensive phenotypes. Data on the association of central BP levels with cardiovascular and mortality outcomes, are conflicting. Future extensive cross-sectional and longitudinal studies are needed to evaluate head-to-head the corresponding levels and results of each method of BP measurement, as well as to highlight disparities in their prognostic utility.
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Affiliation(s)
| | | | | | - Vasilios Papademetriou
- Veterans Affairs Medical Center, Georgetown University, Washington, DC 20422, United States
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Lopez-Sublet M, Girerd N, Bozec E, Machu JL, Ferreira JP, Zannad F, Mourad JJ, Rossignol P. Nondipping Pattern and Cardiovascular and Renal Damage in a Population-Based Study (The STANISLAS Cohort Study). Am J Hypertens 2019; 32:620-628. [PMID: 30753257 DOI: 10.1093/ajh/hpz020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The attenuation of physiological nocturnal decline of blood pressure (BP)-called nondipper pattern-has previously been reported to be associated with target organ damage in hypertensive subjects. However, this association remains debated and poorly studied in normotensive patients. This study aimed to investigate the association between nondipper pattern and subclinical cardiovascular and renal damage in an initially healthy population-based cohort study. METHODS The STANISLAS Cohort is a single-center, familial longitudinal cohort composed of 1,006 families (4,295 subjects) recruited in 1993-1995 for a 5-year periodic health examination. A total of 1,334 subjects from the 4th visit (2011-2016) of the STANISLAS cohort were included. This 4th examination included estimated glomerular filtration rate, albumin/creatinine ratio, pulse wave velocity, central systolic BP, carotid intima-media thickness and distensibility, left ventricular mass index, left ventricular hypertrophy, diastolic dysfunction, and ambulatory blood pressure monitoring (ABPM). Nondipping status was defined as a mean reduction in systolic BP (SBP) or diastolic BP (DBP) lower than 10% during nighttime. RESULTS Data were obtained from 798 normotensive subjects (45 ± 14 years, 395 [49%] nondippers, SBP/DBP mmHg 24 hours: 116/71 ± 7/5) and 536 hypertensive patients (56 ± 11 years, 257 [48%] nondippers, SBP/DBP mmHg 24 hours: 127/78 ± 10/7). Mean 24-hour and daytime ABPM measurements were within the normal range, even in hypertensive participants (19% treated). The nondipping pattern was not associated with cardiovascular or renal alterations in this population. CONCLUSION In this middle-aged population with an overall 24-hour optimal BP control, the nondipper pattern was not associated with increased cardiovascular or renal damage.
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Affiliation(s)
- Marilucy Lopez-Sublet
- Department of Internal Medicine, ESH Hypertension Excellence Centre, CHU Avicenne, AP-HP, Bobigny, France
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
| | - Nicolas Girerd
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
| | - Erwan Bozec
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
| | - Jean-Loup Machu
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
| | - João Pedro Ferreira
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Faiez Zannad
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
| | - Jean-Jacques Mourad
- Department of Internal Medicine, ESH Hypertension Excellence Centre, CHU Avicenne, AP-HP, Bobigny, France
| | - Patrick Rossignol
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
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15
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Chan KS, Lai KPL, Chan PF, Luk MHM, Chao VKD. Evaluation of the applicability of deep breathing test in the diagnosis of hypertension with white-coat effect in Chinese patients in primary care. Clin Hypertens 2019; 25:2. [PMID: 30774977 PMCID: PMC6357457 DOI: 10.1186/s40885-018-0106-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/19/2018] [Indexed: 01/01/2023] Open
Abstract
Purpose The current gold standard for the diagnosis of white-coat effect is by the 24-h ambulatory blood pressure monitoring (ABPM) which may not be readily available in every primary care setting. Previous studies had shown that deep breathing, through modulating the baroreceptor reflex sensitivity to vagal stimulation over 30 to 60 s, was useful in detection of the white-coat effect. The aim of our study was to evaluate the diagnostic accuracy of the deep breathing test (DBT) as compared with the gold standard of ABPM in the diagnosis of hypertension with white-coat effect in Chinese patients in primary care. Methods This cross sectional study recruited 178 consecutive, eligible, consented, hypertensive patients receiving treatment at a local public primary care Hypertension Clinic. The diagnostic accuracy of the DBT in all recruited patients, patients not taking beta-adrenergic blockers and patients with different clinic SBP cut-off before the DBT by means of area under the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values was evaluated. Results The results for the ROC curves for systolic and diastolic BP changes after the DBT were statistically insignificant. The ROC curve was statistically significant for SBP change in patients not taking beta-adrenergic blockers and with pre-DBT clinic SBP ≥ 165 mmHg (ROC curve area of 0.719, 95% CI 0.53 to 0.91, p = 0.04). The corresponding sensitivity and specificity of the DBT were 40.9 and 90.9% respectively if SBP drop was > 30 mmHg. Conclusion The DBT, even though could not be clinically applied to all patients, was proven to be a potential screening and diagnostic test for white-coat effect in Chinese hypertensive patients with a pre-test SBP of ≥165 mmHg and who were not taking beta-adrenergic blockers. Trial registration This study was approved by Kowloon East Cluster/ Kowloon Central Cluster Research Ethics Committee/Institutional Review Board of Hospital Authority of Hong Kong under the registration KC/KE-16-0084/ER-3.
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Affiliation(s)
- Kam Sum Chan
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Kit Ping Loretta Lai
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Pang Fai Chan
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Man Hei Matthew Luk
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
| | - Vai Kiong David Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Tseung Kwan O, Hong Kong, China
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16
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Nilsson IL. Primary hyperparathyroidism: should surgery be performed on all patients? Current evidence and residual uncertainties. J Intern Med 2019; 285:149-164. [PMID: 30289185 DOI: 10.1111/joim.12840] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Primary hyperparathyroidism (pHPT) is the third most common endocrine disease and is characterized by hypercalcaemia and elevated or inappropriately 'normal' levels of the parathyroid hormone (PTH). The main target organs of PTH are the skeletal system and the kidneys. Before the 1970s, pHPT was a rarely detected disease associated with notable morbidity and premature mortality. Introduction of biochemical screening, allowing for a wide range of indications, has contributed to the detection of the full spectrum of the disease. A new entity with an isolated elevation of PTH, normocalcaemic HP, has emerged and is currently being explored. The highest incidence of pHPT, 3-5%, is observed amongst women, and the prevalence increases with age. The female-to-male ratio is 3-4 : 1 except in younger patients where distribution is equal and known hereditary causes account for approximately 10% of the cases. In the last few decades, it has become evident that fewer patients than previously believed are truly asymptomatic. The cause of pHPT is often a benign tumour, a parathyroid adenoma, and the only definite treatment is parathyroidectomy (PTX). No medical treatment, single or combined, can achieve a curing of pHPT. Recent data indicate that PTX, despite being proven to be cost-effective compared to conservative treatment, is underutilized, especially in elderly pHPT patients. The decision of PTX should always be based on a safe diagnosis, and the potential benefits of curative treatment should not be outweighed by the risks of surgery or anaesthesia.
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Affiliation(s)
- I-L Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department ofBreast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
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17
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Izzo JL. Barriers to blood pressure control initiatives: Regional diversity, inadequate measurement techniques, guideline inconsistencies, and health disparities. J Clin Hypertens (Greenwich) 2019; 21:204-207. [PMID: 30609230 DOI: 10.1111/jch.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph L Izzo
- Departments of Medicine and Pharmacology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York.,Department of Medicine, Erie County Medical Center, Buffalo, New York
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18
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Kim YS, Davis SCAT, Stok WJ, van Ittersum FJ, van Lieshout JJ. Impaired nocturnal blood pressure dipping in patients with type 2 diabetes mellitus. Hypertens Res 2018; 42:59-66. [PMID: 30401911 DOI: 10.1038/s41440-018-0130-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 01/21/2023]
Abstract
Hypertension is a common comorbidity of type 2 diabetes mellitus (T2DM). Both conditions are associated with an increased cardiovascular risk, which is reduced by tight blood pressure (BP) and glycemic control. However, nondipping BP status continues to be an enduring cardiovascular risk factor in T2DM. Cardiovascular autonomic neuropathy and endothelial dysfunction have been proposed as potential mechanisms. This study tested the hypothesis that microvascular disease rather than cardiovascular autonomic neuropathy interferes with the physiological nocturnal BP reduction. Cardiovascular autonomic function and baroreflex sensitivity were determined in 22 type 2 diabetic patients with (DM+) and 23 diabetic patients without (DM-) manifest microvascular disease. BP dipping status was assessed from 24-hour ambulatory BP measurements. Sixteen nondiabetic subjects served as controls (CTRL). Cardiovascular autonomic function was normal in all subjects. Baroreflex sensitivity was lower in DM- compared with CTRL (7.7 ± 3.3 vs. 12.3 ± 8.3 ms·mm Hg-1; P < 0.05) and was further reduced in DM + (4.6 ± 2.0 ms·mm Hg-1; P < 0.01 vs. DM- and CTRL). The nocturnal decline in systolic and diastolic BP was blunted in DM- (12% and 14% vs. 17% and 19% in CTRL; P < 0.05) and even more so in DM+ (8% and 11%; P < 0.05 vs. DM- and P < 0.001 vs. CTRL). A nocturnal reduction in pulse pressure was observed in CTRL and DM- but not in DM+ (P < 0.05 vs. DM- and P < 0.01 vs. CTRL). In T2DM, progression of microvascular disease interferes with the normal nocturnal BP decline and coincides with a persistently increased pulse pressure and reduced baroreflex sensitivity, contributing to their increased cardiovascular risk.
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Affiliation(s)
- Yu-Sok Kim
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands. .,Laboratory for Clinical Cardiovascular Physiology, Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.
| | - Shyrin C A T Davis
- Laboratory for Clinical Cardiovascular Physiology, Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Wim J Stok
- Laboratory for Clinical Cardiovascular Physiology, Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Frans J van Ittersum
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes J van Lieshout
- Laboratory for Clinical Cardiovascular Physiology, Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.,MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, Queen's Medical Centre, School of Life Sciences, University of Nottingham Medical School, Nottingham, United Kingdom
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19
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Yagita K, Tsukita K, Shinde A, Suenaga T. Nocturnal Hypertension in Multiple System Atrophy May Cause Posterior Reversible Encephalopathy Syndrome. Intern Med 2018; 57:3187-3191. [PMID: 29877278 PMCID: PMC6262696 DOI: 10.2169/internalmedicine.0759-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/03/2018] [Indexed: 11/16/2022] Open
Abstract
Nocturnal hypertension (NH) is a symptom of cardiovascular dysautonomia in multiple system atrophy (MSA); however, care and medication are often insufficient. We herein report a patient with MSA who showed posterior reversible encephalopathy syndrome (PRES) caused by hypertension during sleep. He presented clinically with total blindness; T2-weighted magnetic resonance imaging showed high signal intensities in the bilateral subcortical occipital-temporal lobes. His PRES was completely reversed by blood pressure control. NH may contribute to the development of PRES. The appropriate assessment and management of hemodynamic changes in MSA, including NH, is necessary to prevent severe complications such as PRES.
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20
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Validation of the Beneware model ABP-021 ambulatory blood pressure monitor according to the revised 2010 European Society of hypertension international protocol. Blood Press Monit 2018; 23:210-213. [PMID: 29894314 DOI: 10.1097/mbp.0000000000000330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to evaluate the accuracy of the Beneware model ABP-021 oscillometric blood pressure monitor in the general population according to the European Society of Hypertension International Protocol (ESH-IP). The accuracy of the device was assessed in relation to various clinical variables, including age, sex, BMI, and arm circumference. METHODS Thirty-three individuals (18 men and 15 women), with a mean age of 36±14 years (age range: 20-68 years), were studied according to the recommendations of the ESH-IP. Sequential same-arm blood pressure measurements were performed, alternating between a mercury standard and the automatic device. The differences among the test-control measurements were assessed and divided into categorization zones of 5, 10, and 15 mmHg discrepancy. RESULTS The device complied with the quality requirements of the ESH-IP. The device-observer disagreement was -1.2±4.7 mmHg for systolic blood pressure (SBP) and -1.7±4.3 mmHg for diastolic blood pressure (DBP). The device produced 77, 93, and 98 measurements, respectively, within the 5, 10, and 15 mmHg discrepancy limits for SBP. For DBP, 80, 97, and 99 measurements were observed within the 5, 10, and 15 mmHg discrepancy limits. The number of participants with two or three of the device-observer differences within 5 mmHg was 26 for SBP and 29 for DBP, whereas there were only two participants with no device-observer differences within 5 mmHg for DBP. CONCLUSION These data show that the Beneware model ABP-021 monitor meets the requirements of the ESH-IP, in static conditions, indicating its suitability for measuring blood pressure in the general adult population.
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21
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22
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Yamashiro K, Tanaka R, Shimo Y, Oyama G, Ogawa T, Umemura A, Hattori N. Cerebral microbleeds and blood pressure abnormalities in Parkinson's disease. eNeurologicalSci 2017; 10:5-11. [PMID: 29736422 PMCID: PMC5933993 DOI: 10.1016/j.ensci.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 09/17/2017] [Accepted: 12/20/2017] [Indexed: 01/12/2023] Open
Abstract
Blood pressure abnormalities are frequently observed in patients with Parkinson's disease (PD), and are associated with cerebrovascular diseases such as white matter hyperintensities and carotid atherosclerosis. We assessed the relationship between blood pressure abnormalities and cerebral microbleeds (CMBs), a marker of cerebral small vessel disease, in 128 patients with PD. We examined supine and orthostatic blood pressures and used 24-hour ambulatory blood pressure monitoring to assess the presence or absence of orthostatic hypotension (OH), supine hypertension (SH), nocturnal hypertension (NH), and loss of nocturnal blood pressure dips (non-dipping). CMBs were found in 13 (10.2%) patients, and the median number of CMBs was 1 (range: 1 to 10). Six of these patients had deep or infratentorial CMBs, six had strictly lobar CMBs, and one had mixed CMBs. Linear regression analysis indicated that presence of both OH and SH was independently associated with greater numbers of CMBs in deep or infratentorial regions, independent of age, sex, cardiovascular risk factors, and white matter hyperintensities. NH and non-dipping were not associated with CMBs in deep or infratentorial regions, and there was no association between blood pressure and CMBs in lobar regions. Our results suggest that the presence of both OH and SH may be related to deep or infratentorial CMBs in patients with PD. CMBs were found in 13 out of 128 (10.2%) patients with PD. Presence of both OH and SH was associated with deep or infratentorial CMBs. NH and non-dipping were not associated with deep or infratentorial CMBs. Neither orthostatic nor nocturnal blood pressures were associated with lobar CMBs.
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Affiliation(s)
- Kazuo Yamashiro
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryota Tanaka
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasushi Shimo
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Genko Oyama
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Ogawa
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsushi Umemura
- Department of Research and Therapeutics for Movement Disorders, Juntendo University School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
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23
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Guo S, Lin H, Pan S, Zhai X, Meng L. The differential diagnostic value of serum homocysteine for white coat hypertension. Oncotarget 2017; 8:101271-101283. [PMID: 29254163 PMCID: PMC5731873 DOI: 10.18632/oncotarget.21020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 08/28/2017] [Indexed: 01/31/2023] Open
Abstract
Objective To assess the value of serum homocysteine (Hcy) in differential diagnosis of white coat hypertension (WCH). Results In this retrospective study, serum Hcy levels were elevated in hypertensive patients (P < 0.001) compared to WCH patients. Serum Hcy levels were positively correlated with 24-h mean systolic blood pressure, r = 0.1378, P < 0.001. The results of the receiving operating characteristic (ROC) curve showed that the AUC value of Hcy was 0.80 (95% CI, 0.77–0.83), the cut-off value was 13.8 μmol/L, the sensitivity was 68.58% and the specificity 87.21%. In the prospective study, the AUC value of Hcy was 0.73 (95% CI: 0.67–0.78), higher than N - terminal pro - brain natriuretic peptide(NT-pro-BNP) (0.64, 95% CI:0.58–0.70) and cystatin C (Cys-C) (0.62, 95% CI:0.55–0.68). Hcy, NT-proBNP and Cys-C combined, provided a better indication of a differential diagnosis of WCH, than Hcy alone. Materials and Methods This investigation involved both a retrospective and a prospective study. Clinical data including blood pressure, age, sex, height, weight, BMI, smoking status, past history, and behavioral electrocardiogram of patients who had undergone 24-hour ambulatory blood pressure monitoring (ABPM) with elevated clinical blood pressure (BP) were recorded. Pearson correlation analysis was used to test the correlation between Hcy and BP. The ROC curve was used to analyze the value of measuring Hcy levels in differential diagnosis of WCH. Conclusions Serum Hcy was decreased in WCH patients and therefore could be a biomarker for differential diagnosis of WCH.
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Affiliation(s)
- Shitian Guo
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Hui Lin
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Sunlei Pan
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoya Zhai
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China
| | - Liping Meng
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China
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Ayala C, Tong X, Neeley E, Lane R, Robb K, Loustalot F. Home blood pressure monitoring among adults-American Heart Association Cardiovascular Health Consumer Survey, 2012. J Clin Hypertens (Greenwich) 2017; 19:584-591. [PMID: 28371252 DOI: 10.1111/jch.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/20/2016] [Accepted: 12/25/2016] [Indexed: 01/13/2023]
Abstract
Home blood pressure monitoring (HBPM) among hypertensive adults was assessed using the 2012 American Heart Association Cardiovascular Health Consumer Survey. The prevalence of hypertension was 25.5% and 53.8% of those reported HBPM. Approximately 63% of hypertensive adults 65 years and older reported HBPM followed by 51% and 34.6% (35-64 and 18-34 years, respectively; P=.001). Those who had seen a healthcare professional within a year reported HBPM compared with those who had not (54.8% vs 32.8%, P=.047). Those who believed that lowering blood pressure can reduce risk of heart attack and stroke had a higher percentage of HBPM compared with those who did not (55.5% vs 33.1%, P=.01). Age and the belief that lowering blood pressure could reduce cardiovascular disease risk were significant factors associated with HBPM. Half of the adult hypertensive patients reported HBPM and its use was greater among those who reported a positive attitude toward lowering blood pressure to reduce cardiovascular disease risk.
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Affiliation(s)
- Carma Ayala
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Eunice Neeley
- University of California at San Francisco Medical School, San Francisco, GA, USA
| | - Rashon Lane
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| | - Karen Robb
- American Heart Association/American Stroke Association, Dallas, TX, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
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Ambulatory versus clinic blood pressure in predicting overall subclinical target organ damage progression in essential hypertensive patients: a 3-year follow-up study. Blood Press Monit 2017; 21:319-326. [PMID: 27579902 DOI: 10.1097/mbp.0000000000000209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ambulatory blood pressure (BP) was shown to predict specific subclinical target organ damage (TOD) progression better than clinic BP, whereas the usefulness of ambulatory and clinic BP measurements to predict overall TOD progression is not well established. METHODS AND RESULTS Clinic and 24-h ambulatory BP values were obtained in 280 patients on baseline. A total of 199 participants (mean age 62.5±9.5, 59.3% men) were followed up for an average of 39 months and overall subclinical TOD were recorded at the end of follow-up period. Patients with increased TOD number had higher baseline clinic, 24-h, day and night systolic blood pressure (SBP), and pulse pressure, but baseline ambulatory and clinic diastolic blood pressure showed no differences. Multiple logistic regression analysis showed that the independent predictors of the overall TOD number increased were clinic [relative ratio (RR)=1.023, P=0.006], 24-h (RR=1.034, P=0.005), day (RR=1.023, P=0.04) and night (RR=1.038, P=0.001) SBP, as well as 24-h (RR=1.050, P=0.005), day (RR=1.037, P=0.02) and night (RR=1.062, P=0.001) ambulatory pulse pressure, and night average diastolic blood pressure with boundary correlation (RR=1.034, P=0.048). The night-time SBP value was more strongly associated with the risk of overall increased TOD number than the daytime (RR=1.049, P=0.003) or clinic SBP (RR=1.026, P=0.02). Similarly, 24-h pulse pressure was superior to clinic (RR=1.045, P=0.02) and night-time was superior to daytime pulse pressure (RR=1.104, P=0.002). CONCLUSION The risk of overall subclinical TOD progression increased more with a given increase in baseline ambulatory night-time BP than baseline clinic or daytime BP in essential hypertension.
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Costa D, Peixoto Lima R. Cost-effectiveness of ambulatory blood pressure monitoring in the management of hypertension. Rev Port Cardiol 2017; 36:129-139. [PMID: 28159431 DOI: 10.1016/j.repc.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/17/2016] [Accepted: 09/02/2016] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The prevalence of hypertension in Portugal is between 29.1% and 42.2%. International studies show that 13% of individuals have masked hypertension and 13% of diagnoses based on office blood pressure measurements are in fact white coat hypertension. More sensitive and specific blood pressure measuring methods could avoid costs associated with misdiagnosis. The aim of this study was to review the cost-effectiveness of ambulatory blood pressure monitoring (ABPM) compared to other methods in the management of hypertension. METHODS We performed a literature search in CMA Infobase, Guidelines Finder, National Guideline Clearinghouse, Bandolier, BMJ Clinical Evidence, the Cochrane Library, DARE, Medline, the Trip Database, SUMSearch and Índex das Revistas Médicas Portuguesas. We researched articles published between January 2005 and August 2015 in Portuguese, English and Spanish, using the MeSH terms "Hypertension", "Blood Pressure Monitoring, Ambulatory" and "Cost-Benefit Analysis" and the Portuguese search terms "Hipertensão", "Monitorização Ambulatorial da Pressão Arterial" and "Análise Custo-Benefício". Levels of evidence and grades of recommendation were attributed according to the Oxford Centre for Evidence-Based Medicine scale. RESULTS Five hundred and twenty-five articles were identified. We included five original studies and one clinical practice guideline. All of them state that ABPM is the most cost-effective method. Two report better blood pressure control, and a Portuguese study revealed a saving of 23%. CONCLUSIONS The evidence shows that ABPM is cost-effective, avoiding iatrogenic effects and reducing expenditure on treatment (grade of recommendation B). The included studies provide a solid basis, but further evidence of reproducibility is needed in research that is not based mainly on analytical models.
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Affiliation(s)
- Diogo Costa
- Unidade de Saúde Familiar Santa Clara, Agrupamento de Centros de Saúde Grande Porto IV, Vila do Conde, Portugal.
| | - Ricardo Peixoto Lima
- Unidade de Saúde Familiar das Ondas, Agrupamento de Centros de Saúde Grande Porto IV, Póvoa de Varzim, Portugal
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Cost-effectiveness of ambulatory blood pressure monitoring in the management of hypertension. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nilsson IL, Norenstedt S, Granath F, Zedenius J, Pernow Y, Larsson TE. FGF23, metabolic risk factors, and blood pressure in patients with primary hyperparathyroidism undergoing parathyroid adenomectomy. Surgery 2016; 159:211-7. [DOI: 10.1016/j.surg.2015.06.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/26/2015] [Accepted: 06/03/2015] [Indexed: 01/01/2023]
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Blumenthal JA, Sherwood A, Smith PJ, Mabe S, Watkins L, Lin PH, Craighead LW, Babyak M, Tyson C, Young K, Ashworth M, Kraus W, Liao L, Hinderliter A. Lifestyle modification for resistant hypertension: The TRIUMPH randomized clinical trial. Am Heart J 2015; 170:986-994.e5. [PMID: 26542509 PMCID: PMC4636732 DOI: 10.1016/j.ahj.2015.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 08/10/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resistant hypertension (RH) is a growing health burden in this country affecting as many as 1 in 5 adults being treated for hypertension. Resistant hypertension is associated with increased risk of adverse cardiovascular disease (CVD) events and all-cause mortality. Strategies to reduce blood pressure (BP) in this high-risk population are a national priority. METHODS TRIUMPH is a single-site, prospective, randomized clinical trial to evaluate the efficacy of a center-based lifestyle intervention consisting of exercise training, reduced sodium and calorie Dietary Approaches to Stop Hypertension eating plan, and weight management compared to standardized education and physician advice in treating patients with RH. Patients (n = 150) will be randomized in a 2:1 ratio to receive either a 4-month supervised lifestyle intervention delivered in the setting of a cardiac rehabilitation center or to a standardized behavioral counseling session to simulate real-world medical practice. The primary end point is clinic BP; secondary end points include ambulatory BP and an array of CVD biomarkers including left ventricular hypertrophy, arterial stiffness, baroreceptor reflex sensitivity, insulin resistance, lipids, sympathetic nervous system activity, and inflammatory markers. Lifestyle habits, BP, and CVD risk factors also will be measured at 1-year follow-up. CONCLUSIONS The TRIUMPH randomized clinical trial (ClinicalTrials.gov NCT02342808) is designed to test the efficacy of an intensive, center-based lifestyle intervention compared to a standardized education and physician advice counseling session on BP and CVD biomarkers in patients with RH after 4 months of treatment and will determine whether lifestyle changes can be maintained for a year.
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Affiliation(s)
- James A Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Lana Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Pao-Hwa Lin
- Department of Medicine, Duke University Medical Center, Durham, NC
| | | | - Michael Babyak
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Crystal Tyson
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Kenlyn Young
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Megan Ashworth
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - William Kraus
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Lawrence Liao
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Alan Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Conkar S, Yılmaz E, Hacıkara Ş, Bozabalı S, Mir S. Is Daytime Systolic Load an Important Risk Factor for Target Organ Damage in Pediatric Hypertension? J Clin Hypertens (Greenwich) 2015; 17:760-6. [DOI: 10.1111/jch.12608] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/13/2015] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Seçil Conkar
- Department of Pediatric Nephrology; Ege University Medical Faculty; Izmir Turkey
| | - Ebru Yılmaz
- Dr. Behcet Uz Children Diseases Teaching and Research Hospital Pediatric Nephrology; Izmir Turkey
| | - Şükriye Hacıkara
- Department of Pediatric Nephrology; Ege University Medical Faculty; Izmir Turkey
| | - Sibel Bozabalı
- Department of Pediatric Cardiology; Ege University Medical Faculty; Izmir Turkey
| | - Sevgi Mir
- Department of Pediatric Nephrology; Ege University Medical Faculty; Izmir Turkey
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Tweddell JS, Ghanayem NS, Hoffman GM. All this monitoring…what's necessary, what's not? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014; 17:81-90. [PMID: 24725722 DOI: 10.1053/j.pcsu.2014.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The goal of perioperative monitoring is to aid the clinician in optimizing care to achieve the best possible survival with the lowest possible morbidity. Ideally, we would like to have monitoring that can rapidly and accurately identify perturbations in circulatory well-being that would permit timely intervention and allow for restoration before the patient is damaged. The evidence to support the use of our standard monitoring strategies (continuous electrocardiography, blood pressure, central venous pressure, oxygen saturation and capnography) is based on expert opinion, case series, or at best observational studies. While these monitoring parameters will identify life-threatening events, they provide no direct information concerning the oxygen economy of the patient. Nevertheless, they are mandated by professional societies representing specialists in cardiac disease, critical care, and anesthesiology. Additional non-routine monitoring strategies that provide data concerning the body's oxygen economy, such as venous saturation monitoring and near infrared spectroscopy, have shown promise in prospective observational studies in managing these complex groups of patients. Ideally, high-level evidence would be required before adopting these newer strategies, but in the absence of new funding sources and the challenges of the wide variation in practice patterns between centers, this seems unlikely. The evidence supporting the current standard perioperative monitoring strategies will be reviewed. In addition, evidence supporting non-routine monitoring strategies will be reviewed and their potential for added benefit assessed.
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Affiliation(s)
- James S Tweddell
- Herma Heart Center, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI; Department of Surgery, Division of Cardiothoracic Surgery, Milwaukee, WI.
| | - Nancy S Ghanayem
- Herma Heart Center, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI; Department of Pediatrics, Section of Critical Care, Milwaukee, WI
| | - George M Hoffman
- Herma Heart Center, Milwaukee, WI; Children's Hospital of Wisconsin, Milwaukee, WI; Department of Anesthesiology, The Medical College of Wisconsin, Milwaukee, WI
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Fanciulli A, Strano S, Ndayisaba JP, Goebel G, Gioffrè L, Rizzo M, Colosimo C, Caltagirone C, Poewe W, Wenning GK, Pontieri FE. Detecting nocturnal hypertension in Parkinson’s disease and multiple system atrophy: proposal of a decision-support algorithm. J Neurol 2014; 261:1291-9. [DOI: 10.1007/s00415-014-7339-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 11/28/2022]
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Becker AM, Goldberg JH, Henson M, Ahn C, Tong L, Baum M, Buchanan GR. Blood pressure abnormalities in children with sickle cell anemia. Pediatr Blood Cancer 2014; 61:518-22. [PMID: 24424792 DOI: 10.1002/pbc.24843] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 10/07/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Kidney disease is an important cause of morbidity and mortality in patients with sickle cell anemia (SCA). The factors that affect progression of renal disease are unknown, especially in children and adolescents. Alterations in blood pressure, including hypertension and lack of the normal nocturnal dip in blood pressure, are important determinants of diabetic nephropathy and other renal diseases and may play a role in sickle cell nephropathy. Our primary hypothesis was that children with SCA who have microalbuminuria will demonstrate less nocturnal dipping of blood pressure compared to patients without microalbuminuria. We also investigated other potential factors associated with microalbuminuria. PROCEDURE This prospective study of 52 adolescents with SCA followed in the Children's Medical Center Dallas Comprehensive Sickle Cell Center characterized 24-hour ambulatory blood pressure profiles and presence of microalbuminuria. Stepwise logistic regression was performed to identify significant independent factors that are associated with microalbuminuria. RESULTS Thirty-five percent of patients were identified as having previously unrecognized hypertension, and 17% had pre-hypertension (blood pressure greater than the 90th percentile but less than the 95th percentile). Fifty-six percent of patients lacked the normal nocturnal dip in blood pressure. In addition, 21% had microalbuminuria, and their percent nocturnal dip was significantly less than those without microalbuminuria (P = 0.01). CONCLUSIONS Blood pressure abnormalities are common in adolescents with SCA and are a possible modifiable risk factor in the progression of sickle cell nephropathy.
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López-Jaramillo P, Sánchez RA, Díaz M, Cobos L, Bryce A, Parra-Carrillo JZ, Lizcano F, Lanas F, Sinay I, Sierra ID, Peñaherrera E, Benderky M, Schmid H, Botero R, Urina M, Lara J, Foos MC, Márquez G, Harrap S, Ramírez AJ, Zanchetti A. Consenso latinoamericano de hipertensión en pacientes con diabetes tipo 2 y síndrome metabólico. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2014; 26:85-103. [DOI: 10.1016/j.arteri.2013.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/26/2013] [Indexed: 12/14/2022]
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Abstract
Over the last two decades, essential hypertension has become common in adolescents, yet remains under-diagnosed in absence of symptoms. Diagnosis is based on normative percentiles that factor in age, sex and height. Evaluation is more similar to adult essential hypertension than childhood secondary hypertension. Modifiable risk factors such as obesity, sodium consumption and low exercise should be addressed first. Many anti-hypertensive medications now have specific regulatory approval for children. Sports participation need not be limited in mild or well-controlled cases. Primary care physicians play an important role in reduction of cardiovascular mortality by early detection and referral when needed.
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Affiliation(s)
- Stanley S. Franklin
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
| | - Lutgarde Thijs
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
| | - Tine W. Hansen
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
| | - Eoin O’Brien
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
| | - Jan A. Staessen
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
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Norenstedt S, Pernow Y, Brismar K, Sääf M, Ekip A, Granath F, Zedenius J, Nilsson IL. Primary hyperparathyroidism and metabolic risk factors, impact of parathyroidectomy and vitamin D supplementation, and results of a randomized double-blind study. Eur J Endocrinol 2013; 169:795-804. [PMID: 24026893 PMCID: PMC3805017 DOI: 10.1530/eje-13-0547] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vitamin D insufficiency may increase the risk for cardio metabolic disturbances in patients with primary hyperparathyroidism (PHPT). OBJECTIVE To analyze the vitamin D status and indices of the metabolic syndrome in PHPT patients and the effect of vitamin D supplementation after parathyroid adenomectomy (PTX). DESIGN AND METHODS Double-blinded, randomized clinical trial (ClinicalTrials.gov identifier: NCT00982722) performed at Karolinska University Hospital, Sweden, April 2008 to November 2011. One hundred and fifty consecutive patients with PHPT (119 women) were randomized after PTX, 75 to oral treatment with calcium carbonate 1000 mg daily and 75 to calcium carbonate 1000 mg and cholecalciferol 1600 IU daily over 12 months. Changes in metabolic profile and ambulatory blood pressure (BP) were analyzed. Main outcome measures were changes in metabolic factors, BP, and body composition. RESULTS The 25-hydroxyvitamin D (25-OH-D)-level was <50 nmol/l in 76% of the patients before PTX. After PTX, glucose, insulin, and IGF1 decreased, while the 25-OH-D and the IGF-binding protein 1 increased and remained unchanged at follow-up after study medication. One year of vitamin D supplementation resulted in lower parathyroid hormone (PTH) (40 (34-52) vs 49 (38-66) ng/l) and higher 25-OH-D (76 (65-93) vs 49 (40-62) nmol/l; P<0.05). Other laboratory parameters were stable compared with after PTX. Systolic BP decreased and total bone mineral content increased in both groups. CONCLUSION Except for the lowering of the PTH level, no additive effect of vitamin D supplementation was seen. However, PTX proved effective in reducing insulin resistance.
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Affiliation(s)
- Sophie Norenstedt
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrine SurgeryKarolinska University HospitalStockholmSweden
- (Correspondence should be addressed to S Norenstedt who is now at Department of Breast and Endocrine Surgery, Karolinska University Hospital, P9:03, SE-171 76 Stockholm, Sweden; )
| | - Ylva Pernow
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
| | - Kerstin Brismar
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
| | - Maria Sääf
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrinology, Metabolism and DiabetesKarolinska University HospitalStockholmSweden
| | - Ayla Ekip
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | | | - Jan Zedenius
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrine SurgeryKarolinska University HospitalStockholmSweden
| | - Inga-Lena Nilsson
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Endocrine SurgeryKarolinska University HospitalStockholmSweden
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Yoshida H, Akasaka H, Saitoh S, Shimamoto K, Miura T. Comparative effects of telmisartan and valsartan as add-on agents for hypertensive patients with morning blood pressure insufficiently controlled by amlodipine monotherapy. Hypertens Res 2013; 37:225-31. [PMID: 24108237 DOI: 10.1038/hr.2013.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/02/2013] [Accepted: 08/22/2013] [Indexed: 11/09/2022]
Abstract
The aim of this study was to determine the efficacies of valsartan and telmisartan as add-on agents for the control of morning blood pressure (BP) in patients already on amlodipine monotherapy. A total of 414 hypertensive patients were prospectively enrolled in a 4-week run-in period when they were treated with amlodipine (5 mg/day), and home BP was measured in the morning and evening. Patients with home systolic BP (SBP) being 135-159 mm Hg in the morning at the end of the run-in period were randomized to additional treatment with valsartan (80 mg/day) or with telmisartan (40 mg/day) for 8 weeks. The primary endpoint was the change in morning home BP, and secondary endpoints included variability of morning home BP. Of the 282 patients randomized, 262 patients (n=131, in each treatment) completed the protocols. Demographic parameters and baseline morning SBP/diastolic BP (DBP) (146.3±7.1/84.8±9.3 vs. 146.0±7.1/84.2±9.1 mm Hg) were comparable in the valsartan group and telmisartan group, and changes in SBP/DBP after 8-week treatment were not significantly different between the two groups (-7.4±10.6/-3.9±6.1 vs. -8.3±9.9/-5.0±5.9 mm Hg). Valsartan significantly increased individual standard deviation and variation coefficient of morning SBP, but telmisartan did not change either of these indices of SBP variation. In subgroups with baseline SBP being above the median (145.2 mm Hg), change in DBP was significantly larger by telmisartan than by valsartan (-6.3±5.6 vs. -3.9±6.7 mm Hg, P<0.05). These results suggest that telmisartan is more useful than valsartan as an add-on agent for reducing the level and variability of morning BP in patients on amlodipine monotherapy.
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Affiliation(s)
- Hideaki Yoshida
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Hiroshi Akasaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Shigeyuki Saitoh
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Kazuaki Shimamoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, School of Medicine, Sapporo, Japan
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van Rijn-Bikker PC, Snelder N, Ackaert O, van Hest RM, Ploeger BA, van Montfrans GA, Koopmans RP, Mathôt RA. Nonlinear mixed effects modeling of the diurnal blood pressure profile in a multiracial population. Am J Hypertens 2013; 26:1103-13. [PMID: 23939415 DOI: 10.1093/ajh/hpt088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiac and cerebrovascular events in hypertensive patients are related to specific features of the 24-hour diurnal blood pressure (BP) profile (i.e., daytime and nighttime BP, nocturnal dip (ND), and morning surge (MS)). This investigation aimed to characterize 24-hour diurnal systolic BP (SBP) with parameters that correlate directly with daytime and nighttime SBP, ND, and MS using nonlinear mixed effects modeling. METHODS Ambulatory 24-hour SBP measurements (ABPM) of 196 nontreated subjects from three ethnic groups were available. A population model was parameterized in NONMEM to estimate and evaluate the parameters baseline SBP (BSL), nadir (minimum SBP during the night), and change (SBP difference between day and night). Associations were tested between these parameters and patient-related factors to explain interindividual variability. RESULTS The diurnal SBP profile was adequately described as the sum of 2 cosine functions. The following typical values (interindividual variability) were found: BSL = 139 mm Hg (11%); nadir = 122 mm Hg (14%); change = 25 mm Hg (52%), and residual error = 12 mm Hg. The model parameters correlate well with daytime and nighttime SBP, ND, and MS (R (2) = 0.50-0.92). During covariate analysis, ethnicity was found to be associated with change; change was 40% higher in white Dutch subjects and 26.8% higher in South Asians than in blacks. CONCLUSIONS The developed population model allows simultaneous estimation of BSL, nadir, and change for all individuals in the investigated population, regardless of individual number of SBP measurements. Ethnicity was associated with change. The model provides a tool to evaluate and optimize the sampling frequency for 24-hour ABPM.
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Affiliation(s)
- Petra C van Rijn-Bikker
- Department of Clinical Pharmacy, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Pessanha P, Viana M, Ferreira P, Bertoquini S, Polónia J. Diagnostic value and cost-benefit analysis of 24 hours ambulatory blood pressure monitoring in primary care in Portugal. BMC Cardiovasc Disord 2013; 13:57. [PMID: 23937261 PMCID: PMC3765836 DOI: 10.1186/1471-2261-13-57] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 07/23/2013] [Indexed: 12/04/2022] Open
Abstract
Background Hypertensive patients (HTs) are usually attended in primary care (PC). We aimed to assess the diagnostic accuracy and cost-benefit ratio of 24-hour ambulatory blood pressure monitoring (ABPM) in all newly diagnosed hypertensive patients (HTs) attended in PC. Methods In a cross-sectional study ABPM was recorded in all 336 never treated HTs (Office BP ≥140 and/or ≥ 90 mm Hg) that were admitted during 16 months. Since benefits from drug treatment in white-coat hypertension (WCH) remain unproven, a cost benefit estimation of a general use of ABPM (vs absence of ABPM) in HTs was calculated comparing the cost of usual medical assistance of HTs only diagnosed in office with that based both on refraining from drug treatment all subjects identified as WCH and on the reduction by half of the frequency of biochemical exams and doctor visits. Results Women were 56%, age 51 ± 14 years and BMI 27 ± 4 Kg/m2. Out of these, 206 were considered as true HTs, daytime ABPM ≥ 135 and/or ≥85 mm Hg and 130 (38,7%) were identified as having white coat hypertension (WCH), daytime ABPM <135/85 mm Hg. Versus HTs, WCH group showed higher percentage of women (68% vs 51%) and lower values of an index composed by the association of cardiovascular risk factors. We estimated that with ABPM total medical expenses can be reduced by 23% (157.500 euros) with a strategy based on ABPM for 1000 patients followed for 2 years. Conclusions In PC, the widespread use of ABPM in newly diagnosed HTs increases diagnostic accuracy of hypertension, improves cardiovascular risk stratification, reduces health expenses showing a highly favourable benefit-cost ratio vs a strategy without ABPM.
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Affiliation(s)
- Paulo Pessanha
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
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Shivpuri S, Allison MA, Macera CA, Lindsay S, Gallo LC. Associations between nocturnal blood pressure dipping and the metabolic syndrome in high- vs. low-acculturated Mexican American women. Am J Hypertens 2013; 26:1030-6. [PMID: 23645325 DOI: 10.1093/ajh/hpt061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Less nocturnal blood pressure (BP) dipping has been associated with greater odds for the metabolic syndrome (MetS), a constellation of risk factors associated with cardiovascular disease (CVD). Little work has examined this association in Hispanics, who have elevated rates of MetS, or investigated differences in this relationship by level of acculturation. The purpose of this study was to examine the association between BP dipping and MetS in Hispanic women and to determine if this association is moderated by acculturation status. METHODS Two hundred eighty-six Mexican American women underwent assessment of MetS components (BP, waist circumference, fasting glucose, high-density lipoprotein cholesterol, and triglycerides) and completed a 36-hour ambulatory BP monitoring protocol, during which systolic BP (SBP) and diastolic BP readings were obtained. Nocturnal BP dipping was calculated as the percentage difference between average daytime and nighttime BP. Acculturation was defined by the language (Spanish, English) in which participants preferred to complete study instruments. RESULTS Although no significant main effects for BP dipping or acculturation emerged for MetS, the SBP dipping by acculturation interaction was significantly related to MetS (P < 0.01). Simple slope analyses revealed that less SBP dipping related to greater odds of MetS in high-acculturated women, but SBP dipping and MetS were unrelated in low-acculturated women. CONCLUSIONS The strength of the association between BP dipping and CVD risk (as measured by MetS) appears to vary by acculturation in Hispanic women. Future studies should explore mechanisms behind the BP dipping and CVD risk association and relevant modifying factors.
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Affiliation(s)
- Smriti Shivpuri
- San Diego State University/University of California-San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
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Erdogan D, Icli A, Aksoy F, Akcay S, Ozaydin M, Ersoy I, Varol E, Dogan A. Relationships of different blood pressure categories to indices of inflammation and platelet activity in sustained hypertensive patients with uncontrolled office blood pressure. Chronobiol Int 2013; 30:973-80. [PMID: 23834704 DOI: 10.3109/07420528.2013.790045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Failure to decrease blood pressure (BP) normally during nighttime (non-dipping) in hypertension is associated with higher cardiovascular morbidity and mortality. In addition, non-dipping BP is associated with increased platelet activity and inflammatory response; however, there has been no study to evaluate the relationship of non-dipping BP to indices of platelet activity and inflammation in uncontrolled hypertensive patients. In the present study, hypertensive subjects with uncontrolled office BP were firstly divided into three groups: 84 subjects with white coat effect and 365 subjects with true uncontrolled hypertension. Then, true uncontrolled hypertensive patients were divided into two groups: 158 patients with dipping and 207 patients with non-dipping. Mean platelet volume (MPV), uric acid (UA), γ-glutamyltransferase (GGT), C-reactive protein (CRP), and high-sensitivity CRP (hs-CRP) levels were studied. The general characteristics and risk factors for coronary artery disease (CAD) of the study population were similar among the groups. MPV, UA, GGT, CRP, and hs-CRP levels were significantly higher in non-dipper group than both dipper and white coat effect groups, and were significantly higher in dipper group than in white coat effect group (MPV: 9.1 ± 1.3, 8.7 ± 1.1, and 8. ± 0.9 fL; UA: 6.9 ± 1.2, 5.9 ± 1.4, and 4.1 ± 0.8 mg/dL; GGT: 38.9 ± 11.1, 33.6 ± 14.9, and 25.2 ± 9.2 U/L; CRP: 7.1 ± 2.4, 6.2 ± 1.9, and 3.9 ± 0.8 mg/dL; hs-CRP: 3.8 ± 1.5, 3.3 ± 1.2, and 2.0 ± 0.6, non-dipper, dipper, and white coat effect groups, respectively, all p values <0.01). All study parameters strongly correlated with each other. In conclusion, in hypertensive patients with uncontrolled office BP, presence of non-dipping BP is associated with increased platelet activity and inflammation, which can be one of the underlying plausible mechanisms of non-dipping BP status.
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Affiliation(s)
- Dogan Erdogan
- Department of Cardiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey.
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Latin American consensus on hypertension in patients with diabetes type 2 and metabolic syndrome. J Hypertens 2013; 31:223-38. [PMID: 23282894 DOI: 10.1097/hjh.0b013e32835c5444] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present document has been prepared by a group of experts, members of cardiology, endocrinology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of 'metabolic syndrome' is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that 'metabolic syndrome' is a useful nosographic entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particularly high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.
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Non-invasively estimated end-systolic elastance in patients with resistant hypertension and type 2 diabetes mellitus. Heart Vessels 2013; 29:375-83. [DOI: 10.1007/s00380-013-0371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
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Braddock M, Heilbraun J, Mendzelevski B. Cardiovascular safety and hemodynamic considerations in oncology drug development - webinar highlights October 10th 2012. Expert Opin Drug Saf 2013; 12:783-91. [PMID: 23651420 DOI: 10.1517/14740338.2013.797407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Development of new drugs in oncology may have implications for cardiovascular risk. This report describes some aspects of our growing knowledge in the area of evaluating benefit-risk and may be of direct importance to scientists working in drug discovery and development. AREAS COVERED This report of webinar highlights entitled "Trends in CardiOncology: the evolution of blood pressure and electrocardiogram (ECG) Markers" covers the current state of pharmacology of selected drugs which induce blood pressure elevation and best practices in employing the measurement of blood pressure elevation and cardiac safety parameters for drug development in oncology. EXPERT OPINION Oncology drug-induced cardiotoxicity has recently been recognised as an important drug development and clinical issue. The recognition of the risks and opportunities has prompted intensive research into mechanisms of chemotherapy-induced cardiotoxicity and potential prevention strategies. Drug-induced blood pressure elevation has emerged as a key area of interest, both as a marker of efficacy of vascular targeted chemotherapies as well as a target for early intervention strategies. While further research is ongoing, current data strongly suggest that early intervention strategies may provide significant short- and long-term clinical benefits to cancer patients undergoing chemotherapy.
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Affiliation(s)
- Martin Braddock
- Global Medicines Development, AstraZeneca R&D, Parklands,, Alderley Park, Macclesfield, SK10 4TG England, UK.
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Bulpitt CJ, Beckett N, Peters R, Staessen JA, Wang JG, Comsa M, Fagard RH, Dumitrascu D, Gergova V, Antikainen RL, Cheek E, Rajkumar C. Does White Coat Hypertension Require Treatment Over Age 80? Hypertension 2013; 61:89-94. [DOI: 10.1161/hypertensionaha.112.191791] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
White coat hypertension is considered to be a benign condition that does not require antihypertensive treatment. Ambulatory blood pressure (ABP) was measured in 284 participants in the Hypertension in the Very Elderly Trial (HYVET), a double-blind randomized trial of indapamide sustained release 1.5 mg±perindopril 2 to 4 mg versus matching placebo in hypertensive subjects (systolic blood pressure 160–199 mm Hg) aged >80 years. ABP recordings (Diasys Integra II) were obtained in 112 participants at baseline and 186 after an average follow-up of 13 months. At baseline, clinic blood pressure (CBP) exceeded the morning ABP by 32/10 mm Hg. Fifty percent of participants fulfilled the established criteria for white coat hypertension. The highest ABP readings were in the morning (average 140/80 mm Hg), the average night-time pressure was low at 124/72 mm Hg, and the average 24-hour blood pressure was 133/77 mm Hg. During follow-up, the systolic/diastolic blood pressure placebo-active differences averaged 6/5 mm Hg for morning ABP, 8/5 mm Hg for 24-hour ABP, and 13/5 mm Hg for CBP. The lowering of blood pressure over 24 hours supports the reduction in blood pressure with indapamide sustained release±perindopril as the explanation for the reduction in total mortality and cardiovascular events observed in the main HYVET study. Because we estimate that 50% had white coat hypertension in the main study, this condition may benefit from treatment in the very elderly.
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Affiliation(s)
- Christopher J. Bulpitt
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Nigel Beckett
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Ruth Peters
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Jan A. Staessen
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Ji-Guang Wang
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Marius Comsa
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Robert H. Fagard
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Dan Dumitrascu
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Vesselka Gergova
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Riitta L. Antikainen
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Elizabeth Cheek
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
| | - Chakravarthi Rajkumar
- From the Department of Medicine, Imperial College London, London, United Kingdom (C.J.B., N.B., R.P., R.L.A.); Brighton and Sussex Medical School, Brighton, United Kingdom (C.J.B., C.R.); Department of Cardiology, University of Leuven, Leuven, Belgium (J.A.S., R.H.F.); Centre for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Institute of Hypertension, China (J.-G.W.); Strada Narciselor, Fagaras, Romania (M.C.); Spitalul Judetean Cluj, Clinica Medicala 2, Cluj, Romania (D.D
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Home versus ambulatory and office blood pressure in predicting target organ damage in hypertension: a systematic review and meta-analysis. J Hypertens 2012; 30:1289-99. [PMID: 22499289 DOI: 10.1097/hjh.0b013e3283531eaf] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Studies have shown that ambulatory blood pressure (BP) is more closely related to preclinical target organ damage than office measurements. A review and meta-analysis of studies investigating the association of home BP measurements with target organ damage was performed. METHODS A PubMed and Cochrane Library search (1950-2011) revealed 23 studies reporting comparative data of home BP versus ambulatory and/or office measurements in terms of their association with several indices of target organ damage. Correlation coefficients were pooled by random-effects model meta-analysis. RESULTS Fourteen studies (n = 2485) assessing echocardiographic left ventricular mass index (LVMI) showed similar correlations with home (coefficients r = 0.46/0.28, systolic/diastolic) as with ambulatory BP (0.37/0.26, P = NS for difference versus home BP), and superior to office measurements (r = 0.23/0.19, P < 0.001/0.009 for difference versus home BP). Four methodologically heterogeneous studies assessing the glomerular filtration rate (n = 609) could not be pooled or lead to a concrete result. Four studies assessing carotid intima-media thickness (n = 1222), three assessing pulse wave velocity (n = 720) and two assessing urinary protein excretion (n = 156) showed no difference in pooled correlation coefficients with home versus office BP measurements. With all the measurement methods SBP was more closely associated with target organ damage than DBP. CONCLUSION These data suggest that home BP is as good as ambulatory monitoring and superior to office measurements in regard to their association with preclinical organ damage assessed by echocardiographic LVMI. More research is required to evaluate the relationship of home BP with other indices of target organ damage.
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Knudsen ST, Jeppesen P, Frederiksen CA, Andersen NH, Bek T, Ingerslev J, Mogensen CE, Poulsen PL. Endothelial perturbation: a link between non-dipping and retinopathy in type 2 diabetes? ACTA ACUST UNITED AC 2012; 1:208-15. [PMID: 20409852 DOI: 10.1016/j.jash.2007.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Revised: 02/20/2007] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
Reduced diurnal blood pressure (BP) variation ("non-dipping") is associated with both micro- and macrovascular complications in patients with type 2 diabetes. The relation between endothelial perturbation and diurnal BP variation in diabetic subjects has not previously been studied. Seventy-six subjects, stratified to 4 gender-, age-, and duration-matched groups of 19 subjects each, were studied (group A: non-diabetic subjects; group B to D, type 2 diabetic subjects; group B: no retinopathy; group C: minimal background retinopathy; group D: diabetic maculopathy). All subjects underwent a 24-hour ambulatory BP monitoring. von Willebrand factor (vWF), fibrinogen, E-selectin, and intercellular adhesion molecule-1 were measured in plasma. Systolic night/day BP ratio increased gradually in groups A to D: 85.2 +/- 5%, 85.7 +/- 7%, 88.5 +/- 6%, and 90.5 +/- 7%, respectively, P < .05. Among diabetic patients, non-dippers had significantly higher plasma levels of vWF and fibrinogen than dippers (median/interquartile range 1.7/1.4 to 2.1 vs. 1.2/0.9 to 1.5 U/mL, P < .01 and 3.6/3.6 to 3.7 vs. 2.9/2.5 to 3.6 g/L, P = .01). Non-dipping is associated with elevated plasma levels of proteins related to endothelial cell activation as well as with retinopathy in subjects with type 2 diabetes. This finding suggests a possible mechanism linking non-dipping with microvascular complications in these subjects.
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Affiliation(s)
- Søren Tang Knudsen
- Medical Department M (Diabetes & Endocrinology), Aarhus University Hospital, Aarhus, Denmark
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Determination of central blood pressure by a noninvasive method (brachial BP and QKD interval). J Hypertens 2012; 30:1533-9. [DOI: 10.1097/hjh.0b013e328354dd26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Hypertension is an important risk factor for the development of cardiovascular disease, and is a major cause of morbidity and mortality worldwide. Traditionally, hypertension diagnosis and treatment and clinical evaluations of antihypertensive efficacy have been based on office blood pressure (BP) measurements; however, there is increasing evidence that office measures may provide inadequate or misleading estimates of a patient’s true BP status and level of cardiovascular risk. The introduction, and endorsement by treatment guidelines, of 24-hour ambulatory BP monitoring and self (or home) BP monitoring has facilitated more reliable and reproducible estimations of true BP, including the identification of white-coat and masked hypertension, and evaluation of BP variability. In addition, ambulatory BP monitoring enables accurate assessment of treatment effectiveness over 24 hours and both ambulatory and self BP monitoring may lead to better tailoring of therapy according to BP profile and concomitant disease. This review describes the clinical benefits and limitations of out-of-office assessments and their applications for effective management of hypertension and attainment of BP control.
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Affiliation(s)
- Jean-Philippe Baguet
- Department of Cardiology, University Hospital, Joseph Fourier University, Grenoble, France
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