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Muntner P, Shimbo D, Schwartz JE. Does nondipping blood pressure provide prognostic information for all-cause and cardiovascular mortality independent of nighttime blood pressure? J Hypertens 2024; 42:1151-1153. [PMID: 38818839 DOI: 10.1097/hjh.0000000000003746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York
| | - Joseph E Schwartz
- Department of Medicine, Columbia University Irving Medical Center, New York
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
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2
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Atasoy S, Henningsen P, Johar H, Middeke M, Sattel H, Linkohr B, Rückert-Eheberg IM, Heier M, Peters A, Ladwig KH. Hypertension in the first blood pressure reading and the risk of cardiovascular disease mortality in the general population: findings from the prospective KORA study. J Hypertens 2024; 42:521-529. [PMID: 38088424 DOI: 10.1097/hjh.0000000000003629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND The risk of cardiovascular disease (CVD) mortality in individuals with an alerting reaction, assessed by hypertension in the first blood pressure (BP) reading but normal BP in further readings, remains unknown in the general population. METHODS AND RESULTS In a sample of 11 146 adults (51.5% men and 48.5% women) with a mean age of 47.1 years (SD ± 12.3) from a German population-based cohort, we analyzed risk factors and CVD mortality risk associated with an alerting reaction. An alerting reaction was prevalent in 10.2% of the population and associated with sociodemographic, lifestyle, and somatic CVD risk factors. Within a mean follow-up period of 22.7 years (SD ± 7.05 years; max: 32 years; 253 201 person years), 1420 (12.7%) CVD mortality cases were observed. The CVD mortality rate associated with an alerting reaction was significantly higher than in normotension (64 vs. 32 cases/10 000 person-years), but lower than hypertension (118 cases/10 000 person-years). Correspondingly, the alerting reaction was associated with a 23% higher hazard ratio of CVD mortality than normal blood pressure [hazard ratio 1.23 (95% confidence interval 1.02-1.49), P = 0.04]. However, adjustment for antihypertensive medication use attenuated this association [1.19 (0.99-1.44), P = 0.06]. CONCLUSION The results may warrant monitoring of an alerting reaction as a preventive measure of CVD mortality in untreated individuals with elevated first BP readings, as well as optimized treatment in treated individuals.
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Affiliation(s)
- Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hamimatunnisa Johar
- Department of Psychosomatic Medicine and Psychotherapy, University of Giessen and Marburg, Germany
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Martin Middeke
- Hypertension Center Munich, a European Society of Hypertension (ESH) Center of Excellence, Munich, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich
| | - Ina-Maria Rückert-Eheberg
- Institute of Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Kora Study Centre, University Hospital of Augsburg, Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum Munich - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich
- Hypertension Center Munich, a European Society of Hypertension (ESH) Center of Excellence
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3
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Lee DR, Chenoweth M, Chuong LH, Villaflores CW, Cuevas M, Vangala S, Borenstein J, Kwak H, Chima-Melton C, Han M, Skootsky SA, Chan Tack T, Branagan L, Martin H, Gupta R, Phan L, Sanchez MA, Malaak MM, Dermenchyan A, Pearson KN, Altunyan M, Barakat PF, Pablo R, Sarkisian C. A Multisite Electronic Health Record Integrated Remote Monitoring Intervention for Hypertension Improvement: Protocol for a Randomized Pragmatic Comparative Effectiveness Trial. JMIR Res Protoc 2023; 12:e45915. [PMID: 37902819 PMCID: PMC10644190 DOI: 10.2196/45915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Hypertension is a major contributor to various adverse health outcomes. Although previous studies have shown the benefits of home blood pressure (BP) monitoring over office-based measurements, there is limited evidence comparing the effectiveness of whether a BP monitor integrated into the electronic health record is superior to a nonintegrated BP monitor. OBJECTIVE In this paper, we describe the protocol for a pragmatic multisite implementation of a quality improvement initiative directly comparing integrated to nonintegrated BP monitors for hypertension improvement. METHODS We will conduct a randomized, comparative effectiveness trial at 3 large academic health centers across California. The 3 sites will enroll a total of 660 participants (approximately n=220 per site), with 330 in the integrated BP monitor arm and 330 in the nonintegrated BP control arm. The primary outcome of this study will be the absolute difference in systolic BP in mm Hg from enrollment to 6 months. Secondary outcome measures include binary measures of hypertension (controlled vs uncontrolled), hypertension-related health complications, hospitalizations, and death. The list of possible participants will be generated from a central data warehouse. Randomization will occur after enrollment in the study. Participants will use their assigned BP monitor and join site-specific hypertension interventions. Cross-site learning will occur at regular all-site meetings facilitated by the University of California, Los Angeles Value-Based Care Research Consortium. A pre- and poststudy questionnaire will be conducted to further evaluate participants' perspectives regarding their BP monitor. Linear mixed effects models will be used to compare the primary outcome measure between study arms. Mixed effects logistic regression models will be used to compare secondary outcome measures between study arms. RESULTS The study will start enrolling participants in the second quarter of 2023 and will be completed by the first half of 2024. Results will be published by the end of 2024. CONCLUSIONS This pragmatic trial will contribute to the growing field of chronic care management using remote monitoring by answering whether a hypertension intervention coupled with an electronic health record integrated home BP monitor improves patients' hypertension better than a hypertension intervention with a nonintegrated BP monitor. The outcomes of this study may help health system decision makers determine whether to invest in integrated BP monitors for vulnerable patient populations. TRIAL REGISTRATION ClinicalTrials.gov NCT05390502; clinicaltrials.gov/study/NCT05390502. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45915.
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Affiliation(s)
- David R Lee
- Division of Geriatrics, University of California, Los Angeles, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matthew Chenoweth
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Linh H Chuong
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Chad W Villaflores
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Miguel Cuevas
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sitaram Vangala
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jeff Borenstein
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hannah Kwak
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Chidinma Chima-Melton
- Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Maria Han
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Samuel A Skootsky
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- University of California Health, Oakland, CA, United States
| | - Therese Chan Tack
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Linda Branagan
- Telehealth Resource Center, University of California, San Francisco, San Francisco, CA, United States
| | - Heather Martin
- Department of Pharmacy, University of California Davis Health, Davis, CA, United States
| | - Reshma Gupta
- Department of Internal Medicine, University of California, Davis Health, Sacramento, CA, United States
| | - Linda Phan
- Department of Pharmacy, University of California Davis Health, Davis, CA, United States
| | - Michael A Sanchez
- University of California Office of the President, Oakland, CA, United States
| | - Mina M Malaak
- Ambulatory and Community Practices, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anna Dermenchyan
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kandyce N Pearson
- Ambulatory and Community Practices, University of California, Los Angeles, Los Angeles, CA, United States
| | - Marine Altunyan
- Ambulatory and Community Practices, University of California, Los Angeles, Los Angeles, CA, United States
| | - Peter F Barakat
- Ambulatory and Community Practices, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ray Pablo
- University of California Health Data Warehouse, University of California Health, Irvine, CA, United States
| | - Catherine Sarkisian
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Geriatrics Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
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4
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Roche V, Robert JP, Salam H. A holistic AI-based approach for pharmacovigilance optimization from patients behavior on social media. Artif Intell Med 2023; 144:102638. [PMID: 37783543 DOI: 10.1016/j.artmed.2023.102638] [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: 12/22/2021] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 10/04/2023]
Abstract
In this paper, we propose a holistic AI-based pharmacovigilance optimization approach using patient's social media data. Instead of focusing on the detection and identification of Adverse Drug Events (ADE) in social media posts in single time points, we propose a holistic approach that looks at the evolution of different user behavior indicators in time. We examine various NLP-based indicators such as word frequency, semantic similarity, Adverse Drug Reactions mentions, and sentiment analysis. We introduce a classification approach to identify normal vs. abnormal time periods based on patient comments. This approach, along with user behavior indicators, can optimize the pharmacovigilance process by flagging the need for immediate attention and further investigation. We specifically focus on the Levothyrox® case in France, which sparked media attention due to changes in the medication formula and affected patient behavior on medical forums. For classification, we propose a deep learning architecture called Word Cloud Convolutional Neural Network (WC-CNN), trained on word clouds from patient comments. We evaluate different temporal resolutions and NLP pre-processing techniques, finding that monthly resolution and the proposed indicators can effectively detect new safety signals, with an accuracy of 75%. We have made the code open source, available via github.
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Affiliation(s)
- Valentin Roche
- Université Claude Bernard - Lyon 1, Faculté de Pharmacie, Institut des Sciences Pharmaceutiques et Biologiques, 8 Avenue Rockefeller, 69008, Lyon, France.
| | - Jean-Philippe Robert
- Université Claude Bernard - Lyon 1, Faculté de Pharmacie, Institut des Sciences Pharmaceutiques et Biologiques, 8 Avenue Rockefeller, 69008, Lyon, France.
| | - Hanan Salam
- SMART Lab, New York University Abu Dhabi, Saadiyat Island, Abu Dhabi, PO Box 129188, United Arab Emirates.
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5
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Alreja A, Ward MJ, Ma Q, Russ BE, Bickel S, Van Wouwe NC, González-Martínez JA, Neimat JS, Abel TJ, Bagić A, Parker LS, Richardson RM, Schroeder CE, Morency LP, Ghuman AS. A new paradigm for investigating real-world social behavior and its neural underpinnings. Behav Res Methods 2023; 55:2333-2352. [PMID: 35877024 PMCID: PMC10841340 DOI: 10.3758/s13428-022-01882-9] [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] [Accepted: 05/15/2022] [Indexed: 11/08/2022]
Abstract
Eye tracking and other behavioral measurements collected from patient-participants in their hospital rooms afford a unique opportunity to study natural behavior for basic and clinical translational research. We describe an immersive social and behavioral paradigm implemented in patients undergoing evaluation for surgical treatment of epilepsy, with electrodes implanted in the brain to determine the source of their seizures. Our studies entail collecting eye tracking with other behavioral and psychophysiological measurements from patient-participants during unscripted behavior, including social interactions with clinical staff, friends, and family in the hospital room. This approach affords a unique opportunity to study the neurobiology of natural social behavior, though it requires carefully addressing distinct logistical, technical, and ethical challenges. Collecting neurophysiological data synchronized to behavioral and psychophysiological measures helps us to study the relationship between behavior and physiology. Combining across these rich data sources while participants eat, read, converse with friends and family, etc., enables clinical-translational research aimed at understanding the participants' disorders and clinician-patient interactions, as well as basic research into natural, real-world behavior. We discuss data acquisition, quality control, annotation, and analysis pipelines that are required for our studies. We also discuss the clinical, logistical, and ethical and privacy considerations critical to working in the hospital setting.
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Affiliation(s)
- Arish Alreja
- Center for the Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, USA.
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, USA.
- Machine Learning Department, Carnegie Mellon University, Pittsburgh, USA.
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA.
| | - Michael J Ward
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Qianli Ma
- Language Technologies Institute, Carnegie Mellon University, Pittsburgh, USA
| | - Brian E Russ
- Nathan Kline Institute for Psychiatric Research, Orangeburg, USA
| | - Stephan Bickel
- Department of Neurosurgery and Neurology, Northwell Health, The Feinstein Institutes for Medical Research, Manhasset, USA
| | - Nelleke C Van Wouwe
- Department of Neurological Surgery, University of Louisville, Louisville, USA
| | | | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, USA
| | - Taylor J Abel
- Center for the Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
- Brain Institute, University of Pittsburgh, Pittsburgh, USA
| | - Anto Bagić
- Department of Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Lisa S Parker
- School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - R Mark Richardson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
- Department of Neurosurgery, Harvard Medical School and Massachusetts General Hospital, Boston, USA
| | - Charles E Schroeder
- Nathan Kline Institute for Psychiatric Research, Orangeburg, USA
- Departments of Neurosurgery and Psychiatry, Columbia University, New York, USA
| | | | - Avniel Singh Ghuman
- Center for the Neural Basis of Cognition, Carnegie Mellon University and University of Pittsburgh, Pittsburgh, USA
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, USA
- Brain Institute, University of Pittsburgh, Pittsburgh, USA
- Departments of Psychology, Neurobiology, and Psychiatry, University of Pittsburgh, Pittsburgh, USA
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6
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Hu Y, Huerta J, Cordella N, Mishuris RG, Paschalidis IC. Personalized hypertension treatment recommendations by a data-driven model. BMC Med Inform Decis Mak 2023; 23:44. [PMID: 36859187 PMCID: PMC9979505 DOI: 10.1186/s12911-023-02137-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/09/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Hypertension is a prevalent cardiovascular disease with severe longer-term implications. Conventional management based on clinical guidelines does not facilitate personalized treatment that accounts for a richer set of patient characteristics. METHODS Records from 1/1/2012 to 1/1/2020 at the Boston Medical Center were used, selecting patients with either a hypertension diagnosis or meeting diagnostic criteria (≥ 130 mmHg systolic or ≥ 90 mmHg diastolic, n = 42,752). Models were developed to recommend a class of antihypertensive medications for each patient based on their characteristics. Regression immunized against outliers was combined with a nearest neighbor approach to associate with each patient an affinity group of other patients. This group was then used to make predictions of future Systolic Blood Pressure (SBP) under each prescription type. For each patient, we leveraged these predictions to select the class of medication that minimized their future predicted SBP. RESULTS The proposed model, built with a distributionally robust learning procedure, leads to a reduction of 14.28 mmHg in SBP, on average. This reduction is 70.30% larger than the reduction achieved by the standard-of-care and 7.08% better than the corresponding reduction achieved by the 2nd best model which uses ordinary least squares regression. All derived models outperform following the previous prescription or the current ground truth prescription in the record. We randomly sampled and manually reviewed 350 patient records; 87.71% of these model-generated prescription recommendations passed a sanity check by clinicians. CONCLUSION Our data-driven approach for personalized hypertension treatment yielded significant improvement compared to the standard-of-care. The model implied potential benefits of computationally deprescribing and can support situations with clinical equipoise.
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Affiliation(s)
- Yang Hu
- Department of Electrical and Computer Engineering, Division of Systems Engineering, Boston University, 8 Saint Mary's St., Boston, MA, 02215, USA
| | - Jasmine Huerta
- Department of Medicine, Boston Medical Center, School of Medicine, Boston University, Boston, MA, USA
| | - Nicholas Cordella
- Department of Medicine, Boston Medical Center, School of Medicine, Boston University, Boston, MA, USA
| | - Rebecca G Mishuris
- Department of Medicine, Boston Medical Center, School of Medicine, Boston University, Boston, MA, USA
| | - Ioannis Ch Paschalidis
- Department of Electrical and Computer Engineering, Division of Systems Engineering, Boston University, 8 Saint Mary's St., Boston, MA, 02215, USA.
- Department of Biomedical Engineering, Faculty of Computing & Data Sciences, Hariri Institute for Computing and Computational Science & Engineering, Boston University, 8 Saint Mary's St., Boston, MA, 02215, USA.
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7
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Atkinson T, Brown E, Jones G, Sage K, Wang X. "I Assumed It Would Be Somebody Who Had a Stroke That Was Doing This": Views of Stroke Survivors, Caregivers, and Health Professionals on Tailoring a Relaxation and Mindfulness Intervention. Healthcare (Basel) 2023; 11:healthcare11030399. [PMID: 36766974 PMCID: PMC9914663 DOI: 10.3390/healthcare11030399] [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: 12/21/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
Stroke survivors and informal caregivers experience high levels of stress and anxiety, linked to heightened risk of secondary stroke in survivors. Relaxation and mindfulness could reduce stress and anxiety; being most effective when tailored to the target populations. Aims of the PPI include to: (1) consult on possible alterations to an existing relaxation and mindfulness intervention, delivered via YouTube/DVD and (2) discuss relevance and preference of prompts and cues designed to facilitate the daily practice of the intervention. Eleven UK PPI contributors were consulted during 2020: four stroke survivors (F = 2, M = 2), three caregivers (F = 1, M = 2), and four HCPs (F = 4) (range = 23-63 years). Contributors watched the existing intervention and provided feedback via online discussions. Transcripts were analysed using thematic analysis. Five themes were identified, highlighting several necessary alterations to the intervention: "Who represents the stroke population?"; "The paradox of age"; "Specifically selected language"; "Visual presentation of the intervention"; and the "Audio qualities". Contributors ranked the prompts and cues in order of preference with setting alarms and email alerts as the most popular. The PPI consultations resulted in several alterations enabling a revised version of the intervention. Including a PPI consultation at an early stage of the research improves the relevance and appropriateness of the research. The revised intervention is more representative of the stroke population thus more likely to be practised by survivors and caregivers, which will enhance the extent of effectiveness, reducing the risk of a secondary stroke.
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Affiliation(s)
- Thomas Atkinson
- Psychology, Leeds School of Social Sciences, Leeds Beckett University, Leeds LS1 3HE, UK
- Correspondence:
| | - Emma Brown
- Psychology, Leeds School of Social Sciences, Leeds Beckett University, Leeds LS1 3HE, UK
| | - Georgina Jones
- Psychology, Leeds School of Social Sciences, Leeds Beckett University, Leeds LS1 3HE, UK
| | - Karen Sage
- Applied Clinical Research, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Xu Wang
- Psychology, Leeds School of Social Sciences, Leeds Beckett University, Leeds LS1 3HE, UK
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8
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“What if It’s not Just an Item of Clothing?” – A Narrative Review and Synthesis of the White Coat in the Context of Aged Care. Psychol Belg 2022; 62:62-74. [PMID: 35291725 PMCID: PMC8877653 DOI: 10.5334/pb.1138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/29/2022] [Indexed: 11/20/2022] Open
Abstract
Although increasingly disputed, the white coat uniform is ubiquitous in geriatric care, which may reflect a phenomenon called medicalisation of ageing. This narrative review is the first attempt at integrating several theoretical approaches, such as the “white coat effect” and “enclothed cognition”, in order to gain a comprehensive understanding of the use of this clothing item. Based on extensive empirical evidence, we will examine the consequences of wearing a uniform, not only on patients (in this case, older patients) and healthcare professionals, but also on their relationship. The white coat has powerful symbolic functions for healthcare professionals and is still preferred by older adults. However, the negative repercussions of wearing a uniform require us to question its use, particularly in environments where older persons live, such as nursing homes.
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9
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Hiremath S, Ramsay T, Ruzicka M. Blood pressure measurement: Should technique define targets? J Clin Hypertens (Greenwich) 2021; 23:1538-1546. [PMID: 34268883 PMCID: PMC8678755 DOI: 10.1111/jch.14324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
Accurate assessment of blood pressure (BP) is the cornerstone of hypertension management. The objectives of this study were to quantify the effect of medical personnel presence during BP measurement by automated oscillometric BP (AOBP) and to compare resting office BP by AOBP to daytime average BP by 24‐h ambulatory BP monitoring (ABPM). This study is a prospective randomized cross‐over trial, conducted in a referral population. Patients underwent measurements of casual and resting office BP by AOBP. Resting BP was measured as either unattended (patient alone in the room during resting and measurements) or as partially attended (nurse present in the room during measurements) immediately prior to and after 24‐h ABPM. The primary outcome was the effect of unattended 5‐min rest preceding AOBP assessment as the difference between casual and resting BP measured by the Omron HEM 907XL. Ninety patients consented and 78 completed the study. The mean difference between the casual and Omron unattended systolic BP was 7.0 mm Hg (95% confidence interval [CI] 4.5, 9.5). There was no significant difference between partially attended and unattended resting office systolic BP. Resting office BP (attended and partially attended) underestimated daytime systolic BP load from 24‐h ABPM. The presence or absence of medical personnel does not impact casual office BP which is higher than resting office AOBP. The requirement for unattended rest may be dropped if logistically challenging. Casual and resting office BP readings by AOBP do not capture the complexity of information provided by the 24‐h ABPM.
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Affiliation(s)
- Swapnil Hiremath
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Kidney Research Center, University of Ottawa, Ontario, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marcel Ruzicka
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Kidney Research Center, University of Ottawa, Ontario, Canada
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10
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Vambheim SM, Daniali H, Flaten MA. Placebo Effects on Stress, but Not on Pain Reports. A Multi-Experiment Study. Front Psychol 2021; 12:639236. [PMID: 34163396 PMCID: PMC8215114 DOI: 10.3389/fpsyg.2021.639236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Contextual factors, such as participant/experimenter sex may moderate the placebo effects. We tested whether the participant and experimenter sex modulated placebo effects on experimentally induced pain and associated stress. Objective To investigate if (i) participant sex and (ii) experimenter sex influence placebo analgesia and subjective and physiological stress in two experiments employing a within-subjects and a mixed design, respectively. Placebo effects were investigated in pain reports, stress, and blood pressure. Methods Participants received painful stimulations and a placebo cream. In Experiment One (N = 59) participants underwent a placebo condition (PC) and a natural history condition (NHC) in random order. A placebo cream was applied in the PC and then the heat stimulation temperature was surreptitiously lowered. Identical stimulations were administered in the NHC, but with no cream, no information, and no lowered temperature. In Experiment Two, participants (N = 93) were randomly assigned to three groups receiving either a placebo cream with surreptitiously lowered intensity of electric stimuli (Placebo, PG), a placebo cream (Cream-Control, CCG) without changing the stimuli, or lowered intensity, but with no cream (Pain-Control, PCG) in a mixed design. All participants in both experiments received the same stimuli in the post-test as in the pre-test. Four experimenters (two females) in Experiment One, and five experimenters (two females) in Experiment Two conducted the studies. Results No placebo effect was seen on pain. However, there were placebo effects on stress, moderated by participant and experimenter sex: in Experiment One males in the PC had lower diastolic blood pressure (DBP) compared to males in the NHC. Participants in the PC had lower DBP compared to the NHC when tested by a female. In Experiment Two, participants expected more cream effectiveness when a female experimenter administered it, and reported lower stress in the PG compared to the PCG when tested by females. Conclusion Our findings highlight a distinction between placebo effects on pain and on associated stress. Secondly, female experimenters recorded lower physiological and subjective stress, higher effectiveness expectations, and lower pain from both sexes compared to male experimenters. Possible reasons for the failure to find a pain placebo effect are discussed.
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Affiliation(s)
| | - Hojjat Daniali
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Magne Arve Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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11
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Ghazi L, Drawz PE, Pajewski NM, Juraschek SP. The Association of Orthostatic Hypotension With Ambulatory Blood Pressure Phenotypes in SPRINT. Am J Hypertens 2021; 34:511-520. [PMID: 33186448 PMCID: PMC8140655 DOI: 10.1093/ajh/hpaa184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinic blood pressure (BP) when measured in the seated position, can miss meaningful BP phenotypes, including low ambulatory BP (white coat effects [WCE]) or high supine BP (nocturnal non-dipping). Orthostatic hypotension (OH) measured using both seated (or supine) and standing BP, could identify phenotypes poorly captured by seated clinic BP alone. METHODS We examined the association of OH with WCE and night-to-daytime systolic BP (SBP) in a subpopulation of SPRINT, a randomized trial testing the effects of intensive or standard (<120 vs. <140 mm Hg) SBP treatment strategies in adults at increased risk of cardiovascular disease. OH was assessed during follow-up (6, 12, and 24 months) and defined as a decrease in mean seated SBP ≥20 or diastolic BP ≥10 mm Hg after 1 min of standing. WCE, based on 24-hour ambulatory BP monitoring performed at 27 months, was defined as the difference between 27-month seated clinic and daytime ambulatory BP ≥20/≥10 mm Hg. Reverse dipping was defined as a ratio of night-to-daytime SBP >1. RESULTS Of 897 adults (mean age 71.5±9.5 years, 29% female, 28% black), 128 had OH at least once. Among those with OH, 15% had WCE (vs. 7% without OH). Moreover, 25% of those with OH demonstrated a non-dipping pattern (vs. 14% without OH). OH was positively associated with both WCE (OR=2.24; 95%CI: 1.28, 4.27) and reverse dipping (OR=2.29; 95% CI: 1.31, 3.99). CONCLUSIONS The identification of OH in clinic was associated with two BP phenotypes often missed with traditional seated BP assessments. Further studies on mechanisms of these relationships are needed. CLINICAL TRIALS REGISTRATION Trial Number NCT03569020.
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Affiliation(s)
- Lama Ghazi
- Yale University, School of Medicine, Clinical and Translational Research Accelerator, New Haven, Connecticut, USA
| | - Paul E Drawz
- University of Minnesota Medical School, Department of Medicine, Division of Nephrology and Hypertension, Minneapolis, Minnesota, USA
| | - Nicholas M Pajewski
- Wake Forest School of Medicine, Department of Biostatistics and Data Science, Winston-Salem, North Carolina, USA
| | - Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Medicine, Division of General Medicine, Boston, Massachusetts, USA
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12
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Sanz A, Méndez-Ulrich JL. Intraocular Pressure Reactivity to Social Stressors. J PSYCHOPHYSIOL 2021. [DOI: 10.1027/0269-8803/a000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. A field study was carried out in an optometry clinic, aimed at assessing the role of perceived control and aversiveness of non-contact tonometry in intraocular pressure (IOP) reactivity to psychosocial stressors, and analyzing the covariation with cardiovascular and affective reactivity. Forty-four customers volunteered to participate in the study. Perceived control (self-efficacy and threat) was assessed at the onset. IOP, systolic and diastolic blood pressure, heart rate, affect, and aversiveness of the IOP measurement procedure were assessed throughout five phases with a mean duration for each phase of 9 min: arrival, optometry, baseline, stressor task (speech in public task), and recovery. The results suggest that IOP decreases over time and the stressor task induced a remarkable reactivity in all the physiological variables assessed. The interaction between self-efficacy and threat partially explains individual variability in IOP: a high threat combined with a high self-efficacy yielded higher reactivity in IOP or increased tonic values throughout the phases. The aversiveness of the measurement procedure did not affect IOP. Intraocular Pressure (IOP) is reactive to social stressors and perceived control partially explains individual variability. Cardiovascular and IOP reactivity are parallel phenomena but do not share a common regulatory mechanism.
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Affiliation(s)
- Antoni Sanz
- Research Group on Stress and Health, Department of Basic, Developmental and Educational Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Jorge Luis Méndez-Ulrich
- Department of Methods of Research and Diagnosis in Education, Faculty of Education, University of Barcelona, Barcelona, Spain
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13
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Gomes JT, Gregorio PHP, Santos ES, Ribeiro BP, Gregório MG. Effectiveness of Spacer Devices on Preventing Undesirable Cardiovascular Effects of Inhaled Salbutamol. J Aerosol Med Pulm Drug Deliv 2020; 34:217-222. [PMID: 33030386 DOI: 10.1089/jamp.2019.1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Currently, there are no regulatory guidelines indicating spacer devices/valved holding chamber (VHC) should be used routinely during pulmonary function tests, and few studies evaluated if spacer devices reduce beta-agonist bronchodilators' side effects. Methods: A prospective study compared salbutamol's cardiovascular effects and bronchodilation response during spirometry tests with and without a spacer device/VHC. Heart rate (HR), the corrected QT interval (QTc), and systolic and diastolic blood pressure were measured 10 minutes after the first spirometry test, before the drug administration, and 20 minutes after inhalation in both groups. Spirometric parameters (forced expiratory volume in the first second [FEV1], forced vital capacity [FVC], and FEV1/FVC) were also measured for both groups. Results: HR and QTc increase were significantly higher in the pressurized meter dose inhalers alone group versus the VHC group [mean SD] [73.1 ± 10 bpm to 74.3 + 10 bpm, p = 0.021] and [median (25%-75% interquartile range)] [389 ms (381-404) to 398 ms (387-407), p = 0.045] vs. [mean SD] [75.4 ± 9 to 73.8 + 8 bpm, p = 0.4] and [median (25%-75% interquartile range)] [388 ms (347-408) to 385 ms (366-408), p = 0.35], respectively. FEV1 variation before and after salbutamol were similar between both groups. Discussion: Although VHC significantly reduces HR and QTc variation when using beta-agonist bronchodilators in healthy patients, no clinical repercussions of this variation were found in this study, since no event of tachycardia or pathological QTc was recorded. Conclusion: VHC has a diminished clinical impact for healthy patients when considering cardiovascular effects and spirometric parameters. Beta-agonist bronchodilators may be administrated despite the use of spacer devices in patients without known cardiovascular diseases. Its significance for other populations still needs to be determined.
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14
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Daniali H, Flaten MA. Placebo Analgesia, Nocebo Hyperalgesia, and the Cardiovascular System: A Qualitative Systematic Review. Front Physiol 2020; 11:549807. [PMID: 33101048 PMCID: PMC7544987 DOI: 10.3389/fphys.2020.549807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Placebo/nocebo effects involve the autonomic nervous system, including cardiac activity, but studies have reported inconsistent findings on how cardiac activity is modulated following a placebo/nocebo effect. However, no systematic review has been conducted to provide a clear picture of cardiac placebo responses. Objective: The main goal of the present study is to review the effects of placebo analgesia and nocebo hyperalgesia on cardiac activity as measured by blood pressure, heart rate, and heart rate variability. Methods: Using several Boolean keyword combinations, the PubMed, EMBASE, PsycINFO, Cochrane Review Library, and ISI Web of Knowledge databases were searched until January 5, 2020, to find studies that analyzed blood pressure, heart rate, or heart rate variability indexes following a placebo analgesic/nocebo hyperalgesic effect. Results: Nineteen studies were found, with some reporting more than one index of cardiac activity; eight studies were on blood pressure, 14 studies on heart rate, and six on heart rate variability. No reliable association between placebo/nocebo effects and blood pressure or heart rate was found. However, placebo effects reduced, and nocebo effects increased low-frequency heart rate variability, and heart rate variability significantly predicted placebo effects in two studies. Conclusion: Placebo/nocebo effects can have reliable effects on heart rate variability, but not on heart rate and blood pressure.
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Affiliation(s)
| | - Magne Arve Flaten
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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15
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Evaluation of Unattended Automated Office, Conventional Office and Ambulatory Blood Pressure Measurements and Their Correlation with Target Organ Damage in an Outpatient Population of Hypertensives: Study Design and Methodological Aspects. High Blood Press Cardiovasc Prev 2019; 26:493-499. [DOI: 10.1007/s40292-019-00344-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022] Open
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16
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Torres-Prioris MJ, López-Barroso D, Paredes-Pacheco J, Roé-Vellvé N, Dawid-Milner MS, Berthier ML. Language as a Threat: Multimodal Evaluation and Interventions for Overwhelming Linguistic Anxiety in Severe Aphasia. Front Psychol 2019; 10:678. [PMID: 31133908 PMCID: PMC6517493 DOI: 10.3389/fpsyg.2019.00678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/11/2019] [Indexed: 12/30/2022] Open
Abstract
Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behavior, and it is accentuated during language testing in persons with aphasia (PWA). The presence of LA in PWA may jeopardize the interpretation of cognitive evaluations, leading to biased conclusions about the severity of the language alteration and the effectiveness of the treatments. In the present study, we report the case of a woman (Mrs. A) with severe chronic mixed transcortical aphasia due to left frontal and parietal hemorrhages that partially spared the perisylvian area. Mrs. A was treated with the dopamine agonist Rotigotine alone and combined with Intensive Language-Action Therapy (ILAT). Complementary evaluations included autonomic reactivity during the performance of different language tasks, resting state functional magnetic resonance imaging (rs-fMRI) and [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We found that formal language testing in a clinical setting triggered a dramatic increase of automatic echolalia, perseverations and frustration, making the task completion difficult. The treatment improved aphasia, but gains were more robust when evaluation was performed by Mrs. A's husband at home than by clinicians. Autonomic evaluation under Rotigotine revealed higher reactivity during tasks tapping an impaired function in comparison with a task evaluating a preserved function (verbal repetition). Baseline 18F-FDG-PET analysis showed decreased metabolic activity in left limbic-paralimbic areas, whereas rs-fMRI revealed compensatory activity in the right hemisphere. We also analyzed the different factors (e.g., premorbid personality traits, task difficulty) that may have contributed to LA in Mrs. A during language testing. Our findings emphasize the usefulness of implicating adequately trained laypersons in the evaluation and treatment of PWA showing LA. Further studies using multidimensional evaluations are needed to disentangle the interplay between anxiety and abnormal language as well as the neural mechanisms underpinning LA in PWA.
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Affiliation(s)
- María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit (UNCA), Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga - IBIMA, University of Málaga, Málaga, Spain.,Area of Psychobiology, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Diana López-Barroso
- Cognitive Neurology and Aphasia Unit (UNCA), Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga - IBIMA, University of Málaga, Málaga, Spain.,Area of Psychobiology, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - José Paredes-Pacheco
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of Malaga, Málaga, Spain.,Molecular Imaging and Medical Physics Group, Department of Psychiatry, Radiology and Public Health, University of Compostela, Santiago de Compostela, Spain
| | - Núria Roé-Vellvé
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, General Foundation of the University of Malaga, Málaga, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain
| | - Marc S Dawid-Milner
- Neurophysiology of Autonomic Nervous System Laboratory, Centro de Investigaciones Médico-Sanitarias, University of Málaga, Málaga, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit (UNCA), Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga - IBIMA, University of Málaga, Málaga, Spain
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17
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Using out-of-office blood pressure measurements in established cardiovascular risk scores: a secondary analysis of data from two blood pressure monitoring studies. Br J Gen Pract 2019; 69:e381-e388. [PMID: 31064741 DOI: 10.3399/bjgp19x702737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/07/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Blood pressure (BP) measurement is increasingly carried out through home or ambulatory monitoring, yet existing cardiovascular risk scores were developed for use with measurements obtained in clinics. AIM To describe differences in cardiovascular risk estimates obtained using ambulatory or home BP measurements instead of clinic readings. DESIGN AND SETTING Secondary analysis of data from adults aged 25-84 years in the UK and the Netherlands without prior history of cardiovascular disease (CVD) in two BP monitoring studies: the Blood Pressure in different Ethnic groups (BP-Eth) study and the Home versus Office blood pressure MEasurements: Reduction of Unnecessary treatment Study (HOMERUS). METHOD The primary comparison was Framingham risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements. Statistical significance was determined using non-parametric tests. RESULTS In 442 BP-Eth patients (mean age = 58 years, 50% female [n = 222]) the median absolute difference in 10-year Framingham cardiovascular risk calculated using BP measured as in the Framingham study or daytime ambulatory BP measurements was 1.84% (interquartile range [IQR] 0.65-3.63, P = 0.67). In 165 HOMERUS patients (mean age = 56 years, 46% female) the median absolute difference in 10-year risk for daytime ambulatory BP was 2.76% (IQR 1.19-6.39, P<0.001) and only 8 out of 165 (4.8%) of patients were reclassified. CONCLUSION Estimates of cardiovascular risk are similar when calculated using BP measurements obtained as in the risk score derivation study or through ambulatory monitoring. Further research is required to determine if differences in estimated risk would meaningfully influence risk score accuracy.
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18
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Shahab H, Khan HS, Almas A, Khan SA, Artani A, Khan AH. Defining the hemodynamic response of hypertensive and normotensive subjects through serial timed blood pressure readings in the clinic. Clin Hypertens 2019; 25:8. [PMID: 30984413 PMCID: PMC6442419 DOI: 10.1186/s40885-019-0114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Every third patient in the clinic is misdiagnosed due to white-coat phenomenon, necessitating needless and costly treatment. We aimed to study the hemodynamic response of the physician’s visit on hypertensive and normotensive patients by investigating the trend of blood pressure (BP) before, during and 15 min after the physician-patient encounter. Methods A descriptive, cross-sectional study was conducted over a period of 8 months in the cardiology clinics at the Aga Khan University Hospital, Karachi. Both hypertensive and normotensive patients, aged ≥18 years, were recruited. Pregnant females or those with a history of volume loss were excluded. BP readings were taken using an automated, validated device (Omron-HEM7221-E) at three points: pre-clinic BP by the assessment nurse, in-clinic BP by the attending physician and post-clinic BP 15-min after the physician-patient encounter by a research assistant. Independent samples t-test was used to calculate the statistical difference between hypertensive and normotensive BP values. Results Of 180 participants, 71% (n = 128) were hypertensive and 57% (n = 103) of all were males. The mean age of the participants was 57 ± 15 years. The mean and standard deviation(±SD) systolic BP (SBP) taken pre-clinic, in-clinic and 15-min post-clinic for hypertensive population was 128.7 ± 20 mmHg, 137.1 ± 21 mmHg and 127.9 ± 19 mmHg. The mean and standard deviation(±SD) SBP taken pre-clinic, in-clinic and 15 min post-clinic for normotensive population was 112 ± 16 mmHg, 115.8 ± 20 mmHg and 111.8 ± 15 mmHg. The hypertensive SBP values showed statistically significant difference from the normotensive values (difference in pre-clinic SBP: 16.7 mmHg, p-value < 0.001; in-clinic SBP: 21.3 mmHg, p-value < 0.001; and 15 min post-clinic: 16.1 mmHg, p-value < 0.001). Conclusions Hypertensive and normotensive patients display congruent hemodynamics upon visiting the physician, the alert response being accentuated amongst the hypertensive group. In-clinic BP readings are higher for both hypertensive and normotensive patients making them unreliable for screening and management of hypertension amongst both the groups.
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Affiliation(s)
- Hunaina Shahab
- 1Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800 Pakistan
| | - Hamza Sohail Khan
- 1Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800 Pakistan
| | - Aysha Almas
- 1Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800 Pakistan
| | - Sohail Abrar Khan
- 2Tabba Heart Institute, St-1, Block 2, Federal B Area, Karachi, 75950 Pakistan
| | - Azmina Artani
- 1Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800 Pakistan
| | - Aamir Hameed Khan
- 1Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800 Pakistan
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19
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Reducing the invasive nature of tear stability assessments. Ocul Surf 2019; 17:174-175. [PMID: 30831251 DOI: 10.1016/j.jtos.2019.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 02/09/2019] [Accepted: 02/25/2019] [Indexed: 11/21/2022]
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20
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Warner BE, Velardo C, Salvi D, Lafferty K, Crosbie S, Herrington WG, Haynes R. Feasibility of Telemonitoring Blood Pressure in Patients With Kidney Disease (Oxford Heart and Renal Protection Study-1): Observational Study. JMIR Cardio 2018; 2. [PMID: 30596204 PMCID: PMC6309686 DOI: 10.2196/11332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Blood pressure (BP) is a key modifiable risk factor for patients with chronic kidney disease (CKD), with current guidelines recommending strict control to reduce the risk of progression of both CKD and cardiovascular disease. Trials involving BP lowering require multiple visits to achieve target BP, which increases the costs of such trials, and in routine care, BP measured in the clinic may not accurately reflect the usual BP. Objective We sought to assess whether a telemonitoring system for BP (using a Bluetooth-enabled BP machine that could transmit BP measurements to a tablet device installed with a bespoke app to guide the measurement of BP and collect questionnaire data) was acceptable to patients with CKD and whether patients would provide sufficient BP readings to assess variability and guide treatment. Methods A total of 25 participants with CKD were trained to use the telemonitoring equipment and asked to record BP daily for 30 days, attend a study visit, and then record BP on alternate days for the next 60 days. They were also offered a wrist-worn applanation tonometry device (BPro) which measures BP every 15 minutes over a 24-hour period. Participants were given questionnaires at the 1- and 3-month time points; the questionnaires were derived from the System Usability Scale and Technology Acceptance Model. All eligible participants completed the study. Results Mean participant age was 58 (SD 11) years, and mean estimated glomerular filtration rate was 36 (SD 13) mL/min/1.73m2. 13/25 (52%) participants provided >90% of the expected data and 18/25 (72%) provided >80% of the expected data. The usability of the telemonitoring system was rated highly, with mean scores of 84.9/100 (SE 2.8) after 30 days and 84.2/100 (SE 4.1) after 90 days. The coefficient of variation for the variability of systolic BP telemonitoring was 9.4% (95% CI 7.8-10.9) compared with 7.9% (95% CI 6.4-9.5) for the BPro device, P=.05 (and was 9.0% over 1 year in a recently completed trial with identical eligibility criteria), indicating that most variation in BP was short term. Conclusions Telemonitoring is acceptable for patients with CKD and provides sufficient data to inform titration of antihypertensive therapies in either a randomized trial setting (comparing BP among different targets) or routine clinical practice. Such methods could be employed in both scenarios and reduce costs currently associated with such activities. Trial Registration International Standard Randomized Controlled Trial Number ISRCTN13725286; http://www.isrctn.com/ISRCTN13725286 (Archived by WebCite at http://www.webcitation.org/74PAX51Ji).
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Affiliation(s)
- B E Warner
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Velardo
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - D Salvi
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - K Lafferty
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Crosbie
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - W G Herrington
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Haynes
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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21
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Cuesta-Frau D, Novák D, Burda V, Molina-Picó A, Vargas B, Mraz M, Kavalkova P, Benes M, Haluzik M. Characterization of Artifact Influence on the Classification of Glucose Time Series Using Sample Entropy Statistics. ENTROPY 2018; 20:e20110871. [PMID: 33266595 PMCID: PMC7512430 DOI: 10.3390/e20110871] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 01/02/2023]
Abstract
This paper analyses the performance of SampEn and one of its derivatives, Fuzzy Entropy (FuzzyEn), in the context of artifacted blood glucose time series classification. This is a difficult and practically unexplored framework, where the availability of more sensitive and reliable measures could be of great clinical impact. Although the advent of new blood glucose monitoring technologies may reduce the incidence of the problems stated above, incorrect device or sensor manipulation, patient adherence, sensor detachment, time constraints, adoption barriers or affordability can still result in relatively short and artifacted records, as the ones analyzed in this paper or in other similar works. This study is aimed at characterizing the changes induced by such artifacts, enabling the arrangement of countermeasures in advance when possible. Despite the presence of these disturbances, results demonstrate that SampEn and FuzzyEn are sufficiently robust to achieve a significant classification performance, using records obtained from patients with duodenal-jejunal exclusion. The classification results, in terms of area under the ROC of up to 0.9, with several tests yielding AUC values also greater than 0.8, and in terms of a leave-one-out average classification accuracy of 80%, confirm the potential of these measures in this context despite the presence of artifacts, with SampEn having slightly better performance than FuzzyEn.
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Affiliation(s)
- David Cuesta-Frau
- Technological Institute of Informatics, Universitat Politècnica de València, Alcoi Campus, 03801 Alcoi, Spain
- Correspondence: ; Tel.: +34-96-652-85-05
| | - Daniel Novák
- Department of Cybernetics, Czech Technical University in Prague, 16000 Prague, Czech Republic
| | - Vacláv Burda
- Department of Cybernetics, Czech Technical University in Prague, 16000 Prague, Czech Republic
| | - Antonio Molina-Picó
- Technological Institute of Informatics, Universitat Politècnica de València, Alcoi Campus, 03801 Alcoi, Spain
| | - Borja Vargas
- Internal Medicine Department, Teaching Hospital of Móstoles, 28935 Madrid, Spain
| | - Milos Mraz
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague 1st Faculty of Medicine, 12108 Prague, Czech Republic
| | - Petra Kavalkova
- Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague 1st Faculty of Medicine, 12108 Prague, Czech Republic
| | - Marek Benes
- Hepatogastroenterology Department, Transplant centre, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic
| | - Martin Haluzik
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, General University Hospital, Charles University in Prague 1st Faculty of Medicine, 12108 Prague, Czech Republic
- Obesitology Department, Institute of Endocrinology, 11694 Prague, Czech Republic
- Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, 14021 Prague, Czech Republic
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22
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Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control 2018; 11:73-79. [PMID: 30519088 PMCID: PMC6233698 DOI: 10.2147/ibpc.s152761] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hypertension is closely linked to increased cardiovascular risk and development of target organ damage (TOD). Therefore, proper clinical follow-up and treatment of hypertensive subjects are mandatory. A great number of individuals present a variation on blood pressure (BP) levels when they are assessed either in the office or in the out-of-office settings. This phenomenon is defined as white coat syndrome - a change in BP levels due to the presence of a physician or other health professional. In this context, the term "white coat syndrome" may refer to three important and different clinical conditions: 1) white coat hypertension, 2) white coat effect, and 3) masked hypertension. The development of TOD and the increased cardiovascular risk play different roles in these specific subgroups of white coat syndrome. Correct diagnose and clinical guidance are essential to improve the prognosis of these patients. The aim of this review was to elucidate contemporary aspects of these types of white coat syndrome on general and hypertensive population.
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Affiliation(s)
- Mariana R Pioli
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
| | - Alessandra Mv Ritter
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
| | - Ana Paula de Faria
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
| | - Rodrigo Modolo
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil, .,Laboratory of Cardiac Catheterization, Department of Internal Medicine, Cardiology Division, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
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23
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Validity of ambulatory blood pressure monitoring in daily primary healthcare practice in France. Blood Press Monit 2018; 23:288-293. [PMID: 30048256 DOI: 10.1097/mbp.0000000000000342] [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
OBJECTIVE The objective of the study was to assess 24-h ambulatory blood pressure monitoring (ABPM) validity in daily primary healthcare practice in France. PATIENTS AND METHODS An observational, longitudinal, prospective, multicenter study was performed in the Burgundy region, France. Participants were patients who had been prescribed ABPM by their general practitioner (GP), whatever its indication. ABPM was performed by employees of the healthcare providers group, which is publicly funded. The validity of ABPM was established according to the European Society of Cardiology (ESC) criteria. GPs interpretation of the ABPM results was collected and compared with the ESC recommendations. Determinants of ABPM validity were identified using logistic regression models. RESULTS Among the 531 patients included, 357 (67.23%) had a valid ABPM measurement. Multivariate analyses showed that ABPM validity was associated with nonmanual worker status [odds ratio (OR)=1.14; 95% confidence interval (CI)=1.04-1.23], participant's age of at least 65 years (OR=0.88; 95% CI=0.81-0.95) and participant's BMI above 30 kg/m (OR=0.90; 95% CI=0.81-0.99). GPs' interpretation of ABPM results was consistent with the ESC recommendation in 508 (95.67%) cases. CONCLUSION ABPM is feasible in daily primary healthcare practice in the studied condition, that is to say relying on trained employees. GPs should be careful when prescribing ABPM to patients aged 65 years and older, to those with BMI over 30 or to manual workers.
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Stevens SL, McManus RJ, Stevens RJ. Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective 'mystery shopper' study in UK primary care. BMJ Open 2018; 8:e020589. [PMID: 29654037 PMCID: PMC5898319 DOI: 10.1136/bmjopen-2017-020589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments. DESIGN (1) An online cross-sectional survey and (2) a prospective 'mystery shopper' study where patients agreed to report how BP was measured during their next appointment. SETTING Primary care. PARTICIPANTS Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes. PRIMARY OUTCOME Proportion of patients having BP measured according to guidelines. RESULTS 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively). CONCLUSIONS Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance.
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Affiliation(s)
- Sarah L Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard John Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Could White Coat Ocular Hypertension Affect to the Accuracy of the Diagnosis of Glaucoma? Relationships Between Anxiety and Intraocular Pressure in a Simulated Clinical Setting. Appl Psychophysiol Biofeedback 2017; 43:49-56. [DOI: 10.1007/s10484-017-9385-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ogata S, Kamide K, Asayama K, Tabara Y, Kawaguchi T, Satoh M, Katsuya T, Sugimoto K, Hirose T, Inoue R, Hara A, Obara T, Kikuya M, Metoki H, Matsuda F, Staessen JA, Ohkubo T, Rakugi H, Imai Y. Genome-wide association study for white coat effect in Japanese middle-aged to elderly people: The HOMED-BP study. Clin Exp Hypertens 2017; 40:363-369. [PMID: 29058489 DOI: 10.1080/10641963.2017.1384481] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUND White coat effect (WCE), the blood pressure (BP) difference between clinical and non-clinical settings, can lead to clinical problems such as misdiagnosis of hypertension. Etiology of WCE has been still unclear, especially from genetic aspects. The present article investigated association between genome-wide single nucleotide polymorphisms (SNPs) and WCE in patients with essential hypertension. METHODS The present cross-sectional analyses were based on 295 Japanese essential hypertensive outpatients aged ≧40 years enrolled in randomized control study, Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) study, who were not taking antihypertensive medications before the randomization. Home and clinic BP were measured. WCE was defined by subtracting home BP from clinic BP. Genotyping was conducted with 500K DNA microarray chips. Association between genome-wide SNPs and WCE were analyzed. For replication (p < 10-4), we analyzed participants from Ohasama study who took no antihypertension medications and whose SNPs were collected. RESULTS Genome-wide SNPs were not significantly associated with WCE of systolic and diastolic BP after corrections of multiple comparisons (p < 2 × 10-7). We found suggestive SNPs associated with WCE of systolic and diastolic BP (p < 10-4). However, the consistent results were not obtained in the replication study. CONCLUSION The present article showed no significant association between genome-wide SNPs and WCE. Since there were several suggestive SNPs associated with WCE, the present study warrants a further study with bigger sample size for investigating the genetic influence on WCE.
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Affiliation(s)
- Soshiro Ogata
- a Department of Health Promotion Science , Osaka University Graduate School of Medicine , Osaka , Japan.,b Channing Division of Network Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts , USA.,c Japan Society for the Promotion of Science , Tokyo , Japan
| | - Kei Kamide
- a Department of Health Promotion Science , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Kei Asayama
- d Department of Hygiene and Public Health , Teikyo University School of Medicine , Tokyo , Japan
| | - Yasuharu Tabara
- e Center for Genomic Medicine, Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Takahisa Kawaguchi
- e Center for Genomic Medicine, Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Michihiro Satoh
- f Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine , Tohoku Medical and Pharmaceutical University , Sendai , Japan
| | - Tomohiro Katsuya
- g Department of Geriatric and General Medicine , Osaka University Graduate School of Medicine , Osaka , Japan.,h Department of Clinical Gene Therapy , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Ken Sugimoto
- g Department of Geriatric and General Medicine , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Takuo Hirose
- i Mechanisms and therapeutic strategies of chronic kidney diseases , Institut Necker Enfants Malades (INEM)/Inserm U1151/CNRS UMR8253/Hopital Necker , Paris , France.,o Department of Planning for Drug Development and Clinical Evaluation , Tohoku University Graduate School of Pharmaceutical Sciences , Sendai , Japan
| | - Ryusuke Inoue
- j Department of Medical Informatics , Tohoku University Graduate School of Medicine , Sendai , Japan
| | - Azusa Hara
- k Department of Social Pharmacy and Public Health , Showa Pharmaceutical University , Tokyo , Japan
| | - Taku Obara
- l Department of Preventive Medicine and Epidemiology , Tohoku Medical Megabank Organization, Tohoku University , Sendai , Japan
| | - Masahiro Kikuya
- l Department of Preventive Medicine and Epidemiology , Tohoku Medical Megabank Organization, Tohoku University , Sendai , Japan
| | - Hirohito Metoki
- f Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine , Tohoku Medical and Pharmaceutical University , Sendai , Japan
| | - Fumihiko Matsuda
- e Center for Genomic Medicine, Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - Jan A Staessen
- m Studies Coordinating Centre, Research Unit Hypertension & Cardiovascular Epidemiology, Department of Cardiovascular Sciences , University of Leuven , Leuven , Belgium.,n R&D Group VitaK , Maastricht , The Netherlands
| | - Takayoshi Ohkubo
- d Department of Hygiene and Public Health , Teikyo University School of Medicine , Tokyo , Japan
| | - Hiromi Rakugi
- g Department of Geriatric and General Medicine , Osaka University Graduate School of Medicine , Osaka , Japan
| | - Yutaka Imai
- o Department of Planning for Drug Development and Clinical Evaluation , Tohoku University Graduate School of Pharmaceutical Sciences , Sendai , Japan
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Patel S, McGinnis RS, Silva I, DiCristofaro S, Mahadevan N, Jortberg E, Franco J, Martin A, Lust J, Raj M, McGrane B, DePetrillo P, Aranyosi AJ, Ceruolo M, Pindado J, Ghaffari R. A wearable computing platform for developing cloud-based machine learning models for health monitoring applications. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:5997-6001. [PMID: 28269619 DOI: 10.1109/embc.2016.7592095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Wearable sensors have the potential to enable clinical-grade ambulatory health monitoring outside the clinic. Technological advances have enabled development of devices that can measure vital signs with great precision and significant progress has been made towards extracting clinically meaningful information from these devices in research studies. However, translating measurement accuracies achieved in the controlled settings such as the lab and clinic to unconstrained environments such as the home remains a challenge. In this paper, we present a novel wearable computing platform for unobtrusive collection of labeled datasets and a new paradigm for continuous development, deployment and evaluation of machine learning models to ensure robust model performance as we transition from the lab to home. Using this system, we train activity classification models across two studies and track changes in model performance as we go from constrained to unconstrained settings.
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Agarwal R. Blood pressure is blood pressure is blood pressure: Or is it? J Clin Hypertens (Greenwich) 2017; 19:303-304. [PMID: 28084026 DOI: 10.1111/jch.12964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University and Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
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Harper MB, Kanayama-Trivedi S, Caldito G, Montgomery D, Mayeaux EJ, DelRosso LM. Photographic art in exam rooms may reduce white coat hypertension. MEDICAL HUMANITIES 2015; 41:86-88. [PMID: 25861793 DOI: 10.1136/medhum-2014-010609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Blood pressure (BP) elevation in medical office settings in patients who are normotensive in nonmedical settings is an effect known as 'white coat hypertension'. This phenomenon is thought to be due to situational anxiety caused by the experience of visiting a doctor and the anxiety-inducing nature of the medical office. Our study was designed to determine if carefully selected photographic art could counter the anxiety that causes white coat hypertension and lead to lower BP recordings in some patients. METHODS 117 adults, non-pregnant patients from the Louisiana State University Health Sciences Center Family Medicine Resident Clinic participated in this study. After the triage nurse measured the BP, the patients were randomly placed in either an exam room with standard medical posters (control room) or in an exam room with photographic art (photo room). The BP was measured in the exam room. After the medical visit, the patients switched rooms and the BP was measured a third time. The patients were asked to fill out a questionnaire to identify room preference. RESULTS On average, the BP obtained in the control rooms was higher than that obtained in the photo rooms. There was a statistically significant difference between the mean arterial pressure, systolic BP and diastolic BP between the control room and the photo room. CONCLUSIONS Landscape photographic art may have the beneficial effect of reducing BP in medical office examination rooms.
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Affiliation(s)
- Michael B Harper
- Department of Family Medicine, Louisiana State University Health Sciences Center (LSUHSC), Shreveport, Louisiana, USA
| | - Stacy Kanayama-Trivedi
- Department of Family Medicine, Louisiana State University Health Sciences Center (LSUHSC), Shreveport, Louisiana, USA
| | - Gloria Caldito
- Department of Family Medicine, Louisiana State University Health Sciences Center (LSUHSC), Shreveport, Louisiana, USA
| | - David Montgomery
- Department of Family Medicine, Louisiana State University Health Sciences Center (LSUHSC), Shreveport, Louisiana, USA
| | - E J Mayeaux
- Department of Family Medicine, Louisiana State University Health Sciences Center (LSUHSC), Shreveport, Louisiana, USA
| | - Lourdes M DelRosso
- Department of Family Medicine, Louisiana State University Health Sciences Center (LSUHSC), Shreveport, Louisiana, USA
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Screening for non-adherence to antihypertensive treatment as a part of the diagnostic pathway to renal denervation. J Hum Hypertens 2015; 30:368-73. [PMID: 26446393 PMCID: PMC4856755 DOI: 10.1038/jhh.2015.103] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/21/2015] [Accepted: 08/07/2015] [Indexed: 01/12/2023]
Abstract
Renal denervation is a potential therapeutic option for resistant hypertension. A thorough clinical assessment to exclude reversible/spurious causes of resistance to antihypertensive therapy is required prior to this procedure. The extent to which non-adherence to antihypertensive treatment contributes to apparent resistance to antihypertensive therapy in patients considered for renal denervation is not known. Patients (n=34) referred for renal denervation entered the evaluation pathway that included screening for adherence to antihypertensive treatment by high-performance liquid chromatography-tandem mass spectrometry-based urine analysis. Biochemical non-adherence to antihypertensive treatment was the most common cause of non-eligibility for renal denervation-23.5% of patients were either partially or completely non-adherent to prescribed antihypertensive treatment. About 5.9% of those referred for renal denervation had admitted non-adherence prior to performing the screening test. Suboptimal pharmacological treatment of hypertension and 'white-coat effect' accounted for apparently resistant hypertension in a further 17.7 and 5.9% of patients, respectively. Taken together, these three causes of pseudo-resistant hypertension accounted for 52.9% of patients referred for renal denervation. Only 14.7% of referred patients were ultimately deemed eligible for renal denervation. Without biochemical screening for therapeutic non-adherence, the eligibility rate for renal denervation would have been 38.2%. Non-adherence to antihypertensive treatment and other forms of therapeutic pseudo-resistance are by far the most common reason of 'resistant hypertension' in patients referred for renal denervation. We suggest that inclusion of biochemical screening for non-adherence to antihypertensive treatment may be helpful in evaluation of patients with 'resistant hypertension' prior to consideration of renal denervation.
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Modolo R, de Faria AP, Sabbatini AR, Barbaro NR, Ritter AMV, Moreno H. Refractory and resistant hypertension: characteristics and differences observed in a specialized clinic. ACTA ACUST UNITED AC 2015; 9:397-402. [PMID: 25979412 DOI: 10.1016/j.jash.2015.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 10/23/2022]
Abstract
Resistant hypertension (RH) is defined as uncontrolled blood pressure (BP) despite the use of ≥3 anti-hypertensive drugs, or controlled requiring use of ≥4 drugs. Recently, a new definition for an extreme phenotype of RH (uncontrolled BP using at least five drugs) has emerged-the refractory hypertension (RfH). Although characteristics of RH are well established, little is known about this newly described subgroup. For this work, 116 subjects with RH were enrolled from a specialized clinic and divided into RH (n = 80) and RfH (n = 36). Subjects were submitted to echocardiography, 24-hour ambulatory BP measurement and biochemical analyses. Logistic regression analysis demonstrated that: (1) white-coat effect (odds ratio [OR], 3.23; 95% confidence interval [CI], 1.12-9.27; P = .03), (2) black race (OR, 6.67; 95% CI, 1.99-16.16; P < .001), and (3) left ventricular mass index (OR, 1.02; 95% CI, 1.01-1.03; P = .04) were independent predictors of refractoriness. In conclusion, RfH and RH present different patient characteristics, and these phenotypic aspects can be useful for better understanding this harder-to-treat subgroup.
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Affiliation(s)
- Rodrigo Modolo
- Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil.
| | - Ana Paula de Faria
- Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil
| | - Andréa Rodrigues Sabbatini
- Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil
| | - Natália Ruggeri Barbaro
- Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil
| | - Alessandra M V Ritter
- Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil
| | - Heitor Moreno
- Faculty of Medical Sciences, Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, University of Campinas, Campinas, SP, Brazil
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Redon J, Lurbe E. Ambulatory Blood Pressure Monitoring Is Ready to Replace Clinic Blood Pressure in the Diagnosis of Hypertension. Hypertension 2014; 64:1169-74; discussion 1174. [DOI: 10.1161/hypertensionaha.114.03883] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Josep Redon
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
| | - Empar Lurbe
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
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Mallat SG, Samra SA, Younes F, Sawaya MT. Identifying predictors of blood pressure control in the Lebanese population - a national, multicentric survey -- I-PREDICT. BMC Public Health 2014; 14:1142. [PMID: 25373466 PMCID: PMC4246605 DOI: 10.1186/1471-2458-14-1142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blood Pressure (BP) is not well controlled and factors that predict BP control are not well identified in Lebanon. Improvement of hypertension management requires an understanding of patients' characteristics and factors associated with uncontrolled BP. This national, multicentric, observational prospective study was designed to determine the predictors of BP control in patients followed up to 6 months. METHODS I-PREDICT study was conducted on 988 patients with newly diagnosed or uncontrolled hypertension. Socio-demographic and clinical characteristics were analyzed. The level of agreement between doctors' perceptions on BP control status and JNC VII guidelines was analyzed. RESULTS The predictor associated with poor BP control was diabetes (OR = 0.17, CI = 0.10-0.28 at month-1; OR = 0.15, CI = 0.10-0.24 at month-6). The predictors associated with better BP control at month-6 were the early control of BP at month-1 (OR = 10.39, CI = 6.18-17.47) and combination therapy prescribed at baseline and month-1 (OR = 15.14, CI = 1.09-208.46, P = 0.04). In the sub-group of diabetes, the predictors that were associated with better BP control at 6 months were following diet at V1 (OR = 2.27, CI = 1.01 to 5.12) and BP control at V2 (OR = 7.34, CT = 3.83 to 14.07). The predictors that were associated with poor BP control at 6 months were middle economic class (OR = 0.036, CI = 0.16-0.94) and upper economic class (OR = 0.036; CI = 0.13-0.93).The rate of BP control was significantly higher at month 6 versus month 1 (67.52% vs 44.08%, P = 0.001). Additional analysis showed poor agreement between the doctors' perceptions on BP control status and the guidelines. CONCLUSIONS Reaching an early BP control and combination therapy were significant predictors of better BP control, whereas diabetes was a significant predictor of poor BP control. A poor agreement between JNC VII guidelines and clinical practice was observed. I-PREDICT study identified factors that can be targeted for improving BP control.
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Affiliation(s)
- Samir G Mallat
- Department of Internal Medicine, American University of Beirut, Riad El-Solh, P,O, Box 11-0236, Beirut 11072020, Lebanon.
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Head GA. Ambulatory blood pressure monitoring is ready to replace clinic blood pressure in the diagnosis of hypertension: pro side of the argument. Hypertension 2014; 64:1175-81; discussion 1181. [PMID: 25331849 DOI: 10.1161/hypertensionaha.114.03882] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Geoffrey A Head
- From the Neuropharmacology Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
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Comparative Epidemiology of Resistant Hypertension in Chronic Kidney Disease and the General Hypertensive Population. Semin Nephrol 2014; 34:483-91. [DOI: 10.1016/j.semnephrol.2014.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Clark CE, Horvath IA, Taylor RS, Campbell JL. Doctors record higher blood pressures than nurses: systematic review and meta-analysis. Br J Gen Pract 2014; 64:e223-32. [PMID: 24686887 PMCID: PMC3964448 DOI: 10.3399/bjgp14x677851] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 11/11/2013] [Accepted: 12/20/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The magnitude of the 'white coat effect', the alerting rise in blood pressure, is greater for doctors than nurses. This could bias interpretation of studies on nurse-led care in hypertension, and risks overestimating or overtreating high blood pressure by doctors in clinical practice. AIM To quantify differences between blood pressure measurements made by doctors and nurses. DESIGN AND SETTING Systematic review and meta-analysis using searches of MEDLINE, CENTRAL, CINAHL, Embase, journal collections, and conference abstracts. METHOD Studies in adults reporting mean blood pressures measured by doctors and nurses at the same visit were selected, and mean blood pressures extracted, by two reviewers. Study risk of bias was assessed using modified Cochrane criteria. Outcomes were pooled across studies using random effects meta-analysis. RESULTS In total, 15 studies (11 hypertensive; four mixed hypertensive and normotensive populations) were included from 1899 unique citations. Compared with doctors' measurements, nurse-measured blood pressures were lower (weighted mean differences: systolic -7.0 [95% confidence interval {CI} = -4.7 to -9.2] mmHg, diastolic -3.8 [95% CI = -2.2 to -5.4] mmHg). For studies at low risk of bias, differences were lower: systolic -4.6 (95% CI = -1.9 to -7.3) mmHg; diastolic -1.7 (95% CI = -0.1 to -3.2) mmHg. White coat hypertension was diagnosed more frequently based on doctors' than on nurses' readings: relative risk 1.6 (95% CI =1.2 to 2.1). CONCLUSIONS The white coat effect is smaller for blood pressure measurements made by nurses than by doctors. This systematic difference has implications for hypertension diagnosis and management. Caution is required in pooling data from studies using both nurse- and doctor-measured blood pressures.
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Affiliation(s)
- Christopher E Clark
- Primary Care Research Group, Institute of Health Services Research, University of Exeter Medical School, Exeter, UK
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Modolo R, Ruggeri Barbaro N, de Faria AP, Rodrigues Sabbatini A, Paganelli MO, Fontana V, Moreno H. The white-coat effect is an independent predictor of myocardial ischemia in resistant hypertension. Blood Press 2014; 23:276-80. [DOI: 10.3109/08037051.2014.883194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Inter-arm blood pressure differences compare with ambulatory monitoring: a manifestation of the 'white-coat' effect? Br J Gen Pract 2014; 63:237. [PMID: 23643208 DOI: 10.3399/bjgp13x667060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Hermida RC, Ayala DE. Prognostic value of ambulatory blood pressure measurements for the diagnosis of hypertension in pregnancy. Expert Rev Cardiovasc Ther 2014; 2:375-91. [PMID: 15151484 DOI: 10.1586/14779072.2.3.375] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several studies have indicated that the use of the 24 h mean blood pressure, mainly using reference thresholds derived from general nonpregnancy practice, does not provide an effective test for an individualized early diagnosis of hypertension in pregnancy, thus concluding that ambulatory blood pressure monitoring is not a valid approach in pregnancy. With the use of ambulatory blood pressure monitoring, epidemiologic studies have reported gender differences in the circadian variability of blood pressure and heart rate. Typically, men exhibit a lower heart rate and higher blood pressure than women, the differences being larger for systolic than for diastolic blood pressure. Moreover, normotensive and hypertensive pregnant women are characterized by differing but predictable patterns of blood pressure variability throughout gestation. However, the diminished blood pressure in nongravid women as compared with men, the added decrease in blood pressure during the second trimester of gestation in normotensive but not in hypertensive pregnant women and the large amplitude of the circadian pattern that characterizes the blood pressure of healthy pregnant women at all gestational ages, have not been taken into account when establishing reference thresholds for the diagnosis of hypertension in pregnancy. This review will describe these issues, summarize previous results from independent groups on the prognostic value of ambulatory blood pressure monitoring in pregnancy, propose answers as to an accurate reference threshold for blood pressure at different stages of gestation and suggest how this information should be used in order to identify those women at a higher risk of hypertension, who will also be more suitable for prophylactic and/or therapeutic intervention in the early stages of pregnancy.
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Affiliation(s)
- Ramón C Hermida
- Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo 36200, Spain.
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Agarwal R, Weir MR. Treated hypertension and the white coat phenomenon: Office readings are inadequate measures of efficacy. ACTA ACUST UNITED AC 2013; 7:236-43. [PMID: 23523137 DOI: 10.1016/j.jash.2013.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/04/2013] [Accepted: 02/13/2013] [Indexed: 01/19/2023]
Abstract
To better define the prevalence of white coat hypertension (WCH) among patients with type 2 diabetes mellitus and to estimate the magnitude of white coat effect (WCE), before and after antihypertensive therapy, we gathered data from an open-label forced-titration study of a combination of antihypertensive drugs that was titrated sequentially, in the order amlodipine, olmesartan, and hydrochlorothiazide, over an 18-week period among 187 patients with type 2 diabetes mellitus. WCH was defined as daytime ambulatory blood pressure (BP) of 135/85 mm Hg or less, but clinic BP of 140/90 mm Hg or more. WCE was obtained as the mean difference between clinic and daytime ambulatory BP. At baseline, the prevalence of WCH was 12%; all but one subject had WCE of >10/5 mm Hg. After treatment, the prevalence of WCH had increased to 39% (P < .001). In the overall population, at baseline, the mean (±SD) WCE for systolic BP was 10.4 ± 10.9 mm Hg and 3.7 ± 8.6 mm Hg for diastolic BP. After treatment, the reduction in systolic WCE was 3.01 ± 0.93 (SE; P < .0001); no reduction was seen for diastolic WCE. Among patients treated with amlodipine-olmesartan combination, WCE at baseline was 11 mm Hg systolic and was attenuated to -0.9 mm Hg. Among patients treated with amlodipine-olmesartan-hydrochlorothiazide combination, systolic WCE was similar at baseline (10.1 mm Hg) and at end of therapy (8.1 mm Hg). Mean systolic difference between dual and triple therapy of 9.9 mm Hg, SE 2.98 was significant (P < .001). The drop in diastolic WCE from 6.4 with dual therapy to -1.2 with triple therapy was also significant (mean difference 7.6, SE 2.2; P < .001). In conclusion, the prevalence of WCH increases three-fold with treatment as a result of fewer patients having sustained hypertension. Thus, out-of-office BP monitoring especially among treated hypertensive patients with type 2 diabetes is necessary to provide better assessment of overall BP and response to treatment.
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Affiliation(s)
- Rajiv Agarwal
- Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana 46202, USA.
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Baker J, Davies B, McCormick MC, Graham M. An elevated systolic blood pressure response at 8 minutes in full contact exercise may identify hypertensive subjects. Res Sports Med 2013; 21:1-11. [PMID: 23286418 DOI: 10.1080/15438627.2012.738440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to identify hypertension (HT) in karate competitors (KCs) in high intensity exercise. Values were compared with an exercise control group (EC). The 84 subjects were randomly divided into two groups: KC and EC. Resting blood pressure (BP) was measured the day before and immediately precompetition. A further three measurements were taken postexercise for all subjects at 1-, 2-, and 8- minute intervals. At rest, day one, mean BP of KC was 134/84 ± 3/2 mmHg vs. EC, 124/72 ± 1/2 mmHg and on day 2, was 141/79 ± 3/2 mmHg vs. EC, 125/72 ± 1/2 mmHg, respectively. Eight minutes postcompetition, BP of KCs was 140/77 ± 2/1 mmHg vs. EC 135/75 ± 2/1 mmHg. High blood pressure (HBP) was recorded in 60.5% of KCs on day 2, and essential HT that required medical therapy was subsequently diagnosed in 5% of KCs. Five percent of EC also had HBP, but subsequent medical examination reported normal values.
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Affiliation(s)
- Julien Baker
- University of West of Scotland, Health and Exercise Science Research Laboratory, Hamilton, United Kingdom
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Abstract
Hypertension is the most common modifiable risk factor for cardiovascular disease. Antihypertensive treatment substantially reduces the risk of heart failure, stroke, and myocardial infarction. Current guidelines recommend screening all adults for high blood pressure (BP). Lifestyle modifications to help control high BP include weight loss, exercise, moderation of alcohol intake, and a diet low in sodium and saturated fats and high in fruits and vegetables. Out-of-office BP monitoring should be used to confirm suspected white coat effect, especially in patients with apparent resistant hypertension.
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Affiliation(s)
- Katherine H Winter
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC 27599-7595, USA
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Ayala DE, Hermida RC. Ambulatory Blood Pressure Monitoring for the Early Identification of Hypertension in Pregnancy. Chronobiol Int 2012; 30:233-59. [DOI: 10.3109/07420528.2012.714687] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Figueiredo VN, Martins LC, Boer-Martins L, Cabral de Faria AP, de Haro Moraes C, Cardoso Santos R, Nogueira AR, Moreno H. The white coat effect is not associated with additional increase of target organ damage in true resistant hypertension. Med Clin (Barc) 2012; 140:1-5. [PMID: 22995840 DOI: 10.1016/j.medcli.2012.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/11/2012] [Accepted: 04/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE White coat effect (WCE) (i.e., the difference between office blood pressure [OBP] and awake ambulatory blood pressure monitoring [ABPM]) may be present in hypertensive individuals. The relationship between occurrence of WCE and target organ damage (TOD) has not yet been assessed in true resistant hypertension (RHTN). PATIENTS AND METHODS RHTN patients were divided into two groups: RHTN with WCE (WCE, n=66) and RHTN without WCE (non-WCE, n=61). All patients were submitted to OBP measurement, ABPM, echocardiography and renal function evaluation in three visits. RESULTS No differences were observed between the WCE and non-WCE groups regarding age, body mass index or gender. OBP were 169.8±15.8/95.1±14.0 (WCE) and 161.9±9.0/90.1±10.4mmHg (non-WCE), ABPM=143.0±12.8/86.1±9.9 (WCE) and 146.1±13.6/85.1±14.9mmHg (non-WCE). No statistical differences were observed between WCE and non-WCE subgroups with respect to left ventricular mass index (LVMI) (WCE=131±4.7; non-WCE=125±2.9g/m(2)), creatinine clearance (WCE=78±4.7; non-WCE=80±3.6ml/min/m(2)) and microalbuminuria (MA) (WCE=44±8.4; non-WCE=49±6.8mg/g Cr). CONCLUSIONS This finding may suggest that WCE is not associated with additional increase of TOD in true RHTN subjects.
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Affiliation(s)
- Valéria Nasser Figueiredo
- Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
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Within-visit blood pressure variability: relevant factors in the general population. J Hum Hypertens 2012; 27:328-34. [PMID: 22971753 DOI: 10.1038/jhh.2012.39] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The objective of this study was to use a nationwide epidemiological survey to investigate the factors that affect within-visit blood pressure (BP) variability. We analyzed the Korean National Health and Nutrition Examination Survey (KNHNES) data for 2005 (n=5488). We examined three within-visit BP variability parameters that include the following: the alarm reaction (AR), defined as the first BP reading minus the third BP reading; the BP discrepancy, defined as the maximal BP reading minus the minimal BP reading (ΔBPmax); and the s.d. (BPSD). Age, fasting glucose, eGFR, total cholesterol, LDL cholesterol, and the metabolic syndrome (MetS) score were the relevant factors that affected the systolic AR, ΔSBPmax and SBPSD. Multiple linear regression models revealed that age (P<0.0001), the office systolic BP (SBP) level (P<0.0001), the MetS score (P<0.0001), the female gender (P=0.007) and the eGFR (P=0.049) were independently associated with the systolic AR, whereas age (P<0.0001), the office SBP level (P<0.0001), and the female gender (P=0.024 and 0.022) were independently associated with ΔSBPmax and SBPSD, respectively. Within-visit BP variability, especially the variability associated with the SBP, was significantly associated with increased age, female gender and cardiovascular risk factors, such as hypertension, low eGFR and adverse glucose and lipid profiles. In addition, increased age, female gender, the eGFR and the MetS score were independently relevant factors that affected the systolic AR. Systolic within-visit BP variability and systolic AR are associated with cardiovascular risk factors.
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Palatini P, Dorigatti F, Saladini F, Benetti E, Mos L, Mazzer A, Zanata G, Garavelli G, Casiglia E. Factors associated with glomerular hyperfiltration in the early stage of hypertension. Am J Hypertens 2012; 25:1011-6. [PMID: 22673015 DOI: 10.1038/ajh.2012.73] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Glomerular hyperfiltration predicts development of nephropathy in hypertension but the factors responsible for increased glomerular filtration rate (GFR) are not well known. Aim of this study was to examine which clinical variables influence GFR in the early stage of hypertension. METHODS Participants were 1,106 young-to-middle-age hypertensive adults with creatinine clearance >60 ml/min/1.73 m(2). Clinic and ambulatory blood pressures (BPs) were measured and the difference between clinic and 24-h systolic BP was defined as the white-coat effect (WCE). In 606 participants, 24-h urinary epinephrine and norepinephrine were also measured. Glomerular hyperfiltration, defined as a GFR ≥150 ml/min/1.73 m(2), was present in 201 subjects. RESULTS Patients' mean age was 33.1 ± 8.5 years and office BP was 146 ± 10.5/94 ± 5.0 mm Hg. In multivariable linear regression, significant predictors of GFR were younger age (P < 0.0001), male gender (P < 0.0001), 24-h systolic BP (P = 0.0001), body mass (P < 0.0001), WCE (P = 0.02), log-epinephrine (P = 0.01), and coffee use (P < 0.01). In a logistic model, independent predictors of glomerular hyperfiltration were obesity (odds ratio, 95% confidence interval = 6.1, 3.8-9.8), male gender (2.9, 1.8-4.9), age <33 years (2.1, 1.5-3.1), ambulatory hypertension (2.0, 1.4-3.0), WCE >15 mm Hg (1.6, 1.1-2.3), heavy coffee use (2.0, 1.1-3.8), and epinephrine >25 mcg/24 h (1.9, 1.2-3.1). CONCLUSIONS The novel finding of this study is that hyper-reactivity to stress, as determined by urinary epinephrine level and WCE, and coffee use contribute to determining glomerular hyperfiltration in the early stage of hypertension. Our data may help to identify a subset of patients with glomerular hyperfiltration, who may be at increased risk of chronic kidney disease and may benefit from antihypertensive treatment.
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Abstract
BACKGROUND We evaluated the agreement between office blood pressure (OBP) measured by a mercury sphygmomanometer (Sphyg) and an automatic (Auto) device without any observers, and compared Auto and Sphyg OBP with ambulatory blood pressure (ABP) and home blood pressure (HBP). METHODS OBP was measured in 75 hypertensive patients at two sites using an automatic monitor without a doctor or a nurse present and by Sphyg during three clinic visits. Between visits, monitoring of ABP and HBP was also performed. RESULTS The mean Auto OBP was similar to that of Sphyg OBP and the values were closely correlated (intraclass correlation coefficient=0.84 for systolic OBP and 0.91 for diastolic OBP); however, the difference between Auto and Sphyg systolic OBP (1.6 ± 8.2 mmHg) varied by the first office visit, sex, and the site. Auto systolic OBP was lower than both systolic awake ABP (137.1 ± 14.7 mmHg) and HBP (139.2 ± 15.6 mmHg). Auto systolic OBP and Sphyg OBP were similarly correlated with systolic awake ABP (both r=0.59, P<0.001). The mean Auto diastolic OBP was similar to that of Sphyg OBP (81.1 ± 11.3 vs. 80.3 ± 13.3 mmHg, P=0.20, intraclass correlation coefficient=0.91), and diastolic awake ABP and HBP. Auto diastolic OBP and Sphyg OBP were related to diastolic awake ABP (both r>0.68, P<0.001). In multivariable analyses, neither OBP measure was a significantly stronger predictor of out-of-office blood pressure than the other. CONCLUSION Auto systolic OBP measured without a doctor or a nurse present was lower than systolic awake ABP and HBP. Auto and rigorously assessed Sphyg OBP had similar means and were similarly related to awake ABP. Auto OBP might be an advantageous alternative to Sphyg measurements in the usual clinic setting.
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Sendra-Lillo J, Sabater-Hernandez D, Sendra-Ortola A, Martinez-Martinez F. Agreement between community pharmacy, physician's office, and home blood pressure measurement methods: the PALMERA Study. Am J Hypertens 2012; 25:290-6. [PMID: 22089107 DOI: 10.1038/ajh.2011.207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The usefulness of the community pharmacy blood pressure (BP) (CPBP) method in assessing the effectiveness of antihypertensive treatment has not been adequately studied. The aim of this study was to assess the agreement between community pharmacy, home, and physician office BP (POBP) measurement methods in treated hypertensive patients. METHODS BP was measured at the pharmacy (three visits), at home (4 days) and at the physician office (three visits). The Lin correlation-concordance coefficient (CCC) was used to evaluate the quantitative agreement. The qualitative agreement between methods to establish the patient's hypertensive state was evaluated using the κ-coefficient. Using home BP (HBP) monitoring as the reference method, the sensitivity, specificity, positive and negative likelihood ratios of the CPBP and POBP measurement methods were calculated. RESULTS The study included 70 patients. Agreements were acceptable-moderate between CPBP and HBP (CCC (systolic BP (SBP)/diastolic BP (DBP)) = 0.79/0.66; κ = 0.56), moderate between CPBP and POBP (CCC = 0.57/0.61; κ = 0.35), and moderate-poor (CCC = 0.56/0.49; κ = 0.28) between POBP and HBP. The sensitivity, specificity, positive and negative likelihood ratio for the CPBP and the POBP measurement methods were: 60.7%, 92.9%, 8.5, 0.4 and 75.0%, 54.8%, 1.7, 0.5, respectively. CONCLUSIONS In this sample of treated hypertensive patients, the agreement between the community pharmacy and HBP measurement methods was acceptable-moderate and greater than other agreements. The CPBP measurement method was more reliable than the POBP measurement method for detecting the presence of both uncontrolled and controlled BP and could be a good alternative to HBP monitoring when the latter lacks suitability.
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Magnitude of the white-coat effect in the community pharmacy setting: the MEPAFAR study. Am J Hypertens 2011; 24:887-92. [PMID: 21509052 DOI: 10.1038/ajh.2011.68] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND There is little information regarding the community pharmacy blood pressure (CPBP) measurement method and their differences with home (HBP) or ambulatory BP (ABP). The aim of this study was to measure such differences and their variation over successive visits. METHOD Cross-sectional study carried out in eight pharmacies in Gran Canaria (Spain). The study included 169 treated hypertensive patients. BP was measured at the pharmacy (four visits), at HBP (4 days) and 24-h ABP monitoring. We defined pharmacy white-coat effect (PWCE) as differences between CPBP and HBP (home PWCE) or daytime ABP (ambulatory PWCE). RESULTS The overall (pooled values for all visits) ambulatory PWCE was not significantly different from zero for systolic BP (SBP) (-0.4 mm Hg (95% confidence interval (CI): -1.8 to 1.1)), but greater than zero for diastolic BP (DBP) (3.4 mm Hg (95% CI: 2.3 to 4.6)). The overall home PWCE was not significantly different from zero, both for SBP (1.2 mm Hg (95% CI: -0.1 to 2.6)) and DBP (0.1 mm Hg (95% CI: -0.7 to 1.0)). The ambulatory and home PWCE on the first visit were greater than zero (P < 0.001) (SBP/DBP): 3.5/4.8 and 1.9/1.5 mm Hg, respectively; but showed important reductions at the second visit and became not significantly different from zero, except the ambulatory PWCE in DBP, which persisted until the last visit. CONCLUSION The trend in the PWCE decreased over the successive visits to the pharmacy. Only the ambulatory PWCE in DBP proved to be statistically greater than zero after the second visit. Repeated CPBP measurements could be a useful alternative to assess the response to antihypertensive treatment.
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Sabater-Hernández D, Sánchez-Villegas P, García-Corpas JP, Amariles P, Sendra-Lillo J, Faus MJ. Predictors of the community pharmacy white-coat effect in treated hypertensive patients. The MEPAFAR study. Int J Clin Pharm 2011; 33:582-9. [DOI: 10.1007/s11096-011-9514-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 04/11/2011] [Indexed: 10/18/2022]
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