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HUA Q, FAN L, WANG ZW, LI J. 2023 Guideline for the management of hypertension in the elderly population in China. J Geriatr Cardiol 2024; 21:589-630. [PMID: 38973827 PMCID: PMC11224653 DOI: 10.26599/1671-5411.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Affiliation(s)
| | - Qi HUA
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li FAN
- Chinese PLA General Hospital, Beijing, China
| | - Zeng-Wu WANG
- Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing LI
- Xuanwu Hospital, Capital Medical University, Beijing, China
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Pham S, Mock G, Camferdam R. Acarbose Unveiled: A Breakthrough in Postprandial Hypotension Treatment. Cureus 2024; 16:e62378. [PMID: 39006592 PMCID: PMC11246765 DOI: 10.7759/cureus.62378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/16/2024] Open
Abstract
Postprandial hypotension (PPH) is characterized by a drop in blood pressure (BP) of at least 20 mmHg within 15 minutes to two hours after any meal. This phenomenon is observed in approximately half of patients with type 2 diabetes mellitus and can also affect otherwise healthy elderly patients. Prolonged instances of PPH can cause serious complications, including but not limited to dizziness, frequent falls, weakness, and even loss of consciousness. Nonpharmacologic interventions can help, such as discontinuing any exacerbating medications, increasing salt and water intake, adopting lifestyle modifications, and engaging in muscle tension-reducing exercises. When these strategies fail, pharmacological treatments may become necessary. Medications like midodrine (an alpha-adrenergic agonist) or droxidopa (a norepinephrine precursor) are commonly prescribed to help maintain BP. However, should BP persistently remain low despite these interventions, alternative therapies are explored. Acarbose, an antidiabetic medication, is an alpha-glucosidase inhibitor that targets pancreatic alpha-amylase and membrane-bound intestinal alpha-glucoside hydrolase. The inhibition slows glucose absorption, further reducing postprandial glucose blood concentrations. This case report presents the management of a 67-year-old woman with persistent PPH that is unresponsive to midodrine, atomoxetine, and sodium chloride tablets. The addition of acarbose to her regimen yields appropriate maintenance of BP after meals. The patient was able to be safely discharged home after.
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Affiliation(s)
- Steven Pham
- Internal Medicine, White County Medical Center, Searcy, USA
| | - Gregory Mock
- Nephrology, White County Medical Center, Searcy, USA
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Huang L, Li S, Xie X, Huang X, Xiao LD, Zou Y, Jiang W, Zhang F. Prevalence of postprandial hypotension in older adults: a systematic review and meta-analysis. Age Ageing 2024; 53:afae022. [PMID: 38411408 PMCID: PMC10898335 DOI: 10.1093/ageing/afae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Older adults with postprandial hypotension (PPH) increase susceptibility to falls, syncope, stroke, acute cardiovascular diseases and even death. However, the prevalence of this condition varies significantly across studies. We aimed to determine the prevalence of PPH in older adults. METHODS Web of Science, PubMed, Cochrane Library, Embase and CINAHL were searched from their inception until February 2023. Search terms included 'postprandial period', 'hypotension' and 'postprandial hypotension'. Eligible studies were assessed using the Joanna Briggs Institute tool. Meta-analyses were performed among similar selected studies. RESULTS Thirteen eligible studies were included, and data from 3,021 participants were pooled. The meta-analysis revealed a PPH prevalence of 40.5% [95% confidence interval (CI): 0.290-0.519] in older adults, and this was prevalent in the community (32.8%, 95% CI: 0.078-0.647, n = 1,594), long-term healthcare facility (39.4%, 95% CI: 0.254-0.610, n = 1,062) and geriatrics department of hospitals (49.3%, 95% CI: 0.357-0.630, n = 365). The pooled results showed significant heterogeneity (I2 > 90%), partially related to the different ages, sex, pre-prandial systolic blood pressure levels of participants, or the different criteria and methodology used to diagnose PPH. CONCLUSIONS PPH is a prevalent condition in older adults. Further research is needed to confirm this result, and priority should be given to establishing international consensus on PPH diagnostic criteria and designing its diagnostic procedure.
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Affiliation(s)
- Lei Huang
- West China School of Nursing/Nursing Key Laboratory of Sichuan Province/Innovation Center of Nursing Research/West China Hospital, Sichuan University, 37, Guoxue Alley, Chengdu, Sichuan, 610041, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaofeng Xie
- West China School of Nursing/Nursing Key Laboratory of Sichuan Province/Innovation Center of Nursing Research/West China Hospital, Sichuan University, 37, Guoxue Alley, Chengdu, Sichuan, 610041, China
| | - Xiaoli Huang
- Center of Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Ying Zou
- West China School of Nursing/Nursing Key Laboratory of Sichuan Province/Innovation Center of Nursing Research/West China Hospital, Sichuan University, 37, Guoxue Alley, Chengdu, Sichuan, 610041, China
| | - Wenyi Jiang
- West China School of Nursing/Nursing Key Laboratory of Sichuan Province/Innovation Center of Nursing Research/West China Hospital, Sichuan University, 37, Guoxue Alley, Chengdu, Sichuan, 610041, China
| | - Fengying Zhang
- West China School of Nursing/Nursing Key Laboratory of Sichuan Province/Innovation Center of Nursing Research/West China Hospital, Sichuan University, 37, Guoxue Alley, Chengdu, Sichuan, 610041, China
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Awosika A, Adabanya U, Millis RM, Omole AE, Moon JH. Postprandial Hypotension: An Underreported Silent Killer in the Aged. Cureus 2023; 15:e35411. [PMID: 36851946 PMCID: PMC9964048 DOI: 10.7759/cureus.35411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/01/2023] Open
Abstract
Orthostatic hypotension (OH) is one of the most common autonomic dysfunctions, with high prevalence in populations of elderly, hypertensive, diabetic, or Parkinson's patients. Evidence is emerging that OH co-occurs with postprandial hypotension (PPH); a greater prevalence of PPH than of OH is reported for Parkinson's disease patients. OH is diagnosed by measuring the blood pressure changes associated with postural changes and often produces alterations in consciousness or other such bothersome symptoms as fainting. PPH is diagnosed by measuring the blood pressure changes associated with ingesting high carbohydrate test meals. Because of the time lag between food ingestion and absorption, PPH is often not reported as symptomatic and, therefore, not diagnosed as PPH. OH and PPH are independent predictors for all causes of mortality. Relative underdiagnosis may qualify PPH as a "silent killer" disease. This review is aimed at providing updates on the epidemiology, pathophysiology, and clinical aspects associated with the diagnosis and treatment of PPH. Highlighting the current gaps in knowledge and research about PPH is expected to make medical practitioners more cognizant of the dangers of underdiagnosis and motivate future research to identify individuals and populations at high risk for PPH and its sequelae.
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Affiliation(s)
- Ayoola Awosika
- College of Medicine, University of Illinois, Chicago, USA.,College of Health Sciences and Professions, Ohio University, Athens, USA
| | | | - Richard M Millis
- Pathophysiology, American University of Antigua, St. John's, ATG
| | - Adekunle E Omole
- Anatomical Sciences, American University of Antigua, St. John's, ATG
| | - Jin Hyung Moon
- General Medicine, Mercer University School of Medicine, Columbus, USA
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Jenkins DJA, Sahye-Pudaruth S, Khodabandehlou K, Liang F, Kasmani M, Wanyan J, Wang M, Selvaganesh K, Paquette M, Patel D, Glenn AJ, Srichaikul K, Kendall CWC, Sievenpiper JL. Systematic review and meta-analysis examining the relationship between postprandial hypotension, cardiovascular events, and all-cause mortality. Am J Clin Nutr 2022; 116:663-671. [PMID: 35675216 PMCID: PMC9437988 DOI: 10.1093/ajcn/nqac158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/03/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Postprandial hypotension (PPH) has been reported to be associated with syncope, falls, adverse cardiovascular outcomes, and increased all-cause mortality. It has been reported to have an incidence as high as 30% in the elderly and persons with diabetes. We therefore performed a meta-analysis to determine the relation of PPH with cardiovascular disease (CVD) events and all-cause mortality. OBJECTIVES Our objective was to conduct a systematic review and meta-analysis of cohort and cross-sectional studies to determine the association of PPH with CVD and all-cause mortality. METHODS We searched the databases MEDLINE, EMBASE, and Cochrane library up to 13 April 2022 for prospective cohort and cross-sectional studies that examined the association of PPH with CVD outcomes and all-cause mortality. Data were analyzed using the generic inverse variance method with a random-effects model. Grading of Recommendations, Assessment, Development, and Evaluation approach assessed the certainty of evidence. RESULTS Seven studies that included 2389 participants met our inclusion criteria. PPH was associated with each outcome individually, including increased all-cause mortality, total CVD, CVD mortality, and stroke. CVD outcomes and all-cause mortality combined were also associated with PPH (RR: 1.52; 95% CI: 1.05, 2.18; P = 0.03; I2 = 77%). The certainty of evidence was graded as very low due to significant heterogeneity and the limited number of studies. CONCLUSIONS This assessment indicates an association of PPH with CVD and all-cause mortality. Further studies are required to improve CVD and mortality estimates, but the potential seriousness of CVD and all-cause mortality as outcomes of PPH justifies more screening, diagnosis, and research.
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Affiliation(s)
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Fred Liang
- Department of Physiology and Immunology, University of Toronto, Toronto, Ontario
| | - Maaria Kasmani
- School of Medicine, University College of Dublin, Dublin, Ireland
| | - Jessica Wanyan
- Department of Human Biology, University of Toronto, Toronto, Ontario
| | - Maggie Wang
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrea J Glenn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, Ontario, Canada,Clinical Nutrition Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
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Wang B, Zhao J, Zhan Q, Wang R, Liu B, Zhou Y, Xu F. Acarbose for Postprandial Hypotension With Glucose Metabolism Disorders: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8:663635. [PMID: 34095252 PMCID: PMC8172613 DOI: 10.3389/fcvm.2021.663635] [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: 02/03/2021] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Postprandial hypotension (PPH) is an independent predictive factor of all-cause mortality in older people. Drug management has not achieved a satisfactory effect yet. In recent years, many studies have found that acarbose may be effective in the treatment of PPH with glucose metabolism disorders. Objective: To assess the efficacy and safety of acarbose on PPH with glucose metabolism disorders. Methods: PubMed (MEDLINE), Cochrane, EMBASE, Web of Science, Clinical Trials, and relevant Chinese databases were searched from inception to October 1, 2020. Randomized controlled studies of acarbose in the treatment of PPH with glucose metabolism disorders were included. Review Manager 5.3 software was used for quality evaluation and meta-analysis. GRADEpro GDT software was used to GRADE the evidence for the research objectives. Results: A total of 4 randomized controlled studies including 202 participants were identified after screening. The meta-analysis showed that acarbose significantly attenuated the decrease in postprandial systolic blood pressure [weighted mean difference (MD): −9.84, 95% CI: −13.34 to −6.33], diastolic blood pressure (MD: −6.86, 95% CI: −12.89 to −0.83), and mean arterial pressure (MD: −8.10, 95% CI: −12.40 to −3.49) compared with the control group. One study reported a case of adverse reactions that included mild abdominal distension in the acarbose group (4.8%, 1/21). No adverse reactions were reported in the other three studies. Conclusion: Acarbose may attenuate the decrease in postprandial blood pressure and avoid the occurrence of PPH in patients with PPH and abnormal glucose metabolism disorders. More clinical trials are needed to make a clear conclusion. Registration: PROSPERO CRD42020171335.
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Affiliation(s)
- Biqing Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China.,Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Junnan Zhao
- Institute of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiuxiao Zhan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rongyanqi Wang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Birong Liu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Zhou
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Fengqin Xu
- Institute of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Postprandial Hypotension and Spinal Cord Injury. J Clin Med 2021; 10:jcm10071417. [PMID: 33915893 PMCID: PMC8037943 DOI: 10.3390/jcm10071417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/17/2022] Open
Abstract
Postprandial hypotension (PPH) is defined as a fall of ≥20 mmHg in systolic blood pressure (SBP) or a SBP of <90 mmHg after having been >100 mmHg before the meal within two hours after a meal. The prevalence of PPH among persons with spinal cord injury (SCI) is unknown. Ambulatory blood pressure measurement was performed in 158 persons with SCI, 109 men, median age was 59.1 years (min.:13.2; max.: 86.2). In total, 78 persons (49.4%) had PPH after 114 out of 449 meals (25.4%). The median change in SBP during PPH was −28 mmHg (min.: −87; max.: −15 mmHg) and 96% of the PPH episodes were asymptomatic. The occurrence of PPH was correlated to older age (p = 0.001), level of injury (p = 0.023), and complete SCI (p = 0.000), but not, gender or time since injury. Further studies are needed to elucidate if PPH contributes to the increased cardiovascular mortality in the SCI population.
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Kraaijenhof J, Muskiet MHA, Tonneijck L, Ouwens DM, Kramer MHH, van Raalte DH, Smits MM. Effects of dipeptidyl peptidase-4 inhibitor linagliptin versus sulphonylurea glimepiride on systemic haemodynamics in overweight patients with type 2 diabetes: A secondary analysis of an 8-week, randomized, controlled, double-blind trial. Diabetes Obes Metab 2020; 22:1847-1856. [PMID: 32476255 PMCID: PMC7540521 DOI: 10.1111/dom.14107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
AIM To determine the glucose-independent effect of the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin versus the sulphonylurea glimepiride on systemic haemodynamics in the fasting and postprandial state in patients with type 2 diabetes (T2D). MATERIALS AND METHODS In this prespecified secondary analysis of a phase IV, double-blind trial, 46 metformin-treated, overweight patients with T2D were included and randomly assigned (1:1) to once-daily linagliptin (5 mg) or glimepiride (1 mg) for 8 weeks. In a sub-study involving 26 patients, systemic haemodynamics were also assessed following a standardized liquid meal (Nutridrink Yoghurt style). Systemic haemodynamics (oscillometric device and finger photoplethysmography), arterial stiffness (applanation tonometry) and cardiac sympathovagal balance (heart rate variability [HRV]) were measured in the fasting state and repetitively following the meal. Ewing tests were performed in the fasting state. RESULTS From baseline to week 8, linagliptin compared with glimepiride did not affect systemic haemodynamics, arterial stiffness or HRV in the fasting state. Linagliptin increased parasympathetic nervous activity, as measured by the Valsalva manoeuvre (P = .021) and deep breathing test (P = .027) compared with glimepiride. Postprandially, systolic blood pressure (SBP) dropped an average of 7.6 ± 1.6 mmHg. Linagliptin reduced this decrease to 0.7 ± 2.3 mmHg, which was significant to glimepiride (P = .010). CONCLUSIONS When compared with glimepiride, linagliptin does not affect fasting blood pressure. However, linagliptin blunted the postprandial drop in SBP, which could benefit patients with postprandial hypotension.
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Affiliation(s)
- Jordan Kraaijenhof
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - Marcel H. A. Muskiet
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - Lennart Tonneijck
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - D. Margriet Ouwens
- German Diabetes Center (DDZ), Leibniz Center for Diabetes ResearchHeinrich Heine University, Medical FacultyDüsseldorfGermany
- German Center for Diabetes Research (DZD)Muenchen‐NeuherbergGermany
- Department of EndocrinlogyGhent University HospitalGhentBelgium
| | - Mark H. H. Kramer
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - Daniël H. van Raalte
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
| | - Mark M. Smits
- Diabetes Centre, Department of Internal MedicineAmsterdam University Medical Centers, location VUmcAmsterdamThe Netherlands
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Special Issue on Clinical Medicine for Healthcare and Sustainability. J Clin Med 2020; 9:jcm9072206. [PMID: 32668562 PMCID: PMC7408837 DOI: 10.3390/jcm9072206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
Recently, due to the advancement of network technology, big data and artificial intelligence, the healthcare industry has undergone many sector-wide changes. Medical care has not only changed from passive and hospital-centric to preventative and personalized, but also from disease-centric to health-centric. Healthcare systems and basic medical research are becoming more intelligent and being implemented in biomedical engineering. This Special Issue on "Clinical Medicine for Healthcare and Sustainability" selected 30 excellent papers from 160 papers presented in IEEE ECBIOS 2019 on the topic of clinical medicine for healthcare and sustainability. Our purpose is to encourage scientists to propose their experiments and theoretical researches to facilitate the scientific prediction and influential assessment of global change and development.
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