Blood Pressure Monitoring最新文献

Objective: To investigate the associations between phenotypic age acceleration (PhenoAgeAccel) and all-cause/cardiovascular disease (CVD)-related mortality in hypertensive patients.

Methods: We analyzed data from 14 352 hypertensive adults (≥20 years) in the National Health and Nutrition Examination Survey 1999-2010. PhenoAge was calculated using chronological age and nine biomarkers (albumin, creatinine, glucose, C-reactive protein, lymphocyte%, mean cell volume, red blood cell distribution width, alkaline phosphatase, and white blood cell count). PhenoAgeAccel was derived as residuals from linear regression of PhenoAge on chronological age. Participants were stratified by PhenoAge [<46.6792 (792-64.774 (T1-T2), ≥64.774 (≥T2)] and PhenoAgeAccel [<-4.3382 (382-0.9896 (T1-T2), ≥0.9896 (≥T2)] tertiles. Cox proportional hazards models assessed mortality risks.

Results: Increased all-cause mortality was observed in hypertensive patients with PhenoAge in T1-T2 group [hazards ratio = 4.38, 95% confidence interval (CI): 3.79-5.06] and greater than or equal to T2 (hazards ratio = 14.22, 95% CI: 12.32-16.43). Significant association between PhenoAgeAccel greater than or equal to T2 and increased risk of all-cause mortality in hypertensive patients (hazards ratio = 1.41, 95% CI: 1.29-1.55) was identified. PhenoAge of T1-T2 (hazards ratio = 5.15, 95% CI: 3.86-6.86) and greater than or equal to T2 (hazards ratio = 20.20, 95% CI: 14.98-27.26) were related to increased CVD-related mortality in hypertensive patients. Increased risk of CVD-related mortality was identified in hypertensive patients with PhenoAgeAccel greater than or equal to T2 (hazards ratio = 1.35, 95% CI: 1.17-1.56).

Conclusion: Elevated PhenoAge and PhenoAgeAccel significantly predict higher all-cause and CVD mortality in hypertension, supporting clinical risk stratification.

Objective: This study aimed to evaluate the accuracy of OMRON J7136 and HEM-7361T oscillometric blood pressure (BP) monitors in the general population according to the International Organization for Standardization (ISO) 81060-2:2018 and amendment (Amd) 1:2020 standard.

Method: Subjects were recruited to fulfill the age, gender, BP, and cuff distributions of the ISO Universal Standard in the general population using the same arm sequential BP measurement method. Three cuffs of the OMRON J7136 were used for arm circumference 17-22 cm (small), 22-32 cm (medium), and 32-42 cm (large). A single cuff 17-36 cm was used on the OMRON HEM-7361T.

Results: The mean ± SD of the differences between the OMRON J7136 and reference BP readings was -2.14 ± 6.45/-1.43 ± 5.88 mmHg (systolic/diastolic) for criterion 1. The SD of the average BP differences between the OMRON J7136 and reference BP per subject was 5.49/5.36 mmHg (systolic/diastolic) for criterion 2. For the study on the OMRON HEM-7361T, the corresponding values were -2.56 ± 6.35/-3.18 ± 5.67 mmHg (systolic/diastolic) for criterion 1 and 5.33/5.32 mmHg (systolic/diastolic) for criterion 2.

Conclusion: The OMRON J7136 and HEM-7361T BP monitors both fulfilled the requirements of the ISO Universal Standard (ISO 81060-2:2018/AMD 1:2020) in the general population and can be recommended for self-measurement in adults.

The current 2024 European Society of Cardiology (ESC) guideline for the management of elevated blood pressure and hypertension defines blood pressure less than 115/65 mmHg by ambulatory blood pressure monitoring (ABPM) as nonelevated, blood pressures in-between 115-129 and 65-79 mmHg as elevated blood pressure, and hypertension as ≥130/80 mmHg. There, might be patients seeking medical attention for the symptoms, apparently nonspecific but suggestive of hypertension with optimal, or not elevated, or elevated blood pressure values. A female patient with complaints of headache and dizziness lasting for 2 months has been evaluated in cardiology outpatient clinic and assessed by ABPM. It has been told that she had previously blood pressure of 90-100/50-60 mmHg and was suffering from headache when systolic blood pressure exceeds 110 mmHg. Her 24-h ABPM revealed systolic and diastolic blood pressure as 106/63 mmHg showing nighttime decrease compared with daytime pressures (98/59 mmHg and 108/68 mmHg, respectively). Thereafter, she was instructed to keep continuing the life-style modification and given to beta-blocker (bisoprolol 5 mg) as an antihypertensive treatment. At the end of the 2 weeks of follow-up period, she was headache-free and was feeling comfortable and well with a mean home blood pressure of 98/56 mmHg. We have presented prosperous antihypertensive treatment of a female patient suffering from headache and dizziness with a numerically normal or nonelevated blood pressure. In the presence of symptoms and having not elevated or elevated blood pressure levels, patients' history on previous measure of blood pressure might facilitate our decision-making process.

Objective: Unobserved automated office blood pressure (uAOBP) measurement is better correlated to daytime ambulatory blood pressure monitoring (dABPM) than traditional office blood pressure (BP) measurements. However, prolonged uAOBP duration may underestimate BP levels. We aimed to determine the duration of uAOBP that has the lowest proportion of white-coat hypertension (WCH) or masked hypertension (MH) compared with the gold-standard using dABPM in patients with type 2 diabetes (T2DM). Additionally, we examined variables associated with discrepancy between uAOBP and dABPM.

Methods: A total of 135 patients with T2DM underwent dABPM as well as uAOBP. uAOBP recordings were taken in the sitting position without prior rest for 24 min at 3-min intervals. Hypertension was defined as blood pressure ≥135/85 mmHg. Multiple uAOBP measurement intervals were compared with dABPM by the proportions of patients with WCH, MH, or consistent classification.

Results: Participants had a mean age of 57.7 years, 38% were female, and 66% used antihypertensive drugs. Average dABPM was 126.9/79.5 mmHg. Extension of uAOBP measurements from 3 to 24 min reduced the proportion with WCH significantly (20.7 vs. 27.4%, P  = 0.012), with an identical proportion of MH (4.4 vs. 3.7%). Higher BMI, higher urine albumin-creatinine ratio, and higher education were associated with MH, while WCH was associated with older age and early retirement.

Conclusion: Extending the duration of uAOBP measurements from 3 to 24 min in patients with T2DM increased the proportion of patients with consistent classification by reducing WCH without increasing MH, but clinically relevant individual differences between uAOBP measurements and dABPM remained.

Objective: Visit-to-visit variability in SBP (VVV-SBP) is associated with increased cardiac events, including atrial fibrillation (AF). P-wave signal-averaged electrocardiography (P-SAECG) detects subtle atrial conduction abnormalities such as atrial late potential (ALP). This study examined the association between VVV-SBP and atrial conduction.

Methods: A total of 128 male participants (mean age: 50.8 ± 10.3 years) with normal cardiac function underwent annual blood pressure measurements over 5 years. VVV-SBP was assessed using both the SD and the coefficient of variation (CV) of SBP, calculated from five BP measurements taken annually during the 5 years prior to the P-SAECG. P-SAECG parameters included the filtered P-wave duration (FPD) and the root-mean-square voltage of the last 20 ms of the P-wave (RMS20). ALP positivity was defined as FPD > 120 ms and RMS20 < 3.5 µV.

Results: ALP positivity was observed in 33 participants (25.8%). SD-SBP was higher in the ALP-positive group (9.59 ± 4.15 vs. 7.92 ± 3.66 mmHg; P  = 0.031). This trend was seen in CV-SBP (ALP-positive; 0.077 ± 0.031 vs. ALP-negative; 0.064 ± 0.027; P  = 0.022). ALP positivity was significantly less frequent in the lowest quartile and more frequent in the highest quartile of both SD-SBP and CV-SBP. In multivariable logistic regression analysis, higher quartiles of both SD-SBP and CV-SBP were independently associated with ALP positivity (e.g. SD-4; P  = 0.014; CV-4; P  = 0.009).

Conclusion: Elevated VVV-SBP, assessed by SD and CV, is associated with impaired atrial conduction, highlighting its potential role as a predictor of atrial conduction abnormalities and a tool for AF risk stratification.

Objective: This study aimed to explore the factors associated with orthostatic hypotension and to develop a nomogram to predict the risk of orthostatic hypotension.

Methods: Orthostatic hypotension is defined as a fall in systolic blood pressure (SBP) of at least 20 mmHg or diastolic blood pressure (DBP) of at least 10 mmHg within 3 min of standing. In this cross-sectional analysis, 1708 patients were collected from January 2016 to June 2018. These patients were divided into the orthostatic hypotension group and the non-orthostatic hypotension group. The variables were selected by least absolute shrinkage and selection operator (LASSO) regression. The characteristic variables selected in the LASSO regression were analyzed using multivariable logistic regression to construct the predictive model. The predictive model was displayed using a nomogram. The model performances were evaluated by the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis.

Results: The prevalence of orthostatic hypotension was 14.3% in this study. The LASSO and multivariable logistic regression analyses suggested that age, diabetes duration, seat SBP, supine SBP, and albumin were associated with orthostatic hypotension. The AUC of the nomogram was 0.796 [95% confidence interval (CI): 0.759-0.834] in the training set and 0.832 (95% CI: 0.780-0.885) in the validation set. Calibration curves were drawn and showed acceptable predictive performance, and the decision curve analysis showed that the proposed nomogram had strong clinical applicability.

Conclusion: Age, diabetes duration, seat SBP, supine SBP, and albumin were associated with orthostatic hypotension. The nomogram model established by the factors provided an effective way to forecast the risk of orthostatic hypotension.

Objective: This study investigated the relationship of maternal serum uric acid, cystatin C (CysC), and coagulation indices [international normalized ratio (INR) and fibrinogen (FIB)] during pregnancy with clinical features and prognosis of early-onset pre-eclampsia.

Methods: Patients with pre-eclampsia (n = 133) were retrospectively selected, with clinical features and maternal uric acid, CysC, INR, and FIB levels collected. The relationship between clinical features and maternal uric acid, CysC, INR, and FIB was analyzed by Pearson's and Spearman's analyses. The receiver operating characteristic curve was used to analyze the discriminative power of maternal uric acid, CysC, INR, and FIB during pregnancy for the adverse maternal and infant outcomes.

Results: In patients with early-onset pre-eclampsia, uric acid and CysC levels positively correlated with mean arterial pressure (MAP) at diagnosis and 24-h proteinuria quantification. FIB negatively correlated with MAP at diagnosis, while INR did not significantly correlate with MAP at diagnosis and 24-h proteinuria quantification. Severe early-onset pre-eclampsia patients and early-onset pre-eclampsia patients with adverse maternal and perinatal outcomes had elevated maternal uric acid and CysC and decreased INR and FIB expression. These four indices were independently correlated with maternal and infant prognoses and had certain discriminative power, while their combination had higher discriminative power for adverse maternal and infant outcomes, which was significantly higher than that of disease severity alone.

Conclusion: The combined detection of uric acid, CysC, INR, and FIB had high discriminative power for adverse maternal and infant outcomes in patients with early-onset pre-eclampsia, significantly surpassing the discriminative power of clinical disease severity.

To examine the evolution, adoption, and impact of the 2020 International Society of Hypertension Global Hypertension Practice Guidelines (ISH-GHPG) globally. A scoping review, guided by the Conceptual Model for Nursing and Health Policy, was conducted using four databases: PubMed, CINAHL, APA PsycINFO, and Web of Science. Studies were included if they focused on individuals aged 18 years and older and addressed hypertension management, clinical practice guidelines for hypertension, or related interventions. Eight studies were eligible for inclusion in the review, from which four themes were identified: multicomponent interventions, adherence to practice guidelines, screening and educational programs, and lifestyle interventions. Notably, multicomponent and lifestyle interventions, such as the Dietary Approaches to Stop Hypertension diet and weight management, demonstrated significant reductions in blood pressure. Educational campaigns were effective in enhancing awareness, while adherence to guidelines by both clinicians and patients was associated with improved hypertension management. The 2020 ISH-GHPG has achieved global recognition and adoption, enhancing hypertension management across diverse healthcare settings. However, challenges persist in ensuring consistent implementation. Future research should prioritize increasing global awareness, culturally tailoring interventions, and promoting patient self-care to optimize adherence to guidelines and improve cardiovascular outcomes.