Blood Pressure Monitoring最新文献

Background: In Latin America and the Caribbean (LAC), hypertension is the leading cause of death and disability. Accurate diagnosis requires validated blood pressure measurement devices (BPMD). This study aimed to assess the characteristics and validation status of blood pressure measuring devices available for online purchase within Peru.

Methods: Between September and November 2023, we performed an electronic search of major retailers and online pharmacies. Devices were classified as validated if they were listed in databases recommended by the 2023 European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension or deemed equivalent by the manufacturer. Validation status was verified using a proposed algorithm.

Results: We identified 13 retailers and 12 pharmacies selling BPMDs online, yielding 530 devices. Of these, 176 were assessed for validation, with 15 devices (8.5%) considered as validated and two (1.1%) as equivalent. Among validated devices, seven used the ESH 2010 protocol, and four each used the ISO 81060-2:2018 standard [adopted by the Association for the Advancement of Medical Instrumentation (AAMI) and ESH] and the ESH 2002 protocol. Six validated devices were from Omron, with two each from Andon, Beurer and Microlife. Prices ranged from 30.1 USD to 351.5 USD.

Conclusion: The high prevalence of nonvalidated BPMDs available online in Peru underscores the risk of inaccurate blood pressure readings, potentially compromising patient monitoring and treatment. These findings highlight the need for BPMD education for physicians and patients, and advocate for regulatory policies mandating BPMD validation to improve hypertension management in Peru and potentially the LAC region.

Objective: To evaluate the clinical measurement accuracy of the BP2 oscillometric upper arm blood pressure monitor in the general population according to the ISO 81060-2:2018+Amd 1:2020 standard.

Methods: Participants were recruited and the same arm sequential method was used for blood pressure measurement according to the ISO 81060-2:2018+Amd 1:2020. The validation results were assessed following the protocol and the Bland-Altman scatterplot was used to show the difference between the test device and reference results.

Results: A total of 85 participants were included in the final analysis. For the validation criterion 1, the mean ± SD of the differences between the test device and reference readings was -2.93 ± 7.65 and -2.40 ± 6.82 mmHg for systolic and diastolic blood pressure, respectively. For criterion 2, the ±SD of the averaged differences between the test device and reference readings per participant was ±6.16 and ±5.74 mmHg for systolic and diastolic blood pressure, respectively.

Conclusion: The BP2 upper arm blood pressure monitor passed all the requirements of the ISO 81060-2:2018+Amd 1:2020 standard and can be recommended for clinical use and self-measurement in the general population.

Background: High normal blood pressure (HNBP) is common in adults worldwide and is associated with a greater likelihood of developing hypertension. Thus, identifying those at risk is crucial, in order to intervene early and reduce future cardiovascular risk. This study aims to examine the role of sympathetic nervous system (SNS), aortic stiffness, and blood pressure (BP) response to exercise as predictors for development of hypertension in individuals with HNBP.

Methods: One hundred individuals with HNBP were included in the study. Baseline anthropometric characteristics, BP levels, an electrocardiogram, and an echocardiogram were obtained. In order to evaluate the effect of SNS, aortic stiffness, and exercise response in the transition from the prehypertensive to hypertensive phenotype, we measured the levels of muscle sympathetic nerve activity (MSNA), pulse wave velocity (PWV), and exaggerated BP response (EBPR) to cardiopulmonary exercise, respectively.

Results: At 3 years follow up, 40 patients (40%) developed hypertension. Baseline characteristics were similar between the two groups. Those who developed hypertension had sympathetic overactivation, as indicated by the higher mean values of MSNA (35 ± 4.4 vs 28 ± 3.8 bursts per minute; P  = 0.003), increased aortic stiffness, and PWV (8.2 ± 0.7 vs 7.2 ± 0.5 m/s; P  < 0.001), as well as an EBPR to exercise ( P  < 0.001).

Conclusion: Increased values of MSNA, PWV, and EBPR were found to be statistically related with hypertension development in HNBP phenotypes. These markers could be of great clinical use in identifying prehypertensives at high risk for developing hypertension.

Objectives: Lower SBP is associated with worse prognosis in precapillary pulmonary hypertension patients. This study aimed to assess the prevalence of hypotension in precapillary pulmonary hypertension patients with preserved right ventricle function receiving pulmonary arterial hypertension (PAH)-specific medication with 24-h ambulatory blood pressure monitoring (ABPM) and to compare the burden of hypotension between patients receiving PAH-specific monotherapy and dual combination therapy (DCT).

Methods: This cross-sectional study included 44 precapillary pulmonary hypertension patients who underwent clinical assessment, echocardiography, and 24-h ABPM. Patients were grouped according to the type of treatment regimen: monotherapy or DCT. Hypotension was defined as the occurrence of at least one valid measurement of SBP < 100 mmHg.

Results: Mean 24-h, daytime, and nighttime SBP were significantly lower in patients receiving DCT compared to patients receiving monotherapy ( P  < 0.05 for all). Episodes with SBP < 100 mmHg during the 24-h, daytime, and nighttime periods were significantly more common in the patients receiving DCT (21.26 ± 9.33 vs 12.26 ± 3.61, 15.58 ± 8.17 vs 8.57 ± 3.60, 5.68 ± 2.63 vs 3.70 ± 2.27, respectively, P  < 0.05 for all).

Conclusion: Patients on DCT who had relatively advanced pulmonary vascular disease have a higher burden of hypotension. We propose that estimation of the mortality risk relying on a single office blood pressure measurement, as is the case with contemporary risk scores, may give rise to inaccurate results and the incorporation of the assessment of hypotension burden with 24-h ABPM into the risk assessment tools might improve risk stratification.

Background: Individuals with postacute COVID-19 syndrome (PACS) typically exhibit abnormal hemodynamic responses during upright positioning, including orthostatic hypotension and postural orthostatic tachycardia syndrome. The 10-minute NASA lean test (NLT) has been suggested for this condition. However, no comparative study with the head-up tilt table test (HUTT) has been conducted. This study aimed to compare blood pressure and heart rate responses during the 10-minute duration of NLT and HUTT.

Methods: Eighty young individuals (aged 22.0 ± 3.1 years) with PACS underwent both tests, with a 30-minute interval between tests. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured every minute, and the differences between supine and upright positions were analyzed.

Results: There were no significant differences in SBP changes between HUTT and NLT (-7.8 ± 6.2 vs. -7.1 ± 7.5 mmHg) with a mean difference of -0.7 ± 9.0 mmHg. However, DBP changes were significantly lower in HUTT compared to NLT (-0.9 ± 6.4 vs. 1.5 ± 6.9 mmHg for NLT) with a mean difference of -2.4 ± 7.1 mmHg. Maximal HR was significantly lower in HUTT compared to NLT (92.0 ± 11.4 vs. 96.2 ± 10.8 bpm for NLT) with a mean difference of -4.2 ± 6.9 bpm. Additionally, HR changes were significantly lower in HUTT compared to NLT (21.5 ± 8.1 vs. 27.0 ± 9.0 bpm) with a mean difference of -5.4 ± 6.4 bpm.

Conclusion: The NLT demonstrated comparability with the HUTT in detecting SBP changes. However, clinical applications should consider differences in measuring DBP and HR changes.

Objective: Uscom BP+ is a cuff-based blood pressure (BP) device designed to noninvasively estimate central BP as distinct from conventional brachial BP. This study aimed to assess the accuracy of the Uscom BP+ device compared with invasively measured BP.

Methods: Automated noninvasive cuff central BP (using the Uscom BP+ device) and invasive central aortic BP were recorded simultaneously in 191 participants (65% male, aged 66 ± 11 years) receiving coronary angiography at three independent research sites in Australia, Poland, and Italy. Validation procedures were undertaken according to the Artery Society recommendations and with a minimally acceptable error (mean ± SD) of ≤5 ± ≤8 mmHg as pass criteria.

Results: Using the device default calibration technique [brachial cuff systolic blood pressure (SBP) and diastolic blood pressure (DBP)], cuff central SBP underestimated invasive central SBP [mean (SD) difference: -10.2 (11.2) mmHg] and cuff central DBP overestimated invasive central DBP [mean (SD) difference: 9.8 (8.5) mmHg]. When calibrating by brachial cuff mean arterial pressure and DBP, SBP accuracy was improved, but variability remained high [mean (SD) difference: -6.3 (14.4) mmHg, P  = 0.004 vs. default calibration, whereas DBP accuracy and variability remained similar [mean (SD) difference: 10.9 (8.5) mmHg, P  = 0.19 vs. default calibration].

Conclusion: The Uscom BP+ cuff device does not pass the Artery Society accuracy criteria compared with invasively measured central BP.

Objective: Renal artery stenosis (RAS) which is a potentially reversible cause of hypertension and renal insufficiency is associated with poor prognosis in ischemic stroke patients. The inter-arm blood pressure difference (IABD) is independently related to the atherosclerosis of the arteries. This study was to evaluate the relationship of RAS with IABD in ischemic stroke patients.

Materials and methods: This study was a cross-sectional observational study of consecutive patients with ischemic stroke who had not a history of RAS. Abdominal aortography was performed to screen for RAS after the cerebrovascular diagnostic procedure. RAS was defined as the presence of ≥50% stenosis in either renal artery. Univariate and multivariate analysis were performed to investigate the association of the clinical variables including IABD with RAS.

Results: RAS and systolic IABD ≥ 10 mmHg were detected in 62 (14.7%) and 142 (33.6%) of all ischemic stroke patients ( n  = 422), respectively. Patients with systolic IABD ≥ 10 mmHg were more likely to have RAS than patients without (59.7 vs 29.2%, P   <  0.001). The logistic regression analysis showed that systolic IABD ≥ 10 mmHg was independently associated with RAS (odds ratio, 3.67; 95% confidence interval: 2.02-6.65; P   <  0.001).

Conclusion: Measuring SBP between arms may help identify individuals with RAS in ischemic stroke patients.

To validate the accuracy of the YuWell YE990 automated oscillometric upper-arm medical blood pressure (BP) monitor in adults according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal standards (ISO 81060-2:2018 and Amendment 1:2020). Participants were recruited to meet the age, sex, BP, and cuff distribution criteria of the AAMI/ESH/ISO standards. BP was measured using a mercury sphygmomanometer (reference device) and YE990 (test device) following a same-arm sequential protocol with two trained observers and a supervisor. Bland-Altman plots were used to assess agreement, and scatter plots were used to assess the performance across varying arm sizes. Ninety-nine subjects were recruited and 85 were analyzed. The YE990 passed the accuracy requirements of the AAMI/ESH/ISO standards, with mean differences of 0.4 ± 6.31 mmHg for systolic BP and -0.9 ± 6.28 mmHg for diastolic BP for validation criterion 1. For validation criterion 2, the SD of the average BP difference between the test device and reference BP per subject was 5.00/5.70 mmHg (systolic/diastolic). YuWell YE990 meets the AAMI/ESH/ISO universal accuracy standard (ISO 81060-2:2018+Amd.1:2020) and is recommended for clinical use.

Objective: The discrepancy in blood pressure (BP) measurements while in a supine position using an upper-arm automated sphygmomanometer equipped with cuffs of varying sizes remains unresolved.

Methods: In this single-center, randomized crossover trial, a total of 223 inpatients from the Affiliated Hospital of Putian University were enrolled between August and September 2023. Three sets of triplicate BP measurements were obtained while the participants were in a supine position using an automated sphygmomanometer with randomly assigned appropriately sized, undersized, or oversized BP cuffs.

Results: The average age of the subjects was 65.1 ± 18.4 years, with 109 (48.9%) being male and 78 (35%) having coexisting hypertension. Based on the measured mid-arm circumference, a small-sized, regular-sized, and large-sized BP cuff was deemed appropriate for 50, 113, and 60 participants, respectively. In patients requiring small-sized cuffs, the use of regular and large-sized cuffs resulted in a significant reduction in systolic BP by -4.0 [95% confidence interval (CI): -9.8 to 1.9] mmHg and -6.9 (95% CI: -8.0 to -5.8) mmHg, respectively, as well as diastolic BP by -3.4 (95% CI: -8.0 to 1.2) mmHg and -4.1 (95% CI: -5.3 to 2.8) mmHg, respectively. In contrast, among patients requiring large-sized cuffs, the use of small and regular-sized cuffs increased systolic BP by 6.2 (95% CI: 4.2 to 8.2) mmHg and 2.3 (95% CI: -1.4 to 6.1) mmHg, respectively, and diastolic BP increased by 2.6 (95% CI: 1.5 to 3.7) mmHg and 0.2 (95% CI: -4.7 to 5.2) mmHg, respectively.

Conclusion: Our findings suggest that miscuffing affects supine BP measured by an automated sphygmomanometer.

Objective: Home blood pressure (BP) measurement is important for adequate BP control in patients with hypertension. BP targets for frail older adults need to be determined on an individual basis. This study aimed to examine the effect of frailty on home BP measurement status.

Methods: This study enrolled 682 older participants from a community cohort study conducted in Tarumizu City in 2019. We explained that home BP monitors could be lent free of charge to participants who wished to measure their BP at home. We evaluated frailty and daily living functions, such as technology usage, information practice, life management, and social engagement. We investigated how these indicators were associated with the desire to borrow home BP monitors and adherence to home BP measurements.

Results: A total of 304 participants agreed to borrow the home BP monitors. Multivariable logistic analysis revealed that the presence of frailty, low technology usage, and information practice were negatively associated with borrowing a home BP monitor, independent of age, sex, BMI, smoking history, and the presence of hypertension, diabetes, and dyslipidaemia. In contrast, the presence of prefrailty and frailty was positively associated with daily home BP measurements, independent of age, sex, BMI, smoking history, presence of hypertension, diabetes, and dyslipidaemia.

Conclusion: Frailty is associated with a lower desire to monitor home BP, but is associated with higher adherence to home BP monitoring once it is initiated.