Blood Pressure Monitoring最新文献

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.

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.