Blood Pressure Monitoring最新文献

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.

Background: Noninvasive assessment of cardiac function is useful in the management of heart failure (HF).

Objectives: We developed a novel pulse waveform index, 'Sf/Am', from cuff-oscillometric ambulatory blood pressure (BP) monitoring (ABPM), to estimate cardiac function. This study aimed to investigate the usefulness of square forward pulse wave/amplitude measure pulse wave (Sf/Am), which reflects cardiac systolic function in ambulatory settings, for estimating echocardiographic left ventricular ejection fraction (LVEF) in patients with HF.

Methods: A cuff volumetric waveform was obtained from the diastolic phase of each BP measurement with a multisensor-ABPM (TM-2441, A&D). The area of the ejection is the Sf. Sf is divided by the Am, that is, Sf/Am, to eliminate the effects of arterial and cuff compliance. This index was hypothesized to represent left ventricular systolic function. LVEF was determined using the modified Simpson's method.

Results: A total of 195 participants with HF completed ABPM and echocardiogram. After excluding 76 participants with atrial fibrillation, 119 participants (mean age, 70.0 ± 15.9 years; 58.8% male) were included in the analysis. Sf/Am was correlated with LVEF (r = 0.550, P < 0.001). This relationship remained significant in a multivariable linear regression model adjusted for BP level and other confounders (β = 0.603, P < 0.001). The area under the curve values 95% confidence interval (CI) for Sf/Am in predicting LVEF < 40% and <30% were 0.814 (0.738-0.890) and 0.897 (0.840-0.953), respectively.

Conclusion: Pulse waveform analysis using ABPM has potential for noninvasive estimation of echocardiographic LVEF.

To determine the accuracy of the Hingmed Q06B monitor for upper arm blood pressure (BP) measurement according to the new International Organization for Standardization (ISO) 81060-2:2018/Amd1:2020/Amd2:2024 protocol ('Universal Protocol'). The Q06B device, an oscillometric fully automatic BP monitor for BP measurement at home, has a single wide-range cuff for arm circumferences ranging from 22 to 41 cm. The device was tested in 85 subjects from the general population with a mean age of 53.6 ± 11.7 years. The mean device-observer difference was in agreement with criterion one of the protocol standard requirements (≤5 ± 8 mmHg), being -0.7 ± 3.7 mmHg for systolic BP and -1.6 ± 3.6 mmHg for diastolic BP. The measurement errors had a similar magnitude across the entire range of arm sizes. Criterion two of the ISO 81060-2:2018/Amd1:2020/Amd2:2024 protocol is satisfied. The SD of systolic and diastolic BPs were 2.1 and 2.8 mmHg, respectively, well below the maximum values required by the protocol (6.90 and 6.76 mmHg for systolic and diastolic BPs, respectively). These data show that the Hingmed BP monitor Q06B satisfied the requirements of the ISO 81060-2:2018/Amd1:2020/Amd2:2024 protocol for the general population, demonstrating that a single wide-range cuff can provide reliable measurements across a wide range of arm circumferences.

Background: Blood pressure (BP) control is often challenging. We study whether a pictorial BP log is associated with improved adherence to medical management and BP control.

Method: A sample of mostly Blacks and Hispanics with uncontrolled hypertension were either provided with a pictorial log ( n  = 75) or recommended to complete a log to record their BP ( n  = 75). The primary outcome was bringing any BP log to a subsequent follow-up visit. Secondary outcomes were BP values, BP control, and adherence to antihypertensive medication.

Results: The pictorial log-provided group had a significantly greater percentage than the no log-provided group for bringing a log to a visit within 6 months (53.3 versus 8.0%, P  < 0.001). The pictorial log-provided had a significantly ( P  = 0.03) greater mean reduction of diastolic BP ( M  = -5.2, SD = 10.98) than the no log-provided group ( M  = -1.0, SD = 9.95). There were no significant differences in BP control or adherence to antihypertensive medication between the groups. Improved adherence to antihypertensive medication was observed in patients who were adherent to bringing any BP log to a visit (odds ratio: 4.59, 95% confidence interval:1.16-18.10, P  = 0.03).

Conclusion: Pictorial logs were associated with bringing such logs to subsequent visits and for reduced diastolic BP. However, pictorial logs were not associated with improved BP control or adherence to antihypertensive medication but rather any log was associated with greater adherence to antihypertensive medication. We recommend the use of BP logs of any type for successful BP management.

Objective: The aim of this study was to evaluate the accuracy of the CONTEC08A oscillometric upper-arm blood pressure (BP) monitor for BP measurement in adults according to the International Organization for Standardization (ISO) 81060-2:2018 and amendment (Amd)1:2020 standard.

Methods: Eighty-five subjects (male 40 and female 45) were recruited to fulfill the age, sex, BP, and cuff distribution criteria of the ISO standard in the general population, and had a mean age of 40.2 years. The same arm sequential BP measurement method was used with three differently sized cuffs for the arm circumference ranging from 18 to 26 cm (small), 22-32 cm (medium), and 22-43 cm (large), respectively, for the test device, and two differently sized cuffs for the arm circumference ≤32 cm (standard) and >32 cm (large), respectively, for the mercury sphygmomanometer.

Results: Two hundred and fifty-five comparison pairs were obtained for analysis. For validation criterion 1, the mean ± SD of the differences between the test device and reference SBP/DBP readings was 1.1 ± 6.7/3.0 ± 5.3 mmHg. For validation criterion 2, the SD of the averaged SBP/DBP differences between the test device and reference BP per subject was 5.63/4.68 mmHg.

Conclusion: The automated upper-arm BP monitor CONTEC08A has passed the requirements of the ISO Universal Standard in the general population, and can be recommended for BP measurement in adults.

Background and objective: Ambulatory blood pressure monitoring (ABPM) requires automatic measurement and the use of a validated device, according to current guidelines and international standardization. The TM-2441 (A&D Co. Ltd, Tokyo, Japan) ABPM device is small, lightweight, and suitable for use in ambulatory settings. It was validated against the ISO 81060-2:2013 standard in the general population. This study investigated the reliability of the ABPM device for patients with type 2 diabetes.

Methods: Individuals aged more than 12 years affected with type 2 diabetes were recruited by our outpatient clinic. The blood pressure assessment was performed using the opposite limb simultaneous measurement according to the updated ISO 81060-2:2018.

Results: Forty-five subjects were included in the clinical investigation. The mean difference between blood pressure values measured by the TM-2441 ABPM device and the reference sphygmomanometer was within limits allowed by the ISO standard. Bland-Altman plots of the measurements and differences between the values obtained from the study device and those from the reference device showed no systematic variations in error. It was not possible to perform a stress test in most patients due to refusal or poor physical condition.

Conclusion: The TM-2441 ABPM device fulfilled all the requirements of the ISO standard for ambulatory testing not only in a general population but also in the subgroup of subjects with type 2 diabetes.

Objective: The objective of this study was to investigate the efficacy of the nitrendipine/atenolol combination in comparison with standard-dose nitrendipine or atenolol monotherapy in reducing blood pressure (BP) and blood pressure variability (BPV) as assessed by ambulatory BP monitoring.

Methods: In a randomized, crossover trial, 32 patients (30-65 years) with grade 1 hypertension and elevated daytime reading-to-reading BPV were randomly assigned to receive either the nitrendipine/atenolol combination (10/20 mg) or standard-dose nitrendipine (10 mg) or atenolol (25 mg) monotherapy for 6 weeks, followed by a crossover to another treatment for 6 weeks.

Results: The final analysis included 31 patients (mean [±SD] age, 49.2 ± 9.6 years) and 12 men. The nitrendipine/atenolol combination significantly reduced from baseline clinic and ambulatory BP and pulse rate ( P  ≤ 0.002), and 24 h and daytime systolic and diastolic BPV as assessed by SD and average real variability ( P  ≤ 0.042), but not the coefficient of variation nor nighttime BPV indices ( P  ≥ 0.06). Significant differences between the nitrendipine/atenolol combination and nitrendipine or atenolol monotherapy at the end of treatment were observed in clinic BP and pulse rate ( P  ≤ 0.042), but not in 24 h, daytime and nighttime blood pressure and pulse rate, except for daytime DBP and 24 h and daytime pulse rate ( P  ≤ 0.049). There were no significant differences in BPV between the combination and monotherpy groups at the end of treatment ( P  ≥ 0.25).

Conclusion: The nitrendipine/atenolol combination reduced daytime reading-to-reading BPV, but did not show superiority to nitrendipine or atenolol monotherapy.