Blood Pressure最新文献

Purpose: This study aimed to investigate the effects of public health nursing combined with dietary intervention on metabolic control, self-management abilities, and quality of life in patients with both diabetes mellitus (DM) and hypertension (HTN).

Materials and methods: A total of 120 patients with DM and HTN were randomly classified into a control group or an intervention group. Baseline data, SBP, DPB, FPG, 2hPG, and HbA1c were compared between the two groups before and after the intervention. Disease knowledge was assessed using the Diabetes Knowledge Questionnaire (DKQ). Dietary behaviour management was evaluated using a 5-point Likert scale and management norms for DM and HTN. Quality of life was assessed utilising the GQOLI-74. Self-management ability was recorded as the proportion of patients meeting the established criteria. Patient satisfaction was compared using a hospital-developed satisfaction questionnaire.

Results: Following the intervention, the intervention group demonstrated notably lower levels of SBP, DPB, FPG, 2 hPG, and HbA1c (p < 0.01). The intervention group exhibited significant improvements in DKQ scores, dietary behaviour, and GQOLI-74 scores, as well as significantly higher compliance rates across all dimensions of self-management ability (p < 0.01). Moreover, overall patient satisfaction was significantly higher in the intervention group (p < 0.01).

Conclusion: Public health nursing combined with dietary interventions can effectively improve blood pressure, glycemic control (FPG, 2hPG, HbA1c), disease knowledge, dietary behaviour, and self-management ability, while also enhancing quality of life and patient satisfaction in patients with DM and HTN.

Objective: To determine the prevalence rate and risk factors for systemic arterial hypertension in infants with congenital heart diseases.

Methods: A retrospective cohort study of postoperative systemic arterial hypertension incidence in infants who underwent cardiac surgery was conducted. The primary diagnosis was retrieved. The general characteristics, surgical information, and blood pressure data at five periods were also collected. The five periods were at admission, 48 hours after cardiac surgery (postoperative), at discharge, at full-time, and at any time during hospitalisation. The risk factors for postoperative hypertension and hypertension at discharge were determined by multivariate logistic regression.

Results: This study enrolled 1205 eligible infants. The age and weight at surgery were 27.0 (13.0, 59.0) days and 3.53 ± 0.96 kg, respectively. The prevalence rates of postoperative hypertension and hypertension at discharge were 12.8 (10.9-14.7)% and 6.9 (5.5-8.3)%, respectively. The incidence of postoperative hypertension varies greatly across different types of congenital heart diseases. A low weight Z score, preoperative hypertension, patent ductus arteriosus, and coarctation of the aorta were risk factors for postoperative hypertension, whereas transposition of the great arteries grouped with pulmonary atresia, pulmonary stenosis, and total anomalous pulmonary venous connection was a protective factor. The ventricular septal defect was a risk factor for postoperative hypertension but not for hypertension at discharge.

Conclusions: The incidence of postoperative systemic arterial hypertension is high in infants after cardiac surgery. The prevalence of hypertension decreased at discharge. Prospective long-term follow-up studies are needed to delineate the natural history of hypertension in high-risk children.

Background: High blood pressure variability (BPV) is associated with cerebrovascular damage and dementia, but it is unknown whether short-term BPV during hospitalisation is also associated with cerebral white matter (WM) damage. We examined whether BPV, measured in-hospital using continuous monitoring, is associated with WM microstructural integrity in COVID-19 patients.

Methods: We included hospitalised COVID-19 patients from the CORONavirus and Ischemic Stroke (CORONIS) study who underwent continuous vital signs monitoring using a wearable device during hospital admission and had an MRI shortly after discharge. Systolic BPV was calculated as Average Real Variability (ARV) and Coefficient of Variation (CV) with 1-, 5- and 20-minute intervals. We used diffusion tensor imaging to assess fractional anisotropy (FA) and peak width of skeletonised mean diffusivity (PSMD) as markers of WM integrity. Associations between BPV and WM integrity were examined with linear regression adjusted for age, mean systolic blood pressure (BP), number of BP measurements and type of respiratory support.

Results: We included 47 COVID-19 patients (mean age: 59.6 years). BP was measured 6306 ± 4343 times per patient (median admission: 11 days (Interquartile Range [IQR] 7.5-15.0). Both higher ARV and CV were associated with lower WM microstructural integrity, reflected by lower FA (ARV: β = -0.40, p = .010; CV: β = -0.33, p = 0.026) and higher PSMD (CV: β = 0.28, p = .038) after adjustment for confounders. Correction for WM hyperintensities did not change these results.

Conclusions: High BPV during hospitalisation is associated with lower WM integrity in COVID-19 patients, although causality needs to be demonstrated. Our findings need validation in hospitalised patients without COVID-19 to examine generalisability.

Introduction: Radiofrequency renal denervation (RF RDN) has been recommended as an adjunct therapeutic option for uncontrolled including resistant hypertension. This analysis sought to evaluate the cost-effectiveness of RF RDN treatment in the Dutch healthcare setting.

Methods: A previously published decision-analytic model was utilised to project outcomes over a lifetime horizon for RF RDN vs. standard of care (SoC). Data from the SPYRAL HTN-ON MED study informed the cohort characteristics and base case treatment effect modelled (-4.9 mmHg office-based systolic blood pressure (oSBP) reduction vs. sham), while alternate assumptions were explored in sensitivity analyses. Cost-effectiveness was evaluated against a burden of disease-determined threshold of €20,000 per quality-adjusted life year gained, according to Dutch guidelines.

Results: In the base case, ten-year clinical event risk reductions were 0.80 for stroke, 0.88 for myocardial infarction, 0.89 for angina pectoris and coronary heart disease, 0.72 for heart failure, 0.96 for end-stage renal disease, and 0.93 for all-cause death. Over lifetime and under the base case effect size, RF RDN resulted in increased costs of €4,137 (€46,769 (RF RDN) vs. €42,632 (SoC)) and quality-adjusted life years (QALY) of 0.61 (17.49 RF RDN vs. 16.88 SoC), with an incremental cost-effectiveness ratio (ICER) of €6,784 per QALY gained. RF RDN was highly cost-effective or dominant across the range of scenario and sensitivity analyses performed.

Conclusion: Over lifetime, RF RDN was found cost-effective in the Dutch healthcare system, with an ICER substantially below the applicable willingness-to-pay threshold, while providing meaningful reductions in clinical events for uncontrolled including resistant hypertension patients.

Background: The weight-adjusted waist index (WWI) is a novel obesity measure standardizing waist circumference by body weight. While linked to cardiometabolic disorders, its association with hypertension (HTN) and the mediating role of systemic inflammation remain unclear. This study investigated the WWI-HTN relationship and the mediating effects of C-reactive protein-albumin-lymphocyte ratio (CALLY), C-reactive protein-albumin ratio (CAR), and lymphocyte-C-reactive protein ratio (LCR).

Methods: We analyzed data from 10,869 adults (≥20 years) in NHANES 1999-2010. Associations of WWI with HTN and inflammatory markers were examined using multivariable regression, restricted cubic splines (RCS), and generalized additive models (GAM). Mediation was evaluated through bootstrap analysis.

Results: Higher WWI was strongly associated with HTN risk (OR = 1.79; 95% CI: 1.66-1.93; P < 0.001). Participants in the highest quartile had nearly fourfold greater risk than those in the lowest (OR = 3.79; 95% CI: 3.04-4.72). The relationship remained robust after adjusting for inflammatory markers (OR = 1.62; 95% CI: 1.49-1.75). Elevated log-CALLY and log-LCR were protective, whereas higher log-CAR increased HTN risk. Mediation analyses showed CALLY, LCR, and CAR explained 12.81%, 12.54%, and 15.89% of the association, respectively, with a combined effect of 13.91%. Subgroup analyses confirmed WWI as a consistent risk factor, and RCS/GAM demonstrated a nonlinear positive association with a threshold at WWI = 11.70.

Conclusion: WWI is independently and nonlinearly associated with hypertension risk, particularly when WWI ≤11.70. Systemic inflammation partially mediates this association, underscoring its role in obesity-related hypertension.

Background: Remote blood pressure monitoring (RBPM), an effective method of enhancing BP control for patients with hypertension, can potentially helpovercome geographic limitations of health care services. We conducted a 90-day pilot to explore combining an interactive care plan (ICP) with RBPM.

Method: The pilot invited fifty adult patients with uncontrolled hypertension (BP ≥140/90 mm Hg) empanelled to a rural primary care practice in midwestern United States. Participants received instructions for downloading an ICP app and were given a wireless BP monitoring device that automatically transmitted readings to their care team. Patients were surveyed after 30 and 90 days about program experience.

Results: Thirty-six patients enrolled. Mean participant age was 59.1 years; most were male, married, and White. Mean baseline BP was 153/89 mm Hg. Participants who engaged in the program for at least 75 days (n = 15) had a postintervention mean BP of 135/80 mm Hg. Sixteen participants (44%) had 1 outpatient visit (no multiple outpatient visits): only 4 (11%) had an emergency department visit. Among survey respondents, most strongly agreed or agreed that 1) ICP app was easy to use, 2) BP device was helpful in home care, 3) interacting remotely with care team was smooth, and 4) they were satisfied with functionality of the RBPM device.

Conclusion: An ICP paired with an RBPM device is a reasonable intervention for managing hypertension in a primary care practice particularly for patients in rural areas. New strategies must be developed to reduce barriers to meaningful engagement, achieve sustainability, and ensure successful widespread adoption.

Introduction: Radiofrequency renal denervation (RF RDN) is a catheter-based therapy for uncontrolled hypertension. This model-based analysis examined the cost-effectiveness of RF RDN in Sweden.

Methods: Clinical events, costs, quality-adjusted life-years (QALYs) were projected over 10-year and lifetime horizons using a decision-analytic Markov model. Primary health states, included hypertension alone, myocardial infarction (MI), stroke, other symptomatic coronary heart disease (CHD), heart failure (HF), end-stage renal disease (ESRD), and death. Health state transitions were informed by multivariate risk equations. Clinical evidence from the SPYRAL HTN-ON MED trial informed the treatment effect modelled (-4.9 mmHg reduction in office systolic blood pressure (SBP) vs. sham). The base case was conducted from the Swedish healthcare payer perspective. The primary outcome was the incremental cost-effectiveness ratio (ICER),RF RDN vs. standard of care (SoC), evaluated against an assumed willingness-to-pay threshold of SEK 500,000 per QALY gained. Extensive sensitivity analyses were performed.

Results: At 10-years, the relative risks with RF RDN were 0.80 for stroke, 0.88 for MI, 0.89 for CHD, 0.72 for HF, 0.96 for ESRD, 0.86 for cardiovascular death and 0.93 for all-cause death. Over lifetime, RF RDN led to incremental costs of SEK 63,136 (total costs SEK 497,498 vs. SEK 434,362) and incremental QALY gain of 0.45 (14.79 vs. 14.34), yielding an ICER of SEK 139,280 per QALY gained. RF RDN was cost-effective across all scenarios and sensitivity analyses.

Conclusion: Model projections suggest RF RDN to be a cost-effective therapy for uncontrolled including resistant hypertension in Sweden based on contemporary clinical evidence.

Background: Evidence has linked blood pressure (BP) phenotypes with certain clinical, psychosocial, and occupational features, and characteristic BP variability.

Objective: We aimed to evaluate the value of a diagnostic score developed from these characteristics in predicting BP phenotypes, when used in a manner comparable to the application of out-of-office techniques.

Methods: Adult patients with no prior diagnosis of hypertension attending their office appointments, were prospectively enrolled. Their clinical, psychosocial, and occupational data were collected. 3-consecutive pre-appointment BP measurements, and BP variability with standing and the 6-minute walk test (6MWT) were obtained. All participants underwent 24-hour BP monitoring which was paired with office BP as the reference standard for BP phenotyping. Two scores were developed from the variables selected using linear regression analysis to differentiate between masked hypertension (MH) and normotension, and sustained hypertension (SH) and white coat hypertension (WCH).

Results: In total 212 participants completed the study. Among office-normotensives, a score of 7 (calculated from, variables (points): dyslipidemia (3), irritable bowel syndrome (IBS) (3), orthostatic increase in SBP >5 mmHg (1), SBP increase >10 after 6MWT (1), and BP ≥130/80 after 6MWT (3)) identified MH with 90% sensitivity, 86% specificity, 70% positive predictive value (PPV), and 96% negative predictive value (NPV). Conversely, among office-hypertensives, a score of 6 (male sex (2), no IBS (2), ≥3 metabolic syndrome criteria (3), obesity (3), standing BP ≥140/90 (3), BP ≥140/90 after 6MWT (1)) identified SH with 82% sensitivity, 78% specificity, 90% PPV, and 64% NPV.

Conclusions: BP phenotypes correspond to distinct clinical phenotypes and can be predicted with acceptable sensitivity and specificity using BP phenotype scores. This novel approach to BP phenotyping provides an accessible addition, not a replacement, to available out-of-office techniques, particularly useful for screening for MH, and to support office diagnosis of SH when out-of-office measures are unavailable or not tolerated.