Search

Introduction: Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. Thus, regular and accurate measurement of Blood Pressure (BP) is essential for its early diagnosis and follow-up. There is a surge in popularity of digital sphygmomanometer due to its convenience of use and functionality. In contrast, the traditional universally accepted sphygmomanometer is aneroid type, hence there arise a need for comparison of digital and universally accepted Aneroid Sphygmomanometer in terms of agreement and correlation. Aim: To evaluate the agreement and correlation between blood pressure measurement by digital and aneroid sphygmomanometer. Materials and Methods: The clinic based cross-sectional study was conducted in the Out Patient Department (OPD) of Urban Heath Centre, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India. Adults visiting the OPD on two chosen days of the week, between June 2019 to July 2019 were selected using systematic random sampling. A total of 400 participants were included. Agreement and correlation between BP measurements by digital and aneroid sphygmomanometer was analysed by Cohen's Kappa, Bland Altman Plot along with sensitivity, specificity and predictive values using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 16.0. the p-value <0.05 was considered significant for the statistical test in the analysis. Results: Cohen's Kappa value (0.59) revealed these two tools had moderate agreement in diagnosing hypertension. Sensitivity and specificity of digital sphygmomanometer taking aneroid sphygmomanometer as gold standard is 86% and 83.1% respectively. The BP readings of these two-tools showed moderate correlation as Intraclass Correlation Coefficient (ICC) for Systolic BP (SBP) and Diastolic BP (DBP) were 0.804 and 0.624, respectively. Bland Altman plot showed gross disagreement of SBP findings and disagreement between DBP findings was also noted. Conclusion: Digital device was found to be less accurate in detecting hypertension. Therefore, more similar research work is solicited to verify the accuracy of the very easy to use, the Digital BP monitor. [ABSTRACT FROM AUTHOR]

This study identified predictors of appointment adherence and examined its impacts on improvements in metabolic risk factors in a free city-wide cardiovascular disease prevention program in Seoul, South Korea. Data of 8251 citizens with metabolic syndrome were used. Appointment adherers were defined as having 70% or higher adherence rates, that is, 3 or more visits. Of the 8251 citizens, 17.6% were appointment adherers. Appointment adherers were significantly more likely to be older, low-income earners, nonsmokers, and nonobese than appointment nonadherers. Moreover, appointment adherers, compared with nonadherers, showed significant improvements in waist circumference, systolic blood pressure, and high-density lipoprotein cholesterol, but not in fasting glucose and triglycerides. Designing strategies for increasing appointment adherence to a free city-wide cardiovascular disease prevention program is essential to improve health outcomes, especially targeting population groups with young age, high-income, current smoking, or obesity. [ABSTRACT FROM AUTHOR]

BACKGROUND Obesity and hypertension are public health priorities, with obesity considered to be a potential cause of hypertension. Accurate blood pressure (BP) determination is required and often obtained by automated oscillometric cuff devices. We sought to determine the correlation of oscillometric measurement in children, and if obesity was associated with worse correlation between methods than nonobese children. METHODS Retrospective matched case-controlled study of 100 obese (97–99th percentile) and 100 nonobese (25–70th percentile) children after cardiac surgery with simultaneous systolic, diastolic, and mean invasive and oscillometric measurements. Matching was 1:1 for age, sex, race, and Risk Adjustment for Congenital Heart Surgery-1 score. Intraclass correlation coefficients and Bland–Altman plots were used to determine agreement with 0.75 as threshold. RESULTS Median age was 13 years (10–15). Agreement was low for systolic (0.65 and 0.61), diastolic (0.68 and 0.61), and mean measurements (0.73 and 0.69) (obese/nonobese). Bland–Altman plots demonstrated oscillometric BP measurements underestimated systolic hypertension (oscillometric readings lower than intra-arterial). Oscillometric measurements underestimated hypotension (systolic oscillometric measurements were higher than intra-arterial). This occurred in obese and nonobese patients. Correlation of oscillometric measurements was similar for nonobese and obese patients. CONCLUSIONS In this first ever study of simultaneous BP measurement by oscillometric vs. intra-arterial in obese and nonobese children, correlation is below accepted norms. The correlation of oscillometric cuff measurements is not affected by habitus in children. There is less correlation between oscillometric measurements and intra-arterial measurements during hypertension or hypotension. Healthcare providers should be aware of the limitations of oscillometric measurements. [ABSTRACT FROM AUTHOR]

Background : Automated office blood pressure (AOBP) machines measure blood pressure (BP) multiple times over a brief period. We aimed to compare the results of manual office blood pressure (MOBP) and AOBP methods with ambulatory BP monitoring (ABPM) in patients with chronic kidney disease (CKD). Methods : This study was performed on 64 patients with CKD (stages 3-4). A nurse manually measured the BP on both arms using a mercury sphygmomanometer, followed by AOBP of the arm with the higher BP and then ABPM. Mean BP readings were compared by paired t test and Bland-Altman graphs. Results : The mean ± standard deviation (SD) age of participants was 59.3 ± 13.6. The mean ± SD awake systolic BP obtained by ABPM was 140.2 ± 19.0 mmHg, which was lower than the MOBP and AOBP methods (156.6 ± 17.8 and 148.8 ± 18.6 mmHg, respectively; P < 0.001). The mean ± SD awake diastolic BP was 78.6 ± 13.2 mmHg by ABPM which was lower than the MOBP and AOBP methods (88.9 ± 13.2 and 84.1 ± 14.0 mmHg, respectively; P < 0.001). Using Bland-Altman graphs, MOBP systolic BP readings showed a bias of 16.4 mmHg, while AOBP measurements indicated a bias of 8.6 mmHg compared with ABPM. Conclusion : AOBP methods may be more reliable than MOBP methods for determining BP in patients with CKD. However, the significantly higher mean BPs recorded by AOBP method suggested that AOBPs may not be as accurate as ABPM in patients with CKD.

Background Estimating the burden of hypertension in Nigeria hitherto relied on clinic blood pressure (BP) measurement alone. This excludes individuals with masked hypertension (MH), i.e. normotensive clinic but hypertensive out-of-clinic BP. Methods In a nationally representative sample of adult Nigerians, we obtained clinic BP using auscultatory method and out-of-clinic BP by self-measured home BP with semi-automated oscillometric device. Clinic BP was average of 5 consecutive measurements and home BP was average of 3 days duplicate morning and evening readings. MH was clinic BP <140 mm Hg systolic and 90 mm Hg diastolic and home BP ≥135 mm Hg systolic and/or 85 mm Hg diastolic. Results Among 933 participants, the prevalence of sustained hypertension, MH, and white-coat hypertension was 28.3%, 7.9%, and 11.9%, respectively. Among subjects whose clinic BP were in the normotensive range (n = 558), the prevalence of MH was 13%; 12% among untreated and 27% among treated individuals. The mutually adjusted odds ratios of having MH among all participants with normotensive clinic BP were 1.33 (95% confidence interval, 1.10–1.60) for a 10-year higher age, 1.59 (1.09–2.40) for a 10 mm Hg increment in systolic clinic BP, and 1.16 (1.08–1.28) for a 10 mg/dl higher random blood glucose. The corresponding estimates in the untreated population were 1.24 (1.03–1.51), 1.56 (1.04–2.44), and 1.16 (1.08–1.29), respectively. Conclusions MH is common in Nigeria and increasing age, clinic systolic BP, and random blood glucose are the risk factors. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) has seen an upsurge in the past few decades due to changing life style especially in sub-Saharan African countries. Aim: The aim of this study was to determine the prevalence of type 2 DM among men and women above 30 years in the Ho municipality. Subjects and methods: The study involved 202 adults in the Ho Municipality of the Volta Region of Ghana. Body weight and height were determined, and body mass index (BMI) calculated. Venous blood samples were collected after 8 to 12 h of overnight fast into fluoride tube and plasma obtained used for the determination of fasting blood glucose using a spectrophotometer. Hemoglobin A1c (HbA1c) and oral glucose tolerance test (OGTT) were also determined. Socio-demographic data were collected using questionnaire and blood pressure determined using sphygmomanometer. Type 2 DM was defined as Fasting Blood Glucose (FPG) ≥ 7 mmol/L. Results: The prevalence of type 2 DM and pre-diabetes were 6.9% (n = 14) and 17.3% (n = 35), respectively. The prevalence of type DM in the study participants increased from 0% in those between 30 and 39 years to 42% in the aged 40–49 years' group. Its prevalence was 21.4% for both 50-59 and 60-69 year age groups with those aged 70 years and above recording 14.3%. Additionally, 12.5% of alcohol consumers had diabetes mellitus against 7.1% of non-alcohol consumers whiles 14% of those with hypertension had diabetes as against 2.3% of the normotensives. Conclusion: Diabetes prevalence was 6.9% and was higher in older people, people with hypertension, alcohol consumers and abdominally obese men. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Exercise Therapy & Rehabilitation is the property of Yavuz Yakut and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Hypertension is a modifiable risk factor for multiple cardiovascular diseases. Early identification and intervention of new cases are crucial to improve patients' outcomes. May Measurement Month (MMM) is an annual global synchronised blood pressure (BP) screening campaign. Participants can have their BP measured at the screening sites. It may be a possible way to identify undiagnosed hypertensive patients in the population. Methods. It was a cross-sectional study of BP among Hong Kong adults. Multiple screening sites were set in local community pharmacies and on the campus of the Chinese University of Hong Kong. Participants were asked to fill in a questionnaire regarding their demographics, medical history, and social history. Then, they took at least one BP reading using an automated sphygmomanometer after sitting at for 5 minutes. Up to three BP readings were taken and recorded for each participant, with one-minute intervals between readings. Results. A total of 3224 adults participated in MMM between 2017 and 2019. The average BP among the 3224 participants was 139.8/75.5 mmHg. The prevalence of hypertension was 2282 (70.8%), of which 635 (27.8%) were undiagnosed before MMM. Among the 1647 participants previously diagnosed with hypertension, 1007 (61.1%) had uncontrolled hypertension. Conclusion. A high number of cases can be identified with untreated, or treated but uncontrolled, hypertension from MMM. Citizens should be encouraged to check BP regularly and take follow-up actions if hypertension is suspected. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness of the application of topical heat, high pressure or a combination of both on antebrachial venous cannulation. Design: A cross‐over clinical trial blinded for haemolysis analysis. Methods: This cross‐over clinical trial with two periods was performed in the Clinical Trial Unit of Hospital Universitario de La Princesa (Madrid) during June–July of 2017 in 59 healthy adults who were randomly allocated to one of three interventions: (1) Using dry topical heat for 7 min produced by two hot seed bags (N = 21), (2) Applying controlled pressure from a sphygmomanometer inflated to 100 mmHg (N = 18) and (3) combining heat and pressure (N = 20) in one period out of two. All interventions were contrasted to standard clinical practice in the other period. The comparator involved a standard tourniquet around the upper arm to restrict venous blood flow. The primary outcome was effectiveness measured as vein cannulation at first attempt. Secondary outcomes were vein perception, pain, haemolysis in blood samples and adverse events. Results: All the interventions were more effective than comparator. Vein perception was optimized in about all individuals. Moreover, pain relief was significantly higher when high pressure was applied. Haemolysis was not affected in any of the three interventions. In addition, no serious adverse events appeared. Conclusion: High pressure is determined to be the most effective in vein catheterization, pain relief, vein perception and quality of blood sample inalterability. Moreover, it is safe considering that only one adverse event appeared. Impact: Vein cannulation is a very common invasive technique, where repeated failures have been registered. Thus, we consider it relevant to develop interventions to achieve venous catheterization at first attempt to alleviate the pain and anxiety associated with this technique. We advocate using high pressure intervention for emergency, due to swiftest method and feasible in case of lacking resources, such as sphygmomanometers in the ambulance. Interventions can be extrapolated to healthy young adults, adults and patients who have healthy vein status perception. Pressure intervention could be an alternative to heat intervention when performing vein cannulation due to its lower risk of transient paresthesia for older people who often suffer from arterial hypertension. [ABSTRACT FROM AUTHOR]

High systolic blood pressure (BP) is the single leading modifiable risk factor for death worldwide. Accurate BP measurement is the cornerstone for screening, diagnosis, and management of hypertension. Inaccurate BP measurement is a leading patient safety challenge. A recent World Health Organization report has outlined the technical specifications for automated noninvasive clinical BP measurement with cuff. The report is applicable to ambulatory, home, and office devices used for clinical purposes. The report recommends that for routine clinical purposes, (1) automated devices be used, (2) an upper arm cuff be used, and (3) that only automated devices that have passed accepted international accuracy standards (eg, the International Organization for Standardization 81060-2; 2018 protocol) be used. Accurate measurement also depends on standardized patient preparation and measurement technique and a quiet, comfortable setting. The World Health Organization report provides steps for governments, manufacturers, health care providers, and their organizations that need to be taken to implement the report recommendations and to ensure accurate BP measurement for clinical purposes. Although, health and scientific organizations have had similar recommendations for many years, the World Health Organization as the leading governmental health organization globally provides a potentially synergistic nongovernment government opportunity to enhance the accuracy of clinical BP assessment. [ABSTRACT FROM AUTHOR]

High blood pressure (BP) is a strong modifiable risk factor for cardiovascular disease (CVD). Longitudinal BP patterns themselves may reflect the burden of risk and vascular damage due to prolonged cumulative exposure to high BP levels. Current studies have begun to characterize BP patterns as a trajectory over an individual's lifetime. These BP trajectories take into account the absolute BP levels as well as the slope of BP changes throughout the lifetime thus incorporating longitudinal BP patterns into a single metric. Methodologic issues that need to be considered when examining BP trajectories include individual-level vs. population-level group-based modeling, use of distinct but complementary BP metrics (systolic, diastolic, mean arterial, mid, and pulse pressure), and potential for measurement errors related to varied settings, devices, and number of readings utilized. There appear to be very specific developmental periods during which divergent BP trajectories may emerge, specifically adolescence, the pregnancy period, and older adulthood. Lifetime BP trajectories are impacted by both individual-level and community-level factors and have been associated with incident hypertension, multimorbidity (CVD, renal disease, cognitive impairment), and overall life expectancy. Key unanswered questions remain around the additive predictive value of BP trajectories, intergenerational contributions to BP patterns (in utero BP exposure), and potential genetic drivers of BP patterns. The next phase in understanding BP trajectories needs to focus on how best to incorporate this knowledge into clinical care to reduce the burden of hypertensive-related outcomes and improve health equity. [ABSTRACT FROM AUTHOR]

Background: African American (AA) male survivors of strokes or transient ischemic attacks (TIA) have the highest risk of recurrent stroke when compared to other racial-ethnic men. However, there is a paucity of evidence-based strategies, including organizational, educational, or behavioral interventions, that targets secondary stroke risk reduction in AA men. Methods: Targeted Management for Reducing Stroke Risk (TEAM) is an ongoing, 6-month prospective, randomized controlled trial that will determine whether a curriculum-guided self-management approach, using peer dyads (men who had a stroke or TIA and their care partners) will improve post-stroke care in AA men. Results: The study sample will consist of 160 AA men who have experienced a stroke or TIA within 5 years, randomized to TEAM or Wait-list control group. The primary outcome changes in systolic blood pressure (BP) and high-density lipoprotein (HDL), while secondary outcomes include diastolic BP, total cholesterol, low-density lipoprotein, triglycerides, and glycemic control for diabetics. We hypothesize that AA men in TEAM will have significantly lower systolic BP and higher HDL when compared to AA men in the Wait-list control group at 6-month. Conclusion: Persistent disparities for stroke burden in AA men highlight the need for novel interventions to promote secondary stroke-risk reduction. Building on promising pilot data, TEAM uses a group format, with a nurse and patient co-led intervention focused on AA men and family needs, practice in problem-solving, and attention to emotional and role management. In addition, the TEAM approach may help reduce stroke risk factors and health disparities in AA men. Clinicaltrials.gov Identifier: NCT04402125. [ABSTRACT FROM AUTHOR]

Background. Several studies had suggested that complex body stature could be a risk factor of hypertension. Objectives. We aim to correlate body mass index (BMI), waist-hip ratio (WHR), and waist-height ratio (WHtR) of rural dwellers in Afikpo community, Ebonyi State, Nigeria, with blood pressure parameters. Furthermore, we aim to ascertain how each of the anthropometric variables affects blood pressure in men and women, respectively. Materials and Methods. A sample of 400 (200 males and 200 females) adults aged 18–89 years were selected for the correlation cross-sectional study. Data for weight, height, waist, and hip circumferences were collected by means of anthropometric measurement protocol with the aid of a calibrated flexible tape and health scale and mercury sphygmomanometer for measurement of blood pressure. A participant was classified as being hypertensive if systolic blood pressure (SBP) was >140 mmHg and diastolic blood pressure (DBP) >90 mmHg. Pulse pressure was recorded as the numeric difference of SBP and DBP. Results. The result revealed that male BMI and WHR were higher than those of females while female WHtR was higher than that of males (P < 0.01). The prevalence of hypertension failed to correlate with sex among participants in the study (χ2 = 0.567; P < 0.05). Variation in SBP and DBP of both sexes was dependent on BMI, WHtR, and waist and hip circumference, but not on WHR. The SBP of both sexes and female pulse pressure did correlate with age (P < 0.001). Waist circumference, BMI, and WHtR correctly predicted the variations in SBP, DBP, and pulse pressure. Conclusion. The strength of association of BMI, WHtR, and waist girth with SBP and DBP of both sexes was robust and similar, but inconsistent with WHR. Thus, a simple estimation of the trio-anthropometric predictors could serve as a means for routine check or preliminary diagnosis of a patient with hypertension. [ABSTRACT FROM AUTHOR]

Purpose: Wrist-cuff oscillometric blood pressure monitors are very popular in the portable medical device market. However, its accuracy has always been controversial. In addition to the oscillatory pressure pulse wave, the finger photoplethysmography (PPG) can provide information on blood pressure changes. A blood pressure measurement system integrating the information of pressure pulse wave and the finger PPG may improve measurement accuracy. Additionally, a neural network can synthesize the information of different types of signals and approximate the complex nonlinear relationship between inputs and outputs. The purpose of this study is to verify the hypothesis that a wrist-cuff device using a neural network for blood pressure estimation from both the oscillatory pressure pulse wave and PPG signal may improve the accuracy. Design/methodology/approach: A PPG sensor was integrated into a wrist blood pressure monitor, so the finger PPG and the oscillatory pressure wave could be detected at the same time during the measurement. After the peak detection, curves were fitted to the data of pressure pulse amplitude and PPG pulse amplitude versus time. A genetic algorithm-back propagation neural network was constructed. Parameters of the curves were inputted into the neural network, the outputs of which were the measurement values of blood pressure. Blood pressure measurements of 145 subjects were obtained using a mercury sphygmomanometer, the developed device with the neural network algorithm and an Omron HEM-6111 blood pressure monitor for comparison. Findings: For the systolic blood pressure (SBP), the difference between the proposed device and the mercury sphygmomanometer is 0.0062 ± 2.55 mmHg (mean ± SD) and the difference between the Omron device and the mercury sphygmomanometer is 1.13 ± 9.48 mmHg. The difference in diastolic blood pressure between the mercury sphygmomanometer and the proposed device was 0.28 ± 2.99 mmHg. The difference in diastolic blood pressure between the mercury sphygmomanometer and Omron HEM-6111 was −3.37 ± 7.53 mmHg. Originality/value: Although the difference in the SBP error between the proposed device and Omron HEM-6111 was not remarkable, there was a significant difference between the proposed device and Omron HEM-6111 in the diastolic blood pressure error. The developed device showed an improved performance. This study was an attempt to enhance the accuracy of wrist-cuff oscillometric blood pressure monitors by using the finger PPG and the neural network. The hardware framework constructed in this study can improve the conventional wrist oscillometric sphygmomanometer and may be used for continuous measurement of blood pressure. [ABSTRACT FROM AUTHOR]

Screening strategies to diagnose previously undetected atrial fibrillation (AF), especially silent AF (SAF), in at-risk populations may help reduce the number of strokes. We prospectively assessed the incidence rate of AF, including SAF, using an automated AF-detection capable sphygmomanometer in the General Practitioner (GP) setting. This was a population-based prospective study of unselected general population of ≥65 years without prior AF. Participating GPs were requested, in the period February 2018–April 2019, to record all AF diagnoses including those derived from the AF-detection capable sphygmomanometer and confirmed by 12‑lead ECG or ECG Holter in asymptomatic patients. Overall, 14,987 patients assisted by 76 GPs accumulated 16,838 patient-years of follow up. The incidence rate of AF was 2.25% patient-years (95%CI 2.03–2.48). AF was more frequently detected in male, older, overweight, and patients with prior stroke, congestive heart failure, and chronic kidney disease. One in four patients had device-detected SAF (0.56% patient-years, 95%CI 0.46–0.69). Age, overweight, and the number of annual visits, were independent predictors of both SAF and AF. In addition, congestive heart failure, mitral valve disease were independent predictors of AF. Due to the interaction between blood pressure and age the risk of AF increased exponentially after 75 years of age in patients with higher systolic blood pressure values. We found a higher than previously reported incidence rate of AF possibly by capturing SAF. Our simple protocol might be feasible in large-scale screening for AF and SAF in routine GP care. Large scale screening of an at-risk population in the general practitioner setting using an automated rhythm detection blood pressure monitor, revealed an incidence rate of overall AF of 2.25% patient-years, with 25% of patients being asymptomatic for AF related symptoms Unlabelled Image • Stroke incidence can be substantially reduced by early detection of unknown AF. • AF may be symptomatic or asymptomatic and both carry an increased risk of stroke. • Population screening of AF has not been implemented for cost-effectiveness concerns. • Rhythm-detection devices may aid in diagnosis of AF without impacting routine GP. [ABSTRACT FROM AUTHOR]

Objective: To estimate the uncertainty in the calibration of sphygmomanometers according to OIML R16-1 from a legal metrology perspective. Materials and methods: Four (4) sphygmomanometers of different brands with a resolution of 2 mmHg were selected to perform the calibration, using several direct comparisons between a sphygmomanometer and a digital standard manometer with a resolution of 0.01 mmHg, generating pressure with a pneumatic clamp. The uncertainty was estimated using the Guide to the Expression of Uncertainty in Measurement (GUM) and the OIML R16-1 international recommendation. Two measurement series were computed, each with upward and decent sequence, to achieve 4 measurements each time with the corresponding errors. Results and discussion: Several uncertainty representations were achieved, in particular expressions such as type A, type B, and expanded, employing a physic modeling and a non-stochastic mathematic model. From the sphygmomanometer measurement series in calibration processes, the uncertainty contributions were analyzed, finding that the dominant uncertainty source, in most cases, is derived from the equipment resolution, followed by repeatability and hysteresis in the sphygmomanometer test processes. Conclusions: The proposed structure for estimating uncertainty follows international regulations and can be used in procedures for approval of models with a final impact on patient safety. [ABSTRACT FROM AUTHOR]

Background and Objectives: Blood pressure (BP) measurement using an auscultatory sphygmomanometer is recommended for diagnosing hypertension in children. As mercury sphygmomanometers (MSs) are banned owing to environmental concerns, it is crucial to determine the accuracy of mercury-free sphygmomanometers to replace them. We analyzed the accuracy of these devices to guide the National Survey selection., Methods: BP was measured thrice each with MS, auscultatory device (AD), and oscillometric device (OD) in 104 participants aged 10-18 using the National Survey data. The difference in BP was defined as the difference between MS and other devices. The BP differences, correlations, and influencing factors were analyzed. The frequencies of hypertension were also compared., Results: Systolic BP (SBP) and diastolic BP (DBP) differences between MS and AD were 0.88±3.36 mmHg and 0.63±3.95 mmHg, and those between MS and OD were 0.43±5.83 mmHg and 4.57±6.89 mmHg, respectively. The absolute error of <10 mmHg for DBP between MS and OD was 76%. The concordance correlation coefficient between MS and AD was 0.94 for SBP and 0.90 for DBP, and 0.81 and 0.67, respectively for MS and OD. Arm circumference negatively correlated with BP differences except for SBP between the MS and OD. The frequency of hypertension was not different between MS and AD but was underestimated by OD., Conclusions: AD correlated well with MS, while OD did not, especially for DBP. The superiority of AD over OD suggests AD as a possible alternative for MS in the National Survey., Competing Interests: The authors have no financial conflicts of interest., (Copyright © 2024. The Korean Society of Cardiology.)

Background: Self-measured blood pressure (SMBP) monitoring is increasingly used for remote hypertension management, but the real-world performance of home blood pressure (BP) devices is unknown. We examined BP measurements from patients' home devices using the American Medical Association's (AMA) SMBP Device Accuracy Test tool., Methods: Patients at a single internal medicine clinic underwent up to five seated, same-arm BP readings using a home device and an automated BP device (Omron HEM-907XL). Following the AMA's three-step protocol, we used the patient's home device for the first, second, and fourth measurements and the office device for the third and fifth (if needed) measurements. Device agreement failure was defined as an absolute difference in systolic BP >10 mm Hg between the home and office devices in either of two confirmatory steps. Performance was examined by brand (Omron vs. non-Omron). Moreover, we examined patient factors associated with agreement failure via logistic regression models adjusted for demographic characteristics., Results: We evaluated 152 patients (mean age 60 ± 15 years, 58% women, 31% Black) seen between October 2020 and November 2021. Device agreement failure occurred in 22.4% (95% CI: 16.4%, 29.7%) of devices tested, including 19.1% among Omron devices and 27.6% among non-Omron devices (P = 0.23). No patient characteristics were associated with agreement failure., Conclusions: Over one-fifth of home devices did not agree based on the AMA SMBP device accuracy protocol. These findings confirm the importance of office-based device comparisons to ensure the accuracy of home BP monitoring., (© The Author(s) 2023. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd.)

Objective: To validate the ANDON KD-595 automated upper-arm blood pressure monitor for clinical use and self-measurement blood pressure measurement according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard., Methods: Same left-arm blood pressure was sequentially measured in 90 qualified adult participants and compared with a standard mercury sphygmomanometer. A total of 270 comparison pairs were obtained and analyzed according to the universal standard., Results: For the validation Criterion 1 of the universal standard, the mean ± SD of the differences between the test device and reference blood pressure readings was 0.96 ± 5.35 and 0.82 ± 5.08 mmHg for SBP and DBP, respectively. For Criterion 2, the SDs of the averaged blood pressure differences between the test device and reference blood pressure per subject were 4.84 and 4.64 mmHg (with maximum allowed SDs of 6.87 and 6.89 mmHg) for SBP and DBP, respectively., Conclusion: The ANDON KD-595 automated upper-arm blood pressure monitor passed all the validation requirements according to the AAMI/ESH/ISO Universal Standard and can be recommended for clinical use and self-measurement blood pressure measurement in the general population., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To evaluate the accuracy of the Wellvii VitalDetect automated oscillometric finger blood pressure monitor (single cuff size) for self/home blood pressure measurement according to the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018)., Methods: According to the universal standard, a total of 92 participants were recruited and finally blood pressure of 85 eligible participants was sequentially measured and compared with a standard mercury sphygmomanometer., Results: A total of 255 comparison pairs were obtained and analyzed based on the universal standard. For the validation criterion 1 of the ISO 81060-2:2018 universal standard, the mean ± SD of the differences between the test device and reference blood pressure readings was 1.66 ± 7.67 and 1.04 ± 6.45 mmHg for systolic and diastolic blood pressure, respectively. For criterion 2, the SD of the averaged blood pressure differences between the test device and reference blood pressure per subject was ± 6.49 mmHg (pass ≤ 6.73 mmHg) and ± 5.67 mmHg (pass ≤ 6.86 mmHg) for systolic and diastolic blood pressure, respectively., Conclusion: The Wellvii VitalDetect automated finger blood pressure monitor passed all the requirements for validation by the ISO 81060-2:2018 universal standard and can be recommended for self/home blood pressure measurement in general population., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: There is an increasing number of cuffless blood pressure (BP) measurement (BPM) devices. Despite promising results when comparing single measurements, the ability of these devices to track changes in BP levels over 24 h related to an initial calibration BP (CalibBP) is unknown. Our aim was to analyse this ability in a cuffless device using pulse transit time., Methods: We prospectively enrolled 166 participants for simultaneously performed cuffless (Somnotouch-NIBP) and cuff-based (Spacelabs 90217A/IEM Mobil-O-graph) 24 h BPM. As CalibBP for the cuffless device, first cuff-based BP was used. As surrogate for changes in BP levels after the CalibBP, we used the difference between the CalibBP and mean 24 h, awake and asleep BP measured by the two devices. In addition, we analysed the relationship between the difference of the CalibBP and the cuff-based BPM versus the difference between the cuff-based and the cuffless BPM devices., Results: Mean(SD) difference between the CalibBP and mean 24hBP by the cuff-based or cuffless BP device were 7.4 (13.2) versus 1.8 (8.3) mmHg for systolic ( P  < 0.0001) and 6.6 (6.8) versus 1.6 (5.8) mmHg for diastolic ( P  < 0.0001). A near linear relationship was seen among the difference between the CalibBP and the cuff-based BPM values and the difference between the cuff-based and cuffless BPM device., Conclusion: Our data indicate a lower ability of the cuffless BPM device to track changes of BP levels after CalibBP. In addition, cuffless device accuracy was associated with the changes in BP levels after the initial CalibBP - the larger the BP level change, the larger the difference between the devices., Registration: https://www.clinicaltrials.gov ; Unique identifier: NCT03054688; NCT03975582., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

The aim of this study was to investigate that inter-arm blood pressure (BP) difference (IAD) and reference arm in 420 post-stroke patients with hemiparesis. Synchronous bilateral-arm BP was measured with two automatic BP devices, and the systolic BP difference of ≥10 mm Hg was recorded as increased sIAD. The arm with higher systolic BP (SBP) was assigned as the reference arm. Our results showed that the prevalence of sIAD was 18.1% in the total group. The paretic arms had similar mean SBP levels (133.6±18.4 vs. 133.8±18.4 mm Hg, NS) and DBP (77.8±11.5 vs. 77.2±10.9 mm Hg, NS) as compared with the unaffected arms. The detection rate of hypertension or uncontrolled hypertension on the SBP values of the reference arm was higher than that on the unaffected arm (41.8% vs. 36.3%). It is concluded that in the post-stroke patients with hemiparesis in the rehabilitation period, the prevalence of sIAD ≥10 mmHg was relatively higher, and using the unaffected arm, rather than the unaffected arm, for BP measurement could induce correctly detection of hypertension., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Keywords: blood pressure; blood pressure monitors; quality improvement EN blood pressure blood pressure monitors quality improvement 94 96 3 01/20/22 20220111 NES 220111 Renal-Electrolyte and Hypertension Division (J.B.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia. Blood pressure, quality improvement, blood pressure monitors. [Extracted from the article]

Only minimal attention has been given to analyzing interactional moments when patients and providers talk about "pain" in general consultations and primary care, and no attention has focused on how pain gets managed during oncology interviews. Conversation analysis (CA) is used to examine a sampling of instances drawn from a collection of 146 pain instances across 65 video recorded and transcribed clinical encounters in a comprehensive cancer clinic. Specific attention is drawn to how pain descriptions are not static but malleable as cancer patients upgrade, downgrade, and produce combined orientations when making their experiences available to oncologists. In response, it is shown that doctors acknowledge patients' descriptions, but do not elaborate nor affiliate with, important pain disclosures. Three interactional environments are closely examined: 1) Reporting and responding to past pain/hurt incidents; 2) Doctor's missing assessments in response to good news announcements about patients' minimal pain; and 3) Patient-initiated pain responses to doctors' questions. These empirical findings confirm identified patterns of interactional asymmetries comprising pain events in UK consultations and USA primary care. Close examination of these social actions provides basic knowledge about how pain communication reframes historical understandings of individuals' pain experiences. Implications for future research are identified, and a protocol is described for how clinical practice and medical education can be improved by refining understandings of pain communication to promote increased sensitivities and more personalized responses to pain expressions. [ABSTRACT FROM AUTHOR]

Objectives Objectively measuring pain sensitivity has not been easy in primary care clinics. A sphygmomanometer test (a sensory test that measures an individual's nociceptive response to pressure using a standard blood pressure cuff) has recently been established to test pain sensitivity. Here, we examined the feasibility of using the sphygmomanometer test with chronic pain patients. Design Population, observational study. Settings A community hospital multidisciplinary Pain Center and a private nonprofit university. Subjects Healthy controls and chronic pain patients were recruited. Methods All subjects underwent four pain sensitivity tests: a pressure algometer test, a cold pressure test, a heat sensitivity test, and a sphygmomanometer test. Participants then completed four established surveys for evaluating depression (Patient Health Questionnaire–9), anxiety (General Anxiety Disorder–7), fatigue (Fatigue Severity Scale), and pain catastrophizing (Pain Catastrophizing Scale). Results Although pain patients had significantly higher levels of depression, anxiety, fatigue, and pain catastrophizing, as well as reported pain scores, no significant differences in pain sensitivity were detected via any of the pain sensitivity tests. In the control but not the patient group, results from all pain sensitivity tests including the sphygmomanometer test were significantly correlated with each other. Unlike other pain sensitivity tests, the sphygmomanometer test did not correlate with measures of depression, anxiety, fatigue, or pain catastrophizing characteristics. Conclusions Our results indicate the unique characteristics of the sphygmomanometer test as a pain sensitivity test, particularly when utilized for individuals with chronic pain. Multiple pain sensitivity tests that assess various sensory modalities are needed to evaluate pain sensitivities in chronic pain patients. [ABSTRACT FROM AUTHOR]

Background The U.S. Preventive Services Task Force recommends the use of 24-hour ambulatory blood pressure monitoring (ABPM) as part of screening and diagnosis of hypertension. The optimal ABPM device for population-based surveys is unknown. Methods We compared the proportion of valid blood pressure (BP) readings, mean awake and asleep BP readings, differences between awake ABPM readings and initial standardized BP readings, and sleep experience among three ABPM devices. We randomized a convenience sample of 365 adults to 1 of 3 ABPM devices: Welch Allyn Mobil-O-Graph (WA), Sun Tech Classic Oscar2 (STO) and Spacelabs 90227 (SL). Participants completed sleep quality questionnaires on the nights before and during ABPM testing. Results The proportions of valid BP readings were not different among the 3 devices (P > 0.45). Mean awake and asleep systolic BP were significantly higher for STO device (WA vs. STO vs. SL: 126.65, 138.09, 127.44 mm Hg; 114.34, 120.34, 113.13 mm Hg; P < 0.0001 for both). The difference between the initial average standardized mercury systolic BP readings and the ABPM mean awake systolic BP was larger for STO device (WA vs. STO. vs. SL: –5.26, –16.24, –5.36 mm Hg; P < 0.0001); diastolic BP mean differences were ~ –6 mm Hg for all 3 devices (P = 0.6). Approximately 55% of participants reported that the devices interfered with sleep; however, there were no sleep differences across the devices (P > 0.4 for all). Conclusion Most of the participants met the threshold of 70% valid readings over 24 hours. Sleep disturbance was common but did not interfere with completion of measurement in most of the participants. [ABSTRACT FROM AUTHOR]

Prevention and treatment of hypertension (HTN) are a challenging public health problem. Recent evidence suggests that artificial intelligence (AI) has potential to be a promising tool for reducing the global burden of HTN, and furthering precision medicine related to cardiovascular (CV) diseases including HTN. Since AI can stimulate human thought processes and learning with complex algorithms and advanced computational power, AI can be applied to multimodal and big data, including genetics, epigenetics, proteomics, metabolomics, CV imaging, socioeconomic, behavioral, and environmental factors. AI demonstrates the ability to identify risk factors and phenotypes of HTN, predict the risk of incident HTN, diagnose HTN, estimate blood pressure (BP), develop novel cuffless methods for BP measurement, and comprehensively identify factors associated with treatment adherence and success. Moreover, AI has also been used to analyze data from major randomized controlled trials exploring different BP targets to uncover previously undescribed factors associated with CV outcomes. Therefore, AI-integrated HTN care has the potential to transform clinical practice by incorporating personalized prevention and treatment approaches, such as determining optimal and patient-specific BP goals, identifying the most effective antihypertensive medication regimen for an individual, and developing interventions targeting modifiable risk factors. Although the role of AI in HTN has been increasingly recognized over the past decade, it remains in its infancy, and future studies with big data analysis and N -of-1 study design are needed to further demonstrate the applicability of AI in HTN prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: The limb occlusion pressure (LOP) is determined to calculate the relative LOP. The different levels of relative LOP (percentage of LOP) influence the treatment effect and perceived discomfort during low-load blood flow restriction (BFR) strength training. Thus, determining the LOP is of the utmost importance when using BFR in clinical practice. Purpose: The objective of this study was to investigate the concurrent validity and intra-rater (test-retest), intra-day reliability of an inexpensive, portable, easy-to-use handheld (HH) oximeter compared to a high-resolution Doppler ultrasound scanner in detecting LOP in the lower extremity. Study design: Cross-sectional validity and reliability study Methods: Two raters who were blinded from each other simultaneously assessed 50 healthy participants (mean age of 25.8 years). A 20 cm-wide thigh cuff with an attached sphygmomanometer was inflated until the raters independently registered the LOP with the HH oximeter and the Doppler ultrasound scanner. The test session was repeated once after a five-minute time interval. Results: The HH oximeter recorded a non-significantly higher LOP than the Doppler ultrasound scanner, with a mean difference of 6.3 mmHg in the test session (95% limits of agreement (LoA): -16.2 to 28.8, p = 0.13) and 5.4 mmHg in the retest session (95% LoA: -13.3 to 24.0, p = 0.10). The intra-rater reliability for both devices was moderate (ICC = 0.72-0.79). The measured LOP was significantly lower (p < 0.005) in the retest session than in the test session for both the HH oximeter (mean difference: -5.7 mmHg) and the Doppler ultrasound scanner (mean difference: -4.8 mmHg). Conclusions: The HH oximeter is a valid and reliable measuring device for determining the LOP in the lower extremity in healthy adults. The authors recommend performing at least two LOP measurements with a one-minute rest interval. [ABSTRACT FROM AUTHOR]

Introduction: The hypertension incidences in the elderly does not only cause stroke but also an increase in the mortality rate. The elderly who suffer from hypertension require further therapy to lower their blood pressure levels. One of the self-therapies that nurses can provide to hypertensive patients is deep breathing therapy. This study aims to determine the effects of deep breathing therapy in the elderly with hypertension. Method: This study employed a quasi-experimental research design with two groups of pretest-posttest design. A total of 12 research samples were divided into two groups: the treatment group and the control group, each group consisted of six respondents. The research instruments utilized were a questionnaire, SOP (Standard Operating Procedure) of breathing techniques, blood pressure measurement tools (sphygmomanometer and stethoscope) and observation sheets on blood pressure measurement. The data were analyzed using paired t-test and independent t-test. Results: All of the respondents in the study were women aged 55 years old or older. The mean value of systolic blood pressure before being given the intervention was 158.33 mmHg in the treatment group and 157.69 mmHg in the control group. The analysis with an Independent t-test between the control group and the treatment group indicated p = 0.002 (α<0.05) as the difference in systolic blood pressure between the two groups. The treatment group experienced a drop in blood pressure by 10-30 mmHg. Conclusion: Deep breathing therapy effectively reduces blood pressure in the elderly with hypertension by consistent interventions for seven consecutive days. [ABSTRACT FROM AUTHOR]

Background: A wrist‐cuff automated oscillometric device is portable and useful for self‐monitoring of blood pressure (BP) at home and outdoors when an upper arm device is not available. Although the height of the forearm in wrist BP measurement is acknowledged to be the major cause of measurement error, it remains unclear whether exercise affects subsequent wrist BP measurement. Methods and Results: Ninety‐seven healthy college students (median age of 20 years with an age range of 19 to 36 years, 70.1% males) participated in this study. Care was taken to keep the position of the wrist at a level near the upper arm level in BP measurement. At rest, BP measured by a wrist‐cuff oscillometric device (Omron HEM‐6183) was generally acceptable when it was compared with BP measured by an upper arm oscillometric device (Omron HEM‐7130‐HP) and with BP measured by the auscultatory method using a mercury sphygmomanometer. However, the ratio of systolic BP measured by oscillometric devices just after a two‐step exercise test to that before exercise on the wrist (1.22 ± 0.14) was significantly lower than the ratio on the upper arm (1.27 ± 0.14), and the difference was significantly correlated with exercise‐induced increase in pulse rate (Spearman's ρ = 0.23), suggesting a possible role of autonomic nerve activity in the blunted response to exercise‐induced BP elevation in wrist BP measurement. Conclusions: The results indicate that the blunted response to exercise‐induced BP elevation should be considered in wrist BP measurement when using a wrist‐cuff oscillometric device. [ABSTRACT FROM AUTHOR]

Background: Detecting the suitable non-invasive Blood Pressure (BP) measurement method is a quandary in clinical settings for accurate diagnosis of Hypertension (HTN) status. Objectives: This study aimed to evaluate the efficiency of indirect BP measurement methods in comparison to the gold standard among Iranian patients admitted for Coronary Angiography (CAG). Methods: This observational study was conducted on 150 CAG candidates randomly selected using the computerized random numbers from March 2019 to September 2019. The participants' BPs were measured via three different non-invasive methods, including brachial and wrist oscillometric cuffs plus brachial sphygmomanometer, and the results were compared to simultaneous intra-arterial reading as the gold standard. The associations between different non-invasive BP measurements and direct arterial BP reading were assessed using different statistical analyses, including correlation coefficient, chi-square, independent and paired t-test, and Analysis of Variance (ANOVA), as appropriated. Results: The mean age of the participants was 60.56 ± 11.16 years. Both Systolic BP (SBP) and Diastolic BP (DBP) were positively correlated to the gold standard reading in all measurement methods (P < 0.001). After adjustment for potential confounders, the findings revealed no significant difference between the pre-defined BP measurement methods, including brachial sphygmomanometer, brachial oscillometric, and wrist oscillometric, and intra-arterial BP reading regarding the means of SBP and DBP (P > 0.05). Conclusions: The present study findings showed that the selected solution was appropriate in terms of clinical aspects for the patients undergoing CABG surgery with long surgical duration or low Ejection Fraction (EF) and reduced the costs to half. Considering the significant difference in the CK-MB level and the lower troponin level in the combined group (not statistically significant), further studies are required to confirm the clinical priority of the combined solution. [ABSTRACT FROM AUTHOR]

Background: Home blood-pressure (BP) monitoring is recommended in guidelines and is increasingly popular with patients and health professionals, but the accuracy of patients' own monitors in real-world use is not known.Aim: To assess the accuracy of home BP monitors used by people with hypertension, and to investigate factors affecting accuracy.Design and Setting: Cross-sectional, observational study in urban and suburban settings in central England.Method: Patients (n = 6891) on the hypertension register at seven practices in the West Midlands, England, were surveyed to ascertain whether they owned a BP monitor and wanted it tested. Monitor accuracy was compared with a calibrated reference device at 50 mmHg intervals between 0-280/300 mmHg (static pressure test); a difference from the reference monitor of +/-3 mmHg at any interval was considered a failure. Cuff performance was also assessed. Results were analysed by frequency of use, length of time in service, make and model, monitor validation status, purchase price, and any previous testing.Results: In total, 251 (76%, 95% confidence interval [95% CI] = 71 to 80%) of 331 tested devices passed all tests (monitors and cuffs), and 86% (CI] = 82 to 90%) passed the static pressure test; deficiencies were, primarily, because of monitors overestimating BP. A total of 40% of testable monitors were not validated. The pass rate on the static pressure test was greater in validated monitors (96%, 95% CI = 94 to 98%) versus unvalidated monitors (64%, 95% CI = 58 to 69%), those retailing for >£10 (90%, 95% CI = 86 to 94%), those retailing for ≤£10 (66%, 95% CI = 51 to 80%), those in use for ≤4 years (95%, 95% CI = 91 to 98%), and those in use for >4 years (74%, 95% CI = 67 to 82%). All in all, 12% of cuffs failed.Conclusion: Patients' own BP monitor failure rate was similar to that demonstrated in studies performed in professional settings, although cuff failure was more frequent. Clinicians can be confident of the accuracy of patients' own BP monitors if the devices are validated and ≤4 years old. [ABSTRACT FROM AUTHOR]