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Kontogiorgos I, Georgianos PI, Tsikliras NC, Leonidou K, Vaios V, Roumeliotis S, Karpetas A, Kantartzi K, Panagoutsos S, Liakopoulos V. The association of home blood pressure with all-cause mortality in hemodialysis patients: A prospective observational study. Ther Apher Dial 2024. [PMID: 38742273 DOI: 10.1111/1744-9987.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/16/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Prior observational studies conducted in the hemodialysis population have suggested a reverse association between dialysis-unit blood pressure (BP) and mortality. The present study aimed to investigate the prognostic association of home versus dialysis-unit BP with all-cause mortality in hemodialysis patients. METHODS At baseline, 146 patients receiving maintenance hemodialysis underwent assessment of their BP with the following methods: (i) 2-week averaged routine predialysis and postdialysis BP measurements; (ii) home BP monitoring for 1 week that included duplicate morning and evening BP measurements with the use of validated devices. RESULTS Over a median follow-up period of 38 months (interquartile range [IQR]: 22-54), 44 patients (31.1%) died. In Kaplan-Meier curves, predialysis and postdialysis systolic BP (SBP) was not associated with all-cause mortality, while home SBP appeared to be of prognostic significance (log rank p = 0.029). After stratifying patients into quartiles, all-cause mortality was lowest when home SBP was ranging from 128.1 to 136.8 mmHg (quartile 2). In univariate Cox regression analysis, using quartile 2 as a referent category, the risk of all-cause mortality was 3.32-fold higher in quartile 1, 1.53-fold higher in quartile 3 and 3.25-fold higher in quartile 4. The risk-association remained unchanged after adjustment for several confounding factors (adjusted hazard ratio: 4.79, 1.79, 3.63 for quartiles 1, 3, and 4 of home systolic BP, respectively). CONCLUSION Our findings suggest that among hemodialysis patients, 1-week averaged home SBP is independently associated with all-cause mortality. In sharp contrast, SBP recorded either before or after dialysis over 2 weeks is not prognostically informative.
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Affiliation(s)
- Ioannis Kontogiorgos
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis I Georgianos
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Kallistheni Leonidou
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilios Vaios
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Roumeliotis
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Konstantia Kantartzi
- Department of Nephrology, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kim Y, Park SH, Shin J, Sung K, Ihm S, Kim SH, Kim D, Park SM, Cho IJ, Oh KW, Lee EM. Comparisons of an automated oscillometric device with a hybrid manual auscultatory device for the Korea National Health and Nutrition Examination Survey. J Clin Hypertens (Greenwich) 2024; 26:532-542. [PMID: 38552166 PMCID: PMC11088422 DOI: 10.1111/jch.14805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 02/25/2024] [Accepted: 03/07/2024] [Indexed: 05/12/2024]
Abstract
This study evaluated an oscillometric device (OD), Microlife WatchBP Office AFIB, and a hybrid manual auscultatory device (AD), Greenlight 300TM, to determine a suitable blood pressure (BP) measurement device for the Korea National Health and Nutrition Examination Survey in a mercury-free context. Adhering to the 2018 Universal Standard's suggested consensus, the study involved 800 subjects (mean age 51.2 ± 17.5 years; 44.3% male), who underwent triplicate BP measurements following 5 min of rest in a randomized order (OD-first: 398 participants; AD-first: 402 participants). BP difference was calculated as OD value minus AD value, with results stratified by measurement sequence. The overall BP difference and tolerable error probability were -1.1 ± 6.5/-2.6 ± 4.9 mmHg and 89.2%/92.5% for systolic/diastolic BP (SBP/DBP), respectively. Lin's concordance correlation coefficient was 0.907/0.844 for SBP/DBP (OD-first/AD-first: 0.925/0.892 for SBP, 0.842/0.845 for DBP). The overall agreement for hypertension (BP ≥ 140 and/or 90 mmHg) was 0.71 (p < 0.0001), and the OD underestimated the overall hypertension prevalence by 5.1%. Analysis of the AD-first data revealed a lower level of agreement compared to the OD-first data; however, the observed blood pressure difference adhered to Criterion 1 of the 2018 Universal Standard. Microlife met the Criterion 1 of 2018 Universal Standard but underestimated the prevalence of hypertension. The BP discrepancy increased with higher BP levels, male sex, and smaller AC. With increasing age, the discrepancy decreased for SBP and increased for DBP.
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Affiliation(s)
- Yu‐Mi Kim
- Department of Preventive MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
- Graduate School of Public HealthHanyang UniversitySeoulRepublic of Korea
| | - Sang Hyeon Park
- Division of CardiologyDepartment of Internal MedicineWonkwang University Sanbon HospitalGunpoGyeonggi‐doRepublic of Korea
| | - Jinho Shin
- Division of CardiologyDepartment of Internal MedicineCollege of MedicineHanyang UniversitySeoulRepublic of Korea
| | - Ki‐Chul Sung
- Division of CardiologyDepartment of Internal MedicineKangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Sang‐Hyun Ihm
- Division of CardiologyDepartment of Internal MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Seong Heon Kim
- Department of PediatricsSeoul National University Children's HospitalSeoulRepublic of Korea
| | - Dae‐Hee Kim
- Cardiac Imaging CenterAsan Medical Center Heart InstituteUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Sang Min Park
- Divison of CardiologyDepartment of Internal MedicineNowon Eulji Medical CenterEulji University College of MedicineSeoulRepublic of Korea
| | - In Jeong Cho
- Division of CardiologyDepartment of Internal MedicineEwha Womans University Seoul HospitalEwha Womans University College of MedicineSeoulRepublic of Korea
| | - Kyung Won Oh
- Division of Health and Nutrition SurveyKorea Disease Control and Prevention AgencyOsong‐eupRepublic of Korea
| | - Eun Mi Lee
- Division of CardiologyDepartment of Internal MedicineWonkwang University Sanbon HospitalGunpoGyeonggi‐doRepublic of Korea
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Guo N, Zhang Y, Chen W, Zhong H, Li L, Xie H, Zhu W, Liu J, Li S. Validation of the Mindray VS9 Vital Signs Monitor in a combined adult and pediatric population according to ISO Standard 81060-2:2018. Blood Press Monit 2024:00126097-990000000-00106. [PMID: 38523458 DOI: 10.1097/mbp.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
We aimed to validate the accuracy of the Mindray VS9 Vital Signs Monitor, which features the Mindray TrueBP inflation algorithm for oscillometric blood pressure (BP) measurement, to check if it complies with the International Organization for Standardization Standard (ISO 81060-2:2018) in a combined adult and pediatric population. A total of 86 participants, including both adult and pediatric subjects, were recruited. The distribution of their ages, gender, BPs and limb sizes all complied with the requirement of the ISO standard. The inflation and deflation algorithms were validated independently using the same-arm sequential BP measurement method. For each subject, the BP was first determined by two independent observers using a mercury sphygmomanometer (R1). The BP of the subject was then determined by the third observer using the test equipment (T1). Then, using a mercury sphygmomanometer, two independent observers were asked to determine the subject's BP (R2) again. R1-T1-R2 were considered a valid pair of data. This cycle continued until 3 pairs of valid data were achieved. We collected 258 pairs of valid BP data for the validation of the inflation and deflation algorithms respectively. For validation Criterion 1, the mean ± SD of the differences between the readings obtained from the test device and reference BP was 0.0 ± 6.6/-1.8 ± 7.1 mmHg (systolic/diastolic) when the deflation algorithm was used, and 2.4 ± 6.3/ 0.3 ± 6.9 mmHg (systolic/diastolic) when the inflation algorithm was used. For validation Criterion 2, the SD of the averaged BP differences between the test device and the reference BP per subject was 5.35/6.33 mmHg (systolic/diastolic) when the deflation algorithm was used, and 5.17/5.75 mmHg (systolic/diastolic) when the inflation algorithm was used. The VS9 Vital Signs Monitor fulfilled all the criteria in the ISO Standard. Moreover, the inflation algorithm had a shorter Measure Time (by 7-21 s) and lower maximum inflation pressure (by 9.7-22 mmHg). The VS9 Vital Signs Monitor fulfilled all the requirements of the ISO Standard (ISO 81060-2:2018) in a combined adult and pediatric population and is recommended for clinical use.
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Affiliation(s)
- Na Guo
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Yihan Zhang
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Weiqiang Chen
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Hexian Zhong
- Shenzhen Mindray Bio-medicical Electronics Co., LTD., Shenzhen, Guangdong, China
| | - Liping Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Hanbin Xie
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Wenxiu Zhu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Jun Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Shangrong Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
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Bakris GL, Saxena M, Gupta A, Chalhoub F, Lee J, Stiglitz D, Makarova N, Goyal N, Guo W, Zappe D, Desai AS. RNA Interference With Zilebesiran for Mild to Moderate Hypertension: The KARDIA-1 Randomized Clinical Trial. JAMA 2024; 331:740-749. [PMID: 38363577 PMCID: PMC10873804 DOI: 10.1001/jama.2024.0728] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 02/17/2024]
Abstract
Importance Angiotensinogen is the most upstream precursor of the renin-angiotensin-aldosterone system, a key pathway in blood pressure (BP) regulation. Zilebesiran, an investigational RNA interference therapeutic, targets hepatic angiotensinogen synthesis. Objective To evaluate antihypertensive efficacy and safety of different zilebesiran dosing regimens. Design, Setting, and Participants This phase 2, randomized, double-blind, dose-ranging study of zilebesiran vs placebo was performed at 78 sites across 4 countries. Screening initiation occurred in July 2021 and the last patient visit of the 6-month study occurred in June 2023. Adults with mild to moderate hypertension, defined as daytime mean ambulatory systolic BP (SBP) of 135 to 160 mm Hg following antihypertensive washout, were randomized. Interventions Randomization to 1 of 4 subcutaneous zilebesiran regimens (150, 300, or 600 mg once every 6 months or 300 mg once every 3 months) or placebo (once every 3 months) for 6 months. Main Outcomes and Measures The primary end point was between-group difference in least-squares mean (LSM) change from baseline to month 3 in 24-hour mean ambulatory SBP. Results Of 394 randomized patients, 377 (302 receiving zilebesiran and 75 receiving placebo) comprised the full analysis set (93 Black patients [24.7%]; 167 [44.3%] women; mean [SD] age, 57 [11] years). At 3 months, 24-hour mean ambulatory SBP changes from baseline were -7.3 mm Hg (95% CI, -10.3 to -4.4) with zilebesiran, 150 mg, once every 6 months; -10.0 mm Hg (95% CI, -12.0 to -7.9) with zilebesiran, 300 mg, once every 3 months or every 6 months; -8.9 mm Hg (95% CI, -11.9 to -6.0) with zilebesiran, 600 mg, once every 6 months; and 6.8 mm Hg (95% CI, 3.6-9.9) with placebo. LSM differences vs placebo in change from baseline to month 3 were -14.1 mm Hg (95% CI, -19.2 to -9.0; P < .001) with zilebesiran, 150 mg, once every 6 months; -16.7 mm Hg (95% CI, -21.2 to -12.3; P < .001) with zilebesiran, 300 mg, once every 3 months or every 6 months; and -15.7 mm Hg (95% CI, -20.8 to -10.6; P < .001) with zilebesiran, 600 mg, once every 6 months. Over 6 months, 60.9% of patients receiving zilebesiran had adverse events vs 50.7% patients receiving placebo and 3.6% had serious adverse events vs 6.7% receiving placebo. Nonserious drug-related adverse events occurred in 16.9% of zilebesiran-treated patients (principally injection site reactions and mild hyperkalemia) and 8.0% of placebo-treated patients. Conclusions and Relevance In adults with mild to moderate hypertension, treatment with zilebesiran across a range of doses at 3-month or 6-month intervals significantly reduced 24-hour mean ambulatory SBP at month 3. Trial Registration ClinicalTrials.gov Identifier: NCT04936035.
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Affiliation(s)
| | - Manish Saxena
- Barts Health NHS Trust, London, United Kingdom
- Queen Mary University of London, London, United Kingdom
| | - Anil Gupta
- Albion Finch Medical Centre, Toronto, Ontario, Canada
| | - Fadi Chalhoub
- Clinical Neuroscience Solutions, Jacksonville, Florida
| | - Jongtae Lee
- Alnylam Pharmaceuticals, Cambridge, Massachusetts
| | | | | | | | - Weinong Guo
- Alnylam Pharmaceuticals, Cambridge, Massachusetts
| | - Dion Zappe
- Alnylam Pharmaceuticals, Cambridge, Massachusetts
| | - Akshay S. Desai
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
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5
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Gnanenthiran SR, Tan I, Atkins ER, Avolio A, Bennett B, Chapman N, Chow CK, Freed R, Gnjidic D, Hespe C, Kaur B, Liu HM, Patel A, Peiris D, Reid CM, Schlaich M, Sharman JE, Stergiou GS, Usherwood T, Gianacas C, Rodgers A, Schutte AE. Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol. Am Heart J 2023; 265:50-58. [PMID: 37479162 DOI: 10.1016/j.ahj.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/02/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions. METHODS The NEXTGEN-BP open-label, multicenter, randomized controlled trial will investigate the efficacy, safety, acceptability and cost-effectiveness of a wearable blood pressure monitor-based care strategy for the treatment of hypertension, compared to usual care, in lowering clinic blood pressure over 12 months. NEXTGEN-BP will enroll 600 adults with high blood pressure, treated with 0 to 2 antihypertensive medications. Participants attending primary care practices in Australia will be randomized 1:1 to the intervention of a wearable-based remote care strategy or to usual care. Participants in the intervention arm will undergo continuous blood pressure monitoring using a wrist-wearable cuffless device (Aktiia, Switzerland) and participate in 2 telehealth consultations with their primary care practitioner (general practitioner [GP]) at months 1 and 2. Antihypertensive medication will be up-titrated by the primary care practitioner at the time of telehealth consults should the percentage of daytime blood pressure at target over the past week be <90%, if clinically tolerated. Participants in the usual care arm will have primary care consultations according to usual practice. The primary outcome is the difference between intervention and control in change in clinic systolic blood pressure from baseline to 12 months. Secondary outcomes will be assessed at month 3 and month 12, and include acceptability to patients and practitioners, cost-effectiveness, safety, medication adherence and patient engagement. CONCLUSIONS NEXTGEN-BP will provide evidence for the effectiveness and safety of a new paradigm of wearable cuffless monitoring in the management of high blood pressure in primary care. TRIAL REGISTRATION ACTRN12622001583730.
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Affiliation(s)
- Sonali R Gnanenthiran
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Isabella Tan
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Emily R Atkins
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Alberto Avolio
- Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Belinda Bennett
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Niamh Chapman
- University of Tasmania, Menzies Institute for Medical Research, Hobart, Australia
| | - Clara K Chow
- Department of Cardiology, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Ruth Freed
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Charlotte Hespe
- The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Baldeep Kaur
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Huei Ming Liu
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia
| | - Anushka Patel
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - David Peiris
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - James E Sharman
- University of Tasmania, Menzies Institute for Medical Research, Hobart, Australia
| | - George S Stergiou
- Third Department of Medicine, Hypertension Center STRIDE-7, School of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tim Usherwood
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Christopher Gianacas
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Anthony Rodgers
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Aletta E Schutte
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, UNSW Sydney, Sydney, NSW, Australia.
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Kim HL, Park SM, Cho IJ, Kim YM, Kim DH, Kim SH, Kim KI, Sung KC, Ihm SH, Shin J, Kim Y, Oh K, Lee EM. Standardized protocol of blood pressure measurement and quality control program for the Korea National Health and Nutrition Examination Survey. Clin Hypertens 2023; 29:28. [PMID: 37821979 PMCID: PMC10568909 DOI: 10.1186/s40885-023-00252-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
Accurate blood pressure (BP) measurement is crucial for hypertension detection and management. The Korea National Health and Nutrition Examination Survey (KNHANES) assesses the health of Koreans using representative cross-sectional data. BP measurements were historically done with mercury sphygmomanometers for participants aged ≥10 years. However, KNHANES transitioned to Greenlight 300TM (mercury-free auscultatory device) in 2020 for participants aged ≥6 years and used dual devices (Microlife WatchBP Office AFIB and Greenlight) in 2021-2022. To ensure consistency, KNHANES will adopt Microlife as the unified BP device with Greenlight for device validation from 2023. Under the new protocol, participants aged ≥6 years will have their BP measured three times at 30-second intervals after a 5-minute rest under ambient temperature (20-25℃) and noise ≤65 dB. The average of the 2nd and 3rd readings will be used as the representative BP value. The quality control (QC) program involves four trained examiners passing the "quality control and assurance of BP measurement program" three times annually, and undergoing "video monitoring of weekly calibration process" once a year. Additionally, the QC team will conduct "on-site evaluations of BP measurement" at mobile examination centers three times a year. A Five-Step QC process for BP devices was also developed. This document outlines the standardized BP measurement protocol and rigorous QC program in KNHANES, aiming to ensure accurate and reliable BP data for epidemiological research and public health policymaking in South Korea.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Park
- Divison of Cardiology, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - In Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Yu-Mi Kim
- Department of Preventive, College of Medicine, Hanyang University, Seoul, Republic of Korea
- Hanyang University School of Public Health, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Hye Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Kwang-Il Kim
- Division of Geriatrics, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Hyun Ihm
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Yoonjung Kim
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Kyungwon Oh
- Division of Health and Nutrition Survey and Analysis, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea
| | - Eun Mi Lee
- Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, 15865, Republic of Korea.
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7
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Firima E, Retselisitsoe L, Leisa I, Manthabiseng M, Sematle MP, Bane M, Khomolishoele M, Gonzalez L, Gupta R, McCrosky S, Lee T, Chammartin F, Leigh B, Weisser M, Amstutz A, Burkard T, Labhardt ND. Head-to-head comparison of the WHO STEPwise approach with immediate unattended and delayed unattended automated blood pressure measurements during household-based screening: a diagnostic accuracy study in Lesotho. EClinicalMedicine 2023; 63:102197. [PMID: 37680951 PMCID: PMC10480531 DOI: 10.1016/j.eclinm.2023.102197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
Background WHO introduced the STEPwise approach to surveillance (STEPS) to monitor trends in non-communicable diseases. For arterial hypertension, the STEPS protocol takes the average of the last two out of three standard blood pressure measurements (SBPM). This study assesses the diagnostic accuracy of SBPM, same-day and next-day unattended automated measurement (uABP), with 24 h ambulatory measurement (24 h-ABPM) as reference. Methods This diagnostic accuracy study was done within a population-based household survey on cardiovascular risk factors in two districts in Northern Lesotho. Adults (aged ≥ 18 years) with elevated SBPM (defined as ≥140/90 mmHg), and 2:1 age- and sex-matched participants with normal SBPM during the survey were recruited. Following SBPM, first uABP readings were obtained on survey day. Afterwards, participants received a 24 h-ABPM device. Second uABP readings were taken 24 h later, after retrieval of the 24 h-ABPM. The main outcome was overall diagnostic accuracy of all screening measurements (SBPM, first uABP, and second uABP), determined using area under the receiver operating characteristic curve (AUROC), with 24 h-ABPM as a reference. Findings Between November 2, 2021 and August 31, 2022, 275 participants (mean age 58 years (SD: 16 years), 163 (59%) female) were enrolled, 183 of whom had elevated and 92 had normal SBPM. Mean difference between systolic daytime 24 h-ABPM and screening measurements was highest for SBPM (mean difference: -13 mmHg; 95% CI: -14 to -11). Mean difference between diastolic daytime 24 h-ABPM and diastolic SBPM was -2 mmHg (95% CI: -4 to -1), whereas no difference was found for mean diastolic first uABP (mean difference: -1 mmHg; 95% CI: -2.0 to 0.3); and mean diastolic second uABP (mean difference: 1.0 mmHg; 95% CI: -0.4 to 2.3). White coat hypertension was highest with SBPM (55 [20%]), followed by first uABP (27 [9.8%]), and second uABP (18 [6.5%]). Using systolic daytime 24 h-ABPM as a reference, the uABPs had higher AUROC (first uABP: 87% [95% CI: 83-91]; second uABP: 88% [95% CI: 84-92]); SBPM: (79% [95% CI: 74-85]). This difference was significant between first uABP and SBPM (P = 0.0024), and between second uABP and SBPM (P = 0.0017). Interpretation uABP had better diagnostic performance than SBPM. Integration of uABP into STEPS protocol should be considered. Funding Swiss Agency for Development and Cooperation under the ComBaCaL project, and the World Diabetes Foundation.
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Affiliation(s)
- Emmanuel Firima
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | | | | | | | | | - Lucia Gonzalez
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Ravi Gupta
- SolidarMed, Partnerships for Health, Maseru, Lesotho
| | - Stephen McCrosky
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Tristan Lee
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Frédérique Chammartin
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Bailah Leigh
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, Freetown, Sierra Leone
| | - Maja Weisser
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Ifakara Health Institute, Ifakara, Tanzania
| | - Alain Amstutz
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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8
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Goupil R, Nadeau-Fredette AC, Prasad B, Hundemer GL, Suri RS, Beaubien-Souligny W, Agharazii M. CENtral blood pressure Targeting: a pragmatic RAndomized triaL in advanced Chronic Kidney Disease (CENTRAL-CKD): A Clinical Research Protocol. Can J Kidney Health Dis 2023; 10:20543581231172407. [PMID: 37168686 PMCID: PMC10164859 DOI: 10.1177/20543581231172407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/26/2023] [Indexed: 05/13/2023] Open
Abstract
Background Emerging data favor central blood pressure (BP) over brachial cuff BP to predict cardiovascular and kidney events, as central BP more closely relates to the true aortic BP. Considering that patients with advanced chronic kidney disease (CKD) are at high cardiovascular risk and can have unreliable brachial cuff BP measurements (due to high arterial stiffness), this population could benefit the most from hypertension management using central BP measurements. Objective To assess the feasibility and efficacy of targeting central BP as opposed to brachial BP in patients with CKD G4-5. Design Pragmatic multicentre double-blinded randomized controlled pilot trial. Setting Seven large academic advanced kidney care clinics across Canada. Patients A total of 116 adults with CKD G4-5 (estimated glomerular filtration rate [eGFR] < 30 mL/min) and brachial cuff systolic BP between 120 and 160 mm Hg. The key exclusion criteria are 1) ≥ 5 BP drugs, 2) recent acute kidney injury, myocardial infarction, stroke, heart failure or injurious fall, 3) previous kidney replacement therapy. Methods Double-blind randomization to a central or a brachial cuff systolic BP target (both < 130 mm Hg) as measured by a validated central BP device. The study duration is 12 months with follow-up visits every 2 to 4 months, based on local practice. All other aspects of CKD management are at the discretion of the attending nephrologist. Outcomes Primary Feasibility: Feasibility of a large-scale trial based on predefined components. Primary Efficacy: Carotid-femoral pulse wave velocity at 12 months. Others: Efficacy (eGFR decline, albuminuria, BP drugs, and quality of life); Events (major adverse cardiovascular events, CKD progression, hospitalization, mortality); Safety (low BP events and acute kidney injury). Limitations May be challenging to distinguish whether central BP is truly different from brachial BP to the point of significantly influencing treatment decisions. Therapeutic inertia may be a barrier to successfully completing a randomized trial in a population of CKD G4-5. These 2 aspects will be evaluated in the feasibility assessment of the trial. Conclusion This is the first trial to evaluate the feasibility and efficacy of using central BP to manage hypertension in advanced CKD, paving the way to a future large-scale trial. Trial registration clinicaltrials.gov (NCT05163158).
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Affiliation(s)
- Rémi Goupil
- Hopital du Sacré-Coeur de Montréal, Université de Montréal, QC, Canada
| | | | | | - Gregory L. Hundemer
- Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Rita S. Suri
- McGill University Health Centre, McGill University, Montréal, QC, Canada
| | | | - Mohsen Agharazii
- Centre Hospitalier Universitaire de Québec, Université Laval, Canada
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9
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Khan Mamun MMR, Sherif A. Advancement in the Cuffless and Noninvasive Measurement of Blood Pressure: A Review of the Literature and Open Challenges. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 10:bioengineering10010027. [PMID: 36671599 PMCID: PMC9854981 DOI: 10.3390/bioengineering10010027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Hypertension is a chronic condition that is one of the prominent reasons behind cardiovascular disease, brain stroke, and organ failure. Left unnoticed and untreated, the deterioration in a health condition could even result in mortality. If it can be detected early, with proper treatment, undesirable outcomes can be avoided. Until now, the gold standard is the invasive way of measuring blood pressure (BP) using a catheter. Additionally, the cuff-based and noninvasive methods are too cumbersome or inconvenient for frequent measurement of BP. With the advancement of sensor technology, signal processing techniques, and machine learning algorithms, researchers are trying to find the perfect relationships between biomedical signals and changes in BP. This paper is a literature review of the studies conducted on the cuffless noninvasive measurement of BP using biomedical signals. Relevant articles were selected using specific criteria, then traditional techniques for BP measurement were discussed along with a motivation for cuffless measurement use of biomedical signals and machine learning algorithms. The review focused on the progression of different noninvasive cuffless techniques rather than comparing performance among different studies. The literature survey concluded that the use of deep learning proved to be the most accurate among all the cuffless measurement techniques. On the other side, this accuracy has several disadvantages, such as lack of interpretability, computationally extensive, standard validation protocol, and lack of collaboration with health professionals. Additionally, the continuing work by researchers is progressing with a potential solution for these challenges. Finally, future research directions have been provided to encounter the challenges.
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Affiliation(s)
| | - Ahmed Sherif
- School of Computing Sciences and Computer Engineering, The University of Southern Mississippi, Hattiesburg, MS 39406, USA
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10
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Stabouli S, Chainoglou A, Evripidou K, Simão C, Antza C, Petrou P, Hamdani G, Calpe J, Lurbe E. Comparison of validation protocols for blood pressure measuring devices in children and adolescents. Front Cardiovasc Med 2022; 9:1001878. [PMID: 36505363 PMCID: PMC9727228 DOI: 10.3389/fcvm.2022.1001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Accuracy of blood pressure (BP) measurement is important for the evaluation of hypertension in children and adolescents, and it is critically dependent upon the accuracy of the BP measuring device. A device that could pass validated protocols with reliable accuracy would be desirable in clinical and research settings. Several scientific organizations have published recommendations on the validation of different BP measuring devices. Most of them focus on adults but separate recommendations and validation criteria for BP devices intended for use in children and adolescents are included in some validation protocols. In this review, we compare the validation criteria for BP measuring devices among consensus documents from different scientific organizations focusing on the pediatric population and we discuss the evidence gaps targeting the needs for validated BP measuring devices in children and adolescents. We also highlight common pitfalls in the validation studies of BP measuring devices in children and adolescents using the example of office BP devices.
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Affiliation(s)
- Stella Stabouli
- 1st Department of Pediatrics, Faculty of Health Sciences, School of Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece,*Correspondence: Stella Stabouli,
| | - Athanasia Chainoglou
- 1st Department of Pediatrics, Faculty of Health Sciences, School of Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kleo Evripidou
- 1st Department of Pediatrics, Faculty of Health Sciences, School of Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Carla Simão
- Department of Pediatrics, Faculty of Medicine, Hospital Universitario de Santa Maria, FMUL, Lisbon, Portugal
| | - Christina Antza
- 3rd Department of Medicine, Faculty of Health Sciences, School of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Petrou
- Pharmacoepidemiology-Pharmacovigilance, Pharmacy School, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus
| | - Gilad Hamdani
- Nephrology and Hypertension Institute, Schneider Children’s Medical Center, Petah Tikva, Israel
| | | | - Empar Lurbe
- Department of Pediatrics, Centro de Investigación Biomédica en Red (CIBER) Fisiopatologia Obesidad y Nutricion, Instituto de Salud Carlos III, University of Valencia, Valencia, Spain
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11
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Groenland EH, Vendeville JPAC, Bemelmans RHH, Monajemi H, Bots ML, Visseren FLJ, Spiering W. Smartphone Application-Assisted Home Blood Pressure Monitoring Compared With Office and Ambulatory Blood Pressure Monitoring in Patients With Hypertension: the AMUSE-BP Study. Hypertension 2022; 79:2373-2382. [PMID: 35959685 PMCID: PMC9444260 DOI: 10.1161/hypertensionaha.122.19685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The development of automated, smartphone application (app)-assisted home blood pressure monitoring (HBPM) allows for standardized measurement of blood pressure (BP) at home. The aim of this study was to evaluate the (diagnostic) agreement between app-assisted HBPM, automated office BP (OBP), and the reference standard 24-hour ambulatory BP monitoring (ABPM).
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Affiliation(s)
- Eline H Groenland
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Jean-Paul A C Vendeville
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Remy H H Bemelmans
- Department of Internal Medicine, Ziekenhuis Gelderse Vallei, Ede, the Netherlands (R.H.H.B.)
| | - Houshang Monajemi
- Department of Internal Medicine, Rijnstate, Arnhem, the Netherlands (H.M.)
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (M.L.B.)
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands (E.H.G., J.-P.A.C.V., F.L.J.V., W.S.)
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12
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Zhang HJ, Zhang J, Wang SL, Zhang J, Teng LN, Zhang SJ, Zhou DJ, Long MZ. Validation of the YuWell YE900 oscillometric blood pressure monitor for professional office use in adults and children according to the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018). Blood Press Monit 2021; 26:396-399. [PMID: 34480474 DOI: 10.1097/mbp.0000000000000541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the accuracy of the YuWell YE900 oscillometric upper-arm professional office blood pressure monitor in adults and children according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018). METHODS Subjects were recruited to fulfill the age, sex, blood pressure and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in adults and children (aged 3-12 years) using the same arm sequential blood pressure measurement method. Three cuffs of the test device were used for arm circumference 18-22 cm (small), 22-32 cm (medium) and 32-42 cm (large). RESULTS Ninety-two subjects were recruited, and 85 (50 adults and 35 children) were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference blood pressure readings was 1.7 ± 6.62/3.1 ± 5.76 mmHg (systolic/diastolic). For validation criterion 2, the SD of the averaged blood pressure differences between the test device and reference blood pressure per subject was 5.25/5.13 mmHg (systolic/diastolic). CONCLUSION The YuWell YE900 professional electronic blood pressure monitor has passed the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) in adults and children and can be recommended for clinical use.
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Affiliation(s)
| | | | - Su-Lan Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin Zhang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li-Ni Teng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shu-Juan Zhang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - De-Jun Zhou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming-Zhi Long
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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13
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Reply. J Hypertens 2021; 39:1928-1929. [PMID: 34397633 DOI: 10.1097/hjh.0000000000002890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Pucci G, Santoni E, Bisogni V, Calandri C, Cerasari A, Dominioni I, Sanesi L, D'Abbondanza M, Veca V, Vaudo G. Screening for atrial fibrillation during automated blood pressure measurement among patients admitted to internal medicine ward. Intern Emerg Med 2021; 16:1605-1611. [PMID: 33743149 PMCID: PMC8354958 DOI: 10.1007/s11739-021-02691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF), the commonest sustained cardiac arrhythmia affecting the adult population, is often casually discovered among hospitalized people. AF onset is indeed triggered by several clinical conditions such as acute inflammatory states, infections, and electrolyte disturbance, frequently occurring during the hospitalization. We aimed to evaluate whether systematic AF screening, performed through an automated oscillometric blood pressure (BP) device (Microlife WatchBP Office AFIB, Microlife AG, Switzerland), is effective for detecting AF episodes in subjects admitted to an Internal Medicine ward. 163 patients consecutively hospitalized at the Unit of Internal Medicine of the "Santa Maria" Terni University Hospital between November 2019 and January 2020 (mean age ± standard deviation: 77 ± 14 years, men proportion: 40%) were examined. Simultaneously with BP measurement and AF screening, a standard 12-lead electrocardiogram (ECG) was performed in all subjects. AF was diagnosed by ECG in 29 patients (18%). AF screening showed overall 86% sensitivity and 96% specificity. False negatives (n = 4) had RR-interval coefficient of variation lower than true positives (n = 25, p < 0.01), suggesting a regular ventricular rhythm during AF. The repeated evaluation substantially confirmed the same level of agreement. AF screening was positive in all patients with new-onset AF (n = 6, 100%). Systematic AF screening in patients admitted to Internal Medicine wards, performed using the Microlife WatchBP Office AFIB, is feasible and effective. The opportunity to implement such technology in daily routine clinical practice to prevent undiagnosed AF episodes in hospitalized patients should be the subject of further research.
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Affiliation(s)
- Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy.
- Department of Medicine and Surgery, Unit of Internal Medicine, Terni University Hospital, University of Perugia, Piazzale Tristano Di Joannuccio, 1, T05100, Terni, Italy.
| | - Edoardo Santoni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Valeria Bisogni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Camilla Calandri
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Alberto Cerasari
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Irene Dominioni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Leandro Sanesi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Marco D'Abbondanza
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Vito Veca
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
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15
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Stambolliu E, Kollias A, Bountzona I, Ntineri A, Servos G, Vazeou A, Stergiou GS. Nighttime Home Blood Pressure in Children: Association with Ambulatory Blood Pressure and Preclinical Organ Damage. Hypertension 2021; 77:1877-1885. [PMID: 33840203 DOI: 10.1161/hypertensionaha.121.17016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Emelina Stambolliu
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Ioanna Bountzona
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Angeliki Ntineri
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - George Servos
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
| | - Andriani Vazeou
- First Department of Pediatrics (A.V.), P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece (E.S., A.K., I.B., A.N., G.S.S.)
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16
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Magnitude and significance of interarm blood pressure differences in children and adolescents. J Hypertens 2021; 39:1341-1345. [PMID: 33657583 DOI: 10.1097/hjh.0000000000002797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An interarm difference (IAD) in blood pressure (BP) of 10 mmHg or more is a potential cardiovascular risk factor in adults, given its association with cardiovascular events/mortality. In children and adolescents, accurate BP assessment is critical for identifying risk of end organ damage. However, IAD has not been systematically studied in paediatric patients; if present and of significant magnitude, measuring BP in only one arm could lead to misclassification of hypertensive status. METHOD In 95 children/adolescents with a normal aorta (including 15 with a history of tetralogy of Fallot) aged 7-18 years attending the Royal Children's Hospital, Melbourne, we aimed to determine the magnitude of IAD, frequency of IAD of at least 10 mmHg, difference in BP classification between arms, and influence of repeat measures on IAD in a single visit. After 5 min rest, simultaneous bilateral BP was measured in triplicate with an automated device. RESULTS Absolute systolic IAD was 5.0 mmHg (median, interquartile range 2-8 mmHg) and was 10 mmHg or more in 14%, with no change on repeat measures. In patients with a history of aortic surgery, IAD of 10 mmHg or more occurred in 27% (transposition of the great arteries, n = 15) and 75% (aortic coarctation, n = 8). Differences in BP classification, based on initial left vs. right arm measures, occurred in 25% (normal aorta) and 40%/63% (aortic surgery), or 17% and 33%/50%, respectively if second and third measurements were averaged. CONCLUSION Substantial interarm BP differences were common, even in apparently healthy children and adolescents: evaluation of IAD may, therefore, be important for BP classification in the paediatric setting.
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17
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Cho KY. Lifestyle modifications result in alterations in the gut microbiota in obese children. BMC Microbiol 2021; 21:10. [PMID: 33407104 PMCID: PMC7789654 DOI: 10.1186/s12866-020-02002-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023] Open
Abstract
Background The association between the gut microbiota and pediatric obesity was analyzed in a cross-sectional study. A prospective study of obese children was conducted to assess the gut microbial alterations after a weight change. We collected fecal samples from obese children before and after a 2-month weight reduction program that consisted of individual counseling for nutritional education and physical activity, and we performed 16S rRNA gene amplicon sequencing using an Illumina MiSeq platform. Results Thirty-six participants, aged 7 to 18 years, were classified into the fat loss (n = 17) and the fat gain (n = 19) groups according to the change in total body fat (%) after the intervention. The baseline analysis of the gut microbiota in the preintervention stages showed dysbiotic features of both groups compared with those of normal-weight children. In the fat loss group, significantly decreased proportions of Bacteroidetes phylum, Bacteroidia class, Bacteroidales order, Bacteroidaceae family, and Bacteroides genus, along with increased proportions of Firmicutes phylum, Clostridia class, and Clostridiales order, were observed after intervention. The microbial richness was significantly reduced, without a change in beta diversity in the fat loss group. The fat gain group showed significantly deceased proportions of Firmicutes phylum, Clostridia class, Clostridiales order, Lachnospiraceae family, and Eubacterium hallii group genus, without a change in diversity after the intervention. According to the functional metabolic analysis by the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States 2, the “Nitrate Reduction VI” and “Aspartate Superpathway” pathways were predicted to increase significantly in the fat loss group. The cooccurring networks of genera were constructed and showed the different microbes that drove the changes between the pre- and postintervention stages in the fat loss and fat gain groups. Conclusions This study demonstrated that lifestyle modifications can impact the composition, richness, and predicted functional profiles of the gut microbiota in obese children after weight changes. Trial registration ClinicalTrials.govNCT03812497, registration date January 23, 2019, retrospectively registered. Supplementary information Supplementary information accompanies this paper at 10.1186/s12866-020-02002-3.
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Affiliation(s)
- Ky Young Cho
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
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18
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Altered Gut Microbiota and Shift in Bacteroidetes between Young Obese and Normal-Weight Korean Children: A Cross-Sectional Observational Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6587136. [PMID: 32908903 PMCID: PMC7450312 DOI: 10.1155/2020/6587136] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 12/25/2022]
Abstract
Emerging data suggest that the gut microbiome is related to the pathophysiology of obesity. This study is aimed at characterizing the gut microbiota composition between obese and normal-weight Korean children aged 5-13. We collected fecal samples from 22 obese and 24 normal-weight children and performed 16S rRNA gene sequencing using the Illumina MiSeq platform. The relative abundance of the phylum Bacteroidetes was lower in the obese group than in the normal-weight group and showed a significant negative correlation with BMI z-score. Linear discriminative analysis (LDA) coupled with effect size measurement (LEfSe) analysis also revealed that the Bacteroidetes population drove the divergence between the groups. There was no difference in alpha diversity, but beta diversity was significantly different between the normal-weight and obese groups. The gut microbial community was linked to BMI z-score; blood biomarkers associated with inflammation and metabolic syndrome; and dietary intakes of niacin, sodium, vitamin B6, and fat. The gut microbiota of the obese group showed more clustering of genera than that of the normal-weight group. Phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) analysis revealed that the functions related to carbohydrate and lipid metabolism in the microbiota were more enriched in the normal-weight group than in the obese group. Our data may contribute to the understanding of the gut microbial structure of young Korean children in relation to obesity. These findings suggest that Bacteroidetes may be a potential therapeutic target in pediatric obesity.
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Ahles S, Stevens YR, Joris PJ, Vauzour D, Adam J, de Groot E, Plat J. The Effect of Long-Term Aronia melanocarpa Extract Supplementation on Cognitive Performance, Mood, and Vascular Function: A Randomized Controlled Trial in Healthy, Middle-Aged Individuals. Nutrients 2020; 12:nu12082475. [PMID: 32824483 PMCID: PMC7468716 DOI: 10.3390/nu12082475] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/27/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
Cognitive decline is associated with lifestyle-related factors such as overweight, blood pressure, and dietary composition. Studies have reported beneficial effects of dietary anthocyanins on cognition in older adults and children. However, the effect of anthocyanin-rich Aronia melanocarpa extract (AME) on cognition is unknown. Therefore, this study aimed to determine the effect of long-term supplementation with AME on cognitive performance, mood, and vascular function in healthy, middle-aged, overweight adults. In a randomized double-blind placebo-controlled parallel study, 101 participants either consumed 90 mg AME, 150 mg AME, or placebo for 24 weeks. The grooved pegboard test, number cross-out test, and Stroop test were performed as measures for psychomotor speed, attention, and cognitive flexibility. Mood was evaluated with a visual analogue scale, serum brain-derived neurotrophic factor (BDNF) was determined, and vascular function was assessed by carotid ultrasounds and blood pressure measurements. AME improved psychomotor speed compared to placebo (90 mg AME: change = -3.37; p = 0.009). Furthermore, 150 mg AME decreased brachial diastolic blood pressure compared to 90 mg AME (change = 2.44; p = 0.011), but not compared to placebo. Attention, cognitive flexibility, BDNF, and other vascular parameters were not affected. In conclusion, AME supplementation showed an indication of beneficial effects on cognitive performance and blood pressure in individuals at risk of cognitive decline.
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Affiliation(s)
- Sanne Ahles
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6200 MD Maastricht, The Netherlands; (S.A.); (P.J.J.); (J.A.)
- BioActor BV, Gaetano Martinolaan 85, 6229 GS Maastricht, The Netherlands;
| | - Yala R. Stevens
- BioActor BV, Gaetano Martinolaan 85, 6229 GS Maastricht, The Netherlands;
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Peter J. Joris
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6200 MD Maastricht, The Netherlands; (S.A.); (P.J.J.); (J.A.)
| | - David Vauzour
- Biomedical Research Centre, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK;
| | - Jos Adam
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6200 MD Maastricht, The Netherlands; (S.A.); (P.J.J.); (J.A.)
| | - Eric de Groot
- Imagelabonline & Cardiovascular, 4117 GV Erichem, The Netherlands;
- Department of Gastroenterology, Amsterdam UMC—Location Academic Medical Centre, 1105 AZ Amsterdam, The Netherlands
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6200 MD Maastricht, The Netherlands; (S.A.); (P.J.J.); (J.A.)
- Correspondence:
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20
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Kollias A, Kyriakoulis KG, Gravvani A, Anagnostopoulos I, Stergiou GS. Automated pulse wave velocity assessment using a professional oscillometric office blood pressure monitor. J Clin Hypertens (Greenwich) 2020; 22:1817-1823. [PMID: 32762109 DOI: 10.1111/jch.13966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/22/2020] [Accepted: 06/06/2020] [Indexed: 11/30/2022]
Abstract
Carotid-femoral pulse wave velocity (cfPWV) is the gold standard method for assessing arterial stiffness. This study evaluated automated brachial-ankle PWV (baPWV) taken by a professional oscillometric blood pressure monitor (Microlife WatchBP Office Vascular) versus reference cfPWV (Complior device). Subjects recruited from a hypertension outpatient clinic had duplicate baPWV and cfPWV measurements (randomized crossover design) and carotid ultrasonography. Of 102 subjects recruited, 101 had valid baPWV measurements. Four subjects were excluded and 97 were analyzed (age 58.3 ± 11.4 years, men 70%, hypertensives 76%, diabetics 17%, cardiovascular disease 10%, smokers 23%). The mean difference between baPWV (13.1 ± 1.8 m/s) and cfPWV (9.1 ± 1.8 m/s) was 4.0 ± 1.4 m/s (P < .01) with close association between them (r = 0.70, P < .01). baPWV and cfPWV were correlated with age (r 0.54/0.49 respectively), systolic blood pressure (0.45/0.50), carotid intima-media thickness (0.31/0.44), and carotid distensibility coefficient (-0.47/-0.34) (all P < .05; no difference between the two methods, z test). There was reasonable agreement (77%) between the two methods in identifying subjects at the top quartile of their distributions (kappa 0.39, P < .01). The areas under the receiver operating characteristic curves for the identification of carotid plaques were comparable for cfPWV and baPWV (0.79 and 0.74 respectively, P = NS). Automated baPWV measurement by a professional oscillometric blood pressure monitor is feasible and observer-independent. baPWV values differ from those by cfPWV, yet they are closely correlated, have reasonable agreement in detecting increased arterial stiffness and give similar associations with carotid stiffness and atherosclerosis.
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Affiliation(s)
- Anastasios Kollias
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Konstantinos G Kyriakoulis
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Areti Gravvani
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Ioannis Anagnostopoulos
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - George S Stergiou
- Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece
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21
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Boonyasai RT, McCannon EL, Landavaso JE. Automated Office-Based Blood Pressure Measurement: an Overview and Guidance for Implementation in Primary Care. Curr Hypertens Rep 2019; 21:29. [PMID: 30949872 DOI: 10.1007/s11906-019-0936-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The purposes of this study are to review evidence supporting the use of automated office blood pressure (AOBP) measurement and to provide practical guidance for implementing it in clinical settings. RECENT FINDINGS Mean AOBP readings correlate with awake ambulatory blood pressure monitor (ABPM) values and predict cardiovascular outcomes better than conventional techniques. However, heterogeneity among readings suggests that AOBP does not replace ABPM. Blood pressure (BP) measurement protocols differ among commonly described AOBP devices, but all produce valid BP estimates. Rest periods should not precede AOBP with BpTRU devices but should occur before use with Omron HEM-907 and Microlife WatchBP Office devices. Attended and unattended AOBP appear to produce similar results. This review also describes a framework to aid AOBP's implementation in clinical practice. Evidence supports AOBP as the preferred method for measuring BP in office settings, but this approach should be a complement to out-of-office measurements, such as self-measured BP monitoring or 24-h ABPM, not a substitute for it.
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Affiliation(s)
- Romsai T Boonyasai
- Division of General Internal Medicine, John Hopkins University, Baltimore, MD, 21205, USA. .,Center for Health Equity, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | - Erika L McCannon
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Joseph E Landavaso
- Center for Health Equity, Johns Hopkins University, Baltimore, MD, 21205, USA
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