The Critical Role of Community Pharmacists in Blood Pressure Monitoring.

Arterial hypertension is the most important modifiable risk factor for cardiovascular morbidity and mortality. In some countries, pharmacists' patient-centered approach has become a common practice, and their role in supporting the management of cardiovascular disease has been successfully developed for years. In particular, recent findings have confirmed benefits of pharmacist-provided hypertension care. Current guidelines emphasize the need for regular BP measurements in subjects age 40 years and older, who are at increased risk of hypertension. A panel of experts in cardiology, hypertensiology, family medicine, and pharmacy presented a narrative review of implementing community pharmacy blood pressure (CPBP) measurements into Polish pharmacy practice to assist pharmacists in CPBP readings. The paper focuses on basic aspects of management of untreated patients with elevated blood pressure levels, as well as management of individuals diagnosed with hypertension, who should follow their primary care physicians' recommendations for anti-hypertensive therapy. The article also includes a few important aspects related to CPBP measurement, such as equipment and techniques. Development of ready-made schemes of procedures for patients with different results of blood pressure measurement could ensure a uniform standard of services provided by pharmacists. This gives an opportunity to provide such patients with medical care and initiate treatment, and facilitates effective maintenance of BP in hypertensive subjects. This article reviews the role of pharmacists in Poland in screening for hypertension by taking blood pressure measurements.

Evaluation of lingual oscillometric blood pressure measurement in anaesthetized pigs.

OBJECTIVE: To evaluate the agreement between measurements of invasive blood pressure (IBP) and oscillometric blood pressure from the tongue (OBPton) using a multiparameter monitor. STUDY DESIGN: Unblinded, prospective, experimental study. ANIMALS: A total of 12 female Large White crossbreed pigs. METHODS: Pigs undergoing experimental procedures that required arterial cannula placement were recruited. A blood pressure cuff with the closest width to 40% of the circumference of the tongue was placed rostral to the lingual frenulum. Systolic, mean and diastolic IBP and OBPton were measured simultaneously at 5 minute intervals. Agreement between paired measurements was examined using Bland-Altman analysis. Mean bias, precision (standard deviation of mean bias), 95% limits of agreement, correlation coefficients and percentage of measurements within 10 and 20 mmHg of IBP were calculated. RESULTS: The total numbers of paired measurements recorded were 124, 126 and 124 for systolic, mean and diastolic blood pressures, respectively. The mean bias, precision and 95% limits of agreement for systolic OBPton were 11.5, 11.5 (-11.1 to 34.2), for mean OBPton 5.6, 5.7 (-5.7 to 16.8) and for diastolic OBPton 7.6, 10.1 (-12.1 to 27.4) mmHg. Correlation coefficients were greater than 0.9 for mean OBPton only. More than 50% of measurements were within 10 mmHg of IBP and 80% of measurements were within 20 mmHg of IBP for mean and diastolic OBPton only. CONCLUSIONS AND CLINICAL RELEVANCE: The tongue as a cuff site for oscillometric blood pressure measurement is a useful site for measuring mean arterial, but not systolic or diastolic blood pressure in anaesthetized Large White crossbreed pigs. This technique fulfils the American College of Veterinary Internal Medicine criteria for measuring mean arterial pressure but not systolic or diastolic arterial pressure.

Comparison of cardiopulmonary effects of propofol, ketamine-propofol and isoflurane anesthesia in the domestic chicken (Gallus gallus domesticus).

OBJECTIVE: To compare the effects of propofol, ketamine-propofol and isoflurane, at similar anesthetic depth, on cardiopulmonary variables in unpremedictated chickens. STUDY DESIGN: Prospective, randomized, crossover experimental trial. ANIMALS: A total of 10 male Leghorn domestic chickens, aged 3 months and body mass 1.4-2.0 kg. METHODS: Birds were randomly assigned to each of three anesthetic protocols, 7 days apart: intravenous propofol, intravenous ketamine-propofol or isoflurane. Anesthesia was induced (indicated by loss of righting reflex and tracheal intubation) and maintained with propofol (10 mg kg-1 minute-1, then 1.1 mg kg-1 minute-1), ketamine-propofol (5 mg mL-1 ketamine and 5 mg mL-1 propofol combined; 10 mg kg-1 minute-1, then 1.1 mg kg-1 minute-1) or isoflurane [5% vaporizer setting initially, then end-tidal concentration (Fe'Iso) of 2%] for 65 minutes. Anesthesia was maintained at a similar anesthetic depth based upon positive or negative responses to toe pinch. Heart rate (HR), respiratory rate (fR), noninvasive arterial blood pressure and arterial blood gases were measured during anesthesia. Propofol or ketamine-propofol infusion rates and Fe'Iso required to prevent movement in response to a noxious stimulus and recovery times were recorded. RESULTS: Anesthesia induction dose was 9.0 ± 0.8 (mean ± SD) and 12.2 ± 0.3 mg kg-1 for propofol and ketamine-propofol, respectively. Propofol and ketamine-propofol infusion rates and Fe'Iso required to prevent movement in response to the noxious stimulus were 0.88 ± 0.14 mg kg-1 minute-1, 0.92 ± 0.14 mg kg-1 minute-1 and 1.45 ± 0.28%, respectively. Cardiopulmonary variables remained clinically acceptable, but ketamine-propofol was associated with a significantly higher HR (p = 0.0001) and lower fR (p = 0.0001). Time to extubation did not differ among treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Cardiovascular and respiratory variables were maintained within normal ranges in all treatments. Coadministration of ketamine with propofol significantly reduced the induction and maintenance dose of propofol.

Effect of health extension workers-led home-based multicomponent intervention on blood pressure reduction among hypertensive patients in rural districts of northwest Ethiopia: a cluster-randomised controlled trial.

OBJECTIVES: To evaluate effects of health extension workers-led home-based multicomponent intervention on blood pressure change in hypertensive patients in rural districts of northwest Ethiopia. DESIGN: Two-arm cluster randomised controlled trial was conducted. PARTICIPANTS: Hypertensive patients' age ≥25 years were included. 20 clusters or kebeles with 456 participants were randomly assigned to the intervention group (10 clusters with 228 participants) and the control group (10 clusters with 228 participants). INTERVENTIONS: Participants in the intervention kebeles received health extension workers-led home-based multicomponent interventions every other month for 40-60 min for 9 months. MAIN OUTCOME MEASURES: The primary outcomes were the differences in mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) changes from baseline between patients in the intervention and control groups. Intention-to-treat analysis was used for the primary analyses. Linear mixed effect model was used to evaluate the intervention's effect on change in mean SBP and DBP. Effect sizes of mean difference and relative benefit increase were used. RESULTS: At 9 months, the mean SBP decreased by 15.8 mm Hg (95% CI: 13.5, 18.1) in the intervention and 10.8 mm Hg (95% CI: 8.7, 12.9) in the control groups; with a 5.0 mm Hg (95% CI: 1.9, 8.1) greater reduction in the intervention group. The mean DBP decreased by 12.1 mm Hg (95% CI: 10.6, 13.5) in the intervention and 8.4 mm Hg (95% CI: 7.0, 9.8) in the control group. The proportion of optimal blood pressure control was higher in the intervention group (45.8%) than the control group (28.2%) with percentage difference of 17.6% (95% CI: 8.5, 26.7). CONCLUSIONS: Health extension workers-led home-based multicomponent intervention has resulted significant reduction of blood pressure and achieved a higher proportion of optimal blood pressure control. This strategy is effective, but further research is needed to determine its cost effectiveness for scaling up and integrating in primary care settings. TRIAL REGISTRATION: The trial is registered with Pan African clinical trial registry (PACTR202102729454417).

Randomised controlled decentralised feasibility trial of a fixed low-dose combination antihypertensive drug strategy to attenuate cognitive decline in high-risk adults.

OBJECTIVES: The Action To promote brain HEalth iN Adults study aimed to determine the feasibility and applicability of recruitment using home blood pressure (BP) monitoring, routine blood biochemistry and videoconference measures of cognition, in adults at high risk of dementia. DESIGN: A decentralised double-blind, placebo-controlled, randomised feasibility trial with a four-stage screening process. SETTING: Conducted with participants online in the state of New South Wales, Australia. PARTICIPANTS: Participants were aged 50-70 years with moderately elevated BP (systolic >120 and <160 mm Hg or diastolic >80 and <95 mm Hg) and ≥1 additional enrichment risk factor of monotherapy treatment of hypertension, diabetes mellitus, elevated low-density lipoprotein cholesterol, obesity, current smoking or a first degree relative with dementia, which indicated an elevated risk for future cognitive decline. INTERVENTION: Triple Pill (active antihypertensive treatment of telmisartan 20 mg, amlodipine 2.5 mg and indapamide 1.25 mg) or placebo Triple Pill (blinded study capsules). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was feasibility of the study expressed as the percentage of participants randomised from those who were screened. Secondary outcomes were the applicability of videoconference measures of cognition and the overall trial, tolerability of the Triple Pill, safety outcomes and medication adherence. RESULTS: The proportion (95% CI) of patients randomised to those screened was 5% (2%-10%). The applicability of the trial expressed as percentage of those who completed all remote assessments over the number of randomised participants was 67% (95% CI 05 to 22%). There were no serious adverse events or withdrawals from treatment. All participants adhered to study medication, except for one person who had two capsules left at the end of the study period. CONCLUSIONS: The feasibility of this decentralised trial on BP lowering in patients at high risk for dementia is low. However, the applicability of remote assessments of cognitive function is acceptable. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000121864.

Impact of Hypertension on the Dose-Response Association Between Physical Activity and Stroke: A Cohort Study.

BACKGROUND: Regular physical activity is associated with a reduced stroke risk. However, this relationship might be attenuated in the presence of hypertension and antihypertensive medication use. We examined the dose-response relationship between physical activity and stroke in normotensive and hypertensive individuals. METHODS: A Dutch population-based cohort including 139 930 individuals (41% men; mean age, 44±13) was performed (median follow-up, 6.75 years). Participants were stratified at baseline as hypertensive (44%) or normotensive (56%) and categorized into quartiles of the lowest (Q1) to the highest (Q4) moderate-to-vigorous, self-reported physical activity. The primary outcome was incident stroke (fatal and nonfatal). Cox regression estimated hazard ratios and 95% CIs. The main analyses were stratified on baseline blood pressure and adjusted for confounders. Hypertensives were stratified into medicated (21%) or non-medicated (79%). RESULTS: Compared with Q1, adjusted hazard ratios were 0.87 (0.69-1.10; P=0.23), 0.75 (0.59-0.95; P=0.02), and 0.94 (0.74-1.20; P=0.64) for Q2 to Q4, respectively in the total population. Hazard ratios for normotensives were 0.79 (0.50-1.25; P=0.32), 0.75 (0.48-1.18; P=0.22), 0.97 (0.62-1.51; P=0.90) for Q2 to Q4, respectively. In hypertensives, hazard ratios were 0.89 (0.68-1.17; P=0.41), 0.74 (0.56-0.98; P=0.03), 0.92 (0.69-1.23; P=0.56) for Q2 to Q4, respectively. There was no significant interaction between hypertension status for the relation between physical activity and stroke risk. The stratified analysis revealed a smaller benefit of moderate-to-vigorous physical activity in medicated hypertensives compared with nonmedicated hypertensives, but no significant interaction effect was found. CONCLUSIONS: Regular moderate-to-vigorous physical activity is beneficial for stroke risk reduction (Q3 compared with Q1), which is not affected by hypertension. Antihypertensive medication may be associated with a smaller benefit of moderate-to-vigorous physical activity on the risk of stroke, but further research is warranted.

Pilot Study of Intelligent Office Blood Pressure Measurement Model in Shanghai, China, 2022.

Introduction: An intelligent office blood pressure measurement (IOBPM) model for community-based hypertension management was piloted in Shanghai, China, to overcome the conventional blood pressure management (CBPM) model's deficiencies. Methods: We selected adults aged 35-89 years who were being treated and managed for hypertension in two community health centers for the IOBPM and CBPM models. The IOBPM model consisted of two or three consecutive blood pressure (BP) measurements using a pre-programmed and validated automatic device. The BP data for the CBPM model were obtained from the routine follow-up records of hypertensive patients and derived from the Shanghai Non-communicable Diseases Management Information System. Subjects in the IOBPM model were selected by a simple random sampling method, and propensity score matching was used to select a comparable control population from the CBPM model based on important covariables. The BP levels, end-digit preferences, frequency distribution, and BP control were compared between the two models. Results: We selected 2,909 patients for the IOBPM model and 5,744 for the CBPM model. The systolic BP in the CBPM model was 12.3 mmHg lower than in the IOBPM model. In the CBPM model, there were statistically significant end-digit preferences (P < 0.001), with zero being the most reported end-digit (23.3% for systolic BP and 27.7% for diastolic BP). There was no significant end-digit preference in the IOBPM model. Certain BP values below 140/90 mmHg in the CBPM model were more frequent, while the IOBPM model showed a normal distribution. The BP control in the CBPM model was significantly higher than the IOBPM model (P < 0.001). Conclusion: The IOBPM model appears to overcome the deficiencies of the CBPM model, leading to more accurate and reliable BP measurements.

The effect of different levels of systolic blood pressure control on new-onset chronic kidney disease in hypertension multimorbidity.

To explore the effect of different levels of systolic blood pressure (SBP) control on new-onset chronic kidney disease in hypertension multimorbidity. The hypertensive patients with multimorbidity information were enrolled from the Kailuan Study. The isolated hypertension patients undergoing physical examination during the same period were selected in a 1:1 ratio as control. Finally, 12,897 participants were divided into six groups: Group SBP < 110 mmHg, Group 110 ≤ SBP < 120 mmHg, Group 120 ≤ SBP < 130 mmHg, Group 130 ≤ SBP < 140 mmHg, Group 140 ≤ SBP < 160 mmHg and Group SBP ≥ 160 mmHg. The outcomes were new-onset CKD, new onset proteinuria, decline in eGFR and high or very high risk of CKD. Cox proportional hazards regression was used to examine the hazard ratios (HRs) of the outcomes among SBP levels. When 110 ≤ SBP < 120 mmHg, the incidence density of new-onset CKD, new onset proteinuria and decline in eGFR were 59.54, 20.23 and 29.96 per 1000 person-years, respectively. Compared to this group, the HR (95% CI) values for the risk of new-onset CKD from Group SBP < 110 mmHg to Group SBP ≥ 160 mmHg were 1.03 (0.81-1.32), 1.04 (0.91-1.19), 1.09 (0.95-1.16), 1.16 (1.02-1.21) and 1.18 (1.04-1.24), respectively. For patients over 65 years old, the risks of outcomes were increased when SBP < 120 mmHg. The lowest HR of high or very high risk of CKD for participants with or without multimorbidity occurred when 120 ≤ SBP < 130 mmHg. The HR of new-onset CKD in hypertension multimorbidity was lowest at 110-120 mmHg. The optimal SBP level was between 120 and 130 mmHg for individuals with high or very high risk of CKD. For patients over 65 years old, the low limit of target BP is advised to be not lower than 120 mmHg.

The hemodynamic response to nitrite is acute and dependent upon tissue perfusion.

In the vasculature, nitric oxide (NO) is produced in the endothelium by endothelial nitric oxide synthase (eNOS) and is critical for the regulation of blood flow and blood pressure. Blood flow may also be regulated by the formation of nitrite-derived NO catalyzed by hemoproteins under hypoxic conditions. We sought to investigate whether nitrite administration may affect tissue perfusion and systemic hemodynamics in WT and eNOS knockout mice. We found that global eNOS KO mice show decreased tissue perfusion compared to WT mice by using laser speckle contrast imaging. To study both the acute and long-term effects of sodium nitrite (0, 0.1, 1, and 10 mg/kg) on peripheral blood flow and systemic blood pressure, a bolus of nitrite was delivered intraperitoneally every 24 h over 4 consecutive days. We found that nitrite administration resulted in a dose-dependent and acute increase in peripheral blood flow in eNOS KO mice but had no effects in WT mice. The nitrite induced changes in tissue perfusion were transient, as determined by intraindividual comparisons of tissue perfusion 24-h after injection. Accordingly, 10 mg/kg sodium nitrite acutely decreased blood pressure in eNOS KO mice but not in WT mice as determined by invasive Millar catheterization. Interestingly, we found the vasodilatory effects of nitrite to be inversely correlated to baseline tissue perfusion. These results demonstrate the nitrite acutely recovers hypoperfusion and hypertension in global eNOS KO mice and suggest the vasodilatory actions of nitrite are dependent upon tissue hypoperfusion.

Associations of fruit intake with adiposity and cardiometabolic biomarkers in UK Biobank.

BACKGROUND: Fruit consumption has been associated with a lower cardiovascular disease (CVD) risk but the underlying mechanisms are unclear. We investigated the cross-sectional and prospective associations of fruit consumption with markers of adiposity, blood pressure, lipids, low-grade inflammation, glycaemia, and oxidative stress. METHODS: The main analyses included 365 534 middle-aged adults from the UK Biobank at baseline, of whom 11 510, and 38 988 were included in the first and second follow-up respectively, free from CVD and cancer at baseline. Fruit consumption frequency at baseline was assessed using a questionnaire. We assessed the cross-sectional and prospective associations of fruit with adiposity (body mass index, waist circumference and %body fat), systolic and diastolic blood pressure, lipids (low-density and high-density lipoproteins, triglycerides and apolipoprotein B), glycaemia (haemoglobin A1c), low-grade inflammation (C-reactive protein) and oxidative stress (gamma-glutamyl-transferase) using linear regression models adjusted for socioeconomic and lifestyle factors. Analyses were repeated in a subset with two to five complete 24-h dietary assessments (n = 26 596) allowing for adjustment for total energy intake. RESULTS: Fruit consumption at baseline generally showed weak inverse associations with adiposity and biomarkers at baseline. Most of these relationships did not persist through follow-up, except for inverse associations with diastolic blood pressure, C-reactive protein, gamma-glutamyl transferase and adiposity. However, for most mechanisms, mean levels varied by less than 0.1 standard deviations (SD) between high and low fruit consumption (> 3 vs < 1 servings/day) in further adjusted models (while the difference was < 0.2 SD for all of them). For example, waist circumference and diastolic blood pressure were 1 cm and 1 mmHg lower in high compared to low fruit intake at the first follow-up (95% confidence interval: -1.8, -0.1 and -1.8, -0.3, respectively). Analyses in the 24-h dietary assessment subset showed overall similar associations. CONCLUSIONS: We observed very small differences in adiposity and cardiometabolic biomarkers between those who reported high fruit consumption vs low, most of which did not persist over follow-up. Future studies on other mechanisms and detailed assessment of confounding might further elucidate the relevance of fruit to cardiovascular disease.

Effects of 12 weeks of functional training vs. Muay Thai on cardiac autonomic modulation and hemodynamic parameters in older adults: a randomized clinical trial.

BACKGROUND: The elevated blood pressure (BP) and lower cardiac autonomic modulation (CAM) are associated with higher morbidity mortality risk among older adults. Although exercise is an important intervention for cardiovascular promotion, it is unclear whether combat sports training could benefit cardiovascular outcomes as much as autonomic in this population. This study compared the effects of 12 weeks of Muay Thai (MT) training against functional training (FT) on CAM and hemodynamic parameters in older adults. METHODS: The sample consisted of 50 older adults (41 women; 66.0 ± 5.3 years old), who were equaly randomized into FT (n = 25) and MT (n = 25) intervention groups. CAM was measured by 30-min rest heart rate variability. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and resting heart rate (RHR) were measured using an automatic oscillometric device. Pulse pressure (PP) and the double product (DP) were also calculated. The interventions were carried out three times a week, with 60-min length per session, during 12 consecutive weeks. The intensity of the interventions was measured using the subjective perception of exertion scale and by accelerometer. Two-factor repeated measures analysis of covariance was used for groups comparison, considering intervention group and body mass as factors. The 95% confidence interval of the difference (95%CIdif) was also calculated and the effect size was measured using partial eta squared (η2p). RESULTS: CAM indices did not show significant changes across moments and intervention groups. In hemodynamic parameters, only in DBP was there an effect of the moment (F1,39 = 8.206; P = 0.007; η2p = 0.174, large) and interaction effect between group*moment (F1,39 = 7.950; P = 0.008; η2p = 0.169, large). Specifically, the MT group at the post-training moment showed lower DBP (P = 0.010; 95%CIdif = -13.3; -1.89) in relation to the FT group. Furthermore, the MT group showed a decrease in DBP during training (P = 0.002; 95%CIdif = -10.3; -2.6). Also, an increase in training intensity was also found over the 12 weeks in FT, with no difference between the groups. CONCLUSION: After 12 weeks of MT practice there was a reduction in DBP compared to FT in older adults. TRIAL REGISTRATION: NCT03919968 Registration date: 01/02/2019.

Effectiveness of high intensity and sprint interval training on metabolic biomarkers, body composition, and physical fitness in adolescents: randomized controlled trial.

Objective: The aim of this study was to evaluate the effect of HIIT and SIT programmes on body composition, blood pressure, lipid profile, glucose, cardiorespiratory fitness, and strength of adolescents and to compare the effect between those different protocols. Methods: Sixty adolescents were recruited from a high school and were randomly placed into three groups. SIT and HIIT undertook a training for 8 weeks, twice a week, for 12 min per session, during their Physical Education lessons. SIT group performed 6 sets of 60 s of work (90-95%HRmax) / 60 s of rest (50-55%HRmax), and HIIT group performed 3 sets of 2 min of work (80-85%HRmax) / 2 min of rest (50-55%HRmax). Results: After adjustment by sex, both experimental groups exhibited a significant reduction in fat mass (p < 0.01), and trunk fat mass (p < 0.01), as well as a significant increase in lean mass (p = 0.01; <0.01), hand-grip strength (p < 0.01) and standing long jump (p = 0.05-0.04, respectively). In addition, HIIT showed a significant (p < 0.05) improvement in blood pressure, diastolic blood pressure, heart rate and VO2max, and a tendency toward a significant reduction in low density lipoprotein. Conclusion: The implementation of a HIIT protocol within high school Physical Education sessions, maintained for 8 weeks, at a rate of 3 sets of 2 min of work (80-85% RHR)/2 min of rest (50-55% RHR) generated adaptations such as improved fitness condition, changes in body composition, and improvements in blood parameters and blood pressure. However, the group of adolescents who performed SIT, shorter but more intense sets, did not experience as many benefits.

Study on the effectiveness of a community hypertension management model based on home smart blood pressure monitoring using IoT technology.

Background: Hypertension is rapidly increasing in China, but control rates are significantly low. There is a pressing need for effective management models in primary community health settings. Methods: In April 2023, 459 patients from six communities in Jinan City were enrolled using a multi-stage random sampling method and assigned to either a control group comprising 243 participants or an intervention group comprising 216 participants. The control group received standard hypertension care, whereas the intervention group participated in a novel IoT-based remote blood pressure monitoring program for 6 months. Data collection was conducted through detailed questionnaire surveys, cloud platform records, and community management records, both before and after the intervention period. The study employed difference-in-differences (DID) and mediation effect models to assess the effects of the IoT-based management model. Results: The DID model demonstrated that the intervention significantly reduced systolic blood pressure by 9.883 mm Hg and diastolic blood pressure by 6.553 mm Hg. The mediation effect model showed that the frequency of blood pressure measurement and attitudes and beliefs toward hypertension treatment had mediating effects, accounting for 5.82 and 8.07% of the total effect, respectively. The heterogeneity analysis revealed significant regional differences: rural residents experienced a greater decrease in systolic and diastolic blood pressures by 14.85 mm Hg and 6.591 mm Hg, respectively, compared to urban residents, whose diastolic pressure decreased by 6.046 mm Hg. Recommendations: It is advisable to develop differentiated hypertension management strategies tailored to specific regional needs to promote the deep integration and widespread application of smart blood pressure monitoring technology. Enhancing patient awareness and capabilities in managing their health condition is crucial for improving the blood pressure control level among community hypertension patients.

[Status of elevated blood pressure among Chinese children and adolescents aged 7-17 from 2016 to 2017 according to 4 different references].

OBJECTIVE: To describe and analysis the detection rate of high normal blood pressure and high blood pressure among Chinese children and adolescents aged 7-17 years from 2016 to 2017 according to the clinical practice guideline for screening and management of high blood pressure in Children and Adolescents published by the American Academy of Pediatrics(the AAP reference), the international blood pressure references among Children and Adolescents aged 6 to 17 years(the international reference), health industry standard of the People's Republic of China "Reference of screening for elevated blood pressure among children and adolescents aged 7 to 18 years(WS/T 610-2018)"(the industry reference) and updating blood pressure references for Chinese children aged 3 to 17 years(the guideline reference). METHODS: Data was from the China Nutrition and Health Surveillance of Children and Lactating Women(2016-2017), in which the multistage stratified whole group random sampling method was used to draw participants from 275 surveillance sites in 31 provinces(autonomous regions and municipalities). In total, 67 231 participants were included according to the inclusion and exclusion criteria. Blood pressure was measured three times by trained staff using a validated oscillometric blood pressure monitor at the same point. The average blood pressure was calculated for the three measurements for SBP and DBP. To match the sampling design methodology, all values were weighted to represent the total population of Chinese children and adolescents 7-17 years of age considering sampling weights for each stratification based on the sixth population census data provided by the National Bureau of Statistics. RESULTS: The detection rate varied greatly under different references. The detection rate of high normal blood pressure was ranked from high to low according to the AAP reference(20.15%) > the guideline reference(17.29%) > the industry reference(13.14%) > the international reference(12.66%); the detection rate of high blood pressure in descending order is the guideline reference(24.31%) > the international reference(21.34%) > the AAP reference(20.59%) > the industry reference(19.96%). CONCLUSION: Although the consistency between the AAP references and international references and our national two references were medium to high, the difference in detection rate obtained by analysis was large. Considering the differences of demographic characteristics in the reference population, caution should be taken when applying foreign references to judge the blood pressure status of children and adolescents in China.

Association of Wearable Device-Measured Step Volume and Variability With Blood Pressure in Older Chinese Adults: Mobile-Based Longitudinal Observational Study.

BACKGROUND: The paucity of evidence on longitudinal and consecutive recordings of physical activity (PA) and blood pressure (BP) under real-life conditions and their relationships is a vital research gap that needs to be addressed. OBJECTIVE: This study aims to (1) investigate the short-term relationship between device-measured step volume and BP; (2) explore the joint effects of step volume and variability on BP; and (3) examine whether the association patterns between PA and BP varied across sex, hypertension status, and chronic condition status. METHODS: This study used PA data of a prospective cohort of 3070 community-dwelling older adults derived from a mobile health app. Daily step counts, as a proxy of step volume, were derived from wearable devices between 2018 and 2022 and categorized into tertiles (low, medium, and high). Step variability was assessed using the SD of daily step counts. Consecutive daily step count recordings within 0 to 6 days preceding each BP measurement were analyzed. Generalized estimation equation models were used to estimate the individual and joint associations of daily step volume and variability with BP. Stratified analyses by sex, the presence of hypertension, and the number of morbidities were further conducted. RESULTS: A total of 3070 participants, with a median age of 72 (IQR 67-77) years and 71.37% (2191/3070) women, were included. Participants walked a median of 7580 (IQR 4972-10,653) steps and 5523 (IQR 3590-7820) meters per day for a total of 592,597 person-days of PA monitoring. Our results showed that higher levels of daily step volume were associated with lower BP (systolic BP, diastolic BP, mean arterial pressure, and pulse pressure). Compared with participants with low step volume (daily step counts <6000/d) and irregular steps, participants with high step volume (≥9500/d) and regular steps showed the strongest decrease in systolic BP (-1.69 mm Hg, 95% CI -2.2 to -1.18), while participants with medium step volume (6000/d to <9500/d) and regular steps were associated with the lowest diastolic BP (-1.067 mm Hg, 95% CI -1.379 to -0.755). Subgroup analyses indicated generally greater effects on women, individuals with normal BP, and those with only 1 chronic disease, but the effect pattern was varied and heterogeneous between participants with different characteristics. CONCLUSIONS: Increased step volume demonstrated a substantial protective effect on BP among older adults with chronic conditions. Furthermore, the beneficial association between step volume and BP was enhanced by regular steps, suggesting potential synergistic protective effects of both increased step volume and step regularity. Targeting both step volume and variability through PA interventions may yield greater benefits in BP control, particularly among participants with hypertension and a higher chronic disease burden.

[Resistant hypertension and the risk of major adverse cardiac and cerebrovascular events in outpatients].

Objective: To investigate the prevalence and associated risk of cardiovascular event of resistant hypertension in treated outpatients. Methods: This study was a nationwide multi-center prospective cohort study. The participants were treated outpatients enrolled in the China Nationwide Ambulatory and Home Blood Pressure Registry study of 42 hospitals in 19 provinces across the country from August 2009 to October 2017. Apparent resistant hypertension was defined as uncontrolled office blood pressure (≥140/90 mmHg, 1 mmHg=0.133 kPa) in spite of the use of three antihypertensive drugs or controlled office blood pressure (<140/90 mmHg) with four antihypertensive drugs or more. Subjects diagnosed with uncontrolled office blood pressure were further subdivided as pseudo-resistant hypertension and true resistant hypertension based on 24 h ambulatory blood pressure monitoring. The primary endpoint was fatal and non-fatal cardiovascular and cerebrovascular events, which was a composite endpoint consisting of cardiovascular and cerebrovascular death, ischemic and hemorrhagic stroke, myocardial infarction, coronary artery revascularization, unstable angina, heart failure, and coronary artery stenosis≥50% confirmed by coronary angiography. Secondary outcomes included fatal and non-fatal stroke or cardiac events. Patients with controlled office blood pressure after taking only 1 or 2 antihypertensive drugs were included as control. Kaplan-Meier survival curves, log-rank test, and Cox proportional risk model were used to evaluate the risk of apparent refractory hypertension in relation to cardiovascular and cerebrovascular prognosis. Results: A total of 2 782 treated hypertensive patients, aged (58.1±12.3) years were enrolled, including 1 403 (50.4%) men. The prevalence of apparent and true resistant hypertension was 15.1% (420/2 782) and 10.5% (293/2 782), respectively. Among patients with apparent resistant hypertension, during a median of 5 years follow-up, the cumulative incidence rate was 28.2, 11.2 and 19.1 per 1 000 person-years for fatal and non-fatal cardiovascular events (n=58), stroke (n=24) and cardiac events (n=40), respectively. The Kaplan-Meier curve and log-rank test showed that those patients with true resistant hypertension, had the highest cumulative incidence rate of fatal and non-fatal cardiovascular events, stroke, and cardiac events. Multivariable Cox regression analyses showed that true resistant hypertension was associated with a significantly higher risk of fatal and non-fatal cardiovascular events (HR=1.73, 95%CI 1.17-2.56, P=0.006) and stroke (HR=2.81, 95%CI 1.53-5.17, P=0.001). Conclusion: Resistant hypertension, especially true resistant hypertension, is associated with a higher risk of fatal and non-fatal cardiac and cerebrovascular events.

[Effect of RDN on long-term blood pressure in refractory hypertensive patients with different cardiovascular risk stratification].

Objective: To investigate the long-term therapeutic effects and safety of renal denervation (RDN) on hypertensive patients with different cardiovascular risks, as well as its impact on adverse events, cardiovascular death and all-cause mortality. Methods: This was a single-center, single-arm, real-world retrospective study. Patients with refractory hypertension who underwent RDN at Tianjin First Central Hospital from July 6, 2011 to December 23, 2015 were enrolled and divided into either a high or intermediate-low risk group based on baseline cardiovascular risk. The treatment responsiveness of hypertensive patients with different cardiovascular stratification to RDN was assessed by comparing the results of office blood pressure, home blood pressure, and 24-h ambulatory blood pressure monitoring at 1, 5, and 11 years after RDN. Long-term safety of RDN was assessed by creatinine, and estimated glomerular filtration rate (eGFR) at 1 and 11 years after RDN. In addition, the total defined daily dose (DDD) of antihypertensive medications and the incidence of long-term adverse events, cardiovascular deaths, and all-cause deaths after RDN were followed up 11 years after RDN in person or by telephone. Results: A total of 62 patients with refractory hypertension, aged (50.2±15.0) years, of whom 35 (56.5%) were male, were included. There were 35 cases in high-risk group and 27 cases in low and medium risk group. The decrease in clinic systolic blood pressure (high risk vs. low-medium risk: (-38.0±15.1) mmHg vs. (-25.0±16.6) mmHg(1 mmHg=0.133kPa),P=0.002), home self-measured systolic blood pressure ((-28.4±12.7) mmHg vs. (-19.7±13.1) mmHg,P=0.011) and clinic systolic blood pressure 11 years after RDN ((-43.0±18.4) mmHg vs. (-27.8±17.9) mmHg,P=0.003) in the high-risk group was significantly higher than that in the low-medium risk group. The differences in heart rate and the decrease in total DDD number of antihypertensive drugs between the two groups were not statistically significant (all P>0.05). Creatinine and eGFR levels in the two groups at 1 and 11 years after RDN were not statistically significant when compared with the baseline values (all P>0.05). The cumulative cardiovascular mortality rate was 1.6% (1/62) and 8.1% (5/62), and the cumulative all-cause mortality rate was 3.2% (2/62) and 11.3% (7/62) at 5 and 11 years after RDN, respectively. The differences in the incidence rate of adverse events, cardiovascular mortality, and all-cause mortality rate between the two groups were not statistically significant (all P>0.05). Conclusions: RDN has long-term antihypertensive effect and good safety. Hypertensive patients who belong to the high-risk stratification of cardiovascular risk may respond better to RDN treatment.