ABSTRACT
To facilitate the applications of home blood pressure (HBP) monitoring in clinical settings, the Taiwan Hypertension Society and the Taiwan Society of Cardiology jointly put forward the Consensus Statement on HBP monitoring according to up-to-date scientific evidence by convening a series of expert meetings and compiling opinions from the members of these two societies. In this Consensus Statement as well as recent international guidelines for management of arterial hypertension, HBP monitoring has been implemented in diagnostic confirmation of hypertension, identification of hypertension phenotypes, guidance of anti-hypertensive treatment, and detection of hypotensive events. HBP should be obtained by repetitive measurements based on the " 722 " principle, which is referred to duplicate blood pressure readings taken per occasion, twice daily, over seven consecutive days. The " 722" principle of HBP monitoring should be applied in clinical settings, including confirmation of hypertension diagnosis, 2 weeks after adjustment of antihypertensive medications, and at least every 3 months in well-controlled hypertensive patients. A good reproducibility of HBP monitoring could be achieved by individuals carefully following the instructions before and during HBP measurement, by using validated BP devices with an upper arm cuff. Corresponding to office BP thresholds of 140/90 and 130/80 mmHg, the thresholds (or targets) of HBP are 135/85 and 130/80 mmHg, respectively. HBP-based hypertension management strategies including bedtime dosing (for uncontrolled morning hypertension), shifting to drugs with longer-acting antihypertensive effect (for uncontrolled evening hypertension), and adding another antihypertensive drug (for uncontrolled morning and evening hypertension) should be considered. Only with the support from medical caregivers, paramedical team, or tele- monitoring, HBP monitoring could reliably improve the control of hypertension.
ABSTRACT
This paper proposes an efficient method for automatically segmenting vessels from angiogram sequences. The method includes two steps: extracting high-contrast angiograms and segmenting vessels. First, we select high-contrast angiograms automatically using vessel intensity distribution. Based on multiscale Hessian-based filtering, we propose an adaptive feature transformation function to improve the vesselness response. This method overcomes numerous problems, which exist in the X-ray angiograms by using the scale factors and transformed intensities. Various scales are established to mitigate variations of the intensity distribution. The transformed intensities are applied to coping with lower contrast and nonuniform intensity distribution. Finally, the connected component labeling method is used to extract the vessels. The proposed method can distinguish between the vessel and the background in a complex background. In our experiments, 20 angiogram sequences are used to evaluate the accuracy of the selected high-contrast angiogram. The accuracy of extracting high-contrast angiograms is 98%. For evaluating the accuracy of the segmentation results, 72 angiograms were selected. The accuracy of the proposed segmentation method is 96.3%. The Kappa value is 81.8%. After inspection by a cardiologist, the experimental results show that the proposed method can automatically and accurately segment vessels.
Subject(s)
Angiography/methods , Image Processing, Computer-Assisted/methods , Databases, Factual , Female , Humans , MaleABSTRACT
BACKGROUND: It has been shown that metabolic syndrome is associated with lower levels of plasma N-terminal pro-B-type natriuretic peptide (Nt-proBNP) in the general population. However, there is no study about the association between Nt-proBNP and metabolic syndrome in hypertensive patients. AIM: : To elucidate the relationship between Nt-proBNP and components of metabolic syndrome in hypertensive patients. METHODS: Fasting blood samples were obtained from 74 hypertensive patients in our institution. Plasma levels of Nt-proBNP and other biochemical data were measured. Metabolic syndrome and its components were defined using diagnostic criteria from the International Diabetes Federation. RESULTS: Forty-four hypertensive patients met the criteria for metabolic syndrome. We found that plasma Nt-proBNP levels were lower in hypertensive patients with metabolic syndrome attributable to inverse relationships between Nt-proBNP and albumin, triglyceride, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and pancreatic ß-cell function (HOMA-ß). We further performed a multivariable linear regression analysis. The result showed that HOMA-IR is the independent predictor of plasma Nt-proBNP levels in hypertensive patients. CONCLUSIONS: Plasma Nt-proBNP levels are inversely associated with metabolic syndrome in hypertensive patients. HOMA-IR is the independent predictor of Nt-proBNP in hypertensive patients.
