Simple Memorable Formulas for Screening Hypertension in Children: Based on the New American Academy of Pediatrics Guideline.

INTRODUCTION: Hypertension (HTN), also known as high blood pressure (BP), is a major global risk factor for cardiovascular and kidney diseases. Although annual BP screenings for children over three years of age are recommended, underdiagnosis of HTN in children is common. To address this issue, the American Academy of Pediatrics updated its guideline for screening and managing high BP in children in 2017, which can be cumbersome to implement in clinical practice due to the numerous cut-off points and tables. The purpose of our study is to design formulas to detect HTN in children based on the new Clinical Practice Guideline for screening and management of high BP in children and adolescents. METHODS: In this research, we analyzed forty-eight cut-off points using the 90th percentile systolic and diastolic BPs for the fifth percentile height. The final mathematical model consisted of four formulas based on different ages and sex which in turn were rounded by 0.1 and 1.0 for both systolic and diastolic BPs. The formulas were further modified to be lower than the 95th percentile systolic BPs for the fifth percentile of height to minimize false negative results. RESULTS: As evidenced by the tables included in this paper, except for a few exceptions, all rounded systolic and diastolic values for both sexes were equal to or lower than the 90th percentile. In a few cases where the cutoff points calculated by the formula were higher than the ones provided in the 2017 guideline, the differences were less than 2 mmHg. CONCLUSION: In this study to address the complexity of the routine guidelines, we present simplified formulas for screening children aged 1 to 12 years in figures and tables and recommend their use, particularly in office and emergency settings, as an easier-to-implement first step in screening for HTN in children.  DOI: 10.52547/ijkd.7525.

Validity of the Adrogué-Madias Formula for the Management of Acute Dysnatremias in Critically Ill Children: A Prospective Multicenter Analysis.

OBJECTIVE: Current conventional formulas do not predict the expected changes in serum sodium after administration of various fluids to correct serum sodium abnormalities. The Adrogué-Madias formula is currently the preferred and widely used fluid prescription for adult patients with dysnatremias, but its therapeutic efficacy has not been validated in pediatric patients. METHODS: In this prospective study, we used the Adrogué-Madias formula for calculating the appropriate rate of various fluids administration to correct serum sodium abnormalities in 7 critically ill children with acute dysnatremias. RESULTS: After administration of various intravenous fluids using the Adrogué-Madias formula, the anticipated as well as the achieved sodium concentrations were almost similar. CONCLUSIONS: This study demonstrates that the use of the Adrogué-Madias quantitative formula allows to calculate the appropriate rate of administration of various fluids. The calculated fluid administration resulted in the subsequent actual laboratory values and clinical changes.

Predicting childhood overweight status by accelerated weight gain from neonatal period to infancy.

Background: The increased prevalence of obesity in early childhood is a public health problem. Childhood obesity may affect cardiorespiratory fitness and can induce obesity and its comorbidities in adulthood. We aimed to assess childhood overweight status by accelerated weight gain during infancy. Materials and Methods: This is a historical cohort that was conducted on 637 7-year-old students of Guilan province, north of Iran. Data were collected, including demographic characteristics, weight at 4, 6, 12, and 18 months, and clinical examination. The ROC curve was designated based on the standardized z-scores, and the most appropriate cutoff point by sensitivity and specificity was noted for predicting obesity at 7 years. Rapid weight gain (RWG) was also assessed. Results: Among participants, 334 (53.3%) were female. In this study, the mean and standard deviation of RWG in 0-4 months, 0-6 months, 0-12 months, and 0-18 months were 3.50 ± 0.89, 4.64 ± 1.02, 6.54 ± 1.21, and 8.00 ± 1.46 kg, respectively. The highest AUC was dedicated to 0-18 months (0.7 ± 0.05) and the suitable cut-off for RWG in this interval was 8.55 kg with 65.5% and 72.0% sensitivity and specificity, respectively. Conclusion: Although in the previous investigations, the changes in the first 3 years of life had a significant role in further complications, regarding our results, it seems that even earlier consideration of excess weight gain may be necessary.

Normal saline, the known but least-examined fluid therapy method for preventing heme-induced nephropathy in children with glucose 6 phosphate dehydrogenase deficiency: a randomized controlled clinical trial.

BACKGROUND: Glucose 6 phosphate dehydrogenase deficiency (G6PDd) is the most common enzyme deficiency in humans. Randomized clinical trials comparing the efficacy of different types of fluid therapy for prevention of acute kidney injury (AKI) following hemolysis in patients with G6PDd are lacking. The present study aimed to compare the efficacy of three different types of fluid administration, isotonic saline with or without acetazolamide versus bicarbonate solution in prevention of AKI among children with acute hemolysis due to G6PDd. METHODS: In this double-blind randomized controlled clinical trial, 120 infants and children with acute hemolysis due to G6PDd were randomly divided into three groups consisting of 40 participants in each group. Group A received normal saline. Group B received normal saline plus oral acetazolamide at a dose of 5 mg/kg/day, and group C received half saline plus 75 mEq/L sodium bicarbonate. The primary outcome of this study was the frequency of AKI among the different types of fluid administration. RESULTS: In this study, 72 (60%) patients were boys with the mean age and length of hospital stay of 3.9 ± 2.2 years and 54.4 ± 29.9 h, respectively. AKI as the primary outcome of this study occurred only in one patient in group C and the rate of AKI did not differ significantly among patients receiving different types of fluid resuscitation (P > 0.05). CONCLUSION: Normal saline was equivalent to fluids containing alkalinizing agents in preventing heme-induced nephropathy in patients with G6PDd. A higher resolution version of the Graphical abstract is available as Supplementary information.

Point-of-care ultrasound in pediatric nephrology.

Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances.

The effect of short-course point-of-care echocardiography training on the performance of medical interns in children.

BACKGROUND: Point-of-care ultrasound (POCUS) can add complementary information to physical examination. Despite its development in several medical specialties, there is a lack of similar studies on children by medical interns and cardiologists. Therefore, investigators aimed to assess the effect of short-course training on the performance of medical interns in point-of-care echocardiography in children. METHODS: This analytic cross-sectional study was conducted on 161 hospitalized children in 17 Shahrivar children's hospital, Iran, from January 2021 to May 2021. Seven interns (trainees) participated in a short course of point-of-care echocardiography to assess left ventricular ejection fraction (LVEF), inferior vena cava collapsibility index (IVCCI), and the presence of pericardial effusion (PEff). Each patient underwent point-of-care echocardiography by one of the trainees. Then, in less than one hour, the echocardiography was performed by a single cardiologist. Agreement between the cardiologist and trainees was examined using Cohen's kappa coefficient and Prevalence-Adjusted Bias-Adjusted Kappa (PABAK). For numerical variables, the agreement was examined using the concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC). RESULTS: Results showed that the cardiologist and trainees detected LVEF >50, IVCCI >50%, and the absence of PEff in most of the participants. A good agreement in terms of ICC and CCC for LVEF (0.832 and 0.831, respectively) and a good agreement in terms of ICC and CCC for IVCCI (0.878 and 0.877, respectively) were noted. Using categorical scoring of LVEF and IVCCI showed 94.4% and 87.6% complete agreement, respectively. Furthermore, using categorical scoring of LVEF and IVCCI, Cohen's kappa coefficient was 0.542 (moderate) and 0.619 (substantial), respectively. The PABAK for LVEF and IVCCI were 0.886 (almost perfect) and 0.752 (substantial), respectively. For PEff, Cohen's kappa and PABAK were 0.797 (moderate) and 0.988 (almost perfect), respectively, and the complete agreement was noted in 160 patients (99.4%). CONCLUSIONS: This study showed that a short teaching course could help medical interns to assess LVEF, IVCCI, and PEff in children. Therefore, it seems that adding this course to medical interns' curricula can be promising.

Revisiting the Management of Pediatric Kidney Transplants, A Multicenter Analysis

The newest Kidney Disease Improving Global Outcomes (KDIGO) guideline recommendations were investigated mainly for the care of adult kidney transplant recipients, but no guideline exists for the management of pediatric transplant recipients. This review provides update recommendations in the management of pediatric kidney transplantation. Four electronic databases, PubMed, EMBASE, Google Scholar, and Web of Science were searched systematically for the last two decades, using Mesh terms in English language. The Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach was used for grading the quality of the overall evidence and the strength of recommendations for each outcome across the studies. The overall quality of evidence categorized as high (A), moderate (B), low (C), or poor (D). The strength of a recommendation was determined as level 1 (recommended) or level 2 (suggested). The ungraded statements were determined on the basis of common sense to provide general advice. Of the 317 citations which were screened for the evidence review, 62 were included in data extraction. The included studies were randomized controlled trials, prospective cohorts and cross-sectional, descriptive, and review studies. Of the 115 statements, 56 (48.6%) were graded 1 (we recommend), 34 (29.5%) were graded 2 (we suggest), and 25 (21.7%) were ungraded statements. Altogether, only 22 (19.1%) of recommendations reached the "A" or "B" levels of quality of evidence. The pediatric kidney transplant recipients are different from adult recipients regarding the primary kidney diseases, surgical techniques, drug metabolism, adherence to medications, growth and neurocognitive development and immunization needs prior to transplantation.  DOI: 10.52547/ijkd.7179.

The Cutoff of Gonadotropins for Close Evaluation of Cardiometabolic Risk Factors in Turner Syndrome.

Background: Turner syndrome is a common genetic disorder in females. It is a disorder characterized by variable number of clinical features, so it needs a multidisciplinary approach for care. Therefore, we aimed to define the cutoff of gonadotropins for close evaluation of cardiometabolic risk factors in Turner syndrome. Methods: This is a case-control study on 31 patients with Turner syndrome and 31 healthy individuals. Clinical examination including blood pressure measurement and systems evaluation was performed. Laboratory testing, which included 12-h fasting, assessed lipid profile, glucose, and serum gonadotropin. Results: Turner syndrome had a higher BMI, systolic, and diastolic blood pressure than the normal group (P < 0.001) Patients with Turner syndrome had significantly higher total cholesterol, low-density lipoprotein, triglyceride, and TG-to-high-density lipoprotein ratio compared to the healthy individuals (P < 0.05). With increasing LH and FSH, BMI values, systolic blood pressure, and total cholesterol increased significantly (P < 0.001). Serum TG levels in Turner syndrome were only positively correlated with LH and not correlated with FSH. The cutoff point of LH and FSH for triglyceride in upper 75 percentile were 31 (sensitivity = 38.1%, specificity = 80%) and 48 (sensitivity = 61.9%, specificity = 70%), respectively. Conclusions: Based on dyslipidemia and lower level of ejection fraction, considering cardiometabolic risk factors in lower age groups in Turner syndrome can be recommended.

Strengthening the success rate of suprapubic aspiration in infants by integrating point-of-care ultrasonography guidance: A parallel-randomized clinical trial.

BACKGROUND: Urinary tract infection (UTI) is a common disease in childhood. A sterile collection of urine samples using suprapubic aspiration (SPA) and bladder catheterization (BC) is helpful for rapid and accurate diagnosis of UTI in infants. With the advent of point-of-care ultrasound (POCUS), the use of ultrasound by non-radiologists at the patient's bedside, great advancement has been noticed in various medical fields. Considering the importance and advantages of using POCUS in the physical examination and guiding procedures, the authors aimed to compare urine sampling's success rate by SPA, BC, and POCUS guided SPA (POCUS-SPA) in infants performed by three pediatricians. MATERIALS AND METHODS: This study is a randomized clinical trial conducted on 114 neonates and infants with suspected UTI admitted to 17-Shahrivar children's hospital from April 2017 to September 2019. Neonates and infants were randomly assigned to three groups of BC, SPA, and POCUS-SPA. The primary outcome was the success of sampling defined by obtaining 1cc of urine in each method. The secondary outcome was assessing the pain level. RESULTS: Results showed that the POCUS-SPA had the highest success rate in urine sampling, and a statistically significant relation was noted among the three groups (P = 0.0001). From 38 patients in each group, 37 patients of POCUS-SPA (97.4%), 34 patients of BC (89.5%), and 23 patients of SPA (60.5%) had a successful sampling. Most of the patients in all three groups experienced severe pain. CONCLUSIONS: In the current study, results showed that the POCUS-SPA significantly increased the success rate of urine sampling and most of the patients in all three groups had severe pain. Based on the shortage of access to radiologists in emergency setups, it seems that the POCUS-SPA by the pediatricians can be one of the most appropriate and applicable diagnostic methods in infants with UTI.

Assessment of Medical Student's Skill for Pediatric Blood Pressure Measurement.

INTRODUCTION: The main reason for this study is regarding the importance of correct estimation, which can consequently decreases the risk of under or over estimation. METHODS: This was an observational analytic cross-sectional study. An online data collection tool "Google Form" was used to gather personal information and self-assessment score. RESULTS: From the 121 participants, the majority of them (76) were women. Most of the participants (33.9%) were seventh-year medical students. The results of this study showed that 100% of the participants believed that they possessed the skillset to measure BP correctly with an average self-assessment score of 8.20 ± 1.05. However, the mean total score for the participants was 3.69 ± 1.59, with only two of the participants scoring as high as 7. CONCLUSION: The majority of participants attained low average score of correct blood pressure measurements. However, they noted high self-assessment scores before conducting the study. This disparity between reported results may show and emphasizes the importance of considering these 11 tips in the BP training courses.

Early Kidney Damage Markers after Deferasirox Treatment in Patients with Thalassemia Major: A Case-Control Study.

BACKGROUND: The life of patients with ß-thalassemia major depends on blood transfusion. Regular blood transfusion leads to hemosiderosis in their main organs. The aim of this study was to compare the effects of deferasirox and deferoxamine on renal damage in patients with ß-thalassemia major. METHOD: The present case-control study was conducted on 60 individuals who were referred to the 17th Shahrivar Tertiary Referral Hospital in Guilan province, Iran. In this study, patients with ß-thalassemia major who used deferasirox (n = 21) and patients who used deferoxamine (n = 19) were evaluated. The control group (n = 20) was selected from healthy individuals. Serum creatinine (CREA), blood urea nitrogen (BUN), and Cystatin C were measured from blood samples. Furthermore, urinary (U.) neutrophil gelatinase-associated lipocalin (NGAL), albumin (Alb), interleukin- (IL-) 18, and Kidney Injury Molecule-1 (KIM-1) were measured by the ELISA method and normalized for U. creatinine (CREA). RESULTS: U. NGAL, U. IL-18, and BUN biomarkers in the deferasirox group were significantly higher than those in the control group (p < 0.001). U. NGAL/CREA and U. KIM-1/CREA ratios increased in both the deferoxamine and deferasirox groups compared to the control group (p < 0.05). U. Alb was significantly higher in patients treated with deferoxamine than in healthy participants (p < 0.05). CONCLUSION: The findings of this study indicate that after taking deferasirox, there was renal damage and an increase in inflammatory factors. Also, minor renal impairment was observed after deferoxamine administration, but it was not confirmed at the molecular level (U. NGAL and KIM-1). Therefore, it seems that patients who are taking these two drugs should be monitored carefully.

Birth Weight as a Cardio Metabolic Risk Factor in Iranian Adolescents.

BACKGROUND: A large number of epidemiological studies from different geographical regions showed a considerable relationship between low birth weight (LBW) and adverse health effects later in life. This study aims to assess the birth weight (BW) as a cardio metabolic risk factor in Iranian adolescents. METHODS: This cross-sectional study was conducted on 12-year-old students from different areas of Rasht, North Iran. Data were collected by a questionnaire including variables as birth height, BW, gestational age, blood pressure, and laboratory tests including triglycerides (TGs), total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and insulin level. Data were analyzed using t-test, Chi-square, and Pearson correlation coefficient. RESULTS: Overall, 858 adolescents participated in this study. Results showed significant correlation between BW and abdominal circumference, hip circumference, total cholesterol, TG, HDL-C and LDL-C (P = 0.064, 0.194, 0.224, 0.017, and 0.017, respectively). CONCLUSIONS: The study findings on the correlation between BW and cardio metabolic factors might serve as confirmatory evidence on the association of LBW with future cardio metabolic disorders.

Is Infantile Colic an Early Life Expression of Childhood Migraine?

OBJECTIVE: Migraine is the mosyndrome and infantile colic is a common cause of infantile cry. The pathogenesis of migraine and colic has not been well established and different factors may cause them. There is an association between infantile colic and the occurrence of childhood migraine. We aimed to assess whether infantile colic could be noted as an early life expression of childhood migraine or not. MATERIALS & METHODS: This retrospective case-control study was conducted on 5-15-year-old childrenin Rasht, Iran during 2015-2016. Forty-one cases were children with migraine with or without aura. Overall, 123 Control participants were children with the same age referred to the pediatric clinic for routine care. Data were gathered by a checklist including age, sex, birth weight, family history of migraine, the occurrence of colic and type of feeding during infancy. Data were reported by descriptive statistics and analyzed by Fisher exact test using SPSS ver. 19. RESULTS: Overall, 164 children with the mean age of 8.36± 2.53 yr were enrolled. Seventeen (41.46%) children with migraine vs. 44 (35.7%) children in control group had the positive history of infantile colic and Fisher exact test noted significant relation between migraine and colic. Thirty-three children with infantile colic (46.57%) had the positive family history of migraine, which was significantly higher than 27 children without colic (29.7%). There was a significant relation between infantile feeding and migraine. CONCLUSION: There is a probable relation between colic and migraine, therefore, migraine and colic as 2 pain syndromes may have a common pathophysiology and further investigations on this common pathophysiology is justified.

Point-of-Care Ultrasonography: Is It Time Nephrologists Were Equipped With the 21th Century's Stethoscope?

In the past 3 decades, ultrasonography has gifted internal organs visualization to physicians to have a better detection of various diseases. Previously performed solely by radiologists as a method with high feasibility and accuracy, recently ultrasonography is being recommended and used by many other physicians in practice. Ultrasonography not only can be used to diagnose and manage kidney diseases, but also is an essential tool in nephrology for the guidance of invasive procedures. This method of bedside ultrasonography by physicians in real time is called point-of-care ultrasonography (POCUS). Given the limitations of collecting information by routine physical examination in kidney diseases and the simplicity of performing ultrasonography to examine kidney location, architecture, and restricted pathologies, nephrologists that have been lagging in this area, should join the spectrum of clinicians using the POCUS to provide safe and rapid diagnosis of common renal abnormalities. Although physicians may imagine POCUS as a difficult tool to use and there has been an initial resistance and reluctance to use ultrasonography by nonradiologists, investigations have shown that learning and doing POCUS was possible even for undergraduate medical students during a short course. According to the collected evidence in the field of POCUS in different branches of medicine, it seems that it should be added to nephrology examination room in the near future.

Prevalence of Hypertension and Obesity-related Hypertension in Urban School-aged Children in Rasht.

INTRODUCTION: Hypertension is a worldwide health concern. Complications of hypertension not only affect adult patients, but also involve children. Given the importance of assessing children with hypertension in order to decrease adulthood complications, we aimed to assess the prevalence of hypertension in urban school-aged children in Rasht, Iran. MATERIALS AND METHODS: This cross-sectional study was conducted on 2072 school-aged children in Rasht, Iran, from January 2013 to December 2015. Inclusion criteria were age between 7 and 17 years and residence and attending school in the urban area of Rasht. RESULTS: Overall, 205 (9.9%) and 144 (6.9%) of the participants were hypertensive and prehypertensive, respectively. The mean systolic blood pressure was 124.54 ± 11.86 mm Hg in the children. The prevalence of obesity in the children was 3.5%. Comparing the normal, prehypertensive, and hypertensive groups, there was a significantly increasing trend regarding age, height, weight, and body mass index associated with higher blood pressure categories. CONCLUSIONS: This study showed a high rate of hypertension among school-aged children in Rasht. Hypertensive children tended to be have a higher body mass index than the prehypertensive and normal-weight participants. Case identification and early assessment of these children is recommended.

Suitable intravenous fluid for preventing dysnatremia in children with gastroenteritis; a randomized clinical trial.

INTRODUCTION: Gastroenteritis (GE) is one of the most common pediatric diseases. Hyponatremia commonly occurs by administering hypotonic fluids to GE and hospitalized children. Yet, there is no consensus on the ideal method of treatment. OBJECTIVES: we aimed to assess suitable intravenous (IV) fluid for preventing dysnatremia in children with GE. PATIENTS AND METHODS: This is a double blind randomized clinical trial, which was conducted on infants of 6 months up to 14 years children with GE. Children were randomly assigned in 2 different groups. Group A; received 20 cc/kg 0.9% isotonic saline as a bolus, and 0.45% hypotonic saline as sum of maintenance fluid and volume deficit. Group B was treated with the same bolus and 0.9% isotonic saline with 20 mEq/L KCl as sum of maintenance fluid and volume deficit. Blood and urine samples were taken at admission, 4 and 24 hours. Data were analyzed by independent t test, Mann-Whitney U test, Friedmann test, chi-square and 2-tailed repeated measurements by SPSS version 19. RESULTS: Baseline hyponatremia and isonatremia were detected in 24 (31.5%) and 51 (67.1%) patients, respectively. Mean level of sodium at T0, T4 and T 24 mentioned no significant difference between groups. No hypernatremia was noted by administering isotonic saline. RESULTS showed that 4 and 24 hours after administration isotonic saline, the mean plasma sodium differed significantly in baseline hyponatremic patients. However, no significant difference was noted after 4 and 24 hours in group A. CONCLUSION: According to the considerable effect of isotonic saline on hyponatremic patients, it seems that administering isotonic fluids regardless of the types of dysnatremia can be recommended to lessen clinicians' conflicting decision-making in selecting an appropriate fluid.

The Percentage of Error of Different Weight Estimation Methods toward Actual Weight in Children Admitted to 17 Shahrivar Hospital.

BACKGROUND: In pediatric resuscitation, it is necessary to distinguish the weight in order to provide proper doses of drugs, equipment selection, and ventilator settings, therefore, access to a simple, unbiased, and accurate formula can decrease mistakes. The aim of this study is to determine the percentage of error (PE) of different weight estimation methods toward actual weight in children admitted to 17 Shahrivar Hospital. METHODS: This is a descriptive cross-sectional study conducted on 1-10 years children admitted in the pediatric clinic of 17 Shahrivar Hospital in Rasht. Data were collected by a checklist, including age, sex, height and mid-arm circumference (MAC). Investigators compared estimated weight by ten different methods with the actual weight. Finally, clinicians measured the PE and data were analyzed in SPSS software version.18. RESULTS: About 50.9% of participants were male. The mean age was 4.59 ± 3.35 years and the mean weight was 17.4 ± 5.69 (6.5-45) kg. Results showed no significant difference between the estimated weight and the actual one based on visual expert estimation and advanced pediatric life support (APLS) method. Visual estimation (0.017%) and MAC (25.48%) noted the lowest and highest PE, respectively. CONCLUSIONS: Results indicated a significant difference between the estimated weight and the actual one based on visual expert's estimation and APLS method. As, these methods were easy, rapid and accurate for body weight estimation in emergencies and may be more accurate than parent's estimation, it seems that it could be helpful for prescribing medication dosage and equipment sizes.

Strategies to reduce pitfalls in measuring blood pressure.

Errors in blood pressure (BP) measurement are common in the clinical practice. Inaccurate measurements of BP may lead to misdiagnosis and inappropriate treatment of hypertension. The preferred method of BP measurement in the clinical setting is auscultation, using the first and the fifth Korotkoff sounds. However, the use of mercury sphygmomanometer is declining. Automated oscillometric devices are an acceptable alternative method of BP measurements if the proper cuff size is used. Aneroid devices are suitable, but they require frequent calibration. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. At 24 h ambulatory monitoring is also useful for diagnosing white-coat hypertension and resistance hypertension. There is increasing evidence that lack of nocturnal BP dipping during the night may be associated with increased cardiovascular event. This report attempts to address the need for accurate BP measurements in children and adolescents by reducing human and equipment errors and providing clinicians with the accurate measurement of BP, which is essential to classify individuals, to ascertain BP-related CV risks and to guide management.