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1.
Adv Exp Med Biol ; 1232: 315-322, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31893426

RESUMEN

We present an unobtrusive cuff-less sphygmomanometer based on contact-type and optical pulse sensors for continuous and minimally invasive monitoring of blood pressure (BP). We developed a cuff-less sphygmomanometer that utilizes the pulse arrival time (PAT) to estimate continuous BP. To assess its accuracy, we recruited 10 healthy subjects in whom we carried out BP studies using the cuff-less sphygmomanometer compared with a standard cuff-type device in a stationary sitting patient. Preliminary results showed that the mean difference (MD) of estimated systolic blood pressure and diastolic blood pressure were 0.96 ± 9.6 (mean ± SD) mmHg and 1.14 ± 7.5 mmHg, respectively, compared to the control. The corresponding correlation between the estimated BP values and controls were 0.78 for systolic blood pressure (p < 0.01) and 0.69 for diastolic blood pressure (p < 0.01); thus, there were significant correlations. These results suggest that the developed cuff-less sphygmomanometer has the potential for continuous BP monitoring. Finally, we conducted a preliminary study of simultaneous monitoring of cuff-less BP and near-infrared spectroscopy to evaluate the potential for assessment of autonomic nervous system functions during mental stress tasks.


Asunto(s)
Determinación de la Presión Sanguínea , Esfigmomanometros , Adulto , Sistema Nervioso Autónomo/fisiología , Presión Sanguínea , Determinación de la Presión Sanguínea/instrumentación , Electrocardiografía , Frecuencia Cardíaca , Humanos , Masculino , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/normas , Esfigmomanometros/normas , Adulto Joven
2.
Anaesthesia ; 75(1): 37-44, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31556454

RESUMEN

The inflationary non-invasive blood pressure monitor (iNIBP™) uses a new measurement method, whereby the cuff is slowly inflated whilst simultaneously sensing oscillations, to determine the diastolic blood pressure first and then the systolic pressure. It may measure blood pressure more quickly than the conventional non-invasive blood pressure monitor. We studied 66 patients undergoing general anaesthesia, comparing the time taken to measure the blood pressure between the two monitors at times when there were marked changes (increases or decreases by 30 mmHg or greater) in the systolic blood pressure. The median (IQR) [range]) time was significantly longer for the non-invasive blood pressure monitor (38.8 (31.5-44.7) [18.0-130.0] s) than for the iNIBP (14.6 (13.7-16.4) [11.5-35.5] s), p = 0.001, 95%CI for difference 22-25 s). We also studied 30 volunteers to evaluate the accuracy of the iNIBP, comparing it with the mercury sphygmomanometer. There was good agreement between the two monitors, with a mean difference of 0 (95% limit of agreement -12 to 11) mmHg for the systolic blood pressure. We also compared the degree of pain during cuff inflation between the automated non-invasive blood pressure and iNIBP monitors. Pain was significantly more for the non-invasive blood pressure monitor (22 of 30 volunteers had less pain with the iNIBP). We have shown that the iNIBP measured the blood pressure quicker than the conventional non-invasive blood pressure monitor and the speed of measurement was not significantly affected by marked changes in the blood pressure.


Asunto(s)
Determinación de la Presión Sanguínea/instrumentación , Determinación de la Presión Sanguínea/métodos , Estudios Cruzados , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Factores de Tiempo
3.
Bratisl Lek Listy ; 120(12): 894-898, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31855047

RESUMEN

OBJECTIVES: Central systolic blood pressure (CSBP) is the pressure in the root of aorta, which directly influences organs such as brain, heart and kidneys and is related to organ damage. Its value increases with the aortic stiffness. The aim of this study was to analyze the relationships of CSBP to aortic stiffness parameters. METHODS: Central blood pressure (BP) and related parameters were measured by Arteriograph, working based on oscillometric principle, using pulse wave analysis (PWA) approach. We examined 123 patients (69 females, 54 males) with a primary hypertension. RESULTS: Using a linear correlation analysis, we found that CSBP was correlated to aortic pulse wave velocity (PWV), aortic and brachial pulse pressure (PP), aortic augmentation index, return time of reflected pressure wave (RT) and aortic and brachial augmentation indexes. Multivariate analysis defines the aortic pulse pressure (PPao) as the most powerful parameter influencing CSBP. By an individual analysis of BP in each patient separately, we defined two different types of central hemodynamics; those with a higher CSBP than brachial SBP occur in stiffer aorta. CONCLUSION: The CSBP increases with aortic PP, the most powerful stiffness parameter of aorta. Higher CSBP than brachial SBP usually accompanies a stiffer aorta (Tab. 5, Ref. 19).


Asunto(s)
Presión Sanguínea/fisiología , Análisis de la Onda del Pulso/métodos , Rigidez Vascular , Presión Arterial , Determinación de la Presión Sanguínea , Femenino , Humanos , Masculino
4.
Kardiologiia ; 59(11): 56-65, 2019 Dec 11.
Artículo en Ruso | MEDLINE | ID: mdl-31849300

RESUMEN

Blood pressure variability (BPV) is the fluctuations of blood pressure over a certain period of time under the influence of various factors. The issue of increased BPV is of particular clinical importance due to high predictive value of this parameter as a risk factor for fatal and non-fatal cardiovascular, cerebrovascular and renal events. It is proved that in the BPV increasing, the key role is played by impairments in arterial baroreflexes, which, in turn, are mediated by increased vascular stiffness, impact of angiotensin II and the sympathetic nervous system, endothelial dysfunction, nitric oxide deficiency and aging, including the vascular aging. Antihypertensive drugs that targeting largest amount of pathophysiological mechanisms in BPV increasing have a most advantages in correcting excessive pressure fluctuations. In this regard such drugs are perindopril and amlodipine, which can eliminate almost the entire spectrum of increased BPV causes and, therefore, optimally reduce the cardiovascular risk.


Asunto(s)
Antihipertensivos/uso terapéutico , Hipertensión , Presión Sanguínea , Determinación de la Presión Sanguínea , Humanos , Hipertensión/tratamiento farmacológico
9.
Rev Lat Am Enfermagem ; 27: e3179, 2019.
Artículo en Portugués, Inglés, Español | MEDLINE | ID: mdl-31596414

RESUMEN

OBJECTIVE: to evaluate the effect of an educational program on blood pressure recording for nursing professionals in relation to theoretical knowledge and the quality of these records. METHOD: quasi-experimental study conducted in a hospital service located in the city of São Paulo. The theoretical knowledge of 101 professionals was measured using a validated questionnaire before and after the educational intervention; the quality of blood pressure records was evaluated using a validated form which was applied to 354 records in the pre-intervention period and 288 in the post-intervention period. The educational program was based on active teaching-learning methodologies and consisted of two strategies: expository/dialogue class and a board game. The Wilcoxon, Mann-Whitney, Fisher and Chi-Square tests were used for comparisons, adopting a level of significance of α=0.05. RESULTS: the median of the professionals' scores increased from 19 to 22 points in the post-intervention period (p<0.001). There was an improvement in the quality of the blood pressure recordings regarding the variables: cuff size (p<0.001), arm used in the procedure (p<0.001) and patient position (p<0.001). CONCLUSION: the educational program showed positive results in the promotion of knowledge among nursing professionals and in the improvement of the quality of blood pressure recording.


Asunto(s)
Determinación de la Presión Sanguínea/enfermería , Educación Continua en Enfermería/métodos , Personal de Enfermería en Hospital/educación , Adulto , Presión Sanguínea , Determinación de la Presión Sanguínea/instrumentación , Brasil , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Personal de Enfermería en Hospital/normas , Mejoramiento de la Calidad , Encuestas y Cuestionarios
13.
Kardiologiia ; 59(8S): 63-72, 2019 Sep 16.
Artículo en Ruso | MEDLINE | ID: mdl-31526363

RESUMEN

AIM: To assess the incidence of blood pressure (BP) control and various phenotypes of BP by comparing the results of office and 44-hour ambulatory brachial and central BP measurement in patients with end-stage renal disease (ESRD) on program hemodialysis (HD). MATERIALS AND METHODS: In 68 patients ESRD receiving renal replacement therapy we evaluated office peridialysis BP and performed 44-hour ambu latory monitoring (ABPM) of brachial and central BP during peridialysis period using a validated oscillometric device BPLabVasotens (OOO "Petr Telegin"). Results were considered statistically significant with p<0.05. RESULTS: The frequency of control of peripheral office BP before the HD session was 25%, after - 23.5%; control of central BP - 48.6% and 49%, respectively. According to office measurement the frequency of systolic-diastolic hypertension was 44.1%, isolated systolic hypertension - 25%, isolated diastolic hypertension - 5.9%. The values of peripheral and central office systolic BP (SBP) before and after HD were not consistent with the corresponding mean and daily SBP levels for 44 hours and for the first and second days of the interdialysis period. The frequency of true uncontrolled arterial hypertension (AH) according to peripheral ABPM was 66.5%, masked uncontrolled AH - 9%. Circadian rhythm abnormalities for 44-h peripheral BP were detected in 77%, for central - in 76%. In 97% of patients agreement between phenotypes of the daily profile of peripheral and central BP was observed. 73% of patients had a significant increase in peripheral and central SBP and pulse pressure (PP) and an increase in the proportion of non-dippers from the 1st to the 2nd day. CONCLUSION: Patients with ESRD on HD were characterized by poor control of BP control and predominance of unfavourable peripheral and central ambulatory BP phenotypes. A single measurement of clinical peripheral and central BP in the peridialysis period was not sufficient to assess the control of hypertension in this population. The 24-h BP profiles in the 1st and 2nd days of interdialysis period had significant differences.


Asunto(s)
Hipertensión , Fallo Renal Crónico , Presión Sanguínea , Determinación de la Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Humanos , Fallo Renal Crónico/terapia , Diálisis Renal
17.
Hypertension ; 74(5): 1172-1180, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31542965

RESUMEN

Blood pressure variability (BPV) has been shown to have predictive value over blood pressure (BP) levels alone in stroke patients. We assessed whether BPV predicts cognitive and functional decline in Alzheimer disease, using data from a randomized trial (NILVAD [A European Multicentre Double-blind Placebo-controlled Phase III Trial of Nilvadipine in Mild to Moderate Alzheimer's Disease]). Patients with mild-to-moderate Alzheimer disease were included if they had ≥3 office BP measurements available to determine visit-to-visit BPV. Day-to-day BPV was assessed using home BP measurements in a subsample. The variation independent of mean was used to calculate BPV. Outcomes were change in Alzheimer's Disease Assessment Scale-cognitive subscale-12 and Disability Assessment for Dementia after 1 and 1.5 years. A total of 460 patients aged 72.1 (SD=8.1) years, with mean BP of 134.0/75.1 (10.9/6.3) mm Hg were included. After 1 year, patients in the highest quartile of BPV had deteriorated more on Alzheimer's Disease Assessment Scale-cognitive subscale compared with patients in the lowest quartile (systolic: ß, 2.24 [95% CI, 0.11-4.38], P=0.040; diastolic: ß, 2.54 [95% CI, 0.33-4.75] P=0.024). This association was still present after 1.5 years (systolic: ß, 2.86 [95% CI, 0.35-5.36], P=0.026; diastolic: ß, 3.30 [95% CI, 0.67-5.93], P=0.014). There was no effect of visit-to-visit BPV on Disability Assessment for Dementia. Day-to-day BPV was available for 46 patients. Significant associations were observed between day-to-day BPV and deterioration on Alzheimer's Disease Assessment Scale-cognitive subscale (systolic: P=0.036) and Disability Assessment for Dementia (systolic: P=0.020; diastolic: P=0.007) after 1 year, but not after 1.5 years. All associations were adjusted for potential confounders, including intervention group. In conclusion, this post hoc analysis indicates that higher visit-to-visit and day-to-day BPV might be associated with progression of Alzheimer disease. Targeting BPV may be a future target to slow decline in patients with Alzheimer disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02017340.


Asunto(s)
Enfermedad de Alzheimer/fisiopatología , Antihipertensivos/uso terapéutico , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Nifedipino/análogos & derivados , Anciano , Enfermedad de Alzheimer/epidemiología , Determinación de la Presión Sanguínea/métodos , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/fisiopatología , Intervalos de Confianza , Progresión de la Enfermedad , Método Doble Ciego , Femenino , Humanos , Hipertensión/epidemiología , Modelos Lineales , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Análisis Multivariante , Nifedipino/uso terapéutico , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad
18.
Kardiologiia ; 59(9): 64-70, 2019 Sep 17.
Artículo en Ruso | MEDLINE | ID: mdl-31540577

RESUMEN

In this review we present analysis the European recommendations on hypertension - what's new and what has changed in the tactics of managing patients with arterial hypertension (AH). We compared recommendations on hypertension of the European Society of Cardiology (ESC) and the European Society of hypertension (ESH) 2018 with European recommendations of previous years. In the updated version of guidelines, it is still recommended to determine AH as blood pressure (BP) ≥140 and / or ≥90 mm Hg; to subdivide BP levels into optimal, normal, and high normal, to classify severity of AH as 3 degrees, and to distinguish separately its isolated systolic form. Values for out-of-office BP remained unchanged, but recommendations emerged concerning wider use of ambulatory BP monitoring and self-measurement of BP. For initial therapy, it was recommended to use two drugs combinations preferably as single pill combinations. An increase of the role of nurses and pharmacists in teaching, supporting patients and controlling hypertension has been noted. This can improve the achievement of target BP and, as a result, reduce the cardiovascular risk. New European recommendations highlight the modern aspects of classification and diagnosis of AH, main stages of screening, and algorithm of drug treatment of AH.


Asunto(s)
Hipertensión , Antihipertensivos , Presión Sanguínea , Determinación de la Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Humanos
19.
Hypertension ; 74(5): e45-e51, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31522617

RESUMEN

Hypertension and obesity are known risk factors for atrial fibrillation (AF). However, it is unclear whether uncontrolled, long-standing hypertension has a particularly profound effect on AF. Because they have a similar underlying pathophysiology, hypertension and obesity could act synergistically in the context of AF. We evaluated how various stages of hypertension and body weight status affect new-onset AF. We analyzed a total of 9 797 418 participants who underwent a national health checkup. Hypertension was classified into 5 stages: nonhypertension, prehypertension, hypertension without medication, hypertension with medication <5 years, and hypertension with medication ≥5 years. The participants were also stratified based on body mass index and waist circumference. During the 80 130 161 person×years follow-up, a total of 196 136 new-onset AF cases occurred. The incidence of new-onset AF gradually increased among the 5 stages of hypertension: the adjusted hazard ratio for each group was 1 (reference), 1.145, 1.390, 1.853, and 2.344 for each stage of hypertension. A graded escalation in the risk of new-onset AF was also observed in response to increased systolic and diastolic blood pressure. The incidence of new-onset AF correlated with body mass index and waist circumference, with obese people having a higher risk than others. Hypertension and obesity acted synergistically: obese people with hypertension on medication ≥5 years had the highest risk of AF. In conclusion, the degree and duration of hypertension, as well as the presence of hypertension, were important factors for new-onset AF. Body weight status was significantly associated with new-onset AF and acted synergistically with hypertension.


Asunto(s)
Fibrilación Atrial/epidemiología , Índice de Masa Corporal , Hipertensión/epidemiología , Prehipertensión/epidemiología , Adulto , Distribución por Edad , Edad de Inicio , Anciano , Fibrilación Atrial/diagnóstico , Determinación de la Presión Sanguínea/métodos , Estudios Transversales , Femenino , Humanos , Hipertensión/diagnóstico , Masculino , Persona de Mediana Edad , Prehipertensión/diagnóstico , Prevalencia , Pronóstico , Modelos de Riesgos Proporcionales , Curva ROC , República de Corea , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Factores de Tiempo , Circunferencia de la Cintura
20.
Hypertension ; 74(5): 1192-1199, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31522619

RESUMEN

Black Americans suffer disproportionately from hypertension and hypertensive heart disease. Out-of-office blood pressure (BP) is more predictive for cardiovascular complications than clinic BP; however, the relative abilities of clinic and out-of-office BP to predict left ventricular hypertrophy in black and white adults have not been established. Thus, we aimed to compare associations of out-of-office and clinic BP measurement with left ventricular hypertrophy by cardiac magnetic resonance imaging among non-Hispanic black and white adults. In this cross-sectional study, 1262 black and 927 white participants of the Dallas Heart Study ages 30 to 64 years underwent assessment of standardized clinic and out-of-office (research staff-obtained) BP and left ventricular mass index. In multivariable-adjusted analyses of treated and untreated participants, out-of-office BP was a stronger determinant of left ventricular hypertrophy than clinic BP (odds ratio per 10 mm Hg, 1.48; 95% CI, 1.34-1.64 for out-of-office systolic BP and 1.15 [1.04-1.28] for clinic systolic BP; 1.71 [1.43-2.05] for out-of-office diastolic BP, and 1.03 [0.86-1.24] for clinic diastolic BP). Non-Hispanic black race/ethnicity, treatment status, and lower left ventricular ejection fraction were also independent determinants of hypertrophy. Among treated Blacks, the differential association between out-of-office and clinic BP with hypertrophy was more pronounced than in treated white or untreated participants. In conclusion, protocol-driven supervised out-of-office BP monitoring provides important information that cannot be gleaned from clinic BP assessment alone. Our results underscore the importance of hypertension management programs outside the medical office to prevent hypertensive heart disease, especially in high-risk black adults. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00344903.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Monitoreo Ambulatorio de la Presión Arterial/métodos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertrofia Ventricular Izquierda/etiología , Imagen por Resonancia Cinemagnética/métodos , Adulto , Factores de Edad , Antihipertensivos/uso terapéutico , Teorema de Bayes , Determinación de la Presión Sanguínea/métodos , Estudios Transversales , Electrocardiografía/métodos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etnología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Hipertrofia Ventricular Izquierda/etnología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Texas
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