Central-to-peripheral blood pressure amplification: role of the recording site, technology, analysis approach, and calibration scheme in invasive and non-invasive data agreement.

Background: Systolic blood pressure amplification (SBPA) and pulse pressure amplification (PPA) can independently predict cardiovascular damage and mortality. A wide range of methods are used for the non-invasive estimation of SBPA and PPA. The most accurate non-invasive method for obtaining SBPA and/or PPA remains unknown. Aim: This study aims to evaluate the agreement between the SBPA and PPA values that are invasively and non-invasively obtained using different (1) measurement sites (radial, brachial, carotid), (2) measuring techniques (tonometry, oscillometry/plethysmography, ultrasound), (3) pulse waveform analysis approaches, and (4) calibration methods [systo-diastolic vs. approaches using brachial diastolic and mean blood pressure (BP)], with the latter calculated using different equations or measured by oscillometry. Methods: Invasive aortic and brachial pressure (catheterism) and non-invasive aortic and peripheral (brachial, radial) BP were simultaneously obtained from 34 subjects using different methodologies, analysis methods, measuring sites, and calibration methods. SBPA and PPA were quantified. Concordance correlation and the Bland-Altman analysis were performed. Results: (1) In general, SBPA and PPA levels obtained with non-invasive approaches were not associated with those recorded invasively. (2) The different non-invasive approaches led to (extremely) dissimilar results. In general, non-invasive measurements underestimated SBPA and PPA; the higher the invasive SBPA (or PPA), the greater the underestimation. (3) None of the calibration schemes, which considered non-invasive brachial BP to estimate SBPA or PPA, were better than the others. (4) SBPA and PPA levels obtained from radial artery waveform analysis (tonometry) (5) and common carotid artery ultrasound recordings and brachial artery waveform analysis, respectively, minimized the mean errors. Conclusions: Overall, the findings showed that (i) SBPA and PPA indices are not "synonymous" and (ii) non-invasive approaches would fail to accurately determine invasive SBPA or PPA levels, regardless of the recording site, analysis, and calibration methods. Non-invasive measurements generally underestimated SBPA and PPA, and the higher the invasive SBPA or PPA, the higher the underestimation. There was not a calibration scheme better than the others. Consequently, our study emphasizes the strong need to be critical of measurement techniques, to have methodological transparency, and to have expert consensus for non-invasive assessment of SBPA and PPA.

Design of a Multisensory Device for Tomato Volatile Compound Detection Based on a Mixed Metal Oxide-Electrochemical Sensor Array and Optical Reader.

Insufficient control of tomato ripening before harvesting and infection by fungal pests produce large economic losses in world tomato production. Aroma is an indicative parameter of the state of maturity and quality of the tomato. This study aimed to design an electronic system (TOMATO-NOSE) consisting of an array of 12 electrochemical sensors, commercial metal oxide semiconductor sensors, an optical camera for a lateral flow reader, and a smartphone application for device control and data storage. The system was used with tomatoes in different states of ripeness and health, as well as tomatoes infected with Botrytis cinerea. The results obtained through principal component analysis of the olfactory pattern of tomatoes and the reader images show that TOMATO-NOSE is a good tool for the farmer to control tomato ripeness before harvesting and for the early detection of Botrytis cinerea.

Aortic systolic and pulse pressure invasively and non-invasively obtained: Comparative analysis of recording techniques, arterial sites of measurement, waveform analysis algorithms and calibration methods.

Background: The non-invasive estimation of aortic systolic (aoSBP) and pulse pressure (aoPP) is achieved by a great variety of devices, which differ markedly in the: 1) principles of recording (applied technology), 2) arterial recording site, 3) model and mathematical analysis applied to signals, and/or 4) calibration scheme. The most reliable non-invasive procedure to obtain aoSBP and aoPP is not well established. Aim: To evaluate the agreement between aoSBP and aoPP values invasively and non-invasively obtained using different: 1) recording techniques (tonometry, oscilometry/plethysmography, ultrasound), 2) recording sites [radial, brachial (BA) and carotid artery (CCA)], 3) waveform analysis algorithms (e.g., direct analysis of the CCA pulse waveform vs. peripheral waveform analysis using general transfer functions, N-point moving average filters, etc.), 4) calibration schemes (systolic-diastolic calibration vs. methods using BA diastolic and mean blood pressure (bMBP); the latter calculated using different equations vs. measured directly by oscillometry, and 5) different equations to estimate bMBP (i.e., using a form factor of 33% ("033"), 41.2% ("0412") or 33% corrected for heart rate ("033HR"). Methods: The invasive aortic (aoBP) and brachial pressure (bBP) (catheterization), and the non-invasive aoBP and bBP were simultaneously obtained in 34 subjects. Non-invasive aoBP levels were obtained using different techniques, analysis methods, recording sites, and calibration schemes. Results: 1) Overall, non-invasive approaches yielded lower aoSBP and aoPP levels than those recorded invasively. 2) aoSBP and aoPP determinations based on CCA recordings, followed by BA recordings, were those that yielded values closest to those recorded invasively. 3) The "033HR" and "0412" calibration schemes ensured the lowest mean error, and the "033" method determined aoBP levels furthest from those recorded invasively. 4) Most of the non-invasive approaches considered overestimated and underestimated aoSBP at low (i.e., 80 mmHg) and high (i.e., 180 mmHg) invasive aoSBP values, respectively. 5) The higher the invasively measured aoPP, the higher the level of underestimation provided by the non-invasive methods. Conclusion: The recording method and site, the mathematical method/model used to quantify aoSBP and aoPP, and to calibrate waveforms, are essential when estimating aoBP. Our study strongly emphasizes the need for methodological transparency and consensus for the non-invasive aoBP assessment.

Brachial Blood Pressure Invasively and Non-Invasively Obtained Using Oscillometry and Applanation Tonometry: Impact of Mean Blood Pressure Equations and Calibration Schemes on Agreement Levels.

The use of oscillometric methods to determine brachial blood pressure (bBP) can lead to a systematic underestimation of the invasively measured systolic (bSBP) and pulse (bPP) pressure levels, together with a significant overestimation of diastolic pressure (bDBP). Similarly, the agreement between brachial mean blood pressure (bMBP), invasively and non-invasively measured, can be affected by inaccurate estimations/assumptions. Despite several methodologies that can be applied to estimate bMBP non-invasively, there is no consensus on which approach leads to the most accurate estimation. Aims: to evaluate the association and agreement between: (1) non-invasive (oscillometry) and invasive bBP; (2) invasive bMBP, and bMBP (i) measured by oscillometry and (ii) calculated using six different equations; and (3) bSBP and bPP invasively and non-invasively obtained by applanation tonometry and employing different calibration methods. To this end, invasive aortic blood pressure and bBP (catheterization), and non-invasive bBP (oscillometry [Mobil-O-Graph] and brachial artery applanation tonometry [SphygmoCor]) were simultaneously obtained (34 subjects, 193 records). bMBP was calculated using different approaches. Results: (i) the agreement between invasive bBP and their respective non-invasive measurements (oscillometry) showed dependence on bBP levels (proportional error); (ii) among the different approaches used to obtain bMBP, the equation that includes a form factor equal to 33% (bMBP = bDBP + bPP/3) showed the best association with the invasive bMBP; (iii) the best approach to estimate invasive bSBP and bPP from tonometry recordings is based on the calibration scheme that employs oscillometric bMBP. On the contrary, the worst association between invasive and applanation tonometry-derived bBP levels was observed when the brachial pulse waveform was calibrated to bMBP quantified as bMBP = bDBP + bPP/3. Our study strongly emphasizes the need for methodological transparency and consensus for non-invasive bMBP assessment.

Application of Digital Olfaction for Table Olive Industry.

The International Olive Council (IOC) established that olives must be free of odors, off-flavors, and absent of abnormal ongoing alterations or fermentations. The use of electronic devices could help when classifying defects in a fast, non-destructive, cheap, and environmentally friendly way. For all of that, table olives were evaluated according to IOC regulation in order to classify the defect predominant perceiving (DPP) of the table olives and their intensity. Abnormal fermentation defects of Spanish-style table olives were assessed previously by an IOC-validated tasting panel. 'Zapateria', 'Putrid', and 'Butyric' were the defects found at different concentrations. Different volatile compounds were identified by gas chromatography in altered table olives. The same samples were measured with an electronic nose device (E-nose). E-nose data combined with chemometrics algorithms, such as PCA and PLS-DA, were able to successfully discriminate between healthy and non-healthy table olives, being this last one also separated between the first and second categories. Volatile compounds obtained with gas chromatography could be related to the E-nose measuring and sensory analysis, being capable of matching the different defects with their correspondents' volatile compounds.

Determination of the Masking Effect of the 'Zapateria' Defect in Flavoured Stuffed Olives Using E-Nose.

Spanish-style table olives are one of the most common processed foods in the Mediterranean countries. Lack of control during fermentation can lead to one of the main defects of the olive, called 'Zapateria', caused by the combination of volatile fatty acids reminiscent of rotten leather. In this study, table olives altered with 'Zapateria' defect were stuffed with a hydrocolloid flavoured with the aroma 'Mojo picón' to improve consumer acceptance. Sensory analysis, determination of volatile compounds and electronic nose (E-nose) were used to evaluate the quality of the olives. The control samples had a high concentration of the defect 'Zapateria' and were classified in the second commercial category, while higher 'Mojo picón' flavour concentrations resulted in these olives being classified as 'extra category' (a masking effect). The main volatile compounds in olives with 'Zapateria' defect were cyclohexanecarboxylic acid and pentanoic acid. E-nose allowed discrimination between stuffed olives without added flavouring and olives with 'Mojo picón' flavouring at different concentrations. Finally, PLS regression allowed a predictive linear model to be established between E-nose and sensory analysis values. The RP2 values were 0.74 for perceived defect and 0.86 for perceived aroma. The E-nose was successfully applied for the first time to classify Spanish-style table olives with 'Zapateria' defect intensity and with the addition of the 'Mojo picón' aroma masking the defect.

Application of Electronic Nose to Discriminate Species of Mold Strains in Synthetic Brines.

The chemical composition of the brine for Spanish-style table olives plays a crucial role during the fermentation process. Traditional laboratory analysis requires a high consumption of reagents, highly qualified personnel, sophisticated equipment, long analysis times, and large amounts of samples. Analysis carried out using an electronic nose (E-nose) offers an alternative, non-destructive technique and is useful in determining alterations in brines caused by microorganisms. In the present research, nine mold strains isolated from spoiled olives were inoculated in synthetic brines to determine the effect of microbial development on sensory quality, volatile profile, and the capacity of E-nose to discriminate altered brines from the healthy ones. The brines inoculated with the mold strains presented negative attributes related to aromas of mold, wood, leather, rancidity and, organic solvents among others. The highest intensity of defect was presented by the brines inoculated with the strains Galactomyces geotricum (G.G.2); three Penicillium expansum (P.E.3, P.E.4, and P.E.20); one Penicillium glabrum (P.G.19); three Aspergillus flavus (A.F.9, A.F.18, and A.F.21); and one Fusarium solani (F.S.11). A total of 19 volatile compounds were identified by gas chromatography. Sensory analysis allowed us to classify the synthetic brines based on the degree of alteration produced by the mold strains used. Also, the E-nose data were able to discriminate the inoculated brines regardless of the intensity of the defect. These results demonstrate the capacity of the E-nose to discriminate alterations in brines produced by molds, thereby making it a useful tool to be applied during the elaboration process to detect early alterations in table olive fermentation.

E-Nose Discrimination of Almond Oils Extracted from Roasted Kernels.

Almonds contain around 50% fat with a health-promoting fatty acid profile that can be extracted by pressing to obtain high-quality oils. To improve oil sensory properties, the almonds can be subjected to roasting treatments before oil extraction. However, intense thermal treatments may cause the appearance of undesirable volatile compounds causing unpleasant aromas. Thus, oils from almonds subjected to different roasting treatments (30, 45, 60 and 90 min at 150 °C) were analyzed from sensory and the chemical points of view. In addition, an electronic device (E-nose) was used in order to evaluate its usefulness in discriminating samples according to their aromas. The almonds' roasting treatments caused changes in the sensory properties, since defects such as a burned, dry smell or wood fragrance appeared when almonds were subjected to roasting treatments (>45 min). These data agree with the analysis of volatile compounds, which showed an increase in the content of aldehyde and aromatic groups in roasted almonds oils while alcohols and terpenes decreased. Partial least squares discriminant analysis and partial least squares obtained from the E-nose were able to classify samples (97.5% success) and quantify the burned defect of the oils (Rp2 of 0.88), showing that the E-nose can be an effective tool for classifying oils.

Electronic nose application for the discrimination of sterilization treatments applied to Californian-style black olive varieties.

BACKGROUND: Olive oil continues to be the main destination for olives. The production of table olives is increasing. 'Californian-style' processes are among the most frequently employed to produce oxidized olives. Sensory evaluation requires the development of an instrumental detection method that can be used as an adjunct to traditional tasting panels. RESULTS: An electronic nose (E-nose) was used to classify two varieties of olives following exposure to different sterilization. Principal component analysis (PCA) revealed that both varieties had different volatile profiles. Sensory panel evaluations were similar for both. Partial least squares-discriminant analysis (PLS-DA) obtained from the E-nose was able to separate the two varieties and explained 82% of total variance. Moreover, volatile profiles correctly classified olives according to sterilization times recorded up to 121 °C . The only exception was at F0 ≥ 22 min, at which a plot of PCA outcomes failed to differentiate scores. E-nose data showed similar results to those produced from the volatile analysis when grouping samples were sterilized to F0 ≥ 18 min, at the same time distinguishing these samples from those subjected to less intense thermal treatments. A partial least squares (PLS) chemometric approach was evaluated for quantifying important olive quality parameters. With regards to validation parameters, R P 2 pertaining to perceived defect was 0.88, whilst R P 2 pertaining to overall assessment was 0.78. CONCLUSIONS: E-nose offers a fast, inexpensive and non-destructive method for discriminating between varieties and thermal treatments up to a point at which cooking defects are highly similar (from F0  = 18 onwards). © 2021 Society of Chemical Industry.

Characterization of Polyphenol and Volatile Fractions of Californian-Style Black Olives and Innovative Application of E-nose for Acrylamide Determination.

Californian-style black olives require a sterilization treatment that produces a carcinogenic contaminant, acrylamide. Thus, this compound was evaluated in two different olive cultivars using an electronic nose (E-nose). The sterilization intensity had a significant influence on the final phenol concentrations, acrylamide content, and volatile compounds. Increasing the sterilization intensity from 10 to 26 min (F0) reduced the phenol content, but it promoted acrylamide synthesis, leading to a wide range of this toxic substance. The Ester and phenol groups of volatile compounds decreased their content when the sterilization treatment increased; however, aldehyde and other volatile compound groups significantly increased their contents according to the thermal treatments. The compounds 4-ethenyl-pyridine, benzaldehyde, and 2,4-dimethyl-hexane are volatile compounds with unpleasant odours and demonstrated a high amount of influence on the differences found after the application of the thermal treatments. The "Manzanilla Cacereña" variety presented the highest amount of phenolic compounds and the lowest acrylamide content. Finally, it was found that acrylamide content is correlated with volatile compounds, which was determined using multiple linear regression analysis (R2 = 0.9994). Furthermore, the aroma of table olives was analysed using an E-nose, and these results combined with Partial Least Square (PLS) were shown to be an accurate method (range to error ratio (RER) >10 and ratio of performance to deviation (RPD) >2.5) for the indirect quantification of this toxic substance.

Autologous Dendritic Cells in Combination With Chemotherapy Restore Responsiveness of T Cells in Breast Cancer Patients: A Single-Arm Phase I/II Trial.

Introduction: Animal studies and preclinical studies in cancer patients suggest that the induction of immunogenic cell death (ICD) by neoadjuvant chemotherapy with doxorubicin and cyclophosphamide (NAC-AC) recovers the functional performance of the immune system. This could favor immunotherapy schemes such as the administration of antigen-free autologous dendritic cells (DCs) in combination with NAC-AC to profit as cryptic vaccine immunogenicity of treated tumors. Objective: To explore the safety and immunogenicity of autologous antigen-free DCs administered to breast cancer patients (BCPs) in combination with NAC-AC. Materials and Methods: A phase I/II cohort clinical trial was performed with 20 BCPs treated with NAC-AC [nine who received DCs and 11 who did not (control group)]. The occurrence of adverse effects and the functional performance of lymphocytes from BCPs before and after four cycles of NAC-AC receiving DCs or not were assessed using flow cytometry and compared with that from healthy donors (HDs). Flow cytometry analysis using manual and automated algorithms led us to examine functional performance and frequency of different lymphocyte compartments in response to a stimulus in vitro. This study was registered at clinicaltrials.gov (NCT03450044). Results: No grade II or higher adverse effects were observed associated with the transfer of DCs to patients during NAC-AC. Interestingly, in response to the in vitro stimulation, deficient phosphorylation of Zap70 and AKT proteins observed before chemotherapy in most patients' CD4 T cells significantly recovered after NAC-AC only in patients who received DCs. Conclusions: The transfer of autologous DCs in combination with NAC-AC in BCPs is a safe procedure. That, in BCPs, the administration of DCs in combination with NAC-AC favors the recovery of the functional capacity of T cells suggests that this combination may potentiate the adjuvant effect of ICD induced by NAC-AC on T cells and, hence, potentiate the immunogenicity of tumors as cryptic vaccines.

E-Nose Discrimination of Abnormal Fermentations in Spanish-Style Green Olives.

Current legislation in Spain indicates that table olives must be free of off-odors and off-flavors and without symptoms of ongoing alteration or abnormal fermentations. In this regard, the International Olive Council (IOC) has developed a protocol for the sensory classification of table olives according to the intensity of the predominantly perceived defect (PPD). An electronic nose (e-nose) was used to assess the abnormal fermentation defects of Spanish-style table olives that were previously classified by a tasting panel according to the IOC protocol, namely zapateria, butyric, putrid, and musty or humidity. When olives with different defects were mixed, the putrid defect had the greatest sensory impact on the others, while the butyric defect had the least sensory dominance. A total of 49 volatile compounds were identified by gas chromatography, and each defect was characterized by a specific profile. The e-nose data were analyzed using principal component analysis (PCA) and partial least square discriminant analysis (PLS-DA). The different defects were clearly separated from each other and from the control treatment, independently of PPD intensity. Moreover, the e-nose differentiated control olives from table olives with combined sensory defects despite the dilution effect resulting from the combination. These results demonstrate that e-nose can be used as an olfactory sensor for the organoleptic classification of table olives and can successfully support the tasting panel.

[Proposal to reorder dental health care in the National Health System. The experience of Toledo's "Unidad de Medicina y Cirugía Oral".] / Propuesta para reordenar la asistencia sanitaria odontológica en el Sistema Nacional de Salud. La experiencia de la unidad de Medicina y Cirugía Oral de Toledo.

The portfolio of services in Oral Health of the National Health System (SNS in Spanish) is very broad and includes different areas of assistance. The focus of the System managers has focused on improving dental health benefits for children. The relevance that Children´s Dental Assistance Programs (PADI, Planes de Atención Dental Infantil in Spanish) have been acquiring in the oral care of the SNS has led to the resources being directed towards the prevention, diagnosis and treatment of dental pathology in the child population. The structure in Unidades de Salud Bucodental focused on strictly dental pathology does not allow the development of all health services. There is a large number of services that within the oral benefits provided by Primary Care are diverted to other hospital services or that are not even provided. Different experiences have been developed in different autonomous Health Systems to improve these benefits. Since 2012, the Toledo Unidad de Medicina y Cirugía Oral has carried out actions that have managed to improve oral care for the population, thus improving their general health. This Unit allows resources to be allocated to those activities that require training and guidance in the more medical-surgical than dental service. We recommend the implementation of services of this type within Primary Services to improve the provision of oral health services.

La cartera de servicios en Salud Bucodental del Sistema Nacional de Salud (SNS) es muy amplia y contempla distintas áreas de asistencia. El foco de los gestores del Sistema desde hace décadas se ha centrado en mejorar las prestaciones de salud dental en población infantil. La importancia que los Planes de Atención Dental Infantil (PADI) han ido adquiriendo en la asistencia Bucodental del SNS ha hecho que los recursos se orienten a la prevención, diagnóstico y tratamiento de la patología dentaria de la población infantil. La estructura en Unidades de Salud Bucodental centradas en la patología estrictamente dentaria no permite desarrollar todas las prestaciones sanitarias. Existe una gran cantidad de servicios que dentro de las prestaciones bucodentales que tiene la Atención Primaria (AP) se desvían a otros servicios hospitalarios o que incluso no se prestan. En diferentes sistemas de salud autonómicos se han desarrollado experiencias para conseguir mejorar estas prestaciones. Desde 2012, la Unidad de Medicina y Cirugía Oral de Toledo realiza acciones que han conseguido mejorar la asistencia bucodental de la población, mejorando así su salud general. Esta Unidad permite destinar los recursos a aquellas actividades que necesitan una formación y una orientación en el servicio más médico-quirúrgico que dentario. Recomendamos la implantación de servicios de este tipo dentro de la AP para mejorar la prestación de los servicios de salud bucodental.

Renal Function, Albumin-Creatinine Ratio and Pulse Wave Velocity Predict Silent Coronary Artery Disease and Renal Outcome in Type 2 Diabetic and Prediabetic Subjects.

INTRODUCTION: Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre-diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure. AIM: To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD. METHODS: We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD. All type 2 DM patients were under antidiabetic treatment with A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, coronary angiography was performed. In addition, PWV, glomerular filtration rate, and ACR were evaluated. STATISTICS: mean±SEM, and ANOVA among groups. RESULTS: 48.59% of DM2 and 25.58% of GI patients had silent coronary artery had silent coronary artery disease and higher ACR, PWV and reduced GFR. Higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and <60ml.min (p<0.05) in patients with CAD, suggesting a cardio-renal interaction in DM2. CONCLUSION: Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors as in DM2. Diabetic and prediabetics still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease.

Multicentric evidence of emotional impairments in hypertensive heart disease.

The mechanisms underlying emotional alterations constitute a key research target in neuroscience. Emerging evidence indicates that these disruptions can be related to abnormal interoception (i.e., the sensing of visceral feelings), as observed in patients with cardiodynamic deficits. To directly assess these links, we performed the first multicenter study on emotion recognition and interoception in patients with hypertensive heart disease (HHD). Participants from two countries completed a facial emotion recognition test, and a subsample additionally underwent an interoception protocol based on a validated heartbeat detection task. HHD patients from both countries presented deficits in the recognition of overall and negative emotions. Moreover, interoceptive performance was impaired in the HHD group. In addition, a significant association between interoceptive performance and emotion recognition was observed in the control group, but this relation was abolished in the HHD group. All results survived after covariance with cognitive status measures, suggesting they were not biased by general cognitive deficits in the patients. Taken together, these findings suggest that emotional recognition alterations could represent a sui generis deficit in HHD, and that it may be partially explained by the disruption of mechanisms subserving the integration of neuro-visceral signals.

Central Blood Pressure Waves Assessment: A Validation Study of Non-invasive Aortic Pressure Measurement in Human Beings.

INTRODUCTION: Measurement of central (aortic) systolic blood pressure has been shown to provide reliable information to evaluate target organ damage. However, non-invasive central blood pressure measurement procedures are still under analysis. AIM: To compare human pressure waveforms invasively obtained in the aorta, with the corresponding waveforms non-invasively recorded using an oscillometric device (Mobil-O-Graph). METHODS: In this research were included 20 subjects in which invasive percutaneous coronary interventions were performed. They were 10 males (68 ± 12 y. o. , BMI: 27.4 ± 4.6 kg/m2) and 10 females (77 ± 8 y. o. , BMI: 28.5 ± 5.3 kg/m2). During the invasive aortic pressure recording, a synchronized non-invasive Mobil-O-Graph acquisition beat by beat and reconstructed central pressure wave was performed. Both, invasive and non-invasive pressure waves were digitized and stored for subsequent analysis and calculations. A computerized interpolation procedure was developed in our laboratory to compare these pressure waves. RESULTS: A significant correlation between Mobil-O-Graph central blood pressure measurements and the corresponding invasive values was found in males (r < 0.81; p < 0.01) and females (r < 0.93; p < 0.01). However, in both genders, the slope of the regression lines was lesser than 1 (males: y = 0.7354x + 18.998; females: y = 0.9835x + 2.8432). In the whole population (n = 20), a significant correlation between Mobil-O-Graph central blood pressure measurements and the corresponding invasive values was found (r < 0.89; p < 0.01) and the regression line was lesser than 1 (y = 0.9774x + 1.7603). CONCLUSIONS: In this research, a high correlation between invasive central blood pressure values and those measured with the Mobil-O-Graph device was found in males, females and the whole population. However, a sub estimation of Mobil-O-Graph central blood pressure values was observed.

Recommendations for home blood pressure monitoring in Latin American countries: A Latin American Society of Hypertension position paper.

Out-of-office blood pressure (BP) monitoring appears to be a very useful approach to hypertension management insofar it allows to obtain multiple measurements in the usual environment of each individual, allows the detection of hypertension phenotypes, such as white-coat and masked hypertension, and appears to have superior prognostic value than the conventional office BP measurements. Out-of-office BP can be obtained through either home or ambulatory monitoring, which provide complementary and not identical information. Home BP monitoring yields BP values self-measured in subjects' usual living environment; it is an essential method for the evaluation of almost all untreated and treated subjects with suspected or diagnosed hypertension, best if combined with telemonitoring facilities, also allowing long-term monitoring. There is also increasing evidence that home BP monitoring improves long-term hypertension control rates by improving patients' adherence to prescribed treatment. In Latin American Countries, it is widely available, being relatively inexpensive, and well accepted by patients. Current US, Canadian, Japanese, and European guidelines recommend out-of-office BP monitoring to confirm and refine the diagnosis of hypertension.

Ambulatory blood pressure monitoring over 24 h: A Latin American Society of Hypertension position paper-accessibility, clinical use and cost effectiveness of ABPM in Latin America in year 2020.

Accurate office blood pressure measurement remains crucial in the diagnosis and management of hypertension worldwide, including Latin America (LA). Office blood pressure (OBP) measurement is still the leading technique in LA for screening and diagnosis of hypertension, monitoring of treatment, and long-term follow-up. Despite this, due to the increasing awareness of the limitations affecting OBP and to the accumulating evidence on the importance of ambulatory BP monitoring (ABPM), as a complement of OBP in the clinical approach to the hypertensive patient, a progressively greater attention has been paid worldwide to the information on daytime and nighttime BP patterns offered by 24-h ABPM in the diagnostic, prognostic, and therapeutic management of hypertension. In LA countries, most of the Scientific Societies of Hypertension and/or Cardiology have issued guidelines for hypertension care, and most of them include a special section on ABPM. Also, full guidelines on ABPM are available. However, despite the available evidence on the advantages of ABPM for the diagnosis and management of hypertension in LA, availability of ABPM is often restricted to cities with large population, and access to this technology by lower-income patients is sometimes limited by its excessive cost. The authors hope that this document might stimulate health authorities in each LA Country, as well as in other countries in the world, to regulate ABPM access and to widen the range of patients able to access the benefits of this technique.

Latin American Consensus on the management of hypertension in the patient with diabetes and the metabolic syndrome.

: The prevalence of hypertension, type 2 diabetes mellitus (DM2) and the metabolic syndrome continues to increase in Latin America, while the rates of diagnosis, treatment and control of these disorders remain low. The frequency of the risk factors that constitute the metabolic syndrome and are associated with an increased risk of cardiovascular disease has not diminished since the publication of the previous consensus. This document discusses the socioeconomic, demographic, environmental and cultural characteristics of most associated Latin American countries and partially explains the lack of better results in improving clinical and public health actions that allow high morbidity and mortality rates caused by cardiovascular diseases and DM2 to be reduced through programs aligned with the so-called precision medicine, which should be predictive, preventive, personalized and participatory. The Consensus ratifies the diagnostic criteria expressed in the previous consensus to define hypertension and DM2 but, for the metabolic syndrome, and in the absence of evidence, the recommendation is to implement a cohort study that determines the abdominal perimeter value associated with hard outcomes, such as DM2 and CVD. Meanwhile, we recommend modifying the criterion to more than 94 cm in men and more than 84 cm in women according to WHO recommendations. We also recommend the carrying out of a study that identifies the situation of hypertension and DM2 in people of African ancestry who, in Latin America, exceed 75 million and whose epidemiology does not include solid studies. With respect to the proposed therapeutic targets, we recommended maintaining those defined in the previous consensus, but insisting that early pharmacological management of prediabetes with metformin should be introduced, as should the treatment of diabetic hypertensive patients with a combination therapy of two fixed-dose antihypertensive drugs and management with statins. To increase adherence, the use of different drugs combined in a single pill (polypill) is recommended. The simplification of the therapeutic regimen is accompanied by greater control of cardiovascular risk factors, both in primary and secondary prevention, and has been shown to be cost-effective. The consensus recommends the use of the currently available polypill combining an angiotensin-converting enzyme inhibitor, a statin and aspirin for secondary cardiovascular prevention and in patients with a high cardiovascular risk, such as hypertension patients with DM2.