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1.
Sensors (Basel) ; 21(5)2021 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-33800106

RESUMO

Blood pressure (BP) monitoring has significant importance in the treatment of hypertension and different cardiovascular health diseases. As photoplethysmogram (PPG) signals can be recorded non-invasively, research has been highly conducted to measure BP using PPG recently. In this paper, we propose a U-net deep learning architecture that uses fingertip PPG signal as input to estimate arterial BP (ABP) waveform non-invasively. From this waveform, we have also measured systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP). The proposed method was evaluated on a subset of 100 subjects from two publicly available databases: MIMIC and MIMIC-III. The predicted ABP waveforms correlated highly with the reference waveforms and we have obtained an average Pearson's correlation coefficient of 0.993. The mean absolute error is 3.68 ± 4.42 mmHg for SBP, 1.97 ± 2.92 mmHg for DBP, and 2.17 ± 3.06 mmHg for MAP which satisfy the requirements of the Association for the Advancement of Medical Instrumentation (AAMI) standard and obtain grade A according to the British Hypertension Society (BHS) standard. The results show that the proposed method is an efficient process to estimate ABP waveform directly using fingertip PPG.


Assuntos
Hipertensão , Fotopletismografia , Pressão Arterial , Pressão Sanguínea , Determinação da Pressão Arterial , Humanos , Hipertensão/diagnóstico
2.
Nat Commun ; 12(1): 1387, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33654082

RESUMO

Wearable sensors to continuously measure blood pressure and derived cardiovascular variables have the potential to revolutionize patient monitoring. Current wearable methods analyzing time components (e.g., pulse transit time) still lack clinical accuracy, whereas existing technologies for direct blood pressure measurement are too bulky. Here we present an innovative art of continuous noninvasive hemodynamic monitoring (CNAP2GO). It directly measures blood pressure by using a volume control technique and could be used for small wearable sensors integrated in a finger-ring. As a software prototype, CNAP2GO showed excellent blood pressure measurement performance in comparison with invasive reference measurements in 46 patients having surgery. The resulting pulsatile blood pressure signal carries information to derive cardiac output and other hemodynamic variables. We show that CNAP2GO can self-calibrate and be miniaturized for wearable approaches. CNAP2GO potentially constitutes the breakthrough for wearable sensors for blood pressure and flow monitoring in both ambulatory and in-hospital clinical settings.


Assuntos
Determinação da Pressão Arterial/métodos , Adulto , Algoritmos , Pressão Sanguínea , Calibragem , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Miniaturização , Monitorização Fisiológica/instrumentação , Pulso Arterial , Processamento de Sinais Assistido por Computador , Software , Adulto Jovem
3.
Medicine (Baltimore) ; 100(11): e25152, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33726000

RESUMO

ABSTRACT: Noninvasive continuous arterial pressure monitoring may be clinically useful in patients who require continuous blood pressure monitoring in situations where arterial catheter placement is limited. Many previous studies on the accuracy of the noninvasive continuous blood pressure monitoring method reported various results. However, there is no research on the effectiveness of noninvasive arterial pressure monitoring during one-lung ventilation. The purpose of this study was to compare arterial blood pressure obtained through invasive method and noninvasive method by using ClearSight during one-lung ventilation.In this retrospective observational study, a total of 26 patients undergoing one-lung ventilation for thoracic surgery at a single institution between March and July 2019 were recruited. All patients in this study were cannulated on their radial artery to measure continuously invasive blood pressures and applied ClearSight on the ipsilateral side of the cannulated arm. We compared and analyzed the agreement and trendability of blood pressure recorded with invasive and noninvasive methods during one-lung ventilation.Blood pressure and pulse rate showed a narrower limit of agreement with a percentage error value of around 30%. In addition, the tracking ability of each measurement could be determined by the concordance rate, all of which were below acceptable limits (92%).In noninvasive arterial blood pressure monitoring using ClearSight, mean blood pressure and pulse rate show acceptable agreement with the invasive method.


Assuntos
Determinação da Pressão Arterial/instrumentação , Monitores de Pressão Arterial/estatística & dados numéricos , Monitorização Intraoperatória/instrumentação , Ventilação Monopulmonar , Procedimentos Cirúrgicos Torácicos , Idoso , Pressão Arterial , Determinação da Pressão Arterial/métodos , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Artéria Radial/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 100(10): e24072, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725818

RESUMO

BACKGROUND: Blood pressure lowering treatments can help prevent cardiovascular disease. However, little is known about the possibility of home visiting programs for hypertension. This study aims to evaluate the effectiveness of home visiting programs on hypertensive patients. METHODS: We systematically reviewed the medical literature and performed a meta-analysis. Five electronic databases were systematically searched from their inception to September 2019. Two reviewers independently assessed the risk of bias of the studies included in the review using tools developed by the Cochrane Collaboration. The meta-analysis was performed using Review Manager software (version 5.3). RESULTS: Thirteen RCTs with 2674 participants were identified. The home visiting program demonstrated a greater reduction in systolic blood pressure (MD = -5.63, 95% confidence interval (CI): -8.32 to -2.94), diastolic blood pressure (MD = -4.14, 95% CI: -6.72 to -1.56) and waist circumference (MD = -2.61, 95% CI: -3.5, -1.72) during a 6 month intervention. However, there were no significant differences between the groups in terms of body mass index, weight, or blood lipids. CONCLUSION: Home visiting programs were associated with improved BP control and reduced blood pressure, which indicate that it might be an effective method for management of hypertension.


Assuntos
Assistência ao Convalescente/métodos , Visita Domiciliar , Hipertensão/terapia , Cuidados de Enfermagem/métodos , Determinação da Pressão Arterial/estatística & dados numéricos , Humanos , Hipertensão/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
5.
Sensors (Basel) ; 21(5)2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-33668778

RESUMO

Estimating blood pressure via combination analysis with electrocardiogram and photoplethysmography signals has attracted growing interest in continuous monitoring patients' health conditions. However, most wearable/portal monitoring devices generally acquire only one kind of physiological signals due to the consideration of energy cost, device weight and size, etc. In this study, a novel adaptive weight learning-based multitask deep learning framework based on single lead electrocardiogram signals is proposed for continuous blood pressure estimation. Specifically, the proposed method utilizes a 2-layer bidirectional long short-term memory network as the sharing layer, followed by three identical architectures of 2-layer fully connected networks for task-specific blood pressure estimation. To learn the importance of task-specific losses automatically, an adaptive weight learning scheme based on the trend of validation loss is proposed. Extensive experiment results on Physionet Multiparameter Intelligent Monitoring in Intensive Care (MIMIC) II waveform database demonstrate that the proposed method using electrocardiogram signals obtains estimating performance of 0.12±10.83 mmHg, 0.13±5.90 mmHg, and 0.08±6.47 mmHg for systolic blood pressure, diastolic blood pressure, and mean arterial pressure, respectively. It can meet the requirements of the British Hypertension Society standard and US Association of Advancement of Medical Instrumentation standard with a considerable margin. Combined with a wearable/portal electrocardiogram device, the proposed model can be deployed to a healthcare system to provide a long-term continuous blood pressure monitoring service, which would help to reduce the incidence of malignant complications to hypertension.


Assuntos
Determinação da Pressão Arterial , Hipertensão , Pressão Sanguínea , Eletrocardiografia , Humanos , Hipertensão/diagnóstico , Fotopletismografia
6.
Sensors (Basel) ; 21(5)2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-33668822

RESUMO

Continuous hemodynamic monitoring is important for long-term cardiovascular healthcare, especially in hypertension. The impedance plethysmography (IPG) based carotid pulse sensing is a non-invasive diagnosis technique for measuring pulse signals and further evaluating the arterial conditions of the patient such as continuous blood pressure (BP) monitoring. To reach the high-resolution IPG-based carotid pulse detection for cardiovascular applications, this study provides an optimized measurement parameter in response to obvious pulsation from the carotid artery. The influence of the frequency of excitation current, electrode cross-sectional area, electrode arrangements, and physiological site of carotid arteries on IPG measurement resolution was thoroughly investigated for optimized parameters. In this study, the IPG system was implemented and installed on the subject's neck above the carotid artery to evaluate the measurement parameters. The measurement results within 6 subjects obtained the arterial impedance variation of 2137 mΩ using the optimized measurement conditions, including excitation frequency of 50 kHz, a smaller area of 2 cm2, electrode spacing of 4 cm and 1.7 cm for excitation and sensing functions, and location on the left side of the neck. The significance of this study demonstrates an optimized measurement methodology of IPG-based carotid pulse sensing that greatly improves the measurement quality in cardiovascular monitoring.


Assuntos
Determinação da Pressão Arterial , Análise de Onda de Pulso , Pressão Sanguínea , Impedância Elétrica , Humanos , Pletismografia de Impedância , Pulso Arterial
7.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(3): 335-338, 2021 Mar 06.
Artigo em Chinês | MEDLINE | ID: mdl-33730824

RESUMO

Hypertension is a major problem of public health that endangers the health of the oldest old. However, the current guidelines for hypertension management do not uniformly diagnose hypertension among the oldest old, nor recommend a normal blood pressure range, which is not convictive enough to support the decision making to the prevention of blood pressure-related adverse events. This guideline gives guiding opinions on optimal blood pressure range for the Chinese oldest old, which applies to the staff of medical and health institutions at all levels nationwide to evaluate the blood pressure levels of the oldest old. It includes the sections of general principles, methods and standards of blood pressure evaluation, measurement conditions, specifications of blood pressure measurement, implementation approaches, etc. The guideline has important directive significance for improving the blood pressure management and decision-making level of the Chinese oldest old.


Assuntos
Hipertensão , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Pressão Sanguínea , Determinação da Pressão Arterial , China , Humanos , Hipertensão/diagnóstico , Hipertensão/prevenção & controle
8.
Medicine (Baltimore) ; 100(5): e24061, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592858

RESUMO

ABSTRACT: Irisin, a novel myokine, is believed to be the crucial factor in converting white adipose tissue to beige adipose tissue. For this paper, we studied the relationship among irisin and components of metabolic syndrome (MetS), and insulin secretion and resistance in schoolchildren of Taiwan.Subjects receiving routine annual health examination at elementary school were enrolled. Demographic data, anthropometry, MetS components, irisin, and insulin secretion and resistance were collected. Subjects were divided into normal, overweight, and obese groups for evaluation of irisin in obesity. Finally, the relationship between irisin and MetS was analyzed.There were 376 children (179 boys and 197 girls), aged 10.3 ±â€Š1.5 years, were enrolled. In boys, irisin levels were not associated with body mass index percentile, body fat, blood pressure, lipid profiles, insulin secretion or resistance. After adjusting for age, the irisin level in boys was negatively related to fasting plasma glucose (FPG) (r = -0.21, P = .006). In girls, after adjusting for age, the irisin levels were positively related only to FPG (r = 1.49, P = .038). In both genders, irisin levels were similar among normal, overweight, and obese groups, and between subjects with and without MetS.The irisin levels were not associated with MetS in either boys or girls. In girls, circulating irisin levels have a nonsignificant declining trend in overweight and obese girls. However, irisin levels were negatively related to FPG in boys and positively related to FPG in girls. The contrary relationship between irisin and FPG in boys and girls needs further exploration.


Assuntos
Tecido Adiposo/metabolismo , Fibronectinas , Secreção de Insulina/fisiologia , Insulina , Síndrome Metabólica , Sobrepeso , Antropometria/métodos , Determinação da Pressão Arterial/métodos , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Fibronectinas/sangue , Fibronectinas/metabolismo , Humanos , Insulina/sangue , Insulina/metabolismo , Resistência à Insulina/fisiologia , Masculino , Síndrome Metabólica/sangue , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/metabolismo , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Sobrepeso/metabolismo , Serviços de Saúde Escolar/estatística & dados numéricos , Taiwan/epidemiologia
9.
Nefrología (Madrid) ; 41(1): 17-26, ene.-feb. 2021. tab
Artigo em Espanhol | IBECS | ID: ibc-199569

RESUMO

INTRODUCCIÓN: La hipertensión arterial (HTA) en los pacientes en hemodiálisis (HD) es muy frecuente y se asocia a un aumento de la morbimortalidad. Los objetivos de nuestro trabajo han sido: 1. Conocer la tensión arterial (TA) en la sesión de HD. 2. Estudiar la TA, en el periodo interdialítico, mediante monitorización ambulatoria de presión arterial (MAPA) de 44 horas. 3. Conocer la concordancia entre la TA en la sesión de HD y MAPA. 4. Valorar los cambios de tratamiento después de la realización del MAPA. 5. Realizar una bioimpedancia espectroscópica (BIS) a todos los pacientes y en los hiperhidratados e hipertensos, según MAPA, valorar cambios en la TA después de ajustar el peso seco (PS). 6. Conocer factores asociados a la TA sistólica (TAS) y TA diastólica (TAD) promedio del MAPA. MATERIAL Y MÉTODOS: Estudio prospectivo observacional, que incluyó a 100 pacientes de nuestra unidad de diálisis. Se han recogido las tensiones pre y post-HD, durante dos semanas y, posteriormente, colocamos a los pacientes un aparato de MAPA a mitad de semana, durante 44 horas. Previo a comenzar la siguiente sesión de diálisis, realizamos una BIS. A aquellos pacientes hiperhidratados e hipertensos, según MAPA, se les realizó un segundo MAPA para valorar cambios en los valores de TA. RESULTADOS: Según MAPA, el 65% de pacientes presentaron una TA diurna > 135/85 mmHg, 90% TA nocturna > 120/70 mmHg y 76% TA promedio > 130/80 mmHg. El 11% presentó un patrón dipper, 51% no dipper y 38% riser. Las TAS y TAD promedio fueron 4,7 mmHg (3,8%) y 1,1 mmHg (1,64%) más altas el segundo día. En el 6% de pacientes fue necesario bajar la dosis de antihipertensivos, 9% suspenderlos, 28% aumentar dosis y 17% añadir un nuevo fármaco. La TAD pre-HD es la que mejor concordancia presenta con el MAPA. Después de realizar BIS y ajustar PS hubo un descenso significativo en todas las cifras de TA. El análisis univariante mostró que la TAS promedio fue más alta en pacientes con baño alto en calcio, mayor cantidad de fármacos antihipertensivos y mayores dosis de eritropoyetina (EPO). El análisis multivariante mostró asociación significativa para EPO y número de fármacos (p < 0,01). La TAD promedio fue más alta en pacientes más jóvenes, con Charlson más bajos, menor índice de masa corporal (IMC), menos diuresis, no diabéticos y con mayores dosis de EPO. El estudio de regresión lineal mostró como variables significativas la edad (p < 0,005), IMC (p < 0,03) y EPO (p < 0,03). CONCLUSIONES: Nuestro estudio muestra: 1. La variabilidad de criterio de HTA, según utilicemos cifras de TA durante la sesión de HD o MAPA. 2. La variabilidad de TA en el periodo interdiálisis. 3. La TAD prediálisis es la que mejor concordancia presenta con el MAPA. 4. La utilización conjunta de la BIS y el MAPA mejora el control de la TA. 5. La dosis de EPO es el factor más importante asociado a la HTA en nuestros pacientes


INTRODUCTION: Hypertension is very common in haemodialysis (HD) patients, and is associated with increased morbidity and mortality rates. The goals of our research were to: 1. Measure blood pressure (BP) during HD sessions; 2. Study BP in between HD sessions with 44-hour Ambulatory Blood Pressure Monitoring (ABPM); 3. Identify differences between the BP recorded during HD and with the ABPM; 4. Evaluate changes in treatment after the ABPM; 5. Perform bioimpedance spectroscopy (BIS) on all patients and, in those hyper-hydrated or hypertensive according to ABPM, assess for changes in BP after adjusting the dry weight; 6. Identify factors associated with average systolic and diastolic BP measured by ABPM. MATERIAL AND METHODS: Prospective observational study, which included 100 patients from our dialysis unit. We measured BP before and after the HD sessions for two weeks and then, mid-week, we attached the ABPM device to the patients for 44 hours. Before starting the following dialysis session, we performed BIS. A second ABPM was performed on hyper-hydrated patients and patients hypertensive according to ABPM to evaluate changes in BP values. RESULTS: According to the ABPM, 65% of patients had daytime BP > 135/85 mmHg, 90% night-time BP > 120/70 mmHg and 76% average BP > 130/80 mmHg; 11% had a dipper pattern, 51% non-dipper and 38% riser. The average systolic and diastolic BP readings were 4.7 mmHg (3.8%) and 1.1 mmHg (1.64%) higher on the second day. The dose of antihypertensive medication had to be lowered in 6% of patients, 9% had to stop taking it, 28% needed increased doses and 17% had to add a new drug. The pre-HD diastolic BP best matched the ABPM. After performing the bioimpedance and adjusting dry weight, there was a statistically significant decrease in all BP values. The univariate analysis showed that the average systolic BP was higher in patients with a high-calcium dialysis bath, more antihypertensive drugs and higher doses of EPO. The multivariate analysis showed significant association for EPO and number of drugs (p < 0.01). The average diastolic BP was higher in younger patients and patients with lower Charlson index, lower body mass index and less diuresis, those on higher doses of EPO and non-diabetics. The linear regression study showed age (p < 0.005), body mass index (p < 0.03) and EPO (p < 0.03) as significant variables. CONCLUSIONS: Our study shows: 1. The variability of hypertension criteria according to use of BP values from during the HD session or ABPM; 2. The variability of BP in the interdialysis period; 3. That the pre-dialysis diastolic BP best corresponds with the ABPM. 4. That the use of both BIS and ABPM improves the control of BP; 5. That the dose of EPO is the most important factor associated with hypertension in our patients


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Hipertensão/prevenção & controle , Hipertensão/terapia , Diálise Renal , Espectroscopia Dielétrica/métodos , Monitorização Ambulatorial da Pressão Arterial/métodos , Insuficiência Renal Crônica , Determinação da Pressão Arterial/métodos , Estudos Prospectivos , Impedância Elétrica
10.
High Blood Press Cardiovasc Prev ; 28(2): 185-249, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33620672

RESUMO

INTRODUCTION: Systolic blood pressure (SBPA) and pulse pressure amplification (PPA) were quantified using different methodological and calibration approaches to analyze (1) the association and agreement between different SBPA and PPA parameters and (2) the association between these SBPA and PPA parameters and left ventricle (LV) and atrium (LA) structural and functional characteristics. METHODS: In 269 healthy subjects, LV and LA parameters were echocardiography-derived. SBPA and PPA parameters were quantified using: (1) different equations (n = 9), (2) methodological approaches (n = 3): brachial sub-diastolic (Mobil-O-Graph®) and supra-systolic oscillometry (Arteriograph®) and aortic diameter waveform re-calibration (RCD; ultrasonography), and (3) using three different calibration schemes: systo-diastolic (SD), calculated mean (CM) and oscillometric mean (OscM). RESULTS: SBPA and PPA parameters obtained with different equations, techniques, and calibration schemes show a highly variable association level (negative, non-significant, and/or positive) among them. The association between SBPA and PPA with cardiac parameters were highly variable (negative, non-significant, or positive associations). Differences in BPA parameter data between approaches were more sensitive to the calibration method than to the device used. Both, SBPA and PPA obtained with brachial sub-diastolic technique and calibrated to CM or OscM showed higher levels of association with LV and LA structural characteristics. CONCLUSIONS: Our data show that many of the parameters that assume to quantify the same phenomenon of BPA are not related to each other in the different age groups. Both, SBPA and PPA obtained with brachial sub-diastolic technique and calibrated to CM or OscM showed higher levels of association with LV and LA structural characteristics.


Assuntos
Função do Átrio Esquerdo , Determinação da Pressão Arterial/normas , Pressão Sanguínea , Coração/fisiologia , Função Ventricular Esquerda , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Calibragem , Criança , Estudos Transversais , Ecocardiografia Doppler , Feminino , Voluntários Saudáveis , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Oscilometria , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Adulto Jovem
11.
Am J Physiol Heart Circ Physiol ; 320(4): H1601-H1608, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33606582

RESUMO

Central systolic blood pressure (cSBP, the peak of the central waveform) is usually regarded as the determinant of peripheral systolic blood pressure with amplification of peripheral systolic blood pressure (pSBP) measured with reference to cSBP. However, the earlier portion of the central waveform up to the first systolic shoulder (P1) may be the major determinant of pSBP. We performed in silico simulation studies and examined previously acquired experimental data (n = 131) in which peripheral and central blood pressure waveforms had been acquired both invasively and noninvasively to examine the determinants of pSBP. Measurements were made at baseline and during perturbation of hemodynamics by inotropic and vasoactive drugs. In silico simulations using a central-to-peripheral transfer function demonstrated that pSBP is dependent on P1 and the rate of change (dP/dt) of central pressure up to the time of P1 but not cSBP. In computational simulations, peripheral reflection in the radial artery was closely related to dP/dt, and 97% of the variability in amplification as measured with reference to P1 was explained by dP/dt. In vivo, amplification of pSBP over P1 was correlated with dP/dt (R > 0.75, P < 0.0001 for all data sets), and P1 and dP/dt were independently correlated with pSBP, explaining 90% of the variability in pSBP. We conclude that P1 and dP/dt are major determinants of pSBP and that pSBP and cSBP are, in part, determined by different cardiac, central, and peripheral vascular properties.NEW & NOTEWORTHY Peripheral systolic BP is determined mainly by the first shoulder and the rate of rise of the central systolic blood pressure waveform rather than the peak of this waveform (central systolic BP). Peripheral and central systolic blood pressure are determined by different cardiac and vascular properties.


Assuntos
Pressão Arterial , Artérias/fisiopatologia , Determinação da Pressão Arterial , Hipertensão/diagnóstico , Modelos Cardiovasculares , Função Ventricular Esquerda , Adulto , Idoso , Estudos de Casos e Controles , Simulação por Computador , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Numérica Assistida por Computador , Valor Preditivo dos Testes , Sístole , Fatores de Tempo
12.
Am J Physiol Heart Circ Physiol ; 320(4): H1554-H1564, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33606586

RESUMO

Accurate assessment of the left ventricular (LV) systolic function is indispensable in the clinic. However, estimation of a precise index of cardiac contractility, i.e., the end-systolic elastance (Ees), is invasive and cannot be established as clinical routine. The aim of this work was to present and validate a methodology that allows for the estimation of Ees from simple and readily available noninvasive measurements. The method is based on a validated model of the cardiovascular system and noninvasive data from arm-cuff pressure and routine echocardiography to render the model patient-specific. Briefly, the algorithm first uses the measured aortic flow as model input and optimizes the properties of the arterial system model to achieve correct prediction of the patient's peripheral pressure. In a second step, the personalized arterial system is coupled with the cardiac model (time-varying elastance model) and the LV systolic properties, including Ees, are tuned to predict accurately the aortic flow waveform. The algorithm was validated against invasive measurements of Ees (multiple pressure-volume loop analysis) taken from n = 10 patients with heart failure with preserved ejection fraction and n = 9 patients without heart failure. Invasive measurements of Ees (median = 2.4 mmHg/mL, range = [1.0, 5.0] mmHg/mL) agreed well with method predictions (normalized root mean square error = 9%, ρ = 0.89, bias = -0.1 mmHg/mL, and limits of agreement = [-0.9, 0.6] mmHg/mL). This is a promising first step toward the development of a valuable tool that can be used by clinicians to assess systolic performance of the LV in the critically ill.NEW & NOTEWORTHY In this study, we present a novel model-based method to estimate the left ventricular (LV) end-systolic elastance (Ees) according to measurement of the patient's arm-cuff pressure and a routine echocardiography examination. The proposed method was validated in vivo against invasive multiple-loop measurements of Ees, achieving high correlation and low bias. This tool could be most valuable for clinicians to assess the cardiovascular health of critically ill patients.


Assuntos
Algoritmos , Determinação da Pressão Arterial , Ecocardiografia , Insuficiência Cardíaca/diagnóstico , Hemodinâmica , Modelos Cardiovasculares , Função Ventricular Esquerda , Idoso , Determinação da Pressão Arterial/instrumentação , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Esfigmomanômetros , Sístole
13.
Blood Press Monit ; 26(2): 156-159, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33577185

RESUMO

OBJECTIVE: The present study aimed to evaluate the accuracy of the Omron HEM-7600T automated oscillometric upper-arm blood pressure (BP) monitor according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 protocol. METHODS: We recruited individuals until we obtained 86 eligible participants whose BP levels and ranges of arm circumference met the BP distribution requirements specified by the ANSI/AAMI/ISO. In each individual, we sequentially measured systolic and diastolic blood pressures (DBPs) using a mercury sphygmomanometer (two observers) and the HEM-7600T device (one supervisor) in the left upper arm. Data analysis was performed according to the ANSI/AAMI/ISO guidelines. RESULTS: A total of 101 individuals were recruited, and 86 were finally included in the analysis. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP was -0.6 ± 6.6/1.0 ± 6.5 mmHg (systolic/diastolic). The data were in accordance with criterion 1 of the ANSI/AAMI/ISO 81060-2:2013 standard requirements (≤ 5 ± ≤ 8 mmHg). In addition, the mean device-observer difference in the 86 participants was -0.6 ± 5.65 mmHg for systolic blood pressure and 1.0 ± 5.96 mmHg for DBP, fulfilling criterion 2 with an SD of ≤6.91 mmHg for systolic blood pressure and ≤6.87 mmHg for DBP. CONCLUSION: The Omron HEM-7600T BP monitor fulfilled the requirements of the ANSI/AAMI/ISO validation protocol in adults and can be recommended for home BP measurements.


Assuntos
Determinação da Pressão Arterial , Dispositivos Eletrônicos Vestíveis , Adulto , Arritmias Cardíacas , Pressão Sanguínea , Monitores de Pressão Arterial , Humanos , Padrões de Referência , Estados Unidos
14.
Nutr Metab Cardiovasc Dis ; 31(4): 1209-1218, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33618920

RESUMO

BACKGROUND AND AIMS: Elevated serum uric acid (SUA) is associated with hypertension according to its traditional definition. We investigated the association between SUA and incident hypertension according to the European Society of Cardiology (ESC) and American Society of Cardiology (ACC) guidelines. METHODS AND RESULTS: In this retrospective cohort study, we enrolled 10,537 healthy individuals ≥30 years old who underwent a routine annual health examination with office blood pressure recorded at our hospital in 2016; of the participants, 7349 repeated the exam in 2017. According to the ESC and ACC guidelines, hypertension was defined as office BP ≥ 140/90 mmHg or ≥130/80 mmHg. Hyperuricemia (HUA) was defined as SUA ≥7 mg/dL in men and ≥6 mg/dL in women. The hypertension incidence was 5.8% among 6378 individuals in the ESC cohort and 19% among 4330 individuals in the ACC cohort. Incident hypertension was significantly more common in the hyperuricemic group than in the normouricemic group (ESC: 8.6% vs. 4.7%, P < 0.001; ACC: 25.5% vs. 16.9%, P < 0.001). In the fully adjusted multivariate logistic regression analyses, each increase in SUA was associated with an increase in incident hypertension risk (ESC: adjusted OR: 1.167, 95% CI: 1.061-1.284, P = 0.001; ACC: adjusted OR: 1.125, 95% CI: 1.044-1.213, P = 0.002). The association can be explained by a significant correlation of baseline SUA with the BP in the following year (r = 0.24, P < 0.001 for baseline SUA and SBP in the following year; r = 0.239, P < 0.001 for baseline SUA and DBP in the following year). CONCLUSION: Elevated SUA was associated with incident hypertension in healthy individuals according to various contemporary BP guidelines (ClinicalTrials.gov: NCT03473951). CLINICAL TRIALS: ClinicalTrials.gov with the identification number of NCT03473951.


Assuntos
Determinação da Pressão Arterial/normas , Pressão Sanguínea , Hipertensão/epidemiologia , Hiperuricemia/epidemiologia , Guias de Prática Clínica como Assunto/normas , Ácido Úrico/sangue , Adulto , Biomarcadores/sangue , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hiperuricemia/sangue , Hiperuricemia/diagnóstico , Incidência , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taiwan/epidemiologia , Fatores de Tempo , Regulação para Cima
15.
Zhonghua Yi Xue Za Zhi ; 101(4): 239-242, 2021 Jan 26.
Artigo em Chinês | MEDLINE | ID: mdl-33486930

RESUMO

Chronic kidney disease (CKD) and hypertension are two closely interlinked public health problems. Kidney is an important organ for regulating blood pressure. Renal lesions may lead to increased blood pressure, and hypertension further accelerates the progression of renal disease, thereby forming a vicious circle which affects the prognosis of patients. Volume overload is an important mechanism in the development of hypertension in patients with CKD. Therefore, more emphasis should be put on volume management of CKD patients with hypertension.


Assuntos
Hipertensão , Insuficiência Renal Crônica , Pressão Sanguínea , Determinação da Pressão Arterial , Progressão da Doença , Humanos , Rim , Insuficiência Renal Crônica/complicações
16.
Ann Intern Med ; 174(1): JC7, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33395341

RESUMO

SOURCE CITATION: Juraschek SP, Hu JR, Cluett JL, et al. Effects of intensive blood pressure treatment on orthostatic hypotension: a systematic review and individual participant-based meta-analysis. Ann Intern Med. 2020. [Epub ahead of print.] 32909814.


Assuntos
Hipertensão , Hipotensão Ortostática , Adulto , Pressão Sanguínea , Determinação da Pressão Arterial , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/tratamento farmacológico , Hipotensão Ortostática/prevenção & controle
17.
Blood Press Monit ; 26(2): 149-155, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33470646

RESUMO

PURPOSE: Multiple devices capable of measuring ambulatory blood pressure without cuffs have been recently developed and it is required that they offer high-accuracy measurements. The purpose of this prospective study was to compare the performance of a tonometric blood pressure monitor with that of an oscillometric cuff-based device used as a reference in healthy and hypertensive subjects over 24 hours of ambulatory use. MATERIALS AND METHODS: Conventional oscillometric cuff-based device (Oscar 2; Sun Tech Medical) was placed in the left arm of 33 subjects, and a watch-type device based on the tonometric method (Bpro; HealthSTATS International, Singapore) was positioned in the right wrist. Both devices were synchronized to measure simultaneously over 24 hours. RESULTS: The difference between the means over 24 hours of the oscillometric and the tonometric devices was -0.9 mmHg for SBP and -4.5 mmHg for DBP; the standard deviations were 14.7 and 12.2 mmHg, respectively. Greater differences in bias and dispersion were observed overnight than during the daytime. The accuracy of the tonometric device for diagnosing hypertension was 75% and for detecting the non-dipper profile, 48%. CONCLUSION: The test device presented a high disagreement (especially during the night) compared to the oscillometric cuff-based device against which it was initially calibrated. This disagreement resulted in limited accuracy for diagnosing patients with suspected arterial hypertension and detecting non-dipper profiles.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão , Pressão Sanguínea , Determinação da Pressão Arterial , Humanos , Hipertensão/diagnóstico , Estudos Prospectivos , Esfigmomanômetros
18.
Anesthesiology ; 134(2): 179-188, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33326001

RESUMO

BACKGROUND: The optimal method for blood pressure monitoring in obese surgical patients remains unknown. Arterial catheters can cause potential complications, and noninvasive oscillometry provides only intermittent values. Finger cuff methods allow continuous noninvasive monitoring. The authors tested the hypothesis that the agreement between finger cuff and intraarterial measurements is better than the agreement between oscillometric and intraarterial measurements. METHODS: This prospective study compared intraarterial (reference method), finger cuff, and oscillometric (upper arm, forearm, and lower leg) blood pressure measurements in 90 obese patients having bariatric surgery using Bland-Altman analysis, four-quadrant plot and concordance analysis (to assess the ability of monitoring methods to follow blood pressure changes), and error grid analysis (to describe the clinical relevance of measurement differences). RESULTS: The difference (mean ± SD) between finger cuff and intraarterial measurements was -1 mmHg (± 11 mmHg) for mean arterial pressure, -7 mmHg (± 14 mmHg) for systolic blood pressure, and 0 mmHg (± 11 mmHg) for diastolic blood pressure. Concordance between changes in finger cuff and intraarterial measurements was 88% (mean arterial pressure), 85% (systolic blood pressure), and 81% (diastolic blood pressure). In error grid analysis comparing finger cuff and intraarterial measurements, the proportions of measurements in risk zones A to E were 77.1%, 21.6%, 0.9%, 0.4%, and 0.0% for mean arterial pressure, respectively, and 89.5%, 9.8%, 0.2%, 0.4%, and 0.2%, respectively, for systolic blood pressure. For mean arterial pressure and diastolic blood pressure, absolute agreement and trending agreement between finger cuff and intraarterial measurements were better than between oscillometric (at each of the three measurement sites) and intraarterial measurements. Forearm performed better than upper arm and lower leg monitoring with regard to absolute agreement and trending agreement with intraarterial monitoring. CONCLUSIONS: The agreement between finger cuff and intraarterial measurements was better than the agreement between oscillometric and intraarterial measurements for mean arterial pressure and diastolic blood pressure in obese patients during surgery. Forearm oscillometry exhibits better measurement performance than upper arm or lower leg oscillometry.


Assuntos
Cirurgia Bariátrica , Determinação da Pressão Arterial/métodos , Monitorização Intraoperatória/métodos , Obesidade/cirurgia , Pressão Sanguínea , Determinação da Pressão Arterial/estatística & dados numéricos , Cateterismo Periférico/métodos , Cateterismo Periférico/estatística & dados numéricos , Feminino , Dedos , Humanos , Masculino , Pessoa de Meia-Idade , Oscilometria/métodos , Oscilometria/estatística & dados numéricos , Estudos Prospectivos , Reprodutibilidade dos Testes
19.
Med Educ Online ; 26(1): 1841982, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33135567

RESUMO

BACKGROUND: Simulation-Based Education (SBE) simulates specific physiological characteristics of a patient, allowing student practice in developing clinical skills and assessment of skill competency. Literature is limited regarding SBE's effectiveness in curriculum enrichment. This study investigated Blood Pressure (BP) measuring proficiency of second-year medical students with first-year SBE training and a second-year review, by comparing data from Simulation-Based assessments in 2017 and 2019. METHODS: Second-year medical students measured BP on three manikin arms, associated with distinct clinical contexts (healthy young male, young female experiencing hypotension, and older male suffering hypertension and diabetes). All manikins' BP settings were independent of clinical context. In January 2019, 108 second-year medical students who received traditional training, as well as SBE in 2017 and Simulation-Based practice in 2018, were divided into four groups (n = 32, 24, 24, and 28), with two groups each assessed on consecutive days. The proportions of correct BP values in each of three contexts were compared between experiments in 2017 and 2019. Additionally, systolic (SBP) and diastolic (DBP) blood pressure results were stratified into three groups: lower than setting value, correct, and higher than setting vgalue, with proportions for each group compared for the 2017 and 2019 studies using Fisher's Exact Tests. RESULTS: In Case Two and Three, the proportion of correct BP values significantly increased from 2017 (Case Two: 51%; Case Three: 55%) to 2019 (Case Two: 73%; Case Three: 75%). Additionally, proportions of students who reported lower SBP values than setting values were significantly decreased in Case One and Two, with five failing all contexts. CONCLUSIONS: Second-year student BP measurement skills were improved, not only due to repeated Simulation-Based practice but advancing basic science knowledge and mastery experience in ongoing curriculum. Simulation-Based assessment provided an effective tool for evaluating skill retention and proficiency in medical training.


Assuntos
Determinação da Pressão Arterial , Pressão Sanguínea , Competência Clínica , Estudantes de Medicina , Determinação da Pressão Arterial/métodos , Currículo , Educação Continuada , Feminino , Humanos , Masculino , Manequins , Exame Físico , Treinamento por Simulação
20.
J Am Geriatr Soc ; 69(3): 767-772, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33314116

RESUMO

BACKGROUND: Exacerbation of or new onset orthostatic hypotension in perioperative patients can occur. There is complex underlying pathophysiology with further derailment likely caused by acute cardiovascular changes associated with surgery. The implications for post-operative recovery are unclear, particularly in frail and older patients. We retrospectively explored patient notes for evidence of post-operative orthostatic intolerance in relation to pre-operative orthostatic hypotension. METHODS: Supine and 1-minute and 3-minute standing blood pressure measures obtained from adult patients before mainly general, orthopedic or uro/gynecology surgery were compared to post-operative outcome, specifically, evidence in patient notes about falls, feeling dizzy/unsteady and/or fearful to stand. Orthostatic hypotension was defined as a 20 mmHg or more and/or 10 mmHg or more fall in systolic and diastolic blood pressure, respectively, within ~3 minutes of standing after lying supine for an electrocardiogram. RESULTS: Whilst all patients included had a 1-minute standing blood pressure assessment (N = 170), 3-minute assessment was performed less commonly (N = 113). Nevertheless, one-quarter (23.5%; N = 40) of 170 patients had pre-operative orthostatic hypotension. This was not clearly explained by cardiac or neurological disease or by common medications, but did occur more frequently in older patients and in those aged 65 years or more with higher clinical frailty scale scores. The COVID-19 pandemic reduced the number of patients progressing to surgery within the planned study timescale (N = 143/170; 84.1%). Nevertheless, patients with orthostatic hypotension stayed longer in hospital post-operatively and were more likely to have an episode of fall, unsteadiness and/or dizziness documented (un-prompted) in their notes. CONCLUSIONS: These data provide further impetus for research into modifiable perioperative risk factors associated with orthostatic hypotension. These risks are not confined to those with a pre-existing dysautonomia diagnosis.


Assuntos
Pressão Sanguínea , Fragilidade/fisiopatologia , Hipotensão Ortostática/diagnóstico , Intolerância Ortostática/etiologia , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial , Feminino , Fragilidade/complicações , Fragilidade/cirurgia , Avaliação Geriátrica , Humanos , Hipotensão Ortostática/etiologia , Masculino , Período Pré-Operatório , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
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