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ABSTRACT Spot central and peripheral blood pressure are predictors for future hypertension, but the associations between central or peripheral systolic blood pressure (SBP) changes and new‐onset hypertension are unclear. Annual changes in central and peripheral SBP over a mean interval of 2.36 years were calculated for 815 Chinese community residents without cardiovascular disease and hypertension at the first two visits, with the formula: ([2nd SBP−1st SBP]/1st SBP) × 100%/time interval (years). The independent and joint associations of these SBP changes with new‐onset hypertension at the third visit were assessed with multivariable logistic regression models. During a mean follow‐up interval of 4.37 years since the second visit, 171 new cases of hypertension were observed. Central and peripheral SBP changes were significantly associated with new‐onset hypertension (central SBP change rate: odds ratio [OR]: 1.19 [95% confidence intervals (CI) 1.13, 1.26]; peripheral SBP change rate: OR: 1.25 [95% CI 1.17, 1.33]), even after adjusting for each other. Compared to the group with neither SBP increased, the group with both SBPs increased showed a significantly higher risk of new‐onset hypertension (OR: 4.52 [95% CI 2.54, 8.04]). The model including both SBP changes had a higher area under the curve (AUC) for predicting hypertension in receiver operating characteristic (ROC) analyses than those with either change alone. Central and peripheral SBP changes are independently and jointly associated with new‐onset hypertension. It is recommended to regularly monitor both central and peripheral blood pressures.

This meta‐analysis evaluated the potential association of a simultaneously measured inter‐arm systolic blood pressure difference (IASBPD) and all‐cause mortality and cardiovascular mortality. The Medline, Cochrane Library, Embase, and PubMed databases were searched through to April 14, 2023 for relevant literature. The outcomes were the associations of IASBPD with all‐cause and cardiovascular mortality. Finally, 10 cohort studies that included 15 320 individuals were included. An IASBPD of ≥15 mm Hg was associated with increased all‐cause mortality (pooled hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.02–1.61) but an IASBPD of ≥10 mm Hg was not (pooled HR 1.28, 95% CI 0.89–1.85). The pooled HR for cardiovascular mortality was 1.88 (95% CI 1.31–2.71) for an IASBPD of ≥10 mm Hg and 1.93 (95% CI 1.24–2.99) for an IASBPD of ≥15 mm Hg. Subgroup analysis showed that younger patients (HR 9.03, 95% CI 2.00–40.82, p = .004) with an IASBPD ≥15 mm Hg were at higher risk of cardiovascular mortality than older patients (HR 1.67, 95% CI 1.06–2.64, p = .03); the difference between groups was statistically significant (p = .04). In conclusions, our findings show that a simultaneously measured IASBPD ≥15 mm Hg predicts increased all‐cause mortality and an IASBPD of ≥15 mm Hg or ≥10 mm Hg predicts increased cardiovascular mortality. An IASBPD ≥15 mm Hg appears to be more correlated with cardiovascular mortality in younger patients than in older patients.

This study aimed to investigate the predictive values of central systolic blood pressure (cSBP) and peripheral systolic blood pressure (pSBP) for the progression of carotid intima-media thickness (cIMT). A total of 953 Chinese participants from an atherosclerosis cohort with complete information, including baseline cSBP, questionnaire information, biochemical examination, baseline, and follow-up carotid ultrasonography quantitative data, were included in this study. A multilinear regression model, adjusted for possible covariates, was used to investigate the predictive values of cSBP and pSBP for rate of cIMT change. The average age of all participants was (52.11 ± 4.74 years). The baseline levels of cSBP, pSBP, max cIMT, and mean cIMT were (132.55 ± 18.18)mmHg, (130.76 ± 15.40)mmHg, (813.52 ± 118.49)µm and (681.11 ± 99.90)µm, respectively Those with hypertension, diabetes and dyslipidemia accounted for 40.71% (388), 18.05% (172), and 70.41% (671), respectively. After 2.3 years of follow-up, the average rates of max and mean cIMT change were 8.70 (-0.49-19.43)% and 2.59 (-4.72-10.81)%, respectively. Per standard deviation increase of cSBP, but not pSBP, was associated with increases of max (for cSBP, β 1.07, 95%CI 0.18-1.96, p = 0.018; for pSBP, β 0.48, 95%CI -0.45-1.41, p = 0.315) and mean (for cSBP, β 0.84%, 95%CI 0.10-1.58, p = 0.027; for pSBP, β 0.59%, 95%CI -0.18-1.37, p = 0.135) cIMT change rate after adjusting for possible covariates. In conclusion, cSBP, but not pSBP, is independently associated with cIMT progression in our community-based Chinese population. cSBP should be considered for the purpose of CVD primary prevention.

Masked hypertension (MH) and masked uncontrolled hypertension (MUH) remain largely underdiagnosed with no efficient detection algorithm. We recently proposed a novel classification of office systolic hypertension phenotypes defined on the basis of both brachial and aortic systolic blood pressure (bSBP/aSBP) and showed that type III (\"isolated high office aSBP\" phenotype: normal office bSBP but high office aSBP) has higher hypertension-mediated organ damage (HMOD). We tested whether MH/MUH (1) can be detected with the \"isolated high office aSBP\" phenotype and (2) if it is associated with elevated office aSBP with respect to normotension. We classified two separate and quite different cohorts (n = 391 and 956, respectively) on the basis of both bSBP and aSBP into four different phenotypes. Participants were classified as sustained hypertensives, masked hypertensives/masked uncontrolled hypertensives (MHs/MUHs), white coat hypertensives, and normotensives according to their office and out-of-office BP readings. The majority (more than 60% in cohort A and more than 50% in cohort B) of type III individuals were MHs/MUHs. Almost 35% of MHs/MUHs had optimal office bSBP rather than high normal bSBP. In both cohorts, the detection of more than 40% of MH/MUH was feasible with the type III phenotype. MHs/MUHs had higher office aSBP than individuals with sustained normotension (p < 0.05). In conclusion, in the absence of an efficient screening test, the diagnosis of MH/MUH can be assisted by the detection of the \"isolated high office aSBP\" phenotype, which can be measured in a single office visit. MHs/MUHs have increased aSBP relative to normotensives, further explaining the increased mortality of MH/MUH.

Nocturnal trough systolic blood pressure (NTSBP) and Time Point of Nocturnal Trough Systolic Blood Pressure (T‐NTSBP) were important parameters of nocturnal blood pressure, the predictive values of which are unclear for stroke outcome. This study aimed to examine the relationship between NTSBP/T‐NTSBP and stroke outcome. The authors used data from a nationwide ambulatory blood pressure monitoring cohort study conducted in China, which recruited 2348 ischemic stroke and transient ischemic attack (TIA) patients. NTSBP was defined as the lowest SBP during nighttime (22:00–6:00), and T‐NTSBP was defined as the corresponding time point of NTSBP. The associations between NTSBP/T‐NTSBP and stroke outcome (stroke recurrence and combined vascular event [CVE]) at 90 days or 1 year were analyzed using cox regression models. According to NTSBP classified by quartile, hazard ratio (HR) with 95% confidence interval (CI) for NTSBP quartile 4 (>129 mm Hg) was 2.727 (1.148–6.478) for CVE at 90‐day, compared with quartile 1 (≤102 mm Hg). However, an attenuated association between NTSBP and CVE was observed at 1 year. In addition, we observed the group of T‐NTSBP at 4:00–6:00 had a lowest CVE incidence at 90 days among four groups (22:00–23:59, 00:00–1:59 2:00–3:59, 4:00–6:00). After multivariable adjustment, T‐NTSBP was significantly associated with CVE incidence at 90 days (T‐NTSBP at the 4:00–6:00 versus the 22:00–23:59 group: HR, 0.433; 95%CI, 0.190–0.986), independent of NTSBP and average nocturnal SBP. Both of NTSBP and T‐NTSBP were important predictors for short‐term cardiovascular risk in ischemic stroke and TIA patients.

BackgroundVibration-induced white finger (VWF) is the vascular component of the hand–arm vibration syndrome (HAVS). Two tests have been standardised so as to assist the diagnosis of VWF: the measurement of finger rewarming times and the measurement of finger systolic blood pressures (FSBPs).ObjectivesThis study investigates whether the two tests distinguish between fingers with and without symptoms of whiteness and compares individual results between the two test methods.MethodsIn 60 men reporting symptoms of the HAVS, the times for their fingers to rewarm by 4°C (after immersion in 15°C water for 5 min) and FSBPs at 30°C, 15°C and 10°C were measured on the same day.ResultsThere were significant increases in finger rewarming times and significant reductions in FSBPs at both 15°C and 10°C in fingers reported to suffer blanching. The FSBPs had sensitivities and specificities >90%, whereas the finger rewarming test had a sensitivity of 77% and a specificity of 79%. Fingers having longer rewarming times had lower FSBPs at both temperatures.ConclusionsThe findings suggest that, when the test conditions are controlled according to the relevant standard, finger rewarming times and FSBPs can provide useful information for the diagnosis of VWF, although FSBPs are more sensitive and more specific.

In electroconvulsive therapy (ECT), remifentanil is often used concurrently with anesthetics. The objective of this study was to provide an up-to-date and comprehensive review on how the addition of remifentanil to anesthetics affects seizure duration and circulatory dynamics in mECT. We performed a meta-analysis of RCTs that investigated seizure duration and circulatory dynamics in patients treated with ECT using anesthetics alone (non-remifentanil group) and with anesthetics plus remifentanil (remifentanil group). A total of 13 RCTs (380 patients and 1024 ECT sessions) were included. The remifentanil group showed a significantly prolonged seizure duration during ECT compared to the non-remifentanil group [motor: 9 studies, SMD = 1.25, 95 % CI (0.21, 2.29), p  = 0.02; electroencephalogram: 8 studies, SMD = 0.98, 95 % CI (0.14, 1.82), p  = 0.02]. The maximum systolic blood pressure (SBP) was significantly reduced in the remifentanil group compared to the non-remifentanil group [7 studies, SMD = −0.36, 95 % CI (−0.65, 0.07), p  = 0.02]. Substantial heterogeneity was observed for meta-analyses for seizure durations, but a pre-planned subgroup analysis revealed that seizure duration was prolonged only when the use of the anesthetic dose was reduced in the remifentanil group. The results of our study suggest that addition of remifentanil to anesthesia in ECT may lead to prolonged seizure duration when it allows the use of reduced anesthetic doses. Further, the addition of remifentanil was associated with reduced maximum SBP.

A thin, flexible and skin-attachable sensor for continuous monitoring of blood pressure is reported. The sensor was fabricated as a layered structure of ferroelectret film, specially designed electrodes and a flexible electronic circuit, which together enable simultaneous measurement of ballistocardiogram and an electrocardiogram on the human chest with minimal discomfort. To investigate the feasibility of continuous blood pressure monitoring, systolic blood pressure was estimated using the RJ interval, which is computed as the time delay between the R peak of the electrocardiogram and the J peak of the ballistocardiogram. The results indicate that the estimated systolic blood pressures are in excellent agreement with the reference values, achieving an intraclass correlation coefficient of 0.95 (P < 0.01), and complying with the recommended guidelines from the Association for the Advancement of Medical Instrumentation in the United States and the British Hypertension Society.

Objective: To assess the haemodynamic effect of simultaneously adjusting atrioventricular (AV) and interventricular (VV) delays. Method: 35 different combinations of AV and VV delay were tested by using digital photoplethysmography (Finometer) with repeated alternations to measure relative change in systolic blood pressure (SBPrel) in 15 patients with cardiac resynchronisation devices for heart failure. Results: Changing AV delay had a larger effect than changing VV delay (range of SBPrel 21 v 4.2 mm Hg, p < 0.001). Each had a curvilinear effect. The curve of response to AV delay fitted extremely closely to a parabola (average R2  =  0.99, average residual variance 0.8 mm Hg2). The response to VV delay was significantly less curved (quadratic coefficient 67 v 1194 mm Hg/s2, p  =  0.003) and therefore, although the residual variance was equally small (0.8 mm Hg2), the R2 value was 0.7. Reproducibility at two months was good, with the SD of the difference between two measurements of SBPrel being 2.5 mm Hg for AV delay (2% of mean systolic blood pressure) and 1.5 mm Hg for VV delay (1% of mean systolic blood pressure). Conclusions: Changing AV and VV delays results in a curvilinear acute blood pressure response. This shape fits very closely to a parabola, which may be valuable information in developing a streamlined clinical protocol. VV delay adjustment provides an additional, albeit smaller, haemodynamic benefit to AV optimisation.

Hypertension is a risk factor for generalized periodontitis (GP) and chronic kidney diseases (CKD). However, the role of isolated systolic blood pressure as one of the major risks for these inflammatory diseases has not been explored. Very limited studies exist identifying the red-complex bacteria in association with the isolated systolic blood pressure. Hence, the main objective of this study was to assess the isolated systolic blood pressure and the red-complex bacteria along with the demographic variables, periodontal parameters, and renal parameters in patients with generalized periodontitis and chronic kidney disease. One hundred twenty participants (age 30–70 years) were divided into four groups—Group C: control (systemically and periodontally healthy subjects), Group GP: generalized periodontitis, Group CKD: subjects with CKD with good periodontal health, Group CKD + GP: subjects with both generalized periodontitis and CKD. Demographic variables and periodontal parameters were measured and recorded. Blood pressure measurements and a detailed history and renal parameters such as serum creatinine, eGFR, and fasting blood sugar were recorded. The red-complex bacteria (RCB) were assessed in the subgingival plaque samples of all four groups using RT-PCR. Older participants (above 50 years) showed worse periodontal scores in the CKD + GP group along with elevated isolated systolic blood pressure, higher serum creatinine, and fasting blood sugar. eGFR was significantly decreased compared to the other groups. Bacterial counts were higher in the GP + CKD group, suggesting that they may be at a higher risk for generalized periodontitis and chronic kidney disease. Isolated systolic blood pressure (ISBP) and RCB were significantly correlated with the renal and periodontal parameters. A log-linear relationship exists between periodontal disease, CKD, RCB, and isolated systolic hypertension levels.