Concept: Orthostatic hypotension
Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension.
Mitral regurgitation in people without prior cardiac disease is considered a degenerative disease with no established risk factors for its prevention. We aimed to test the hypothesis that elevated systolic blood pressure (SBP) across its usual spectrum is associated with higher risk of mitral regurgitation.
The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) jointly developed this guideline to present the evidence and provide clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older.
High blood pressure (HBP) is a major cardiovascular disease (CVD) risk factor. Clinical trials including Dietary Approaches to Stop Hypertension (DASH) have demonstrated beneficial effects of dairy consumption on risks of HBP and CVD. Yogurt, a fermented dairy product, may independently be related to CVD risk.
Salt sensitivity of blood pressure affects >30% of the hypertensive and >15% of the normotensive population. Variants of the electrogenic sodium bicarbonate cotransporter NBCe2 gene, SLC4A5, are associated with increased blood pressure in several ethnic groups. SLC4A5 variants are also highly associated with salt sensitivity, independent of hypertension. However, little is known about how NBCe2 contributes to salt sensitivity, although NBCe2 regulates renal tubular sodium bicarbonate transport. We hypothesized that SLC4A5 rs10177833 and rs7571842 increase NBCe2 expression and human renal proximal tubule cell (hRPTC) sodium transport and may be a cause of salt sensitivity of blood pressure.
High blood pressure (BP) is a major cardiovascular risk factor that is treatable, yet hypertension awareness and control rates are low. Ubiquitous BP monitoring technology could improve hypertension management, but existing devices require an inflatable cuff and are not compatible with such anytime, anywhere measurement of BP. We extended the oscillometric principle, which is used by most automatic cuff devices, to develop a cuff-less BP monitoring device using a smartphone. As the user presses her/his finger against the smartphone, the external pressure of the underlying artery is steadily increased while the phone measures the applied pressure and resulting variable-amplitude blood volume oscillations. A smartphone application provides visual feedback to guide the amount of pressure applied over time via the finger pressing and computes systolic and diastolic BP from the measurements. We prospectively tested the smartphone-based device for real-time BP monitoring in human subjects to evaluate usability (n= 30) and accuracy against a standard automatic cuff-based device (n= 32). We likewise tested a finger cuff device, which uses the volume-clamp method of BP detection. About 90% of the users learned the finger actuation required by the smartphone-based device after one or two practice trials. The device yielded bias and precision errors of 3.3 and 8.8 mmHg for systolic BP and -5.6 and 7.7 mmHg for diastolic BP over a 40 to 50 mmHg range of BP. These errors were comparable to the finger cuff device. Cuff-less and calibration-free monitoring of systolic and diastolic BP may be feasible via a smartphone.
Failure to confirm high blood pressures in pediatric care-quantifying the risks of misclassification
- Journal of clinical hypertension (Greenwich, Conn.)
- Published about 3 years ago
Pediatric practice guidelines call for repeating an elevated office blood pressure (BP) at the same visit, but there are few data available to support this recommendation. We compared the visit results in children aged 3 to 17 years with a BP reading ≥95th percentile (n = 186 732) based on the initial BP and the mean of two BP readings, using electronic medical records from 2012-2015. Failure to repeat an initial BP reading ≥95th percentile would lead to a false “hypertensive” visit result in 54.1% of children who would require follow-up visits. After an initial visit result indicating hypertension, hypertension stage I or stage II was sustained in 2.3% and 11.3% of youth during their next visits, respectively. In conclusion, only approximately half of the pediatric patients would be correctly classified based on their initial BP. The recommendation to repeat high BP during the same visit needs to be emphasized because it saves unnecessary follow-up visits.
A lot of attention has been paid to the relationship of blood pressure and dementia because epidemiological research has reported conflicting evidence. Observational data has shown that midlife hypertension is a risk factor for cognitive decline and dementia later in life, whereas there is evidence that low blood pressure is predictive in later life. The aim of the present study was to examine the association between dementia and blood pressure measured up to 27 years (mean 17.6 years) prior to ascertainment.
Blood pressure is a potent determinant of cardiovascular risk, but the most appropriate targets for blood-pressure lowering have long been debated. Observational studies with a low risk of confounding have shown a linear relationship between blood pressure and cardiovascular risk down to 115/75 mm Hg,(1) but some observational studies with a greater potential for confounding, involving persons at increased risk, have suggested a J-shaped curve - that is, below a given blood pressure, risk would increase. When trials of blood-pressure-lowering drugs have shown benefits in patients without hypertension, these effects have often been ascribed to alternative mechanisms. The widespread uncertainty . . .
To compare the risk associated with systolic blood pressure that meets current recommendations (that is, below 140 mm Hg) with the risk associated with lower levels in patients who have type 2 diabetes and no previous cardiovascular disease.