Patients with acute ischemic stroke (AIS) have elevated blood pressure (BP) variability (BPV) and reduced baroreflex sensitivity (BRS) at rest for several days after initial stroke symptoms. We aimed to assess BPV and BRS in AIS patients during pressor challenge maneuvers in the acute and subacute phases of stroke. Pressor challenge maneuvers simulate day-to-day activities and can predict the quality of life. Continuous beat-to-beat BP and ECG in 15 AIS patients (mean age 69 ± 7.5 years) and 15 healthy controls (57 ± 16 years) were recorded at rest and during a 5-min rapid head positioning (RHP) paradigm. Patients were assessed within 24 h (acute phase) and 7 days (subacute phase) of stroke onset. Low frequency (LF) SBP power (measure of BPV), LF-α, and combined α-index (measure of BRS) were calculated from the recordings. In the acute phase, at rest, LF-SBP power was higher ( P = 0.024) and α-index was lower ( P = 0.006) in AIS patients than in healthy controls. There was no change in LF-SBP during RHP in the patients but in healthy controls, it increased significantly ( P = 0.018). In the subacute phase, at rest, the alpha-index increased ( P = 0.037) and LF-SBP decreased ( P = 0.029) significantly in the AIS patients, however, there was still no rise in the LF-SBP power during RHP ( P = 0.240). AIS patients have a high resting BPV. High resting BPV may be responsible for blunted BPV responses during pressor challenge maneuvers such as RHP, suggesting ongoing autonomic dysfunction and compromised quality of life.

Physiologically, at night, blood pressure (BP) is expected to decrease by at least 10% in hypertensive individuals. The absence of this decrease, called non-dipper hypertension, is associated with increased end-organ damage and cardiovascular mortality and morbidity in hypertensive individuals. It is known that increased inflammatory process plays an important role in the etiopathogenesis of non-dipper hypertension pattern. In recent years, it has been shown that inflammation-based markers (IBMs) obtained by combining various inflammation-related hematological and biochemical parameters in a single fraction have stronger predictive value than single inflammatory parameters. However, until now, there has not been a study investigating the relationship of these markers with dipper/non-dipper status in newly diagnosed hypertensive patients. Based on ambulatory BP monitoring, 217 dipper and 301 non-dipper naive hypertensive subjects were included in this study. All subjects' IBM values were compared between dipper and non-dipper hypertensive individuals. IBMs [C-reactive protein/albumin ratio (CAR), monocyte/high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio, systemic immune-inflammation index (SII), uric acid/albumin ratio (UAR)] were significantly higher in the non-dipper group. CAR, MHR, NLR, SII, and UAR were determined as independent predictors for non-dipper pattern ( P < 0.05, for all). Also, UAR's diagnostic performance for non-dipper pattern was found to be superior to other IBMs (area under the curve: 0.783, 95% confidence interval: 0.743-0.822; P < 0.001). These findings suggest an association between elevated IBMs, particularly UAR, and the non-dipper hypertension pattern observed in our study.

The purpose of our study was to analyze the association of blood pressure and blood pressure progression with heart disease and stroke among Chinese population. We included a total of 10 122 adults aged 45 years and above free of heart disease or stroke at baseline from the China Health and Retirement Longitudinal Study cohort. We used Cox proportional hazards models to analyze the relationship between cardiovascular risk and prehypertension in subjects with or without progression to hypertension. During a mean follow-up of 6.5 years, 1972 subjects were either diagnosed with heart disease or had a stroke (composite outcome). Compared with individuals with normotension at baseline, the fully adjusted hazard ratio (HR) [95% confidence interval (CI)] was 1.25 (1.10-1.42) and 1.52 (1.34-1.74) for composite outcome in individuals with prehypertension and hypertension at baseline, respectively. The subjects who progressed to hypertension had higher risk of cardiovascular outcomes than those who remained at normal blood pressure or prehypertension in a fully adjusted model. The subjects who progressed from prehypertension to hypertension had 1.72 times higher risk [HR (95% CI): 1.72 (1.37-2.16)] of cardiovascular outcomes than those who remained at normal blood pressure or prehypertension in a fully adjusted model. The cardiovascular risk of subjects with prehypertension is higher than that of subjects with normal blood pressure. After a diagnosis of hypertension, subjects who progressed from normal blood pressure to hypertension had an increased risk of heart disease and stroke.

Obtaining accurate and reliable blood pressure (BP) readings in pediatric patients is challenging, given difficulties in adhering to measurement guidelines, limited device validation and variable patient cooperation. This study aimed to investigate clinicians' perspectives surrounding noninvasive pediatric BP assessment to identify opportunities for improvement in BP technology and clinical practice. Based on an adapted version of the extended Technology Acceptance Model 2, semi-structured interviews were conducted with clinicians involved in noninvasive pediatric BP assessment in a major Australian children's hospital. Transcripts were analyzed thematically and guided by Technology Acceptance Model 2. Clinician responses ( n = 20) revealed that poor patient tolerance of BP measurement resulting from excessive cuff inflation is a major hindrance to reliable pediatric BP assessment. Clinicians described low trust in BP readings from automated devices, often relating to poor patient tolerance to cuff inflation, thereby diminishing the clinical utility of these readings in informing treatment decisions. Auscultatory measurement was regarded as more trustworthy and better tolerated, but less convenient to perform as compared with oscillometric measurement. A dissonance exists between (1) low trust and clinical utility of the most common and easy-to-use BP measurement approach (automated devices), versus (2) higher trust and clinical utility, but efficiency and user-related impediments, for the auscultatory method. Based on our results, we have developed the Blood Pressure Acceptance Model, which can be used to explain and predict clinicians' acceptance of BP technology. Further work is needed to improve the tolerability and accuracy of automated BP devices in real-world pediatric settings.

Different lifestyle changes have been employed to improve clinical hypertension. However, there is scarce evidence on the blood pressure responsiveness to resistance training (RT) in hypertensive older adults. Consequently, little is known about some participants clinically reducing blood pressure and others not. Thus, we investigate the effects and responsiveness of RT on blood pressure in hypertensive older adults. We secondarily evaluated the biochemical risk factors for cardiovascular disease and functional performance. Older participants with hypertension were randomly assigned into RT (n = 27) and control group (n = 25). Blood pressure, functional performance (timed up and go, handgrip strength, biceps curl and sit-to-stand), fasting glucose, and lipid profiles were evaluated preintervention and postintervention. The statistic was performed in a single-blind manner, the statistician did not know who was the control and RT. RT was effective in reducing systolic blood pressure (SBP) (pre 135.7 ± 14.7; post 124.7 ± 11.0; P < 0.001) and the responses to RT stimuli varied noticeably between hypertensive older adults after 12 weeks. For example, 13 and 1 responders displayed a minimal clinical important difference for SBP attenuation (10.9 mmHg) in the RT and control groups, respectively. RT improved the functional performance of older people with hypertension, while no differences were found in biochemical parameters (triglycerides, HDL, LDL, fasting glucose) after 12 weeks. In conclusion, responses to RT stimuli varied noticeably between hypertensive individuals and RT was effective in reducing SBP.

This study aimed to assess the agreement between direct intra-arterial pressure and ClearSight finger cuff arterial pressure measurements in elderly patients undergoing transcatheter aortic valve replacement (TAVR). A prospective observational study was conducted at Hitachi General Hospital, Japan, involving 30 patients aged 65 years and older who underwent TAVR under general anesthesia. Intra-arterial pressure and finger cuff arterial pressure measurements were recorded for 30 min after valve deployment. Bland-Altman analysis, four-quadrant plot analysis, and error grid analysis were used to assess the concordance between the two methods. Multiple regression analysis was performed to explore potential confounding factors affecting the agreement. The bias and precision of ClearSight measurements were -4.88 ± 15.46 (mmHg) for SBP, 4.73 ± 8.95 (mmHg) for mean, and 9.53 ± 9.01 (mmHg) for DBP. The Bland-Altman analysis demonstrated acceptable agreement between intra-arterial pressure and finger cuff arterial pressure measurements. The four-quadrant plot analysis showed good trend-tracking ability, and the error grid analysis revealed that most of the observed values fell into the no-risk category. The mean BP match ratio and SBP match ratio were influenced by several factors such as age, BSA, ejection fraction, valve size, and gender. The ClearSight finger cuff arterial pressure measurement showed good agreement with direct intra-arterial pressure in elderly patients undergoing TAVR. However, factors such as age, BSA, ejection fraction, valve size, and gender may influence the agreement between the two methods.

Limited and conflicting data have been reported on the prognostic relevance of central blood pressure (CBP) compared with brachial blood pressure (BP) in the anticipation of hypertension-mediated organ damage and the majority of data derived using applanation tonometry with its known complexities. The objective of the present study was to investigate the diagnostic factors of left ventricular hypertrophy (LVH) with a special highlight on the utility of non-invasive oscillometric CBP measurement and derived hemodynamic indices compared to brachial BP as indicators of LVH. This cross-sectional study included 300 hypertensive patients (mean age 55.3 years, 61.3% female, 51.7% obese) with a mean duration of hypertension was 5.8 years. They underwent measurement of brachial BP, using a mercury sphygmomanometer, and CBP, using a Mobil-O-Graph, alongside the determination of left ventricular (LV) mass by two-dimensional transthoracic echocardiography. LVH and LV geometric patterns were defined by LV mass index/height 2.7 and relative wall thickness. Bivariate then multivariate analysis showed that age, BMI, central systolic BP (SBP), and pulse wave velocity (PWV) were significant determinants of LVH and optimally controlled brachial BP was a significant negative determinant for LVH. Central SBP had an acceptable diagnostic performance to determine LVH in patients with hypertension (AUC = 0.722, 95% confidence interval: 0.618-0.824, SE = 0.21, P -value <0.001). Using one-way ANOVA, a comparison of means among age groups showed that the steady increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients. Estimated central SBP using Mobil-O-Graph showed a significantly higher correlation to LVH than brachial SBP values. The consistent increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients.

To evaluate the accuracy of the YuWell YE660D oscillometric upper-arm blood pressure (BP) monitor in general population (for clinic and home BP measurements in adults) according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2 : 2018) and its Amendment 1. 2020. Subjects were recruited to fulfill the age, sex, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in general population using the same arm sequential BP measurement method. Two cuffs of the test device were used for arm circumferences 22-32 cm (standard) and 22-45 cm (wide range). Ninety-two subjects were recruited and 85 subjects were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.3 ± 7.2/2.2 ± 5.5 mmHg (systolic/diastolic). For validation criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 6.1/4.8 mmHg (systolic/diastolic). The YuWell YE660D oscillometric upper-arm electronic BP monitor has passed the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2 : 2018) and its Amendment 1. 2020 in adults and hence can be recommended for home and clinical use.

Glyceryl trinitrate (GTN) provoked cardioinhibitory syncope during the head-up tilt test is preceded by a period of disrupted blood pressure variability (BPV). Endogenous nitric oxide (NO) attenuates BPV independently of blood pressure (BP). We hypothesized that exogenous NO donor GTN might decrease BPV during the presyncope period. A decrease in BPV may predict the tilt outcome. We analyzed 29 tilt test recordings of subjects with GTN-induced cardioinhibitory syncope and 30 recordings of negative subjects. A recursive autoregressive model of BPV after GTN was performed; powers of the respiratory (0.15-0.45 Hz) and nonrespiratory frequency (0.01-0.15 Hz) bands were calculated for each of the 20 normalized time periods. The post-GTN relative changes in heart rate, BP, and BPV were calculated. In the syncope group, spectral power of nonrespiratory frequency systolic and diastolic BPV progressively felt for 30% after GTN application and stabilized after 180 s. BP started to fall 240 s after the GTN application. Decrease in nonrespiratory frequency power of diastolic BPV 20 s after GTN administration predicted cardioinhibitory syncope (area under the curve 0.811; 77% sensitivity; 70% specificity; cutoff value > 7%). GTN application during the tilt test attenuates systolic and diastolic nonrespiratory frequency BPV during the presyncope period, independent of BP. A decrease in nonrespiratory frequency diastolic BPV 20 s after GTN application predicts cardioinhibitory syncope with good sensitivity and moderate specificity.

Hypertension is the leading risk factor for cardiovascular disease yet also one of the most readily preventable causes of death. Isometric resistance training (IRT) has gained increasing popularity in recent times as a viable nonpharmacological management option for hypertension. Whilst there have been several reviews on this topic, with varying findings, this umbrella review aimed to summarize the current evidence underpinning the effectiveness of IRT for hypertension. Quantitative systematic reviews and meta-analyses published in English were considered for inclusion. Commercially produced and grey literature was searched between December 2021 and January 2022. Methodological quality of included reviews was determined using the AMSTAR 2 critical appraisal tool. Customized data extraction tools were developed for this review and data were synthesized using the National Health and Medical Research Council FORM Framework. Twelve reviews published between 2011 and 2021 of varying methodological quality were identified. Isometric handgrip exercise training with four sets of 2-min contractions and 1 min rest period between each set was the most utilized intervention, undertaken three times per week for at least 8 weeks. Collectively, there is consistent evidence to indicate IRT has positive impacts on SBP and DBP as well as mean arterial pressure. These positive impacts were reported for normotensive as well as hypertensive individuals. Given IRT is a readily available, easy-to-use intervention with minimal financial cost, it could be considered a viable treatment option for people with, and at risk of, hypertension.