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  1. Fulltext Office blood pressure measurement: A comprehensive review
    Siddique S, Hameed Khan A, Shahab H, Zhang YQ, Chin Tay J, Buranakitjaroen P, et al.
    J Clin Hypertens (Greenwich), 2021 03;23(3):440-449.
    PMID: 33420745 DOI: 10.1111/jch.14169
    The conventional auscultatory methods for measuring blood pressure have been used to screen, diagnose, and manage hypertension since long. However, these have been found to be prone to errors especially the white coat phenomena which cause falsely high blood pressure readings. The Mercury sphygmomanometer and the Aneroid variety are no longer recommended by WHO for varying reasons. The Oscillometric devices are now recommended with preference for the Automated Office Blood Pressure measurement device which was found to have readings nearest to the Awake Ambulatory Blood Pressure readings. The downside for this device is the cost barrier. The alternative is to use the simple oscillometric device, which is much cheaper, with the rest and isolation criteria of the SPRINT study. This too may be difficult due to space constraints and the post-clinic blood measurement is a new concept worth further exploration.
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory*
  2. Fulltext Standardized home blood pressure monitoring: Rationale behind the 722 protocol
    Lin HJ, Pan HY, Chen CH, Cheng HM, Chia YC, Sogunuru GP, et al.
    J Clin Hypertens (Greenwich), 2022 Sep;24(9):1161-1173.
    PMID: 36196472 DOI: 10.1111/jch.14549
    Home blood pressure (HBP) has been recognized as a prognostic predictor for cardiovascular events, and integrated into the diagnosis and management of hypertension. With increasing accessibility of oscillometric blood pressure devices, HBP monitoring is easy to perform, more likely to obtain reliable estimation of blood pressures, and feasible to document long-term blood pressure variations, compared to office and ambulatory blood pressures. To obtain reliable HBP estimates, a standardized HBP monitoring protocol is essential. A consensus regarding the optimal duration and frequency of HBP monitoring is yet to be established. Based on the current evidence, the "722" protocol, which stands for two measurements on one occasion, two occasions a day (morning and evening), and over a consecutive of 7 days, is most commonly used in clinical studies and recommended in relevant guidelines and consensus documents. HBP monitoring based on the "722" protocol fulfills the minimal requirement of blood pressure measurements to achieve agreement of blood pressure classifications defined by office blood pressures and to predict cardiovascular risks. In the Taiwan HBP consensus, the frequency of repeating the "722" protocol of HBP monitoring according to different scenarios of hypertension management, from every 2 weeks to 3 months, is recommended. It is reasonable to conclude that the "722" protocol for HBP monitoring is clinically justified and can serve as a basis for standardized HBP monitoring.
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination/methods
  3. Fulltext Diversity of and initiatives for hypertension management in Asia-Why we need the HOPE Asia Network
    Kario K, Chia YC, Sukonthasarn A, Turana Y, Shin J, Chen CH, et al.
    J Clin Hypertens (Greenwich), 2020 Mar;22(3):331-343.
    PMID: 31773883 DOI: 10.1111/jch.13733
    The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was set up to improve the management of hypertension in Asia with the ultimate goal of achieving "zero" cardiovascular events. Asia is a diverse continent, and the prevalence of hypertension has increased over the last 30 years. There are a number of Asia-specific features of hypertension and hypertension-related cardiovascular complications, which means that a region-specific approach is needed. White-coat hypertension will become more of an issue over time as Asian populations age, and masked hypertension is more prevalent in Asian than in Western countries. Identifying and treating masked hypertension is important to reduce cardiovascular risk. Abnormal patterns of blood pressure (BP) variability common in Asia include exaggerated early morning BP surge and nocturnal hypertension. These are also important cardiovascular risk factors that need to be managed. Home blood pressure monitoring (HBPM) is an important tool for detecting white-coat and masked hypertension, and monitoring BP variability, and practices in Asia are variable. Use of HBPM is important given the Asia-specific features of hypertension, and strategies are needed to improve and standardize HBPM usage. Development of HBPM devices capable of measuring nocturnal BP along with other information and communication technology-based strategies are key developments in the widespread implementation of anticipation medicine strategies to detect and prevent cardiovascular events in patients with hypertension. Region-wide differences in hypertension prevalence, control, and management practices in Asia highlight the importance of information sharing to facilitate best practices.
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory
  4. Fulltext Current status of ambulatory blood pressure monitoring in Asian countries: A report from the HOPE Asia Network
    Shin J, Kario K, Chia YC, Turana Y, Chen CH, Buranakitjaroen P, et al.
    J Clin Hypertens (Greenwich), 2020 03;22(3):384-390.
    PMID: 31696632 DOI: 10.1111/jch.13724
    Ambulatory blood pressure monitoring (ABPM) can measure 24-hour blood pressure (BP), including nocturnal BP and diurnal variations. This feature of ABPM could be of value in Asian populations for preventing cardiovascular events. However, no study has yet investigated regarding the use of ABPM in actual clinical settings in Asian countries/regions. In this study, 11 experts from 11 countries/regions were asked to answer questionnaires regarding the use of ABPM. We found that its use was very limited in primary care settings and almost exclusively available in referral settings. The indications of ABPM in actual clinical settings were largely similar to those of home BP monitoring (HBPM), that is, diagnosis of white-coat or masked hypertension and more accurate BP measurement for borderline clinic BP. Other interesting indications, such as nighttime BP patterns, including non-dipper BP, morning BP surge, and BP variability, were hardly adopted in daily clinical practice. The use of ABPM as treatment guidance for detecting treated but uncontrolled hypertension in the Asian countries/regions didn't seem to be common. The barrier to the use of ABPM was primarily its availability; in referral centers, patient reluctance owing to discomfort or sleep disturbance was the most frequent barrier. ABPM use was significantly more economical when it was reimbursed by public insurance. To facilitate ABPM use, more simplified indications and protocols to minimize discomfort should be sought. For the time being, HBPM could be a reasonable alternative.
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory
  5. Home blood pressure-centered approach - from digital health to medical practice: HOPE Asia Network consensus statement 2023
    Kario K, Tomitani N, Wang TD, Park S, Li Y, Shin J, et al.
    Hypertens Res, 2023 Dec;46(12):2561-2574.
    PMID: 37605071 DOI: 10.1038/s41440-023-01397-6
    Recent innovations in digital technology have enabled the simultaneous accumulation, and the linking and analysis of time-series big data relating to several factors that influence blood pressure (BP), including biological indicators, physical activity, and environmental information. Various approaches can be used to monitor BP: in the office/clinic; at home; 24-h ambulatory recording; or with wearable and cuffless devices. Of these, home BP monitoring is a reliable and convenient method, and is recommended for hypertension management by current national and international guidelines. This recommendation is based on evidence showing that home BP is an important predictor of cardiovascular, cerebrovascular and kidney disease in patients with hypertension. In addition, lifetime personalized health record (PHR)-based home BP with telemonitoring combined with co-interventions has been shown to lower BP more effectively than the traditional approach based on office BP. Thus, home BP represents a key metric for personalized anticipation medicine, from digital healthcare to digital medicine. This paper summarizes the latest evidence on home BP monitoring and proposes a Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network consensus on a home BP-centered approach to the management of hypertension.
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination/methods; Blood Pressure Monitoring, Ambulatory
  6. Fulltext Neurodegenerative diseases and blood pressure variability: A comprehensive review from HOPE Asia
    Turana Y, Shen R, Nathaniel M, Chia YC, Li Y, Kario K
    J Clin Hypertens (Greenwich), 2022 Sep;24(9):1204-1217.
    PMID: 36196471 DOI: 10.1111/jch.14559
    Asia has an enormous number of older people and is the primary contributor to the rise in neurodegenerative diseases such as Alzheimer's and Parkinson's disease. The therapy of many neurodegenerative diseases has not yet progressed to the point where it is possible to alter the course of the disease. Mid-life hypertension is an important predictor of later-life cognitive impairment and brain neurodegenerative conditions. These findings highlight the pivotal role of preventing and managing hypertension as a risk factor for neurodegenerative disease. Autonomic dysfunction, neuropsychiatric and sleep disturbances can arise in neurodegenerative diseases, resulting in blood pressure variability (BPV). The BPV itself can worsen the progression of the disease. In older people with neurodegenerative disease and hypertension, it is critical to consider 24-h blood pressure monitoring and personalized blood pressure therapy.
    Matched MeSH terms: Blood Pressure/physiology; Blood Pressure Determination/methods
  7. Fulltext Target blood pressure and control status in Asia
    Chia YC, Kario K, Turana Y, Nailes J, Tay JC, Siddique S, et al.
    J Clin Hypertens (Greenwich), 2020 Mar;22(3):344-350.
    PMID: 31742891 DOI: 10.1111/jch.13714
    It is widely accepted that hypertension constitutes a significant cardiovascular risk factor and that treating high blood pressure (BP) effectively reduces cardiovascular risk. An important issue in Asia is not just the high prevalence of hypertension, particularly in some countries, but also the low level of awareness and treatment rates in many regions. The 2017 update of the American College of Cardiology/American Heart Association hypertension guidelines raised the question about which BP threshold should be used to diagnose and treat hypertension. Although there is a theoretical rationale for a stricter BP criterion in Asia given the ethnic-specific features of hypertension in the region, the majority of countries in Asia have retained a diagnostic BP threshold of ≥140/90 mm Hg. Although lowering thresholds might make theoretical sense, this would increase the prevalence of hypertension and also markedly reduce BP control rates. In addition, there are currently no data from robust randomized clinical trials of the benefits of the lower targets in preventing cardiovascular disease and reducing cardiovascular risk, particularly in high-risk patients and especially for Asian populations. There is also no defined home BP treatment target level for an office BP treatment target of 130/80 mm Hg. However, in this regard, in the interim, lifestyle modifications, including reducing body weight and salt intake, should form an important part of hypertension management strategies in Asia, while studies on treating at lower BP threshold level in Asians and getting to lower BP targets will be helpful to inform and optimize the management of hypertension in the region.
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory*
  8. Fulltext Recent Advances in Non-Invasive Blood Pressure Monitoring and Prediction Using a Machine Learning Approach
    Ismail SNA, Nayan NA, Jaafar R, May Z
    Sensors (Basel), 2022 Aug 18;22(16).
    PMID: 36015956 DOI: 10.3390/s22166195
    Blood pressure (BP) monitoring can be performed either invasively via arterial catheterization or non-invasively through a cuff sphygmomanometer. However, for conscious individuals, traditional cuff-based BP monitoring devices are often uncomfortable, intermittent, and impractical for frequent measurements. Continuous and non-invasive BP (NIBP) monitoring is currently gaining attention in the human health monitoring area due to its promising potentials in assessing the health status of an individual, enabled by machine learning (ML), for various purposes such as early prediction of disease and intervention treatment. This review presents the development of a non-invasive BP measuring tool called sphygmomanometer in brief, summarizes state-of-the-art NIBP sensors, and identifies extended works on continuous NIBP monitoring using commercial devices. Moreover, the NIBP predictive techniques including pulse arrival time, pulse transit time, pulse wave velocity, and ML are elaborated on the basis of bio-signals acquisition from these sensors. Additionally, the different BP values (systolic BP, diastolic BP, mean arterial pressure) of the various ML models adopted in several reported studies are compared in terms of the international validation standards developed by the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS) for clinically-approved BP monitors. Finally, several challenges and possible solutions for the implementation and realization of continuous NIBP technology are addressed.
    Matched MeSH terms: Blood Pressure/physiology; Blood Pressure Determination*
  9. Endocrine hypertension--current understanding and comprehensive management review
    Sukor N
    Eur J Intern Med, 2011 Oct;22(5):433-40.
    PMID: 21925049 DOI: 10.1016/j.ejim.2011.05.004
    Hypertension is a very common disease, leading to significant morbidity with reduction in quality of life. In addition to being a major cause of morbidity and mortality, hypertension places a heavy burden on health care systems, families, and society as a whole. In patients with hypertension, the ability to identify a contributing or secondary cause that is potentially curable or amenable to specific forms of management is of great importance. Endocrine hypertension has emerged as one of the common forms of secondary hypertension. Primary aldosteronism, pheochromocytoma and Cushing's syndrome are among the common causes of endocrine hypertension. The application of new clinical, biochemical, and radiologic approaches has significantly advanced our understanding of the pathophysiology and clinical spectrum of these diseases and improved the management strategies of these challenging conditions.
    Matched MeSH terms: Blood Pressure/physiology*
  10. Intensive blood pressure-lowering strategy should also be offered to older patients
    Kow CS, Hasan SS
    J Hypertens, 2021 04 01;39(4):812-813.
    PMID: 33649284 DOI: 10.1097/HJH.0000000000002778
    Matched MeSH terms: Blood Pressure/drug effects
  11. Fulltext Standing Up for Frailty: Blood Pressure Changes Do Matter
    Tan MP
    J Am Heart Assoc, 2020 04 07;9(7):e016222.
    PMID: 32223391 DOI: 10.1161/JAHA.120.016222
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination
  12. Highly-sensitive graphene-based flexible pressure sensor platform
    Muhammad Aniq Shazni, Lee MW, Lee HW
    Sains Malaysiana, 2017;46:1155-1161.
    In this work, graphene has been utilized as the sensing material for the development of a highly-sensitive flexible pressure sensor platform. It has been demonstrated that a graphene-based pressure sensor platform that is able to measure pressure change of up to 3 psi with a sensitivity of 0.042 psi-1 and a non-linearity of less than 1% has been accomplished. The developed device, which resides on a flexible platform, will be applicable for integration in continuous wearables health-care monitoring system for the measurement of blood pressure.
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination
  13. Fulltext Effects of qigong on systolic and diastolic blood pressure lowering: a systematic review with meta-analysis and trial sequential analysis
    Ching SM, Mokshashri NR, Kannan MM, Lee KW, Sallahuddin NA, Ng JX, et al.
    BMC Complement Med Ther, 2021 Jan 06;21(1):8.
    PMID: 33407414 DOI: 10.1186/s12906-020-03172-3
    BACKGROUND: The benefits of qigong for systolic and diastolic blood pressure (BP) reduction have been noted in previously published systematic reviews; however, the data on its effectiveness has been at best scarce. We aimed to update the evidence of qigong on blood pressure reduction after taking into consideration the risks of random error and reliability of data in the cumulative meta-analysis using trial sequential analysis (TSA).

    METHODS: Included trials were assessed using Cochrane risk of bias instrument. We performed meta-analysis with random-effects model and random errors were evaluated with TSA. We performed the search for the eligible randomized controlled trial (RCT) through Medline, Cinahl, Cochrane Central Register of Controlled Trials and also PubMed.

    RESULTS: A total of 370 subjects sourced from seven eligible RCTs were entered into the analysis. The pooled results demonstrated the significant reduction with the use of qigong of the systolic blood pressure [weighted mean difference (WMD), - 10.66 mmHg (95% confidence interval (CI) = - 17.69,-3.62, p 

    Matched MeSH terms: Blood Pressure*
  14. Fulltext Clinical significance of nocturnal home blood pressure monitoring and nocturnal hypertension in Asia
    Fujiwara T, Hoshide S, Tomitani N, Cheng HM, Soenarta AA, Turana Y, et al.
    J Clin Hypertens (Greenwich), 2021 03;23(3):457-466.
    PMID: 33591641 DOI: 10.1111/jch.14218
    Nocturnal home blood pressure (BP) monitoring has been used in clinical practice for ~20 years. The authors recently showed that nocturnal systolic BP (SBP) measured by a home BP monitoring (HBPM) device in a Japanese general practice population was a significant predictor of incident cardiovascular disease (CVD) events, independent of office and morning home SBP levels, and that masked nocturnal hypertension obtained by HBPM (defined as nocturnal home BP ≥ 120/70 mmHg and average morning and evening BP 
    Matched MeSH terms: Blood Pressure; Blood Pressure Monitoring, Ambulatory
  15. Fulltext Characteristics and control of the 24-hour ambulatory blood pressure in patients with metabolic syndrome
    Huang JF, Li Y, Shin J, Chia YC, Sukonthasarn A, Turana Y, et al.
    J Clin Hypertens (Greenwich), 2021 03;23(3):450-456.
    PMID: 33629806 DOI: 10.1111/jch.14229
    Asian countries are facing an increasing prevalence of metabolic syndrome (MetS), which may aggravate the burden of cardiovascular diseases in this region. MetS is closely associated with ambulatory blood pressure (BP). Patients with MetS, compared to those without, had a twofold higher risk of new-onset office, home, or ambulatory hypertension. Furthermore, the risk of new-onset MetS in patients with white-coat, masked and sustained hypertension was also doubled compared to normotensives. High-risk masked hypertension and blunted nighttime BP dipping are common in patients with MetS, suggesting perfect 24-hour BP control with long-acting antihypertensive drugs and early initiation of combination therapy might be especially important for patients with MetS.
    Matched MeSH terms: Blood Pressure; Blood Pressure Monitoring, Ambulatory
  16. Fulltext A Shallow U-Net Architecture for Reliably Predicting Blood Pressure (BP) from Photoplethysmogram (PPG) and Electrocardiogram (ECG) Signals
    Mahmud S, Ibtehaz N, Khandakar A, Tahir AM, Rahman T, Islam KR, et al.
    Sensors (Basel), 2022 Jan 25;22(3).
    PMID: 35161664 DOI: 10.3390/s22030919
    Cardiovascular diseases are the most common causes of death around the world. To detect and treat heart-related diseases, continuous blood pressure (BP) monitoring along with many other parameters are required. Several invasive and non-invasive methods have been developed for this purpose. Most existing methods used in hospitals for continuous monitoring of BP are invasive. On the contrary, cuff-based BP monitoring methods, which can predict systolic blood pressure (SBP) and diastolic blood pressure (DBP), cannot be used for continuous monitoring. Several studies attempted to predict BP from non-invasively collectible signals such as photoplethysmograms (PPG) and electrocardiograms (ECG), which can be used for continuous monitoring. In this study, we explored the applicability of autoencoders in predicting BP from PPG and ECG signals. The investigation was carried out on 12,000 instances of 942 patients of the MIMIC-II dataset, and it was found that a very shallow, one-dimensional autoencoder can extract the relevant features to predict the SBP and DBP with state-of-the-art performance on a very large dataset. An independent test set from a portion of the MIMIC-II dataset provided a mean absolute error (MAE) of 2.333 and 0.713 for SBP and DBP, respectively. On an external dataset of 40 subjects, the model trained on the MIMIC-II dataset provided an MAE of 2.728 and 1.166 for SBP and DBP, respectively. For both the cases, the results met British Hypertension Society (BHS) Grade A and surpassed the studies from the current literature.
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination
  17. Fulltext The variability of blood pressure following repeated measurements
    Singh HJ, Singh R, Sirisinghe RG, Upadaya S
    Med J Malaysia, 1991 Dec;46(4):356-62.
    PMID: 1840445
    Two series of Blood Pressure (BP) measurements were carried out to assess the variability in BP following repeated measurements in normotensive individuals. In one series, measurement of BP on three occasions three and seven days apart revealed a significant drop in BP in unaccustomed subjects ('untrained'). In a second series assessing the significance of time-interval between measurements or the number of measurements, it was found that a significant fall in BP occurred over the first four days in 'untrained' individuals, whose blood pressure was measured repeatedly for five consecutive days. A significant positive correlation was evident between the falls in systolic and diastolic pressures and the pressure at first screening. Assessment of the anxiety status revealed a significantly lower state anxiety in 'trained' subjects. It therefore appears that (a) BP in normotensive individuals previously unaccustomed to BP measurements, drops significantly with repeated measurements, (b) the number of measurements seem more important than the time-interval between measurements, (c) the largest falls occur in individuals with high initial pressures and (d) the fall upon repeated measurements may be due to reduced anxiety as familiarity with the procedure makes the subjects comparatively relaxed and less state anxious.
    Matched MeSH terms: Blood Pressure*; Blood Pressure Determination
  18. Self-measured bed-time, arising and day blood pressures of normotensive young male and female adults
    Wai, Nyunt, Thing, Sze Wei, Liing, Ting Ngiik
    International e-Journal of Science, Medicine & Education, 2011;5(1):31-33.
    MyJurnal
    Morning surge in blood pressure is an independent cardiovascular risk factor in the middleaged and the elderly. Whether such a surge occurs in young subjects is not known. Eighty normotensive subjects (age: 21.8 ± 1.3 yr) measured their own blood pressure (BP) using an automatic device (Omron HEM-7080,) on going to bed and on waking up, for 2 consecutive days. In contrast to large morning BP surges reported for older age groups, there was much smaller but significant (P
    Matched MeSH terms: Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory
  19. Fulltext 2020 Consensus summary on the management of hypertension in Asia from the HOPE Asia Network
    Kario K, Park S, Chia YC, Sukonthasarn A, Turana Y, Shin J, et al.
    J Clin Hypertens (Greenwich), 2020 03;22(3):351-362.
    PMID: 31816164 DOI: 10.1111/jch.13751
    Hypertension professionals from Asia have been meeting together for the last decade to discuss how to improve the management of hypertension. Based on these education and research activities, the Hypertension, brain, cardiovascular and renal Outcome Prevention and Evidence in Asia (HOPE Asia) Network was officially established in June 2018 and includes experts from 12 countries/regions across Asia. Among the numerous research and review papers published by members of the HOPE Asia Network since 2017, publications in three key areas provide important guidance on the management of hypertension in Asia. This article highlights key consensus documents, which relate to the Asian characteristics of hypertension, home blood pressure monitoring (HBPM), and ambulatory blood pressure monitoring (ABPM). Hypertension and hypertension-related diseases are common in Asia, and their characteristics differ from those in other populations. It is essential that these are taken into consideration to provide the best opportunity for achieving "perfect 24-hour blood pressure control", guided by out-of-office (home and ambulatory) blood pressure monitoring. These region-specific consensus documents should contribute to optimizing individual and population-based hypertension management strategies in Asian country. In addition, the HOPE Asia Network model provides a good example of the local interpretation, modification, and dissemination of international best practice to benefit specific populations.
    Matched MeSH terms: Blood Pressure; Blood Pressure Monitoring, Ambulatory*
  20. Fulltext Estimating Blood Pressure from the Photoplethysmogram Signal and Demographic Features Using Machine Learning Techniques
    Chowdhury MH, Shuzan MNI, Chowdhury MEH, Mahbub ZB, Uddin MM, Khandakar A, et al.
    Sensors (Basel), 2020 Jun 01;20(11).
    PMID: 32492902 DOI: 10.3390/s20113127
    Hypertension is a potentially unsafe health ailment, which can be indicated directly from the blood pressure (BP). Hypertension always leads to other health complications. Continuous monitoring of BP is very important; however, cuff-based BP measurements are discrete and uncomfortable to the user. To address this need, a cuff-less, continuous, and noninvasive BP measurement system is proposed using the photoplethysmograph (PPG) signal and demographic features using machine learning (ML) algorithms. PPG signals were acquired from 219 subjects, which undergo preprocessing and feature extraction steps. Time, frequency, and time-frequency domain features were extracted from the PPG and their derivative signals. Feature selection techniques were used to reduce the computational complexity and to decrease the chance of over-fitting the ML algorithms. The features were then used to train and evaluate ML algorithms. The best regression models were selected for systolic BP (SBP) and diastolic BP (DBP) estimation individually. Gaussian process regression (GPR) along with the ReliefF feature selection algorithm outperforms other algorithms in estimating SBP and DBP with a root mean square error (RMSE) of 6.74 and 3.59, respectively. This ML model can be implemented in hardware systems to continuously monitor BP and avoid any critical health conditions due to sudden changes.
    Matched MeSH terms: Blood Pressure*; Blood Pressure Determination*
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