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  1. 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 Determination/methods
  2. 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 Determination/methods
  3. 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 Determination/methods
  4. Xi B, Zong X, Kelishadi R, Hong YM, Khadilkar A, Steffen LM, et al.
    Circulation, 2016 Jan 26;133(4):398-408.
    PMID: 26671979 DOI: 10.1161/CIRCULATIONAHA.115.017936
    Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States).
    Matched MeSH terms: Blood Pressure Determination/methods
  5. Aris IB, Wagie AA, Mariun NB, Jammal AB
    J Telemed Telecare, 2001;7(1):51-3.
    PMID: 11265939
    We developed a personal blood pressure monitoring system for patients with hypertension or hypotension. The system can be used to measure a patient's blood pressure at home and to transmit the data automatically to a hospital database via the Internet. The accuracy of blood pressure readings using the system was assessed by comparison with readings from a standard digital sphygmomanometer in four subjects. The measurement error for the systolic readings was 1.7-2.7% and for the diastolic readings 2.7-3.2%. The system therefore appears to be a promising means of assessing blood pressure remotely.
    Matched MeSH terms: Blood Pressure Determination/methods*
  6. Mahmood S, Shah KU, Khan TM, Nawaz S, Rashid H, Baqar SWA, et al.
    Ir J Med Sci, 2019 May;188(2):437-452.
    PMID: 30136222 DOI: 10.1007/s11845-018-1889-8
    Hypertension is a major risk factor for a number of cardiovascular diseases. Proper management of hypertension may require both pharmacological and non-pharmacological interventions. Non-pharmacological interventions help reduce the daily dose of antihypertensive medication and delay the progression from prehypertension to hypertension stage. Non-pharmacological interventions include lifestyle modifications like dietary modifications, exercise, avoiding stress, and minimizing alcohol consumption. Nutritional requirements of hypertensive individuals can be addressed through adopting either the DASH diet or through traditional Mediterranean diet. These dietary guidelines promote the consumption of fruits, vegetables, grains, dairy products, and food rich in K+, Mg+2, Ca+2, and phosphorus. Restriction of Na+ intake has the greatest role in lowering the blood pressure. The DASH diet alone has the effect equal to that of a single drug therapy. After dietary modifications, exercise and weight loss are the second major intervention for hypertension management. Avoiding stressful lifestyle, depression, and anxiety also help to reduce elevated blood pressure. Minimizing alcohol intake also favors the blood pressure reduction. However, lifestyle modification is a dynamic process and requires continuous adherence. It is a multi-factorial approach targeting more than one intervention. However, 6-12-month lifestyle modifications can be attempted in stage-1 hypertensive patients without any cardiovascular complication, in the hope that they may be sufficiently effective to make it unnecessary to use medicines.
    Matched MeSH terms: Blood Pressure Determination/methods*
  7. Lim PK, Ng SC, Jassim WA, Redmond SJ, Zilany M, Avolio A, et al.
    Sensors (Basel), 2015 Jun 16;15(6):14142-61.
    PMID: 26087370 DOI: 10.3390/s150614142
    We present a novel approach to improve the estimation of systolic (SBP) and diastolic blood pressure (DBP) from oscillometric waveform data using variable characteristic ratios between SBP and DBP with mean arterial pressure (MAP). This was verified in 25 healthy subjects, aged 28 ± 5 years. The multiple linear regression (MLR) and support vector regression (SVR) models were used to examine the relationship between the SBP and the DBP ratio with ten features extracted from the oscillometric waveform envelope (OWE). An automatic algorithm based on relative changes in the cuff pressure and neighbouring oscillometric pulses was proposed to remove outlier points caused by movement artifacts. Substantial reduction in the mean and standard deviation of the blood pressure estimation errors were obtained upon artifact removal. Using the sequential forward floating selection (SFFS) approach, we were able to achieve a significant reduction in the mean and standard deviation of differences between the estimated SBP values and the reference scoring (MLR: mean ± SD = -0.3 ± 5.8 mmHg; SVR and -0.6 ± 5.4 mmHg) with only two features, i.e., Ratio2 and Area3, as compared to the conventional maximum amplitude algorithm (MAA) method (mean ± SD = -1.6 ± 8.6 mmHg). Comparing the performance of both MLR and SVR models, our results showed that the MLR model was able to achieve comparable performance to that of the SVR model despite its simplicity.
    Matched MeSH terms: Blood Pressure Determination/methods*
  8. Zahedi E, Sohani V, Ali MA, Chellappan K, Beng GK
    J Healthc Eng, 2015;6(1):121-44.
    PMID: 25708380 DOI: 10.1260/2040-2295.6.1.121
    The feasibility of a novel system to reliably estimate the normalized central blood pressure (CBPN) from the radial photoplethysmogram (PPG) is investigated. Right-wrist radial blood pressure and left-wrist PPG were simultaneously recorded in five different days. An industry-standard applanation tonometer was employed for recording radial blood pressure. The CBP waveform was amplitude-normalized to determine CBPN. A total of fifteen second-order autoregressive models with exogenous input were investigated using system identification techniques. Among these 15 models, the model producing the lowest coefficient of variation (CV) of the fitness during the five days was selected as the reference model. Results show that the proposed model is able to faithfully reproduce CBPN (mean fitness = 85.2% ± 2.5%) from the radial PPG for all 15 segments during the five recording days. The low CV value of 3.35% suggests a stable model valid for different recording days.
    Matched MeSH terms: Blood Pressure Determination/methods*
  9. Sogunuru GP, Kario K, Shin J, Chen CH, Buranakitjaroen P, Chia YC, et al.
    J Clin Hypertens (Greenwich), 2019 02;21(2):324-334.
    PMID: 30525279 DOI: 10.1111/jch.13451
    Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. To effectively prevent end-organ damage, maintain vascular integrity and reduce morbidity and mortality, it is essential to decrease and adequately control blood pressure (BP) throughout each 24-hour period. Exaggerated early morning BP surge (EMBS) is one component of BP variability (BPV), and has been associated with an increased risk of stroke and cardiovascular events, independently of 24-hour average BP. BPV includes circadian, short-term and long-term components, and can best be documented using out-of-office techniques such as ambulatory and/or home BP monitoring. There is a large body of evidence linking both BPV and EMBS with increased rates of adverse cardio- and cerebrovascular events, and end-organ damage. Differences in hypertension and related cardiovascular disease rates have been reported between Western and Asian populations, including a higher rate of stroke, higher prevalence of metabolic syndrome, greater salt sensitivity and more common high morning and nocturnal BP readings in Asians. This highlights a need for BP management strategies that take into account ethnic differences. In general, long-acting antihypertensives that control BP throughout the 24-hour period are preferred; amlodipine and telmisartan have been shown to control EMBS more effectively than valsartan. Home and ambulatory BP monitoring should form an essential part of hypertension management, with individualized pharmacotherapy to achieve optimal 24-hour BP control particularly the EMBS and provide the best cardio- and cerebrovascular protection. Future research should facilitate better understanding of BPV, allowing optimization of strategies for the detection and treatment of hypertension to reduce adverse outcomes.
    Matched MeSH terms: Blood Pressure Determination/methods*
  10. Marques FZ, Jama HA, Tsyganov K, Gill PA, Rhys-Jones D, Muralitharan RR, et al.
    Hypertension, 2019 12;74(6):1279-1293.
    PMID: 31679421 DOI: 10.1161/HYPERTENSIONAHA.119.13079
    Hypertension is a complex and modifiable condition in which environmental factors contribute to both onset and progression. Recent evidence has accumulated for roles of diet and the gut microbiome as environmental factors in blood pressure regulation. However, this is complex because gut microbiomes are a unique feature of each individual reflecting that individual's developmental and environmental history creating caveats for both experimental models and human studies. Here, we describe guidelines for conducting gut microbiome studies in experimental and clinical hypertension. We provide a complete guide for authors on proper design, analyses, and reporting of gut microbiota/microbiome and metabolite studies and checklists that can be used by reviewers and editors to support robust reporting and interpretation. We discuss factors that modulate the gut microbiota in animal (eg, cohort, controls, diet, developmental age, housing, sex, and models used) and human studies (eg, blood pressure measurement and medication, body mass index, demographic characteristics including age, cultural identification, living structure, sex and socioeconomic environment, and exclusion criteria). We also provide best practice advice on sampling, storage of fecal/cecal samples, DNA extraction, sequencing methods (including metagenomics and 16S rRNA), and computational analyses. Finally, we discuss the measurement of short-chain fatty acids, metabolites produced by the gut microbiota, and interpretation of data. These guidelines should support better transparency, reproducibility, and translation of findings in the field of gut microbiota/microbiome in hypertension and cardiovascular disease.
    Matched MeSH terms: Blood Pressure Determination/methods
  11. Abougalambou SS, Abougalambou AS
    Diabetes Metab Syndr, 2013 Apr-Jun;7(2):83-6.
    PMID: 23680246 DOI: 10.1016/j.dsx.2013.02.019
    INTRODUCTION: Hypertension is extremely common disease found in patients with diabetes mellitus. Eighty to 90% of patients with type 2 diabetes mellitus will develop hypertension, and about 20% of hypertensive patients develop diabetes. The aim of this study was designed to assess the prevalence of hypertension and factors affecting the control of hypertension among type 2 diabetic patients.
    MATERIALS AND METHODS: A total of 1077 type 2 diabetes mellitus patients were included in this study who attended at diabetes clinic of Universiti Sains Malaysia (USM) teaching hospital in Kelantan. All these patients were prospectively followed from January to December 2008. Logistic regression analysis was used to assess the independent effect of variables on hypertension.
    RESULTS: The prevalence of hypertension (BP>130/80 or on medication for high blood pressure) was 92.7%. A total 471 (47.2%) patients had achieved blood pressure targets ≤ 130/80 mmHg. The logistic regression indicated that hypertension was positively associated with age (P=0.040), BMI (P=0.027), HbA1c (P=0.046), and level of education (P=0.039).
    CONCLUSION: Hypertension is a common co-morbidity among diabetic patients. Hypertension was not controlled to the recommended levels of blood pressure in about one-half (52.8%) of diabetes patients. Age, BMI, HbA1c and level of education are factors affecting on hypertension.
    Matched MeSH terms: Blood Pressure Determination/methods
  12. Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Poi PJ, Chee KH, et al.
    Medicine (Baltimore), 2016 May;95(19):e3614.
    PMID: 27175670 DOI: 10.1097/MD.0000000000003614
    To evaluate the utility of blood pressure variability (BPV) calculated using previously published and newly introduced indices using the variables falls and age as comparators.While postural hypotension has long been considered a risk factor for falls, there is currently no documented evidence on the relationship between BPV and falls.A case-controlled study involving 25 fallers and 25 nonfallers was conducted. Systolic (SBPV) and diastolic blood pressure variability (DBPV) were assessed using 5 indices: standard deviation (SD), standard deviation of most stable continuous 120 beats (staSD), average real variability (ARV), root mean square of real variability (RMSRV), and standard deviation of real variability (SDRV). Continuous beat-to-beat blood pressure was recorded during 10 minutes' supine rest and 3 minutes' standing.Standing SBPV was significantly higher than supine SBPV using 4 indices in both groups. The standing-to-supine-BPV ratio (SSR) was then computed for each subject (staSD, ARV, RMSRV, and SDRV). Standing-to-supine ratio for SBPV was significantly higher among fallers compared to nonfallers using RMSRV and SDRV (P = 0.034 and P = 0.025). Using linear discriminant analysis (LDA), 3 indices (ARV, RMSRV, and SDRV) of SSR SBPV provided accuracies of 61.6%, 61.2%, and 60.0% for the prediction of falls which is comparable with timed-up and go (TUG), 64.4%.This study suggests that SSR SBPV using RMSRV and SDRV is a potential predictor for falls among older patients, and deserves further evaluation in larger prospective studies.
    Matched MeSH terms: Blood Pressure Determination/methods
  13. Naing C, Yeoh PN, Wai VN, Win NN, Kuan LP, Aung K
    Medicine (Baltimore), 2016 Jan;95(2):e2417.
    PMID: 26765422 DOI: 10.1097/MD.0000000000002417
    This study aimed to determine trends in prevalence, awareness, and control of hypertension in Malaysia and to assess the relationship between socioeconomic determinants and prevalence of hypertension in Malaysia.The distribution of hypertension in Malaysia was assessed based on available data in 3 National Health and Morbidity Surveys (NHMSs) and 1 large scale non-NHMS during the period of 1996 to 2011. Summary statistics was used to characterize the included surveys. Differences in prevalence, awareness, and control of hypertension between any 2 surveys were expressed as ratios. To assess the independent associations between the predictors and the outcome variables, regression analyses were employed with prevalence of hypertension as an outcome variable.Overall, there was a rising trend in the prevalence of hypertension in adults ≥30 years: 32.9% (30%-35.8%) in 1996, 42.6% (37.5%-43.5%) in 2006, and 43.5% (40.4%-46.6%) in 2011. There were significant increase of 32% from 1996 to 2011 (P 
    Matched MeSH terms: Blood Pressure Determination/methods
  14. Zhang ZY, Yang WY, Dominiczak AF, Wang JG, Wu Y, Almustafa B, et al.
    Hypertension, 2019 11;74(5):1064-1067.
    PMID: 31422692 DOI: 10.1161/HYPERTENSIONAHA.119.13206
    Matched MeSH terms: Blood Pressure Determination/methods
  15. Lim HM, Chia YC, Ching SM, Chinna K
    BMJ Open, 2019 Apr 20;9(4):e025322.
    PMID: 31005918 DOI: 10.1136/bmjopen-2018-025322
    OBJECTIVE: To determine the reproducibility of visit-to-visit blood pressure variability (BPV) in clinical practice. We also determined the minimum number of blood pressure (BP) measurements needed to estimate long-term visit-to-visit BPV for predicting 10-year cardiovascular (CV) risk.

    DESIGN: Retrospective study SETTING: A primary care clinic in a university hospital in Malaysia.

    PARTICIPANTS: Random sampling of 1403 patients aged 30 years and above without any CV event at baseline.

    OUTCOMES MEASURES: The effect of the number of BP measurement for calculation of long-term visit-to-visit BPV in predicting 10-year CV risk. CV events were defined as fatal and non-fatal coronary heart disease, fatal and non-fatal stroke, heart failure and peripheral vascular disease.

    RESULTS: The mean 10-year SD of systolic blood pressure (SBP) for this cohort was 13.8±3.5 mm Hg. The intraclass correlation coefficient (ICC) for the SD of SBP based on the first eight and second eight measurements was 0.38 (p<0.001). In a primary care setting, visit-to-visit BPV (SD of SBP calculated from 20 BP measurements) was significantly associated with CV events (adjusted OR 1.07, 95% CI 1.02 to 1.13, p=0.009). Using SD of SBP from 20 measurement as reference, SD of SBP from 6 measurements (median time 1.75 years) has high reliability (ICC 0.74, p<0.001), with a mean difference of 0.6 mm Hg. Hence, a minimum of six BP measurements is needed for reliably estimating intraindividual BPV for CV outcome prediction.

    CONCLUSION: Long-term visit-to-visit BPV is reproducible in clinical practice. We suggest a minimum of six BP measurements for calculation of intraindividual visit-to-visit BPV. The number and duration of BP readings to derive BPV should be taken into consideration in predicting long-term CV risk.

    Matched MeSH terms: Blood Pressure Determination/methods
  16. Kario K, Shin J, Chen CH, Buranakitjaroen P, Chia YC, Divinagracia R, et al.
    J Clin Hypertens (Greenwich), 2019 Sep;21(9):1250-1283.
    PMID: 31532913 DOI: 10.1111/jch.13652
    Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio-/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory blood pressure monitoring (ABPM) is an important out-of-office blood pressure (BP) measurement tool that should play a central role in hypertension detection and management. The use of ABPM is particularly important in Asia due to the specific features of hypertension in Asian patients, including a high prevalence of masked hypertension, disrupted BP variability with marked morning BP surge, and nocturnal hypertension. This HOPE Asia Network document summarizes region-specific literature on the relationship between ABPM parameters and cardiovascular risk and target organ damage, providing a rationale for consensus-based recommendations on the use of ABPM in Asia. The aim of these recommendations is to guide and improve clinical practice to facilitate optimal BP monitoring with the goal of optimizing patient management and expediting the efficient allocation of treatment and health care resources. This should contribute to the HOPE Asia Network mission of improving the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia.
    Matched MeSH terms: Blood Pressure Determination/methods*
  17. Kario K, Tomitani N, Buranakitjaroen P, Chia YC, Park S, Chen CH, et al.
    J Clin Hypertens (Greenwich), 2018 12;20(12):1686-1695.
    PMID: 30444315 DOI: 10.1111/jch.13415
    A self-measured home blood pressure (BP)-guided strategy is an effective practical approach to hypertension management. The Asia BP@Home study is the first designed to investigate current home BP control status in different Asian countries/regions using standardized home BP measurements taken with the same validated home BP monitoring device with data memory. We enrolled 1443 medicated hypertensive patients from 15 Asian specialist centers in 11 countries/regions between April 2017 and March 2018. BP was relatively well controlled in 68.2% of patients using a morning home systolic BP (SBP) cutoff of <135 mm Hg, and in 55.1% of patients using a clinic SBP cutoff of <140 mm Hg. When cutoff values were changed to the 2017 AHA/ACC threshold (SBP <130 mm Hg), 53.6% of patients were well controlled for morning home SBP. Using clinic 140 mm Hg and morning home 135 mm Hg SBP thresholds, the proportion of patients with well-controlled hypertension (46%) was higher than for uncontrolled sustained (22%), white-coat (23%), and masked uncontrolled (9%) hypertension, with significant country/regional differences. Home BP variability in Asian countries was high, and varied by country/region. In conclusion, the Asia BP@Home study demonstrated that home BP is relatively well controlled at hypertension specialist centers in Asia. However, almost half of patients remain uncontrolled for morning BP according to new guidelines, with significant country/regional differences. Strict home BP control should be beneficial in Asian populations. The findings of this study are important to facilitate development of health policies focused on reducing cardiovascular complications in Asia.
    Matched MeSH terms: Blood Pressure Determination/methods*
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