Despite increased awareness, poor adherence to treatments for chronic diseases remains a global problem. Adherence issues are common in patients taking antihypertensive therapy and associated with ...increased risks of coronary and cerebrovascular events. Whilst there has been a gradual trend toward improved control of hypertension, the number of patients with blood pressure values above goal has remained constant. This has both personal and economic consequences. Medication adherence is a multifaceted issue and consists of three components: initiation, implementation, and persistence. A combination of methods is recommended to measure adherence, with electronic monitoring and drug measurement being the most accurate. Pill burden, resulting from free combinations of blood pressure lowering treatments, makes the daily routine of medication taking complex, which can be a barrier to optimal adherence. Single-pill fixed-dose combinations simplify the habit of medication taking and improve medication adherence. Re-packing of medication is also being utilized as a method of improving adherence. This paper presents the outcomes of discussions by a European group of experts on the current situation of medication adherence in hypertension.
In a registry study of 63,910 adults, 24-hour ambulatory BP was a stronger predictor of mortality than BP measured in the clinic. Masked hypertension (normal BP in the clinic but elevated ambulatory ...BP) was associated with a greater risk of death than sustained hypertension.
Ambulatory blood pressure provides a more comprehensive assessment than clinic blood pressure, and has been reported to better predict health outcomes than clinic or home pressure. We aimed to ...examine associations of clinic and 24-h ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of primary care patients referred for assessment of hypertension.
We did an observational cohort study using clinic and ambulatory blood pressure data obtained from March 1, 2004, to Dec 31, 2014, from the Spanish Ambulatory Blood Pressure Registry. This registry included patients from 223 primary care centres from the Spanish National Health System in all 17 regions of Spain. Mortality data (date and cause) were ascertained by a computerised search of the vital registry of the Spanish National Institute of Statistics. Complete data were available for age, sex, all blood pressure measures, and BMI. For each study participant, follow-up was from the date of their recruitment to the date of death or Dec 31, 2019, whichever occurred first. Cox models were used to estimate associations between usual clinic or ambulatory blood pressure and mortality, adjusted for confounders and additionally for alternative measures of blood pressure. For each measure of blood pressure, we created five groups (ie, fifths) defined by quintiles of that measure among those who subsequently died.
During a median follow-up of 9·7 years, 7174 (12·1%) of 59 124 patients died, including 2361 (4·0%) from cardiovascular causes. J-shaped associations were observed for several blood pressure measures. Among the top four baseline-defined fifths, 24-h systolic blood pressure was more strongly associated with all-cause death (hazard ratio HR 1·41 per 1 – SD increment 95% CI 1·36–1·47) than clinic systolic blood pressure (1·18 1·13–1·23). After adjustment for clinic blood pressure, 24-h blood pressure remained strongly associated with all-cause deaths (HR 1·43 95% CI 1·37–1·49), but the association between clinic blood pressure and all-cause death was attenuated when adjusted for 24-h blood pressure (1·04 1·00–1·09). Compared with the informativeness of clinic systolic blood pressure (100%), night-time systolic blood pressure was most informative about risk of all-cause death (591%) and cardiovascular death (604%). Relative to blood pressure within the normal range, elevated all-cause mortality risks were observed for masked hypertension (HR 1·24 95% CI 1·12–1·37) and sustained hypertension (1·24 1·15–1·32), but not white-coat hypertension, and elevated cardiovascular mortality risks were observed for masked hypertension (1·37 1·15–1·63) and sustained hypertension (1·38 1·22–1·55), but not white-coat hypertension.
Ambulatory blood pressure, particularly night-time blood pressure, was more informative about the risk of all-cause death and cardiovascular death than clinic blood pressure.
Spanish Society of Hypertension, Lacer Laboratories, UK Medical Research Council, Health Data Research UK, National Institute for Health and Care Research Biomedical Research Centres (Oxford and University College London Hospitals), and British Heart Foundation Centre for Research Excellence.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Gap wind jets (Tehuano winds) trigger supersquirts of colder water and mesoscale asymmetric dipoles in the Gulf of Tehuantepec (GT). However, the effects of successive gap wind jets on dipoles and ...their effects inside eddies have not yet been studied. Based on the wind fields, geostrophic currents, and surface drifter dispersion, this research documented three dipoles triggered and modified by Tehuano winds. Once a dipole develops, successive gap wind jets strengthen the vortices, and the anticyclonic eddy migrates southwestward while the cyclonic eddy is maintained on the east side of the GT. During the wind relaxation stage, the cyclonic eddy may propagate westward, but due to the subsequent re-intensification of the Tehuano winds, the vortex could break down, as was suggested by surface drifter dispersion pattern and geostrophic field data. The effect of the Tehuano winds was evaluating via eddy-Ekman pumping. Under Tehuano wind conditions, Ekman downwelling (upwelling) inside the anticyclonic (cyclonic) eddies may reach ~ -2.0 (0.5) m d-1 and decrease as the wind weakens. In the absence of Tehuano winds, Ekman downwelling inside the anticyclonic eddy was ~ 0.1 (-0.1) m d-1. The asymmetry of downwelling and upwelling inside eddies during Tehuano wind events may be associated with Tehuano wind forcing.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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•A novel soft robotic in vitro test inspired by the anatomy of a 2-year-old child was developed based on data from the literature.•Based on the in vitro results, semi-solid foods like ...yoghurt and apple puree may be considered more suitable than thin liquids for swallowing mini-tablets (MT).•The reduction of MT size did not favour its in vitro swallowability in the range considered.•Spreading MT on top of a teaspoon full of carrier should be preferred to favour the in vitro MT swallowability.•The volume fraction of MT could be increased up to 0.20 without influencing any aspect of swallowability in the in vitro conditions tested.
Soft robotics could help providing a better understanding of the mechanisms underpinning the swallowability of solid oral dosage forms (SODF), especially by vulnerable populations such as the elderly or children.
In this study a novel soft robotic in vitro device is presented, the Pediatric Soft Robotic Tongue (PSRT), inspired by the literature data on the anatomy and physiology of a 2-year-old child. Multi-particulate oral formulations (i.e., mini-tablets (MT)) were considered, including different scenarios such as SODF carrier (i.e., soft-food, liquid), administration methods, SODF size and volume fraction.
In vitro results showed that semi-solid foods like yoghurt and apple puree (shear viscosity above ∼ 150 mPa.s at γ̇ = 50 s−1, and its yield stress up to ∼ 5 Pa) may be considered more suitable than thin liquids (i.e., xanthan gum 0.25 %) for swallowing MT. However, the reduction of MT size did not bring any benefit in terms of swallowability in the range studied. Regarding the administration method, spreading MT on top of a teaspoon full of carrier should be preferred over mixing MT with the carrier or placing MT on the tongue first to favour their swallowability. Finally, and under the in vitro conditions studied using yoghurt as carrier, it would be possible to increase the volume fraction of SODF up to 0.20 without influencing swallowability according to the three parameters evaluated (% of MT swallowed, bolus velocity, and post-swallow residues). These results should help to design more focused sensory and/or clinical tests to improve product formulation and patient acceptability.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In the past two decades, techniques for the measurement of blood pressure outside the medical setting have unmasked highly prevalent situations. A significant proportion of patients with office blood ...pressure levels above the thresholds for diagnosing hypertension or above the limits where those being treated are considered to be adequately controlled actually show normal ambulatory blood pressure levels. These patients have white-coat hypertension if untreated or false resistance to antihypertensive therapy because of the white-coat effect if treated. However, some individuals with normal office blood pressure measurements show elevated ambulatory blood pressure levels, and thus have masked hypertension if untreated or masked uncontrolled hypertension if treated. When looking for white-coat hypertension in patients with elevated office blood pressure levels or when looking for masked hypertension in office-controlled patients, up to one in three patients in each scenario would have white-coat or masked hypertension. Although related clinical factors, such as age, gender and global cardiovascular risk, are associated with both conditions, their abilities to predict such a misclassification are very low. Thus, assessing individual blood pressure levels by means of an ambulatory technique, particularly ambulatory blood pressure monitoring, is now considered a priority in diagnosing hypertension and in evaluating hypertension control.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
In this study, a wavelet analysis with panel data is performed to conclude about the causality relationship between the GDP and energy consumption of 74 countries of the world, for the years 1972 to ...2014. We add a frequency-domain perspective to conclude about the effects at different time periods, while the panel data analysis allows us to study different heterogeneities that may occur due to geography, GDP per capita, and human development classification. For all of the sample, there is bi-causality between electrical energy consumption and GDP in the long run, while for the short and medium run, causality is verified from GDP to electricity consumption. When segmented by continents, the results are mixed; however, when the division is done by HDI, there is bi-causality between electricity consumption and GDP for high HDI countries. In contrast, for countries with a low HDI, there is causality from electricity consumption to GDP. This poses a set of particularly important policy implications for countries with low human development.
•The relationship GDP-Electricity Consumption is analyzed for 76 countries in different time terms.•There is long-term cyclicality between energy consumption and GDP.•Bi-causality is indicated in the Granger causality test in the long term for most countries.•Countries with low human development do not possess bi-causality in the long term.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The main advantage of automated office (AO)BP in hypertension screening is that it eliminates white-coat effect seen in routine office practice, with readings similar to awake ambulatory (A)BP. ...Recent studies examining the possible equivalence between AOBP recorded with and without research staff present have reported attended systolic AOBP to be 5.8 mmHg higher. Moreover, attended automated SBP readings in 27 211 patients in clinical practice were 25 mmHg higher than awake ABP. These data are consistent with the presence of staff increasing AOBP. In research studies, all types of office BP measurement at target SBP less than 130 mmHg were generally lower than awake ABP, whereas, in clinical practice, attended automated office BP was slightly higher than awake ABP. However, AOBP may still be preferred, if target BP is to be similar to 24-h ABP. Further research is needed to determine the optimum technique for recording office BP at target.
Background
We aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we ...assessed the prevalence of white‐coat RfH and clinical differences between true‐ and white‐coat RfH patients.
Methods and Results
The present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. RH and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 (RH) and 5 (RfH) antihypertensive drugs. White‐coat RfH was defined by RfH with normal (<130/80 mm Hg) 24‐hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of RH, and 955 (1.4%) were considered as having RfH. Compared with RH patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white‐coat RH (26.7% versus 37.1%, P<0.001). White‐coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; P=0.018) and microalbuminuria (28.3% versus 42.9%; P=0.047).
Conclusions
The prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with RH. One out of 4 patients with RfH have normal 24‐hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult‐to‐treat patients.
The complementary nature of different modalities and multiple bands used in remote sensing data is helpful for tasks such as change detection and the prediction of agricultural variables. ...Nonetheless, correctly processing a multi-modal dataset is not a simple task, owing to the presence of different data resolutions and formats. In the past few years, graph-based methods have proven to be a useful tool in capturing inherent data similarity, in spite of different data formats, and preserving relevant topological and geometric information. In this paper, we propose a graph-based data fusion algorithm for remotely sensed images applied to (i) data-driven semi-unsupervised change detection and (ii) biomass estimation in rice crops. In order to detect the change, we evaluated the performance of four competing algorithms on fourteen datasets. To estimate biomass in rice crops, we compared our proposal in terms of root mean squared error (RMSE) concerning a recent approach based on vegetation indices as features. The results confirm that the proposed graph-based data fusion algorithm outperforms state-of-the-art methods for change detection and biomass estimation in rice crops.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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