Abstract Background and objectives Non-invasive methods based on applanation tonometry have been proposed to estimate central blood pressure. However, the accuracy of these methods hasn't been ...systematically examined. Methods We performed a systematic review and meta-analysis of studies comparing estimated and invasively measured central BP. Results Sufficient data were available in 22 studies for meta-analysis (857 subjects and 1167 measurements). Acquired arterial pressure waveforms in these studies were directly measured, calibrated to match invasive aortic mean BP and diastolic BP or calibrated to match brachial BP measured with a sphygmomanometer, cuff BP. Of the former 2 conditions, the errors of estimated central BP were small with a mean and standard deviation of difference − 1.1 ± 4.1 mm Hg (95% limits of agreement − 9.1–6.9 mm Hg) for central systolic BP; − 0.5 ± 2.1 mm Hg (− 4.6–3.6 mm Hg) for central diastolic BP; and − 0.8 ± 5.1 mm Hg (− 10.8–9.2 mm Hg) for central pulse pressure. However, the errors inflated to − 8.2 ± 10.3 mm Hg (− 28.4–12.0 mm Hg) for central systolic BP, 7.6 ± 8.7 mm Hg (− 9.5–24.6 mm Hg) for central diastolic BP, and − 12.2 ± 10.4 mm Hg (− 32.5–8.1 mm Hg) for central pulse pressure, when calibrated to cuff BP. The findings were still evident in subgroup analysis conducted with different central BP estimating methods and validated cuff BP monitors. Conclusion Present tonometry-based central BP estimating methods are acceptable in theory, with small errors. However, based on current available evidence, there is substantial room for improvement in measurement accuracy of central BP when cuff BP is used to calibrate the peripheral waveforms.
Hypertension is an important public health issue due to its association with a number of serious diseases, including cardiovascular disease and stroke. The importance of evaluating hypertension ...taking into account different blood pressure (BP) profiles and BP variability (BPV) is increasingly being recognized, and is particularly relevant in Asian populations given the specific features of hypertension in the region (including greater salt sensitivity and a high rate of nocturnal hypertension). Ambulatory BP monitoring (ABPM) is the gold standard for diagnosing hypertension and assessing 24‐hour BP and provides data on several important parameters that cannot be obtained using any other form of BP measurement. In addition, ABPM parameters provide better information on cardio‐ and cerebrovascular risk than office BP. ABPM should be used in all patients with elevated BP, particularly those with unstable office or home BP, or who are suspected to have white‐coat or masked hypertension. ABPM is also an important part of hypertension diagnosis and monitoring in high‐risk patients. ABPM needs to be performed using a validated device and good practice techniques, and has a role both in hypertension diagnosis and in monitoring the response to antihypertensive therapy to ensure strict BP control throughout the 24‐hour period. Use of ABPM in clinical practice may be limited by cost and accessibility, and practical education of physicians and patients is essential. The ABPM evidence and practice points in this document are based on the Hypertension Cardiovascular Outcome Prevention and Evidence (HOPE) Asia Network expert panel consensus recommendations for ABPM in Asia.
ABPM plays an important role in the diagnosis and management of hypertension, and is recognized as an essential part of good clinical practice in the field. The goal of the practice points provided is to help clinicians incorporate ABPM into their everyday practice to help improve patient outcomes.
The prevalence of hypertension is high and still increasing in almost all communities regardless of high, middle, or low income. The control rate remains low in most countries. Telemedicine offers ...possibilities to improve blood pressure control. The past two decades witnessed the fast evolving telecommunication from telephone transmission to smart mobile phone technology for telemedicine. There is some evidence from randomized controlled trials that telemonitoring improves blood pressure control. However, it requires co‐interventions. The emerging new technology may offer even more possibilities in telemonitoring and co‐interventions, for instance, an interactive platform between patients and health professionals for the management of hypertension. Telemedicine might ultimately change the situation of the unsatisfactory management of hypertension in many communities. It helps fully utilize antihypertensive treatment, the most effective cardiovascular prevention, to achieve the goal of ending atherosclerosis and arteriosclerosis in humans.
Background The prognostic value of chronic obstructive pulmonary disease (COPD) as a comorbidity in heart failure has been well documented. However, the role of pulmonary function indices in patients ...with heart failure and preserved ejection fraction (HFpEF) remains to be elucidated. Methods Subjects with HFpEF received pulmonary function tests and echocardiogram. Total lung capacity (TLC), residual volume (RV), forced expiratory flow rate between 25% and 75% of vital capacity (FEF25-75), forced expiratory volume in the 1.sup.st second (FEV1), forced vital capacity (FVC), and vital capacity (VC) were measured. Echocardiographic indices, including pulmonary artery systolic pressure (PASP), the ratio of early ventricular filling flow velocity to the septal mitral annulus tissue velocity (E/e'), and left ventricular mass (LVM), were recorded. National Death Registry was linked for the identification of mortality. Results A total of 1194 patients (72.4#177;13.2 years, 59% men) were enrolled. PASP, E/e' and LVM were associated with either obstructive (RV/TLC, FEV1 and FEF25-75) or restrictive (VC and TLC) ventilatory indices. During a mean follow-up of 23.0#177;12.8 months, 182 patients died. Subjects with COPD had a lower survival rate than those without COPD. While VC, FVC, RV/TLC, and FEV1 were all independently associated with all-cause mortality in patients without COPD, only FEF25-75 was predictive of outcomes in those with COPD. Conclusions The abnormalities of pulmonary function were related to the cardiac hemodynamics in patients with HFpEF. In addition, these ventilatory indices were independently associated with long-term mortality, especially in those without COPD.
Summary Acupressure is a non-invasive treatment in which pressure is applied to specific body points. Following public health concerns about poor sleep quality and increasing interest in alternative ...treatments, a systematic review and meta-analysis were designed to evaluate the effects of acupressure on the quality of sleep. Ten English (PubMed, CENTRAL, CINAHL etc.) and five Chinese (CNKI, WANFANG etc.) databases were searched and the validity of the eligible studies was critically appraised. Thirty-two eligible randomized controlled trials of moderate to high quality which employed polysomnography, actigraphy, or self-assessment sleep quality tools were included. We conducted a meta-analysis using a random effects model with the Pittsburgh sleep quality index (PSQI) as the primary outcome measure (968 adult patients, 13 trials) for trials investigating the effects of traditional Chinese medicine acupressure compared with standard and sham treatments. We performed subgroup analyses to detect sources of heterogeneity, identify the use of acupoints in different populations and explore the contributions of PSQI domains to the total score change. Comparison with the sham group (7 trials with 385 patients) yielded low heterogeneity and an overall effect of 13% to 19% improvement in the PSQI score (MD = -3.41, 95% CI -4.08, -2.75; I2 =12%). Based on data from four trials (n=250), sleep latency and sleep duration were most affected. No adverse effects were reported in any of the reviewed trials. Within the limitations of clinical heterogeneity, the results showed that even fragile populations such as the elderly and dialysis patients can benefit from acupressure. Standardized treatment protocols involved 3 to 5 kg of pressure for one to five minutes per acupoint, delivered three to seven times a week for three to four weeks with the HT7 (Shenmen) acupoint used in most procedures. A high risk of bias due to absence of blinding of patients and personnel remains a serious methodological challenge for acupressure trials and poses a main limitation to presented results. This review has been registered in PROSPERO (registration number CRD42015025013).
Whole body vibration (WBV) has been suggested to improve athletes' neuromuscular strength and power. This study investigated the effect of single WBV stimulation on volleyball-specific performance. ...The participants were 20 elite male volleyball players who performed a 1-min warm-up exercise on a vibration platform at a frequency of 30 Hz and peak-to-peak displacement of 2 mm. After the warm-up exercise, the participants performed a blocking agility test (BAT), 10-m sprinting test, agility T-test, and counter movement jump test. We compared the participants' performance at four time points (Pretest, Post 0, Post 1, and Post 2). The results revealed that the participants' BAT performance and maximum rate of force development improved significantly 1 min after the vibration stimulation (p < 0.01). The WBV (frequency of 30-Hz, peak-to-peak displacement of 2 mm) intervention significantly improved the volleyball-specific defensive performance and speed strength of the participants. Accordingly, by undergoing WBV as a form of warm-up exercise, the technique and physical fitness of volleyball players can be improved.
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.
Aim
To clarify the importance of HbA1c reduction and antidiabetic drug use in preventing major adverse cardiovascular events (MACE) for patients with type 2 diabetes (T2D).
Materials and Methods
We ...conducted an updated systematic review of contemporary large randomized controlled trials assessing the relative efficacy and safety of antidiabetic drugs with less hypoglycaemia risk in adult T2D patients. Mixed‐effects meta‐regression was performed to examine the associations of HbA1c reduction with subsequent risk of macrovascular and microvascular events. We evaluated the potential mediating role of HbA1c reduction in the relationship between antidiabetic drugs and MACE.
Results
Eighteen placebo‐controlled trials comprising 155 610 participants were included. The effects of treatment differed among antidiabetic drug classes for most adverse outcomes with high heterogeneity (I2: 63.7%‐95.8%). Mean HbA1c reduction was lowest with dipeptidyl peptidase‐4 inhibitors (0.30%), followed by sodium‐glucose co‐transporter‐2 inhibitors (0.46%), and was highest with glucagon‐like peptide‐1 receptor agonists (0.58%) and thiazolidinediones (0.60%). Lower relative risks of MACE were significantly associated with larger reductions in achieved HbA1c (β −0.3182; 95% CI: −0.5366 to −0.0998; P = .0043), even after adjusting for drug classes. When considering HbA1c lowering as a mediator to be controlled, beneficial effects owing to specific antidiabetic treatment for MACE were not observed (χ2 = 1.4494; P = .6940). The proportion mediated by HbA1c reduction was 50.0%‐63.5% for these antidiabetic agents.
Conclusions
The main benefits of antidiabetic agents might result from the reduction in blood sugar levels and are generally independent of drugs used. Risk reduction in MACE was proportional to the magnitude of HbA1c decrease conferred by antidiabetic agents with less hypoglycaemic hazard.
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