Abstract The measurement of central blood pressure has generated interest as a tool in predicting cardiovascular events. The purpose of this article is to review the meaning and measurement of the ...central blood pressure and consider its potential value as an index of the antihypertensive response. Indirect estimation of central aortic pressures is obtained by the study of the radial pulse wave compared with a central pulse wave contour measured at the carotid or femoral artery level. The sum of the forward pressure wave created by ventricular contraction and of the reflected pressure wave from the peripheral arterial system produce the peak systolic blood pressure in the aorta. Measurement of the peripheral reflected-wave contribution to aortic blood pressure can be quantified as the augmentation index. Also, the increase in the rapidity of this travelling wave can be measured as the pulse wave velocity. These 2 parameters are considered to be valid indices of the peripheral arterial stiffness. Along with the calculation of systolic and diastolic aortic pressures, these measurements can give a better understanding of the actual central blood pressure to which core organs like heart, brain, and kidneys are submitted. There is tantalizing evidence for the potential value of central blood pressure as a useful index of antihypertensive action, but until clear evidence is obtained, its use should continue to be considered exploratory.
The objective of this study was to compare serial readings from an in-pharmacy automated blood pressure (BP) kiosk to mean daytime ambulatory BP. A total of 100 community-dwelling adults with ...hypertension underwent (1) three baseline automated office readings; (2) three in-pharmacy readings on each of four visits (12 total) using the PharmaSmart PS-2000 kiosk; and (3) 24-hour ambulatory BP monitoring between in-pharmacy visits two and three. Paired t-tests, Bland-Altman plots, and Pearson correlation coefficients were used for analysis. Mean BPs were 137.8 ± 13.7/81.9 ± 12.2 mm Hg for in-pharmacy and 135.5 ± 11.7/79.7 ± 10.0 mm Hg for daytime ambulatory (difference of 2.3 ± 9.5/2.2 ± 6.9 mm Hg P ≤ .05). Bland-Altman plots depicted a high degree of BP variability but did not show clinically important systematic BP differences. With ambulatory BP as the reference standard, in-pharmacy device results were similar to automated office results. The PharmaSmart PS-2000 closely approximated mean daytime ambulatory BP, supporting the use of serial readings from this device in the assessment of BP.
Objective To update the evidence-based recommendations for the prevention and management of hypertension in adults. Options and outcomes For lifestyle and pharmacological interventions, evidence was ...preferentially reviewed from randomized controlled trials and systematic reviews of trials. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity and mortality data in this field. Progression of kidney dysfunction was also accepted as a clinically relevant primary outcome among patients with chronic kidney disease. Evidence A Cochrane collaboration librarian conducted an independent MEDLINE search from 2006 to August 2007 to update the 2007 recommendations. To identify additional published studies, reference lists were reviewed and experts were contacted. All relevant articles were reviewed and appraised independently by content and methodological experts using prespecified levels of evidence. Recommendations For lifestyle modifications to prevent and treat hypertension, restrict dietary sodium intake to less than 100 mmol/day (and 65 mmol/day to 100 mmol/day in hypertensive patients); perform 30 min to 60 min of aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index 18.5 kg/m2 to 24.9 kg/m2 ) and waist circumference (smaller than 102 cm for men and smaller than 88 cm for women); limit alcohol consumption to no more than 14 units per week in men or nine units per week in women; follow a diet that is reduced in saturated fat and cholesterol, and one that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and consider stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should be predicated on by the patient's global atherosclerotic risk, target organ damage and comorbid conditions. Blood pressure should be decreased to lower than 140/90 mmHg in all patients, and to lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease. Most patients will require more than one agent to achieve these target blood pressures. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic and/or systolic hypertension include angiotensin-converting enzyme (ACE) inhibitors (in nonblack patients), long-acting calcium channel blockers (CCBs), angiotensin receptor antagonists (ARBs) or beta-blockers (in those younger than 60 years of age). A combination of two first-line agents may also be considered for initial treatment of hypertension if systolic blood pressure is 20 mmHg above target or if diastolic blood pressure is 10 mmHg above target. Other agents appropriate for firstline therapy for isolated systolic hypertension include long-acting dihydropyridine CCBs or ARBs. In patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor/diuretic combination is preferred; in patients with proteinuric nondiabetic chronic kidney disease, ACE inhibitors are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with hypertension but who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy. Once blood pressure is controlled, acetylsalicylic acid therapy should be considered. Validation All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
In the context of motion estimation for video coding, combining a successive elimination algorithm (SEA) with a motion estimation algorithm reduces the number of computed cost functions without ...impact on rate or distortion. The SEAs use the sum of absolute differences to eliminate motion vector candidates in the search area that cannot improve the current minimum. The novelty in this paper is that instead of relying on a static geometric pattern (i.e., like a spiral), we proposed a dynamic algorithm that creates a cost-based search orderings. A dynamic cost-based search ordering not only improves elimination but also allows for early termination which removes, on average, 61% of the block-matching loop iterations performed by the rate-constrained successive elimination algorithm (RCSEA). Our experiments show that the proposed solution is 5 times faster than the high efficiency video coding (HEVC) HM encoder software in full search mode with a 0.02% impact on BD-Rate. This is twice the speed of the HEVC HM software encoder using only the RCSEA.
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and ...pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
Chaque année Hypertension Canada publie une mise à jour de ses lignes directrices fondées sur des données probantes relatives au diagnostic, à l'évaluation, à la prévention et au traitement de l'hypertension chez l'adulte et l'enfant. Cette année, les lignes directrices applicables aux adultes et aux enfants sont combinées en un seul document. Les nouvelles lignes directrices 2018 portant précisément sur l'hypertension pendant la grossesse sont publiées séparément. Pour 2018, cinq nouvelles lignes directrices sont présentées, et une ligne directrice existante portant sur les seuils et les cibles de pression artérielle dans le contexte de la thrombolyse dans un cas d'accident vasculaire cérébral ischémique aigu est révisée. L'utilisation de tensiomètres-bracelets validés pour l'estimation de la pression artérielle chez les personnes dont le bras a une circonférence élevée est à présent incluse. Des indications sont données pour les mesures de la pression artérielle dans le cadre d'un suivi à l'aide de méthodes normalisées et de dispositifs électroniques (oscillométriques) positionnés au niveau du bras chez les personnes hypertendues, ainsi que de la surveillance de la pression artérielle ambulatoire ou à domicile chez les personnes sujettes au « syndrome de la blouse blanche ». Nous recommandons notamment de procéder à une évaluation du risque cardiovasculaire global de toutes les personnes atteintes d'hypertension afin de les inciter à adopter de saines habitudes de vie permettant d’abaisser leur pression artérielle. Enfin, chez les personnes atteintes d'insuffisance cardiaque (présentant une fraction d'éjection < 40 %) qui sont symptomatiques malgré un traitement de cette affection à des doses appropriées et conforme aux lignes directrices, il est recommandé d'utiliser une association de médicaments inhibiteurs des récepteurs de l'angiotensine et de la néprilysine au lieu d’un inhibiteur de l’enzyme de conversion de l'angiotensine ou d'un antagoniste des récepteurs de l'angiotensine en monothérapie. Les données probantes et la justification qui sous-tendent chacune de ces lignes directrices sont analysées.
Hypertension Canada’s 2020 guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children provide comprehensive, evidence-based guidance for health ...care professionals and patients. Hypertension Canada develops the guidelines using rigourous methodology, carefully mitigating the risk of bias in our process. All draft recommendations undergo critical review by expert methodologists without conflict to ensure quality. Our guideline panel is diverse, including multiple health professional groups (nurses, pharmacy, academics, and physicians), and worked in concert with experts in primary care and implementation to ensure optimal usability. The 2020 guidelines include new guidance on the management of resistant hypertension and the management of hypertension in women planning pregnancy.
Les lignes directrices 2020 d’Hypertension Canada pour la prévention, le diagnostic, l'évaluation des risques et le traitement de l'hypertension chez l’adulte et l’enfant fournissent aux professionnels de la santé et aux patients des conseils complets et fondés sur des données probantes. Hypertension Canada élabore ces lignes directrices en utilisant une méthodologie rigoureuse, en atténuant soigneusement le risque de partialité dans notre processus. Tous les projets de recommandations sont soumis à une évaluation critique par des experts en méthodologie, sans partialité, afin d'en garantir la qualité. Notre panel de lignes directrices est diversifié, comprenant de multiples groupes de professionnels de la santé (soins infirmiers, pharmacie, universitaire et médecins), et a travaillé de concert avec des experts en soins primaires et d’experts en mise en œuvre pour garantir une utilisation optimale. Les lignes directrices 2020 comprennent de nouvelles orientations sur la gestion de l'hypertension résistante et la prise en charge de l'hypertension chez les femmes qui planifient une grossesse.
Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force provides annually updated, evidence-based recommendations to guide the diagnosis, assessment, prevention, and ...treatment of hypertension. This year, we present 4 new recommendations, as well as revisions to 2 previous recommendations. In the diagnosis and assessment of hypertension, automated office blood pressure, taken without patient-health provider interaction, is now recommended as the preferred method of measuring in-office blood pressure. Also, although a serum lipid panel remains part of the routine laboratory testing for patients with hypertension, fasting and nonfasting collections are now considered acceptable. For individuals with secondary hypertension arising from primary hyperaldosteronism, adrenal vein sampling is recommended for those who are candidates for potential adrenalectomy. With respect to the treatment of hypertension, a new recommendation that has been added is for increasing dietary potassium to reduce blood pressure in those who are not at high risk for hyperkalemia. Furthermore, in selected high-risk patients, intensive blood pressure reduction to a target systolic blood pressure ≤ 120 mm Hg should be considered to decrease the risk of cardiovascular events. Finally, in hypertensive individuals with uncomplicated, stable angina pectoris, either a β-blocker or calcium channel blocker may be considered for initial therapy. The specific evidence and rationale underlying each of these recommendations are discussed. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will continue to provide annual updates.
Chaque année, le groupe de travail du Programme éducatif canadien sur l’hypertension d’Hypertension Canada fournit une mise à jour de ses recommandations fondées sur des données probantes en vue de la prévention, du diagnostic, de l’évaluation et du traitement de l’hypertension. Cette année, nous vous présentons quatre nouvelles recommandations et deux recommandations révisées. En clinique, pour évaluer la présence de l'hypertension et poser le diagnostic, on recommande désormais les mesures électroniques oscillométrique en série qui ne nécessitent pas la présence du professionel de la santé durant la mesure. Chez les patients hypertendus, le bilan lipidique demeure un examen de laboratoire de routine, mais il est désormais acceptable que la prise de sang soit effectuée que le patient soit à jeun ou non. Chez les patients atteints d’hypertension secondaire liée à un hyperaldostéronisme primaire, on recommande de procéder à un échantillonnage des veines surrénales chez les candidats à une surrénalectomie. En ce qui a trait au traitement de l’hypertension, la nouvelle recommandation porte sur l’augmentation de l’apport en potassium alimentaire pour réduire la pression artérielle des patients qui ne sont pas à risque élevé de présenter une hyperkaliémie. Chez certains patients à risque élevé d’événement cardiovasculaire, on devrait envisager un traitement en vue d’obtenir une importante réduction de la pression artérielle systolique jusqu’à une valeur cible ≤ 120 mm Hg afin de réduire le risque de survenue d’un tel événement. Enfin, chez les hypertendus atteints d’angine de poitrine stable, on peut désormais envisager un traitement de première intention par un β-bloquant ou un bloqueur des canaux calciques. Les données probantes appuyant chacune des recommandations et leur justification sont aussi présentées dans cet article. Le groupe de travail du Programme éducatif canadien sur l’hypertension continuera de fournir une mise à jour annuelle de ses recommandations.
In the context of motion estimation for video coding, successive elimination algorithms (SEAs) significantly reduce the number of candidates evaluated during motion estimation without altering the ...resulting optimal motion vector. Nevertheless, SEA is often only used in conjunction with exhaustive search algorithms (e.g., full search). In this paper, we combine the multi-level successive elimination algorithm (ML-SEA) and the rate-constrained successive elimination algorithm (RCSEA) and show that they can be advantageously applied to suboptimal search algorithms. We demonstrate that the savings brought about by the new multi-level RCSEA (ML-RCSEA) outweigh the pre-computational costs of this approach for the Test Zonal (TZ) Search algorithm found in the HM reference encoder. We propose a novel multi-level composition pattern for performing RCSEA on an asymmetric partitioning. We introduce a double-check mechanism for RCSEA, and show that on average, it avoids computing 71% of motion vector (MV) costs. We also apply the proposed ML-RCSEA to bi-predictive refinement search and leverage a cost-based search ordering to remove 56% of error metric computations, on average. When compared to the HM reference encoder, our experiments show that the proposed solution reduces the TZ Search time by approximately 45%, contributing to an average encoding time reduction of about 7%, without increasing the Bjøntegaard delta rate (BD-Rate).
•Rate-constrained successive elimination algorithm (RCSEA) reduces complexity.•Multi-level RCSEA (ML-RCSEA) can be applied to HEVC’s fast motion estimation methods.•ML-RCSEA does not affect the compression performance of motion estimation methods.•New ML-RCSEA patterns improve transitive elimination performance and reduce memory.•ML-RCSEA may be applied to Versatile Video Coding and Intra Block Copy.
Abstract Hypertension Canada provides annually-updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. ...Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic blood pressure readings ≥140 mmHg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic pressure ≤60 mmHg, especially in the presence of left ventricular hypertrophy. Following a hemorrhagic stroke, in the first 24 hours, systolic blood pressure lowering to <140 mmHg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.
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