Abstract This thesis describes the development of pressure sensor arrays and a range of methods suitable for the long-term measurement of heart rate and blood pressure determination using a cuff and a pressure sensor array on the radial artery. This study also reviews the historical background of noninvasive blood pressure measurement methods, summarizes the accuracies achieved and explains the requirements for common national and international standards of accuracy. Two prototype series of pressure transducer arrays based on electro-mechanical film (EMFi) were designed and tested. By offering high (∼TΩ) resistance, EMFi is an excellent material for low-current long-term measurement applications. About 50 transducer arrays were built using different configurations and electrode materials to sense low-frequency pressure pulsations on the radial artery in the wrist. In addition to uniform quality, essential requirements included an adequate linear response in the desired temperature range. Transducer sensitivity was tested as a function of temperature in the range of 25–45 °C at varying static and alternating pressures. The average sensitivity of the EMFi used in the transducers proved adequate (∼2.2 mV/mmHg and ∼7 mV/mmHg for normal and high sensitive films) for the intended purpose. The thesis also evaluates blood pressure measurements by the electronic palpation method (EP) and compares the achieved accuracy to that of the oscillometric method (OSC) using average intra-arterial (IA) blood pressure as a reference. All of these three measurements were made simultaneously for each person. In one test group, measurements were conducted on healthy volunteers in sitting and supine position during increasing and decreasing cuff pressure. Another group, comprising elderly cardiac patients, was measured only in the supine position during cuff inflation. The results showed that the EP method was approximately as accurate as the OSC method with the healthy subjects and slightly more accurate with the cardiac patient group. The advantage of the EP method is that also the wave shape and velocity of arterial pressure pulses is available for further analysis, including the assessment of arterial stiffness.

Analysis of blood pressure measurement in Czech pharmacies I. Author: Jakub Prouza Tutor: Josef Malý1 1 Department of Social and Clinical Pharmacy, Charles University in Prague, Faculty of Pharmacy in Hradec Králové Introduction: Arterial hypertension is one of the most serious health problems of today and its therapy must be approached comprehensively. In addition to medical care, to the improvement of the health status of the patient significantly contribute properly implemented pharmaceutical care and blood pressure measurement in pharmacy. Objectives: The aim of the thesis was to describe and analyse conditions of blood pressure measurement in a sample of Czech pharmacies. Methods: Data were collected via questionnaire survey in 2012 and 2013 in three districts. The survey was conducted using two questionnaires, which were filled at pharmacies with possible help of trained interviewer. The first questionnaire was completed by the authorized employee representative of the pharmacy and included questions characterizing the pharmacy. Furthermore the question whether they provided blood pressure measurement in the pharmacy. If they did, further questions were on the frequency of measurement, instrumentation and space equipment in pharmacy. The second questionnaire was completed by the pharmacy...

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Ambulatory blood pressure (BP) monitoring (ABPM) remains a reference standard but the number of readings required to make the measurement valid has not been empirically validated. Methods: Among 360 patients with chronic kidney disease and 38 healthy controls, BP was recorded 2 per hour during the night and 3 per hour during the day over 24h using a validated ABPM device; all had at least 90% of the expected readings. From this full set of ABPM recording, a variable number of BP measurements were selected and we compared the performance of the selected readings against that of the full sample using random or sequential selection schemes. To address the question whether random or sequential selection schemes affect the diagnostic performance in diagnosing hypertension control we compared the diagnostic decisions reached with the subsample and the full sample using area under the receiver operating-characteristic curves (AUC ROC). To answer the question regarding the number of readings needed to achieve over 90% coverage of the mean BP of the full ABPM sample we ascertained the point and confidence interval (CI) estimates based on the selected data. Results: To diagnose hypertension control, the number of readings randomly drawn to establish lower bound with 2.5% error of area under the receiver operating-characteristic curve (AUC ROC) of 0.9 was 3, 0.95 was 7, and 0.975 was 13 . In contrast, the corresponding number of readings with serial selections was 18, 30 and 39 respectively. With a random selection scheme, 18 readings provided 80% coverage of the 90th percentile of CI of the true systolic BP mean, for 90% coverage, 26 readings were needed, for 95% coverage 33. With serial selections, the number of readings increased to 42, 47, and 50 respectively. Similar results emerged for diastolic BP. Conclusions: For diagnosing hypertension control 3 random measurements or 18 serial measurements is sufficient. For quantitative analysis, the minimal sufficient number of 24h ambulatory BP is 26 random recordings or 42 serial recordings.

A proof-of-concept indirect tire-pressure monitoring system is developed using neural net- works to identify the tire pressure of a vehicle tire. A quarter-car model was developed with Matlab and Simulink to generate simulated accelerometer output data. Simulation data are used to train and evaluate a recurrent neural network with long short-term memory blocks (RNN-LSTM) and a convolutional neural network (CNN) developed in Python with Tensorflow. Bayesian Optimization via SigOpt was used to optimize training and model parameters. The predictive accuracy and training speed of the two models with various parameters are compared. Finally, future work and improvements are discussed.

Background: A major problem in the treatment of human hypertension is the late diagnosis of hypertension and, hence, the delayed start of treatment. Very often, hypertension has existed for a long time and cardiac damage has already developed. Therefore, we tested whether late- onset antihypertensive treatment is effective in lowering blood pressure (BP) and in reducing or even preventing left ventricular hypertrophy and fibrosis. Methods: Twenty-one male 60-week-old spontaneously hypertensive rats (SHR) were included. Fourteen rats received oral treatment with captopril (CAP) either as monotherapy or combined with nifedipine (CAP + NIF) over 22 weeks. Seven untreated SHR served as controls. We examined the therapeutic effects on BP, heart weight and histological and biochemical markers of left ventricular remodeling and fibrosis. Results: At 82 weeks of age, BP was reduced in the CAP and CAP + NIF groups by 44 and 51 mmHg, respectively (p < 0.001), but not in untreated controls. Despite the late therapy start, cardiac hypertrophy and fibrosis were attenuated compared to controls. Both treatments reduced heart weight by 1.2 mg/g (25%, p = 0.001) and collagens I and III by 66% and 60%, respectively (p < 0.001), thus proving nearly equivalent cardioprotective efficacy. Conclusion: These data clearly emphasize the benefit of antihypertensive treatment in reducing BP and mitigating the development of cardiac amage even when treatment is started late in life.

Objective: This study explored the relationship of risk perception with change in health behaviors and social cognitive theory (SCT) constructs. Additionally, this study evaluated the feasibility, utility, and practice of self blood pressure monitoring (SBPM). Design: Adults with prehypertension, ages 45-62 (N = 23) completed the Risk Perception Survey for Developing Hypertension (RPS-DH) and Health Belief Survey (HBS) during the screening portion of Dash-2-Wellness (D2W), a lifestyle modification intervention. Participants were randomized into one of two treatment groups, Dash-2-Wellness Plus (D2W Plus) or Dash-2-Wellness Only (D2W Only). Both groups were given dietary counseling regarding the DASH diet and encouraged to monitor their physical activity using a pedometer. The D2W Plus group also engaged in SBPM. Results: Moderate correlations were found between composite risk perception and change in step count (r = -.47, p = .03), and change in systolic blood pressure (r = .42, p = .04). Baseline risk perception was not related to SCT variables, with few exceptions. High levels of compliance (M = 90.36%, SD = 12.62) were reported for SBPM. Conclusions: Findings indicate that risk perception may play a limited role in motivating change in continuous health behaviors, particularly in asymptomatic conditions. Additionally, the nature of the risk reduction offered by the behavior may also influence its association with risk perception as a motivator for change. Findings suggest that SBPM is a feasible and useful behavior. Reports regarding positive affect and ease of machine use in regards to this behavior may increase the likelihood of regular compliance. / Master of Science

O índice de área hiperbárica (IAH), uma nova metodologia de análise da MAPA, foi relacionado a alterações cardíacas, em especial o índice de massa ventricular esquerda (IMVE). Utilizou-se método baseado em limites pressóricos pré-definidos para os períodos de vigília e sono, considerando-se a área excedente a tais limites durante o exame como o índice hiperbárico. Observou-se relação linear direta e significativa entre IAH e IMVE. Observou-se também maior participação dos IAH de sono, sistólicos e diastólico, em determinar alterações de IMVE / The hyperbaric index area (HIA), a new methodology for ABPM analysis, was tested for its relationship to cardiac alterations, particularly with left ventricular mass index (LVMI). Calculation was based on pre-defined pressure limits for ABPM periods of sleep and activity, considering the exceeding area during the time of exam as the hyperbaric index. It was observed a statistically significant linear relation between HIA and LVMI. It was also observed a greater relation for the sleep HIA, both systolic and diastolic with changes in LVMI

O índice de área hiperbárica (IAH), uma nova metodologia de análise da MAPA, foi relacionado a alterações cardíacas, em especial o índice de massa ventricular esquerda (IMVE). Utilizou-se método baseado em limites pressóricos pré-definidos para os períodos de vigília e sono, considerando-se a área excedente a tais limites durante o exame como o índice hiperbárico. Observou-se relação linear direta e significativa entre IAH e IMVE. Observou-se também maior participação dos IAH de sono, sistólicos e diastólico, em determinar alterações de IMVE / The hyperbaric index area (HIA), a new methodology for ABPM analysis, was tested for its relationship to cardiac alterations, particularly with left ventricular mass index (LVMI). Calculation was based on pre-defined pressure limits for ABPM periods of sleep and activity, considering the exceeding area during the time of exam as the hyperbaric index. It was observed a statistically significant linear relation between HIA and LVMI. It was also observed a greater relation for the sleep HIA, both systolic and diastolic with changes in LVMI

Thesis (MMed (Obstetrics and Gynaecology))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: OBJECTIVE: The aim of this study was to compare the accuracy of non-invasive blood pressure measurements, using automated and manual devices, against invasive intra-arterial blood pressure measurements in patients with pre-eclampsia, during a hypertensive blood pressure peak. STUDY DESIGN: In this prospective study, women admitted to the Obstetrics Critical Care Unit, with confirmed pre-eclampsia and acute severe hypertension, who had an intra-arterial line in situ, were asked to participate. During an intra-arterial blood pressure peak, both an automated oscillometric and a blinded manual aneroid sphygmomanometric blood pressure was recorded. These two methods of blood pressure measurements were compared to intra-arterial blood pressure measurements. The accuracy of a mean arterial pressure (MAP) ≥ 125mmHg in detecting a systolic blood pressure (SBP) ≥ 160mmHg, using all three methods, was also determined. RESULTS: There was poor correlation between intra-arterial SBP and automated and manual SBP (r = 0.34, p < 0.01; r = 0.41, p < 0.01 respectively). The mean differences between automated and manual SBP compared to the intra-arterial SBP was 24 ± 17mmHg (p < 0.01) and 20 ± 15 mmHg (p < 0.01) respectively. There was better correlation between intra-arterial diastolic blood pressure (DBP) and automated and manual DBP (r = 0.61, p < 0.01; r = 0.59, p < 0.01 respectively). The mean differences of the automated and manual DBP was not statistically significant when compared to the intra-arterial DBP. There was poor correlation between the intra-arterial MAP and the automated MAP (r = 0.44, p < 0.01) and good correlation with the manual MAP (r = 0.56, p < 0.01). The mean differences of the automated and manual MAP were statistically significant (5 ± 13mmHg, p < 0.01; 8 ± 11mmHg, p < 0.01 respectively). The sensitivity of automated and manual methods in detecting a SBP ≥ 160mmHg was 23.4% and 37.5% respectively. A MAP ≥ 125mmHg in detecting a SBP ≥ 160mmHg, when using intra-arterial, automated and manual methods of blood pressure measurements showed low sensitivity (35.9%, 21.9% and 17.2% respectively). CONCLUSION: This study demonstrated that both the automated and manual methods of blood pressure measurements were not an accurate measure of the true systolic intra-arterial blood pressure, when managing pre-eclamptic patients with acute severe hypertension. In such situations, intra-arterial blood pressure monitoring should be used when possible. When this is not possible, manual aneroid sphygmomanometry is recommended. Underestimating blood pressure, particularly SBP, may lead to severe maternal morbidity and mortality. / AFRIKAANSE OPSOMMING: DOELWIT: Die doel van hierdie studie is om die akuraatheid van nie invasiewe bloeddruk metings, wanneer geneem met outomatiese en manuele aparate, te vergelyk met intra-arteriele bloed druk metings in pasiente met pre-eklampsie, gedurende ‘n hipertensiewe bloeddruk piek. STUDIE ONTWERP: In hierdie prospektiewe beskrywende dwarssnit studie, was pasiente wat toegelaat was tot die Obstetriese Kritieke Sorg Eenheid met pre-eklampsie, akute erge hipertensie en ‘n intra-arteriele lyn in situ gevra om deel te neem. Gedurende ‘n intra-arteriele erge hipertensiewe piek is beide die outomatiese ossilometriese en die geblinde aneroide sfigmometer lesing neergeskryf. Hierdie twee metodes van non invasiewe bloed druk lesings is vergelyk met intra-arteriele bloed druk lesings. Die akuraatheid van ‘n gemiddelde arteriele bloeddruk ≥ 125mmHg om ‘n sistoliese bloeddruk ≥ 160mmHg op te tel met gebruik van al die drie metodes is ook uitgewerk. RESULTATE: Daar was swak korrelasie tussen intra-arteriele sistoliese bloed druk (SBD) metings en outomatiese en manuele SBD (r = 0.34, p < 0.01; r = 0.41, p < 0.01 onderskeidelik). Die gemiddelde verskille tussen outomatiese en manuele SBD wanneer vergelyk met intra-arteriele SBD was 24 ± 17mmHg (p < 0.01) en 20 ± 15 mmHg (p < 0.01) onderskeidelik. Beter korrelasie was gevind tussen intra-arteriele diastoliese bloed druk (DBD) en outomatiese en manuele DBD (r = 0.61, p < 0.01; r = 0.59, p < 0.01 onderskeidelik). Die gemiddelde verskille tussen outomatiese en manuele DBD wanneer dit vergelyk was met intra-arteriele DBD was nie statisties betekenisvol nie. Daar was swak korrelasie tussen intra arteriele gemiddelde arteriele bloeddruk en outomatiese gemiddelde arteriele bloeddruk (r = 0.44, p < 0.01) en beter korrelasie met manuele gemiddelde arteriele bloeddruk (r = 0.56, p < 0.01). Die gemiddelde verskille van outomatiese en manuele gemiddelde arteriele bloeddruk was betekenisvol (5 ± 13mmHg, p < 0.01; 8 ± 11mmHg, p < 0.01 onderskeidelik). Die sensitiwiteit van outomatiese en manuele metodes om ‘n intra-arteriele SBD ≥ 160mmHg op te tel was 23.4% en 37.5% onderskeidelik. Die vermoë van ‘n gemiddelde arteriele bloeddruk ≥ 125mmHg om ‘n SBD ≥ 160mmHg op te tel, gemeet deur intra-arterieel, outomatiese en manuele metodes het lae sensitiwiteit getoon (35.9%, 21.9% en 17.2% onderskeidelik). GEVOLGTREKKING: Hierdie studie het gedemonstreer dat outomatiese en manuele metodes van bloeddruk meting nie akurate metodes is om ware intra-arteriele sistoliese bloeddruk te meet in pasiente met erge pre-eklampsie tydens ‘n erge hipertensiewe episode nie. In hierdie omstandighede moet intra-arteriele bloeddruk gemeet word indien beskikbaar. Indien dit nie beskikbaar is nie moet die manuele aneroiede sfigmomanometer gebruik word. Onderskatting van bloeddruk, veral sistoliese bloeddruk, kan lei tot erge moederlike morbiditeit en mortaliteit.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: OBJECTIVE: The aim of this study was to compare the accuracy of non-invasive brachial blood pressure measurements, using automated and manual devices, to invasive brachial intra-arterial blood pressure measurements in patients with preeclampsia, during acute severe hypertension. STUDY DESIGN: A prospective descriptive cross sectional study was conducted in the Obstetrics Critical Care Unit (OCCU) of Tygerberg Hospital. Pre-eclamptic patients with acute severe hypertension, who required the placement of brachial intra-arterial lines due to failed radial intra-arterial line placement, were included in the study. Both automated oscillometric and blinded manual aneroid sphygmomanometric blood pressures were recorded during hypertensive peaks and after stabilization of BP using intravenous Labetalol or Nepresol. These two noninvasive methods of blood pressure measurements were compared to brachial intraarterial blood pressure measurements. RESULTS: There was weak correlation between manual and intra-arterial SBP (r = 0.27, p = 0.048) for SBP≥160mmHg. The calculated mean difference between manual SBP compared to the intra-arterial SBP in this group was -23.19mmHg (+/- 19.40). There was moderate correlation between automated and intra-arterial SBP (r = 0.69, p < 0.05). The calculated mean difference between automated SBP compared to the intra-arterial SBP in this group was -16.85mmHg (+/- 11.58). CONCLUSION: This study of pre-eclamptic women demonstrated that both non-invasive methods of BP measurement were inaccurate measures of the true systolic intra-arterial BP and significantly underestimated SBP≥160mmHg when compared to brachial intra-arterial measurements. The SBP was also underestimated, to a lesser degree, for mild moderate hypertension. This study also demonstrated that direct invasive BP monitoring using the brachial artery is a safe method for accurate haemodynamic monitoring. We recommend the use of intra-arterial BP monitoring in pre-eclamptic women with acute severe hypertension. Radial arterial cannulation should be used as the first option and the brachial artery should be used if the first option fails. / AFRIKAANSE OPSOMMING: DOELWIT: Die doel van hierdie studie was om die akuraatheid van nie indringende bragiale bloeddruk metings, wat met outomatiese en manuele aparate geneem is, te vergelyk met bragiale intra-arteriele bloeddruk metings gedurend akute erge hipertensie in pasiente met pre-eklampsie, STUDIE ONTWERP: ʼn Prospektiewe beskrywende dwarssnit studie was in die Obstetriese Kritiese Sorg Eenheid (OCCU) van Tygerberg Hospitaal uit gevoer. Preeklamptiese pasiente met akute erge hipertensie, wat bragiale intra-arteriele lyne nodig gehad het, as gevolg van gefaalde radiale intra-arteriele lyn plasing, was in hierdie studie ingesluit. Beide outomatiese ossilometriese en geblinde aneroide sfigmomanometriese bloeddrukke, tydens hipertensiewe pieke en na stabilisering van bloeddrukke met binneaarse Labetalol of Nepresol, was aangeteken, Die twee nie indringende metodes van bloeddruk meting was met bragiale intra-arteriele bloeddruk metings vergelyk. RESULTATE: Daar was ʼn swak korrelasie tussen manuele en intra-arteriele sistoliese bloedrukke SBP (r = 0.27, p = 0.048) vir SBP≥160mmHg. Die berekende gemiddelde verskil tussen manuele SBP en intra-arteriele SBP was -23.19mmHg (+/- 19.40) in hierdie groep. Daar was ʼn matige korrelasie tussen outomatiese en intra-arteriele SBP (r = 0.69, p < 0.05). Die berekende gemiddelde verskil tussen outomaties SBP vergelyk met intra-arteriele SBP was -16.85mmHg (+/- 11.58) in hierdie groep. GEVOLGTREKKING: Hierdie studie van pre-eklamptiese vrouens, het getoon dat beide nie indringende metodes van bloeddruk meting, nie akurate metings van ware sistoliese intraarteriele bloeddruk is nie, en SBP≥160mmHg word aansienlik onderskat wanneer dit met bragiale intra-arteriele metings vergelyk word. Die SBP was ook tot ʼn minder mate onderskat vir matige hipertensie. Die studie het ook getoon dat die direkte bragiale intra-arteriele metode van bloeddruk monitering, ʼn veilige metode van hemodinamiese monitering is. Ons beveel die gebruik van intra-arteriele bloeddruk monitering aan, in preeklamptiese vrouens met akute erge hipertensie. Radiale arteriele kanulasie moet gebruik word as die eerste opsie en die bragiale arterie moet gebruik word as die eerste opsie faal.