Yes / This study investigated the relationship of ethnicity to the differences between blood pressure (BP) measured in a clinic setting and by ambulatory blood pressure monitoring (ABPM) in individuals with a previous diagnosis of hypertension (HT) and without a previous diagnosis of hypertension (NHT). A cross-sectional comparison of BP measurement was performed in 770 participants (white British (WB, 39%), South Asian (SA, 31%), and African Caribbean (AC, 30%)) in 28 primary care clinics in West Midlands, United Kingdom. Mean differences between daytime ABPM, standardized clinic (mean of 3 occasions), casual clinic (first reading on first occasion), and last routine BP taken at the general practitioner practice were compared in HT and NHT individuals. Daytime systolic and diastolic ABPM readings were similar to standardized clinic BP (systolic: 128 (SE 0.9) vs. 125 (SE 0.9) mm Hg (NHT) and 132 (SE 0.7) vs. 131 (SE 0.7) mm Hg (HT)) and were not associated with ethnicity to a clinically important extent. When BP was taken less carefully, differences emerged: casual clinic readings were higher than ABPM, particularly in the HT group where the systolic differences approached clinical relevance (131 (SE 1.2) vs. 129 (SE 1.0) mm Hg (NHT) and 139 (SE 0.9) vs. 133 (SE 0.7) mm Hg (HT)) and were larger in SA and AC hypertensive individuals (136 (SE 1.5) vs. 133 (SE 1.2) mm Hg (WB), 141 (SE 1.7) vs. 133 (SE 1.4) mm Hg (SA), and 142 (SE 1.6) vs. 134 (SE 1.3) mm Hg (AC); mean differences: 3 (0-7), P = 0.03 and 4 (1-7), P = 0.01, respectively). Differences were also observed for the last practice reading in SA and ACs. BP differences between ethnic groups where BP is carefully measured on multiple occasions are small and unlikely to alter clinical management. When BP is measured casually on a single occasion or in routine care, differences appear that could approach clinical relevance.

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

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

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

Despite the evident improvements in the awareness of hypertension among the adult population in the United States, disparities remain in the burden of the disease, its treatment efficacy, and its control when data are compared along age, gender, and race. The purpose of this study was to determine the strength of the relationship between blood pressure control and prescription medication and lifestyle modification (smoking cessation, changes in eating habits, and weight loss). The target population were adult young Black men, and the control variables were age, low socioeconomic status (SES), and disparities in health care. A convenience sample of Black men (age 16-45 years) was obtained (N = 297) from the 2013-2014 NHANES dataset, and bivariate and multiple regressions were conducted after the assumptions were satisfied. The results indicated a statistically significant relationship between prescription medication and systolic blood pressure control (B = -4.327, p = 0.009). The findings of the study can promote social change by highlighting that medication compliance must be encouraged and adhered to by members of this high-risk group. However, further research is suggested to explore the efficacy of lifestyle modification closely to determine if this is a viable treatment option for young Black men of low SES in the United States.

Exploiting photoplethysmography signals (PPG) for non-invasive blood pressure (BP) measurement is interesting for various reasons. First, PPG can easily be measured using fingerclip sensors. Second, camera based approaches allow to derive remote PPG (rPPG) signals similar to PPG and therefore provide the opportunity for non-invasive measurements of BP. Various methods relying on machine learning techniques have recently been published. Performances are often reported as the mean average error (MAE) on the data which is problematic. This work aims to analyze the PPG- and rPPG based BP prediction error with respect to the underlying data distribution. First, we train established neural network (NN) architectures and derive an appropriate parameterization of input segments drawn from continuous PPG signals. Second, we use this parameterization to train NNs with a larger PPG dataset and carry out a systematic evaluation of the predicted blood pressure. The analysis revealed a strong systematic increase of the prediction error towards less frequent BP values across NN architectures. Moreover, we tested different train/test set split configurations which underpin the importance of a careful subject-aware dataset assignment to prevent overly optimistic results. Third, we use transfer learning to train the NNs for rPPG based BP prediction. The resulting performances are similar to the PPG-only case. Finally, we apply different personalization techniques and retrain our NNs with subject-specific data for both the PPG-only and rPPG case. Whilst the particular technique is less important, personalization reduces the prediction errors significantly.

No description available.

Background The prevalence and incidence of stroke are known to increase with age, which, combined with demographic change, means that very old patients with stroke are a growing patient group. Risk factors for incident stroke among very old people have not been widely investigated. The impact of depression on mortality in very old people who have had a stroke also remains unclear.  The aim of this thesis was to investigate the risk factors for incident stroke, the epidemiology of stroke and depression, and the consequences of having had a stroke regarding the risk of depression and mortality among very old people. Methods A randomly selected half of 85-, all 90-, and all ≥95-year-olds in certain municipalities in Västerbotten County, Sweden, and Pohjanmaa County, Finland were targeted in a population-based cohort study from 2000-2012. The 65-, 70-, 75-, and 80-year-olds in all the rural and random samples from the urban municipalities in the same counties were furthermore targeted in a survey in 2010. In the cohort study patients were assessed in their homes, by means of the 15-item Geriatric Depression Scale (GDS-15) and other assessment scales, as well as blood pressure measurements, several physical tests, and a review of medical diagnoses appearing in the medical charts. Incident stroke data were collected from medical charts guided by hospital registry records, cause of death records, and reassessments after 5 years. Depression was defined as a GDS-15 score ≥5. A clinical definition of all depressive disorders, based on assessment scale scores and review of medical charts was also used. A specialist in geriatric medicine evaluated the diagnoses. The survey included yes/no questions about stroke and depression status, and the 4-item Geriatric Depression Scale. Associations with mortality and incident stroke were tested using Cox proportional-hazard models.  Results In the ≥85-year-olds examined in 2005-2007 (n=601), the stroke prevalence was 21.5%, the prevalence of all depressive disorders was 37.8% and stroke was independently associated with depressive disorders (odds ratio 1.644, p=0.038). The prevalence of depression according to GDS-15 scores was 43.2% in people with stroke compared with 25.0% in people without stroke (p=0.001). However, in ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, depression was not independently associated with incident stroke.  In ≥65-year-olds who responded to a survey in 2010 (n=6098), the stroke prevalence rose with age from 4.7% among the 65- to 11.6% among the 80-year-olds (p<0.001). The prevalence of depression rose from 11.0% among the 65- to 18.1% among the 80-year-olds (p<0.001). In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year, while in the non-stroke group, depression was independently associated with several additional demographic, social and health factors. In ≥85-year-olds examined in 2005-2007 with valid GDS-15 tests (n=452), having had a stroke was associated with increased 5-year mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.15-2.03]. Having had a stroke and depression was associated with increased 5-year mortality compared with having only stroke (HR 1.90, 95% CI 1.15-3.13), having only depression (HR 1.59, 95% CI 1.03-2.45), and compared with having neither stroke nor depression (HR 2.50, 95% CI 1.69-3.69). Having only stroke without a depression did not increase mortality compared with having neither stroke nor depression. In ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, the stroke incidence was 33.8/1000 person-years during a mean follow-up period of about three years. In a comprehensive multivariate model, atrial fibrillation (HR 1.85, 95% CI 1.07–3.19) and higher systolic blood pressure (SBP; HR 1.19, 95% CI 1.08–1.30 per 10-mmHg increase) were associated with incident stroke overall. In additional multivariate models, diastolic blood pressure (DBP) ≥90 mmHg (HR 2.45, 95% CI 1.47–4.08) and SBP ≥160 mmHg (v. <140 mmHg; HR 2.80, 95% CI 1.53–5.14) were associated with incident stroke. Conclusion The prevalence of both stroke and depression increased with age, and rates were especially high among very old people. Having had a stroke was independently associated with a higher prevalence of depression among very old people, however, depression was not independently associated with a higher incidence of stroke. Having had a stroke was associated with increased all-cause mortality among very old people, but only among those who were also depressed. High SBP (≥160 mmHg), DBP (≥90 mmHg) and atrial fibrillation were the only consistent independent risk factors for incident stroke among very old people. / I västvärlden inklusive Sverige så ökar gruppen av människor som uppnår åldern 80 år eller äldre. Människorna som uppnår denna mycket höga ålder har en hög förekomst av kardiovaskulära riskfaktorer, har ofta flera samtidiga sjukdomar och ofta funktionsnedsättningar. Medicinska behandlingsåtgärder är ofta mindre effektiva och förknippade med biverkningar i åldersgruppen. Stroke är en sjukdom som beror på skada av hjärnvävnad till följd av minskad blodtillhörsel till delar av hjärnan. Det är känt att såväl förekomsten av och insjuknandet i stroke ökar med stigande ålder. Den som drabbas av stroke löper risk att få en bestående funktionsnedsättning och att dö i förtid. En vanlig komplikation efter att ha drabbats av stroke är nedstämdhet eller depression. Vetenskapliga studier om stroke har tidigare negligerat mycket gamla människor, vilket i takt med den pågående demografiska utvecklingen framstått som allt mer orimligt. Det är ej helt klarlagt vilka riskfaktorer som leder till att insjukna med stroke i mycket hög ålder. Överdödligheten förknippad med att drabbas av depression efter stroke är också oklar i åldersgruppen. Det är också oklart vad som skiljer depression efter stroke från depression bland den övriga befolkningen av åldrade människor. Den populations-baserade kohortstudien GErontologisk Regional DAtabas (GERDA) inleddes år 2000 för att kartlägga faktorer förknippade med gott åldrande bland mycket gamla människor. Hälften av 85-åringarna, alla 90-åringar och alla ≥95-åringar i utvalda kommuner i Västerbotten erbjöds att delta i studien. Därefter har återbesök hos tidigare deltagare i sina nya åldersgrupper och rekrytering av nya deltagare genomförts vart femte år. Studien utvidgades med utvalda kommuner i Österbotten, Finland vid den första femårsuppföljningen. Datainsamlingen i studien bestod av demografiska frågor, skattningsskalor, blodtrycksmätning och kognitiva test genomförda vid ett hembesök i deltagarens hem, samt genomgång av journalhandlingar. År 2010 skickades även en enkät ut till 65-, 70-, 75- och 80-åringar i alla kommuner i Västerbotten och Österbotten. Enkäten innehöll frågor om demografi, hälsa, sjukdomar och intressen. Bland deltagarna i kohortstudien bestämdes förekomsten av tidigare stroke baserat på genomgång av journaluppgifter och uppgifter från hembesöken. Förekomsten av depression bestämdes baserat på poängsättning från en validerad skattningsskala för depression, samt baserat på en sammanvägning av journaluppgifter och skattningsskalor. En specialist i geriatrik fattade det slutliga beslutet om diagnoser. Insjuknande i stroke bestämdes baserat på journalgenomgång av individer med stroke-relaterade diagnoskoder i sjukhusregistret, i dödsorsaksregistret eller uppgift om stroke vid femårsuppföljningen i studien. Bland deltagarna i enkätstudien bestämdes förekomsten av tidigare stroke baserat på självrapportering, och förekomsten av depression bestämdes baserat på en sammanvägning av självrapportering och en skattningsskala för depression.  Förekomsten av stroke i enkätstudien steg med ålder, från 4.7% bland 65-åringar till 11.6% bland 80-åringar. Förekomsten av stroke var omkring 20% bland ≥85-åringar, med minimal variation mellan 85-, 90- och ≥95-åringar. Förekomsten av depression var högre bland dem med stroke jämfört med de övriga deltagarna, både gällande den sammavägda diagnosen och baserat endast på poängsättning. Stroke och sömnproblem var oberoende associerade med depression. Bland ≥65-åringar i enkätstudien var funktionsnedsättning och genomgången livskris associerade med depression hos dem med en tidigare stroke. Bland deltagare utan stroke var ett antal ytterligare externa faktorer, inklusive subjektiv upplevelse av dålig ekonomi och att inte ha någon att anförtro sig till, associerade med depression. Både stroke och depression var associerade med ökad dödlighet bland ≥85-åringar. De med stroke utan depression hade en dödlighet i linje med normalbefolkningen utan stroke eller depression. Förekomsten av samtidig stroke och depression var associerad med högre dödlighet än normalbefolkningen, jämfört med dem med enbart stroke eller enbart depression. Högt systoliskt blodtryck (≥160 mmHg), högt diastoliskt blodtryck (≥90 mmHg) och förmaksflimmer var oberoende riskfaktorer för att insjukna i stroke bland ≥85-åringarna. Sambandet mellan blodtryck och strokerisk försvagades ej hos människor med kognitiv eller funktionell nedsättning. Tidigare stroke, hjärtsvikt, kognitiv nedsättning, näringsbrist, depressiva symtom och låg gånghastighet var också associerade med att insjukna i stroke, men ej oberoende av varandra. Sammanfattningsvis så stiger förekomsten av stroke med åldern och är särskilt hög bland mycket gamla människor. Depression är betydligt vanligare hos mycket gamla människor med stroke, även justerat för störningsfaktorer. Depression är främst associerat med funktions-nedsättning hos människor med stroke, men med ett större antal externa faktorer hos människor utan stroke. Mycket gamla människor med stroke har särskilt hög dödlighet om de samtidigt är deprimerade, men en dödlighet i linje med normalbefolkningen om de inte är deprimerade. Högt systoliskt och diastoliskt blodtryck samt förmaksflimmer är viktiga och behandlingsbara orsaker till att drabbas av stroke i mycket hög ålder.

Les auto-tensiomètres (AT) sont parmi les dispositifs les plus utilisés en clinique et à domicile pour la mesure de la pression artérielle (PA). Ces appareils utilisent deux algorithmes heuristiques (Height-Based/HB et Slope-Based/SB) pour déterminer les pressions artérielles systoliques (PAS) et diastoliques (PAD) à partir de l'enregistrement de la pression oscillométrique dans le brassard. La mise sur le marché de ces appareils est actuellement assujettie à la directive 93/42/CE, qui nécessite une étude clinique basée sur une comparaison avec des mesures de la PA par auscultation. Cette méthode, qui consiste à détecter des sons de Korotkoff dans l'artère auscultée, présente l'inconvénient d'être praticien dépendante et engendre une incertitude sur la mesure de la PAS et de la PAD. Il est donc nécessaire de s'assurer de la fiabilité de ces instruments en proposant un dispositif expérimental de référence permettant en outre de pallier l'étude clinique qui s'avère longue et coûteuse. Cette thèse est dédiée à la mise en place de ce dispositif ou chaîne de référence, qui associe un banc d'essai permettant la validation des auto-tensiomètres et une base de données de mesure de PA. Afin de réaliser notre objectif, une étude clinique a été réalisée à l'hôpital Nord de Marseille à l'issue d'un examen de coronarographie. L'étude, réalisée sur 115 patients, compare des mesures de pression invasives (mesures de référence) à des mesures de pression non-invasives : des mesures auscultatoires, des mesures via un auto-tensiomètre commercial et des mesures oscillométriques. Ces dernières ont été réalisées concomitamment avec la PA invasive. / Automated blood pressure (ABP) devices are among the most commonly used devices for diagnosis arterial blood pressure (BP) for clinical and home use. These devices use two heuristic algorithms (Height-Based/HB and Slope-Based/SB) to determine the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) from the recording of an oscillometric pressure signal collected using an inflatable cuff. Currently ABP are in the scope of Directive 93/42/CE, which requires a clinical study based on a comparison of BP measurements using auscultatory method. Unfortunately auscultatory measurements have the disadvantage of the uncertainties related to perception of Korotkoff sounds, leading to an uncertainty of measuring SBP and DBP. Therefore it is necessary to ensure the reliability of these instruments and to propose an experimental reference chain to validate ABP devices without returning to expensive and long clinical campaign. The purpose of this thesis is to create and develop a calibration chain for measuring arterial BP, which is composed of database of arterial BP measurements and a patient simulator for regenerating oscillometric measurements. To achieve our target, a clinical study was conducted at the northern hospital of Marseille (l'hôpital Nord) after a coronary exam. The clinical study of 115 patients compares invasive blood pressure measurements (reference measurements) and non-invasive blood pressure measurements: auscultatory measurements, measurements using a commercial automated blood pressure device and oscillometric measurements. The latter were carried out simultaneously with the invasive BP measurements.

Avaliou-se a prevalência de hipertensão arterial sistêmica (HAS) e a variação circadiana da pressão arterial (PA), através da Monitorização ambulatorial da pressão arterial (MAPA), em pacientes com oclusão do ramo da veia central da retina (ORVCR). Foram avaliados, prospectivamente, 93 casos/olhos de 83 pacientes. A ausência do descenso fisiológico da PA durante o sono ("non-dipper") foi definida como diminuição da pressão sistólica = 10% e a presença de descenso quando este valor fosse maior ("dipper"). Há uma prevalência extremamente alta (94%) de HAS em pacientes com ORVCR. Entre os hipertensos, uma grande parcela dos indivíduos "non-dipper" (n=34; 44,2%). Estas evidências sugerem que um nível mais sustentado de PA nas 24 horas possa ser um fator de risco para o desenvolvimento da ORVCR / Objective: Identifying with Blood pressure monitoring (BPM) in patients with branch retinal vein occlusion (BRVO): high blood pressure (HBP) prevalence, possible cases of white-coat normotension (WCNT) and variation of circadian blood pressure (BP). Methods: Prospectively, 93 cases/eyes of 83 patients with BRVO were evaluated at Ophthalmological Clinic of "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo" (HCFMUSP). After that, patients were taken to Hypertension League of Nephrology Chair of HCFMUSP (LH-HCFMUSP) for clinical evaluation and blood pressure monitoring. Non-dipper was defined as a fall in systolic blood pressure = 10%, and dipper when this value was higher