BACKGROUND:Automated blood pressure (BP) devices may be less accurate in females than males, but this requires further investigation. This study aimed to determine sex differences in automated BP, measured with a single brand and model of device, compared with manual BP, with a focus on cuff sizes and associations with measures of adiposity. METHODS:Automated (Omron HEM-907XL) and manual BP were taken sequentially in a random order among a subsample of participants attending the US National Health and Nutrition Examination Survey, 2017 to 2018. Anthropometry and dual-energy x-ray absorptiometry were used to record body size and composition. Analyses, including multivariable regression to determine sex differences in BP, by cuff size, followed complex survey statistical principles. RESULTS:A total of 3735 participants (49.0% female [95% CI, 46.4-51.6], 45 years [43-46]) were included. In females, automated systolic BP (SBP) incrementally underestimated manual SBP across larger cuffs up to extra-large (-6.4 mm Hg [-8.0 to -4.9]). In males, automated SBP underestimated manual SBP only with extra-large cuffs (-2.4 mm Hg [95% CI-3.9 to -0.9]). Underestimation by automated SBP with extra-large cuffs was independently associated with all measures of body size indicative of increased adiposity in both females and males. Hypertension classification from automated and manual SBP had moderate agreement for adult/large cuffs (weighted kappa range 0.66-0.79) but weak agreement for extra-large cuffs (0.55-0.58) for females and males. CONCLUSIONS:The automated device used in this study underestimated manual SBP at larger cuff sizes, which was associated with indices of adiposity. Poorer accuracy of automated BP in larger cuff sizes could contribute to inequitable BP-related health care for females and males and requires further investigation.

Differences between automated cuff oscillometric blood pressure (BP) and invasive measurements are well described, but the causes are not fully understood. Automated BP devices record cuff oscillometric mean arterial pressure (MAP) as a key measurement step that is presumed to be accurate, but if not, could create error in cuff systolic (SBP) and diastolic BP (DBP) estimations. This has never been determined and was the aim of the study. Data from five studies with similar protocols were analysed (N = 262 patients undergoing coronary angiography, 61 ± 11 years, 65% male). Cuff oscillometric MAP was measured using five different models of automated cuff BP devices simultaneous to invasively measured MAP (fluid-filled or solid-state catheters). Cuff SBP and DBP were estimated by device-specific algorithms. Differences (∆) were calculated as cuff–invasive aortic BP. There were significant associations between ∆MAP and ∆SBP in four out of five devices (unstandardised β range = 0.42–1.04). The ∆MAP explained 6–52% of the variance in ∆SBP. In the same four devices, there were significant associations between ∆MAP and ∆DBP (unstandardised β range = 0.57–0.97) and ∆MAP explained 35–52% of the variance in ∆DBP. In conclusion, there are differences between cuff oscillometric MAP and invasive MAP which are associated with ∆SBP and ∆DBP. Further research is required to improve cuff oscillometric BP and greater transparency needed to understand algorithms used in these devices.

Central blood pressure can be estimated non-invasively using radial applanation tonometry. However, the stability and accuracy of applanation tonometry signals is operator-dependent. We examined the concordance between finger and radial artery pressure waveforms captured using an automated, beat-by-beat, photoplethysmograph device (Finometer PRO) and radial applanation tonometry respectively, to estimate central pressure waveform characteristics including systolic (SP), diastolic (DP), augmented (AP), reservoir (RP), and excess (XSP) pressure at rest and during a period of elevated and sustained arterial blood pressure. The central pressure waveform characteristics were estimated from finger artery pressure waveforms captured by the Finometer, and were compared to those derived from radial artery pressure waveforms captured using applanation tonometry at baseline (Rest) and during a brief period of circulatory occlusion (OCC) immediately following an isometric handgrip exercise challenge (performed at 40

High blood pressure (BP) affects >1 billion adults worldwide, with many cases undiagnosed and/or ineffectively controlled. There is a need for complementary approaches to that of in-clinic BP measurement at rest to identify uncontrolled high BP (≥140/90 mmHg). A hypertensive response to exercise (HRE) is associated with increased cardiovascular risk and likely represents poor BP control not detected via standard in-clinic BP at rest. Many clinical exercise professionals measure exercise BP as part of standard practice and are therefore uniquely placed to identify uncontrolled high BP from exercise BP. This statement was developed with the aim of providing exercise professionals with consensus and practical guidance to support best-practice BP management via the measurement of exercise BP. Exercise and Sports Science Australia (ESSA) consensus statement. An international authorship team with research and clinical expertise covering exercise physiology, cardiology, blood pressure, and general practice was assembled to review evidence and develop a series of consensus recommendations. Exercise BP measurement has significant potential to identify individuals with uncontrolled high BP. Exercise BP should be measured using best-practice technique during fixed workload exercise that elicits up to a moderate intensity (e.g., 64 < 76 % maximal heart rate). If an HRE is recorded (exercise systolic BP ≥170 mmHg), uncontrolled high BP should be assumed and trigger: 1) correspondence with a primary care physician (PCP) encouraging follow-up testing to ascertain BP status; 2) guidance for the patient to complete home BP measurement as part of ascertaining BP status and encouragement to report their findings to a PCP; and 3) with PCP confirmation of raised BP, ongoing exercise and lifestyle intervention to lower high BP. This consensus statement provides a recommended clinical pathway for clinical exercise professionals to utilise exercise BP measurement in practice and take a complementary role in the identification and management of high BP.

OBJECTIVE:Uscom BP+ is a cuff-based blood pressure (BP) device designed to noninvasively estimate central BP as distinct from conventional brachial BP. This study aimed to assess the accuracy of the Uscom BP+ device compared with invasively measured BP. METHODS:Automated noninvasive cuff central BP (using the Uscom BP+ device) and invasive central aortic BP were recorded simultaneously in 191 participants (65% male, aged 66 ± 11 years) receiving coronary angiography at three independent research sites in Australia, Poland, and Italy. Validation procedures were undertaken according to the Artery Society recommendations and with a minimally acceptable error (mean ± SD) of ≤5 ± ≤8 mmHg as pass criteria. RESULTS:Using the device default calibration technique [brachial cuff systolic blood pressure (SBP) and diastolic blood pressure (DBP)], cuff central SBP underestimated invasive central SBP [mean (SD) difference: -10.2 (11.2) mmHg] and cuff central DBP overestimated invasive central DBP [mean (SD) difference: 9.8 (8.5) mmHg]. When calibrating by brachial cuff mean arterial pressure and DBP, SBP accuracy was improved, but variability remained high [mean (SD) difference: -6.3 (14.4) mmHg, P  = 0.004 vs. default calibration, whereas DBP accuracy and variability remained similar [mean (SD) difference: 10.9 (8.5) mmHg, P  = 0.19 vs. default calibration]. CONCLUSION:The Uscom BP+ cuff device does not pass the Artery Society accuracy criteria compared with invasively measured central BP.

Exercise is a crucial component of cardiac rehabilitation; however, lack of physical assessment and consideration of the full cardiovascular risk profile limits individualization and potentially effectiveness. We propose a model to prescribe exercise dose, dosing, and dosage that considers cardiorespiratory fitness, strength, blood pressure, glucose, and cholesterol concentrations, along with medications and nutrition to improve individual outcomes from cardiac rehabilitation.

BACKGROUND:Systolic blood pressure (SBP) amplification is a physiological phenomenon related to the level of pressure difference between the aorta and brachial artery and is associated with cuff blood pressure (BP) measurement inaccuracy. However, knowledge on the invasively measured level of aortic-to-brachial SBP amplification is limited. This study aimed to explore this, as well as anticipated effects on hypertension classification. METHODS:A systematic review and individual participant data meta-analysis identified invasive brachial and aortic BP recorded in 1151 participants (62±12 years, 72% male). SBP amplification was calculated as brachial SBP minus aortic SBP. Hypertension classification (defined according to previously described thresholds for brachial and aortic BP) was compared between the aortic and brachial BP measures. RESULTS:There was a wide range of SBP amplification, which was similar between male and female (mean±SD, 8±9 mm Hg and 7±10 mm Hg, respectively) and decreased with increasing age. High SBP amplification (>15 mm Hg) was observed in 17.4% (male, 16.8% versus female, 19.5%; P=0.44), and low SBP amplification (<5 mm Hg) in 37.3% of participants (male, 37.2% versus female, 37.4%; P=0.95). The overall level of agreement between hypertension classification based on brachial and aortic BP was moderate (κ, 0.67; P<0.001; agreement, 87.4%). Agreement in hypertension classification was 65.0%, 38.1%, and 92.7% across classifications of optimal, prehypertension, and hypertension, respectively. CONCLUSIONS:In males and females there is wide variability in aortic-to-brachial SBP amplification. There were major theoretical differences in hypertension classification based on brachial versus aortic BP. This knowledge may help toward innovations for improving cuff BP measurement accuracy.

OBJECTIVES:High blood pressure (BP) affects >1 billion adults worldwide, with many cases undiagnosed and/or ineffectively controlled. There is a need for complementary approaches to that of in-clinic BP measurement at rest to identify uncontrolled high BP (≥140/90 mmHg). A hypertensive response to exercise (HRE) is associated with increased cardiovascular risk and likely represents poor BP control not detected via standard in-clinic BP at rest. Many clinical exercise professionals measure exercise BP as part of standard practice and are therefore uniquely placed to identify uncontrolled high BP from exercise BP. This statement was developed with the aim of providing exercise professionals with consensus and practical guidance to support best-practice BP management via the measurement of exercise BP. DESIGN:Exercise and Sports Science Australia (ESSA) consensus statement. METHODS:An international authorship team with research and clinical expertise covering exercise physiology, cardiology, blood pressure, and general practice was assembled to review evidence and develop a series of consensus recommendations. RESULTS:Exercise BP measurement has significant potential to identify individuals with uncontrolled high BP. Exercise BP should be measured using best-practice technique during fixed workload exercise that elicits up to a moderate intensity (e.g., 64 < 76 % maximal heart rate). If an HRE is recorded (exercise systolic BP ≥170 mmHg), uncontrolled high BP should be assumed and trigger: 1) correspondence with a primary care physician (PCP) encouraging follow-up testing to ascertain BP status; 2) guidance for the patient to complete home BP measurement as part of ascertaining BP status and encouragement to report their findings to a PCP; and 3) with PCP confirmation of raised BP, ongoing exercise and lifestyle intervention to lower high BP. CONCLUSIONS:This consensus statement provides a recommended clinical pathway for clinical exercise professionals to utilise exercise BP measurement in practice and take a complementary role in the identification and management of high BP.

Structured health system-based programs, such as cardiac rehabilitation, may reduce the risk of recurrent stroke. This study aimed to co-design and evaluate a structured program of rehabilitation, developed based on insights from focus groups involving stroke survivors and health professionals. Conducted in Tasmania, Australia in 2019, the 7-week program comprised one hour of group exercise and one hour of education each week. Functional capacity (6 min walk test), fatigue, symptoms of depression (Patient Health Questionnaire), and lifestyle were assessed pre- and post-program, with a historical control group for comparison. Propensity score matching determined the average treatment effect (ATE) of the program. Key themes from the co-design focus groups included the need for coordinated care, improved psychosocial management, and including carers and peers in programs. Of the 23 people approached, 10 participants (70% men, mean age 67.4 ± 8.6 years) completed the program without adverse events. ATE analysis revealed improvements in functional capacity (139 m, 95% CI 44, 234) and fatigue (−5 units, 95% CI −9, −1), with a small improvement in symptoms of depression (−0.8 units, 95% CI −1.8, 0.2) compared to controls. The co-designed program demonstrated feasibility, acceptability, and positive outcomes, suggesting its potential to support stroke survivors.

ABSTRACT Hypertension affects one in three adults globally and is the leading modifiable risk factor for cardiovascular disease. Although blood pressure measurements at rest are fundamental to the detection and management of hypertension, abnormal blood pressure responses to exercise, namely, an exaggerated exercise blood pressure (EEBP), can provide additional independent information about current and future hypertension risk. This paper summarizes a symposium entitled, “The Role of Exercise Blood Pressure in Hypertension: Measurement, Mechanisms and Management” included at the 2023 American College of Sports Medicine annual meeting, which presented a timely discussion about the clinical utility of EEBP. Here we will summarize the evidence presented by the speakers including considerations for blood pressure measurement during exercise, an overview of EEBP thresholds and discussion about the value of EEBP during submaximal exercise for the identification and management of hypertension, a summary of the potential physiological mechanisms underpinning an EEBP, and a review of exercise prescription guidelines based on new and emerging evidence as they relate to the American College of Sports Medicine’s exercise recommendations for hypertension. We conclude by highlighting areas for future research with the overarching goal of improving the measurement and management of hypertension.

Clinic blood pressure (BP) is recommended for absolute cardiovascular disease (CVD) risk assessment. However, in ‘real-world’ settings, clinic BP measurement is unstandardised and less reliable compared to more rigorous methods but the impact for absolute CVD risk assessment is unknown. This study aimed to determine the difference in absolute CVD risk assessment using real-world clinic BP compared to standardised BP methods. Participants were patients (n = 226, 59 ± 15 years; 58% female) with hypertension referred to a BP clinic for assessment. ‘Real-world’ clinic BP was provided by the referring doctor. All participants had unobserved automated office BP (AOBP) and 24-h ambulatory BP monitoring (ABPM) measured at the clinic. Absolute CVD risk was calculated (Framingham) using systolic BP from the referring doctor (clinic BP), AOBP and ABPM, with agreement assessed by Kappa statistic. Clinic systolic BP was 18 mmHg than AOBP and daytime ABPM and 22 mmHg higher than 24-h ABPM (p < 0.001). Subsequently, absolute CVD risk scores using clinic BP were higher compared to AOBP, daytime ABPM and 24-h ABPM (10.4 ± 8.1%, 7.8 ± 6.4%, 7.8 ± 6.3%, and 7.3 ± 6.1%, respectively, P < 0.001). As a result, more participants were classified as high CVD risk using clinic BP (n = 89, 40%) compared with AOBP (n = 44, 20%) daytime ABPM (n = 38, 17%) and 24-h ABPM (n = 38, 17%) (p < 0.001) with weak agreement in risk classification (κ = 0.57[0.45–0.69], κ = 0.52[0.41–0.64] and κ = 0.55[0.43–0.66], respectively). Real-world clinic BP was higher and classified twice as many participants at high CVD risk compared to AOBP or ABPM. Given the challenges to high-quality BP measurement in clinic, more rigorous BP measurement methods are needed for absolute CVD risk assessment.

Background. A hypertensive response to exercise is associated with left ventricular (LV) remodelling, a principal sign of hypertensive heart disease. Fitness may modify this relationship, making clinical interpretation of peak exercise systolic blood pressure (SBP) challenging. This study examines the influence of fitness on the relationship between peak exercise SBP and LV structure. Methods. Cardiovascular structure and function (LV mass index (LVMI), LV relative wall thickness (RWT), cardiac output (CO) and total peripheral resistance (TPR)) were assessed at rest by echocardiography on 4,309 individuals (aged 58.6±12.7 years,52.0% male). SBP was measured at peak treadmill exercise, and fitness (exercise duration (minutes)) was grouped into thirds. Multiple regression analysis was conducted with fitness as an interaction term with peak exercise SBP, adjusted for age, sex, pre-exercise SBP, and cardiovascular disease (CVD) history. Results. Peak exercise SBP was similar across low (180±26.5mmHg), moderate (181±26.3mmHg) and high (182±24.5mmHg) fitness groups. Fitness modified the relationship between exercise SBP and LVMI; each 5mmHg increase in exercise SBP was associated with LVMI in moderate [0.27(0.10–0.43) and high [0.25(0.06–0.43)] fitness groups, which was not observed among those with low fitness [-0.05(-0.22–0.12)]. RWT increased with higher peak exercise SBP at all fitness levels (all p<0.001), with higher values among those with low fitness. Prevalence of LV concentric remodelling was highest in those with low fitness (29.9%) and lowest in those with high fitness (10.8%). A lower CO and higher TPR were observed in the low fitness group (7.5±2.5L/min and 14.3±5.1mmHg min/L) compared to those with high fitness (10.9±3.1L/min and 9.2±2.09mmHg min/L). Conclusion. Whilst a small effect, fitness modified the peak exercise SBP-LV structure relationship, such that for similar peak exercise SBP, those with low fitness exhibit a more adverse LV remodelling, with lower CO and higher TPR, compared to those with higher fitness. Considering fitness when interpreting SBP and cardiac imaging results from exercise stress testing may be relevant in identifying CVD risk and optimal patient management.

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools.

Background. A hypertensive response to exercise (HRE) is associated with a high prevalence of left ventricular hypertrophy (LVH), both being related to an increased risk of cardiovascular disease (CVD). However, these associations may be influenced by aerobic capacity (fitness). This study aimed to determine if an HRE considered relative-to-fitness and LVH are associated with increased risk for CVD events. Methods. Records for 4,307 individuals (aged 58.6±12.7 years, 52.0% male) who underwent exercise stress echocardiography were linked to administrative health datasets (hospital and emergency admissions) to ascertain CVD events (n=458, mean follow-up, 44.8±25.9 months). LVH presence/absence (LVH+/LVH-) was defined as LV mass index adjusted for body surface area around a cut point of ≥115 g/m2 for men and ≥95 g/m2 for women. HRE presence/absence (HRE+/HRE-) relative-to-fitness was defined as peak systolic blood pressure (SBP) divided by peak metabolic equivalents around a cut point of ≥90th percentile. Survival analysis using Cox-proportional hazard regression was used to compare CVD event rates across the four groups defined by the combinations of HRE+/HRE- with LVH+/LVH-, adjusted for age, sex, pre-exercise SBP, and CVD history. Results. Compared to the reference group (HRE-/LVH-), there was a stepwise increase in CVD event rate (Figure 1) across the following groups: HRE+/LVH- [Adjusted HR(95%CI), 1.34(1.02-1.76)], HRE-/LVH+ [Adjusted HR(95%CI), 2.1(1.6-3.76)], HRE+/LVH+ [Adjusted HR(95%CI), 2.55(1.64-3.97)]. Conclusion. Individuals with both HRE considered relative-to-fitness and LVH are at the highest risk of CVD events, greater than either clinical presentation alone. These results emphasise the need to address an HRE and low fitness in people with LVH to improve CVD risk management.

Blood pressure(BP) management interventions have been shown to be more effective when accompanied by appropriate patient education. As high BP remains poorly controlled, there may be gaps in patient knowledge and education. Therefore, this study aimed to identify specific content and delivery preferences for information to support BP management among Australian adults from the general public. Given that BP management is predominantly undertaken by general practitioners(GPs), information preferences to support BP management were also ascertained from a small sample of Australian GPs. An online survey of adults was conducted to identify areas of concern for BP management to inform content preferences and preferred format for information delivery. A separate online survey was also delivered to GPs to determine preferred information sources to support BP management. Participants were recruited via social media. General public participants (n = 465) were mostly female (68%), >60 years (57%) and 49% were taking BP-lowering medications. The management of BP without medications, and role of lifestyle in BP management were of concern among 30% and 26% of adults respectively. Most adults (73%) preferred to access BP management information from their GP. 57% of GPs (total n = 23) preferred information for supporting BP management to be delivered via one-page summaries. This study identified that Australian adults would prefer more information about the management of BP without medications and via lifestyle delivered by their GP. This could be achieved by providing GPs with one-page summaries on relevant topics to support patient education and ultimately improve BP management.

PURPOSE: A hypertensive response to exercise (HRE) recorded during clinical exercise testing is independently associated with cardiovascular disease (CVD), but its interpretation may be clouded by functional capacity (fitness). Type-2 diabetes (T2DM) is associated with increased prevalence of HRE, but whether this confers additional CVD risk in T2DM when HRE is considered relative to fitness has never been determined and was the aim of this study. METHODS: Clinical exercise test records were analysed from 14,449 people (aged 52.4 ± 13.5 years, 58.7% male) who completed the Bruce treadmill protocol (stages 1-4, and peak) at 6 Australian hospitals. Records (including BP) were linked to administrative health datasets (hospital and emergency admissions, death register) to define clinical characteristics, classify T2DM (n = 1,321) vs. no-T2DM (n = 13,128) and determine the primary outcome of CVD events and death (mean follow-up, 56 ± 33 months, n = 1452 events). To consider exercise systolic BP relative to fitness, systolic BP was divided by peak METs and defined as HRE if values were ≥ 90th percentile for each exercise test stage. Survival analysis using cox-proportional hazards was undertaken to compare outcome rates across strata of those with (+) and without (-) HRE and T2DM. RESULTS: Compared to HRE- and T2DM- (reference), there was a stepwise increase in age and sex adjusted CVD event and death rate across the strata (HRE+ and T2DM-, HRE- and T2DM+, HRE+ and T2DM+), with those HRE+ and T2DM+ showing the highest risk at exercise test stage 1 (HR 1.95, 95%CI: 1.61-2.35), stage 2 (HR 2.05, 95%CI: 1.71-2.47), stage 3 (HR 2.52, 95%CI: 2.12-3.00), stage 4 (HR 3.04, 95%CI: 2.88-3.72) and at peak exercise (HR 1.71, 95%CI: 1.39-2.10). These associations were stronger than if HRE was not considered relative to fitness and persisted when the sample was restricted to those without a history of CVD at baseline (P < 0.01 at stages 1-4 and peak exercise). CONCLUSIONS: When the systolic BP response to exercise testing is considered relative to fitness, those with T2DM and HRE have increased risk of CVD events and death compared to those without. This suggests that clinicians supervising exercise testing should be alert to HRE and impaired functional capacity in people with T2DM and optimise therapy to address heightened CVD risk.

Objective: The online purchase of automated blood pressure (BP) devices is a multibillion-dollar industry, but most BP devices available for online purchase have not passed adequate clinical validation testing. This study aimed to determine the extent to which BP devices available in best-selling lists of the e-commerce business Amazon were properly validated for accuracy, as well as their cost and ratings. Design and method: The 100 best-selling automated (upper arm and wrist) cuff BP devices sold by Amazon in 10 countries located in Europe, Asia-Pacific, North and South America were recorded at seven time points during a 12-month period of observation. Results: 81% of the 100 best-selling BP devices had not undergone adequate clinical validation (interquartile range [IQR] 74 to 90, averaged across all countries and time points) and this percentage was highly consistent within each country across the measurement period. The highest percentages of properly validated upper-arm BP devices being sold were 35% in Germany and 31% in Canada, whereas the lowest percentages were 3% in India and 5% in Australia. Non-validated upper-arm cuff BP devices were cheaper than clinically validated devices (median, IQR: $32.0 USD (26.0 to 43.9) versus $67.2 USD, (42.7 to 89.7)). Non-validated upper-arm cuff BP devices received fewer total numbers of consumer ratings than clinically validated devices (median, IQR: 210, 44 to 770 versus 651, 95 to 2962) despite near identical consumer ratings out of five stars (median, IQR: 4.5, 4.2 to 4.6 versus 4.5, 4.3 to 4.7). Similar patterns were observed for wrist-cuff BP devices. None of the wrist-cuff devices being sold in the US were clinically validated. Conclusions: Four out of five automated BP devices within the 100 best-selling lists of Amazon had not passed adequate clinical validation testing for BP measurement accuracy and precision. People should not buy a BP device online unless they can be certain it has passed adequate clinical validation testing.

Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Automated cuff BP and invasive brachial BP were recorded in 795 participants (74% male, aged 64 ± 11 years) receiving coronary angiography at five independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference –7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R2 = 19%). The accuracy of cuff SBP was greatest among participants with the lowest SBP amplification (ptrend < 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). The level of SBP amplification is a critical factor associated with the accuracy of conventional automated cuff measured BP.

ZusammenfassungDie Qualität der Luft beeinflusst in besonderer Weise die menschliche Gesundheit und hat auch Auswirkungen auf die Landwirtschaft und Ökosysteme. Viele Luftschadstoffe absorbieren oder streuen zudem die Sonnen- oder Wärmestrahlung und sind daher klimawirksam. Luftchemische Prozesse hängen, ebenso wie die Emissionen, von klimatischen Faktoren wie Sonneneinstrahlung, Temperatur und Niederschlag ab. Deshalb ist zu erwarten, dass die projizierten Klimaänderungen für Deutschland die Luftschadstoffkonzentrationen ebenfalls beeinflussen werden, auch wenn dieser Zusammenhang noch nicht gut erforscht ist. Dieses Kapitel vermittelt einen Überblick über die Zusammenhänge und weist zumindest qualitativ auf mögliche künftige Entwicklungen hin. Im Vordergrund stehen die Entwicklungen bei Feinstaub und Ozon.

Objective:Hypertension management is directed by cuff blood pressure (BP), but this may be inaccurate, potentially influencing cardiovascular disease (CVD) events and health costs. This study aimed to determine the impact on CVD events and related costs of the differences between cuff and invasive SBP.Methods:Microsimulations based on Markov modelling over one year were used to determine the differences in the number of CVD events (myocardial infarction or coronary death, stroke, atrial fibrillation or heart failure) predicted by Framingham risk and total CVD health costs based on cuff SBP compared with invasive (aortic) SBP. Modelling was based on international consortium data from 1678 participants undergoing cardiac catheterization and 30 separate studies. Cuff underestimation and overestimation were defined as cuff SBP less than invasive SBP and cuff SBP greater than invasive SBP, respectively.Results:The proportion of people with cuff SBP underestimation versus overestimation progressively increased as SBP increased. This reached a maximum ratio of 16 : 1 in people with hypertension grades II and III. Both the number of CVD events missed (predominantly stroke, coronary death and myocardial infarction) and associated health costs increased stepwise across levels of SBP control, as cuff SBP underestimation increased. The maximum number of CVD events potentially missed (11.8/1000 patients) and highest costs ($241 300 USD/1000 patients) were seen in people with hypertension grades II and III and with at least 15 mmHg of cuff SBP underestimation.Conclusion:Cuff SBP underestimation can result in potentially preventable CVD events being missed and major increases in health costs. These issues could be remedied with improved cuff SBP accuracy.