Comparison between blood pressure readings using a mercury versus an aneroid sphygmomanometer Objective For more than a century since its introduction, mercury sphygmomanometer (HgS) had been the mainstay for office measurement of blood pressure (BP). In light of the environmental and health hazards associated with mercury, there is a need to replace it with mercury-free alternatives all over the world. We aimed to validate the widely used aneroid sphygmomanometer (AnS) by comparing its BP readings against BP readings taken with an HgS. Methods We compared the BP readings using AnS vs. HgS on a sample of 300 patients of 18 years or older age admitted to a tertiary care hospital in Karachi, Pakistan. Results The differences between mean HgS and AnS BP readings were found to be statistically significant (P-value <0.01). The mean systolic blood pressure (SBP) readings of the two devices were still significantly correlated (r = 0.989; P < 0.01). Similarly, the mean diastolic blood pressure (DBP) readings were also significantly correlated (r = 0.988; P < 0.01). The aneroid device identified a higher proportion of hypertensive participants compared to the mercury device. Conclusion The difference in the two devices used was found to be significant; however, the readings were correlated with each other. The AnS significantly overestimated BP readings, thereby identifying a higher proportion of hypertensives as compared to the HgS. There is a considerable room for improvement in the accuracy of the AnS, only then an accurate and a well-calibrated AnS could provide an acceptable alternative to the use of the HgS. Received 1 March 2019 Accepted 15 October 2019 Correspondence to S. Tahira Shaheera Shah Naqvi, Jinnah Medical and Dental College, 22-23 Shaheed-e-Millat Road, Bihar Muslim Society BMCHS Sharafabad, Karachi 74800, Pakistan, Tel: +923312639953; e-mail: shah.tahira@rocketmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Endothelial dysfunction predicted increased left atrial volume index in newly diagnosed nondiabetic hypertensive patients Background Arterial hypertension is associated with cardiovascular morbidity and mortality. It was previously shown that left atrium volume increase associated with mortality and atherosclerotic heart disease. The aim of the present study was to demonstrate the value of endothelial dysfunction in predicting left atrium volume increase in newly diagnosed hypertension patients. Methods This study included 96 consecutive newly diagnosed hypertensive patients. Left atrium volume and left ventricular ejection fraction were calculated. Pulse wave velocity and brachial artery flow-mediated dilation measurements were obtained from each patient. Results Left Ventricle Mass Index (114 ± 29 g/m2, 91 ± 17 g/m2, P < 001), left ventricular septum (P < 0.001) and posterior wall thickness (P = 0.001), left ventricular end diastolic diameter (P = 0.016) were significantly higher in patients with higher left atrial volume index. FMD% was lower in patients with higher left atrial volume index those without (9.7 ± 3.5 vs. 13.31 ± 6.01, P = 0.004). Lateral wall E wave velocity was significantly lower (8.68 ± 2.8, 10.2 ± 2.8; P = 0.009), while isovolumetric relaxation time (101.9 ± 19.9 ms, 85.7 ± 15.2 ms; P < 0.001), and ejection time was longer (101.9 ± 19.9 ms, 85.7 ± 15.2 ms; P = 0.077) and Mitral E/ lateral wall E ratio (E/E relation) was significantly higher (P = 0.031) in patients with higher left atrial volume index. Conclusion The rate of isovolumetric relaxation time, FMD% and E/E′ ratio independently predicted left atrial volume index increase in newly diagnosed hypertension patients Received 4 June 2019 Accepted 20 October 2019 Correspondence to Ahmet Seyda Yılmaz, Department of Cardiology, Recep Tayyip Erdogan Research and Training Hospital, Postal codes: 53020, Rize, Turkey, Tel: +90 464 2130491; fax: +90 464 2130644; e-mail: ahmetseydayilmaz@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Inflationary noninvasive blood pressure measurement reduces the incidence of subcutaneous hemorrhage Objective We verified the hypothesis that in noninvasive blood pressure (NIBP) measurement, inflationary NIBP measurement using the new type of cuff (YP-71xT series, Nihon Koden, Tokyo, Japan) might be associated with a reduced risk of subcutaneous hemorrhage. Methods The study involved 30 healthy volunteers (15 males and 15 females). The blood pressure was measured by deflationary NIBP measurement + conventional cuff (control group), deflationary NIBP measurement + cuff (YP-71xT series) (deflationary measurement group), or inflationary NIBP measurement + cuff (YP-71xT series) (inflationary measurement group). NIBP measurement was performed five times in a row, then the presence or of subcutaneous hemorrhage was evaluated. The three different methods were used as cross-over design at 1-week interval for each subject so that all three methods were used for all the subjects. Results The measurement time was significantly shorter in the inflationary measurement group than other groups. The incidence of subcutaneous hemorrhage significantly was lower in the inflationary measurement group (3%) than in control group (53%) (P < 0.001) and the deflationary measurement group (37%) (P = 0.002). Conclusion This study revealed that inflationary NIBP measurement was associated with a dramatically reduced incidence of subcutaneous hemorrhage. Synergistic effect of the newly designed cuff, short measurement time, and low inflation pressure may allow the risk of subcutaneous hemorrhage. Received 10 May 2019 Accepted 21 October 2019 Correspondence to Yasuhiro Morimoto, MD, Department of Anesthesia, Ube Industries Central Hospital, 750 Nishikiwa, Ube 755-0151, Japan, Tel: +81 836 51 9221; fax: +81 836 51 9454; e-mail: yasumorimo@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Measurement reliability of automated oscillometric blood pressure monitor in the elderly with atrial fibrillation: a systematic review and meta-analysis Objectives This study aimed to identify whether automated oscillometric blood pressure monitor (AOBPM) is a reliable blood pressure (BP) measurement tool in geriatric patients with atrial fibrillation (AF) with high variability in BP and to evaluate whether it can be applied in practice. Methods Electronic searches were performed in databases including MEDLINE, EMBASE, the Cochrane Library, and CINAHL by using the following keywords: ‘atrial fibrillation,’ ‘atrial flutter, ‘blood pressure monitor’, ‘sphygmomanometer.’ The QUADAS-2 was applied to assess the internal validity of selected studies. Meta-analysis was performed using RevMan 5.3 program. Design: Systematic review. Results We identified 10 studies, including 938 geriatric patients with AF. We compared with the previously used BP measurement method (mainly office) and AOBPM, and the patients with AF were divided into the AF-AF (atrial fibrillation rhythm continued) and AF-SR groups (sinus rhythm recovered). The difference in the systolic BP was −3.0 mmHg [95% confidence interval (CI): −6.58 to 0.59] and −1.62 (95% CI: −6.08 to 2.84) mmHg in the AF-AF and AF-SR groups, respectively. The difference in the diastolic BP was 0.17 (95% CI: −2.90 to 3.25) mmHg and −0.23 (95% CI: −5.11 to 4.65) mmHg, respectively. Conclusion This review showed that the BP difference from AOBPM compared with the auscultatory BP method was less than 5 mmHg in the elderly with AF. This difference is acceptable in clinical practice. However, AOBPM compared with invasive arterial BP in the diastolic BP was a difference of 5 mmHg or more, and so its accuracy cannot be assured. Received 8 May 2019 Accepted 5 October 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.bpmonitoring.com. Correspondence to Yun-Kyoung Choi, Associate Professor, Korea National Open University, Department of Nursing, 1-83, Dongsung-dong, Jongno-gu, Seoul 03087, Korea. Tel: +82 2 3668 4745; fax: +82 2 3673 4274; e-mail: ykchoi2012@knou.ac.kr Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Addressing the wide-range cuff dilemma No abstract available

Inter-arm difference of systolic blood pressure measured by automated double-cuff device is associated with arterial stiffness in patients with hypertension Purpose: Inter-arm differences of SBP ≧5 mmHg have been associated with all-cause and cardiovascular mortalities in hypertensive subjects. Inter-arm differences of SBP appears to be mediated by arterial stiffness. We hypothesized inter-arm differences of SBP ≧5 mmHg may be related to higher pulse pressure/stroke volume index, a surrogate marker of arterial stiffness. Materials and methods: To obtain inter-arm differences of SBP (the absolute difference of right and left arm) and ankle-brachial index, bilateral blood pressures were measured simultaneously at the four limbs using an automated oscillometric device in patients with treated hypertension (n = 234) and in normotensive subjects (n = 40). Pulse pressure was calculated as SBP–DBP. Stroke volume was obtained by time-velocity integral method using echocardiography. Left ventricular mass and relative wall thickness were calculated by the conventional methods. Results: All hypertensive patients were medically treated and had average blood pressure levels of 135/85 mmHg. Inter-arm differences of SBP ≧5 mmHg was detected in 26.5% of hypertensive patients. Hypertensive patients with inter-arm differences of SBP ≧5 mmHg had higher pulse pressure/stroke volume index, lower ankle-brachial index, higher BMI, and higher relative wall thickness, higher prevalence of female than those with inter-arm differences of SBP <5 mmHg. Multiple linear regression analysis confirmed inter-arm differences of SBP ≧5 mmHg was associated with higher pulse pressure/stroke volume index, higher relative wall thickness, and lower ankle-brachial index. Conclusion: Inter-arm difference of SBP measured by automated double-cuff device was related to large artery stiffness in patients with hypertension. Received 20 July 2019 Accepted 5 October 2019 Correspondence to Masato Iida, MD, PhD, Department of Cardiology, Aichi Sannomaru Clinic, 3-2-1, Sannomaru, Naka-ku, Nagoya 456-0013, Japan.E-mail: okaseitani_chikusa@sf.starcat.ne.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The usefulness of 24-hour blood pressure monitoring for the patients with atrial fibrillation: based on the variability of blood pressure parameters Objective The aim of this study was to test whether ambulatory blood pressure monitoring (ABPM) in patients with atrial fibrillation is reliable as in patients with sinus rhythm. Method This study included 92 persistent atrial fibrillation patients (50% females; mean age 70.49 ± 11.56 years) and 92 matched sinus rhythm patients (46% females; mean age 69.23 ± 12.63 years). The participants were examined simultaneously with 24-hour ABPM and 24-hour Holter electrocardiography. The mean 24-hour (24-hour-), daytime (day-) and nighttime (night-) BP, types of BP curve, morning systolic BP (SBP) surge (MBPS), the SD of BP readings and the coefficient of variability (the SD/mean BP × 100%) were compared between atrial fibrillation and sinus rhythm patients. Results No differences of 24-hour-, day- and night-SBP levels were observed between two groups. Meanwhile, the 24-hour-SD, day-SD and night-SD, as well as the coefficient of variability for SBP were also similar between two groups. There was no significant difference in the number of MBPS between the two groups. On diastolic BP (DBP), the similar 24 hour and day levels, the 24-hour-SD, day-SD and night-SD as well as the coefficient of variability were also similar between two groups. But the nighttime DBP levels and the night-SD were higher in atrial fibrillation than in sinus rhythm. Conclusion ABPM provides data with similar SBP variability in patients with atrial fibrillation as in subject with normal cardiac rhythm. The ABPM on oscillometric method may be suitable for the atrial fibrillation patients, especially for the SBP evaluation. Received 14 June 2019 Accepted 9 October 2019 Correspondence to Hai Su, PhD. Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, China. Tel: +86(0)791 86301105; fax: +86(0)791 86301105; e-mail: suyihappy@sohu.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Accuracy testing of a new optical device for noninvasive estimation of systolic and diastolic blood pressure compared to intra-arterial measurements Objective The objective of this study was to compare the systolic (S) and diastolic (D) blood pressure (BP) estimations from a new optical device at the wrist with invasive measurements performed on patients scheduled for radial arterial catheterization in the ICU. Optical signals were automatically processed by a library of algorithms from Aktiia SA (OBPM – optical blood pressure monitoring algorithms). Methods A total of 31 participants from both sexes, aged 32–87 years, were enrolled in the study (NCT03837769). The measurement protocol consisted of the simultaneous recording of reflective photoplethysmographic signals (PPG) from the cuffless optical device and the reference BP values recorded by a contralateral radial arterial catheter. From the 31 participants, 23 subjects whose reference data quality requirements were adequate were retained for further analysis. The PPG signals from these patients were then automatically processed by the Aktiia OBPM library of algorithms, which generated uncalibrated estimates of SBP and DBP. After the automatic assessment of optical signal quality, 326 pairs of uncalibrated SBP and DBP determinations from 16 patients were available for analysis. These values were finally transformed into calibrated estimations (in mmHg) using arterial catheter SBP and DBP values, respectively. Results For SBP, a mean difference (±SD) of 0.0 ± 7.1 mmHg between the arterial catheter and the optical device values was found, with 95% limits of agreement in the Bland-Altman method of –11.9 to + 12.2 mmHg (correlation of r = 0.87, P < 0.001). For DBP, a mean difference (±SD) of 0.0 ± 2.9 mmHg between arterial catheter and the optical device values was found, with 95% limits of agreement in the Bland-Altman method of –4.8 to + 5.5 mmHg (correlation of r = 0.98, P < 0.001). Conclusion SBP and DBP values obtained by radial artery catheterization and those obtained from optical measurements at the wrist were compared. The new optical technique appears to be capable of replacing more traditional methods of BP estimation. * Retired Received 5 August 2019 Accepted 20 October 2019 Correspondence to Josep Solà, PhD, Aktiia SA, Neuchâtel, Switzerland. Tel: +41 32 552 20 52; e-mail: josep@aktiia.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Validation of the HL868ED upper-arm blood pressure monitor for clinical use and self-measurement according to the European Society of Hypertension International Protocol revision 2010 Objective: The aim of this study was to evaluate the accuracy of the automated oscillometric upper arm blood pressure monitor HL868ED for clinical use and self-measurement according to the International Protocol of the European Society of Hypertension revision 2010. Method: Systolic and diastolic blood pressure were measured sequentially in 43 adult Chinese (21 women, mean age 51.7 years) using a mercury sphygmomanometer (two observers) and the HL868ED device (one supervisor). A total of 99 pairs of comparisons were obtained from 43 participants for judgements in two parts with three grading phases. Results: The HL868ED device achieved the targets in part 1 of the validation study. The number of absolute differences between device and observers within 5, 10 and 15 mmHg was 68/99, 91/99 and 97/99, respectively, for systolic blood pressure and 85/99, 95/99 and 99/99, respectively, for diastolic blood pressure. The device also fulfilled the criteria in part 2 of the validation study. Twenty-four and 30 participants for systolic and diastolic blood pressure, respectively, had at least two of the three device-observer differences within 5 mmHg (required ≥24). Three participants for systolic and one participant for diastolic blood pressure had all the three device-observer comparisons greater than 5 mmHg. Conclusion: The Health & Life blood pressure monitor HL868ED has passed the requirements of the International Protocol revision 2010 and hence can be recommended for blood pressure measurements in adults. Received 2 July 2019 Accepted 14 September 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.bpmonitoring.com. Correspondence to Ji-Guang Wang, MD, PhD, The Shanghai Institute of Hypertension, Ruijin 2nd Road 197, Shanghai 200025, China. Tel: +86 21 64370045 x610911; fax: +86 21 64662193; e-mail: jiguangwang@aim.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

A pilot study of hypertension management using a telemedicine treatment approach No abstract available