Clinical and Therapeutic Evaluation of Hypertensives According to the Practice of Ambulatory Blood Pressure Measurement (ABPM) at the Bel Air International Clinic in Conakry from January 1, 2019 to November 30, 2022

Introduction: Ambulatory Blood Pressure Measurement (ABPM) is a non- invasive examination recommended for subjects at high cardiovascular risk, and those requiring a nocturnal drop in BP such as elderly and obese subjects, those with secondary hypertension or resistant, diabetics, subjects with metabolic syndrome or sleep apnea syndrome. The objective of this study was to evaluate the contribution of ABPM in the diagnosis and evaluation of the level of control of hypertension under treatment at the Bel Air international clinic. Materials and Methods: This is a retrospective, cross-sectional and descriptive study, carried out at the Bel Air International Clinic in Conakry (Guinea) between January 2019 and November 30, 2022. It included a consecutive series of 180 consenting patients recruited through an ambulatory measurement of 24-hour blood pressure from a FUGADA brand device. Results: We collected 180 patients, with a male predominance (sex-ratio M/F = 2.46). The mean age of the patients was 48.48 ± 14.23 years. The most represented age group was that of 32 to 42 years with 50 cases (27.8%) followed by that of 43 to 52 years with 42 cases or 23.3%. The indication was for diagnostic purposes in 106 cases 58.9%, the therapeutic evaluation in 58 patients (32.2%). The examination was prescribed by a cardiologist in 98 cases (54.4%), a general practitioner in 71 cases (39.4%), a neurologist in 11 cases (6.1%). In the therapeutic evaluation, high blood pressure was controlled in 24 patients (13.3%) and uncontrolled in 34 cases (18.9%). In the diagnostic indication, high blood pressure was confirmed in 79 cases (43.9%) with a statistically significant link (Chi2 = 4.57 and p-value = 0.032). The nycthemeral mean was 187.27 ± 26.22 mmHg for systolic blood pressure (SBP) and 110.37 ± 19.06 mmHg for diastolic blood pressure (DBP), during the day, 151.64 ± 21.45 mmHg for SBP and 71.59 ± 8.67 mmHg for diastolic blood pressure. During the study 65 patients (36.1%) were identified as dippers and 115 patients (63.9%) were no-dipping. The antihypertensive protocol used was monotherapy in 68 cases (37.8%), dual therapy in 46 cases (25.6%), triple therapy in 17 cases (9.4%). However 39 patients or 21.7% were not taking any antihypertensive. Conclusion: This preliminary study, despite the modest sample size, showed the importance of ABPM as a tool for diagnosis, monitoring of hypertensive patients and therapeutic adaptation. A large-scale national study would be necessary for the rational use of ambulatory blood pressure measurement in our context in order to improve the management of hypertensive patients.

Reliability of Blood Pressure Measurements: An Analysis of the White Coat Effect and Its Fluctuations

In this paper, we evaluate the difference between the first and second measurements of blood pressure (BP) when BP is measured twice using the results of 17,775 medical checkups. The two measurements for both systolic BP (SBP) and the diastolic BP (DBP) fluctuated a large amount even though they were measured at a short interval. The first measurements were 6.7 and 2.4 mmHg higher than the second ones for SBP and DBP, suggesting a white coat effect. Then, the factors that might affect the differences between the two measurements were analyzed by the regression models. For both SBP and DBP, the difference increased as the first measurement increased. Age, gender, BMI and alcohol consumption were other important factors affecting the difference. In the case of a typical male individual, the typical criteria for hypertension of 140/90, 160/100 and 180/110 mmHg criteria in the first measurement would correspond to 135/86, 150/94 and 165/102 mmHg in the second measurement. The necessity of developing accurate and cost-efficient BP measurement methods is strongly suggested.

Numerical analysis of stress distribution in the upper arm tissues under an inflatable cuff：Implications for noninvasive blood pressure measurement

An inflatable cuff wrapped around the upper arm is widely used in noninvasive blood pressure measurement.However, the mechanical interaction between cuff and arm tissues, a factor that potentially affects the accuracy of noninvasive blood pressure measurement, remains rarely addressed. In the present study, finite element（FE） models were constructed to quantify intra-arm stresses generated by cuff compression, aiming to provide some theoretical evidence for identifying factors of importance for blood pressure measurement or explaining clinical observations. Obtained results showed that the simulated tissue stresses were highly sensitive to the distribution of cuff pressure on the arm surface and the contact condition between muscle and bone. In contrast, the magnitude of cuff pressure and small variations in elastic properties of arm soft tissues had little influence on the efficiency of pressure transmission in arm tissues. In particular, it was found that a thickened subcutaneous fat layer in obese subjects significantly reduced the effective pressure transmitted to the brachial artery, which may explain why blood pressure overestimation occurs more frequently in obese subjects in noninvasive blood pressure measurement.

Hygienic and Dietary Measures in Cameroonian Hypertensive Patients Followed at the Douala General Hospital: Knowledge, Compliance and Effect on Blood Pressure Control

Introduction: The management of hypertension is mostly based on pharmacotherapy and hygienic and dietary measures (HDMs) for which little data is available in Cameroon. The concern to improve the quality of life of hypertensive patients led us to study the knowledge, compliance and effect of HDMs among Cameroonian hypertensive patients. Methods: This was a cross-sectional study carried out at the Douala General Hospital;the census of patients was carried out from 05 March to 10 May 2018. The data evaluated were knowledge and compliance with HDMs with an inference of their effect on blood pressure control. Results: We recruited 330 participants at mean age of 60 ± 11 years, 37.9% men;57.3% with blood pressure (BP) controlled. Out of 330 subjects, 308 (93.3%) who had been educated about dietary health measures for hypertension were assessed on knowledge, compliance and effect of these measures against 22 (6.7%) who had never heard about them. Around 85.7% of participants had good knowledge of HDMs and 78.9% had good compliance with them. There was no statistically significant influence of knowledge and compliance with HDMs on blood pressure control. Conclusion: The level of knowledge and adherence to HDMs of hypertensive patients at the Douala General Hospital was appreciable. It is however appropriate for physicians to intensify patient education on HDMs and BP control.

A Deep Learning-Based Continuous Blood Pressure Measurement by Dual Photoplethysmography Signals

This study proposed a measurement platform for continuous blood pressure estimation based on dual photoplethysmography(PPG)sensors and a deep learning(DL)that can be used for continuous and rapid measurement of blood pressure and analysis of cardiovascular-related indicators.The proposed platform measured the signal changes in PPG and converted them into physiological indicators,such as pulse transit time(PTT),pulse wave velocity(PWV),perfusion index(PI)and heart rate(HR);these indicators were then fed into the DL to calculate blood pressure.The hardware of the experiment comprised 2 PPG components(i.e.,Raspberry Pi 3 Model B and analog-todigital converter[MCP3008]),which were connected using a serial peripheral interface.The DL algorithm converted the stable dual PPG signals acquired from the strictly standardized experimental process into various physiological indicators as input parameters and finally obtained the systolic blood pressure(SBP),diastolic blood pressure(DBP)and mean arterial pressure(MAP).To increase the robustness of the DL model,this study input data of 100 Asian participants into the training database,including those with and without cardiovascular disease,each with a proportion of approximately 50%.The experimental results revealed that the mean absolute error and standard deviation of SBP was 0.17±0.46 mmHg.The mean absolute error and standard deviation of DBP was 0.27±0.52 mmHg.The mean absolute error and standard deviation of MAP was 0.16±0.40 mmHg.

A blood pressure measurement method based on synergetics theory

The principle for blood pressure measurement using pulse transit time is introduced in this paper.And the math model of synergetics theory is studied in detail.The synergetics theory is applied in the analysis of blood pressure measurement data.The simulation results show that the application of synergetics theory is helpful to judge the normal blood pressure,and the accuracy is up to 80%.

THE STUDY ON A FAST BLOOD VISCOSITY MEASUREMENTINSTRUMENT

Blood viscosity, measurement is of great significance for diagnosing manydiseases. Traditional methods such as cone method, capillary method have manyshortcomings. In this paper, after establishing a model of blood movement in. capillaryat a non-steady state, we develop a new type of blood viscometer. The instrument canmeasure blood viscosity in vivo rapidly and accurately. Moreover, the results canreflect the non-Newton property of blood.

Non-Contact Blood Pressure Measurement Based on IPPG

Blood pressure is an important physiological parameter to reflect human vital signs.In order to achieve the non-contact dynamic blood pressure acquisition based on ordinary optical camera,a theoretical understanding of the functional relationship between blood pressure and pulse wave signal conduction time.And through imaging photoelectric plethysmography(IPPG),pulse wave signal conduction time of forehead and hand was obtained with ordinary optical camera.First,the pulse wave conduction time was obtained by recording the video with an ordinary optical camera.Second,real-time blood pressure values were collected.Finally,based on the relationship between blood pressure and pulse wave conduction time,a non-contact blood pressure measurement prediction model was obtained through neural network fitting.So that non-contact blood pressure measurement with optical camera could be completed.The method in this paper has several advantages,such as low requirements on measuring equipment,low cost,and simple operation.It can let people get rid of the discomfort caused by measuring equipment such as cuff and can measure blood pressure at any time.The predicted blood pressure results were compared with an Omron wrist electronic sphygmomanometer.The calculated error of systolic blood pressure is-9.28%~3.16%,and the error of diastolic blood pressure is-9.84~4.35%.

Pulse palpation and limited joint mobility examination are better indicators than oscillometric measurement for diagnosing abnormal ankle-brachial index

Background: Peripheral artery disease (PAD) is the least recognized form of atherosclerosis and may even result in amputation if the diagnosis is delayed. Manual pulse palpation is the traditional way to diagnose PAD. Doppler ultrasonographic measurement of ankle-brachial index (ABI) is the gold standard diagnosing method but requires training and is not necessarily available as an outpatient procedure. Using automated oscillometric blood pressure devices has been suggested as an easier method for measuring the ABI. Methods: A single observer palpated the arterial dorsalis pedis, examined hand joints and measured the ABI of one hundred diabetic patients using both Doppler and oscillometric methods. The purpose of this study was to compare the oscillometric method and the manual diagnosing methods to the gold standard method of using a hand held Doppler device for measuring the ABI and detecting PAD. Results: ABI was abnormal in 24 patients (24%) (22 males, 2 females) when measured with the Doppler method. Of these 24 patients, the oscillometric method would have missed 12 giving 12 false negatives. We found that the sensitivity of the oscillometric method was 50.0% and specificity 90.8%. Clinical examination with palpation of ADP combined with limited joint mobility (LJM) scoring would have missed only four cases. Conclusions: Although the oscillometric method is easy and accessible, it is not sensitive enough to be used as the only method in measuring ABI. The simple and inexpensive ADP pulse palpation combined with testing for LMJ was able to find 20 of the 24 (83%) patients with an abnormal ABI measured by Doppler stethoscope.

成渝地区双城经济圈无偿献血志愿服务运营模式分析与改进

目的调研分析成渝地区双城经济圈无偿献血志愿服务队伍的建设及运营模式,提出改进策略,为优化献血志愿服务管理策略提供科学依据。方法研究选取了2024年1月—6月期间,重庆和成都各500名共1000名志愿者作为研究对象,采用问卷调查法收集数据。问卷内容包括基本信息和评分量表两部分,后者采用李克特量表对行为方式、主观意识、服务动机、生活幸福感及持续服务意向进行评分。数据通过SPSS 26.0进行统计分析,包括描述性统计、因子分析、线性回归分析以及模型拟合度评估。结果研究发现,年轻(如18~25岁)、高学历(如本科及以上)和高收入(如月收入8001元以上)群体在服务动机(得分分别为3.38,3.40,3.47,P<0.05)和生活幸福感(得分分别为3.53,3.57,3.63,P<0.05)上得分显著较高;成都志愿者在主观意识(得分3.59,P<0.01)、服务动机(得分3.35,P<0.01)和持续服务意向(得分3.57,P<0.05)上显著高于重庆志愿者(得分分别为3.51,3.28,3.39);线性回归分析显示,生活幸福感(偏回归系数=0.214,P<0.001)、服务动机(偏回归系数=0.200,P<0.001)、主观意识(偏回归系数=0.117,P=0.013)和行为方式(偏回归系数=0.130,P=0.019)对持续服务意向有显著正向影响;模型拟合度评估表明,模型的拟合度良好,卡方自由度比(χ^(2)/df)=1.844,GFI=0.933,RMSEA=0.006,CFI=0.919,NFI=0.958,NNFI=0.942,均满足拟合优度标准。结论本研究揭示了影响无偿献血志愿者行为及态度的关键因素,并发现成都和重庆地区在志愿服务方面的差异。建议通过增强社会责任感、优化招募与培训策略、提升服务动机和主观意识、关注生活幸福感、建立激励机制及加强区域合作等措施,促进成渝地区双城经济圈内无偿献血志愿服务队伍的高质量发展。

基于BiLRCN和注意力机制的脉搏波血压测量

为了提高无创血压测量的精度,提出了基于双向长期递归卷积网络(Bidirectional Long-term Recurrent Convolutional Network,BiLRCN)和注意力机制的脉搏波血压测量方法。通过2个卷积神经网络(Convolutional Neural Network,CNN)层提取出光电容积脉搏信号的高维度特征,将其作为双向长短期记忆(Bidirectional Long Short-Term Memory,BiLSTM)网络的输入,通过BiLSTM提取输入序列前后向的特征信息进行预测;根据注意力机制自动分配权重的特征,给予重要时刻脉搏特征数据较大的权重,并通过2个全连接层得到血压的测量值。将所提出的方法与CNN、长短期记忆(Long Short-Term Memory,LSTM)网络、BiLSTM网络、长期递归卷积神经网络(Long-term Recurrent Convolutional Network,LRCN)方法进行了收敛速度和血压测量的对比实验。实验结果表明,所提出的方法较LRCN均方误差降低了21.63%,平均绝对误差降低了67.5%,确定性相关系数提高了0.42%。所提出的方法的收敛速度更快、血压测量精度更高。

可穿戴人体无创血压测量技术

针对传统的连续无创血压测量设备结构复杂、体积大、不宜穿戴、限制患者运动等问题,设计一种可穿戴设备对人体血压进行实时无创测量。通过硬件设备同步获取心电-脉搏波信号,设计信号处理算法,提取特征点用于后续血压估计。应用MIMIC数据中心电-脉搏-血压信号计算脉搏波传导时间及射血前期,并利用最小二乘法进行线性回归分析,构建血压测量模型,实现个性化血压检测算法。实验验证结果表明:采用该技术检测人体血压时,误差的标准差在±8 mmHg(1 mmHg≈133 Pa)范围内,平均绝对误差小于5 mmHg,满足AAMI国际血压计准确性评价标准的要求。

地奥心血康软胶囊联合依那普利对冠心病合并心房颤动患者血压测量波动性的影响

目的:探讨地奥心血康软胶囊联合依那普利对冠心病合并心房颤动患者血压测量波动性的影响。方法:选取2021年1月~2021年10月就诊于九江市第一人民医院的136例冠心病合并持续性非瓣膜性心房颤动患者,计算分析包括年龄、性别、合并疾病、合并用药等参数在内的各项因素和血压波动的相关性,并就是否联合使用地奥心血康软胶囊在管理血压波动方面的价值进行探索。结果:年龄、性别、合并疾病(高血压、糖尿病、卒中、心力衰竭、高脂血症)、合并用药[血管紧张素转化酶抑制剂(ACEI)、血管紧张素受体拮抗剂(ARB)、β受体阻滞剂、钙离子通道阻滞剂(CCB)、利尿剂、抗凝药、抗血小板药、他汀]与基线水平血压波动之间的相关性差异无统计学意义(P>0.05);在将计算血压波动结点值设置为“6 mmHg”这一前提下,总体研究对象的血压波动达标率为29.4%,联药组在随访过程中的血压波动达标率呈逐渐上升趋势,单药组的血压波动达标率也呈现了波动性,单药组对应时间节点的血压波动达标率较之于联药组均偏低。结论:地奥心血康软胶囊与血压管理具有良好的相关性且能够降低血压的波动性,可以考虑联合依那普利作为降压控压方案。

省域血站主要血液质量指标监测值框量区间的建立与应用成效

目的获得河北省域血站提供临床使用的红细胞类、血浆及衍生物类及去白细胞单采血小板等主要血液成分的几项质量指标监测值框量区间,了解监测值分布状态及监测水平变化,进一步加强全省血站质控实验室同质化建设。方法2023年收集河北省12家血站2015—2022年常供血液成分抽检数据,制作散点图并设置框量标记,以均值±SD线作为框量区间上限和下限,2024年补充2023年监测数值后对比前后两个框量区间变化,进行稳定性、整体水平分析。结果2015—2022年框量区间与2015—2023年框量区间标准差对比:去白细胞悬浮红细胞-血红蛋白含量由8.132减小为7.993;洗涤红细胞-血红蛋白含量由6.252减小为6.104;洗涤红细胞-上清蛋白质含量由0.273减小为0.267;冷沉淀凝血因子-FⅧ含量由57.506减小为56.276;新鲜冰冻血浆-FⅧ含量由0.920减小为0.892;去白细胞单采血小板-白细胞残留量由0.653减小为0.644、去白细胞单采血小板-红细胞混入量由2.653减小为2.603,以上项目标准差范围缩小,监测值更为集中,离散度降低;2015—2022年框量区间与2015—2023年框量区间均值对比:去白细胞悬浮红细胞的白细胞残留量均值由0.362增长为0.476、洗涤红细胞的血红蛋白含量均值由44.915减小为44.861、上清蛋白质含量均值由0.280增长为0.283、溶血率均值由0.137增长为0.142、冷沉淀凝血因子的FⅧ含量均值由133.989减小为133.271、新鲜冰冻血浆的血浆蛋白含量均值由60.262减小为60.208、FⅧ含量均值由1.301减小为1.277、去白细胞单采血小板-血小板含量均值由3.036减小为3.033,均值距离国标线更近,反映出2023年监测数值不合格值或接近国标线值增多。各项目分类观察:凝血类项目长期合格率较低,未见好转;生化类均稳定性增强但发生整体偏移,平均值近国标线,后续检测不合格可能性增强;计数类涉及项目较多,未表现明显共同性特征。结论探索采用“mean±SD”形式在各项汇总数据分析中的应用,能够较为直观地展现全省监测值在不同项目中呈现的分布状态,形成了既往9年的指标区间框架,表现了各项目类型特征,为后续各单位的质控实验室数据分析提供思路,以采取积极措施提升监测水平。

儿科护士血压测量操作的现状调查

目的了解儿科护士血压测量操作现状,为规范儿童血压测量提供依据。方法采用便利抽样法抽取全国18个省、2个自治区、3个直辖市共230所医院的2817名儿科护士,使用自行编制的儿童血压测量操作现状问卷进行调查。结果有效调查2674名;788名(29.47%)护士选择的血压测量设备在儿童中经过验证;2037名(76.18%)护士根据儿童上臂围选择袖带型号,但1669名(62.42%)护士测量上臂围方法错误;护士血压测量次数及数值报告方法各异,甚至有17.31%的护士仅测量1次血压就取读数。结论儿童血压测量操作临床实践差异较大,需制定儿童血压测量规范化操作流程及标准,加强儿童血压测量技术的培训及推广,以提高儿科护士进行血压测量操作的规范性。

组织仿体的光学特性对糖信号检测灵敏度的影响分析

由于经人体组织的传输光子携带的血糖信号非常微弱,近红外光谱法测量血糖的灵敏度不高,难以获得较高的准确度。因此通过优化测量波长、测量距离等尝试提高测量灵敏度的研究一直在进行。然而,这些研究多倾向于关注血糖引起的组织吸收系数和散射系数的变化,而忽视了不同部位组织本身的光学特性对灵敏度的影响,缺乏比较不同部位之间的灵敏度差异。实际上,组织本身的光学参数会通过影响光程来影响吸收变化、散射变化作用于光强变化的系数的大小,因此,综合考虑上述两方面的因素后确定出的血糖测量灵敏度是更合理的。为了探究这种综合作用,选取2%、5%、10%和20%四种浓度的intralipid溶液作为人体组织仿体,通过蒙特卡洛模拟的方法,探讨了在1000~1660 nm波段,四种溶液中糖的吸收作用、散射作用和两者综合作用下的糖灵敏度,以及各部分灵敏度与其本身光学参数的关系。结果表明,在散射系数最大的20%intralipid溶液中检测到的糖信号也最强。据此,该研究将为部位优选提供依据,以获得较大的糖灵敏度。同时,对1000~1660 nm波段内的糖信号进行分析,发现在1000~1350 nm波段,糖引起的吸收作用基本可以忽略,信号的差异主要来自于散射的变化;而在1350~1660 nm,散射和吸收共同作用,其中散射的贡献大于吸收,散射最优的测量波长在1450 nm附近;而考虑散射和吸收的共同作用时,最优的测量波长在1400 nm附近。最后,为了验证理论分析的有效性,对四种溶液进行了实验,采用了1000~1660 nm波段中的六个典型波长,结果表明四种溶液中糖信号最大的检测波长均为1409 nm,且在20%intralipid中的糖信号灵敏度最大,说明实验结果与理论分析吻合较好。综上,该研究可为人体无创血糖检测合适的测量部位、合适的波长选择提供借鉴。

一款无创连续血压测量设备研制及其准确性验证

目的:研制一款无创连续血压测量设备NC-BPM型并验证其监测血压的准确性。方法:研制一款NC-BPM型无创连续血压测量设备(简称NC-BPM),整套设备系统主要由指套传感器、信号采集和压力控制单元、高度校正系统和主机4个模块组成。使用欧姆龙J760电子血压计(简称J760)和CNAP Monitor 500连续无创血压监测系统(简称CNAP Monitor 500)作为监测血压准确性验证的参考血压计,按照美国电气和电子工程师协会(IEEE)有关可穿戴无袖带血压测量装备标准测试流程,分别测量25名受试者静态期、血压变化期和校准后期3个阶段的血压,验证NC-BPM测量血压的准确性。结果:使用NCBPM与CNAP Monitor 500均采集到13753个数据点,两种仪器测得收缩压(SBP)、舒张压(DBP)及平均血压(MAP)具有高度相关性(r=0.96、0.97、0.98,P<0.05);欧姆龙J760采集到379个数据点,NC-BPM与欧姆龙J760测得SBP和DBP数据亦有高度相关性(r=0.98、0.95,P<0.05)。按照英国高血压协会(BHS)和美国医疗仪器促进协会(AAMI)标准的等级评价,NCBPM与CNAP Monitor500的SBP差值在0~5 mmHg、0~10 mmHg和0~15 mmHg范围内的占比分别为85.01%、97.60%和99.47%,DBP占比分别为84.34%、99.85%和100%,MAP占比分别为92.66%、99.72%和99.96%,三者均属BHS标准A级;两种仪器测量的指动脉SBP、DBP和MAP压差值分别为(0.67±5.07)mmHg、(2.43±2.87)mmHg和(1.43±2.89)mmHg,均在AAMI标准(5±8)mmHg范围内。NC-BPM与欧姆龙J760的SBP差值0~5 mmHg、0~10 mmHg和0~15 mmHg范围内占比分别为79.95%、97.36%和100%,DBP占比分别为89.71%、99.74%和100%,两者均属BHS标准A级;两种仪器测量的肱动脉收缩压、舒张压差值分别为(1.57±4.18)mmHg、(0.57±5.20)mmHg,均在AAMI标准(5±8)mmHg范围内。结论:NC-BPM设备已通过了IEEE标准下AAMI标准的第一阶段临床试验,可进行下一阶段临床验证试验。

上海市护理学会《有创动脉血压监测方法》团体标准解读

上海市护理学会于2023年11月发布了《有创动脉血压监测方法》团体标准,规范了成人和儿童有创动脉血压的监测方法,包括基本要求、监测对象、测量通路、测量方法、操作要点、导管维护与观察及并发症预防。文章对标准中给出的建议进行解读,以期帮助各类医疗机构护士更好地理解并应用该标准。