2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents

Increasing prevalence of hypertension (HTN) in children and adolescents has become a significant public health issue driving a considerable amount of research. Aspects discussed in this document include advances in the definition of HTN in 16 year or older, clinical significance of isolated systolic HTN in youth, the importance of out of office and central blood pressure measurement, new risk factors for HTN, methods to assess vascular phenotypes, clustering of cardiovascular risk factors and treatment strategies among others. The recommendations of the present document synthesize a considerable amount of scientific data and clinical experience and represent the best clinical wisdom upon which physicians, nurses and families should base their decisions. In addition, as they call attention to the burden of HTN in children and adolescents, and its contribution to the current epidemic of cardiovascular disease, these guidelines should encourage public policy makers to develop a global effort to improve identification and treatment of high blood pressure among children and adolescents

Connaissances, perception et pratique des professionnels de la santé concernant les méthodes de mesure de la pression artérielle Knowledge, perception, and practice of health professionals regarding blood pressure measurement methods

L'hypertension est un facteur de risque mondial majeur qui touche environ 23 % de la population canadienne. Si elle n'est pas diagnostiquée et traitée adéquatement, l'hypertension artérielle entraînera des complications affectant le cœur, le cerveau ou les reins. Le diagnostic et le traitement de l'hypertension dépendent en grande partie d'une mesure valide de la pression artérielle (PA). Les lignes directrices d'Hypertension Canada préconisent l'utilisation de méthodes de la mesure de la PA standardisé, à savoir à domicile (MPAD), ambulatoire (MAPA), en clinique (MPAC) et en clinique oscillométrique en série (MPAC-OS) pour la prise en charge de l'hypertension. Ces méthodes de mesure de la PA ont été étudiées de façons indépendantes en ce qui concerne les connaissances, la perception ou la pratique, mais pas systématiquement et seulement partiellement au Canada. Les professionnels de la santé, à savoir les médecins, les infirmières et les pharmaciens, jouent un rôle important dans la mesure de la PA et, par conséquent, une image plus claire de leurs connaissances, de leur perception et de leur pratique est nécessaire. L'objectif de cette étude était ainsi d'évaluer les connaissances, la perception et la pratique des médecins, infirmières et pharmaciens de travail en milieux de soins primaires à travers le Québec concernant les quatre méthodes de mesure de la PA. Pour identifier la littérature publiée sur ce sujet, une revue de la portée a été réalisée évaluer systématiquement la littérature pour les quatre méthodes de la mesure de la PA en regard des trois concepts pour les professionnels de la santé. Lorsque les résultats rapportés des études individuelles étaient supérieurs à 50%, les études étaient classées comme adéquates pour les connaissances, positives pour la perception et satisfaisantes pour la pratique. Au total, 72 études ont été identifiées. Les résultats ont montré que les perceptions des professionnels de la santé étaient positives, mais que leurs connaissances étaient insuffisantes et leur pratique insatisfaisante, et que les infirmières et les pharmaciens demeurent sous-étudiés. Ceci est le premier article de la thèse, et il a été publié. Une étude descriptive a été menée pour évaluer les connaissances, la perception et la pratique les professionnels de la santé concernant la mesure de la PA tant en clinique qu’en ambulatoire. À l'aide des lignes directrices d'Hypertension Canada et de la littérature pertinente, un questionnaire élaboré par la chercheure a été formulé et traduit en anglais et en français, puis validé par un panel de quatre experts dans le domaine de l'hypertension. La population de l’étude concernait tous les médecins, infirmières et pharmaciens exerçant en soins primaires au Québec ont été sélectionnés pour cette étude. Le recrutement des participants a été réalisé en collaboration avec leurs associations professionnelles respectives. Les médecins et pharmaciens ont été recrutés via la lettre d’information mensuelle de leurs associations, tandis qu'une invitation personnalisée a été envoyée par courriel aux infirmières. Un lien vers une plateforme sécurisée suivi de deux rappels a été transmis aux participants. La collecte des données a eu lieu entre novembre 2019 et janvier 2020. Un certificat d'éthique a été obtenu de l'UQTR. Les données ont été analysées à l'aide de statistiques descriptives comprenant la fréquence, le pourcentage, la moyenne et les écart types. Quant aux résultats, un total de 453 infirmières a participé au sondage. Le score global des connaissances était inférieur à 50%, ce qui a été jugé insuffisant. Cependant, le score global pour la perception était supérieur à 50%, ce qui montre leur accord sur l'utilité des méthodes la mesure de la PA pour la gestion de l'hypertension. La pratique n'était pas satisfaisante pour les méthodes ambulatoires, en particulier dans les domaines de l'éducation dispensée aux patients mais également des conseils dispensés. Une légère évolution dans l’utilisation des dispositifs oscillométriques plutôt que les mesures manuelles a été observée. Cependant, au Canada, l'MPAC-OS, qui est la méthode préférée en clinique, n'est utilisée de façon routinière que par un quart des infirmières. Il s’agit du deuxième article de la thèse. Pour les résultats des médecins et des pharmaciens, un total de 45 médecins et 30 pharmaciens ont participé à l'enquête. Leur score global de perception était supérieur à 50%, tandis que le score global de connaissance était légèrement supérieur à 50%, ce qui est assez adéquat. La pratique était assez satisfaisante pour toutes les méthodes de mesure de la pression artérielle. Cependant, un pourcentage substantiel de médecins (32%) et de pharmaciens (7%) utilisent encore l'auscultation manuelle comme méthode de routine en clinique, tandis que seulement 13% des médecins et 3% des pharmaciens utilisent la méthode MPAC-OS. À notre connaissance, il s'agit de la première étude au Québec à dresser un portrait complet de la connaissance, de la perception et de la pratique les professionnels de la santé pour les quatre méthodes la mesure de la PA. Les résultats de l'examen de portée ont mis en évidence qu'une connaissance inadéquate et une pratique insatisfaisante des méthodes de la mesure de la PA restent une préoccupation majeure dans le monde. Le fait est que les infirmières et les pharmaciens ont été peu étudiés, bien qu'une approche d'équipe multidisciplinaire soit fortement encouragée pour la gestion de l'hypertension. Les résultats pour les médecins, les infirmières et les pharmaciens soulignent que les connaissances et la pratique sont sous-optimales et doivent être améliorées. La généralisabilité des résultats est cependant limitée pour les médecins et les pharmaciens en raison de l'échantillon limité. Ces résultats pourraient aider à planifier d'autres stratégies pour mettre en œuvre la certification la mesure de la PA, guider l'application des connaissances, mener d'autres recherches à travers le Canada pour obtenir une vue d'ensemble, identifier les obstacles en la mesure de la PA et aider à combler le fossé entre les lignes directrices et la pratique. Les efforts d'Hypertension Canada et d'autres sociétés d'hypertension pour fournir des ressources éducatives et des outils aux professionnels de la santé sont louables. Il faut donc s'assurer que les ressources disponibles sont mises en œuvre et que la formation continue est encouragée.Hypertension is a leading global risk factor affecting approximately 23% of the Canadian population. If not diagnosed and treated accurately, hypertension will lead to complications affecting the heart, brain, or kidneys. The diagnosis and treatment of hypertension depend largely on accurate blood pressure measurement (BPM). Hypertension Canada Guidelines recommend using standardized BPM methods, namely home (HBPM), ambulatory (ABPM), office (OBPM), and automated (AOBP) for hypertension management. These BPM methods have been studied independently concerning either knowledge, perception, or practice, but not systematically and only partially in Canada. Health professionals (HPs), namely the physicians, nurses, and pharmacists, play a significant role in BPM, and therefore a clearer picture of their knowledge, perception, and practice is needed. The objective of this study was to assess the knowledge, perception, and practice of the physicians, nurses, and pharmacists working in the primary care settings across Quebec concerning the four BPM methods. To identify the published literature on this topic, a scoping review was performed that systematically appraised the literature for the four BPM methods and three concepts for HPs. When results reported from individual studies were above 50%, studies were classified as adequate for knowledge, positive for perception, and satisfactory for practice. A total of 72 studies were identified. The results showed that health professionals' perceptions were positive, but their knowledge was inadequate, the practice was unsatisfactory, and nurses and pharmacists remained understudied. This is the first article of the thesis, and it was published. A descriptive study was conducted to assess knowledge, perception and practice of HPs concerning ambulatory and clinic BPM methods. Using Hypertension Canada Guidelines and relevant literature, an investigator-initiated questionnaire was formulated and translated in English and French and further validated by a panel of four experts in the field of hypertension. All registered physicians, nurses, and pharmacists practicing in primary care across Quebec were selected for this study. Recruitment of participants was executed in collaboration with their respective professional associations. Physicians and pharmacists were recruited through the monthly newsletter of their associations, while a personalized invitation was sent by email to nurses. A link to a secured platform followed by two reminders was provided to participants. Data collection took place between November 2019-January 2020. An ethical certificate was obtained from UQTR. Data was analyzed using descriptive statistics including frequency, percentage, mean and standard deviation. As for results, a total of 453 nurses participated in the survey. The overall knowledge score was below 50%, which was considered inadequate. However, the overall perception score was above 50%, showing their agreement on the usefulness of BPM methods for hypertension management. The practice was unsatisfactory for HBPM and ABPM methods, especially in the areas of education and frequency of recommending it to patients, while a slight change from manual auscultation to the oscillometric device is observed. However, in Canada, AOBP, which is the preferred method in-clinic, is used routinely only by a quarter of the nurses. This is the second article of the thesis. For the results of physicians and pharmacists, a total of 45 physicians and 30 pharmacists participated in the survey. Their overall perception score was above 50%, while the overall knowledge score was slightly above 50%, which is fairly adequate. The practice was somewhat satisfactory for all BPM methods. However, a substantial percentage of physicians (32%) and pharmacists (7%) use manual auscultation as a routine in-clinic method, while only 13% of physicians and 30% of pharmacists use the AOBP method. To our best knowledge, this is the first study in Québec and Canada to depict a complete picture of the knowledge, perception, and practice of HPs for all four BPM methods. The results of the scoping review highlighted that inadequate knowledge and unsatisfactory practice of BPM methods remain a major concern worldwide. The fact is that the nurses and pharmacists were understudied, although a multidisciplinary team approach is strongly promoted for the management of hypertension. The results for physicians, nurses, and pharmacists highlight that the knowledge and practice are suboptimal and need improvement. However, the generalisability of the results is limited for physicians and pharmacists due to the limited sample. These findings could help plan further strategies to implement BPM certification, guide in knowledge translation, conduct further research across Canada to get a larger picture, identify barriers in BPM, and help bridge the gap between guidelines and practice. The efforts of Hypertension Canada and other hypertension societies to provide educational resources and tools for HPs are commendable. Therefore, it must be ensured that the available resources are implemented, and that continuing education is encouraged

Mutual effect of homocysteine and uric acid on arterial stiffness and cardiovascular risk in the context of predictive, preventive, and personalized medicine

Background: Arterial stiffness is a major risk factor and effective predictor of cardiovascular diseases and a common pathway of pathological vascular impairments. Homocysteine (Hcy) and uric acid (UA) own the shared metabolic pathways to affect vascular function. Serum uric acid (UA) has a great impact on arterial stiffness and cardiovascular risk, while the mutual effect with Hcy remains unknown yet. This study aimed to evaluate the mutual effect of serum Hcy and UA on arterial stiffness and 10-year cardiovascular risk in the general population. From the perspective of predictive, preventive, and personalized medicine (PPPM/3PM), we assumed that combined assessment of Hcy and UA provides a better tool for targeted prevention and personalized intervention of cardiovascular diseases via suppressing arterial stiffness. Methods: This study consisted of 17,697 participants from Beijing Health Management Cohort, who underwent health examination between January 2012 and December 2019. Brachial-ankle pulse wave velocity (baPWV) was used as an index of arterial stiffness. Results: Individuals with both high Hcy and UA had the highest baPWV, compared with those with low Hcy and low UA (β: 30.76, 95 % CI: 18.36 – 43.16 in males; β: 53.53, 95 % CI: 38.46–68.60 in females). In addition, these individuals owned the highest 10-year cardiovascular risk (OR: 1.49, 95 % CI: 1.26 – 1.76 in males; OR: 7.61, 95 % CI: 4.63 – 12.68 in females). Of note, males with high homocysteine and low uric acid were significantly associated with increased cardiovascular risk (OR: 1.30, 95 % CI: 1.15 – 1.47), but not the high uric acid and low homocysteine group (OR: 1.02, 95 % CI: 0.90 – 1.16). Conclusions: This study found the significantly mutual effect of Hcy and UA on arterial stiffness and cardiovascular risk using a large population and suggested the clinical importance of combined evaluation and control of Hcy and UA for promoting cardiovascular health. The adverse effect of homocysteine on arteriosclerosis should be addressed beyond uric acid, especially for males. Monitoring of the level of both Hcy and UA provides a window opportunity for PPPM/3PM in the progression of arterial stiffness and prevention of CVD. Hcy provides a novel predictor beyond UA of cardiovascular health to identify individuals at high risk of arterial stiffness for the primary prevention and early treatment of CVD. In the progressive stage of arterial stiffness, active control of Hcy and UA levels from the aspects of dietary behavior and medication treatment is conducive to alleviating the level of arterial stiffness and reducing the risk of CVD. Further studies are needed to evaluate the clinical effect of Hcy and UA targeted intervention on arterial stiffness and cardiovascular health

Enabling Wearable Hemodynamic Monitoring Using Multimodal Cardiomechanical Sensing Systems

Hemodynamic parameters such as blood pressure and stroke volume are instrumental to understanding the pathogenesis of cardiovascular disease. Unfortunately, the monitoring of these hemodynamic parameters is still limited to in-clinic measurements and cumbersome hardware precludes convenient, ubiquitous use. To address this burden, in this work, we explore seismocardiogram-based wearable multimodal sensing techniques to estimate blood pressure and stroke volume. First, the performance of a multimodal, wrist-worn device capable of obtaining noninvasive pulse transit time measurements is used to estimate blood pressure in an unsupervised, at-home setting. Second, the feasibility of this wrist-worn device is comprehensively evaluated in a diverse and medically underserved population over the course of several perturbations used to modulate blood pressure through different pathways. Finally, the ability of wearable signals—acquired from a custom chest-worn biosensor—to noninvasively quantify stroke volume in patients with congenital heart disease is examined in a hospital setting. Collectively, this work demonstrates the advancements necessary towards enabling noninvasive, longitudinal, and accurate measurements of these hemodynamic parameters in remote settings, which offers to improve health equity and disease monitoring in low-resource settings.Ph.D

The 2023 wearable photoplethysmography roadmap

Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology

Connaissances, perception et pratique des professionnels de la santé concernant les méthodes de mesure de la pression artérielle = Knowledge, perception, and practice of health professionals regarding blood pressure measurement methods

L'hypertension est un facteur de risque mondial majeur qui touche environ 23 % de la population canadienne. Si elle n'est pas diagnostiquée et traitée adéquatement, l'hypertension artérielle entraînera des complications affectant le cœur, le cerveau ou les reins. Le diagnostic et le traitement de l'hypertension dépendent en grande partie d'une mesure valide de la pression artérielle (PA). Les lignes directrices d'Hypertension Canada préconisent l'utilisation de méthodes de la mesure de la PA standardisé, à savoir à domicile (MPAD), ambulatoire (MAPA), en clinique (MPAC) et en clinique oscillométrique en série (MPAC-OS) pour la prise en charge de l'hypertension. Ces méthodes de mesure de la PA ont été étudiées de façons indépendantes en ce qui concerne les connaissances, la perception ou la pratique, mais pas systématiquement et seulement partiellement au Canada. Les professionnels de la santé, à savoir les médecins, les infirmières et les pharmaciens, jouent un rôle important dans la mesure de la PA et, par conséquent, une image plus claire de leurs connaissances, de leur perception et de leur pratique est nécessaire. L'objectif de cette étude était ainsi d'évaluer les connaissances, la perception et la pratique des médecins, infirmières et pharmaciens de travail en milieux de soins primaires à travers le Québec concernant les quatre méthodes de mesure de la PA. Pour identifier la littérature publiée sur ce sujet, une revue de la portée a été réalisée évaluer systématiquement la littérature pour les quatre méthodes de la mesure de la PA en regard des trois concepts pour les professionnels de la santé. Lorsque les résultats rapportés des études individuelles étaient supérieurs à 50%, les études étaient classées comme adéquates pour les connaissances, positives pour la perception et satisfaisantes pour la pratique. Au total, 72 études ont été identifiées. Les résultats ont montré que les perceptions des professionnels de la santé étaient positives, mais que leurs connaissances étaient insuffisantes et leur pratique insatisfaisante, et que les infirmières et les pharmaciens demeurent sous-étudiés. Ceci est le premier article de la thèse, et il a été publié. Une étude descriptive a été menée pour évaluer les connaissances, la perception et la pratique les professionnels de la santé concernant la mesure de la PA tant en clinique qu’en ambulatoire. À l'aide des lignes directrices d'Hypertension Canada et de la littérature pertinente, un questionnaire élaboré par la chercheure a été formulé et traduit en anglais et en français, puis validé par un panel de quatre experts dans le domaine de l'hypertension. La population de l’étude concernait tous les médecins, infirmières et pharmaciens exerçant en soins primaires au Québec ont été sélectionnés pour cette étude. Le recrutement des participants a été réalisé en collaboration avec leurs associations professionnelles respectives. Les médecins et pharmaciens ont été recrutés via la lettre d’information mensuelle de leurs associations, tandis qu'une invitation personnalisée a été envoyée par courriel aux infirmières. Un lien vers une plateforme sécurisée suivi de deux rappels a été transmis aux participants. La collecte des données a eu lieu entre novembre 2019 et janvier 2020. Un certificat d'éthique a été obtenu de l'UQTR. Les données ont été analysées à l'aide de statistiques descriptives comprenant la fréquence, le pourcentage, la moyenne et les écart types. Quant aux résultats, un total de 453 infirmières a participé au sondage. Le score global des connaissances était inférieur à 50%, ce qui a été jugé insuffisant. Cependant, le score global pour la perception était supérieur à 50%, ce qui montre leur accord sur l'utilité des méthodes la mesure de la PA pour la gestion de l'hypertension. La pratique n'était pas satisfaisante pour les méthodes ambulatoires, en particulier dans les domaines de l'éducation dispensée aux patients mais également des conseils dispensés. Une légère évolution dans l’utilisation des dispositifs oscillométriques plutôt que les mesures manuelles a été observée. Cependant, au Canada, l'MPAC-OS, qui est la méthode préférée en clinique, n'est utilisée de façon routinière que par un quart des infirmières. Il s’agit du deuxième article de la thèse. Pour les résultats des médecins et des pharmaciens, un total de 45 médecins et 30 pharmaciens ont participé à l'enquête. Leur score global de perception était supérieur à 50%, tandis que le score global de connaissance était légèrement supérieur à 50%, ce qui est assez adéquat. La pratique était assez satisfaisante pour toutes les méthodes de mesure de la pression artérielle. Cependant, un pourcentage substantiel de médecins (32%) et de pharmaciens (7%) utilisent encore l'auscultation manuelle comme méthode de routine en clinique, tandis que seulement 13% des médecins et 3% des pharmaciens utilisent la méthode MPAC-OS. À notre connaissance, il s'agit de la première étude au Québec à dresser un portrait complet de la connaissance, de la perception et de la pratique les professionnels de la santé pour les quatre méthodes la mesure de la PA. Les résultats de l'examen de portée ont mis en évidence qu'une connaissance inadéquate et une pratique insatisfaisante des méthodes de la mesure de la PA restent une préoccupation majeure dans le monde. Le fait est que les infirmières et les pharmaciens ont été peu étudiés, bien qu'une approche d'équipe multidisciplinaire soit fortement encouragée pour la gestion de l'hypertension. Les résultats pour les médecins, les infirmières et les pharmaciens soulignent que les connaissances et la pratique sont sous-optimales et doivent être améliorées. La généralisabilité des résultats est cependant limitée pour les médecins et les pharmaciens en raison de l'échantillon limité. Ces résultats pourraient aider à planifier d'autres stratégies pour mettre en œuvre la certification la mesure de la PA, guider l'application des connaissances, mener d'autres recherches à travers le Canada pour obtenir une vue d'ensemble, identifier les obstacles en la mesure de la PA et aider à combler le fossé entre les lignes directrices et la pratique. Les efforts d'Hypertension Canada et d'autres sociétés d'hypertension pour fournir des ressources éducatives et des outils aux professionnels de la santé sont louables. Il faut donc s'assurer que les ressources disponibles sont mises en œuvre et que la formation continue est encouragée.Hypertension is a leading global risk factor affecting approximately 23% of the Canadian population. If not diagnosed and treated accurately, hypertension will lead to complications affecting the heart, brain, or kidneys. The diagnosis and treatment of hypertension depend largely on accurate blood pressure measurement (BPM). Hypertension Canada Guidelines recommend using standardized BPM methods, namely home (HBPM), ambulatory (ABPM), office (OBPM), and automated (AOBP) for hypertension management. These BPM methods have been studied independently concerning either knowledge, perception, or practice, but not systematically and only partially in Canada. Health professionals (HPs), namely the physicians, nurses, and pharmacists, play a significant role in BPM, and therefore a clearer picture of their knowledge, perception, and practice is needed. The objective of this study was to assess the knowledge, perception, and practice of the physicians, nurses, and pharmacists working in the primary care settings across Quebec concerning the four BPM methods. To identify the published literature on this topic, a scoping review was performed that systematically appraised the literature for the four BPM methods and three concepts for HPs. When results reported from individual studies were above 50%, studies were classified as adequate for knowledge, positive for perception, and satisfactory for practice. A total of 72 studies were identified. The results showed that health professionals' perceptions were positive, but their knowledge was inadequate, the practice was unsatisfactory, and nurses and pharmacists remained understudied. This is the first article of the thesis, and it was published. A descriptive study was conducted to assess knowledge, perception and practice of HPs concerning ambulatory and clinic BPM methods. Using Hypertension Canada Guidelines and relevant literature, an investigator-initiated questionnaire was formulated and translated in English and French and further validated by a panel of four experts in the field of hypertension. All registered physicians, nurses, and pharmacists practicing in primary care across Quebec were selected for this study. Recruitment of participants was executed in collaboration with their respective professional associations. Physicians and pharmacists were recruited through the monthly newsletter of their associations, while a personalized invitation was sent by email to nurses. A link to a secured platform followed by two reminders was provided to participants. Data collection took place between November 2019-January 2020. An ethical certificate was obtained from UQTR. Data was analyzed using descriptive statistics including frequency, percentage, mean and standard deviation. As for results, a total of 453 nurses participated in the survey. The overall knowledge score was below 50%, which was considered inadequate. However, the overall perception score was above 50%, showing their agreement on the usefulness of BPM methods for hypertension management. The practice was unsatisfactory for HBPM and ABPM methods, especially in the areas of education and frequency of recommending it to patients, while a slight change from manual auscultation to the oscillometric device is observed. However, in Canada, AOBP, which is the preferred method in-clinic, is used routinely only by a quarter of the nurses. This is the second article of the thesis. For the results of physicians and pharmacists, a total of 45 physicians and 30 pharmacists participated in the survey. Their overall perception score was above 50%, while the overall knowledge score was slightly above 50%, which is fairly adequate. The practice was somewhat satisfactory for all BPM methods. However, a substantial percentage of physicians (32%) and pharmacists (7%) use manual auscultation as a routine in-clinic method, while only 13% of physicians and 30% of pharmacists use the AOBP method. To our best knowledge, this is the first study in Québec and Canada to depict a complete picture of the knowledge, perception, and practice of HPs for all four BPM methods. The results of the scoping review highlighted that inadequate knowledge and unsatisfactory practice of BPM methods remain a major concern worldwide. The fact is that the nurses and pharmacists were understudied, although a multidisciplinary team approach is strongly promoted for the management of hypertension. The results for physicians, nurses, and pharmacists highlight that the knowledge and practice are suboptimal and need improvement. However, the generalisability of the results is limited for physicians and pharmacists due to the limited sample. These findings could help plan further strategies to implement BPM certification, guide in knowledge translation, conduct further research across Canada to get a larger picture, identify barriers in BPM, and help bridge the gap between guidelines and practice. The efforts of Hypertension Canada and other hypertension societies to provide educational resources and tools for HPs are commendable. Therefore, it must be ensured that the available resources are implemented, and that continuing education is encouraged

The impact of currently recommended antihypertensive therapy on depression and other psychometric parameters: preliminary communication

AIMS: Current evidence on the psychological effects of antihypertensive medications is controversial. The aim of this study was to evaluate the effect of current antihypertensive medication on different psychometric parameters and on serum brain-derived neurotrophic factor (BDNF) level. METHODS: Psychometric, haemodynamic, arterial stiffness and laboratory parameters were evaluated before and 3 months after the initiation of antihypertensive medication in untreated hypertensive patients (HT, n=31), and once in healthy controls (CONT, n=22). Subjects completed the following psychometric tests: Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A), Symptom Checklist 90 Revised (SCL-90), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Big Five Inventory, Pain Vigilance and Awareness Questionnaire and Berkeley Expressivity Questionnaire. Amlodipine and/or perindopril compounds were preferred medications. Serum BDNF was measured with ELISA. RESULTS: Brachial systolic blood pressure, as well as pulse wave velocity were significantly improved in the HT group over the 3-month follow-up (153.3±15.9 mmHg vs. 129.5±10.0 mmHg and 8.2±1.4 m/s vs 7.5±1.6 m/s, respectively). Similarly, we found improvements in BDI (0.73 points) and in several Scl-90 subscales. Serum BDNF was not different between CONT and HT and did not change for therapy. CONCLUSIONS: Our results indicate that initiation of currently recommended antihypertensive medications in newly diagnosed patients may have a significant impact on psychological well-being of patients and could influence quality of life as well

Effects of Aerobic Fitness Training on Migraine Headache

This study investigated the effectiveness of a 12 week aerobic fitness training program at reducing migraine headache symptoms in a sample of formerly sedentary, community-recruited adult chronic migraine sufferers. Seven subjects (5 females, 2 males) monitored their headache symptoms four times daily throughout the five months of the study, which mcluded a one month baseline period, three consecutive months of fitness training, and a one month posttreatment period. During the fitness training phase, subjects\u27 blood pressures and p 1se rates were recorded before and after each exercise session, which occurred three times per week. All subjects walked for .-0 minutes per exercise session at a rate sufficient to maintain heart rates in their aerobic training range, which was defined as 65 to 80% cf their maximum heart rate. Results indicated that the training program was effective at increasing aerobic and cardiovascular fitness. While there was no change in psychological distress (depression, anxiety, anger) as a result of treatment, a significant decrease was observed in headache index from baseline to treatment month 1. Peak headache intensity per week decreased significantly from baseline to treatment months 1,3, and the posftreatment month. Significant increases were observed for number of headache-free days per week from baseline to treatment months 1 and 2. No changes were observed in medication usage. These results suggest that an aerobic fitness training program may be an effective treatment for certain aspects of migraine symptomatology for some individuals who suffer from chronic migraine

National eHealth system – platform for preventive, predictive and personalized diabetes care

National eHealth System, covering all citizens and all healthcare levels in Republic of Macedonia, was introduced in July 2013, has been internationally recognized System for successful reduction of waiting times and instrumental in the management of national healthcare resources. For the first time, National Diabetes Committee, formed in February 2015 according to the Law on healthcare and being overall responsible for the diabetes care in the country, was able to derive exact figures on the national diabetes prevalence from the System, instead of extrapolations used before, serving as a basis for development of strategies for prediction and prevention of diabetic complications, as well as for personalized diabetes care. Number of diabetes cases identified through the National eHealth System in June 2015 was 84,568 (4.02 % of total population), 36,119 males (3.42 % of total male population) and 48,449 females (4.61% of total female population). Age stratified diabetes prevalence was as follows: less than 20 years – 549 cases (0.11 % of respective population), 20-39 years – 3,202 (0.49 %), 40-59 years – 26,561 (4.58 %), 60-79 years – 48,470 (14.57 %), 80 years or more – 5,786 (12.96 %). Addition of parameters for metabolic control and diabetic complications in the System is under way, further facilitating the modeling of diabetes treatment, metabolic control and the outcomes. Inclusion of pre-diabetes patients (IGT and IFG) is also planned, thus providing opportunity to also focus healthcare activities for prevention of progression into overt type 2 diabetes

The 2023 wearable photoplethysmography roadmap

Photoplethysmography is a key sensing technology which is used in wearable devices such as smartwatches and fitness trackers. Currently, photoplethysmography sensors are used to monitor physiological parameters including heart rate and heart rhythm, and to track activities like sleep and exercise. Yet, wearable photoplethysmography has potential to provide much more information on health and wellbeing, which could inform clinical decision making. This Roadmap outlines directions for research and development to realise the full potential of wearable photoplethysmography. Experts discuss key topics within the areas of sensor design, signal processing, clinical applications, and research directions. Their perspectives provide valuable guidance to researchers developing wearable photoplethysmography technology