May Measurement Month 2017: an analysis of blood pressure screening results in Armenia-Europe

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The study was conducted in public areas (14 sites in Yerevan and 18 in regions), both indoor and outdoor, as well as in 42 primary care centres. A total of 9199 individuals were screened during MMM17 of which 9186 had three BP measurements available. The mean age of screened individuals was 50 ± 16.7 years, 57.3% was female. At the time of screening 17.9% were on antihypertensive medication. After imputation, a percentage of participants with hypertension was 33.9%, and 52.9% of them were on treatment. Of those treated, 77.0% had uncontrolled BP. MMM17 was the largest BP screening campaign undertaken in Armenia. We found that in Armenia, untreated hypertension is common, as is not adequately treated hypertension

An analysis of blood pressure screening of 21 112 participants in Armenia: May Measurement Month 2018.

Elevated blood pressure (BP) is a growing burden worldwide and is the leading cause of mortality and disability-adjusted life years all over the world. May Measurement Month (MMM) is a global initiative aimed to raise awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May to July 2018. Blood pressure measurement, the definition of hypertension (HTN) and statistical analysis followed the standard MMM protocol. The study was conducted in public areas (17 sites in Yerevan and 22 in regions), both indoor and outdoor, as well as in 78 primary care centres. A total of 21 112 individuals were screened during MMM18, of which 20 732 had three BP measurements available. The mean age of screened individuals was 46.2 ± 17.3 years, 57.8% were female. At the time of screening, 26.1% were on antihypertensive medication. After imputation, the percentage of participants with HTN was 38.7%, and 76.7% of them were aware of their high BP. Of participants receiving treatment, 47.1% had a controlled BP. MMM18 was the largest BP screening campaign undertaken in Armenia. We found that the proportion of HTN is substantial in Armenia, which may be a vital contributor to the growing burden of non-communicable diseases. Our results also suggest that untreated HTN is common and when treated still not adequately controlled in Armenia. The current situation, with an insufficient control rate of HTN, must be changed as soon as possible

2019 ESC/EAS guidelines for the management of dyslipidaemias : Lipid modification to reduce cardiovascular risk

Correction: Volume: 292 Pages: 160-162 DOI: 10.1016/j.atherosclerosis.2019.11.020 Published: JAN 2020Peer reviewe

Clinical accuracy of the Omron M3 Comfort® and the Omron Evolv® for self-blood pressure measurements in pregnancy and pre-eclampsia – validation according to the Universal Standard Protocol

Jirar Topouchian,1 Zoya Hakobyan,2 Jennifer Asmar,3 Svetlana Gurgenian,4 Parounak Zelveian,2 Roland Asmar5 1Diagnosis and Therapeutic Center, Hôtel Dieu Hospital, Paris, France; 2Department of Preventive Cardiology, Institute of Cardiology, Yerevan, Armenia; 3Department of Gynecology-Obstetric, Foch Hospital, Suresnes, France; 4Department of Arterial Hypertension, Institute of Cardiology, Yerevan, Armenia; 5Foundation-Medical Research Institutes (F-MRI)®, Geneva, Switzerland Background: Electronic devices for blood pressure (BP) measurements need to go through independent clinical validation as recommended by different authorities, both in general and in special populations such as pregnancy. Objective: To evaluate the accuracy of the Omron Evolv® (HEM-7600T-E) and the Omron M3 Comfort® (HEM-7134-E) devices in pregnancy and pre-eclampsia according to the Universal Standard Validation Protocol. Methods: Both devices, the Evolv and the M3 Comfort, measure BP at the brachial level using the oscillometric method. The study was performed according to the recently published protocol, the so-called “modified Advancement of Medical Instrumentation (AAMI)/British Hypertension Society (BHS)/European Society of Hypertension (ESH) protocol” or the “Universal Standard Protocol.” Validation of each device included 45 pregnant women in the second and third gestational trimester of whom 15 had pre-eclampsia, 15 had gestational hypertension and 15 were normotensives. BP differences between the observer and the device BP values were classified into three categories (≤5, ≤10, and ≤15 mmHg) and the mean BP differences (test vs reference) and its SD were calculated. Results: Both devices, the Evolv and the M3 Comfort, achieved a grade A/A in both pregnancy and pre-eclampsia. The mean difference (SD) between the mercury standard and the device BP values in pregnancy were: 1) for the Evolv of –0.7±2.3 mmHg for systolic blood pressure (SBP) and –0.1±1.8 mmHg for diastolic blood pressure (DBP); 2) for the M3 Comfort of –1.6±2.8 mmHg for SBP and –0.1±2.3 mmHg for DBP. Conclusion: Both devices, the Evolv and the M3 Comfort, achieved a grade A/A for both SBP and DBP and fulfill the validation protocol criteria in pregnancy and pre-eclampsia. Consequently, these two devices can be recommended for home BP measurements in this specific population. Keywords: blood pressure, blood pressure measurements, validation, pregnancy, pre-eclampsia, home blood pressure, self-BP measuremen

May Measurement Month 2019: an analysis of blood pressure screening results from Armenia.

Elevated blood pressure (BP) is an enormous public health problem and a growing burden worldwide and the biggest single risk factor for cardiovascular death. May Measurement Month (MMM) is a global initiative aimed to raise awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May to July 2019. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The study was conducted in public areas (23 sites in the capital city Yerevan and 13 in other regions), both indoor and outdoor, as well as in primary and secondary healthcare centres. In total, 9818 individuals (11.3% participated in either MMM2017/2018 or both) were screened of which 9786 had three BP measurements available, 1.6% of them reported never having had their BP measured. The mean age of screened participants was 47.6 (SD ± 16.5) years, 61.9% were female. After multiple imputation, 41.6% of participants had hypertension and 72.8% of them were aware of their high BP, 65.4% were on treatment, and of those treated, 46.5% had controlled BP (<140/90 mmHg). Of 4088 participants with hypertension, 30.4% had controlled BP. Of all risk factors analysed, reported use of anti-hypertensive medication and a previous diagnosis of hypertension were the strongest predictors of higher levels of BP. We found that the prevalence of hypertension, untreated and treated, but uncontrolled hypertension is still substantial in Armenia, which maybe a vital contributor to the growing burden of non-communicable diseases

Validation of BP devices QardioArm&reg; in the general population and Omron M6 Comfort&reg; in type II diabetic patients according to the European Society of Hypertension International Protocol (ESH-IP)

Mirna N Chahine,1,2 Jirar Topouchian,3,4 Parounak Zelveian,3 Zoya Hakobyan,3 Arevik Melkonyan,3 Alaa Azaki,1 Reem Diab,1 Aya Harb,1 Roland Asmar1,2 1Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon; 2Foundation-Medical Research Institutes (F-MRI), Beirut, Lebanon; 3Preventive Cardiology Center, Yerevan, Armenia; 4Diagnostic Center, Hotel-Dieu Hospital, Paris, France Background: Following the European Society of Hypertension International Protocol (ESH-IP) Revision 2010, QardioArm&reg; and Omron M6 Comfort IT&reg; oscillometric devices were evaluated in the general population and in patients with type II diabetes, respectively, for self-blood pressure (BP) measurement. Methods: Both devices, QardioArm&reg; and Omron M6 Comfort&reg;, measure BP at the brachial level. The ESH-IP Revision 2010 includes a total number of 33 subjects. For each measure, the difference between observer and device BP values was calculated. In all, 99 pairs of BP differences are classified into three categories (&le;5, &le;10, and &le;15 mmHg). The protocol procedures were followed precisely. Results: QardioArm&reg; and Omron M6 Comfort&reg; fulfilled the requirements of the ESH-IP and passed the validation process successfully. For QardioArm&reg;, a total of 69 out of 99 comparisons for systolic blood pressure (SBP) showed an absolute difference within 5&thinsp;mmHg and 82 out of 99 for diastolic blood pressure (DBP). As for Omron M6 Comfort&reg;, a total of 83 out of 99 comparisons for SBP showed an absolute difference within 5&thinsp;mmHg and 77 out of 99 for DBP. The mean differences between the device and mercury readings were 0.7&plusmn;5.9 mmHg for SBP and 0.3&plusmn;4.1 mmHg for DBP for QardioArm&reg; and &minus;1.4&plusmn;4.7 mmHg for SBP and &minus;2.1&plusmn;4.3 mmHg for DBP for Omron M6 Comfort&reg;. With regard to part 2 of ESH-IP 2010, 27 out of 33 subjects had a minimum of two out of three measurements within 5&thinsp;mmHg difference for SBP and 31 out of 33 subjects for DBP for the QardioArm&reg;, and 29 out of 33 patients had a minimum of two out of three measurements within 5&thinsp;mmHg difference for SBP and 26 out of 33 patients for DBP for Omron M6 Comfort&reg;.Conclusion: QardioArm&reg; and Omron M6 Comfort&reg; readings differing from the mercury standard by &lt;5, 10, and 15 mmHg fulfill the ESH-IP Revision 2010 requirements. Consequently, these two devices are suitable for use in the general population and non-insulin-dependent type II diabetic patients, respectively. Keywords: QardioArm&reg;, Omron M6 Comfort&reg;, validation, blood pressure measurement, type II diabetes, International Protoco

Effects of metabolic syndrome on arterial function in different age groups: The Advanced Approach to Arterial Stiffness study

Objective: The aim of the Advanced Approach to Arterial Stiffness study was to compare arterial stiffness measured simultaneously with two different methods in different age groups of middle-aged and older adults with or without metabolic syndrome (MetS). The specific effects of the different MetS components on arterial stiffness were also studied. Methods: This prospective, multicentre, international study included 2224 patients aged 40 years and older, 1664 with and 560 without MetS. Patients were enrolled in 32 centres from 18 European countries affiliated to the International Society of Vascular Health &amp;amp; Aging. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI) and the carotid-femoral pulse wave velocity (CF-PWV) in four prespecified age groups: 40-49, 50-59, 60-74, 75-90 years. In this report, we present the baseline data of this study. Results: Both CF-PWV and CAVI increased with age, with a higher correlation coefficient for CAVI (comparison of coefficients P&amp;lt;0.001). Age-adjusted and sex-adjusted values of CF-PWV and CAVI were weakly intercorrelated (r2=0.06, P&amp;lt;0.001). Age-adjusted and sex-adjusted values for CF-PWV but not CAVI were higher in presence of MetS (CF-PWV: 9.57±0.06 vs. 8.65±0.10, P&amp;lt;0.001; CAVI: 8.34±0.03 vs. 8.29±0.04, P=0.40; mean±SEM; MetS vs. no MetS). The absence of an overall effect of MetS on CAVI was related to the heterogeneous effects of the components of MetS on this parameter: CAVI was positively associated with the high glycaemia and high blood pressure components, whereas lacked significant associations with the HDL and triglycerides components while exhibiting a negative association with the overweight component. In contrast, all five MetS components showed positive associations with CF-PWV. Conclusion: This large European multicentre study reveals a differential impact of MetS and age on CAVI and CF PWV and suggests that age may have a more pronounced effect on CAVI, whereas MetS increases CF-PWV but not CAVI. This important finding may be due to heterogeneous effects of MetS components on CAVI. The clinical significance of these original results will be assessed during the longitudinal phase of the study. Copyright © 2018 The Author(s)

Effects of metabolic syndrome on arterial function in different age groups: The Advanced Approach to Arterial Stiffness study

Objective: The aim of the Advanced Approach to Arterial Stiffness study was to compare arterial stiffness measured simultaneously with two different methods in different age groups of middle-aged and older adults with or without metabolic syndrome (MetS). The specific effects of the different MetS components on arterial stiffness were also studied. Methods: This prospective, multicentre, international study included 2224 patients aged 40 years and older, 1664 with and 560 without MetS. Patients were enrolled in 32 centres from 18 European countries affiliated to the International Society of Vascular Health &amp; Aging. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI) and the carotid-femoral pulse wave velocity (CF-PWV) in four prespecified age groups: 40-49, 50-59, 60-74, 75-90 years. In this report, we present the baseline data of this study. Results: Both CF-PWV and CAVI increased with age, with a higher correlation coefficient for CAVI (comparison of coefficients P&lt;0.001). Age-adjusted and sex-adjusted values of CF-PWV and CAVI were weakly intercorrelated (r2=0.06, P&lt;0.001). Age-adjusted and sex-adjusted values for CF-PWV but not CAVI were higher in presence of MetS (CF-PWV: 9.57±0.06 vs. 8.65±0.10, P&lt;0.001; CAVI: 8.34±0.03 vs. 8.29±0.04, P=0.40; mean±SEM; MetS vs. no MetS). The absence of an overall effect of MetS on CAVI was related to the heterogeneous effects of the components of MetS on this parameter: CAVI was positively associated with the high glycaemia and high blood pressure components, whereas lacked significant associations with the HDL and triglycerides components while exhibiting a negative association with the overweight component. In contrast, all five MetS components showed positive associations with CF-PWV. Conclusion: This large European multicentre study reveals a differential impact of MetS and age on CAVI and CF PWV and suggests that age may have a more pronounced effect on CAVI, whereas MetS increases CF-PWV but not CAVI. This important finding may be due to heterogeneous effects of MetS components on CAVI. The clinical significance of these original results will be assessed during the longitudinal phase of the study. Copyright © 2018 The Author(s)

Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: the ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology

Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset &lt;24h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0-100%), fibrinolysis (18.8%; 0-100%), and no reperfusion therapy (9.0%; 0-75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.55.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8 97.5%) for the performance of reperfusion therapy of all patients with STEMI &lt;12h and 54.4% (region range 37.1-70.1%) for timely reperfusion. Conclusions The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality. [GRAPHICS]