Comparison of validation protocols for blood pressure measuring devices in children and adolescents

Accuracy of blood pressure (BP) measurement is important for the evaluation of hypertension in children and adolescents, and it is critically dependent upon the accuracy of the BP measuring device. A device that could pass validated protocols with reliable accuracy would be desirable in clinical and research settings. Several scientific organizations have published recommendations on the validation of different BP measuring devices. Most of them focus on adults but separate recommendations and validation criteria for BP devices intended for use in children and adolescents are included in some validation protocols. In this review, we compare the validation criteria for BP measuring devices among consensus documents from different scientific organizations focusing on the pediatric population and we discuss the evidence gaps targeting the needs for validated BP measuring devices in children and adolescents. We also highlight common pitfalls in the validation studies of BP measuring devices in children and adolescents using the example of office BP devices

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Measuring methods of blood pressure (Home, ABPM, Clinic) which can predict early vascular ageing

The present study compared the diagnostic accuracy of blood pressure (BP) measurement methods, office BP, ambulatory BP monitoring (ABPM) and home BP, in the identification of early vascular aging (EVA) and developed a score to predict the risk of EVA in hypertensive patients. Methods: 282 consecutive subjects (39.7% male) aged 56.8 ± 15.8 years were included. Office and out of office BP measurements including ABPM on a usual working day and seven days home BP monitoring were performed. Carotid-femoral pulse wave velocity (c-f PWV) was measured in all patients. EVA was defined as c-f PWV values higher than the expected for age average values according to European population data. Results: In univariate analysis EVA was significantly correlated with office systolic BP, average 24h systolic and diastolic BP, average 24h and office heart rate. The area under the curve for predicting EVA was 0.624 (95% CI 0.551 to 0.697, p<0,001), 0.559 (95% CI 0.484 to 0.635, p=0,127) and 0.565 (95% CI 0.49 to 0.641, p=0,093), for daytime, home, and office systolic BP, respectively. Ambulatory BP variables, age, sex, BMI, diabetes mellitus (yes/no) and eGFR were used to develop a new score for EVA providing a total accuracy of 0.82, 0.84 sensitivity and 0.78 specificity. Conclusions: 24h ABPM can better predict EVA compared to the other BP measuring methods. In conclusion, the new risk score EVAAs, may accurately identify hypertensive patients with EVA using ABPM values and classic cardiovascular risk factors.Η παρούσα μελέτη συγκρίνει τη διαγνωστική ακρίβεια των μεθόδων καταγραφής της αρτηριακής πίεσης (ΑΠ)- στο ιατρείο, στο σπίτι, με την 24ωρη περιπατητική καταγραφή (ABPM)- για τον προσδιορισμό της πρώιμης αγγειακής γήρανσης (EVA) και σκοπεύει στη δημιουργία ενός μοντέλου πρόβλεψης της EVA στον υπερτασικό πληθυσμό. Μέθοδοι: 282 συμμετέχοντες (39,7% άνδρες) ηλικίας 56,8 ± 15,8 ετών συμπεριλήφθηκαν στη μελέτη. Η ΑΠ μετρήθηκε στο ιατρείο, 7 συνεχόμενες ημέρες στο σπίτι και με την 24ωρη ABPM σε μία τυπική εργάσιμη ημέρα. Η καρωτιδο-μηριαία ταχύτητα σφυγμικού κύματος (c-f PWV) μετρήθηκε σε όλους τους συμμετέχοντες. Η EVA καθορίστηκε ως οι τιμές της c-f PWV που είναι υψηλότερες από τις αναμενόμενες για την ηλικία, βάση των δεδομένων για τον Ευρωπαϊκό πληθυσμό. Αποτελέσματα: Στη μονοπαραγοντική ανάλυση, η EVA συσχετίστηκε στατιστικά σημαντικά με την συστολική ΑΠ ιατρείου και τη καρδιακή συχνότητα ιατρείου, το μέσο όρο της συστολικής και διαστολικής ΑΠ από την 24ωρη ABPM και από τη καρδιακή συχνότητα της 24ωρη ABPM. Η περιοχή κάτω από την καμπύλη ROC για την πρόβλεψη της EVA ήταν 0,624 (95% CI 0,551-0,697, p<0,001), 0,559 (95% CI 0,484-0,635, p=0,127) και 0,565 (95% CI 0,490-0,641, p=0,093), για τη συστολική ΑΠ ημέρας από την 24ωρη ABPM , τη συστολική ΑΠ στο σπίτι και τη συστολική ΑΠ στο ιατρείο, αντίστοιχα. Οι μεταβλητές της 24ωρης ABPM, η ηλικία, το φύλο, ο δείκτης μάζας σώματος, η ύπαρξη σακχαρώδη διαβήτη (ναι/όχι) και ο ρυθμός σπειραματικής διήθησης χρησιμοποιήθηκαν για την ανάπτυξη ενός νέου μοντέλου υπολογισμού της EVA, που παρέχει υψηλή ακρίβεια, ευαισθησία και ειδικότητα. Συμπεράσματα: Η 24ωρη ABPM προβλέπει καλύτερα την ύπαρξη της EVA συγκριτικά με τις μετρήσεις στο σπίτι και στο ιατρείο. Ένα νέο μοντέλο πρόβλεψης, το EVAAs, δημιουργήθηκε για να ανιχνεύσει ασθενείς με EVA βάση των παραμέτρων της 24ωρης ABPM και των κλασσικών παραγόντων καρδιαγγειακού κινδύνου

Familial hypercholesterolemia and its manifestations: Practical considerations for general practitioners

Familial hypercholesterolemia (FH) is the most common genetic disorder of lipid metabolism, affecting almost 1 in 250 individuals worldwide. It is usually inherited via the autosomal dominant way and is characterized by aberrantly high total and low-density lipoprotein cholesterol (LDL-C) concentrations from early childhood, predisposing to increased risk of premature atherosclerotic cardiovascular disease (ASCVD), mostly coronary heart disease (CHD). Despite its high prevalence in the general population and the high ASCVD risk, FH is often underdiagnosed and undertreated. Genetic diagnosis is not always necessary since specific criteria, taking into account the patient’s individual and family history, clinical signs, and untreated LDL-C concentrations, may be used for prompt diagnosis. Except for CHD, which may be already evident at diagnosis, leading to increased mortality, other non-CHD morbidities, such as stroke, peripheral artery disease, carotid artery stenosis, and aortic valve calcification may be also present, substantiating the need for prompt intervention. Statins constitute the mainstay of treatment both in adults and children &gt;8 years old. In cases of statin intolerance or not achieving the LDL-C target despite maximally tolerated statin dose, ezetimibe and/or proprotein convertase subtilisin-kexin type 9 inhibitors may be used. The advent of recently approved medications, such as inclisiran and bempedoic acid, either as monotherapy or as add-on therapy to statins, has further enhanced the therapeutic armamentarium that can be used in FH patients. The purpose of this narrative review is to provide practical considerations regarding the diagnostic and therapeutic approach to FH patients

The links between sleep duration, obesity and type 2 diabetes mellitus.

Global rates of obesity and type 2 diabetes mellitus (T2DM) are increasing globally concomitant with a rising prevalence of sleep deprivation and sleep disorders. Understanding the links between sleep, obesity and T2DM might offer an opportunity to develop better prevention and treatment strategies for these epidemics. Experimental studies have shown that sleep restriction is associated with changes in energy homeostasis, insulin resistance and β-cell function. Epidemiological cohort studies established short sleep duration as a risk factor for developing obesity and T2DM. In addition, small studies suggested that short sleep duration was associated with less weight loss following lifestyle interventions or bariatric surgery. In this article, we review the epidemiological evidence linking sleep duration to obesity and T2DM and plausible mechanisms. In addition, we review the impact of changes in sleep duration on obesity and T2DM

The development of an oral GLP-1 receptor agonist for the management of type 2 diabetes: evidence to date.

Glucagon-like peptide 1 receptor agonists (GLP1-RA) are prominent agents in the therapeutics of type 2 diabetes mellitus due to their exemplary efficacy in both preprandial and postprandial glycemia, their safety, low risk of hypoglycemia, their multilevel pathophysiological superiority, weight loss and importantly the observed benefits in cardiovascular disease reduction. Their major drawback is the subcutaneous route of administration, constituting a barrier to adoption and reason for treatment discontinuation. Thus, the development of an oral GLP1-RA agent would promote medication adherence and quality of life, further consolidating its beneficial effects in real-life clinical practice. However, this task is hampered by suboptimal gastrointestinal protein absorption. Yet, the introduction of oral semaglutide, a modified form of semaglutide with the addition of a carrier sodium N-(8-[2-hydroxybenzoyl] amino) caprylate, may have provided a safe and effective way to reach systemic circulation while other molecules are in development. Whether this molecule still has the impressive cardiovascular effects demonstrated with the use of its precursor remains to be explored. However, to date, its efficacy and safety have already been showcased in a randomized trial. More research is warranted in order to further consolidate these findings across different type 2 diabetes mellitus (T2DM) subpopulations, and adequately powered studies with a longer follow-up that would allow the exploration of microvascular and macrovascular complications are needed. Finally, studies comparing oral semaglutide and similar molecules with other currently established antidiabetic agents to evaluate the relative efficacy, the cost-effectiveness and further understand its place in T2DM therapeutic algorithm are needed. This review focuses on the development of oral GLP1-RA agents and summarizes the challenges, milestones and expected benefits associated with a successful introduction

Sleep behaviours and associated habits and the progression of pre-diabetes to type 2 diabetes mellitus in adults:A systematic review and meta-analysis

INTRODUCTION: Certain sleep behaviours increase risk of type 2 diabetes mellitus (T2DM) in the general population, but whether they contribute to the progression from pre-diabetes to T2DM is uncertain. We conducted a systematic review to assess this. METHODS: Structured searches were performed on bibliographic databases (MEDLINE, EMBASE and CINAHL) from inception to 26/04/2021 for longitudinal studies/trials consisting of adults⩾18 years with pre-diabetes and sleep behaviours (short or long sleep duration (SD), late chronotype, insomnia, obstructive sleep apnoea, daytime napping and/or night-shift employment) that reported on incident T2DM or glycaemic changes. The Newcastle-Ottawa Scale was used for quality assessment. RESULTS: Six studies were included. Meta-analysis of three studies (n = 20,139) demonstrated that short SD was associated with greater risk of progression to T2DM, hazard ratio (HR) 1.59 (95% CI 1.29-1.97), I(2) heterogeneity score 0%, p < 0.0001, but not for long SD, HR 1.50 (0.86–2.62), I(2) heterogeneity 77%, p = 0.15. The systematic review showed insomnia and night-shift duty were associated with higher progression to T2DM. Studies were rated as moderate-to-high quality. CONCLUSIONS: Progression from pre-diabetes to T2DM increases with short SD, but only limited data exists for insomnia and night-shift duty. Whether manipulating sleep could reduce progression from pre-diabetes to T2DM needs to be examined