Association of Isolated Diastolic Hypertension Based on the Cutoff Value in the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines With Subsequent Cardiovascular Events in the General Population

Kaneko, Hidehiro; Itoh, Hidetaka; Yotsumoto, Haruki; Kohno, Hiroyuki; Kamon, Tatsuya; Fujiu, Katsuhito; Morita, Kojiro; Michihata, Nobuaki; Jo, Taisuke; Takeda, Norifumi; Morita, Hiroyuki; Yasunaga, Hideo; Komuro, Issei

doi:10.1161/jaha.120.017963

Cited by 61 publications

(53 citation statements)

References 38 publications

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“…The dependability of the diastolic foot and our robust DBP estimation were necessary before performing in-depth analyses with confidence. Although elevated SBP is considered to be the greatest predictor of future cardiovascular risk [ 39 , 40 ], elevated DBP has nonetheless been shown to independently increase the risk of subsequent cardiac events [ 39 , 41 ]. In addition, DBP is a greater contributor to MAP, which in older patients with isolated systolic hypertension, when compared with an equivalent increase in pulse pressure, has been shown to be a comparable independent predictor of both stroke and all-cause mortality [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study

Ganti¹,

Carek²,

Jung³

et al. 2021

JMIR Mhealth Uhealth

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Background Noninvasive and cuffless approaches to monitor blood pressure (BP), in light of their convenience and accuracy, have paved the way toward remote screening and management of hypertension. However, existing noninvasive methodologies, which operate on mechanical, electrical, and optical sensing modalities, have not been thoroughly evaluated in demographically and racially diverse populations. Thus, the potential accuracy of these technologies in populations where they could have the greatest impact has not been sufficiently addressed. This presents challenges in clinical translation due to concerns about perpetuating existing health disparities. Objective In this paper, we aim to present findings on the feasibility of a cuffless, wrist-worn, pulse transit time (PTT)–based device for monitoring BP in a diverse population. Methods We recruited a diverse population through a collaborative effort with a nonprofit organization working with medically underserved areas in Georgia. We used our custom, multimodal, wrist-worn device to measure the PTT through seismocardiography, as the proximal timing reference, and photoplethysmography, as the distal timing reference. In addition, we created a novel data-driven beat-selection algorithm to reduce noise and improve the robustness of the method. We compared the wearable PTT measurements with those from a finger-cuff continuous BP device over the course of several perturbations used to modulate BP. Results Our PTT-based wrist-worn device accurately monitored diastolic blood pressure (DBP) and mean arterial pressure (MAP) in a diverse population (N=44 participants) with a mean absolute difference of 2.90 mm Hg and 3.39 mm Hg for DBP and MAP, respectively, after calibration. Meanwhile, the mean absolute difference of our systolic BP estimation was 5.36 mm Hg, a grade B classification based on the Institute for Electronics and Electrical Engineers standard. We have further demonstrated the ability of our device to capture the commonly observed demographic differences in underlying arterial stiffness. Conclusions Accurate DBP and MAP estimation, along with grade B systolic BP estimation, using a convenient wearable device can empower users and facilitate remote BP monitoring in medically underserved areas, thus providing widespread hypertension screening and management for health equity.

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Section: Discussionmentioning

confidence: 99%

Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study

Ganti¹,

Carek²,

Jung³

et al. 2021

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

show abstract

“…At present, there are conflicting results from previous large epidemiological studies on whether the 2017 ACC/AHA guideline‐based IDH is associated with an increased risk of CVD outcomes. 8 , 9 , 14 , 18 , 19 The studies by McEvoy and coworkers 8 in American adults and McGrath and coworkers 14 in the United Kingdom Biobank cohort showed that there was no association between the 2017 ACC/AHA guideline‐defined IDH and an increased risk of CVD outcomes. This conclusions was contrary to our findings, and these differences with our findings might be attributable to the differences in the study population, study design, end points, follow‐up time, and location.…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to these studies that reported an absence of any association between IDH and CVD outcomes, the following studies showed a significant association between IDH and CVD outcomes. A large‐scale, epidemiological study in Japan 18 showed that IDH as defined by the 2017 ACC/AHA guideline was associated with an increased risk of CVD events. This conclusions is similar to our study results, but the primary end points in our study and theirs were different.…”

Section: Discussionmentioning

confidence: 99%

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Association of isolated diastolic hypertension based on different guideline definitions with incident cardiovascular risk in a Chinese rural cohort

Zhang

Liu

Jiao

et al. 2021

J of Clinical Hypertension

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The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline lowered the threshold (systolic blood pressure [SBP] <130 mm Hg and diastolic blood pressure [DBP] ≥80 mm Hg) for isolated diastolic hypertension (IDH), whereas the 2018 Chinese guideline still recommends the old threshold (SBP <140 mm Hg and DBP ≥90 mm Hg). This study aimed to investigate the association between IDH, as defined by both guidelines, and the risk of incident cardiovascular disease (CVD) in rural areas of northeast China. This prospective study included participants whose baseline data were collected between 2004 and 2006. The exclusion criteria were baseline CVD, incomplete data, and systolic hypertension. The primary end point was incident CVD, a composite end point including nonfatal myocardial infarction (MI), nonfatal stroke, and CVD death. Multivariate Cox models were used to evaluate the association of IDH with CVD risk. The authors analyzed 19 688 participants (7140 participants with IDH) according to the ACC/AHA guideline. Compared with normotensive participants, individuals with ACC/AHA‐defined IDH were at a high risk of CVD (HR = 1.177, 95% CI: 1.035–1.339). A similar difference in CVD risk was noted when normotensive participants were compared with those with IDH, determined based on the 2018 Chinese guideline (HR = 1.218, 95% CI: 1.050–1.413). Similar results were found in participants who did not take antihypertensives at baseline. Moreover, IDH defined by either guideline was significantly associated with nonfatal MI. ACC/AHA‐defined IDH was associated with a risk of CVD, implying that blood pressure management should be improved in rural areas of China.

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“…The dependability of the diastolic foot and our robust DBP estimation were necessary before performing in-depth analyses with confidence. Although elevated SBP is considered to be the greatest predictor of future cardiovascular risk [39,40], elevated DBP has nonetheless been shown to independently increase the risk of subsequent cardiac events [39,41]. In addition, DBP is a greater contributor to MAP, which in older patients with isolated systolic hypertension, when compared with an equivalent increase in pulse pressure, has been shown to be a comparable independent predictor of both stroke and all-cause mortality [42].…”

Section: Accurately Estimating Bp In a Diverse Population Using A Multimodal Wearable Devicementioning

confidence: 99%

Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study (Preprint)

Ganti¹,

Carek²,

Jung³

et al. 2021

Preprint

View full text Add to dashboard Cite

BACKGROUND Noninvasive approaches to monitor blood pressure (BP), in light of their convenience and accuracy, have paved the way towards remote screening and management of hypertension. However, existing noninvasive methodologies—which operate on mechanical, electrical, and optical sensing modalities—have not been thoroughly evaluated in demographically and racially diverse populations. Thus, the potential accuracy of these technologies in the very populations where they could have the most impact has not been sufficiently addressed. This presents challenges towards clinical translation, due to concerns of perpetuating existing health disparities. OBJECTIVE Here, we present findings on the feasibility of a cuff-less, wrist-worn, pulse transit time (PTT) based device for monitoring BP in a diverse population. METHODS The diverse population was recruited through a collaborative effort with a non-profit working with medically underserved areas (MUA) in Georgia. We used our custom, multi-modal, wrist-worn device to measure the PTT through photoplethysmography—as the distal timing reference—and seismocardiography—as the proximal timing reference. In addition, we created a novel data-driven beat selection algorithm to reduce noise and improve the robustness of the method. We compared the wearable PTT measurements to those from a finger-cuff continuous BP device over the course of several perturbations used to modulate BP. RESULTS Our PTT-based wrist-worn device accurately monitors BP in a diverse population (N = 44 subjects) with a mean-absolute-difference (MAD) of 2.90 mmHg after calibration. We further show the ability of our device to capture commonly observed demographic differences in underlying arterial stiffness. CONCLUSIONS Accurate BP estimation using a convenient wearable device can empower users and facilitate remote blood pressure monitoring in MUAs, thus providing widespread hypertension screening and management towards health equity.

show abstract

Association of Isolated Diastolic Hypertension Based on the Cutoff Value in the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines With Subsequent Cardiovascular Events in the General Population

Cited by 61 publications

References 38 publications

Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study

Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study

Association of isolated diastolic hypertension based on different guideline definitions with incident cardiovascular risk in a Chinese rural cohort

Enabling Wearable Pulse Transit Time-Based Blood Pressure Estimation for Medically Underserved Areas and Health Equity: Comprehensive Evaluation Study (Preprint)

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