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Study Finds Innovative Cuffless Blood Pressure Device Streamlines And Enhances Hypertension Management

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Image of the cuffless blood pressure monitoring device that study participants wore.

Credit: Aktiia SA

A study led by a Brigham investigator evaluated a novel device that automatically measures blood pressure at the wrist, generating hundreds of readings within days that may help clinicians determine cardiovascular risk and improve hypertension care

High blood pressure, the leading risk factor for death worldwide, is present in one in every two adults. Only one-quarter of individuals with hypertension have their blood pressure under control, highlighting the need for innovative strategies for blood pressure management. A study led by an investigator from Brigham and Women's Hospital, a founding member of the Mass General Brigham healthcare system, evaluated a cuffless monitor that uses optical sensors to record blood pressure continually and efficiently, without disruption to the patient. The study, published in Frontiers in Medicine, highlights promising advancements in hypertension diagnosis, risk assessment and management that may be enabled by use of cuffless devices.

"The successful management of hypertension depends on patients being able to take blood pressure measurements easily and reliably outside of the traditional doctor's office setting," said corresponding author Naomi Fisher, MD, of the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women's Hospital. "Cuffless devices have the potential to revolutionize hypertension management. They provide many more readings than traditional devices, during both the day and night, which can help confirm the diagnosis of hypertension and guide medication titration."

Medical guidelines increasingly recommend the incorporation of at-home blood pressure monitoring into hypertension diagnosis and management. This is because isolated blood pressure readings taken at a clinician's office may be inaccurate: for some, blood pressure tends to rise in medical settings ("white coat hypertension") while others have normal blood pressure during examination despite hypertensive readings at home ("masked hypertension").

Time-in-target-range (TTR) describes how often a patient's blood pressure is in the normal range, and it is emerging as a promising metric of cardiovascular risk. But TTR requires more frequent blood pressure readings that can feasibly be obtained by patients with traditional blood pressure cuffs, which can be inconvenient, burdensome and sometimes uncomfortable for patients.

Fisher, who designed and led the study, collaborated with co-authors from Aktiia SA, a Swiss biotechnology company, to analyze over 2.2 million blood pressure readings from 5,189 subjects in Europe and the U.K. Who wore a cuffless wrist monitor manufactured by Aktiia. On average, the Aktiia device collected 29 readings per day, a substantial increase from the number of blood pressure readings patients typically take with home devices (guidelines recommend four per day, which is more than most patients measure). Over a 15-day period, the researchers obtained an average of 434 readings from each patient.

By calculating TTR over a 15-day period, the researchers were able to risk stratify participants by percentage of readings in target range and compare these classifications to those generated via traditional measurement patterns, using either 24-hour or week-long daytime monitoring schedules. They found that the traditional methods misclassified 26 and 45 percent of subjects, respectively, compared to the reference TTR. They determined that continual monitoring for seven days is required to obtain 90 percent or greater accuracy in hypertension risk classification, a frequency of measurement that may only be possible with cuffless monitors.

Though the cuffless device studied here has not been approved by the U.S. Food and Drug Administration, it has been validated in multiple studies and is available for over-the-counter purchase in Europe and the U.K. Work to evaluate and set standards for such devices in the U.S. Is ongoing.

"For the first time, by using a cuffless device, we can collect continual out-of-office blood pressure readings and use these data to calculate a new metric, time-in-target-range, which shows great promise as a predictor of risk," Fisher said. "The use of cuffless devices could create a shift in the paradigm of blood pressure monitoring and hypertension management."

Authorship: Fisher's co-authors on the paper include Tiago P. Almeida, David Perruchoud, Jay Shah, and Josep Sola.

Disclosures: Fisher serves as a consultant for Aktiia SA. Almeida, Perruchoud, Shah, and Sola are employees of Aktiia SA.

Funding: No financial support was received for this research.

Paper cited: Fisher, ND et al. "Optimizing Time-in-Target-Range Assessment for Blood Pressure: Insights from a Large-Scale Study with Continual Cuffless Monitoring" Frontiers in Medicine DOI: 10.3389/fmed.2024.1396962

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Journal

Frontiers in Medicine

Method of Research

Observational study

Subject of Research

People

Article Title

Optimizing Time-in-Target-Range Assessment for Blood Pressure: Insights from a Large-Scale Study with Continual Cuffless Monitoring

Article Publication Date

26-Jun-2024

COI Statement

Fisher serves as a consultant for Aktiia SA. Almeida, Perruchoud, Shah, and Sola are employees of Aktiia SA.

Disclaimer: AAAS and EurekAlert! Are not responsible for the accuracy of news releases posted to EurekAlert! By contributing institutions or for the use of any information through the EurekAlert system.

Study Indicates Nonphysician-implemented Multifaceted Intervention Beneficial For Hypertension

For older and younger adults with hypertension, a nonphysician-implemented, multifaceted, intensive blood pressure intervention can reduce the risk for cardiovascular disease (CVD) and all-cause mortality, according to a study published online June 18 in JAMA Cardiology.

Xiaofan Guo, M.D., Ph.D., from the First Hospital of China Medical University in Shenyang, and colleagues conducted a 48-month follow-up study of the China Rural Hypertension Control Project from 2018 to 2023. Participants recruited from 326 villages in rural China, aged 60 years and older and younger than 60 years, with a diagnosis of hypertension were included (22,386 and 11,609 individuals, respectively).

Among the older adults with hypertension, 11,289 and 11,097 were randomly assigned to a nonphysician, community health care practitioner-implemented multifaceted intervention to achieve blood pressure of less than 130/80 mm Hg and to a usual-care group, respectively. The researchers found a significantly lower rate of total CVD and all-cause mortality in the intervention group versus usual-care group (hazard ratios, 0.75 and 0.90, respectively).

The risk reductions were also significant for total CVD, stroke, heart failure, and cardiovascular death among adults younger than 60 years (hazard ratios, 0.64, 0.64, 0.39, and 0.54, respectively). No significant between-group differences were seen in the incidences of injurious falls, symptomatic hypotension, syncope, and results for kidney outcomes in either age group.

"These results have substantial implications for the future of hypertension management among older adults who represent a large proportion of the population and high absolute risk for CVD complications," the authors write.

More information: Xiaofan Guo et al, Multifaceted Intensive Blood Pressure Control Model in Older and Younger Individuals With Hypertension, JAMA Cardiology (2024). DOI: 10.1001/jamacardio.2024.1449

Daniel W. Jones, A Pathway to Better Blood Pressure Control, JAMA Cardiology (2024). DOI: 10.1001/jamacardio.2024.1463

Citation: Study indicates nonphysician-implemented multifaceted intervention beneficial for hypertension (2024, June 20) retrieved 30 June 2024 from https://medicalxpress.Com/news/2024-06-nonphysician-multifaceted-intervention-beneficial-hypertension.Html

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Study: Hypertension Emerges As Most Common Modifiable Risk Factor For Dementia Globally

Hypertension is now the top dementia risk factor. That compares to past years when smoking or less education were the leading risk factors, a new study finds.

The findings were published Wednesday in The Lancet Public Health, which explored how the prevalence of dementia risk factors have changed over time and how this could affect rates of dementia in the future. The team looked at 27 studies about people with dementia around the world, with data spanning 1947 to 2020. Investigators pulled out data about dementia risk factors and then calculated how many dementia cases were linked to each one.

Over time, having less education and smoking were less common and were associated with a decline in rates of dementia. Rates of obesity and diabetes have gone up over time, as has their contribution to the risk for dementia. Per the latest data, hypertension was the greatest risk factor, though proactively managing the condition has improved over time as well.

"Cardiovascular risk factors may have contributed more to dementia risk over time, so these deserve more targeted action for future dementia prevention efforts," Naaheed Mukadam, a professor at University College London, said in a statement. "Our results show that levels of education have increased over time in many higher income countries, meaning that this has become a less important dementia risk factor. Meanwhile, smoking levels have also declined in Europe and the USA as it has become less socially acceptable and more expensive."

"These patterns suggest that population-level interventions could significantly impact the occurrence of dementia risk factors, and governments should consider implementing schemes such as worldwide policies of education, and restrictions on smoking," Mukadam added.

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