Validation of the YuWell YE680B upper-arm blood pressure monitor in adults according to the ANSI/AAMI/ISO 81060-2: 2013 standard Objective: To evaluate the accuracy of the YuWell YE680B oscillometric upper-arm blood pressure monitor for clinic and home blood pressure measurements in adults according to the American National Standards Institute/the Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 standard. Method: Eighty-five subjects (male 46 and female 39) with a mean age of 44.6 years were recruited to fulfill the age, sex, blood pressure, and cuff distribution criteria of the ANSI/AAMI/ISO standard in the general population using the same arm sequential blood pressure measurement method. Two differently-sized cuffs were used for arm circumferences 22–32 cm (medium) and 22–45 cm (large), respectively, for the test device, and for arm circumferences ≤32 cm (standard) and >32 cm (large), respectively, for the mercury sphygmomanometer. Results: A total of 255 comparison pairs were obtained for analysis. For validation criterion 1, the mean ± SD of the differences between the test device and reference systolic/diastolic blood pressure readings was −2.2 ± 7.2/−3.9 ± 5.2 mmHg. For validation criterion 2, the SD of the averaged systolic/diastolic blood pressure differences between the test device and reference blood pressure per subject was 5.70/4.67 mmHg. Conclusion: The automated upper-arm blood pressure monitor YuWell YE680B has passed the requirements of the ANSI/AAMI/ISO81060-2:2013 standard, and hence can be recommended for blood pressure measurement in the general population. Received 30 June 2019 Accepted 14 August 2019 Correspondence to Ji-Guang Wang, MD, PhD, The Shanghai Institute of Hypertension, Ruijin 2nd Road 197, Shanghai 200025, China, Tel: +86 21 64370045 x610911; fax: +86 21 64662193; e-mail: jiguangwang@aim.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Validation of Transtek TMB-1776 according to European Society of Hypertension International Protocol revision 2010 in adults In the present study, accuracy of Transtek TMB-1776 upper-arm blood pressure monitor in adult subjects was determined by comparing with a non-invasive (auscultatory) reference mercury sphygmomanometer, following the European Society of Hypertension International Protocol revision 2010 (ESH-IP 2010). All the validation requirement were reached: 74, 93, and 98 of systolic blood pressure measurements and 86, 97, and 99 of diastolic blood pressure measurements were within 5, 10, and 15 mmHg of absolute difference, respectively. The mean ± SD device-observer difference was −1.2 ± 4.9 mmHg for systolic blood pressure and −0.7 ± 3.5 mmHg for diastolic blood pressure. For systolic blood pressure and diastolic blood pressure, respectively, 25 and 30 of subjects had at least two of their three difference within 5 mmHg, and three and zero subject showed no difference within 5 mmHg. In conclusion, Transtek TMB-1776 has passed all phases of ESH-IP 2010 and is suitable for self/home blood pressure measurement of adults. Received 11 June 2019 Accepted 16 August 2019 Correspondence to Zhong Hua Liu, MD, Department of Neurology, Zhongshan People’s Hospital, Zhongshan 528403, Guangdong, China, Tel: +86 760 89880205; e-mail: liu-zhonghua@outlook.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Large body mass index and waist circumference are associated with high blood pressure and impaired fasting glucose in young Chinese men Background: Obesity is closely related to many chronic diseases and metabolic risk factors. The present study examined the relationship of obesity-related indices to blood pressure (BP) and fasting plasma glucose (FPG) among young Chinese men. Methods: A total of 1193 male college students aged 18–22 years participated in the study. Height, weight, waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and FPG were measured. High BP was defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg. Impaired fasting glucose (IFG) was defined as FPG ≥5.6 mmol/L. Results: BMI, WC and WHtR were positively correlated with BP and FPG (rBMI-SBP = 0.455, rBMI-DBP = 0.367, rBMI-FPG = 0.113, rWC-SBP = 0.445, rWC-DBP = 0.382, rWC-FPG = 0.115, rWHtR-SBP = 0.396, rWHtR-DBP = 0.302, rWHtR-FPG = 0.106, P all < 0.01). When categorized by BMI (underweight, normal weight, overweight and obesity), the mean values of SBP, DBP, FPG and the prevalence of high BP and IFG increased with BMI, significant differences were observed among the four groups (P < 0.01). When categorized by WC and WHtR, similar differences were observed, with subjects in the large WC/WHtR group had a higher BP and FPG than their counterparts in the low WC/WHtR group (P < 0.01). Conclusion: Large BMI and WC/WHtR are associated with high BP and IFG. Our results suggested that prevention of obesity in youth may be an effective approach for preventing the development of diabetes and hypertension in the future. * Dr. Shu-rong Wang and Dr. Ying-xiu Zhang contributed equally to the writing of this article, and should be considered as co-first authors. Received 15 April 2019 Accepted 14 August 2019 Correspondence to Ying-xiu Zhang, Shandong Center for Disease Control and Prevention, Shandong University Institute of Preventive Medicine, 16992 Jingshi Road, Jinan, Shandong 250014, China, Tel: +86 0531 82679413; fax: +86 0531 82679413; e-mail: sdcdczyx@163.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Ambulatory blood pressure monitoring parameters in obese children and adolescents with masked hypertension Objective We aimed to compare the demographic, laboratory, and ambulatory blood pressure monitoring (ABPM) parameters of patients with masked hypertension (MHT), define factors predicting MHT, and determine the ABPM parameters affecting left ventricular mass index (LVMI) in obese youth. Methods Data of obese patients were evaluated retrospectively. Patients with ambulatory hypertension (AHT), white-coat hypertension (WCHT), MHT, or normotension (NT) were determined. Demographic and laboratory findings, office and ABPM measurements, blood pressure variability (BPV), and heart rate variability (HRV) were compared between the groups. The factors predicting MHT and the association between LVMI and ABPM, BPV/HRV parameters were analyzed. Results None of the 118 patients (M/F: 52/66) had WCHT. Three groups were formed: AHT (n: 60, 51%), MHT (n: 46, 39%), and NT (n: 12, 10%). Striae were significantly more frequent in AHT and MHT groups (P: 0.003). Cut-off levels for office BP measurements predicting MHT were 0.85 and 0.76 for systolic and diastolic BP (SBP and DBP) indexes, respectively. Most of the ABPM parameters of MHT group were as high as those of AHT group. On regression analysis, only daytime MAP had a positive (β: 0.340; P < 0.01) and diastolic dip (β: −0.204; P < 0.01) had a significantly negative association with LVMI. Conclusion Stria and cut-off levels for office SBP/DBP indexes, which were defined for the first time in this study, may determine the patients at risk of MHT. Although BPV or HRV had no relation to LVMI, daytime MAP and diastolic dip represented independent associations with LVMI. * Gökçe Yegül Gülnar and Belde Kasap Demir contributed equally to the writing of this article. * Nejat Aksu deceased. Received 29 May 2018 Accepted 1 August 2019 Correspondence to Belde Kasap-Demir, MD, Department of Pediatrics, Division of Pediatric Nephrology, İzmir Katip Çelebi University, İzmir, Türkiye, Tel: +90 532 5034675; fax: +90 232 433 07 56; e-mail: beldekasap@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Relationship between the fall in blood pressure in the standing position and diaphragmatic muscle thickness: proof of concept study Background The diaphragm is an important muscle of respiration, and regulates the intrathoracic pressure. Blood pressure is regulated by the baroreceptor reflex system, and is also affected by intrathoracic pressure. We examined the relationship between the diaphragmatic muscle thickness and the degree of drop in blood pressure in the standing position. Methods We prospectively studied 15 healthy subjects. The diaphragmatic muscle thickness was measured using a B-mode ultrasonic imaging device. The blood pressure before and after standing was measured by a head-up tilt test. Results The diastolic blood pressure difference during expiration and inspiration showed a significant correlation with the diaphragmatic muscle thickness (r = 0.578, P = 0.024 and r = 0.518, P = 0.048, respectively). Conclusion The diaphragmatic muscle thickness was related to the fall in diastolic blood pressure in the standing position. This indicates that adequate diaphragmatic muscle thickness helps to maintain intrathoracic pressure and prevents excessive drop in blood pressure in the standing position. Received 11 January 2019 Accepted 5 August 2019 Correspondence to Atsushi Ichikawa, PhD, Department of Cardiovascular Control, Kochi Medical School, Oko-cho, Nankoku, 783–8505, Japan, Tel: +81 88 880 2587; fax: +81 88 880 2310; e-mail: ichik@kochi-u.ac.jp Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Simulator-based assessment of ankle arterial systolic blood pressure measurement skills Objective Learning basic vascular examination is a complex process. Very few studies have focused on the ability to measure the arterial systolic blood pressure at the ankle (ASBPa). The aim of this study was to objectively assess the effects of a 1-h practical educational intervention on the ability to measure ASBPa among medical students. Methods A total of 27 medical students were prospectively recruited. Two evaluation sessions of ASBPa measurement skills were conducted, before (T1) and after a 1-h practical lesson (T2). To assess the learning effect associated to the simulator-based evaluation, a control group composed by nonmedical students, not involved in the practical lesson, was also tested. Objective assessments of ASBPa measurements were performed by an instrumented leg prototype. Results There was a nonsignificant decreasing trend measurement time after practical lesson. The average pressure determination error (ΔP) was significantly reduced: ΔPT1: 10.5 ± 13.8 mmHg vs. ΔPT2: 5.7 ± 6.0 mmHg (P = 0.002). The mean deflation rate (DR) of the cuff was significantly decreased: DRT1: 12.9 ± 9.2 mmHg/s vs. DRT2: 8.7 ± 4.6 mmHg/s (P = 0.001). The control group did not show significant changes. Conclusion A 1-h practical learning could improve some parameters of the ASBPa measurement among medical students, but was not sufficient to allow the measured technical factors to reach established guidelines. Received 6 September 2018 Accepted 18 July 2019 Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.bpmonitoring.com. Correspondence to Florian Congnard, IFEPSA, 49 rue des Perrins, 49130 Les Ponts-de-Cé, France, Tel: +33 (0)2 41 45 26 40; fax: +33 (0)2 41 45 26 44; E-mail: fcongna2@uco.fr Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Evaluating the performance of automated sphygmomanometers using a patient simulator Background and objective: Automated sphygmomanometers use the oscillometric method to measure blood pressure, which is based on an algorithm that relates the amplitude of the oscillometric waveform pulses and the pressure inside the cuff. Validation uses empirical information from clinical trials conducted by each manufacturer. Consequently, measurement algorithms are not harmonized, being based on distinct arterial waveforms, according to each group of volunteers of the clinical test. In the present study, a patient simulator was used to generate standardized, consistent oscillometric waveform pulses to test the algorithms used in six sphygmomanometers. Materials and methods: Six different upper arm and wrist-based automated sphygmomanometers were tested using a patient simulator comprising four different blood pressure levels, Psys/dia (mmHg): 80/50; 120/80; 150/100; 200/150. The devices were also submitted to conformity assessment. The variance of repeatable measurements was also analyzed. Results: All tested automated sphygmomanometers complied with metrological requirements, presenting results within the range of ±2 mmHg for static calibration. Systematic discrepancies, greater than 20 mmHg, were observed between sphygmomanometers’ results from upper arm and wrist-based models. Differences reaching 12.8 mmHg in diastolic pressure results were observed among upper arm devices. Conclusion: These results may have a clinical impact and indicate the need for a standardized algorithm, with a harmonized approach for validation. Moreover, the algorithm of the wrist-based devices is being affected by the use of the brachial artery waveform as reference for its validation, which also reveals that the current approach needs standardization, especially regarding the use of patient simulators. Received 2 April 2019 Accepted 27 June 2019 Correspondence to Bruno Amado Rodrigues Filho, PhD, National Institute of Metrology, Quality and Technology–Inmetro, São Paulo Office, 1922 Santa Cruz St., São Paulo, SP 04122-002, Brazil, Tel: +551135812460; e-mail: bafilho@inmetro.gov.br Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.