M4 plus

The clinical assessment focused on cardiovascular risk factors, including a family history of cardiovascular conditions; cardiovascular symptoms; comorbidities; nicotine dependence; impaired carbohydrate metabolism; lifestyle; office blood pressure measurement (OBPM) (systolic and diastolic BP [SBP and DBP]), heart rate (HR), and BMI. The standard OBPMs were conducted with an automatic sphygmomanometer (Omron M4 Plus, Japan) in accordance with European Society of Cardiology (ESC) guidelines (21 (link)).

The clinical examination focused mainly on cardiovascular risk factors, such as family history of cardiovascular disease or nicotinism, and BMI. Office BP measurements were automated (Omron M4 Plus, Japan) according to ESC guidelines (6 (link)). Office systolic blood pressure (SBP) and office diastolic blood pressure (DBP) measurements were performed in the presence of a trained physician or nurse, in a quiet room, in a sitting position after a minimum of 5 min of rest, with the arm supported and legs uncrossed. Subjects were instructed not to smoke; drink alcohol, coffee, or other fluids potentially increasing BP; or take drugs potentially affecting BP (e.g., pain killers) for a minimum 12-h period before the measurement. The mean of two measurements of both SBP and DBP was included in the final analysis.

All study subjects underwent a clinical examination for cardiovascular risk factors. This included a thorough history for any cardiovascular symptoms, comorbidities, smoking, carbohydrate metabolism disorders, lifestyle, and family history of cardiovascular disease. Measurements included anthropometric parameters (body weight, height, BMI), heart rate (HR), and office systolic and diastolic BP (SBP and DBP) values. Office BP measurements (OBPM) were performed according to the European Society of Cardiology (ESC) guidelines using an automatic sphygmomanometer (Omron M4 Plus, Kyoto, Japan) [26 (link)].

Peripheral SBP and DBP measurements were performed automatically (Omron M4 Plus, Japan) at the brachial artery of the non-dominant arm in a relaxed seated position. Two BP measurements obtained at an interval of 5 min during the same visit were averaged. Central hemodynamics and parameters were assessed with pulse wave analysis of the radial artery using commercially available radial artery tonometry (SphygmoCor, AtCor Medical, Sydney, Australia) [7 (link), 8 (link)]. The measurements were obtained in the supine position after a minimum of 5 min of rest just before the echocardiogram. Peripheral pressure wave form was recorded from the radial artery with a high-fidelity micromanometer (Millar Instruments, Houston, TX) [8 (link), 9 (link)]. Central systolic blood pressure (BP), diastolic BP, pulse pressure (PP), augmentation pressure, and augmentation index (AIx) were analyzed from 20 sequential pulse waveforms. PP was calculated as the difference between SBP and DBP. Augmentation pressure was the maximum systolic pressure minus pressure at the inflection point. The AIx was defined as AP divided by PP and expressed as a percentage. As in previous studies, because AIx is influenced by the heart rate, it was normalized for a heart rate of 75 bpm (AIx@75) [10 ]. Pulse wave velocity (PWV) was measured using carotid-femoral pressure pulse transit time.

The clinical examination was conducted with a particular focus on cardiovascular risk factors (including family history of cardiovascular disease; cardiovascular symptoms; comorbidities; nicotine dependence; impaired carbohydrate metabolism; lifestyle; office BP measurement, including systolic and diastolic blood pressure (SBP and DBP); heart rate (HR); and anthropometric measurements (height, body weight, BMI). The office BP measurement was performed with the use of an automatic device (Omron M4 Plus, Japan) in accordance with European Society of Cardiology guidelines (13 (link)).