Hem 9000ai

Height was measured using a rigid stadiometer (TTM stadiometer; Tsutsumi Co., Ltd., Tokyo, Japan). Weight was measured using calibrated scales (AD-6107NW; A&D Medical Co., Ltd., Tokyo, Japan). BMI was calculated as body weight in kilograms divided by the square of body height in meters. Waist circumference was measured at the umbilical level at the end of exhalation in a standing position. Handgrip strength was measured using a Smedley analog hand dynamometer (No. 04125; MIS, Tokyo, Japan) with both hands in a standing position. The measurements were first performed for the dominant hand. Subjects performed two maximum attempts for each hand with approximately 1-min rest period between trials. We used the average handgrip strength in kilograms. According to a consensus report of the Asian Working Group for Sarcopenia, we defined sarcopenic subjects as follows: age, ≥ 65 years and handgrip strength, <26 kg for men and <18 kg for women^{49 (link)}.
Blood pressure was measured in a seated position using an automatic sphygmomanometer (HBP-9020; Omron Co., Ltd, Tokyo, Japan). Arterial stiffness was examined by measuring both baPWV and AIx₇₅ using a pulse pressure analyzer (BP-203RPE; Nihon Colin, Tokyo, Japan) and a digital automatic sphygmomanometer (HEM-9000AI; Omron Co., Ltd, Tokyo, Japan), respectively.

A noninvasive blood pressure monitor (HEM-9000AI; Omron, Kyoto, Japan) that can record the corresponding blood pressure and heart rate was used for the ABPM of subjects every 30 min during daytime (06:00–22:00) and every 60 min during nighttime (22:00–06:00). Daytime systolic and diastolic, nocturnal systolic and diastolic, morning surge in systolic and diastolic blood pressure (DSBP, DDBP, NSBP, NDBP, MSBP, and MDBP, respectively) and the daytime and nocturnal mean heart rates (D-HR and N-HR, respectively) were recorded. Effective blood pressure and heart rate data should be greater than 85% of the set number; otherwise, they were retested.

Participants took a rest of about 10 min, and then vascular function and blood pressure were measured. Vascular function was evaluated by acceleration plethysmogram (APG) using a Pulse Analyzer^® device (Pulse Analyzer Plus View^®, YKC Corporation, Tokyo, Japan) as described in the previous report [15 (link)]. Briefly, APG was measured with the device attached to the left middle finger of each participant. APG is the second derivative wave of the photoplethysmogram, which consisted of a, b, c, and d waves, namely, early systolic positive wave, early systolic negative wave, late systolic re-increasing wave, and late systolic re-decreasing wave, respectively. Their magnitudes and the height ratios of b/a, c/a, and d/a were measured. Vascular age was calculated from the second derivative of the photoplethysmogram aging index, which is [(b-c-d-e)/a] wave ratio [20 (link),21 (link),22 (link)]. Vascular waveform, waveform score, and peripheral vascular health were calculated from a wave pattern, and the ratios of these 4 waves were calculated using software for the Pulse Analyzer^®. Systolic, diastolic, and central blood pressure were measured in the right upper arm using an automated sphygmomanometer (HEM-9000AI, OMRON Corporation, Kyoto, Japan).

The brachial and central BP measured in the morning after 5-min of rest. The right brachial BP was oscillometrically measured and the left radial arterial pulse waves were recorded simultaneously by the tonometry (HEM 9000AI, Omron Healthcare, Kyoto, Japan)^{21 (link)}. For each patient, the measurements described above were repeated twice. The averaged radial artery waveforms were processed with dedicated software and corresponding central aortic pressure waveforms were derived. Peripheral AIx and AIx75, an index normalized for a 75-bpm heart rate, were used because of a close agreement between central and peripheral Aix^{22 (link)}. Arterial wave contours were digitalized by a GetData graph digitizer (GetData Pty Ltd., Kogarah, Australia) consequently analysed using statistical software R developed by R Core Team, 2015 (R Foundation for Statistical Computing, Vienna, Austria). Area under the curve (AUC) was calculated in the area of rectangle (100 × 600).

Central BP was evaluated noninvasively by mathematically transforming the radial artery pulse waveform to the aortic pulse waveform with an automated tonometric system, HEM-9000AI (Omron Healthcare, Kyoto, Japan) in a sitting position after at least 5 min of rest. The radial artery pressure waveform was recorded for 10 sec with the HEM-9000AI system. The radial pulse wave was calibrated to brachial BP, measured with an automated oscillometric device. From the average radial pulse wave form, the corresponding ascending aortic pulse wave form was derived, using a validated generalized transfer function incorporated in the software (Omron Healthcare), which also provided the calculated central BP and the calculated central Aix. The measurements of blood pressure were performed twice by the same trained observer in same day at intervals of at least one minute.