Padwal Raj

University of Alberta | UAlberta · Department of Medicine

This study evaluates the accuracy of the Hipermax-BF model A7101 (Combiomed, Havana, Cuba) automatic oscillometric upper-arm sphygmomanometer for office and home use in general population as part of the HEARTS in the Americas initiative. The research was developed according to the Universal Standard AAMI/ESH/ISO ISO 81060-2:2018/Amd 1:2020. The sub...

Accurate arm circumference (AC) measurement is required for accurate blood pressure (BP) readings. Standards stipulate measuring arm circumference at the midpoint between the acromion process (AP) and the olecranon process. However, which part of the AP to use is not stipulated. Furthermore, BP is measured sitting but arm circumference is measured...

Background Whether certain medical conditions are associated with blood pressure (BP) treatment and control is unclear. Methods Using the Canadian Health Measures Survey (2007-2019), BP was assessed according to the presence of selected comorbidities, including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus,...

Objective Understanding of how oscillometric waveforms (OMW) vary between pregnant and nonpregnant individuals remains low. An exploratory analysis was completed to assess for quantitative and qualitative changes in OMW and oscillometric envelope features in pregnancy. Design and methods Eighteen pregnant individuals (over 20 weeks gestational age...

This study was designed to evaluate the accuracy of the Hipermax-BF model A7101 automatic oscillometric arm sphygmomanometer (Combiomed, Havana, Cuba) in general population. The research was developed according to the Universal Standard AAMI/ESH/ISO (ISO 81060-2:2018) and the ISO 81060-2:2018/DAM amendment 1 of 2020. The subjects were recruited acc...

Background The hypertension specialist often receives referrals of patients with young-onset, severe, difficult-to-control hypertension, patients with hypertensive emergencies, and patients with secondary causes of hypertension. Specialist hypertension care compliments primary care for these complex patients and contributes to an overall hypertensi...

Introduction: The gold standard for diagnosis hypertension is a 24-hour ambulatory blood pressure monitor (ABPM). In-office blood pressure may be falsely high in 30% of individuals (white coat hypertension) or falsely normal in 20% of individuals (masked hypertension). We hypothesize that ABPM funding varies across Canada and the U.S, and sought to...

Background: HTN treatment based on AOBP lowers risk of CVD. SMBP has been promoted as an alternative to AOBP that could improve access and achieve more timely BP control. However, questions remain about the concordance between SMBP and AOBP. Objective: To compare SMBP and AOBP measurements in a 6-month SMBP program. Methods: In this quality improve...

Office blood pressure measurement has been the primary means of diagnosing and treating hypertension for almost a century. Increasingly, guidelines recommend out-of-office measurements (ambulatory or home blood pressure measurement) to confirm the diagnosis of hypertension and to follow treated patients. Ambulatory blood pressure measurement includ...

Objectives: We sought to validate, or refute, the common belief that bedtime diuretics are poorly tolerated due to nocturia. Design: Prespecified prospective cohort analysis embedded within the randomised BedMed trial, in which hypertensive participants are randomised to morning versus bedtime antihypertensive administration. Setting: 352 comm...

Self-measured blood pressure (SMBP) telemonitoring is the process of securely storing and tele-transmitting reliably measured, patient self-performed blood pressure (BP) measurements to healthcare teams, while ensuring that these data are viewable and clinically actionable for the purposes of improving hypertension diagnosis and management. SMBP te...

Hypertension is a major cause of cardiovascular disease worldwide and a major cause of morbidity and mortality in patients with chronic kidney disease (CKD). The Systolic Blood pressure Intervention Trial (SPRINT) demonstrated that blood pressure (BP) measurement techniques may have an impact on the achievement of outcomes. Home BP monitoring (HBPM...

Measurement of blood pressure (BP) through manual auscultation and the observation of Korotkoff sounds (KSs) remains the gold standard in BP methodology. Critical to determining BP levels via auscultation is the determination of KS audibility. While absolute sound level audibility is well researched, the problem has not been approached from the poi...

Hypertensive disorders of pregnancy are leading causes of maternal and perinatal morbidity and mortality. Automated blood pressure (BP) measurements are being used in clinical practice; however, understanding of how oscillometric waveform vary between pregnant and non-pregnant individuals remains low. Pregnant individuals over 20 weeks gestational...

Oscillometric device accuracy may be decreased, and variability may be increased, in patients with chronic kidney disease. The objective of this study was to compare three oscillometric algorithms to identify which minimizes oscillometric blood pressure variability in chronic kidney disease. Sixty patients with chronic kidney disease were studied....

The online purchase of automated blood pressure (BP) devices is a multibillion-dollar industry, but most BP devices available for online purchase have not passed adequate clinical validation testing. This study aimed to determine the extent to which BP devices available in best-selling lists of the e-commerce business Amazon were properly validated...

Accurate blood pressure (BP) assessment is essential for the optimal diagnosis and management of hypertension. Contemporary clinical practice guidelines strongly endorse use of automated cuff blood pressure measuring devices (BPMD) as the preferred means of measuring and monitoring BP in the office, at home and with ambulatory blood pressure monito...

As the leading risk for death, population control of increased blood pressure represents a major challenge for all countries of the Americas. In the early 1990’s, Canada had a hypertension control rate of 13%. The control rate increased to 68% in 2010, accompanied by a sharp decline in cardiovascular disease. The unprecedented improvement in hypert...

Background: Home blood pressure (BP) telemonitoring combined with case management leads can reduce BP in adults with hypertension. However, the benefits of telemonitoring and case management for hypertension are not well established in older (age >= 65 years) adults. Interventions that can safely improve BP control in this distinct group will be cr...

Clinically validated, automated arm-cuff blood pressure measuring devices (BPMDs) are recommended for BP measurement. However, most BPMDs available for purchase by consumers globally are not properly validated. This is a problem because non-validated BPMDs are less accurate and precise than validated ones, and therefore if used clinically could lea...

Background Hypertension is a major cause of cardiovascular disease, chronic kidney disease (CKD), and death. Several studies have demonstrated the efficacy of home blood pressure telemonitoring (HBPT) for blood pressure (BP) control and outcomes, but the effects of this intervention remain unclear in patients with CKD. Objective To determine the i...

Automated ‘oscillometric’ blood pressure (BP) measuring devices (BPMDs) were developed in the 1970s to replace manual auscultatory BP measurement by mercury sphygmomanometer. Automated BPMDs that have passed accuracy testing versus a reference auscultatory sphygmomanometer using a scientifically accepted validation protocol are recommended for clin...

A recent study found that only 23.8% of blood pressure (BP) devices available for purchase from Australian pharmacies were validated for accuracy. The extent to which pharmacists are aware of this, and other issues related to the accuracy of BP devices, is not known and gathering this information was the aim of this study. An online survey of Austr...

Ambulatory blood pressure measurement (ABPM) is the gold-standard method for blood pressure assessment. However, it is markedly underutilized, in part because legacy software provided with ABPM devices is archaic and inefficient. Herein, we illustrate an example of a recently developed cloud-based ABPM platform. Such a platform offers several disti...

Professional societies, guideline writing committees, and other interested parties emphasize the importance of accurate measurement of blood pressure for clinical and public health decisions related to prevention, treatment, and follow-up of high blood pressure. Use of a clinically validated instrument to measure blood pressure is a central compone...

This perspective article outlines collaborative work between PAHO, implementing countries and partners to improve the regulatory landscape related to BPMDs in countries implementing HEARTS. First, the WHO/PAHO position on ensuring the quality of medical devices, including BPMDs will be described. Second, the relevance of regulating market approval...

Background Resistant hypertension is associated with cardiovascular morbidity and mortality. The objective of this study was to estimate the prevalence of apparent treatment-resistant hypertension in Canadian adults and examine the characteristics of those affected. Methods A nationally-representative, cross-sectional study was conducted using Can...

Background Hypertension, together with poorly controlled blood pressure (BP) are known risk factors for kidney disease and progression to kidney failure as well as increased cardiovascular (CV) morbidity and mortality. Several studies in patients without kidney disease have demonstrated the efficacy of home BP telemonitoring (HBPT) for BP control....

Introduction Sleep-time blood pressure correlates more strongly with adverse cardiovascular events than does daytime blood pressure. The BedMed trial evaluates whether bedtime antihypertensive administration, as compared with conventional morning use, reduces major adverse cardiovascular events. Methods and analysis Design Prospective randomised,...

During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during CO...

Introduction Hypertension is a common public health problem and a key modifiable risk factor for cardiovascular (CV) and chronic kidney disease (CKD). Home blood pressure (BP) telemonitoring (HBPT) and management is associated with improved BP control, accelerated delivery of care and decision-making strategies that can reduce adverse outcomes asso...

Introduction The Acute Care for the Elderly (ACE) model has demonstrated clinical benefit, but there is little evidence regarding quality of life after discharge. The Elderfriendly Approaches to the Surgical Environment (EASE) study was conducted to assess implementation of an ACE unit on an acute surgical service. Improved clinical and economic ou...

Background: Severe obesity is associated with adverse health outcomes and increased risk of death. This study evaluates the real-world cost-utility of therapy for severe obesity, from the publicly funded health care system and societal perspectives. Methods: We conducted a cost-utility analysis using primary data from a prospective observational...

Importance Primary aldosteronism (PA) is one of the most common causes of secondary hypertension but remains largely unrecognized and untreated. Objective To understand the outcomes of a specialized clinic on rates of evaluation and treatment of PA in the context of secondary factors. Design, Setting, and Participants This population-based cohort...

Surgeons are increasingly treating seniors with complex care needs who are at high-risk of readmission and functional decline. Yet, the prognostic importance of post-operative mobilization in older surgical patients is under-investigated and remains unclear. Thus, we evaluated the relationship between post-operative mobilization and events after ho...

Clinical practice guidelines recommend several routine laboratory tests in patients diagnosed with hypertension. However, the rates of clinically relevant laboratory abnormalities are unknown. Therefore, we conducted a retrospective cohort study using administrative and laboratory data of patients diagnosed with hypertension between April 2010 and...

Background and aims The accuracy of some portable indirect calorimeters in estimating resting energy expenditure (REE) - and hence energy recommendations - among pre-bariatric patients is unknown. Our objective was to assess the accuracy of the MedGem® among individuals with class II or III obesity awaiting bariatric surgery. Methods Male and fema...

Background/objectives Resting energy expenditure (REE) is the largest component of total energy expenditure. As such, inaccurate estimation or measurement of REE may impact the development of individualized energy intake recommendations. The objective of this observational study was to assess the accuracy and reliability of REE measured with a port...

[This corrects the article DOI: 10.1371/journal.pone.0211032.].

Importance The Elder-Friendly Approaches to the Surgical Environment (EASE) initiative is a novel approach to acute surgical care for elderly patients. Objective To determine the cost-effectiveness of EASE. Design, Setting, and Participants An economic evaluation from the perspective of the health care system was conducted as part of the controll...

Background Hypertension continues to be the leading cause of preventable death and disability. The objective of this study was to examine hypertension prevalence, awareness, treatment, and control for women and men in Canada over the last decade. Methods A nationally representative, cross-sectional study was conducted using the Canadian Health Mea...

Importance Older adults, especially those with frailty, have a higher risk for complications and death after emergency surgery. Acute Care for the Elderly models have been successful in medical wards, but little evidence is available for patients in surgical wards. Objectives To develop and assess the effect of an Elder-Friendly Approaches to the...

: The Lancet Commission on Hypertension identified that a key action to address the worldwide burden of high blood pressure (BP) was to improve the quality of BP measurements by using BP devices that have been validated for accuracy. Currently, there are over 3000 commercially available BP devices, but many do not have published data on accuracy te...

High blood pressure is the world’s leading cause of death, but despite treatment for hypertension being safe, effective, and low cost, most people with hypertension worldwide do not have it controlled. This article summarizes lessons learned in the first 2 years of the Resolve to Save Lives (RTSL) hypertension management program, operated in coordi...

Aims Obesity is associated with high rates of cardiac fatty acid oxidation, low rates of glucose oxidation, cardiac hypertrophy, and heart failure. Whether weight loss can lessen the severity of heart failure associated with obesity is not known. We therefore determined the effect of weight loss on cardiac energy metabolism and the severity of hear...

Background: Aging populations have led to increasing numbers of seniors presenting for emergency surgery. Older patients are at a higher risk of postoperative complications, prolonged hospitalization, and increased institutionalization. We hypothesized that increased frailty would be a risk factor for increased health care costs in elderly surgica...

: High blood pressure (BP) is a highly prevalent modifiable cause of cardiovascular disease, stroke, and death. Accurate BP measurement is critical, given that a 5-mmHg measurement error may lead to incorrect hypertension status classification in 84 million individuals worldwide. This position statement summarizes procedures for optimizing observer...

Importance The 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure (BP) guidelines redefined hypertension using a BP threshold of 130/80 mm Hg or greater and applied a treatment target of less than 130/80 mm Hg. Objective To evaluate the potential change in the diagnosis, treatment, and control of hypertensi...

Background and objectives Management of hypertension in chronic kidney disease (CKD) remains a major challenge. We conducted a systematic review to assess whether exercise is an effective strategy for lowering blood pressure in this population. Design, setting, participants, and measurements We searched MEDLINE, EMBASE, the Cochrane Library, CINAH...

Meta-analysis–High intensity exercise versus regular intensity exercise. CI confidence interval, MD mean difference. (PDF)

Funnel plot of non-ambulatory systolic blood pressure: exercise versus no intervention. Each trial’s precision (the inverse of the standard error of each trial’s effect estimate) is plotted against each trials’ effect estimate (mean difference). (TIF)

Thompson-SR Ex and BP on CKD-PRISMA 2009 checklist. (DOCX)

Objective: Uncertainty exists regarding the accuracy of automated blood pressure (BP) measurement in children. We recorded oscillometric waveforms in children, derived oscillometric BPs using two standard algorithms, and compared the results to simultaneous auscultation. Patients and methods: Twenty children aged 2-12 years were recruited from a...

Home blood pressure (BP) telemonitoring and pharmacist case management reduce BP, but cost‐effectiveness assessments are mixed. We examined the incremental cost‐effectiveness of this intervention vs usual care in Canadians with cerebrovascular disease. A Markov decision model cost‐utility analysis examining community‐residing, high‐risk patients wi...

The general consensus is that heart switches from fatty acid oxidation (FAO) to glucose metabolism in heart failure. However, what happens to FAO in heart failure associated with obesity, a condition known to increase cardiac FAO, is not known. We therefore, investigated what effect obesity has on cardiac FAO and function in the failing heart, and...

Prescribing medications safely and effectively in older adults is a complex process. This review discusses challenges with medication prescribing in older adults and outlines a holistic approach to medication management in older adults. Well-known challenges including the alterations in pharmacokinetics and pharmacodynamics that often occur with ag...

Objective: Uncertainty exists regarding the accuracy of automated blood pressure (BP) measurement in children. We recorded oscillometric waveforms in children, derived oscillometric BPs using two standard algorithms, and compared the results to simultaneous auscultation. Methods: Twenty children aged 2-12 years were recruited from a tertiary-care P...

Background: Home BP telemonitoring, with pharmacist case management, leads to clinically important BP reductions. Our objective was to determine the incremental cost-effectiveness of this intervention compared with usual care BP control in patients with cerebrovascular disease in Alberta, Canada. Methods: A cost-utility analysis using a Markov deci...

Objective: The extent to which different oscillometric blood pressure (BP) algorithms differ in how they derive BP in patients with chronic kidney disease (CKD) is unknown. We compared the performance of three different oscillometric algorithms against a known oscillometric reference standard in this patient population. Methods: Thirty intermittent...

Background: Hypertension is a major cause of cardiovascular disease in older individuals. To ensure that blood pressure (BP) levels are within the optimal range, accurate BP monitoring is required. Contemporary hypertension clinical practice guidelines strongly endorse the use of home BP measurement as a preferred method of BP monitoring for indiv...

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) showed significant reductions in major cardiovascular events and all-cause mortality with a systolic blood pressure (BP) goal of < 120 mm Hg compared with < 140 mm Hg. We sought to determine the proportion of Canadian adults who meet SPRINT eligibility criteria. Methods: We cond...

Background Orthostatic hypotension (OH) is associated with falls and cardiovascular events. There is growing evidence that central blood pressure (CBP) is better than peripheral blood pressure (PBP) in predicting adverse outcomes. The objectives of this study were to assess 1) the prevalence of OH identified using PBP and CBP and the levels of agre...

We propose a method for estimating blood pressure (BP) non-invasively from electrocardiogram (ECG) and photoplethysmogram (PPG) signals. This method has potential to be used as a continuous form of BP estimation. Along with these signals, to our knowledge, for the first time in the BP measurement studies, we included accelerometric and gyroscopic s...

Hypertension Canada provides annually-updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidel...

Background: Frailty is a state of vulnerability to diverse stressors. We assessed the impact of frailty on outcomes after discharge in older surgical patients. Methods: We prospectively followed patients 65 years of age or older who underwent emergency abdominal surgery at either of 2 tertiary care centres and who needed assistance with fewer th...

Diabetes is a highly prevalent medical condition that commonly coexists with hypertension. The presence of diabetes and hypertension significantly increases the risk of adverse cardiovascular events. Although compelling evidence exists from randomized controlled trials demonstrating that blood pressure reduction effectively prevents cardiovascular...