There is strong evidence that sex chromosomes and sex hormones influence blood pressure (BP) regulation, distribution of cardiovascular (CV) risk factors and co-morbidities differentially in females and males with essential arterial hypertension. The risk for CV disease increases at a lower BP level in females than in males, suggesting that sex-specific thresholds for diagnosis of hypertension may be reasonable. However, due to paucity of data, in particularly from specifically designed clinical trials, it is not yet known whether hypertension should be differently managed in females and males, including treatment goals and choice and dosages of antihypertensive drugs. Accordingly, this consensus document was conceived to provide a comprehensive overview of current knowledge on sex differences in essential hypertension including BP development over the life course, development of hypertension, pathophysiologic mechanisms regulating BP, interaction of BP with CV risk factors and co-morbidities, hypertension-mediated organ damage in the heart and the arteries, impact on incident CV disease, and differences in the effect of antihypertensive treatment. The consensus document also highlights areas where focused research is needed to advance sex-specific prevention and management of hypertension.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Wrist-worn tracking devices such as the Apple Watch are becoming more and more integrated in healthcare. However, validation studies of these consumer devices remain scarce. Objective: This study aimed to determine the accuracy of the Apple Watch in measuring heart rate (HR) and estimating energy expenditure (EE) during a cardiopulmonary exercise test (CPET) in patients with cardiovascular disease. Methods: Forty patients (mean age 61.9 +/- 15.2 yrs, 80% male) with cardiovascular disease (70% ischemic, 22.5% valvular, 7.5% other) completed a graded maximal CPET on a cycle ergometer while wearing an Apple Watch. A 12-lead electrocardiogram (ECG) was used as criterion for HR, indirect calorimetry was used as criterion for EE. HR was analysed at three levels of intensity (seated rest, HR1; moderate intensity, HR2; maximal performance, HR3) for 30 seconds. The EE of the entire test was used. Bias or mean difference (MD), standard deviation of difference (SDD), limits of agreement (LoA) and intraclass correlation coefficients (ICCs) were calculated. Bland-Altman plots and scatterplots were constructed. Results: SDD for HR1, HR2 and HR3 was 12.4, 16.2 and 12.0 beats/min respectively. Bias and LoA (lower, upper LoA) were 3.61 (-20.74, 27.96) for HR1, 0.91 (-30.82, 32.63) for HR2 and -1.82 (-25.27, 21.63) for HR3. The ICC was 0.729 (p<.001) for HR1, 0.828 (p<.001) for HR2 and 0.958 (p<.001) for HR3. Bland-Altman plots and scatterplots showed good correlation without systematic error when comparing Apple Watch with ECG measurements. SDD for EE was 17.5 kcal. Bias and LoA were 30.47 (-3.80, 64.74). The ICC for EE was 0.797 (p<.001). The Bland-Altman plot and a scatterplot directly comparing Apple Watch and indirect calorimetry showed systematic bias with an overestimation of EE by the Apple Watch. Conclusions: In patients with cardiovascular disease the Apple Watch measures HR with clinically acceptable accuracy during exercise. If confirmed, it might be considered safe to incorporate the Apple Watch in HR-guided training programs in the setting of cardiac rehabilitation. However, the Apple Watch systematically overestimates EE in this group of patients. Some caution might therefore be warranted when using the Apple Watch for measuring EE.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Cardiac rehabilitation (CR) is an essential part of coronary heart disease (CHD) management. However, patients exiting a center-based CR program have difficulty retaining its benefits. Objective: The purpose of the TRiCH study is to evaluate the added benefit of a home-based (HB) CR program with telemonitoring guidance on physical fitness in patients with coronary artery disease (CAD) who are being discharged from a phase II ambulatory CR program, and to compare its effectiveness to a prolonged center-based (CB) CR intervention. Methods: Between February 2014 and August 2016, 90 CAD patients (61.2±7.6yrs, 89% males, 1.73±0.7m, 82.9±13kg, 27.5±3.4kg/m2) who successfully completed a three month ambulatory CR program were randomly allocated to one of three groups: HB (=30), CB (=30) or a control group (CG) (=30) on a 1:1:1 basis. HB patients received a home-based exercise intervention with telemonitoring guidance consisting of weekly emails or phone calls, CB patients continued the ambulatory-hospital CR and CG patients received usual care including the recommendation to remain physically active. All patients underwent cardiopulmonary exercise testing to assess peak oxygen uptake (VO2P) at baseline and after the 12 week intervention period. Secondary outcomes included physical activity behavior, anthropometric characteristics, cardiovascular risk factors and quality of life. Results: The increase in VO2P was larger following 12 weeks of intervention in the CB group (P = .03) and HB group (P = .04) compared to the control group. In addition, oxygen uptake at the first ventilatory threshold (P-interaction = .03) and the second ventilatory threshold (P-interaction = .03) increased significantly more in the HB group compared to CB. No significant changes were found in the secondary outcomes. Conclusions: Adding a HB exercise program with telemonitoring guidance following completion of a phase II ambulatory CR program results in further improvement of physical fitness and is as equally effective as prolonging a CB CR in patients with coronary artery disease. Clinical Trial: NCT02047942.

Cardiac rehabilitation (CR) can slow or reverse the progression of cardiovascular disease (CVD). However, uptake of community-based CR is very low. E-cardiology, e-health and technology solutions for physical activity uptake and monitoring have evolved rapidly and have potential in CVD management. However, it is unclear what the current technology usage is of CVD patients, and their needs and interests for technology enabled CR. A technology usage questionnaire was developed and completed by patients from a supervised ambulatory CR program and an adult congenital heart disease clinic and from two community-based CR programs. Results were described and related with age, gender and educational level by Spearman correlations. Of 310 patients, 298 patients (77 % male; mean age 61,7 ± 14,5 years) completed at least 25 questions of the survey and were included in the analysis (completion rate 96 %). Most (97 %) patients had a mobile phone and used the internet (91 %). Heart rate monitors were used by 35 % and 68 % reported to find heart rate monitoring important when exercising at home. Physical activity monitoring was reported by 12 % of the respondents. Respondents were interested in CR support through internet (77 %) and mobile phone (68 %). Many patients reported interest in game-based CR (67 %) and virtual rehabilitation (58 %). At least medium interest in technology enabled CR was reported by 75 % of the patients. Interest decreased with increasing age (r = −0.16; p = 0.005). CVD patients show interest for technology enabled home-based CR. Our results could guide the design of a technology-based, virtual CR intervention.

AI-based software applications for personalized nutrition have recently gained increasing attention to help users follow a healthy lifestyle. In this paper, we present a knowledge-based recommendation framework that exploits an explicit dataset of expert-validated meals to offer highly accurate diet plans spanning across ten user groups of both healthy subjects and participants with health conditions. The proposed advisor is built on a novel architecture that includes (a) a qualitative layer for verifying ingredient appropriateness, and (b) a quantitative layer for synthesizing meal plans. The first layer is implemented as an expert system for fuzzy inference relying on an ontology of rules acquired by experts in Nutrition, while the second layer as an optimization method for generating daily meal plans based on target nutrient values and ranges. The system’s effectiveness is evaluated through extensive experiments for establishing meal and meal plan appropriateness, meal variety, as well as system capacity for recommending meal plans. Evaluations involved synthetic data, including the generation of 3000 virtual user profiles and their weekly meal plans. Results reveal a high precision and recall for recommending appropriate ingredients in most user categories, while the meal plan generator achieved a total recommendation accuracy of 92% for all nutrient recommendations.