Finalize your ST0-250 Exam Questions with these ST0-250 real questions and study guide

We provide ST0-250 exam questions with 100% pass guarantee.You need to rehearse inquiries for at least 24 hours to get the best scores in the test. Your real errand to breeze through in ST0-250 test, starts with killexams.com ST0-250 test practice questions. All ST0-250 exam dumps refreshed and approved on standard premise.

Exam Code: ST0-250 Practice exam 2022 by Killexams.com team
Symantec Messaging Gateway 10.5 Technical Assessment
Symantec Assessment Study Guide
Killexams : Symantec Assessment Study Guide - BingNews https://killexams.com/pass4sure/exam-detail/ST0-250 Search results Killexams : Symantec Assessment Study Guide - BingNews https://killexams.com/pass4sure/exam-detail/ST0-250 https://killexams.com/exam_list/Symantec Killexams : 'Who He Play For' study guide for 2022-23 season
Austin Rivers (left), Andre Drummond (middle) and Kentavious Caldwell-Pope joined new teams this summer.

Austin Rivers (left), Andre Drummond (middle) and Kentavious Caldwell-Pope joined new teams this summer.

Get NBA League Pass NOW: Stream FREE for 7 days

It’s almost everyone’s favorite time of year: Charles Barkley gets put to the test as we witness how closely the ‘Inside the NBA’ analyst followed offseason player movement. With approximately 100 players on different teams this season, it’s not easy to keep track of all the changes.

So, here is our ‘Who He Play For’ Study Guide — 25 familiar faces in new places for the 2022-23 season. 

Tune in to TNT on opening week to see how Chuck performs. He went 0-for-4 last year.

> Offseason Player Movement | Offseason Trade Tracker | Free Agent Tracker | Kia Season Preview

Will Barton

Will Barton

New team: Washington Wizards | Old team: Denver Nuggets

Bruce Brown

Bruce Brown

New team: Denver Nuggets | Old team: Brooklyn Nets

Alec Burks

Alec Burks

New team: Detroit Pistons | Old team: New York Knicks

Kentavious Caldwell-Pope

Kentavious Caldwell-Pope

New team: Denver Nuggets  | Old team: Washington Wizards

Matthew Dellavedova

Matthew Dellavedova

New team: Sacramento Kings | Old team: Cleveland Cavaliers

Gorgui Dieng

Gorgui Dieng

New team: San Antonio Spurs | Old team: Atlanta Hawks

Donte DiVincenzo

Donte DiVincenzo

New team: Golden State Warriors  | Old team: Sacramento Kings

Andre Drummond

Andre Drummond

New team: Chicago Bulls | Old team: Brooklyn Nets

Bryn Forbes

Bryn Forbes

New team: Minnesota Timberwolves | Old team: Denver Nuggets

Taj Gibson

Taj Gibson

New team: Washington Wizards | Old team: New York Knicks

Danny Green

Danny Green

New team: Memphis Grizzlies | Old team: Philadelphia 76ers

Juancho Hernangomez

Juancho Hernangomez

New team: Toronto Raptors | Old team: Utah Jazz 

Joe Ingles

Joe Ingles

New team: Milwaukee Bucks | Old team: Portland Trail Blazers

Josh Jackson

Josh Jackson

New team: Toronto Raptors | Old team: Sacramento Kings

Frank Kaminsky

Frank Kaminsky

New team: Atlanta Hawks | Old team: Phoenix Suns

Damion Lee

Damion Lee

New team: Phoenix Suns | Old team: Golden State Warriors

Robin Lopez

Robin Lopez

New team: Cleveland Cavaliers | Old team: Orlando Magic

Boban Marjanovic

Boban Marjanovic

New team: Houston Rockets | Old team: Dallas Mavericks

Markieff Morris

Markieff Morris

New team: Brooklyn Nets | Old team: Miami Heat

Josh Okogie

Josh Okogie

New team: Phoenix Suns | Old team: Minnesota Timberwolves

Kelly Olynyk

Kelly Olynyk

New team: Utah Jazz | Old team: Detroit Pistons

Austin Rivers

Austin Rivers

New team: Minnesota Timberwolves | Old team: Denver Nuggets

Ish Smith

Ish Smith

New team: Denver Nuggets | Old team: Washington Wizards

Daniel Theis

Daniel Theis

New team: Indiana Pacers | Old team: Boston Celtics

Delon Wright

Delon Wright

New team: Washington Wizards | Old team: Atlanta Hawks

Thu, 13 Oct 2022 05:51:00 -0500 en text/html https://www.nba.com/news/who-he-play-for-study-guide-2022-23
Killexams : Redmond Intelligence Report: Kubernetes Readiness Assessment

Redmond Intelligence Report: Kubernetes Readiness Assessment

The questions presented by this five minute readiness assessment tool ask you about your organization’s current status and future plans in areas that would affect how well prepared your organization is to leverage the advantages of Kubernetes in managing application delivery.

Please provide an honest appraisal of your organization's state of readiness to ensure that you and others participating in this study receive accurate insights based on real-world situations.

Questions are organized according to four dimensions for Kubernetes readiness:

  • Organizational Readiness
  • IT Readiness
  • Application Readiness
  • DevOps Readiness

After completing the readiness survey, you get more...

Once you’ve answered all the questions, the tool will present scores that quantify your readiness per dimension, as well as overall. You will also see scores representing the average readiness of other organizations that have participated in this study.

Additionally, you will be be presented with a link to download the corresponding guide to assist you with interpreting your scores.


Sun, 24 Oct 2021 13:05:00 -0500 en-US text/html https://virtualizationreview.com/whitepapers/2021/08/redmond-intelligence-report-kubernetes-readiness-assessment-080021.aspx?admgarea=symantec&tc=page0
Killexams : Study Suggests That This Particular Exercise May Boost Memory

Ah, the burpee. Who hasn’t been forced against their will to perform way too many arduous reps of this exercise? Touted as the ultimate full-body workout that requires no equipment, gym teachers and drill instructors across the world swear by its efficacy.

As grueling as it can be, it may turn out that your lousy gym teacher was right: new research suggests that burpees not only improves endurance in teenagers — as you might expect — but it may be linked to a marked improvement in short term memory as well.

For those unfamiliar, the infamous exercise popularized by the military involves lowering into a squat from standing, shooting your legs out behind you into a plank position, performing a pushup, and then jumping up — and then repeating, often ad nauseam.

Published in the journal Environmental Research and Public Health, the study involved 52 teenaged boys and girls between 15 and 16 years old, since existing scholarship shows that that period in life is a particularly sensitive one for improving endurance. For four months, the researchers split the adolescents into a control and experimental group. The former participated in a typical endurance program that didn’t involve burpees, while the latter followed the same program but with the all-too-dreaded exercise exercise tacked on. In practice, the teenagers started by performing 60 seconds worth of burpees, with the duration increasing as the study went on.

The researchers found that the adolescents involved in the burpee program ran a significantly improved 8.6 percent faster in a 2000 meter run (about 1.25 miles). Meanwhile, teens stuck in the control group were only 1.9 percent faster, which the data indicates is not a statistically significant difference.

Even before getting to the cognitive effects, it may seem obvious that performing burpees would Excellerate endurance, but it surprised even the researchers just how much more effective burpees were at making the teens better runners than the plain-Jane endurance program of the control group. In fact, the researchers note that so far, there have been "no scientific studies showing the burpee exercise as an effective element of physical activity for adolescents."

Things get even more interesting when you look at short term memory. According to the study, the adolescents involved in the burpee program exhibited a whopping 26 percent improvement in the well-known and reliable Jacobs test, a short term memory evaluation that uses a digit span that participants must recall in the same order the numbers were presented in.

Tamping down expectations a little bit, the researchers do concede that they "do not know whether the burpee exercise caused these positive effects per se or if it was the interaction with the program." In other words, it's hard to tell if it's a case of direct memory improvement, or simply the teens getting more amped up and engaged as a result of being involved in the study. And, of course, the study says nothing about how burpees might affect the fitness or cognition of other age groups.

Still, the results are significant enough that the researchers posit that "adding the burpee to an exercise program constitutes at least a preliminary practical approach to improving the effectiveness of physical education programs such as the one that was adopted."

As a word of caution, that doesn’t mean teenagers should be instructed to go all out on burpees, as the researchers stress that finding the right balance is crucial. Too little exercise wouldn’t result in significant improvement, whereas too much could physically and psychologically drain them, and maybe demotivate them from performing burpees further. Teens can be fickle.

Future studies, the researchers say, should focus on the dosage of the exercise needed for optimal improvement.

It's early days, but the findings are intriguing, if far from definitive. It's possible the improvement might be down to the slight increase in volume of exercise, rather than the exercise itself. Nevertheless, regular burpees won't turn your average teen into a savant with eidetic memory, but as the study and decades of widespread adoption have shown, it'll probably still be good for them.

More on fitness: Scientists Find That Lifting Weights for Just Three Seconds Is Quite Good for You


Thu, 22 Sep 2022 02:58:00 -0500 text/html https://futurism.com/neoscope/study-exercise-boost-memory
Killexams : Dementia could be spotted years sooner with this half-hour test: study

A relatively brief logic and memory assessment could become pivotal in spotting dementia sooner, scientists said.

The University of Cambridge’s Dr. Timothy Rittman created a 30-minute test for problem-solving capabilities, reaction times and number sequencing through card matching — all of which may spot symptoms of the neurological disorder up to 10 years ahead of the usual diagnosis, the Times reported.

The testing also shows how outlying health conditions may come into play with contracting dementia, according to study leader Dr. Nol Swaddiwudhipong.

“This is a step toward us being able to screen people who are at greatest risk — for example, people over 50 or those who have high blood pressure or do not do enough exercise — and intervene at an earlier stage to help them reduce their risk.”

A test for dementia might lead to the disease being spotted sooner than later.
A test for dementia might lead to the disease being spotted sooner than later.
Getty Images/Westend61

“When we looked back at patients’ histories, it became clear that they were showing some cognitive impairment several years before their symptoms became obvious enough to prompt a diagnosis,” he added. “The impairments were often subtle, but [they were seen] across a number of aspects of cognition.”

About 500,000 patients — between the ages of 40 to 69 in the UK — underwent the tests from Rittman and his team. In addition to cognitive skills, reaction times and grip strength in patients were also recorded in the study.

Participants also had to solve as many logic problems as possible in two minutes.

One memory test — also known as the card game Snap! — involved subjects matching face down cards shown on a computer screen in the quickest amount of time possible and with the fewest attempts. The first round featured three pairs in a six-second period. The average person made two errors while those at risk of Alzheimer’s often made three.

The card game "Snap!" has been used in a study to help identify dementia early on.
The card game Snap! was used in the study.
Alamy Stock Photo

Another examination was done by showing people a two-digit number before it vanished; the number would extend a digit as rounds furthered. In that case, most people could remember seven numbers whereas six was the average for people who developed Alzheimer’s.

However, low testing results don’t necessarily mean people should panic, according to Rittman.

“Even some healthy individuals will naturally score better or worse than their peers,” he said. “But we would encourage anyone who has any concerns or notices that their memory or recall is getting worse to speak to their [general practitioner].”

Thu, 13 Oct 2022 20:43:00 -0500 en-US text/html https://nypost.com/2022/10/13/dementia-could-be-spotted-sooner-with-this-half-hour-test-study/
Killexams : GDPR Compliance Software Market Analysis, Research Study With Talend, Symantec, Protegrity

New Jersey, United States, Sept. 20, 2022 /DigitalJournal/ The GDPR Compliance Software Market research report provides all the information related to the industry. It gives the markets outlook by giving authentic data to its client which helps to make essential decisions. It gives an overview of the market which includes its definition, applications and developments, and technology. This GDPR Compliance Software market research report tracks all the accurate developments and innovations in the market. It gives the data regarding the obstacles while establishing the business and guides to overcome the upcoming challenges and obstacles.

GDPR compliance software helps businesses manage customer data, consent forms, and data security. Some platforms also allow a companys customers to modify the personal data stored or processed about them.

Get the PDF trial Copy (Including FULL TOC, Graphs, and Tables) of this report @:

https://a2zmarketresearch.com/sample-request

Competitive landscape:

This GDPR Compliance Software research report throws light on the major market players thriving in the market; it tracks their business strategies, financial status, and upcoming products.

Some of the Top companies Influencing this Market include:Talend, Symantec, Protegrity, Proofpoint, Microsoft, Oracle, Metricstream, Onetrust, Capgemini, Informatica, AWS, Snow Software, Hitachi Systems Security, SAS Institute, Absolute Software, Swascan, SAP, Micro Focus, Actiance, IBM, Nymity, Mimecast

Market Scenario:

Firstly, this GDPR Compliance Software research report introduces the market by providing an overview that includes definitions, applications, product launches, developments, challenges, and regions. The market is forecasted to reveal strong development by driven consumption in various markets. An analysis of the current market designs and other basic characteristics is provided in the GDPR Compliance Software report.

Regional Coverage:

The region-wise coverage of the market is mentioned in the report, mainly focusing on the regions:

  • North America
  • South America
  • Asia and Pacific region
  • Middle East and Africa
  • Europe

Segmentation Analysis of the market

The market is segmented based on the type, product, end users, raw materials, etc. the segmentation helps to deliver a precise explanation of the market

Market Segmentation: By Type

Cloud-based
On Premise

Market Segmentation: By Application

Small and Medium-Sized Enterprises
Large Enterprises

For Any Query or Customization: https://a2zmarketresearch.com/ask-for-customization

An assessment of the market attractiveness about the competition that new players and products are likely to present to older ones has been provided in the publication. The research report also mentions the innovations, new developments, marketing strategies, branding techniques, and products of the key participants in the global GDPR Compliance Software market. To present a clear vision of the market the competitive landscape has been thoroughly analyzed utilizing the value chain analysis. The opportunities and threats present in the future for the key market players have also been emphasized in the publication.

This report aims to provide:

  • A qualitative and quantitative analysis of the current trends, dynamics, and estimations from 2022 to 2029.
  • The analysis tools such as SWOT analysis and Porter’s five force analysis are utilized, which explain the potency of the buyers and suppliers to make profit-oriented decisions and strengthen their business.
  • The in-depth market segmentation analysis helps identify the prevailing market opportunities.
  • In the end, this GDPR Compliance Software report helps to save you time and money by delivering unbiased information under one roof.

Table of Contents

Global GDPR Compliance Software Market Research Report 2022 – 2029

Chapter 1 GDPR Compliance Software Market Overview

Chapter 2 Global Economic Impact on Industry

Chapter 3 Global Market Competition by Manufacturers

Chapter 4 Global Production, Revenue (Value) by Region

Chapter 5 Global Supply (Production), Consumption, Export, Import by Regions

Chapter 6 Global Production, Revenue (Value), Price Trend by Type

Chapter 7 Global Market Analysis by Application

Chapter 8 Manufacturing Cost Analysis

Chapter 9 Industrial Chain, Sourcing Strategy and Downstream Buyers

Chapter 10 Marketing Strategy Analysis, Distributors/Traders

Chapter 11 Market Effect Factors Analysis

Chapter 12 Global GDPR Compliance Software Market Forecast

Buy Exclusive Report @: https://www.a2zmarketresearch.com/checkout

Contact Us:

Roger Smith

1887 WHITNEY MESA DR HENDERSON, NV 89014

[email protected]

+1 775 237 4157

Tue, 20 Sep 2022 02:59:00 -0500 A2Z Market Research en-US text/html https://www.digitaljournal.com/pr/gdpr-compliance-software-market-analysis-research-study-with-talend-symantec-protegrity
Killexams : Taste test: the great coffee guide

The daily caffeine fix is a large part of many people’s lives. I should know. It’s the oil to my cogs every morning. I don’t just drink coffee; I have to drink coffee. Without it I grind to a halt, stuck mumbling on the hard shoulder until somebody puts the kettle on and brings me a cup.

All of which means that, as well as having taken out a small mortgage to fund my addiction, I have drunk my fair share of lousy coffee. Cups of too watery, too bitter, too “fruity” or, the worst offender, too weak brown liquid.

It also means I’ve drunk a lot of brilliant cups, and I’m sharing my favourites here. Coffee snobs will spill their brew when they read

Fri, 23 Sep 2022 11:02:00 -0500 en text/html https://www.thetimes.co.uk/article/taste-test-the-great-coffee-guide-jk6lhfsz7
Killexams : IDC MarketScape: Worldwide Unified Endpoint Management Software 2019–2020 Vendor Assessment

IDC MarketScape: Worldwide Unified Endpoint Management Software 2019–2020 Vendor Assessment

VMware has been named a Leader in the IDC MarketScape: Worldwide Unified Endpoint Management Software 2019-2020 Vendor Assessment. download an excerpt of the report to see why we believe VMware is uniquely positioned to help you Excellerate cost savings, security, and user experience with Workspace ONE Unified Endpoint Management (UEM).


Sun, 18 Sep 2022 15:42:00 -0500 en-US text/html https://virtualizationreview.com/whitepapers/2020/02/vmware-idc-marketscape.aspx?admgarea=symantec&tc=page0
Killexams : Blood test could predict who is likely to get long COVID, study shows

A blood test taken at the time of Covid-19 infection could predict who is most likely to develop long Covid, suggests a new small-scale study led by UCL researchers.

The study, published in Lancet eBioMedicine, analysed proteins in the blood of healthcare workers infected with SARS-CoV-2, comparing them to samples from healthcare workers who had not been infected.

Usually protein levels in the body are stable, but the researchers found a dramatic difference in levels of some of the proteins up to six weeks following infection, suggesting disruption to a number of important biological processes.

Using an artificial intelligence (AI) algorithm, they identified a "signature" in the abundance of different proteins that successfully predicted whether or not the person would go on to report persistent symptoms a year after infection.

The researchers say that, if these findings are repeated in a larger, independent group of patients, a test could potentially be offered alongside a polymerase chain reaction (PCR) test that could predict people's likelihood of developing long Covid.

Lead author Dr Gaby Captur (MRC Unit for Lifelong Health and Ageing at UCL) said: "Our study shows that even mild or asymptomatic Covid-19 disrupts the profile of proteins in our blood plasma. This means that even mild Covid-19 affects normal biological processes in a dramatic way, up to at least six weeks after infection.

"Our tool predicting long Covid still needs to be validated in an independent, larger group of patients. However, using our approach, a test that predicts long Covid at the time of initial infection could be rolled out quickly and in a cost-effective way.

"The method of analysis we used is readily available in hospitals and is high-throughput, meaning it can analyse thousands of samples in an afternoon."

Senior author Dr Wendy Heywood (UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital) said: "If we can identify people who are likely to develop long Covid, this opens the door to trialling treatments such as antivirals at this earlier, initial infection stage, to see if it can reduce the risk of later long Covid."

For the study, researchers analysed blood plasma samples from 54 healthcare workers who had PCR- or antibody-confirmed infection, taken every week for six weeks in spring 2020, comparing them to samples taken over the same period from 102 healthcare workers who were not infected.

They used targeted mass spectrometry, a form of analysis that is extremely sensitive to tiny changes in the amount of proteins in blood plasma, to look at how Covid-19 affected these proteins over the course of six weeks.

The researchers found abnormally high levels of 12 proteins out of the 91 studied among those infected by SARS-CoV-2, and that the degree of abnormality tracked with the severity of symptoms.

The research team found that at the time of first infection, abnormal levels of 20 proteins studied were predictive of persistent symptoms after one year. Most of these proteins were linked to anti-coagulant (anti-clotting) and anti-inflammatory processes.

A machine learning algorithm, trained on the protein profiles of the participants, was able to distinguish all of the 11 healthcare workers who reported at least one persistent symptom at one year, from infected healthcare workers who did not report persistent symptoms after a year. Another machine learning tool was used to estimate the likelihood of error and suggested a possible error rate of 6% for this method.

The study, carried out at the UCL Biological Mass Spectrometry Centre (BMSC), was supported by the National Institute for Health and Care Research Great Ormond Street Hospital Biomedical Research Centre (NIHR GOSH BRC), as well as the British Heart Foundation and the Barts Charity.

Mon, 26 Sep 2022 11:59:00 -0500 en text/html https://www.sciencedaily.com/releases/2022/09/220927192653.htm
Killexams : Cloud-Based Email Security Market 2022: Comprehensive Study by Top Key Players FireEye Inc, Cisco Systems Inc, Symantec Corporation

New Jersey, United States, Sept. 19, 2022 /DigitalJournal/ The Cloud-Based Email Security Market research report provides all the information related to the industry. It gives the markets outlook by giving authentic data to its client which helps to make essential decisions. It gives an overview of the market which includes its definition, applications and developments, and technology. This Cloud-Based Email Security market research report tracks all the accurate developments and innovations in the market. It gives the data regarding the obstacles while establishing the business and guides to overcome the upcoming challenges and obstacles.

Cloud email security solutions are designed to provide comprehensive protection against cyber threats delivered through email. Essential features of a cloud email security solution include: Anti-Phishing: Phishing attacks are becoming more sophisticated, making them difficult to detect and block. The financial sector generates a massive volume of data generated by its customers. Banks and financial organizations are increasingly using services to store and analyze complex data in order to utilize data collected across various data points and Excellerate customer satisfaction. Additionally, with higher customer expectations, growing technological capabilities and regulatory requirements, banking institutions are being pressured to take a proactive approach to security.

Get the PDF trial Copy (Including FULL TOC, Graphs, and Tables) of this report @:

https://a2zmarketresearch.com/sample-request

Competitive landscape:

This Cloud-Based Email Security research report throws light on the major market players thriving in the market; it tracks their business strategies, financial status, and upcoming products.

Some of the Top companies Influencing this Market include:FireEye Inc, Cisco Systems Inc, Symantec Corporation, Mimecast Inc, Dell Technologies Inc, Fortinet Inc, Forcepoint LLC, Sophos Group PLC, Proofpoint Inc, Trend Micro Inc

Market Scenario:

Firstly, this Cloud-Based Email Security research report introduces the market by providing an overview that includes definitions, applications, product launches, developments, challenges, and regions. The market is forecasted to reveal strong development by driven consumption in various markets. An analysis of the current market designs and other basic characteristics is provided in the Cloud-Based Email Security report.

Regional Coverage:

The region-wise coverage of the market is mentioned in the report, mainly focusing on the regions:

  • North America
  • South America
  • Asia and Pacific region
  • Middle East and Africa
  • Europe

Segmentation Analysis of the market

The market is segmented based on the type, product, end users, raw materials, etc. the segmentation helps to deliver a precise explanation of the market

Market Segmentation: By Type

Public, Private, Hybrid

Market Segmentation: By Application

BFSI, Government, IT and Telecommunications, Retail, Others

For Any Query or Customization: https://a2zmarketresearch.com/ask-for-customization

An assessment of the market attractiveness about the competition that new players and products are likely to present to older ones has been provided in the publication. The research report also mentions the innovations, new developments, marketing strategies, branding techniques, and products of the key participants in the global Cloud-Based Email Security market. To present a clear vision of the market the competitive landscape has been thoroughly analyzed utilizing the value chain analysis. The opportunities and threats present in the future for the key market players have also been emphasized in the publication.

This report aims to provide:

  • A qualitative and quantitative analysis of the current trends, dynamics, and estimations from 2022 to 2029.
  • The analysis tools such as SWOT analysis and Porter’s five force analysis are utilized, which explain the potency of the buyers and suppliers to make profit-oriented decisions and strengthen their business.
  • The in-depth market segmentation analysis helps identify the prevailing market opportunities.
  • In the end, this Cloud-Based Email Security report helps to save you time and money by delivering unbiased information under one roof.

Table of Contents

Global Cloud-Based Email Security Market Research Report 2022 – 2029

Chapter 1 Cloud-Based Email Security Market Overview

Chapter 2 Global Economic Impact on Industry

Chapter 3 Global Market Competition by Manufacturers

Chapter 4 Global Production, Revenue (Value) by Region

Chapter 5 Global Supply (Production), Consumption, Export, Import by Regions

Chapter 6 Global Production, Revenue (Value), Price Trend by Type

Chapter 7 Global Market Analysis by Application

Chapter 8 Manufacturing Cost Analysis

Chapter 9 Industrial Chain, Sourcing Strategy and Downstream Buyers

Chapter 10 Marketing Strategy Analysis, Distributors/Traders

Chapter 11 Market Effect Factors Analysis

Chapter 12 Global Cloud-Based Email Security Market Forecast

Buy Exclusive Report @: https://www.a2zmarketresearch.com/checkout

Contact Us:

Roger Smith

1887 WHITNEY MESA DR HENDERSON, NV 89014

[email protected]

+1 775 237 4157

Mon, 19 Sep 2022 01:44:00 -0500 A2Z Market Research en-US text/html https://www.digitaljournal.com/pr/cloud-based-email-security-market-2022-comprehensive-study-by-top-key-players-fireeye-inc-cisco-systems-inc-symantec-corporation
Killexams : Study shows the importance of night-time blood pressure assessment for diagnosing hypertension

Around 15% of people aged 40-75 may have a form of undiagnosed high blood pressure (hypertension) that occurs only at night-time. Because they do not know about this, and therefore are not being treated for it, they are at a higher risk of cardiovascular disease such as stroke, heart failure, and even death, suggests new research from the University of Oxford published in the British Journal of General Practice.

When blood pressure is monitored over 24 hours, individuals can be divided into three groups according to their blood pressure pattern:

  • 'dippers', for whom the night-time blood pressure is lower than the day-time blood pressure (which is the case for healthy young people),
  • 'non-dippers', for whom night-time and day-time blood pressure values are not very different, and
  • 'reverse dippers', for whom, contrary to expectations, the night-time blood pressure is higher than the day-time blood pressure, when they are up and active.

When undiagnosed and untreated, hypertension (also known as high blood pressure) causes cardiovascular disease, which is one of the main causes of death and disability in the UK. 1 in 8 people in England have undiagnosed hypertension, putting them at risk of cardiovascular disease.

24-hour blood-pressure monitoring (usually called ambulatory blood pressure monitoring, ABPM) has become less frequent in primary care since the beginning of the COVID-19 pandemic. Home blood-pressure monitoring, using a monitor often purchased by individuals themselves, is the common alternative. However, home blood-pressure monitors cannot be used when the individual is asleep and so cannot measure night-time blood pressure. Therefore, those people whose blood pressure is normal during the day but whose night-time blood pressure, unbeknown to them, rises at night have undiagnosed hypertension, with all the associated risks.

This new study from the University of Oxford looked at 24-hour blood pressure patterns in patients admitted to hospital, and found that nearly half of these patients have a blood pressure rise at night ('reverse-dipper pattern). The study researchers then looked at blood pressure patterns from patients in primary care from the same age group (40-75), who had been monitored for 24 hours during their normal daily activities using ABPM. The proportion of the population in this group who were 'reverse-dippers' was around 15%. There are several possible reasons for the difference in the proportion of people found to have a 'reverse dipping' blood pressure pattern in the two patient groups. One possible reason is that the community group included a much higher proportion of people who had already been diagnosed with hypertension, and these people are more likely to be 'dippers' rather than 'reverse dippers'. This is because people whose blood pressure is highest in the day and drops at night are more likely to get picked up as having hypertension in GP surgeries and clinics.

Key findings:

  • About 15% of individuals in the community between the ages of 40 and 75 have a blood pressure rise at night-time.
  • This 24-hour blood pressure pattern is called 'reverse dipping', because pressure rises ('reverse dip') during the night instead of falling ('dipping'), the latter being the normal pattern for healthy young people.
  • The blood pressure for 'reverse dippers' is lowest during the day-time, when they would have their blood pressure checked by their GP and so these people are at risk of having a missed diagnosis of hypertension.
  • Conversely, the blood pressure of 'dippers' decreases during the night and their blood pressure is highest in the day, so they are more likely to be diagnosed with hypertension.
  • There is a well-established body of research which shows that 'reverse dippers' are at higher risk of cardiovascular disease such as stroke, heart failure, and even death. The new study found that across all sexes and in both hospital and community patient groups, at least 1 in 3 reverse dippers had at least one cardiovascular disease.

Co-author, Professor Lionel Tarassenko, Professor of Electrical Engineering and founder Director of the Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, says:
"Blood pressure follows a cyclical pattern over 24 hours. Normally, it goes down (or 'dips') at night during sleep and then rises after waking. For 'reverse dippers' (mostly elderly people, sometimes with diabetes or kidney disease), the pattern is reversed: the blood pressure goes up (or 'reverse dips') at night, and then decreases after waking. This means that 'reverse dippers' have their lowest blood pressure during the day, and so they will be falsely reassured by day-time monitoring at home or in the GP clinic. Day-time blood pressure measurements are not enough: it is vitally important to identify who is a reverse dipper through 24-hour ambulatory blood pressure monitoring."

Commenting on the importance of the new research findings for policymakers and clinicians, co-author Laura Armitage, Doctoral Research Fellow of the University of Oxford's Nuffield Department of Primary Care Health Sciences and a practicing GP, says:

"The UK NICE Guidelines presently recommend GPs diagnose hypertension based on day-time blood pressure measurements only. However, day-time blood pressure measurements are not capable of detecting high blood pressure in these highest-risk patients whose blood pressure rises at night. Our research shows that measuring night-time blood pressure could help identify the 1 in 8 adults in England who have undiagnosed hypertension. Importantly, this would also lead to a reduction in cardiovascular disease and death. This highlights the need for GPs to offer 24-hour blood-pressure assessment to their patients. This is particularly important for those above the age of 60, as the higher night-time blood pressure increases with age and blood pressure checks in the surgery and patient-self monitoring at home is not capable of picking up high night-time blood pressure."

The authors note several limitations to their study:

  • Choice of age group: the researchers did not find any significant differences between the average systolic blood pressure of men and women in the daytime or the night-time, but this may be because of the choice of age group (40-75). In previous work, the researchers had shown that women below the age of 60 had lower systolic blood pressure than men, but the opposite was true above the age of 60. However, we would expect these two phenomena would average out in a combined 40-75 age group.
  • This study used systolic blood pressure only to compute the 24-hour blood pressure patterns of the included participants, conforming to common practice in this field. The authors identify that future work could include an analysis of whether 24-hour diastolic blood pressure profiles (the force of blood against the artery walls between heart beats) provide independent information.

Failing to measure night-time blood pressure puts all groups other than dippers at risk of failure to identify hypertension. We recommend that, in addition to taking blood pressure measurements in the surgery GPs should offer 24-hour ambulatory blood pressure monitoring (ABPM) in the home to all patients aged 60 and over as a minimum, when assessing for hypertension.

Whilst we welcome the additional screening for hypertension recently deployed in pharmacies, it does not address the key issue highlighted in our paper: there is a substantial sub-set of individuals above the age of 60 who have low blood pressure during the day (for example, when screened in the pharmacy) but who have an elevated night-time blood pressure and hence a high risk of serious cardiovascular disease. Those individuals will not be offered ABPM because of their low day-time blood pressure and will be falsely reassured."

Laura Armitage, Doctoral Research Fellow, University of Oxford's Nuffield Department of Primary Care Health Sciences

Source:

Journal reference:

Armitage, L.C., et al. (2022) Diagnosing hypertension in primary care: the importance of night-time blood pressure assessment. British Journal of General Practice. doi.org/10.3399/BJGP.2022.0160.

Sun, 25 Sep 2022 12:00:00 -0500 en text/html https://www.news-medical.net/news/20220926/Study-shows-the-importance-of-night-time-blood-pressure-assessment-for-diagnosing-hypertension.aspx
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