In recent years, the incidence of hypertension has become younger and younger, and hypertension is closely related to cardiovascular disease. How to better manage blood pressure and how to evaluate more accurately, with these questions, Professor Gianfranco Parati of San Luca Hospital in Italy gave a wonderful sharing.
International Circulation: How does blood pressure measurement time affect the results, and what are the requirements for different measurement methods?
Professor Gianfranco Parati: Blood pressure is a dynamic parameter. There is not any magic number that you can measure just once. So by definition, the longer we keep monitoring, the more precise is our estimate, and then the more accurate is the diagnostic evaluation.
We can measure blood pressure using different methods. If you consider, for example, the office readings, we should definitely avoid quick spot measurements. The Guidelines are very clear in this regard - they recommend repeated measurements during a given visit, and repeated visits before drawing any conclusions. So even with office pressures, we need to measure the blood pressure repeatedly over time. Considering home blood pressure measurement, the indication we are already giving is that there should ideally be one week of measurement (twice in the morning, twice in the evening) before each physician visit. If seven days is difficult, at least no less than three days; but again, the longer time may be more useful because you get more information. Finally, if you consider the classic ambulatory blood pressure measurement, we are already asking for 24 hours, and we should definitely have 24 hours, not shorter time periods. It is very important to include day and night, because we get different information.
International Circulation: For hypertension patients, how should the frequency and intervals of blood pressure measurement be controlled?
Professor Gianfranco Parati: In hypertensive patients, where we already have a diagnosis, of course we need to repeatedly check the blood pressure. How frequently? This depends on the severity of hypertension, and the severity of the cardiovascular risk level. For mild hypertension, low cardiovascular risk, maybe once or twice a year could be enough to keep things under control. But of course, if you have an increased risk, you need to do it much more frequently, depending on the need you have to get information to optimize blood pressure control.
International Circulation: What time of day is the best time to measure blood pressure?
Professor Gianfranco Parati: As I said, blood pressure is a dynamic parameter. There is no ideal time of the day. What we try to do is standardize the time, at least to be able to compare data. Obviously, blood pressure can be different in the morning and the evening, after a meal, when you wake up, when you go to bed. If you want to compare between different people, it would be nice to have comparable situations. What we recommend in the office is to measure blood pressure after a five minute rest when seated and then take the measurement. At home, we recommend having a blood pressure measurement in the morning before taking medication and before having a meal, and in the evening, before dinner. This provides comparable data. Of course, you might wish to add an additional measurement at a specific time of the day, and the selection of that time depends on the information you have to get. This needs to be personalized depending on the individual.
International Circulation: With several guidelines and new research published this year at ESC2022, which research are you most interested in?
Professor Gianfranco Parati: Recently, we have been facing a continuous flow of evidence and new recommendations. Before this conference, we published some recommendations for the European Society of Hypertension on home blood pressure measurement and blood pressure measurements taken in the clinical setting. There we gave a lot of detailed information. Now there is another paper coming out on blood pressure variability, which is very important, because it is the phenomenon behind our measurements. At this specific conference, there are other guidelines being updated related to arrhythmias and pulmonary hypertension, and indeed there is a lot of new evidence being presented also, but what is going to be discussed most at this conference is the need for prevention and the importance of diagnostics, in particular imaging, which is one of the key issues at this Congress.
International Circulation: As a participating expert, what do you think is the biggest highlight this year?
Professor Gianfranco Parati: Definitely, there is a lot of focus on imaging. That is one of the main topics selected for this conference. There is a lot of information also on blood pressure measurement using all kinds of technological support including digital help, that may help us diagnose something earlier and prevent the appearance of serious complications.
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