How to measure blood pressure in the best way? Office vs. home vs. 24-hour monitor. 6

How to measure blood pressure in the best way? Office vs. home vs. 24-hour monitor. 6

How to measure blood pressure in the best way? Office vs. home vs. 24-hour monitor. 6

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- Maybe this is the opportunity to mention that when people get blood pressure measured in the doctor's office, it's usually a little bit higher [than home measurement]. In some of the publications, including some of the reviews that you published - it was an important analysis how different clinical trials measured blood pressure in a different ways. Now we have devices for home monitoring of blood pressure that might give more true values of blood pressure. Could you please discuss? [office vs. home blood pressure measuring] Yes, the point is - the main question that we ask is Why do we treat high blood pressure? We treat hypertension to prevent future disease - stroke, myocardial infarction, congestive heart failure. What can predict best the future? We found that the single arterial blood pressure measurement in the clinic predicts the future, but 24-hour blood pressure monitoring predicts the future much better. We found also that - we did several studies - that we a certain percent of the population, around 20 - 25% - they have elevated blood pressure measurements in the clinic but when we do 24-hour blood pressure measurements, we see that the blood pressure is normal. So this is a "white coat effect" [anxiety] We also found that we could measure the blood pressure during a night time, and we found a subpopulation [some people among those studied] that don't lower the blood pressure during night time, which means there are "non-dippers". We also know that this "non-dippers" population are at a greater risk for the future [stroke, heart attack, heart failure]. So we know today that measuring blood pressure in the clinic is not necessarily correct and it does not reflect in all patients a 24-hour pattern of the blood pressure. So we prefer today to use more and more 24-hour blood pressure measurement equipment to define how the blood pressure is controlled, if the patient has elevated blood pressure or not. British NICE in their recommendations suggested to do the 24-hour blood pressure monitoring in every new patient. American and the European [hypertension society guidelines] say, OK, we need to use out of the clinic blood pressure levels but not necessarily 24-hour blood pressure monitoring. It can also be done at home by the patient. The point is that many patients at home are anxious when they see the elevated level of blood pressure - it causes more anxiety and then the blood pressure goes up and they're in a vicious circle that you cannot stop. So we prefer, and I personally prefer, to use more and more the 24-hour blood pressure monitoring equipment to define hypertension - "white coat syndrome", "dipper" or "non-dipper". I get much more information when I use 24-hour blood pressure monitoring as compared to just partial measurements at the clinic. Blood pressure numbers that you would look at in a 24-hour blood pressure measurement would be the average blood pressure numbers? Yes, average during the day, average during the night. You can also see the heart rate, which is very important for choosing the medications, and you can see also what we call blood pressure variability - What is the difference between measurement to measurement - if it's too chaotic and they have low and high blood pressure values - these patients are at a high risk [for stroke, heart attack or heart failure]
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