How to measure blood pressure best? Hypertension tests at office or home or 24-hour monitoring. 6
When doctors check blood pressure, it’s often high. This is “white coat syndrome”. When patients self-check blood pressure at home, it can also be high due to anxiety. Both hypertension testing methods might give false numbers. How to measure blood pressure best? Why 24-hour blood pressure monitoring might be the best? Patients get blood pressure measured in the doctor’s office. It’s usually a little bit higher than home measurement of blood pressure. Dr. Anton Titov, MD. Maybe this is the opportunity to mention that fact. Some of the publications and some reviews that you published provided an important analysis. Dr. Anton Titov, MD. They reviewed how different clinical trials measured blood pressure in a different ways. Now we have devices for home monitoring of blood pressure. They might give more true values of blood pressure. Dr. Anton Titov, MD. Could you please discuss office vs. home blood pressure measuring? Dr. Ehud Grossman, MD. Yes, the point is this. The main question that we ask is this. Why do we treat high blood pressure? We treat hypertension to prevent future disease. It is 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 clinical trials. A certain percent of the population, around 20 – 25%, 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”. It is anxiety. Dr. Ehud Grossman, MD. We also found that we could measure the blood pressure during a night time. We found some patients among those studied. They don’t lower the blood pressure during night time. This means there are “non-dippers”. We also know that “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. It does not reflect in all patients a 24-hour pattern of the blood pressure. So we prefer today to use more and more a 24-hour blood pressure measurement. We have equipment to define how the blood pressure is controlled. A 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 this. Dr. Ehud Grossman, MD. 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. They see the elevated level of blood pressure. It causes more anxiety and then the blood pressure goes up. They are in a vicious circle that you cannot stop. So we prefer this. Dr. Ehud Grossman, MD. I personally prefer to use more and more the 24-hour blood pressure monitoring equipment to define hypertension. Dr. Anton Titov, MD. “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. Dr. Anton Titov, MD. What are blood pressure numbers that you would look for in a 24-hour blood pressure measurement? What would be the average blood pressure numbers? Yes, average during the day, average during the night. You can also see the heart rate. This is very important for choosing the medications. Dr. Ehud Grossman, MD. 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 and heart attack or heart failure.
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