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[Cardiovascular risk and the measurement of arterial pressure]
B Vaisse1, F Silhol, K Bouchlagem
1Service de médecine interne à orientation angéiologique, CHU Timone, Marseille.
Insights
Accurate blood pressure measurement is key for managing hypertension and cardiovascular risk. New methods like ambulatory monitoring better predict outcomes than traditional readings, guiding optimal treatment strategies.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- Cardiovascular risk assessment integrates blood pressure with factors like cholesterol, smoking, age, sex, diabetes, and heredity.
- Optimal blood pressure targets and control rates in treated hypertensive patients remain subjects of debate, with low population-level control observed.
- Traditional clinical blood pressure measurements may not fully capture a patient's cardiovascular risk or predict outcomes effectively.
Purpose of the Study:
- To evaluate the correlation of new blood pressure measurement methods with cardiovascular events and mortality.
- To assess the predictive value of ambulatory blood pressure monitoring for left ventricular hypertrophy regression.
- To inform optimal blood pressure control strategies and future research directions in hypertension management.
Main Methods:
- Comparison of clinical blood pressure measurements with ambulatory blood pressure monitoring (ABPM) and self-measurement.
- Analysis of correlation between different blood pressure measurement techniques and cardiovascular outcomes.
- Review of current recommendations and guidelines regarding blood pressure monitoring in hypertensive patients.
Main Results:
- Ambulatory blood pressure monitoring and self-measurement show stronger correlations with cardiovascular events and mortality compared to standard clinical readings.
- Ambulatory blood pressure recording appears more predictive of left ventricular hypertrophy regression.
- Current recommendations suggest using ABPM or self-measurement when clinical readings are uncertain or in cases of apparent drug resistance.
Conclusions:
- Newer blood pressure monitoring techniques offer superior correlation with cardiovascular outcomes and left ventricular hypertrophy regression.
- Physician doubt regarding clinical blood pressure values, especially with apparent drug resistance, warrants the use of ambulatory or self-measurement.
- Further prospective studies are needed to define optimal blood pressure control and its implications for absolute cardiovascular risk in 1988.
Abstract:
Clinical measurement of the blood pressure associated with assessment of the other cardiovascular risk factors: cholesterol, smoking, age, sex, diabetes and cardiovascular heredity, allow appreciation of the cardiovascular risk of hypertensive patients after the results of the Framingham study. There is no consensus about the optimal clinical blood pressure with treatment and about the control of treated hypertensives which remains low in population studies (28% in France, 27% in the United States). New methods of blood pressure measurements such as ambulatory blood pressure monitoring and self-measurement of the blood pressure are better correlated to cardiovascular events and morbi-mortality than measurement of the blood pressure during consultation in hypertensive patients. Ambulatory blood pressure recording also seems to be more predictive of regression of left ventricular hypertrophy. Therefore, the latest recommendations, especially the American consensus, advise using these techniques when the physician is in doubt about the value of the clinical blood pressure measurement of hypertensive patients, especially in the case of apparent antihypertensive drug resistance. Finally, what does good blood pressure control imply in 1988: normal clinical blood pressure measurements compared with ambulatory blood pressure monitoring or self-measurement of the blood pressure? Does it mean control of the patient's absolute cardiovascular risk? The answers to these questions can only be obtained by future prospective studies.