In the ever increasing fight against vascular disease and related health problems the role of the silent marker – Blood Pressure has always been regarded as a sentinel sign. The levels determined to be safe have been adjusted over the years to try and develop a public and medical policy towards compression of risk. Therefore nurses and Dr’s perform clinic blood pressure tests to look for indications of different states of hypertension. This study from the BMJ indicates who and how, has significant effects on results/intervention.[1]
Clinic blood pressure measurements taken by doctors were considerably higher than those taken by trained staff and therefore gave inappropriate estimates of ambulatory thresholds.1
It is already known that ambulatory blood pressure observed over 24 hours is significantly lower than clinic blood pressure, measured at a one off event, even in patients with moderate and severe hypertension. The disparity between both methods also increases with increasing clinic blood pressure values raising questions about the validity of relying on clinical evaluation alone.[2]
There are a number of factors that affect blood pressure, from Vit D status to menopause but what if one of the most dramatic is simply from white coat hypertension – magnified by the Dr actually taking the test. What if the effect of this is so great that many patients may well have been prescribed anti-hypertensive medication incorrectly?
It is already recognised that the adverse effects of NSAID’s can include hypertension, leading to adverse drug related prescription therapy, rather than physiological prescription.[3] Yet single spikes in systolic blood pressure previously thought to be a benign event if overall BP was within normal bounds has now been identified as an increased risk for stroke development.[4]
This further implies that a progressive ambulatory approach will provide a more accurate blood pressure analysis than a single clinical reading as the risk for over prescription will now rise in light of the implications for stroke management.1
Comment
The risks of untreated hypertension are well established and treatment recommendations have undergone significant periods of review and reflection over the last 10 years. The use of medications can be lifesaving and at times provide dramatic benefits. Many patients however, do not respond well to the medication either in terms of limited BP reduction benefit, or reaction to the medication and others simply wish to explore alternative strategies.
Hypertension is a major risk factor for cardiovascular morbidity and mortality. Blood pressure measurements taken in the clinic or office provide limited information about the true blood pressure load, and measurements taken elsewhere are often needed to best guide the diagnosis and treatment of hypertension.1
Lifestyle changes can have significant effects of hypertension and are low risk interventions, albeit difficult to manage complete compliance in many cases. Dr Marc Houston a cardiologist has published a paper on the effects of a supplement programme on the resolution of hyperlipidemia a condition often found in coexistance with hypertension and presents some early data with a compelling outcome for clinical strategy where medication is unsuited or unwanted. This paper and other relevant information can be found in the lecture pack provided by Michael Ash from his presentation at the 2010 CAM conference on a Nutritional Therpaist approach to CVD using evidence based strategies and treatments.
Other lifestyle strategies have demonstrated improvement in blood pressure levels and represent a practical long term strategy.[5]
References
[1] Head GA, Mihailidou AS, Duggan KA, Beilin LJ, Berry N, Brown MA, Bune AJ, Cowley D, Chalmers JP, Howe PR, Hodgson J, Ludbrook J, Mangoni AA, McGrath BP, Nelson MR, Sharman JE, Stowasser M. Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study. BMJ. 2010 Apr 14;340:c1104. doi: 10.1136/bmj.c1104. View Full Paper
[2] Bur A, Herkner H, Vlcek M, Woisetschläger C, Derhaschnig U, Hirschl MM. Classification of blood pressure levels by ambulatory blood pressure in hypertension. Hypertension. 2002 Dec;40(6):817-22. View Abstract
[3] Rochon PA, Gurwitz JH. Drug therapy. Lancet. 1995 Jul 1;346(8966):32-6. Review. View Abstract
[4] Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010 Mar 13;375(9718):895-905. View Abstract
[5] Fleet JC. DASH without the dash (of salt) can lower blood pressure. Nutr Rev. 2001 Sep;59(9):291-3. Review. View Abstract
