Keeping your blood pressure under control is important. Why thehypertension, even alone, increases the risk of experiencing heart attacks and strokes. It is essential to carefully follow the therapies, based on the doctor’s instructions. But attention must also be paid to variations in blood pressure, especially when these variations imply reaching excessively low values or exceeding good blood pressure control. Particularly when it comes to systolic pressure (or maximum). Therefore, where it varies excessively from one detection to the next, even in the presence of appropriate therapy, it is necessary to discuss it with the doctor for a possible, but appropriate, fine-tuning of the therapy. This is because good blood pressure control is crucial, but an important role is also played by the time the patient spends permanently inside it.
The measurement diary
The longer the time in good control and the lower the variability of blood pressure, in fact, the lower the future risk of experiencing cardio and cerebrovascular accidents (i.e. heart attack and brain stroke). For this reason, it is important to keep a diary of blood pressure self-measurements and any measurements by healthcare personnel or pharmacists, perhaps using the smartphone diary, always specifying where, when and by whom the measurement was carried out. Without ever exaggerating with the frequency of measurements, both at home and in the clinic, and therefore without any anxiety-producing excess, the detection of significant changes between one measurement and another must be known to the patient and the doctor, in order to take the appropriate measures therapeutics and thus reduce cardiovascular risk more effectively. This reality is highlighted, with figures in hand, by research involving scholars from Imperial College London, coordinated by Peter Sever (first name Ajay Gupta). The data emerges from a new analysis of the study data ASCOT-BPLApublished on European Heart Journal.
How important is “ballerina” pressure
In the survey by London scholars – carried out years after the execution of a famous controlled clinical study, called ASCOT-BPLA – over 100,000 blood pressure measurements were evaluated in approximately 7,000 participants observed after the end of the same study for 21 years follow up. In four out of five cases the patients were male (average age 64 years). The statistical analysis was carried out in various ways, but the most indicative one is certainly the division into three groups based on blood pressure control and blood pressure variability during the study. In particular, the risk of experiencing a cardiovascular event was lower both in patients who had a systolic blood pressure equal to or lower than 132 millimeters of mercury, and in those who at the same time showed a variability between visit and visit contained within 9.30 millimeters of mercury. The worst prognosis, however, belonged to those who had high blood pressure systolic equal to or greater than 140 millimeters of mercury, as for those who had a variability of the same systemic blood pressure equal to or greater than 13 millimeters of mercury.
What do we have to do
“Controlling one’s blood pressure, especially systemic, is therefore fundamental, but equally so is checking that the oscillations – which are inevitable – are not excessive and, not a secondary detail, do not imply that the systemic blood pressure is not stably well controlled – he comments Claudio Ferri, full professor of Internal Medicine at the University of L’Aquila. In addition to this, the study also tells us a second important point. The re-evaluation of the ASCOT-BPLA was carried out using the data obtained during the controlled clinical study, but projecting them into the context of 21 years of follow up. This allows us to emphasize the very close “link” between the actual achievement of good blood pressure control and long-term benefit (and what a distance, it is worth repeating: 21 years!)”.
The importance of stability
In addition to informing on the specific protective value of two drugs compared, therefore, this reevaluation of the ASCOT-BPLA study once again signals to clinicians and patients the crucial importance of good blood pressure control, the accurate choice of therapies and the persistent maintenance of control itself, without excessive variations between one measurement and another. “It is essential to suggest to the hypertensive patient to measure the blood pressure themselves blood pressure, without falling into anxiety-inducing excesses, but in any case every week, and not to overestimate the harmful role of a single measurement not in line with the previous ones, certainly not underestimating excessive variability between measurements over time – concludes Ferri. This without ever losing sight of the fact that the main objective is to bring systolic and diastolic blood pressure stably into the context of normality.”
by Federico Mereta