Interviews by Sophia Palma to the professors Frank Cecchi e Gianfranco Parati

What is high blood pressure? 

Prof. Franco Cecchi

Prof. Franco Cecchi

Arterial hypertension is a condition characterized by the constant presence of blood pressure values ​​above the norm (i.e. equal to or greater than 140/90 mmHg if measured by the doctor, or equal to or greater than 135/85 mm Hg when considering the average of more self-measurement days at home) at any age. 

It should be considered that blood pressure values ​​can be very variable, in relation to the emotional state: higher if we are scared or angry, while they are generally lower after a meal, during rest or while sleeping. 

Even high pressure values ​​are usually not perceived and are not associated with any symptoms. This means that we do not know if we are hypertensive if we do not measure the pressure at home or at the doctor. 

What does high blood pressure involve? 

High blood pressure (AI) is an important cardiovascular risk factor. This means that a person with AI has an increased risk of developing complications, such as stroke and heart attack, kidney failure, heart failure or cognitive impairment, compared to the population with normal blood pressure values, especially in smoking and / or diabetic patients or when others are present. risk factors such as a high LDL cholesterol value or a very low HDL cholesterol value. 

What are the threshold values ​​for diagnosing hypertension? 

Prof. Gianfranco Parati

Prof. Gianfranco Parati

Threshold values ​​are those blood pressure values ​​above which a diagnosis of AI is made. 

It is known that the blood pressure values ​​recorded by the doctor are generally higher than those recorded by the patient at home and in any case the values ​​recorded at the first measurement are higher than those measured at the second or third measurement. For this reason, a single measurement is not enough. It is therefore very important to record blood pressure values ​​during at least two subsequent visits to the doctor (at least two-three measurements per visit) and monitor them at home every day, twice in the morning and twice in the evening, in the week preceding a medical examination. ., in order to verify the need to start a therapy, if the values ​​exceed the thresholds indicated above. 

In the presence of highly variable blood pressure values, or in the event of a discrepancy between the pressure measured by the doctor and the self-measured pressure at home, a dynamic pressure monitoring for 24 hours can be useful, which allows you to accurately evaluate beyond the average values ​​of the 24 hours, even the values ​​recorded separately during day and night. The values ​​recorded during normal sleep are lower than during the day. 

Given the clinical importance of blood pressure measurements at home, what are the practical methods to be followed so that the values ​​obtained are reliable? 

First, measurements should only be made with fully automated and certified gauges for their accuracy (see list at www.stridebp.org) equipped with a cuff of appropriate size for your arm, for example larger in obese subjects. The use of wrist and especially finger gauges is not recommended. The pressure measurement must be carried out in a moment of tranquility, in a sitting position, after at least 5 minutes of rest, with the back and feet supported and the arm where the measurement is carried out resting on a support and positioned at the level of the heart. Measurements should be taken twice one minute apart, respectively in the morning before taking the medication and in the evening before dinner. 

Can blood pressure monitors also detect the presence of an arrhythmia, such as atrial fibrillation, which is the most common arrhythmia in patients with cardiomyopathy? 

There are some devices that allow you to evaluate the presence of an arrhythmia, that is, an irregular rhythm, such as, for example, atrial fibrillation. Detecting an arrhythmia is important because, in the presence of atrial fibrillation, anticoagulant therapy or in any case a therapy to avoid its onset may be advisable. However, these tools cannot give certainty. In the event that an arrhythmia is reported during blood pressure measurement, it is advisable to have confirmation by recording an Electrocardiogram (ECG), with instruments suitable for your home (for example with a smartwatch capable of recording the ECG), or by going to the doctor or cardiologist, or by calling 112 if you have symptoms such as chest pain or difficulty breathing. 

How often and how should blood pressure measurements be taken? 

In subjects with AI, it is recommended to measure blood pressure at home once or twice a week in the period between two consecutive medical visits, and for at least 3, but better for 7 days in the week before each scheduled visit. The values ​​recorded at home can be shown at the medical examination or sent by email to your doctor or cardiologist, after agreement with the doctor himself. 

The measurement of blood pressure at home is an important tool at the service of the therapeutic alliance between doctor and patient: the pressure diary, in fact, allows the informed patient to suddenly notice a change in his pressure profile and therefore to alert the doctor early that , based on the reported values, he / she can insert or modify the antihypertensive therapy. 

However, it should be remembered that self-modification of antihypertensive therapy by the patient on the basis of the data collected is not recommended, unless it has been agreed in advance with your doctor. When it is noticed that the blood pressure values ​​are constantly altered, that is on average higher than 135 / 85mmHg, or lower than 110 mmHg (except in cases of "constitutional hypotension") it is advisable to contact the doctor to evaluate together how to correct the therapy. 

What should we watch out for when taking high blood pressure medications? 

It is essential to take liquids regularly, drinking water, juices, or using soups, preferably vegetables or legumes (lentils, beans, etc) especially during the summer, when taking drugs for AI. It is also important to reduce the use of salt, on the table, or in the kitchen, and limit the intake of salty foods (cold cuts, cheeses, salted fish, etc). It is important to carry out regular physical activity, according to the advice of your doctor. 

Finally, it is essential, as mentioned above, to keep blood pressure constantly monitored according to the indicated schemes.