Current applications and limitations of European guidelines on blood pressure measurement: implications for clinical practice

Abstract

Hypertension is the most common cardiovascular (CV) risk factor, strongly and independently associated with an increased risk of major CV outcomes, including myocardial infarction, stroke, congestive heart failure, renal disease and death due to CV causes. Effective control of hypertension is of key importance for reducing the risk of hypertension-related CV complications, as well as for reducing the global burden of CV mortality. However, several studies reported relatively poor rates of control of high blood pressure (BP) in a setting of real-life practice. To improve hypertension management and control, national and international scientific societies proposed several educational and therapeutic interventions, among which the systematic implementation of out-of-office BP measurements represents a key element. Indeed, proper assessment of individual BP profile, including home, clinic and 24-h ambulatory BP levels, may improve awareness of the disease, ensure high level of adherence to prescribed medications in treated hypertensive patients, and thus contribute to ameliorate BP control in treated hypertensive outpatients. In line with these purposes, recent European guidelines have released practical recommendations and clear indications on how, when and how properly measuring BP levels in different clinical settings, with different techniques and different methods. This review aimed at discussing current applications and potential limitations of European guidelines on how to measure BP in office and out-of-office conditions, and their potential implications in the daily clinical management of hypertension.

Keywords: Cardiovascular prevention; Home blood pressure; Hypertension; Office blood pressure; Out-of-office blood pressure.

Fig. 1

Schematic representation of the current diagnostic approach to hypertension, as recommended by current guidelines. Office and out-of-office BP measurements are currently recommended by European guidelines to confirm the diagnosis of hypertension, as well as to properly identify different hypertension phenotypes. Unattended (office) BP measurements have been recently proposed as a valid option in the diagnostic work-up of hypertension. BP blood pressure, HTN hypertension, WCHT white-coat hypertension, MKHT masked hypertension