What’s new in blood pressure measurement? A workshop ofthe European Society of HypertensionEoin O’Brien
Blood Pressure Monitoring 2004, 9:281–282
Received 4 October 2004 Accepted 4 October 2004
Chairman of the European Society of Hypertension Working Group on BloodPressure Monitoring.
A workshop on what’s new in blood pressure measure-
range from a low of 8% to a high of 49%, and that ABPM is
ment was held in Paris in June 2004 at the 14th European
a prerequisite for its diagnosis, explores the character-
Meeting on Hypertension of the European Society of
istics of the condition that might assist in identifying
Hypertension. Since its foundation in 1999, the Working
Group has held annual workshops devoted to bloodpressure measurement and Blood Pressure Monitoring has
In 4939 treated hypertensive patients in the SHEAF
published over 80 papers from the proceedings of these
study the prevalence of masked hypertension varied
workshops. These papers and those published in this
from 8.9–12.1% depending on the number of measure-
issue reflect the underlying ethos of the Working Group,
ments made, and Jean-Michel Mallion and colleagues
which is that accurate and informative measurement is
(Grenoble, France) shows data suggesting that for office
mandatory for the diagnosis and management of hyper-
measurement at least three measurements at two visits
tension and for research into hypertension. If the
and for home measurement three measurements twice a
measurement of blood pressure is inaccurate it follows
day over 2 days are required to diagnose the condition
that all other considerations, be they related to patient
management or scientific enquiry, must be inappropriateand erroneous.
Eamon Dolan et al. (Dublin, Ireland) presenting data from5714 patients referred over a 22-year period with an
Observing that the many guidelines for the management
overall prevalence of white-coat hypertension of 15.4%,
of hypertension largely ignore the information obtained
shows that older adults, females, and cigarette smokers
with automated devices used for self and 24-h ambulatory
are more likely to have the phenomenon [6].
blood pressure measurement (ABPM), Martin Myers,(Toronto, Canada) proposes a new algorithm incorporat-
Elly Den Hond and colleagues (Leuven, Belgium) using
ing automated measurements for use in patients with
data from the THOP Trial in which 400 hypertensive
uncomplicated essential hypertension [1].
patients had blood pressure-lowering therapy adjusted onthe basis of the self-measured pressure at home or
Paul Padfield and colleagues (Edinburgh, Scotland)
conventional measurement measured at the doctor’s
present evidence that a direct access service for ABPM
office, shows that therapy guided by home blood pressure
for general practitioners in Edinburgh has significantly
led to less intensive drug treatment and marginally lower
influenced the management of patients most notably by a
costs, but also to less blood pressure control [7].
20% reduction in the number of patients treated withantihypertensive drugs that would result in a financial
Takayoshi Ohkubo et al. (Sendai, Japan) presents
saving more than adequate to pay for the technology
evidence from the Ohasama study to show that home
blood pressure is an independent predictor for haemor-rhagic and ischaemic stroke in the general population
George Stergiou et al. (Athens, Greece) reviewing the
compared to conventional blood pressure [8].
evidence for blood pressure measurement in children andadolescents, concludes that ABPM is already finding a role
Thomas Mengden and colleagues (Bonn, Germany) using
as a supplementary source of information in children and
telemonitoring of self-measurement of blood pressure in a
adolescents, whereas at present home measurements should
trial of olmesartan medoxomil shows that the technique
not be used for decision-making in this population [3].
allows for the early identification of responders anddemonstrates that olmesartan provides effective and
Paolo Palatini (Padova, Italy) remarking that prevalence
reliable blood pressure lowering throughout the 24-h
of masked hypertension in the general population may
Copyright Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Dolan E, Stanton A, Atkins N, Den Hond E, Thijs L, McCormack P, et al.
Myers MG. Blood pressure measurement and the guidelines: a proposed new
Determinants of white-coat hypertension. Blood Press Monit 2004;
algorithm for the diagnosis of hypertension. Blood Press Monit 2004; 9:283–286.
Richards C, Sutherland M, Gough K, Padfield PL. Direct access to
DenHond E, Staessen JA, Celis H, Fagard R, Keary L, Vandenhoven G,
ambulatory BP monitoring: the Edinburgh experience. Blood Press Monit
O’Brien ET, for the Treatment of Hypertension Based on Home or Office
Blood Pressure (THOP) Trial Investigators. Antihypertensive treatment based
Stergiou GS, Alamara CV, Vazeou A, Stefanidis CJ. Office and out-of-office
on home or office blood pressure—the THOP trial. Blood Press Monit 2004;
blood pressure measurement in children and adolescents. Blood Press Monit
Ohkubo T, Asayama K, Kikuya M, Metoki H, Obara T, Saito S, et al.
Palatini P. Masked hypertension: how can the condition be detected? Blood
Prediction of ischaemic and haemorrhagic stroke by self-measured
blood pressure at home: the Ohasama study. Blood Press Monit 2004;
Mallion JM, Gene`s N, Vaur L, Clerson P, Vaı¨sse B, Bobrie G, Chatellier G.
Detection of masked hypertension by home blood pressure measurement: is
Mengden T, Ewald S, Kaufmann S, vor dem Esche J, Uen S, Vetter H.
the number of measurements an important issue? Blood Press Monit 2004;
Telemonitoring of blood pressure self measurement in the OLMETEL study.
Blood Press Monit 2004; 9:321–325.
Copyright Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
You now know a lot more about stress and how it affects you (Part A & B of Week 1 handouts). The information in this section will help you to make changes that will put you in a better position to learn how to manage stress. Clearing the decks Before you learn new ways to get on top of stress, you must get rid of the things that might be making it worse. These may include: Alcoho
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