2023-11-14 09:37:59
by Antonella Sparvoli
Research published in the Lancet confirms the key role of nocturnal hypertension as a cardiovascular (and non-cardiovascular) risk factor. Ideal values for health
The increase in pressure at night is more dangerous than during the day. Nocturnal hypertension, measured through 24-hour monitoring (otherwise known as Holter blood pressure), would in fact have a greater impact on the risk of death from cardiovascular (and non-cardiovascular) causes than daytime blood pressure. one of the most relevant observations that emerged from a large study published in the scientific journal The Lancet. More than 59 thousand patients from a Spanish registry were examined in the research and kept under observation for 10 years.
I study
The study compared the predictive value of blood pressure measurement in 24 hours compared to that performed by the doctor on deaths due to cardiovascular causes and for all causes, finding a series of interesting data that confirm results already observed in the past, on smaller numbers .
First of all, the study confirms that high systolic blood pressure (the “maximum”) is the most dangerous – explains Marina Alimento of the Heart Failure, Clinical and Rehabilitation Cardiology Operational Unit of the Monzino Cardiology Institute in Milan -. In particular, you point out that systolic blood pressure assessed over 24 hours correlates 5 times more with death than systolic blood pressure measured in an outpatient clinic, by a doctor or a nurse. Furthermore, by analyzing night-time blood pressure values separately from those during the day and 24 hours, the Spanish researchers saw that the measurement of night-time blood pressure provides 6 times more precise information than the systolic blood pressure measured in the clinic regarding the risk of mortality.
Greater risk if high even at night
Usually people who have high blood pressure at night are also hypertensive during the day, but failure to reduce blood pressure at night, when the heart should start to beat more slowly and decrease blood pressure, can expose them to a greater risk of events. cardiovascular. Generally these people have an overactivation of the sympathetic nervous system, responsible for managing stressful situations in the body. This pathological behavior, with nocturnal rise in blood pressure and heart rate, can be modulated with some antihypertensive drugs that act on this component of the autonomic nervous system – explains the expert -. To combat nocturnal hypertension, other measures can also be taken, such as taking blood pressure medications in the evening rather than in the morning. In this way the therapy is used when it is most effective, i.e. in the first 12 hours after intake.
Several factors
When treating a hypertensive person, however, various factors must be taken into consideration and, to start off on the right foot, it is essential to carefully determine the characteristics of the hypertensive state. To understand the situation well, it is not enough to measure the blood pressure in the clinic. It is also a good idea to use a blood pressure Holter test, performed before setting up any therapy or to monitor its effectiveness. In fact, blood pressure can have different characteristics and these must be identified, observes Alimento.
The white coat effect
For example, it is important to distinguish forms of sustained hypertension from so-called white coat high blood pressure or masked high blood pressure. White coat hypertension is frequently encountered and occurs when high blood pressure values are detected in the doctor’s office, but normal at home and on 24-hour monitoring, while in masked hypertension the opposite happens: the blood pressure values are normal during visit, while they are increased on Holter – clarifies the cardiologist -. “Sustained” hypertension, on the other hand, is characterized by high values both when blood pressure is measured in the clinic and during 24-hour monitoring.
As the new Spanish study also points out, masked hypertension should not be underestimated: it is in fact associated with an increased risk, which is not observed with white coat hypertension.
Possible symptoms
High blood pressure usually causes no symptoms. Sometimes, however, some signs can be seen, including headaches in people who have never suffered from them, reduced tolerance to minor efforts, or even the frequent need to urinate at night. To confirm the rise in blood pressure, it is necessary to measure it with a sphygmomanometer. The specialist may suggest performing 24-hour monitoring.
At what age to check your blood pressure
There is no precise age at which to start checking blood pressure, however the age of 20 is considered a good time for annual measurements, while after the age of 40 the doctor will indicate the optimal frequency of checks, also depending on the presence of risk factors, such as smoking, high cholesterol, sedentary lifestyle, etc. reports Food. Normal blood pressure is when the systolic value is less than 140 mmHg (millimeters of mercury) and the diastolic value is less than 90 mmHg. Ideal for health are values lower than 130/85 mmHg.
Meaning of the difference between maximum and minimum
When treating hypertension, another important parameter must also be taken into consideration, the so-called differential pressure, or the difference between the maximum and minimum. The further apart the minimum and maximum pressure are, the higher the differential pressure will be. For example, if the systolic pressure is 160 and the diastolic pressure is 80, the differential pressure will be 80 mmHg, a value considered high. A high differential pressure reflects an increase in the stiffness of the large arteries, which generally concerns the elderly – explains Alimento -. A high value of the differential associated with a greater cardiovascular risk. Unfortunately there is no specific therapy, but the antihypertensive treatment can be calibrated, for example by making do with bringing the systolic to 150-140 to prevent the diastolic from decreasing too much, given that antihypertensive drugs act on both. It’s a balancing act.
Go to the FORUM The doctor responds to Corriere Salute
November 14, 2023 (modified November 14, 2023 | 08:37)
© ALL RIGHTS RESERVED
#dangerous #high #night #Symptoms #time.news