For treatment-resistant high blood pressure, it might be best to ditch arm cuff blood pressure measurements
Arm cuff blood pressure measurements may not work optimally for predicting heart disease risk in some patients with difficult-to-treat high blood pressure, according to preliminary findings presented at an American Heart Association meeting in New Orleans this week.
Researchers believe that a measurement of central blood pressure instead of traditional arm cuff readings could work better for select patients. Central blood pressure, or blood pressure amplification, is measured at the aorta.
"The findings imply that amplification of blood pressure and pulse pressure remains high in patients with resistant hypertension regardless of blood pressure control," said Badhma Valaiyapathi, MPH, lead study author, in a press statement. "This means their arteries are stiffer than [those of] patients with controlled blood pressure, and they're having problems in their vessels that are leading to heart disease even though they are on medications and even though their blood pressure is under control."
After comparing measurements of patients in three categories—controlled nonresistant blood pressure; controlled resistant blood pressure; and uncontrolled resistant blood pressure—researchers found the highest blood pressure amplification was in patients with uncontrolled resistant blood pressure. On the other hand, the lowest blood pressure amplification was observed in patients who were in the controlled nonresistant category. Valaiyapathi said this explains why risk severity tends to be highest among some adults who have uncontrolled high blood pressure and are resistant to certain medications.
"We found that higher differences in blood pressure between the arm and the aorta are associated with increased incidence of heart disease in the general population," said Valaiyapathi.
Although the results are preliminary and the study was small, Valaiyapathi suggested that physicians tailor blood pressure treatment for patients with treatment-resistant high blood pressure by taking into account central blood pressure and amplification, and by reinforcing the importance of lifestyle modifications—not just medications—to reduce heart disease risk.