Lower Blood Pressure

We’ve learned of new results from blood pressure research studies, that indicate people whose blood pressure fluctuates, are more at risk of developing a stroke than those who have steady raised blood pressure (or hypertension). Fluctuating blood pressure is known as episodic hypertension.

This is prompting a rethink of the advice given to doctors who may have previously overlooked occasional high blood pressure readings in their patients, and who now need to consider treatments, including prescribing high blood pressure medication, that produces the most even blood pressure readings over the long term.

The research is published in the UK Medical Journal – The Lancet, and was carried out by UK and Swedish researchers, led by Professor Peter Rothwell from the department of Clinical Neurology at the University of Oxford. It examined data associated with statistical variations in blood pressure readings, taken from doctors’ medical examination results. This confirmed that those with fluctuating high blood pressure readings taken across several different appointments, proved to be at the greatest risk of developing a future stroke, irrespective of what their average blood pressure reading was.

Doctors normally use average blood pressure reading

Usually doctors are advised to use an average value of a number of patient blood pressure measurements as the best way to warn of an increased stroke risk. This may now have to be updated with new advice not to ignore the occasional high blood pressure reading. Previously, they may have overlooked a single abnormal high blood pressure test result, and only commenced any form of treatment if repeated blood pressure readings were high.

The United Kingdom Stroke Association has now recommended that the national advice given to Doctors should be updated to reflect the results of this research, according to their their spokesperson Joe Korner. He said that many people who have occasional high blood pressure readings are not being diagnosed or treated.

Professor Rothwell’s explanation for the research findings is that rapid fluctuations in blood pressure can cause a turbulent flow of blood through the arteries that can cause stiffening and damage to the arterial walls. He said anyone diagnosed with high blood pressure who performs home blood pressure testing and monitoring should report any fluctuations in their readings to their doctor.

‘Clinical guidelines need to be reviewed’

The UK National Institute for Health and Clinical Excellence’s (NICE) guidelines on high blood pressure is in the process of being rewritten and these latest studies will apparently be taken into account. NICE have released the following statement :-

“With this new research it is now important that the clinical guidelines about treating high blood pressure are reviewed.  “In the meantime we urge General Practitioners [Doctors] to read this research to help them prescribe the best treatment for people at risk of stroke.”

The British Heart Foundation have responded more cautiously, with their statement, issued by Professor Peter Weissberg;- medical director :-

“Current practice is not wrong, but this might add a new measure to help doctors make decisions on who to treat for hypertension and which drug to use.”