Objectives Standard operating procedures for office blood pressure measurement (OBPM) vary greatly between guidelines and studies. We aimed to compare the difference between a single OBPM and the mean of the three following measurements. Further, we studied how many patients with possible hypertension may be missed due to short-term masked hypertension (STMH) and how many might be overdiagnosed due to short-term white coat hypertension (STWCH). Design and setting In this cross-sectional, single-centre trial, 1000 adult subjects were enrolled. After 5 min of rest, four sequential standard OBPMs were performed at 2 min intervals in a quiet room in sitting position. We compared the first (fBPM) to the mean of the second to fourth measurement (mBPM). STMH was defined as fBPM <140 mm Hg systolic and <90 mm Hg diastolic and mBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg. STWCH was defined as fBPM systolic ≥140 mm Hg or diastolic ≥90 mm Hg and mBPM <140 mm Hg systolic and 2 mm Hg, >5 mm Hg and >10 mm Hg, respectively. In 3.4% of initially normotensives STMH and in 34.3% of initially hypertensives, STWCH was apparent. Conclusions There are significant differences between a single OBPM and the mean of consecutive BP measurements. Our study provides evidence that a single OBPM should not be the preferred method and should be discouraged in future guidelines. Trial registration number NCT02552030;Results.

Sustained hypertension causes structural, functional, and neurohumoral abnormalities in the heart, a disease commonly termed hypertensive heart disease (HHD). Modern concepts of HHD, including processes of remodeling leading to the development of various LVH patterns, HF patterns accompanied by micro- and macrovasculopathies, and heart rhythm and conduction disturbances, are missing in the available definitions, despite copious studies being devoted to the roles of myocardial and vascular fibrosis, and neurohumoral and sympathetic regulation, in HHD development and progression. No comprehensive and generally accepted universal definition and classification of HHD is available to date, implementing diagnostic criteria that incorporate all the possible changes and adaptions to the heart. The aim of this review series is to summarize the relevant literature and data, leading to a proposal of a definition and classification of HHD. This first article reviews the processes of initial myocardial remodeling, and myocardial and vascular fibrosis, occurring in HHD. We discuss important pathophysiological and microstructural changes, the different patterns of fibrosis, and the biomarkers and imaging used to detect fibrosis in HHD. Furthermore, we review the possible methods of targeting myocardial fibrosis in HHD, and highlight areas for further research.

Hypertensive heart disease (HHD) remains a major global public health concern despite the implementation of new approaches for the management of hypertensive patients. The pathological changes occurring during HHD are complex and involve the development of structural and functional cardiac abnormalities. HHD describes a broad spectrum ranging from uncontrolled hypertension and asymptomatic left ventricular hypertrophy (LVH), either a concentric or an eccentric pattern, to the final development of clinical heart failure. Pressure-overload-induced LVH is recognised as the most important predictor of heart failure and sudden death and is associated with an increased risk of cardiac arrhythmias. Cardiac arrhythmias are considered to be one of the most important comorbidities affecting hypertensive patients. This is the second part of a three-part set of review articles. Here, we focus on the macrostructural and functional abnormalities associated with chronic high pressure, their involvement in HHD pathophysiology, and their role in the progression and prognosis of HHD.

The clinical spectrum of hypertrophic cardiomyopathy (HCM) is complex and includes a variety of phenotypes, which leads to different types of manifestations. Although most of the patients are asymptomatic, a significant proportion of them will develop symptoms or risk of arrhythmias and sudden cardiac death (SCD). Therefore, the objectives of HCM diagnosis and management are to relieve the patients’ symptoms (chest pain, heart failure, syncope, palpitations, etc.), prevent disease progression and major cardiovascular complications and SCD. The heterogeneity of HCM patterns, their symptoms and assessment is a challenge for the cardiologist.

Objective Recently, a cuffless blood pressure (BP) measurement device using pulse transit time (PTT) for beat-to-beat calculation of BP values has been validated over a short time period. However, it remains unknown how values obtained with this device compare with standard ambulatory measurements over a 24-hour period. We hypothesised that BP values measured by a cuffless PTT device (TestBP) are comparable with measurements by a standard upper arm cuff-based BP device (RefBP) in clinical practice over 24 hours. Methods Between May and December 2017, 71 individuals were prospectively included. Cuffless using the Somnotouch-NIBP (Somnomedics GmbH, Randersacker, Germany) and cuff-based standard 24-hour BP measurements were performed simultaneously on the left and right arm, respectively. The first RefBP measurement was used as calibration measurement for the TestBP. Results Mean (±SD) age was 49.3 (15.1) years, and 51% were male. Mean 24-hour BP for TestBP and RefBP were 140.8 (20.0) versus 134.0 (17.3) mm Hg for systolic (p<0.0001) and 85.8 (14.1)versus79.3 (11.7) mm Hg for diastolic (p<0.0001) measurements, respectively. Mean absolute systolic and diastolic disagreements between TestBP and RefBP were 10.2 (7.2) and 8.2 (5.5) mm Hg, respectively. The number (percentage) of absolute differences between the mean 24-hour BP values of the TestBP and RefBP within 5, 10 and 15 mm Hg were 23 (32.4), 43 (60.6) and 54 (74.6) for systolic and 24 (33.8), 51 (71.8) and 65 (91.6) for diastolic measurements, respectively. Conclusion In clinical practice over 24 hours, there was a significant difference between the TestBP and RefBP with higher systolic and diastolic BP measured with the cuffless PTT device. Reasons for this difference need to be investigated. Clinical trial registration NCT03054688; Results.