Hypertension (HT) remains the most common preventable risk factor for cardiovascular (CV) morbidity and mortality. There are exciting new data about epidemiology, brachial blood pressure (BP), ambulatory blood pressure monitoring (ABPM) and pre-hypertension from large clinical trials.
Increasing Burden of Hypertension Worldwide
The incidence of HT is rising worldwide due to common environmental factors. These include excessive dietary sodium, obesity, physical inactivity, alcohol intake, psychological stress and increased survival of ageing populations. In 2000, 972 million people were thought to be hypertensive, and this is projected to increase by 60% to a total of 1.56 billion (or 29% of the worldwide adult population) by 2025.1 Most of these predicted cases of HT are expected to occur in developing countries, which are projected to bear 75% of the global burden by 2025. Two fast-growing economies from Asia (India and China) have a huge burden of HT that is projected to increase significantly by 2025. A recent article in a prestigious Indian journal (prompted by the Chennai Urban Rural Epidemiology [CURES] study) warned that India may soon become the HT capital of the world. It already has the infamous distinction of being the diabetes capital.2 Another disturbing factor from a public health point of view concerns childhood obesity and its correlation with HT. A school health survey of 3,589 subjects aged nine, 13 and 16 years in Quebec, Canada measured BP using an oscillometric device.3 The prevalence of high, normal or elevated systolic BP was 12, 22 and 30% among nine-, 13- and 16-year-old males, respectively, and 14, 19, and 17% among females of the same ages. The prevalence of high–normal or elevated diastolic BP was <1%. Global approaches are needed to focus on lifestyle changes that may be preventative. A comprehensive population-based approach, such as that adopted by Cuba,4 is an excellent preventative model.
Brachial Blood Pressure Measurement
Reportedly, British scientist Stephen Hales was the first person to measure BP experimentally, in 1733.5 The technique for the measurement of arterial pressure using the Riva-Rocci sphygmomanometer and the Korotokov sounds has been in use for over a century, and its benefit to medicine and the care of patients has been inestimable. Recently, a greater understanding of the physiological nuances of systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and mean BP (MBP) have led to doubts about the accuracy and relevance of brachial artery BP.6
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