Understanding Blood Pressure Variability:
Ambulatory Monitoring and the Impact of Stress
Reading duration: Approximately 6 minutes
Professor Philippe Gabriel STEG
Professor Philippe Gabriel STEG is a leading cardiologist and researcher at Hôpital Bichat and Université Paris-Cité. Renowned for his work in cardiovascular medicine, he has published extensively on acute coronary syndromes and atherosclerosis. His contributions have greatly advanced the understanding and treatment of heart disease. He has been” highly cited researcher” every year since 2014. He is Senior Associate Editor for Circulation.
In this article
What is Hypertension?
Standard Blood Pressure Measurement Methods
Innovative Approaches to Blood Pressure Monitoring
Conclusion
What is
Hypertension?
Persistently elevated levels of blood pressure, known as
hypertension, are extremely frequent in the adult population and are associated with many
medical conditions, some of which are life-threatening. Hypertension significantly increases the
risk of:
•Stroke
•Heart Attack
•Heart Failure
•Renal Failure
Because hypertension generally does not cause symptoms, it’s referred to as the "silent killer." It is only the conditions favoured by hypertension that will cause symptoms. However, if hypertension is detected and treated in time, the potential deleterious conditions it creates can be avoided or their risk minimized.
Why Regular Blood Pressure Monitoring is Essential
Detecting and managing hypertension early is vital. Here’s why regular monitoring is important:
•Prevention of Serious Health Issues: Regular monitoring helps in early detection, which
alerts users to seek professional medical supervision and may prevent severe complications.
•Accurate Diagnosis: Consistent monitoring can support
medical professionals in providing a more detailed picture of blood pressure fluctuations.
•Effective Treatment: Properly monitored blood pressure
provides greater insight for healthcare professionals in assessing the effectiveness of
treatment plans.
Standard Blood Pressure Measurement Methods
The standard method for measuring blood pressure requires a calibrated blood pressure device which uses an inflatable cuff placed around the arm, and which can, automatically, measure the levels of systolic and diastolic blood pressure. Traditionally, this measurement is conducted by a healthcare professional in a medical office, known as office blood pressure monitoring, which is the most studied and validated approach. However, there are challenges with office measurements:
Variability in Readings : Blood pressure levels can undergo large variations related to:
•Body position: Readings can vary based on whether you're lying down, sitting, or standing. It's
best to measure while seated with your back supported for consistency.
•Physical activity: Exercise temporarily raises blood pressure. Ensure you are at rest before taking
a measurement to get an accurate baseline.
•Stress and emotions: Emotional stress can cause temporary spikes in blood pressure. Measuring in a
calm, stress-free environment is recommended.
•Sleep: Blood pressure typically dips during sleep. A lack of this dip could indicate potential
cardiovascular risks.
•‘White coat hypertension’: this is a phenomenon where some individuals experience elevated blood
pressure in a medical environment even though their blood pressure may be normal at home.
•Other factors: Factors like recent food intake, caffeine, or talking during measurement can affect
readings.
To standardize measurements, it is important to measure blood pressure at rest, after 5 minutes of
immobility in a stress-free environment.
Good to Know: How does Stress affect my blood pressure ?
Stress significantly impacts blood pressure. Understanding its effects is crucial for managing hypertension.
Stress triggers the "fight or flight" response, releasing hormones like adrenaline and cortisol, temporarily increasing heart rate and blood pressure, causing short-term spikes.
Chronic stress can lead to sustained high blood pressure, increasing the risk of heart disease, stroke, and kidney damage. It often results in unhealthy behaviors like poor diet, inactivity, smoking, and excessive alcohol consumption, further elevating blood pressure.
Chronic high blood pressure due to stress is a major risk factor for cardiovascular diseases. Stress-induced hypertension can also lead to anxiety and depression, complicating blood pressure management.
Home and Ambulatory Blood Pressure Monitoring
Given the variability and potential stress of office measurements, home and ambulatory
monitoring are excellent alternatives. These methods allow for repeated measurements taken
both in the morning and evening, providing a more comprehensive picture of blood pressure
throughout the 24-hour cycle, accommodating both short- and long-term variations.
Home Blood Pressure Monitoring
Patients can be taught to measure their own blood pressure at home, providing readings in a
more relaxed environment. This allows for
repeated measurements, giving a clearer picture of blood pressure throughout the day.
Ambulatory Blood Pressure Monitoring (ABPM)
An alternative method for blood pressure measurement is the automated
ambulatory blood pressure monitoring (ABPM). This technique uses an electronic device to
monitor blood pressure continuously over 24 hours, with repeated inflations of the blood
pressure cuff (e.g., every 30
minutes). ABPM provides a detailed picture of blood pressure variations throughout the day
and night.
However, ABPM has its drawbacks:
•Specialized Equipment: It requires specific equipment that may not be readily
available.
•Appointments Needed: Patients must schedule appointments to have the device fitted
and monitored.
•Cost: ABPM is relatively expensive, making it less attractive for
widespread use, especially given the high prevalence of hypertension in the adult
population.
Despite the importance of accurately and repeatedly measuring blood pressure, and despite
decades or research and efforts, it remains often difficult to get patients and physicians
to properly measure blood
pressure. Sometimes, a combination of methods is necessary for diagnosis and monitoring of
blood pressure in a given individual.
Properly measuring and regularly monitoring blood pressure levels is critical for the management of hypertension. Devices such as the HUAWEI WATCH D2 with the new ABPM feature can be very helpful in this regard
Innovative Approaches to Blood Pressure Monitoring
HUAWEI WATCH D2
Ambulatory Blood Pressure Monitoring Precisely manage your health every moment
All-round Health Management
Light and Slim Design
Smart Living Experience Bluetooth calling, music playback and more
Medically Certified
Compatible with iOS and Android
The challenges of traditional methods have stimulated efforts to devise simpler and more accessible
methods for blood pressure measurement. Wearable devices, such as smartwatches, now allow for easy
and quick measurements by each subject. In particular, the HUAWEI WATCH D and HUAWEI WATCH D2 are smartwatches that are known for their accurate blood pressure measurement.
Notably, a recent study found that the
HUAWEI WATCH D2 provides results that are closely comparable to those obtained from the gold standard
clinical sphygmomanometer. While these advancements show great promise, it is essential to
continue validating these devices against established methods over the long term.
A key feature of the HUAWEI WATCH D2, the successor to the HUAWEI WATCH D, is its 24-hour ambulatory blood pressure monitoring (ABPM), allowing continuous tracking day and night, even during sleep and daily activities. This provides a comprehensive view of blood pressure fluctuations that single, in-office readings might miss.
The HUAWEI WATCH D2 also includes smart reminders for daytime measurements and automatic night time monitoring with minimal disruption, making it easy to incorporate continuous monitoring into daily life. This is especially helpful for tracking variations due to diet, and daily routines, which often follow a “two peaks and a trough” pattern throughout the day.
The smartwatches offer interesting monitoring capabilities, including both blood pressure measurement and ECG functionality, which may significantly enhance the detection and follow-up of blood pressure and of cardiac rhythm abnormalities in the general population, representing a useful tool for physicians and patients, particularly if arrhythmias are rare.
Conclusion
Accurate and regular blood pressure monitoring is vital for detecting and managing hypertension. Whether through traditional office methods, home monitoring, or the latest wearable technology, ensuring reliable and repeated blood pressure readings can significantly improve public health. As technology advances, the future of blood pressure monitoring looks promising, offering easier and more effective ways to stay ahead of hypertension.
Medical disclaimer:
The HUAWEI WATCH D and HUAWEI WATCH D2 and the ECG feature is intended to be used by people aged 18 years and over, but is not intended to replace any medical diagnosis or treatment. Data obtained during the use of this device and feature is for personal reference only. Before using the device, please carefully read the Quick Start Guide, Wearing Guide, and Instruction for Use.
Due to national restrictions on obtaining approval / registration as a medical device, the HUAWEI WATCH D and HUAWEI WATCH D2 and will only be available in selected European markets, and the ECG feature only works on watches and smartphones purchased in countries where the service is available.
- Supported smartphones: Mobile phones with Android 6.0 or compatibles, HarmonyOS 2.0 or
compatibles, or iOS 12.0 or compatibles. The Huawei Health app version on your mobile phone must
be 11.0 or compatibles. Please make sure that your wearable device and phone are running the latest
versions before using ECG.
Heart rate, SpO2, stress and skin temperature are not medical device features, monitoring data and
results are for reference only and should not be used as a basis for medical diagnosis or
treatment.
[References]
- 1. World Health Organization Factsheet on hypertension: https://www.who.int/news-room/fact-sheets/detail/hypertension
- 2. What are the signs and symptoms of high blood pressure ? American Heart Assocation:
https://www.heart.org/en/health-topics/high-blood-pressure/know-your-risk-factors-for-high-blood-pressure/what-are-the-symptoms-of-high-blood-pressure - 3. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). Mancia G, Kreutz R, Brunstrom M et al. J Hypertens. 2023; 41: 1874-2071
- 4. Yi, L., Lv, Z. H., Hu, S. Y., Liu, Y. Q., Yan, J. B., Zhang, H., Li, H. B., Chen, Q., Li, Y. Y., Jiang, Y. F., Zhou, H., Li, M. D., Chen, R. D., Li, X. L., Zhou, S. S., & Chen, Y. D. (2022). Validating the accuracy of a multifunctional smartwatch sphygmomanometer to monitor blood pressure. Journal of geriatric cardiology : JGC, 19(11), 843–852. https://pubmed.ncbi.nlm.nih.gov/36561062/
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