CAMAGUEY.- The measurement of blood pressure emerged in 1896 in a non-invasive way from the hands of the Italian doctor Scipione Riva-Rocci, who introduced the sphygmomanometer, an event that allowed the measurement of systolic blood pressure —known as the maximum— and almost a decade later , the Russian vascular surgeon Nicolai Korotkoff developed the auscultator technique, through which it was possible to measure the systolic and diastolic blood pressure —the minimum.

Such historical data were disclosed by Dr. Elizabeth Sellén Sanchén, 2nd Degree Specialist in Cardiology, Master in Medical Emergencies, from the Manuel Ascunce Domenech University Hospital, and Assistant Professor and Assistant Researcher, from the University of Medical Sciences, of this city, who elaborated that the first records of intra-arterial pressure in the last century in hospitalized patients showed that there was variability in blood pressure measurements in the same subject, even from one hour to another, from one day to another and up from minute to minute.

All of the above aroused interest in knowing what the real blood pressure was during the 24 hours of the patients who attended consultations. That is why, said the also head of the Provincial Cardiology Group, that in 1960 and through well-founded studies, Maurice Sokolow and a group of collaborators from the University of Oxford, in England, applied the oscillometer method of blood pressure measurement , an event that opened the doors to ambulatory blood pressure monitoring and since then increasingly friendly equipment is widely used in clinical practice.

This is the reason for today's topic by Professor Sellén Sanchén, to make public what concerns ambulatory blood pressure monitoring (ABPM) in hypertensive patients, through the Cuban Hipermax registrar, which consists: "In a non-invasive technic method who intends to obtain a blood pressure measurement for a certain time, generally 24 hours and outside the consultation or hospital".

—What characterizes blood pressure taken in 24 hours?

—It presents a circadian rhythm —regulates the changes that occur in the individual during 24 hours— and this shows a typical progressive drop in systolic and diastolic at the beginning of the night until reaching the nadir —low point— during sleep, followed by a phase of plateau with maximum peak in the morning, coinciding with waking up. It is scientifically based on chronobiology, which is the science in charge of studying biological rhythms and their underlying mechanisms, describing four modalities of nocturnal pattern of blood pressure and that the doctor dominates.

"It's good to know that the individual's blood pressure peak is recorded at dawn, coinciding with the REM phase of sleep (rapid eye movement).

"And other changes occur in this phase in uncontrolled hypertensive patients that bring with them the tendency of acute cardio and cerebrovascular events, ischemic or hemorrhagic, and the exacerbation of chronic kidney disease."

—Would dawn be propitious for such diseases in hypertensive people?

—Especially in those with uncontrolled blood pressure during the crucial hours of the day, they constitute a potential risk of even sudden death.

"All this is related to the circadian rhythm. After dawn there is a tendency to stability with certain variability with blood pressure figures, according to the activity carried out by the individual, such as: if he drinks coffee, if he is a teacher and teaches a conference, if he faces some physiological type, reading or hearing about a certain news can increase his blood pressure without necessarily being high.

"There are those in whom the blood pressure curve declines in various ways during the early morning in relation to that of the day, and in correspondence with the behavior will be the characterization that the doctor makes of his patient, while they will also be classified if what happens is the increase in blood pressure and based on the figures will be diagnosed and treated.

"We did a study with people with left ventricular hypertrophy —an independent risk factor for vascular damage— and we know it through the electrocardiogram or echocardiogram, the latter with greater sensitivity and accuracy, and these were the ones with the highest pulse pressure, they were the most elderly and with a greater number of risk markers, so they were not only uncontrolled hypertensive patients, but also smokers, who had dyslipidemia—high lipid concentration—, with chronic kidney disease not on a dialysis regimen, or with cerebrovascular disease, among other ailments".

—Those studied were selected randomly assigned?

—No, by design, they were heart disease patients, especially those who had suffered acute myocardial infarction or acute unstable angina.

—Most interesting results from the use of ABPM?

—We support ourselves to indicate the medication because it is the only method that comes close to knowing the elements mentioned about the circadian rhythm because it takes the patient's blood pressure during sleep, a stage in which we do not have access neither in the hospital consultation nor in the monitoring performed by the patient himself with his equipment at home, nor through the use of the sphygmomanometer in the office.

— Does the ABPM present any disadvantages?

—That the equipment is not friendly to the patient due to multiple measurements during the day, from seven in the morning to 10 at night every 15 minutes and at night every 30 minutes until dawn. In Cuba, the individual who presents figures of 140 by 90 mm/Hg or more is considered hypertensive, while other consensuses consider it with figures higher than 130 by 80 mm/Hg.

—What would be the importance of the determination?

—It is that the medication would be indicated to the patient according to the time in which he exhibits the high blood pressure figures (chronotherapy) and with that a personalized medicine is guaranteed, something of great value worldwide.

"This is vital, especially if we know that this disease has a genetic polymorphism - it involves one of two or more variants of a particular DNA sequence - and Cubans have a great mixture and different genes code for high blood pressure, apart from the fact that each individual has his own circadian rhythm and his own schedules, it is important to take into account the results of the ABPM, I repeat, when establishing treatment.

"The study we did showed that those who suffered from left ventricular hypertrophy suffered from more nocturnal systolic hypertension, were older, and had a greater number of risk factors, such as: diabetes mellitus, smoking, obesity, and overweight, for only mention a few.

"This is based on chronobiology, as it is the science that studies biological rhythms and their underlying mechanisms."

- Is there a predominance of sex?

—We have a large number of hypertensive women, because they have a significant social burden, they face roles in the family and in society that lead to this and the stage of pre-menopause, in addition, they do not attend medical consultations because they prioritize other members of the family. It is wrong that men get more heart disease than women and cardiovascular events occur in both sexes with the difference of hormonal protection in women, estrogens protect us and that is the reason why vascular disease appears up to ten years older later than in men, but we die of the same.

—Do you think that this topic in women deserves a separate consultation?

—Without a doubt.

—Does skin color matter?

—White-skinned hypertensive patients respond better to one group of medications and those with black skin to others, although most need more than one drug for control, which I do not mention to avoid self-medication.

—Does it have an age preference?

—Those over 60 years of age were the ones with the highest absolute frequency in the study.

—What would be the way to prevent or improve?

—With changes in life habits and eliminating toxins.

"High blood pressure is known as the silent killer and if we don't personalize this condition we will have a poor quality of life and that is what we intend to achieve because it is a chronic non-communicable disease related to heredity, genetics and it is controllable."