Banegas JR, Ruilope LM, from Sierra A, et al. New England Journal of Medicine

In almost 64,000 patients from the cohort of the Spanish Registry of ambulatory blood pressure monitoring, with a mean follow-up of 4.7 years and with mortality data, ambulatory monitoring is clearly superior to clinical pressure in the prediction of global mortality and cardiovascular mortality. The phenotype known as "white coat" hypertension, characterized by high figures in the consultation and normal in the monitoring is not an innocent phenotype and increases the risk of mortality compared to those with normal figures both in consultation and monitoring. On the other hand, the phenotype known as masked hypertension (normal figures to the consultation but elevated to monitoring) is associated with the worse prognosis.



From Sierra A, et al. Circulation 2.018.

The new American guidelines establish normal values ​​for pressure figures below 130/80 mmHg. In this brief description, it is clear that -although having normal blood pressure levels- one in five patients may have masked hypertension (high figures in 24-hour monitoring). This data is important if it is combined with the known fact of the high risk that this masked HTA phenotype entails.



From Sierra A, et al. J Hypertens 2018

In a group of more than 20,000 hypertensive patients receiving treatment with 3 or more antihypertensive drugs, it is evaluated whether the use of specific families of drugs or specific compounds within each family is associated with a greater probability of gaining control of the figures tensional The results indicate that combinations of renin-angiotensin system blockers with calcium channel blockers and diuretics and the use of aldosterone antagonists are associated with better control of the figures. Within each pharmacological group, the drugs that improve control are ramipril, olmesartan, amlodipine and chlorthalidone.



Stergiou G, Palatino P, Asmar R, of Sierra A, et al. 2018 hypertension

The new American guidelines recommend the use of pressure measurement outside of the consultation (self-administered home or ambulatory monitoring) to confirm the diagnosis of hypertension before starting a treatment and in the patients treated as a guide to correct control. In this consensus article, the working group on measurement and variability of blood pressure of the European Society of Hypertension comments on the most relevant aspects of these recommendations and their practical application. Despite recognizing the difficulties involved in its application, the working group emphasizes the imprecision of the clinical measure and recommends the 24-hour average obtained for ABPM as the best tool for decision-making in hypertensive patients.