Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.

Accurate measurement of blood pressure is essential to classify individuals, to ascertain blood pressure-related risk, and to guide management. The auscultatory technique with a trained observer and mercury sphygmomanometer continues to be the method of choice for measurement in the office, using the first and fifth phases of the Korotkoff sounds, including in pregnant women. The use of mercury is declining, and alternatives are needed. Aneroid devices are suitable, but they require frequent calibration. Hybrid devices that use electronic transducers instead of mercury have promise. The oscillometric method can be used for office measurement, but only devices independently validated according to standard protocols should be used, and individual calibration is recommended. They have the advantage of being able to take multiple measurements. Proper training of observers, positioning of the patient, and selection of cuff size are all essential. It is increasingly recognized that office measurements correlate poorly with blood pressure measured in other settings, and that they can be supplemented by self-measured readings taken with validated devices at home. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. Twenty-four-hour ambulatory monitoring gives a better prediction of risk than office measurements and is useful for diagnosing white-coat hypertension. There is increasing evidence that a failure of blood pressure to fall during the night may be associated with increased risk. In obese patients and children, the use of an appropriate cuff size is of paramount importance.

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Recommendations for Blood Pressure Measurement in Humans and Experimental Animals Part 1: Blood Pressure Measurement in Humans: A Statement for Professionals From the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research

A consistent link appears to exist between predominance of vagal or sympathetic activity and predominance of HF or LF oscillations, respectively: RR variability contains both of these rhythms, and their relative powers appear to subserve a reciprocal relation like that commonly found in sympathovagal balance. In this respect, it is our opinion that rhythms and neural components always interact, just like flexor and extensor tones or excitatory and inhibitory cardiovascular reflexes, and that it is misleading to separately consider vagal and sympathetic modulations of heart rate. In humans and experimental animals, functional states likely to be accompanied by an increased sympathetic activity are characterized by a shift of the LF-HF balance in favor of the LF component; the opposite occurs during presumed increases in vagal activity. In addition, LF oscillation evaluated from SAP variability appears to be a convenient marker of the sympathetic modulation of vasomotor activity. Although based on indirect markers, the exploration in the frequency domain of cardiovascular neural regulation might disclose a unitary vision hard to reach through the assemblage of more specific but fragmented pieces of information.

Cardiovascular neural regulation explored in the frequency domain.

IntroductionOver the past 20 years or so, the accuracy of the conventional Riva-Rocci/Korotkoff technique of blood pressure measurement has been questioned and efforts have been made to improve the technique with automated devices. In the same period, recognition of the phenomenon of white-coat hype

European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure

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European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement.

Reduced parasympathetic cardiac control in patients with hypertension at rest and under mental stress.

It has been claimed that an increase in the 0.1-Hz component in power spectra of heart rate variability indicates an increased sympathetic tone. We tested 135 middle-aged unmedicated men (mean age 44 +/- 7 years) with two types of mental tasks, a reaction-time test and a mental arithmetic test, to determine whether the results were comparable with those from tilt tests. Although both tasks significantly increased the heart rate and blood pressure, to the same extent as the tilt tests, energy in the 0.1-Hz band decreased during the reaction-time test (from 899 +/- 641 to 482 +/- 430; P less than 0.01) yet was unchanged during the mental arithmetic test. We conclude that the response of the 0.1-Hz component is a task-specific phenomenon.

Spectral analysis of heart rate variability under mental stress.

Normotensives with hypertensive parents have been reported to exhibit enhanced cardiovascular reactions to mental stress. We have examined the question of why this result was not confirmed in all studies. In addition we have investigated whether appropriate tests can be performed under clinical rath

Family history of hypertension and cardiovascular reactivity to mental stress--effects of stimulus intensity and environment.

OBJECTIVE--To test the hypothesis that beta blockers lower blood pressure more effectively than calcium entry blockers in obese hypertensive patients and that calcium entry blockers are more effective in lean patients. DESIGN--Double blind, randomised controlled trial of treatment over six weeks. SETTING--Tertiary referral centre. SUBJECTS--42 white men with uncomplicated mild to moderate essential hypertension (World Health Organisation stage I or II); 36 completed the study. INTERVENTION--Patients were randomised to metoprolol 50-100 mg twice daily or isradipine 2.5-5.0 mg twice daily for six weeks after a two week run in phase. MAIN OUTCOME MEASURE--Blood pressure after six weeks of treatment. RESULTS--When stratified according to treatment and presence of obesity (body mass index

https://www.bmj.com/content/bmj/307/6903/537.full.pdf

Heinz Rüddel

Papers

Reduced parasympathetic cardiac control in patients with hypertension at rest and under mental stress.

Spectral analysis of heart rate variability under mental stress.

Family history of hypertension and cardiovascular reactivity to mental stress--effects of stimulus intensity and environment.

Obesity as a determinant for response to antihypertensive treatment.

Hemodynamic response patterns to mental stress: diagnostic and therapeutic implications.