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Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions – Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability

Stergiou, George S.a; Parati, Gianfrancob,c; Vlachopoulos, Charalambosd; Achimastos, Apostolosa; Andreadis, Emanouele; Asmar, Rolandf; Avolio, Albertog; Benetos, Athanaseh; Bilo, Grzegorzc; Boubouchairopoulou, Nadiaa; Boutouyrie, Pierrei; Castiglioni, Paoloj; de la Sierra, Alejandrok; Dolan, Eamonl; Head, Geoffreym; Imai, Yutakan; Kario, Kazuomio; Kollias, Anastasiosa; Kotsis, Vasilisp; Manios, Efstathiosq; McManus, Richardr; Mengden, Thomass; Mihailidou, Anastasiat; Myers, Martinu; Niiranen, Teemuv; Ochoa, Juan Eugenioc; Ohkubo, Takayoshiw; Omboni, Stefanox; Padfield, Pauly; Palatini, Paoloz; Papaioannou, Theodoreaa; Protogerou, Athanasiosbb; Redon, Josepcc; Verdecchia, Paolodd; Wang, Jiguangee; Zanchetti, Albertoff; Mancia, Giuseppegg; O’Brien, Eoinhh

doi: 10.1097/HJH.0000000000000969

Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).

aHypertension Center STRIDE-7, National and Kapodistrian University of Athens, Third Department of Medicine, Sotiria Hospital, Athens, Greece

bDepartment of Medicine and Surgery, University of Milan-Bicocca

cDepartment of Cardiovascular Neural and Metabolic Sciences, S.Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy

dFirst Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens

eFourth Department of Medicine, Evangelismos General Hospital, Athens, Greece

fFoundation-Medical Research Institutes (F-MRI), France

gDepartment of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia

hGeriatric Department University Hospital of Nancy, FHU CARTAGE and INSERM U1116 Université de Lorraine, France

iUniversité Paris Descartes, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, France

jIRCCS Fondazione Don Carlo Gnocchi, Milan, Italy

kDepartment of Medicine, University of Barcelona & Hypertension Unit, Hospital Mutua Terrassa, Spain

lStroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland

mBaker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia

nDepartment of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Japan

oDivision of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan

pHypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece

qDepartment of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Greece

rNuffield Department of Primary Care Health Sciences, University of Oxford, UK

sESH Excellence Centre, Kerckhoff Clinic Bad, Nauheim, Germany

tNorthern Sydney Local Health District & University of Sydney, Australia

uDivision of Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada

vDepartment of Health, National Institute for Health and Welfare, Finland

wDepartment of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan

xClinical Research Unit, Italian Institute of Telemedicine, Varese, Italy

yEmeritus Professor of Hypertension, University of Edinburgh, UK

zVascular Medicine, Department of Medicine, University of Padova, Italy

aaBiomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens

bbCardiovascular Prevention & Research Unit, Department of Pathophysiology, National & Kapodistrian University of Athens, Greece

ccINCLIVA Research Institute, University of Valencia, CIBERObn, ISCIII, Madrid, Spain

ddDepartment of Medicine, Hospital of Assisi, Italy

eeCentre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China

ffCentro di Fisiologia Clinical e Ipertensione, University of Milan, Ospedale Maggiore

ggUniversity of Milano-Bicocca, Milan, Italy

hhConway Institute, University College Dublin, Ireland

Correspondence to George S. Stergiou, MD, FRCP, Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Third Department of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece. Tel: +30 2107763117; fax: +30 2107719981; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; ACEI, angiotensin-converting enzyme inhibitor; AOBP, automated office blood pressure measurement; ARB, angiotensin receptor blocker; ARV, average real variability; ASCOT, Anglo-Scandinavian Cardiac Outcome Trial; BP, blood pressure; BPV, blood pressure variability; CCB, calcium-channel blocker; ceBP, central blood pressure; CV, coefficient of variation; ESH, European Society of Hypertension; HBPM, home blood pressure monitoring; MRC, Medical Research Council; PP, pulse pressure; VIM, variance independent of mean

Received 6 January, 2016

Revised 10 March, 2016

Accepted 20 April, 2016

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