17 May 2022 is World Hypertension Day – this year’s theme is ‘Measure your blood pressure accurately, control it, live longer!’ Meanwhile, the International Society of Hypertension and World Hypertension League have jointly designated the whole month of May as ‘May Measurement Month’, as a reflection of the rapidly increasing disease burden of hypertension and associated conditions.
Why is hypertension important?
Globally, around 1.28 billion adults aged between 30 and 79 have hypertension, also referred to as high blood pressure (BP) – but less than half of them (around 560 million) are receiving treatment.1 During the COVID-19 pandemic, the average blood pressure of US adults rose further.2 Raised blood pressure is a causative factor in around 12.8% of all deaths worldwide.3
Hypertension and healthcare delivery
Both the method by which a BP reading is taken and the setting in which is performed can have tangible effects on the readings given. The presence of a physician or other healthcare professional can have a tangible adverse effect on a patient’s BP, in a phenomenon known as ‘white coat syndrome’.4
Readings taken at a clinic or pharmacy kiosk may give less accurate results, with a higher risk of false positives for hypertension, than those taken at a patient’s home.5 In cases where BP is measured using a ‘one size fits all’ cuff that is too small for the patient, readings can show higher blood pressure than readings from the same patient taken using a cuff that fits correctly.6
Digital technology and innovation
Researchers are exploring the potential offered by a finger clip device for rapid, noninvasive blood pressure measurement,7 partly in hopes of offsetting some of the stress patients experience when having their BP measured in a doctor’s office. While few wearable devices offering BP monitoring have been clinically approved to date, increasingly accurate devices are being developed and they are considered the ‘technology of the future’ for consistent and affordable independent BP management.8
Artificial intelligence and machine learning have shown potential in a range of possible applications, including predicting risk and outcomes, identifying genetic components of hypertension, identifying external factors affecting adherence to therapeutic regimes, and even estimating patients’ BP.9 Elsewhere, digital therapeutics – whereby an app is used to deliver education, guidance on BP management and physician interventions – have shown success in assisting hypertensive patients to lower their own BP.10
Innovation is also being seen in the way hypertension treatment is delivered. A 2021 study evaluated the potential of a combination ‘quad pill’, containing low doses of four commonly prescribed medications for hypertension (candesartan, amlodipine besylate, indapamide and bisoprolol).11 The quad pill was compared with current standard of care regimens, where treatment is initiated as a single drug and additional medications are added if sufficient control is not achieved. It showed substantial improvement in the proportion of patients achieving blood pressure targets in comparison to monotherapy, with a corresponding projected 20% reduction in cardiac events and strokes.12
- World Health Organization. More than 700 million people with untreated hypertension. 2021. Available at: https://bit.ly/3Pr1Vf6 [Accessed May 2022].
- Laffin LJ, Kaufman HW, Chen Z et al. Rise in blood pressure observed among US adults during the COVID-19 pandemic. Circulation 2022;145(3):235-237. https://doi.org/10.1161/CIRCULATIONAHA.121.057075
- World Health Organization. The Global Health Observatory: blood pressure/hypertension. 2022. Available at: https://bit.ly/3lipZTn [Accessed May 2022].
- Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control 2018;11:73-79. https://doi.org/10.2147/IBPC.S152761
- Green BB, Anderson ML, Cook AJ et al. Clinic, home, and kiosk blood pressure measurements for diagnosing hypertension: a randomised diagnostic study. J Gen Intern Med https://doi.org/10.1007/s11606-022-07400-z
- American Heart Association. Study finds blood pressure cuff size matters, affects blood pressure readings. 2022. Available at: https://bit.ly/39ti3fg [Accessed May 2022].
- University of Missouri. Custom finger clip offers a new way to measure blood pressure, other vitals. 2022. Available at: https://bit.ly/37VEiKE [Accessed May 2022].
- Konstantinidis D, Iliakis P, Tatakis F et al. Wearable blood pressure measurement devices and new approaches in hypertension management: the digital era. J Hum Hypertens https://doi.org/10.1038/s41371-022-00675-z
- Chaikijurajai T, Laffin LJ, Wilson Tang WH. Artificial intelligence and hypertension: recent advances and future outlook. Am J Hypertens 2020;33(11):967–974. https://doi.org/10.1093/ajh/hpaa102
- Kario K, Nomura A, Harada N et al. Efficacy of a digital therapeutics system in the management of essential hypertension: the HERB-DH1 pivotal trial. Eur Heart J 2021;42(40):4111-4122. https://doi.org/10.1093/eurheartj/ehab559
- Chow CK, Atkins ER, Hillis GS et al. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. Lancet 2021;398(10305):1043-1052. https://doi.org/10.1016/S0140-6736(21)01922-X
- University of Sydney. 4 in 1 blood pressure pill much more effective than monotherapy. 2021. Available at: https://bit.ly/3wAkggS [Accessed May 2022].