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S. Wassertheurer, B. Hametner:
"What time is the right time, and how to measure";
Journal of Human Hypertension, 28 (2014), 2; 73 - 74.

Arterial blood pressure and its noninvasive measurement are
strongly influenced by cardiovascular control mechanisms, where
actors are continuously responding to feedback from different
sensors. Various factors of transient nature are therefore affecting
each single blood pressure reading, subsequently leading to the
fact that each measurement just may be seen as an actual
snapshot of hemodynamics with limited persistent information.
With the establishment of ambulatory and oscillometric blood
pressure monitoring, researchers got means to unveil and
especially quantify circadian and short-term variability of blood
pressure. Since that time, phenomena like blood pressure dipping
patterns, white coat and masked hypertension entered the stage
and questioned the usefulness of single (office) measurements. In
addition, the upcoming ability of measuring arterial stiffness
provided evidence that vascular aging influences blood pressure
its variability as well as the measurement itself.
In this issue of the Journal of Human Hypertension Nikolic et al.1
present a remarkable piece of work comparing carefully different
types of blood pressure measurements at various time points to
provide profound information on the transient behavior of blood
pressure regulation and methodological issues of blood pressure
assessment.
They show that some (in particular five) minutes of additional
rest before office blood pressure measurement improves prognostic
value significantly compared with `standard´ 5 min of rest.
The strength of this work is grounded on the diversity of methods
used for the comparison like 7-days home blood pressure, 24-h
ambulatory blood pressure and for the first time office central
pressure. Beyond that, the association of each measurement
method to left ventricular mass index is reported to overcome
elegantly numerical scale offsets between devices and measurement
approaches.
The setting of this trial is pioneering to investigate an emerging
gap. The patho-physiological progression and treatment-induced
remission of hypertensive end organ damage may be hardly
observed by time invariant brachial blood pressure thresholds
alone. Central aortic pressures and their relation to brachial ones
showed to be capable in monitoring these changes in end organ
damage, in particular with focus on left ventricular mass.2-4
Beyond its strengths, the design of the study left over some
challenges that need to be addressed in future work, which are as
follows: