Sympathetic Neural Mechanisms Underlying Attended and Unattended Blood Pressure Measurement.

Guido Grassi,Gino Seravalle,Fosca Quarti-Trevano,Gianluca Perseghin,Raffaella Dell’Oro,Jennifer Vanoli,Giuseppe Mancia

doi:10.1161/hypertensionaha.121.17657

Abstract

[Figure: see text].

Highlights

Whether blood pressure (BP) values differ when BP is measured with or without the presence of a doctor is controversial, and no information exists on whether and to what extent neurogenic mechanisms participate at the possible BP differences between these measurements
Denied by the SPRINT investigators,[2] this is supported by the results of studies which have shown (1) attended BP measurement to be associated with an increase in BP,[3,4,5,6] which, in contrast, does not appear to change if BP is measured automatically or semiautomatically when the patient is alone in the room[4,5,6] and (2) unattended BP measurement to be lower than traditionally measured office BP, variably modestly to markedly different values have been reported in different studies.[4,5,6,7,8,9,10]
The present study provides for the first time documented evidence that sympathetic mechanisms underpin the BP changes associated with unattended or attended BP measurement

Summary

Introduction

Whether blood pressure (BP) values differ when BP is measured with or without the presence of a doctor (attended and unattended BP measurements) is controversial, and no information exists on whether and to what extent neurogenic mechanisms participate at the possible BP differences between these measurements. We assessed continuous beat-to-beat finger systolic BP and diastolic BP, heart rate, muscle, and skin sympathetic nerve traffic (microneurography) before and during BP measurement by an automatic device in the presence or absence of a doctor. This was done in 18 untreated mild-to-moderate essential hypertensive patients (age, 40.2±2.8 years, mean±SEM). This was done by evaluating in 18 untreated mild-tomoderate essential hypertensive patients the muscle sympathetic nerve traffic (MSNA), skin sympathetic nerve traffic (SSNA) and heart rate (HR) changes during unattended and attended BP measurement. During attended BP measurement, there was an increase in BP, a slight HR and SSNA elevation, and a slight MSNA decrease

Methods

Results

Discussion

Conclusion