The Journal of Clinical Hypertension | 2021
Self‐measurement of blood pressure in the workplace: An expansion of out‐of‐office blood pressure measurements to unmask masked hypertension
Abstract
Hypertension is the leading risk factor for cardiovascular disease burden including premature death worldwide.1 Hypertension has many associated risk factors; high dietary sodium intake, excessive alcohol consumption, poor diet, and a sedentary lifestyle are but a few of these risk factors that contribute to the development of hypertension. Optimization of these risk factors has been shown to lower blood pressure which would improve clinical outcomes attributed to the hypertensive process. However, achieving optimal control rates of hypertension at the individual and population levels almost always require a multifaceted approach involving both lifestyle modification and the use of pharmacologic antihypertensive medications.1 The clinical effects of uncontrolled or poorly controlled hypertension are well-established. These effects result from hypertensive target organ damage, such as cardiac disease (congestive heart failure, myocardial infarction, angina, left ventricular hypertrophy, and arrhythmias), cerebrovascular disease (stroke and cognitive decline), renal disease (chronic renal failure and dialysis), and vascular disease (accelerated atherosclerosis and retinopathy).1 Despite countless studies showing the importance of strict blood pressure control in helping to prevent many of these conditions, recent National Health and Nutrition Examination Survey (NHANES) data from the United States, a high-income country, have reported a disturbing trend. Data from NHANES showed that hypertension control rates (defined by a systolic blood pressure of < 140 mmHg and a diastolic of < 90 mmHg) gradually increased from 1999/2000 through 2007/2008, reaching a high of between 50% and 60% nationwide. However, hypertension control rates did not significantly change from 2007/2009 through 2013/2014 and then surprisingly decreased between 2013/2014 through 2017/2018 to approximately 44%.2. If hypertension control is defined as a systolic blood pressure of < 130 mmHg and a diastolic <80 mm Hg, which several recent hypertension guidelines recommend, the hypertension control rate from the 2017/2018 survey is a dismal 19%. This decrease in hypertension control is alarming in that it parallels the ominous recent increase in cardiovascular disease-related events both in highand low-income countries globally.3,4 This alarming data indicate the need for novel strategies which target increasing the awareness, detection, treatment, and control of hypertension in both highand low-to-middle-income countries. In fact, recently the Surgeon General of the United States issued a report for a “Call to Action to Control Hypertension.” Included in this comprehensive report are three goals: 1. Make hypertension control a national priority, 2. Ensure that the places where people live, learn, work, and play support hypertension control, and 3. Optimize patient care for hypertension control including ways to better identify and treat hypertension.5 Pertinent to this commentary, the report strongly recommends increasing out-of-office blood pressure measurements with a variety of methods and in a variety of locations, including in the workplace. This strategy also empowers and increases the direct involvement of the individual. Increasing out-of-office blood pressure measurements will increase the recognition of “true” hypertension (an elevation in blood pressure in both the office and out of the office) and “true” normotension (a normal blood pressure in both the office and out of the office), but also the recognition of