IS ARTERIAL BLOOD-PRESSURE THE RIGHT TARGET FOR MONITORING THE TREATMENT OF HYPERTENSION

In hypertension research one of the paradoxes relates to the arbitrary definition of boundaries of normality (and consequently of abnormality) on the continuum of resting arterial pressure values. This uncertainty is carried over also to the computation of risk profiles and to complex preventive strategies. These approaches sometimes surprisingly failed, viz unsatisfactory results of hypertension treatment as regards the protection from cardiac events. Physiological parameters related to blood pressure control might provide new insights and practical solutions. Recent animal research has indicated the importance of addressing the between heart rate, sympathetic activity and arterial pressure, particularly during spontaneous behavior, rather than focusing on an elusive basic state values. - Computer analysis of heart period variability, which provides quantitative estimates of sympathovagal control of the SA node, under various behavioral conditions was developed in our laboratory. In essential hypertension, the low frequency component of R-R variability, i.e. the marker of sympathetic modulation, was greater than in controls and underwent smaller changes with both physical and mental stimuli, and smaller diurnal oscillations. Essential hypertension seems to be characterized by marked alterations in important control mechanisms, which can be assessed non invasively with spectral analysis of R-R variability and may provide important new cues to control and monitor non-pharmacological treatment of elevated arterial blood pressure.