Cardiovascular risk and blood pressure measurements.

Clinical measurement of the blood pressure associated with assessment of the other cardiovascular risk factors : cholesterol, smoking, age, sex, diabetes and cardiovascular heredity, allow appreciation of the cardiovascular risk of hypertensive patients after the results of the Framingham study. There is no consensus about the optimal clinical brood pressure with treatment and about the control of treated hypertensives which remains low in population studies (28 % in France, 27 % in the United States). New methods of blood pressure measurements such as ambulatory blood pressure monitoring and self-measurement of the blood pressure are better correlated to cardiovascular events and morbi-mortality than measurement of the blood pressure during consultation in hypertensive patients. Ambulatory blood pressure recording also seems to be more predictive of regression of left Ventricular hypertrophy. Therefore, the Latest recommendations, especially the American consensus, advise using these techniques when the physician is in doubt about the value of the clinical blood pressure measurement of hypertensive patients, especially in the case of apparent antihypertensive drug resistance. Finally, what does good blood pressure control imply in 1998 : normal clinical blood pressure measurements compared with ambulatory blood pressure monitoring or self-measurement of the blood pressure ? Does it mean control of the patient's absolute cardiovascular risk ? The answers to these questions can only be obtained by future prospective studies.