The focus of hypertension treatment is shifting. We're moving away from a time when a few scattered blood pressure readings at the doctor's office or at home were used to guess a patient's condition. Now, we are in an era where continuous data, spanning a patient's daily life and sleep, is used to formulate treatment strategies. Recently, a "continuous control" strategy combining cuffless continuous blood pressure monitors and long-acting antihypertensive drugs has been gaining attention in clinical practice.
Dr. Hoon Lee of Cecil Internal Medicine sees this strategy's starting point in a shift in measurement methods. "Previously, we assessed blood pressure control by referring to sporadic records taken at home and in the hospital," he said. "However, there were limitations because the readings could vary depending on the measurement location, time, and the patient's anxiety level, making it difficult to accurately grasp the patient's blood pressure patterns." He continued, "With cuffless devices, continuous measurement for three or more days has become easy, allowing us to track a patient's blood pressure flow in their daily life without interruption, which has increased the precision of the examination."
The CART BP Pro, currently used at Cecil Internal Medicine, is a leading example of such a cuffless continuous blood pressure monitor. It's designed as a ring worn on the finger. While the patient wears it, a sensor inside the device shines a faint light on the blood vessels and analyzes the reflected signal to non-invasively estimate real-time blood pressure. Dr. Lee explained, "The CART BP Pro can be worn comfortably without any pressure, allowing it to naturally capture blood pressure changes during sleep or activity. Patient satisfaction is very high. Since last year, it has also become covered by insurance, further improving accessibility."
The ability to measure continuously has brought previously hard-to-detect risk signals to the surface, allowing for quick intervention. Dr. Lee emphasized, "Continuous measurement can reveal subtle blood pressure patterns that were easy to miss with previous methods, such as nocturnal hypertension or sudden early-morning blood pressure surges. These patterns are closely linked to cardiovascular risk, so their early detection is crucial for establishing a treatment strategy."
Measuring blood pressure in real-time doesn't complete the treatment strategy. A medication strategy that enables "continuous blood pressure control" is also necessary. As a prime example, Dr. Lee cited a combination drug that merges the angiotensin II receptor blocker (ARB) olmesartan with the calcium channel blocker (CCB) amlodipine, which expands blood vessels.
Dr. Lee stated, "For continuous blood pressure control, prescriptions need to consider the patient's blood pressure pattern and co-existing conditions like diabetes, proteinuria, and arteriosclerosis, rather than just lowering blood pressure." He added, "Especially for patients with nocturnal blood pressure spikes, a combination drug of olmesartan and amlodipine, which has a long half-life and lasts all day, is suitable. A single dose once a day can maintain stable blood pressure for 24 hours and even control early morning blood pressure spikes."
The impact in practice is clear. Many patients who had difficulty controlling their blood pressure with single-component drugs have achieved their target blood pressure with a combination drug, often with a lower dose, thanks to a synergistic effect. This is especially beneficial for elderly patients, who often have high blood pressure at the initial diagnosis or experience significant morning fluctuations. The combination drug is well-suited for them, providing high satisfaction in terms of convenience and effectiveness.
The combined use of cuffless blood pressure monitors and long-acting antihypertensive drugs can create a synergistic effect that completes a 24-hour blood pressure management system. A deeper evaluation of factors influencing blood pressure, such as nocturia, insomnia, alcohol consumption, and smoking, allows for a more comprehensive approach. This goes beyond simply lowering a number, helping to stabilize the patient's overall blood pressure rhythm, improve their quality of life, and prevent complications.
Dr. Lee highlights that we are entering an era of precision medicine, where medical devices integrated with AI and digital technology enable more accurate health assessments and personalized management. He foresees this "contributing to reducing the risk of cardiovascular and cerebrovascular diseases by improving the quality of hypertension prevention and management." He concludes, "Practicing drug treatments and comprehensive management strategies perfectly tailored to each patient will be the core of future medicine."
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