Reliability of blood pressure measurement and cardiovascular risk prediction

High blood pressure is one of the leading risk factors for cardiovascular disease, but difficult to reliably assess because there are many factors which can influence blood pressure including stress, exercise or illness. The first part of this thesis focuses on possible ways to improve the reliability of blood pressure measurement for proper cardiovascular risk prediction, both in and out of the doctor’s office. We show that it is possible to obtain a reliable blood pressure without the use of a stethoscope, and that simultaneous blood pressure measurement of both arms is more reliable than sequential blood pressure measurement in establishing inter-arm blood pressure differences. Furthermore, we show that the use of blood pressure measurement devices with a build-in measurement schedule, improves reliability of home blood pressure measurements compared to conventional blood pressure measurement devices. The second part of this thesis focuses on cardiovascular risk prediction. We investigated whether cardiovascular risk can be evaluated by a simple questionnaire. We show that with six simple questionnaire we can identify subjects with an increased 10-year risk of dying from cardiovascular diseases with sufficient accuracy. We also show that with two successive home blood pressure measurements, blood pressure status can be reliably assessed in 6 out of 10 subjects without known hypertension. Finally, we examined whether recently introduced methods to estimate central blood pressure may be of value in future cardiovascular risk prediction by showing that the ankle-central blood pressure index has a higher association with cardiovascular disease than the conventional ankle-brachial index.