Seasonal variation in blood pressure: Evidence, consensus and recommendations for clinical practice. Consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability
: Stergiou George S., Palatini Paolo, Modesti Pietro A., Asayama Kei, Asmar Roland, Bilo Grzegorz, de la Sierra Alejandro, Dolan Eamon, Head Geoffrey, Kario Kazuomi, Kollias Anastasios, Manios Efstathios, Mihailidou Anastasia S., Myers Martin, Niiranen Teemu, Ohkubo Takayoshi, Protogerou Athanasios, Wang Jiguang, O’Brien Eoin, Parati Gianfranco
Publisher: LIPPINCOTT WILLIAMS & WILKINS
: 2020
: Journal of Hypertension
: JOURNAL OF HYPERTENSION
: J HYPERTENS
: 38
: 7
: 1235
: 1243
: 9
: 0263-6352
DOI: https://doi.org/10.1097/HJH.0000000000002341
Blood pressure (BP) exhibits seasonal variation with lower levels at higher environmental temperatures and higher at lower temperatures. This is a global phenomenon affecting both sexes, all age groups, normotensive individuals, and hypertensive patients. In treated hypertensive patients it may result in excessive BP decline in summer, or rise in winter, possibly deserving treatment modification. This Consensus Statement by the European Society of Hypertension Working Group on BP Monitoring and Cardiovascular Variability provides a review of the evidence on the seasonal BP variation regarding its epidemiology, pathophysiology, relevance, magnitude, and the findings using different measurement methods. Consensus recommendations are provided for health professionals on how to evaluate the seasonal BP changes in treated hypertensive patients and when treatment modification might be justified. (i) In treated hypertensive patients symptoms appearing with temperature rise and suggesting overtreatment must be investigated for possible excessive BP drop due to seasonal variation. On the other hand, a BP rise during cold weather, might be due to seasonal variation. (ii) The seasonal BP changes should be confirmed by repeated office measurements; preferably with home or ambulatory BP monitoring. Other reasons for BP change must be excluded. (iii) Similar issues might appear in people traveling from cold to hot places, or the reverse. (iv) BP levels below the recommended treatment goal should be considered for possible down-titration, particularly if there are symptoms suggesting overtreatment. SBP less than 110 mmHg requires consideration for treatment down-titration, even in asymptomatic patients. Further research is needed on the optimal management of the seasonal BP changes.
