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

George S. Stergiou*, Paolo Palatini, Pietro A. Modesti, Kei Asayama, Roland Asmar, Grzegorz Bilo, Alejandro De La Sierra, Eamon Dolan, Geoffrey Head, Kazuomi Kario, Anastasios Kollias, Efstathios Manios, Anastasia S. Mihailidou, Martin Myers, Teemu Niiranen, Takayoshi Ohkubo, Athanasios Protogerou, Jiguang Wang, Eoin O'Brien, Gianfranco Parati

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    27 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)1235-1243
    Number of pages9
    JournalJournal of Hypertension
    Volume38
    Issue number7
    DOIs
    Publication statusPublished - 1 Jul 2020

    Keywords

    • antihypertensive drugs
    • blood pressure variation
    • climate
    • environment
    • hypertension
    • season
    • summer
    • temperature
    • treatment
    • winter

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