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Blood Pressure Monitoring

Role of 24-hour ambulatory blood pressure monitoring in diagnosis and management of hypertension by Dr. Marcel Ruzicka

Ryan Chow, MSc Candidate, Biomedical and Molecular Sciences

Considering hypertension affects 1 in 4 Canadians, it is no wonder why Dr. Marcel Ruzicka calls hypertension the most significant modifiable risk factor for preventing cerebrovascular and cardiovascular disease. Dr. Ruzicka is the Medical Director of the Renal Hypertension Program at The Ottawa Hospital and is an expert on the diagnosis and management of hypertension. In a conversation with the TMED 801 class, Dr. Ruzicka shared his research interests, his journey to becoming a clinician researcher, and his thoughts on a burgeoning market of consumer healthcare technology.

Physicians have been using sphygmomanometers, or inflatable blood pressure measuring devices, since 1905. However, despite significant technological and medical advances over a century, current Canadian sphygmomanometry practice has hardly changed. In his presentation at Grand Rounds, Dr. Ruzicka showed that 24 hr Ambulatory Blood Pressure Monitoring (ABPM) provides superior diagnostic and predictive data compared to dated in-office methods like manual sphygmomanometry and automated oscillometric measurement. ABPM is especially useful at characterizing a wide array of hypertensive conditions like White Coat Hypertension, Masked Hypertension, and Labile Hypertension. ABPM can also be used to identify abnormal nocturnal BP patterns. For example, patients whose blood pressures do not decrease while asleep are classified as “non-dippers” and have an increased risk for adverse cardiovascular events.

Two months ago, an FDA-approved device called the Omron Heartguide was released to the general public. Unlike traditional blood pressure monitors, the Heartguide resembles a traditional smartwatch with a miniaturized inflatable cuff that can record blood pressure at the wrist. Dr. Ruzicka contends that this device is indeed a technological marvel and it has the potential to help an aging population; however, he currently does not recommend this particular model. Dr. Ruzicka likens the Omron Heartguide’s technological advances to Apple iPhone products which come out with a new model every year. He proposes the next generation of watch-sphygmomanometers will provide even greater medical benefit. Dr. Ruzicka is optimistic about the future of medical technology and calls our current age a “Third Industrial Revolution.”

Dr. Marcel Ruzicka was born and raised in the Czech Republic. After completing medical school at Charles University, he pursued internal medicine residency and PhD training at the University of Ottawa. Dr. Ruzicka discovered his penchant for clinical research while performing renal microvascular dissections in pigs for his PhD project. While conducting his experiments, he realised similar studies in humans could yield greater practical benefit. Additionally while studying, Dr. Ruzicka would meet his wife of whom he attributes his proficiency in English and decision to settle down in Ottawa. Dr. Ruzicka immensely enjoys his current research/clinical field of nephrology, but he also admits that cardiac anesthesiology would have also been a rewarding field because of his interest in medical technology. Dr. Ruzicka attributes skiing, spending quality time with his family, and the occasional vacation as his own personal remedy for dealing with physician burnout. He recommends to always pursue what you love, but also to focus on one discipline of study at a time.



Stephen Archer

Mon, 02/11/2019 - 14:12

I enjoyed you blog post-well written, Ryan! Asa cardiologist I find ambulatory BP monitoring very helpful and the talk convinced me to use it even more often.

Stephen Archer


Mon, 02/11/2019 - 16:17

Great review Ryan!
Wrist blood pressure monitors can be beneficial if the information in the instruction manual is followed precisely; They are usually extremely sensitive to body position. in order to get an accurate reading, the wrist must be at heart level. Also with the use of these devices, some patients might tend to not share the data with their physicians which can promote unwarranted self diagnosis or self- adjustment of medication.


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