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Cardiovascular Centre, New York Hospital-Cornell Medical Center, New York 10021.
Three different techniques are now available to measure blood pressure in patients - clinic measurements, self-monitoring by the patient at home and ambulatory monitoring. Clinic measurements are susceptible to a number of biases which make them frequently unrepresentative of pressures at other times. The differences between pressures measured in the clinic and elsewhere tend to be much greater in hypertensive than in normotensive subjects, whereas the diurnal variability of blood pressure is only slightly greater in hypertensives, implying that the traditional diagnosis of hypertension on the basis of clinic pressures may cause a bias in subjects who show an enhanced pressor response to the clinic situation ('white coat effect'). We conclude that all three techniques should be used. Ambulatory monitoring provides information about the diurnal profile of blood pressure, and is particularly suited to the initial evaluation of patients, while home monitoring is ideal for observing the effects of treatment.
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