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January 21, 1998

Ambulatory Blood Pressure Monitoring—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(3):196-197. doi:10.1001/jama.279.3.193

In Reply.—The International Database on Ambulatory Blood Pressure Monitoring1 included 1324 hypertensive patients whose systolic blood pressure on conventional measurement was 160 mm Hg or higher and 1310 hypertensive patients with conventionally measured diastolic blood pressure of 95 mm Hg or higher. In 4577 normotensive subjects, the 90th percentiles for daytime blood pressure were 136 mm Hg systolic and 85 mm Hg diastolic.1 Applying these thresholds, the prevalence of white coat hypertension was 18% for systolic pressure and 25% for diastolic pressure, was higher in women than men, decreased with more elevated conventionally measured blood pressure, and, most important, doubled to quadrupled if the diagnosis of hypertension was based on only 1 office visit or on the average of only 2 clinic readings, as compared with more frequent visits or readings.1 These findings not only confirm Dr Yarows' experience, but also underscore that no technical procedure can replace carefully standardized office measurements.