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January 21, 1974

Blood Pressure Recording In the Tense Patient

Author Affiliations

Health Department New Haven, Conn

JAMA. 1974;227(3):327-328. doi:10.1001/jama.1974.03230160055028

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To the Editor.—  Dr. Klinefelter described (226:81, 1973) a practical maneuver that can produce quick relaxation in a tense patient, before measuring his blood pressure. This consisted of a few preliminary deep breaths. I have used this method for many years and have often been impressed by the rapid reduction of the pressure after such deep breathing. Some apprehensive patients tend to undergo contraction of muscles, including diaphragms, and to hold the breath in reaction to some fear provoked by the taking of the blood pressure.In my opinion, the explanation does not lie in the effect of hyperventilation or associated change in the blood oxygen or carbon dioxide tension, but merely in a state of muscle relaxation (including the diaphragm), combined with the diversion created by taking two deep breaths.I believe that Dr. Klinefelter's suggestion should be followed whenever there are doubts about an elevated pressure reading.