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To the Editor.—
Regarding the letter (227:327, 1974) supporting Dr. Klinefelter's method for recording blood pressure in the tense patient, I have the following comments.A few preliminary deep breaths in most anxious patients will no doubt be followed by a reduction in blood pressure. I agree that muscle relaxation associated with the relaxing effect of the diversion of breathing are the operant psychophysiologic mechanisms.What is evident, however, is that a blood pressure reading under these circumstances is spuriously low secondary to the very factors stated above. The anxious patient most often leads a life of increased muscle tension and minimal diversion from daily stress. To purposely induce decreased blood pressure in a potentially hypertensive patient and record that pressure as "typical" is misleading. Patients who are normotensive in the doctor's office could very well be hypertensive in daily life.
Lippin RA. Blood Pressure Recording In the Tense Patient. JAMA. 1974;227(12):1381. doi:10.1001/jama.1974.03230250013006
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