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March 25, 1974

Blood Pressure Recording In the Tense Patient

Author Affiliations


JAMA. 1974;227(12):1381. doi:10.1001/jama.1974.03230250013006

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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.