Home and office blood pressures. Clinical observations and hemodynamic mechanisms

Abstract

Wide fluctuations in arterial pressure have long been recognized as a feature in many hypertensive patients and have consistently been a major difficulty in decisions for treatment and understanding of pathophysiology. It is only in the past decade that more precise estimates of the degree of diurnal variations could be obtained by ambulatory 24-hour recordings of blood pressure from intra-arterial catheterization (1) or noninvasive methods (2–3). In the absence of these methods, it is still possible to avoid the pitfalls associated with sole dependence on office blood pressure levels by asking the patients to measure their own pressures at home or at work. This was the method used for over forty years in our center; it had many advantages that could outweigh its limited number of daily observations. Blood pressure could be followed over long periods of time and not be limited to one day; the patients developed a greater sense of participating in their follow-up and came to recognize their pressure fluctuations as a physiolgoical variable analagous to changes in daily weight.