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Implications for the Determination of Usual Blood Pressure and the Concept of White Coat Hypertension

Kevin A. Pearce, MD, MPH; Richard H. Grimm, Jr, MD, PhD; Sunil Rao, MS; Kenneth Svendsen, MS; Philip R. Liebson, MD; James D. Neaton, PhD; Kristine Ensrud, MD, MPH

Arch Intern Med. 1992;152(4):750-756.

Abstract
Background.—
Ambulatory blood pressures (BPs) have generally been reported to be lower than office blood pressures, but population-based data are lacking.

Methods.—
To better characterize ambulatory and office BP relationships, we explored the interrelationships of BPs measured in the office by mercury sphygmomanometry, 24-hour ambulatory BP measured with a portable device, and echocardiographic left ventricular mass in a random sample of 50 men aged 51 to 72 years drawn from a much larger pool. Office BP was based on the mean of 10 measurements performed over five visits.

Results.—
Among all participants, mean 24-hour ambulatory and mean office BPs were highly correlated: r (systolic/ diastolic) =.90/.79; and both mean 24-hour and mean awake ambulatory BPs were significantly higher than mean office BPs. For the subsample not receiving antihypertensive therapy, mean ambulatory and office BPs were similar in terms of their associations with Penn left ventricular mass index (LVMI). No association between BP and left ventricular mass was observed among the subjects receiving antihypertensive medication.

Conclusions.—
We conclude that a single session of 24-hour ambulatory BP monitoring is unlikely to improve the determination of usual BP in older white men beyond that achievable with BP carefully measured over five separate office visits; and that white coat hypertension is rare in this population.

(Arch Intern Med. 1992;152:750-756)

Author Affiliations
From the Department of Family Practice and Community Health (Dr Pearce), Division of Epidemiology (Drs Grimm and Ensrud), Coordinating Centers for Biometric Research, Division of Biostatistics (Messrs Rao and Svendsen and Dr Neaton), School of Public Health, University of Minnesota, Minneapolis; and Section of Cardiology, Department of Medicine, Rush-Presbyterian St Luke's Medical Center, Chicago, Ill (Dr Liebson). This work was performed at these departments, plus the Berman Center for Clinical Research, Metropolitan-Mt Sinai Medical Center, Minneapolis, Minn. Dr Pearce is now with the Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC.

Footnotes
Accepted for publication October 14, 1991.

Reprint requests to the Department of Family and Community Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1084 (Dr Pearce).

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