NEW ASPECTS IN DIAGNOSING HYPERTENSIVE PA TIENTS - CASUAL READINGS - AMBULATORY BLOOD-PRESSURE MONITORING - BLOOD-PRESSURE SELF-MONITORING

The ''average'' blood pressure of hypertensives, which is held respons ible for the adverse effects of hypertension is poorly reflected by ca sual readings (CR), which are taken as a surrogate. CR do not only dif fer from average blood pressures, but also fail to give information on blood pressure variability. According to white coat effect and blood pressure variability a satisfying classification of severity and conse cutively of prognosis cannot be done in an individual. Furthermore CR fail to inform us sufficiently about therapeutic effects in single pat ients. To improve we have to change to blood pressure judgements which are based on many instead of occasional readings. Ambulatory blood pr essure monitoring (ABM) is a possibility to overcome this weakness. Co mpared to casual readings the average of the ambulatory readings is hi gher reproducibile and does not depend on placebo treatment. In spite of this advantage a general substitution of CR by ABM is impossible be cause the number of equipment available is too small, nobody wants to cover the costs, the procedure is inconvenient, and up till now we mis s guidelines how to proceed in the daily routine. Blood pressure self- monitoring is an additional way to improve the weakness of CR. The amo unt of blood pressure readings needed for a satisfying judgement of bl ood pressure are taken and registered by the patients. The self record ed data can be used as a valuable data base to calculate average blood pressure and blood pressure variability and drug effects. Mean values of twice daily recordings of a month are highly reproducible and do h ighly correlate to average ABM recordings of the day.