Modern approaches to blood pressure measurement

Background-Blood pressure (BP) is usually measured by conventional sphygmom anometry. Although apparently simple, this procedure is fraught with many p otential sources of error. This review focuses on two alternative technique s of EP measurement: ambulatory monitoring and self measurement. Review-BP values obtained by ambulatory monitoring or self measurement are characterised by high reproducibility, are not subject to digit preference or observer bias, and minimise the transient rise of the blood pressure in response to the surroundings of the clinic or the presence of the observer, the so called white coat effect. For ambulatory monitoring, the upper Limi ts of systolic/diastolic normotension in adults include 130/80 mm Hg for th e 24 hour EP and 135/85 and 120/70 mm Hg for the day time BP and night time BP, respectively. For the the self measured BP these thresholds include 13 5/85 mm Hg. Automated BP measurement is most useful to identify patients wi th white coat hypertension. Whether or not white coat hypertension predispo ses to sustained hypertension remains debated. However, outcome is better c orrelated with the ambulatory BP than with the conventional BP. In patients with white coat hypertension, antihypertensive drugs lower the BP in the c linic, but not the ambulatory BP, and also do not improve prognosis. Ambula tory BF monitoring is also better than conventional BP measurement in asses sing the effects of treatment. Ambulatory BP monitoring is necessary to dia gnose nocturnal hypertension and is especially indicated in patients with b orderline hypertension, elderly patients, pregnant women, patients with tre atment resistant hypertension, and also in patients with symptoms suggestiv e of hypotension. Conclusions-The newer techniques of BP measurement are now well established in clinical research, for diagnosis in clinical practice, and will increas ingly make their appearance in occupational and environmental medicine.