BMJ 1994;308:1634 (18 June)

Letters

Nocturnal ambulatory blood pressure measurement

EDITOR, - We disagree that the findings of R J O Davies and colleagues should be taken into account as part of clinical and epidemiological interpretation.1

The authors assume that the "aroused" ambulatory blood pressure is less accurate than the true physiological pressure. This is self evident but has no clinical relevance, as physiological pressure can never be measured in clinical practice. They also assume that the arousal response is an artefactual source of error. However, recent evidence suggests that such a rise is associated with poor outcome.2 Indeed an increased vascular reactivity depends on this arousal. Furthermore, arousal by ambulatory measurement is likely to be less than arousal induced by conventional measurement, because serial mesurements will remove the "white coat" effects.

It is incorrect for the authors to infer from their work that "the blood pressure recorded by ambulatory machines at night may underestimate to variable degrees the reduction . . . [Full text of this article]


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Relevant Article

Effect of measuring ambulatory blood pressure on sleep and on blood pressure during sleep
R J O Davies, N E Jenkins, and J R Stradling
BMJ 1994 308: 820-823. [Abstract] [Full Text]

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