Rapid Responses to:

LETTERS: Jan H Matthys Teaching students in general practice can affect patients' blood pressure BMJ 2005; 331: 406-b [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

In the ant's house, the dew is a flood

BM Hegde   (12 August 2005)

In the ant's house, the dew is a flood 12 August 2005
BM Hegde, Retired Vice Chancellor Mangalore 575004, India Send response to journal: Re: In the ant's house, the dew is a flood	Dear Editor, The arousal reaction in any patient coming to see a doctor (white coat effect) is such that the blood pressure measurements taken at any time, with or without medical students around, except when the patient is unconscious, should be inaccurate. It is usually much higher than the actual pressure. Adjusting drug dosage to clinic pressure readings, even after more than one measurement could, consequently, be dangerous. Normal blood pressures in the clinic could go down further when the patient goes to sleep. If the diastolic pressures fall, even marginally in deep sleep, coronary filling could suffer (especially in those with compromised coronary circulation) resulting in myocardial infarctions in sleep!The dew could flood the ant's house! yours ever, bmhegde Competing interests: None declared