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Blood Pressure During Normal Daily Activities, Sleep, and Exercise: Title and subTitle BreakComparison of Values in Normal and Hypertensive Subjects FREE

Thomas G. Pickering, MD, DPhil; Gregory A. Harshfield, PhD; Hollis D. Kleinert, PhD; Seymour Blank, MEE; John H. Laragh, MD
[+] Author Affiliations

Reprint requests to Cardiovascular Center, The New York Hospital-Cornell University Medical Center, 525 E 68th St, New York, NY 10021 (Dr Pickering).


JAMA. 1982;247(7):992-996. doi:10.1001/jama.1982.03320320028025
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Blood pressure (BP) readings were taken every 15 minutes using a noninvasive ambulatory BP recorder during 24 hours in 25 subjects with normal BP, 25 with borderline hypertension, and 25 with established essential hypertension. Readings were analyzed for four situations: (1) physician's office, (2) work, (3) at home, and (4) asleep. Treadmill exercise tests were also performed on a separate occasion with the Bruce protocol. The 24-hour recording in all three groups showed the highest BPs at work and the lowest during sleep. The situational BP changes were generally similar, but both hypertensive groups differed from normal subjects in that they showed consistently higher BPs in the physician's office than at home, whereas normal subjects showed little difference. During exercise, the hypertensive groups showed a similar rise of systolic pressure to that of normal subjects. Pressures recorded in the physician's office gave good predictions of the average 24-hour pressure in normal and established hypertensive subjects, but not in the borderline group; in such patients, 24-hour monitoring may be of particular value in establishing the need for treatment.

(JAMA 1982;247:992-996)

REFERENCES

Ayman D, Goldshine AD:  Blood pressure determinations by patients with essential hypertension: I. The difference between clinic and home readings before treatment . Am J Med Sci 1940;;200:465-474.
Harshfield GA, Pickering TG, Kleinert HD, et al:  Situational variations of blood pressure in ambulatory hypertensive patients . Psychosom Med , to be published.
Sealey JE, Laragh JH:  How to do a plasma renin assay . Cardiovasc Med 1979;;2:1079-1092.
Harshfield GA, Pickering TG, Laragh JH:  A validation study of the Del Mar Avionics blood pressure system . Ambulatory Electrocardiography 1979;;4:7-12.
Bevan A, Honour AJ, Stott F:  Direct arterial pressure recording in unrestricted man . Clin Sci 1969;;36:329-344.
Littler WA, Honour AJ, Pugsley DJ, et al:  Continuous recording of direct arterial pressure in unrestricted patients: Its role in the diagnosis and management of high blood pressure . Circulation 1975;;51:1101-1106.
Goldberg AD, Raftery EB, Cashman PMM, et al:  Study of untreated hypertensive subjects by means of continuous intra-arterial blood pressure recordings . Br Heart J 1978;;40:656-664.
Sokolow M, Werdeger D, Kain HK, et al:  Relationship between level of blood pressure measured casually and by portable recorders and severity of complications in essential hypertension . Circulation 1966;;34:279-298.
Horan MJ, Kennedy HL, Padgett NE:  Do borderline hypertensive patients have labile blood pressure? Ann Intern Med 1981;;94:466-468.
Pickering GW: High Blood Pressure . London, J & A Churchill Ltd, 1968;, p 37.
Haynes RB, Sackett DL, Taylor DW, et al:  Increased absenteeism from work after detection and labeling of hypertensive patients . N Engl J Med 1978;;299:741-744.
Julius S:  Neurogenic component in borderline hypertension , in Julius S, Esler MD (eds): The Nervous System in Arterial Hypertension . Springfield, Ill, Charles C Thomas Publisher, 1976;, p 301.
Pickering TG:  Sleep, carcadian rhythms, and cardiovascular disease . Cardiovasc Rev Rep 1980;;1:37-47.
Nathan MA, Reis DJ:  Chronic labile hypertension produced by lesions of the nucleus tractus solitari in the cat . Circ Res 1977;;40:72-81.
 Five-year findings of the Hypertension Detection and Follow-up Program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension, Hypertension Detection and Follow-up Program . JAMA 1979;; 242:2562-2571.

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Ayman D, Goldshine AD:  Blood pressure determinations by patients with essential hypertension: I. The difference between clinic and home readings before treatment . Am J Med Sci 1940;;200:465-474.
Harshfield GA, Pickering TG, Kleinert HD, et al:  Situational variations of blood pressure in ambulatory hypertensive patients . Psychosom Med , to be published.
Sealey JE, Laragh JH:  How to do a plasma renin assay . Cardiovasc Med 1979;;2:1079-1092.
Harshfield GA, Pickering TG, Laragh JH:  A validation study of the Del Mar Avionics blood pressure system . Ambulatory Electrocardiography 1979;;4:7-12.
Bevan A, Honour AJ, Stott F:  Direct arterial pressure recording in unrestricted man . Clin Sci 1969;;36:329-344.
Littler WA, Honour AJ, Pugsley DJ, et al:  Continuous recording of direct arterial pressure in unrestricted patients: Its role in the diagnosis and management of high blood pressure . Circulation 1975;;51:1101-1106.
Goldberg AD, Raftery EB, Cashman PMM, et al:  Study of untreated hypertensive subjects by means of continuous intra-arterial blood pressure recordings . Br Heart J 1978;;40:656-664.
Sokolow M, Werdeger D, Kain HK, et al:  Relationship between level of blood pressure measured casually and by portable recorders and severity of complications in essential hypertension . Circulation 1966;;34:279-298.
Horan MJ, Kennedy HL, Padgett NE:  Do borderline hypertensive patients have labile blood pressure? Ann Intern Med 1981;;94:466-468.
Pickering GW: High Blood Pressure . London, J & A Churchill Ltd, 1968;, p 37.
Haynes RB, Sackett DL, Taylor DW, et al:  Increased absenteeism from work after detection and labeling of hypertensive patients . N Engl J Med 1978;;299:741-744.
Julius S:  Neurogenic component in borderline hypertension , in Julius S, Esler MD (eds): The Nervous System in Arterial Hypertension . Springfield, Ill, Charles C Thomas Publisher, 1976;, p 301.
Pickering TG:  Sleep, carcadian rhythms, and cardiovascular disease . Cardiovasc Rev Rep 1980;;1:37-47.
Nathan MA, Reis DJ:  Chronic labile hypertension produced by lesions of the nucleus tractus solitari in the cat . Circ Res 1977;;40:72-81.
 Five-year findings of the Hypertension Detection and Follow-up Program: I. Reduction in mortality of persons with high blood pressure, including mild hypertension, Hypertension Detection and Follow-up Program . JAMA 1979;; 242:2562-2571.
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