Measuring blood pressure in real life may give truer picture

Some physicians support strapping a blood pressure monitor on a patient for a 24-hour test of a hypertension medication minus the white coat effect.

By Susan J. Landers, AMNews staff. Sept. 8, 2003.

Washington -- For two decades William B. White, MD, director of the University of Connecticut Health Center's division of hypertension and pharmacology, has been a fan of ambulatory blood pressure monitoring.

He even calls himself a "dedicated zealot" and tries to convince health plans that it is a procedure well worth paying for. He has made some headway on that front, and some insurers, including Medicare, do provide limited coverage.

Others physicians still aren't entirely convinced. But recent findings are heating up this ongoing debate.

"Most would agree that there is a place for ambulatory blood pressure monitoring, but it's a fairly modest place," said Paul Whelton, MD, senior vice president for health practices and professor of epidemiology at Tulane University Health Sciences Center in New Orleans.

Three well-done, office-based blood pressure readings spaced at least three days apart could do as well as a 24-hour monitor at gathering accurate information, said Dr. Whelton.

But Dr. White contends that sending an individual home wearing a blood pressure monitor for 24 hours is basically the same as taking numerous readings in an office -- 75 to 150 different readings in the course of a day and night.

"There are two beauties to that approach: One is that the patient is away from the medical care environment so it might eliminate the white coat effect, and second, you get a lot more data, so it's reproducible from one day to the next or one month to the next," he said.