Sam F. Carter, MD
Potential Financial Conflicts of Interest: None disclosed.
Carter S.; Will Running the Numbers First Violate the Principles of Patient-Centered Care?. Ann Intern Med. 2008;149:840. doi: 10.7326/0003-4819-149-11-200812020-00021
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Published: Ann Intern Med. 2008;149(11):840.
TO THE EDITOR:
I am puzzled by the recommendation of Phillips and Twombly (1) to change antihypertensive therapy on the basis of single blood pressure measurements and by their dismissal of home monitoring, given the marked variability of blood pressure over time (especially in older patients with systolic hypertension). I have observed fluctuations in systolic blood pressure of up to 100 points over 24 hours in clinically stable patients in both inpatient and outpatient settings. If I have verified in my clinic the reliability of a patient's blood pressure machine, is the average of multiple home measurements not more important than a single clinic measurement?
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