The diagnosis of hypertension

An argument can be made for modifying the recommendation in the sixth report of the Joint National Committee for Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) for the measurement of blood pressure. If the blood pressure is taken in the erect position immediately after the patient enters the examination room, a much closer approximation of the ambulatory blood pressure is obtained. Another blood pressure taken immediately after assuming the supine position, and a third blood pressure 3-5 minutes after assuming the supine position, will then yield a basal equivalent to the JNC VI recommendation. Postural hypotension in older and diabetic patients can be unmasked by a final erect blood pressure. These procedures will allow a spectrum of blood pressures sufficient to establish the diagnosis of hypertension and monitor its treatment, without resorting to ambulatory blood pressure monitoring.