What is normal blood pressure? Comparison of ambulatory pressure level and variability in patients with normal or...

To assess the level and pattern of normal ambulatory blood pressure (ABP) using a non-BP standard to identify normality, we examined the level and variability of ABP during the waking day, at work, at home, and during sleep and looked at physician and technician BP measurements in 191 adults whose left ventricular (LV) geometry was classified by echocardiography. Clinic BPs were similar in the 120 subjects with normal LV geometry and the 35 subjects with concentric LV remodeling. Pressures were only modestly higher in the 15 subjects with concentric LV hypertrophy than in the 21 with eccentric hypertrophy. In contrast, these subject groups differed with regard to their ABPs during the waking hours, at home, and especially at work. However, no difference in BP variability, as assessed by the standard deviation of awake systolic or diastolic BP, existed among the subject groups identified by LV geometric patterns. Comparison of patients with concentric LV hypertrophy, the LV pattern associated with the worst prognosis, with normotensive subjects with normal LV geometry suggests that awake ABPs in adults below 139/86 mm Hg might be considered normal, whereas values over 149/95 mm Hg might be considered pathologic. Verification of these conclusions is needed, however, in larger series and with the use of additional measures of preclinical hypertensive disease.