We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

ABPM Is Valuable for the Management of Hypertension—Reply

Marvin Moser, MD
Arch Intern Med. 2002;162(13):1531-1532. doi:.
Text Size: A A A
Published online


In reply

The letter by Gupta brings up several interesting points. While it is true that not all patients with IOH, or white coat hypertension, have sustained hypertension (by definition) or the presence of left ventricular diastolic dysfunction, the data from the study by Grandi et al1 indicate that many of these patients do have physiologic (vascular) changes that may be too early to detect on a routine evaluation. Obviously, again by definition, the 20% or more of patients with IOH have normal BP levels outside the physician's office. I would remind Gupta and colleagues that almost all of the data that estimate risk from the long-term well-randomized controlled trials have been based on casual BP measurements. A casual or office BP reading higher than 140/90 mm Hg indicates a poorer prognosis than readings below that level. Also, to repeat what I said in my editorial,2 all the data on benefit have been determined by office or casual BP readings: persons who achieve lower BP levels have the best outcome. The argument that patients with IOH on one occasion will have it again on another indicates that these are probably the individuals who will have vascular changes that are undetectable; these individuals probably should be treated. Subsequent observations find that about 10% to 12% of the persons who are hypertensive on the first visit become normotensive on subsequent testing; they should just receive follow-up.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Does This Patient Have a Hemorrhagic Stroke?

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference