Dr Naschitz and colleagues have raised a number of issues in relation to the reliability of the self-measurement of BP, many of which are presently under consideration by the Working Group on Blood Pressure Monitoring of the European Society of Hypertension. The conclusions of 2 recent meetings held under the auspices of the group may, therefore, be of interest.
At the First Consensus Conference on the Self-Measurement of Blood Pressure held in Paris, France, on June 4, 1999, the participants would not have shared the opinion of Naschitz and colleagues that application of the technique should be restricted to clinical research. In fact, the conference, in keeping with the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines,1 advocated self-monitoring of blood pressure, as an accessory to conventional sphygmomanometry, with a broad role in day-to-day clinical practice. Blood pressure measurement outside the medical environment provides valuable information for the initial evaluation of hypertensive patients and for monitoring the response to treatment. Self-measurement makes it possible to distinguish patients with white-coat hypertension from those with sustained BP elevation.2 This technique also has the potential of improving patient adherence to antihypertensive medication and of reducing the costs of caring for hypertensive patients.1 There is almost general consensus that, for now, at-home BP readings of 135 mm Hg systolic and/or 85 mm Hg diastolic, or greater, should be considered elevated.1- 3 Prospective epidemiologic studies4 and clinical trials5 to validate these thresholds in terms of target organ damage or morbidity and mortality are under way. Useful though the technique may be, it does have limitations, and these have been aired recently in the correspondence columns of the American Journal of Hypertension.6