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Self-measurement provides valuable information on the long-term control of blood pressure 1—3 and increases the reproducibility and precision of blood pressure measurement. Until recently, most of the epidemiologic and pharmacologic studies have used only casual blood pressure measurement.

Various influences that limit the accuracy and validity of casual office blood pressure measurement are well documented.

Several studies have adressed this problem in the past. The difference might be explained by the fact that this proposal is based on a single study using only two measurements on the same day an ambulatory blood pressure recording was performed.

The subjects were not preselected according to their blood pressure levels. Only patients taking antihypertensive drugs were excluded. Office blood pressure was measured twice in the sitting position after a rest of at least 5 min before and after a 2-week period of home blood pressure measurement.

The patients were instructed on the technique of blood pressure self-measurement during the first visit. Oscillometric semiautomatic devices OM 1, Boehringer Mannheim, Switzerland were used both for office and home blood pressure determination. The subjects were instructed to measure blood pressure at home once in the morning and once in the evening over a period of 14 days.

They were instructed to write down the measurements and to report them during their second office visit a mean of Mean office blood pressure There was no significant difference between the first and second visit. Mean office blood pressure was However, the correlation coefficients between the values were lower than those for the comparison between morning and evening self-measured blood pressures. This difference indicates that there was less variation in self-measured blood pressure compared with office blood pressure.

The objective of identifying normal values is to define blood pressure values associated with an increased cardiovascular morbidity and mortality. The predictive value of blood pressure self-measurement seems to be superior to office blood pressure. In the present study, the self-measured blood pressure values were written down by the subjects. We have recently shown an observer bias in the individual patient reporting self-measured blood pressure values.

However, we have also demonstrated that observer bias did not substantially affect group comparisons, 12 and we are confident that we have obtained valid data in the present study. It will be very difficult to conduct such large studies investigating the prognostic significance of self-measured blood pressure in untreated subjects.

The corresponding blood pressure level at the same percentile of the distribution of self-measured values might serve as a reference value for an upper limit of normality. Other methods have been used for the determination of normal home blood pressure values. For the definition of normal values it is not sufficient to introduce the mean differences between self- and office measurement as a correcting factor, as the office-home difference increases with higher levels of blood pressure.

The optimal blood pressure corresponds to percentiles of Thus, the new cutoff values might be more ambitious with respect to the systolic blood pressure as compared to diastolic blood pressure.

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PloS Med. PhD thesis. Getz L: Sustainable and responsible preventive medicine. Conceputalising ethical dilemmas arising from clinical implementation of advancing medical technology. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Halfdan Petursson. JAS and LG conceived the study idea. HP analysed the data and wrote the first draft. All authors participated in further revisions of the paper and approved the final version. This article is published under license to BioMed Central Ltd.

Reprints and Permissions. Petursson, H. Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? BMC Fam Pract 10, 70 Download citation. Received : 17 March Accepted : 30 October Published : 30 October Anyone you share the following link with will be able to read this content:.

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Research article Open Access Published: 30 October Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Abstract Background Previous studies indicate that clinical guidelines using combined risk evaluation for cardiovascular diseases CVD may overestimate risk.

Conclusion The potential workload associated with the European hypertension guidelines could destabilise the healthcare system in Norway, one of the world's most long- and healthy-living nations, by international comparison.

Background The interest in preventive measures for cardiovascular diseases CVD has escalated in the last decades [ 1 ]. Table 1 Participants in the study Full size table. Figure 1. Full size image. Figure 2. Figure 3. Figure 4. Discussion Modelling the implementation of current European guidelines on arterial hypertension [ 13 ] on a general population of Norwegian adults, aged , we found that Conclusion Our findings indicate that the European blood pressure guidelines have an inherent potential to destabilise the healthcare system in Norway, one of the world's most long- and healthy-living nations, by international comparison.

References 1.