Blood pressure during normal daily activities, sleep, and exercise. Comparison of values in normal and hypertensive subjects

Blood pressure (BP) readings were taken every 15 minutes using a noninvasive ambulatory BP recorder during 24 hours in 25 subjects with normal BP, 25 with borderline hypertension, and 25 with established essential hypertension. Readings were analyzed for four situations: (1) physician's office, (2) work, (3) at home, and (4) asleep. Treadmill exercise tests were also performed on a separate occasion with the Bruce protocol. The 24-hour recording in all three groups showed the highest BPs at work and the lowest during sleep. The situational BP changes were generally similar, but both hypertensive groups differed from normal subjects in that they showed consistently higher BPs in the physician's office than at home, whereas normal subjects showed little difference. During exercise, the hypertensive groups showed a similar rise of systolic pressure to that of normal subjects. Pressures recorded in the physician's office gave good predictions of the average 24-hour pressure in normal and established hypertensive subjects, but not in the borderline group; in such patients, 24-hour monitoring may be of particular value in establishing the need for treatment. (JAMA1982;247:992-996)