If you record a high BP in the office, but the patient says it is normal at home, should the dosage of his antihypertensive medication be adjusted? Is 24-hour monitoring of BP useful?
—Bhavana Japi, MD, New Hyde Park, N.Y.

If a patient’s BP is elevated in your office but normal when measured at home, I would not increase the dosage of his antihypertensive medication because at-home BP correlates better with long-term outcome than does office BP. However, I would suggest two caveats: First, at some point, the accuracy of the home BP monitor should be checked before assuming it is correct. Second, if the patient calls his home BP “normal,” but in reality it is 135/90 mm Hg, BP control is not adequate and a higher dose might be needed.

Ambulatory monitoring is useful either if home BP is very erratic or if, for any reason, the reliability of the home readings is unclear. One might also opt for 24-hour monitoring to confirm home readings if home and office readings are extremely divergent. It is also useful in patients with reduced renal function to determine whether BP is elevated at night; such a finding would warrant altering the treatment regimen.
—Samuel J. Mann, MD (119-24)