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Hypertension, one of the most pervasive disease processes in the United States, can lead to target organ damage. Although there is no one cause of primary hypertension, the theory of an unchecked long-term stress response continues to be a valid argument. Conversely, eliciting the relaxation response may alter the course of the unchecked stress response. Massage therapists have suggested that their therapy elicits the relaxation response and therefore can decrease blood pressure (BP) and hypertension. This preliminary study tested the effects of a regularly applied back massage on the BP of patients with clinically diagnosed hypertension. In this experimental, pretest-posttest study, a 10-min back massage was given to the experimental group (n = 8), three times a week for 10 sessions. The control group (n = 6) relaxed in the same environment for 10 min, three times a week for 10 sessions. Analysis of variance determined systolic BP changed significantly, F(1, 12) = 17.90, p = .001, between groups over time as did the diastolic BP, F(1, 12) = 8.34, p = .014. Effect size was 2.25 for systolic pressure and 1.56 for diastolic pressure (alpha of .05 and power at .80). This preliminary study suggests that regular massage may lower BP in hypertensive persons.

Objective: To assess the ability of limited ambulatory blood pressure monitoring as a valid replacement for office blood pressure measurement done to American Heart Association criteria in diagnosing hypertension., Methods: In all, 105 adults, who had been referred for limited ambulatory blood pressure monitoring, participated in the study. Limited ambulatory blood pressure monitoring consisted of 6 h of blood pressure measurement while ambulatory at the Mayo Clinic, using a SpaceLabs 90207 (SpaceLabs Medical, Issaquah, Washington, USA) collecting six readings per hour for the period of observation. The study participants gave consent for three additional consecutive office blood pressure measurements, using a validated aneroid device, done to American Heart Association criteria, by a single hypertension nurse specialist., Results: Mean systolic blood pressure by limited ambulatory blood pressure monitoring was 137.9+/-14.2 mmHg and for the nurse, 137.9+/-20.1 mmHg. Mean diastolic blood pressure by limited ambulatory blood pressure monitoring was 81.5+/-9.7 mmHg and for the nurse, 74.3+/-11.9 mmHg. The intermethod difference for systolic blood pressure was 0.03+/-12.5 mmHg and diastolic blood pressure, -7.2+/-8.0 mmHg. Using <140/90 as criteria factor, limited ambulatory blood pressure monitoring and the trained nurse agreed 77% of the time on whether the patient was hypertensive. This agreement increased to 81% if the participant's referral blood pressure was >or=140/90., Conclusions: Limited ambulatory blood pressure monitoring is an excellent replacement for office blood pressure, done to American Heart Association criteria, in diagnosing hypertension. This avoids issues of variability introduced by the observers, such as digit preference and bias, and increases reproducibility of blood pressure measurements. The appropriate normal value for limited ambulatory blood pressure monitoring is <140/90 mmHg compared with <135/85 mmHg used in 24-h ambulatory blood pressure monitoring.

Despite improvements in the management of hypertension in the past several years, nearly 70% of patients with hypertension are not adequately controlled. Today's physician treating hypertension is armed with numerous efficacious antihypertensive agents. Thus, one of the major contributors to the large number of uncontrolled hypertensive patients appears to be non-compliance with prescribed regimens. Non-compliance is a universal characteristic and can affect all patients. However, the major problem of non-compliance is that it remains largely unrecognised in clinical practice. Several types of non-compliance exist with the 'drug holiday' being the most common. Good communication with the patient and the entire health care team is critical in increasing patient compliance. Long-acting medications that provide good blood pressure control beyond the 24-hour dosing period should be considered drugs of choice in non-compliant hypertensive patients. This article will discuss different types of compliance, methods to measure compliance, and clinical consequences of non-compliance in hypertension.

To determine the effectiveness of a yoga program on blood pressure and stress, a group of hypertensive patients in Thailand were studied, with the experimental group showing significantly decreased mean stress scores and blood pressure, heart rate, and body mass index levels compared with the control group. Further studies are suggested to determine the effects of yoga on hypertension in Thailand.

The purpose of this article is to help clinicians understand how biological, psychological, and sociological stress responses synergistically influence blood pressure in individuals with type 2 diabetes mellitus.

Objectives: A randomized controlled trial involving a nurse administered patient-tailored intervention is being conducted to improve blood pressure (BP) control., Methods: Veterans with hypertension from an outpatient primary care clinic completed a baseline assessment and were randomly allocated to either a nurse administered intervention or to usual care. In this ongoing study, intervention patients receive the tailored intervention bi-monthly for 2 years via telephone; the goal of the intervention is to promote adherence with medication and improve health behaviors. Patient factors targeted for intervention include perceived risk of hypertension, memory, literacy, social support, patients' relationship with their health care provider, side effects of therapy, pill refill, missed appointments, and health behaviors., Results: The sample randomized to the nurse intervention consisted of 294 veterans with hypertension (average age = 63 years; 41% African-American). A comparable sample of veterans was assigned to usual care (n = 294). We have maintained a 97% retention rate for the first 12 months of the study. The average phone call has lasted 3.7 min ranging from less than 1 to 40 min. At 6-month post-enrollment, individuals receiving the nurse intervention had a greater increase in confidence with following hypertension treatment (P < 0.007) than the usual care group., Discussion: The intervention is easily implemented and is designed to enhance adherence with prescribed hypertension regimen. The study includes both general and patient-tailored information based upon need assessment. The study design ensures internal validity as well as the ability to generalize study findings to the clinic settings.

Hypertension is a prevalent chronic illness that is implicated in many cardiovascular diseases. Practice nurses and the district nursing team have a major role to play in its management. In this article, current British Hypertension Society guidelines are presented and discussed with regards to their evidence base. Implications for nursing practice are highlighted.

Automated blood pressure devices have been embraced by clinicians for their convenience and ease of use. However, the pressure to remove mercury-containing medical devices is leading to the demise of the mercury sphygmomanometer and the loss of manual blood pressure measurement skills. The article argues that there is still a place for the mercury sphygmomanometer, particularly when a clinical decision is based on the blood pressure readings. It presents a review of the available literature to explain the rationale for the use of manual sphygmomanometry and gives a step-by-step guide to the procedure with current supporting evidence. There is a brief discussion of special considerations when dealing with certain client groups. Normal blood pressure ranges for adults and children have been included along with a definition of hypertension for both groups.

The incidence of adolescent obesity is increasing dramatically in the United States with associated risks of hypertension, adverse lipid profiles, and Type II diabetes. Unless reversed, this trend predicts an epidemic of adult cardiovascular disease. Interventions at home, at school, and in the community are required to empower teens to increase physical activity and to modify eating habits. This article describes assessment for obesity-related health problems as well as scientific guidelines and research-based intervention strategies to decrease obesity in adolescents.

Background: The premise for the research study was the authors' conviction that the use of nursing diagnostic taxonomies allows the nurse to formulate a thorough and valid diagnosis., Aim: To verify the International Classification for Nursing Practice (ICNP) in the context of a Polish academic nursing programme., Research Questions: Do nursing diagnoses made traditionally and those made with the ICNP reflect the patient's/client's condition? Is the range and type of the two kinds of diagnoses similar or different? Is the level of detail in both types of diagnoses compatible?, Methods: Quasi-experiment in which the experimental group diagnosed patients by means of the ICNP and the control group formulated nursing diagnoses by means of an intellectual decision-making process., Study Groups: 44 students in a MNurs. Programme, Faculty of Nursing and Health Sciences, Medical University in Lublin, Poland., Conclusions: The range and type of nursing diagnoses do not depend on the method used in their formulation. The ICNP diagnoses are compatible with the traditionally formulated ones. The unbalanced size of the experimental and the study groups negatively influenced the validity of conclusions.

Background: Standard office-based approaches to controlling hypertension show limited success. Such suboptimal hypertension control reflects in part the absence of both an infrastructure for patient education and frequent, regular blood pressure (BP) monitoring. We tested the efficacy of a physician-directed, nurse-managed, home-based system for hypertension management with standardized algorithms to modulate drug therapy, based on patients' reports of home BP., Methods: We randomized outpatients requiring drug therapy for hypertension according to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) criteria to receive usual medical care only (UC, n = 76) or usual care plus nurse care management intervention (INT, n = 74) over a 6-month period., Results: Patients receiving INT achieved greater reductions in office BP values at 6 months than those receiving UC: 14.2 +/- 18.1 versus 5.7 +/- 18.7 mm Hg systolic (P < .01) and 6.5 +/- 10.0 versus 3.4 +/- 7.9 mm Hg diastolic, respectively (P < .05). At 6 months, we observed one or more changes in drug therapy in 97% of INT patients versus 43% of UC patients, and 70% of INT patients received two or more drugs versus 46% of UC. Average daily adherence to medication, measured by electronic drug event monitors, was superior among INT subjects (mean +/- SD, 80.5% +/- 23.0%) than among UC subjects (69.2 +/- 31.1%; t(113) = 2.199, P = .03). There were no significant adverse drug reactions in either group., Conclusions: Telephone-mediated nurse management can successfully address many of the systems-related and patient-related issues that limit pharmacotherapeutic effectiveness for hypertension.

Arterial hypertension is a public health problem and patient adherence to treatment is challenging. This study tested whether frequent nurse visits provide additional benefits to antihypertensive treatment. Every 30 days, a pharmacist visited these patients to deliver antihypertensive drugs and perform a pill count. Nurses visited group A (48 patients) every 15 days and group B (52 patients) every 90 days. Ambulatory blood pressure (BP) monitoring was performed 15 and 180 days after randomization. At randomization, groups A and B had the same clinical systolic (191 +/- 5 v 186 +/- 3 mm Hg) and diastolic BP levels (122 +/- 3 v 117 +/- 4 mm Hg), respectively. After 90 days, BP declined more in group A than in group B (35 +/- 5/19 +/- 3 v 27 +/- 5/9 +/- 3 mm Hg). At 180 days, the difference increased because the reduction persisted in group A but decreased in group B (36 +/- 6/21 +/- 4 v 17 +/- 4/10 +/- 2 mm Hg). The mean ambulatory BP monitoring values were similar in both groups at 15 and 180 days. However, the attenuation of the clinic-daytime BP difference was larger in group A than in group B (systolic, -13 +/- 4 v -3 +/- 4 mm Hg; diastolic -11 +/- 3 v -4 +/- 3 mm Hg). The patients with clinic-daytime differences decreased more in group A (systolic, 16 to 10; diastolic, 20 to 14) than in group B (systolic, 19 and 20; diastolic, 22 and 22). These data indicate that frequent nurse visits significantly attenuate the white coat effect (clinic daytime BP difference).

New guidelines for the management of hypertension have just been published. These guidelines are relevant for many nurses but especially for those in primary care, who are often involved in the management of people with hypertension and its complications.

Hypertensive disorders occur in 6% to 8% of all pregnancies, are the second leading cause of maternal death, and contribute to significant neonatal morbidity and mortality. This is a problem not only in inpatient settings, as ambulatory and home-care nurses are increasingly being called upon to monitor women who are at high risk and may have hypertensive disorders. To prevent hypertension-induced problems in pregnant women, nurses must have strong assessment, advocacy, and counseling skills. Nurses also must provide care based on the latest national standards as described in this article.

This work aimed at the application of Nursing appointments to an hypertensive woman based on Orem's Theory, and at the identification of her degree of satisfaction in committing herself to self-care. The appointments were applied monthly for six months to fifty women. At every appointment, an evaluation was made on self-care deficit and on the abilities women showed to develop self-care activities. Most women overcame their self-care deficits, and acquired technical and cognitive abilities to perform self-care activities, falling into a profile that is desirable for improving quality of life. These changes were intensified at each appointment. Evidence showed that the application of this new technology brings highly positive influences to clients and assures quality in the Nursing services provided.

The aim of this review was to examine studies on nursing in hypertension care to find out the nurse's role and skills. Articles were searched during the period 1966-1997. About 650 abstracts were read, and 148 were selected for examination. Forty-two articles were judged to be relevant for the study. The role of the nurse in programs was described as that of a team member, an educator in nonpharmacological treatment, and a translator for the physician with a holistic and psychosocial approach. A nurse participating in hypertension care promoted blood pressure reductions as the patients decreased their weight and sodium intake, stopped smoking, increased their physical activity, took their medication more correctly, and returned for follow-up visits more frequently, and the cost of drugs and visits to the physician decreased. Local programs for hypertension care should be developed with nurses' holistic and psychosocial approach and skills taken into account. More well-designed studies are needed to develop nursing care for hypertensive patients.

Objective: To compare the effectiveness of a nurse-led hypertension clinic with conventional community care in general practice in the management of uncontrolled hypertension in patients with type 2 diabetes., Research Design and Methods: We studied 120 men and women outpatient attendees (61% non-Caucasian) with type 2 diabetes and a seated blood pressure (BP) >or=140/80 mmHg. All patients were being treated for hypertension, and 71% had increased urinary albumin excretion (UAE). Patients were allocated to either a nurse-led hypertension clinic or conventional primary care. The primary outcome measure was a change in systolic BP. Secondary outcome measures were total cholesterol, HDL cholesterol, total triglycerides, HbA(1c), UAE, serum creatinine, and changes in absolute stroke and coronary heart disease (CHD) risk scores., Results: The mean (95% CI) difference in the decrement of systolic BP was 12.6 mmHg (5.9-19.3) (P = 0.000) in favor of the nurse-led group, whose patients were three times more likely to a reach target systolic BP <140 mmHg compared with conventional care (P = 0.003). A significant fall in 10-year CHD (P = 0.004) and stroke risk (P = 0.000) scores occurred only in the nurse-led group. There were no significant differences in the reduction of diastolic BP or any of the other secondary outcome measures at 6 months., Conclusions: Compared with conventional care, a nurse-led hypertension clinic is a more effective intervention for patients with type 2 diabetes and uncontrolled hypertension. A target systolic BP <140 mmHg is more readily achieved and may be associated with significant reductions in 10-year cardiovascular disease risk scores.

Adequate treatment of high blood pressure reduces the risk of strokes and other cardiovascular events, but current treatment in UK general practice is often inadequate. Nurse-led management of people with high blood pressure could lead to improvements due to strict adherence to protocols, agreed target blood pressure, better prescribing and compliance, and regular follow-up. However, a review of the literature shows a lack of robust evidence of the effectiveness of nurse-led hypertension management in primary care. There is a clear need for randomized controlled trials to see if nurse-led management is associated with better blood pressure control than routine care.

Purpose: To review clinical and laboratory findings that will enhance nurse practitioner (NP) recognition of the metabolic syndrome and to increase awareness of recent treatment guidelines and treatment options., Data Sources: Professional association practice guidelines, government documents, original research articles, and journal articles., Conclusions: The metabolic syndrome is a prevalent condition characterized by a cluster of lipid and nonlipid abnormalities, including atherogenic dyslipidemia, elevated fasting blood glucose, hypertension, and abdominal obesity. Many persons with this syndrome are also insulin resistant. Prompt recognition and treatment of the metabolic syndrome can prevent or delay the development of type 2 diabetes and coronary heart disease. Clinical guidelines recommend treating the metabolic syndrome as a secondary target of lipid-lowering therapy after addressing the primary target, low-density lipoprotein cholesterol., Implications for Practice: NPs are in an instrumental position to manage treatment for patients with the metabolic syndrome by (a) evaluating risk factors, including abdominal obesity, physical inactivity, atherogenic dyslipidemia, hypertension, and elevated fasting blood glucose; (b) assisting in the modification of lifestyle factors such as diet and exercise; (c) implementing pharmacological therapy when needed; and (d) providing psychosocial support to encourage therapeutic adherence.

Objective: To determine the effectiveness of specialist nurse-led clinics for hypertension and hyperlipidemia provided for diabetic patients receiving hospital-based care., Research Design and Methods: This study was a randomized controlled implementation trial at Hope Hospital, Salford, U.K. The subjects consisted of 1,407 subjects presenting for annual review with raised blood pressure(>or=140/80 mmHg), raised total cholesterol (>or=5.0 mmol/l), or both. Individuals with diabetes were randomized to usual care or usual care with subsequent invitation to attend specialist nurse-led clinics. Nurses provided clinics for participants, with attendance every 4-6 weeks, until targets were achieved. Lifestyle advice and titration of drug therapies were provided according to the locally agreed upon guidelines. Patients with both conditions were eligible for enrollment in either or both clinics. At subsequent annual review, blood pressure and total cholesterol values were obtained from the Salford electronic diabetes register. Data relating to deaths were obtained from the national strategic tracing service. The primary outcome was the odds ratio of achieving targets in hypertension and hyperlipidemia, attributable to the specialist nurse-led intervention., Results: Overall, specialist nurse-led clinics were associated with a significant improvement in patients achieving the target after 1 year (odds ratio [OR] 1.37 [95% CI 1.11-1.69], P = 0.003). This primary analysis revealed a borderline difference in effect between the two types of clinics (test for interaction between groups: P = 0.06). Secondary analysis, consistent with the prior beliefs of the health care professionals involved, suggested that targets were achieved more frequently in patients enrolled in the specialist nurse-led clinic for hyperlipidemia (OR 1.69 [1.25-2.29], P = 0.0007) than for hypertension (OR 1.14 [0.86-1.51], P = 0.37). Intervention (enrolled to either or both clinics) was associated with a reduction in all-cause mortality (OR 0.55 [0.32-0.92], P = 0.02)., Conclusions: This study provides good evidence to support the use of specialist nurse-led clinics as an effective adjunct to hospital-based care of patients with diabetes. If the standards of care recommended in the National Service Framework for Diabetes are to be achieved, then such proven methods for delivering care must be adopted.

As community hospitals adopt comprehensive stroke pathways, nurses in critical care areas must prepare for each possible complication. Although the thrombolytic component of a new stroke protocol may receive the most attention, the various details of the pathway--in this case, management of blood pressure--should not be overlooked. Critical care nurses who appreciate the considerations for treatment of hypertension and who can correctly and efficiently administer intravenous labetalol may save precious time and enhance outcomes for patients with stroke who have hypertension.

Over the past decade, noninvasive hemodynamic and thoracic fluid status monitoring via impedance cardiography has provided clinicians practicing in the outpatient setting with a valuable tool for managing a myriad of cardiovascular disorders. This article reviews impedance cardiography technology and the use of impedance cardiography in the home and outpatient clinic settings for the assessment and management of heart failure, resistant hypertension, and dual-chamber pacemaker optimization.

Objective: This study evaluated the efficacy of a nurse-care management system designed to improve outcomes in patients with complicated diabetes., Research Design and Methods: In this randomized controlled trial that took place at Kaiser Permanente Medical Center in Santa Clara, CA, 169 patients with longstanding diabetes, one or more major medical comorbid conditions, and HbA(lc) >10% received a special intervention (n = 84) or usual medical care (n = 85) for 1 year. Patients met with a nurse-care manager to establish individual outcome goals, attended group sessions once a week for up to 4 weeks, and received telephone calls to manage medications and self-care activities. HbA(lc), LDL, HDL, and total cholesterol, triglycerides, fasting glucose, systolic and diastolic blood pressure, BMI, and psychosocial factors were measured at baseline and 1 year later. Annualized physician visits were determined for the year before and during the study., Results: At 1 year, the mean reductions in HbA(lc), total cholesterol, and LDL cholesterol were significantly greater for the intervention group compared with the usual care group. Significantly more patients in the intervention group met the goals for HbA(1c) (<7.5%) than patients in usual care (42.6 vs. 24.6%, P < 0.03, chi(2)). There were no significant differences in any of the psychosocial variables or in physician visits., Conclusions: A nurse-care management program can significantly improve some medical outcomes in patients with complicated diabetes without increasing physician visits.

Neonatal hypertension, defined as systolic blood pressure greater than 95th percentile for age, size, and gender, is an uncommon but significant problem. Hypertension may develop secondary to thromboembolic complications of central lines, steroid use, or be a sign of an underlying renal or cardiac problem. Pharmacologic management of hypertension in the neonate includes use of beta blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, and/or diuretics. This article discusses issues in assessment and management of neonatal hypertension and reviews the pharmacologic agents most commonly utilized in the neonatal setting.

White coat hypertension is a clinical phenomenon characterized by elevated arterial blood pressure during a visit to the physician. In this study, we will review the key published studies related to this concept as they evaluate and compare morphological and behavioural characteristics between normotensive individuals, essential hypertension, and white coat patients. A definition of white coat hypertension, as well as information about its prevalence and factors contributing to it are also provided. We will comment on the implications of this type of hypertension in nursing practice, since readings of arterial blood pressure as ascertained by a nurse usually correlate well with those taken at home, a finding that should be considered in the diagnosis and treatment of hypertension.

This study examined the effect of progressive muscle relaxation (PMR) on blood pressure and psychosocial status in clients with essential hypertension. The study, which used a quasi-experimental design, recruited a convenience sample of 40 subjects from a hypertension outpatient clinic. Twenty subjects received PMR training once a week and practiced at home daily for 4 weeks. PMR training had an immediate effect, reducing pulse rate 2.35 beats/min, systolic blood pressure 5.44 mm Hg, and diastolic blood pressure 3.48 mm Hg. After 4 weeks of PMR training, further decreases in pulse rate (2.9 beats/min), systolic blood pressure (5.1 mm Hg), and diastolic blood pressure (3.1 mm Hg) occurred. PMR significantly lowered patients' perception of stress, and it enhanced their perception of health. PMR is beneficial for patients with essential hypertension, and nurses may use it to enhance their independent function as well as their quality of life.

Background: Nurses caring relationships with hypertensive patients can have a positive effect upon their blood pressure and may increase quality of life and prolongation of life. Hypertension affects a large number of people. It is important that those affected receive, in addition to the best available medical treatment, nursing care that best meets their needs and adds to the quality of their lives. Watson's Caring Model is one nursing approach consistent with needs of persons with hypertension, and was used in this study to guide both research and practice., Aim: To determine the effectiveness of a nurse's caring relationship according to Watson's Caring Model on the blood pressure and the quality of life of patients with hypertension., Methods: The design of the study was a one-group pretest and post-test. The study included 52 patients with hypertension in four health care units in Erzurum, Turkey in 2000. These patients had been diagnosed with hypertension and invited to participate in a research project involving nursing care. After acceptance, patients were given questionnaires consisting of demographic characteristics; their blood pressure was measured, and a quality of life scale was administered. Each of the participating nurse researchers was prepared in the use of Watson's Theory and Model of Caring (and the 10 Carative Factors). This training formed the basis of the caring process used by the nurse researchers who then visited the patients and their families once a week for blood pressure measurement for a 3-month period. At the end of care, the quality of life scale was applied to patients, and blood pressures were measured as the post-test., Results: There were statistically significant differences between mean scores of general well-being (t = 3.097, d.f. = 51, P = 0.003), physical symptoms and activity (t = 2.994, d.f. = 51, P = 0.004), medical interaction (t = 2.127, d.f. = 51, P = 0.035). There were also significant differences between blood pressure (systolic: t = 4.830, d.f. = 51, P = 0.000; and diastolic: t = 3.51, d.f. = 51, P = 0.001) in pre- and post-test., Conclusion: This study demonstrated a relationship between care given according to Watson's Caring model and increased quality of life of the patients with hypertension. Further, in those patients for whom the caring model was practised, there was a relationship between the Caring model and a decrease in patient's blood pressure. The Watson Caring Model is recommended as a guide to nursing patients with hypertension, as one means of decreasing blood pressure and increase in quality of life.

Objective: To assess alternatives to measuring ambulatory pressure, which best predicts response to treatment and adverse outcome., Setting: Three general practices in England., Design: Validation study., Participants: Patients with newly diagnosed high or borderline high blood pressure; patients receiving treatment for hypertension but with poor control., Main Outcome Measures: Overall agreement with ambulatory pressure; prediction of high ambulatory pressure (>135/85 mm Hg) and treatment thresholds., Results: Readings made by doctors were much higher than ambulatory systolic pressure (difference 18.9 mm Hg, 95% confidence interval 16.1 to 21.7), as were recent readings made in the clinic outside research settings (19.9 mm Hg,17.6 to 22.1). This applied equally to treated patients with poor control (doctor v ambulatory 21.4 mm Hg, 17.3 to 25.4). Doctors' and recent clinic readings ranked systolic pressure poorly compared with ambulatory pressure and other measurements (doctor r=0.46; clinic 0.47; repeated readings by nurse 0.60; repeated self measurement 0.73; home readings 0.75) and were not specific at predicting high blood pressure (doctor 26%; recent clinic 15%; nurse 72%; patient in surgery 81%; home 60%), with poor likelihood ratios for a positive test (doctor 1.2; clinic 1.1; nurse 2.1, patient in surgery 4.7; home 2.2). Nor were doctor or recent clinic measures specific in predicting treatment thresholds., Conclusion: The "white coat" effect is important in diagnosing and assessing control of hypertension in primary care and is not a research artefact. If ambulatory or home measurements are not available, repeated measurements by the nurse or patient should result in considerably less unnecessary monitoring, initiation, or changing of treatment. It is time to stop using high blood pressure readings documented by general practitioners to make treatment decisions.