Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1993 Aug 15;149(4):409–418.

Report of the Canadian Hypertension Society Consensus Conference: 2. Diagnosis of hypertension in adults.

R B Haynes 1, Y Lacourcière 1, S W Rabkin 1, F H Leenen 1, A G Logan 1, N Wright 1, C E Evans 1
PMCID: PMC1485663  PMID: 8348423

Abstract

OBJECTIVE: To update recommendations for the diagnosis of mild hypertension in adults and to assess the role of echocardiography, self-measurement of blood pressure and ambulatory blood pressure monitoring. DATA SOURCES: Literature reviews of previous consensus conferences were updated with searches of MEDLINE for the period Jan. 1, 1988, to Nov. 15, 1991, and supplemented by reference lists and personal files. STUDY SELECTION: Panel members selected relevant articles and rated them according to methodologic criteria. DATA EXTRACTION: The data extracted concerned the measurement of blood pressure, the diagnosis of hypertension, the treatment of mild hypertension, and the reliability and validity of echocardiography, self-measurement of blood pressure and ambulatory blood pressure monitoring in the diagnosis of mild hypertension. The recommendations made were graded according to the level of evidence available, circulated to many experts and approved at a consensus conference. MAIN RESULTS: Previous recommendations for the accurate measurement of blood pressure remain mostly unchanged. Antihypertensive treatment should be prescribed for patients (including the elderly) with an average diastolic blood pressure of at least 100 mm Hg, for those with isolated systolic hypertension (systolic blood pressure of at least 160 mm Hg and diastolic blood pressure of less than 90 mm Hg) and for patients with a diastolic blood pressure of 90 to 99 mm Hg and target-organ damage. Clinical judgement is required in treating patients with a diastolic blood pressure of 90 to 99 mm Hg without target-organ damage, and individual risk for cardiovascular disease must be taken into account. There is insufficient evidence to warrant the routine use of echocardiography, self-measurement of blood pressure or ambulatory blood pressure monitoring in diagnosis. CONCLUSIONS: Recent high-quality evidence supports several new recommendations for the diagnosis of mild hypertension in adults. Additional research is needed to determine the role of echocardiography, self-measurement of blood pressure and ambulatory blood pressure monitoring.

Full text

PDF
418

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amery A., Birkenhäger W., Brixko P., Bulpitt C., Clement D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet. 1985 Jun 15;1(8442):1349–1354. doi: 10.1016/s0140-6736(85)91783-0. [DOI] [PubMed] [Google Scholar]
  2. Anastos K., Charney P., Charon R. A., Cohen E., Jones C. Y., Marte C., Swiderski D. M., Wheat M. E., Williams S. Hypertension in women: what is really known? The Women's Caucus, Working Group on Women's Health of the Society of General Internal Medicine. Ann Intern Med. 1991 Aug 15;115(4):287–293. doi: 10.7326/0003-4819-115-4-287. [DOI] [PubMed] [Google Scholar]
  3. Baumgart P., Walger P., Jürgens U., Rahn K. H. Reference data for ambulatory blood pressure monitoring: what results are equivalent to the established limits of office blood pressure? Klin Wochenschr. 1990 Jul 17;68(14):723–727. doi: 10.1007/BF01647580. [DOI] [PubMed] [Google Scholar]
  4. Bialy G. B., Ruddy M. C., Malka E. S., Silvay L. A., Kamalakannan N. Comparison of office, home and 24-hour ambulatory blood pressures in borderline and mild hypertension. Angiology. 1988 Aug;39(8):752–760. doi: 10.1177/000331978803900808. [DOI] [PubMed] [Google Scholar]
  5. Birkett N. J., Evans C. E., Haynes R. B., Taylor D. W., Sackett D. L., Gilbert J. R., Johnston M. E., Hewson S. A., Macdonald L. A. Hypertension control in two Canadian communities: evidence for better treatment and overlabelling. J Hypertens. 1986 Jun;4(3):369–374. doi: 10.1097/00004872-198606000-00019. [DOI] [PubMed] [Google Scholar]
  6. Burke M. J., Towers H. M., O'Malley K., Fitzgerald D. J., O'Brien E. T. Sphygmomanometers in hospital and family practice: problems and recommendations. Br Med J (Clin Res Ed) 1982 Aug 14;285(6340):469–471. doi: 10.1136/bmj.285.6340.469. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bättig B., Steiner A., Jeck T., Vetter W. Blood pressure self-measurement in normotensive and hypertensive patients. J Hypertens Suppl. 1989 May;7(3):S59–S63. [PubMed] [Google Scholar]
  8. Carruthers S. G., Larochelle P., Haynes R. B., Petrasovits A., Schiffrin E. L. Report of the Canadian Hypertension Society Consensus Conference: 1. Introduction. CMAJ. 1993 Aug 1;149(3):289–293. [PMC free article] [PubMed] [Google Scholar]
  9. Casale P. N., Devereux R. B., Milner M., Zullo G., Harshfield G. A., Pickering T. G., Laragh J. H. Value of echocardiographic measurement of left ventricular mass in predicting cardiovascular morbid events in hypertensive men. Ann Intern Med. 1986 Aug;105(2):173–178. doi: 10.7326/0003-4819-105-2-173. [DOI] [PubMed] [Google Scholar]
  10. Collins R., Peto R., MacMahon S., Hebert P., Fiebach N. H., Eberlein K. A., Godwin J., Qizilbash N., Taylor J. O., Hennekens C. H. Blood pressure, stroke, and coronary heart disease. Part 2, Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990 Apr 7;335(8693):827–838. doi: 10.1016/0140-6736(90)90944-z. [DOI] [PubMed] [Google Scholar]
  11. Conceiçao S., Ward M. K., Kerr D. N. Defects in sphygmomanometers: an important source of error in blood pressure recording. Br Med J. 1976 Apr 10;1(6014):886–888. doi: 10.1136/bmj.1.6014.886. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Cottier C., Julius S., Gajendragadkar S. V., Schork M. A. Usefulness of home BP determination in treating borderline hypertension. JAMA. 1982 Aug 6;248(5):555–558. [PubMed] [Google Scholar]
  13. Dahlöf B., Lindholm L. H., Hansson L., Scherstén B., Ekbom T., Wester P. O. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) Lancet. 1991 Nov 23;338(8778):1281–1285. doi: 10.1016/0140-6736(91)92589-t. [DOI] [PubMed] [Google Scholar]
  14. Devereux R. B., Lutas E. M., Casale P. N., Kligfield P., Eisenberg R. R., Hammond I. W., Miller D. H., Reis G., Alderman M. H., Laragh J. H. Standardization of M-mode echocardiographic left ventricular anatomic measurements. J Am Coll Cardiol. 1984 Dec;4(6):1222–1230. doi: 10.1016/s0735-1097(84)80141-2. [DOI] [PubMed] [Google Scholar]
  15. Devereux R. B., Pickering T. G., Harshfield G. A., Kleinert H. D., Denby L., Clark L., Pregibon D., Jason M., Kleiner B., Borer J. S. Left ventricular hypertrophy in patients with hypertension: importance of blood pressure response to regularly recurring stress. Circulation. 1983 Sep;68(3):470–476. doi: 10.1161/01.cir.68.3.470. [DOI] [PubMed] [Google Scholar]
  16. Donner A., Bull S. The mean versus the minimum as a criterion for hypertension screening. J Chronic Dis. 1981;34(11):527–531. doi: 10.1016/0021-9681(81)90015-1. [DOI] [PubMed] [Google Scholar]
  17. Donner A., Young C., Bass M. Sequential screening for hypertension in primary care. J Chronic Dis. 1979;32(8):577–581. doi: 10.1016/0021-9681(79)90120-6. [DOI] [PubMed] [Google Scholar]
  18. Echt D. S., Liebson P. R., Mitchell L. B., Peters R. W., Obias-Manno D., Barker A. H., Arensberg D., Baker A., Friedman L., Greene H. L. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991 Mar 21;324(12):781–788. doi: 10.1056/NEJM199103213241201. [DOI] [PubMed] [Google Scholar]
  19. Evans C. E., Haynes R. B., Goldsmith C. H., Hewson S. A. Home blood pressure-measuring devices: a comparative study of accuracy. J Hypertens. 1989 Feb;7(2):133–142. [PubMed] [Google Scholar]
  20. Floras J. S. Will knowing the variability of ambulatory blood pressure improve clinical outcome? An additional consideration in the critical evaluation of this technology. Clin Invest Med. 1991 Jun;14(3):231–240. [PubMed] [Google Scholar]
  21. Gould B. A., Kieso H. A., Hornung R., Altman D. G., Cashman P. M., Raftery E. B. Assessment of the accuracy and role of self-recorded blood pressures in the management of hypertension. Br Med J (Clin Res Ed) 1982 Dec 11;285(6356):1691–1694. doi: 10.1136/bmj.285.6356.1691. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Graettinger W. F., Lipson J. L., Cheung D. G., Weber M. A. Validation of portable noninvasive blood pressure monitoring devices: comparisons with intra-arterial and sphygmomanometer measurements. Am Heart J. 1988 Oct;116(4):1155–1160. doi: 10.1016/0002-8703(88)90181-0. [DOI] [PubMed] [Google Scholar]
  23. Haynes R. B., Sackett D. L., Taylor D. W., Gibson E. S., Johnson A. L. Increased absenteeism from work after detection and labeling of hypertensive patients. N Engl J Med. 1978 Oct 5;299(14):741–744. doi: 10.1056/NEJM197810052991403. [DOI] [PubMed] [Google Scholar]
  24. Hill M. N. Hypertension: what can go wrong when you measure blood pressure. Am J Nurs. 1980 May;80(5):942–946. [PubMed] [Google Scholar]
  25. Ibrahim M. M., Tarazi R. C., Dustan H. P., Gifford R. W., Jr Electrocardiogram in evaluation of resistance to antihypertensive therapy. Arch Intern Med. 1977 Sep;137(9):1125–1129. [PubMed] [Google Scholar]
  26. Imai Y., Abe K., Miura Y., Nihei M., Sasaki S., Minami N., Munakata M., Taira N., Sekino H., Yamakoshi K. Hypertensive episodes and circadian fluctuations of blood pressure in patients with phaeochromocytoma: studies by long-term blood pressure monitoring based on a volume-oscillometric method. J Hypertens. 1988 Jan;6(1):9–15. [PubMed] [Google Scholar]
  27. JULIUS S., MCGINN N. F., HARBURG E., HOOBLER S. W. COMPARISON OF VARIOUS CLINICAL MEASUREMENTS OF BLOOD PRESSURE WITH THE SELF-DETERMINATION TECHNIQUE IN NORMOTENSIVE COLLEGE MALES. J Chronic Dis. 1964 May;17:391–396. doi: 10.1016/0021-9681(64)90099-2. [DOI] [PubMed] [Google Scholar]
  28. James G. D., Pickering T. G., Yee L. S., Harshfield G. A., Riva S., Laragh J. H. The reproducibility of average ambulatory, home, and clinic pressures. Hypertension. 1988 Jun;11(6 Pt 1):545–549. doi: 10.1161/01.hyp.11.6.545. [DOI] [PubMed] [Google Scholar]
  29. Julius S., Ellis C. N., Pascual A. V., Matice M., Hansson L., Hunyor S. N., Sandler L. N. Home blood pressure determination. Value in borderline ("labile") hypertension. JAMA. 1974 Aug 5;229(6):663–666. [PubMed] [Google Scholar]
  30. Julius S., Ellis C. N., Pascual A. V., Matice M., Hansson L., Hunyor S. N., Sandler L. N. Home blood pressure determination. Value in borderline ("labile") hypertension. JAMA. 1974 Aug 5;229(6):663–666. [PubMed] [Google Scholar]
  31. Julius S., Jamerson K., Mejia A., Krause L., Schork N., Jones K. The association of borderline hypertension with target organ changes and higher coronary risk. Tecumseh Blood Pressure study. JAMA. 1990 Jul 18;264(3):354–358. [PubMed] [Google Scholar]
  32. Julius S., Mejia A., Jones K., Krause L., Schork N., van de Ven C., Johnson E., Petrin J., Sekkarie M. A., Kjeldsen S. E. "White coat" versus "sustained" borderline hypertension in Tecumseh, Michigan. Hypertension. 1990 Dec;16(6):617–623. doi: 10.1161/01.hyp.16.6.617. [DOI] [PubMed] [Google Scholar]
  33. Julius S., Schork M. A. Borderline hypertension--a critical review. J Chronic Dis. 1971 Mar;23(10):723–754. doi: 10.1016/0021-9681(71)90005-1. [DOI] [PubMed] [Google Scholar]
  34. Kirkendall W. M., Burton A. C., Epstein F. H., Freis E. D. Recommendations for human blood pressure determination by sphygmomanometers. Circulation. 1967 Dec;36(6):980–988. doi: 10.1161/01.cir.36.6.980. [DOI] [PubMed] [Google Scholar]
  35. Kleinert H. D., Harshfield G. A., Pickering T. G., Devereux R. B., Sullivan P. A., Marion R. M., Mallory W. K., Laragh J. H. What is the value of home blood pressure measurement in patients with mild hypertension? Hypertension. 1984 Jul-Aug;6(4):574–578. doi: 10.1161/01.hyp.6.4.574. [DOI] [PubMed] [Google Scholar]
  36. Kleinert H. D., Harshfield G. A., Pickering T. G., Devereux R. B., Sullivan P. A., Marion R. M., Mallory W. K., Laragh J. H. What is the value of home blood pressure measurement in patients with mild hypertension? Hypertension. 1984 Jul-Aug;6(4):574–578. doi: 10.1161/01.hyp.6.4.574. [DOI] [PubMed] [Google Scholar]
  37. Krakoff L. R., Eison H., Phillips R. H., Leiman S. J., Lev S. Effect of ambulatory blood pressure monitoring on the diagnosis and cost of treatment for mild hypertension. Am Heart J. 1988 Oct;116(4):1152–1154. doi: 10.1016/0002-8703(88)90180-9. [DOI] [PubMed] [Google Scholar]
  38. Laughlin K. D., Sherrard D. J., Fisher L. Comparison of clinic and home blood pressure levels in essential hypertension and variables associated with clinic-home differences. J Chronic Dis. 1980;33(4):197–206. doi: 10.1016/0021-9681(80)90064-8. [DOI] [PubMed] [Google Scholar]
  39. Lerman C. E., Brody D. S., Hui T., Lazaro C., Smith D. G., Blum M. J. The white-coat hypertension response: prevalence and predictors. J Gen Intern Med. 1989 May-Jun;4(3):226–231. doi: 10.1007/BF02599528. [DOI] [PubMed] [Google Scholar]
  40. Levy D., Garrison R. J., Savage D. D., Kannel W. B., Castelli W. P. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990 May 31;322(22):1561–1566. doi: 10.1056/NEJM199005313222203. [DOI] [PubMed] [Google Scholar]
  41. Logan A. G. Report of the Canadian Hypertension Society's consensus conference on the management of mild hypertension. Can Med Assoc J. 1984 Nov 1;131(9):1053–1057. [PMC free article] [PubMed] [Google Scholar]
  42. Manning D. M. Avoiding sphygmomanometer-cuff "hypertension". N Engl J Med. 1982 Jan 14;306(2):108–109. doi: 10.1056/nejm198201143060216. [DOI] [PubMed] [Google Scholar]
  43. Mathieu G., Biron P., Roberge F., Picard J. M., Goulet C., Allard C. Blood pressure determinations during medical examinations: how many? Can J Public Health. 1974 Nov-Dec;65(6):447–450. [PubMed] [Google Scholar]
  44. Maxwell M. H., Waks A. U., Schroth P. C., Karam M., Dornfeld L. P. Error in blood-pressure measurement due to incorrect cuff size in obese patients. Lancet. 1982 Jul 3;2(8288):33–36. doi: 10.1016/s0140-6736(82)91163-1. [DOI] [PubMed] [Google Scholar]
  45. McKay D. W., Campbell N. R., Parab L. S., Chockalingam A., Fodor J. G. Clinical assessment of blood pressure. J Hum Hypertens. 1990 Dec;4(6):639–645. [PubMed] [Google Scholar]
  46. Mejia A. D., Egan B. M., Schork N. J., Zweifler A. J. Artefacts in measurement of blood pressure and lack of target organ involvement in the assessment of patients with treatment-resistant hypertension. Ann Intern Med. 1990 Feb 15;112(4):270–277. doi: 10.7326/0003-4819-112-4-270. [DOI] [PubMed] [Google Scholar]
  47. Mengden T., Bättig B., Vetter W. Self-monitoring of blood pressure. J Hum Hypertens. 1990 Feb;4 (Suppl 1):47–50. [PubMed] [Google Scholar]
  48. Merchant H. W., Carr A. A. Blood pressure measurement: problems and solutions. J Am Dent Assoc. 1977 Jul;95(1):98–102. doi: 10.14219/jada.archive.1977.0548. [DOI] [PubMed] [Google Scholar]
  49. Mossey J. M. Psychosocial consequences of labelling in hypertension. Clin Invest Med. 1981;4(3-4):201–207. [PubMed] [Google Scholar]
  50. Myers M. G., Carruthers S. G., Leenen F. H., Haynes R. B. Recommendations from the Canadian Hypertension Society Consensus Conference on the Pharmacologic Treatment of Hypertension. CMAJ. 1989 May 15;140(10):1141–1146. [PMC free article] [PubMed] [Google Scholar]
  51. Nielsen P. E., Badskjaer J. Assessment of blood pressure in hypertensive subjects using home readings. Dan Med Bull. 1981 Oct;28(5):197–200. [PubMed] [Google Scholar]
  52. O'Brien E. T., O'Malley K. ABC of Blood Pressure Measurement: The observer. Br Med J. 1979 Sep 29;2(6193):775–776. doi: 10.1136/bmj.2.6193.775. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Padfield P. L., Lindsay B. A., McLaren J. A., Pirie A., Rademaker M. Changing relation between home and clinic blood-pressure measurements: do home measurements predict clinic hypertension? Lancet. 1987 Aug 8;2(8554):322–324. doi: 10.1016/s0140-6736(87)90903-2. [DOI] [PubMed] [Google Scholar]
  54. Parati G., Pomidossi G., Albini F., Malaspina D., Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens. 1987 Feb;5(1):93–98. doi: 10.1097/00004872-198702000-00013. [DOI] [PubMed] [Google Scholar]
  55. Perlman L. V., Chiang B. N., Keller J., Blackburn H. Accuracy of sphygmomanometers in hospital practice. Arch Intern Med. 1970 Jun;125(6):1000–1003. [PubMed] [Google Scholar]
  56. Perloff D., Sokolow M., Cowan R. The prognostic value of ambulatory blood pressure monitoring in treated hypertensive patients. J Hypertens Suppl. 1991 Jan;9(1):S33–S40. [PubMed] [Google Scholar]
  57. Perloff D., Sokolow M., Cowan R. The prognostic value of ambulatory blood pressures. JAMA. 1983 May 27;249(20):2792–2798. [PubMed] [Google Scholar]
  58. Pessina A. C., Palatini P., Sperti G., Cordone L., Libardoni M., Mos L., Mormino P., Di Marco A., Dal Palù C. Evaluation of hypertension and related target organ damage by average day-time blood pressure. Clin Exp Hypertens A. 1985;7(2-3):267–278. doi: 10.3109/10641968509073546. [DOI] [PubMed] [Google Scholar]
  59. Pickering T. G., James G. D., Boddie C., Harshfield G. A., Blank S., Laragh J. H. How common is white coat hypertension? JAMA. 1988 Jan 8;259(2):225–228. [PubMed] [Google Scholar]
  60. Prisant L. M., Carr A. A. Ambulatory blood pressure monitoring and echocardiographic left ventricular wall thickness and mass. Am J Hypertens. 1990 Feb;3(2):81–89. doi: 10.1093/ajh/3.2.81. [DOI] [PubMed] [Google Scholar]
  61. Romhilt D. W., Bove K. E., Norris R. J., Conyers E., Conradi S., Rowlands D. T., Scott R. C. A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. Circulation. 1969 Aug;40(2):185–195. doi: 10.1161/01.cir.40.2.185. [DOI] [PubMed] [Google Scholar]
  62. Rosner B., Polk B. F. The implications of blood pressure variability for clinical and screening purposes. J Chronic Dis. 1979;32(6):451–461. doi: 10.1016/0021-9681(79)90105-x. [DOI] [PubMed] [Google Scholar]
  63. Rosner B. Screening for hypertension--some statistical observations. J Chronic Dis. 1977 Jan;30(1):7–18. doi: 10.1016/0021-9681(77)90047-9. [DOI] [PubMed] [Google Scholar]
  64. Scherwitz L. W., Evans L. A., Hennrikus D. J., Vallbona C. Procedures and discrepancies of blood pressure measurements in two community health centers. Med Care. 1982 Jul;20(7):727–738. doi: 10.1097/00005650-198207000-00008. [DOI] [PubMed] [Google Scholar]
  65. Shaw A., Deehan C., Lenihan J. M. Sphygmomanometers: errors due to blocked vents. Br Med J. 1979 Mar 24;1(6166):789–790. doi: 10.1136/bmj.1.6166.789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Shepard D. S. Reliability of blood pressure measurements: implications for designing and evaluating programs to control hypertension. J Chronic Dis. 1981;34(5):191–209. doi: 10.1016/0021-9681(81)90064-3. [DOI] [PubMed] [Google Scholar]
  67. Sokolow M., Werdegar D., Kain H. K., Hinman A. T. Relationship between level of blood pressure measured casually and by portable recorders and severity of complications in essential hypertension. Circulation. 1966 Aug;34(2):279–298. doi: 10.1161/01.cir.34.2.279. [DOI] [PubMed] [Google Scholar]
  68. Staessen J., Bulpitt C., Clement D., De Leeuw P., Fagard R., Fletcher A., Forette F., Leonetti G., Nissinen A., O'Malley K. Relation between mortality and treated blood pressure in elderly patients with hypertension: report of the European Working Party on High Blood Pressure in the Elderly. BMJ. 1989 Jun 10;298(6687):1552–1556. doi: 10.1136/bmj.298.6687.1552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Staessen J., Fagard R., Lijnen P., Thijs L., van Hoof R., Amery A. Reference values for ambulatory blood pressure: a meta-analysis. J Hypertens Suppl. 1990 Dec;8(6):S57–S64. [PubMed] [Google Scholar]
  70. Steinfeld L., Alexander H., Cohen M. L. Editorials: Updating sphygmomanometry. Am J Cardiol. 1974 Jan;33(1):107–110. doi: 10.1016/0002-9149(74)90745-0. [DOI] [PubMed] [Google Scholar]
  71. Verdecchia P., Schillaci G., Boldrini F., Guerrieri M., Gatteschi C., Benemio G., Porcellati C. Risk stratification of left ventricular hypertrophy in systemic hypertension using noninvasive ambulatory blood pressure monitoring. Am J Cardiol. 1990 Sep 1;66(5):583–590. doi: 10.1016/0002-9149(90)90485-j. [DOI] [PubMed] [Google Scholar]
  72. Webb C. H. The measurement of blood pressure and its interpretation. Prim Care. 1980 Dec;7(4):637–651. [PubMed] [Google Scholar]
  73. White W. B., Schulman P., McCabe E. J., Dey H. M. Average daily blood pressure, not office blood pressure, determines cardiac function in patients with hypertension. JAMA. 1989 Feb 10;261(6):873–877. [PubMed] [Google Scholar]
  74. Woythaler J. N., Singer S. L., Kwan O. L., Meltzer R. S., Reubner B., Bommer W., DeMaria A. Accuracy of echocardiography versus electrocardiography in detecting left ventricular hypertrophy: comparison with postmortem mass measurements. J Am Coll Cardiol. 1983 Aug;2(2):305–311. doi: 10.1016/s0735-1097(83)80167-3. [DOI] [PubMed] [Google Scholar]
  75. Zachariah P. K., Krier J. D. Clinical uses of ambulatory blood pressure monitoring. J Hypertens Suppl. 1991 Jan;9(1):S7–S12. [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES