The blood pressure cuff in the care provider's (physician or nurse) office is no substitute for, and
no check of, chronobiologically analyzed serial measurements. The cuff has a place only in the
homes of each individual. In the 1960s and 1970s it was worthwhile to plead, as Frederic C.
Bartter, of Bartter's syndrome, also did, for moving the BP cuff from the providers' offices to
everybody's (including his own) workplace by day and taking it home by night. This
recommendation holds only until a system of C-ABPM becomes affordably available to
everybody, as it is now via BIOCOS. As head of the Hypertension-Endocrine Branch at the U.S.
National Institutes of Health (NIH), and later as head of the NIH's Clinical Center, Bartter
advocated the need for serial measurements before a physical examination since he, like his
predecessors, recognized the unreliability of the best single measurement in individuals who
need multiple measurements because of variable blood pressure.
And in 1974 Bartter (21) suggested, writing about a patient whose BP was diagnosed differently
by two physicians who saw him at different times of day: "By conventional standards, this
patient is clearly normotensive every morning. Yet the blood pressure determined each day at 6
in the afternoon provides especially convincing evidence that this patient is a hypertensive. ....
My plea today is that information contained in such curves [cosinor fits] becomes a routine
minimal amount of information accepted for the description of a patient's blood pressure. The
analysis of this information by cosinor should become a routine. It is essential that enough
information be collected to allow objective characterization of a periodic phenomenon, to wit, an
estimate of M [the time structure or chronome-adjusted mean, or MESOR], an estimate of [the
amplitude] A itself, and finally an estimate of acrophase, [a measure of timing]. In this way, a
patient can be compared with himself at another time, or under another treatment, and the patient
can be compared with a normal or with another patient."
21. Bartter FC. Periodicity and medicine. In: Scheving LE, Halberg F, Pauly JE (Eds.)
Chronobiology. Tokyo: Igaku Shoin Ltd.; 1974. p. 6-13.