Dr Frederic Bartter

Frederic Bartter

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."

Bartter's patient diagnosed as normotensive in the morning and hypertensive in the evening.

21. Bartter FC. Periodicity and medicine. In: Scheving LE, Halberg F, Pauly JE (Eds.) 

Chronobiology. Tokyo: Igaku Shoin Ltd.; 1974. p. 6-13.