Clinical methods and pathophysiology 1 Can the pressor response accompanying blood pressure measurement be limited in young, normotensive women? Marek Czarkowski a , Krzysztof Zaja ˛c a and Krzysztof Ro ´z ˙anowski b Background A decrease in blood pressure (BP) values observed over consecutive measurements may lead to significant discrepancies, affecting individual diagnostic and therapeutic decision making. The goal of the study was to assess whether it was possible to limit or eliminate the tendency for BP values to decline in successive measurements. Methods In a group of 148 normotensive women aged 21.6 ± 1.5 years, two series (S1, S2) consisting of three brachial BP measurements each (I, II, and III) were performed, using an Omron 907 oscillometric manometer. Results Systolic blood pressure (SBP) (mmHg) was higher in measurement I than in II and III, in both S1 and S2: S1-I: 114.9 ± 10.5 vs. S1-II: 112.6 ± 9.9, P < 0.00003, vs. S1-III: 111.0 ± 9.6, P < 0.000001; S2-I: 111.5 ± 9.8 vs. S2-II: 110.1 ± 9.1 P < 0.007, vs. S2-III: 110.1 ± 9.2, P < 0.0008. Furthermore, measurement II was higher than III in S1 (P < 0.002). Similarly, diastolic blood pressure (mmHg) was higher in measurement I than in II and III, in both S1 and S2: S1-I: 68.3 ± 8.4 vs. S1-II: 67.3 ± 8.7, P < 0.008, vs. S1-III: 65.7 ± 8.7, P < 0.000001; S2-I: 66.6 ± 8.3 vs. S2-II: 65.8 ± 8.2, P < 0.04, vs. S2-III: 65.7 ± 8.7, P < 0.02. Measurement II was again higher than III in S1 (P < 0.00003). Conclusions The common alerting reaction to BP measurements cannot be avoided in young, normotensive women, but it can be limited, as demonstrated by the results of BP measurements in S2. The simple procedure of automatic cuff inflation and noninvasive, oscillometric BP measurement may carry an independent pressor effect, which corrupts the accuracy of BP measurements. Blood Press Monit 13:1–5  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins. Blood Pressure Monitoring 2008, 13:1–5 Keywords: blood pressure measurement, Omron HEM 907, oscillometric measurement, repeated measurements, white coat effect a Department of Internal Medicine and Endocrinology, Medical University of Warsaw and b Department of Physiology, Military Institute of Aerospace Medicine, Warsaw, Poland Correspondence to Dr Marek Czarkowski, Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Banacha 1A, Warszawa, 02-097, Poland Tel: + 48 22 5992970; fax: + 48 22 5992975; e-mail: marek.czarkowski@am.edu.pl; mczark@gmail.com Received 27 March 2007 Revised 11 May 2007 Accepted 11 June 2007 Introduction The fact that blood pressure (BP) values decline over successive measurements has been well documented over the past years [1–4]. This phenomenon may be the cause of significant discrepancies in the diagnosis of hyperten- sion, with respect to both epidemiological studies estimating the prevalence of hypertension and the individual diagnostic and therapeutic decision-making process [1–5]. It is commonly accepted that the first BP measurement yields higher values than the second one [1,6]. Additional measurements are indicated if the first two values differ by more than 5 mmHg, and further decisions should be based on the mean value of all measurements [6]. The variability of BP over successive measurements is attributed to the stress related to BP measurement, with the first measurement thought to induce the strongest pressor response, whereas the response to each successive measurement diminishes, owing to progressive adaptation to the diagnostic procedure [1,2]. Several studies have attempted to identify the mechanisms responsible for the alerting reaction confounding BP measurements [7,8]. It remains to be established whether preventive measures can successfully attenuate the nervous reaction, which adversely affects the repeatability of successive BP measurements. The goal of the study was to assess whether it was possible to limit or eliminate the tendency for BP values to decline in successive measurements. The study was performed on a group of young, normotensive women, and consisted of two series of BP measurements, the second performed after a brief interval. Methods The study group consisted of 150 young, healthy women, recruited from the female students of the Medical University of Warsaw and two graduate education centers. Values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) fell in the respective ranges: SBP: 84–141 mmHg; DBP: 45–95 mmHg. Two participants presented with mean values of the three BP measurements in the first series above the cut-off values established in the study inclusion criteria (SBP < 140 mmHg; DBP 1359-5237  c 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins