Letters to the Editor


Am Fam Physician. 2003 Mar 15;69(6):1187.

Hypertension Should Be Confirmed Before Treatment

to the editor: I would like to thank Dr. Niedfeldt and American Family Physician for the fine article, “Managing Hypertension in Athletes and Physically Active Patients.”1 However, I would like to add a point to this statement: “If (hypertension) is diagnosed, appropriate treatment should be started to reduce the risk of morbidity and mortality associated with cardiovascular disease.”1 I believe that it is important to be sure that the patient does indeed have hypertension. Some athletes have extra large or extra small upper arms and have been screened with an inappropriately sized cuff when taking their blood pressure.2 Other athletes exhibit “white coat” hypertension.3 Therefore, when diagnosing hypertension, physicians should use appropriately sized cuffs for those “extra” sized athletes. I have found that the use of ambulatory pressure monitors has saved many athletes with white coat hypertension from taking unnecessary medication.


1. Niedfeldt MW. Managing hypertension in athletes and physically active patients. Am Fam Physician. 2002;66:445–52.

2. Zitelli BJ, Davis HW (eds). Atlas of pediatric physical diagnosis. 3d ed. St. Louis: Mosby-Wolfe, 1997.

3. Noble J, Greene HL. Textbook of primary care medicine. 2d ed. St. Louis: Mosby, 1996.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



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