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.