Blood pressure rising: differences between current clinical and recommended measurement techniques

Strict observation to recommended blood pressure (BP) measurement technique is often not followed in outpatient clinics. The goal of this study was to determine if there was a significant difference in readings obtained using typical clinic procedures versus when following recommended guidelines. One hundred and fifty patients with initial BP readings obtained through usual care above normal per the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (systolic ≥120 mm Hg and/or diastolic ≥80 mm Hg) were included in this prospective cohort study. After obtaining informed consent, BP was reassessed following the American Heart Association guidelines and compared with readings obtained through usual care. BP readings obtained using the recommended technique were significantly lower than usual care (−12.4 mm Hg systolic and −6.0 mm Hg diastolic; P < .0001, respectively). Similar differences existed for those with a preexisting diagnosis of hypertension, those without a preexisting diagnosis, nonelderly (ie, <65 years), and elderly (≥65 years). In patients with a preexisting diagnosis of hypertension (n = 92/150), patients were twice as likely to be considered at goal when following recommended technique (26% vs. 54%; P = .0002). Significant differences exist when BP readings are obtained using recommended technique. Failure to follow guidelines for measurement may have significant clinical implications on treatment decisions.