Office Blood Pressure Measurement
The Weak Cornerstone of Hypertension Diagnosis
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See related article, pp 848–857
For almost a century, office blood pressure (OBP) measurement has been regarded as the cornerstone for diagnosis and management of hypertension because the vast majority of the evidence on the risks associated with elevated BP and the benefits of treatment-induced BP lowering has been based on OBP measurements. However, it is now acknowledged that there are several sources of error with OBP measurement, not least being the recent recognition that the term has been used loosely to denote measurement by several different methods. In addition, OBP is confounded by the white coat and the masked hypertension phenomena, inaccurate devices, and observer-related factors, such as imperfect methodology, observer error and bias, and failure to standardize the circumstances of measurement. Because of these many shortcomings, the 2017 US guidelines now recommend OBP measurement solely as a screening method for the diagnosis of hypertension and out-of-office BP measurement (ambulatory or home) as diagnostic method.1
OBP in the SPRINT
The SPRINT (Systolic Blood Pressure Intervention Trial)2 is a landmark outcome trial which considerably influenced the 2017 US guidelines for hypertension.1 In this issue of the journal, new data examining the impact of differences in OBP measurement methodology on the SPRINT study findings are presented.3 The investigators reported that they have used both unattended and attended OBP measurements using automated devices, and there were no differences between the 2 methods in average follow-up OBP levels and in cardiovascular disease risk reduction in the intensively treated group.3
This article is very important but also problematic.3 It is important because it attempts to clarify the true …