Blood pressure monitoring technique impacts hypertension treatment

J Gen Intern Med. 2012 Jun;27(6):623-9. doi: 10.1007/s11606-011-1937-9. Epub 2011 Dec 8.


Background: In 2005 the American Heart Association (AHA) released updated recommendations for blood pressure (BP) monitoring in order to ensure accurate BP measurements.

Objective: To determine if current methods of BP assessment in an ambulatory clinic result in significantly different BP measurements than those obtained by following the AHA recommendations and if these BP differences impact treatment decisions.

Research design: Randomized prospective analysis.

Setting: University of New Mexico Hospital Adult Internal Medicine clinic.

Patients: Forty adults with hypertension

Methods: Patient BPs were measured using both the traditional triage method and the AHA-recommended method in cross-over fashion in random order. Two complete medical profile summaries were then constructed for each patient: one for each BP measurement obtained by each technique. These profiles were then reviewed by a panel of providers who provided hypothetical hypertension treatment recommendations.

Results: Individual BP results varied greatly between the two methods. SBP readings differed by ≥5 mmHg in either direction for 68% of patients while 78% of patient's DBP readings differed by ≥2 mmHg in either direction. Overall, 93% of patients had a BP difference of either ≥5 mmHg systolic or ≥2 mmHg diastolic. Five patients were determined to be at goal with the triage method, but were higher than their goal BP with the AHA method Significant differences were also seen in treatment recommendations for a given patient based on the differences seen between the two obtained BP readings. The number of patients with treatment variations between their two profiles ranged from 13% to 23% depending on the reviewing provider (p < 0.01 for all providers).

Conclusion: Inaccurate BP assessment is common and may impact hypertension treatment decisions.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Ambulatory Care Facilities
  • Antihypertensive Agents / administration & dosage*
  • Antihypertensive Agents / therapeutic use
  • Blood Pressure / physiology
  • Blood Pressure Determination / methods*
  • Blood Pressure Determination / standards
  • Cross-Over Studies
  • Decision Making
  • Drug Administration Schedule
  • Female
  • Guideline Adherence
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / drug therapy
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Practice Guidelines as Topic
  • Reproducibility of Results
  • Triage / methods


  • Antihypertensive Agents