Office Blood Pressure Readings May Have Too Much Variability to Be Useful on Their Own (2025)

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April 27, 2023

Patient Perspective: I Dread Office BP Readings

Elsa Weber | Patient

There are many reasons that office blood pressures (BPs) are so unreliable.

Here is my BP experience in the doctor's office:

The back office person comes and gets you and walks you back to a station set up in the hallway. First you are weighed fully clothed, then he/she sits you in chair and proceeds to take your BP. They put the cuff on over your clothes and then raise your arm to a wire basket that holds the monitor and tell you to hold the basket. They turn the machine on, and while it

CONFLICT OF INTEREST: None Reported

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April 29, 2023

Office Measurement of Blood Pressure

Tim Burge, MB;Chb, MSc, FRCS (Plast) | Burns Unit, Salisbury District Hospital, Salisbury, UK

In 1983 I was a 24 year old doctor in the British Army. My first job was as a single handed Regimental Medical Officer with an infantry battalion in Hong Kong. As well as the soldiers, I was responsible for their accompanying families. This was a total practice of about 2,500 patients, almost all of whom were young and who would generally be deemed fit and well.

Despite the demographics, high blood pressure readings were occasionally identified.

I was reluctant to treat these, so when they occurred I invited the patients to attend

CONFLICT OF INTEREST: None Reported

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April 28, 2023

Office BP Monitoring

Charles Hubbert, MD | Private Practice

It may be that the public should be educated through social media about hypertension and thus obtain BP monitoring outside the doctor's office, because the majority of BP determinations in a physician's office are not correct. Too much false-positive hypertension is being generated from office visits. I doubt that there is much hope to change this presently, since a visit that has been designated to last 5 minutes will hardly accommodate proper BP monitoring. I hadn't fully realized until recently, with the surge in emphasis on proper measurement, that years ago my wife was diagnosed with hypertension based on one faulty office BP taking; thankfully she questioned the diagnosis and stopped her prescribed medication after getting proper measurements elsewhere. Most of the time office assistants have had no training in proper BP measurement, but maybe artificial intelligence will solve this problem for the future? I am eternally grateful for my basic medical education in learning how to take BPs properly. And a proper BP-taking event can be a psychotherapeutic encounter, as long as there is only "laying on of hands" and not too much talking (possibly billable as such?)

CONFLICT OF INTEREST: None Reported

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April 30, 2023

Ignores Reality

Stephen Kirk, MD | Private Practice

Publications in JAMA routinely criticize physicians for not following a standard protocol in measuring blood pressure, but ignore the very same in patients measuring their own blood pressures.

Few patients (none) in my experience know the recommendations for measuring blood pressure.

Furthermore, the digital cuffs used at home are never calibrated over time. Patients often use wrist blood pressure monitors, which are not recommended by any literature I know of.

I measure every blood pressure myself, never over a sleeve, more than once, and often get lower than what patients measure at home.

JAMA is

CONFLICT OF INTEREST: None Reported

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May 1, 2023

Pediatric Hypertension

Peppino Peppino, MD, Adj Prof of Ped Card | Post Graduate Medical School of Cardiology Univeristy of Palermo Italy

In response to increased global prevalence and underdiagnosis of hypertension in children, the simplified 2017 AAP pediatric hypertension guidelines aimed to improve diagnosis and management of the condition (1). I would like to stress, apart from Dr. Messerli's observation in this article that “lousy blood pressure measurements are just not very useful” (2), the importance of choice of appropriate cuff size, because inappropriate size is the most common cause of hypertension in children (3).The take-home message is to confirm the importance of blood pressure measurement with the proper bladder width-to-length ratio 1:2 calculated for very young people's arms (4).

References

1. Flynn JT, Kaelber DC, Baker-Smith CM, et al; Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904. doi:10.1542/peds.2017-1904

2. Rubin R. More Evidence That Hypertension Treatment Decisions Shouldn’t Depend Solely on In-Office Blood Pressure Readings. JAMA. Published online April 26, 2023. doi:10.1001/jama.2023.5538

3. Pier Paolo Bassareo, Giuseppe Calcaterra, Jolanda Sabatino, et al., on behalf of the Working group on congenital heart disease, cardiovascular prevention in paediatric age of the Italian Society of Cardiology (SIC). Primary and secondary paediatric hypertension. J Cardiovasc Med 2023, April 24 (suppl 1):e77–e85

4. Falkner B, Chair; Gidding SS, Vice Chair;Baker-Smith MC, et al., on behalf of the American Heart Association Council on Hypertension; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Kidney in CardiovascularDisease; Council on Lifestyle and Cardiometabolic Health; and Council on Cardiovascular and Stroke Nursing. Hypertension. 2023; 80:00–00. DOI: 10.1161/HYP.0000000000000228

CONFLICT OF INTEREST: None Reported

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May 4, 2023

They Do Multiple BP Readings in the Office? Really?

Brett Gaspers | Patient

CONFLICT OF INTEREST: None Reported

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