Blood Pressure assessment in adults: Clinic, home & ambulato
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The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers.

In this report, published in the Journal of the American College of Cardiology, the authors have reviewed the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities.

Over the past 2 decades, there have been several developments in the approach to BP measurement that have provided opportunities, yet presented new challenges, for clinical practice and research. BP measurements obtained in routine clinical practice are increasingly being used for research and quality improvement activities. Despite repeated guideline recommendations and educational efforts, it appears that the quality of BP measured routinely in clinical practice remains poor.

Current limitations with clinic BP measurement include lack of standardization, infrequent technician/clinician training and retraining, use of devices that have not been validated and/or regularly calibrated, not using an appropriately sized cuff, improper conditions and technique, and inadequate documentation of the procedure. Also, despite guideline recommendations, the averaging of BP within and across visits is rarely done. There is substantial evidence demonstrating that out-of-clinic BP measurements, using ABPM and HBPM, have stronger associations with risk for CVD events than clinic BP measurements (129).

It is important to recognize that despite strong observational data, ABPM and HBPM have not been used to determine eligibility for or to guide antihypertensive treatment in large randomized controlled trials. Additionally, there has been rapid innovation with a burgeoning array of novel BP measurement devices being developed for out-of-clinic BP measurement, including some that measure BP without cuffs. However, few formal validation studies of the accuracy of these devices have been performed, and at present, these devices cannot be recommended.

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