Time to Abandon Clinic Blood Pressure for the Diagnosis of Hypertension?
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Article, see p 1794
When the Russian military surgeon Korotkoff was listening to the rhythmic beat of blood pressure (BP) and the Italian doctor Riva-Rocci was developing his sphygmomanometer,1 I doubt both would have believed that more than a century later, the screening and stratification for hypertension treatment would still be dependent on clinic-based measurement of seated BP. These methods have served us well and have stood the test of time, but is it time to move on?
Because of the enormous public health impact of hypertension and the proven treatment benefits, the detection and treatment of hypertension has rightly assumed great importance, at least in terms of policy, if not always in terms of implementation. BP is highly variable by design to meet varying metabolic, physical, and postural demands for tissue perfusion. As a consequence, it makes sense to standardize the conditions in which BP is measured in the clinical setting, thereby replicating the conditions used to measure BP in the clinical trials that have generated the evidence base for treatment. Hence, international guidelines have endorsed a standard approach for clinic BP (CBP) measurement, which involves the patient being seated and relaxed for 5 minutes before BP is recorded in the nondominant arm with an appropriately sized cuff and a validated device, with readings taken 3 times, at least 1 minute apart, with the average of the last 2 readings defining CBP. In reality, CBP is rarely measured with this rigor in routine clinical practice. As a consequence, CBP readings are often higher than they would be if standard measurement conditions had been applied.2 This finding has led to the development of automated CBP measurement devices, programmed to record a series of seated BP measurements, unattended by a clinical practitioner, to improve measurement standardization.3
The wider …