Blood Pressure Assessment in Adults in Clinical Practice and Clinic-Based Research
Open accessAbstract
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. The National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health convened a working group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. In this report, the authors review the topics discussed during a 2-day meeting including 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.
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Out-of-office blood pressure measurements are more reproducible than office measurements.
“Out-of-office BP measurements (by patients at home or with 24-hour ambulatory blood pressure monitoring [ABPM]) are more reproducible than office measurements,”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [18]
The Introduction’s discussion of out-of-clinic measurement says home and ambulatory monitoring typically yield more readings than clinic measurement, and its discussion of diagnostic reproducibility says averaging more readings improves reproducibility for both settings (page unavailable). These points support a possible advantage, but the paper does not establish that out-of-office measurements are generally more reproducible than office measurements. (LLM, conf=0.76)
Experimental — accuracy not yet measuredAbout 10% to 15% of subjects attending clinics due to high blood pressure have masked hypertension.
“and 10%-15% have masked hypertension.”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [18]
The Introduction section on BP assessment reports masked hypertension in 15.7% of untreated people with non-hypertensive clinic readings in a New York community sample. That is close to the claimed range, but it does not establish a 10%–15% prevalence among people attending clinics because of high blood pressure; the section also reports 25.4% in another cohort. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAbout 10% to 30% of subjects attending clinics due to high blood pressure have white coat hypertension.
“About 10%-30% of subjects attending clinics due to high BP have white coat hypertension”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [18]
The Introduction section on ambulatory BP assessment reports white-coat hypertension in 19.1% of untreated community participants with elevated clinic BP and 30.2% of untreated Jackson Heart Study participants. Those figures broadly fit the claimed range, but the paper does not establish that prevalence specifically among people attending clinics because of high BP. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSubjects with white coat hypertension are at intermediate cardiovascular risk between normotensives and sustained hypertensives.
“White coat hypertension: These subjects are at intermediate cardiovascular risk between normotensives and sustained hypertensives.”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [18]
In the Introduction’s section on white coat and masked hypertension (page not provided), the paper discusses cardiovascular risk in white coat hypertension but says it is unclear whether that risk is substantially higher than in normotension. It does not establish that cardiovascular risk falls below that of sustained hypertension, so the definite intermediate-risk ranking overstates the source. (LLM, conf=0.83)
Experimental — accuracy not yet measuredOut-of-office blood pressure measurements are more closely associated with hypertension-induced organ damage and the risk of cardiovascular events than office measurements.
“more closely associated with hypertension-induced organ damage and the risk of cardiovascular events”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [18]
The Summary and conclusions states that out-of-clinic blood pressure measurements have stronger associations with cardiovascular event risk than clinic measurements. The passages found do not establish the corresponding comparison for hypertension-induced organ damage (searched: target organ damage; organ damage association). (LLM, conf=0.87)
Experimental — accuracy not yet measured
Patients with masked hypertension are at similar risk of cardiovascular events as sustained hypertensives.
“Masked hypertension: These patients are at similar risk of cardiovascular events as sustained hypertensives.”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [18]
In the Introduction’s discussion of white coat and masked hypertension, the paper reports that some studies found similar cardiovascular disease risk in people with masked and sustained hypertension. The claim presents that similarity without the paper’s “some studies” qualification. (LLM, conf=0.84)
Experimental — accuracy not yet measuredUnattended office blood pressure measurements provide a more standardized evaluation but also lower blood pressure levels than usual office measurements, with an uncertain threshold for hypertension diagnosis.
“Unattended office blood pressure: Multiple automated BP measurements taken while the patient remains alone in the office provide a more standardized evaluation but also lower BP levels than usual office measurements with uncertain threshold for hypertension diagnosis. 17,18,23,24”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [18]
The Introduction’s clinic-measurement section says unattended automated office measurements help prevent protocol violations and reports lower readings than provider-measured clinic BP in a pooled analysis. It also cautions that attended and unattended measurements may not differ when the same device and a rigorous protocol are used. Our copy does not establish that the hypertension diagnostic threshold for unattended office measurement is uncertain; its statement about undetermined thresholds concerns public kiosks, not unattended office measurement. Page numbers were not available in the indexed passages. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe use of office and out-of-office blood pressure measurements identifies individuals with white coat hypertension and those with masked hypertension.
“The use of office and out-of-office (home or ambulatory) BP measurements identifies individuals with white coat hypertension, who have elevated BP only in the office (nonelevated ambulatory or home BP), and those with masked hypertension, who have nonelevated BP in the office but elevated BP out of the office (ambulatory or home). 1,2,17-21,25-27”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [18]
Experimental — accuracy not yet measuredOut-of-office blood pressure measurements identify the white coat and masked hypertension phenomena.
“and identify the white coat and masked hypertension phenomena (see below).”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [18]
Appropriately validated automated BPMDs remain the recommended standard for clinical diagnosis and management of hypertension.
“Automated BPMDs that have passed accuracy testing versus a reference auscultatory sphygmomanometer using a scientifically accepted validation protocol are recommended for clinical use globally.”
From Automated 'oscillometric' blood pressure measuring devices: how they work and what they measure (2022) · cites this paper as [17]
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Can ‘FDA-cleared’ blood pressure devices be trusted? A call to action
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Self-citationAssessing Blood Pressure Accuracy of an Aneroid Sphygmomanometer in a National Survey Environment
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Self-citationIs white-coat hypertension associated with increased cardiovascular and mortality risk?
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Automated measurement of office, home and ambulatory blood pressure in atrial fibrillation
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Self-citationAmbulatory Tonometric Blood Pressure Measurements in Patients with Diabetes
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Improving the Measurement of Blood Pressure: Is It Time for Regulated Standards?
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Mean mid-arm circumference and blood pressure cuff sizes for US adults
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Self-citationBlood pressure measurement in the geriatric population
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Evaluation of blood pressure measuring devices with special reference to ambulatory systems.
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Self-citationDaniels, S. R., Cappuccio, F. P., Lisheng, L., Kaczorowski, J. A., Jula, A., Atrey, A., Touyz, R. M., Correa‐Rotter, R., Weber, M. A., Webster, J. L., et al. (2017) · Journal of Human Hypertension · doi:10.1038/jhh.2017.10 · Cited by 20 · see citing works
Self-citationOrthostatic Hypotension and Symptoms in the AASK Trial
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Self-citationDo subclinical vascular abnormalities precede impaired physical ability and ADL disability?
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Screening Rules for Determining Blood Pressure Status in Clinical Trials
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Self-citationAre kiosk blood pressure readings trustworthy?
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Self-citationEvidence on Blood Pressure Measurement Methodology and Clinical Implementation
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Self-citationAutomated noninvasive blood pressure monitors
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Alpert, B. S. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001392 · Cited by 2 · see citing works
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2020 International Society of Hypertension Global Hypertension Practice Guidelines
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., et al. (2020) · Hypertension · doi:10.1161/hypertensionaha.120.15026 · Cited by 4,132 · see citing works
Self-citation2020 International Society of Hypertension global hypertension practice guidelines
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Self-citationStergiou, G. S., Palatini, P., Parati, G., O’Brien, E., Januszewicz, A., Lurbe, E., Persu, A., Mancia, G., Kreutz, R., & on behalf of the European Society of Hypertension Council and the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002843 · Cited by 859 · see citing works
Self-citationBlood pressure and its variability: classic and novel measurement techniques
Schutte, A. E., Kollias, A., & Stergiou, G. S. (2022) · Nature Reviews Cardiology · doi:10.1038/s41569-022-00690-0 · Cited by 335 · see citing works
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Self-citationInternational Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action
Cheung, A. K., Whelton, P. K., Muntner, P., Schutte, A. E., Moran, A. E., Williams, B., Sarafidis, P., Chang, T. I., Daskalopoulou, S. S., Flack, J. M., et al. (2023) · The American Journal of Medicine · doi:10.1016/j.amjmed.2022.12.015 · Cited by 96 · see citing works
Self-citationAutomated 'oscillometric' blood pressure measuring devices: how they work and what they measure
Sharman, J. E., Tan, I., Stergiou, G. S., Lombardi, C., Saladini, F., Butlin, M., Padwal, R., Asayama, K., Avolio, A., Brady, T. M., et al. (2022) · Journal of Human Hypertension · doi:10.1038/s41371-022-00693-x · Cited by 84 · see citing works
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Self-citationStergiou, G. S., Bountzona, I., Alamara, C., Vazeou, A., Kollias, A., & Ntineri, A. (2021) · Hypertension · doi:10.1161/hypertensionaha.120.16531 · Cited by 31 · see citing works
Self-citationPhenotypes of masked hypertension: Isolated ambulatory, isolated home and dual masked hypertension
Stergiou, G. S., Kyriakoulis, K. G., McManus, R. J., Andreadis, E. A., Jula, A., Kollias, A., Lindroos, A., Ntineri, A., Schwartz, C., & Niiranen, T. J. (2020) · Journal of Hypertension · doi:10.1097/hjh.0000000000002270 · Cited by 24 · see citing works
Self-citationEdward, A., Kagaruki, G. B., Manase, F., Appel, L. J., & Matsushita, K. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08064-5 · Cited by 6 · see citing works
Self-citationMeasurements of arterial pressure and flow in vivo
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- Authors
- Muntner, P., Einhorn, P. T., Cushman, W. C., Whelton, P. K., Bello, N. A., Drawz, P. E., Green, B. B., Jones, D. W., Juraschek, S. P., Margolis, K. L., Miller, E. R., Navar, A. M., Ostchega, Y., Rakotz, M. K., Rosner, B., Schwartz, J. E., Shimbo, D., Stergiou, G. S., Townsend, R. R., Williamson, J. D., Wright, J. T., & Appel, L. J.
- Affiliations
- University of Alabama at Birmingham (US)
- National Institutes of Health (US)
- Memphis VA Medical Center (US)
- Tulane University (US)
- Columbia University Irving Medical Center (US)
- University of Minnesota (US)
- Kaiser Permanente Washington Health Research Institute (US)
- University of Mississippi Medical Center (US)
- Beth Israel Deaconess Medical Center (US)
- HealthPartners (US)
- Johns Hopkins University (US)
- Centers for Disease Control and Prevention (US)
- American Medical Association (US)
- Brigham and Women's Hospital (US)
- Stony Brook University (US)
- National and Kapodistrian University of Athens (GR)
- University of Pennsylvania (US)
- Wake Forest University Health Sciences (US)
- Case Western Reserve University (US)
- Corresponding author
- Muntner, Paul
- ORCID
- Muntner, Paul
- Cushman, William C.
- Whelton, Paul K.
- Bello, Natalie A.
- Drawz, Paul E.
- Green, Beverly B.
- Jones, Daniel W.
- Juraschek, Stephen P.
- Margolis, Karen L.
- Miller, Edgar R.
- Ostchega, Yechiam
- Rakotz, Michael K.
- Rosner, Bernard
- Schwartz, Joseph E.
- Shimbo, Daichi
- Stergiou, George S.
- Townsend, Raymond R.
- Williamson, Jeff D.
- Wright, Jackson T.
- Appel, Lawrence J.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2019-01
- Volume
- 73
- Issue
- 3
- Pages
- 317-335
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC6573014
- OpenAlex
- W2910952524
- Cited by
- 199
- References
- 137
- Citations by year
- 2026: 27 · 2025: 21 · 2024: 34 · 2023: 29 · 2022: 25 · 2021: 25 · 2020: 27 · 2019: 11
- FWCI
- 15.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- BP
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- blood pressure measurement, hypertension diagnosis, clinical practice, oscillometric blood pressure devices, mercury sphygmomanometer, measurement error, quality improvement, research needs
- MeSH terms
- Adult, Blood Pressure Determination, Delivery of Health Care, Humans, Hypertension, Biomedical Research
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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