Measuring and managing blood pressure in a primary care setting: a pragmatic implementation study
Open accessAbstract
BACKGROUND: Accurate blood pressure (BP) measurement is essential to hypertension diagnosis and management. Automated office blood pressure (AOBP) and home blood pressure measurement (HBPM) may improve assessment, but barriers exist in primary care settings. METHODS: We implemented an AOBP/HBPM program in a primary care clinic in 2015 to 2016. Patients with elevated BP determined by guideline-quality observed BP measurement and/or AOBP entered the HBPM program. Patients with average home BP ≥ 135/85 mm Hg provided HBPM results for medication adjustment. Clinic staff and patients completed satisfaction questionnaires. RESULTS: Initial HBPM results in 183 patients with elevated office BP revealed white-coat BP elevation in 35% of untreated patients and in 37% of treated patients. The prevalence of white-coat BP elevation was similar whether enrollment BP was by observed BP or AOBP. Subsequent HBPM facilitated BP control in 49% of patients with elevated home BP. Most providers, staff, and patients endorsed the utility of the program. Barriers to implementation included a temporary period of incorrect AOBP technique, patients failing to provide HBPM results, and incorrect HBPM technique. DISCUSSION: Our clinic-based AOBP/HBPM program detected white-coat BP elevation in one third of enrolled patients, facilitated control of home BP, and was acceptable to staff and patients. We identified barriers to be addressed to ensure sustainability.
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Studies have shown that addressing the barriers to standardized blood pressure measurement can dramatically improve the quality of clinic blood pressure measurements.
“However, studies have also shown that addressing these barriers can dramatically improve the quality of clinic BP measurements.32–36”
From International Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action (2023) · cites this paper as [33]
The Office BP Measurement section describes staff training, monitoring, and reinforcement of guideline-quality clinic measurements. The Conclusion reports early difficulties with correct AOBP use, but does not show that addressing those barriers dramatically improved measurement quality. The study supports the use of standardized techniques, not the claimed magnitude of improvement. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe time required to perform standardized blood pressure measurement is minimal when the clinic workflow is streamlined with an automated blood pressure monitor.
“The amount of time required to perform standardized BP measurement is minimal if the clinic workflow is streamlined with an automated BP monitor.33”
From International Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action (2023) · cites this paper as [33]
Experimental — accuracy not yet measured
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- Authors
- Doane, J., Buu, J., Penrod, M. J., Bischoff, M., Conroy, M. B., & Stults, B.
- Affiliations
- University of Utah (US)
- ORCID
- Conroy, Molly B.
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2018-05
- Volume
- 31
- Issue
- 3
- Pages
- 375-388
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W2802449710
- Cited by
- 23
- References
- 66
- Citations by year
- 2025: 5 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 1 · 2019: 3 · 2018: 2
- FWCI
- 1.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services
- Centers for Disease Control and Prevention
- National Center for Chronic Disease Prevention and Health Promotion (U58 DP004835)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- blood pressure measurement, hypertension, automated office blood pressure, home blood pressure monitoring, white coat hypertension, antihypertensive therapy, primary care, implementation barriers, patient satisfaction, blood pressure control
- MeSH terms
- Implementation Science, Aged, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Female, Humans, Hypertension, Male, Middle Aged, Patient Compliance, Patient Participation, Primary Health Care, Prospective Studies, Surveys and Questionnaires, Utah, Reproducibility of Results, Patient Satisfaction
About these checks
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.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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