Obtaining Accurate In-Office Blood Pressure Readings

Nearly half of adults currently living in the United States have hypertension.[1] Untreated, long-standing hypertension can lead to significant detrimental health effects such as chronic kidney disease, atherosclerosis, heart failure, stroke, retinopathy, and more.[2,3] The American College of Cardiology/American Heart Association 2017 Hypertension guidelines recommend a blood pressure of 140/90 as the cutoff for initiation of hypertension treatment.[4] The ability to consistently obtain accurate BP measurements has significant implications for the categorization, risk stratification, and treatment of hypertension at both a societal and individual level. The gold standard for measuring a patient’s true, intraluminal blood pressure is an intra-arterial device. However, this is not practical for an outpatient clinical setting given the invasive nature, practical considerations, and associated risks. Therefore, there are a number of less invasive techniques that have been developed to estimate a BP measurement. The use of non-invasive techniques is associated with many potential pitfalls that could make BP estimates exceedingly inaccurate, such as the clinical technique, patient setting, or device itself. In this brief review, we describe common sources of error and proper technique for taking non-invasive blood pressure readings, the different types of devices used to estimate BP, and the most recent recommendations highlighting the utility of automated office BP (AOBP) readings.