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Abstract  According to the European Hypertension Guidelines regarding office blood pressure measurements (OBPMs), the mean between second/third or third/fourth OBPM should be taken if the first two readings differ by ≤10 or &gt;10 mmHg, respectively. Our aim was to explore the value of the fourth OBPM and determine whether a simplified OBPM procedure is feasible without loss of quality. In this cross‐sectional study, four standard OBPMs were taken. The mean of the second/third OBPM (S2S3/D2D3) and third/fourth OBPM (S3S4/D3D4) for systolic/diastolic values was calculated. Correlation, agreement, and differences regarding BP classification were explored for the entire cohort and subsets with a difference between the first/second OBPM (S1S2/D1D2) ≤10 and &gt;10 mmHg. Overall ( n  = 802) and for the subsets with an S1S2 ( n  = 596) and D1D2 ( n  = 742) difference ≤10 mmHg, S3S4/D3D4 was in median 0.5 mmHg lower than S2S3/D2D3, respectively ( p  &lt; .0005 for all). In participants with an S1S2 ( n  = 206) and D1D2 ( n  = 60) difference &gt;10 mmHg, S3S4/D3D4 differed numerically from S2S3/D2D3, respectively ( p  &gt; .1 for all). Overall and for all subsets with an S1S2/D1D2 difference ≤10/&gt;10 mmHg, less subjects were numerically classified as hypertensive with S3S4/D3D4 than with S2S3/D2D3 ( p  &gt; .04), but BP reclassification occurred in both directions in 1.0%‐10.0%, depending on the cohort. In conclusion, the third/fourth OBPM results in lower BP values than the second/third measurement, regardless of the difference between first/second OBPM, whereby BP reclassifications occurred in both directions. Therefore, the cutoff of &gt;10 versus ≤10mmHg difference between first/second OBPM to implement a fourth BPM harbors the risk of distorted results. We therefore recommend using the second/third BPM for standardized OBPM.  Trial registration: Registered on clinicaltrials.gov (NCT02552030).

How should we measure blood pressure? Implications of the fourth blood pressure measurement in office blood pressure