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Second blood pressure reading drops 8 mm Hg from initial high reading
Clinical Question
In patients with high blood pressure, does a second reading show lower results?
Bottom line
If you're not rechecking high blood pressures, you should. In fact, set your electronic health record to remind you to do it. In this large study, when reminded, clinicians rechecked elevated blood pressures 83% of the time, finding a median drop in blood pressure of 8 mm Hg during the same visit. That drop is equivalent to a typical reduction in blood pressure with pharmacologic treatment over time, and resulted in one-third fewer patients being labeled with high blood pressure at that visit. 2b
Reference
Study design: Cohort (prospective)
Funding: Government
Setting: Outpatient (primary care)
Synopsis
This study was conducted in primary care offices of a large US health system. The electronic health record was set to remind clinicians to recheck the blood pressure of a patient when a value greater than 140/90 mm Hg was documented. The reminder worked: Clinicians rechecked high blood pressures 83% of the time. The authors then evaluated the effect of this simple intervention on 38,260 patients, average age 61 years, 39% of whom had a high initial reading. With repeated measurement, the median drop in blood pressure was 8 mm Hg (interquartile range 2 mm Hg - 17 mm Hg) and 36% of patients no longer had a blood pressure of 140/90 mm Hg or higher.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Still have a problem of labeled blood pressure and when there is benefit to treat
what isan overpaid gp supposed to do now that this model of measuring non existing disease is removed. No more dollars to her for renewing pill prescriptions. She will starve.
Nice to be reassured and having backed up by scientific studies
repeat blood pressures are always lower due to vascular changes from the compression. I do not see where this is accounted for or any control groups. Also home bps are considered more reliable now
not specified what time elapsed between start of office visit and recording of first measurement and when the second measurement was recorded. Also not clear on whether automated cuff was used
also role of self recorded home readings as well as drug store recorded measurements
It is surprising how much confusion and perhaps overtreatment surrounds the simple diagnosis of high blood pressure
A "priceless" study. Think of how much it costs to do a BP a second time then think of how much money it costs to unnecessarily treat a patient with a BP drug they don't need (and manage occasional but inevitable side effects). This just might be the most cost effective study ever! LIKE IT. :>)
there is more than a simple re-do : time delay in-between measurements used for chatting with patient meaning show interest in her / him and never display hurrying
Agree!
It’s great to have this evidence to support what I’ve also know. Further, if you ask people to mindfully relax the readings go down even further. As an emergency physician many patients have white coat syndrome and elevated blood pressure’s when they first arrive. In many occasions, BP reverts to a normal reading with mindful relaxation.
Great study! Could avoid the first (increased) BP by asking them to sit calmly x 5-10 mins, then do a first BP. Works like a charm. Then they need to also similarly relax for the rest of their daily lives :)
re: July 13, 2018 7:27:01 AM —
wow sir, you DO NOT deserve the privilege of being a physician. i suggest you change careers
Be the first in your clinic to reassure your colleagues. The White Coat Syndrome is out. The Gray Cuff Syndrome is in.
One has to wonder if the new more aggressive targets for BP recently suggested have taken the above study into consideration.
good poem
I will continue to recheck high BP readings on multiple patients - knowing from personal experience, corroborated by this study that BP readings will often be lower, and unnecessary labelling, diagnostic procedures, treatment and consequent side effects will be avoided.
Second Blood Pressure Reading
How long after the first one in office ?