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A single blood pressure measurement is often falsely elevated
Clinical Question
Is a single office blood pressure measurement reliable to assess hypertension?
Bottom line
Don't rely on a single blood pressure measurement. The first blood pressure reading taken during an office visit will be substantially different than subsequent readings in almost half of typical patients, and if relied upon will result in 1 in 8 patients being falsely labeled as hypertensive. 1b
Reference
Study design: Cross-sectional
Funding: Self-funded or unfunded
Setting: Outpatient (primary care)
Synopsis
The authors enrolled 1000 consecutive patients who presented for internal medicine, obstetric, or gynecologic care, though only 802 patients completed the study. Each patient, after 5 minutes of rest, had 4 consecutive blood pressure measurements, 2 minutes apart, by 1 of 13 trained physicians. The first systolic blood pressure was more than 10 mm Hg higher than the mean of subsequent measurements in 23.9% of patients; in total, 45.9% of patients had a systolic difference of more than 5 mm Hg. Similarly, diastolic blood pressures were more than 10 mm Hg different in 4.4% of patients; in total, 21.6% of patients had a difference of more than 5 mm Hg. More important, hypertension would have been diagnosed in error in 1 in 8 patients (12%) if only the first measurement had been obtained, and 2% of patients would have had their hypertension undiagnosed by the single measurement.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Single blood Pressure measurement is not at all good choice to come in to diagnosis. We never do it our practice .
Une confirmation d’une bonne pratique.
The protocol used in this study may still be overestimating the true blood pressure reading as all blood pressure readings were taken in the doctor’s office.
Home or 24 hour ambulatory tradings could possibly have shown even lower readings. Dr. Glen Burgoyne.
When I pressed my own doctor to repeat the measurement twice it dropped each time. In fact after 20 years in family practice followed with 24 years as an ERP ,I have learned that in office practice measuring more than once is uncommon.
I thought this had been established long ago?
still to proof the world is round ?
?IS THERE VARIATION BETWEEN DIGITAL BLOOD PRESSURE MONITORING.
? CAN DIFFERENT PATIENT TRUSTED WITH THEIR OWEN MANUAL BLOOD PRESSURE DEVICE READING
IS DIGITAL BP TAKEN BY ELECTRONIC DVISE BY OFFICE STAFF IS MORE RELIABLE?
We should know this. The only useful single measurement is at the waist.MUCH MORE IMPORTANT.
good poem
The problem is what is the definition of hypertension? What is the outcome of the so called falsely labelled hypertension. May be they are white coat hypertension with poorer outcomes than non hypertensive patients.
good info