The great myth of office blood pressure measurement

Clinical practice guidelines have traditionally recommended manual blood pressure (BP) measurement in the office setting as the standard method for diagnosing hypertension. In reality, manual BP in routine clinical practice is relatively inaccurate, over-diagnoses hypertension by provoking office-induced increases in BP and correlates poorly with both the awake ambulatory BP and target organ damage. The most recent guidelines recommend 24-h ambulatory BP and home BP for diagnosing hypertension. The advent of automated office BP (AOBP) represents a third alternative to conventional manual BP measurement, one that maintains the role of office BP readings in the diagnosis and management of hypertension. AOBP has three basic principles: multiple readings taken using a fully automated sphygmomanometer with the patient resting quietly alone. AOBP eliminates office-induced hypertension such that the cut-point for a normal AOBP is the same as for the awake ambulatory BP and home BP. As compared to routine manual office BP, AOBP provides more accurate BP readings, is more consistent during repeated office visits and in different settings and correlates better with both the awake ambulatory BP and target organ damage. The advantages of AOBP over manual BP measurement support its use in routine clinical practice.