In the linked paper (doi:10.1136/bmj.c1104), Head and colleagues propose new equivalence diagnostic thresholds and treatment targets for ambulatory blood pressure monitoring after undertaking a regression analysis comparison with clinic measures in more than 8500 people recruited from 11 hypertension clinics in Australia.1 Three quarters of participants were receiving antihypertensive treatment, and, importantly, analyses are presented for clinic measurements performed by physicians and non-physicians. The authors report smaller differences between ambulatory and clinic measurements when a non-physician made the measurements than current guidelines imply, particularly at near normal values.2 3 As previously reported, measurements taken by physicians were significantly higher. Although international guidelines agree that ambulatory readings are lower than those measured in clinic, diagnostic and treatment thresholds for ambulatory measurements vary considerably, despite near unanimous agreement for clinic thresholds.2 3 Better agreement on ambulatory thresholds would allow comparisons between countries and reduce confusion for clinicians.

The key messages from this work are that the difference between blood pressure measurements taken by physicians and nurses in the clinic is bigger than that between measurements taken …