Intended for healthcare professionals


Measurement of blood pressure in primary care

BMJ 2011; 342 doi: (Published 07 February 2011) Cite this as: BMJ 2011;342:d382
  1. Jonathan Mant, professor of primary care research1,
  2. Richard McManus, professor of primary care cardiovascular research2
  1. 1General Practice and Primary Care Research Unit, University of Cambridge, Cambridge CB2 0SR, UK
  2. 2Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
  1. jm677{at}

Must be done carefully, or not at all

In the linked cluster randomised controlled trial (doi:10.1136/bmj.d286), Myers and colleagues compare the quality and accuracy of blood pressure measurement of manual sphygmomanometers with automated blood pressure monitors in primary care.1

The value of measuring blood pressure in the clinic is debatable, especially when it is done by doctors.2 Inherent variability means that true changes in blood pressure can be difficult to detect using clinic readings.3 Furthermore, misclassification on the basis of clinic readings can occur in people with “normal” underlying blood pressure who are labelled as hypertensive because of the pressor effects of having blood pressure measured in the clinic (white coat hypertension) and those with hypertension who are labelled as normal because clinic readings are lower than the usual blood pressure (masked hypertension).4 Out of clinic methods of measuring blood pressure, such as ambulatory blood pressure monitoring and home monitoring, are better predictors of cardiovascular outcome than clinic measurements.5 6 Self monitoring and self management can lead to better control of blood pressure than monitoring blood pressure in the clinic.7 8 However, the evidence base for the treatment of hypertension is …

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