Blood pressure measurements for treating hypertension: which method counts the most?

Considerable recent attention has been directed at the assessment and treatment of elevated levels of blood pressure (BP) in patients with hypertension (HTN). Although most of this emphasis has focused on exactly what level of BP requires treatment, an equally important question is what BP measurements should be used to determine optimal BP level and control.1 If blood pressure treatment is based on office BP readings, should this be based on a single BP assessment, which is commonly used in most busy clinical practices, or should this be based on the average of several readings and possibly by the average BP based on several measurements performed after the very initial measurement? In their  Heart  paper, Burkard et al 2 assessed 1000 adult subjects and compared the first office BP measurement to the mean of the second to fourth measurements. Relative to the average BP measurements and the single initial measurement, a high percentage of patients had substantial differences in systolic BP and diastolic BP that could influence clinical management. In fact, over half of patients …