Is usual measurement of blood pressure meaningful?

BACKGROUND: Standardized measurement of blood pressure is widely recommended but rarely applied in usual clinical practice. OBJECTIVE: To determine the differences resulting from physicians using standardized and usual (casual) techniques for measurement of blood pressure. METHODS: Blood pressures measured by a research nurse, ambulatory blood pressure monitoring and echocardiographic estimation of left ventricular mass index were used as standards for comparison. RESULTS: Use of casual technique resulted in blood pressure readings higher than those obtained by standardized technique, namely 6.2 (3.1-9.3) systolic and 3.9 (2.4-5.4) diastolic mmHg means (95% confidence intervals), and readings that were more variable. Sixty-two patients (42%) were classified normotensive by standardized techniques but hypertensive by physicians casual technique. When standardized technique was used 22 patients (15%) were classified hypertensive but blood pressure readings in normal range were obtained by usual technique. Measurements obtained using standardized technique were less variable and were significantly correlated to left ventricular mass index. CONCLUSION: Using standardized technique is important if one is to classify the blood pressures of patients correctly. Use of usual or casual technique results in higher, more variable readings that are not related to left ventricular mass index. Results of this study strongly support recommendations that standardized technique should be used for assessing the cardiovascular risk of all adult patients.