Performance measures, which are often reported using data captured by electronic medical records (EMR), have expanded the role of clinic-based BP. To date, hypertension treatment guidelines and quality control metrics have largely relied on BP measured in the clinic setting. More recently, restrictions on the use of mercury devices, increased availability of oscillometric devices, discrepancies between clinic BP and out-of-clinic BP, and an increasing recognition of the susceptibility of BP assessed using the auscultatory method to measurement error have resulted in uncertainty for clinicians and researchers. This non-invasive auscultatory approach remained the reference standard until the early 21 st century. For much of the 20 th century, BP was assessed through auscultation and the recognition of Korotkoff sounds, with mercury-based sphygmomanometer measurements serving as the reference standard. In the current document, we use the term BP measurement for estimates obtained through non-invasive means. In clinical practice and most clinic-based research studies, BP is estimated using non-invasive methods. The direct measurement of BP requires an intra-arterial assessment. Subsequently, randomized trials demonstrated that lowering BP from levels which were previously considered “essential” (systolic/diastolic BP up to 210/100 mm Hg) reduced the risk of CVD and death. However, it was not until the 20 th century that observational data showed that higher BP levels were associated with increased cardiovascular disease (CVD) risk. ![]() ![]() Researchers first measured BP in the 1700s, and by the late 1800s BP assessment was introduced into clinical practice ( 4). The accurate assessment of arterial blood pressure (BP) levels is needed for the diagnosis and treatment of hypertension. Hypertension affects about 103 million adults in the US and over a billion people worldwide ( 1- 3). In this report, we review the topics discussed during a two-day meeting including the current state of knowledge on BP assessment in clinical practice and clinic-based research, knowledge gaps pertaining to current BP assessment methods, research and clinical needs to improve BP assessment, and the strengths and limitations of using BP obtained in clinical practice for research and quality improvement activities. The National Heart, Lung, and Blood Institute of the US National Institutes of Health convened a Working Group of clinicians and researchers in October 2017 to review data on BP assessment among adults in clinical practice and clinic-based research. Restricted use of mercury devices, increased use of oscillometric devices, discrepancies between clinic and out-of-clinic BP, and concerns about measurement error with manual BP measurement techniques have resulted in uncertainty for clinicians and researchers. The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension.
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