Take Second (and Maybe Third) BP Readings in Routine Follow-up for Hypertension

May 22, 2018

Information sourced from NEJM Journal Watch:


Take Second (and Maybe Third) BP Readings in Routine Follow-Up for Hypertension


In a third of patients with elevated blood pressures on initial readings, second readings were lower than 140/90 mm Hg.


The American Heart Association recommends that at least two blood pressure (BP) readings be taken 1 to 2 minutes apart in routine office practice (NEJM JW Gen Med Dec 15 2017 and J Am Coll Cardiol 2017 Nov 13; [e-pub]), but repeat readings often are skipped. In this Ohio study, researchers assessed the value of second readings at 81,000 primary care visits for patients with hypertension during a single year. Initial measurements were ≥140/90 mm Hg at 39% of visits.


Second readings were taken after 26,000 initially elevated values, and 36% of second readings were <140/90 mm Hg; median improvement in systolic BP was 8 mm Hg. The likelihood of a normal second reading depended on the degree of elevation in the first reading. For example, among patients with initial systolic BPs of 140 to 159 mm Hg, roughly 41% dropped to <140 mm Hg on second readings, compared with only about 13% of those with initial systolic BPs of 160 to 180 mm Hg.




These results are consistent with previous studies and my own clinical experience, but the findings don’t necessarily prove that the second result is the “right” one. Moreover, the report doesn’t tell us whether initial BPs were taken correctly (e.g., with patients seated for several minutes in a quiet area) or the time interval between the two readings. If a second reading is normal, and if I’m going to make an important treatment decision based on it, I will want to see a third reading or several home readings.


Thomas L. Schwenk, MD reviewing Einstadter D et al. JAMA Intern Med 2018 Apr 16




Einstadter D et al. Association of repeated measurements with blood pressure control in primary care. JAMA Intern Med 2018 Apr 16; [e-pub].


NEJM Journal Watch is produced by NEJM Group, a division of the Massachusetts Medical Society. Copyright ©2018 Massachusetts Medical Society. All rights reserved.


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