Is blood pressure reading more accurate at home or clinic?

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A recent study from Kaiser Permanente investigators found that blood pressure measurements taken at home are more accurate than those taken in a clinic setting.

The study tested 510 adults who visited 12 Kaiser Permanente primary care centers in Western Washington between 2017 and 2019.

Researchers used electronic health records to identify potential participants who were at high risk of having hypertension.

Participants were then randomly divided into 3 groups based on the method for obtaining follow-up blood pressure measurements: in clinic, at home, or at kiosks in medical clinics or pharmacies.

Every participant received 24-hour ambulatory blood pressure monitoring, or ABPM, the gold standard test for making a new diagnosis of high blood pressure.

The team found that blood pressure readings taken at home were consistent with ABPM, while readings based on follow-up clinic visits were much lower for the systolic measure.

This led to over half of the people with high blood pressure based on ABPM being missed.

Blood pressure readings from kiosks were significantly higher than measures based on ABPM, resulting in a higher likelihood of overdiagnosis of hypertension.

The team says home blood pressure monitoring is a better option because it was more accurate than clinic blood pressure readings.

Furthermore, a companion study found that patients preferred taking their blood pressure at home.

Proper diagnosis of high blood pressure is crucial as it can cause heart attack, stroke, and kidney damage, among other problems.

Current guidelines for diagnosing high blood pressure recommend that patients who have high blood pressure readings in the clinic have another test to confirm the results.

While the guidelines recommend ABPM or home blood pressure monitoring before making a high blood pressure diagnosis, research shows that providers continue to use in-clinic measurement when conducting the second reading.

The study offers the most powerful evidence to date because of its large number of participants, its involvement of primary care clinics, and its use of real-world practitioners to take blood pressure measures instead of research personnel.

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The study was conducted by Dr. Beverly B. Green et al and published in the Journal of General Internal Medicine.

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