title: How should we measure blood pressure in the doctor's office?
abstract: BACKGROUND
  Blood pressure is the most ubiquitous diagnostic recording made in the doctor's office, but the measurement is subject to a number of sources of bias, which may lead to over- or underestimation. The current study examined the systematic influence of the way in which the measurements were taken - by the physician, by a nurse, or with the patient sitting alone, using an automated device.
  
  
  METHODS
  Blood pressure was measured in 17 essential hypertensive and 10 white-coat hypertensive individuals. On separate clinic visits, measurements were taken by the attending physician, by a nurse and using an automated device (Arteriosonde 1216).
  
  
  RESULTS
  A repeated-measures ANOVA revealed that, for systolic pressure, there was a significant effect of measurement modality on blood pressure. Physician systolic pressures were on average approximately 10 mmHg higher than those taken by a nurse, nurse pressures being approximately 7 mmHg higher than those recorded using Arteriosonde. The effect on diastolic pressure was similar but smaller, and no nurse-Arteriosonde difference was observed.
  
  
  CONCLUSIONS
  We conclude that the routine clinical assessment of blood pressure would be more representative of daily ambulatory pressure if an automated device, without doctor or nurse present, were used.
authors.affiliation: Cornell University Joan and Sanford I. Weill Medical College-New York Presbyterian Hospital, New York 10021, USA. wgerin@med.cornell.edu
authors.forename: W
authors.initials: W
authors.lastname: Gerin
authors.forename: R M
authors.initials: RM
authors.lastname: Marion
authors.forename: R
authors.initials: R
authors.lastname: Friedman
authors.forename: G D
authors.initials: GD
authors.lastname: James
authors.forename: D H
authors.initials: DH
authors.lastname: Bovbjerg
authors.forename: T G
authors.initials: TG
authors.lastname: Pickering
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015982:Bias; D001795:Blood Pressure Determination / Q000379:methods* / Q000523:psychology / Q000592:standards; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009726:Nurses; D009819:Office Visits; D010820:Physicians; D015203:Reproducibility of Results; D012648:Self Care