Does evidence-based medicine suggest that physicians should not be measuring blood pressure in the hypertensive patient?
The most common reason for an outpatient physician visit is for the diagnosis and treatment of hypertension. The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) VII, which is increasingly evidence-based, advises the clinician to use studies of the mean response and benefit derived from reduction in blood pressure (BP) from antihypertensive therapy and to translate this data into recommendations for the individual hypertensive patient. We believe that the increasingly aggressive approach to hypertension mandated by JNC VII calls into question the use of physician-measured BP. Ample evidence has shown that phycisians have not been adequately trained to measure BP and, therefore, rarely measure BP to the standards asked for by JNC VII or the American Heart Association (AHA) guidelines. In addition, the white coat effect dilutes the validity and usefulness of physician-measured BPs. Finally, in the evidenced-based studies used to derive the JNC VII guidelines, BPs were measured by nurses, other "trained observers," or automated devices, not physicians. Accurate BP measurement is critical to diagnosis and management of hypertension. We recommend, therefore, that for this purpose physicians should not measure BP themselves but should rely on BPs from well-trained and monitored observers or validated automated devices to improve the quality of care of the hypertensive patient.
Graves
John W
JW
Division of Hypertension, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. Graves.john@mayo.edu
Sheps
Sheldon G
SG
D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000592:standards; D002983:Clinical Competence; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology*; D009726:Nurses; D010820:Physicians