title: What is the accuracy of clinic blood pressure measurement?
abstract: BACKGROUND
  In clinical practice, blood pressure (BP) is frequently measured at the end of the visit in patients sitting on one side of the bed and not on a chair according to guidelines.
  
  
  METHODS
  In 540 consecutive subjects with essential hypertension (EH) attending a hospital outpatient clinic, BP was measured in the following sequence: 1) patient seated on chair for at least 5 min, 2) patient supine, 3) patient seated on bed, and 4) patient standing for a few minutes.
  
  
  RESULTS
  We found that mean (+/-SEM) BP was 143.5/87.2 +/- 0.9/0.5, 153.4/89.7 +/- 1.0/0.5, 148.9/90.9 +/- 1.0/0.5, and 144.8/91.7 +/- 1.0/0.6 mm Hg, respectively (P < .05 v position 1 for all). In 14% of patients, either systolic BP (SBP) or diastolic BP (DBP) was above the conventional upper limits of normality in the seated-on-bed but not in the recommended seated-on-chair position ("false" high clinic BP), whereas SBP and DBP were "false" normal (below limit for bed-seated and above limit for chair-seated position) in only 6% and 2% of patients, respectively. Overall, SBP and DBP increments from the chair- to the bed-seated position were inversely related to the baseline chair-seated values; systolic increments were directly related to age, in particular in the subgroup of untreated EH (n = 70), and to body mass index. A gender-related difference was apparent, as female subjects had more pronounced increments in SBP (+7.4 +/- 0.8 v +3.5 +/- 0.7 mm Hg) and DBP (+4.4 +/- 0.5 v 2.9 +/- 0.4 mm Hg) than did male subjects (P < .05 for both).
  
  
  CONCLUSIONS
  Clinic SBP and DBP are overestimated in the bed-seated position at the end of the visit compared with the recommended chair-seated position in treated and untreated patients with EH, in particular in elderly obese women with mild hypertension.
authors.affiliation: Istituto Medicina Cardiovascolare and Centro Fisiologia Clinica e Ipertensione, Università di Milano and Ospedale Maggiore IRCCS, Milano, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Sala
authors.forename: Erika
authors.initials: E
authors.lastname: Santin
authors.forename: Marta
authors.initials: M
authors.lastname: Rescaldani
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.forename: Fabio
authors.initials: F
authors.lastname: Magrini
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination / Q000592:standards*; D003971:Diastole; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011187:Posture; D012737:Sex Factors; D016037:Single-Blind Method; D013599:Systole
chemical_list: D000959:Antihypertensive Agents