Letter to the Editor on “Antecedent rest may not be necessary for automated office blood pressure at lower treatment targets”

Dear Editor,

In a comparison of automated office blood pressure (BP) measurements taken with and without five minutes of rest, Colella and colleagues conclude that “when readings in treated patients decrease to a systolic BP <130 mm Hg, the Omron 907XL may be used without any antecedent rest. Doing so would reduce the time required to record the office BP…”.1 How to implement this suggestion in clinical practice is unclear, because it would necessitate knowing the BP level prior to performing the measurement!

Are the authors recommending that clinicians base this decision on prior automated office BP levels, perhaps from prior visits? If so, can they comment on the substantial BP variability found in their study? Despite performing research quality measurements, using the same device and measurement modality for all measurements, and employing a randomized cross‐over design, their reported limits of agreement spanned nearly 30 mm Hg. Variability would be expected to be even higher in a “real world setting.” This would seem to preclude in most patients use of prior measurements for the purposes of determining if a patient should rest.

I suppose one could use out‐of‐office measurements to predict the need for a rest period. However, given the superiority of out‐of‐office over in‐office BP measurements,2, 3 one could simply eliminate the entire in‐office measurement procedure altogether if high‐quality out‐of‐office measurements were available. In fact, this would be the most easily implementable method of “minimizing” the time required for in‐office BP measurement.

CONFLICT OF INTEREST

Raj Padwal is a o‐Founder of a BP measurement start‐up company, mm Hg Inc.