Blood Pressure Measurement in the Post-SPRINT Era: A Canadian Perspective.

Abstract

The Systolic Blood Pressure Intervention Trial (SPRINT) is in the process of changing our approach to diagnosing and treating hypertension.1 This study was stopped early because of a clear benefit in terms of reduced cardiovascular morbidity and mortality in higher-risk, older patients randomized to a target systolic blood pressure (BP) <120 mm Hg compared with the usual target of <140 mm Hg. Although it was not clearly stated when the results of SPRINT were initially published, it is now evident that office BP readings were taken using the automated office BP (AOBP) measurement technique. This method involves using a fully automated, oscillometric sphygmomanometer to record multiple BP readings with the patient resting quietly, without health professionals or research staff being present. In a subsequent commentary on the findings in SPRINT, Cushman et al2 mentioned some aspects of the BP measurement procedures followed in the study, but they did not say that the study personnel were not present during the readings. This point has now been clarified. In SPRINT, study staff were trained to program an Omron 907XL (Omron Healthcare Inc, Lake Forest, IL) to wait 5 minutes and then record 3 readings at 1-minute intervals. After the device was activated, research staff left the examining room, with the patient then being alone during the 5 minute rest period and while the 3 readings were recorded automatically (W.C. Cushman, personal communication, 2016). There is general agreement that AOBP readings are preferable to conventional BP measurement in routine clinical practice because AOBP is not subject to the white coat effect, with readings having a significantly stronger relationship to awake ambulatory and home BP. The advantages of AOBP are mostly because of minimal human involvement during the BP measurement process,3 with no opportunity for conversation, less observer bias (rounding off readings to …