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The first in-office blood pressure reading is often misleadingly high, one study suggested.

Patients who initially had high blood pressure readings had a median drop of 8 mm Hg in systolic pressure when they got a repeat measurement -- and the greater the initial systolic blood pressure, the greater the difference, according to a group led by Douglas Einstadter, MD, MPH, of Cleveland's Case Western Reserve University and MetroHealth Medical Center.

Moreover, 36% of repeat readings fell under the old hypertension threshold of 140/90 mm Hg, which is now the threshold for stage 2 hypertension. Overall, repeat measurements brought the hypertension control rate up from 61% to 73%, the investigators reported online in .

"While much of the change in systolic blood pressure may be attributed to regression to the mean, the observed decrease remains clinically important, comparable with that associated with addition of an antihypertensive medication," Einstadter's group noted.

Having patients go on blood pressure drugs when they don't need them means they are taking "medications that add little or no benefit to their clinical well-being or clinical outcome," said Robert Baron, MD, of the University of California San Francisco, writing in an .

This becomes an especially relevant problem as the U.S. health care system moves toward value-based care initiatives, such as accountable care organizations and shared savings programs, the study investigators suggested.

Their study was based on the records of the MetroHealth urban safety-net health system's patients with a problem list diagnosis of hypertension who were seen at a primary care clinic in 2016 (n=38,260).

Of note, these clinics utilize an electronic health record system with a built-in reminder for healthcare providers to remeasure blood pressure when the first reading exceeds 140/90 mm Hg in the clinic, which happened 83% of the time.

Baron suggested that primary care practices develop a clear strategy for best-practice office measurement that may include changes in staff training, work flow, and physical settings to comply with current .

"Despite the clinical trial emphasis on office-based measurements, most new practice guidelines now also recommend out-of-office measurement to confirm office-based high blood pressure and for ongoing management of hypertension. Unfortunately, this practice is neither standardized nor fully evidence based," according to Baron.

Nonetheless, "ABPM [ambulatory blood pressure monitoring] should be used more than it currently is. It is not clear that it is needed in every patient (as suggested by current guidelines), but it certainly can be useful in a larger number of patients," the editorialist said. "Finding even a few patients in each primary care practice who do not need medications is well worth it. This may be especially true in patients with lower cardiovascular risk."

Moreover, ABPM can help confirm good control throughout the day in high-risk patients, especially those with existing cardiovascular disease, he added.

"As we continue to debate the thresholds and goals of high blood pressure treatment, we will need to better explain to patients the benefits and harms of each approach and solicit their preferences. The least we can do is better define their risk with better measurement of blood pressure," Baron concluded.

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