In-office blood pressure readings may not be sufficient for assessing hypertension risks, as numbers can be skewed. An April report in JAMA Medical News suggests that hypertension treatments and diagnoses should not rely solely on in-office blood pressure readings due to inconsistencies and inaccuracies in results.

Rubin R. More evidence that hypertension treatment decisions shouldn’t depend solely on in-office blood pressure readings. JAMA. 2023;329(19):1630. doi:10.1001/jama.2023.5538

According to Yu-Ming Ni, MD, a cardiologist at California Heart Associates at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, a person’s blood pressure may fluctuate at the doctor’s office due to external stressors like booking difficulties, time constraints, parking issues, or long wait times. These office stressors are known as “white coat hypertension,” which can result in elevated blood pressure for people who may not be at risk for hypertension, he adds. According to Cleveland Clinic, 10% to 30% of people with elevated blood pressure readings in healthcare settings have experienced white coat hypertension.

Cleveland Clinic. 24-Hour Ambulatory Blood Pressure Monitoring.

“Simply being at a doctor's office can be stressful for the patients. That could drive up their blood pressure,” says Ni. “We also know that going to a doctor is not part of a usual routine for someone—our usual day-to-day experience is far different than that on the days when we go see our physician.”

Switching up one’s routine can pull someone out of their element, Ni adds.

“There are a lot of factors that contribute to stress of trying to get to your appointment and why patients have quite different blood pressures in the office than they do at home,” Ni says.

When it comes to their impact on patient well-being, inflated blood pressure readings can have a negative impact, he adds. Among other things, they can lead to misdiagnosis of hypertension or to overmedicating someone with the diagnosis.

“The end result might be that these patients end up taking more medicine than they need—that their doctor admonishes them for their lifestyle choices more than they really should be, thinking that [their blood pressure reading is] related to lifestyle reasons,” says Ni.

Ambulatory blood pressure monitoring (ABPM): a person wears a blood pressure monitor for 24 hours straight to track their blood pressure during waking and sleeping hours. This can be important for seeing whether blood pressure dips at night, which can be dangerous.

At-home blood pressure monitoring: a patient takes their own blood pressure readings multiple times per day or week. This requires the patient to purchase a blood pressure monitor, and the method may be less accurate than ABPM. However, this is a good option for getting more data to confirm or rule out hypertension.

Ni says that it is important to confirm in-office blood pressure readings via ABPM or at-home blood pressure monitoring before diagnosing someone with hypertension. This is already part of the guidelines for physicians, but it is unclear if everyone follows this protocol, he adds.

“There really is no reason to not have your patient check their blood pressure at home at least a few times,” Ni says. “It's very reasonable, and part of what we should be doing as physicians is to better understand what someone's blood pressure is at home.“

He adds that blood pressure cuffs tend to be affordable but that people who cannot afford them may be able to take advantage of programs that offer free cuffs to patients (depending on their insurance).