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Research Letter
April 16, 2018

Association of Repeated Measurements With Blood Pressure Control in Primary Care

Author Affiliations
  • 1Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio
  • 2Division of General Internal Medicine, Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
  • 3Better Health Partnership, Cleveland, Ohio
  • 4Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
  • 5Department of Family Medicine, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
  • 6Population Health Institute, MetroHealth Medical Center, Cleveland, Ohio
  • 7Department of Pediatrics, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio
JAMA Intern Med. Published online April 16, 2018. doi:10.1001/jamainternmed.2018.0315

Hypertension (HTN) is an important clinical problem affecting nearly 80 million people in the United States.1 Despite the recognized importance of blood pressure (BP) control for those with HTN, only 54% of patients with HTN seen in primary care have their BP controlled (defined as systolic BP <140 mm Hg and diastolic BP <90 mm Hg).1 Blood pressure measurement error (including inappropriate cuff size, talking during measurement, terminal digit preference, and incorrect arm and body positioning) is a major cause of poor BP control2 and reducing measurement error has the potential to avoid overtreatment. The American Heart Association recommends repeating a BP measurement at the same clinic visit with at least 1 minute separating BP readings,2 yet in busy primary care practices BP often is measured only once. We evaluated the effect of a second BP measurement on the rate of BP control among more than 38 000 patients with diagnosed HTN and followed in primary care.

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