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Invited Commentary
October 12, 2020

A Tale of 2 Blood Pressures

Author Affiliations
  • 1Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York
  • 2Division of Healthcare Delivery Science, Department of Population Health, New York University Grossman School of Medicine, New York
  • 3Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
JAMA Intern Med. 2020;180(12):1663-1664. doi:10.1001/jamainternmed.2020.5007

In this issue of JAMA Internal Medicine, Drawz et al1 report data from the Systolic Blood Pressure Intervention Trial (SPRINT) comparing office blood pressure (BP) measured in the trial with office BP obtained during routine clinical practice. SPRINT, which enrolled adults 50 years or older without diabetes or stroke to determine whether a more intensive BP treatment target was beneficial, was stopped early after an interim analysis showed that an office systolic BP (SBP) target of less than 120 mm Hg reduced cardiovascular events and all-cause mortality compared with a standard SBP target of less than 140 mm Hg.2 As in many hypertension trials, office BP was measured using a standardized protocol that included use of an oscillometric device and appropriately sized cuff along with a 5-minute period of rest before BP was measured, proper positioning of the participant, and measurement of and calculating the mean of 3 BP readings.

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    1 Comment for this article
    Tale of Two Blood Pressures
    Thomas Shapiro, MD, MLA | Retired
    Blood pressure measurement especially in patients older than sixty Is quite variable. The morbidity end points of the Sprint Trial in this population study employing “research methods” were well defined and easy to document.
    Cardiovascular complications and stroke rates in this population were significantly correlated with successful reduction of systolic BP below 120 as compared with control rates below 140 systolic.
    Since in large populations, the difference between research method BP measurement and standard office measurement was modest and reduction of stroke rates were substantial, it suggests efforts to improve routine BP measurement is
    crucial. Surely “white coat hypertension” is an insufficient explanation for increased stoke rates in patients with office BP.