Methods of Blood Pressure Assessment Used in Milestone Hypertension Trials

Abstract

Accurate blood pressure measurement is critical for the diagnosis and management of hypertension. In the present narrative review, we summarized the blood pressure measurement protocols used in contemporary milestone hypertension trials. In all these trials, clinic blood pressure was used for the diagnosis and therapeutic monitoring of hypertension. The methodological details regarding the observers, devices, number of blood pressure measurements and the time interval between consecutive readings varied considerably between trials. Other aspects, such as the body position and resting time, differed much less across these trials. Details regarding arm side and cuff were infrequently noted. The timing of blood pressure measurement was rarely acknowledged explicitly. Automated office blood pressure measurement has been recently used in clinical trials, and seems to have less white-coat effect. In spite of apparent advantages of the out-of-office blood pressure measurement, either ambulatory or home blood pressure monitoring, it was only used in a subset of study participants of few trials in hypertension, and its superiority over office blood pressure in guiding antihypertensive therapy has not yet been proven by randomized controlled trials. Future randomized clinical trials should consider the use of these novel office or out-of-office blood pressure measurements in the guidance of antihypertensive therapy and prevention of cardiovascular events.