Background Accurate blood pressure (BP) measurement is essential for the diagnosis and management of hypertension. In clinical practice, BP is estimated using noninvasive methods with significant variability of application of guidelines in clinical practice, impacting the accuracy and certainty of BP measurements. Objective We sought to assess how BP is measured in clinical practice. Methods A survey was administered through professional societies that included predominantly cardiologists. Assessment of adherence to guideline recommendations for BP assessment was measured and compared to the level of confidence in clinic BP measurement. Results There were 571 surveys completed. The majority of respondents were cardiologists (61.1%), with 47 preventive cardiologists. BP was routinely checked in both arms by 53% at the initial visit, 48% check BP once each visit, and 64% wait 5 min before initial BP assessment. Automated BP assessment is used by 58% respondents. The majority (83%) trust their BP readings, and those who trust their BP readings are more likely to perform the initial BP assessment themselves, compared to those who do not trust the clinic BP readings (30.2% vs. 13.6%, P = 0.009). Accurate BP measurement is performed by 23% of cardiologists, and more likely performed accurately by a preventive cardiologist (38.3%) compared with other cardiologists (20.0%, P = 0.007). Accurate BP measurement is more likely for those who perform the initial BP themselves rather than any other staff (36.8% vs. 17.9%; P <0.001); and for those who repeat BP manually (80% vs. 54%; P <0.001), compared to those who do not measure BP accurately. Despite the inaccuracy of BP measurement, there is a high level of confidence in the BP readings. Conclusions Accurate BP assessment continues to remain suboptimal in clinical practice. Reliability of BP assessment requires education, identifying barriers to implementation of recommendations and engagement of the entire team to improve BP assessment.

Background: The accurate measurement of blood pressure (BP) is essential for the diagnosis & management of hypertension. In clinical practice, BP is estimated using noninvasive methods but there is significant variability in practice, despite guidelines and recommendations for accurate BP assessment. Individual clinical practices implementation of guidelines for BP assessment influence accuracy and clinical certainty of BP measurements. Hypothesis: We sought to assess how BP is assessed in clinical practice of cardiologists and to assess the clinical certainty of the BP obtained in their clinics. Methods: A survey was administered through professional societies that include predominately cardiologists & via Twitter. Assessment of adherence to guideline recommendations for BP assessment was measured and compared to belief and reliability of BP assessment in clinic. Results: 612 surveys were completed in 30 days, 364 completed by cardiologists; 49 (13%) preventive cardiologists. Majority of cardiologists based in United States. 53% routinely check BP in both arms at initial visit, 48% check BP only 1X/per visit; 64% wait 5 minutes before initial BP assessment. Automated BP assessment is used in 58% of respondents’ clinics. 83% trust their BP readings in clinic. Only 23% (85) of all cardiologist accurately measure BP as recommended by guidelines & it is more likely to be done by a preventive cardiologist (P=0.017). For those who do measure BP correctly, 80% repeat BP manually compared with 54% who do not measure BP accurately (P<0.001). For those who perform BP accurately, 86% report trusting their BP readings in clinic, similar to those who assess BP inaccurately (P=0.45). Conclusions: Accurate BP assessment by cardiologists remains suboptimal. Reliability of BP assessment in clinic requires education, implementation of recommendations and empowerment of the entire team to improve BP assessment & results in improved cardiovascular outcomes for our patients.

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