Version July 2025
| Role in BP evaluation | Minimum number of measurements at a single visit | Is standardized procedure for BP measurement used? | Advantages | Disadvantages and limitations | |
| Office-based measurements | |||||
| Nonstandardized ("casual") BP | Screening only | 1 measurement | No | None. | Wide variability among providers. Lack of standardized procedures may introduce errors in estimating the patient's usual BP. Staff presence introduces the possibility of the white coat response. |
| Unattended AOBP | Diagnosis, management | 3 measurements | Yes | Reduced likelihood of white coat hypertension. Improved accuracy and reduced performance error. Preferred office-based BP measurement method for diagnosis and management. | The BP measurement device must be capable of AOBP (eg, measuring and averaging multiple BP readings). |
| Attended AOBP | Diagnosis, management | 3 measurements | Yes | Improved accuracy and reduced performance error. | Staff presence introduces the possibility of the white coat response and talking during measurement. |
| Standardized office BP | Diagnosis, management | 1 to 2 measurements | Yes | Acceptable office-based measurement if AOBP is not available. | Manual measurement increases performance error. Staff presence introduces the possibility of the white coat response. |
| Ambulatory BP monitoring | Diagnosis, management | NA | NA | Reference standard for the diagnosis of hypertension, white coat hypertension, and masked hypertension; provides readings during sleep, which are valuable for risk assessment. | May not be available or covered by insurance. |
| Self-measured BP | Diagnosis, management | NA | Yes | Reduced likelihood of white coat hypertension. | Requires access to a BP measurement device and ability of patient/caregiver to operate the device correctly; cuff inflation hypertension may occur if the device requires manual inflation. |
The selection of a BP measurement strategy depends on whether the goal is screening or diagnosis and management of hypertension. The criteria for diagnosing hypertension vary by the BP measurement strategy.
We use the American College of Cardiology/American Heart Association (ACC/AHA) definitions and staging system to classify BP. If there is a disparity in category between the systolic and diastolic pressures, the higher value determines the stage. European guidance on the definition of hypertension and associated treatment thresholds contrasts slightly with that of the ACC/AHA. Please refer to related UpToDate content for further detail.
