Clinical Edge

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Managing Blood Pressure in a Primary Care Setting

J Am Board Fam Med; 2018 May-Jun; Doane, et al

An automated office blood pressure (AOBP)/home blood pressure management (HBPM) initiative detected white-coat BP elevation in one-third of patients with elevated office BP and facilitated hypertension control in nearly half of patients with elevated home BP, a recent study found. Researchers implemented an AOBP/HBPM program in a primary care clinic in 2015 to 2016. Patients with elevated BP entered the HBPM program. Patients with average home BP ≥135/85 mm Hg provided HBPM results for medication adjustment. Among the findings:

  • Initial HBPM results in 183 patients with elevated office BP revealed white-coat BP elevation in 35% of untreated patients and in 37% of treated patients.
  • The prevalence of white-coat BP elevation was similar whether enrollment BP was by observed BP or AOBP.
  • Subsequent HBPM facilitated BP control in 49% of patients with elevated home BP.
  • Barriers to implementation included a temporary period of incorrect AOBP technique, patients failing to provide HBPM results, and incorrect HBPM technique.


Doane J, Buu J, Penrod MJ, Bischoff M, Conroy MB, Stults B. Measuring and managing blood pressure in a primary care setting: A pragmatic implementation study. J Am Board Fam Med. 2018;31:375-388. doi:10.3122/jabfm.2018.03.170450.