The improved accuracy of AOBP and its elimination of a white coat effect is of considerable clinical relevance.Mean AOBP is ≈15/10 mm Hg lower than the mean BP recorded in routine clinical practice, regardless of whether readings are taken manually or using an automated recorder.American primary care physicians are already familiar with periodic clinical practice guidelines and practice updates.Upgrading from manual office BP to AOBP has not been a major problem in Canada and should be feasible for American physicians.
A major issue concerning the implementation of the results of SPRINT is that AOBP is not currently being used in clinical practice in many countries, including the United States.
Even when patients take their own BP using an automated sphygmomanometer while alone in an examining room, the mean systolic BP is still ≈5 mm Hg higher than the corresponding awake ambulatory or home BP.
Until recently, there has been an assumption that physicians and nurses in routine clinical practice record BP in the same way as it is done in research studies, on which diagnosis and treatment guidelines are based.
Most of the research into AOBP has been conducted in Canada using the Bp TRU device (Bp TRU Medical Devices Inc., Coquitlam, BC, Canada), which was developed in Vancouver.
Initially, it was thought that AOBP had to be performed in an examining room, which led some critics to complain that the procedure was impractical and too time consuming.
In SPRINT, the readings were taken at 2-minute intervals after a 5-minute rest.