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We thank Dr. Alpert for his interest in our study. For many years, auscultatory blood pressure coupled with a mercury manometer (ABP) was used as the office and hospital gold standard for measuring blood pressure. Most of the antihypertensive drugs on the market were tested in outpatient clinical trials in which ABP was used to assess drug efficacy. Even fairly recent multicenter trials have insisted on the use of ABP. These clinical trials were often coupled with extensive training sessions that allowed clinical investigators to standardize their techniques. Having been involved in several of these clinical trials (R.A.K.), and with appropriate training, it was possible to obtain agreement among clinical investigators on blood pressure values using ABP. As mercury devices are being phased out, most hospitals and offices now rely on the automated oscillometric (AO) technique. Although Dr. Alpert states that “the concept that there is an ‘oscillometric blood pressure value’ is inherently flawed,” the truth is that the oscillometric blood pressure value is what is now most commonly used in clinics and hospitals to determine whether our patients’ blood pressures are under control. Like it or not, the AO technique has now become standard in clinical practice. Yet most physicians and even cardiologists are simply not aware that there could be a discrepancy between what previously had been considered the gold standard—ABP versus the more commonly available AO—and that such a discrepancy can exist was the point of our paper. Although a limitation of our study may have been that we used only 1 AO device, the strengths of our study were that we examined a large number of patients and, upon the same heartbeats, simultaneously measured blood pressure with AO and ABP, which was not the case with many previous such studies. We suspect that our findings would not be unique had we used other oscillometric devices either from the same or another manufacturer. Although we are well aware that the mechanism by which AO blood pressure readings are obtained differs substantially from that of ABP, this does not preclude comparisons between AO and ABP, as Dr. Alpert implies. Because most antihypertensive medicines were approved on the basis of studies involving ABP, but every day, millions of patients have their blood pressure monitored, or are given new antihypertensive medicines, or have their medicines adjusted on the basis of AO readings, it seems logical that comparing ABP to AO is crucial, and our study is one of the few in which these measurements were taken simultaneously. We believe that it will be useful for future studies to consider systematically and simultaneously testing various oscillometric devices (including ones with both the same and different model numbers from the same manufacturer as well as devices from different manufactures) against ABP.

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Dec 22, 2016 | Posted by in CARDIOLOGY | Comments Off on Reply

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