Response: Re: Blood Pressure Checks for Diagnosing Hypertension: Health Professionals' Knowledge, Beliefs, and Practice

To the Editor: This letter to the editor in response to our article “Blood Pressure Checks for Diagnosing Hypertension: Health Professionals' Knowledge, Beliefs, and Practice” was of great interest to us.

The authors of this letter conducted a quasi-experimental study where nurse and physician knowledge of ambulatory blood pressure monitoring (ABPM) was measured pre and post a training intervention.¹ Knowledge was low pre training, with substantial improvement post training. The study took place in Spain, a country where ABPM is more commonly performed than the US. The training session took place at a conference on hypertension, and the nurses and physicians that attended may have not been representative of nurses and physicians working in typical primary care clinics. Furthermore in the US, medical assistants are much more common part of the workforce in primary care than nurses. Medical assistants receive less training than nurses.

Nonetheless, the training intervention was successful, demonstrating that it is possible to improve BP measurement and hypertension diagnostic knowledge, at least in regard to ABPM. Our study in the US^2,3 and a recent study from Canada⁴ showed that new strategies are also needed for improving health professionals' clinic BP and home BP knowledge and practices in addition to ABPM. Future studies should test the effectiveness of programs similar to that described by the author of the letter in larger and real world clinical settings, and determine whether increased knowledge leads to improved BP practices that are durable over time.