We thank Bursztyn for his interest in our article1 and for the opportunity to expand on the differences between the evaluation of hypertension in the office setting and obtaining BP measurements in the emergency department (ED). Reeves2 suggested that, when the first 2 measurements differ by more than 5 mm Hg diastolic, additional BP readings should be obtained until a stable level is reached. Cushman3 recommended that the details about smoking, alcohol, caffeine, pain, and anxiety be taken into account and that patients sit for 5 minutes in quiet room without talking or crossing their legs. Although these procedures may be followed in the office setting, they are clearly impractical in the ED setting.
Our study simulated the manner in which BP measurements are routinely obtained in the ED. We found that the use of common ED methods for obtaining BP readings result in the identification of