Disparities in Blood Pressure Measurement

Abstract

We aimed to examine how inaccuracies and inequities in blood pressure (BP) measurement across office, ambulatory, home, and emerging cuffless modalities contribute to disparities in hypertension diagnosis and control, and to identify strategies to improve measurement equity. Disparities arise from nonstandardized office technique, inappropriate cuff sizing, limited access to validated home and ambulatory devices, reimbursement and implementation barriers, and underrecognition of masked and nocturnal hypertension in populations at higher risk. Cuffless technologies may expand access and reduce cuff-related barriers, but current devices have important limitations in validation, calibration, real-world accuracy, and performance across diverse populations. Improving equity requires standardized measurement, access to appropriately sized validated devices and out-of-office monitoring, inclusive device validation, and reimbursement and implementation strategies that reach underrepresented and under-resourced communities. Future research should test whether these approaches reduce diagnostic misclassification and improve BP control and cardiovascular outcomes across populations.