Improved screening for hypertension needed, according to Maine-Syracuse Longitudinal Study investigators

High blood pressure, a significant risk factor for kidney disease, heart disease, stroke, retinopathy and dementia, has been labeled the silent killer. Early detection and treatment are essential to slow or prevent the adverse consequences of untreated hypertension.  

Consequently, the practice of “opportunistic” blood pressure (BP) measurement has become commonplace in visits to primary care providers and others, including dentists and optometrists. Typically, automated BP measurement devices/monitors are used.

In a major literature review, Maine-Syracuse Longitudinal Study (MSLS) investigators Merrill Elias and Amanda Goodall at the University of Maine examined studies of health provider errors in automated blood pressure measurement and offered a number of procedures for improving the accuracy of these methods (Hypertension, 2021;77(1)). 

In two follow-up opinion pieces, Elias and Goodall pointed out the need for data on errors of automated BP measurement in the dental office, including measurement of BP using the wrist-cuff device with the patient placed in the dental chair with the feet elevated instead of flat on the floor (American Journal of Hypertension, 220; 33(4)) and, with co-author Adam Davey of the University of Delaware, American Journal of Hypertension (ahead of print DOI: 10.1093/ajh/hpaa216 PMID).

Elias, Goodall and Davey offered simple solutions to these problems, most of which emphasize following readily available directions for proper BP measurement. There is ample literature online, including on the American Heart Association and Mayo Clinic websites, about precisely how automated BP measurement should be performed. For example, the arm-cuff automated monitor should be used and the patient should be seated in a straight-backed chair with arms on a table and feet flat on the floor.

The papers by Elias, Goodell and Davey provide important information for patients concerned about how their BP is being assessed by their health care providers. The MSLS authors emphasize that the problem is not measurement of BP in the dental chair when the dental procedure itself requires that BP to be within a safe range, such as tooth extraction or procedures that require anesthesia. The concern is the erroneous practice of seating the patient in the dental chair when the goal is valid opportunistic screening for hypertension. 

The extent of poor measurement practices is not known, according to the authors, but there is much information by way of patient complaints and anecdotal evidence.

More information on these studies and full references to the three papers may be obtained from Elias, MSLS director, A history of MSLS, a listing of funding sources since its beginning in 1975, and a list of publications to present are online.

Contact: Margaret Nagle,