The introduction of HBP measurement for the treatment of hypertension is very useful for reducing medical costs.

The introduction of home blood pressure measurement for the diagnosis and treatment of hypertension would be very effective to save costs.

INTRODUCTIONDespite the enormous burden of hypertension, it has not been effectively controlled. 1 One of the causes underlying this unsatisfactory control of blood pressure (BP) is insufficient compliance of physicians with evidence-based medicine and the recommendations of guidelines. 2,3 Recently, several national hypertension guidelines have emphasized the importance of self-measurement of BP at home (HBP) in clinical practice. 4-8 HBP measurement allows multiple BP measurements to be obtained over a long observation period under relatively controlled conditions. 4-6 Multiple BP measurements reportedly eliminate observer bias, random error and the white-coat effect, so that HBP measurement may be more reliable than the casual clinic BP (CBP) measurements. [4][5][6]9,10 The predictive power for cardiovascular diseases is higher with HBP than with CBP. 9-11 HBP measurement may also provide patients with a better understanding of BP and improve patients' BP control and compliance with therapy. [12][13][14][15]

The optimal procedure for casual-clinic blood pressure (CBP) measurement is outlined in the 2004 Japanese guidelines. We investigated the status of physicians' practices and their awareness of CBP measurement immediately and 4 years after the publication of the guidelines using a questionnaire regarding CBP. This survey was conducted among physicians who attended educational seminars on hypertension in 2004-2005 and in 2007-2008; the questionnaire was distributed, completed and collected just before the start of the seminars. Of the 1966 respondents to the 2004-2005 survey and the 2995 respondents to the 2007-2008 survey, the proportion of physicians who answered that CBP was more important than self-measured BP at home (home BP) was less than 10% in both surveys. The proportion of physicians who used a mercury sphygmomanometer (68.1-75.5%) was higher than those who used an automatic and electronic sphygmomanometer (20.7-29.0%) in both surveys. However, the use of an automatic and electronic sphygmomanometer slightly increased from 20. Keywords: casual-clinic blood pressure; guidelines; physicians INTRODUCTION Blood pressure (BP) is a major vital sign used to evaluate the physical condition of each patient. Measurement of casual-clinic BP (CBP) in clinical settings has been used as the gold standard for hypertension evaluation. Under the Japanese guidelines for the management of hypertension, the optimum conditions for CBP measurement include the use of the auscultation method, with a mercury or aneroid sphygmomanometer for the measurement of CBP, or the use of an automatic sphygmomanometer that has been calibrated. 1,2 Previous reports have shown that CBP, as measured in strict accordance with the procedures set forth in the guidelines, had a clinical value at least comparable with BP measured in out-of-clinical settings, 3 although BP measured in out-of-clinical settings has several advantages, including the avoidance of both observer bias and the white-coat effect. 4,5 Therefore, in clinical trials and epidemiological surveys, CBP has often