Clinical question	Bottom-line answer
1. Measuring blood pressure What is the best way to measure blood pressure?10	Measure blood pressure using a completely bare arm. To get the most accurate measure, let patients relax for a few minutes, and then measure their blood pressure on a completely bare arm. Does a difference of 4 mm Hg systolic and 6 to 7 mm Hg diastolic matter? It might, especially when deciding whether to add a second or third drug.
2. Measuring blood pressure How well does monitoring blood pressure for 30 minutes in the office compare with a single office reading in patients suspected of having white coat hypertension?11	Let patients rest, and consider using an average of several automated cuff measures. In this Dutch study, monitoring blood pressure readings in the office for 30 minutes resulted in markedly lower readings compared with the last office reading (approximately 23/12 mm Hg lower). The clinicians report they would be much less likely to intensify treatment if they used these readings.
3. Harms of intensive blood pressure control Does intensive systolic blood pressure lowering in older patients increase the likelihood of renal dysfunction?12	In older patients, targeting 120/80 mm Hg has benefits but also increases the risk of renal dysfunction. In this post-hoc analysis of the previously published Systolic Blood Pressure Intervention Trial (SPRINT), lowering the systolic blood pressure of patients who are at increased risk of cardiovascular events (average age = 68 years) will decrease their risk of CVD but increase their likelihood of developing moderate renal dysfunction. It will not, at least over three years, increase their likelihood of developing end-stage renal disease.
4. Measuring orthostatic blood pressure Is it better to evaluate for orthostatic hypotension after one minute or three minutes of standing?13	Measure blood pressure after the patient has been standing for one minute, not three minutes. Finding an orthostatic drop within the first minute after standing more accurately predicts dizziness and future adverse events than finding it at the currently recommended three minutes.
5. Treating hyperlipidemia in older patients In patients older than 65 years with elevated low-density lipoprotein levels but no CVD, does cholesterol lowering decrease mortality or morbidity?14	There is no clear evidence of benefit for treating hyperlipidemia in older patients, especially in those older than 75 years. If a patient makes it to 65 years of age without developing CVD, lowering his or her cholesterol level at this point is not effective, and might even be harmful if treatment is started at 75 years of age. Given the lack of benefit also shown in other studies, it might be time to stop checking—and treating—high cholesterol in these age groups.