One Reading is Never Enough: Lessons from SPRINT and the 2025 AHA Guidelines

December 22, 2025

The Hidden Risk in Routine Readings

A single blood pressure (BP) measurement does not define cardiovascular risk. Each value obtained in practice represents a potential diagnostic threshold, a therapeutic trigger or a decision to withhold treatment. Even small deviations of only 2-3 mmHg can alter classification. Hypertension management succeeds or fails on the accuracy of its BP measurement.

The 2025 American Heart Association (AHA) guidelines directly address this risk by elevating averaging of multiple BP readings to being a standard of care. This change reflects robust evidence, most notably from the Systolic Blood Pressure Intervention Trial (SPRINT), where standardized, averaged readings produced reproducible data and measurable reductions in cardiovascular morbidity and mortality.

This blog examines three key areas:

1. Why averaging is essential to diagnostic accuracy and why single BP readings should not be trusted.

2. How SPRINT methodology demonstrated that averaging is both feasible in practice and critical to achieving more accurate treatment decisions and better cardiovascular outcomes.

3. What clinicians must adopt in daily workflow—automation, standardization and repeat measures—to ensure decisions are grounded in valid data.

The evidence is clear: Precision in hypertension care begins with the average, not the outlier.

Why Averaging Has Become the Standard

A single elevated reading often reflects transient factors rather than the patient’s baseline condition. Anxiety, conversation during measurement or poor positioning can raise systolic BP values by 5–10 mmHg.

Evidence confirms this distortion. In a UT Southwestern initiative, nearly one in three patients with an initial elevated BP (>140/90 mmHg) were reclassified after repeat measurements and averaging. Such data demonstrates why the 2025 AHA guidelines elevate averaging from best practice to being a standard of care, making clear that accuracy cannot be trusted to a single number.

Lessons from SPRINT: Standardized Saves Lives

SPRINT set a benchmark for how methodology in BP assessment changes outcomes. Investigators followed a disciplined protocol:

• Five minutes of rest before measurement.

• Automated oscillometric devices to reduce observer bias.

• Multiple readings averaged together to reflect true BP status.

This process produced measurable risk reduction:

• All-cause mortality: ↓ 27%

• Major cardiovascular events: ↓ 25%

• Heart failure incidence: ↓ 30%

• Stroke risk: ↓ 43%

These results were not solely the result of therapeutic interventions. They were enabled by the integrity of the BP measurement process itself. Standardization ensured reproducibility and allowed clinical decisions to be made with confidence for better outcomes.

Case Example: The Power of the Average

A 45-year-old woman presents for a routine wellness examination.

Initial reading

146/92 mmHg → exceeds the threshold for hypertension for AHA guidelines

Averaging protocol

Mean 127/84 mmHg → below treatment threshold

While the initial reading and averaged results show markedly different classifications, the contrast highlights a key point: a single elevated reading can misclassify a patient. Averaging multiple readings provides a more accurate reflection of true resting BP status. Anchoring the first value could have led to unnecessary pharmacologic intervention.

Integrating Standardized Processes into Clinical Workflow

The precision demonstrated in trials such as SPRINT can be translated into everyday practice. Advances in clinical technology now allow structured processes—rest periods, repeat readings and averaging—to be incorporated into routine workflow.

The Midmark IQvitals® Zone is one such solution, designed with BP measurement modes that align to guideline-based practices:

• Spot Mode: Captures a single reading. Appropriate for routine checks or follow-up visits where a quick assessment is sufficient.

• Averaging Mode: Automates a sequence of five readings, discards the first and averages the remainder. This brings the 2025 AHA guidelines on averaging into everyday workflow, helping to ensure every BP measurement clinicians act on is defensible and reproducible.

• SPRINT Protocol Mode: Incorporates a five-minute rest followed by three readings one minute apart, averaged together. This reflects the standardized measurement approach used in the SPRINT study, designed for high-stakes assessments and also allows for reduction of white coat hypertension.

• Custom Protocol Mode: Provides flexibility to define rest periods, number of readings and intervals, enabling organizations to standardize measurement procedures across care teams while adapting to workflow.

Manual BP measurement is prone to variability driven by technique, observer bias and inconsistent adherence to proper protocol. The 2025 findings on automated office blood pressure (AOBP) monitoring demonstrate that automation meaningfully reduces this variability by standardizing the measurement process and removing human-dependent error. By embedding repeatable, guideline-aligned procedures directly into the workflow, automated devices provide more reliable readings and strengthen clinical decision-making based on those results.

Compromised Outcomes

• Skipping averaging: Not using averaging is more than a shortcut, it’s a harmful practice that can compromise patient outcomes.

• Misclassification: A study of over 80,000 office visits found that when BP was rechecked, readings often dropped by 8 mmHg, showing many patients who first appeared to have hypertension were normotensive on repeat measurement. About two-thirds of this drop value was due to natural variation, reinforcing the idea that a single reading can easily lead to misclassification of patients as hypertensive.

• Overtreatment: Anchoring therapy to a single elevated value exposes patients to unnecessary medications, side effects and monitoring costs. In severe cases, overtreatment can lead to hypotension, electrolyte imbalance or kidney strain requiring emergency care.

• Undertreatment: Conversely, a falsely low single reading can delay therapy, allowing hypertension to progress silently until complications arise, such as a stroke. A stroke can incur an estimated lifetime cost of $140,000 including hospitalization, rehabilitation and long-term follow-up care.

• Systemic Burden: NIH researchers estimate that tens of millions of US adults may have their hypertension status misclassified due to systemic bias or random error in BP measurement. Even modest error rates translate into millions of dollars in wasted resources and preventable complications annually.

The time required to perform averaging is measured in minutes. The consequences of skipping it are measured in years of misdirected care, preventable morbidity and billions in healthcare expenditures. The smallest investment of time at the point of BP measurement can prevent the largest costs downstream.

Practical Steps to Strengthen Accuracy

• Standardize every reading: Positioning, rest, environment and technique—applied consistently to all patients.

• Embed averaging into practice: Follow the 2025 AHA guidelines by averaging multiple readings for every diagnosis-related BP assessment.

• Leverage automation: Although not all BP devices on the market today are included on the US Blood Pressure Validated Listing (VDL), automation continues to play a critical role in reducing measurement bias and promoting consistency.

• Apply the evidence: Landmark studies like SPRINT and CORRECT BP confirm that standardized approaches enhance diagnostic precision and support treatment planning.

Beyond a Single Number

In BP management, the margin for error is measured in millimeters of mercury. A single inaccurate reading can set a patient on the wrong clinical path for years. Averaging should not be thought of as a time-consuming extra step, it is the safeguard that separates accuracy from error, preventing harm and saving lives.

The future of cardiovascular care will not be defined by the next drug or the next therapeutic target. It will be defined by the accuracy of the measurement of BP on which every decision rests.

One number can mislead—Averaging reveals the truth.

Additional Resources:

• White Paper: Validating the Clinical Impact of Proper Positioning on BP Measurement

• eBook: Ensuring Accurate BP Measurement for Improved Patient Outcomes

• Webinar: Enhancing BP Measurement Accuracy to Improve Hypertension Control + Chronic Disease Outcomes

• Webinar: Enhancing the Patient Clinical Experience

• CORRECT BP Study

About the Author

With a background in critical care and trauma nursing, combined with an MBA focused on the medical device industry, I bring a unique combination of clinical expertise and business insight to my work. My experience in the ICU and as a flight nurse has given me a deep firsthand understanding of urgency, precision and reliability in patient care and the critical role medical equipment plays in that environment.

In my current role at Midmark, I support the Veterinary division, but my clinical background has also led me to collaborate with the Medical division on authoring a clinical blog aimed at improving healthcare practices. I'm passionate about the intersection of clinical accuracy and technology. I believe that how equipment is used is just as important as the tools themselves in achieving optimal clinical outcomes. This drives my work—ensuring healthcare professionals have both the tools and knowledge to improve patient care and deliver the highest standards of treatment.