Although there is some expense to fully automated oscillometric manometers and concern over pain of measurements, the Work Group believed these issues were minor compared with the benefits of reducing observer error and providing more accurate blood pressure data. As Recommendations 2 and 3 are Reviewed, New-added and Reviewed, New-replaced recommendations, respectively, the Work Group systematically reviewed evidence related to these recommendations in the evidence review conducted as part of this guideline update.[37-42] The Work Group s confidence in the quality of the evidence is very low; however, standard blood pressure measurement technique was used in all major observational studies and RCTs which provide evidence for risk of blood pressure levels and goal blood pressure levels shown to reduce cardiovascular outcomes with treatment. Two SRs showed that fully automated blood pressure measurement accuracy is closer to daytime ambulatory blood pressure measurement accuracy but that research quality (i.e., standard ) measurement could also be acceptable.[37,38] Another SR showed that fully automated readings were similar whether staff were present in the room (attended) or the patient was left alone during the rest and measurements (unattended).[39] Other considerations regarding this recommendation included the benefits of accurate blood pressure data outweighing the potential harm of any adverse events or inconvenience, which was small. Patient values and preferences were somewhat varied. Thus, the Work Group decided upon a Weak for for these recommendations. Recommendation 4. We suggest using out-of-office blood pressure monitoring methods (ambulatory 24-hour monitoring or home blood pressure measurements) to inform the diagnosis and management of hypertension. (Weak for |Reviewed, New-replaced) Discussion Out-of-office blood pressure monitoring methods comprise: (a) 24-hour and daytime/awake ambulatory blood pressure monitoring (ABPM) and (b) home blood pressure monitoring (HBPM). 