[43] The reasons for this include lack of knowledge of proper technique, lack of appreciation of the importance of many aspects of proper technique, and resistance to change, especially taking the extra time needed for quiet during the rest and measurement periods. There also may be resistance to incorporating fully automated blood pressure technique in practice, since it requires time not speaking with the patient and allowing for rest and several measurements (approximately seven to eight minutes on average when accounting for five minutes of rest and time to take measurements). The main concern is the time required for busy clinic staff to incorporate this technique. However, using automated office blood pressure (AOBP) allows staff to attend to other patients or tasks during this time. In the patient focus group carried out as part of this guideline update, patients described the following (see Appendix B): 1. Patients noted that when their blood pressure was measured by machine in the office setting, they experienced pain and uncomfortable pressure. 2. Some of the patients noted that their blood pressure had to be taken twice when in the office setting, as the first reading was rarely accurate. 3. Patients felt the office blood pressure readings were inaccurate; they trusted the devices they use at home more. 4. There were noticeable differences between blood pressure readings when it was taken manually versus with a machine. The Work Group believed these perspectives from patients generally support use of fully automated oscillometric manometers in clinical practice. 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. 